The Padang-Solok route is the busiest causeway in West Sumatra. Has 3 Gas Stations with high traffic. Based on a preliminary study, 66.6% of Gas Station pump workers experience severe work fatigue. The study aimed to determine the relationship between factors and fatigue at Gas Station pump workers. This type of quantitative research uses a cross-sectional approach from February to August 2023. The population and sample are 42 people using the total sampling method. The research instruments were questionnaires, scales, stadiometers, and WBGT. Primary and secondary data collection. Univariate and bivariate data processing with the Chi-Square test with a degree of confidence of 95% (a = 0.05. The results showed that 59.5% of respondents experienced severe fatigue, 16.7% were old, 42.9% were female, 33.3% had abnormal BMI, 21.4% had long working hours, 35.7% worked at high temperatures, and 59.5% had poor sleep quality. The statistical test results showed a significant relationship between gender (p- p-value=0.002), nutritional status/BMI (p-value=0.005), sleep quality (p-value=0.020), and work fatigue. There is no significant relationship between age (p-value=0.210), years of service (p-value=0.60), and ambient temperature (p-value=0.708) with work fatigue. There is a relationship between gender, nutritional status/BMI, and sleep quality with work fatigue among pump workers. It is recommended that Gas Stations complete rest facilities and provide drinking water and chairs in the pumping machine unit.

Primary heart tumors are a rare entity among neoplasms, among them myxoma is the main lesion reported in more than 50% of cases. Myxomas are generally located in the left atrium, however they can be located in any cardiac chamber. Its diagnosis is usually incidental, after some complication, mainly thromboembolic. Transthoracic echocardiography is the first diagnostic method used, however, biopsy with immunohistochemistry is the gold standard.

Acute tubular interstitial nephritis is a form of immune-mediated renal injury characterized by infiltration of immune cells in the renal tubulointerstitium, leading to oliguric or non-oliguric acute kidney injury. It manifests with systemic arterial hypertension, foamy urine, and sometimes with secondary anemia if there is progression to chronic renal disease. The diagnosis of certainty is made by biopsy, the initial treatment consists of identifying and removing the triggering agent to avoid further exposure to toxins, management of the acute renal lesion and in some cases, it may be decided to start corticosteroids to avoid progression to end-stage chronic kidney disease. We present the case of a 24-year-old female patient with a history of consumption of unspecified herbal medicine for aesthetic purposes 3 years prior to our evaluation, who debuted with hypertensive emergency manifested by hypertensive retinopathy, hypertensive renal vasculopathy and tubulointerstitial nephritis, successfully treated with the withdrawal of the aggressor agent, angiotensin converting enzyme inhibitors, nitrates and corticosteroids. After 6 months of follow-up, the patient is asymptomatic and with total recovery of the renal disease documented by normal creatinine in laboratory tests.

Low back pain is one of the most frequent causes of disability, it is a problem that is characterized by its high prevalence in the population and its economic and social repercussions, becoming one of the main causes of work absenteeism. In this entity, there is an association between muscular and psychosocial factors that generate avoidance behaviors, fear and muscle atrophy, causing a vicious circle that favors chronicity and disability. The prevalence of this syndrome is 60-85% during the survival of individuals. Between 15 and 20% of adults suffer from low back pain; in 90% of cases it is non-specific, it affects both men and women, and occurs more in ages between 30 and 50 years; increasing prevalence with age. The most important challenge in the diagnosis of low back pain is to differentiate the 95% whose origin is benign musculoskeletal processes, from the 5% whose low back pain is caused by specific diseases that require rapid and adequate treatment. In this task, the warning signs that help to rule out the most serious processes can be useful. The warning signs in low back pain are: age >50 years, history of neoplasia, constitutional syndrome, no improvement with usual treatments, pain at rest, fever, immunosuppression, previous trauma, osteoporosis, taking corticosteroids and cauda equina syndrome. It should also be noted that in approximately 80% of cases it will not be possible to arrive at a specific diagnosis. Thanks to advances in imaging, neural anatomical findings, new discoveries in the chemical mediation of pain, the development of ultrasound-guided injection techniques, we have greater diagnostic and therapeutic accuracy, and the highest success rate in non-surgical treatments have facilitated the expansion of minimally invasive techniques in pain management. On this occasion, two patients with pain at the level of the intense lumbar region are presented, who were managed with opioid analgesics, NSAIDs without pain improvement, in both cases ultrasound-guided fascetarian blocks were applied, with pain remission on a VAS scale of 10 /10 to 1/10, being discharged from the service.

Multiple myeloma (MM) is a monoclonal gammopathy characterized by malignant proliferation of plasma cells. Considered the second most common hematological neoplasm. Symptoms result from infiltration of plasma cells and secreted monoclonal proteins or interaction of plasma cells with their microenvironment. The classic CRAB criteria (Hypercalcemia, renal failure, anemia and lytic lesions), with renal failure being one of its most frequent complications, are necessary to establish the diagnosis. Our report presents the case of a man in his seventh decade of life, who presented with meningeal syndrome, which motivated the study approach, reaching the conclusion that this entity was due to a state of immunosuppression secondary to multiple myeloma, whose diagnostic suspicion was a finding that was obtained when doing a comprehensive study of the disease, since reaching the diagnosis in this case was a cause of controversy as it had an unusual presentation. This is a good case to discuss differential diagnoses and teaches us that in medical practice we deal with patients and not with diseases, since these debut in a particular way in each individual.

In this work we present the most relevant and important data, so that the reader will be able to identify the disease "Cystic Fibrosis", regardless of the fact that in Mexico this disease is not common, thanks to the fact that in Mexico and in the world newborns are screened. In this way the rate of this disease in Mexico and the world was reduced. In Mexico, there are 350 new cases every year, said the General Director of the National Center for Gender Equity and Reproductive Health, Dr. Ricardo García Cavazos. Thanks to this data, the purpose of this work is to guide readers in the identification of this disease and in this way generate a positive and active influence in the identification of this disease. This disease is a disease that has its historical antecedents since the year 1595, when with the thought of a spell on a girl during her autopsy, the first clinical data that are characteristic of this disease were given. Being in the 70s where with the passage of time and as new knowledge came to what we know today. Cystic fibrosis is an inherited multisystem disorder of children and adults, it is the leading cause of severe chronic lung disease in children. Cystic fibrosis occurs most often in white populations in Northern Europe, North America and Australia/New Zealand and is inherited in an autosomal recessive manner.

Bardet-Biedl Syndrome (BBS) is a rare, genetically heterogeneous, and autosomal recessive ciliopathy characterized by a complex clinical phenotype. This article provides a comprehensive review of BBS, exploring its genetic underpinnings, clinical manifestations, molecular mechanisms, and emerging therapeutic strategies. BBS is associated with primary ciliary dysfunction, leading to a spectrum of clinical features, including obesity, retinal degeneration, renal abnormalities, polydactyly, and cognitive impairments. Understanding the intricate molecular pathways involved in BBS pathogenesis, such as the role of the BBSome and the ciliary transition zone, is crucial for developing targeted treatments. This review also discusses recent advances in the field, including the potential application of gene therapy and small molecule interventions. The aim of this article is to consolidate current knowledge on BBS, shedding light on the complexities of this rare genetic disorder and the potential avenues for future research and therapeutic development.

Hermansky-Pudlak Syndrome (HPS) is a rare, autosomal recessive disorder characterized by a complex clinical phenotype, including oculocutaneous albinism, bleeding diathesis, and a predisposition to pulmonary fibrosis. This article provides a comprehensive examination of HPS, encompassing its genetic underpinnings, molecular mechanisms, clinical manifestations, and emerging therapeutic interventions. HPS is primarily attributed to mutations in multiple genes, causing defects in the biogenesis of lysosome-related organelles, leading to platelet and granule abnormalities, which contribute to the bleeding diathesis. In addition, the oculocutaneous albinism associated with HPS is a result of impaired melanin synthesis. The article explores recent advancements in understanding HPS pathogenesis, such as aberrant platelet function and the dysregulation of various cellular pathways. Additionally, we discuss diagnostic challenges and the need for a multidisciplinary approach in managing patients with HPS. Furthermore, this review highlights the evolving landscape of therapeutic strategies, including experimental therapies targeting the underlying genetic defects, advances in supportive care for bleeding disorders, and novel approaches for managing pulmonary fibrosis. In conclusion, this article underscores the importance of ongoing research in HPS, emphasizing the potential for improved diagnosis and treatment outcomes in patients with this intriguing and complex syndrome.

Breast cancer is the most common malignant tumor in women, internationally, and the leading cause of death from cancer. However, breast cancer in men is an uncommon pathology, corresponding to less than 1% of neoplasms in men. The lifetime risk of breast cancer in a man is approximately 1:1000, compared to 1:8 for a woman. Currently, an increase in timely diagnosis has been demonstrated thanks to the programs that are carried out for the early detection of breast cancer worldwide. Although, unfortunately, early diagnosis is still difficult due to the lack of information that a large part of the population has regarding self-examination, not only in our country, but also around the world, and in the case of breast cancer in men, being such an uncommon condition, its diagnosis is more difficult. The incidence of breast cancer is increasing in the developing world, due to longer life expectancy, increased urbanization and the adoption of Western lifestyles. Among the risk factors that have been seen to increase the risk of breast cancer in men, with scientifically proven evidence, are mainly hormonal disorders, family history and mutations of certain genes that predispose to the disease. The hormonal disorders mentioned above refer to an increase in circulating estrogen levels and a deficiency in the synthesis or action of testosterone. These alterations can be caused by disorders at the level of testicular testosterone synthesis, such as: orchitis, orchiectomy, undescended testicle, congenital inguinal hernia and others. Patients who voluntarily consume exogenous estrogens as part of the treatment of prostate cancer or transsexuals should also be taken into account. Another risk factor that has been found to be implicated in the presentation of this type of neoplasia are medications; many frequently used medications are testosterone antagonists. Alcohol is also implicated, since it decreases testosterone synthesis and the number of testicular receptors for gonadotropin. A higher prevalence has also been seen in patients with obesity, in whom there is a double risk, because as they have a higher peripheral aromatization of androgens, they synthesize a greater amount of circulating estrogens. Approximately 20% of men with breast cancer have a first-line family history, which indicates a two to three times higher risk of developing the disease at some point in their lives and that this risk doubles exponentially with the number of affected family members. Currently there are many programs and organizations that promote the fight against breast cancer, such as the World Health Organization, where there are comprehensive national cancer control programs that are integrated with non-communicable diseases and other related problems. Comprehensive cancer control encompasses prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. Raising awareness of the general public about the problem of breast cancer and control mechanisms, as well as promoting appropriate policies and programs, are key strategies for population-based breast cancer control. Based on what has been mentioned above, the work will be carried out in order to have a better approach to breast cancer in men, due to the little information we have about it, as well as to raise awareness among the general population about the risk factors, prognostic factors, timely diagnosis and treatment of patients with this type of pathology.

Kostmann Syndrome, also known as severe congenital neutropenia type 1 (SCN1), is an exceedingly rare and severe hematological disorder characterized by a near absence of neutrophils in the peripheral blood. This congenital anomaly presents significant challenges in terms of diagnosis, management, and treatment. In this comprehensive article, we delve into the multifaceted aspects of Kostmann Syndrome, providing an in-depth analysis of its pathogenesis, clinical manifestations, genetic underpinnings, and therapeutic interventions. Furthermore, we highlight recent advancements in the understanding of this condition and emerging strategies for its early detection and improved patient care. With this review, we aim to enhance medical practitioners and researchers awareness of this condition and facilitate the development of more effective therapeutic modalities for Kostmann Syndrome.

Appendicitis is a common surgical condition in pediatric patients, with a higher prevalence among males by 55 – 60%. The etiology is not definitively established, but luminal obstruction caused by stool, lymphoid hyperplasia, or parasites is a commonly cited cause. The classic presentation includes the gradual onset of periumbilical abdominal pain with migration to the right lower quadrant within 24 hours, fever, anorexia, nausea, and vomiting. However, infants and young children may present differently. Risk scores have been developed to improve the accuracy of diagnosis by using clinical symptoms, physical examination, and laboratory results. Ultrasound is the recommended imaging modality due to its low cost and avoidance of radiation, with reported sensitivity ranging from 72.5% to 94.8% and specificity of 95% to 99%, depending on the operators experience. In young preschool-age children, acute appendicitis carries a higher risk of complications, including surgical site infections and abscesses. The risk of appendix perforation increases with delayed diagnosis. Treatment involves fluid resuscitation, pain control, antibiotics, and appendectomy. In cases of perforation, percutaneous drainage may be necessary. Hospital readmissions are often due to infection, bowel obstruction, or abdominal pain.

Acute mesenteric ischemia (AMI) is a group of diseases in which blood flow to the intestine is interrupted by occlusive or nonocclusive causes that include mesenteric arterial embolism, mesenteric arterial thrombosis, and mesenteric venous thrombosis. AMI risk factors include advanced age, Caucasian race, history of systemic arterial hypertension, arterial fibrillation, chronic kidney disease, and congestive heart failure. The clinical triad is characterized by the sudden onset of severe abdominal pain accompanied by gastrointestinal symptoms in the presence of an identified embolic source. Diagnosis is commonly made using computed tomography angiography, where the obstruction is observed directly in occlusive causes. Treatment involves fluid resuscitation and restoring mesenteric artery circulation using endovascular or surgical procedures. The mortality rate varies depending on the patients clinical history and treatment approach, with a higher risk associated with open surgery. Lifelong anticoagulation or antiplatelet therapy may be necessary to prevent recurrence. Follow-up evaluations are recommended to monitor for restenosis and to prevent acute myocardial infarction.

Wound dehiscence is a serious surgical complication, particularly in abdominal surgery, with potentially life-threatening consequences. This bibliographic review comprehensively examines the epidemiology and clinical significance of wound dehiscence. It delves into the theoretical framework, including its definition, risk factors, complications, and management strategies. The discussion section highlights emerging approaches and future directions in the management of wound dehiscence. In conclusion, the article underscores the importance of evidence-based practices in addressing this complex surgical challenge.

Giant Zenker diverticulum represents a challenging clinical entity in the field of otolaryngology. We present an interesting case report and a bibliographic review to provide a comprehensive overview of this condition. The article delves into this condition, including its definition, risk factors, complications, and management strategies. The discussion section highlights emerging approaches and future directions in the management of giant Zenker diverticulum. In conclusion, the importance of evidence-based practices in addressing this complex condition is emphasized.

Introduction: Wound closure technique has some variations in reconstructive and plastic surgery. The use of ideal suture material and technique for subcutaneous tissue closure is needed to be established in the current clinical practice to enhance the surgical outcome. Methods: This literature review was compiled using information from numerous open access web databases. Data were compiled and analyzed. Results and Discussions: In term of tensile strength, single layer subcutaneous suture with polyglactin has superior outcome than multi-layer suture combining polyglactin subcutaneous suture and polypropylene interrupted cutaneous suture. In aesthetic consideration, a single-layer subcutaneous closure has better outcome. Previous studies showed there were no significant difference between the two techniques in term of patients satisfaction. Conclusion: The single layer subcutaneous continuous suture with polyglactin and multiple layer subcutaneous suture with combining continuous polyglactin suture and polypropylene interrupted suture has each advantage and need to be considered by surgeon about the wound closure effect and long term prognostic such as cosmetic and satisfaction of the patient.

Urolithiasis, the formation of urinary calculi, remains a prevalent and clinically significant urological disorder worldwide. Despite extensive research, the etiology of urolithiasis remains multifactorial and not entirely understood. Emerging evidence suggests that the urinary microbiome, previously considered sterile, plays a pivotal role in the pathogenesis and progression of urolithiasis. This article delves into the intricate relationship between urolithiasis and the urinary microbiome, elucidating the key microbial players, their potential mechanisms of action, and the clinical implications of this association. We explore recent advancements in metagenomics, metabolomics, and microbial profiling techniques that have revolutionized our understanding of the urinary microbiome in urolithiasis. A comprehensive understanding of the interplay between urolithiasis and the urinary microbiome holds promise for novel diagnostic and therapeutic strategies, offering new avenues for the prevention and management of this debilitating condition.

Background: The Barriers Questionnaire II (BQII) was developed to assess barriers to effective pain management. Objective: This study aims to translate and validate the BQII into Vietnamese. Method: The Viet-BQII was evaluated for content validity and reliability by 6 experts and 30 patients with cancer. The content validity of the questionnaire was measured by Item - content validity index and Scale - content validity index; the test-retest reliability was measured using Intra-Class Correlation; the internal consistency of the scale items was assessed by calculating Cronbach s a value. Results: The Viet - BQII had a content validity in each question that ranges from 0.83 to 1.0, the content value for the scale was 0.92, Cronbachs a was 0.89, and the test-retest reliability with ICC was 0.82 (p <0.001). Conclusions: The Viet-BQII ensures the validity and reliability for measuring patient barriers to pain management in patients with cancer in Vietnam.

Background: Glass ionomer cement (GIC) contains higher porosity than other restorative materials. Porosity can cause the GIC surface to become rough and reduce the materials mechanical properties. Gourami fish scales powder (GFSP) contains hydroxyapatite, which can potentially reduce the porosity of GIC. This research aimed to analyze the porosity depth of conventional GIC by adding 1.5%, 2.5%, and 3.5% GFSP nanoparticles (nGFSP). Materials and Methods: This type of research is an experimental laboratory with a post-test-only control group design. Twelve samples were disc-shaped diameter of 5 mm and a height of 2 mm which were divided into four groups: G0:GIC, G1: GIC+1,5% nGFSP, G2: GIC +2,5% nGFSP, and G3: GIC+3,5% nGFSP). Samples were cut into two parts and observed by Scanning Electron Microscopy (SEM). The results were analyzed by One Way ANOVA and Least Significant Difference (a = 0,05). Result: The average value of the porosity depth from the highest to the lowest is G0, G1, G2, G3. There was a significant difference between all sample groups (p = 0.000). Conclusion: The addition of nanoparticles GFSP reduced the porosity depth of conventional GIC; the addition of 3.5% nanoparticles GFSP showed the shallowest porosity depth.

Background: Breast cancer (BC) is a disease in which abnormal cells in the breast mutate and grow out of control. It is the most common malignancy affecting women in Nigeria. The disease typically affects women of various nationalities and socioeconomic backgrounds, making it a global concern. Aim: The aim of this study is to determine and compare the prevalence of breast cancer among military personnel and non-military personnel attending the Radiology department of 44 Nigerian Army Reference Hospital Kaduna. Methods: A retrospective study involving a total of 508 patients who presented for mammography at the radiology department. A P-value below 0.05 was considered statistically significant. Results: Five-hundred and eight mammographic records were used. The mean age in this study was 44.23years. The prevalence of breast cancer among Nigerian army and civilians in this study were 2.4% and 13.8% respectively. . Conclusion: The prevalence of breast cancer is higher among non-Nigerian Army personnel than their Nigerian army counterparts.

The periodontal ligament is a connective tissue located between the cementum that covers the roots of the tooth and alveolar bone, which is composed of large amounts of fibers, cells, and blood vessels. Orthodontic tooth movements are obtained through periodontal ligament remodeling and alveolar bone in response to orthodontic forces. When the orthodontic force is applied to the teeth, an injury will occur in the periodontal ligament, and the pressure and tension side in the periodontal ligament is formed. Furthermore, vasoconstriction occurs in blood vessels and hypoxia in the periodontal ligament, triggering inflammation, angiogenesis, cell proliferation, degradation, and synthesis of extracellular matrix, bone resorption, and alveolar bone deposition. The purpose of this article is to study the mechanism of periodontal ligament remodeling on orthodontic tooth movement to obtain optimal tooth movements.

Introduction: Cardiovascular disease (CVD) is the leading cause of death in Brazil. CVDs are multifactorial pathologies, defined by the combination of genetic, environmental and behavioral factors, and are characterized as one of the main causes of death in Brazil and worldwide. Objectives: To discuss through a literature review the causes and consequences of the main heart diseases and to present the epidemiological results in Brazil of data collected through the DATASUS System between the years 2021 and 2022. The data observed shows the frequency of the six main causes of death from CVD in the Brazilian population. Results: Between 2021 and 2022, IHD and CVD were responsible, respectively, for 32% / 23% of deaths from CVD in the general population in 2021 and 37% / 14% in 2022, being pointed out as the main causes, with the highest prevalence among the male public and the age group between 60 and 79 years, when analyzed by regions and federative units of Brazil, the highest rates were found in the Southeast region, followed by the Northeast region. When analyzing deaths in terms of place of occurrence, it was observed that the majority occurred in the hospital environment, followed by the home environment. Final considerations: CVD is still the leading cause of death in Brazil. Thus, primary prevention of CVD should be a priority, intensifying control of the main risk factors for CVD, which would also affect incidence and improve early diagnosis.

Introduction: Autoimmune bullous disease (ABD) is a specific autoimmune skin disease characterized by subepidermal vesicles and bullae. In pediatrics, there is an autoimmune bullous disease controversy with clinical clusters of jewel on Chronic bullous disease of childhood (CBDC) but dominant IgG autoantibodies. A similar clinical presentation challenges diagnosis; thus, supporting studies on direct immunofluorescence (DIF) as a specific autoantibody factor are necessary. Case: A 10-year-old boy with clinically tense-walled blisters with or without an erythematous base is itchy all over his body, with a predominance of palmoplantar, neck, inguinal, and axillary, presented by erosions, crusts, and a partial cluster of jewels lesion with mucosal involvement. A complete blood count shows leukocytosis and eosinophilia. Hematoxylin-eosin (HE) staining revealed a subepidermal cleft with eosinophil predominance, while direct immunofluorescence (DIF) revealed IgG deposits in the basal membrana and intercellular parts of the basal stratum. Discussion: Histopathology reveals subepidermal blisters of eosinophil dominance, and direct immunofluorescence (DIF) examination reveals IgG autoantibody deposit dominance, verifying the diagnosis of juvenile bullous pemphigoid. Given that BP180 (BPAG2) is one of the autoantigens involved, there may be similarities between the histology and clinical presentation of Bullous pemphigoid (BP) and CBDC. Conclusion: Autoimmune bullous diseases are difficult to differentiate clinically, histological studies and direct immunofluorescence are necessary to make a diagnosis.

The spontaneous migration of projectiles in the spinal canal due to gunshot wound are a rare entity, and may be associated with multiple complications in the evolution. Given the low prevalence, there are no large series registered, so there is no standardized therapeutic protocol. We made a review of the subject on purpose and presented the case of a 22-year-old patient who suffered a HAF in the cervical spine lodging the projectile at the level of C6-C7, installing a quadriplegia, and in the evolution we observed how the projectile migrated at the lumbosacral level L5-S. The diagnosis, clinical and surgical treatment performed were evaluated.

The passage highlights the complexity of integrated breast cancer care and the importance of effective communication in ensuring treatment compliance, reducing errors and complications, and managing co-morbidities. It emphasizes the need for clarity in the role of the care director to prevent patients from getting lost across different departments. Digital tools are recognized as valuable resources for improving care communication, but their directives and integration within the care team need to be clearly defined. Multidisciplinary team meetings are essential for driving care planning, establishing directives, and collecting structured data. Nurse navigators play a pivotal role in ensuring care continuity and assuming the director s role in the complex landscape of breast cancer care. While AI-driven planning can facilitate their tasks, human intervention remains crucial for providing psychosocial support and addressing unexpected urgencies. The allocation of patients across different healthcare centers is often managed manually and through phone communication, resulting in time-consuming processes and discontinuous system solutions. Privacy rules and competition among providers further limit the effectiveness of current solutions. Additionally, the collection of comprehensive outcome information is currently limited to specific collaborative networks. To address these challenges, AI tools can play a role in facilitating care allocation and predicting risks by leveraging data continuity over time. This can help identify non-compliance issues caused by factors such as limited local resources, distance, and costs. However, it is essential to conduct applied research to bring AI modeling into clinical practice and promote well-coordinated, patient-centric cancer care within the complex healthcare landscape.

Hip fractures are a significant public health concern, particularly in the elderly population. This bibliographic review article provides an in-depth examination of the management of hip fractures, with a focus on epidemiology, clinical importance, theoretical framework, types of injuries, complications, and current management strategies. As the elderly population continues to grow, the management of hip fractures becomes increasingly critical. This review discusses the evolving approaches and evidence-based practices aimed at improving patient outcomes and reducing the burden of hip fractures.

Sigmoid volvulus is a frequent cause of intestinal obstruction, currently shows an incidence between 2 to 50% by demographic variables. In North America the incidence rate is 3-5%1with a ratio 4:1 between males and females, and most frequently presented in the 7th and 8th decades of life. This case involves a relatively frequent illness with an unusual presentation, referring to sigmoid volvulus associated with megacolon in a patient out of the ordinary age of incidence. Thus, this patient presents mild to moderate symptoms, usually it triggers the picture of sudden acute abdominal pain with rapidly evolution to worsening condition if isnt treated. 2

Introduction: Hydrogel dressings have emerged as pivotal tools in wound management, offering a moist environment conducive to tissue repair and demonstrating biocompatibility across various wound types. This literature review examines the historical evolution, properties, applications, recent advances, challenges, and future directions of hydrogel dressings. Methodology: A comprehensive search of databases including PubMed, Web of Science, and Scopus was conducted using search terms such as "hydrogel dressings," "wound management," and "smart hydrogels." Selection criteria involved inclusion of articles on the properties, classifications, applications, and recent innovations of hydrogel dressings, with exclusion criteria focusing on non-peer-reviewed articles and non-English language publications. Results: Historical milestones encompass the development of cross-linking techniques, integration of natural polymers, and recent advancements including smart hydrogels, 3D printing, and drug delivery systems. Challenges such as cost, availability, and potential complications exist. Unresolved questions persist regarding long-term effects and controversies surrounding their comparative efficacy in wound management. Discussion: The findings highlight the need for future research in multifunctional dressings, sensor-integrated smart dressings, and biodegradable hydrogels to optimize wound healing. Moreover, exploration of their environmental impact and prolonged effects in chronic wounds is imperative. Addressing gaps in the literature is crucial to refine protocols and personalize wound care strategies. Conclusion: Hydrogel dressings demonstrate significant promise in wound management. Further research is essential to address challenges, resolve controversies, and advance the efficacy and sustainability of these dressings for improved wound care.

Background: Cognitive impairment is broadly connected as one of the factors that cause disability in the elderly. This study seeks to ascertain the correlation amidst hypertension, diabetes mellitus, physical activity, and cognitive function in the elderly. Methods: A cross-sectional analytical study was carried out using a consecutive sampling method. The data were collected by interviewing elderly patients with Montreal Cognitive Assessment (MoCA) Indonesia and Rapid Assessment of Physical Activity (RAPA) while assessing patient Vascular Metabolism Factor (VMF) such as hypertension, type 2 diabetes mellitus (T2DM), and past history of heart disease. The Statistical Package for the Social Sciences (SPSS) was utilized to analyze the correlation between the aforementioned variables. Results: A total of 277 elderly participants were recruited from February to July 2022. There was a significant correlation between hypertension (OR= 4.8; 95% CI: 2.5-9.1; p < 0.001) and cognitive impairment as well as physical activity (OR= 1.7; 95% CI: 1.3-2.4; p < 0.001). Despite no meaningful correlation amidst diabetes status and cognitive impairment (OR= 1.7; 95% CI: 0.8-3.8; p = 0.14), the number of participants with impaired cognitive function was elevated in the diabetes group (80.7%). Further analysis revealed that the interaction between diabetes, hypertension, and physical activity has a significant correlation with cognitive impairment (p < 0.001; r2= 0.216). Conclusion: This study demonstrated a notable correlation amidst hypertension status, physical activity intensity, and cognitive function in the elderly population at Hative Kecil Public Health Center.

Urological injuries are an uncommon but critical concern in gynecological surgery, carrying the potential for severe complications. This bibliographic review provides a comprehensive examination of urological injuries in the context of gynecological procedures. The article explores their epidemiology, clinical importance, theoretical framework, including their definition, types of injuries, complications, and management. The discussion section highlights emerging approaches and future directions in urological injury management. In conclusion, the article emphasizes the significance of vigilance, prevention, and interdisciplinary collaboration to enhance patient safety in gynecological surgery.

Laparoscopic inguinal hernia repair has gained prominence as a minimally invasive approach to address inguinal hernias. Two primary techniques, transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repair, have been established as effective methods. This bibliographic review aims to provide an in-depth analysis of these techniques, comparing their surgical approaches, complications, and outcomes. The importance of selecting the most suitable approach for a given patient is underscored. The review explores the epidemiology of inguinal hernias, emphasizing the need for optimal repair methods. The discussion section critically evaluates the two techniques, highlighting their respective advantages and drawbacks. Ultimately, the conclusion emphasizes the importance of individualized treatment decisions based on patient characteristics and surgical expertise.

Acute urinary retention (AUR) during pregnancy is a rare yet significant complication, particularly when it occurs in the second trimester due to retroverted uterus. This case report sheds light on this unusual phenomenon, clinical implications, diagnostic approaches, and management strategies. A 27-year-old primigravida at 12 weeks gestation experienced intermittent urinary retention. Foley catheterization relieved an acute episode, evacuating 1.2 liters of urine. Recurrent AUR required intermittent catheterization and probiotics. Gynecological examination and ultrasonography confirmed a retroverted uterus as the cause. Over four weeks, the patient improved, with the uterus repositioning anteriorly by the 16th week, leading to spontaneous resolution. This case highlights the rarity of second-trimester AUR due to retroverted uterus during pregnancy. The interplay of anatomical variations and physiological changes can result in unusual clinical presentations. Swift intervention, including Foley catheterization and patient positioning, achieved successful resolution. Elevated clinical awareness and personalized management are vital for unique pregnancy challenges.

Oncological diseases represent a significant burden on individuals and society. Although the exact causes of cancer are not fully understood, evidence suggests that a combination of genetic, environmental, and lifestyle factors contribute to its development. Methods: This narrative review explores the role of tumor suppressor genes in carcinogenesis. An exhaustive literature search was conducted in electronic databases, selecting articles focused on genetic regulation by tumor suppressor genes for analysis. These genes play a crucial role in cell cycle regulation, DNA repair, and apoptosis, with significant implications for cell function and disease development. Abnormal patterns in these genes have been associated with neurological disorders and oncological diseases. Conclusion: Understanding the role of tumor suppressor genes in carcinogenesis provides insights into disease development and progression and offers opportunities to develop potential therapeutic strategies. However, studying genetic changes in carcinogenesis presents challenges, including the complexity of gene regulation and the heterogeneity of diseases. Nonetheless, the therapeutic potential of tumor suppressor gene regulation in cancer prevention is promising, and more research is needed to understand the underlying mechanisms and develop safe and effective treatments.

Dengue, a mosquito-borne viral infection, is a global health concern with a substantial burden of disease. This bibliographic review article delves into the incidence of liver damage related to dengue, offering insights into the epidemiological aspects, clinical importance, severity criteria, complications, and medical management. With a focus on scientific language and a medical journal-like approach, this review contributes to a comprehensive understanding of the relationship between dengue and liver damage, highlighting the need for vigilance in clinical practice.

A high Interleukin-6 (IL-6) level in COVID-19 plays a major role in the pathophysiology and is considered a reliable parameter in predicting the adversity of the disease. In COVID-19. Extracorporeal blood purification has been proposed as an adjuvant therapy and it aims at controlling the dysregulation in the immune system. Essentially, it lowers the upregulated levels of several mediators and therefore controls the cytokine storm, instead of actively targeting individual pathways of inflammation. Positive IL-6 balance post-Polymethyl methacrylate (PMMA) filter used for Cytokine storm in COVID-19 patients with dialysis has shown to be an independent predictor of mortality. A retrospective analysis of seventeen patients wherein hemofiltration was used for cytokine storm with dialysis, sepsis, and septic shock. The inflammatory markers post-hemofiltration sessions were supervised to understand hemofiltrations efficacy. The average age of the patients was 70.2 (18.2) years. They were classified as responders or non-responder groups based on the decrease or no change/ increase respectively between the pre-and post-filtration IL-6 levels. A 3.6-fold increase was noticed in non-responders (N=11) for IL-6 levels post hemofiltration. Responders demonstrated a 21.4% (p<0.05) reduction in IL-6 levels post hemofiltration. Of these, 4 who survived demonstrated a decrease in IL-6 levels of 66.2%. Of 10 non-responders, none survived. However, the survival rate was 71.43 percent among the responders. There was a significant statistical difference in the mortality rate between the two groups (p= 0.003).Cytokine storm, an overwhelming immunological response in COVID-19 patients, can be controlled successfully by the early and timely use of hemofiltration therapy with PMMA filters like Hemofeel. However, patients with higher positive IL-6 balance post-hemofiltration may be associated with limited outcomes.

The effective management of pain and hemostasis is a pivotal concern in surgical procedures performed on human fingers and toes. The anatomical intricacies and limited tissue volume demand a meticulous approach to ensure both the safety of the patient and the successful outcome of the surgery. The use of vasoconstrictor agents, such as epinephrine, to provide clear surgical field and better surgical outcome further complicates the landscape. While epinephrine is a valuable adjunct to local anesthesia due to its hemostatic properties and ability to prolong anesthetic effects, its application in procedures on fingers and toes necessitates a deep understanding of potential risks and complications. This literature review delves into the comparative analysis of two widely employed local anesthetic solutions which are the 2% lidocaine hydrochloride solution and the 2% lidocaine hydrochloride solution combined with 1:80,000 epinephrine, with specific aim to comprehensively evaluate the efficacy and safety aspects of both local anesthetic solutions. Lidocaine solution alone offers effective pain relief with minimal systemic risks but might lack the extended duration and hemostasis benefits of epinephrine. The lidocaine-epinephrine combination solution provides prolonged anesthesia and reduced bleeding, but clinicians must balance these advantages with the potential for ischemic events and delayed wound healing. Close monitoring, precise dosing, and careful patient selection are paramount in ensuring successful outcomes while minimizing complications.

Hydroelectrolyte imbalances frequently afflict surgical patients, necessitating meticulous management to avert adverse consequences. This bibliographic review explores the epidemiological insights and clinical significance of hydroelectrolyte imbalances in the context of surgical patients. It constructs a theoretical framework by elucidating key concepts, pivotal electrolytes, and therapeutic interventions. The discussion encapsulates the intricacies of considerations and strategies crucial to the adept management of these imbalances. Furthermore, it underscores the pivotal role of proactive management in ameliorating postoperative complications and optimizing patient outcomes.

Electrical injuries are a common form of mechanical trauma that can cause significant damage to the skin and underlying tissues, as well as potentially affect other systems of the body, including the cardiovascular system. Electric burn injury can affect cardiac autonomic function, potentially leading to arrhythmias and heart failure. The autonomic nervous system plays a critical role in regulating cardiac function, acting as the primary regulator of heart rate and contractility. The balance between the two systems, sympathetic and parasympathetic, is essential for optimal cardiovascular function and can be assessed through measures of cardiac autonomic function. The most commonly utilized method is using the electrocardiogram (ECG) in combination with the impedance cardiogram (ICG). The pre-ejection period (PEP) can be extracted from ECG during the left ventricular ejection as a measure of cardiac sympathetic control, and the respiratory sinus arrhythmia can be extracted from ECG during respiration as a measure of cardiac parasympathetic control. This literature review explores the current understanding of how electric burn injury affects cardiac autonomic function and its potential influence on cardiac function. It also emphasize the need of further research to understand the precise mechanisms involved in the effects of electric burn injury on cardiac autonomic function and to develop effective treatment strategies to prevent adverse cardiovascular outcomes.

The integration of artificial intelligence (AI) in plastic surgery holds immense potential for transforming the field, improving outcomes, and enhancing patient satisfaction. This article examines the application of AI in pre-operative planning, intra-operative decision making, and post-operative monitoring. AI tools leverage patient images to provide valuable insights into surgical outcomes, aiding in visualization and communication. Real-time guidance during surgery is facilitated by AI s analysis of intra-operative images, ensuring accurate execution and enhancing safety. In post-operative monitoring, AI analyzes patient data to predict outcomes, detect complications, and optimize wound healing assessment. Despite challenges, the future of AI in plastic surgery looks promising, with advancements in augmented reality, mobile applications, computer vision, and robotically assisted treatments driving progress and strengthening patient-physician relationships.

Introduction: Syndactyly of the hand in Apert syndrome involves all components of the hands. In 1991, Joseph Upton introduced a comprehensive classification of the Apert hands based on its severity. Plain x-ray is the most commonly used to evaluate bony abnormality. Case Presentation: We present two cases with classic characteristics of Apert syndrome with demonstrated different types of Apert hands; type II and type III. Radiographs exhibited bony deformities with typical misalignment and multiple osseous formations in several parts of phalanges. Discussion: Apert hands present complex syndactylies involving the index, middle, and ring fingers in different stages regarding Upton’s classification system. Almost all Apert hands also lack the active motion of the interphalangeal joints. The ossification allowed the synostosis and symphalangism to become evident on radiographs. The abnormality of the epiphysial growth causes short and deviated fingers. Conclusion: Apert hands demonstrate complex deformity involving bony structures that developed prenatally and postnatally. Typical deformities including complex syndactyly, clinodactyly, and symphalangism.

Netherton Syndrome (NS) is a rare and complex autosomal recessive genetic disorder that primarily affects the skin and hair, resulting in a spectrum of dermatological manifestations with profound clinical implications. This article aims to provide a comprehensive overview of NS, shedding light on its etiopathogenesis, clinical presentation, diagnostic modalities, and management strategies. A thorough exploration of the molecular intricacies underlying this condition reveals a captivating interplay of genetics, immunology, and epidermal biology. This syndrome, which arises from mutations in the SPINK5 gene encoding the serine protease inhibitor Kazal-type 5 (LEKTI), manifests with a triad of distinctive features: ichthyosis linearis circumflexa, atopic diathesis, and trichorrhexis invaginata. Notably, NS poses significant diagnostic challenges, and an early and accurate diagnosis is paramount for optimizing therapeutic outcomes. Advances in understanding the diseases pathophysiology have paved the way for innovative treatment modalities, ranging from topical emollients to emerging targeted therapies.

Low back pain is a health problem that can harm several factors related to daily life and work for the entire population. The objective was to evaluate the prevalence of low back pain and quality of life in health students. Descriptive study with a cross-sectional method composed of 74 students enrolled in nine courses related to the health area at a private higher education institution. They were assessed using the participants general characteristics questionnaire, the Oswestry 2.0 questionnaire and the SF-36 Quality of Life Questionnaire. The majority of participants were female, aged between 20 and 30 years old, single, full-time and evening students and studying Physiotherapy and Medicine. 68.9% reported remaining in a sitting position throughout the day, 81.1% had already had attacks of low back pain during the graduation period and 10.8% were already using analgesic medication due to the presence of low back pain. The SF-36 questionnaire presented domain values ??between 45 and 63 points. 87.8% of students were classified by the Oswestry 2.0 index as having minimal lumbar disability, 10.9% with moderate disability and 1.3% with severe disability. Most health students have a history of low back pain, but with limitations considered low

Netherton Syndrome (NS) is a rare and complex autosomal recessive genetic disorder that primarily affects the skin and hair, resulting in a spectrum of dermatological manifestations with profound clinical implications. This article aims to provide a comprehensive overview of NS, shedding light on its etiopathogenesis, clinical presentation, diagnostic modalities, and management strategies. A thorough exploration of the molecular intricacies underlying this condition reveals a captivating interplay of genetics, immunology, and epidermal biology. This syndrome, which arises from mutations in the SPINK5 gene encoding the serine protease inhibitor Kazal-type 5 (LEKTI), manifests with a triad of distinctive features: ichthyosis linearis circumflexa, atopic diathesis, and trichorrhexis invaginata. Notably, NS poses significant diagnostic challenges, and an early and accurate diagnosis is paramount for optimizing therapeutic outcomes. Advances in understanding the diseases pathophysiology have paved the way for innovative treatment modalities, ranging from topical emollients to emerging targeted therapies. This article also explores the ongoing research endeavors and the prospects of gene therapy in the management of NS. Netherton Syndrome remains an intriguing puzzle, with implications extending beyond dermatology, into the realms of immunology, genetics, and personalized medicine.

Wünderlich syndrome or non-traumatic spontaneous renal hemorrhage is a rare entity, with less than 500 cases reported to date. It has multiple associated risk factors, the tumoral etiology is the principal one and the angiomyolipoma is the most frequently associated benign tumor. Other causes that are less frequent are systemic diseases such as polyarteritis nodosa, ruptured renal cysts, coralliform renal lithiasis, among others. It´s most common clinical presentation only occurs in 20% of cases and consists of Lenks triad. Even in cases where the triad is present, the initial diagnosis is by computed tomography (CT) where the retroperitoneal hematoma is observed and sometimes evidencing the underlying etiology as in cases of renal lithiasis. Treatment depends on its severity and extension, ranging from conservative treatment in mild cases to urgent surgery in cases with hemodynamic instability.

Background: There exists a prevalent belief among patients that the use of coffee diminishes the efficacy of local anaesthetic. Caffeine is extensively utilized on a global level through the consumption of coffee, tea, and chocolate. Throughout the duration of the day. Moreover, it is conventionally perceived as a demonstration of communal benevolence, specifically within the context of Saudi Arabia. The mechanism of action of local anaesthetics involves the disruption of sodium channel influx across the neuronal membrane. Methodology: A cross-sectional epidemiological observational study was done in the city of Hail. The data was gathered during a two-month period spanning from July 1st, 2022 to September 1st, 2022. The sample population consisted of individuals who sought dental services within the Hail region. The present investigation had a sample size of 131 individuals, with 47.69% representing the female population and 52.31% representing the male population. However, upon conducting an assessment of patients knowledge and opinions, it was shown that 32% of participants concurred with the notion that coffee possesses the ability to mitigate the occurrence of local anaesthetic failure. A mere 10% of individuals possessed knowledge regarding the scientific evidence that establishes a correlation between the drinking of coffee and the failure of local anaesthetics.Conclusion: Research investigations have demonstrated that caffeine can expedite the recuperation process following anesthesia, exhibiting effectiveness even when administered at elevated levels of anesthesia. Based on the sole existing evidence, it can be inferred that caffeine exhibits a capacity to counteract the effects of general anesthesia. Based on the available scientific evidence, it has been observed that caffeine has the potential to influence cognitive function by enhancing alertness. Additionally, sleep loss has been found to induce worry and anxiety.

Introduction: The 2019 Coronavirus Disease (COVID-19) is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that spread rapidly worldwide through human-to-human transmission. Skin is one of the target organs that involvement in adults and children affected by the novel coronavirus SARS-CoV-2. Despite the pathophysiologic mechanisms of cutaneous manifestations still unclear. Objective: We aim to assess the latest evidence of skin lesions associated with Covid-19 patients with a detailed analysis of skin morphology for early diagnosis and lead to possible better prognosis in COVID-19 patients. Method: We performed a comprehensive search on topics that assessed the manifestations of skin lesions in Covid-19 Patients from inception until February 2022. Result: There were 25 studies out of a total of 2450 patients divided into six patterns of skin lesions that occur in the presence of COVID-19 infection, including maculopapular, urticarial, pseudo-chilblain, vesicular, petechiae/purpura and livedoid. Among these skin lesions, maculopapular and pseudo-chilblains lesions appear to be the most common, followed by urticarial, vesicular, livedoid, and petechial/purpura. These lesions have been found in people of all age groups, including children. Conclusion: In conclusion, this systematic review supplied a complex and detailed analysis of 6 central dermatology patterns common in COVID-19 patients explaining the underlying molecular mechanisms. Another future study on cutaneous manifestations related to COVID-19 is still needed for detailed analysis.

The Van Bogaert-Scherer-Epstein Syndrome (VBSES), also known as Van Bogaert-Scherer-Epstein Disease, is an exceedingly rare and enigmatic neurologic disorder characterized by a complex constellation of clinical symptoms and radiographic findings. Despite its scarcity, VBSES has been a subject of intrigue for medical professionals and researchers due to its intriguing pathogenesis and the challenges it presents in diagnosis and management. In this article, we aim to provide an extensive overview of VBSES, encompassing its historical context, clinical manifestations, diagnostic criteria, radiological features, pathophysiological mechanisms, and therapeutic interventions. Drawing upon an extensive review of the existing literature and a synthesis of relevant case studies, we offer an in-depth analysis of VBSES, shedding light on the current state of knowledge and highlighting the importance of continued research in unraveling this perplexing neurological syndrome

Background: Breast cancer in men, similar to that in women, originates in the mammary gland epithelium (ducts), and although less common than in women, its incidence has increased in recent decades, accompanied by significant advances in understanding the disease as a distinct entity. It shares important similarities with its female counterpart, with significant progress in diagnosis and treatment. Case presentation: In this report, we describe the clinical and imagenological characteristics of a 64-year-old man with metastatic adenocarcinoma to the skin. The patient presented with an ulcerative lesion on the right hemithorax, along the mid-clavicular line and anterior axillary line at the fifth intercostal space. The lesion had a soft, necrotic appearance, was prone to bleeding, and was referred by the patient as "resulting from trauma" a year ago, with progressive expansion and deepening, despite antibiotic use and cleansing of the wound. It invaded the surrounding skin, which appeared desquamated, erythematous with neovascularization, friable to the touch prone to bleeding with difficulty to achieve hemostasis, and multiple brownish nodular satellite lesions, with no other associated symptoms. A thoracic CT scan performed in the emergency department revealed a bilateral pleural effusion, predominantly on the right side, occupying 50% of the right lung space, along with an osteolytic lesion at the level of the manubrium of the sternum. A follow-up thoracic CT scan showed a pleural effusion occupying 80% of the right lung space, with a minor pneumothorax. The placement of an endopleural chest tube on the right side resulted in the extraction of 1800 ml of serosanguineous fluid, and pleural fluid culture did not reveal microorganisms or tumor cells, making the diagnosis of pulmonary adenocarcinoma less likely. A biopsy of the surrounding tissue yielded an invasive, poorly differentiated adenocarcinoma. Immunohistochemical staining was positive for estrogen and progesterone receptors, CK19, and negative for CK7, CK20, leading to the primary diagnosis of breast cancer based on clinical presentation and lesion location. Conclusions: Breast cancer in men, while sharing similarities with its female counterpart, presents its own unique characteristics. The identification of these factors and education about the significance of this condition, along with the discovery of specific biomarkers and targeted therapies, have the potential to significantly improve the prognosis of male patients in the future.

Objective: To find out if the actions taken have an effect on the results on quality assurance and safety culture in a healthcare company. Setting: Health insurance for accidents and illnesses that happen at work. Methods: The research looked at the link between Safety Culture and Quality Assurance measurements over time. It was a longitudinal observational study. People who took part came from small centers with less than eight employees (N = 52), big centers with eight or more employees (N = 707), and centers with quality managers (N = 91). Things were gathered between 2015 and 2016. Results: In 2015, 595 health care workers answered, and in 2016, 491 did. Good progress was seen in both Quality Assurance (T-test = 3.5, p = 0.001) and Safety Culture (T-test = 5.6, p < 0.0001). Because of this, the quality culture improved more quickly (by an average of 5.5%) than the safety culture did (2.1%). Conclusions: The reviews of the quality assurance goals and the reviews of the safety mindset were in line with each other. Because of this, the Safety Culture scores were seen to stay the same over time.

Burns are the fourth most common type of trauma worldwide, after traffic injuries, falls, and interpersonal violence. This is a concise review of recent burn fluid management literature. Strategies to avoid over-resuscitation are discussed. Advances in the care of burned patients have historically been related to the larger field of critical care, especially regarding infectious complications, nutritional supplementation, and metabolic manipulations. The unique resuscitation requirements of burn patients have recently been re-examined to minimize over-resuscitation and its associated complications, which can also be an issue in non-burned critically ill patients. However, burn patients often require multiple sequential operations. The loss of the normal skin barrier increases the risk of multiple infections, sepsis, and organ failure. This review will summarize some of the recent advances in burn care.

Assessing intravascular volume status (IVS) in critically ill patients, especially those in shock, is crucial for appropriate fluid therapy. While central venous pressure (CVP) serves as a gold standard, limitations in predicting IVS prompt exploration of alternative methods. Ultrasound measures of the inferior vena cava (IVC) have been proposed for fluid responsiveness. However, the role of internal jugular vein (IJV) ultrasound measures in estimating IVS and their correlation with CVP in spontaneously breathing critically ill patients remains understudied. This review aims to evaluate the reliability, validity, and correlation of IJV ultrasound measures as indicators of IVS in this patient cohort.

Heart failure with preserved ejection fraction (HFpEF), formerly termed diastolic heart failure, constitutes nearly half the heart failure cases. Patients may exhibit acute heart failure symptoms, yet bedside echocardiograms might indicate normal left ventricular systolic function, potentially leading to the premature exclusion of heart failure as a differential diagnosis. This review delves into fundamental echocardiographic principles associated with diastolic dysfunction, crucial for recognition in HFpEF patients. Specifically, it explores the VALVE protocol, a stepwise approach tailored for the exigent nature of emergency departments. Acquiring accurate imaging windows in acutely ill patients poses a challenge, emphasizing the significance of precise measurements to avoid errors. Techniques such as E-point septal separation (EPSS) must be meticulously positioned for ejection fraction determinations. The discussion focuses on key metrics outlined in the VALVE protocol, encompassing ventricular function, annular tissue Doppler imaging (TDI) measurements, left atrium volume, mitral valve velocities, and the E/e0 ratio as indicators of diastolic dysfunction in HFpEF.

Acute myocardial infarction (MI) in the setting of septic shock presents a multifaceted clinical challenge. In this review, we explore the distinct presentation of type 2 MI among patients grappling with septic shock and coronary artery disease. The coexistence of these conditions poses significant risks, potentially leading to both type 1 and type 2 MIs. We delve into the pathophysiological underpinnings and the clinical implications of these subtypes of MI, emphasizing the altered hemodynamics and increased metabolic demand leading to type 2 MI. Our discussion highlights the differences in management and outcomes, underscoring the critical need for nuanced understanding in clinical practice.

Introduction: Acute bronchiolitis is almost exclusively caused by viral infection in children under 2 years of age. It is a secondary inflammatory viral infection of the lower airways, causing obstruction of the lower respiratory tract. Objective: Review the literature to verify the main causes of viral bronchiolitis in babies. Methods: This study constitutes a systematic review, classified as exploratory and descriptive. The preparation of the research was a bibliographical search in electronic databases on methods associated with RSL (Systematic Literature Review) and the applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings). Results: A comprehensive systematic search of the literature yielded a total of 439 articles referring to the main causes of bronchiolitis in infants. Of these, 29 articles were eligible to be included in this systematic review. Conclusion: The study concluded that bronchiolitis research has seen a significant increase in research and publications, but further investigation is needed to improve our understanding and management of this condition.

Antiplatelet therapy is increasingly common, especially among patients with ischemic heart disease or atrial fibrillation. With the rising number of individuals undergoing anticoagulation treatment, often for conditions like atrial fibrillation, and the increased use of antiplatelet drugs for atherosclerotic disease prevention, the necessity for procedural interventions that require the suspension of these therapies has surged. The decision to interrupt antiplatelet treatment becomes crucial in such scenarios, balancing the risks of thrombotic events and bleeding complications. Implementing appropriate strategies demands a comprehensive understanding of the indications, associated complications, and optimal management of this therapeutic interruption. This review aims to consolidate current knowledge and guidelines, providing insights into the theoretical framework, indications for suspension, potential complications, and practical considerations in managing the suspension of antiplatelet therapy in clinical scenarios related to ischemic heart disease.

Background: Conventional intravenous urography (IVU) is an imaging modality of choice used in evaluating urinary system especially in the third world countries despite recent advancement in imaging Aim: This study is aimed at analyzing the IVU findings in a tertiary center in South-South Nigeria. Study design and settings: A retrospective, observational study was conducted in the Radiology Department of Rivers State University Teaching Hospital (RSUTH). From 1st February 2021 to 28th February 2023. Data analysis: Data were analyzed using SPSS 21.0 version. The level of statistical significance was set at p<0.05. Results: A total of 133 data were analyzed. The age of the study group was between 7 to 72years with a mean age of 39.29 ± 13.63 years. Majority of the age group was 36-46 years (n=49, 36.8%). Females presented more for IVU in this study. The commonest indication is uterine fibroids. Normal IVU was seen in 40(30.1%) of the patients and others had one pathology or the other. Commonest renal pathology was hydronephrosis. There was a significant association between indications and gender (P=0.0001). Conclusion: This study shows that more female presented for IVU which tallies with uterine fibroids being the commonest indication. The commonest finding was hydronephrosis. There was significant association between gender and indications for the study (P=0.0001).

Introduction: Human immunodeficiency virus (HIV) is a neurotrophic, neuroinvasive, and neurovirulent pathogen, which can cause direct infection of the central nervous system (CNS) but also predisposes to a variety of other neuroinfections through impaired T-cell mediated immunity. Among the imaging findings in HIV patient with CNS infection, the presence of ring-enhancing intracranial lesions are considered not rare but quite puzzling diagnostic dilemma. The differential diagnosis for theses lesions commonly includes metastasis, abscess, glioblastoma, infarct, contusion, demyelinating disease, radiation necrosis, resolving hematoma or infections. Many features need to be considered altogether to help narrow the differential. Case description: Male, 32 years old, with history of chronic smoking, pets: one cat dewormed and vaccinated, and positive diagnosis of HIV infection with a CD4 T lymphocyte count of 24 cells/mm3, without antiretroviral treatment. His main symptom was headache, associated with fever, nausea, and vomiting. Therefore, he was hospitalized for his diagnostic approach. Complete laboratory work was done, head CT, lumbar puncture, and MRI, finding rounded intra-axial lesions with well-defined and hyperintense edges in the parietal and occipital region with annular enhancement after the administration of contrast. After symptomatic treatment and anthelmintic therapy, a follow-up imaging study evidenced involution of these lesions. The patient met diagnostic criteria for definitive diagnosis of neurocysticercosis. Conclusion: Even though, Neurocysticercosis is not a rare disease, our group decided to publish this case report because its asocciation with an HIV positive patient, in which has not been yet linked to, in behalf of the lack of evidence and studies, considering the ethical issue of performing rutinary head CT scans in asymptomatic individuals.

Vesicoureteral reflux (VUR) in pediatric patients poses a multifaceted challenge for clinicians, necessitating a thorough exploration of diagnostic strategies, challenges, and optimized management approaches. This article delves into the nuanced aspects of understanding VUR in the pediatric population. Diagnostic modalities, ranging from conventional voiding cystourethrography to advanced imaging techniques, are scrutinized for their efficacy in identifying reflux severity and associated complications. Challenges in the diagnostic process, including age-related variations and the impact of evolving clinical presentations, are discussed. The article also addresses the intricacies of managing pediatric VUR, emphasizing the importance of tailored treatment plans based on reflux grade, patient age, and concurrent conditions. Surgical and non-surgical interventions are appraised, highlighting their respective advantages and limitations. Additionally, the role of antibiotic prophylaxis in preventing urinary tract infections and preserving renal function is explored. Through a comprehensive examination of the diagnostic and management landscape, this article aims to provide clinicians with a nuanced understanding of pediatric VUR, enabling them to navigate the complexities of diagnosis and deliver optimized care to young patients with this urological condition.

Wünderlich syndrome or non-traumatic spontaneous renal hemorrhage is a rare entity, with less than 500 cases reported to date. It has multiple associated risk factors, the tumoral etiology is the principal one and the angiomyolipoma is the most frequently associated benign tumor. Other causes that are less frequent are systemic diseases such as polyarteritis nodosa, ruptured renal cysts, coralliform renal lithiasis, among others. It´s most common clinical presentation only occurs in 20% of cases and consists of Lenks triad. Even in cases where the triad is present, the initial diagnosis is by computed tomography (CT) where the retroperitoneal hematoma is observed and sometimes evidencing the underlying etiology as in cases of renal lithiasis. Treatment depends on its severity and extension, ranging from conservative treatment in mild cases to urgent surgery in cases with hemodynamic instability. We present the case of a 58-year-old male patient with previous inpatient history of acute urinary retention and the finding of right coralliform renal lithiasis, without accepting surgical treatment and was readmitted a few weeks later presenting the characteristic clinical Lenk´s triad he undergoing to simple abdominopelvic computed tomography TC, as initial study and reporting a right perirenal hematoma secondary to obstructive uropathy due to renal lithiasis.

Chagas disease is a vector-borne (triatomine) infection caused by the protozoan parasite Trypanosoma cruzi. Synonyms for this disease are: American trypanosomiasis, Chagas disease and T. cruzi infection. 10, 5 The most common form of transmission of Chagas disease is through hematophagous triatomine insects (triatominae), which develop in dwellings in precarious conditions, The disease can also be transmitted by blood transfusion, organ transplantation, oral and congenital routes, and even more rarely by exceptional routes such as sexual contact and non-Triatominae vectors. American Trypanosomiasis is endemic in much of Mexico, Central and South America 1,11. it is estimated that ~6 million individuals are infected throughout Latin America, while ~300,000 are infected in the U.S.1, 10, 11,16 Chagas disease has two clearly differentiated phases. Initially, the acute phase lasts about two months after infection, they may have a skin lesion or a purplish swelling of an eyelid, they may have fever, headache, enlarged lymph nodes, pallor, muscle aches, shortness of breath, swelling, and abdominal or chest pain. During the chronic phase, the infection can cause sudden death due to cardiac arrhythmias or progressive heart failure due to destruction of the cardiac muscle and its innervations. 15 Appropriate diagnostics for acute infection, nucleic acid amplification testing (NAAT) from blood is recommended; For chronic infection, serological testing is employed. Antitrypanosomal agents, benznidazole and nifurtimox, have shown efficacy in treating T. cruzi infection, The most serious complication is chronic chagasic heart disease, since it is the main cause of death in sick patients.

Aortic aneurysms represent a critical cardiovascular condition characterized by a localized, abnormal dilation of the aorta, presenting a significant risk of rupture and subsequent morbidity and mortality. This review article explores the angiological approach to aortic aneurysms, encompassing epidemiology, classifications, risk factors, complications, and the nuances of angiological management. Through an in-depth examination of these elements, this review aims to provide comprehensive insights into the management of aortic aneurysms, highlighting key considerations and strategies in clinical practice.

Netherton Syndrome (NS) is a rare and complex autosomal recessive genetic disorder that primarily affects the skin and hair, resulting in a spectrum of dermatological manifestations with profound clinical implications. This article aims to provide a comprehensive overview of NS, shedding light on its etiopathogenesis, clinical presentation, diagnostic modalities, and management strategies. A thorough exploration of the molecular intricacies underlying this condition reveals a captivating interplay of genetics, immunology, and epidermal biology. This syndrome, which arises from mutations in the SPINK5 gene encoding the serine protease inhibitor Kazal-type 5 (LEKTI), manifests with a triad of distinctive features: ichthyosis linearis circumflexa, atopic diathesis, and trichorrhexis invaginata. Notably, NS poses significant diagnostic challenges, and an early and accurate diagnosis is paramount for optimizing therapeutic outcomes. Advances in understanding the diseases pathophysiology have paved the way for innovative treatment modalities, ranging from topical emollients to emerging targeted therapies. This article also explores the ongoing research endeavors and the prospects of gene therapy in the management of NS. Netherton Syndrome remains an intriguing puzzle, with implications extending beyond dermatology, into the realms of immunology, genetics, and personalized medicine.

Acute urinary retention (AUR) during pregnancy is a rare yet significant complication, particularly when it occurs in the second trimester due to retroverted uterus. This case report sheds light on this unusual phenomenon, clinical implications, diagnostic approaches, and management strategies. A 27-year-old primigravida at 12 weeks gestation experienced intermittent urinary retention. Foley catheterization relieved an acute episode, evacuating 1.2 liters of urine. Recurrent AUR required intermittent catheterization and probiotics. Gynecological examination and ultrasonography confirmed a retroverted uterus as the cause. Over four weeks, the patient improved, with the uterus repositioning anteriorly by the 16th week, leading to spontaneous resolution. This case highlights the rarity of second-trimester AUR due to retroverted uterus during pregnancy. The interplay of anatomical variations and physiological changes can result in unusual clinical presentations. Swift intervention, including Foley catheterization and patient positioning, achieved successful resolution. Elevated clinical awareness and personalized management are vital for unique pregnancy challenges.

Background: There exists a prevalent belief among patients that the use of coffee diminishes the efficacy of local anaesthetic. Caffeine is extensively utilized on a global level through the consumption of coffee, tea, and chocolate. Throughout the duration of the day. Moreover, it is conventionally perceived as a demonstration of communal benevolence, specifically within the context of Saudi Arabia. The mechanism of action of local anaesthetics involves the disruption of sodium channel influx across the neuronal membrane. Methodology: A cross-sectional epidemiological observational study was done in the city of Hail. The data was gathered during a two-month period spanning from July 1st, 2022 to September 1st, 2022. The sample population consisted of individuals who sought dental services within the Hail region. The present investigation had a sample size of 131 individuals, with 47.69% representing the female population and 52.31% representing the male population. However, upon conducting an assessment of patients knowledge and opinions, it was shown that 32% of participants concurred with the notion that coffee possesses the ability to mitigate the occurrence of local anaesthetic failure. A mere 10% of individuals possessed knowledge regarding the scientific evidence that establishes a correlation between the drinking of coffee and the failure of local anaesthetics.Conclusion: Research investigations have demonstrated that caffeine can expedite the recuperation process following anesthesia, exhibiting effectiveness even when administered at elevated levels of anesthesia. Based on the sole existing evidence, it can be inferred that caffeine exhibits a capacity to counteract the effects of general anesthesia. Based on the available scientific evidence, it has been observed that caffeine has the potential to influence cognitive function by enhancing alertness. Additionally, sleep loss has been found to induce worry and anxiety. These findings partially elucidate the challenges faced by individuals who consume coffee when delivering local anesthetics. In order to mitigate the incidence of local anaesthetic failure, it is advisable for dentists to incorporate stress reduction measures into their routine practice.

Introduction: The 2019 Coronavirus Disease (COVID-19) is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that spread rapidly worldwide through human-to-human transmission. Skin is one of the target organs that involvement in adults and children affected by the novel coronavirus SARS-CoV-2. Despite the pathophysiologic mechanisms of cutaneous manifestations still unclear. Objective: We aim to assess the latest evidence of skin lesions associated with Covid-19 patients with a detailed analysis of skin morphology for early diagnosis and lead to possible better prognosis in COVID-19 patients. Method: We performed a comprehensive search on topics that assessed the manifestations of skin lesions in Covid-19 Patients from inception until February 2022. Result: There were 25 studies out of a total of 2450 patients divided into six patterns of skin lesions that occur in the presence of COVID-19 infection, including maculopapular, urticarial, pseudo-chilblain, vesicular, petechiae/purpura and livedoid. Among these skin lesions, maculopapular and pseudo-chilblains lesions appear to be the most common, followed by urticarial, vesicular, livedoid, and petechial/purpura. These lesions have been found in people of all age groups, including children. Conclusion: In conclusion, this systematic review supplied a complex and detailed analysis of 6 central dermatology patterns common in COVID-19 patients explaining the underlying molecular mechanisms. Another future study on cutaneous manifestations related to COVID-19 is still needed for detailed analysis.

Objective: To find out if the actions taken have an effect on the results on quality assurance and safety culture in a healthcare company. Setting: Health insurance for accidents and illnesses that happen at work. Methods: The research looked at the link between Safety Culture and Quality Assurance measurements over time. It was a longitudinal observational study. People who took part came from small centers with less than eight employees (N = 52), big centers with eight or more employees (N = 707), and centers with quality managers (N = 91). Things were gathered between 2015 and 2016. Results: In 2015, 595 health care workers answered, and in 2016, 491 did. Good progress was seen in both Quality Assurance (T-test = 3.5, p = 0.001) and Safety Culture (T-test = 5.6, p < 0.0001). Because of this, the quality culture improved more quickly (by an average of 5.5%) than the safety culture did (2.1%). Conclusions: The reviews of the quality assurance goals and the reviews of the safety mindset were in line with each other. Because of this, the Safety Culture scores were seen to stay the same over time.

Background: Breast cancer in men, similar to that in women, originates in the mammary gland epithelium (ducts), and although less common than in women, its incidence has increased in recent decades, accompanied by significant advances in understanding the disease as a distinct entity. It shares important similarities with its female counterpart, with significant progress in diagnosis and treatment. Case presentation: In this report, we describe the clinical and imagenological characteristics of a 64-year-old man with metastatic adenocarcinoma to the skin. The patient presented with an ulcerative lesion on the right hemithorax, along the mid-clavicular line and anterior axillary line at the fifth intercostal space. The lesion had a soft, necrotic appearance, was prone to bleeding, and was referred by the patient as "resulting from trauma" a year ago, with progressive expansion and deepening, despite antibiotic use and cleansing of the wound. It invaded the surrounding skin, which appeared desquamated, erythematous with neovascularization, friable to the touch prone to bleeding with difficulty to achieve hemostasis, and multiple brownish nodular satellite lesions, with no other associated symptoms. A thoracic CT scan performed in the emergency department revealed a bilateral pleural effusion, predominantly on the right side, occupying 50% of the right lung space, along with an osteolytic lesion at the level of the manubrium of the sternum. A follow-up thoracic CT scan showed a pleural effusion occupying 80% of the right lung space, with a minor pneumothorax. The placement of an endopleural chest tube on the right side resulted in the extraction of 1800 ml of serosanguineous fluid, and pleural fluid culture did not reveal microorganisms or tumor cells, making the diagnosis of pulmonary adenocarcinoma less likely. A biopsy of the surrounding tissue yielded an invasive, poorly differentiated adenocarcinoma. Immunohistochemical staining was positive for estrogen and progesterone receptors, CK19, and negative for CK7, CK20, leading to the primary diagnosis of breast cancer based on clinical presentation and lesion location. Conclusions: Breast cancer in men, while sharing similarities with its female counterpart, presents its own unique characteristics. The identification of these factors and education about the significance of this condition, along with the discovery of specific biomarkers and targeted therapies, have the potential to significantly improve the prognosis of male patients in the future.

The Van Bogaert-Scherer-Epstein Syndrome (VBSES), also known as Van Bogaert-Scherer-Epstein Disease, is an exceedingly rare and enigmatic neurologic disorder characterized by a complex constellation of clinical symptoms and radiographic findings. Despite its scarcity, VBSES has been a subject of intrigue for medical professionals and researchers due to its intriguing pathogenesis and the challenges it presents in diagnosis and management. In this article, we aim to provide an extensive overview of VBSES, encompassing its historical context, clinical manifestations, diagnostic criteria, radiological features, pathophysiological mechanisms, and therapeutic interventions. Drawing upon an extensive review of the existing literature and a synthesis of relevant case studies, we offer an in-depth analysis of VBSES, shedding light on the current state of knowledge and highlighting the importance of continued research in unraveling this perplexing neurological syndrome

Low back pain is a health problem that can harm several factors related to daily life and work for the entire population. The objective was to evaluate the prevalence of low back pain and quality of life in health students. Descriptive study with a cross-sectional method composed of 74 students enrolled in nine courses related to the health area at a private higher education institution. They were assessed using the participants general characteristics questionnaire, the Oswestry 2.0 questionnaire and the SF-36 Quality of Life Questionnaire. The majority of participants were female, aged between 20 and 30 years old, single, full-time and evening students and studying Physiotherapy and Medicine. 68.9% reported remaining in a sitting position throughout the day, 81.1% had already had attacks of low back pain during the graduation period and 10.8% were already using analgesic medication due to the presence of low back pain. The SF-36 questionnaire presented domain values ??between 45 and 63 points. 87.8% of students were classified by the Oswestry 2.0 index as having minimal lumbar disability, 10.9% with moderate disability and 1.3% with severe disability. Most health students have a history of low back pain, but with limitations considered low

Burns are the fourth most common type of trauma worldwide, after traffic injuries, falls, and interpersonal violence. This is a concise review of recent burn fluid management literature. Strategies to avoid over-resuscitation are discussed. Advances in the care of burned patients have historically been related to the larger field of critical care, especially regarding infectious complications, nutritional supplementation, and metabolic manipulations. The unique resuscitation requirements of burn patients have recently been re-examined to minimize over-resuscitation and its associated complications, which can also be an issue in non-burned critically ill patients. However, burn patients often require multiple sequential operations. The loss of the normal skin barrier increases the risk of multiple infections, sepsis, and organ failure. This review will summarize some of the recent advances in burn care.

Chagas disease is a vector-borne (triatomine) infection caused by the protozoan parasite Trypanosoma cruzi. Synonyms for this disease are: American trypanosomiasis, Chagas disease and T. cruzi infection. 10, 5 The most common form of transmission of Chagas disease is through hematophagous triatomine insects (triatominae), which develop in dwellings in precarious conditions, The disease can also be transmitted by blood transfusion, organ transplantation, oral and congenital routes, and even more rarely by exceptional routes such as sexual contact and non-Triatominae vectors. American Trypanosomiasis is endemic in much of Mexico, Central and South America 1,11. it is estimated that ~6 million individuals are infected throughout Latin America, while ~300,000 are infected in the U.S.1, 10, 11,16 Chagas disease has two clearly differentiated phases. Initially, the acute phase lasts about two months after infection, they may have a skin lesion or a purplish swelling of an eyelid, they may have fever, headache, enlarged lymph nodes, pallor, muscle aches, shortness of breath, swelling, and abdominal or chest pain. During the chronic phase, the infection can cause sudden death due to cardiac arrhythmias or progressive heart failure due to destruction of the cardiac muscle and its innervations. 15 Appropriate diagnostics for acute infection, nucleic acid amplification testing (NAAT) from blood is recommended; For chronic infection, serological testing is employed. Antitrypanosomal agents, benznidazole and nifurtimox, have shown efficacy in treating T. cruzi infection, The most serious complication is chronic chagasic heart disease, since it is the main cause of death in sick patients. 16

Assessing intravascular volume status (IVS) in critically ill patients, especially those in shock, is crucial for appropriate fluid therapy. While central venous pressure (CVP) serves as a gold standard, limitations in predicting IVS prompt exploration of alternative methods. Ultrasound measures of the inferior vena cava (IVC) have been proposed for fluid responsiveness. However, the role of internal jugular vein (IJV) ultrasound measures in estimating IVS and their correlation with CVP in spontaneously breathing critically ill patients remains understudied. This review aims to evaluate the reliability, validity, and correlation of IJV ultrasound measures as indicators of IVS in this patient cohort.

Background: Conventional intravenous urography (IVU) is an imaging modality of choice used in evaluating urinary system especially in the third world countries despite recent advancement in imaging Aim: This study is aimed at analyzing the IVU findings in a tertiary center in South-South Nigeria. Study design and settings: A retrospective, observational study was conducted in the Radiology Department of Rivers State University Teaching Hospital (RSUTH). From 1st February 2021 to 28th February 2023. Data analysis: Data were analyzed using SPSS 21.0 version. The level of statistical significance was set at p<0.05. Results: A total of 133 data were analyzed. The age of the study group was between 7 to 72years with a mean age of 39.29 ± 13.63 years. Majority of the age group was 36-46 years (n=49, 36.8%). Females presented more for IVU in this study. The commonest indication is uterine fibroids. Normal IVU was seen in 40(30.1%) of the patients and others had one pathology or the other. Commonest renal pathology was hydronephrosis. There was a significant association between indications and gender (P=0.0001). Conclusion: This study shows that more female presented for IVU which tallies with uterine fibroids being the commonest indication. The commonest finding was hydronephrosis. There was significant association between gender and indications for the study (P=0.0001).

Heart failure with preserved ejection fraction (HFpEF), formerly termed diastolic heart failure, constitutes nearly half the heart failure cases. Patients may exhibit acute heart failure symptoms, yet bedside echocardiograms might indicate normal left ventricular systolic function, potentially leading to the premature exclusion of heart failure as a differential diagnosis. This review delves into fundamental echocardiographic principles associated with diastolic dysfunction, crucial for recognition in HFpEF patients. Specifically, it explores the VALVE protocol, a stepwise approach tailored for the exigent nature of emergency departments. Acquiring accurate imaging windows in acutely ill patients poses a challenge, emphasizing the significance of precise measurements to avoid errors. Techniques such as E-point septal separation (EPSS) must be meticulously positioned for ejection fraction determinations. The discussion focuses on key metrics outlined in the VALVE protocol, encompassing ventricular function, annular tissue Doppler imaging (TDI) measurements, left atrium volume, mitral valve velocities, and the E/e0 ratio as indicators of diastolic dysfunction in HFpEF.

Introduction: Acute bronchiolitis is almost exclusively caused by viral infection in children under 2 years of age. It is a secondary inflammatory viral infection of the lower airways, causing obstruction of the lower respiratory tract. Objective: Review the literature to verify the main causes of viral bronchiolitis in babies. Methods: This study constitutes a systematic review, classified as exploratory and descriptive. The preparation of the research was a bibliographical search in electronic databases on methods associated with RSL (Systematic Literature Review) and the applications of SMARTER (Simple Multi-Attribute Rating Technique using Exploiting Rankings). Results: A comprehensive systematic search of the literature yielded a total of 439 articles referring to the main causes of bronchiolitis in infants. Of these, 29 articles were eligible to be included in this systematic review. Conclusion: The study concluded that bronchiolitis research has seen a significant increase in research and publications, but further investigation is needed to improve our understanding and management of this condition.

Acute myocardial infarction (MI) in the setting of septic shock presents a multifaceted clinical challenge. In this review, we explore the distinct presentation of type 2 MI among patients grappling with septic shock and coronary artery disease. The coexistence of these conditions poses significant risks, potentially leading to both type 1 and type 2 MIs. We delve into the pathophysiological underpinnings and the clinical implications of these subtypes of MI, emphasizing the altered hemodynamics and increased metabolic demand leading to type 2 MI. Our discussion highlights the differences in management and outcomes, underscoring the critical need for nuanced understanding in clinical practice.

Antiplatelet therapy is increasingly common, especially among patients with ischemic heart disease or atrial fibrillation. With the rising number of individuals undergoing anticoagulation treatment, often for conditions like atrial fibrillation, and the increased use of antiplatelet drugs for atherosclerotic disease prevention, the necessity for procedural interventions that require the suspension of these therapies has surged. The decision to interrupt antiplatelet treatment becomes crucial in such scenarios, balancing the risks of thrombotic events and bleeding complications. Implementing appropriate strategies demands a comprehensive understanding of the indications, associated complications, and optimal management of this therapeutic interruption. This review aims to consolidate current knowledge and guidelines, providing insights into the theoretical framework, indications for suspension, potential complications, and practical considerations in managing the suspension of antiplatelet therapy in clinical scenarios related to ischemic heart disease.

Introduction: Human immunodeficiency virus (HIV) is a neurotrophic, neuroinvasive, and neurovirulent pathogen, which can cause direct infection of the central nervous system (CNS) but also predisposes to a variety of other neuroinfections through impaired T-cell mediated immunity. Among the imaging findings in HIV patient with CNS infection, the presence of ring-enhancing intracranial lesions are considered not rare but quite puzzling diagnostic dilemma. The differential diagnosis for theses lesions commonly includes metastasis, abscess, glioblastoma, infarct, contusion, demyelinating disease, radiation necrosis, resolving hematoma or infections. Many features need to be considered altogether to help narrow the differential. Case description: Male, 32 years old, with history of chronic smoking, pets: one cat dewormed and vaccinated, and positive diagnosis of HIV infection with a CD4 T lymphocyte count of 24 cells/mm3, without antiretroviral treatment. His main symptom was headache, associated with fever, nausea, and vomiting. Therefore, he was hospitalized for his diagnostic approach. Complete laboratory work was done, head CT, lumbar puncture, and MRI, finding rounded intra-axial lesions with well-defined and hyperintense edges in the parietal and occipital region with annular enhancement after the administration of contrast. After symptomatic treatment and anthelmintic therapy, a follow-up imaging study evidenced involution of these lesions. The patient met diagnostic criteria for definitive diagnosis of neurocysticercosis. Conclusion: Even though, Neurocysticercosis is not a rare disease, our group decided to publish this case report because its asocciation with an HIV positive patient, in which has not been yet linked to, in behalf of the lack of evidence and studies, considering the ethical issue of performing rutinary head CT scans in asymptomatic individuals.

Vesicoureteral reflux (VUR) in pediatric patients poses a multifaceted challenge for clinicians, necessitating a thorough exploration of diagnostic strategies, challenges, and optimized management approaches. This article delves into the nuanced aspects of understanding VUR in the pediatric population. Diagnostic modalities, ranging from conventional voiding cystourethrography to advanced imaging techniques, are scrutinized for their efficacy in identifying reflux severity and associated complications. Challenges in the diagnostic process, including age-related variations and the impact of evolving clinical presentations, are discussed. The article also addresses the intricacies of managing pediatric VUR, emphasizing the importance of tailored treatment plans based on reflux grade, patient age, and concurrent conditions. Surgical and non-surgical interventions are appraised, highlighting their respective advantages and limitations. Additionally, the role of antibiotic prophylaxis in preventing urinary tract infections and preserving renal function is explored. Through a comprehensive examination of the diagnostic and management landscape, this article aims to provide clinicians with a nuanced understanding of pediatric VUR, enabling them to navigate the complexities of diagnosis and deliver optimized care to young patients with this urological condition.

Aortic aneurysms represent a critical cardiovascular condition characterized by a localized, abnormal dilation of the aorta, presenting a significant risk of rupture and subsequent morbidity and mortality. This review article explores the angiological approach to aortic aneurysms, encompassing epidemiology, classifications, risk factors, complications, and the nuances of angiological management. Through an in-depth examination of these elements, this review aims to provide comprehensive insights into the management of aortic aneurysms, highlighting key considerations and strategies in clinical practice.

McCune-Albright Syndrome (MAS) is a rare and complex disorder that primarily affects the bones, skin, and endocrine system. It is characterized by a mosaic pattern of somatic mutations in the GNAS gene, leading to constitutive activation of adenylate cyclase and excessive production of cyclic AMP (cAMP). This dysregulated cAMP signaling pathway results in a wide spectrum of clinical manifestations, including polyostotic fibrous dysplasia, café-au-lait skin pigmentation, and various endocrinopathies such as precocious puberty, hyperthyroidism, and hypercortisolism. This comprehensive review aims to provide an in-depth understanding of the pathophysiological mechanisms underlying MAS, a detailed exploration of the diverse clinical features, and a discussion of the current and emerging therapeutic strategies for managing this rare disorder. The article synthesizes research findings, clinical experiences, and genetic insights to shed light on the challenges faced by healthcare providers in diagnosing and treating patients with MAS.

Menstrual Toxic Shock Syndrome (mTSS) stands as a rare yet potentially life-threatening condition, characterized by a cascade of systemic effects resulting from the release of toxic shock syndrome toxin-1 (TSST-1) and other superantigens during menstruation. This article aims to provide an in-depth analysis of the pathophysiological mechanisms underlying mTSS, elucidate the diverse array of risk factors contributing to its development, and present contemporary strategies for the management and prevention of this enigmatic syndrome. By synthesizing current research findings and clinical insights, this comprehensive review seeks to enhance our understanding of mTSS, fostering improved diagnostic precision and optimizing patient outcomes.

Background: Milestones pertain to the customary progression of a childs development within a specific age range. The development of children exhibits significant diversity across different countries, resulting in a lack of fixed milestones tied to certain ages and instead displaying a normal range of variability. The objective of this study was to assess the level of parental awareness regarding childrens developmental milestones in the region of Al-Ahsa, located in Saudi Arabia. The study employed a cross-sectional design and took place from January to March 2022. A pre-designed and validated questionnaire was utilized to collect data from parents residing in Al-Ahsa who were over 18 years of age and had at least one kid between the ages of birth and 14 years. A total of 372 parents participated in the study, with data collection facilitated using local virtual and social media platforms. Result: Among the surveyed parents, a majority of 71% accurately indicated the average age at which children generally commence crawling, while 62.9% provided an accurate response regarding the average age at which children typically begin walking. In the study, it was shown that a higher proportion of moms (9.7%) exhibited an excellent degree of understanding of milestones, as opposed to fathers (3.2%) (P = 0.048). The primary sources of information utilized in this study consisted of internet sites, parents/relatives, and pediatricians or general practitioners, with percentages of 81.4%, 81.4%, and 68.3% respectively. Conclusion: The parental understanding of childrens growth milestones was limited. It is imperative for healthcare providers to prioritize the dissemination of precise information regarding child development to parents through educational interventions conducted during routine visits.

In 2016, the World Health Organization (WHO) stated that 24% of the worlds population is infected with helminthiasis. In Indonesia, the highest prevalence at 30%-90% occurs at the age of 1-12 years, namely in preschool and elementary school children. Helminthiasis infection is transmitted through eggs in human feces. Contaminated soil environments occur in populations with poor sanitation. Helminthiasis can lead to nutritional, physical, intelligence, and productivity problems. Open defecation behavior in the environment makes the soil polluted with feces containing worm eggs. An unhealthy environment and behavior are risk factors for helminthiasis. Health efforts through health education need to always be carried out through the media to disseminate information to the public to prevent helminthiasis. This study aims to determine the effectiveness of video media compared to poster media in the prevention of helminthiasis in increasing the knowledge of mothers who have toddlers. The research method used was a quasi-experiment with a non-equivalent control group design. The population was mothers who have toddlers in the working area of the Ibrahim Adjie Community Health Center with a sample determination through a purposive sampling technique of 18 mothers of toddlers in both the video group and the poster group. The Data analysis used was a paired t-test and independent t-test. The results of the research that has been carried out found that there is a difference in the average knowledge of preventing helminthiasis in the video and poster groups with P-value = 0.000. There is effectiveness of intervention through video media and poster media on knowledge with P value=0.000. Video and poster media on the prevention of helminthiasis can increase the knowledge of mothers who have toddlers. This means that video and poster media on the prevention of helminthiasis can be used as intervention media in increasing the knowledge of mothers who have toddlers to prevent helminthiasis.

Dupuytrens disease, a fibroproliferative disorder of the hand, remains a challenging pathology with significant impact on hand function and quality of life. This article provides a thorough examination of the intricate pathogenesis underlying Dupuytrens disease, delving into the molecular and cellular mechanisms driving abnormal collagen deposition in the palmar fascia. A detailed analysis of the clinical manifestations, from early nodules to advanced contractures, sheds light on the progressive nature of this condition. Furthermore, we explore the intricate interplay between genetic predisposition, environmental factors, and Dupuytren s disease, unraveling the multifaceted etiological landscape. This review synthesizes current diagnostic modalities, emphasizing the importance of advanced imaging techniques and biomarkers for accurate and timely assessment. Additionally, we discuss both conservative and surgical interventions, highlighting emerging therapeutic strategies such as enzyme-based therapies, gene therapies, and novel surgical approaches. The article aims to provide clinicians, researchers, and healthcare professionals with a comprehensive understanding of Dupuytren s disease, fostering a nuanced approach to diagnosis and management.

Cellulitis, a common bacterial skin infection, poses a clinical challenge in its management due to its varied etiology, ranging from streptococcal to staphylococcal species. This review delves into the intricate landscape of cellulitis treatment, exploring the nuances of antibiotic selection based on infection type, severity, and local epidemiology. The empirical use of antibiotics, guided by an understanding of likely pathogens, is crucial in balancing efficacy and preventing resistance. Special attention is given to the inclusion of MRSA coverage in high-risk scenarios. Tailoring antibiotic regimens to specific clinical situations, such as surgical site infections or diabetic foot complications, underscores the importance of flexibility in cellulitis management. Periodic reassessment, guided by culture results and clinical response, ensures a dynamic and effective treatment course. The review also emphasizes the critical role of antibiotic stewardship in combating resistance and sustaining effective cellulitis management.

Scar site recurrence is a rare phenomenon and is more uncommon in squamous cell carcinoma. We present a special case of scar site recurrence in a 40-year-old patient with carcinoma cervix detected on MRI abdomen and pelvis, 5 months after Wertheims hysterectomy. The prognosis is bad in these patients, as they also present with distant organ metastasis.

IgA nephropathy is the most common primary glomerulonephritis, its association with Antineutrophil cytoplasmic antibody (ANCA) vasculitis constitutes a rare way of presentation that is scarcely described in the literature and diagnosed in only 1-2% of the population. The typical clinical presentation is an episode of systemic arterial hypertension with macroscopic hematuria, non-nephrotic proteinuria, acute kidney injury and in the worst-cases if the disturb persists end-stage chronic kidney disease. The definitive diagnosis is made through a biopsy, which shows the main characteristics of this nephropathy, which consists in crescent-shaped glomeruli formation, fibrinoid necrosis, mesangial deposits of IgA, as well as positive ANCA antibodies. Treatment consists in systemic corticosteroids and immunosuppressants to prevent progression to end-stage renal disease. We present a case of a 55-year-old female patient with a history of upper respiratory tract infection 2 weeks prior to the development of macroscopic hematuria, foamy urine, non-nephrotic proteinuria, and persistent acute kidney injury in whom IgA nephropathy was determined, which had a successfully response to treatment with high doses of corticosteroids and systemic immunosuppressants.

Rosacea, a dermatologic disorder characterized by persistent facial erythema, papules, and pustules, often accompanied by ocular involvement, poses diagnostic and therapeutic challenges. This review comprehensively explores the clinical presentation, diagnostic criteria, differential diagnosis, and management strategies for rosacea. Emphasizing the multifactorial nature of its pathogenesis, including genetic and immune components, the review underscores the importance of individualized treatment approaches. Specialist referrals, especially for refractory cases, and a diverse range of treatment modalities, from topical medications to laser therapies, contribute to effective management. Regular monitoring and early intervention mitigate complications, ensuring a favorable prognosis. Ongoing research enhances our understanding of rosacea, guiding advancements in its diagnosis and management.

Introduction: Upper and lower limb malformations are essential things that occur related to congenital disabilities, including syndactyly and polydactyly. It may appear in association with other birth defects as a part of a syndrome and may be present in the upper extremity or lower extremity. Cases of bilateral syndactyly with multiple polydactyly of the hands and feet are the first time in our center, and they must be promptly diagnosed and treated to avoid functional and cosmetic problems. Case presentation: A 3-month-old male toddler presented with webbed index, middle, and ring fingers with synonichia, accompanied by additional fingers on hands and feet. An x-ray examination revealed preaxial polydactyly at both hands with bifid phalanx (Wassel classification) and postaxial polydactyly type B. Duplicated postaxial metatarsal (Venn-Watson classification) and type B postaxial polydactyly also occur on both feet with webbed index and middle toe on the left foot. Direct closure was achieved with a dorsal trapezoidal and zig-zag flap to release the second and third fingers of the right hand, followed by resection of rudimentary fingers to help the child with early stages of motoric functions. Discussion: Syndactyly can cause a length difference that results in growth and functional difficulties. Surgical release of the index to middle and middle to ring fingers should be done early between 3-6 months of age and is expected to help the child grasp, write, and subsequently manipulate objects. We prioritize operating the right hand as around 90% of people prefer to use the right hand. Simple ligation was also performed to recess the rudimentary fingers on both hands and feet. It has no functional benefit and can limit function as it may get caught or make it difficult to wear shoes and gloves. We have to remind the parents that multiple surgeries may be necessary to achieve a satisfactory result and to complete the reconstruction before 24 months of age when the patterns of function of the digits are established. Conclusion: Bilateral complex syndactyly with preaxial and postaxial polydactyly on both hands and feet are distinctly uncommon entities that need multidisciplinary treatment. In this instance, the syndactyly releasing of the second and third fingers on the right hand is prioritized based on the function to be achieved, with excision of the rudimentary fingers.

Behçets syndrome, a systemic vasculitis, manifests across multiple organ systems, presenting challenges in diagnosis and management. This chronic condition, characterized by recurrent oral and genital ulcers, cutaneous lesions, headaches, and ocular symptoms, poses complexities in its clinical evolution. The elusive etiology, potentially rooted in autoimmune reactions triggered by infection or environmental factors, complicates diagnostic endeavors. Diagnosis relies on evolving clinical criteria, necessitating the exclusion of other diseases, with imaging aiding in localizing symptoms. The differential diagnosis involves careful distinction from conditions with similar presentations. Ongoing research explores the intricate interplay of genetic factors, immunology, and environmental influences. A comprehensive understanding holds promise for refined diagnostics and targeted interventions, improving outcomes for those affected.

Psoriasis, a chronic inflammatory skin disorder, presents a therapeutic challenge due to its diverse manifestations and impact on patients lives. This review delves into the intricacies of topical agents used in managing psoriasis, encompassing corticosteroids, vitamin D analogs, retinoids, calcineurin inhibitors, and unconventional treatments like coal tar and salicylic acid. Each agents potency, application, and considerations for different age groups are discussed, providing clinicians with a comprehensive guide for treatment selection. The multifaceted nature of psoriasis requires tailored approaches, and understanding the nuances of these topical therapies is crucial for optimizing outcomes. Ongoing research promises further advancements in psoriasis management, holding potential for more personalized and effective interventions.

Background: The constant upgrades and improvements in Electronic Health Record systems may influence the perceptions and views of healthcare workers. The dynamicity may affect the users view of the culturally dynamic environment of the Middle East. Purpose: This study was conducted to assess the experiences of healthcare workers about the application of electronic health records in the Middle East. Methods: A systematic review was conducted by searching articles from three online journal databases – PubMed Central, MEDLINE, and Google Scholar. The articles were scrutinized for quality before recording the data in the abstraction table. Results: A total of 3456 were retrieved. However, only 13 articles met the inclusion criteria and were considered relevant. These studies were conducted in five countries in the Middle East, including Saudi Arabia, Jordan, Qatar, the United Arab Emirates, and Oman. All the included articles applied quantitative research methodology. Two thematic outcomes were noted: the negative and positive experiences with Electronic Health Records and factors affecting health workers experience with Electronic Health Records. The positive experience came from usability, ease of use, improvements in quality of care, time-saving, clinical workflow, data protection, and reduction in work. On the other hand, negative experiences were mainly attributed to time constraints and system breakdown. The experiences were affected by sociodemographic factors, knowledge, awareness, and training requirements. Conclusion: Electronic Health Records elicit diverse perceptions that may affect their overall usefulness in patient care. Training should be done to improve its positive view

The number of people with diabetes mellitus has grown dramatically around the world. This is mostly due to a rise in type 2 diabetes mellitus (T2DM). 537 million people around the world, or 11% of the population, had diabetes in 2021. By 2045, that number is expected to rise to 783 million, or 12% of the population. The rising number of people with T2DM is a result of the obesity epidemic, which is caused by eating more prepared foods, being less active, and spending more time sitting down. This so-called "Western lifestyle" is linked to more people living in cities and better technology. Chronic kidney disease in a person with diabetes is known as diabetic kidney disease (DKD). It is one of the most common and serious long-term effects of diabetes. Twenty to fifty percent of people with T2DM will eventually develop DKD. DKD is the main cause of chronic kidney disease and end-stage kidney disease around the world, making up half of all cases. In addition, DKD causes a lot of heart disease and death and lowers the quality of life for people who have it. This study gives you the most recent information on how to diagnose DKD, how common it is, and what causes it.