Brunner gland adenoma is a very rare tumor of duodenum. It is usually asymptomatic and detected incidentally during endoscopy. It is a benign tumor with minor risk of malignant transformation. The etiology and pathogenesis of these lesions is not completely understood. Here we present a case of gastric polypoid lesion with features of brunner gland adenoma on histology which is a very unusual site of occurrence.

The field of neuroanesthesia has witnessed profound advancements in recent years, spurred by an evolving understanding of neural physiology and surgical techniques. This article delves into the intricate realm of neuroanesthesia, exploring the nuanced considerations that guide anesthetic management during neurosurgical procedures. From the delicate balance of cerebral perfusion pressure to the intricacies of maintaining an optimal intraoperative neurophysiological environment, this discourse addresses the evolving landscape of neuroanesthetic care. An emphasis is placed on the contemporary challenges faced by anesthesiologists in adapting to novel surgical interventions, such as intraoperative neuroimaging and neurophysiological monitoring. Through an exploration of the latest research and clinical practices, this article aims to provide a comprehensive overview of the multifaceted dimensions inherent in neuroanesthetic decision-making.

Hypocalcemia, characterized by a total serum calcium level below 8.5 mg/dL (corrected for albumin) or an ionized serum calcium level below 4.65 mg/dL, presents a spectrum of clinical manifestations ranging from asymptomatic to life-threatening. Common after neck procedures, early detection and appropriate management are essential. Diagnostic tools include assessing calcium levels, correcting for albumin, and determining the underlying cause through tests like intact parathyroid hormone, serum phosphorus, magnesium, and creatinine. Treatment involves calcium replacement and addressing the root cause, with potential complications such as neuromuscular excitability and cardiac arrhythmias. Prognosis varies based on severity and underlying factors, emphasizing the importance of avoiding diagnostic pitfalls and overtreatment in chronic cases. ECG and genetic testing contribute to accurate diagnosis, aiding in differentiating causes like autosomal dominant hypocalcemia. Recognizing factitious hypocalcemia related to hypoalbuminemia or binding protein alterations is crucial. Understanding the pH-calcium relationship guides clinical evaluation. Holistic management requires a collaborative approach, emphasizing patient engagement and follow-up care. Article Details How to Cite

Gallbladder volvulus, is a rare condition that occurs when the gallbladder twists on its elongated mesentery along the axis of the cystic duct and artery, it occurs in 1 in every 365,000 cases, the mortality of this condition is of 6%. Its clinical presentation is insidious and patients usually go to the emergency department with an acute abdomen. We present the clinical case of a pregnant patient who came with data of acute abdomen, protocolized and operated on by our service with an unexpected outcome: volvulated gallbladder.

Peripheral arterial disease (PAD) is a prevalent vascular disorder characterized by the narrowing or obstruction of arteries, predominantly affecting the lower extremities. This bibliographic review explores the multifaceted aspects of PAD, emphasizing epidemiology, significance, and the theoretical framework encompassing its definition, risk factors, pathophysiology, and contemporary management strategies. In this comprehensive analysis, we delve into the intricate interplay of factors contributing to PAD, from the demographic landscape to the molecular intricacies. Despite advancements in therapeutic modalities, the intricate nature of PAD warrants a nuanced understanding for effective clinical intervention. The ensuing discussion navigates through contemporary perspectives on PAD, synthesizing current evidence to inform clinical practice. In conclusion, this review underscores the imperative of a holistic approach in managing PAD, integrating evolving scientific insights with pragmatic clinical considerations.

Melanoma is one of the most aggressive types of skin cancer. The malignant amelanotic fusocellular melanoma subtype is an uncommon presentation, however, it has a high rate of cardiac involvement, it presents asymptomatic or with symptoms ranging from nonspecific to cardiac tamponade or heart failure. We present a case of a 48-year-old man with recurrent infiltrating amelanotic fusocellular malignant melanoma, with incidentally visualized biventricular lesion and right atrium, with cardiac tamponade with subsequent fluoroscopy-guided pericardiocentesis. Primary cardiac tumors have a prevalence of 1:2000 autopsies and secondary cardiac tumors of 1:100 autopsies, remaining as a secondary: primary ratio of 20:1. In patients with this type of melanoma, although cardiac metastases are common, the diagnosis of them is rare, when it occurs, the disease is very advanced and the treatment is usually palliative.

Background: Awareness, attitude, and routines greatly affect oral health. This survey examined Saudi schoolchildrens oral hygiene knowledge, attitude, and behavior in Al Qassim. Materials and Methods: A cross-sectional study was conducted in the Al Qassim region, focusing on school children. The study utilized a pretested online questionnaire as the primary data collection tool. The initial segment of the questionnaire documented the participants age and dental background, while also capturing their respective experiences. The subsequent section addressed the topics of dental hygiene and dental appointments. The third section of the study was the assessment of students knowledge on oral hygiene. Results: The study revealed that 39% of the students possessed a satisfactory level of oral hygiene knowledge. However, it was observed that students who brushed their teeth regularly or twice a day exhibited a considerably greater level of oral hygiene knowledge (p<0.001). Approximately 56.8% of the student population indicated experiencing oral issues, whereas 20.7% disclosed never having sought dental care during their lifetime. There was a statistically significant difference in the frequency of dental visits seen among students aged 12 years and older last year (p=0.010). Conclusion: It is imperative for educational institutions in Saudi Arabia to initiate the integration of a comprehensive oral health education program that encompasses both students and their parents.

Brain abscesses, focal intracerebral collections of pus, present a formidable challenge in medical practice. Often arising from contiguous infections or hematogenous spread, these conditions demand a high index of suspicion due to their diverse and subtle presentations. Advanced neuroimaging, including CT and MRI, plays a pivotal role in swift diagnosis. Antibiotic therapy, tailored to the underlying pathogenesis, forms the cornerstone of treatment. Surgical interventions, such as bur hole aspiration and excision, offer both diagnostic and therapeutic benefits. Complications, including ventricular rupture and increased intracranial pressure, necessitate vigilant monitoring. Prognosis, influenced by factors like initial presentation and treatment response, underscores the importance of a multidisciplinary and comprehensive approach. This abstract encapsulates the intricate landscape of brain abscess management, emphasizing the need for nuanced strategies and continuous refinement of treatment protocols.

A 30-year-old woman with a history of systemic lupus erythematosus and hypothyroidism . She started with dyspnea on moderate exertion, orthopnea, and a sensation of palpitations an early systolic murmur of mitral regurgitation was found. Transthoracic and transesophageal echocardiography reported hammock congenital mitral valve disease as a cause of mitral regurgitation with impaired functional class, requiring surgical valve replacement. The mitral arcade, or hammock mitral valve, is a very rare entity, even more so in the adult population, with a reported prevalence of 0.5%. It is characterized by abnormal papillary muscles connected directly to the anterior mitral.

This overview delves into the comprehensive management of acute pancreatitis, covering procedures like percutaneous catheter drainage, necrosectomy, endoscopic retrograde cholangiopancreatography (ERCP), and ultrasonography-guided endoscopic cyst gastrostomy. Tailoring interventions to specific patient needs is emphasized, with considerations for special populations such as pregnant individuals and children. The conclusion underscores the importance of judicious procedure selection and ongoing monitoring for optimal outcomes.

Background: Fissure sealant prevented dental caries by applicating material over pit and fissure in posterior teeth, so plaque and debris wouldnt be retain over it. Nowadays, resin based and glass ionomer based used widely as a fissure sealant materials. Glass ionomer based has an advantages in anti-caries effect by fluoride releasing. The adhesion of dental material to the tooth was consider as a factor of material choice. Shear bond strength was a material test to show the attachment of dental material into tooth. Objective: This study was aimed to determine the effect of CPP-ACP paste addition after dental polishing in glass ionomers Fuji VII shear bond strength as a material for fissure sealants. Method: This study was a laboratory experimental research with post-test only group design. Twenty one GIC Fuji VII applied in putty box consist of dental enamel divided into 3 group, each groups consist of 7 samples. The control group was GIC Fuji VII applied without CPP-ACP paste addition after dental polishing. Group 1 was GIC Fuji VII applied with CPP-ACP paste addition after dental polishing and group 2 was GIC Fuji VII applied with CPP-ACFP paste addition after dental polishing. Shear bond strength calculated with UTM machine. Data analysis using Kruskal-wallis followed by Mann-Whitney test. Result: There were significant differences (p <0.05) seen from the GIC Fuji VII shear bond strength on the groups 1 compared with control group. But, there were no significant different seen in control group compare to group 2 and in group 1 compare to group 2. Conclusion: The addition of CPP-ACP paste after dental polishing increased Fuji VII shear bond strength as fissure sealant material.

Background: Among all healthcare professionals, nurses play an extraordinary role in combating COVID-19, which turned into a pandemic in a short time. Nurses are constantly faced with stressful situations that cause emotional exhaustion while managing complex care and treatment processes. Objectives: The study aimed to find out the level of mental stress of nurses involved in the nursing care of COVID-19 patients. Methodology: A descriptive cross-sectional study was conducted among nurses who are involved in nursing care of COVID-19 patients in Shahid Sayed Nazrul Islam Medical College Hospital, Kishoreganj, and 250 Bedded District Hospital, Sunamganj located in Sunamganj of Bangladesh. A purposive sampling technique was applied and a pre-tested semi-structured interview questionnaire was used in this study. Results: A total of 382 respondents were included in this study with a mean age of 27.01 (± 2.692). The major finding of the study shows that 109 (29%) of nurses had low mental stress, 269 (70%) had moderate stress and 4(1%) had high mental stress. Conclusion: The result demonstrates working in that COVID-19 have a great impact on Nurses physical and mental health. Providing support and basic needs to the nurses can play a vital role in maintaining the mental health of Nurses.

Medulloblastoma, a highly aggressive brain tumor, presents a complex clinical landscape driven by intricate genetic variations and diverse risk factors. This review delves into the tumors genetic origins, emphasizing molecular subgroups and their prognostic implications. Examining risk factors such as age, gender, genetics, and ethnicity provides a holistic perspective. Unraveling hereditary forms sheds light on familial predispositions. Racial disparities underscore the importance of tailored approaches. Decoding the complexities surrounding medulloblastoma informs refined diagnostics and personalized treatments, offering hope for enhanced patient outcomes.

Appendiceal mucocele is an appendicular dilation secondary to intraluminal accumulation of mucosal material. Appropriate preoperative diagnosis and surgical resection remain the standard treatment. Here we present the case of a female patient in her third decade who came to the emergency room due to abdominal pain, with a tomography suggestive of appendiceal mucocele, for which she underwent surgery and a conventional appendectomy was performed without complications. The histopathological examination demonstrated simple appendiceal mucocele. without neoplastic activity, at follow-up in one year without recurrences.

Background Protein supplements are commonly utilized by elderly persons who are suffering from sarcopenic obesity. Despite its popularity, however, there is currently a paucity of clear evidence on the possible benefits and negative effects of protein supplements and exercise on sarcopenic obesity (SO). Objective Thus, we wanted to see how protein supplementation and exercise affected older persons with sarcopenic obesity. Method A thorough database search was carried out to look for randomised controlled trials, quasi experimental studies, and pre-post research designs addressing the effects of protein supplementation on reducing sarcopenic obesity in older persons. This scoping review was carried out via PubMed, Embase, Web of Science, and the Cochrane Library databases using PRISMA-Scr protocols. Two independent reviewers conducted a thorough systematic screening approach to determine record eligibility. Results Seven papers met the inclusion criteria out of the 1,811 citations found. Six of the investigations were randomized controlled trials, while one was a pre-post test study. The majority of research addressed the usage of protein supplements as well as exercise training. The protein intake for the intervention group in the included trials ranged from 1.0 to 1.8 g/kg/BW/day, while the duration of exercise conducted ranged from 2 to 3 times per week, with each session lasting 1 hour. Whey protein supplementation has been demonstrated to improve sarcopenic symptoms and weight status in SO people. The combination of resistance training and protein supplementation produced additional benefits in terms of lean muscle mass as well as biomarkers. The study also discovered a lack of uniformity in exercise design among sarcopenic obesity therapies. Conclusion Overall, the combination of resistance training and whey protein supplementation appears to be a good alternative for SO persons seeking to enhance their sarcopenic state and weight status. It does, however, underline the need for prudence when it comes to high protein consumption prescription. Given the scarcity of studies in this area, more research into the appropriate exercise plan for this demographic is necessary.

Neurocysticercosis, caused by Taenia solium larval invasion of the central nervous system, demands a nuanced approach. Treatment involves corticosteroids (dexamethasone, prednisolone, prednisone) and antiparasitic agents (albendazole, praziquantel), tailored to lesion characteristics. Surgical interventions may be necessary. Pregnancy requires anthelmintic therapy deferment. Vigilant monitoring, weaning off antiepileptics, and managing corticosteroid side effects are crucial. This concise overview navigates the intricate landscape of neurocysticercosis management for optimal patient outcomes.

This comprehensive overview delves into the intricacies of managing vestibular schwannomas through microsurgical resection. Highlighting the significance of this approach in varying clinical scenarios, the discussion encompasses indications, complications, and considerations for specific patient populations, such as those with neurofibromatosis type 2. The conclusion emphasizes the need for meticulous monitoring and individualized care in optimizing outcomes. This exploration contributes to a deeper understanding of the role of microsurgical resection in the multifaceted landscape of vestibular schwannoma treatment.

This study investigates family planning practices among eligible couples in the urban setting of Rajshahi City Corporation, Bangladesh. The research aims to determine the prevalence and demographic factors associated with family planning, as well as the types and sources of family planning methods, decision-making processes, and challenges faced. Data was collected through a cross-sectional study, with 300 eligible couples participating. The findings reveal a commendable prevalence of family planning practices (88.0%) in the area, reflecting accessible and effective reproductive health services. Notably, a significant association was found between the sex of respondents and family planning practices (?²= 25.549, p<0.001), with a higher percentage of females (88.2%) actively practicing family planning. Female partners played a central role in decision-making, and small family sizes with shorter age gaps between children were observed. Challenges related to side effects (87.2%) and method-related problems highlighted the need for targeted interventions. Enhancing awareness and education programs, strengthening counseling services, and promoting male involvement. Collaboration with NGOs and healthcare providers is suggested to improve family planning services in urban settings, contributing to healthier demographics in Rajshahi City Corporation. These significant statistics underscore the importance of tailored strategies to enhance family planning practices in urban areas.

In recent years, the field of urological surgery has witnessed a transformative paradigm shift with the integration of robotic-assisted technology, particularly the Da Vinci Surgical System, into its clinical armamentarium. This article explores the profound impact of the Da Vinci robot on urological surgical procedures conducted in the Mexican healthcare landscape. The utilization of robotic platforms in urology has enabled surgeons to achieve unparalleled precision, dexterity, and visualization, thereby revolutionizing the management of complex urological conditions. Through meticulous examination of both historical and contemporary data, this study sheds light on the remarkable evolution of urological surgery in Mexico. Key areas of focus include the burgeoning adoption of robotic techniques for prostatectomy, nephrectomy, cystectomy, and other intricate urological interventions. The incorporation of robotic assistance has translated into reduced operative times, decreased blood loss, shorter hospital stays, and improved postoperative patient outcomes, a fact underscored through comprehensive statistical analysis. Moreover, this article underscores the critical role played by Mexican medical institutions in embracing this cutting-edge technology. It discusses the challenges and opportunities associated with training, credentialing, and establishing best practices to ensure the safe and effective implementation of the Da Vinci system. In conclusion, the article underscores the Da Vinci robots pivotal role in enhancing urological surgery across Mexico. Its growing significance in improving surgical precision and patient well-being cements its status as a groundbreaking tool for the modern urologist. As robotic technology continues to evolve and adapt, urological surgery in Mexico stands on the precipice of further innovation, ultimately leading to improved healthcare outcomes for patients suffering from urological disorders.

Tuberculosis (TB) remains a significant global public health concern, with Pulmonary Tuberculosis (PTB) constituting a substantial burden. This study aimed to assess the socio-demographic profile of PTB patients, with a focus on Multi-Drug Resistant Tuberculosis (MDR-TB) cases, at Chest Diseases Hospital in Rajshahi, Bangladesh. Data from 299 patients were analyzed, considering variables such as age, gender, education, income, and urban or rural residence. The study revealed that the majority of patients were aged 30-44 years, with a mean age of 38.06 years. Gender distribution showed 54.18% males and 45.82% females. Most patients had primary education, and a significant portion were illiterate. Housewives were the largest occupational group, and the majority had a monthly family income of less than Taka 10,000. Furthermore, the study found a significant relationship between MDR-TB and the type of family and monthly family income, with higher MDR-TB prevalence in nuclear families and among those with lower income. This study provides critical insights into the socio-demographic characteristics of PTB patients, especially those with MDR-TB, in Rajshahi, contributing to tailored TB control strategies.

Background: Quality of care is a core concern for healthcare organizations. Quality of nursing care influences the outcomes and patient perception. Although patients perception is an important indicator for measuring the quality of nursing care and patient satisfaction it cannot be emphasized enough. Objective: This studys objective was to explore the patients perceptions regarding the quality of nursing care at tertiary-level hospitals in Bangladesh. Methods: A descriptive cross-sectional study design was carried out at Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2021 to June 2022. Study participants were conveniently selected comprising of sample size of 140. Data were collected by face-to-face interview with a structured questionnaire. Both descriptive and inferential statistics were used for data analysis. Results: The study findings revealed that most of the (79) mothers education levels were SSC and (90) mothers knew about the benefit of breastfeeding by counseling. Only (18) mothers ensure exclusive up to 6 months rest of them introduce various types of food before 6 months. Conclusion: The quality of nursing care was poorly perceived by patients in Dhaka Medical College Hospital. There is a need to improve the quality of nursing care to enhance patientsperceptions.

Hand tendon injuries, comprising both open and blunt traumas, particularly affecting the flexor tendons, are substantial and necessitate skilled surgical intervention. This article emphasizes the critical importance of prompt identification and appropriate treatment for both types of injuries. Diagnostic tools such as ultrasound and MRI play a pivotal role in ensuring accurate assessment. Successful outcomes rely on consistent initial therapy and meticulous aftercare, emphasizing collaborative efforts between the surgeon and the patient. The integration of physiotherapy and occupational therapy is integral to the comprehensive recovery process.

Pilephlebitis or portal septic thrombosis is a rare complication secondary to inflammatory and/or septic processes of abdominal structures whose venous drainage converges to the portal venous system 1. This pathology consists of the formation of thrombi in small caliber vessels within the affected abdominal region, which can progress to directly affect the portal vein and intrahepatic vessels, as well as septic embolisms causing serious complications for the patients health, such as liver abscesses, liver failure, portal hypertension, etc. abdominal sepsis and even death 2. The main pathologies in which this entity can occur are acute appendicitis, diverticulitis, acute cholecystitis, although others such as pelvic inflammatory disease have also been mentioned 3. The most frequently isolated etiologic agents are Bacteroides fragilis and Escherichia coli 4.

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome), also known as drug-induced hypersensitivity syndrome, is a rare severe systemic hypersensitivity drug reaction. Diagnosing DRESS syndrome is challenging due to non-specific manifestations that can make it difficult to recognize. Therefore, addressing and discussing this issue is extremely important, considering the potential lethality of a treatable syndrome. Clinical case: We describe the clinical characteristics of a 39-year-old female who presented with DRESS syndrome associated with the use of ciprofloxacin ophthalmic. The patient manifested a mild maculopapular rash located in the pelvic limbs with subsequent ascending distribution and generalized erythematoviolaceous affecting four extremities, trunk, facial region and scalp, together with fever and lymphadenopathy. Paraclinical tests revealed leukocytosis and eosinophilia. According to RegiScars ranking, it scored 6 points, classifying it as the definitive case for DRESS. He concluded a schedule with prednisone 1 mg/kg/day with a slow reduction dose, obtaining a good response to treatment. Conclusions: DRESS syndrome should be suspected in a patient receiving medical treatment who presents with the following signs and symptoms: rash, fever (38°C), facial edema, and lymphadenopathy. Fortunately, this reaction is usually reversible, with a low incidence of residual damage or mortality, in the case of timely discontinuation of antibiotics and use of topical or systemic corticosteroids.

Introduction: In the changing epidemiological landscape sepsis corresponds to one of the main causes of in-hospital mortality, in third level care units the presence of multidrug resistant bacteria to antimicrobials correspond to a severe health problem, there are studies in intensive care units on mortality related to the appearance of multidrug resistant bacteria in cultures, however infection by multidrug resistant bacteria can appear at any instant of hospital stay which can become an independent risk factor for the appearance of mortality. Aims: To associate the isolation of multidrug-resistant bacteria as an independent mortality factor in patients with suspected sepsis at the Centro Médico Nacional De Occidente. Materials and methods: Place of study: Centro Médico Nacional De Occidente Guadalajara, Jalisco, Mexico. Type of study: Clinical, retrospective cohort type. The clinical records of patients admitted during the study period were searched. Patients with suspected sepsis according to the definition of the Third International Consensus were identified from continuous medical admission and followed up throughout their stay in the hospital. Patients with culture results were evaluated. Two follow-up cohorts were identified: those who presented isolation of multidrug-resistant bacteria at any time during hospitalization and the second cohort those who did not present isolation of multidrug-resistant bacteria; an initial determination of the variables was made and then the clinical records of the patients during their stay in the services were reviewed to search for in-hospital mortality. The association between the occurrence of multidrug-resistant bacteria and mortality was estimated by Hazard Ratio (with 95% confidence intervals). Results: A total of 94 patients were included with a minimum age of 16 years and a maximum age of 91 years with a mean of 48 years with a standard deviation of 20 years. A total of 93 cultures were included of which 21 (22.3%) were isolated with bacterial resistance. Of the positive cultures 42 % (9) were blood culture, 10 % (2) were surgical wound cultures, urine culture 23 % (5), bronchial aspirate 23 % (5). Regarding mortality, 57 % of the patients who presented bacterial resistance presented mortality, presenting a Hazard Ratio of 3.371 with 95% CI (1.125-10.100) p=0.02 Table 2 and 3. Regarding mortality with the different types of bacteria, it was 40 % in Gram negative bacteria with a Hazard Ratio of 1.875 (0.291-12.089), while it was 20 % in Gram positive bacteria, which was not statistically significant p=0.3. Conclusion: Isolation of multidrug-resistant bacteria is an independent mortality factor in patients with suspected sepsis at Centro Médico Nacional De Occidente. There is no relationship with the isolation of Gram-positive and Gram-negative bacteria type with respect to patient mortality.

Esophageal squamous cell carcinoma usually predominates in the flat cells of the upper two thirds of the esophagus and is rare in the distal third due to histologic characteristics. Smoking and alcoholism are the most important associated risk factors and the predominant symptom is dysphagia. Surgery is the treatment of choice in localized disease; in advanced stages chemotherapy is used for palliative purposes. We present the clinical case of a 77-year-old man with a history of significant positive alcoholism and smoking and systemic arterial hypertension. He presented 2 months of evolution with progressive dysphagia, from liquids to solids, anorexia and hematemesis. Endoscopy reports linear erosions in the gastroesophageal junction with a stenosing, infiltrative and partially ulcerated tumor. Computed axial tomography with evidence of hepatic nodules compatible with distant activity. He was referred to general surgery for gastrostomy for enteral tube feeding and to medical oncology for treatment with chemotherapy with palliative intent.

Introduction: Enterocutaneous fistula is a common postoperative complication. The incidence of enterocutaneous fistula as a complication of intestinal tuberculosis is quite rare, so we are interested in reporting this case. Case Report: 32-year-old male presented with history of abdominal pain and fecal matter coming out from an opening in umbilical region for the past 1 month. Patient have history of laparotomy exploration 7 months ago and histopathology showed intestinal tuberculosis. Currently, patient was undergoing TB treatment with anti-tubercular treatment (ATT) for the seventh month. Physical examination showed fistulous opening 2x2 cm over the scar of previous laparotomy. Laboratory examination revealed leukocytosis shift to the left and hypoalbuminemia. Chest X-ray showed active pulmonary tuberculosis. Abdominal CT with with contrast showed localized ileus consist of sentinel loop and suggestive intestinal tuberculosis. Diagnosis of tubercular enterocutaneus fistula arising of as a post-operative complication was made. Patient was given intravenous fluids, antibiotics, antitubercular treatment, and wound care. Patient responded well to conservative management. Discussion: Intestinal tuberculosis (TB) is the sixth most common site of extrapulmonary tuberculosis which can occur primary or secondary. Enterocutaneus fistula (ECF) is a rare complication of intestinal TB and can be managed based on whether the output is low or high. Conservative management can be done through administration of intravenous fluids, antibiotics, antitubercular treatment, and wound care

Sleep deprivation, a prevalent modern-day challenge, has emerged as a critical factor influencing various facets of health, including the immune system. This article delves into the intricate relationship between sleep and immune function, exploring the multifaceted effects of sleep deprivation on immune response modulation. Through an extensive review of current scientific literature, this work aims to shed light on the molecular and cellular mechanisms underpinning the interplay between sleep disruption and immunological changes. Additionally, it discusses the clinical implications of compromised immune function due to inadequate sleep, emphasizing the need for further research and awareness in this evolving field.

Cirrhosis of the liver is a complex and debilitating condition characterized by the progressive deterioration of hepatic function due to chronic liver disease. While hepatic dysfunction remains central to its pathophysiology, cirrhosis often presents with a myriad of extrinsic manifestations that extend beyond the hepatobiliary system. Dermatological manifestations in cirrhotic patients are a frequently encountered yet underappreciated facet of this multisystem disorder. These cutaneous signs can serve as invaluable clinical indicators, aiding in both the early detection and management of cirrhosis. This comprehensive review article aims to elucidate the diverse dermatological presentations associated with cirrhosis, shedding light on their underlying mechanisms, clinical relevance, and diagnostic significance. We delve into the pathophysiological basis of these dermatological manifestations, encompassing conditions such as spider angiomas, palmar erythema, pruritus, and jaundice-associated changes, among others. Furthermore, we explore the intricate interplay between liver dysfunction, immune dysregulation, and the skin, providing a holistic perspective on the dermatological dimension of cirrhosis. Through this comprehensive analysis, we aspire to enhance clinicians awareness and understanding of these dermatological cues, ultimately contributing to improved patient care, early intervention, and a deeper appreciation of the intricate relationship between the liver and the integumentary system.

Dilated cardiomyopathy is considered as a dysfunction of the left ventricle systolic function or even both ventricles associated with myocardial dilation. Approximately 50% of cases have an identifiable cause such as genetic mutations, infectious, autoimmune or metabolic diseases, among others. When the origin of dilated cardiomyopathy is not identified, it is considered idiopathic, which constitutes the other 50% of cardiomyopathies. The diagnostic approach is based on laboratory and image studies trying to identify the known causes of dilated cardiomyopathy, the treatment consists in those cases of known etiology cardiomyopathy in the treatment of the underlying disease as well as the heart failure if it presents, if the etiology is unknown we only focus in improve the symptoms caused by cardiomyopathy. We present a case of a 27-year-old man with history of sudden cardiac death in a second degree relative, who initially presented signs of heart failure with later pulmonary thromboembolism secondary to biventricular intracardiac thrombi. A complete diagnostic approach was performed, ruling out genetic and non-genetic causes of dilated cardiomyopathy, without being perform an endomyocardial biopsy to complete the diagnostic approach due to the risk that the procedure involved and the patients refusal.

Background: This research is a population-based descriptive observational study which aims to determine the profile of oral soft tissue disorders in elementary school students. It is hoped that the data obtained can help map and improve community dental and oral health services. Method: The population in this study was elementary school all students Candijati 01, Arjasa, Jember. The subject sampling technique used in this research was purposive sampling. Results: A total of 155 research subjects consisting of 77 male subjects and 78 were found to have oral soft tissue abnormalities, the majority of which were normal variations in the form of coated tongue (61.07%), oral melanotic macules (9.4%), Recurrent Aphthous Stomatitis (RAS) (7.83%), traumatic ulcer (6.71%), cheilitis (4.03%), geographic tongue (4.03%), fissured tongue (2.68%), atrophic glossitis (2.68%), mucocele (1.34%), and angular cheilitis (0.67%). Conclusion: The most frequently occurring soft tissue abnormalities in the oral cavity are normal variations coated tongue, furthermore oral melanotic macules, and Recurrent Aphthous Stomatitis (RAS)

Background: Many individuals in need of acute health services visit the emergency department (ED) as their initial point of contact. Patient satisfaction with emergency healthcare services was assessed in this pioneering study, which utilized the Arabic version of the Echelle de Qualité des Soins en Hospitalisation (EQS-H) and surveyed patients from various regions of Saudi Arabia. Methodology: The subjects of this cross-sectional survey were 2,997 patients who were admitted to the emergency departments of hospitals located in various regions of Saudi Arabia. Utilizing the EQS-H, a self-reported questionnaire validated to measure patient satisfaction with ED healthcare services, the research was conducted. We utilized an Arabic version of the questionnaire for this research. The statistical analyses were conducted utilizing version 3.6.3 of R. Results: In total, 2,997 patients participated in the study; 36.7% were male and 63.3% were female. In relation to geographical location, the proportion of participants hailing from the central region in the sample was 31.7% (or one-third), while the eastern, western, and southern regions each contributed 24.1% (16.9%), 14.6%, and 14.6%, respectively. The results of the statistical analysis indicated that the central region exhibited a substantially higher average percentage score for information clarity in comparison to the other regions, while the eastern region displayed the lowest score. A shorter length of stay (LOS) in the emergency department (ED), male gender (B = -1.63 and P < 0.05), Saudi nationality (B = -3.81 and P < 0.05), a worse perceived health state (B = -2.19 and P < 0.001), and lower scores on the life satisfaction scale were all significantly correlated with decreased levels of satisfaction with ED services. The most robust indicator of contentment is perceived progress. Conclusion: Patients admitted to emergency departments (EDs) across various regions of Saudi Arabia expressed moderate levels of satisfaction with regard to both the lucidity of information and the association with staff. Notably, the central region exhibited superior outcomes in this regard.

Acute diverticulitis (AD) is a common gastrointestinal disease characterized by abdominal symptoms that can lead to complications such as perforation, peritonitis, and sepsis. Risk factors include a low-fiber diet, high intake of red meat, obesity, sedentarism, alcoholism, and smoking. Computed tomography (CT) imaging is considered key for diagnosis and staging. Different scoring systems help guide treatment decisions, The Hinchey Classification, has been adapted for imaging interpretation. This system categorizes the severity of the disease into stages and helps predict postoperative morbidity and mortality rates, as well as the likelihood of recurrence in patients who are not managed operatively, therefore its the most used classification worldwide. Management of acute diverticulitis depends on disease severity. Antibiotics are recommended for mild cases to reduce recovery time and complications, especially for patients with multiple risk factors and comorbidities. On the other hand, complicated cases require surgical treatment based on the presence of abscesses, perforation, obstruction, or fistulas.

Fabry Disease, a rare X-linked lysosomal storage disorder stemming from alpha-galactosidase A deficiency, has emerged as a multifaceted clinical enigma with profound systemic repercussions. While its multisystemic involvement is well-documented, this article delves into the intricate tapestry of Fabry Disease, focusing keenly on its cardiac implications. The myocardium, subjected to relentless glycosphingolipid deposition and subsequent cascades of molecular maladaptations, becomes a pivotal arena for clinical manifestations. This comprehensive exploration navigates through the molecular intricacies of Fabry-related cardiac pathology, elucidating the underpinnings of ventricular hypertrophy, diastolic dysfunction, and arrhythmogenic predispositions. The interplay between endothelial dysfunction, fibrotic remodeling, and the orchestration of cellular responses within the cardiac milieu unfolds, providing a nuanced understanding of the diseases cardiovascular impact. Furthermore, we scrutinize the evolving landscape of therapeutic interventions, ranging from conventional enzyme replacement therapy to cutting-edge gene therapies. By unraveling the complexities of Fabry Diseases cardiac manifestations, this article aspires to contribute to the refinement of clinical management strategies, offering a beacon of hope to those navigating the intricate interplay of genetic anomalies and cardiovascular compromise. As we venture into this scientific odyssey, the synthesis of molecular insights and clinical implications aims to pave the way for improved patient outcomes and the advancement of targeted therapeutic modalities.

Calcinosis related to systemic sclerosis is a debilitating vascular complication that negatively affects quality of life. It results from the deposition of calcium hydroxyapatite in soft tissues that occurs in the presence of normal calcium and phosphorus metabolism. Injuries can be painful and cause tissue inflammation, ulcers with infections, or deformities that cause functional disability. We present the case of a 29-year-old woman with a history of calcinosis cutis associated with systemic sclerosis, lesions complicated by soft tissue infections, leading to septic arthritis. During the approach, improvement was achieved with the use of intravenous antibiotics and a long oral regimen. As it is a disease without definitive treatment, we improve the patients living conditions and prevent future infections with non-pharmacological therapeutic measures.

Melanoma, the most common cutaneous sarcoma, poses a significant health threat due to its metastatic potential. This review explores the causes, risk factors, and associations of melanoma, emphasizing its diverse presentations and diagnostic considerations. UV light exposure, genetic predisposition, and somatic mutations contribute to melanoma development. The disease affects individuals of all races, with varied clinical manifestations. Prevention strategies involve sun protection behaviors, and early detection through surveillance is crucial for optimal outcomes. Treatment modalities, including surgical excision and adjuvant therapies, are contingent on disease stage. Ongoing monitoring and counseling play key roles in comprehensive care. This review aims to enhance understanding of melanoma, guiding efforts toward prevention, early detection, and effective management.

Background:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the spectrum of one of the most serious dermatological conditions that occur in the hospital setting, considered a dermatological emergency. Stevens-Johnson syndrome is called toxic epidermal necrolysis (TEN) when =30% of the body surface is affected, and it is the most serious form of the disease, with adverse drug reactions being the main etiology, up to 80%. Clinical case:We present the clinical case of a 30-year-old male, with a history of systemic arterial hypertension, who began with symptoms after taking allopurinol after being diagnosed with hyperuricemia. It began with a picture of bilateral conjunctivitis, followed by a sudden appearance of localized dermatosis on the face, characterized by erythematous plaques with indistinct, non-painful borders, and later the appearance of ulcers and blisters, extending to 70% of the body surface. During his hospitalization, he developed a lesion acute renal failure, managed by the intensive care service, with total remission upon discharge and favorable response to treatment thanks to multidisciplinary management. Treatment was provided with human immunoglobulin, vancomycin-based antibiotic therapy, and ciprofloxacin for impetiginization of facial ulcers, fluid therapy, Vaseline gauze dressings, and topical ophthalmological treatment, achieving discharge without comorbidities. Conclusion:Toxic epidermal necrolysis is a severe picture of Steven Johnson Syndrome, potentially fatal, which requires early multidisciplinary management that leads to the recognition and management of associated comorbidities in a timely manner.Key words: Stevens-Johnson syndrome; toxic epidermal necrolysis; halopurinol, drug reaction.

Background: Patients who use drugs in a rational way should get the medicine that is right for them, in the right dose, for the right amount of time, and at the lowest cost to them and their community. In reality, prescribing does not always follow these ideals. Instead, prescribing that is not suitable or logical is what happens most of the time. The studys goals are to find out how common self-medication and legal drug use are among first-year college students in Madinah city so that knowledge in this area can be kept up to date. Methods: The study used a cross-sectional design and looked at medical students in their first year. The sample size was calculated using the Epi Info program, and the number of students was 357 in Madinah City between September 2022 and September 2023. A poll was sent up in the air. As a result, when participants experienced side effects while taking medication, 28.9% stopped taking it, 28.2% talked to their doctor, 19.6% talked to their pharmacist, 13.2% stopped taking the medication and started a new one that had the same effect, 6.2% talked to their family, and 3.9% did nothing. Conclusions: Medical students dont really understand, think about, or act on self-medication or drugs, even though more and more of them are taking antibiotics and medications they didnt get given.

Alopecia, characterized by the loss of hair in various patterns and extents, presents a diverse spectrum of conditions with distinct etiologies and therapeutic considerations. This comprehensive review explores the common types of alopecia encountered in primary care, including telogen effluvium, male- and female-pattern hair loss, alopecia areata, traction alopecia, and tinea capitis. Diagnostic approaches encompass careful history-taking, physical examination, and, when needed, advanced techniques like dermatoscopy. Treatment strategies vary based on the type of alopecia, ranging from topical applications to systemic therapies. Understanding risk factors such as age, genetics, ethnicity, and medication associations is pivotal for tailored interventions. The prevention of specific types of alopecia involves targeted measures, such as wearing cooling caps during chemotherapy to minimize hair loss. By considering these factors, individuals and healthcare providers can collaboratively navigate alopecia, optimizing patient outcomes and quality of life.

Dermatofibrosarcoma protuberans (DFSP) stands as the most prevalent cutaneous sarcoma, marked by slow growth and a protuberant papulonodular appearance. Although rare, its impact is significant, necessitating a comprehensive understanding of its characteristics and optimal management. DFSP typically affects adults, though age variability exists, presenting diagnostic challenges. Histological evaluation, often utilizing CD34 immunohistochemical staining, is crucial for accurate diagnosis. The primary treatment modality remains complete surgical excision, emphasizing the importance of generous margins. Imatinib emerges as a valuable therapeutic option for unresectable or metastatic cases. Complementary approaches such as adjuvant radiation therapy and Mohs surgery enhance the treatment armamentarium, allowing for a tailored, multidisciplinary strategy. Regular follow-up is essential for monitoring and addressing potential complications. While local recurrence is a concern, DFSP generally carries a favorable prognosis, especially with early detection and appropriate intervention. Ongoing research continues to refine treatment paradigms, promising improved outcomes for individuals affected by this distinctive cutaneous sarcoma.

Sporotrichosis, a fungal infection caused by the Sporothrix genus, predominantly presents as cutaneous disease following inoculation through minor skin trauma. Environmental exposure, often linked to soil, plants, or infected animals, is a common source of acquisition. The spectrum of the disease ranges from localized skin lesions to severe disseminated forms, with manifestations including osteoarticular involvement and rare occurrences of meningitis. Prompt diagnosis, typically achieved through culture, is vital for effective management. Treatment, primarily employing antifungal agents like amphotericin B and itraconazole, is essential, as spontaneous resolution is rare. The prognosis varies, with localized infections responding well to treatment, while extracutaneous forms, especially in immunocompromised individuals, may lead to complications and poorer outcomes. Meningitis poses a significant challenge due to limited therapeutic options and diagnostic complexities.

Background: Acute diarrhea is common in Myanmar. People are so used to diarrhea at least once a year that they do not think diarrhea as an important problem. Acute diarrhea in early post-operative period in renal transplant recipient may result in pre-renal failure and delay graft function. This study aimed to identify the prevalence of diarrhea, its severity and response to treatment in early post-operative period (3 weeks after transplant) in living donor kidney transplant (LDKT) recipients. Patients and Methods: LDKT recipients having acute diarrhea in early post-transplant period at two transplant centers (Mingaladon and Nay Pyi Taw) in Myanmar were analyzed over 10 years period; from 2013 to 2023 September. Acute diarrhea is defined as three or more semisolid or liquid stools per day for a minimum of 1 day duration. It was a hospital based observational study. After obtaining diet history and physical examination, laboratory tests were done. Clinical parameters (diet, fever, features of oral candidiasis, features of dehydration, examination of abdomen), stool examination (stool inspection, stool examination for ova and cyst, stool for Clostridium difficle toxin, stool culture), blood tests (total WBC count, serum creatinine, liver function tests) and blood trough level for Tacrolimus and mycophenolate mofetil were done. Management was given according to algorithm and their response to treatment was recorded. Dose modification of immunosuppressants were done depending on full blood count and blood level of them. Results: A total of 230 LDKT recipients were observed; among them, thirteen percent (30/230) of recipients developed acute diarrhea in early post-operative period. The age ranged from 14 to 73 years. A majority of them had mild form; mild dehydration without significant changes in hemodynamic status. The peak onset of diarrhea was 4 to 5 days after transplant; majority resolved over one week. They did not have oral candidiasis. Abdominal examination was normal except mild tenderness over grafted kidney in all of them. Total WBC count and platelet count were normal except in two cases. Stool examination did not show trophozoite or cyst. Stool for Clostridium difficile toxin was not identified. With dietary modification and oral rehydration solution, their motion was back to normal in sixteen percent (5/30). Folic acid therapy with or without probiotics made resolution of diarrhea in 33.3% (10/30). Anti-infective therapy was given in 10% (3/30) of cases; norfloxacin to 2 cases. Intravenous colistin to one case as he had enterocolitis and septicemia due to Klebsiella pneumonia. His stool culture as well as blood culture showed Carbepenem resistant Klebsiella pneumonia; he was known case of myelodysplastic syndrome. Blood level of mycophenolate mofetil was normal; however, the dose was reduced in 2 cases owing to leucopenia or thrombocytopenia. Blood tacrolimus trough level was normal in two-third (20/30); and, it was high in one-third of them (20/30). They passed formed stool 24 - 48 hours after dose reduction of tacrolimus. Conclusion: In this study, 13% of the LDKT recipients had acute diarrhea in early post-operative period. Majority of them had mild form. Half of them recovered with oral rehydration solution, diet modification, folic acid and probiotics. Only one tenth of them had infective in origin and responded to anti-infective therapy. Raised blood tacrolimus trough level was found in one third of LDKT recipients with acute diarrhea; diarrhea improved dramatically after reduction of tacrolimus dose.

Background: Scientific publications are essential for disseminating knowledge and updates among physicians. Integrating scientific research into clinical practice and medical education is crucial for improving patient care. Developing scientific skills alongside clinical skills is essential for applying the scientific method in evidence-based medicine. Publishing research findings in journals is the final step in the scientific process, but it is sometimes overlooked, affecting a countrys scientific output. Aim: The aim of this study is to quantify Mexicos contribution to the most significant international journals in the field of surgery. Material and methods: Descriptive bibliometric study, of articles published in a 5-year period between 2018 and 2022 in one of the top 10 journals with the highest impact factor in the field of general surgery, articles were included if it was identified that one of the authors was affiliated with a Mexican institution. Results: 59 articles published in 10 of the journals with the highest impact in the area of surgery. The journals with the most publications were the British Journal of Surgery with 11 articles (17.2%), Mexico City representing 83.2% of the total publications. The average number of citations for each article was 20.36 ± 31.4 (range 0-198). The institution with the highest number of publications was the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán with 15 (25%). Conclusion This study provides a comprehensive overview of general surgery research in Mexico, highlighting both achievements and areas for improvement. By understanding the current landscape and identifying key challenges, Mexican surgeons and researchers can chart a course for continued growth and advancement in their specialty.

Background: Pulmonary fibrosis is the result of chronic inflammation causing decreased lung function. Severe lung damage and worsening respiratory symptoms can caused by metabolic syndrome. In metabolic syndrome, obesity, dyslipidemia, hypertension, and insulin occurs, also chronic inflammation and increased interleukin-6. Research on rats with high-fat high-fructose diet caused metabolic syndrome that triggered chronic inflammatory formed pulmonary fibrosis, which decreased lung function. The study result aim to increase awareness of pulmonary fibrosis due to chronic inflammation in metabolic syndrome. Methods: The study design was true experimental in vivo test, pre and post test control group, with male Sprague-Dawley rats aged 37 weeks. Comparing each of 10 in control and metabolic syndrome groups. Metabolic syndrome expressed by increase of weight, triglycerides, blood sugar, and low HDL. Pulmonary tissue fibrosis assessed with modified Aschroft score. Examination of plasma and tissue Interleukin-6 by ELISA, and the degree of tissue fibrosis by HE staining under a microscope. Different test with independent T-test and Mann-Whitney methods. Results: There were significant differences in plasma and tissue Interleukin-6 and degree of lung tissue fibrosis between control and metabolic syndrome groups with each p<0.05. There is an increase of plasma Interleukin-6, tissue Interleukin-6, and also degree of lung tissue fibrosis on metabolic syndrom group than control group. Conclusion: There is an increase in the degree of pulmonary tissue fibrosis accompanied by an increase in plasma and tissue IL-6 in rats with metabolic syndrome. KEYWORDS: IL-6, lung fibrosis, metabolic syndrome

Peyronies disease (PD) stands as a distinctive pathology within the realm of urology, presenting a multifaceted clinical panorama characterized by the development of fibrous plaques in the tunica albuginea of the penis. Named after the 18th-century French surgeon François Gigot de la Peyronie, this disorder engenders penile deformities, pain, and psychological distress, underscoring the need for a nuanced understanding and comprehensive management approach. This article endeavors to provide an exhaustive exploration of PD, delving into its intricate etiology, pathophysiological underpinnings, clinical manifestations, and the far-reaching implications on psychosocial well-being. The diseases genesis intertwines genetic predispositions, microtrauma during sexual activity, and inflammatory responses, culminating in dysregulated wound healing processes marked by the excessive deposition of collagen. From a clinical standpoint, PD transcends beyond its physical manifestations, adversely impacting patients mental and emotional states. The altered penile morphology and compromised sexual function pose not only physical challenges but also unravel a complex tapestry of psychological consequences. As such, this article scrutinizes the dual facets of PD, advocating for a holistic approach that addresses both the physical and psychosocial dimensions of the disease. Diagnostic modalities, ranging from clinical evaluation to imaging techniques, form a pivotal aspect of our discourse, providing clinicians with a comprehensive armamentarium for accurate and timely diagnosis. Moreover, an exhaustive review of treatment modalities, encompassing conservative measures, pharmacotherapy, and surgical interventions, aims to distill evidence-based insights guiding therapeutic decision-making. This comprehensive analysis seeks to contribute substantively to the existing body of knowledge, fostering a deeper understanding of PD within the medical community. By amalgamating clinical insights with emerging research trends, this article endeavors to illuminate the path toward refined diagnostic strategies and novel therapeutic interventions, ultimately striving for improved patient outcomes and an elevated standard of care in the management of Peyronies disease.

Objective: Ochoa Syndrome, also recognized as Urofacial Syndrome, presents an intricate confluence of urological anomalies and distinctive facial expressions during micturition. This article endeavors to meticulously dissect the genetic underpinnings and clinical intricacies that define this rare genetic disorder, providing a comprehensive overview for clinicians, geneticists, and researchers. Methods: A thorough review of existing literature, genetic studies, and clinical case reports was conducted to synthesize the current understanding of Ochoa Syndrome. Molecular pathways implicated in the pathogenesis of Ochoa Syndrome, with a focus on the HPSE2 gene, were elucidated, providing a foundation for the exploration of potential therapeutic interventions. Results: Ochoa Syndrome emerges as a consequence of mutations in the HPSE2 gene, unraveling a cascade of molecular events intricately linked to neurogenic bladder dysfunction and unique facial grimacing during voiding. The clinical spectrum encompasses a range of urological challenges, necessitating a nuanced approach to patient management and care. Conclusion: This article illuminates the complexities of Ochoa Syndrome, offering a roadmap for clinicians and researchers to navigate the intricate genetic landscape. By elucidating the molecular labyrinth that underlies this syndrome, we aim to not only enhance diagnostic precision but also pave the way for targeted therapeutic interventions, thereby advancing our collective understanding and management of this rare genetic enigma. Through this exploration, we endeavor to foster a deeper appreciation for the intricacies of Ochoa Syndrome and underscore the imperative for continued research in the pursuit of optimal patient outcomes.

COVID-19 has a lot of different symptoms, and pain syndrome is one of them. Getting a COVID-19 vaccine cut down on illnesses with symptoms and/or high viral loads. The studys goal is to find out how bad the pain syndrome is in people who have been vaccinated against COVID-19 and people who have not been immunized. A cross-sectional observational study was done on 304 COVID-19 patients from September 2021 to April 2023. The patients ages ranged from 18 to 65. After they gave written permission, the people who took part in the study were given an electronic form with 20 questions. The study subjects were split into 5 groups based on their vaccine status: those who had not been vaccinated, those who had been partially vaccinated (= 14 days after dose 1 or < 14 days after dose 2), those who had been fully vaccinated (= 14 days after dose 2), those who had been vaccinated after the third dose, and those who had been vaccinated after the fourth dose. All subjects, vaccinated and not vaccinated, had pain syndrome symptoms, and there were no significant differences (P>0.05). A lot of people who werent protected (40.2% of them) reported severe pain. In the group that got the fourth dose, however, it was not found at all (0%). It was (29.7%), (38.7%), and (39.1%) in the groups that had been partly vaccinated, fully vaccinated, and given the third dose of the vaccine, in that order. In conclusion, pain syndrome was found in all COVID-19 patients. The pain was much worse in patients who had not been vaccinated, but not in those who had gotten the fourth dose of the vaccine.

Multiple Myeloma or Kahlers disease is a neoplasm characterized by proliferation of plasma cells in bone marrow where the most common clinical manifestations include bone pain secondary to osteolysis, kidney damage and hypercalcemia. The most common risk factors associated with this pathology are advanced age, family history of multiple myeloma, alcoholism, smoking, among others. Diagnosis includes the presence of monoclonal protein or paraprotein in serum and urine by electrophoresis, presence of free chain protein in 24-hour urine and immunofixation in serum. We present a clinical case of a 27-year-old female patient who presented lumbar pain as the initial manifestation and on requesting laboratory tests showed alterations compatible with myeloma. Laboratory studies were requested confirming the diagnosis of Multiple Myeloma kappa stage ISS-III in current treatment with cyclophosphamide, dexamethasone and thalidomide.

"Vision 2030" was the framework adopted by the Kingdom of Saudi Arabia to guide its economic development and foster national expansion. The vision outlined the Kingdoms aspirations to establish itself as a global leader by accomplishing the following three primary objectives: a flourishing economy, a dynamic society, and an ambitious nation. In June 2016, the Kingdom initiated a national transformation program (NTP) in accordance with "Vision 2030" in order to achieve this objective. The transformation of health care is among the NTPs eight themes. Healthcare facilities in the Kingdom have a history of nearly a century. To attain the "vision 2030" objective, the Kingdom must modernize its health care system, despite significant strides in improving the health of its population in recent decades. The objective of this essay is to provide a description of the new Model of Care (MOC) as it pertains to the recent healthcare transformation in Saudi Arabia as outlined in the Kingdoms vision 2030. The MOC concept originated from a desire to comprehend the present condition and amass knowledge. It is predicated on the six systems of care (SOC): preventative care, premeditated interventions, pediatric and maternal care, critical issues, chronic ailments, and end-of-life care. The SOC is segmented across various "service layers" in order to facilitate individuals recovery and restore their health when necessary. Twenty-seven of the forty-two interventions described in the new MOC are distributed across the six SOC, while the remaining fifteen are distributed across the numerous SOC. The completion of all MOC interventions will facilitate the Saudi health care systems transition to the "vision 2030" of the kingdom.

This literature review provides a comprehensive analysis of the role of bionanotechnology in surgery field. Bionanotechnology is a new nanotechnology subdiscipline, draws influence from biological processes. Bionanotechnology, which combines nanotechnology and biology, could revolutionise healthcare and medicine. This literature review critically examines the existing literature to provide comprehensive insight into the role and potential of bionanotechnology in surgery and anaesthesiology by presenting an up-to-date overview and summarizing current advances in its application in both fields.

An angiosome is a composite block of tissue fed by a primary source artery. The term angiosome is derived from the Greek words angeion, which means channel, and somite, which means segment or sector of the body derived from soma, body. Angiosomes can be further differentiated into individual skin perforators or into matching venosomes (venous regions) and arteriosomes (arterial territories). The concept of angiosomes plays a pivotal role in surgical procedures involving tissue transplantation and composite flap formation. The secure anatomic borders defined by angiosomes enable the precise identification and isolation of tissues at various layers, facilitating the transplantation of individual components or the creation of composite flaps.

Raynauds phenomenon is a vasospastic condition affecting capillaries in the distal region of the extremities. It is divided into primary and secondary and 80-90% of patients are associated with primary or idiopathic disease, while 10-20% are secondary, with multiple etiologies including connective tissue, vascular, hematologic, and endocrinopathic diseases. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) correspond to a group of necrotizing vasculitides of medium (0.2 to 2.0 mm in diameter) and small blood vessels (arterioles, capillaries, postcapillary venules). Clinically, it is characterized by multisystem involvement, with upper and lower respiratory tract and renal damage standing out for their frequency. The least frequent manifestations are cutaneous, with digital ischemia and gangrene occurring in less than 1% of cases. The diagnosis is based on a detailed clinical history and physical examination in addition to complementary studies including a complete metabolic panel, muscle enzymes, viral panel, thyroid profile and a rheumatologic panel to assess secondary causes of Raynauds phenomenon. Calcium antagonists are considered the first-line treatment in both etiologies, and phosphodiesterase-5 inhibitors are another alternative. This article presents a case of a patient with Raynauds phenomenon as an initial clinical manifestation and later presentation of C-ANCA vasculitis.

Aim of the study: To assess the self-care management interventions for type 2 diabetes mellitus in Saudi Arabia through a systematic review. Methods: A systematic review was conducted by searching for articles from three online journal collection sites – PubMed Central (PMC), CINAHL Open Access and Directory of Open Access Journals (DOAJ). Other articles were obtained from the Google scholar and the Google advanced search engine. The resultant articles were subjected to a thorough scrutiny within the inclusion criteria and quality assessment. An abstraction table was then used to summarize the outcomes. Results: Initial search gave a yield of 2410 articles, which were finally reduced to nine articles. One type of intervention program was identified across the articles – the educational intervention. Across the studies, education program had a significant positive impact on patients self-management of type 2 diabetes mellitus and patients clinical outcomes, with notable impacts on self-care knowledge, behaviors and attitude towards desired practices. There was also a significant impact of the intervention programs on glycemic level and risks of cardiovascular diseases, such as lipid profile. However, the impact of the educational programs depended on smoking and marital status. Conclusion and Recommendations: educational programs are effective in improving the self-management of type 2 diabetes mellitus in Saudi Arabia. However, there is a need to focus on the large-scale application of the education, especially in the clinical setup to come up a sustainable culture of patients education.

Objective: To assess the health care professionals understanding and perceptions of telemedicine in Saudi Arabia. Methods: A systematic review was conducted among the studies 12 empirical studies conducted in Saudi Arabia within the last five years. The articles were sought from PubMed central, CINHAL before an additional search on general open-access database like Google Scholar. The search process of the articles was summarized in a PRISMA diagram, and the included articles were summarized in an abstraction table. Results: The initial search for articles gave a result of 3503 articles, which were scrutinized and 12 articles were noted after excluding all the irrelevant articles. Two key thematic outcomes were noted; an overall positive perception of telemedicine and varying levels of knowledge and awareness among the among healthcare workers. Four factors were noted by the healthcare workers to affect perception on telemedicine; technology, costs, knowledge levels, location and coordination between healthcare staff and the information and communication technicians. Conclusion: There is an increasing knowledge and awareness, and knowledge regarding telemedicine among the healthcare workers in Saudi Arabia. A continuous training of the healthcare workers may improve the positive outcomes of telemedicine application, especially in quality of patient care.

Alagille Syndrome (ALGS) stands as a multifaceted genetic disorder renowned for its distinctive cholestatic liver disease and characteristic facial features. Beyond the hepatic implications, ALGS has been increasingly recognized for its intricate association with a spectrum of congenital heart diseases, presenting a challenging clinical scenario. This article elucidates the complex interrelation between Alagille Syndrome and various cardiac anomalies, delving into the underlying genetic mechanisms and clinical implications. By synthesizing current research, we aim to enhance the understanding of clinicians and researchers regarding the nuanced cardiovascular manifestations of Alagille Syndrome, paving the way for improved diagnostic strategies and targeted interventions.

Background: Carbon monoxide (CO) is a toxic gas that lacks discernible color or scent. Individuals may experience the impact of carbon monoxide (CO) emissions originating from a range of sources, such as gas stoves, water heaters, fireplaces, and motor vehicles. Objective: The objective of this study is to evaluate the perception and knowledge pertaining to symptoms, risk factors, causes, and preventative strategies of carbon monoxide (CO) poisoning among the general population in the Kingdom of Saudi Arabia (KSA). Subjects and methods: The present investigation constitutes a cross-sectional study conducted on the overall population of the Kingdom of Saudi Arabia (KSA). The research focused on those who are not involved in the healthcare profession, utilizing an electronic survey as the primary data collection method. The questionnaire primarily comprises three sections: socio-demographic information, knowledge evaluation, and habitual factors and behaviours pertaining to carbon monoxide poisoning. Results: Out of 568 participants, (52.8%) were aged between 18 to 25 years with (64.1%) being females. A significant proportion of the participants exhibited little knowledge (67.6%), unfavorable attitudes (72.4%), but shown commendable adherence to preventive measures (64.4%). Conclusion: There was a lack of knowledge and a weakness in attitude. Nevertheless, preventive practices are highly motivating. Individuals who possess awareness of carbon monoxide (CO) poisoning tend to demonstrate superior levels of knowledge and adherence to safety precautions when compared to those who lack such awareness.

This comprehensive review explores the dynamic landscape of plastic surgery and facial reconstruction, elucidating the cutting-edge surgical techniques, innovative technologies, and evolving methodologies that have revolutionized the field. As the demand for aesthetic enhancement and facial restoration continues to rise, this article navigates through the intricate nuances of surgical interventions, highlighting their impact on both cosmetic refinement and functional rehabilitation. The integration of advanced imaging modalities, precision surgical approaches, and the incorporation of regenerative medicine are explored in the context of optimizing patient outcomes. Moreover, the article addresses the ethical considerations, patient-centered care, and the pivotal role of interdisciplinary collaboration in the realm of plastic surgery and facial reconstruction. By synthesizing the latest research findings and clinical experiences, this review aims to provide a comprehensive resource for clinicians, researchers, and healthcare professionals engaged in the pursuit of excellence in plastic surgery and facial reconstruction.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, it has a well-defined course with several stages throughout its natural history ranging from primary to tertiary. Rectal syphilis is a rare syphilis presentation and can occur in both primary and secondary syphilis, either in a syphilitic ulcer or proctitis. Its generally doesnt have symptoms, however it can cause rectal bleeding that in most cases tends to be self-limiting. The diagnosis is established when its possible with direct observation studies; However, in cases of concomitant contamination by spirochetes of the usual rectal flora, the sensibility and specificity of direct observation tests decreases, so the diagnosis requires an adequate clinical, serological and, if necessary, histopathological correlation. The treatment and follow-up is the same as in other syphilis types and depends on the time of evolution and specific conditions of the patient in question. We present the case of a male patient with primary rectal syphilis that during his course triggered a state of hypovolemic shock secondary to massive rectal bleeding.

The mucosa-associated lymphoid tissue (MALT) stands as an intricate and versatile arm of the immune system, positioned strategically at the bodys mucosal interfaces. This specialized lymphoid tissue serves as a sentinel against myriad pathogenic challenges while fostering immune tolerance to commensal microorganisms. This article explores the structural and functional attributes of MALT, delving into its critical role in immune surveillance, protection, and homeostasis within mucosal environments. We delve into the intricate interplay between MALT and its cellular constituents, focusing on the lymphocytes, follicular dendritic cells, and the diverse array of immunoglobulins. This comprehensive investigation illuminates the relevance of MALT in the context of infectious diseases, autoimmunity, and inflammation, emphasizing its potential as a therapeutic target. Additionally, we discuss the implications of MALT in the development of mucosal vaccines and the ongoing research avenues poised to unveil novel insights into this remarkable immunological asset.

Background: Numerous investigations have been carried out to evaluate the effectiveness of electronic cigarettes in aiding individuals to quit smoking and to ascertain the security and feasibility of utilizing them as an alternative to traditional tobacco cigarettes. Research expenditures must be allocated significantly to the products evaluation in order to perform an exhaustive examination of its usage prevalence, which includes its use as a smoking cessation tool as well as its adoption as a regular smoking behavior. Methods: The current cross-sectional study was conducted at King Abdulaziz Universitys Faculty of Medicine in the first few months of 2022. There were 263 students that participated in the study in total. In the previous study, the researchers used an anonymous, standardized questionnaire, which they confirmed and put into practice. The concept was assessed and put to the test using statistical analysis using "IBM SPSS Statistics version 20.0." Results: The study included a sample of 263 students, of whom 39.1% were classified as female and 60.9% as male. 49 of the 133 pupils in total were determined to have smoked in the past, while the remaining 86 were smokers currently. Regarding the sort of smoking habit used, it was discovered that 23 people (17.3%) used tobacco cigarettes, whereas 90 people (67.7%) used e-cigarettes or vapes. Furthermore, twenty people (15%) disclosed using other tobacco products. Of those who smoke, 36.1% use electronic cigarettes, or e-cigarettes, to cut back on tobacco use. There was a statistically significant link (P<0.05) found between the individuals marital status and academic year and their regular use of e-cigarettes or vape. Conclusion: The current study found that among a cohort of medical students who successfully quit smoking through its implementation, the use of electronic cigarettes (e-cigarettes) or vaping is a contributing factor in their success. Moreover, it is considered a transitional strategy for individuals who want to cut back on their total tobacco consumption.

Background: As an alternative to hospitalization, home healthcare programs are assuming greater significance on a global scale due to the expanding geriatric population and the prevalence of chronic and acute diseases that require ongoing monitoring and care. In describing and evaluating the quality of life (QOL) and associated determinants of patients enrolled in the Home Health Care (HHC) program affiliated with the Ministry of National Guard Health Affairs in Riyadh, Saudi Arabia, was the overarching purpose of this study. Methods: Participants in this cross-sectional study were HHC program enrolled patients. Utilizing the World Health Organization QOL questionnaire (WHOQOL-BREF), information regarding the various domains of patients QOL was gathered. By fitting logistic regression models, factors associated with a low QOL score were identified. Results: In the research, 253 patients participated. Age distribution: 67.05 (± 20.0). Morbid and sociodemographic characteristics had a substantial impact on the overall quality of life of HHC patients. The final multivariate logistic regression models identified independent associations between marital status, psychological disorders, stroke, and number of illnesses and the overall quality of life (QOL) of HHC patients (p =.022, p =.002, p =.031, and.057, respectively). In a retrospective analysis, the physical health domain score exhibited significant associations with educational attainment, psychological issues, and stroke (p =.028, p =.002, p =.007). Conversely, the psychological domain score demonstrated a significant association with age (p < 0.001) and three distinct forms of chronic ailments—pulmonary (p =.002), psychological problems (p = 0.001), and p =.002. Only the marital status exhibited a significant association with the social domain score (p =.026). There was a significant association between the environmental domain and both education level and stroke incidence (p =.017 vs..027). Conclusions: Multiple factors are substantially correlated with the overall QOL and its domains. A significant number of these factors can be monitored and improved by enhancing the efficacy of HHC services; consequently, this will enhance patients QOL.