One special kind of tissue found in bones is that it may regrow after injury. Nonetheless, for correct alignment and healing, there are some fractures and abnormalities that call for professional intervention. As with any implant, the material chosen to make the implants to treat these issues needs to be carefully considered. The implants themselves may cause bone fractures or abnormalities, or there may be no bone healing at all, if the wrong material is selected. Metals, ceramics, and polymers are the three types of biomaterials that have been employed in the treatment of bone abnormalities as well as fractures. Each class of biomaterial has certain advantages and restrictions related to its uses. In an effort to capitalize on the many advantages that each of these materials has to offer, composites of these various materials have also been developed. This study outlines the many materials that have been developed to treat fractures and bone deformities in place of bone grafts, as well as their drawbacks and the need for more research.

Talalgia is the origin of significant limitation of function in patients. From the point of view of physical medecine and rehabilitation, management is done from the initial phase, that is meaning from diagnosis to therapeutic management. Talalgia is pain of mechanical origin most of the time and the management combine dietary measures and medical treatment with the use of oral or local analgesics if necessary.The guidelines combines physical treatment and pharmacological therapies. A rehabilitation program will be given to the patient adapted to the deficiences observed.

Superior vena cava syndrome results from obstruction of the venous flow or the return of the superior vena cava. Increased venous pressure in the upper body causes edema of the face, neck, and upper extremities occasionally accompanied by vessel distension, cyanosis, cough, dyspnea, stridor, and dysphagia. Cerebral edema causes headaches, confusion, coma, and even death. Lung cancer and non-Hodgkin lymphoma are the most frequent malignant causes (85%) of superior vena cava syndrome, and thyroid cancer is a rare cause (< 5%).

Ureteroceleis a cystic dilatation in the terminal section of the ureter that is located inside the bladder, the urethra, or both. Renal agenesis refers to a congenital absence of one or both kidneys. If bilateral is referred to as classic potter syndrome, the condition is fatal, whereas if unilateral, patients can have a normal life expectancy. Unilateral renal agenesis affects approximately 1 in 500 live births while bilateral agenesis is less common affecting approximately 1 in 4000 live births. There may be a slightly greater male predilection. Radiographic studies have been valuable in diagnosing and confirming diseases in the genitourinary system.Ultrasonography, intravenous urography (IVU) and computed tomography urography (CTU) has greatly helped in evaluation of patients presenting with renal symptoms/abdominal pains.Our case study is a 9 years old male child who presented to the Radiology department for abdominopelvic CT scan/computed urography (CTU) on account of recurrent abdominal pains of two years. Previous abdominopelvic ultrasound scan done reviewed a solitary kidney with left ureterocele not in our center. However, the CT scan done in our center showed the left kidney with left ureterocele

Everyone should have good access toward health serviceswhere and when they need, therefore,various ways are used to seek treatment. In the Madurese, health-seeking behaviour is determined by many factors. The study aimed to analyze the relationship between the level of knowledge and attitudes of the Madurese related to health-seeking practice. The research was conducted on 50 Madurese living in Surabaya. This research was conducted to measure the behaviour of the Madurese in health-seeking. Behaviour is divided into knowledge, attitudes, and practice. The independent variables in this study are knowledge and attitudes, and the dependent variable is the practice or effort of health-seeking. The results showed that the level of knowledge is good (92%), and the attitude toward health-seeking behaviour is negative (78%). Most of therespondents choose self-medication when they are sick (70%). Statistical analysis showed that knowledge was not significantly related to health-seeking practice (p-value = 0,075),while attitudes were significantly related to health-seeking practice (p-value=0,001)

Introduction:The ketogenic diet is an alternative nutritional regimen for refractory epilepsies, including infantile spasms. The objective of our study is the primary and secondary evaluation at 12 months of the effectiveness and tolerance of the ketogenic diet on seizure frequency, EEG (electroencephalogram) patterns, and side effects.Patients and Methods:We evaluated the ketogenic diet as a second-or third-line treatment, following corticosteroid therapy and/or Vigabatrin. We assessed the effectiveness and tolerance of the ketogenic diet based on patients being seizure-free, experiencing a reduction in seizures of more than 50%, improvement in EEG background pattern (suppression of hypsarrhythmia), psychomotor development, side effects, and reduction in antiepileptic drugs during clinical, electrical, and neurocognitive follow-ups at 1, 3, and 12 months.Results:Thirty-eight children, twentytwo boys, and sixteen girls, with a gender ratio of 1.37, presenting with infantile spasms visualized directly clinically or through videos and electric evaluation, with or without hypsarrhythmia on EEG, all symptomatic: genetic etiologies (14, 36.9%), structural in 18 patients (47.3%), and metabolic in six patients (15.8%). At 3 months, the number of patients who were seizure-free with a normal EEG was 22 patients (57.9%), and those with a reduction in seizures of more than50%, 15 patients (39.5%).At 12 months on the ketogenic diet, the number of patients who were seizure-free was 24 (63.2%), and those with a reduction in seizures of more than 50% 14 patients(36.8%). Good tolerance and efficiency of the diet were confirmedby treatment compliance, maintained high response rate, and a reduction in the number of antiepileptic drugs to 1.97. The children became more vigilant, attentive, and responsive to their parents.Conclusion:Implementing the ketogenic diet within a shortperiod of time, less than a year, would yield even better results in terms of seizure frequency and behavior in a developing infant brain.

Introduction-Purpose: It is a fact that there has been a dramatic increase in the global prevalence of overweight children and adolescents with obesity in the last decade. From the existing literature, it has been shown that it is somehow related to the low serum concentrationof 25-hydroxyvitamin D (s25(OH)D). Several studies suggest the consumption of vitamin D supplements in children-adolescent patients with obesity, despite its controversial effectiveness. The aim isto detect a correlation and evaluate the intake of vitamin D supplements and its effectiveness in the treatment of metabolic disorders of overweight and obese children-adolescents. Material andMethod: A review of current literatureon vitamin D and cardiometabolic syndrome (MetS) in children and adolescents was carried out, using several databases such as PubMed, Cross Ref,Cochrane Libraryand Google Scholar. Results: A combination of available sources shows that insufficient vitamin D levels have the potential to affect various aspects of health, including cardiovascular well-being. In children-adolescents with obesity, there is difficulty in increasing vitamin D levels due to its possible thinning in adipose tissue, either due to limited exposure to sunlight or due to low consumption of foods rich in vitaminD. Recommended doses daily vitamin D consumption is usually >4,000IU. A positive impact has been found with vitamin D restoration therapy on insulin secretion and function, improvement of lipid profile and reduction of body mass index (BMI). However, the effect of vitamin D appears to have limited clinical significance and controversial cardiovascular and metabolic effects. Conclusions: In conclusion, it has been found that the consumption of vitamin D supplements slightly increases s25(OH)D levels in overweight-obese children-adolescents and that there is a link between its increase and its effects on certain complications that follow the disease. Nevertheless, more extensive research, continued vigilance of relevant bodies and parents and efforts to promote effective interventions to improve the health of parents are recommended. overweight children-adolescents

Introduction-Purpose: It is a fact that there has been a dramatic increase in the global prevalence of overweight children and adolescents with obesity in the last decade. From the existing literature, it has been shown that it is somehow related to the low serum concentrationof 25-hydroxyvitamin D (s25(OH)D). Several studies suggest the consumption of vitamin D supplements in children-adolescent patients with obesity, despite its controversial effectiveness. The aim isto detect a correlation and evaluate the intake of vitamin D supplements and its effectiveness in the treatment of metabolic disorders of overweight and obese children-adolescents. Material andMethod: A review of current literatureon vitamin D and cardiometabolic syndrome (MetS) in children and adolescents was carried out, using several databases such as PubMed, Cross Ref,Cochrane Libraryand Google Scholar. Results: A combination of available sources shows that insufficient vitamin D levels have the potential to affect various aspects of health, including cardiovascular well-being. In children-adolescents with obesity, there is difficulty in increasing vitamin D levels due to its possible thinning in adipose tissue, either due to limited exposure to sunlight or due to low consumption of foods rich in vitaminD. Recommended doses daily vitamin D consumption is usually >4,000IU. A positive impact has been found with vitamin D restoration therapy on insulin secretion and function, improvement of lipid profile and reduction of body mass index (BMI). However, the effect of vitamin D appears to have limited clinical significance and controversial cardiovascular and metabolic effects. Conclusions: In conclusion, it has been found that the consumption of vitamin D supplements slightly increases s25(OH)D levels in overweight-obese children-adolescents and that there is a link between its increase and its effects on certain complications that follow the disease. Nevertheless, more extensive research, continued vigilance of relevant bodies and parents and efforts to promote effective interventions to improve the health of parents are recommended. overweight children-adolescents

Background. Patients with polytrauma have a high rate of mortality rate in emergencyservices, it is important to detect early the prognostic factors that may influence aspredictors; they have been useful as markers of mortality; shock index and the lactatelevel; those that must be detected in a timely manner for their management, rule outpatientswithlowerrisk,preventcomplicationsandthusreducethemortalityrate.Objective. To determine the shock index and lactate level as prognostic factors for 24hrmortalityinpolytraumatizedpatientsintheemergencydepartmentoftheregionalhospitalnumber1inCharo,Michoacán.Materialandmethods.Observational,analytical,retrospectiveandcross-sectionalstudycarriedoutintheemergencydepartmentofHGR1Charo,MichoacánfromMay2022toApril2023.Theresultsofthegasometricstudyonadmissionwithlactatemeasurementwereevaluated;andcalculation of the shock index, clinical information was recorded, and its progression tomortality.Results:Atotalof108patientswithadiagnosisofpolytraumawererecorded,ofwich13(12%)presentedmortality,demonstratingadirectrelationshipbetween a shock index greater than 0.9 and lactate levels > 2mmol/lt. Of the totalnumber of patients, 82 presented a shock index of less than 0.9, that is, 75.9%, and 26equal to or greater than 0.9, that is, 24.1%. 65 patients presented a lactate level less than2mmol/lt, that is, 60.2% and 43 a lactate level greater than or equal to 2mmol/lt, 39.8%.Conclusions: An initial index score greater than 0.9 and lactate levels > 2mmol/lt onadmission of a polytrauma patient to the ED at HGR No 1 IMSS Charo, is directlyassociatedwithhighermortalityindependentofotherbiochemicalandsociodemographicfactors

Palliative care is increasingly acknowledged as beneficial in supporting patients and families affected by heart failure, but policy documents have generally focused on the chronic form of this disease. Heart failure results from a diverse range of etiological cardiovascular conditions causing a spectrum of systolic and diastolic dysfunction, often mediated by disparate patterns of ventricular remodeling. We present the case of an elderly patient who, after the diagnosis of pump failure through follow-up, palliative care support was determined by the family medicine specialist, reaching optimal end-of-life results, accepting that there is emotional improvement in his hospitalization.

Introduction: The high prevalence of pain in post-digestive surgery patients shows urgency in handling pain management. The role of a nurse anesthetist is needed to conduct pain assessment and pain management to solve the problem. Objective: This study aimedto analyze the phenomenon of pain in post-digestive surgery patients in the inpatient room of Hospital X in West Java, Indonesia.Methods: This research used a quantitative observational approach with 30 post-digestive surgery patients. Sampling used an accidental sampling technique, with an observation sheet using Visual Analogue Scale indicators, then analyzed descriptively.Results and Discussion: Results showed that most of the respondents complained of severe pain after being given the analgesic of Tramadol 100 mg and ketorolac 60 mg drip.Conclusion: This study concludes that the level of pain in post-digestive surgery patients at X Hospital 4 hours after post-surgery is on the severe pain scale. So, it is recommended that pain assessment be further improved and further research on postoperative pain management

Chronic wounds, characterized by prolonged inflammatory responses and impaired healing, pose a significant challenge in clinical practice. This review explores the potential of topical glucocorticosteroids in modulating inflammation and promoting wound healing in chronic wounds. We delve into the mechanisms underlying chronic inflammation, emphasizing the crucial role of proinflammatory cytokines, reactive oxygen species, and impaired cellular responses. Topical corticosteroids, known for their anti-inflammatory, anti-mitotic, and immunosuppressive properties, emerge as promising candidates to influence the transition from the inflammatory to the proliferative phase of wound healing.The discussion encompasses the mechanisms of action of topical corticosteroids, focusing on their binding to glucocorticoid receptors, inhibition of inflammatory mediators, and potential adverse effects. We address the importance of selecting the appropriate corticosteroid based on potency, application duration, and patient-specific factors. Various formulations, such as ointments, creams, gels, and foams, are evaluated in terms of their advantages and drawbacks in wound management.While acknowledging the recognized efficacy of topical corticosteroids in chronic wound management,we highlight concerns regarding their standalone use, such as immunosuppression and potential infection masking. Furthermore, we explore the integration of retinoids with corticosteroids as a novel approach to mitigate unwanted effects and enhance wound healing outcomes. Despite emerging studies on combination therapies, careful consideration and clinical judgment remain paramount for further development and implementation.In conclusion, this comprehensive review provides insights into the potential of topical corticosteroids in chronic wound management. As research in this field progresses, the integration of innovative therapeutic strategies, including retinoids, holds promise for improving outcomes in the challenging realm of chronic wound care

Introduction.Increased monocyte and macrophage inflammatory state and pro-inflammatory cytokine production are linked to type 2 diabetes (T2D). Research design and Methods.This is a case-control study aimed to examine the expression of 23 monocyte genes related to inflammation, adhesion, and repair in individuals with mild (mean HbA1c 7.3%, illness duration 5.6 years) and severe type 2 diabetes (mean HbA1c 8.4%, disease duration 14.2 years) compared also with lean and obese controls. In addition, we determined a set of serum inflammatory cytokines and growth factors. Results.The monocytes of mild T2D patients (who were in general overweight/obese) showed overexpression of a subset of genes related to adhesion (CD9), vascular repair and growth (HGF). The monocytes of the severe T2D patients showed in contrast an upregulation of many of the pro-inflammatory genes, without a significantly increased expression of the repair gene HGF and the adhesion gene CD9. Serum cytokine expression in the severe T2D patients supported the increased inflammatory state of the patients showing high levels of IL-6, IL-1ß, and TNF-a.Conclusions. This study, therefore, shows a pro-inflammatory gene expression profile of monocytes of severe T2D patients, while patients with mild T2D did not show such monocyte profile

Background:Thyroglossalduct cyst is the most common congenital anomaly of the thyroid gland. Carcinoma arising from it is rare which composes 1% of total cases, often diagnosed incidentally after surgical excision. Here we are reporting a case of papillary thyroid carcinoma of thyroglossal cyst in 45-year-old female with normal thyroid gland. Case Description: A 45-year-old female presented with 1 year history of swelling over midline of the neck with normal thyroid gland. FNAC suggested a benign cystic lesion, most likely thyroglossal cyst. CT scan neck showed a well-defined lobulated and septated thin-walled cystic lesion of approx. 6×4×5cm in the midline upper infrahyoid region anterosuperior to thyroid, suggestive of thyroglossal cyst. Sistrunk procedure was performed. HPE revealed papillary thyroid carcinoma of thyroglossal cyst. Conclusion: A case of thyroglossalduct cyst with normal thyroid gland and without any clinical or radiological evidence of malignancy, a possibility of underlying malignancy should be kept in mind and can be managed adequately with Sistrunk procedure only, with regular follow up

Burn injuries are an under-appreciated trauma that can affect anyone, anytime and anywhere. The injuries can be caused by friction, cold, heat, radiation, chemical or electric sources, but the majority of burn injuries are caused by heat from hot liquids, solids or fire. Micronutrients are vitamins and minerals needed by the body in very small amounts. Micronutrients (vitamins and minerals) have numerous health benefits including tissue maintenance, bone and teeth formation and health, serving ascofactors and coenzymes to enzyme various enzyme systems, aiding the regulation and coordination of most body functions, and other biochemical and physiological functions in the body. Major burns require a comprehensive approach addressing both burn severity management and nutritional support. Micronutrients, such as vitamin C, zinc, and vitamin D, play indispensable roles in wound healing, immune function, and overall well-being. Challenges in micronutrient interaction, genetic factors, and patient variability underscore the importance of personalized nutrition therapy in burn care. Future research should explore optimal micronutrient dosages, duration of effectiveness, and potential long-term effects, while precision medicine approaches could enhance burncare by addressing inflammation and infection challenges. Burn management should also integrate precision medicine approaches, recognizing role of inflammation to enhance burn care by mitigating the impact of the hypermetabolic state and providing optimalnutrition. The focus on high-carbohydrate diets, protein supplementation, and careful attention to micronutrient replacement aligns with the goal of meeting heightened caloric needs while minimizing overfeeding

Background:The problem with a night shift working at that, the human race is diurnal, who are functions during day time. Night workers report a number of health problems. Therefore these negative effects have consequences not just for individual, but also for work place, as decreased alertness and reduced job performance that could endanger human lives and affect the quality of life. The assumption is that ergonomically designed shift schedules will assist in the reduction of physiological and psychosocial hazards inthe workplace. Objective:This study was aimed to find out the factors influencing night shift of nurses working in Shahid Ziaur Rahman Medical College Hospital, BograMethods: A descriptive study was used in this study. Data was collected using semi-structured questionnaire and the data was analyzed using SPSS. Results:Here, 16% of the respondents felt discomfort during night shift. 66% they don’t get enough sleep after nightduty. 60% of the respondents mentioned that night shift sometimes affects their attitude negatively. 70% stated that night shift sometimes affects their mood. 70% also stated that night shift sometimes disturbs their social life. 80% mentioned that nightshift sometimes increases interpersonal conflict in their family. Conclusion: The findings revealed that the participated nurses were not comfortable with night shift at all. Night workers accumulate a sleep deficit and sleepy workers make mistakes. The most dangerous are those who build up a “sleep debt” depriving themselves of sleep over long periods.

Lack of nutrition in children and stunting may be caused by several interrelated factors. One of the factors that can influence the emergence of growth retardation in children under five is a lack of food intake such as protein, energy, and zinc children failing to grow. This research analyzes the nutritional values, organoleptic quality, and best level of treatment for Bitterballen with a formulationof chicken meat, sorghum flour, and green spinach as an alternative for providing additional food to stunted toddlers aged 12-23 months. The approach used is quantitative and qualitative by analyzing the organoleptic quality results of Bitterballen, determining the best formulation treatment, and calculating the nutritional value using the yield factor and retention factor for each treatment. The manufacturing procedure was first carried out by formulating three treatments with a ratio of chicken meat, sorghum flour, and green spinach. Of all the treatments, treatment 1 had the highest acceptability, namely containing 287.86 kcal of energy with a nutritional value of 12.71 grams of protein, 17.93 grams of fat, and 19.48 grams of carbohydrates. The organoleptic quality produced by T1 is that it has a light brown color, the aroma is savory, not fishy, and not rancid, the taste produced by T1 is savory and not unpleasant, with the inner texture produced by T1 is not gritty and the outer part is crunchy. The aftertaste is savory and slightly gritty

Background: Community Health Workers (CHWs) play a pivotal role in delivering essential healthcare services, particularly in resource-constrained settings. The outbreak of the COVID-19 pandemic posed unprecedented challenges for CHWs, amplifying the complexity of their work and exposing them to various occupational hazards. Objective:The study intended to assess the work related problems experienced by community health workers during COVID-19 pandemic. Methodology:A descriptive cross-sectional study was conducted among 361 Community Health Workers by face-to-face interview using a pretested semi-structured questionnaire from January 2021 to December 2021 at six Upazila health complex’s in Pabna District. Data were collected by convenience sampling technique. Statistical Package for Social Science (SPSS) version 23 was used to enter and analyze data.Results: A total 361 of respondents, 55.4% were female and the mean age of the respondents was 39±0.854 years. Here, 50.7% (183) protect themselves in pandemic situation by given special attention to hand hygiene, 12.7% (46) said PPE is interference with verbal communication. Majority 48.2% (174) respondents were always wear personal protection equipment (PPE) during procedure. Most of the respondents 53.5% (193) had not feeling of fear during their work. Conclusion: The study revealed a range of difficulties, including prolonged work hours in personal protective equipment (PPE), vision problems related to face shields and goggles, and communication barriers due to PPE

Spontaneous carotid artery dissection is animportantcause of ischemic strokeand is most common in youngandmiddle-aged adult patients.Dissection occurs after tearing of the intima layer of the artery causesthe formation of a thrombus (intramural), and itleads to thrombosis or embolism. The thrombosis or embolism, in turn,interruptsarterial circulation and,subsequently,induces infarction in the territory of the affected artery.Thecase ofanischemic vascular event involvingthe left cerebral hemisphere secondary to a spontaneous dissection of the left internal carotid artery is presentedhere

Alzheimers disease (AD) is a progressive and irreversible pathology in which there is a continuousneurodegeneration process, clinically characterized by decreased cognition, memory and behavior alterations. Currently, the mechanisms behind AD progression are more clear, redefining it as a multifactorial disease on which aging, genetics,metabolism and environment play an important role on theonset.Thecomplexmolecularmechanismsinterplay and generate a state ofinflammation.Thus,creatingneurodegeneration.Objectives:Thisreview focuses on recopilating and describing the molecular mechanism behind neurodegeneration in AD. Furthermore, the relation between risk factors and the mechanism will be encompassed.Methods:A bibliographical review was carried out. Databases such as Pubmed, MDPI,sciencedirect, Termidia publishing house, scielo and the National institute of aging were used. Articles in English and Spanish between 2004 and 2023 were included. The keywords used were:Alzheimers disease, neurodegeneration, beta-amyloid, tau protein, neuroinflammation, cognitive disorder,tangles,biomarkers.Resultsanddiscussion:Millionsof people are exposed to multiple risk factors for AD. In every one of them, there are molecular mechanisms involved, which will eventuallylead to AD ´s main pathological changes, Beta amyloid deposition and tau pathology, causing neurodegeneration.Conclusions: Alzheimers disease is an international public health problem that is affectingthe lives of millions of people.To address this, we have to fully understand the molecular base of its development, in order to approach new treatments.

Long COVID (LC) refers to continuing conditions following acute COVID-19 infection, lasting for weeks to months. It affects a wide range of peoples lives, including physical, physiological, and social-economicaspects. Hence, leads to lowering quality of life and other future health challenges worldwide. Health problems following the acute phase of COVID-19 may persist or appear for days to months after the acute infection is resolved. The phenotype of long COVID-19 commonly manifests as a collection of symptoms such as muscle weakness, neuro-cognitive alteration, and respiratory disturbances. Mechanisms underpinning long COVID-19 are still not fully understood. It is hypothesized that inflammation plays a crucial role in LC development through several complex pathways. Recently, effective treatments for long COVID-19 have not been established. Its management depends on the patients symptoms and needs. Nutritional modulation and physical rehabilitation are advised for long-COVID-19 improvement and increased quality of life. The Mediterranean diet (Med-diet) has been acknowledged for its impact on health through its antioxidant and anti-inflammatory effects. Bioactive compounds in Med-diet have been widely studied to reduce oxidative stress and inflammation in cells. Adherence to Med-diet food intake is linked to a lower incidence of obesity, cancer, cardiovascular disease, and metabolic disease. Therefore, the potential effect of Med-diet as a nutritional approach for long-COVID-19 treatment and prevention will be summarized

Central Centrifugal Cicatricial Alopecia (CCCA) represents a distinct form of scarring alopecia predominantly affecting individuals of African descent. This article provides an in-depth examination of the clinical characteristics, pathogenesis, diagnostic challenges, and evolving therapeutic strategies associated with CCCA. By synthesizing current research findings, we aim to enhance awareness, facilitate early diagnosis, and explore emerging interventions for this enigmatic hair disorder. A comprehensive understanding of CCCA is essential for clinicians to optimize patient care and contribute to ongoing efforts in advancing the field of trichology.

Brain death is a novel construct of death for the procurement of transplantable organs. Brain death is a novel Western construct of human death. Beecher and the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death (1968) introduced this particular concept of death in the USA. Brain death is a neurologic state that belongs to the spectrum of disorders of consciousness and is associated with severe disabilities (1,2). The presence of severe neurologic disabilities should not be confused with death (2,3)

Hypovolemic shock is due to a critical loss in the effective circulating blood volume with systemic hypoperfusion. If left untreated, hypovolemic shock can lead to ischemic injury of vital organs, leading to multi-system organ failure and death. Hypovolemic shock is a potentially life-threatening condition(1,2). There are five causes of hypovolemic shock: hemorrhage, trauma, surgical intervention, burns, and fluid loss caused by vomiting or diarrhea. This woman was involved in a motor vehicle accident, which resulted in a traumatic crash(2,3). This was caused by blood loss to the abdomen, as the physical examination suggested(3). Early recognition and appropriate management are essential. Hypovolemic shock results from depletion of intravascular volume, whether by extracellular fluid loss or blood loss(1,2). The pre-shock stage is characterized by compensatory mechanisms with increased sympathetic tone resulting in increased heart rate, increased cardiac contractility, and peripheral vasoconstriction(2,3)

Introduction: Down syndrome is a common genetic condition affecting approximately 1 in every 1,000 births, caused by a trisomy on chromosome 21. This condition leads to several abnormalities, including cardiac, respiratory, musculoskeletal, and digestive problems such as atresia and duodenal stenosis. The latter may require surgery in childhood, with general or regional anesthesia. The Enhance recovery after surgery (ERAS) Protocol is a set of scientifically supported strategies to reduce surgical stress and improve patient recovery. Although it has been used in adult surgeries for more than 20 years, its implementation in pediatric surgeries is more recent, demonstrating promising results in reducing complications and hospital stays. Case presentation: 3-year-old female, diagnosed with Down syndrome and duodenal stenosis, with a history of closure of the ductus arteriosus at 2 years of age, electively scheduled for diagnostic laparoscopy. Fasting for 6 hours was indicated prior to surgery. Upon her arrival to the operating room, Midazolam and Paracetamol were administered as anxiolysis. Non-invasive continuous cardiac monitoring was initiated in the operating room, anesthetic induction was performed with Fentanyl, Lidocaine, Propofol and Cisatracurium. Orotracheal intubation with videolaryngoscopy was performed. Anesthetic maintenance was using Sevoflurane, as well as Fentanyl infusion. During the surgical procedure, multiple intra-abdominal adhesions were evident, so it was modified to open surgery, performing duodenal-duodenal anastomosis. Bispectral index (BIS) monitoring was performed throughout the procedure with values of 40-60. The fluid balance remained neutral. For analgesia, caudal block with Ropivacaine was used at the end of the surgery. For the prevention of postoperative nausea and vomiting, Ondansetron was administered. Emersion and extubation were performed without complications. Anesthesiology follow-up was carried out in the first 24 hours, with adequate pain control. Enteral feeding was started after 48 hours and progressively. Hospital discharge took place 72 hours after surgery. Clinical discussion: The ERAS protocol was implemented for the first time in adult patients undergoing open colectomy; prolonged fasting, prolonged rest, excessive fluid resuscitation, and opioid analgesia were found to favor hospital stay and complications. For anesthetic management, the main points to take into account are: suspend the consumption of clear liquids up to two hours before surgery; in the perioperative phase, a multimodal approach should be focused on reducing postoperative nausea and vomiting. Regarding Regional anesthesia for abdominal surgery, options such as ultrasound-guided transversus abdominis plane (TAP) block or rectus abdominis sheath block can be used safely; when ultrasound is not available, caudal epidural block is the ideal technique in pediatric patients. The administration of fluids in the perioperative period at an average rate of 2-5 ml/kg/h achieves a neutral balance to reduce complications such as pulmonary edema. Monitoring and maintaining temperature reduces surgical site infections, cardiac complications, as well as bleeding. In the postoperative phase, the multimodal analgesia regimen continues based on Paracetamol, Ketorolac, regional anesthesia, Gabapentin; in addition to implementing the start of enteral feeding and early ambulation in order to reduce postoperative ileus and favor conditions for hospital discharge. Conclusion: The ERAS protocol is a tool that has recently been implemented in pediatric surgery with good results. The reduction in fasting time prior to elective surgery, fluid control, the initiation of multimodal analgesia through the use of paracetamol, non-steroidal anti-inflammatory drugs as well as regional anesthesia techniques have a positive impact on the patient and with better results in the postoperative period.

The latissimus dorsi flap (LDF) is a surgical technique used by surgeons to rebuild many different types of breast cancer surgical defects, such as modified radical mastectomy, quadrantectomy, and lumpectomy. The LDF can be utilized as an autogenous flap alone, in conjunction with implant-based immediate reconstruction, in conjunction with tissue expanders for a phased reconstruction, or in either case, either immediately or later. During breast reconstruction, the LDF is a dependable soft tissue covering option that offers shape and function with manageable short-and long-term morbidities. When tissue is scarce, the LDF can help by providing tissue volume in autologous reconstruction. It can also serve as a dependable vascular pedicle for implant-based repair in situations when the tissue has been exposed to radiation.

Schambergs Purpura, also known as progressive pigmented purpura or Schamberg disease, is a dermatological condition characterized by a distinctive purpuric rash. This article provides a thorough examination of the clinical manifestations, pathophysiological mechanisms, and current management approaches associated with this intriguing disorder. The review aims to consolidate existing knowledge, highlight diagnostic challenges, and explore emerging therapeutic interventions. Through an in-depth analysis of the latest research findings, this comprehensive overview aims to enhance the understanding of Schambergs Purpura among healthcare professionals, facilitating more accurate diagnosis and improved patient outcomes

Irritable bowel syndrome (IBS) is one of the most commonly diagnosed gastrointestinal diseases. IBS, in the absence of any other causative disease, is defined as the presence of abdominal pain or discomfort with altered bowel habits.The etiology of IBS is broad and not clearly understood. Nearly 12 percent of patients seek medical care in primary care practices for IBS related complaints.The pathophysiology of IBS is broad and includes abnormalities involving motility, visceral sensation, brain-gut interaction, and psychosocial distress.The clinical case presented has the textual characteristics that represent treating a patient with diagnostic criteria for this pathology. Presenting prevalent cases helps the physician in training and specialists not to overlook what is common in clinical practice

Acute respiratory distress syndrome (ARDS) is a common complication in severe burn patients, arising from inflammatory responses following burns or inhalation injuries. This literature review explores the mechanisms and diagnostic approaches for ARDS in burn patients. Methods involved searching open-access journals using specific keywords on PubMed, Google Scholar, and Elsevier. The review highlights the involvement of various immune cells and cytokines in ARDS pathophysiology, with diagnostic tools including clinical signs, imaging, and bronchoscopy. Therapeutic strategies focus on ventilation and pharmacological interventions targeting inflammation. Further research is needed to better understand ARDS in burn patients, particularly regarding inflammatory markers and pharmacological treatments.

Diverticulosis refers to the presence of diverticula, or herniations of the intestinal mucosa and submucosa, most often in the sigmoid colon. More than one half of patients over age 50 have incidental colonic diverticula. Diverticulitis is the most common complication of diverticulosis, occurring in up to 20% of patients, and results from a microperforation of a diverticulum from inspissated fecal material that often becomes a phlegmon, or a pericolic or intra -abdominal abscess. The presented clinical case is about diverticular disease (Diverticulosis). Itgenerally affects older patients. It is produced by herniation of the mucosa and submucosa through the muscular layer of the colon.

For the greatest functional outcome, hand reconstruction with soft tissue abnormalities requires an early, single-stage, well-vascularized cover. Since important tissues including tendons, bones, and joints are exposed, a full thickness graft is typically needed, and subsequent repair is frequently necessary. Reverse flow flaps in the posterior interosseous artery provide a flexible and dependable means ofcovering intricate soft tissue abnormalities in the hand in full thickness

Introduction. Mediastinal teratoma is a rare germ cell tumor, located in anterior mediastinum and is lackof population-based study. It usually occurs in the age of 20-40 years, accounting for 15% of anterior mediastinal masses in adults and 25% of anterior mediastinal masses in children. It is frequently diagnosed accidentally on chest imagingdue to itsasymptomaticnature. Hereby, we presented a case of giant anterior mediastinum teratoma with complete surgical excision without any post-operative complication.This case is unique due to its uneventful result after excision. From our literature research, we successfully avoid the potential post operative complications of resecting this tumor such as bleeding, wound dehiscence and evendeath. It is due to early diagnosis, treatment and good intraoperative management of lesion & hemodynamics.Case Report. A 21-year old male was referred from pulmonologist oncologist to our Thoracic Surgical Unit with complainsof dyspnea and chest pain. Physical examination showed no lung sounds in (R) hemithorax and was dull to percussion, ictus cordis shifted 2 fingerbreadths towards left-side. Chest X-ray showed a large well-defined lesion in (R) hemithorax and chest CT-scan with contrast showed hypodense mass on (R) hemithorax adhering & compressing the lung, diaphragm, pericardium & chest wall, with estimation size of 60 x 20 x 12 cm, lesion displaced the heart.Patient was then treated with complete surgical excision and found a huge cystic tumor witha size of 60 x 20 x 12 cm adhering to all parts of (R) lung, diaphragm and pericardium. He underwent(R) pneumonectomy due to adhesion. Histologic examination was consistent with mature teratoma. Patient showed no complication after surgery and was dischargeduneventfullyfrom our hospital after 5 days.Discussion. Approximately 95% of benign teratomas arise in the anterior mediastinum. The tumor grows progressively, mostly asymptomatic, dyspnea and substernal chest painare the most common symptoms if present. Productive Coughof hair or sebum is a pathognomonic sign. Chest radiograph typically reveals a well-circumscribed anterior mediastinal mass that often protrudes into one of the lung, theyare usually large at the time of diagnosis. Complete surgicalexcision is a treatment of choice of mediastinal teratoma, which can be performed through median sternotomy or thoracotomy or thoracoscopy. Some patients require additional procedures (eg, lobectomy, pericardiectomy) for complete tumor resection. Conclusion. There is still limited data on mediastinal teratoma. Early referral & treatment show good prognosis. Benign Mediastinal Teratomas was tricky to be diagnosed, when it is diagnosed, it is usually very large in size. Complete Surgical Excision can be performed safely without any complications.

Introduction: In the field of medicine, the study of hemodynamics is fundamental to understanding the functioning of the cardiovascular system and its impact on tissue oxygenation. Within this context, crucial parameters such as mean systemic filling pressure (MSFP), cardiac output (CO) and oxygen extraction rate (EO2) play essential roles in regulating tissue perfusion and oxygen delivery to the lungs the vital organs. In the case of kidney transplant recipient patients, the interaction between these parameters acquires unique relevance, given the intimate relationship between cardiovascular function and the new implanted kidney. Material And Methods: Material And Methods: A descriptive, observational, single-center, and retrospective study was carried out undergoing living donor kidney transplant patients between June 2022-2023 at the Hospital Juarez de Mexico. Results: 54 patient records were examined, 24 with exclusion criteria. Remaining 30, 18 were female (60%) and 12 were male (40%); Receiver: Age 30.46±11.68 years; Weight: 59.93±11.87kg; Size: 156.20±18.74cm; Hemoglobin: 9.87±1.62g/dl. Prior hemodynamic values to reperfusion: CaO2 (arterial content) 13.44 ± 2.22, CvO2 (venous content) 9.07 ± 2.20, Da-vO2 (arterio-venous difference) 3.67 ± 1.48, CO (cardiac output) 5.65 ± 3.13, VS ( stroke volume) 76.05±41.73, SVR(systemic vascular resistance) 852.61±396.72, DO2(oxygen delivery) 770.89±444.07, VO2(oxygen consumption) 239.33±29.38, EO2(oxygen extraction) 26.83±9.82, PMSF (mean systemic filling pressure) 17.47±3.09 mm Hg with Students T con values of p<0.05 statistically significant; Hemodynamic values after reperfusion: CaO2 13.3±2.18, CvO2 8.11±1.61, Da-vO2 5.03±1.04, CO 4.57±1.26, VS 62.32±17.41, SVR 1265.97±419.41, DO2 621.66±150.83, VO2 239.33±29.38, EO2 37.62 ±5.28, PMSF 14.27±2.44 mm Hg with Students T statistically significant values of p<0.05. Conclusions: Undergoing kidney transplantation patients strategies that include the optimization of PMSF, CO and EO2 based on their determinants can be implemented to improve perfusion and oxygenation of kidney transplanted prior kidney graft reperfusion, which in turn contributes to longterm viability and improved quality of life for the transplant recipient.

Leukocytosis, defined as an elevated white blood cell count, has long been regarded as a crucial indicator of inflammation or infection in surgical procedures. In the context of cleft lip surgeries, normal white blood cell counthas often been considered an absolute requirement for proceeding with the procedure, as it is believed to signal the presence of a potentially infectious or inflammatory state.Therefore,leukocytosis is thought to be a strong precautionary factor.However, recent evidence challenges this long-held belief, suggesting that elevated white blood cell counts may not necessarily be indicative of adverse outcomes in cleft lip surgeries.To explore this notion, we conducted a comprehensive literature review focusing on two case studies involving unilateral cleft lip patients with presurgical white blood cell counts exceeding 10,000 per microlitre. Both cases underwent successful cleft lip repair and demonstrated excellent post-surgicaloutcomes without any signs of inflammation or infection.Both cleft lip repair surgeries results showed no complications, and the patient exhibited optimal wound healing and an aesthetically pleasing outcome at the follow-up appointments.These cases challenge the assumption that normal white blood cell count is anabsolute requirement for cleft lip surgeries and call for a reconsideration of its significance in predicting post-surgicaloutcomes. While leukocytosis is an essential parameter to identify potential infectious or inflammatory states, our findings suggest that it should not be solely relied upon in isolation when assessing the suitability for cleft lip surgeryand predicting the adverse outcomes in cleft lip surgeries.Further studies are warranted to establish a more nuanced understanding of leukocytosisin the context of cleft lip surgeries, including its association with other clinical parameters and potential alternatives for evaluating surgical candidacyand predicting the adverse outcomes in cleft lip surgeries

Introduction:Cutaneous epidermoidcarcinoma (SCC) is a common skin tumor that can arise from precursor lesions or de novo. It is the second leading cause of death from skin cancer and its incidence is expected to double by 2030. Risk factors include gender, ionizing radiation, alcohol andtobacco use, and HPV infection. SCC can be classified into five types according to the Peniche classification, with the ulcerative form being the most frequent. Anesthesia management for head and neck cancers is challenging due to airway complications.Case presentation:An 82-year-old female with a history of biomass combustion smoke exposure and hypertension presented with a painful papular lesion on the left nasal wing. Biopsy revealed well-differentiated epidermoid cancer. Despite treatment, the lesionprogressed rapidly, leading to a request for surgical resection. The patient had predictors of difficult intubation and ventilation, and initial intubation attempts were unsuccessful. After aspiration of secretions and intracavitary bleeding, successful intubation was achieved on the second attempt. Controlled ventilation was initiated with specific settings.Clinical discussion:A difficult airway can pose challenges for anesthesiologists, especially in patients with head and neck cancer. Pre-anesthetic evaluation and preparation for rescue devices or maneuvers are crucial. In this case, the patient had a difficult Intubation Prediction Index. General anesthesia allowed for invasive monitoring, venous access, and reliable mechanical ventilation. Direct laryngoscopy was performed due to retro nasal bleeding, with equipment available for difficult airway management and aspiration.Conclusion:Anesthetic management for patients with head cancer presents challenges in airway management and carries the risk of complications. Pre-anesthetic and airway assessment are crucial to prevent complications and ensure successful intubation

Introduction: Pneumocephalus, or air in the cranial cavity, can have various causes. Traumatic brain injury is the most common cause of pneumocephalus, accounting for 75% of all cases, particularly in those with skull base fractures. Spinal trauma-related pneumocephalusis rare but has been reported, and patients with this condition are usually treated conservatively. Tumors, infections, and iatrogenic causes are responsible for the remaining 25% of cases. Proper management and a high index of suspicion are critical whenconsidering pneumocephalus as a possible complication, as it can result in significant morbidity and potentially life-threatening consequences. Accidental puncture of the dura mater is a common cause of pneumocephalus secondary to epidural anesthesia, andair entry into the intrathecal space is another known cause. Case presentation: This is a 64-year-old female patient who underwent elective ankle surgery, the anesthetic technique was epidural-spinal block needle on needle, no complications during procedure. She was discharged from the Traumatology and Orthopedics service the next morning, 24 hours after her hospital discharge, she was brought back, in the emergency area, she was found with psychomotor agitation, disorientation, no auditory hallucinations, paresthesias were denied, no mentation disorder, with a score on the Glasgow Coma Scale of 14: Eye opening 4 points, Verbal response 4 points, Motor response 6 points. After 48 hours the CT brain scan revealed absortion of pneumocephalus. Clinical discussion: The causes of neumocephalus resulting from epidural or spinal anesthesia procedures are not entirely understood. However, it is believed to occur due to the introduction of air or gas into the subarachnoid or epidural spaces during the puncture, accidental or not . Given the potential severity of this condition, early diagnosis and appropriate management are crucial, even if the symptoms differ from the most common. Conclusion: This research paper highlights the importance of anesthesiologists being aware of the potential risks associated with epidural or spinal block.Future research could investigate the long-term outcomes of patients who experience pneumocephalus during anesthesia procedures and identify strategies for preventing and managing this complication