This article explores the transformative role of artificial intelligence (AI) in modern optometry. AI technologies are revolutionizing the diagnosis and management of eye diseases such as diabetic retinopathy, glaucoma, and age- related macular degeneration. By leveraging machine learning algorithms and high-resolution retinal imaging, AI systems can detect early signs of disease with remarkable precision, often surpassing human capabilities. Beyond diagnostics, AI enhances patient care through automated screenings, teleoptometry, and personalized treatment plans. These innovations are improving early detection, reducing diagnostic errors, and increasing accessibility, particularly in underserved regions, shaping the future of precision eye care.

Keywords: Artificial Intelligence; Eye Care; Machine learning algorithms; Disease detection; Precision diagnostics; Tele-optometry; AI in healthcare

It is essential to comprehend how acetylcholinesterase (AChE) interacts with putative ligands in order to find and create drugs that will treat neurodegenerative illnesses. Using in silico molecular docking analysis, we examined the binding affinities of a number of substances to recombinant human acetylcholinesterase (PDB ID: 4EY6). These compounds included (-)-galantamine, a standard drug, pentachloronitrobenzene, sodium pentachlorophenate, Rogor (Dimethoate), trichloroacetic acid, trichlorphon, triterpenoid, saponin, and steroidal alkaloid. The results provide important new information about the possible pharmacological activity of these substances.

Keywords: Acetylcholinesterase Activity; inhibitors; in silico analysis; molecular docking

The ketogenic diet (KD) is a high-fat, low-carbohydrate, moderate-protein diet that has been traditionally used to manage drug-resistant epilepsy (DRE) in children. In recent years, research has explored its potential applications in other neurological and metabolic conditions, including autism spectrum disorder (ASD), obesity, and type 2 diabetes. This review examines the most recent studies (2023-2024) on the efficacy, safety, and broader applications of KD in pediatric populations. We discuss the positive effects of KD on seizure control, behavior modulation in neurodevelopmental disorders, and metabolic improvements in obesity and type 2 diabetes. Additionally, we explore the risks associated with long-term KD use, such as nutritional deficiencies and growth retardation, and address the need for future research to establish long-term safety and efficacy in children.

Keywords: Ketogenic-diet; children; neurology

Neuroendocrine tumors of the pancreas are rare with an estimated incidence of 1 to 2 per 100000 inhabitants. We report the case of a non-functional neuroendocrine carcinoma of the pancreas in a 23-year-old patient, with no medical and surgical history, admitted to the Sikasso referral health center for a painful epigastric mass. Programmed for antropyloric tumor of the stomach or mesenteric, the intraoperative diagnosis was a tumor of the body of the pancreas of incidental discovery. Treatment consisted of tumor excision by enucleation of the tumor. Histopathological examination of the tumour revealed non-functional neuroendocrine carcinoma. The discovery of such a rare pathology in our health center motivated this work.

Our objective was to report this clinical case and to make a clarification within our health structure.

Keywords: Neuroendocrine carcinoma; non-functional; Pancreas; Sikasso Ref

The global healthcare sector is constantly transforming due to technological advancements, complex clinical cases, evolving patient expectations, and the challenges resulting from global health crises. This is a narrative review that takes into account crucial themes related to healthcare management, clinical practice, and innovation on the topic of clinical governance, diagnostic developments, competency-based education, and technology adoption. Clinical governance is instrumental in guaranteeing accountability and quality care within healthcare systems. It contributes to the reduction of clinical errors and enhances patient safety by fostering a culture of transparency, professional accountability, and continuous improvement. Diagnostic and treatment strategies are increasingly becoming personalized, with conditions like subclinical hyperthyroidism (SCH) and sepsis pointing out the need for individualized care based on patient-specific factors. In addition, the shift from rigid protocols to adaptive, patient-centered approaches underscores the importance of real-time clinical judgment. Competency-based education is essential for preparing healthcare leaders capable of navigating complex systems because it integrates technical, leadership, and management skills into professional development. Integration of Health Information Technology (HIT), including Electronic Health Records (EHRs), telemedicine, and clinical decision-support systems has transformed healthcare delivery by increasing efficiency and accuracy, especially in resource-limited settings. In addition, the integration of AI in diagnostic and treatment processes has transformative potential in predictive analytics and personalized care. The COVID-19 pandemic exposed vulnerabilities in healthcare systems but also demonstrated resilience, driving innovations like telemedicine and remote monitoring. Healthcare systems must adapt to these challenges by focusing on patient-centered, scalable interventions and fostering interdisciplinary collaboration. The challenge will be to address systemic inequities and build resilient systems to ensure the delivery of quality, equitable care.

Keywords: Healthcare Management; Clinical Governance; Diagnostic Advancements; Competency-Based Education; Technology Integration

Not all Brazilians like football! There are two of us Brazilians who, despite liking and playing sports, might be excluded from the great hall of fans. So there is no idolisation, either of football or of people related to football.

Not all Brazilians like soccer! We are two Brazilians who, although we enjoy and practice sports, may be excluded from the vast group of soccer fans. Therefore, there is no idolatry, neither toward soccer, nor regarding anyone associated with soccer.

Due to the power and breadth of the internet and globalisation, footballers end up becoming influencers. They launch fashion! And fashion is not always interesting!

Currently, the majority of footballers wear contact lenses. Considering the current Brazilian football team, of the 22 players in the squad, 11 wear contact lenses.

Children learn language through stimulation and exposure to the environment during their critical period of development. In earlier times children were more socially engaged, however these days they spend more time with electronic screen media. This increased screen time in young children has been associated with detrimental health effects, including reduced cognitive function, delayed language development, and behaviors like short attention spans, irritability, which led to the development of new term known as Virtual Autism. Virtual Autism is also known as Digital Autism or Screen time Autism, refers to a condition where individuals exhibit autistic like symptoms such as social withdrawal and communication difficulties, primarily triggered by excessive screen time and digital interactions. Virtual Autism can affect individual of various ages but research suggests that excessive screen time and digital exposure can impact as early as infancy (6-12 months) and toddlerhood (1-3 years). This concept is not recognized as a distinct medical diagnosis but rather as a subset of symptoms associated with prolonged exposure to digital media. Research suggests that it can exacerbate existing Autism spectrum disorders(ASD), and Virtual Autism can also be reversed with reduced screen exposure and balanced digital habits. As technology continues to dominate, understanding virtual autism’s implications is crucial for promoting healthy digital habits. Preventing virtual autism requires a holistic approach involving parents, educators, and policymakers. Key steps include setting a screen time limit, selecting age-appropriate content, promoting physical activity and outdoor play, nurturing in-person relationships, teaching digital literacy, parental supervision, professional guidance, and parental and educational roles.

A brain abscess, an intracerebral purulent collection caused by bacterial, fungal, or parasitic infections, often arises from primary infectious foci in the ENT sphere or by contiguity. Although rare, it poses significant risks, especially in vulnerable populations such as pregnant women. This report presents the case of a 24-year-old woman at 29 weeks of amenorrhea, admitted for progressive worsening headaches. Initial symptoms included nocturnal paroxysms with bilateral frontal location radiating to the neck, evolving into language disorders and right hemibody functional impairment without convulsive seizures, all in a febrile context suggesting an infection. Notably, the patient had undergone a pus drainage procedure for odontogenic cellulitis one week prior. Clinical examination revealed febrile status, meningeal syndrome, and neurological deficits including dysarthria and right hemiparesis. MRI results showed multiple brain abscesses with peri-lesional cerebral edema. Antibiotic and corticosteroid therapy yielded significant clinical improvement. However, post-treatment imaging revealed hydrocephalus, necessitating extended antibiotic therapy. This case underscores the importance of timely diagnosis and treatment of ENT infections to prevent severe intracerebral complications, particularly in immunocompromised patients.

Anaemia is an error in the biological system which can lead to mortality if the condition deteriorates. India is one of the world’s leading contributors of anaemia. The major reason for this disease is malnutrition and women of reproductive age (WRA) and children are one of the most vulnerable groups to this condition and maternal anaemia is associated with increased mortality. Here in this work, we have compared two devices Device A (HemoQR) and Device B [Haematology Analyzer-Fully Automated-5 parts (Erba H560)] in hospital camp setup using 280 samples from patients of different age groups using fingertip pricked blood for the test. The sensitivity, specificity and accuracy obtained from our study was 92.06 %, 98.67 % and 95.75 % respectively. The results of this study were satisfactory when compared to the criteria of Anemia Mukt Bharat” (AMB) program initiated by the government of India’s Ministry of Health & Family Welfare which states a sensitivity and specificity of 80% minimum for an invasive digital hemoglobinometer. The results of this study concludes that HemoQR can be an efficient, economical and smart point of care (POC) haemoglobin (Hb) detection test system using a mobile based application for analysing and collecting the data. 

Social jetlag refers to the disruption in natural sleep –wake cycle in scientific term the circadian rhythm. It is commonly due to social or work-related obligations. It can cause acute or chronic effects, which vary from fatigue, mood disturbances and impaired cognitive function to increased risk of chronic metabolic and cardiovascular diseases. The preventive strategies rest on establishing consistent sleep schedule to avoid or reduce social jetlag and reinforcing the natural sleep-wake cycle.

Keywords: Circadian rhythm; Cardio-metabolic diseases; Night shift

Introduction: The medical tourism growth along with insurance and corporate, which has increased the demand for quality healthcare, made it create national and international accreditation bodies where care quality is brought in a harmonized way. Accreditation also plays a vital role in building service excellence and patient safety through NABH and JCI frameworks.

Aim: This study aims at investigating different accreditation systems and their benefits to the patients in a selected hospital in Bangalore.

Objectives: The study has been enumerated in two primary objectives, and these are: (1) an investigation of the various accreditation systems available for hospital healthcare in Karnataka and (2) assessment of the benefits and patient satisfaction in the chosen hospital.

Methodology: A descriptive cross-sectional study design was employed. Data regarding the primary and secondary sources were collected. Primary data were collected from structured questionnaires and face-to-face interviews with 100 inpatients, whereas the secondary data were derived from literature pertinent to the area of study. This research has been conducted using a simple random sampling technique and analyzed using frequencies and percentages over a period of 3-4 months.

Result: The findings indicate the ways in which Karnataka accreditation systems, particularly NABH and NQAS, can increase patient safety and improve the quality of care. The patients reported high percentages of access, convenience, and continuity of care with excellent communication among staff. The overall patient dissatisfaction was remarkably low except for some of the areas for improvement. The findings indicated that the accredited hospitals have a proportionate increase in the quality of services and patient safety.

Conclusion: This study will, therefore, underpin the significance of accreditation in healthcare and further proposes some future directions for the improvement of patient satisfaction.

Keywords: Hospital Accreditation; Patient Satisfaction; Quality Healthcare; NABH; ISO; NQAS; Medical Tourism

Background: Dengue fever has been known for more than a century in the tropical countries. Dengue fever is now the most common cause of arboviral disease in the world, with an estimated annual occurrence of 100 million cases  and a mortality rate of 25,000 per year. Dengue is diagnosed by reverse transcription polymerase chain reaction (RT-PCR) and detection of NS1 antigen with corresponding IgM, IgG antibodies by Enzyme immunoassay & Immunochromatographic test. These tests are expensive and may not be available in the periphery. So, the routinely performed hematological parameters and correlation with biochemical parameters will aid in the diagnosis of Dengue Fever.

Objective:  To assess the biochemical markers of renal and liver function, and the hematological markers in dengue fever and to assess correlation of biochemical and hematological parameters with severity of dengue fever.

Methods: This was a record - based study. Data of patients (demographic, clinical details) was collected from hospital information system. Hematological parameters: Hematocrit, total blood count, total WBC count, Total RBC count, Platelet count and Biochemical markers of liver function: Total bilirubin, direct bilirubin, indirect bilirubin, total protein, albumin, A\G ratio, ALT, AST and ALP was retrieved from laboratory information system. The collected data were analyzed for frequency, percentage and mean± SD.

Results: The study was carried out on a total of 170 participants, including 115(68%) male and 55(32%) females. Hematological findings like reduced platelet count and raised leucocytes were seen in majority of the cases. Biochemical findings like raised AST and ALT were seen.

Conclusion:  Thrombocytopenia, raised total leucocyte count, raised AST and ALT will aid in early diagnosis of Dengue infection. Early recognition and prevention rather than treatment of complications is most important for favourable outcome of the disease.

Keywords: Dengue fever; Thrombocytopenia; Hematological and Biochemical parameters

We reported that the multiple bone marrow used to treat and remedy drinking SIGN water led to the reduction of the cancer cells of multiple myeloma from standpoints of the total system in our body. That is why we discuss the SIGN water’s work along the electrical circuit, and we consider the cancer similar to the resistor. The condenser stores electrons and the coil provides them through acupuncture in the body even skin. The infoton in the SIGN water generates magneticity with an electron through coils similar to acupuncture. We propose that magneticity may transfer information with the infoton involving a charge and spin. The essential point is to activate the normal cells around bone marrow due to the infoton resulting in the disappearance of the cancer cells.

Few discoveries and research in medical innovation have had the transformative potential of gene therapy. Amongst the most significant recent developments is Zolgensma, a pioneering spinal Muscular Atrophy (SMA) treatment. This infrequent but devastating genetic disorder disturbs the motor nerve cells in the spinal cord and is characterized by progressive muscle weakness and paralysis.

SMA has long been a source of despair for families worldwide; it claims the lives of many children before their second birthday. However, the advent of Zolgensma, approved by the FDA in 2019, represents a beacon of hope for families grappling with this disease, often seen as a death sentence for infants.

Background: Right atrial thrombus (RAT) is a rare finding that is almost exclusively found complicating pulmonary embolism (PE) and carries a high mortality rate. Emergency treatment is usually required to save life. There is no algorithmic approach of the management of this condition due to the lack of evidence-based guidelines and randomized control trials. Management of RAT is still a subject of debate.

Objective: This study demonstrates the effectiveness of thrombolysis in resolution of right atrial thrombus.

Case Report: Sixty one year-old female, presented with a history of fainting, exertional dyspnea, easy fatigability, and lower limb swelling. A transthoracic echocardiography (TTE) showed a right atrial mass that was moving into right ventricle. Computed tomography pulmonary angiogram (CTPA) confirmed a diagnosis of pulmonary embolism.

The patient was thrombolysed with tenectaplase and a repeat TTE confirmed that the thrombus had resolved with and improvement in the patient’s clinical symptoms.

Discussion: This demonstrates thrombolysis is a rapid and life-saving therapeutic measure reducing the risk of death from thromboembolism.

Keywords: Cardiac Thrombus; Pulmonary Thromboembolism; Thrombolysis

Digital devices have become essential in our lives. They're used for work, school, and fun. In particular mobile gaming has become more popular, especially among young adults. Millions of people play games on mobile which keeps growing yearly. Mobile gaming is becoming increasingly popular, with serious health concerns. The visual and physical demands during prolonged mobile gaming due to smaller screen size and poor posture, have potentially negative consequences such as visual problems, musculoskeletal discomfort, sleep disorders, stress, and behavioral concerns. Despite these issues, mobile gaming has cognitive advantages, such as better memory, concentration, problem-solving abilities, and response times, particularly in action games. Adopting good gaming habits with a balanced diet is crucial to reducing health concerns. Addressing the health consequences of mobile gaming is critical as its popularity grows, demanding further study to better understand long-term implications and develop effective measures for encouraging healthy gaming behaviors

Keywords: Mobile gaming; Health; Digital Devices; Ocular health

VI is a worldwide societal issue with significant economic and social consequences. This review provides an overview of the economic burden due to the direct costs of health care, loss of productivity, and costs of informal care. In developed countries such as the United States, the estimated cost of VI from an economic viewpoint is in billions of dollars annually. In developing countries, such as India, the economic loss is even more. The review also underlines the consequences of socio-economic inequity, which further heightens the burden that is imposed by VI, especially in those settings where eye care services are scarce. These results point to the urgent need for better eye care infrastructure and targeted public health interventions, particularly in low-income and middle-income countries, to reduce economic and social burdens from VI and improve quality of life among affected individuals.

Keywords: vision impairment; economic burden; health care costs; productivity loss; socio-economic inequalities; eye care services

Although relatively rare in developed countries, ileal perforations of typhoid origin are a public health problem in developing countries, particularly in Mali.

The aim of our study was to study ileal perforations of typhoid origin in the surgery department of the Sominé Dolo Hospital in Mopti.

This was a prospective study that took place from November 1, 2017 to October 31, November 2018, i.e. 12 months.

During this study, we observed 58 cases of ileal perforations of typhoid origin, i.e. 8.41% of emergency consultations.

It is a pathology of young people with an average age of 19.7 years.

We found a predominance of men (63.8% males) with a sex ratio of 1.76.

Emergency was the most frequent method of recruitment (91.4%).

The mean time to consultation was 13.1 days after symptoms.

Among the signs suggestive of intestinal perforation, abdominal pain (100%), abdominal defense or contracture (100%), pain on digital rectal examination (94.9%) and abolition of abdominal breathing (74.1%) were the most frequent. Radiography of the abdomen without preparation taking the diaphragmatic cupolas suspected the diagnosis of intestinal perforation through the intercosto-diapragmatic crescent gas in 53.4% of cases.

Widal's serodiagnosis was positive in 74.1% of cases.

Excision-suture was the most used operative technique in our series (58.6%).

Early morbidity was 51.5% and overall mortality was 29.3%, i.e.

17 deaths out of 58 cases of ileal perforations of typhoid origin.

Keywords: Peritonitis; Typhoid; Perforation; Ileum; Surgery

Confirmation bias is the tendency to search for, interpret, and remember information that confirms preexisting beliefs, and significantly impacts healthcare and patient outcomes. This literature review explores the various impacts of confirmation bias on medical professionals, patients, caregivers, etc, and draws from a variety of studies, observations, and surveys. For healthcare providers, confirmation bias can result in diagnostic errors, specified treatment decisions, and biased/skewed interpretation of data regarding a patient which has detrimental effects on clinical judgments and healthcare quality. Similarly, on the patient side, confirmation bias influences health behaviors, following medical advice, and thoughts regarding illnesses, which cause adverse health outcomes. The review emphasizes key mechanisms by which confirmation bias appears in clinical settings, including cognitive heuristics, diagnostic anchoring, and patient-practitioner interactions. Furthermore, the review discusses ways to alleviate the negative impacts of confirmation bias, such as incorporating specified guidelines, increasing training and awareness, and enhancing open communication. By understanding current research, this literature review emphasizes the need for proactive measures addressing confirmation bias to improve decision-making processes and healthcare solutions/outcomes in medical practice.

Infectious keratitis(infectious corneal ulceration) is the fifth leading cause of preventable blindness globally. However, it continues to be a neglected health problem, and is rarely considered to be an environmental work hazard. This is surprising since 20 % to 92 % of infectious keratitis, especially in Asia, is reported to occur following ocular trauma in workers engaged in agricultural chores or other forms of outdoor manual labour. Reported traumatising agents include mud and dust particles and plant material (leaves, tree branches, paddy grain), cow’s tail, sticks, stones and iron particles. Any form of corneal damage is a potential threat to vision, and unilateral or bilateral corneal blindness resulting from infectious keratitis is a devastating economic and psychological occurrence for any individual. Individuals with unilateral or bilateral corneal opacity arising from infectious keratitis have been found to suffer from disturbances in vision-specific mobility (general function), psychosocial vision and visual symptoms, resulting in a poorer vision-related quality of life than normal individuals. Treatment of infectious keratitis may take several days, hence cost of treatment may be prohibitive. Since prompt prophylactic treatment of corneal abrasions with antibacterial and antifungal ointment has been shown to prevent occurrence of infectious keratitis, committed grassroots workers and a fairly extensive rural health network are needed to make this a reality. Campaigns (either official or by word of mouth) are needed make the general public aware of this condition and its possible prevention.

Keywords: infectious keratitis; ocular trauma; prevention; vision-specific quality of life

The possibility of regenerating teeth in people who lose them for varied different reasons is the following step that scientists involved in Regenerative cure are aiming for. The idea of replacing missing teeth with an own individual’s regenerated natural teeth is every Dentist's dream!

Introduction: this study aimed to investigate the aetiological aspects and management of postoperative peritonitis in the surgical department of the Kankan Regional Hospital.

Methodology: this was a 12-month prospective, analytical study of postoperative peritonitis regardless of the location of the initial operation.

Results: out of 737 operations, 50 cases were postoperative peritonitis accounting of 6.78%. The average age was 20.42 years. Women were the most affected (54%). Housewives accounted for 38% and rural women 54%. The initial operation was conducted in private clinics (46%) and health centers (30%). Appendicitis was the initial pathology in 56% of cases, and general practitioners and nurses were the first operators in 64% and 26% of cases respectively. Removal of the appendicular stump was performed by 56% of patients. The operation lasted an average of 95.74 minutes. Follow-up was straightforward in 78% of cases. The average length of stay was 16.4 days. The case fatality rate was 16%.

Conclusion: postoperative peritonitis was frequent and serious. A multicentre study would be necessary to collect data on the aetiological aspects and management.

Keywords: Peritonitis; Post-operative; Hospital; Regional; Kankan

Introduction: The aim of this study was to investigate the indications and results of early reinterventions in individuals of the abdomen in the general surgery department of HRK.

Material and Methods: This was a one-year prospective study, carried out in the Surgery department of the Kankan Regional Hospital, focusing on early re-interventions regardless of the location of the intervention.

Results: During this period, we operated on 1075 patients, among whom 38 cases required re-laparotomies, representing 3.53%. The average age of our patients was 29.68 years, with extremes of 7 and 75 years, mainly affecting individuals aged between 16-25 years, with a predominance of males. The majority of these patients were initially operated on in private clinics (60.53%) by unqualified personnel (76.32%). Appendicitis was the most involved condition, accounting for 44.73%. Peritonitis (68.42%) followed by digestive fistulas (18.42%) were the main postoperative indications. Clinical signs were dominated by abdominal pain. The main re-intervention procedures were peritoneal lavage (92.11%), drainage (81.58%), release of adhesions or bands (31.58%), and resection + anastomosis (26.32%). We recorded a mortality rate of 23.68%.

Conclusion: Better management of initial pathologies through the strengthening of surgical teams' skills, raising awareness and banning unqualified personnel from health centers, and improving technical facilities could contribute to a better prognosis.

Keywords: Early re-interventions; visceral surgery; indications; results; regional hospital; Kankan

Human biology is extremely complex. It is in fact a real reflection of vast Cosmic Mind`s creation. Every bodily system is running cyclically and orderly like a systemic bodily clock. This biological clock is the human circadian system which has a period of 24 hours. Recent studies on circadian rhythm and on the consequences of its disruption- “Chronodisruption” have been expanded to a great extent. Modern life-style and environmental factors can disrupt the circadian system of the body and may lead to adverse effects on individual`s health. Furthermore, complex reciprocal relationship between metabolism and the circadian system of the body have been demonstrated. Current research evidences also provide the impact of the interaction between the circadian system and nutrition and the way this link can influence the epigenome and microbiome. Based on this whole concept, it is possible to develop nutritional strategies to manage circadian-aligned feeding that is what and when to eat in order to reduce the prevalence and burden of chronic diseases.

Keywords: Chronodisruption; Epigenetic; Nutrigenetics; Nutrimicromics

Introduction: Stroke in children is dreadful, although it is ten to twelve times rarer than in adults. The incidence of stroke in children has been little studied. It varies between 1.3 and 13/100,000 children/year. The aim of this study was to describe the clinical, aetiological and scanographic aspects of ischaemic strokes in children aged between 1 month and 15 years in the Paediatrics Department of the Ignace Deen National Hospital.

Setting-Materials and Methods: This was a prospective dynamic study conducted in the Paediatrics Department of the Ignace Deen National Hospital over a 12-month period, from 1 April 2020 to 31 March 2021.

All children hospitalised for ischaemic stroke were included. The diagnosis of stroke was based on any sudden onset neurological deficit that persisted for at least 24 hours, with no apparent cause other than a vascular origin.

Results: We recorded 12 cases of ischemic stroke in the department, i.e. 2.27%. The age group of 11-15 years was more represented 41.66% with extremes of 1 year and 15 years. The female sex was dominant in 7 cases (58.33%). The onset of symptoms was sudden (75%) or rapidly progressive over a few hours (25%). The motor deficit of a hemibody was the main clinical sign, found in 91.67% of cases associated with language disorders (4 cases), convulsions (4 cases), fever (6 cases), headaches and/or vomiting (5 cases), impaired consciousness (2) and facial asymmetry (6 cases). Brain CT was the first-line test required to confirm the diagnosis in 100% of cases. The etiologies were dominated by heart disease (4 cases), sickle cell disease (4 cases), central nervous system infection (1 case) and undetermined (3 cases). The evolution was favourable in 91.67%.

Conclusion: Stroke in children remains rare, and there is no clinical difference between children and adults. Early, multidisciplinary monitoring of patients with sickle cell disease and prevention of rheumatic heart disease would help to considerably reduce the incidence of stroke in children.

Keywords: stroke; neuroimaging; child; Ignace Deen

The article traverses through the issues that have emerged regarding TB in India & at global level. The issues revolve around socio economic, pharmacology in modern system, role of AYUSH & other stakeholders.

The article concludes that nutrition is a big factor in dealing with TB. Immunity is another factor. Life style & health promotion activities are cross cutting. Hence, all these factors should be the part of the entire TB intervention in which pharmacology is just one part.

Keywords: TB; RCT; BCG; Chemotherapy; ATP; AYUSH

We tried to connection of the basic biophysical sense of virus science, in which we discuss the amount of element and chemical bond energy every element in every amino acid relating to a virus. I found some relationship with a virus’ strength, infectious, remedy, etc. We indicate the wide viewpoint meaning virus spread. Furthermore, we introduce the latch circuit for virus-forming variant and associate with the extended--pico-particle water since I research and developed for more than ten years.

Keyword: KP.3 virus; mutant; spike protein; amino acids; extended--pico-particle water

The World Health Organization (WHO) defines disaster as any natural, technological or human-induced event that causes a serious disruption in the functioning of a community or society, exceeds the ability of the affected community or society to cope using its own resources, and causes widespread human, material, economic or environmental losses [1].

In order for an event to be defined as a disaster, normal life must be interrupted and the resource capacity of the society to cope with the event must be exceeded. Over time, people's perspective on disasters has changed due to the increasing importance given to human life, technological and scientific developments, and it has been seen that disasters can be prevented or overcome with minimal damage if the necessary precautions are taken [2].

In the 21st century, there are ten factors that can cause disasters due to the increase in both risks and fragility. These are: population growth, environmental degradation, global warming, deforestation, infectious diseases, hazardous substances, chemical warfare, nuclear substances, economic inequality and ethnic or religious discrimination [3].

On the other hand, development, which is the most important factor in terms of disaster resilience, is still far away for many countries. The wealth gap between countries is widening, and poor countries are getting poorer. According to experts, although natural events develop independently of people, whether they will cause a disaster is determined by society. How much harm will be caused by a hazard depends on the distribution of power and resources within that society. The poor always suffer the most from disasters [4].

Haqua Revitalize^® Therapy (HART) has significant effects on the psychological processes of the human body, enhancing emotional well-being. Here are some keyways in which HART influences psychological processes:

     Emotional health, one of the Five Aspects of Health (FAH), plays a crucial role in our overall well-being. It revolves around how individuals manage and cope with their emotions in response to the incidents and challenges they face in daily life. Emotional well-being, also referred to as emotional health or wellness, is a key component of our overall health and quality of life [23].

The main advantage of systematic review (SR) over other review types, such as narrative review, is its transparent and rigorous approach to minimize bias and ensure future replicability. Reproducibility, comprehensiveness, and transparency are the 3 keys to minimize bias. Reproducibility and transparency are deemed more important than comprehensiveness as missing literature may be identifiable from a reproducible and transparent SR lacking comprehensiveness but missing literature cannot be identified from a comprehensive SR lacking reproducibility and/or transparency. Hence, a SR lacking reproducibility and/or transparency is a narrative review. Several studies on published SRs report poor reproducibility and transparency. Here, we examine a sample of 100 SRs published in 2023 and indexed within PubMed for reproducibility and transparency on 10 criteria - 7 for reproducibility and 3 for transparency. In terms of reproducibility, our results show that only 31 SRs gave sufficient information for reconstructed searches in PubMed to yield search results within 10% of the hits reported. In terms of transparency, none of the SRs provided the full list of search results and only 5 SRs provided sufficient information to determine which study is excluded by which exclusion criterion. Hence, our results support previous studies reporting poor reproducibility and transparency in SRs. We propose that search URLs should be given whenever possible, and the full list of search results with inclusion / exclusion analysis should be given in all cases.

Background: Cancer is commonly associated with depression and depressive symptoms. Depressive disorders often worsen over the course of cancer treatment, persist after cancer therapy, recur with the recurrence of cancer and impact on function and medical outcomes. We aimed at assessing whether depression management could happen at the cancer center without referral to the mental health clinic.

Methods and materials: We conducted a quasi-experimental study for screening and treatment of depressive symptoms among patients living with cancer, who were attending oncology services at Kamuzu Central Hospital between May, 2021 and August, 2022. The intervention arm had screen and treat for depressive symptoms as an integrated approach to cancer care within the study site while the comparison arm had screen and refer patients diagnosed with depressive symptoms to usual mental health clinic. Patients were followed-up for six months and health related quality of life was measured using Euroqol-5 dimession-3 levels tool during each visit. Depressive symptoms were evaluated using the Patient Health Questionnaire-9.

Results: There were 214 participants in the study; 112 in the comparison and 102 in the intervention group. The majority (65%) were females and at least 36% of the participants were in the middle age group (26-45 years); 29% of the participants had unknown HIV status. Participants of high socio-economic status were twice more likely to report poor quality of life than those with lower socio-economic status 1.99 (95% CI: 1-12-3.53, p<0.02). Employed participants were less likely to report poor quality of life 0.62 (95% CI: 0.42-0.90, p<0.01). Poor quality of life was steadily declining with each successive clinic visit, 0.07 (95% CI: 0.05-0.10, p< 0.001) and there were similar patterns of improvement in quality of life between study arms, 1.06 (95% CI:0.73-1.54, p<0.77).

Conclusion: Depression screening and treatment could be integrated within the cancer care for improved quality of life in Malawi. While persons accessing care within hospital can benefit from HIV testing and referral for treatment if found HIV positive, Malawian cancer patients at Kamuzu Central Hospital might not have benefitted from these services as a handful of participants in our study had not been tested.

Keywords: Quality of life; Cancer; Depression

Background: Depression is one of the most common mental health disorders in patients living with cancer worldwide. An understanding of the prevalence of depressive disorders among this sub-group of patients should inform both its prevention and management. There is currently little evidence on correlates of depressive disorders amongst the persons living with cancer in Malawi. Therefore, we conducted this study to estimate prevalence and correlates of probable major depressive disorder among patients living with cancer at a National Cancer Center based at Kamuzu Central Hospital (KCH), Lilongwe in Malawi.

Methods: We utilized a cross-sectional design nested in a larger quasi-experimental study which was evaluating the effect of integrating depression screening and management on clinical outcomes among patients living with cancer who were attending oncology services at Kamuzu Central Hospital in Lilongwe. A validated PHQ-9 tool was used to estimate prevalence and correlates of probable major depressive disorder. A total of 399 consented participants were enrolled from August to December, 2021.

Results: The study comprised more females (64%). Cervical cancer (33%), Kaposi’s Sarcoma (16%), breast cancer (9%) and esophageal cancer (4%) were the top four common malignancies in the study. At least 55% of the study participants had depressive symptoms. The prevalence of probable major depressive disorders was 11.5 %; most (52%) of whom had moderate depressive symptoms on PHQ-9 scale. Patients supported by palliative care were associated with reduced odds of major depressive disorders 0.36 (95% CI: 0.14-0.94).

Conclusion: A high proportion of patients living with cancer had probable major depressive disorder. Patients supported by palliative care had reduced odds of probable major depressive disorder. There was need to integrate screening and management of depressive disorder as well as palliative care services among patients during routine cancer care in Malawi.

Keywords: cancer; prevalence; depression; Patient Health Questionnaire

Introduction: Neonatal meningitis is a medical emergency having consistently high rate of mortality and morbidity in spite of leveled up vaccination, increased institutional deliveries with intrapartum prophylactic antibiotics and asepsis, and good hospital practices.

Material and Methods: Total 718 neonates were enrolled. CSF samples were cultured and read at 24, 48 and 72 hours. WBC Count of CSF of 30 / mm³ was considered cutoff to rule out possible contamination. Culture positive isolates were identified by MALDI-TOF VITEK MS. Antimicrobial susceptibility pattern was noted. PCR was done for atr gene of Streptococcus agalactiae of all culture negative samples.

Result: Out of 718 neonates enrolled 73 CSF were culture positive and 645 cultures were sterile. 5 isolates were probable contamination. Total 68 samples were positive with 63 bacterial isolates and 5 Candida species. Most commonly isolated bacteria were Acinetobacter spp (42%). and Klebsiella pneumoniae (15.9%). Among fungal isolates Candida albicans (4.4%) and Candida parapsilosis (2.9%) were isolated. PCR detected 2 cases of Streptococcus agalactiae causing meningitis.

Conclusion: Percentage positivity of bacterial and fungal meningitis was found to be 9.1 % and 0.7% respectively. Out of 68 samples, 51 had Gram negative and 12 had Gram positive bacteria on culture. Fungal isolates grew in 5 samples. Rare organism like Elizabethkingia anophelis (2.9 %), Chryseobacterium indologenes (2.9 %) Aerococcus viridians (1.4%) were isolated. PCR detected 2 cases of Streptococcus agalactiae (atr gene) of bacterial meningitis. Streptococcus agalactiae being a common etiology, had not been isolated in our cultures.

Keywords: Neonatal meningitis; Etiology; Antimicrobial Susceptibility Pattern; Risk Factors

     It was the middle of August 2023, a fine Sunday afternoon in Brooklyn. Running around with my fellow international medical students in Dr. Hameed’s office, taking history, participating in patient care, and trying to soak up the essence of the American healthcare model, we were waiting for Dr. Moskowitz to come to the office for our research undertakings.

     Dr. Hameed’s office was a melting pot for us South Asian students to do our clinical rotations. A humble-looking office space could easily be mistaken for just another medical office. But looking closely, there were some striking differences. Great ideas were discussed here casually. The Global Population Health Management Forum was born here, as were dozens of other initiatives aimed at improving America’s healthcare delivery for the better.

Quinoa has recently gain popularity since the declaration of International Year of Quinoa in 2013. However, there are still limited reviews on quinoa in terms of nutrition and health. Thus, the aim of this 10-year systematic review is to assess the nutritional profile and potential health benefits of quinoa. PubMed search was done on 10 January 2024 and 164 papers were identified within the past 10 years (1 January 2014 to 1 January 2024). After exclusions, a total of 35 papers were included in this systematic review. The 35 papers were categorised into three main themes: (a) effects of processing techniques, (b) potential health benefits, and (c) genotype and phenotype variation.

Objective: To study the immediate and long-term results of revascularizing osteotrepanation and lumbar sympathectomy in patients with critical ischemia of the lower extremities (CILE) on the background of distal arterial steno-occlusion.

Material and methods: The results of standard treatment and the use of various types of indirect revascularization in 171 patients with CILE against the background of distal arterial steno-occlusion were analyzed. The etiological factors of CILE were obliterating atherosclerosis (115 patients) and thromboangiitis obliterans (56 patients). The level of arterial damage: femoropopliteal segment -26 (15.2%), popliteal-tibial segment -56 (32.7%), tibial-foot segment -50 (29.2%), foot - 25 (14.6%), multilevel lesion -14 (8.2%). To establish a diagnosis and assess the results of treatment, changes in the clinical status of patients were traced, Doppler ultrasound with angioscanning, multispiral computer-tomographic angiography, rheovasography were performed, and skin oxygen saturations were determined. The immediate results of treatment were assessed by the Rutherford R.B. et al. (1997) scale.

Results: 48 patients (control group) underwent standard treatment. The following types of indirect revascularization were performed to stimulate regional circulation: revascularizing osteotrepanation (ROT) in 64 patients, lumbar sympathectomy (LSE) in 59 patients. In patients with CILE against the background of distal arterial steno-occlusion, ROT and LSE improve the immediate and long-term results of surgical treatment, make it possible to preserve the supporting function of the limb, reduce the frequency of rehospitalization, and continue an active lifestyle.

Conclusions: Correlation and statistical analysis revealed a significant dependence of the results obtained on the method of revascularization. The technical simplicity of performing the operation of ROT and LSE creates the prerequisites for the introduction of surgical departments of multidisciplinary clinics in daily practice.

Keywords: distal occlusion of the arteries; critical ischemia of the lower extremities; revascularizing osteotrepanation; lumbar sympathectomy

     There are some nature radiations from the ground and we discuss sun light for human health as well we protect some of sun light beams. Another daily life radiation, we discuss the activated LED for health. We also discussed the water transparence of weak energy radiation like THz. We followed the radiation from the Fukushima contaminated soils, and its reduction by the activated water resulting in nuclear transformation to obtain the stable elements. From our experiments, we presume tritium to generate lithium by the nuclear transformation.

Objective: The Advanced Life Support in Obstetrics (ALSO) course was designed as a two-day interprofessional course to equip participants to manage various low frequency obstetrical emergencies nationally and internationally. It is used nationally by numerous Family Medicine Residency programs to improve safety in maternity care, optimize team-based care, and showcase obstetrical care by family physicians. In 2017, the course was redesigned into a one-day course, yet the outcomes of this new course design have not been examined. This study assessed non-inferiority for confidence in managing emergencies and skills before and after the single day ALSO course.

Methods: Participants completed questionnaires before and immediately following ALSO training assessing confidence managing OB emergencies: hypertensive disorders of pregnancy, malpresentations/malposition/multiple gestations, assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, and maternal resuscitation/trauma. A Likert scale was used with response choices ranging from strongly disagree (1) to strongly agree (5) for each item.

Results: Over three sessions, 69 participants received ALSO training (49 pre-surveys and 36 post-surveys completed). Of the participants, 24 (51.0%) were first year residents, 6 (12.2%) were second year residents, 5 (10.2%) were third year residents, 6 (6.1%) were attending physicians, 3 (6.1%) were nurses, 1 (2.0%) midwife, and 6 (12.2%) were medical students. Total confidence managing individual conditions increased significantly from pre- to post-survey (p<0.001).

Conclusions: The one day ALSO course demonstrates improved confidence in obstetrical emergencies immediately after the course for all conditions. It is non-inferior to the previous 2- day training course.

Keywords: Family Medicine Obstetrics; Advanced Life Support in Obstetrics

During the last decades, patient faith in physicians has declined. Doctors are distrusted for several reasons, including incorrect conclusions that had fatal consequences for patients. Doctors may have prescribed inappropriate medications which produced negative effects or didn't benefit patients. Medical blunders have sometimes occurred due to carelessness or neglecting information. Patients feel abandoned and don't know what their doctors are doing. Customers are even less trusting of the medical industry due to excessive pricing and lack of transparency. All of these things have made people more skeptical of the medical system, which has caused the doctor-patient relationship to break down. Doctors must address these challenges and regain patient trust to improve healthcare.

Keywords: doctor-patient relationship; large language model; Mind Genomics; trust in physicians

     The curriculum of our medical career proposes a humanistic training model for medical students that includes as objectives: increasing their self-knowledge, personal emotional growth, cognitive and critical development, fostering the spirit of solidarity, encouraging enthusiasm and balance in their academic and then professional life (and in their entire life), and an empathetic and compassionate behavior with patients.

     Different authors and scholars dedicated to humanistic training in medicine have proposed various educational models. William Branch, who can be considered a pioneer of the inclusion of humanism in undergraduate medicine, and his proposals, along with those of other authors who emphasize the value of narrative, reflection, and humanistic development integrated into clinical training, have been powerful inspirations for our program.

Anemia is one of the major leading health concerns globally and India is one of the leading countries contributing to the global burden of anemia. Anemia plays out differently depending on the group that is struggling with the condition. Women of reproductive age (WRA) are one of the most vulnerable groups to this condition and maternal anemia is associated with increased mortality. The physical diagnosis of anemia is often based on clinical signs alone such as pallor of the conjunctivae, nail beds, face, palms, and palmar creases. Anemia can also be determined by biomarker assessment which is Hb concentration. It is the most preferred biomarker for diagnosis. HemoQR is a Hb detection test kit consisting of a detection strip and a software application which enables immediate reporting and data-driven decision making. It is a point-of-care test based on a mobile application, making it user-friendly and low maintenance to be used anytime, anywhere. In this paper we have done a comparative study of HemoQR and Hematology Analyzer using 24 EDTA blood samples. The study was conducted in Patkar laboratory. The results showed 95% repeatability and 96% reproducibility for the Haemoglobin Detection Kit.

Introduction: Intestinal parasitic infections (IPIs) constitute a substantial global health challenge, particularly in developing nations where environmental, socioeconomic, and health factors contribute to their widespread prevalence. This study focuses on protozoan parasites and soil-transmitted helminths, assessing their prevalence and exploring potential shifts in infection rates amid the COVID-19 pandemic.

Material & Methods: A retrospective analysis of 3070 stool samples collected from patients admitted to a tertiary care hospital in Lucknow, spanning from January 2018 to December 2023, was conducted. The data were categorized by age groups, gender, and seasonal variations. Statistical analyses, including chi-square tests and t-tests, were employed to evaluate the significance of differences in infection rates across seasons and pre-and post-COVID-19 periods.

Results: The study revealed varying prevalence rates across age groups, with the 20-40 age group exhibiting the highest IPI prevalence at 9.6%. Gender disparities were observed, with higher rates in males. Notably, a decrease in IPI cases was observed post-2020, aligning with the onset of the COVID-19 pandemic. Giardia intestinalis, Entamoeba histolytica, Ancylostoma duodenale, Hymenolopsis nana, Ascaris, and Strongyloides were identified in the stool samples, with a shift in prevalence post-2020.

Conclusion: This retrospective study provides insights into the complex relationship between the COVID-19 pandemic and the prevalence of intestinal parasitic infections. The observed decline in IPI cases post-2020 suggests the unintended positive consequences of pandemic-induced lifestyle changes on parasitic infections and effect of antiparasitic drugs which were taken porphetically during pandemic. However, the study acknowledges limitations, and future research employing more sensitive diagnostic methods is recommended.

Keywords: protozoan parasites; retrospective study; prevalence; covid-19; intestinal parasitic infections

This study presents the case of a 55-year-old woman from a rural village in Uttar Pradesh, North India, with a history of rheumatic heart disease. Over the past 3-4 years, she experienced nonspecific symptoms including intermittent fever, cough, chest pain, and shortness of breath, with reported exposure to pets and animals. Radiological assessments revealed a solitary hydatid cyst in the left lung, confirmed by microscopic examination of hydatid fluid and subsequent microbiological analysis detecting Echinococcus spp. The patient underwent surgical intervention alongside treatment with antiparasitic drugs for management.

Keywords: Tapeworm; Chest pain; Cestode; Hydatid fluid; Echinococcus

Teacher evaluation forms in their current format are not useful appraisal instruments for performance testing and improving academic courses. These tools fall short in accuracy, validity and reliability in their design. A more useful approach should visit the potential for interactions between factor levels within the instrument together with hypothesis testing for variations in the mean responses solicited from the subjects which can harbor latent errors, misconceptions and imperfections in the findings.

A two-way policy agreement between teacher and student is therefore proposed in this paper for sign off by both teacher and student. The agreement is then tested for violations from both parties and whether there is any bias in the responses.

A statistical analysis is adopted to test the significance in the population differences in the means of dependent variables of choice in the instrument and for variance in the means of the factor levels used in the instrument. Logistic regression is finally instituted for self- test evaluation to determine the odds of a good performance rating (from a teacher), if you are a teacher over if you are not (student) for the same policy instrument. The scores for the teacher from the student on the teacher’s instrument and the scores the teacher gives himself from the same teacher’s instrument are compared.

The final product offers schools and universities an improved method for justifying students’ evaluation of their lecturers while allowing the lecturers to evaluate themselves and can be extended for use in business organizations for conducting appraisals of workers. The instrument’s reliability and validity are also tested as a quality control measure.

Keywords: Teacher evaluation; statistical analysis; odds ratio; appraisal instruments; quality control

Background: Acute pancreatitis results from abnormal activation of pancreatic enzymes and inflammatory mediators, leading to an acute inflammatory process. It ranges from mild to life-threatening and is a frequent cause of acute abdominal issues. While its prevalence is rising globally, the specific incidence in Ethiopia remains unknown, with only two hospital-based studies conducted.

Objective: To assess the management outcome and associated factors of Acute Pancreatitis among patients admitted with acute abdomen.

Methods: An institution based cross sectional study was conducted among 60 patients with acute pancreatitis. SPSS statistical software version 25 was used for data entry and analysis. Fisher’s exact test used to see association and p-value<0.05 considered stastically significant.

Result: The study found that abdominal pain was the most common symptom by most patients. The most frequent physical findings were tachycardia with abdominal tenderness, followed by abdominal tenderness alone. The primary identified etiology was alcohol in 36.2% of cases, followed by idiopathic, gallstone, and multiple causes in 29.3%, 19%, and 15.5% respectively. The majority of patients had mild acute pancreatitis, with 13.8% and 29.3% experiencing severe and moderate forms, respectively. Most (91.4%) patients showed improvement upon discharge, while 8.6% died in the hospital. Mortality in acute pancreatitis was associated with comorbidities (P<0.023), delayed presentation (P<0.013), age ≥60 years (P<0.003), BISAP >2(P<0.001), and severe acute pancreatitis (P<0.001).

Conclusion: The study identified alcohol, idiopathic causes, and gallstones as the most common etiologies. Diagnosis of acute pancreatitis relies on clinical presentation, elevated pancreatic enzyme levels, and imaging for uncertain cases. Management typically involves conservative measures. Morbidity and mortality outcomes in acute pancreatitis heavily rely on timely diagnosis and appropriate management.

Keywords: Acute Pancreatitis; Etiologies; Severity scoring

The essential function of SIGN water is a chemical reduction by infoton, < H⁺~e^- > which is the pico-sized particle (1/1000 of nanometer). The epidermis in a skin contains 60% water giving good effects as well as blood in capillaries. Water plays an important role regardless of the lens and vitreous body in the eyes. We introduce to cure thyroid gland and kidney diseases with water. The Alzheimer’s disease must be a total issue in the body due to the brain, and the disease can be cured by the reductive action of the infoton in the water. Furthermore, if a proton in the infoton, < H⁺~e^- >, works effectively for a nuclear transmutation at room temperature, then the radioactive body could be decontaminated with the water.

Keywords: pico-sized water; skin; cataract; thyroid; kidney; Alzheimer’s; radiation reduction

Man gets tired, but machines don’t get tired. Man can become emotional at times, but Machines do not allow emotion to influence their judgement. And finally, Machines make decisions faster and machines can be programmed to learn more rapidly than humans.

We read, with great enthusiam, the article entitled “Forensic Dentistry - Need to Expand the Horizon”, authored by Sukhpal Kaur, and published in volume 3, issue 3 (December 2023) of Medicon Dental Science [1]. We congratulate the author on the article and its broad and visionary approach. The article is well-written and describes the importance of the dental surgeon's forensic work, particularly in the criminal field. However, the role of the dental surgeon in the legal sphere goes beyond the elucidation of criminal situations.

Background: The COVID-19 pandemic did not spare Madagascar, and we observed that a significant number of inpatients who were transferred passed away. The aim of this study was to investigate how admission by transfer influences the outcome of COVID-19 patients and to identify factors associated with mortality in patients admitted through interhospital transfer.

Methods: This is a retrospective cohort study conducted at the Andohatapenaka University Hospital over a three-month period from December 2021 to February 2022. The first group included in the study population was composed of patients from interhospital transfers (n=54). The second group consisted of patients admitted by other admission methods (n=127). The chi-square test was used to check the validity of the relative risk (RR), and the significance threshold was set by a p value < 0.05.

Results: After analysis, it was found that the mode of admission interhospital transfer was associated with patient mortality (RR=1.47 [1.06-2.04]). Additionally, we identified several factors associated with mortality in COVID-19 patients, including a history of diabetes (RR=1.58[1.02-2.43]), a respiratory rate of more than 30 cycles/min (RR=1.58[1.02-2.45]), SpO₂ less than or equal to 88% (RR=2.45[1.21-4.92]), Glasgow score between 9 and 12 (RR=2.09[1.55-2.83]), critical form (RR=2.41 [1.68-3.47]), lung involvement greater than 50% (RR=1.99 [1.05-3.74]), presence of complications (RR=1.90 [1.24-2.93]), complications by myocardial infarction (RR=2.00 [1.50-2.65]), and use of noninvasive ventilation (RR=2.00 [1.50-2.65]). Therefore, admission through interhospital transfer influenced the unfavorable patient outcome.

Conclusion: Our study shows that admission by transfer is associated with mortality in COVID-19 patients. We recommend that healthcare professionals exercise vigilance in managing these patients to improve outcomes.

Keywords: admission; COVID-19; mortality; transfer

Introduction: Bruxism, characterized by involuntary teeth grinding, poses a significant oral health concern affecting a notable portion of the adult population.

Aim & Objective: To assess osseous changes in the mandibular condyle among patients with bruxism, considering age, gender, and specific temporomandibular joint conditions.

Methods: 246 individuals of age 18-40 years were screened and clinically evalluated for bruxism. Patients indicated for orthopantomogram [OPG] were utilized to study condylar osseous changes. Statistical analysis was conducted to examine age-related variations, gender-specific differences, and associations with tongue indentation, teeth attrition, and muscle hypertrophy.

Results: Age-related trends revealed tendencies towards surface flattening and osteophyte occurrence in the left condyle, while gender-specific variations highlighted higher frequencies of osteophyte and sclerosis in females and increased sclerosis in males, particularly in the right condyle. Tongue indentation and teeth attrition emerged as potential risk indicators, whereas the association with muscle hypertrophy requires further investigation.

Conclusion: Tailored diagnostic and management strategies are essential for addressing variations in bruxism prevalence and severity, considering age, gender, and specific TMJ conditions. Further research into the relationship between muscle hypertrophy and bruxism could provide valuable insights into TMJ disorder mechanisms.

Keywords: Bruxism; Orthopantomogram [OPG]; Condylar osseous changes

This case highlighted the tremendous improvement experience in patient with Multiple Sclerosis treated when conventional treatments were combined with PMF capsules and Camel milk drink.

We therefore conclude from what is observed and suggest possible link between PMF and camel milk drink in this patient’s tremendous improvement from MS. Further research is necessary including case series documentations to further reinforce the hypothesis that can be proven in larger case-control or cohort studies.

Our case demonstrated improvement in the management of Multiple sclerosis using PMF capsule with intermittent drinking of camel Milk.

Keywords: PMF; Multiple Sclerosis; Camel milk; Case repot

Background: Virgin Coconut Oil (VCO), obtained naturally without chemical processing, boasts anti-inflammatory, antimicrobial, and antioxidant properties, making it a potential adjunct in treating periodontal diseases like gingivitis and periodontitis. Despite its benefits, research on VCO's specific effects as an adjunct to the treatment of periodontal disease remains limited. Aim: This review aims to explore existing data on VCO's potential in addressing periodontal issues. Materials and Method: PubMed and Google Scholar databases were searched for available literature with the keywords; (periodontal disease OR periodontitis OR periodontal therapy OR periodontium) AND (gingivitis OR gingival disease) AND (virgin coconut oil OR VCO) spanning from 2003 to 2024. This review only included original articles that were fully written in English. Results: A total of seven articles were found on VCO related to periodontology. VCO adjunctive applications were reported to result in further reductions of plaque index, gingival index, inflammatory mediators, and inhibition of periodontal pathogens. Conclusions: From this review, it can be concluded that VCO exerts multiple beneficial effects such as anti-oxidant, anti-inflammatory, healing properties, anti-plaque, anti-gingivitis and anti-bacterial that are beneficial for various periodontal disease management.

Keyword: Anti-bacterial; anti-gingivitis; Anti-inflammatory; anti-oxidant; anti-plaque; periodontal disease; virgin coconut oil

The concept of "deathbed" refers to a social process in which emotions are shared collectively while sending a dying person to their last journey, accompanied by different rituals across cultures. The dying person's family members, but also relatives and friends, as well as medical professionals and religious officials invited according to the individual's beliefs, are actively involved in the deathbed process. This process also produces a social space where many common values and religious activities emerge.

Supernumerary teeth are defined as additional teeth to normal series of primary and permanent teeth. These additional teeth can occur anywhere in the oral cavity, presenting challenges in diagnosis and treatment [1]. The etiology of supernumerary teeth is thought to be both genetic and environmental factors like hyperactivity of dental lamina, tooth bud dichotomy, trauma, infection etc. [2, 3]. Often in regular dental practice the supernumerary tooth is often missed unless it affects the treatment process. Understanding the rate of incidence, causes, and management of supernumerary teeth helps dental practitioners to provide effective care. This is an attempt to record some cases seen among the expat patients of different nationality in the UAE.

Mycotic keratitis is a sight-threatening disease, caused by infection of the cornea by filamentous fungi or yeasts. This paper reviews data on the prevalence, diagnosis, therapy and prevention of mycotic keratitis in different states in India, and in other countries, namely Pakistan, Nepal, Bangladesh, Sri Lanka and Bhutan, in the Indian subcontinent. In vivo confocal microscopy and molecular techniques(polymerase chain reaction) have improved management of the condition.

Keywords: Keratitis; etiological agents; clinical features; therapy; prevention

Introduction: Convulsions are attacks of muscular contracture of cerebral origin, of multiple etiologies.

Objective: To determine the epidemiological, diagnostic and therapeutic profile of convulsions in children.

Method: This was a prospective descriptive study lasting six months involving 137 patients hospitalized in the pediatric department of the Labé regional hospital.

Results: out of a population of 522 patients, we recorded 137 cases of convulsions in the pediatric department, representing a frequency of 26.2%.

The etiologies of seizures in children were dominated by severe malaria with a frequency of 72.2% followed by lower respiratory infections with 24.8% and epilepsy 11.6%.

In our study, antipyretics were the most used with a frequency of 90.5% followed by antimalarials 72.2% and anticonvulsants 37.9%.

Conclusion: convulsions are very common symptoms of multiple etiologies, treatment remains symptomatic and etiological.

The availability of EEG and blood ionogram would facilitate diagnosis and improve management.

Keywords: convulsions; epilepsy; child; Labé

Patient admission to the Intensive Care Unit leads to pathological changes in the stomatognathic system. Most of the time, due to the absence of enteral feeding when patients are intubated, xerostomia is widely observed, increasing the risk of intraoral opportunistic infections. These infections, in turn, can lead to other systemic complications, increasing hospitalization time and costs and requiring prolonged pharmacological therapies, thus increasing the morbidity and mortality rate. In view of this, considering the preventive aspects, the presence of a dental surgeon in the Intensive Care Unit promotes oral hygiene care for patients, favouring quality of life and improvements in hospital care.

Keywords: Dentistry; Hospital; Intensive Care Unit; Oral Health; Oral Hygiene

This research aims to clarify the PRF / CGF membranes and sticky bone preparation together with other platelet concentrates. A few clinical cases will show how sticky bone is together with PRF membranes applicative in different oral surgery indications [1]. Growth Factor are polypeptide hormones or biological factors. They mediate many cellular processes for the various stages of growth. Endodontic therapy, commonly known as root canal treatment, is indeed highly successful in most cases, with success rates typically ranging from 85% to 97%. However, in a minority of cases, symptoms may persist or reoccur despite initial treatment. In such situations, periapical surgery, also referred to as apical surgery or apicoectomy, may be recommended as the next step. Periapical surgery involves accessing the tip of the tooth's root (apex) and removing any infected tissue or lesions in the surrounding area. This procedure is often indicated when conventional root canal treatment has failed, or when there are persistent issues such as chronic periapical lesions or apical periodontitis. During periapical surgery, the endodontist or oral surgeon will make a small incision in the gum tissue near the affected tooth to access the root tip. The infected tissue is then removed, and the tip of the root may be reshaped or sealed to prevent further infection. Finally, the gum tissue is sutured back into place.

Keywords: Autologous platelets concentrate; concentrated growth factor; endodontic surgery; sticky bone

A 60-year-old patient, with no history, non-smoking, consulted for dyspnea with chest pain that had been progressing for five days in the context of apyrexia. A significant weight loss had been noted for 1 month. Physical examination revealed an isolated tachypnea with no evidence of respiratory struggle. Biologically, leukopenia was found (1800) with a moderate increase in CRP (40 mg/l). A chest CT scan was performed (Figs. 1 and 2).

Background: From healthcare associated infections surgical site infection is the most commonly encountered in problem surgically admitted patients which results undesirable outcome and treatment cost burden.

Aim of the study: The aim of the study was to determine magnitude of surgical site infection and associated factors in patients to whom surgery was done at Yekatit 12 Hospital Medical College.

Methodology: A longitudinal study design was used to conduct the study and all patients admitted to the surgical wards for which surgery was done in July and August 2022 was included. Binary logistic regression model was used to identify risk factors associated with surgical site infections and statistically significant associations were declared for p value less than 0.05 using adjusted odds ratio with 95% confidence interval.

Result: In the current study, 24 of 419 5.7% (95% CI: 3.7, 8.4%) patients developed surgical site infections out of which 3 of 419 (0.7%) died from surgical site infection complication. Surgical site infections were significantly associated with hospital stay (AOR: 35.3, 95% CI: 11.2, 112.8) ** and gastrointestinal surgeries (AOR: .299, 95% CI: .090, .999) *.

Conclusion: The magnitude of surgical site infection in this study was slightly higher than the accepted infection rate but by far low than other studies with comparable set ups.

Keywords: Surgical site infection; wound class; surgical wards

Endogenous Cushing syndrome (CS) during childhood is rare and mostly due to steroid taken for treatment of other diseases. Due to delayed diagnosis of endogenous Cushing syndrome it results high morbidity and mortality. The incidence of CS is about 2 to 3 cases per million of populations and 10% of them occur in children. Patients with endogenous CS are presented with typical features of facial plethora, weight gain, glucose intolerance, hypertention, osteoporosis, proximal body weakness, fracture opportunistic infections, easily bruising and striae. We are reporting that an 8-year-old boy presented with central body weight gain, facial plethora, hypertension, and delayed weight gain. He was diagnosed to have left suprarenal mass with imaging and corticotrophin-independent crushing’s syndrome from a laboratory profile. Although laparoscopic transperitoneal adrenalectomy is mentioned as the gold standard treatment, with the introduction of surgical robotic systems, surgeons are experiencing different approaches to adrenalectomy. Our patient was operated on with a robotic adrenalectomy through a posterior retroperitoneoscopic approach successfully, and the final histopathology report was adrenocorticaladenoma. Corticotrophic-independent CS is more common in young children mostly younger than 7-year old, hence our patient is 8-year old which goes with possible explanation.

Keyword: Cushing’s syndrome/disease; ACTH; Robotic surgery

Automated wound detection using computer vision has emerged as a promising approach in healthcare, offering efficient and accurate identification of various acute injuries such as burns, abrasions, and traumatic wounds. Traditional manual assessment methods are time-consuming and subjective, leading to potential human errors. Leveraging state-of-the-art deep learning techniques, this study investigates the application of YOLO v8, a real-time object detection framework, for automated wound detection in diverse clinical scenarios. The research focuses on delineating the architecture and implementation details of YOLO v8, emphasizing its adaptability and efficiency in identifying and localizing acute injuries. Additionally, the paper discusses methodologies for dataset preparation, including collection, annotation, and augmentation of wound images crucial for training and validating the model, while addressing challenges such as class imbalance and ensuring model robustness across different wound appearances.

Keywords: Customized First Aid; YOLO V8; Object Detection; Transfer Learning

Background: Elective surgical case cancellation refers to scheduled patients not operated on the scheduled date. The reason for cancelations on mostly related to patients, organizational issues, and clinical staff. Hence, the objective of this study was to assess the magnitude of surgery cancellation and associated factors in Yekatit 12 Hospital Medical College.

Methods: A prospective cross-sectional study was conducted at Yekatit 12 Hospital Medical College. All patients scheduled for surgery in the major Operating room (OR) from June 01/2022 to September 30/2022G.C were included in the study and data were collected from the patient registry for cancelation and recovery registry logbook using data extraction checklist and entered into EpiData and then exported to SPSS version 25 for data analysis.

Results: In this study, about 692 patients were scheduled for elective surgeries and the surgery of 42 (6.1%), (95% CI: 4.4, 8.1%) patients were canceled. The most common reason identified for cancellation -facility-related (40%), patient-related (16.7%), staff-related (11.9%), emergency (11.9%), acute medical illness (7.1%), lack of investigation (7.1%), and emergency (4.8%). General surgery (20%) and orthopedic surgery (6%) were the most common cases of canceled surgeries.

Conclusion: The magnitude of elective surgery cancelation in this study was 6.1% and it was relatively lower than most other studies. Causes for cancellation are preventable and feedback of appropriate data to surgeons and other healthcare workers involved in the care has been shown to be an important component of strategies to reduce cancellation.

Keywords: Cancellation; elective surgery; Yekatit 12 hospital medical college; Ethiopia

Antimicrobial resistance increases morbidity and mortality for individual patients as well as pose a threat to public health. Antimicrobial resistance threatens human, animal and environmental health, killing at least 1.27 million people worldwide and is associated with nearly 5 million deaths in 2019 [1, 2]. The widespread and often inappropriate use of antibiotics is the root cause of antimicrobial resistance and it needs to be addressed urgently [3].

Drug resistance is a consequence of the evolution of microorganisms in the presence of antibiotics. The resistance is inevitable, but the pace and extent of propagation of resistant organisms can be governed by monitoring antibiotic consumption by humans and animals, hygiene, sanitation and infection control [3]. Global Antimicrobial Resistance and Use Surveillance System (GLASS) reported that ciprofloxacin resistance varies from 8.4%-92.9% for Escherichia coli and 4.1%-79.4% for Klebsiella pneumoniae. Additionally, colistin-resistant bacteria have been found in numerous locations, and are producing diseases with no effective antibiotic treatment [3, 4].

Aims: Sudden exposure to bright light (ACHOO syndrome) could be a bizarre reason for a sneeze. Sneezing due to the explosive exhalation of potentially pathogenic droplets is an immediate danger for SARS CoV-2 contagion. This article highlights the insidious phenomenon of the photic sneeze reflex and points out the social effect of sneezing in the middle of the pandemic.

Methods: We created an Instagram account, called photicsneezereflex, to educate our followers and derive our statistics. We set, via Instagram stories, the following questions: 1) How much will you be bothered by someone who is sneezing near to you?, 2) How possible could it be to consider him/her a SARS CoV-2 carrier?, 3) How possible could it be to consider him/her a photic sneezer? The answers were scaled on a 1 to 5 climate, and a descriptive statistical analysis was carried out.

Results: For the first question, merely 25% scaled their annoyance with a score lower than three, while the median rating was 4 (mean= 3.7, SD= 1.26). Question two showed the most fluctuated results, with a median score of 3 (mean= 3, SD= 1.35). Finally, the median score for the possibility of photic sneezing was 2, with a mean=2.26 and an SD= 1.22.

Conclusions: This report primarily aims to promote that a pure habit could become very threatening for a society during a pandemic. Spreading coronaviruses widely, engendering confusion and fear, and causing frustration are only some deleterious side effects for public health and society.

This paper seeks to establish a paradigm for Medical Herbalism research, harmonious with the manner in which Medical Herbalism is conducted. Researching herbal medicines in controlled experiments with un-standardised extracts to identify causal relationships is inherently difficult. The poly-phytochemical nature and complex interactions of medicinal herbs make definitively identifying active ingredients challenging. The effects and variability of the phytochemical makeup within plant material also complicate controlling for phytochemical consistency and observed effect. Utilising pharmaceutical research methods, where a single chemical can be isolated, standardised and its effect observed, is not possible for the conduct of herbal medicinal research. It requires a significant deviation from the natural variations in plantsʼ poly- phytochemical profiles occurring within species, which is assumed implicitly in Medical Herbalism.

We propose a paradigm which shifts the observation from the phytochemicals to observable effects, by utilising continuous biomonitoring technology through using Wearable Health Technology. The purpose is to observe quantitative and qualitative patterns of change in actual people engaged in their everyday activities, which is then subjected to Machine Learning analysis of the gathered data to find patterns of physiological change and develop ontological databases of effects. We may overlay the quantitative research with qualitative data to understand the experience of people as a result of the changes. For this we need to explore and develop Medical Herbalism specific approaches.

The necessity of shifting the focus from the poly-phytochemical problem to quantitative changes in the experimental subject opens new horizons. It shifts the focus from causative to statistical correlative methods and provides a platform for more targeted phytochemical profile research, utilising Machine Learning methods such as Semantic Similarity to identify complex effects resulting from variations within the poly- phytochemical profiles of herbs. Such a framework would require ontological databases of effects linked to herbs, providing infrastructure for more targeted phytochemical research.

     There is significant gap between the learning impaired and normal children. This study considers the engagement of visual art in the development deaf children to adequately reduce the gaps. Deaf children are physically challenged in hearing but the visual ability of such persons are alert and functional. This hearing disability affects hearing of language and communication generally. The deaf may be disabled in auditory ability but not in sight; therefore developments of skills in areas that require sight will lighten the burden of their handicaps. The major mental abilities underlying intellectual tasks are reasoning ability to visualize partial relationships, word fluency, numerical ability and perceptual speed. The deaf have sound visual acuity and intellectual abilities. Engaging visual considered as an aspect which could advance the communication ability of deaf children and minimize the effect of their disability.

     Normal children are able to use their auditory modality to build up an early mastery of the sound, shop and sense of their language. The deaf Children acquisition of language may depend primarily on vision. Visual art is directly related to vision in its two-dimensional and three-dimensional forms, and also has various positive functions in the area of training and development of individuals including deaf children.

     Visual art also engages in the expressive and creative processes to enhance psychosocial, physiological emotional social and spiritual well-being in people of all ages. According to Ahessy (2022) observes that "the outs com help us to "Understand, communicate and cope with various experiences of lemon illness and incorporating them in our health care strategies improves the well-being and experience of both the patient and physician”. The exploration of engaging visual arts in the study helps to increase awareness out reinforce the use of art from early childhood, particularly for the acoustically challenges.

An uncommon form of malignant melanoma is anorectal malignant Melanoma (ARMM), attributing to only 1% of all rectal malignancies. About There are times when the diagnosis appears straight forward, and at other times it is confusing thereby requiring a high degree of suspicion on the part of the treating physician. Due to the aggressive nature of this disease, an early diagnosis and prompt treatment are essential. Specific mutations in the c-Kit/stem cell factor (SCF) pathway, the endothelin receptor type B/endothelin pathway, and the Sox10transcription factor are being incriminated in the pathogenesis pigment and enteric nervous system disorders including melanomas. This may form a basis for further research and treatment of these disorders.

Keywords: Anorectal Melanoma; aggressive; Ckit/stem cell factor (SCF) pathway

Long-chain polyunsaturated fatty acids are crucial for infants as they reach mature breast milk through the bloodstream, originating from the digestion and absorption of ingested fat and/or mobilization of maternal fat reserves. Research indicates that blood plasma fatty acids are of dietary origin, suggesting that their content in mature breast milk is dependent on their circulating quantity in the plasma.

Objective: To evaluate the serum fatty acid profile and its influence on the fatty acid content in mature breast milk.

Materials and Methods: Fifty women breastfeeding for a minimum of 30 days participated. Thirty milliliters of mature breast milk were collected from both breasts between 7 to 9 AM using manual extraction, along with 2 milliliters of blood. Fatty acid profiling for mature breast milk and plasma was conducted using gas chromatography, employing an internal standard and a reference pattern (FAME Mix of 37 components) for fatty acid identification.

Results: Minimal correlation was found, such as in linoleic acid, cis-docosahexaenoic acid, and cis-eicosapentaenoic acid; low correlation was observed with palmitoleic acid, while there was no correlation with the rest of the fatty acids. Conclusions: There was no significant correlation between plasma fatty acid content and mature breast milk. Its content appears to be primarily driven by the baby's nutritional needs and is directly related to a physiological process of the mammary gland.

Keywords: Human milk; fatty acids; blood plasma; data correlation

     We back to 2019 in the world by SARS-CoV-2 which was acute respiratory disease. I calculated the cumulative confirmed COVID-19 cases according to WHO data. The increasing data for one year period from January 2023 up to the present; Japan:15.7%, China:14.0%, India:0.76%. In Europa; France 2.3, Germany 2.8, UK 2.7%, 4% in USA, 0 % in Australia, and 8.9% in Russia each country.

We report various research studies on minimal catalyst (MICA) water and another spin information gauge network (SIGN) water from 2009 to the present. The theme expands our bodies, plants, animals, and other substances like concrete, vinyl bags, fibre, LED light, and even the atmosphere. Furthermore, we also reported the nuclear changes from radioactive caesium to stable barium in the contaminated soils in the Fukushima accident (2011.3.11). Relating to our body, we previously discussed cerebral infarction and skin care in terms of electrodynamics. Our water science and technology are talking about an essential property of water relevant to dissociating hydrogen bonds in water. We fabricated SIGN water under the pressure of more than 100MPa rather than 3MPa for MICA water. The difference may be the abundance rate of the elementary-like particle; namely, we assume the amount of the particle is three times in SIGN water than in MICA water, although it is the same works, and both emit far-infrared through terahertz. Here, we focus on a mental disorder as a resounding theme in our brain.

Background: The present study aimed to correlate the age at onset of menarche and Body Mass Index (BMI) among high school students in Kerala. Objectives: To assess the age at onset and menarche among high school students. To assess and correlate age at onset of menarche and BMI among high school students. Materials & Methods: Quantitative approach with a cross-sectional retrospective study conducted among 200 high school girls students based on purposive sampling technique. Height, Weight, and BMI were calculated based on standard protocol and structured baseline proforma was completed including age of attainment of menarche among selected high school students through random selection. Results: The present study shows that most of the students prefer mixed dietary patterns (86%). Most of the mothers had attained their menarche at 13 years (67%). Most of the samples attained menarche at 14 years of age (40.50%). The correlation coefficient between BMI and age of attainment of menarche was -0.18. Conclusion: It is a moderately negative correlation since it lies between -1 and 0. The study concluded that there is no correlation found between age at the onset of menarche and BMI, also no association between age at the onset of menarche and BMI.

Keywords: Age and menarche; Body Mass Index; High school students

We are sincerely thankful to Ms. Husna Nazar, Medical Secretary, Al Kuwait Hospital, Emirates Health Services, Dubai, United Arab Emirates for extending her kind support by helping in an intangible way for this article.

Several studies suggest that HIV / AIDS is a pathology that causes a succession of traumas. These traumas are inaugurated by the announcement of the positive diagnosis and maintained by the course of the disease, at different levels, biopsychosocial. In addition to the attacks on life and the relationship, the authors have pointed out psychogenic problems related to the relationship with oneself and with otherness, as manifested by the many narcissistic, relational crises; the alteration of the relationship to sexuality, to life ... We also observe the emergence of many problems of self-esteem. The traumatic dimension of the disease is reinforced by the unspeakable nature of the perspective of one's own death, which is structured by the collective representations of the disease, the current absence of curative treatment ... The somato-psychic attacks and complications of the disease mobilize an important anxiety of death. Often faced with the need to survive, individuals must mobilize more or effective coping mechanisms to stave off the effects of traumatic stress-induced degradation. This work examines the impact of the trauma of the announcement of the positive HIV test and analyzes, in four female subjects, the implementation of mechanisms and guardians of resilience. Clinical and diagnostic interviews highlight three important groups of factors that contribute to resilience: specialized psychosocial support, social and family support, psychic elaboration mechanisms.

Keywords: HIV / AIDS; trauma, resilience; resilience tutors; idiosyncrasy; social support

Purpose: This cross-sectional study aimed to investigate the association between hypertension and D-dimer levels in COVID-19 patients.

Patients and methods: A total of 173 PCR-positive patients were included in the study. Hypertension status was determined, and D-dimer levels were measured. Correlation analysis using Pearson's coefficient was performed to assess the association between hypertension and D-dimer levels. Odds ratios were calculated to evaluate the risk of D-dimer elevation in hypertensive patients. Relevant statistical analyses were conducted to derive meaningful insights.

Results: Among the patients, 70.5% were hypertensive. The average D-dimer level in hypertensive patients was 3533.78, whereas it was 3264.78 in normotensive patients. Correlation analysis revealed a positive association between hypertension and D-dimer levels (r = 0.0354). When considering D-dimer levels as a dichotomous variable, hypertensive patients exhibited a higher elevation-to-normal ratio (E/N ratio) of 4.54 compared to normotensive patients (E/N ratio = 2.92). The odds ratio for hypertension was 1.55, indicating an increased risk of D-dimer elevation in hypertensive patients.

Conclusion: This cross-sectional study demonstrates a positive association between hypertension and D-dimer levels in COVID-19 patients. Hypertensive individuals exhibited higher average D-dimer levels, suggesting a potential link between hypertension and increased coagulation activity in the context of COVID-19. These findings contribute to the growing body of evidence linking hypertension to COVID-19 severity and emphasize the importance of monitoring D-dimer levels in hypertensive patients during COVID-19 management. Further research is needed to elucidate the underlying mechanisms and causality between hypertension and D-dimer elevation in COVID-19 patients.

Keywords: COVID-19; hypertension; D-dimer levels; association; coagulation activity

Manganese has been shown to deposit in the basal ganglia. While its toxicity has a low incidence, it can result in Parkinsonian syndrome. We describe a case of a 43-year-old man, with medical history of congenital portosystemic shunt, who presented with parkinsonism in the setting of manganese encephalopathy. CTA of abdomen and pelvis showed findings of pelvic portosystemic shunting. Brain MRI with and without contrast showed T1 hyperintensity within the bilateral basal ganglia and anterior midbrain. Patient was started on developed levodopa - carbidopa with mild improvement of motor symptoms but it was stopped due to the development of psychosis. This report emphasizes the importance of early recognition of congenital portosystemic shunt as an etiology of secondary Parkinsonism as early closure of it can be curative.

Keywords: Manganes; Parkinsonism; Levodopa Carbidopa; Portosystemic shunt

Breakfast has been touted as the most important meal of the day, especially for school-aged individuals who requires energy and nutrients to support activities in school. However, the effects of breakfast on school performance have not been systematically reviewed. This study aims to fill this gap by conducting a systematic review on the effects of breakfast on school performance using articles indexed in PubMed prior to 2023. 41 of the original 94 articles (43.6%) were included. Majority of the studies have concluded that regular breakfast allows students to perform better in school; hence, skipping breakfast, especially prolonged skipping of meals, is not encouraged for school-aged individuals as it may lead to impaired cognitive function required for education.

This paper discusses the five pillars of lifestyle medicine and how college students can benefit from implementing this lifestyle into their routine. It covers the statistics of students with their eating patterns, sleep cycle, risky substance consumption, stress management, and social connections. It emphasizes the importance of college students making their mental health a priority and ensuring the sustainability of prolonged brain development. The mental health of college students is vital for their academic success, as well as their overall wellbeing. Further discussed in the paper, there will be various statistics of lifestyle patterns of college students that are compared.

Medication reconciliation is a process of screening of patient prescription, obtaining accurate list of previous medication and comparing it with prescription after transition of care (on admission, after transfer to another clinical unit, and at discharge) [1]. Medication reconciliation is a safety strategy used to prevent the discrepancies, has been adopted by many healthcare organizations. It was first implemented in 2005 as a National Patient Safety Goal (NPSG) by the Joint Commission and later the WHO collaborators involved themselves in endorsing this strategy across many countries [2]. The accurate medication history was one of the patient safety solutions disseminated in 2007 by the WHO [3].

Kenya struggles with a limited number of cardiologists, which poses a significant gap in the healthcare system's ability to provide adequate cardiovascular care. To bridge this gap, cardiology clinical officers plays a vital role in preventing, diagnosing, treating, and managing various cardiovascular conditions. As the healthcare landscape advanced, clinical officers began specializing in various areas to meet the growing demand for specialized care. The involvement of clinical officers in different specialties have significantly expanded healthcare access and improved the quality of care provided. According to WHO (2019) in Sub-Saharan Africa, Cardiovascular Diseases(CVD) contribute to around 1 million deaths annually, representing 5.4% of global CVD-related fatalities and 13% of total deaths in Africa.

Aim: To determine the role of clinical officers in cardiology and to explore factors that will enhance the training and to promote collaboration between clinical officers in cardiology and physician cardiologist.

Methodology: A study design applying a qualitative approach. The sampling frames comprised all Clinical Officers working in 5 selected health facilities within Nairobi County. A purposive sampling technique was utilized to obtain the study sample.

Findings/Results: 95.2% of respondents could perform initial assessment and diagnosis of CVDs, 4.8 % could perform and interpret Echo & ECG, 54.7% could treat, plan and prescribe medication, 28.6% could monitor patients' progress and adjust treatment plans, 73.8% could give Patient education on lifestyle modification and disease management.

Conclusion: 88.1% of the respondents proposed training clinical officers on cardiology as faculty in colleges. A paradigm shift is needed to bridge the gap between primary and tertiary levels of cardiovascular healthcare by utilizing cardiology clinical officers and expanding cardiology training programs.

Keywords: Cardiology; Clinical officers; Clinical officer training; Physician assistants; PA

Esophageal cancer is the eighth most common cancer worldwide. The prognosis for patients with esophageal cancer is poor, with published data indicating only about 12-39% of patients surviving for five years following radical treatment. As more than 50% of patients with esophageal cancer are beyond the reach of radical treatment at the time of diagnosis, palliative management becomes a fundamental approach. Several techniques for restoring the esophageal lumen have gained recognition, including mechanical methods such as esophageal dilation and stenting, as well as ablative techniques like photodynamic therapy, laser therapy, and cryotherapy. Treating patients with advanced esophageal cancer or those deemed unfit for surgery poses a significant challenge. An individualized approach to patient care requires a comprehensive understanding of various therapeutic methods. Therefore, this paper seeks to present current knowledge on available methods for alleviating esophageal obstruction in patients suffering from dysphagia due to esophageal cancer.

Keywords: Esophageal cancer; Palliative treatment; Esophageal lumen restoration; Esophageal stenting; Ablative techniques

This study aimed to assess the impact of post-COVID-19 rehabilitative exercises on the physical and mental well-being of patients who have completed a rehabilitation program consisting of aerobic exercises, resistance training, and breathing exercises. The study used a quantitative research approach, data was collected from a sample of male and female patients aged 18 years and above.

Quantitative data analysis revealed significant improvements in physical and mental well-being scores after completing the rehabilitation program. Additionally, the study found that certain demographic factors such as age and gender may impact the effectiveness of the rehabilitation programs. Study also identified several themes related to participants' experiences with the rehabilitation program, including increased motivation and confidence, improved sleep, and enhanced overall well-being.

Overall, this study provides valuable insights into the effectiveness of post-COVID-19 rehabilitative exercises in addressing the long-term physical and mental health complications many patients experience after recovering from COVID-19. The findings of this study could inform the development of more effective rehabilitation programs for post-COVID-19 patients and contribute to the ongoing effort to improve the care and management of individuals recovering from COVID-19.

Keywords: COVID 19; Post COVID 19 syndrome; Rehabilitative exercises; Physical well-being; Mental well-being

After tooth extraction, some biological tissue repair phenomena occur. Invagination of the gingival epithelial tissue and subsequent resorption of the alveolar bone walls is expected. Clinically, bone resorption can compromise the future installation of osseointegrated implants, hindering the rehabilitation of edentulous areas. Guided Tissue Regeneration and Guided Bone Regeneration techniques can be used to prevent post-tooth extraction bone resorption. These techniques should also be associated with more cautious and preservative extractions to safeguard regenerative results. The polypropylene membrane has been used after tooth extraction with the main aim of maintaining and immobilising the blood clot inside the alveolus and, due to the possibility of exposure to the oral environment, without suffering contamination or adsorption of dental biofilm and subsequent infection. The purpose of this article is to present the case of the use of a polypropylene membrane after the extraction of a molar, in order to preserve and maintain bone tissue for the immediate installation of an osseointegrated implant and the respective implantoprosthetic rehabilitation. The case has been followed up for 12 years.

Keywords: Tissue Regeneration; Bone Regeneration; Oral Surgery; Bioengineering; Implantology

Condition known as allopecia areata is characterised by temporary, non-scarring hair loss and preservation of the hair follicle. The various types of hair loss, which can affect all hair-bearing areas, range from loss in clearly defined patches to diffuse or total hair loss. The most typical type of alopecia is patchy hair loss on the scalp [1]. After male and female pattern alopecia, alopecia areata is the second most common non-scarring alopecia. Alopecia areata typically has extremely unique clinical hair loss patterns. The most typical pattern is a tiny annular or patchy bald lesion (patchy alopecia areata), typically on the scalp, which may progress to total hair loss only on the scalp (alopecia totalis) and total hair loss on the entire body (alopecia universalis) [2]. Alopecia areata affects approximately 2% of the general population at some point during their lifetime [3]. Depression, anxiety, and a number of autoimmune diseases like thyroid disease (hyperthyroidism, hypothyroidism, goitre ant thyroiditis), lupus erythematosus, vitiligo, psoriasis, rheumatoid arthritis, and inflammatory bowel disease are all associated with alopecia areata [4]. Alterations in the nails may be present in severe alopecia areata. Alopecia areata patients also have higher than predicted rates of atopic disorders as sinusitis, asthma, rhinitis, and especially atopic dermatitis. It is common recognised that pregnancy causes changes in body organs other than those more closely related to gestation.

Obesity is a chronic medical condition characterized by excessive body fat accumulation. It is a primary global health concern associated with various adverse health outcomes. Lack of physical activity is one of the primary reasons for obesity. This study compares the abdominal pressure changes and cardiac parameters between obese individuals with and without powerlifting exercises. This study included 50 individuals divided into 25 in each group. The first group was only obese individuals who weren’t doing any exercises, whereas the second group of individuals were participating in the powerlifting exercises. Selection criteria are male powerlifters, obese individuals with a BMI over 30, age group of 25—40 years, and powerlifters doing powerlifting for a minimum of two years without cardiac anomalies, pain, or pulmonary complications. The intra-abdominal pressure and cardiac parameters were measured using the Chattanooga stabilizer pressure feedback device and pulse oximeter. The collected data were analyzed using SPSS 24.0. There was no significance when comparing the pre-intervention values; all the p-values are insignificant. While comparing the values of the immediate powerlifting intervention (6.926 p < 0.462, 4.599 p < 0.0001, 10.437 p < 0.617) and five minutes post power lifting intervention (6.178 p < 1.133, 6.871 p < 1.161, 9.975 p < 4.96), there is a marked significance. This study concludes that when comparing intra-abdominal pressure and cardiac parameters between obese individuals who engage in powerlifting exercises and those who do not, a significant reduction in intra-abdominal pressure is noted in powerlifters. In contrast, obese individuals who do not engage in powerlifting exercises do not experience a reduction in intra-abdominal pressure, and their cardiac parameters remain unchanged.