PriMera Scientific Medicine and Public Health (ISSN: 2833-5627)

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Generally, stillbirth is only experienced in about 1 out of every 200 pregnancies. Most stillbirths occur before delivery, however, up to 14% of all stillbirths do occur during the delivery period. Infection is an important cause of stillbirths worldwide: in low-income and middle-income countries, 50% of stillbirths or more are probably caused by infection. Infection may cause stillbirth by a number of mechanisms, including direct infection, placental damage, and severe maternal illness. A large variety of organisms have been associated with stillbirth, including many bacteria, viruses, and protozoa.

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The aim of the study - to investigate the influence of risk factors in the mother and morbidity in the neonatal period on the development of hypoxic-ischemic encephalopathy of newborns, depending on their gestational age, as well as to determine the effect of neuroprotection on the development of hypoxic brain lesions in premature infants. 
Materials and Methods At the first stage, a retrospective analysis of the course of pregnancy, child birth and the condition of newborns was carried out in 150 women whose children had suffered from hypoxic-ischemic brain damage. Group I (I G) consisted of 62 women who gave birth to full-term babies, Group II (II G) - 88 women who gave birth prematurely at 26+6 - 33+6 weeks of gestation. At the second stage, the level of neurospecific markers of nerve tissue damage (NSE and S100) was prospectively investigated in 60 preterm infants at gestational terms up to 32 weeks, which were divided in to two groups. The main group (MG) consisted of 30 preterm infants whose mothers were injected with magnesium sulfate for the purpose of neuroprotection, the comparison group (CG) - 30 preterm infants whose mothers did not receive neuroprotection for various reasons.
Results and Discussion The risk factors for the birth of children with HIE include extra genital pathology in the mother (OR 1090.818, 95% CI 64.501-18447.401), urogenital infections-chlamydia (OR 21.87, 95% CI 1.264 - 378.397), prematurity, low weight bodies at birth, PROM, chorionamnionitis (OR 17.6, 95% CI 2.288 - 135.407), Apgar score <7 points, morbidity in the neonatal period. Neurospecific enolase (NSE) was significantly higher in children with gestational age up to 32 weeks and an Apgar score of <6 points. The lower concentration of protein S 100 in
newborns of the main group can be explained by the protective effect of magnesium sulfate on the central nervous system of a premature new born.
Conclusions Risk factors for neurological disorders in newborns include extragenital pathology, urogenital infections of the mother, prematurity, premature rupture of the membranes, the development of chorionamnionitis, and fetal growth retardation. Conducting neuroprotection
with magnesium sulfate before delivery is an important measure to prevent hypoxic-ischemic brain damage to the fetus and premature newborn.
Keywords: hypoxic-ischemic encephalopathy; prematurity; preterm labor; chorionamnionitis; neuroprotection

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The answer posed by the title of this article may seem obvious: that pandemic policies are formulated as a crucial part of public health. However, a more in-depth exploration show that the situation is complex and one may not simply assume that all pandemic policies equate with good public health. To do so would imply that these policies override all other aspects of public health. Current debates among Western societies on this topic are highlighted, and discussed with respect to current pandemic policies in Hong Kong, where differences in culture and health and social systems exist. 

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Hand hygiene is fundamental to clinical practice and has been shown to reduce the risk of major diseases. School children and for that matter, primary school pupils are at higher risk the most because of the lack of paying special attention to a simple but very important personal hygiene behavior such as frequently washing hands with soap under running water and also due to insufficient knowledge on good hand washing with soap practice. Between November 2021 and March 2022, this study was conducted in Tehsil Lalian District Chiniot Pakistan. Data on hand washing practiced among primary school children were collected by using questionnaires. Ten students from each school were selected for the questionnaires and 20 schools in urban and 20 schools in rural areas were covered. The study helped us to check the current knowledge about hygiene and the availability of hand washing facilities in the school. Data were collected from above-mentioned schools by using questionnaires. Interviews were taken from the class students to check their knowledge about hygiene which they are given to the students to guide them about their hygiene and how they teach the students to keep them healthy. In rural schools, about 39% students were selected from class 3, 32% from class 4, and 29% students were selected from class 5, while in urban schools, about 35.5% students were taken from class 3, 36.5% from class 4 and 28% students from class 5 were selected. All schools (rural and urban) have the facility of hand washing points. About 96.75% schools have water supply within hand washing point while only 3.25 schools do not have a water supply. They have tissue papers facility instead of water. About 87.75% schools have sign boards of hand washing to guide the students while only 12.25% schools do not have sign boards on hand washing guide the students. About 71.5% students from rural schools wash their hands before eating food while 28.5% students wash their hands after eating. Further, 66.5% students from urban schools wash their hands before eating food while 32.5% students wash their hands after eating. About 74.5% students from rural schools, wash their hands after playing with friends while 25.5% students sometimes wash their hands. About 63.5% students from urban schools wash their hands after playing with friends while 36% students sometimes wash their hands and 0.5% never wash their hands after playing with friends. About 77% students know the importance to wash their hands with soap when in school and 23% students do not. About 42.75% students strongly agree that hand hygiene reduces the chances of spreading infections, 28% student only agree, 13% disagree, 12% don’t know while 4.25% strongly disagree. About 81% students think proper handwashing minimizes the risk of germ attack while 19% students do not think so. About 88.75% students know that if they fail to wash their hands properly, they will be exposed to the disease while 11.25% students do not think so. About 80.25% students think that poor hand washing can cause disease while 19.75% students do not think so.
Keywords: hand washing; disease prevalence; school children; washing practice; rural areas; urban areas

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This article is addressed to [1] All those who have been part of international development particularly in the healthcare sector long enough to be sick and tired of watching people die or suffer in outrageous numbers of preventable causes in more or less challenging environments, [2] Young professional who are witnessing unbearable facts (waste of minds, waste of resources, indifference, bias, etc.), and [3] Everyone who thinks the state of Global Health is disgraceful compared to what it could and should be and do not want to face any longer conditions included in the following loose and open-ended enumeration

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     Behavior and cognitive functions are results of a fine tuning of multiple neuronal synapsis and a myriad of biochemical reactions whose number, location, components, sequence, and logic are unknown.
     In entirely theoretical terms deleterious effects of reactive oxygen species (ROS) production during aerobic metabolism are neutralized by the antioxidant systems and in this manner the brain effectively regulates its oxygen consumption and redox generation capacity. 
     The knowledge about the metabolic processes of the CNS is so elementary, so theoretical, that only in the previous paragraph we find two notable errors: aerobic metabolism and oxygen consumption.
     The phrase aerobic metabolism refers to the fact that the oxygen contained in any tissue of the human organism, such as the CNS, comes from the air that surrounds us, since it is supposedly absorbed through the lungs and reaches the bloodstream to be distributed to all the cells of the organism.
     However, since 1850 researchers of the stature of Christian Bohr, Carl Ludwig, and Halender, published works in which, according to their experiments, the diffusion of atmospheric oxygen through the pulmonary alveoli could not explain the enormous difference between the concentration of atmospheric oxygen, which ranges between 19 and 21%, and the % SpO2 in the blood that reaches values of 98 and 99% [1].
     It was precisely the search for the mechanism that would explain such a difference between oxygen in the atmosphere and blood oxygen, which led these researchers to publish that there was no such thing, and that diffusion alone did not explain such a difference. 
     Unfortunately, at that time, the work of Krogh appeared [2] who, by means of a theoretical mathematical model, apparently simple, explained the unlikely passage of atmospheric oxygen to the bloodstream through the pulmonary alveoli. Krogh’s lung gas exchange model has been the foundation of respiratory physiology for the past 100 years even though the mathematical concepts it handles are so far-fetched that they cannot even be experimentally contrasted.
     Krogh’s original model has been modified and something like 100 equations have been added to try to explain the supposed passage of atmospheric oxygen to the bloodstream through the pulmonary alveoli, but even so, the experimental results do not
square with the predictions of such a model. So, research and care for patients during the past 100 years has been based on eminently theoretical models.
     So, returning to the phrase “aerobic metabolism of the CNS”, we have the surprise that it is wrong because the oxygen we have inside the body does not come from the air that surrounds us but from the water that contains inside each cell that conforms us.
Keywords: Oxygen; aerobic; Krogh´s model; energy; combustion; CSF

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At my practice, Shirodhara technique was tested on a group of 25 people who did not know what they were going to test. Each received a treatment of approximately 1 hour.
The following questions were asked before and after the session:
“If 0% is the minimum and 100% the maximum of physical and mental stress that you have experienced in your life, how much stress do you feel right now, for physical stress and mental stress?”

The novelty of this research consists in studying the psychological, physiological and ethno-cultural aspects of the use of the ancient Kazakh musical instrument kobyz for health purposes.

Due to the modern stressful rhythm of life, ecological, economic and social problems there is an alarming tendency of general growth of mental morbidity and psychological disorders [1]. Therefore the search for new non-drug methods of psychological correction and recovery is the most actual modern task. Recently the methods of music therapy have become more and more widespread.

Keywords: Bai Chay hospital; Quang Ninh; cancer patient; treatment at home; scientific technology

El-Kass et al (2021) stated Cancer is the leading cause of death in economically developed countries and is a threat to human lives. Cancer and chemotherapy side effects may affect the daily activity of cancer patients and their families on many levels confronted by changes in health status and lifestyles, leading to impaired self-care efficacy. Bai Chay Hospital in Quang Ninh province has been a pioneer in applying tech ology in medical services. Hospitals increase IT application, move towards paperless hospitals, and at the same time improve operating capacity and modernize. Our study shows that Home care service for cancer patients who want palliative care after cancer treatment or terminal cancer patients has been developed in big cities in Vietnam in order to solve one important thing is the psychological problem, when treating at home and reducing waiting time for cancer patients at hospitals.

1. UV Laser (Excimer).
2. Visible Laser (Argon).
3. IR Laser (Ionization Resonance).

The word LASER stands for Light Amplification by Stimulated Emission of Radiation. According to this abbreviation that summarizes the energy generation; it is the light that occurs when the crystal between two full and semi reflective mirrors is exposed to intensified energy amplification the type of laser is named with the substance in the liquid crystal [1, 2]. Laser was first applied in the musculoskeletal system w by Whipple in 1984 using C02 laser. Classification according to the laser optic parameters (wavelength, power and dose) was developed in clinical trials after that date [1, 3]. Laser is known to change cell proliferation, motility and secretion at different doses. Tissue interaction can occur in the form of destruction, liquification, heating and evaporation depending on dose. The type of laser commonly used for the musculoskeletal system is resonance type which can be classified as follows [2];

Keywords: semi-arid; overexploitation of aquifers; planning; crops

The overexploitation of water sources together with the lack of rain due to climate change that causes problems in the recharge of aquifers, this has led to the analysis of possible crops suitable for the current situation to ensure food self-sustainability in the future. Using a system of linear equations in an optimization model, emphasizing the water requirements to ensure the total development of the crop with new technologies, as well as the restriction to the availability of water for agricultural use in the region, feasible and substitutes crops were found. These crops maximize the value of production from the producer’s point of view and cross-price elasticities of supply. This tool will support decision-making in strategic planning in agribusiness and government policies.

On psychiatric consultation of 546 cancer patients there was revealed that 54% of the referrals were diagnosed as having adjustment disorders, 15% delirium and 9% major depression [1]. The results showed elevated risk of comorbid common mental health disorders among persons who at the time of the study were undergoing treatment for cancer across all countries studied compared with either cancer survivors or cancer-free respondents.

Cancer diseases affect approximately 10 million people only in Europe. As a result of the demographic development, their prevalence is expected to double during the next 10 years. Cancer accounted for nearly ten million deaths worldwide in 2020, or nearly 1 in 6 deaths. Meanwhile the number of survivors continues to grow, not just because of earlier detection and treatment, but also because of revolutionary new therapies. This changes the landscape from a terminal illness to more of a chronic illness. Such perspective on neoplasms has broadened the scope of care from treating the disease alone to managing cancer-related symptoms at different stages of the disease trajectory including mental disorders.

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Recently, in standard family conditions, unsocial humans with repetitive behaviors attracts increasing attention. Autism spectrum disorders (ASD) with all its behavioral disorders with deficit communication leading to lack in social interaction, obviously, induced central nervous system perturbations. Awareness of caregivers remains the most important factor facilitating the early diagnosis of autism in children. The educated level in some studies did not contribute for solving the problem of people-misunderstand completely, because their awareness depends on education field and their personality. We suggest that deletion of coding and non-coding genes transmitted from mother to son, resulted from oxidative stress due high anxiety levels, induced ASD. The neuroprotective effect of SNL in combination with MEM, DNP, CTP and ARP exhibited by the restoration levels of dopamine, acetylcholine, serotonin and glutamate. Modulations in neurotransmitters and pro-inflammatory cytokines succeed in adjusting stereotypes behaviors of VAP rats and mice.

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Harmine recently known by its multi-beneficial effects like neuroprotection, anti-diabetic and antitumor effect, but its impact upon animals and human during pregnancy remain pre-estimated with undesirable effects of Peganum harmala, as the plant usually used as an abortifacient by Middle Eastern population, morocco and many other countries. It took place an in depth debate due to its multiple uses and importance, the most abundant alkaloid in the parts of the plant is harmine that concentrated most in dry seeds and roots, but miss in flowers.

Keywords: regenerative medicine; stem cells; classification; differentiation; proliferation

This article is devoted to important issues of regenerative medicine and fetal stem cells administration as its valuable instrument. Herewith we will describe various types of stem cells, mechanisms of stem cells action and the spheres of their broad clinical application.

     The earliest land plants date back to around 3.70 Billion years before. Estimates on the number of Earth's current species range from 10 million to 14 million. They have major impact on Mankind. The impact of the Moon and its rotation around the Earth has many effects on life on the Earth and Mankind. Earth Science taught the Mankind, how to take care of the Nature and obtain the benefits of the atmosphere through plants so as to have a smooth life and healthy longevity.

     The burning of fossil fuels by humans is the largest source of emissions of carbon dioxide which is one of the greenhouse gases that allows radiative forcing and contributes to global warming. For that reason humans should use plant based foods for their overall health instead of animal based foods and plants as a medicines instead of Chemical Drugs.

     During the Nutrition month of September 2020, Government of India has taken a Plantation drive for Promotion of Kitchen Garden under “POSHAN KE LIYE PAUDHE ” (in Hindi language).

     Plants give us various types of seeds and dry fruits which in tern give us Vitamin E. This Vitamin E plays important role in human personality as well as in immune system as an antioxidant, preventing important molecules and structures in the cell from reacting to oxygen. When the delicate components of living protoplasm are attacked by oxygen they are often injured. If one wants to live longer, he/she has to be very friendly with vitamin E. It has now been found out that it has good role to play in many types of pains, not as a pain killer but a pain reliever. Vitamin E may help ease muscle aches after a tough workout, a new study suggests. Researchers believe that the antioxidant mops up the damaging by products created by a strenuous workout.

     Thus depending upon requirements of a person, various plants can be useful to maintain an overall health of a person so as to maintain his or her Healthy Longevity.

     In one study participants took a relatively high dose of vitamin E, the average person could probably get the same benefits from lower doses of between 200 to 400 IU per day.

     Thus the vitamin E which is a water soluble vitamin can be a good pain reliever as also immunity enhancer, if taken in proper proportion as also in proper Natural form.

     Our day-to-day eating habits provide many opportunities for us to support our immune system’s power to protect us. All these are from plant foods like….

    Black resins, dates & apple, provide us with Iron (Fe), Watermelon seeds give us Zn., Cereal sprouts give us Amino Acids. Gooseberry (Amala), Cranberry, Lime juice Sweet lime provide us vitamin C, Sunflower seeds give us Selenium. All these vitamins are plant sourced and are good for enhancing immunity but doses differs from person to person since unique physiological characteristics .Also it is important to know, how the nutrients are prepared & processed & what other substances accompany them into body. This is a Pharmacology of Nutrition. Further it considers alteration in food due to food processing, adulteration & contaminations. Hence food should be healthy & ideally suited to a particular person.

How can our diet affect immune health?

     Our body produces highly reactive molecules called free radicals as part of normal metabolic processes & in response to exposures like pollution & tobacco smoke. Immune cells produce them as a way to fight infections. High levels of free radicals trigger inflammation. Antioxidant nutrients consumed in excess may actually interfere with the body’s antioxidant defences. One has to be very careful while using any nutrient, including plant that high doses of one nutrient can create deficiencies of other nutrients, including those needed by the immune system.

     High-fibre diets can nurture gut microbes that provide anti-inflammatory protection. These microbes protect cells within the colon & seem likely to help protect against inflammation throughout the body. Now we are looking for plant based proteins and try avoid animal based proteins, so more of plant utilisation for our health.

     Make nutrient-dense foods the majority of our plate to provide the wide range of nutrients needed for immune system cells & function. This includes – but is not limited to – minerals like Zn, Se, Fe & Cu,omega-3 fats & protein.

A few more examples where plants can be of more beneficial are like…

     Lemon grass-Cloudy lemonade is served hot as a remedy for chest congestion. Ginger plant Juice-Contains gingerol, is very good muscle pain reliever. It is useful in cough and cold. Watermelon-Cucumber-Mint Juice This drink if taken during summer, it will have a soothing effect on hyperthermic body of a person. Cloves’ Powder and Honey.

     Cloves contain a natural compound eugenol which helps to stabilize blood sugar & has positive effect on artery clogging cholesterol. Carrot juice along with lemon juice works in case of Diabetic persons. Coriander, Basil, Pudina, Aloe vera, Moringa, Turmeric, Garlic and such other plants are good for Human health.

     The European Society of Clinical Nutrition and Metabolism guidelines on nutrition emphasize that their nutritional needs should be met through a balanced diet, adjusted as needed to meet each individual’s condition. But in general, the guidelines say that use of single high-dose micronutrients should be avoided.

In short, more is not always better.

     Free radicals are normal. They are important signals within cells & “turn on” body antioxidant defences but excessive levels of free radicals can damage cells & promote inflammation. Likewise, short-term inflammation is part of how the body clears an infection. If inflammation is out of control however, it can create cell & tissue damage that is difficult to reverse. Most us may be tempted to assume, “if some is good, more is better,” to fight these diseases. But that’s not what evidence shows.

     Pandemic Covid 19 has taught us many things during last two years. One of that is use of Plants for our health. Human body contents Plasma which carries substances like hormones, vitamins, amino acid & antibodies & also contains proteins called clotting factors that help the blood to coagulate. Balance of Saliva, Mucus & cerebrospinal fluids, is important for overall health of a person. Nature plays a major role in Human Health through various plants. Stress has been shown to increase clinical viral respiratory illness in humans. Immunity changes are associated with distress can contribute to the etiology and course of immunologically resisted diseases, such as infections, autoimmune diseases or cancer. So we will see how plants are associated with our health.

Keywords: Turmeric; In-vitro; Antioxidant; Ameliorative; Haemolysis; Radicals; Scavenging

Antioxidants are widely distributed in plants that are either used as food or medicine. These natural antioxidants, especially carotenoids, and polyphenols exhibit a wide range of biological effects which include; anti-inflammatory, anti-aging, anti-atherosclerosis and anticancer. Extraction and proper assessment of antioxidants from plants are crucial to explore the potential antioxidant sources and promote the application in functional foods, additives and pharmaceutical. The in-vitro antioxidant and ameliorating effect of butanol extract of Turmeric (C. longa) on osmotic-induced haemolysis was examined. Various experimental model including iron (III) reducing capacity, total antioxidant capacity, DPPH scavenging activity and in-vitro inhibition of osmotic-induced haemolysis were used for the characterization of antioxidant activity and ameliorating effect of the extract. The extract showed various degree of efficacy in each assay in dosed depended manner. In addition, at concentration of 1000µg/ml, the DPPH radical scavenging activity of the extract was found to compare well with that of the standard compound of ascorbic and gallic acids. From the obtained results, C. longa may be considered to be a source of antioxidant which can prevent oxidative stress.

     An important element to consider is that people with dementia may have limited access to information on COVID-19 and experience difficulties in applying safety strategies (social isolation, self-quarantine measures, wearing masks, and personal hygiene). Therefore, people with dementia may be more dependent on family members and social caregivers to support them [7] to live within government guidelines. This is further impounded by the provision of information through social media and the implementation of digital health technologies. Older people with dementia living in residential settings have not been able to engage with their family members due to the banning of visitors and with the cessation of group activities [8], older people, and those with dementia, are becoming further isolated [9].
     The consideration of the impact of COVID-19 on older people and those with dementia is essential due to the aging global population [10]. The global population of those over 65 years of age was estimated to be over 562 million in 2012, and the population of older adults rose by 55 million in 2015, which is projected to be double by 2050 [11]. Cognitive impairment is common in the older population, although is not a natural part of ageing [12]. The cognitive function of an individual may decrease with age, but mild cognitive impairment and dementia impacts on the person’s ability to independently complete their own activities of daily living, as well as impacting on their memory, language, and orientation. Recent studies showed that the use of computer helped in cognitive stimulation and improved cognitive function with mild cognitive impairment of elderly people [45]. The combined intervention of digital inclusion and physical exercise helped to prevent cognitive and functional loss with elderly [46]. Cognitive decline is a significant issue in aging and it is associated of dementia patients and increases independence, quality of life and falls. Thus, dementia can negatively impact on a person’s quality of life and life expectancy [13]. Dementia poses a challenge to the long-term financial sustainability of health systems worldwide [14]. Likewise, the number of people living with dementia in the developing countries will reach to 71% by 2040 [15] in developed countries such as Western Europe 9.9%, in North America 9.2%, and in America 9.1% of the population by 2040 [16] furthermore, older adults with dementia require further care services such as; care delivery, medication management, education and training for family members and informal caregivers, cognitive interventions, but also leisure activities to support a person with dementia to remain independent, all of which are currently extremely limited [17].
     Interventions to support people with dementia at home, have begun to use video telehealth, which has been found to be feasible to deliver cognitive rehabilitation [18] and improve cognitive performance [19, 20]. Face to face videoconference [21], pharmacological interventions [22], technology-based behavioral interventions [23] and cognitive assessments [24]. These approaches demonstrate that technology-based interventions for older people and those with dementia appears both affordable [25] and reliable [26]. COVID-19 has forced and enabled the adoption of technology in dementia support and care in the form of prevention, early detection, care, management and diagnosis [27]. The applications of these technologies could support older people and those living with dementia in rural areas, and those who have migrated and may have linguistically diverse languages. The COVID-19 crisis has provided the opportunity to embrace technology, to support older people, and those with dementia to maintain their connections with the outside world during self-isolation. Health policy makers, service providers and clinicians need to consider these innovative opportunities and support the technological transformation of dementia practice in the coming years [28].
     Digital health technologies can support a reduction in the provision of care in hospital settings, and support the management of infections [29]. Considering a significant contribution of digital technologies, the American Academy of Neurology has developed guidelines to implement telemedicine services for clinicians to assess and examine their patients, although some limitations have been acknowledged, such as the follow-up appointments [30]. However, this has not been converted into clinical practice as yet. COVID-19 has forced nations to consider the use of digital health, such as telehealth and e-health, which can contribute to the management of communicable diseases during the pandemic and possibly slow the infection rate of COVID-19 through supporting social distancing [31]. Digital health technologies provide and improve patients’ health, and reduces expenses and as well as the need for care facilities [32]. Telemedicine and mobile care tele-mentoring, tele critical care were significantly useful to offer care facilities during COVID-19 [33]. Within the specialist field of dementia memory screening tools, care, management of behavioral and psychological symptoms in dementia and consultations [34], have occurred through the use of remote technology. This approach has supported the difficult balance of maintaining social distancing and continuing to support people living with dementia, and those caring for them, but has also enable a significant cost reduction to the health system and decreased the risk of infections [35]. Furthermore, these processes have enabled clinical decisions, diagnoses and outcomes to be supported in a timelier manner, supporting earlier intervention opportunities [36] to support and improve mental health.
     Technology can also contribute to the reduction of the burden on healthcare institutions and professionals [37]. Technology has also been applied through satellite monitoring, health sensors and apps, Drones (drones were applied in carrying medicine), spraying disinfectants and 3D Printing which was deployed to mitigate shocks to the supply chain and export bans on personal protective equipment [38]. Digital health technologies have not only supported older people and those with dementia, through remote screening and the facilitation of care during a pandemic [39]. Telehealth played directly and indirectly in reducing the contamination by enabling physical distancing, tracking symptoms and detecting timely using interventions [40]. Further, telehealth supported to bring out put with patients’ safety, reliable and flexible regulatory [41]. Virtual care using technologies in home patients and out patients care in health institution, initial COVID-19 hospital surge, and post pandemic recovery was most effective for the care of the dementia patients [42].
     Emerging technologies are changing our daily lives under lockdown. The COVID-19 crisis has shown a further way that emerging technologies like the internet and artificial intelligence are not just tools, they are essential to the functioning of our society and economy in this 21st century. Thus, such digital tools must adapt as essential developmental procedure as the time progress. It is not only for COVID-19 issues but also should be implemented to make our daily life easiest than before to fight with communicable disease. Digital technology enables to educate from remote to health workers and populations to follow better care in limited resources and accurately using the Chatbots information getting update of current health systems and patients care home location of their activities and protect from the spread of the virus. Also, saved time, money and to all the sectors and will be cost effective [43].
     However, is still a gap in the research regarding how and which digital health (DH) technologies can be effective to support older people and those with dementia patients. But the reality is we are seeking more reliable proof to apply and implement the full potential of this growing area in health science [44]. Therefore, supporting older adults with dementia and maintaining their well-being during COVID-19 has become an urgent to apply digital health technology.

     COVID-19 is a global pandemic, with the highest rates in the US [1]. Many countries have enforced lockdown and social distancing as a process to control the epidemic [2]. Despite such stringent global efforts, the numbers of cases are again continuing to rise [3], and all aspects of society are being impacted [4]. The cases of COVID-19 in South Asian are comparatively less than developed countries, even though poor health care facilities are available [5]. Internationally, health authorities and governments are warning older people (those over 65 years old) of the high risk of negative outcomes associated with COVID?19 [6]. Older people and those with dementia are at high-risk of COVID-19 due to their age and multiple comorbidities.

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Keywords: Systematic literature review; systematic review; Meta analysis, protocols

     Evidence in clinical practice shows us various effects of improper communication on individuals; they range from minor to significant alteration of people’s health, according to the subject matter, transmission channel [oral, written format], interaction [face to face, virtual] type of communication [verbal, and nonverbal], time and exposure magnitude, dissemination area, environment characteristics, and sensitivity and vulnerability of intended recipient. Middle-aged people and the elderly are more sensitive to offensive attitudes and inappropriate words' energy transfer to them. Unskilful interactions imply the adrenergic pathway increasing activity determining changes in the blood volume flowing through the vessels, finally altering the cell’s functionality in the fragile area. Transitory and persistent unsafe communication increases blood pressure; it is another key for initiating, maintaining, and accelerating the evolution of arterial hypertension, affecting the heart and blood vessels. High blood pressure in arteries determines changes and adaptation of their structure and function in line with time action, forces, and individual susceptibility; it goes along with other risk factors for the building-up of atherosclerotic plaque. Atherosclerosis narrows blood vessels, disturbing the corresponding areas working. If nutrients and oxygen supply decrease by another medical condition interplay, the summative for possible exponential count effects increases. Atrial fibrillation, heart failure, stroke, peripheral arterial disease, chronic kidney disease, vision loss, or altered mind activity may be some effects of such disturbed blood volume flowing. Suggestive clinical signs and symptoms accompany the gradual or sudden loss of function of altered zones. Compiling all factors implying the functionality of the cardiovascular system, including communication skills, we have a general picture of its changing harmony and possible fissures; brain haemorrhage is an unwanted situation. The loss of proper control of the individual working appears under excessive nervous tension. Usually, forceful discussions between business partners, family, and community members may generate haemorrhage in fragile areas. Words’ battle forces exceeding limits lead to subsequent disorders in the easily broken zone. Other effects of inappropriate communication are initiation and advances of dyslipidaemia, altered blood sugar control, leads to depression, and generates people’s conflict ending in their separation or death by victim’s physical aggression or suicide. Concern about the wrong delivery of bad news in clinical practice is necessary since unskilful transmission of such info can lead to disaster in a person at risk. Improper communication affects an individual [intended recipient], but the effects extend to their dear ones, who will suffer for their distress. Finally, unsuitable communication alters individuals’ well-being.

     By contrast, the best communication skills delight people, amend the worsening of individual health, and improve life quality and expectancy. The right, kind words and attitudes act as medicines and must be considered in the personal therapeutic plan; they may resonate with a person, harmonizing his mind-sets. Practical, suitable terms and images created with the words assist the people passing trouble time for a better emotional state and enhance their ability to deal with dilemmas. Magnificent word composition energizes and inspires humans. Stars in this zone fascinate the individual since their words are a miracle in the body's functioning. The best words’ composition, products of divine inspiration, produces a good, bright effect.

     There are communications in front of indifference.

    Therefore the words represent a valuable communication channel for people’s collaboration; they inform us about the difference between individuals. Words influence the nervous system’s functioning through their energy and meaning. Appropriate word energy people use in interaction leads to effective clinical outcomes in practice. Unsuitable words’ energy and power alter their health and decrease work efficiency and social and professional life. For these reasons, communication skills represent a central theme for public health. In a family, there are differences between generations. The aspirations of older adults do not align with those of a young age, leading to conflict. Excessive debates and opinion differences generate nervous tension, leading to disaster for vulnerable people, as mentioned. Respect and appreciation for the parents’ input for their children’s professional, social, and cultural life formation are required. Over time the parents usually do not have a good memory or judgment. Their child has to impart compassion, be polite, and be attentive to them. Promoting good habits in doing well for other people, especially with the parents, is mandatory. Health promotion messages, such as ‘Be polite, and you’ll be rewarded,’ can effectively increase attentiveness and interest in communication. Encouragement and emotional support are essential for the elderly health improvement. We must advocate for the refinement into a partnership between the patient’s family, community members, and business partners. Professionalism in all domains is necessary. Unhealthy behavioural manifestations may originate in mental disorders, and we must identify and treat them. Modelling people's interaction adversities is a key to preventing and treating other disorders, including recuperating altered personality traits; social, professional, and culturally safe work is essential for society’s refinement and advancement. Artificial Intelligence supply offers another perspective for analysis, modelling, and applying the best communication skills in practice. Based on an analysis of ‘what happened?’ guided by AI experts, we can predict what will happen, and they can insert an influence mechanism as a solution and services for corrective actions to mitigate the harmful effects of an individual’s improper communication. Educational programs, hybrid models, IT devices, and artificial intelligence supply offer us the opportunity for instruction, modelling, and recovery in a short time, and that chance never existed before. They ensure human safety for a better life in an unceasingly changeable environment. The people must be aware, especially of words’ power to illuminate or destroy personal values. In this digital era of innovation, technological advances and discoveries allow us to use the words’ composition to our advantage, with cost and time saving, at our e-comfort, when and where necessary, for revitalization or peaceful moments. The ability to cope with harsh conditions makes us influential people in dilemmas. Improving our knowledge, communication skills in daily practice, customer centricity, increased revenue, and best interaction with other trades define us as professionals. Guidance in this direction assists us through excellence in the way of living, in the end, appreciation, and offerings abundantly supplying.

     People interact with their energy with or without words, attitudes, and images thinking of them. Their relationships vary individual emotional states, ways of thinking, and acting toward others. Unsafe interactions between them alter the personal equilibrium, and the best communication skills offer comfort and improve life quality and the person’s health. Genetic and environmental factors influence verbal and nonverbal communication styles. Well-educated behaviour elements ensure people effective collaboration. Instinctive and unskilful cooperation between them is in front of illusory health, deceptive clinical manifestations following.

Aim

     To highlight communication dimensions between generations and new choices for moral distress restoration in the digital era.

Material and Methods

     A qualitative study performed by the author in the community, 2008-2022, relating to communication value for people’s health. The effects of inappropriate communication were noticed and corrected when and where necessary and preventive actions were initiated.

Findings

     One day in the spring of 2021, a patient, 89, in interaction with a physician in public, used impolite attitudes and words, determining moral distress for the physician.

Patient medical history; widow: 1972; HTA: from 1972. Heart failure, NYHA class II, 2021; NYHA class III, 2022.

Patient family health history: brothers, sisters, parents: HTA.

Actions were taken

     The physician made no comment in public, but a few hours after that incident, when observed the patient alone, she went to her and compassionately scolded her. The patient commented: ‘I said it, and if I said it, what should I do now? Take a cake here from mine to pass you by! I am upset since my son-in-law passed away; he was diagnosed with COVID, and today is the funeral.’ The doctor was affected by the situation and expressed her condolences. To amend the moral distress generated by interaction with that patient, the physician listened to a selected classical music program and enjoyed chosen lectures.

Results

     No other offensive communications were noticed for that person.

Conclusion

     Grave life events and medical conditions make an older person less attentive in interaction with others in public. Supportive actions from the community can ameliorate their suffering. The digital era offers a new perspective on moral distress restoration.

Discussion/ Implications

     Older people were more affected by the pandemic COVID ID19; the loss of their dear ones makes them more vulnerable and sometimes unwise in interaction with others. That patient, in those moments, was probably furious with all physicians, considering the loss of her son-in-law. People must resonate with their suffering, understand their judgment impairment, and support them. Compassion, kind words, friendly attitudes, and encouragement are practical actions to ameliorate their distress. Moral distress restoration benefits in this era of technological advances; IT devices offer a new perspective that never existed before. The selection of the different programs according to individual preference, using the ‘watch on demand’ function, images from nature, reading stories of interest, and channels-mid conversation with dear ones are helpful instruments for restoration of moral distress. Digital products inspire, energize, and encourage us, even in difficult times. Walking in nature is another effective, cheaper technique for health improvement. Self-esteem in intersection with the principles for people’s collaboration in public may exceed the limits; the elderly often hurt us since time slowly undermine all.

     The people interact through their energy, with and without words, attitudes, sounds, and images, thinking of them. Individual behaviour reflects mind activity relating to others. A young person’s voice usually varies from that of an older individual; the elderly often share memory impairment and judgment differences; sometimes, reasoning deviance and unskilful transmission of their viewpoint in public are observed.

     The author of the article owns a series of publications highlighting the features of the pathogenesis of a new disease: "COVID - 19 - POSTCOVID SYNDROME", as well as a method of treatment and prevention of this disease based on the scientifically proven healing properties of Hirudo medicinalis medical leeches [3-13]. At the same time, the editors of three scientific medical journals have already adopted the author's concept of the name of the disease - "COVID - 19 - POST-COVID SYNDROME" [11-13], which reflects the understanding that this is a single disease that has two phases: the first phase is an acute process, which usually lasts 2-3 weeks - ("COVID - 19") and the next phase is the development of a chronic process - ("POSTCOVID]. The team of MGNOT doctors, represented by its Chairman - Professor A.P. Vorobyov, offers the following treatment for "Post-Covid syndrome": 1. Apply direct oral anticoagulants, twice a day; 2. Plasmapheresis - at least 900 ml, for 1 procedure, at least 5 procedures, daily, with plasma replacement with saline to reduce intoxication [6]. It should be noted that the use of direct anticoagulants has a number of limitations and significant complications with damage to the central nervous system, they can cause nasal, throat and renal bleeding. Plasmapheresis is applicable only if there is special equipment and trained personnel in the clinics. Given the huge masses of the population affected by the pandemic, the proposed treatment technology has no chance of large-scale application. SYNDROME"), which can last for 18-24 months.

     Such a definition of the new pandemic is important not only from a taxonomic point of view, but, above all, from a mental point of view, so it gives the doctor an understanding of the complexity of the course of the disease and requires monitoring patients during the entire specified period, for example, monitoring the dynamics: D-dimers, prothrombin time, platelet count and the level of fibrinogen in the blood of convalescents. These are the recommendations of the International Society on Thrombosis and Hemostasis (ISTH) [15]. Now these are the most informative markers of the danger of thrombosis. The term "Long COVID" does not reflect the essence of the disease process [13].

     It should be clearly distinguished that the cause of the disease is the virus "COVID-19" (Beta-coronavirus SARS-CoV-2), and the disease itself, for these reasons, should be called "COVID-19 - POSTCOVID SYNDROME".

     Analyzing the pathogenesis of this disease, we will dwell on the analysis of the pathogenesis and treatment offered by two scientific schools of Russia. One of them is the analysis and opinion of doctors united in the Moscow City Scientific Society of Therapists (MCSST) named after Professor S.P. Botkin. After examination and treatment of a significant number of patients (more than 2,000 people), with a confirmed diagnosis of “COVID-19”, during 2020-2021, the diagnosis of «POSTCOVID SYNDROME" was formulated. According to MCSST " POSTCOVID SYNDROME " is: “Chronically occurring thrombovasculitis with a predominant lesion of the nervous system (Central, autonomous and peripheral) and skin” [14].

     The team of MCSST doctors, represented by its Chairman - Professor A.P. Vorobyov, offers the following treatment for "POSTCOVID SYNDROME":

1. Apply direct oral anticoagulants, twice a day;
2. Plasmapheresis - at least 900 ml, for 1 procedure, at least 5 procedures, daily, with plasma replacement with saline to reduce intoxication [6].

     It should be noted that the use of direct anticoagulants has a number of limitations and significant complications with damage to the central nervous system; they can cause nasal, throat and renal bleeding. Plasmapheresis is applicable only if there is special equipment and trained personnel in the clinics.

     Given the huge masses of the population affected by the pandemic, the proposed treatment technology has no chance of large-scale application.

     Another clinical school, headed by academician Makatsaria A.D., believes that the leading pathological sign of this disease is the "Syndrome of disseminated intravascular coagulation - (DIC) syndrome [15]. The most unfavorable prognostic sign, according to the authors of this school, is coagulopathy.

     If the parameters of the main markers of coagulopathy (D-dimers, prothrombin platelet time, count and fibrinogen levels) worsen, more "aggressive" resuscitation care should be carried out: Low molecular weight heparin (LMWH) should be prescribed to all patients with diagnosed “COVID-19” infection (including non-critical patients) who require hospitalization, in the absence of contraindications to LMWH in these patients. The use of LMWH drugs by this school (Enaxiparin, Nadroparin, Dalteparin) in a prophylactic dose is also justified, which does not require special control. It is recommended to take these drugs to all patients, even with a mild course of the disease, excluding active bleeding, platelet count < 25x10⁹/l, intolerance to LMWH, severe renal failure.

      At the same time, it is not known how these drugs will behave with prolonged use, except for the above limitations for them.

     The author of this article spoke at the 11^th European Congress for Integrative Medicine in 2018 in Ljubljana (Slovenia) [1] and at the 5^th International Meeting on Traditional and Alternative Medicine in Rome (Italy) April 2019 with a report: "The Renaissance of hirudotherapy in Russia: The end of XX and the beginning XXI century [2]. These speeches and publications were positively received by the medical community, which served as an incentive for a more complete coverage of the topic of the current state of hirudotherapy in Russia [11-13].

     Without reducing the importance of the recommendations of the MCSST therapy of "POSTCOVID SYNDROME"), we offer an alternative way to solve the problem of reducing mortality from pneumonia and other complications caused by “COVID-19”. Previously, we expressed the same point of view in the treatment of elderly people with multi-organ pathology, namely, they become primarily victims of this pneumonia [4].

     This is the application of the "System Method of Leeching" (SML) - (hirudotherapy). The method is based on a combination of the principles of homeopathy and acupuncture (hirudopuncture, our definition). The proposed solution is based on the almost 30-year use of SML in elderly people with multi-organ pathology and children treated at the Academy of Hirudotherapy of St. - Petersburg [16]. The preventive and therapeutic plan for anticoagulant and antiplatelet therapy for the prevention of DIC- syndrome, distress syndrome is considered step by step from the standpoint of the “System Method of Leeching” (SML) in recent publications [4, 17].

     We remind readers about some unknown properties of leech.

     Over the past 30 years, the Academy of Hirudotherapy in St.- Petersburg has obtained a number of new fundamental facts when applying the “System Method of Leeching (SML), which can significantly enhance the clinical effect of its use, and will reduce the mortality of patients with pneumonia caused by the “COVID-19” virus.

In addition to the already known properties of hirudotherapy - antithrombic and thrombolytic, anti-inflammatory, countercurrent, new properties of medical leeches were discovered at the department:

• Discovery of the energy effect (information-entropic);
• Discovery of the neurostimulating effect of the medical leech;
• Discovery of the acoustic effect of leeching (hirudotherapy);
• Discovery of the detoxification effect of leeching (hirudotherapy);
• Discovery of the phenomenon of local hyperthermia in the body of a benign brain tumor - neurinoma;
• Discovery of the negentropic effect of leeching (hirudotherapy);
• The role of autohemogyrudotherapy in the formation of the immunomodulatory effect of leeching (hirudotherapy) is shown;
• Discovery of the aquastructuring effect of leeching (hirudotherapy);
• Discovery of the "Resonance-wave effect" of leech on the state of the human aquasystem.

     Descriptions of all these discoveries are detailed in the author's publications [3-13, 17].

     Therefore, as soon as the pandemic caused by the “COVID-19” virus was pumped up in Russia, our doctors, trained in the SML technology, began to actively apply this method in the treatment of the disease "COVID-19 - POST-COVID SYNDROME".

     At the same time, it was shown that SML is a pathogenetic method of treating this disease, including well-known signs of damage to the central and peripheral nervous system, (restoring smell, hearing and vision loss, manifesting antidepressant syndrome) preventing the development of DIC - syndrome.

     It should be noted that the use of SML has no restrictions on the timing of use, so a patient with a brain tumor - a neurinoma (schwanoma) received treatment for 23 years, demonstrating a positive result of treatment (Clinical case

described [18]).

     Why do we refer to hirudotherapy as a “Method of information medicine”?

      Not only because this method has about 20 types of therapeutic effect. But also because in the process of treatment with medical leeches, which is first shown in our studies, there is an impact on the information-entropy processes in the aqua system of patients, which leads to a process of harmony between the indicators of the chaos criterion (C_c) and the order criterion (C_o), with access to the harmony parameters - "Golden Proportion" or "Golden Ratio", which is characteristic of a high level of health [5, 19].

     Known for many centuries, the method of hirudotherapy, as part of Ayurveda or Ayurvedic medicine, is still revered and used in India and the countries of South-East Asia.

     At present, thanks to new knowledge in the field of hirudology and hirudotherapy, reflected in the "System Method of Hirudotherapy", the Ayurveda method has acquired a new image, content and capabilities.

Conclusion

     The SML method has no complications and can be used as monotherapy in both the acute and chronic stages of the disease "COVID - 19 - POSTCOVID SYNDROME".

The article discusses the mechanism of the disease "COVID - 19 - POSTCOVID SYNDROME". The mechanisms of pathogenesis of this disease are affected. The most proven mechanisms of the pathogenesis of the disease and the most effective methods of treatment according to the literature are considered. In comparative terms, the advantage of the "System Method of Leeching" in comparison with the proposed methods of treatment is shown. The possibility of monotherapy with medical leeches (hirudotherapy) of this disease is shown, as an example of information medicine.

Keywords: Disease "COVID - 19 - POSTCOVID SYNDROME"; damage to the nervous system (central and peripheral); DIC- syndrome; “System Method of leeching” (SML) - hirudotherapy; new effects of hirudotherapy

Robotics in medicine is very innovative field of research and exploration recently. Recent advancements in different robotics technologies utilized in medical and personalized healthcare are in huge concerns both in academia and industry fields. Getting yourself to be familiar in the recent state-of-art in the different fields covering robotics in medicine is great step towards being professional in high demand for medical, personal healthcare, robotics and IT industries.

Topic Field-1: The board Spectrum of Robotics Applications in Medical and HealthCare Monitoring.

Topic Field-2: Recent Advancements of Medical Teleoperations.

Topic Field-3:  Medical Imaging and Image-guided Surgery.

Topic Field-4: Kinematics of Medical Robotics.

Topic Field-5:  Tracking & Surgical Navigation.

Topic Field-6: Surgical Collaborative Robots.

Topic Field-7: The Rise of Metaverse in Future Surgery.

Topic Field-8:  Towards Successful and Widely Adoption of Robotic Surgery in Common Surgical Procedures.

Topic Field-9: IoT and Digital Human-Body Twin for Precise and Reduced Cost Remote Robotic-Surgery.

Topic Field-10: The power of Artificial Intelligence in Personalized HealthCare and RoboticSurgery.

The section of robotics in medicine covers a wide spectrum of the recent advancements of connected modern technological infrastructure that allow collaborative and remotely precise surgical operations. The analysis of the potentials of the medical system under investigation in this book are hugely beneficial for researchers in the fields of personalized healthcare, remote precise surgical operation, modern image processing and visualization techniques and artificial intelligent automated services in medicine.

Public health medicine faces many obstacles and challenges, especially in developing countries. One of these challenges is that public health medicine is not given a high priority like other specialties of medicine. The reason is that health planners in these countries are focusing their efforts on secondary, tertiary, and advanced healthcare services and do not give the required support to public health medicine that considers effective wall to enhance the general health of the population, through the building of an integrated primary health care programs to detect and deal early with cases that may slip to higher levels of health care and cost healthcare systems a lot of money.

Governments and policymakers across the globe should give more attention to the public health medicine discipline as it is considered one of the pillars that enhance the health of societies and make them active and productive at the same time.

The health of the population is not the responsibility of the healthcare system, but of society as a whole. So, while public health may be within the health care system, it necessarily operates to a large extent beyond that system, at a community and societal level. Public health defines as the is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society. On other hand, Public Health Medicine is one of the specialties of medicine that aims to promote health and prevent diseases and injuries (primordial and primary prevention), in contrast to the medical model of care, which focuses more on reacting to the illness through diagnosing and treating them after they occur (secondary and tertiary prevention). Public health medicine also focuses on assessing and measuring the health status of populations and developing effective interventions at the population level rather than individuals and creating the conditions that enable people to make healthy choices to improve their health.

   In fact, the feeding of human populations has gone from the collection of fresh vegetables in nature, to specialized production in large monoculture extensions, with high mechanization and use of agrochemicals; that is, from natural foods to those manipulated through different technological processes. The latter have become a few basic products, whose negative effects are well known, due to prolonged exposure over many generations to a low diversity of foods and their associated microbiota, which is why nutrition and immunity functions have been reduced naturally in the human microbiota (Vázquez 2022).

   Paradoxically, families from periurban communities, sometimes socially marginalized, are more likely to obtain food in small spaces, which provide them with a diversity of seminatural fresh products, because they are obtained with minimal physical interventions, not chemicals and very little manipulation, whose biotic direct interactions contacts with family members influence nutrition and health, facilitating a sustainable quality of life despite living with low income. In fact, these periurban communities constitute coinnovation niches that can serve as a reference for designing the food systems of the future.

Habitat and feeding

   An estimated 800 million city dwellers worldwide are involved in agriculture-related activities in cities and towns, where they produce food and generate income. A combination of data from national censuses, household surveys and research projects from various agencies indicate that up to two thirds of urban and periurban households are involved in agriculture, through local government, institutional, community and family programs (FAO 2010).

   It is interesting to observe that in the members of these families there are contrasts of origin, training and ages, which converge with a permacultural, organic or agroecological perception regarding family farming, mainly when elderly people of peasant or rural origin live together, who transmit their cultural traditions; also, people who have received training that allows them to understand the differences regarding feeding with products from conventional agriculture.

   Carrying out biodiversity management practices in small scale agricultural production systems, with social and environmental advantages in historical, socioeconomic, and geographical contexts in Latin America, has helped to maintain more sustainable agricultural systems than the technified ones (Mougeot 2006). These urban green spaces can provide vegetation structures and biodiversity for ecosystem functions and services, across fragmented habitats and spatial scales (Lin and Fuller 2013).

   Although urban agriculture alone will not solve the complex ecological and social problems of cities, given the multiplicity of factors that intervene in it. Agrocultural development in the city constitutes an effective strategy for the management, protection, and recovery of the urban environment from various spheres of action (Moreno 2007). In fact, small scale agricultures are those that produce around 70% of the food worldwide, using only 30% of the productive resources, while industrial agriculture produces 30% of the food in 70% of the surface (ETC 2017).

   Small scale food production in urban and periurban areas has become an important component in the design of feeding strategies in large cities of the developing world and is an agricultural production alternative with almost nonexistent negative environmental impacts (Morello 2000), experiences that justify the importance of integrating the habitat with the self management of food that can be considered as seminatural.

   In fact, human health is closely related to the environmental factors (Mejías 2013). The different existing models on health determinants contemplate the environment as an important factor to take into account (Evans et al 1996). Considering that the city is the main environment in which life takes place for a large part of the population and that, as has already been seen, it is possible that it will increasingly accommodate a greater number of people, it seems advisable to study how to make these ecosystems healthy spaces (Mejías 2013).

   Several studies indicate that contact with nature and the inclusion of green spaces in urban environments promote psychological wellbeing, stress reduction and improve the perception of health of its residents (Largo-Wight 2011).

   Given this need, agroecology emerges as a discipline that provides the basic ecological principles on how to study, design, and manage agroecosystems that are both productive and conserving natural resources, and that are also culturally sensitive and socioeconomically viable (Altieri 2010).

Food and health

   The modern diet is vastly different from that of our Paleolithic ancestors, who had an annual base of some 500 different plants, whereas ours has fewer than 50; they ate their food raw and often fermented, while we preserve, dry and cook our food, processes known to destroy many sensitive nutrients and antioxidants. This may be the reason why we are now seeing an increase in various atopic diseases, infections and so-called Western diseases (Bengmark 2001).

   Several leading authoritative reviews have shown that dietary diversity is associated with better health outcomes, and that a monotonous diet, even biofortified, is associated with nutritional deficiencies and high rates of chronic disease (Bélanger and Johns 2008). Another potential positive effect of participation in urban gardens is an improvement in nutritional habits there are studies that indicate that the consumption of fresh fruits and vegetables is higher among horticulturists than among those who are not (Alaimo et al. 2008).

   On the other hand, the postharvest rehandling of fresh agricultural products is a factor that can generate risks for healthy eating, mainly when good packaging, transportation and temporary storage practices are not guaranteed and the marketing circuits are long. This situation does not occur in family and community agriculture, where freshly harvested food is used or consumed in a short time, either by the family or community members.

   Through social practice, societies have developed experiences and systematized special ways of "know and to know" about health and disease, which have gradually shaped a set of notions and knowledge formed in people's daily and spontaneous common practice, until arriving at the empirical practice that concentrates and systematizes the experience of the community in a long time. This informal knowledge, of unquestionable cultural value, is considered by some health professionals as something that must be preserved or recovered due to its secular value (Silva 1997).

Sustainable quality of life

   The sustainable quality of life, although it is a highly complex socioeconomic challenge for health systems, can be considered as one of the priorities for the survival of human populations. It is a holistic approach to health conservation, which is particularly different in urban, periurban and rural systems, where factors that determine habitat quality, healthy eating and natural medication converge.

   People who have a working life in different occupations in society, find a moment to take care of plants and animals, which means a change of work that they do with pleasure, because it has the double function of contributing to the wellbeing of the family and their health, for being doing physical work. This is the integral health of the family, because they coexist in harmony with plants and animals that provide them with different benefits, be they food, nutrition, medicine and pleasure.

   Another problem is the social isolation suffered by a significant number of older people, which is an important risk factor for developing other disorders or pathologies (Kharicha et al 2007). It is mentioned that, for example, in Sri Lanka the shade, freshness and diversity of these orchards are considered essential for people's physical and mental wellbeing (Lok 1998).

   Although the current needs of human populations are diverse and of a high magnitude, integrating orchards into urban, periurban, and rural family homes has an invaluable contribution to sustainable quality of life, because it contributes to rediscovering habitat, food, and health.

   The original human populations lived in communities, where they coexisted in a feeding system integrated into the natural habitat. With social development, they were regrouped into urban (towns and cities), periurban and rural socioecosystems. These characteristics have contributed to the fact that today's society is made up of population conglomerates in anthropized habitats, where the quality of food and the state of health, which are still valued separately, have become important social problems, including in rural areas, where the influences of modernity have eroded traditional food culture and medication.

   Our world revolves around its advanced axis. Everything is progressive and innovative. Newer technology is on the horizon, and it has changed the spectrum of our world and transformed the way people live. This digital rise brought pros and cons to our scheme. This technological breakthrough contributed to different spheres of existence.

   The security of its citizens is the government's first priority. Since individuals are the most valuable resource the government has, improving medicine and medical procedures is essential if we want to win the public's trust. The delivery of public health is efficient if one medical practice is effective. We refer to this as the "parallel effect."

   Public health and medicine are intricately intertwined. The understanding of and contribution to public health made by medicine are changing along with the world. All facets are moving toward high definition and the internet of things as we reach the fourth industry. The cosmos is increasingly facing extreme climate change, which has negative effects on human health and the ecosystem. People are more involved in unrelated work, which increases the likelihood that health hazards will arise. Because of this, innovation in medicine and public health must coexist.

   By properly implementing various programs and curricula related to the effective use of medication as a therapy for any disease, public health is the process of creating a healthy environment for healthy people. The challenge here is how well public health professionals can treat everyone with inclusive medication in order to prevent any health complications. The 4^thIndustrial Revolution has profoundly changed the medical industry in many ways, so it is important to take that into account while promoting public health. Extensive learning is essential in order to practice advanced medicine.

   In a general sense, the primary goal of medicine and public health is to promote and improve the health of every individual and the whole population. This must include appropriate program implementation for the right people at the right time and in the right place. A comprehensive and thorough understanding of how to carry out this attempt in order to promote healthy well-being and a disease-free environment that is resilient throughout the seasons.

   The exceptional effect of COVID-19 disease greatly affects everything in the system. When it strikes, many lose their jobs and even their precious loved ones. Everything was on the brink of closure, and health is the major concern at this time. For the past two years of battling against COVID-19 disease, we have been in a health recovery as we face the so-called "new normal. Post-pandemic experiences improved the medical world's understanding of public health issues and concerns. Medicine, like technology, is evolving at a rapid pace today.

   Best practices of hospital, efficient leadership in healthcare, appropriate delivery of services to the patient at right time/ pace and empowered patient are the scenario of win-win. The grapes not only appear sour but also bitter!  Countries, companies and organisations are all striving to contain cost but the tug of war is highly imbalanced.

What is the solution?

   A techie / IT professional is much well paid, doctor is always on the receiving end, nurse is never polite and what not. Despite all Care of the infirm is a priority. Let us strive and make the system better. Pleasant interactions at a hospital are possible with these

• Patient centric management.
• Responsible reception desk.
• Well oriented progressive signages.
• Concerted team management of HR.
• Individualised billing priority.
• Incentivised feedback.
• Universal coverage. F.2

   To err is human, agreed. But amidst these humans exist the divine species of healthcare workers. Governments, policy makers and the general masses need to realise this and implement this in day to day lives.

   As per IMCA London, Cost Accounting is defined as “the process of accounting of cost from the point the expenditure is incurred or committed or committed to the establishment of its ultimate relationship with cost center & cost unit”. F.1

Three Kenya Medical Training college campuses were selected purposively, mainly, Bungoma in Bungoma County, Webuye in Bungoma County and Kakamega in Kakamega County. Across sectional analytical Study design was employed. A sample of 222 students and 12 key informants were included in the study. Systematic random sampling was used for selection of students. Structured questionnaires were used to collect data from students, Interview schedules used to collect data from Key Informants. Collected data was entered in the SPSS Version 21.0 and data analysed by descriptive statistics using percentages and means and inferential statistics of odds ratio used to test strength of association and 0.05 set as p value used to test the hypothesis in academic dishonesty. The response rate was (90.1%) n=202. The study findings revealed that out of 202, (47%) n=95 agreed to have been involved in some form of academic dishonesty; Most students, (40.1%), n=81 confessed to have received information on academic honesty through students’ hand book. The results revealed examination cheating as the main form of academic dishonesty (71.6%) n=145. The main contributing factor to academic dishonesty was lack of lecturers adhering to policies in administration of examinations and overcrowding (OR: 2.3; 95% CI: 1.2-4.5; p=0.01), students not aware of college rules (OR: 0.6; 95% CI: 0.3-1.0; p=0.07) followed by family pressure to score high 47.8% (n=97). Students reported that punishment, remedial teaching and ant plagiarism software detection strategies were explained to them at the beginning of the training (OR: 1.4; 95% CI: 0.7-2.7; p=0.03). Consequences for academic dishonesty differed from college to college (OR: 1.9; 95% CI: 0.9-4.0; p=0.04). The most employed strategy for addressing academic dishonesty was use of punishment. In conclusion, the study revealed that academic dishonesty was prevalent in the three colleges with cheating as the commonest form. Punishment was the commonest of all strategies used to deter students’ involvement in academic dishonesty. This study therefore recommends that lecturers should adhere to college policies particularly during invigilation of examinations and provision of enough spacing during examination to reduce examination malpractices and more current strategies like software plagiarism detection to be employed by the college administration in curbing academic dishonesty.

Globally, over 80 % (6.8 millions) of college students believe dishonesty in academics is a necessity to excel. On average, 70% of students confessed to having engaged in different forms of academic dishonesty. In Sub Saharan Africa approximately 50% (4.1 millions) students were involved in acts of academic dishonesty. In Kenya about 50% (70234) academic dishonesty occurs in most colleges in the Kenya Medical Training College with various forms being reported in the year 2012 and specific to western region, about 50% (20,243) of students in higher institutions of learning admitted to have engaged in different forms of academic dishonesty. A report by Kenya Medical Training College for the year 2015/2016 revealed an upsurge in academic dishonesty in most colleges nationwide. Contrary to the fact that Student are expected to be honest in their training as their future career revolved around taking care of people. Specific to Western region in Kenya, there has been limited documentation on academic dishonesty. Therefore, this study aimed at investigating academic dishonesty among nursing students in Kenya Medical Training Colleges in Western Kenya to specifically identify prevalence, factors contributing to academic dishonesty and strategies to prevent the same.

Keywords: Epidemiology; bacteriology; urinary tract infection; Sikasso; Mali

The objective of this work was to describe the epidemiological and bacteriological aspects of urinary tract infection in Sikasso hospital. This descriptive prospective cross-sectional study took place from February to August 2022 in the laboratory of Sikasso hospital. The identification of the bacteria was made from cultural, biochemical (Api 20E gallery) and antigenic characters. Antibiotic resistance was performed using the disc technique in agar medium and interpretation was made according to the recommendations of the antibiogram committee of the French microbiology society. We practiced 448 uine cytobacteriological examinations of which 61 met the urinary tract infection criteria, ie a prevalence of 13.62%. Gram-negative bacteria accounted for 98.36% of isolates with a predominance of E. coli 75.40%, followed by Klebsiella pneumonia 18.03%. The age group 60 and over in males was the most affected with 64.86% (p: 0.0001) of cases. A significant relationship was found for age (p: 0.0001), gender (p: 0.04) and the urinary tract infection. Concerning sensitivity to antibiotics E. coli opposed a resistance of 92.50% to aminopenicillins, 82.93% to cotrimoxazole, 76.09% to 3rd generation cephalosporins and 65.22% to ciprofloxacin. The resistance mechanism by extended-spectrum betalactamase production was observed in 47.83% of E. coli strains. At the end of this study, the hospital prevalence of urinary tract infection is estimated at 13.64% with Escherichia coli and Klebsiella pneumoniae as the majority microorganisms.

Clinical Presentation

     A 50 years old non diabetic, non-hypertensive male patient presented with acute onset fever for past 5 days and persistant hiccough and drowsiness for last 1 day. Fever was intermittent (twice daily), not associated with chill and rigor. It was associated with generalised weakness and myalgia. There was no history of cough and cold, dyspnea, abdominal pain, dysuria, headache, nausea, vomiting.

     On examination, patient was drowsy, GCS 14/15. Neck rigidity was absent. Chest examination revealed mild inspiratory crepitations over left lower zone.

Investigations

Complete hemogram shows Hb 11.5, TLC 3500 (N58L40E1M1), platelet 75000. LDH 780.
Liver function test showed total bilirubin 0.8, SGOT 170, SGPT 44, ALP 92, albumin 3.1, total protein 6.
Renal function test showed urea 51, creatinine 1.5, serum sodium 125, potassium 3.6.
C reactive Protein was 75.5.
Urine examination was normal.
Chest x ray was normal.

USG whole abdomen showed liver 14 cm, spleen 14 cm.
2 D echocardiography- Normal.
Malarial parasite and Dual antigen Negative.
Dengue IgM Negative, Typhidot IgM negative.
Leptospira IgM-positive (titre-1:80).
Scrub typhus IgM-positive (titre-1:80).

Clinical Course

Patient was managed conservatively with Ceftriaxone, Doxycycline and 3% Nacl, But didn't improve. He developed dyspnea and progressive drowsiness.

CSF analysis showed protein 72mg/dl, sugar 54mg/dl.cell count 3, all lymphocytes.

Further examination revealed Triglyceride was 613mg/dl, ferritin was 14540mg/dl.

Bone marrow examination revealed Haemophagocytes.

Management

     The patient was diagnosed with Macrophage Activation Syndrome secondary to Scrub typhus and Leptospirosis. He was treated with intravenous dexamethasone along with antibiotics. Patient improved dramatically from third day and he was discharged with oral antibiotic and oral steroid for total 14 days.

Learnings

     We have to keep Macrophage Activation Syndrome in our mind while treating a febrile patient who was not responding to antimicrobial therapies rather who was gradually deteriorating because antimicrobials without immunosuppresion in these cases can lead to fatal consequences.

Reference

1. Diwan AG., et al. “Triple trouble--macrophage activation syndrome in a case of severe leptospirosis and scrub typhus co-infection”. The Journal of the Association of Physicians of India 62.1 (2014): 58-61.

Acute onset febrile illness is one of the most challenging disease to physician. It can occur in various infective, inflammatory, neoplastic diseases. Sometimes it is very difficult to find the cause and sometimes it is also difficult to treat.

Keywords: Sepsis; Septic Shock; Biomarker; Presepsin; Procalcitonin; C-reactive Protein; Interleukin-6

The number of different biomarkers used in patients admitted in ICU for SIRS, sepsis and septic shock is extremely high, but no single one has high specificity and sensitivity so it has been suggested that combinations of several biomarkers may be more effective than single biomarkers. The aim of this study was to investigate the use of Presepsin, a soluble fragment of the cluster of differentiation marker protein 14 (CD14), involved in pathogen recognition by innate immunity. In selected ICU patients and cardiac surgery patients we tried to investigate the diagnostic and prognostic value of Presepsin (PSP) compared to Procalcitonin (PCT), C-reactive Protein (CRP), White blood cells (WBC) and IL6. The assay for biomarkers were performed on whole venous or arterial blood, on days 1, 2, 4, and 7 from admission of patients eligible for the study. The diagnostic accuracy of the biomarkers studied was evaluated using the areas under the curve (AUCs). The accuracy of all biomarkers decreases with time until they are no longer useful. The use of Presepsin (PSP) to early detect the presence of infection could improve patient survival and outcome in distinguishing sepsis from SIRS in intensive care unit.

Keywords: Autism Fetal stem cells Transplantation Cell therapy Biopharmacy

Autism spectrum disorders (ASDs) are heterogeneous complex neurodevelopmental pathologies defined by behavioral symptoms, but which have well-characterized genetic, immunological, and physiological comorbidities. Despite extensive research efforts, there are presently no agreed upon therapeutic approaches for either the core behaviors or the associated comorbidities. In particular, the known autoimmune disorders associated with autism are appealing targets for potential stem cell therapeutics. Of the various stem cell populations, fetal stem cells (FSCs) offer the potent immunoregulatory functions found in primordial mesenchymal stem cells, while exhibiting rapid expansion capacity and recognized plasticity. These properties enhance their potential for clinical use. Furthermore, FSCs are potent and implantable “biopharmacies” capable of delivering trophic signals to the host, which could influence brain development.

Keywords: Athlete; Semi-marathon; caffeine-based stimulant drink; acute dehydration; athlete's heart

Syncope is one of the rare but serious heart attacks occurring in an athlete during a semi-marathon race. The aim of this case report is to bring awareness of such accidents to the sports community in sub–Saharan Africa where little is published about syncope in athletes. We are reporting the case of a 31-year-old Cameroonian half-marathoner with no contributing past medical history, and whose Precompetition medical assessment (PCMA) performed 48 hours before the race was normal. The young man started the race at a favorable temperature of 26°C at 6 AM in Yaounde. An hour prior to the beginning of the race, the semi-marathoner drank without medical advice 66cl of a caffeine-based energy drink. After 17 kilometers of running without oral rehydration (out of medical advice), he abandoned the race, due to intense physical asthenia, constrictive pain under the diaphragmatic muscle, dizziness, palpitations, then fall from its height occurring 30 minutes after stopping the race with the spontaneous recovery of the state of consciousness a few minutes later during his medical transportation to the Emergency center of Yaounde were the early management showed a conscious, restless athlete with stable hemodynamic parameters: BP: 116/53mmhg, Regular and symmetric pulses at 63 pulsations/minute, Regular Respiratory Rate: 22 cycles per minute, the Body temperature of 37,8°C, Blood saturation (SaO2) of 94% in ambient air, Glycemia on the spot found at 1,03 g/l. The resting 12 leads Electrocardiography done at the emergency unit was like that of the PCMA excluding the absence of bradycardia. Doppler echocardiography is normal, as well as Troponin that was done 12 hours (H12) after the beginning of chest pain. So far, the working diagnosis was syncope due to a probable coronary Vaso spasm following the ingestion of a stimulant substance in the context of acute dehydration and intense physical exertion. The possibility of a paroxysmal rhythm disorder was still to be excluded.

Keywords: Deaths; cholera; conceptual mode; DRC

Context. In the Democratic Republic of Congo (DRC), the epidemiological profile is dominated by infectious diseases including cholera. It evolves in endemic and epidemic form depending on the province. Despite multisectoral and multidisciplinary interventions organized in the field, the number of deaths remains high, as some contributing factors remain unknown while interventions need to be directed towards these factors.

Objective. Develop and analyse the conceptual model of the factors underlying cholera deaths in the community and in cholera treatment centres (CTCs).

Methodology. A retrospective cross-sectional study, from 2000 to 2013, of descriptive and exploratory type was used. It used the Directorate of Disease Control (DLM) database of 500,670 cases and 11,560 deaths. Finally, the qualitative and prospective method was carried out from 16 September to 16 December 2016, multicentric and covering five cities: Kinshasa, Lubumbashi, Kisangani, Mbandaka and Kalemie. Focus group techniques with 50 community leaders, an in-depth semi-structured interview with 50 patients, 15 health experts and 25 cholera patients. And a structured face-to-face interview with 15 health workers assigned to the CTC was organized. The percentage (%) of respondents' responses was calculated. Content analysis and triangulation of information was performed. Some qualitative survey data was collected by telephone, for obvious reasons.

Results. Four main groups of factors: (i) Organization of services (training of providers, availability of inputs, principles of separation of treatment rooms, lack of working hours, poor management of inputs, lack of systematic follow-up and evaluation of patients, poor clinical evaluation of patients), (ii) Individual factors (physiological state, pathological state and immunological status), (iii) Cholera profile (endemic area, epidemic and virulence of Vibrio cholerae). (iv) Socio-community and anthropological factors (perception and representation of cholera on the one hand, and treatment on the other). These factors can be influenced by complex interrelations without linearity.

Conclusion. Our study, to the importance of developing a conceptual model of the factors of death due to cholera. Understanding the factors that influence and interact with death is the straight line on which efforts must be focused to effectively and significantly reduce mortality from this disease. This conceptual model was designed to develop and analyze more than 96% of these factors, with the exception of those related to the biology of Vibrio cholera, including virulence genes. An ongoing prospective analytical study will determine virulence gene characteristics and antibiotic susceptibility profiles of Vibrio cholerae O1 in clinical and environmental isolates in Lubumbashi, Democratic Republic of Congo.

Conclusion. Our study showed the importance of developing a new conceptual model of cholera death factors. Understanding the factors that influence and interact on death is the straight line on which efforts must be focused to effectively and significantly reduce mortality from this disease. In our view, actors targeting these factors would ipsofacto reduce cholera deaths in the Democratic Republic of Congo.

     Early diagnosis and management of COVID 19 improves prognosis. During the onset manifestation, the most common symptoms were fever (98%), cough (76%) and myalgia or fatigue (44%); less frequent symptoms were sputum production (28%), headache (8%), hemoptysis (5%) and diarrhea (3%) and more than half of the patients developed dyspnea [3]. At this stage, primary viral replication followed by cellular damage is presumed to occur in the mucous epithelium of the upper respiratory tract (nasal cavity and pharynx), with additional multiplication in the lower respiratory tract and the gastro-intestinal mucosa [4]. Activation of the immune system, which follows, is important. If this immunological response is adequate, the infection can be controlled and the patient remains asymptomatic. In contrast, it has been shown that SARS CoV 2 can block this antiviral immunity early, effectively and durably in the most serious cases [5]. Anticoronavirals should be helpful during this stage. It should be remdesivir (by antiviral activity against SARS-CoV-2), ritonavir boosted nirmatrelvir (SARS-CoV-2 main protease inhibitor and an HIV-1 protease inhibitor and CYP3A inhibitor), chloroquine and its derivative hydroxychloroquine (by a modification of an attachment protein on the head of the virus), baricitinib (by inhibiting cyclin G), among others. After this stage, major manifestations could be occurred.

     Major clinical manifestations linked to COVID 19 include digestive disorders, coagulation disorders, acute respiratory distress syndrome (ARDS), macrophagic activation syndrome, etc. These imply specific therapeutic approaches over anticoronaviral therapy.

Digestive disorders

     The digestive manifestations during COVID 19 are various: anorexia (83.8%), diarrhea (29.3%), vomiting (0.8%) and abdominal pain (0.4%) [6]. The interaction between SARS COV2 and intestinal microbiota on the one hand resulting a modification of microbiota, thus favoring the appearance of the cytokine storm and on the other hand interaction between SARS COV 2 and intestinal cells leads to their destruction [6]. Therefore, one of the therapeutic targets would be to add commensal bacteria to improve this modification. Another would also be to manage the cytokine storm. Some biological Disease-Modifying Antirheumatic Drugs (bDMARD) and targeted synthetic Disease-Modifying Antirheumatic Drugs (tsDMARDs) have given encouraging results in the cytokine storm management.

Coagulation disorders

     It manifests as thrombosis of small pulmonary vessels, pulmonary embolism, thrombosis of small skin vessels, deep vein thrombosis, hemorrhage of small vessels, disseminated intravascular circulation (DIC), etc. Activation of the coagulation system and fibrinolytic system result from systemic inflammation, endothelial dysfunction by interaction with SARS COV 2, severe hypoxemia and the production of antiphospholipid antibodies leading to clot formation. Anticoagulants are therefore essential in the management of these coagulation disorders. Heparin and direct oral anticoagulants can be used [7].

Acute respiratory distress syndrome (ARDS)

     It is characterized by acute onset of respiratory distress maked by dyspnea with hypoxia and hypocapnia; tachypnea; intercostal, sub sternal, supernal, supraclavicular pulling; crackling rales etc. The interaction between SARS COV 2 and red blood cells leads to a decrease in the capacity of hemoglobin to transport and efficiently exchange CO2 and O2 through the alveolo-capillary barrier which in the long term causes an alteration of the alveolo-capillary barrier, then can progress to pulmonary fibrosis. In addition, the interaction between SARS COV 2 and alveolar epithelial type II cells leads to the destruction of alveolar epithelial type II cells with production of hyaline membrane plus the alveolo-capillary barrier damage [2, 8]. A treatment based on hydroxychloroquine (by its action on the preservation of hemoglobin) allows to maintain the normal transport of oxygen (O2) and carbon dioxide (CO2) through the alveolo-capillary membrane. Certain bDMARDs can be used such as interleukin-6 (IL-6) blocker that seems to hold great promise for managing the massive cytokine storm associated with the development of typical lung damage and ARDS). tsDMARD can be also used (by interference with Janus kinase) in its management. Corticosteroids reduce excessive and harmful pulmonary inflammation, but they also inhibit the beneficial immune response which allows the patient to eliminate pathogens.

Macrophagic activation syndrome

     It manifests clinically by high fever, hepatosplenomegaly, lymphadenopathy among others and biologically by hyperferritinemia, hypofibrinogemia, pancytopenia, hepatocellular insufficiency etc. The interaction between SARS COV2 and cells having ACE 2 receptor induces an activation of the inflammatory process: vasodilation, vascular hyperpermeability, infiltration of inflammatory cells leading to the release of pyrogenic cytokines or even a cytokine storm (interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor, etc) [2]. Therapies targeting the pro-inflammatory cytokines can improve macrophagic activation syndrome. Corticosteroid therapy and certain bDMARDS such as Anakinra (interleukin 1 receptor antagonist) have been discussed in management.

     So, what therapeutic strategy? The complexity of its pathophysiology, the multiple therapeutic targets and the absence of effective anticoronaviral monotherapy proven at the current state of knowledge are arguments to say that it is necessary to consider blocking several therapeutic targets in order to increase the anticoronaviral effectiveness. Hence the need to combine anticoronaviral therapeutic means taking into account the type of COVID 19 patient and in particular all the major clinical manifestations linked to COVID 19.

     Anticoronaviral multitherapy proposed by some authors may be the solution, if and only if, it can suppress viral replication and prevent the immune system from dysregulation. Indeed, clinical trial is underway to assess the efficacy and tolerance of the triple-drug therapy combining baricitinib, lopinavir / ritonavir and remdesivir [9]. The genetic susceptibility of COVID 19 patients to develop the severe form is not yet well established. Could anticoronaviral multitherapy prevent progression towards severe form? However, it has been shown that a reduced viremia does not prevent the immune system from racing and its progression towards the severe form [1]. Suppressing the virus does not seem to be enough. It would be better that all the management strategies are focused on the early diagnosis and adequate treatment of the type of COVID 19 patient and in particular all the major clinical manifestations linked to COVID 19. Anecdotally, we will say that no drug proposed is effective, all the drugs proposed are effective, it is a question of early diagnosis and adequate treatment of the types of patient and all the major clinical manifestations linked to COVID 19.

     This information will help to develop therapeutic strategies depending on the type of COVID 19 patient and in particular all the major clinical manifestations linked to COVID 19 instead to continuing to take account only an anticoronaviral monotherapy or anticoronaviral multitherapy, knowing well that the immune system dysregulation with its inflammatory corollary persists despite the decrease of viremia.

Competing interests

     Authors declare no competing interests.

Authors contributions

     Authors has read and agreed to the final manuscript.

References

1. Lescure F-X., et al. “Clinical and virological data of the first cases of COVID-19 in Europe: a case series”. The Lancet Infectious Diseases 20.6 (2020): 697-706.
2. Yuefei J., et al. “Virology, Epidemiology, Pathogenesis, and Control of COVID-19”. Viruses 12.4 (2020): 372.
3. Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395.10223 (2020): 497-506.
4. Xiao F., et al. “Evidence for gastrointestinal infection of SARS-CoV-2”. medRxiv 158.6 (2020): 1831-1833.e3.
5. Meijuan Z., et al. “Functional exhaustion of antiviral lymphocytes in COVID-19 patients”. Cellular & Molecular Immunology 17.5 (2020): 533-535.
6. Lei P., et al. “Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study”. Am J Gastroenterol 115.5 (2020): 766-773.
7. McGonagle D., et al. “Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia”. Lancet Rheumatol 2.7 (2020): e437-e445.
8. Wenzhong L and Hualan L. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism (2020).
9. Stebbing J., et al. “COVID-19: combining antiviral and anti-inflammatory treatments”. Lancet Infect Dis 20.4 (2020): 400-402.

     The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. World Health Organization (WHO) reported, globally, the number of new weekly cases (21 to 27 November 2022) was just fewer than 2.7 million new cases reported and the number of new weekly deaths with about 8400 fatalities. And, as of 27 November 2022, 637 million confirmed cases and 6.6 million deaths have been reported globally. Three types of COVID 19 patients are distinguished from the French study, (i) patients with few clinical signs but with a high nasal viral load and being highly contagious; (ii) patients with mild symptoms at the beginning but worsening towards the tenth day with the appearance of a severe acute respiratory syndrome despite a decreasing viral load; (iii) patients with a rapid worsening to an acute respiratory syndrome with persistence of a high viral load in the nose and throat and appearance of SARS-CoV-2 blood viremia causing multivisceral failure leading to death [1]. The major clinical manifestations linked to COVID 19 are numerous and diverse, among which there are digestive disorders, coagulation disorders, acute respiratory distress syndrome, macrophagic activation syndrome, myocarditis linked to SARS COV2, acute tubulopathy linked to SARS COV2, meningoencephalitis linked to SARS COV 2. These can be explained by the fact that the cellular tropism of SARS COV 2 is numerous as well as the physiopathogenic consequences. It concerns all cells with an angiotensin-converting enzyme 2 (ACE 2) receptor (example, alveolar epithelial type II cells, upper and stratified epithelial cells of the esophagus, absorbent enterocytes of the ileum and colon, pancreatic cells, glial cells, Sertoli cells) [2]. The interactions between SARS COV 2 and ACE2 cells lead to their internalization and massive viral replication with cellular damage, activation of the inflammatory process, activation of the immunological system, stimulation of the coagulation system, among others [2]. The various physiopathogenic consequences during COVID 19 largely explain its numerous therapeutic targets. What physicians need to know about physiopthothogeny with identified therapeutic targets, holistic diagnostic and therapeutic approach of Covid-19 is the subject of ongoing updates from experts at this Journal.

References

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     Sampling design is one of the most recurrently conversed and discussed topics in research studies. Which sampling design is preferable and suitable in research primarily depends on the characteristics of a population through which we form a sample for the study. A sampling design is distinct plan for attaining a sample from the given population. The principal objective of this article is to choose the appropriate probability sampling designs in research studies. The present study is qualitative in nature and the data are collected from the secondary sources. This article will no doubt be beneficial to the persons who are engrossed in research studies as it provides them with a clear concept of types of the probability sampling designs so that they can cull an apt probability sampling design to carry out the research studies.

Keywords: Probability; research; sample; sampling design

References

1. Army Blood Transfusion Center. Blood product supplies. Paris: CTSA (2016).
2. MINSANTE Cameroon. Health Sector Strategy 2016-2027. Yaoundé: Sopecam- Cameroon (2017).
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9. World Health Organization. Current status of blood safety and supply in the WHO African Region: Survey report 2013. Geneva: WHO; 2017.

Background: Cameroon faces security challenges that significantly impact the demand for blood and blood products in its care facilities, including military ones. The blood bank of the Military Hospital Region I Yaounde (MHRI) because of its human, material and managerial potential, and its situation provided the framework for analysing the communicational issues of the blood supply.

Methods: A descriptive qualitative-quantitative situational analysis of the military hospital's blood bank communication system, and its deployment in 2017 has been carried out. The 2014 Who Global Database on Blood Safety (OMS) collection and analysis tool used the bank's staff and routine documents.

Results: The bank registered 1101 candidates in the [18-27] bracket. There was no communication programme geared towards defence institutions, schools and university faculties. The staff's action, restricted but of good quality, was supported by financial and technical partners.

Conclusion: There are significant mobilization potentials at MHRI, and the value of setting up and supporting communication strategies to unite these dynamics for an efficient blood supply is needed.

Keywords: blood; communication; supply; MHRI

     Patients’ social behaviour toward the medical team mainly supposes appreciation and respect since there is a considerable investment in a medical carrier: long education period, financial resources, and emotional involvement. In medicine, responsibility is at the highest level; nothing can replace the loss of dear ones, and our mission is to improve and save life. To achieve these goals, a professional in the healthcare industry must have specific knowledge, quickly manage info and deliver medical services when and where necessary. The art of communication with patients and community members with different backgrounds helps us to attain the best results in clinical practice. To do that, theoretically, a medical team member must not be buried, not in his daily program or society. But in their daily routine, they can experience offensive comments or attitudes from persons with reasoning or communication problems.

     How much must we tolerate facing daily work adversities from the patients or other individuals?

     Genetics, perception abnormalities, info-processing deficiency, reasoning nonconformity, and tolerance groups determine a patient’s social behaviour deviance. Medical conditions may affect them at various levels. Misinformation sources must be disapproved, detected, and punished when necessary. Broad-minded groups must be trained for multiple situations that are emerging offensive human actions. Identifying the origin of an individual’s wrong and cruel actions towards others and corrective actions are needed. An ethical, respectful approach to the problem must be considered.

     Patients’ intentions may differ from their actions’ end. Good intentions following the worst results reveal judgment impairment or misinformation processing; modelling such gaps helps us improve behaviour and joy in redressing individual misconduct in social interaction.

     Repetitive unpleasant people interactions must be stopped when necessary since improper people collaboration may lead to depression, hypertension, type 2 diabetes, or dyslipidaemia in vulnerable persons.

     So, making the individual aware of the consequences of his unconventional social behaviour is mandatory.

     The healthcare professionals offended by the patient may deny the further patient’s requests for healthcare services [except emergency care], The patient will be obliged to look after another healthcare provider, and that technique may initiate the patient’s reflection about his actions, consciousness’ activation and self-awareness for further interactions with professionals. Applying this possible convincing technique adds benefit to problem-solving mastery.

     Suppose the patient’s social behaviour deviance maintains after initial corrective actions. In that case, interdisciplinary collaboration, a multi-level intervention approach, and a corporate strategy for individual life quality and safety are required. Prompt and proper attitudes for social behaviour improvement can solve harsh work conditions.

     In this digital era, AI supply quickly detects and offers an ending to this problem with positive changes.

     Usually, medical conditions alter the individual judgment and actions toward others, especially for senior adults; we may tolerate their social behaviour deviance, but not in repetition and not too much, to protect ourselves.

      Time slowly undermines all, early enough for each one, and it is better not to get its work done in advance.

     Individual behaviour is how one acts or conducts oneself, especially toward others. Human conscious or subconscious response to various internal or external stimuli communicates to us about the person’s approach in different circumstances; it reflects the individual’s genetics, educational and relational development in a specific environment.

References

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7. Fati Sidikou., et al. Polymérase Chain Reaction Assay and Bacterial Meningitidis Surveillance in Remote Areas, Niger.
8. Frasch CE, Preziosi M-P and LaForce FM. “Development of a group A meningococcal conjugate vaccine, Men Afri Vac(TM)”. Hum Vaccin Immunother 8.6 (2012): 715-24.
9. Mamoudou Harouna Djingarey. Development and introduction of meningococcal A conjugate vaccine; Planning workshop for the introduction of the A conjugate vaccine (MenAfrivac) and operationalization of case-by-case surveillance in Burkina Faso; Bobo Dioulasso (2009).
10. SadouKalilou Moussa. “Evaluation of the response to the meningitis epidemic in the health district of Say, Niger, 2006”. Thesis for obtaining an interuniversity diploma, in Ouidah (2007).
11. WHO: Meningitis Weekly Epidemiological Bulletin 2010, week 48–52.
12. WHO: Meningitis Weekly Epidemiological Bulletin 2011, Week 48–52.
13. Sanon Adama. “Epidemiological, clinical, bacteriological and evolutionary aspects of bacterial meningitis about 179 cases at the Souro Sanou University Hospital in Bobo Dioulasso”. Thesis of Medicine, Burkina Faso (2004).
14. A Dembele. “Purulent meningitis in newborns from 0 to 60 days in the pediatric intensive care unit of the Gabriel Touré Hospital in Bamako”. Thesis of Medicine, University of Bamako (2001).
15. Towa Djeungoue Stéphanie Jackie. “Epidemiology of meningitis in Mali in 2007”. Thesis of Medicine, University of Bamako.
16. Abdoulkarim Sabo. Epidemiology and treatment of purulent meningitis at the infectious diseases clinic of the CHU de Fann in Dakar about 262 cases collected from 1994 to 1997, Thesis of pharmacy, Cheick AntaDiop University of Dakar (1998).
17. G Campagne., et al. Epidemiology of bacterial meningitis, Niamey (Niger), 1981-1996 Bulletin of World Health Organ 77.6 (1999): 499-506.
18. Amadou Oumarou. “Purulent meningitis in children (epidemiological, clinical, etiological, therapeutic and evolutionary aspects)”. Thèse de médecine, Niamey (Niger) (1898).
19. Barbach Youness. Management of meningitis in the emergency department of the Hassan II University Hospital – Fez (about 15 cases), Thesis of Medicine, Sidi Mohamed Ben Abdallah University of Fez, Morocco.
20. Julie Chaix. “Community-based purulent meningitis in children: a retrospective study from 1998 to 2003 of two cohorts in Dakar, Senegal and Nancy, France”. Life Sciences [q-bio]. FFHAL-01731977 (2006).
21. Taha MK. Meningococcal infections. EMC - Infectious Diseases 9.3 (2012): 1-17.
22. Syrogiannopoulos GA., et al. “Dexamethasone Therapy for Bacterial Meningitis in Children: 2- versus 4-Day Regimen”. The Journal of Infectious Diseases 169.4 (1994): 853-8.
23. Fabrice Bruneel and Michel Wolf. acute meningitis; Encyclopediamedico-surgical 17-160-C-10.
24. V des Portes. Sequelae of bacterial meningitis in children and adults; incidences, types, methods of evaluation; Medicine and infectious diseases 39.7-8 (2009): 572-580.
25. E Forestier. “Strategy for the management of presumed bacterial acute community-acquired meningitis in adults”. Medicine and Infectious Diseases 39.7-8 (2009): 606-614.
26. H Ben Hamouda., et al. “Clinical and evolutionary aspects of neonatal bacterial meningitis”. Pediatrics Archive 20 (2013): 938-944.

     The countries of the Peysonnia belt are paying a heavy price for bacterial meningitis. Morbidity and mortality of bacterial meningitis is linked to certain factors.

     It is a descriptive and analytical prospective study over a period of two months from April 15 to June 15, 2015 in subjects admitted for suspected meningitis at the National Hospital of Niamey. Identifying predictors of poor prognosis during this outbreak is our goal.

     One hundred and five patients were enrolled. The majority were young. Signs of severity were coma (22.9%), seizures (12.4%), signs of focus (9.5%), shock (7.5%). Delay in management and hyperproteinrachia have also been identified as poor prognostic factors. Sequelae were balance disorders (n=20; 19%), hearing loss (n=7; 6.6%), purpura fulminans (n=13; 12.4%). There were 12 deaths or 11.4% of which 11 comas (91.66%), 2 convulsions (16.66%), 1 purpura fulminans (8.3%), 6 shock (50%), 5 signs of focus (41.66%), 8 of these patients (66.66%) came 3 days after the onset of signs.

     Poor prognosis factors were related to brain damage, shock and delayed management. Improving Niger's health system will reduce them.

Keywords: bacterial meningitis; poor prognostic factors; Niamey; Niger

References

1. Amegbor K., et al. “Cancers in Togo from 1984 to 2008: Epidemiological and pathological aspects of 5251 cases”. J Cancer Epidemiol (2011) : 1-7.
2. Darre T., et al. “Descriptive Epidemiology of Cancers in Asian”. Pac J Cancer Prev 18.12 (2017): 3.
3. Walla A., et al. “Primitive bone tumors of the limbs at CHu Tokoin”. European Scientific Journal 11 (2015): 149-157.
4. Moore DD and Lu HH. Osteosarcoma. “Orthopedic Oncology: Primary and Metastatic Tumors of the Skeletal System”. Cham: Springer International Publishing; Cancer Treatment and Research (2014): 65?9.
5. Gnassingbe K., et al. “Cancer in the pediatric surgical setting in Togo”. The Pan African Medical Journal 17.209 (2014).
6. LA Omolade, CU Nwandinigwe and EC Onyegbule. “Pattern of bone tumors seen in a regional orthopedic hospital in Nigeria”. Niger J Med 23.1 (2014): 46-50.
7. Diop M. “The state of medical oncology in Senegal”. Cancer medical science 13 (2019): 941.
8. Rajani R and Gibbs CP. “Treatment of Bone Tumors”. Surg Pathol Clin 5.1 (2012): 3.
9. Thaler M and Khosravi I. “Therapeutic management in bone sarcoma”. memo 13.2 (2020): 1.
10. Sun J., et al. “Progress of Phototherapy Applications in the Treatment of Bone Cancer”. Int J Mol Sci 22.21 (2021): 11354.
11. Ambrosio L., et al. “Biomaterials for the Treatment of Bone Cancer”. Int J Mol Sci 22.15 (2021): 8.
12. Tapsoba TL., et al. “Contribution of bone scintigraphy in the assessment of extension of cancers at Yalgado Ouédraogo University Hospital Center (CHUYO): about 70 cases”. Nuclear Medicine 37.10 (2013): 466?71.
13. Kasongo MM., et al. “Multidisciplinary management of an osteosarcoma in a child in an underequipped environment: a clinical case”. African Annals of Medicine 12.4 (2019): e3473-e3478.
14. Ottaviani G and Jaffe N. “The epidemiology of osteosarcoma”. Cancer Treat Res 152 (2009): 3-13.
15. Errani C, Tsukamoto S and Mavrogenis AF. “Imaging Analyzes of Bone Tumors”. Rev. JBJS March 8 (2020): e0077.
16. Chelli Bouaziz M., et al. “The value of MRI in the diagnosis of joint involvement in malignant primitive tumors of the knee”. Bull Cancer 103.11 (2016): 911-920.
17. Choi JH and Ro JY. “The 2020 WHO Classification of Tumors of Bone: An Updated Review”. Advances in Anatomic Pathology 28.3 (2021): 119-138.
18. Serfaty A and Samim M. “Bone Tumors: Imaging Features of the Most Common Primary Osseous Malignancies”. North Am Radiol Clin 60.2 (2022): 221-238.
19. Biazzo A and De Paolis M. “Multidisciplinary approach to osteosarcoma”. Acta Orthop Belg 82.4 (2016): 690-698.
20. Voskuil R., et al. “Malignant Bone Tumors of the Knee: How to Identify and Treat”. J Knee Surg 32.4 (2019): 305-14.
21. Ban J., et al. “Mechanisms, Diagnosis and Treatment of Bone Metastases”. Cells 10.11 (2021): 2944.
22. Anract P. “Principles of surgical treatment of primitive malignant bone tumors”. Bulletin of the National Academy of Medicine 193.1 (2009): 107?2.
23. Garcia RA, Inwards and Unni KK. “Benign bone tumors--recent developments”. Semin Diagn Pathol 28.1 (2011): 73-85.
24. Steffner R. “Benign bone tumors”. Cancer Treat Res 162 (2014): 31-6.

Introduction: The objective of the study was to describe the epidemiological, diagnostic, therapeutic and evolutive aspects of long bones primary tumors at the Regional Hospital of Sokode.

Patients and Method: It was a prospective descriptive study of patients with long bone primary tumors for a period of 04 years from January 2019 to December 2022.

Results: Twenty-eight tumors were identified in 18 men and 10 women. The morphological assessment was standard radiography (n=28), CT scan was performed in 18% (n=05). These were osteolytic tumors (39.2%), osteocondensing tumors (21.4%), mixed tumors (25%) and mixed tumors with fracture (14.4%). Anatomopathology examination of 14 patients showed osteosarcoma (n=06), chondrosarcoma (n=03), Ewing's sarcoma (n=01) and an osteochondroma (n=04). Surgical treatment by transfemoral amputation was performed in 06 cases for malignant tumors. An excision biopsy was performed for the 04 lesions whose diagnosis was an osteochondroma.

Conclusion: Diagnosis and treatment of primary long bone tumors is difficult in isolated surgical areas. The subsidy of their treatment, the implementation of diagnostic and therapeutic tools could improve the vital prognosis of patients with malignant tumor.

Keywords: bone tumor; radiography; biopsy; treatment

     According to their disorder, middle-aged people and senior adults may experience difficulties in physical exercises; in that case, a remote job [virtual] or another job selection is recommended.

     Regular physical activity maintains and improves the well-being of people in good health. Daily fine-organized exercise program duration, frequency, and intensity ensure a better life, but excessive limits for physical exercise make an individual vulnerable.

     People at risk of various medical conditions, with specific demographic data, may carry out physical exercises well settled beyond hurt.

     For a weak individual, disproportionate physical activities can lead to disaster. In addition, the warm or cold season easily facilitates brain haemorrhage or myocardial infarction for these individuals doing excessive physical work.

     Generally, physical exercise, including walking in nature, is recommended to maintain and improve individual health. For young and middle age people with moral distress but a good heart activity, walking in nature is an effective remedy; fresh air, water flow sound, floral scent, and impressive or rousing trees have a positive impact on the respiratory system, blood flow and composition, and on mental functioning. It is a relatively inexpensive mode to attain expected clinical outcomes.

     Some senior adults may benefit from an accurate physical exercise program. Most old persons are registered with heart failure, respiratory diseases, and mobility problems. For this category, physical exercises may generate dyspnoea, fatigue, and pain with additional discomfort on relatives and social workers excessively implied in their care. Clinical practice evidence shows that even walking a short distance can be fatal for older adults with advanced heart disease. But in the digital era, they may use IT devices to admire nature’s splendor or paintings, watch on-demand musical programs and movies, update the information of interest, lecture, and communicate with their loved ones, and this option never existed.

     Physical exercise is a convenient remedy with a wide range of advice or limitation, adjusted to individual medical history and clinical and demographic data. Harm and benefit are two facets of the same method for dealing with problems for recovering and improving mental and physical health.

     There is a time to use or decline the physical exercises in the best interest of the individual health.

     The art of adjusting specific procedures to personal data to achieve the desired target return in the form of gratitude and admiration from the community we serve.

     Better to keep physical exercise limits on the way, and in the end, be able to open the door coming the night.

Work ennobles us and assures our dignity and prosperity in a never-ending natural world.

     ‘Those who do not work do not eat, except for individuals with serious illnesses’ - is a divine message.

     There is a hierarchy of work design, effecting, and monitoring; each individual has to be in a position according to his expertise and ability to play his role. Harmonic mental and physical activities ensure job performance.

     Job descriptions inform in some way prospective employees about their work-out to achieve better duties. A person’s good health facilitates job completion, but an altered physical activity declines a specified standing for an individual. Each selection compels work necessities and personal health, and individual medical conditions impose attention not to harm.

Introduction

     A significant global public health and economic concern was raised by the recent (COVID-19) outbreak brought on by (SARS-CoV-2). Every day, more information is learned about how the COVID-19 virus spreads. In order to open up society during the (COVID-19) crisis, many nations intend to make face masks compulsory. In order to avoid the transmission of (COVID-19) and other respiratory viral illnesses, it is recommended that people use masks as part of a comprehensive package of preventative and control measures.

     Face masks are the ubiquitous symbol of a pandemic that has sickened 35 million people and killed more than 1 million. In hospitals and other health-care facilities, the use of medical-grade masks clearly cuts down transmission of the (SARS-CoV-2) virus. But for the variety of masks in use by the public, the data are messy, disparate and often hastily assembled.

     Face masks are incredibly popular right now due to the corona virus outbreak. According to prior advice from the World Health Organization, healthy individuals should only use masks when caring for someone who may have (COVID-19) or when they are coughing or sneezing. However, using a mask alone is insufficient to provide an effective level of protection or source control; additional actions at the individual and community levels should be taken to prevent the spread of respiratory viruses. Whether or not masks are worn, adherence to hand cleanliness, physical segregation, and other infection prevention and control (IPC) measures is essential to preventing (COVID-19) transmission from person to person. The World Health Organization (WHO) has created particular advice on IPC strategies for healthcare settings [1], Long-Term Care Facilities (LTCF) [2] and home care [3].

     Face masks can help protect against many respiratory infections that are spread through the droplet route, and that includes coronavirus and the flu. Proper donning and doffing technique are also critical measure to prevent disease transmission. The (WHO) also cautions us that masks are only effective when they are worn in conjunction with regular, effective hand washing. Furthermore, if we choose to wear a mask, we must know how to utilize it and properly dispose of it out of an abundance of caution.

     WHO advises health professionals administering direct care to (COVID-19) patients to wear a medical mask in the absence of Aerosol Generating Procedures (AGPs) [4] (in addition to other PPE that are part of droplet and contact precautions). Activated carbon, spun bond, and melt blown materials are used to make facial masks (breathing masks). Combination masks with activated carbon can reduce hazardous pollution. Many diverse approaches exist for masks to protect both the wearer and others. Mechanical interception and inertial impaction are the two "intuitive methods" that masks filter bigger aerosols. A substance filters more effectively the denser its fibers are. Because of this, greater thread counts result in greater efficacy. Just more virus blockers are available. However, some masks (such those made of silk) also possess electrostatic qualities that can attract tiny particles and prevent them from passing through the mask as well. We can reduce our risk of contracting the corona virus by using one of two different types of face masks. The first of the two face masks is a surgical face and of the second type are also referred to as (N 95) masks.

     The general public does not need the (N 95) respirator. The (N 95) respirator filters at least 95% of airborne particles but is not resistant to oil [5]. Filtering face piece respirators, commonly referred to as (N 95) masks, are regulated by the National Institute for Occupational Safety and Health.

N: Respirator Rating Letter Class: This. It stands for ("Non-Oil,") indicating that you can use the mask in a work setting if there are no oil-based particulates present. Other mask classifications include R (eight hours of oil resistance) and P(oil proof).

95: Masks ending in a 95, have a 95 percent efficiency. and that is the same as a High Efficiency Particulate Air(HEPA) and Aerosol Generating Procedures (AGPs).

Microns: Dust, mist, and fume pollutants are filtered out by the masks. Large droplets and particles with a minimum size of.3 microns won't be able to cross past the barrier, according to the Centres for Disease Control and Prevention (CDC.)

Material: The filtration material on the mask is an electrostatic non-woven polypropylene fiber.

Valve: halation valves are available as an option with some disposable N95 masks. According to the (CDC), "having an expiration valve reduces exhalation resistance, which makes it simpler to breathe (exhale)".

     N 95 masks, which are worn by medical professionals and emergency personnel, offer superior shielding from corona virus particles than fabric or surgical masks. Protecting people who are most at risk of infection requires the use of N 95 respirators. The N 95 mask is designed for healthcare professionals, and the (WHO) states that it can be used for several patients with the same diagnosis for up to four hours. Gloves and labels should be applied to the N 95 masks before disposal. Used masks need to be destroyed or properly disposed of. Even though the majority of readily accessible N 95 pollution masks can be worn and used again, they do have a shelf life. When the mask wears out or the filter becomes clogged by pollutants, it loses its ability to effectively shield us from pollution. Masks contaminated with corona virus debris have recently emerged as a major global environmental issue. In one day, millions of masks are used and subsequently discarded globally. contrary to popular belief, the CO₂ footprint of the cotton face mask is 20% greater than that of the N 95 protective face mask. 850 tonnes of CO₂ are emitted by just 17 million of our protective N 95 masks. Imagine that a straightforward adjustment in the face masks' material may cut their impact by 20%. If 12 billion masks were used, 144.000 tonnes of CO₂ emissions would be avoided.

     N 99 masks, which are one of the best options for blocking the virus because they can reduce average risk by 94-99% for 20-minute and 30-second exposures, are more effective at filtering airborne particles than N 95 masks. However, they can be difficult to find, and there are ethical considerations such as leaving those available for medical professionals.

     From a purely medical perspective, the effectiveness of measures to contain the spread of the virus is independent of the geographic area where these measures are implemented. A well-fitting mask keeps the virus from reaching others. It can also protect the wearer from becoming infected.

     Masks should be worn anytime you are in public or people are nearby. Masks act as a physical barrier to protect you and others from viral and bacterial particulates. Many people unknowingly infect others by going out and spreading germs by coughing or touching other. Infections spread from person to person in the community, and it is essential to identify and implement measures to reduce transmission to slow down or even stop spread. Public officials and governments strongly encourage the use of wide spread face masks in public, including the use of appropriate regulation. Research on the efficacy of face shields, including in combination with masks, is needed, along with research into the efficacy of masks with transparent windows for the mouth. It is also important for health authorities to provide clear guidelines for the production, use, and sanitization or reuse of face masks, and consider their distribution as shortages allow.

Diagnosis

     Fever, exhaustion, dry cough, dyspnea, and other signs of an upper respiratory infection are also present in SARS-CoV-2 illness cases.

Conclusion

     In conclusion, masks and other Personal Protective Equipment (PPE) are essential for individuals battling the pandemic and are frequently utilised by the general people. Environmentalists worry, however, that the fight against mask pollution and adverse effects on animals would result from improper disposal of masks. In the future, we must ensure that we are prepared for pandemics like this one and that we are prepared to respond to them sustainably and one does not have to come at the expense of the other.

References

1. Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: World Health Organization (2020).
2. Infection prevention and control for long-term care facilities in the context of COVID-19: interim guidance. Geneva: World Health Organization (2020).
3. Home care for patients with COVID-19 presenting with mild symptoms and management of contacts: interim guidance. Geneva: World Health Organization (2020).
4. The WHO list of Aerosol Generating Procedures (AGPs) includes: tracheal intubation, non-invasive ventilation, tracheotomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy, sputum induction induced by using nebulized hypertonic saline, and autopsy procedures.
5. NIOSH-approved N95 Particulate Filtering Facepiece Respirators.

One of the most harmful, communicable, and infectious diseases nowadays is COVID-19. The SARS-CoV-2-related illness COVID-19 is extremely contagious. Wuhan, China is where the corona virus first appeared, and it has since spread over the entire world. Common signs of this virus include headache, shortness of breath, fever, cough, cold, and sore throat. At this point, risk assessments and starting outbreak control efforts depend on readiness, openness, and information exchange. Face masks may become quite popular if a pandemic affecting the respiratory system breaks out. her individual and societal steps should be taken to prevent the spread of respiratory viruses because the wearing of a mask alone does not provide an appropriate level of protection or source control. Used masks need to be destroyed or properly disposed of.

Keywords: Covid-19; SARS-Cov-2; Face masks; N 95; respiratory viruses

Cloud and Edge Computing

     Many traditional healthcare and medical systems have faced a big problem of massive unstructured, diverse, and exponential-growing data collected from different sources, thus arising much more challenges to store and process data effectively and securely. To this end, the advanced techniques and high capacities of cloud computing allow analysing healthcare and medical big data. F

Immersive Technology

     Immersive technology, a term that refers to the technologies for reality extension using the neuroscience of the human brain, aims to create distinct experiences by merging the physical world with a digital or simulated reality.

Besides augmented reality (AR) and virtual reality (VR) as two primary types of immersive technologies, it includes ex- tended reality (XR), mixed reality (MR), holography, telepresence, digital twins, and first-person view (FPV) drone

flight. The above-mentioned immersive technologies can be briefly featured as follows:

• VR: a technology that allows the creation of a fully immersive digital environment, in which the physical or real-world environment is entirely suppressed.
• AR: a technology that enables the superposition of digital elements into the real-world environment, i.e., the composite view of physical and digital elements can be observed.
• MR: a technology that not only allows the superposition of digital elements being viewed in the real-world environment but also establishes their interaction.
• XR: an umbrella term that encompasses any types of technology that alters reality (e.g., adding digital/virtual elements to the physical environment at any level, thus nearly erasing the line between the digital world and the physical world). Indeed, XR includes AR, VR, MR, and other technologies.
• Holography: or hologram is a technology to product three-dimension image of an object with highest resolution of any imaging for device-free watching.
• Telepresence: a novel form of robotic remote control, in which a human operator can observe, feel, interact, and collaborate an object from distance.
• Digital twins: a virtual replication of real-world project, which is require for connecting the physical object for real-time data collection, processing, and response.
• FPV drone flight: a technology uses unmanned aerial vehicle (UAV) with a camera for transferring high- quality videos to goggles, headsets, and mobile devices or another screen, thus allowing users to enjoy environing- mental experience in the first-person view.
• Haptics: refers to a technology that uses tactile (touch) sensation to interact with the computer applications to uplift user experience.

Enabling Technologies of The Metaverse for Healthcare

     This section presents a detailed discussion of the enabling technologies of the Metaverse for healthcare, which includes extended reality, blockchain, artificial intelligence, IoT, 5G and beyond, digital twin, big data, quantum computing, human-computer interaction, computer vision, edge computing, and 3D modelling. The illustration of the above- mentioned enabling technologies of the Metaverse for health- care is depicted in the next Fig. F

A. Extended reality

     Extended reality includes technologies such as augmented reality (AR), virtual reality (VR), and mixed reality (MR), aided by artificial intelligence, computer vision, and connected devices like mobile phones, wearables, and head- mounted displays. By incorporating voice, gestures, motion tracking, vision, and haptics, this new technology is transforming the way services are delivered, improving the quality in various sectors.

B. Blockchain

     The foundation of blockchain emerged in a 2008 white paper written by Satoshi Nakamoto. A blockchain is a digital database of transactions that is duplicated and dispersed over the entire blockchain network. Each block in the chain contains several transactions, and whenever a new transaction occurs on the blockchain, a record of it is added to all participant’s ledgers.

C. Artificial Intelligence

     Artificial intelligence (AI), also known as machine intelligence, focuses on the development and management of technology that can autonomously learn to make decisions and carry out tasks on behalf of humans. AI is a collection of technologies that incorporates any software or hard-ware component that facilitates machine learning, computer vision, natural language understanding (NLU), and natural language processing. AI will help strengthen the Metaverse infrastructure, enhancing the 3D immersive experience, and boosting the virtual worlds’ built-in services. AI technology will also help in improving the quality of services and the Metaverse ecosystem.

      The health industry has recently begun utilizing revolutionary techniques such as XR and big data combined with AI in software and hardware to increase the efficacy of medical devices, reduce the cost of health services, enhance healthcare operations, and broaden access to medical.

D. Internet of Things

     The phrase "Internet of Things" (IoT) refers to the billions of devices that are currently connected to the Internet and exchanging data. Due to the introduction of low-cost computer chips and the broad availability of wireless net- works, everything from smartphones to intergalactic operations can now be connected to the IoT. Due to the incorporation of sensors and the capacity to communicate with one another, these devices can share real-time data without the need for a human supervisor.

E. 5G & Beyond

     The term "5G and beyond" refers to the fifth generation and beyond of wireless technology. It outperforms 4G LTE networks in terms of both speed and latency, and it has a higher capacity. In contrast to the maximum speed of 4G technology, which is only 1 Gbps, the maximum speed of 5G technology can exceed 20 Gbps. Additionally, delivers reduced latency, which has the potential to enhance the performance of commercial applications and other digital experiences.

F. Digital Twin

     A digital twin is a virtual representation that acts as the digital counterpart of a physical object or process in real-time. The first practical definition of a digital twin was proposed by NASA in 2010 to enhance the physical-model simulation of spacecraft.

G. Big Data

     Big data is defined as the "Information asset characterized by such a High Volume, Velocity and Variety to require specific Technology and Analytical Methods for its transformation into Value".

H. Quantum Computing

     Quantum computing is a form of computation whose activities can exploit quantum mechanical phenomena such as superposition, interference, and entanglement.

I. Human Computer Interaction

     Human-computer interaction (HCI) is a multidisciplinary topic of research that focuses on the design of computer technology and, specifically, the interaction of humans and computers. Voice, gesture, visual, and brain signal interaction have replaced textual or display-based control as the dominant paradigm in HCI. HCI, VR, AR, and the future of content creation and collaboration technologies will enable the creation of the Metaverse. The visual interactions in the Metaverse will be carried out by HCI technology which is called wearable consumer head-mounted displays (HMD). These HMDs will play a crucial role in the communication between the users and surroundings in the Metaverse.

J. Computer Vision

     Computer vision is the study of how computers visualize and interpret digital images and videos. Computer vision encompasses all activities done by biological vision systems, including perceiving a visual signal, interpreting what is being seen, and extracting complicated information in a form accessible by other processes.

K. Edge Computing

     Edge computing is a distributed computing paradigm that moves computation and data storage closer to the data sources. Edge computing will improve response times and conserves bandwidth.

L. 3D Modeling

     3D modelling is the process of producing a mathematical coordinate-based representation of any three-dimensional surface of an item using specific 3D modelling techniques. As a result of advancements in image processing, computer- aided design, and modelling techniques, it is now feasible to create extremely realistic and trustworthy 3D models. Multiple sectors, including cinema, animation, and gaming, as well as interior design and architecture, utilize 3D modelling.

     Medical diagnosis is the process of determining the medical condition of a patient based on the symptoms. Adoption of the Metaverse in healthcare significantly helps in efficient diagnosis of the medical conditions of a patient with the help of various advanced technologies such as AR and VR enabled MIoT models, extended digital twin, blockchain, 5G and so on. F

A. Medical Diagnosis

     Medical diagnosis is the process of determining the medical condition of a patient based on the symptoms.

B. Patient Monitoring

     The convergence of telepresence, digital twinning and blockchain will reap amazing benefits of the Metaverse in healthcare, especially in terms of patient monitoring.

C. Medical Education

     The Metaverse is a remarkable milestone in the field of medical education.

D. Surgeries

     The Metaverse is becoming an important technology in the medical industry, especially in surgery. Surgeons are currently using tools that range from VR headsets to haptic gloves to mimic surgical procedures, boosting prepared- ness and efficiency in the operating room.

E. Medical Therapeutics & Theranostics

     Medical therapeutics can be regarded as the branch of medicine that deals specifically with the treatment of diseases. Digital therapeutics (DTx) deliver evidence-based therapeutic interventions and can be considered as a class of digital medicine. Digital Therapeutics Alliance defines digital therapeutics as products that “deliver evidence-based therapeutic interventions to patients that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease”. F

Ongoing and Upcoming Projects

1. Healthify.
2. Dehealth.
3. Bump galaxy.
4. Accuvein.
5. Hintvr.
6. Healthblocks.

Challenges & Open Issues

• Data privacy concerns.
• Information Security Concerns.
• Interoperability Issues.
• High Cost of Technology.
• The Personal Touch is Lost.
• Legal and Regulatory Challenges.

References

1. J Thomason. “Big tech, big data and the new world of digital health”. Glob. Health J., in press.
2. World Economic Forum. “Building the healthcare system of the future”. (2016).
3. J Gaubert. “Seoul to become the first city to enter the Metaverse. What will it look like?”. Euronews.next (2021).
4. J Burke. “Reintroducing the open Metaverse OS paper”. Outlier Ventures (2021).
5. Feldman J. “Flickplay’s 3d social media platform presents as an industry first”. Influencive (2020).

     The rapid progress in digitalization and automation have led to an accelerated growth in healthcare, generating novel models that are creating new channels for rendering treatment with reduced cost. The Metaverse is an emerging technology in the digital space which has huge potential in healthcare, enabling realistic experiences to the patients as well as the medical practitioners. The Metaverse is a confluence of multiple enabling technologies such as artificial intelligence, virtual reality, augmented reality, internet of medical devices, robotics, quantum computing, etc. through which new directions for providing quality healthcare treatment and services can be explored. F

     The amalgamation of these technologies ensures immersive, intimate, and personalized patient care. It also provides adaptive intelligent solutions that eliminates the barriers between healthcare providers and receivers. Healthcare is one of the most significant determinants of ensuring general, physical, social and mental well-being of the entire human population.

     In the world. The primary objective of any healthcare system is to channelize its efforts towards activities that promotes, restores, maintains and improves healthcare services. The recent pandemic of COVID-19 have added enormous pressure to the global healthcare sector and related workforce, infrastructure and supply chain management. The COVID-19 has been the primary reason for accelerating rapid change across the healthcare ecosystem and have compelled the stake holders to pursue adaptation and innovation of all the technologies used in this sector. The need to deploy advanced digital tools and services has become a necessity to provide optimized This digital transformation has significantly impacted the healthcare ecosystem by improving their working capability, access to services, patient-clinician experience by using artificial intelligence, cloud computing, Augmented Reality (AR), Virtual Reality (VR) technologies]. The healthcare system in the Metaverse provides health-care service experience that is interactive, immersive and recreational customized to meet individual patient’s needs. The use of these technologies provides exposure towards new ways of delivering treatment in significantly lower cost thereby enhancing patient outcomes. The Metaverse technologies can help healthcare professionals in effective planning and diagnosis of diseases. The Metaverse environment enables enhanced surgical pre-operative planning by transforming CT scans into 3D reconstructions using headsets. This also helps the surgeons to specifically view, isolate and manipulate anatomical regions to perform critical surgeries. Plastic surgery is an extremely complex procedure which requires reconstruction of human body parts. In case of plastic surgeries, the use of VR in the Metaverse could play an important role wherein the virtual avatar could accurately predict the outcome of a plausible plastic surgery.

     The health data can be visualized by the patients on the virtual dashboard helping them to communicate with clinicians, researchers, nutritionists, and other stake holders for achieve individual care and treatment. The Metaverse has the potential to revolutionize medical education and training. The use of AR provides the conducive environment to explain practical procedures rather than disseminating theoretical knowledge.

     The Metaverse can provide 360 degrees visualization of the body ailments and can act as the most helpful surgical training tool fostering optimum level of cooperation and highest degree of immersion.

     The global statistics of the Metaverse reveal that the global healthcare market in the Metaverse holds a value of 5.06 billion Dollars in 2021 and is expected to reach 71.97 billion Dollars by 2030 with a compound annual growth rate (CAGR) of 34.8 percent during considered period of forecast.

Sensors

     The precision of personal healthcare analysis partly depends on the measurement of different physiological parameters using sensors. Recently, an innovative wearable temperature sensor technology which utilizes freestanding single reduction graphene oxide fibre was introduced and developed with many benefits, such as fast response, high stability and repeatability under mechanical deformation, and wearable comfort. Despite being readily available, medical equipment is costly and consumes a lot of power. With biomedical sensors, medical systems are flexible with machine-to-machine interactions, saving time of both patients and medical institutions, and offering treatment plans over tele diagnosis. Among various sensors, temperature, electrocardiogram (ECG), and pulse are the most important ones for health status evaluation besides blood pressure, accelerometers, and imaging sensors.

     The following part will discuss some relevant sensors commonly used in healthcare and medical systems.

In general, big data is currently characterized by seven Vs as follows: volume (a large amount of data), variety (including structured, semi-structured, and unstructured data with different formats), velocity (high rates of data inflow and real-time processing), veracity (detailed data accumulation), value (in-depth and meaningful information), variability (offering extensionality and scalability), and valence (data interconnection).

• Big data collection: Sqoop is an open-source framework for data import and export between Hadoop Distributed File System (HDFS).
• Big data processing: MapReduce is a programmable model that simplifies and accelerates a massive amount of data, featured by three main functions (e.g., mapping, sorting, and reducing)
• Big data storage: Hadoop performs the distributed system HDFS and the non-relational databased HBase for big data storage. HDFS, a primary component of a Hadoop cluster, provides high throughput access to application data and is suitable for high-volume data applications.

Artificial Intelligence

In the last decade, several modern technologies and tools based on distributed architectures, along with large memory and powerful computing units, have been introduced for big data processing in healthcare and medical domains:

     All in healthcare is an all-encompassing term used to describe the use of ML algorithms to mimic human cognition in presenting, analysing, understanding, and learning complex healthcare and medical data. In fundamental, most of the existing AI/ML algorithms can be grouped into two categories: traditional techniques and advanced techniques, which can solve three principal problems: clustering, classification, and regression. Conventional AI/ML algorithms usually performs four data-based learning types: supervised learning (i.e., learn the relation between input and output via a mapping function using labelled data and classify/predict the outcome for an unforeseen input sample using the trained model), unsupervised learning (i.e., involve the utilization of ML algorithms for unlabelled data analysis and clustering, and can find out data groups without the need for human intervention), semi-supervised learning (i.e., trained upon the combination of clustering similar data using an unsupervised learning algorithm and using the existing labelled data to label the remaining unlabelled data), and reinforcement learning (i.e., make a sequence of decisions, in which an agent learns to attain a goal in an uncertain and complex environment). Recently, deep learning (DL) is a subset of ML with advanced architectures, e.g., recurrent neural network, long short-term memory network, and convolutional neural network, relying on multi-layered artificial neural networks, to attain ground-breaking performance in many classification and regression tasks of healthcare and medical domains.

Wireless Communication Networks

     Many innovative communication technologies have been introduced in the last decade due to the explosion of IoT technologies with edge and mobile devices along with the diversity of applications and services, especially in the health- care and medical domains.

Cellular network: As so-called mobile network, a cell network is a radio network distributed over land areas called     cells. Each cell is served by at least one fixed-location transceiver, a.k.a., cell site or base station. Remarkably, cellular networks can enable a huge number of portable receivers to communicate with each other and other fixed transceivers via base stations.

Wi-Fi: is a wireless networking technology that allows diverse devices, such as computers (desktops, laptop, and tablets), mobile devices (smart phones, smart watches, and wearables) and others (printers, TVs, projectors, and video cameras) to connect the Internet.

References

1. Michael Ahdoot., et al. “MRI-Targeted, Systematic, and Combined Biopsy for Prostate Cancer Diagnosis”. N Engl J Med 382.10 (2020): 917-928.
2. Yasuhiro Y., et al. “Moving away from systematic biopsies: image-guided prostate biopsy (in-bore biopsy, cognitive fusion biopsy, MRUS fusion biopsy)-literature review”. World J Urol 39.3 (2021): 677-686.
3. Xiang Tu., et al. “Transperineal Magnetic Resonance Imaging-Targeted Biopsy May Pefrform Better Than Transrectal Route in the Detection of Clinically Significant Prostate Cancer: Systematic Review and Meta-analysis”. Clin Genitourin Cancer 17.5 (2019): e860-e870.
4. Marco R and Sebastiano DL. “Transperineal Freehand US/MRI Fusion Target Prostate Biopsy using the Esaote MylabTM9 System: A Step by Step Guide”. J Dise Dis Tre (2022).
5. Bass EJ., et al. Emberton M, Ahmed HU. “Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach”. Prostate Cancer Prostatic Dis 20.3 (2017): 311- 317.
6. Smith CP and Tu?rkbey B. “PI-RADS v2: Current standing and future outlook”. Turk J Urol 44.3 (2018): 189-194.
7. EAU Guidelines on Prostate Cancer (2022).
8. Marco R et Sebastiano DL. “Are there Detection Rate Differences of Transperineal Freehand US/MRI Fusion Target Prostate Biopsy in Two Different Patient Settings: Under Local Anesthesia or Under Deep Sedation?”. Int J Clin Invest Case Rep (2022).
9. Stacy Loeb., et al. “Pathological characteristics of prostate cancer detected through prostate specific antigen based screening”. J Urol 175 (2006): 902-6.
10. Jerome P Richie., et al. “Effect of patient age on early detection of prostate cancer with serum prostate-specific antigen and digital rectal examination”. Urology 42.4 (1993): 365-74.
11. William J Catalona., et al. “Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men”. J Urol 197.2S (2017): S200-S207.
12. Smith CP and Tu?rkbey B. “PI-RADS v2: Current standing and future outlook”. Turk J Urol 44.3 (2018): 189-194.
13. Blake BA., et al. “Extraprostatic Extension Is Extremely Rare for Contemporary Gleason Score 6 Prostate Cancer”. Prostate Cancer 72.3 (2017): 455-460.

Introduction:  Currently prostatic biopsy on target found at the multiparametric MRI of the prostate is the best way to diagnose prostate cancer.

The European Association of Urology guidelines, updated to 2022, recommend to perform MRI-targeted prostate biopsy plus standard prostate biopsy when a PI-RADS 3 to 5 lesion is detected. 

The aim of the study is to establish if there is a real benefit of perfoming MRI-targeted prostate biopsy plus standard sampling when every PI-RADS 3 lesion is detected.

Case study: We performed a retrospective monocentric study at “San Pio” Hospital of Castellaneta, Italy.

76 patients underwent MRI-targeted prostatic biopsy with fusion or cognitive approach, associated with random sampling.

Results: Among the 124 biopsies on PI-RADS 3 lesions of our study only two PI-RADS 3 reported a positive outcome for not significant PCa detection.

Conclusion: Our results do not show a sure and real advantage in performing targeted prostate biopsy in all the patients with only PI-RADS 3 lesions and it may be appropriate to evaluate biopsy performance in these patients from case to case.

Keywords: Transperineal Prostate Biopsy; Fusion-Targeted Biopsy; Cognitive-targeted biopsy; Magnetic Resonance Imaging; PI-RADS 3; Prostate Cancer; Detection Rate

References

1. Andersson EK., et al. “Registered nurses’ descriptions of caring: a phenomenographic interview study”. BMC nursing 14 (2015): 16.
2. Nascimento KC and Erdmann AL. “Understanding the dimensions of intensive care: transpersonal caring and complexity theories”. Revista Latino-Americana de Enfermagem 17 (2009): 215-21.
3. Bridges J., et al. “Capacity for care: meta?ethnography of acute care nurses' experiences of the nurse?patient relationship”. Journal of advanced nursing 69.4 (2013): 760-72.
4. Carter C and Notter J. “Reorganization of critical care services”. Covid-19: An Open Access Critical Care Textbook 11 (2021): 41.
5. Kirchhoff KT and Kowalkowski JA. “Current practices for withdrawal of life support in intensive care units”. American Journal of Critical Care 19.6 (2010): 532-41.

     Quality assured patient care is expected by nurses all over the world. Caring has been acknowledged as the inner and essence of nursing. For a critical care nurse, caring for a patient implies saving life. While working in an intensive care unit, learning about various life saving procedures such as Cardio pulmonary resuscitation, endotracheal intubation. inserting a central venous catheter is a wonderful experience. Postings in different intensive care units gives worthwhile experiences in different specialties. However, when providing reassurance to patient about their wellbeing, they taught us how to fight with life. Apart from providing care to the patients, critical care nurse acts as a communicator, a liasor between patient, relatives and health care team. The demand of critical care nurses is in increasing trend all over the world. One should not think twice before choosing critical care as a speciality. From creating a spark of hope in patient’s eyes to provide them care at the end of life, critical acre nurses acts as a sole support for the patients and family.

Keywords: critical care nurse; perspective of critical care nurse

References

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     The defensive enzymes like glutathione preoxidase, glutathione reductase and catalase along with the defensive metabolites like reduced glutathione and oxidised glutathione were measured in red blood cells of acute constipated rats also along with sanay treated constipated rats. It was observed a decrease in GPx activity in both sexes of rats i.e., males and females. The GR activity in constipated rats was shown to be increased by more than GPx activity. The catalase activity has been observed to be increased insignificantly in acute condition. However, the GSH levels were found to be decreased in acute constipated rats but GSSG levels enhanced in acute condition. The sanay leaves treatment to acute condition rats restored the changed enzymes activities and metabolites levels.

     The liver function test carried out by the two enzymes namely GOT & GPT which increased in constipated rats. It shows that the enhanced GOT & GPT activities caused dysfunction of liver and invite kinds of liver diseases. The creatinine levels in red blood cells showed insignificant changes in both acute constipated rats and its treated condition with sanay leaves. It may be concluded that sanay treatment restores the low defense system found in constipated rats as well as the liver function which is slightly changed during constipation.

     H. pylori could migrate or get forced to migrate to the colon under the influence of antibiotics where it will continue to produce ammonia for a reason or no reason leading to accumulation of profuse amounts of ammonia un-opposed or buffered by any acidity. Accumulation of profuse amounts of ammonia in the colon is toxic and could constitute a biological stress to the body causing toxic pancreatitis that could lead to potential stress diabetes in predisposed children. The spread of H. pylori-induced childhood diabetes could constitute more than 90% of the world’s burden of childhood diabetes during the latest three decades specifically since the implementation of the triple anti-H. pylori antibiotic eradication strategy in 1986 [7-10].

     The concept of the biological toxic stress leading to an onset of H. pylori-induced childhood diabetes is not just hypothetical or scientific fantasy as upon the basis of this concept the newly-discovered childhood diabetic condition has been readily and adequately corrected in many children; around 89% of cases in some recent studies [10].

     Colon clear with the senna leaves extract purge and vinegar-mixed food therapy have been recently demonstrated to effectively deal with the challenge of H. pylori including eradication of colonic and abnormal-behavior gastric H. pylori strains in addition to prevention of recurrence [8, 9].

Therefore; countries should follow a characteristic strategy towards H. pylori dyspepsia and H. pylori-related dysglycemia:

• Any newly discovered childhood diabetes should be first considered a potential condition not an established illness and should be treated as stress diabetes. Children should be immediately investigated for existence of colonic H. pylori strains and immediate employment of colon clear with the senna leaves purge once followed by vinegar mixed salad or yogurt with principal meals once or twice daily for one week. Patients with inadequate response to colon care and colon clear by vinegar and the senna could do revision of the senna purge twice with one-month space between them. Patients who remain hyperglycemic in spite of these measures should be given one-week physical rest together with physiological rest of the pancreas by administration of fractionated regular insulin doses for one week. Children who do not recover after that could be considered established diabetics and could receive the anti-diabetic medication appropriate to their condition.
• Children who recover a potential diabetic condition should practice extreme carefulness towards out-side home meals and should return to colon care and colon clear either on regular basis or at least whenever they develop colonic troubles. They should care from gastric recurrence by regular dental hygiene and cleaning of dental plaques as being possible reservoirs for H. pylori or children can just employ mouth wash with diluted dietary vinegar as tolerated once or twice weekly together with washing hands with vinegar and water after washing with soap in order to avoid fecal-oral recurrence as soap alone does kill H. pylori [8].
• The antibiotic aggression towards H. pylori should be re-discussed in details and gastric sedatives including anti-urease activity should be subjected to severe revision and accurate re-determination.
• The world should stop searching/re-searching after H. pylori; save these funds and direct them towards raising the life and water supply standards in poor and developing countries as the matter of H. pylori is essentially a sanitary conflict before it is a medical challenge and rich people tour in poor countries while poor people travel to work as food handlers in rich countries; that is how abnormal H. pylori strains travel from stomach to stomach via meals and navigate all over the world [8].
• Patients and families should be educated as concerns misbehavior in food habits and antibiotic use.
• Orientation of primary health care units as concerns natural measures towards H. pylori dyspepsia.
• Dyspeptic mothers should investigate for existence of colonic H. pylori strains and deal with them via employing natural measures (colon care and colon clear) but not antibiotics in order to avoid transmitting H. pylori to their kids. Mothers preparing food for their kids particularly if dyspeptic should usually wash hands with vinegar then water after washing with soap.
• Pregnant mothers should not feel lazy to cook and should not love the fast food for themselves and their kids during pregnancy.
• Food handlers should strictly and frequently disinfect hands with vinegar and travelers should make vinegar a friend to their meals while touring.

References

1. Habib HS. “Frequency and clinical presentation of ketoacidosisat onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia”. Saudi Med J 26.12 (2005): 1936-9.
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3. De Ferranti SD and Osganian SK. “Epidemiology of pediatric metabolic syndrome and type 2 diabetes mellitus”. Diab Vasc Dis Res 4.4 (2007): 285-96.
4. Al-Nozha MM., et al. “Diabetes mellitus in Saudi Arabia”. Saudi Med J 25.11 (2004): 1603-10.
5. Salardi S., et al. “Helicobacter pylori and type 1 diabetes mellitus in children”. J Pediatr Gastroenterol Nutr 28.3 (1999): 307-9.
6. Dore MP., et al. “Diabetes mellitus and Helicobacter pylori infection”. Nutrition 16.6 (2000): 407-10.
7. Farinha P and Gascoyne RD. “Helicobacter pylori and MALT Lymphoma”. Gastroenterology 128.6 (2005): 1579-605
8. Nasrat AM., et al. “Misconception and misbehavior towards Helicobacter pylori is leading to major spread of illness”. General Med S1 (2015): 002.
9. Nasrat SAM., et al. “The dramatic spread of diabetes mellitus worldwide and influence of Helicobacter pylori”. General Med 3.1 (2015): 159-62.
10. Nasrat AM., et al. “The challenge of childhood diabetes”. General Med 3.4 (2015): 193.

     The frequency of ketoacidosis at onset of childhood in the world particularly in developing countries is significant. Prevention of diabetic ketoacidosis and control of its rising frequency should be a healthcare target [1]. The epidemic of childhood diabetes is a worldwide challenge that could be directly related to the whole world challenging epidemic of childhood obesity or it is simply part of the dramatic spread of adulthood diabetes worldwide [2-4].

     Similar to the spread of adult DM, Helicobacter pylori could arise as a major environmental reason that could be directly related to the flaring challenge of childhood diabetes. A possible link between H. pylori and diabetes mellitus in children has been mentioned in some studies while this relation has been denied by other reports [5, 6].

References

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Background: There may be some significant relationships between smoking and triglycerides and low density lipoproteins (LDL) in the plasma.

Methods: Consecutive daily smokers at least for a period of six months and age and sex-matched non-smokers were included into the study. Cases with regular alcohol consumption (one drink a day) and patients with inflammatory, infectious, or devastating disorders including eating disorders, malignancies, acute or chronic renal failure, cirrhosis, chronic obstructive pulmonary disease, hyper- or hypothyroidism, or heart failure were excluded from the study.

Results: The study included 150 smokers (99 males) and 162 non-smokers. The mean age of smokers was 45.9 years, and 66.0% of them were male. Although the mean body weight, body mass index, systolic and diastolic blood pressures, and hematocrit values were similar in both groups, triglycerides (163.3 versus 151.8 mg/dL, p<0.05) and LDL (126.1 versus 117.4 mg/dL, p<0.05) were higher in the smokers, significantly. Similarly, erythrocyte sedimentation rate (ESR) (10.8 versus 9.4 mm/h, p<0.05) and C-reactive protein (CRP) (2.5 versus 2.1 mg/L, p<0.05) values were also higher in the smokers. On the other hand, high density lipoproteins (HDL) (41.1 versus 44.0 mg/dL, p<0.05) and fasting plasma glucose (FPG) (101.9 versus 111.9 mg/dL, p<0.01) values were lower in the smokers, significantly.

Conclusion: Smoking causes a low-grade systemic inflammation on vascular endothelium terminating with an accelerated atherosclerosis-induced end-organ insufficiencies all over the body. As significant indicators of the systemic inflammation, smoking increases triglycerides and LDL, parallel to ESR and CRP, whereas decreases HDL and FPG in the body.

Keywords: Smoking, triglycerides, low density lipoproteins, high density lipoproteins, fasting plasma glucose, erythrocyte sedimentation rate, C-reactive protein

     Among the commensal community, mucosa associated commensal species such as segmented filamentous bacteria (SFB) are a minority regulating strongly the host immune response. Autoimmune diseases, especially RA, are involved in such modulation by gut microbiota. SFB drive autoimmune arthritis in the K/BxN mouse model of arthritis by triggering signals that instruct gut T helper 17 (Th17) cells to differentiate and help in autoantibody production.

     T follicular helper (Tfh) cells contribute in the production of high-titer antibodies (Abs) through helping B cells to produce high affinity Abs and long-lived plasma cells by inducing somatic hypermutation and class switching.

     The frequency of Tfh cells significantly increased in RA peripheral blood and this was accompanied by increased level of anti-citrullinated protein autoantibodies (ACPAs) indicating the possible involvement of Tfh cells in development of RA.

     In a K/BxN RA mouse model, SFB interfered with Tfh differentiation in Peyer’s Patches and supported antigen specific Tfh dissemination at systemic sites which could also support the contribution of both SFB and Tfh in RA pathogenesis.

     The effects of long-term antibiotics on the microbiota are not yet understood and the emergence of resistance due to genetic alteration in microbiota, still to be investigated.

     In conclusion, the crucial role of the microbiota in health and disease is well firmly established. Studies must be undertaken to better understand human microbiome in terms of composition, metabolic pathways and its role in RA. There is evidence that targeted modulation of the microbiota may improve clinical outcome in RA suggesting that personalized treatment strategies based on patient microbiome profiles may increase drug efficacy, safety, and prognosis. This might benefit in establishing a highly individualized management for each RA patient.

Background

     Rheumatoid arthritis (RA) is a chronic autoimmune disorder where genetic and environmental factors contribute to the pathogenesis of disease.

     RA leads to functional disability; it was found that 30% of patients are unable to work after 3 years of disease. The gut contains about 29% of all micro-organisms that live in and on the human body. Their function is to help in digestion, nutrition, energy production and vitamin synthesis. Gut microbiota are an environmental factor that regulate the immune system thus providing health benefits to their host.

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Using the example of modern biopsychosocial urological models, the article shows that the syndrome of chronic urological pelvic pain has a multi-factorial Genesis and requires an integrative, multidisciplinary approach (urologist, neurologist, and clinical psychologist).In this regard, the identification of individual urological clinical phenotypes of patients allows us to identify predisposing, provoking and supporting factors that determine the course of the disease and the response to therapy. The phenotypic urological systems are described: Marr, UPOINT, and DABBEC. The specifics of mental comorbidity (depression, panic disorder, borderline personality disorder, etc.) in this group of urological patients are detailed. The Association of symptoms of depression and changes in sexual functioning with urological chronic pelvic pain syndrome is shown. For the first time, the models of urinary-bladder-bowel-brain by L. Karsten are described; accumulated stress and falsification of anxiety, loss of control in patients with urological pelvic pain by D. Dasalakis and models of the influence of the patient's mental state on muscle-tonic manifestations in the urological clinic of Yaong Ki. Personal characteristics of patients with urological pelvic pain neuroticism, compliance, openness, conscientiousness, conscientiousness, changes in masculine identity, alexithymia, catastrophization) are systematized and described. The tactics of conducting a full and rapid comprehensive psychological assessment of a urological patient are presented.

Keywords: chronic prostatitis; chronic pelvic pain syndrome; prostatitis; biopsychosocial approach; catastrophization, neuroticism; depression

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The paper conducts an analytical review of the history of understanding the phenomenon of health, reveals all the diversity in approaches and judgments about this conceptual category. It is emphasized that the interpretation of the concept of health is important not only the medical and scientific aspect, but also has a key socio-psychological significance for the development of modern society and the formation of a person's personality. On the example of coronavirus infection, the article provides a justification for the relevance of the semantic content of this conceptual category now. The scientific novelty of this work lies in the analytical studies of the concept of health as a basic socio-psychological conceptual category and the development on this basis of new theoretical approaches and corresponding definitions of the concept of health and its main derivatives. The proposed interpretations, according to the author, have a more pronounced social and psychological determinant for the formation in modern society of a new worldview regarding the concept of health and its derivatives. Because of new conceptual priorities, as shown in the work, it is possible to significantly strengthen the health of the population, increase the individual, herd level of immunity, and improve, ultimately, the quality of the very realization of a person in all spheres of his life.

Keywords: psychology; social psychology; practical psychology; health; mental health; physical health; reproductive health; sexual health; terms and concepts

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Methods: Moderately curved root canals of 36 identified mandibular premolars were standardized in length and divided into 3 groups (n=12). Initial scans were taken using µCT. All canals were instrumented with Profile^® DENTSPLY0.06 taper NiTi rotary instruments using saline, 17% EDTA (Pulpdent Corp., Watertown, MA) or RC Prep™(Premier). After instrumentation, lengths were re-measured and all the teeth were re-scanned. Using computer software, 3-dimensional models were created from the pre and post-instrumentation scans. Models were compared for changes in volume and transportation.

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A comprehensive search was carried out in mainstream bibliographic databases or Medical Subject Headings, including ScienDirect, PubMed, Scopus, and ISI Web of Science. The search was applied to the articles that were published between January 2020 and early 2023 With strict literature search and screening processes, it yielded 14 articles from 373 articles of initial literature database. Among 14 study results, there was acceptable for immunogenicity, both humoral and cellular immune responses in 11 studies (78.57 %), whereas acceptable potent immunogenicity was found in patients aged more than 40 years with chronic diseases, particularly, chronic respiratory diseases and coronary artery diseases. Only potent T-cell response was identified in one study. No significant difference in vaccine safety compared with healthy subjects and effective neutralizing antibodies (two doses completion) against SARS-CoV-2 (COVID-19) in patients older than 60 years with diabetes and/or hypertension were demonstrated after completion of COVID-19 vaccination. Immunogenicity and safety in aged people and individuals living with various chronic diseases (both infectious and non-infectious) is highlighted in this study. In conclusion, specified local and systemic AEs and unsolicited AEs, AESI, and SAEs after each vaccination and after the second dose should be monitored. Recording the adverse events of special interest (AESI) and serious adverse events (SAEs) throughout the patients’ vaccination course should be performed and can decrease COVID-19 vaccination hesitancy in these persons.

Keywords: adverse reactions; COVID-19; immunogenicity; neutralizing antibody; safety; vaccine

Historical Background

     Before 1967, abortion was generally illegal in the United States of America except to save the patient’s life [1]. From 1967 to 1973, some states like New York, Washington, Alaska, Hawaii and California liberalized abortion laws. The landmark US Supreme Court judgement of Roe and Wade in Jan 1973 legalized abortion nationwide [1] Despite this, opposition across the US led to the camps of abortionists and the Pro–life. This had a great impact on the political dynamics of the country and also globally. The abortionist camp through advocacy, sponsorship, education and NGOs campaign against unsafe abortion and its implications led to the adoption of abortion laws or modified forms in different counties.

     Despite the obvious positive effects of Abortion laws in reducing maternal mortality and morbidity, the Pro-life in the US continued its efforts to repeal the laws through legislation and the Courts. In 1992 the Supreme Court almost overturned the Roe decision, (Planned Parenthood of Southeastern Pennsylvania v Casey, 505 US 833) [1].

      About fifty years after the Roe decision that legalized abortion was overturned on June 2022 by the US Supreme Court and individual states in the US were empowered to decide the legal parameters for abortion [2]. The effects of this decision will not only affect women in the US but globally, considering the global impact of US policies. The US is the leading donor globally to family planning and abortion care and has a rule that prohibits the use of its funds for a program that conflicts with its policies. The “global gag rule” will affect reproductive rights services in other countries especially the Sub –Saharan Africa which depends heavily on donor-funded program [2].

Unsafe Abortion and abortion laws in Sub-Saharan Africa

     Globally there were about 6.8 million unsafe abortions annually with the majority occurring in sub-Saharan Africa. Evidence has shown that the incidence of abortions is the same worldwide whether abortion law is liberalized or restricted. Thirty-five per cent of abortions are unsafe in regions where the abortion laws are restrictive while only 1% of abortions are unsafe in counties where the abortion laws have been liberalized [3]. In Sub-Saharan Africa, 77% of abortions are unsafe due to restrictive laws on abortions [3].

     According to 2019 figures, sub-Saharan Africa has the highest case fatality of 185/100,000 unsafe abortions resulting in over 15,000 avoidable deaths [3]. This was a remarkable improvement from the 2000 figure of 315 / 100,000 which was due to the availability of abortion care / post-abortion care services and the improvement of abortion law in the region [3].

     Extensive work was done on unsafe abortions and abortion laws in the last two–three decades by Bankole et al of the Guttmacher Institute and published in 2020 titled “From unsafe to safe abortion in Sub-Saharan Africa: Slow but steady progress”. From the study, great progress has been made. The African Union Maputo agreement of 2003 stipulated the legal criteria of allowing abortion when the woman’s life or physical or mental health is threatened and in cases of rape, incest and grave fetal anomaly. Some countries have gone beyond the Maputo agreement and have liberalized abortion laws (Category 6) including South Africa, Cape Verde, Guinea-Bissau, and Sao Tome & Principe. Zambia also has broadly liberalized abortion law - Category 5. Twenty-seven of the 48 – sub-Saharan African countries have moderately restrictive abortion laws (abortions to save the woman’s life and to preserve her physical or mental health).

     The majority of the countries in the Sub-African have either liberalized or moderately restrictive laws on abortion. Despite the above statement majority of the populace live within the highly restrictive due to the high population of countries like Nigeria in this category.

     Other countries in the region have highly restrictive abortion laws which are to save the life of the mother (Category 2) except for six with total restriction on abortion – Category 1(Madagascar, Angola, DRC, Mauritania, Seria-Leone & Senegal).

     Most of the progress in ensuring safe abortions in this region through legal and political means was hinged on the Roe and Wade case, the global funding for safe abortion and NGO partnership. The question of whether this overturning will have effects on reproductive rights and the safety of our women in the reproductive age is not in doubt.

The effects and the way forward

     The effect of restrictive abortion laws is not limited to the termination of unwanted pregnancy but may affect adequate post-abortion care after miscarriages, and those with a significant maternal or fetal condition that requires interventions [2]. All these will hinder the achievement of the United Nations Sustainable Development goals of reducing maternal mortality to 70 per 100,000 live births by 2030.

     One of the main drives to liberalize abortion law in this region was the US bio-political pressure emanating from Roe and Wade’s decision for the last half a century [2]. Reversal of this decision and the anti–abortion policy at the Federal level, may lead to counter bio-political pressure in the opposite direction.

     Most of the abortion care and family planning materials were donor-driven and subsidized. This reversal may lead to reduced funding and an increase in cost even when available, coupled with the current economic downturn worldwide will harm SDG -Goal 3 3.

     The decision to restrict abortion at the federal level in the US may resonate in African countries with more countries becoming more restrictive too. As it had been shown restrictive abortion law does not reduce the incidence of abortion but rather increases the incidence of unsafe abortions [1.3]. This will further increase the maternal mortality rate thereby making SDG 2030 unrealistic.

     This decision will also have negative implications for medical education funding in abortion care and will influence the knowledge, skills, and quality of care provided by medical practitioners as documented by Traub and co-workers. This will be more pronounced since most funds for reproductive health education and training were from International NGOs and Partners of which the US accounts for the bulk of the donation

Conclusion

     There is no doubt the Overturning Roe and Wade decision will adversely affect the African policy on Safe abortion practices and with the likelihood of increased unsafe abortion with associated mortality and morbidity.

     Africans need to meet to take their destiny into their hand by ensuring local funding for reproductive health services and post–abortion care to manage complications from unsafe abortions.

References

1. Levine PB., et al. “Roe v Wade and American fertility”. American Journal of Public Health 89.2 (1999): 199-203.
2. Coen-Sanchez K., et al. “Repercussions of overturning Roe v. Wade for women across systems and beyond borders”. Reproductive Health 19.1 (2022): 1-5.
3. Bankole A., et al. “From unsafe to safe abortion in Sub-Saharan Africa: Slow but steady progress”. New York: Guttmacher Institute (2020).
4. Traub AM., et al. “The implications of overturning Roe v. Wade on medical education and future physicians”. The Lancet Regional Health–Americas (2022): 100334.

     Unsafe abortion and its complications remain a major contributor to maternal mortality which is still very high worldwide, especially in the sub-Saharan. The legalization of abortion remains the most impactful way of minimizing the mortality and morbidity from unsafe abortion and its complications.

     The legalization of abortion remains one of the most contentious issues in modern medicine with great emotional, religious, cultural, legal, political and medical discourse.

Reference

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Background: Engaging in athletic training not only improves cardiovascular, pulmonary, and musculoskeletal function but also has been shown to enhance neural capabilities.

Purpose: The purpose of this study is to examine how the positioning of the forearm and elbow joint affects median nerve conduction velocity (NCV) among three groups: throwers, archers, and non-athletes.

Method: This study included a total of 34 subjects of both genders, with body mass indices (BMI) ranging from 18.5 to 24.9 Kg/m². To measure median nerve conduction velocity (NCV) across the elbow joint at various angles (0° elbow extension, 45°, 90°, and 120° elbow flexion) and different forearm positions, NeuroStim NS2 EMG/NCV/EP System was used.

Result: Repeated Measure Analysis of Variance (RMANOVA) demonstrated a statistically significant difference in the mean values of median NCV across different angles, forearm positions, and groups (p<0.05).

Conclusion: The positioning of the forearm and elbow joint can significantly impact median nerve conduction velocity, particularly among athletes who engage in repetitive upper limb motions. Study showed that the archers had significantly faster NCV than throwers and non-athletes at 0° of elbow flexion.

Keywords: Angles; Joints; Motor; Peripheral nerve

     Unintentional errors necessitate moderation in spreading data, compassion, and even forgiveness.

     Minor to moderate unintentional errors may benefit from the community's emotional support; frequently, they explore the problem and consider the individual's past performance and successful activities completed before the error happens. Their actions during his troubled time express their inner voice toward him.

     If this doesn't happen, he must reflect on his past acts to be sure if there are some possible gaps in effecting job requirements or relational problems; these potential breaches must be detected and corrected accordingly.

     Their attitude of criticism or a lack of interest in him in troubled times will determine a similar response from him when they are in need.

     Intentional errors must be identified and punished; minor to significant corrective and curative actions, according to error, will be used to avoid other misconduct with more people suffering.

     Consciousness and more reflection on mistakes following undesired effects on the individual and community level are necessary. Through the power of a negative example, remediation is possible only using the image of such action, without any words or aggression.

     Individuals with genetic abnormalities facilitating disapproval behaviour should be re-educated for improvement since each individual has an ineffable spark.

     The people responsible for spreading misinformation must be punished, paying for moral distress to the intended recipient.

     In this digital era, spreading bad news about an individual alters his credibility. Honour is essential for practical, successful work, and its alteration by lousy information shared wide affects personal health.

     If an untruth is applied rapidly, a disaster could follow since affected personality traits for an innocent, not guilty person exponentially amplify his distress, leading to significant mental and physical disorders.

     Verification for honest info before spreading prevents possible disasters.

     Sometimes, envy subtly controls the envisioned steps to attain the intended goal. Such encounters are better to be identified and exposed to the public so as not to fall again someone.

     The world includes a variety of individuals, and not all are gentle, honest people. Selective relationships for life quality improvement define us, ensuring ill prediction, termination, and rehabilitation of the individual.

     People's successful relationships suppose truth, respect, and consideration. To work in dignity is a requirement, and the individual good morality and integrity assure esteem in the community.

     Lack of respect and admiration from our community alters mind functioning and job performance and declines perspective.

     Error is usual, but not exceeding limits for survival.

     Disgrace means the loss of people’s respect as a response to the individual’s misconduct.

     Personal acting up has various effects on the community and determines feedback; the error in practice outlines humiliation.

     In the digital era, good and bad news rapidly spreads. Usually, people are curious and quickly respond to new info. The data spread about someone may be correct or false, including intentional or unintentional errors. The fast distribution of inaccurate data dangerously works on the equilibrium of the receiver, sender, and producer.

     In the healthcare industry, individual medical errors rapidly circulate by media, commonly generating people to disapprove and censure the following behaviour. People's criticism increases the suffering in the heart and mind of an individual making mistakes; prolonged suffering can lead to disaster since the mind's activity influences bodily function, and fragile areas can decline their activities under excessive distress. Therefore, reputation must be ameliorated and recuperated quickly, whenever possible. Proper actions to rapidly establish the truth and collective support for health improvement may ease the torment.

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In the month of December 2019, Wuhan which is a city of Hubei, state of China suffered an unusual outburst of pneumonia of unclear origin. The causative agent was described as a novel coronavirus, which the WHO (World Health Organization) designated as COVID-19. Coronavirus-19 is initiated by a β-coronavirus called SARS-Covid-2 that presents itself as pneumonia and disturbs the lower respiratory tract in individuals. It's related to SARS and MERS. Covid-19 continues to spread amid worldwide isolation and quarantine attempts. We summaries the existing state of awareness concerning COVID-19 as a response to this global outbreak.

Keywords: Coronavirus (COVID-19); Pathogenesis; Global Outbreak

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The present study deals with identifying the impact of COVID-19 pandemic and vaccination in context of India. The impact of pandemic on the organization, management, and Health of people of India has been thoroughly described. Several strategies have been taken by management and Indian government in order to control the pandemic situation. The strategies and the importance of vaccination has been discussed in the study. Vaccination can be seen as an important part for mitigating health issue and control the risk of spreading the virus. This study focusing on discussing the vaccination process and how the vaccination helps the country to improve its condition and mitigate the pandemic risk. Quantitative research strategy has been employed in the study in order to collect data and achieve get an outcome of the research. Primary data has been collected from 51 participants and statistical analysis has been done on the collected data. According to the analysis of the data it can be stated that, Covid-19 pandemic reduces movement of the people that are forced to stop production of several organization. Moreover, vaccination method was more seen to be helpful for different management and organisation to mitigate issues and reboot financial activities.

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Chronic constipation developed by loperamide in Wistar rats were subjected to experimentation and their treatments with senna leaves extracts. It was observed that there was an increase of body weight, swollen stomach and belly size. The stools were hard and less in amount in constipated rats which all they got normalized with sanay treatments.

In chronic constipation the glutathione peroxidase activity was observed to be decreased by 18% approximately in case of male and 16% approximately in case of female. The glutathione reductase activity also increased by 22% in male and 25% in female rats red blood cells. The catalase activity has shown an increase of 14% in males and 32% approximately in female rats red blood cells. The GOT activity increased by 54% in males and 48% in females. The GPT activity in red blood cells was observed to be increased by 36% approximately in case of male and 44% in female. The catalase activity was found to be increased by 14% in male and 32% in female rats red blood cells. All these enzymes activities normalized after sanay leaves extract treatments to chronic constipated rats.

The metabolites levels of GSH also decreased by 25% in both male and female rats and the GSSG levels increased by 77% in male and 66% in female. The sanay treatments to both male and female rats normalized the metabolites levels.

In chronic constipation the creatinine levels were observed to be increased by 8% approximately in case of male and 13% in case of female. This metabolits level was observed to be normalized after sanay leaves extracts treatments to chronic constipated rats.

It may be concluded that the female rats suffer the most biochemical dysfunction in comparison to male in chronic constipation.

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