PriMera Scientific Medicine and Public Health

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

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

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

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.

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.

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.

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 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":

Apply direct oral anticoagulants, twice a day;
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".

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.

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.

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.

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

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.

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

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.
Yuefei J., et al. “Virology, Epidemiology, Pathogenesis, and Control of COVID-19”. Viruses 12.4 (2020): 372.
Huang C., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 395.10223 (2020): 497-506.
Xiao F., et al. “Evidence for gastrointestinal infection of SARS-CoV-2”. medRxiv 158.6 (2020): 1831-1833.e3.
Meijuan Z., et al. “Functional exhaustion of antiviral lymphocytes in COVID-19 patients”. Cellular & Molecular Immunology 17.5 (2020): 533-535.
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.
McGonagle D., et al. “Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia”. Lancet Rheumatol 2.7 (2020): e437-e445.
Wenzhong L and Hualan L. COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism (2020).
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.

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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.

References

Alexis Kafando. “Evaluation of the introduction of the new A conjugate vaccine (MenAfrivac) at the national level on the epidemiology of bacterial meningitis in Burkina Faso”. University Diploma in Vaccinology, University of Bordeaux, Ecole Val de Grace (2011).
WHO: Weekly Epidemiological Record: Executive Brief: WHO Position on Meningococcal Vaccines, November (2011).
Yazi Mai Aiki Abdoul Aziz. “Clinical and paraclinical investigations of the probable sequelae of bacterial meningitis in Niger”. Medical Thesis No. 0 1935, Abdou Moumouni University of Niamey, (2011).
Adrien Deroubaix. “Impact of desert aerosols and climate on meningitis epidemics in the Sahel”. PhD thesis, Pierre and Marie Curie University. France (2013).
WHO/EMC/BAC/98.3: WHO practical guidance, Controlling meningococcal meningitis epidemics. www.who.int/emc.
WHO: Weekly Epidemiological Record: Executive Brief: WHO Position on Meningococcal Vaccines, November (2011).
Fati Sidikou., et al. Polymérase Chain Reaction Assay and Bacterial Meningitidis Surveillance in Remote Areas, Niger.
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.
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).
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).
WHO: Meningitis Weekly Epidemiological Bulletin 2010, week 48–52.
WHO: Meningitis Weekly Epidemiological Bulletin 2011, Week 48–52.
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).
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).
Towa Djeungoue Stéphanie Jackie. “Epidemiology of meningitis in Mali in 2007”. Thesis of Medicine, University of Bamako.
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).
G Campagne., et al. Epidemiology of bacterial meningitis, Niamey (Niger), 1981-1996 Bulletin of World Health Organ 77.6 (1999): 499-506.
Amadou Oumarou. “Purulent meningitis in children (epidemiological, clinical, etiological, therapeutic and evolutionary aspects)”. Thèse de médecine, Niamey (Niger) (1898).
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.
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).
Taha MK. Meningococcal infections. EMC - Infectious Diseases 9.3 (2012): 1-17.
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.
Fabrice Bruneel and Michel Wolf. acute meningitis; Encyclopediamedico-surgical 17-160-C-10.
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.
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.
H Ben Hamouda., et al. “Clinical and evolutionary aspects of neonatal bacterial meningitis”. Pediatrics Archive 20 (2013): 938-944.

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.

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

Infection prevention and control during health care when COVID-19 is suspected: interim guidance. Geneva: World Health Organization (2020).
Infection prevention and control for long-term care facilities in the context of COVID-19: interim guidance. Geneva: World Health Organization (2020).
Home care for patients with COVID-19 presenting with mild symptoms and management of contacts: interim guidance. Geneva: World Health Organization (2020).
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.
NIOSH-approved N95 Particulate Filtering Facepiece Respirators.

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

Healthify.
Dehealth.
Bump galaxy.
Accuvein.
Hintvr.
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

J Thomason. “Big tech, big data and the new world of digital health”. Glob. Health J., in press.
World Economic Forum. “Building the healthcare system of the future”. (2016).
J Gaubert. “Seoul to become the first city to enter the Metaverse. What will it look like?”. Euronews.next (2021).
J Burke. “Reintroducing the open Metaverse OS paper”. Outlier Ventures (2021).
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.

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

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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

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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.

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The use of radiation in diagnosis and therapy is common but not without fear of detrimental risks and a general feeling of uneasiness. Effects of LDR have not been adequately elucidated and more research is needed to unravel the underlying mechanisms. However, LDR is known to cause stimulations in a variety of cellular processes resulting in beneficial effects which offer new opportunities to harness the protection to normal cells and therapeutic outcomes through toxic effects. It is pertinent to recall that billions of years ago the living organisms from bacteria to humans evolved in high ionizing radiation background and they armed themselves with complex protective machineries for survival against external stressors. In the present time, average annual natural environmental radiation is estimated ~2.4 mSv which, of course, varies at various locations on the earth ranging from about 1 mSv in Japan to 260 mSv in Iran. Most interestingly, it is found that people residing in such natural high background radiation (HBR) areas live a normal life and there are no reported significant health issues.

The living organisms exhibit adaptation offering protection against radiation exposure and learn to live below certain threshold dose. Furthermore, a low radiation dose causes stress to cells which turn on genes at specific threshold of radiation dose. The radiation activated genes up-regulate the protection systems which produce enhanced positive effects e.g. prevention of cancer, risk prediction and suppression of diabetes etc. Presumably, the LDR induced positive effects arise due to intracellular production of reactive oxygen species (ROS) which initiate production of endogenous antioxidants for its neutralization and signaling processes. More importantly, LDR activate repair of the damaged DNA, induce the mechanism of apoptosis causing the self-destruction of cancerous cells. LDR could modulate excessive inflammatory responses, regulating lymphocyte counts, and controlling bacterial co-infections in patients with COVID-19. Also, it is known to boost immunity which can annihilate cancer cells as well as reduce or counter virus assaults. Overall, LDR initiates recruitment and rescue operation in the injured cell which results in protection against radiation in normal cells or to the pathogenic agents including COVID-19 virus attack. On the other hand, a higher dose of ionizing radiation overstresses the organisms and the genes are turned on/off at specific radiation doses. It is known that different genes are activated by high and low doses. Thus, the built in protection system in cells is overtaken at higher doses and harmful effects are observed. That is to say, the low dose induced beneficial effects are generally marred by high dose radiation exposures. Another important finding in radiobiology is the observation of damage to non-irradiated cells called bystander effect. The DNA damage, apoptosis and other effects in non-irradiated cells show different patterns. It remains to be seen how bystander effect will modify cancer therapy outcome, risk estimates(carcinogenesis) and protection against radiation. Evidently, the promise of LDR in therapy of cancer and other diseases (e.g.cardiovascular) needs to be isolated, identified and tested in clinic. More importantly, a new opportunity is in the sight to optimize a window of LDR doses, say between 10 mSv to 200 mSv, that needs to be tested and optimized in the therapy of chosen lung cancers and novel COVID -19 infection which locates in the lower respiratory system and causes pneumonia symptoms leading to breath deterioration and eventually death.

In the evolution of life, organisms have harnessed the low dose stimulation to their survival advantage. It is no surprise that extensive LDR research in environmental ranges at molecular, cellular, and animal level has shown no adverse or detrimental effects. Thus, the concern for likely safety of health issue is critical. In fact, the safety concerns of scientists from LDR therapy seem to entail from the Reports of International Commission for Radiation Protection (ICRP) which believes in Linear-No- Threshold (LNT) model which is based on the assumption that no dose is safe however small. The ICRP prefers to ignore biological fact of intrinsic cellular repair machinery and hence believes in no threshold. Radiobiological studies on the surviving population from Hiroshima and Nagasaki atom bomb have shown that the cancer rate increases in proportion to the amount of exposure to radiation at acute high doses. However, there is no convincing data that shows the increase in cancer rate with a low level of exposure. On the contrary, there are even reports indicating that the cancer rate declines in high background radiation studies in China, India Brazil and Iran. The observed adaptability and the built in intrinsic protection system in living organisms against radiation are ignored for establishing the regulation and standards for radioprotection. In this context, the observed threshold of LDR dose at which genes are turned on and the dose at which they are turned off are important transition from beneficial to harmful effects of radiation. Of course, the dose thresholds and the amounts of benefit and harm observed are the characteristics for each organism. But, the remarkable demarcation of response of organisms from a LDR to acute radiation dose (ARD) is frequently observed which needs re-examination for the validity of LNT model.

In summary, the studies on low dose radiation effects on living organisms needs re-focus and role of LDR therapy in fighting cancer merits re-examination, a fresh look at carcinogenic risk evaluation/prediction (in view of Adaptive response and bystander effects) and developing novel tools for treating COVID-19 appear highly urgent and it’s use in therapy deserves re-evaluation and rigorous analysis of the clinical data. International scientific community is divided on the carcinogenic risk of LDR but recent surge in publications on evaluation of low dose therapy in the treatment of pneumonia caused by the novel COVID-19 and cancer re-emphasizes the need for technical developments and brings new hope for saving human life.

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Healthy relationships always suppose trust, respect, and appreciation between interest groups; sicknesses play down these fundamental components, annoying the beneficiaries.

Prosperous affairs or weak spots going down them continuously appear, soothing or distressing the individuals. Younger individuals are more candid, genuine, heartfelt, and open to challenging situations. Still, they have less life experience than adults or seniors. Old individuals are frequently registered with many diseases, including arterial hypertension and type 2 diabetes shading their performance. For all categories, illnesses get in the way of thinking and acting and may cause disruptions in interpersonal relationships. An unfair manifestation of judgment makes partners terminate the connection, amplifying mental suffering in the sick individual.

Rational thinking and performing duties gratifies people working and attract individuals, but imbalanced actions can harm their other relationships. People look for another collaborator when they are disappointed by unsafe collaboration. They usually need to prepare for such turning effects and want a more direct and effective way of interaction.

Persistent bad feelings disturb the human equilibrium, primarily affecting lipid profile and glycaemic control that alter cell functioning.

Therefore, people’s health ensures a prosperous social, professional, cultural, and emotional life. A deep look through the factors implying the appearance and evolution of various illnesses is necessary. A medical team’s mission is to identify all risk factors connected with the clinical manifestations of multiple diseases that affect reasoning and measures to attenuate or eliminate them when possible.

Disorder management has a different approach in this century. Person-centricity leads to a better- understanding of diseases, moving to their origin, and considering human life evolving and undergoing rational transformation.

People’s complex connectivity infers numerous parts that vary by age, instruction, setting, surroundings, and circumstances. The inability to select the most advantageous factors for enhancing professional and social life needs improvement.

Occasionally dire conditions cannot be avoided, and the individual must be prepared to deal with dilemmas. Successfully coping with unexpected problems defines the capacity to beat barriers, or if an inevitable fall occurs, rising above is preferable. The excellent position gained after falling depicts the victory against overcoming adversities, illuminating a path for restorative health and optimistic well-being improvement.

Sometimes illogical actions originate in intentional immoral thinking, finally repulsing, revolting, or shocking the recipients. Corrective and informative actions are indispensable to going back to normality. The artificial Intelligence supply and instruction hybrid model add benefit for remodelling unhealthy behaviour.

Acting as professionals, we gain recognition from the community we serve.

And so, mental activity may also be evaluated by the effectiveness of connections between individuals with various backgrounds and demographic data.

Individual reasoning change over time is expected. It should be better to have its improvement, but if decline appears, it has to be eased, and it is preferable not to fall again. Rising once more for the beauty of life in this natural and perceptible world that will end up sooner or later for each one is wanted.

Individual working reflects genetics, education, social connection, and environmental characteristics. It is advisable to maintain an equilibrium between intellectual activity and physical exercises. Moreover, intellect work can relax in the digital age, along with a personal choice from diverse virtual offerings aiding in recharging, ensuring a harmonious state of being.

People’s data fast circulates by media, helping individuals to better decide on their collaborators. Personal reputation, appreciation, trust, and respect are fundamental for long-lasting relationships. Good partnership work ensures a prosperous social, cultural, professional, and emotional life. Unsafe people interactions have detrimental effects on their health and, consequently, decline work efficiency and well-being. IT advancement facilitates blocking collaboration with dishonest or uneducated people.

The medical team’s mission is to detect the negative impact of unhealthy behaviour on individuals’ well-being and provide timely solutions for that, utilizing information technology resources for a swift recovery.

Immoral conduct in daily work is easily identified by using specialized electronic tools for monitoring; applying reasonable measures for remediation makes possible fast restoration of bad habits and ameliorates offensive people collaboration. Nowadays, corrective actions for harmful human behaviour are used more gently and with more permission, exploring self-reflection value for improvement.

AI-powered tools can assist in restoring health, expanding knowledge, and enhancing the overall quality of life, finally leading to increased life expectancy.

The latest technological advancement in healthcare delivery is used in clinical diagnosis, which may be established using only virtual patient data. Various IT devices are available for both rich and poor people in need. But just using a modest mobile phone makes the connection between the physician, nurse, and patient possible; online voice analysis combined with breath characteristics and face and hands info enables a rapid clinical diagnosis with no more time-consuming. This new practice model is more facile and accessible, gaining benefits for all parties implied in dealing with medical conditions: health professionals, patients, their families, pharmaceutical departments, and representatives of other trades connected for social support.

Recording people’s physical or online interactions allows us to revisit communication for analysis; this helps detect possible gaps, correct them, and improve business or corporate performance.

Customer experience reflects the professionalism of individuals collaboratively working and offering their products; the client’s knowledge, involvement, skills, emotional state, and proficiency are examined by gathering data from various touch-points and other communication channels. Consumer satisfaction ensures increased revenues, improved practice efficiency, and societal progress.

People’s interaction with robots replacing their labour is a new, more accurate, rapid, and cost-saving alternative in service mode.

As for each fact, there are two opposite facets of the advancement of technologies these days. The optimistic attributes of IT may fascinate us but are easily eclipsed by other elements with detrimental effects on individual health: more absorbed time to navigate them, a decreased program for physical activities or relaxation in nature, less time interacting in person, and disturbed slipping rhythm. These factors, if unbalanced, can lead to increased body mass index and brain disorders; sleep disruption represents a point start of other medical conditions. Ingenuity for an educational platform focussing on people’s health in the digital age is imperative.

A fair digital program for an individual ensures a healthy life expedition, attaining excellence in living in the natural and perceptible - audible and visible world.

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Introduction: Very low birth weight (VLBW) is a term used to describe babies who are born weighing less than 1,500 grams (3 pounds, 4 ounces). Infants who are born preterm with low birth weight and secondary to intrauterine growth restriction, can be subjected to increased morbidity, mortality, and cost [5]. Babies with a very low birth weight are at a higher risk of motor development, depression, Attention deficits and other psychiatric conditions in adulthood, compared with those born a healthy weight [6]. The purpose of this study is to find out the effect of very low birth weight and gestational age on motor development in preterm infants at 18 months of corrected age.

Materials and Methods: This study is a observational study design and was conducted in VAPMS College of Physiotherapy, outpatient Department and R.K. MISSION hospital. A study sample of 50 subjects was selected on simple random sampling method. The study questionnaire was applied and the infants were prospectively evaluated using Alberta Infant Motor Scale (AIMS) for their gross motor development at 18 months of corrected age. The observational study was done for 20 minutes for each infant. In addition, the perinatal and the socio-environmental data were obtained from the parental interview. The assessment emphasizes the anti gravity movement of the limbs in prone, supine, sitting and standing positions, postural alignment, weight bearing of the body with further evaluation in attainment of gross motor skills.

Results: The sample was segregated into three sub group model and thus identified 3 motor trajectories among VLBW preterm infants: stably normal (n=36), slightly deteriorating (n=11), persistently delayed (n = 3). Infants with a normal trajectory manifested the typical motor performance with AIMS Z scores of 0.4 to 0.5. Infants with deteriorating trajectory displayed the motor performance in the typical range initially but then deteriorated from 12 months. Infants with a persistently delayed trajectory revealed a significant delay from 9 months. All the infants were observed at 18 months of corrected age.

Conclusion: The study concluded that very low birth weight has a significant effect on the motor development observed in preterm infant. The early motor trajectories were also a predictive of subsequent developmental outcomes in preterm infants specifically with VLBW. In addition the study emphasizes that socio-environmental factors are not associated with motor trajectories in preterm infants with VLBW.

Keywords: Very low birth weight; Preterm infant; Gross motor trajectories

Research supported the evidence stating that mental health is likely multifaceted by nature, that includes genetic, biochemical, physiological, and environmental factors. The Human Genome Project, completed in 2003, opened new avenues for genetic research. Since then, genome-wide association studies (GWAS) and other genetic analyses have identified specific genetic variants associated with mental health disorders. Genetic variations can contribute to an individual's susceptibility to mental health disorders.

Over the years, researchers have made significant progress in identifying and understanding various biomarkers associated with mental health disorders. In the mid-20th century, researchers started investigating the relationship between neurotransmitters and mental health. Scientists have learned that alterations in neurochemicals are related to mental diseases. For instance, the significant milestone was the discovery of antipsychotic drugs in the 1950s, which specifically targeted dopamine receptors and shed light on the involvement of neurotransmitters in conditions such as schizophrenia (Sawa &Snyder, 2003). Another early discovery was the neurotransmitter serotonin. These neurochemicals are released into the synaptic region in depressed individuals than in healthy individuals. Selective serotonin reuptake inhibitors (SSRIs), a class of drugs, work by increasing the quantity of serotonin in the synaptic region, which alleviates symptoms of depression (Bethesda, 2007). Several combinations of single nucleotide polymorphisms in an individual's genetic makeup and some environmental stressors may contribute to these mental conditions. When a person is stressed, the cortisol hormone is released into the bloodstream (Cay et al., 2018). In the 1980s and 1990s, the role of cortisol as a prognostic biomarker in mental health disorders gained attention. Studies found dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to abnormal cortisol levels. Cushing's syndrome (Lacroix et al., 2015) is caused by too much cortisol, while Addison's disease (Charmandari et al., 2014) is caused by adrenal damage and is associated with too little cortisol. Drugs related to cortisol (e.g., prednisolone) will suppress cortisol secretion from the adrenal gland if taken for a period. The inherited genetic error can cause disorders in the human body, such as Huntington's disease (HD). HD is caused by the mutation in the gene resulting in increased repetition of cytosine, adenine, and guanine (CAG). This error in the DNA codes for genes makes defective nerve cells in the brain gradually break down and die, causing the body to lose important signals to keep it in its proper function and response.

These breakthroughs emphasized the significance of neurotransmitter imbalances in mental health disorders and paved the way for further research in this field. Measuring these chemicals in the blood or the cerebrospinal fluid with neuroimaging techniques, mass spectrometry, and genetic testing can help identify these biomarkers. Advances in neuroimaging techniques like positron emission tomography (PET), magnetic resonance imaging (MRI), and functional MRI (fMRI) can reveal structural and functional brain abnormalities associated with mental health disorders. Brain imaging biomarkers help understand brain circuitry, identify treatment targets, and evaluate treatment response.

Multi-omics approaches, such as integrating multiple biological data sources, such as genomics, proteomics, metabolomics, and transcriptomics, have opened new avenues for biomarker discovery. These multi-omics approaches allow researchers to explore complex interactions and networks underlying mental health disorders. It's important to note that the field of mental health biomarkers is still evolving. Many biomarkers are in the early stages of research and require further validation and standardization before they can be implemented in clinical practice. Nonetheless, the ongoing discoveries in this field hold great promise for personalized approaches to diagnosis, treatment, and understanding of mental health disorders.

References

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Background: In Bangladesh, Pharmacists have an advantage over other healthcare professionals as they have easier and more frequent access to the public.

Objective: This study aims to address this knowledge gap and provide valuable insights to guide future interventions.

Methods: The study was conducted through cross-sectional quantitative methods in purposively selected eight districts from October 2020 to December 2020. A structured questionnaire was distributed among a sample of pharmacists, and the collected data was analysed using statistical methods. The ethical clearance of the study was taken before data collection. Sixteen trained data collectors collected 627 data through face-to-face interviews with the Pharmacists using a pretested structured questionnaire. Descriptive analysis was performed, and quality control and risk management were performed strictly for maintaining the accuracy of the data.

Results: The study found that about 70% (n=438) pharmacies were found registered, and above 77% (n=483) pharmacies were owned by Pharmacists themselves. About 85.5% (n=536) had knowledge on counselling of patients in pharmacy but only 62% (n=389) had knowledge on SRH-related counselling. The highest duration of counselling of patients by Pharmacists was 1-5 minutes, 66.2% (n=355). Only 48.5% (n=304) had knowledge on complications and 69.7% (n=437) had knowledge on the side effect of SRH medicines. About 64.6% (n=405) of Pharmacists reported hearing the SRH-related issues from patients before selling medicine. About 80% (n=501) of Pharmacists reported having knowledge on menstrual hygiene, 49.4% (n=310) had knowledge of post-abortion care, and 56.8% (n=356) had knowledge of Postpartum family planning. About 76.6% (n=480) Pharmacists had knowledge of maternal complications, where 75.8% (n=475) mentioned haemorrhage and 71.1% (n=446) mentioned eclampsia as maternal complications. About 90.6% (n=568) of pharmacists mentioned that they required training on dispensing SRH-related medicine.

Conclusions: Though A grade (Graduate Pharmacist) and B grade (Diploma Pharmacist) Pharmacists had little knowledge of SRH medicine dispensing but C grade (Pharmacy Technician) had no proper knowledge and practices regarding SRH-related medicine dispensing. Most of the Pharmacists were in C grade, so their training on SRH-related medicine dispensing is very much essential. The findings contribute to evidence-based strategies for enhancing pharmacists’ involvement in promoting SRH and FP services in Bangladesh.

Keywords: Pharmacists; Sexual and Reproductive Health; Family Planning; Bangladesh

Background: Fistula in Ano is a chronic abnormal communication runs outward from anorectal lumen (int opening) to an external opening on the skin of perineum or buttock. History of ischiorectal, perianal abscess is the main hindering reason. Tuberculosis, IBD (Crohns or ulcerative proctocolitis), trauma can also lead to development of anal fistula. Sometimes termed as nonspecific, idiopathic or cryptoglandular and intersphincteric anal gland infection. chronic discharge, occasional pain and blood staining, foul smelling, cloths soiling and disturbance in religious purposes for muslims are the reasons to operate.

Objectives: To specify duration of healing in low variety fistula in Ano after surgery and staying time in Hospitals. Other concomitant issues in perioperative period.

Methodology: This cross sectional study was carried out in Bangabandhu sheikh Mujib Medical university from April to Sept 2012. Total 50 patients were selected as study population whom were admitted with low anal fistula and internal opening is below anorectal ring. Horse shoe, high variety fistula, associated disease (TB, IBD), malignancy were excluded from study population. Patient were grouped in A and B. A for Fistulectomy and B for fistulotomy. 25 patients in Group A, 25 patients in Group B. surgery was conducted by spinal anaesthesia and preoperatively 1 gm ceftriaxone and 1 bottle (500 gm) metronidazole given in each patient. Patients were discharged in 2^nd post operative day with some guidelines and education of treatment maneuver. First follow up after 7 days and 2^nd follw up after 4 wks.

Results: Total 50 patients admitted in BSMMU surgery Department and grouped in A (Fistulectomy) and B (Fistulotomy). Age range was 20-70 yrs and male are suffered more than female. low socioeconomic groups are presented more with history of anorectal abscess. Mean hospital stay was more in Fistulectomy with raised pain score than fistulotomy.

Conclusion: Anal fistula is a common cause of chronic pain and anal nuisance. Delineation of anal anatomy and identification of fistulas tract is important to prevent recurrence. Fistulotomy patient has less post operative pain with less hospital stay than fistulectomy in low variety anal fistula.

Keywords: Fistulectomy; Fistulotomy; Low variety fistula

References

Padmini Shukla and Shashi Alok. Pharmacognosy and Phytochemistry-I; Nirali Prakashan (2021): 1.1.
SB Gokhale and CK Kokate. Pharmacognosy and Phytochemistry-I; Nirali Prakashan (2019): 3.2-3.3.
G Jayapriya and F Gricilda Shoba. “GC-MS analysis of bio-active compounds in methanolic leaf extracts of Justicia adhatoda (Linn.)”. Journal of Pharmacognosy and Phytochemistry 4.1 (2015): 113-117.
Pharmacology and Morphology of Some Species of Adhatoda vasaka. International Journal of Pharmaceutical Research and Applications 6.4 (2021): 276-283.
Gauri Badgujar and Samiksha Bhagat. “Pharmacology and Morphology of Some Species of Adhatoda vasaka”. International Journal of Pharmaceutical Research and Applications 6.4 (2021): 276-283.
M Prathapa Reddy and TR Shantha. “Pharmacognostical and Physicochemical Evaluation on the Flowers of Justicia adhatoda L.”. Research Journal of Pharmacognosy and Phytochemistry 7.2 (2015): 73-90.
Dhankhar S. “Aegle marmelos (Linn.) Correa: A source of Phytomedicine”. J MediPlants Res 5.9 (2010): 1497-1507.
Santosh Kumar Singh., et al. “Pharmacognostic study and phytochemical screening of leaf of Adhatoda vasica (Acanthaceae)”. Journal of Medicinal Plants Studies 2.4 (2014): 29-31.
R Nithyatharani and US Kavitha. “Phytochemical Analysis of the Leaves of Adhatoda Vasica”. IJCRT 6.1 (2018): 451-454.
Thokchom P Singh and Okram M Singh. “Adhatoda vasica Nees: Phytochemical and Pharmacological Profile”. The Natural Products journal 1 (2011): 29.39.
R Parthasarathy and R Ilavarasan. “Pharmacognostical Studies on Thespesia populnea Bark”. Research Journal of Pharmacognosy and Phytochemistry 1.2 (2009): 128-131.
Khandelwal KR. “Practical Pharmacognosy (Techniques and Experiments)”. Nirali Prakashan (2008): 09-19.
Satish Kumar BN and Gobinda Mohan Behera. “Pharmacognosy, Phytochemistry and Pharmacology of Annona squamosa Linn”. Research Journal of Pharmacognosy and Phytochemistry 3.3 (2011): 93-102.
Tushar P Dukre, Ganesh N Wadekar and Harshad B Pawar. “Pharmacognostic and Phytochemical Evaluation of Herbal Plant: Alangium lamarkii”. Research Journal of Pharmacognosy and Phytochemistry 14.2 (2022): 65-68.
Kokate CK. “Practical Pharmacognosy”. 3rd edition, Vallabh Prakashan (1994): 107.
Gupta Abhishek and Joshi Apurva. “Pharmacognostic Study of Justicia adhatoda Linn. Leaf”. International Journal of Herbal Medicine 1.6 (2014): 01-04.
Khandelwal KR. “Practical Pharmacognostic Techniques and Experiments”. Nirali Prakashan (2010): 12.30-13.32.
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References

Shivshankar Kanhuji Chopkar. “Supreme God Power Always Exist in The Universe, Active as Soul In Human Being Body”. International Journal of Humanities and Social Sciences (IJHSS) 10.1 (2021): 99-104.
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Christianity Bible. Search on Google: It can be found that “God is responsible for the creation of the Earth, world, and universe in human religion and mythology” which finds reference in the Holy Bible which is a revelation of God” (2019).
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Zoroastrian. He believed that a single divine force created the entire world and resided within it. In his belief, God was not separate from the world and ... Judaism is the parent of both Christianity and Islam. It proclaims that there is only one God, whose name is Yahweh, and He is the creator and ruler of the universe (2018).

The evidence in clinical practice shows that extended and intense mental activities and sleep deprivation can be in front of heart disease for people in four or five decades. More intellectual and emotional engagement in daily work for a prolonged period leads to sleep schedule disruption. The body’s nervous system cannot adequately recover from sleep deprivation, resulting in accumulating fatigue. Unbalanced fatigue determines the nervous cells’ inefficiency in controlling bodily function, and chaotic heart activity can follow sooner or later in connection with adrenergic pathway activation. Therefore an unhealthy lifestyle can negatively impact mental and heart function, so informative programs are needed.

In the digital age, technological advancement facilitates fast disorders management.

An acute episode of heart disease imposes laboratory testing and specific investigations. Typically, the family physician’s clinic may not have all the necessary tools for a precise medical diagnosis, as specialized departments can do it in a public or private hospital. Their referrals to specific medical units ensure the best management of illnesses, and cardiology is at the top of necessity. A cardiologist is best equipped and finalizes an accurate diagnosis and treatment, while a family doctor can provide more information about the origin of heart disorders.

The family physician accumulates more info about the patient’s lifestyle since their longitudinal data are accounted for. Business continuity ensures endless patient observation, motivation, and the effectiveness of corrective measures applied when necessary. The cooperation of a family doctor with colleagues from other medical specialties is imperative for the sake of public health. Instant communications of interest for the patient and the medical team, discoveries of new drugs, and various alternative therapies can all make the patient’s recovery more straightforward and accessible in this digital world.

The person-centred approach offers another dimension for understanding and applying the knowledge in practice; a deep look at the origins of the clinical manifestation of the illnesses and utilizing advanced technologies to address them enables a short revitalization. In a clinical case analysis, possible cumulative internal and external risk factors must be considered: their magnitude, interdependence, time action, and individual vulnerability - to predict their adverse effects on people’s equilibrium.

Research data from the Hospital and the Primary Care Clinic supplies the gaps in the disease approach. Their collaborative work, rapid communication, and the use of a new AI algorithm in handling data lead to healthcare betterment, increase patient enjoyment, life quality, and expectancy, and offer a prosperous personal, professional, and social life in a world where time is our precious gift.

Headache is a universal experience. It is one of the most common complaints in the field of medicine & neurology. The article deals with the issue of ‘headache’ in the field of medical science. It does not consider ‘Migraine’. It hampers the quality of life in all age sections as headaches have multiple reasons. Headaches are a part of everyone’s lives. Most headaches are usually harmless but in some cases they\can be harmful too. The article covers both harmful and harmless headaches that hamper the quality of life. Medical science has not been successful to elicit the cause of each headache and thereafter treatment plans are multiple in nature, confusing and a definite plan has not been deduced.

Ancient references to headache, migraine & neuralgia can be found in the Ebers Papyrus (1200 BC). Evidence of trepanation of 9000 year old Neolithic skulls suggests the first headache treatment. Visual symptoms associated with the headache were described by Hippocrates who lived during 460-370 BC. The father of medicine from Greece on whose name the Hippocratic Oath is taken by the budding doctors across the globe was the first to scientifically elucidate headaches clinically through his observations. That is why Hippocrates is known as the first analytical epidemiologist. Aretaeus provided one of the earliest classifications of headache around 200 AD.

The reader will get an idea of the problem of headache at the global & national level through the eyes of clinical health in the beginning sections before delving in to the Homoeopathic system of the AYUSH platform. Currently, the AYUSH platform has regained its value in the era of the current pandemic. The pandemic has further escalated the issue of headache, further precipitated by the increased stress levels. In the absence of effective therapy in the modern medicine, the article delves into what homoeopathy can offer to deal with headache issues that fulfil the triad criteria of essential medicines as per the National List of Essential Medicines (NLEM). The criteria is that these medicines need to be effective clinically, clinically safe and should be without side effects. Thus Homoeopathy is the leading therapeutic system that can deal with headaches and can cover masses while being cost effective [1-3, 17-19].

Brief of the article

The current article looks into the aspects of headache during the life period out of which managing headaches is one of the main challenges.

The article looks into the brief history of public health programs on headache issues in India & the emergence of headache as an issue. As headaches are a cross cutting problem among many health conditions, there is no specific public health program on headaches. However, there are programs like National Programme for Prevention & Control of Cancer, Diabetes, Cardio Vascular Diseases & Stroke (NPCDCS) & National Mental Health Program (NMHP) that cover both the primary & secondary headaches. These health issues that cover both mental and physical aspects are triggering factors for headaches.

The article now moves on to the current situation of headaches in India & the role of Homoeopathy to deal with these headache disorders therapeutically as a component of Ministry of AYUSH. The article suggests the integration of medical pluralism in headache therapy through inclusion of Homoeopathy in the gamete of physical and mental health conditions that are related to headaches.

As each & every drug in Homoeopathy is only proved on human beings, all the drugs have a mental component as it is only human beings who can express their physical & mental symptoms during proving of the drugs as per the guidelines set by the Homoeopathic Research Councils (HRC) of each nation. In India, Central Council for Research in Homoeopathy, an autonomous body under the ministry of AYUSH lays out such guidelines.

The article gains more relevance during the current COVID 19 pandemic which has precipitated the stress levels of population since March 2020 and most of the adults are more prone to headache disorders during their life stage besides finding it difficult to manage these headaches [14, 15, 18, 19].

Keywords: Headache; Homoeopathic Materia Medica; Constitutional medicine; Nosode; Bach Flower Remedy; Bowel Nosode; Miasms

References

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Objective: To determine and analyze the frequency of fetal growth restriction (FGR-syndrome) in pregnant women with hypertensive disorders as a variant of perinatal complication.

Methods: A retrospective analysis of the delivery histories of 2735 women with singleton pregnancies at the regional perinatal center in 2020 was conducted, including 2680 live births (97.9%) and 55 stillbirths (2.21%). Hypertensive disorders during pregnancy were present in 272 women (9.95%). FGR-syndrome in women with hypertensive disorders was detected in 130 cases (47.8%), while in normotensive courses of pregnancies it was 28.2% (680 children from the total number).

Results: A detailed analysis of pregnancy course in 42 women with hypertensive disorders and FGR revealed that gestational hypertension was present in 6 (14.3%), chronic arterial hypertension in 6 (14.3%), and preeclampsia in 30 (71.4%). A high percentage of preterm deliveries occurred in women with hypertensive disorders - 22 (52.38%). The degree of prematurity of newborns according to gestational age was: I - 18 (81.82%), II - 2 (9.09%), III – 0, IV - 2 (9.09%). The number of low birth weight infants for gestational age was 28 (66.67%), and varitable FGR-syndrome of grade 1 (below the 10th percentile) was present in 6 (14.29%) infants, and grade 2 in 8 (19.05%) infants.

Discussion: According to the obtained data on the mass-growth parameters of newborns and analysis using the T. Fenton table (2013), it was established that true FGR-syndrome in women with hypertensive disorders was detected in 33.33% of cases, while in 66.67% there were low-weight babies for their gestational age.

Conclusions: Based on a retrospective study of the course of pregnancy and childbirth, it has been established that women with hypertensive disorders are a high-risk group for adverse perinatal outcomes and the birth of children with congenital anomalies. It is advisable to further analyze and organize possible methods of comprehensive diagnosis of changes in peripheral vascular resistance in the cardiovascular system of the mother and fetus in hypertensive disorders in order to prevent the aforementioned complications.

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A study was carried out to find out the existing knowledge of students and to develop, implement and evaluate for nursing students about knowledge about safety measure and prevention of covid-19 among nursing students. In the present study non-experimental design was used. The study was conducted at V3 College of nursing at Rudrapur. 100 Nursing students were selected as sample by non-probability convenient sampling technique. Data were collected in 2 parts; part A includes the questions regarding their demographic characteristics and part B the knowledge questionnaire regarding safety measures and prevention of covid-19.1 Section A: description of sample in term of demographic variables. Section B: - it includes 34 questionnaires which are divided into 3 parts Introduction, Safety measures and Prevention.

The study shows that out of 100 samples most of the nursing students (63%) was having moderate knowledge, (36%) students were having inadequate knowledge and (1%) has adequate knowledge. It was revealed that majority of the students (54%) were belonged to the age group of 18-20 Years followed by (42%) age group of 21-23 years and (4%) students were from age group above 24 years. Maximum numbers of students (85%) were females and (15%) students were male. Maximum numbers of students (54%) were belonged to non- medical family background and (46%) students were belonged to medical family background. Majority that is (95%) had previous information about safety measures and prevention of covid-19 while only (5%) do not have previous information about safety measures and prevention of covid-19. Source of information like majority of information was found from television that is (37%), social media that is (35%), other source of information that is (20%) and newspaper that is (8%).

In demographic variables we found that the mean value of Age is 20.5 with SD=1.72, in Gender mean value of male was found 0.15 with SD=1.48 and mean value of female was found 0.85 with SD=8.41, in educational status for B.Sc. nursing mean value is 0.64 with SD=6.33 and mean value for GNM was found 0.36 with SD=3.56, In family income the mean value was 33.33 with SD=18.19, in medical family background the mean value was found 0.46 with SD=4.55 and in non-medical family background the mean value was found 0.54 with SD=5.34, in previous knowledge about covid-19 if yes the mean value was found 0.95 with SD=9.40 and if No the mean value was found 0.05 with SD=0.48 and source of information the mean value was found for newspaper 0.08 with SD=0.78, for television the mean value was found 0.37 with SD=3.66, for social media the mean value was found 0.35 with SD=3.46 and any other the mean value was found 0.2 with SD=1.97.

The chi square analysis was carried out to determine the association between knowledge level and demographic variables. It was evident from result that nursing students were influenced by their Gender, Family income, Family background, previous information about safety measures and prevention of covid-19, and source of information. Here the H1 was accepted for association of knowledge level with variables Gender, Family income, Family background, previous information about safety measures previous and prevention of covid-19 and source of information. By using inferential statistics knowledge level of students were associated with their selected demographical characteristics. In gender the chi square value was found(p=0.271) which is less than the table value at(p=5.99), in family income the chi square value was found(p=4.93) which is less than the table value at(p=9.49), in family background the chi square value was found (p=2.989) which is less than the table value (p=5.99) and previous knowledge about the safety measures and prevention of covid-19 the chi square value was found (p= 0.101) which is less than the table value at ( p=5.99), If yes, source of information the chi value was found (p=7.685) which is less than the table value (p=12.59) at the 0.05 level of significant which clearly indicated that there is association between the these above demographical variables and knowledge of students.

However, demographical variables such as age, and educational status were found to be non-significant. According to age chi square value was found (p=30.59) which is more than the table value (p=9.49), which is clearly indicate that there is no association between the age and knowledge of student. In education status the chi square value was found (p=9.5835) which is more than the table value (p=5.99) which is clearly indicated that there is no association between these demographic variables and knowledge of students.

On the basis of present study, the researcher concluded that most of the nursing students had moderate knowledge about safety measures andprevention of covid-19. Researcher assessed the knowledge about safety measures and prevention of covid-19 to prevent suffering from covid-19. Researcher also open-up new pathway for future studies on the topic for more generalization. This concluded that the how many students are aware about safety measures and prevention of covid-19.

Keywords: covid-19; safety measures; prevention; knowledge; students

Targeted group of people who are the candidate for transplantation and the donor selection criteria is a big chapter. In our common practices organ donation is still cumbersome in way of donor selection, non biasness, matching with patient and some medicolegal issues. Brain death donor or deceased donor would be the ideal organ donor though large, prompt, and dedicated group of medical people and logistics is the prime criteria and is demanding.

A successful Liver transplantation is combined success of two surgery, both donor and receipient and the donor is prime one. Completion of two successful surgery at a time is lead by chief transplant surgeon, co-surgeon, Anaesthetist, Medical team including paramedics, technicians, nurses, and postoperatively by dedicated critical care unit in comprehensive manner which is lead by ICU consultant.

Success is - return to home and maintain quality of life in both donor and receipient. Peroperative good surgical recovery is a finest work of a transplant surgeon and is directly a gift from Allah (swt). Liver surgery in Donor is segmental resection, lobectomy, partial hepatectomy. In receipient it’s a wide work in liver parenchyma, Major vascular structures and in biliary tree. This finest anastomosis is the key to successful outcome.

Immediate postoperative recovery is very vital. In donor –fluid management, nutrition and pain management with coverage of broad spectrum antibiotics and closely observe the immediate response of residue liver by biochemical analyzer. In receipient- start from whether receiving the organ in new host and then proper functioning of vascular and biliary anastomosis. Total calorie value estimation, fluid and pain management with control of sepsis is a finest co ordination. Every hours maintenance of intake output, meet up exact calorie demand, fluid management by measuring CVP (central venous pressure), orotracheal clearance and lungs care is the prime concern for good functioning of newer receipient tissues.

Execution of first 24 -72 hrs services –A group of ICU doctor, nurses, patient care attendant, ward boy, cleaners participation is mandatory. A good handover of Doctor – Doctor, Nurse – nurse is a safe transfer of patient to a safer one. In our common practices many mishaps are conducted by negligence, ignorance of medical team which was avoidable if prompt/alert action was taken immediately even in mid night. Should be kept in mind this initial hours of monitoring has no day night. This is in count of hours – for a good recovery.

A transplant surgeon should have the vast knowledge not only in surgery but also in critical care / Acute care services. Good co ordination is mandatory with critical care team and transplant team. In near future we wont loose any diseased with lack of organ and comprehensive services.

Spoken words extend human energy, interrelating with other energies and surroundings. This combination modifies their energetic picture in motion, which can maintain, improve, or decline their functionality. Evidence in clinical practice has shown that positive energy resulting from these interactions improves cell functionality; suitable and helpful word energy use in disorders management benefits everyone involved in patient care, including providers, clients, their dear ones, and families. Therefore, the medical team must model and use positive speech energy to improve patients’ emotional well-being, ultimately leading to increased satisfaction, better experience, business or corporate efficiency, enhanced reputation, and long-term client relationships. An increase in return on investment validates their work effectiveness, improving personal, professional, and social life satisfaction.

By contrast, aggressive words energy use in collaboration with others declines cell functionality in fragile areas, leading to disorders such as dyslipidaemia, type 2 diabetes, other endocrine diseases, arterial hypertension, and even brain haemorrhage or tumour. These disorders can be attributed to genetics and the frequency and magnitude of exposure to inappropriate communication. Words and tone misuse generate discomfort and decline the production process, altering mainly the emotional lives of collaborators. Deceptive people interactions harm the individual equilibrium.

Personal attitudes, words, and voice nuances validate individual thinking and abilities to use knowledge in collaboration with others. Expertise in the domain prepared for, fast and efficient data handling, building trustful, respectful relationships with partners, professional behaviour in society, and appropriate voice utilization in daily work are all essential to ensuring a prosperous personal, professional, social, and emotional life. These drivers contribute to the success of any endeavour.

Professionally speaking, sharing the presence, applying info in practice, and dealing with adversities make an individual esteemed and appreciated in the community they serve.

Unprofessional conduct in daily work causes detriment to all parties involved in affairs.

The healthcare industry professionals can utilize voice analytics for managing various disorders. They can focus on respiratory and heart functioning, nervous system control, distribution and composition of human body fluids, velocity, digestive, endocrine abnormalities, or environmental characteristics. Voice can be used as a clinical sign offering adequate details for analysis and decision-making in clinical practice.

Subjective or AI for voice analysis are options for disease management in the digital age, according to preferences and financial capacity, to adhere to new monitoring algorithms.

The speech analytics market has several major vendors, including Almawave, Avaya, CallMiner, Chorus.ai, Cogito, Dialpad, Genesys, Invoca, NICE, OpenText, Plum Voice, Prodigal, Qualtrics, Salesken, Talkdesk, Tether, and Verint. Speech analytics solutions are mainly utilized by industry verticals such as retail, telecom, banking, healthcare, travel, and hospitality. NICE, CallMiner, and Verint are the speech analytics industry’s top performers and market leaders.

Promising projects using AI for voice analysis conduct to healthcare advancement. AI provides a fast diagnosis, but even without technological progression, we can make a clinical diagnosis by just using an individual's face and hand info and listening to a few words.

In today's digital age, voice analytics has become an essential tool for businesses; analysing voice data allows them to gain valuable insights into clients' behavior and preferences. This info helps businesses to improve their clients' offerings, individualize marketing works, and ultimately increase revenue. With technological advancements, voice analytics has become more precise and effective; it is an increasingly current choice for businesses of all sizes.

It is a fact, although unknown to many, that the first hospital use of drug that would be named as antibiotic, was the so called pyocyanate prepared by Rudolf Emmerich and Oscar Low, two German physicians, in 1899 from Paeudomonas aeruginosa. However, the accidental discovery of penicillin by Alexander Fleming in 1928 was an event that re-defined treatment of infectious diseases, but was short-lived as it was soon discovered that microbial pathogens amplified their armamaterium to dwarf this very high hope.

Drug companies were very interested in Alexander Flemming’s discovery and started making penicillin for commercial purposes, which was widely used for treating soldiers with battle wounds and pneumonia during World War II. From mid- to late 1940s, it became widely accessible for the general public use. However, in the 1930s, the first commercially available antibacterial agent called Prontosil, a sulfonamide was developed by a German biochemist called Gerhard Domagk. In 1945, penicillin was introduced on a large scale in the treatment of bacterial infections, especially through the work of Howard Florey and Ernst Chain, who efficiently purified penicillin and scaled-up production.

The introduction of penicillin marked the beginning of the’ golden era of antibiotics’ classes for use in medicine, when antibiotics were discovered and introduced to the market between 1940 -1962. Each class contained several antibiotics which were discovered and modified versions of earlier types. Today, very few novel antibiotics are being developed while antimicrobial resistant bacteria that survive antimicrobial treatment are on the increase. These bacteria render most antibiotics ineffective or useless, which has further complicated this global health burden.

The time-line of the discovery of different classes of antibiotics in clinical use, otherwise known as “the discovery void’ refers to the period from 1987 until today, as the last antibiotic class was introduced for treatment of infectious diseases in 1987.

Bacteria use several mechanisms of drug resistance, some of the major ones of which include: 1) Drug inactivation using bacterial enzymes, 2) structural modification of drug’s target site by mutation, 3) reduction of drug intake through lowering of bacterial cell permeability, 4) drug efflux outside the bacterial cell membrane etc.

The AMR crisis due to increasing global incidence of infectious diseases is affecting the human population. This thus threatens human and animal health, and welfare for food and nutrition security, the environment, economic development as well as equity within societies.

Some causes of antibiotic resistance include: 1) over or under-prescription , 2) patients’ inability to complete antibiotic course, 3) overuse of antibiotics in livestock and fish farming, 4) poor sanitation and hygiene, 5) poor access to quality drugs, 6) poor infection and disease prevention and control in healthcare facilities, 7) lack of access to clean water, sanitation, and hygiene (WASH) for both human and animals, 8) self medication and 9) non-application of one health as a preventive strategy.

World Health Organization categorised antibiotic resistant bacteria into 3 groups, as mainly critical, high and medium priority; critical group include Pseudomonas aeruginosa, Acinetobacter baumannii and members of the family Enterobacteriaceae, aetiological agents of pneumonia and blood stream infections, the high and medium priority group include drug resistant bacteria like Salmonella that causes common infections like gastroenteritis, diarrhoea, food poisoning and Neisseria gonorrhoeae, a sexually transmitted pathogen.

The prevalence of drug resistance limits therapeutic options for the treatment of infectious diseases, thus contribute to the specter of “post-antibiotic era" in which most antibiotics are already ineffective.

The consequences of multiple drug resistance is the emergence of the superbugs, which are strains of bacteria, parasites, fungi, and viruses, that are resistant to most of the antibiotics and other medications used in the treatment of their infections. Superbug refers to bacteria which infections cannot be treated with two or more antibiotics. Examples of superbugs include drug resistant bacteria that cause pneumonia, complicated urinary tract infections (cUTI), skin infections etc. Infections by superbugs can however be successfully treated, although, they are much more challenging to treat and manage. A few examples are methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterbacteriaceae (CRE), vancomycin-resistant Enterococcus (VRE), multi-drug resistant Pseudomonas aeruginosa (MRPA) and multi-drug resistant Eshcerichia coli (MREC).

The loss of efficacy by antibiotics surely undermines man’s ability to fight and win the battle against infectious diseases and manage complications among vulnerable patients especially those undergoing chemotherapy, invasive treatment procedures, surgery and organ transplantation.

Various options are applied in the treatment of antimicrobial resistant bacterial infections such as combinatorial drug approaches, antimicrobial polymeric bio-material products, bio- nanotechnology approach, among others.

Therapy against superbugs particularly employ two major methods: 1) pathogen-directed therapeutics approach which decreases bacterial toxicity by alteriing their virulence factors and 2) the host-directed therapeutics approach which limits the superbug by modulating immune cells, enhance host cells’ functions and effectively modify disease pathology. Where the first line and second line antibiotic treatment options are limited by resistance or are unavailable, healthcare providers are compelled to use toxic antibiotics in the treatment of patients, which often result in high treatment cost, definitely less effective treatment characterised by high mortality, longer hospital stay, delayed recuperation and long term disability.

Conerted efforts are required to fight the spread of AMR, some of which are : 1) prevent infections from occurring and preventing resistant bacteria from spreading, 2) minimise the use of broad spectrum antibiotics and promoting the use of narrow spectrum antibiotics, 3) tracking drug resistant bacteria, 4) promoting development of new antibiotics, 5) building on the foundation of proven public health strategies, 6) immunization, 7) infection prevention and control, 8) protecting food supply, antibiotic stewardship and 9) minimizing person-to-person transmission or spread of infections, by screening, diligent treatment and education.

Preventive measures must be taken to minimise the menace of AMR, through rational use of antimicrobial drugs whenever necessary. Healthcare professionals should endeavour to promote drug safety awareness. The proper use of disinfectant must be practiced by both patients and health-workers, so as prevent nosocomial spread of multiple drug resistant bacteria.

In the global attempt at mitigating AMR, nearly 43 new antibiotics are in clinical development by the top 50 pharmaceutical companies with significant antibacterial properties against life-threatening infections, 18 of which have shown potential action against drug resistant Gram negatives and 10 others against Neisseria gonorrhoeae.

While attempts must be made to search for the best treatment strategies against super bugs, as resistance can easily be developed against new and novel antibiotics in the nearest future, rational antibiotic use and proper hygiene practices among patients and health-workers should be compulsory.

Communication skills with the people in need, as required, make their work different from that in other industries. The evidence in clinical practice shows the benefit of kind-hearted work for all parties: patients, their families, and the medical team. Medical professionals who resonate with people’s suffering are preferred to those who bring down the emotional involvement in care. Kind words, friendly attitudes, respect, generosity, encouragement, and consideration for helpless seniors aid in restoring and improving health, offering a warm, calming, and peaceful light that alleviates distress.

By contrast, disheartened doings disappoint the patient and decrease their loyalty towards their healthcare provider and adherence to the therapy plan. The negative experience during an episode of care may cause the patient and their loved ones to look for another provider from the offerings for future episodes of care. As a result, the provider may experience a decrease in their investment return, affecting their business continuity and growth, professional name, and advancement.

Therefore, how an individual applies the knowledge in practice, interacts with customers, collaborators, and other community members, and shares their presence impacts their reputation and quality of life.

The patient experience reflects the medical professional’s skills in handling their data and communicating with them in various contexts. A provider who carefully examines the medical and social history of the patient and makes alliances with them and their loved ones in managing disorders is likely to have better results in practice. By considering an individual's medical and social history, the provider can correlate past and existing data and make accurate decisions.

Respecting patient preferences in therapy plans is essential; reflecting on their financial situation and time availability, the most beneficial therapy options for them will be selected.

Patient involvement in the therapy plan supposes the art of communication with them, understanding their feelings determined by affected human body functioning, and reducing fears of possible remaining work impairment. Encouragement, lowering pain, and emotional support for them and their dear ones create a model of care for sustaining and advancing life quality, which benefits providers and end-users. As a result, their positive comments can increase the number of new customers, ensuring the healthcare business’ prosperity and continuity.

That’s why kind-hearted work ensures a better life; it should be acknowledged as essential in business development and advancing one's career.

Contrarily, deceptive people’s interactions affect their health and wealth.

The impact of different communication styles on patient’s experience, business continuity, and personal life should be comprehended.

How individuals interact with different parts of society defines their professional and social lives.

Background and Purpose: Usually resistance training can only be done in the active state. The difficulty of upper limb rehabilitation of stroke patients lies in the inability to complete resistance training on the antagonistic muscle groups with high muscle tension. The vast majority of stroke patients experience upper limb or arm extensor muscle weakness, and many lose the strength of their antagonistic muscle groups, preventing them from performing progressive resistance training, resulting in a large number of stroke patients with long-term upper limb disability. We took the lead in proposing induced passive resistance training to form passive resistance thinking and mode that activated antagonistic muscle groups in the upper limb of stroke, and selected stroke patients who were more than one year old and still had obvious flexion spasm in the upper limb as demonstration objects to observe the intervention effect of this method on abnormal muscle strength.

Methods: Functional acupuncture and passive resistance of upper extremity extensor group induced by Professor Yan Zhi were the main intervention methods. Implementation requirements are as follows: a) Selection of therapeutic positions. b) Selection of intervention site. c) Selection of strength and waveform. d) Real-time evaluation of intervention effects after intervention. e) Multi-task intervention training of upper limb extensor muscle group after treatment.

Results: After 20 minutes of intervention, flexor tension of upper limb, elbow joint, wrist joint and finger joint was improved obviously, extensor function of elbow and wrist joint was recovered obviously, elbow extension resistance function of left upper limb was recovered obviously. After one month of the above intervention treatment, the abnormal muscle tone of the left upper limb of the patient was significantly reduced, the elbow extensor strength score was increased from 0 to 5, and the flexion spasm of the upper limb was significantly improved in multiple scenarios.

Conclusion: The demonstration of this method highlights the significance of three aspects: A) Patients with upper limb flexion spasm more than 1 year after stroke with this method showed obvious intervention effect immediately. b) To confirm that functional acupuncture and medium-frequency induced passive resistance training are the most effective methods for the intervention of abnormal muscle tone in the upper extremity. c) The control of intervention dose and the repetition of precise rehabilitation training have a positive effect on the improvement and continuation of the therapeutic effect.

Keywords: Passive resistance training; Abnormal muscle tone; Stroke

Vaginal Microbiome and RPL

The vaginal microbiome plays a crucial role in women's reproductive health, particularly during pregnancy and the postpartum period. Research has shown that substantial changes occur in the composition of the vaginal microbiome following the end of pregnancy Nunn et al. (2021). These changes are associated with hormonal fluctuations, menstrual flow, cervical and vaginal secretions, and sexual activity (Walther-Antonio et al., 2014). Disruption of the vaginal microbiome has been linked to various pregnancy complications, including recurrent miscarriages, preterm birth, intrauterine infection, and stillbirth. Moreover, the maintenance of vaginal microbiota has been highlighted as an important factor in achieving ideal pregnancy outcomes (Celik et al., 2022). Furthermore, the vaginal microbiome has been studied in the context of premature ovarian insufficiency, recurrent implantation failure, and unexplained infertility, highlighting its potential role in RPL (Rezende et al., 2023; Patel et al., 2022; Lk et al., 2019). The vaginal microbiome undergoes significant changes during pregnancy, characterized by reduced diversity and increased stability, with a dominance of Lactobacillus species (MacIntyre et al., 2015; Serrano et al., 2019; Freitas et al., 2017; Walther-Antonio et al., 2014; Morselli et al., 2022; Nunn et al., 2021). Studies have identified specific microbial species that are commonly found in the vaginal microbiome, including Lactobacillus crispatus, Lactobacillus iners, Lactobacillus gasseri, and Lactobacillus jensenii, which are known to dominate the vaginal microbiome in healthy individuals (Doyle et al., 2018; Chang et al., 2020). The presence of other microbial species, such as Gardnerella vaginalis, Prevotella, and Megasphaera, has been associated with alterations in the vaginal microbiome and gynecological conditions (Putonti et al., 2021; Mu et al., 2019). Additionally, Grewal et al. (2022) reported low co-occurrence of L. crispatus, a species associated with vaginal bacterial stability, with other microbial species in RPL cases. Moreover, the association between gut dysbacteriosis and an imbalanced cytokine network in women with unexplained miscarriage has been identified, highlighting the potential role of gut microbiome dysbiosis in adverse pregnancy outcomes, including RPL (Liu et al., 2020). The microbiome in the female reproductive tract, including the endometrial and vaginal microbiota, has been associated with RPL, suggesting that microbiota composition may play a role in the etiology of RPL (Peuranpää, 2021; Peuranpää, 2022).

Need for studies in RPL and vaginal microbiome

Conducting studies on the relationship between the vaginal microbiome and recurrent pregnancy loss (RPL) is crucial for several reasons. Firstly, for investigating the vaginal microbiome in individuals experiencing recurrent pregnancy loss can help identify specific microbial factors or dysbiosis patterns associated with increased risk. This knowledge is essential for understanding the root causes of RPL. Secondly, these studies can lead to discovery of novel microbial biomarkers associated with recurrent pregnancy loss. Establishing such biomarkers could facilitate the development of diagnostic tools that help identify individuals at risk of RPL, enabling early intervention and personalized care. In addition, it can also contribute to the development of targeted therapeutic interventions based on the modulation of the vaginal microbiome. Understanding how specific microbial profiles influence pregnancy outcomes may lead to novel treatments or preventive measures. Studies can help in categorizing individuals into risk groups based on their vaginal microbiome composition. This risk stratification can guide healthcare providers in tailoring interventions and monitoring strategies for those at higher risk of recurrent pregnancy loss. Insights into the role of the vaginal microbiome in recurrent pregnancy loss can enhance the success rates of assisted reproductive technologies. Optimizing the microbiome environment may improve outcomes for individuals undergoing procedures like in vitro fertilization (IVF). Understanding the interplay between individual variations in the vaginal microbiome and recurrent pregnancy loss allows for personalized medical approaches. Tailoring interventions based on a person's unique microbial profile can enhance treatment effectiveness. As recurrent pregnancy loss has significant emotional and economic implications, studies on the vaginal microbiome can have a broader public health impact. Insights gained may lead to interventions that reduce the overall burden of RPL on individuals and healthcare systems. In summary, studies on the vaginal microbiome and recurrent pregnancy loss are essential for advancing our understanding of the underlying mechanisms, improving diagnostic capabilities, and developing targeted interventions to enhance reproductive outcomes for individuals experiencing RPL.

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Road traffic accidents are on the increase despite interventions implemented by states, stakeholders and partners. World Health Organization (2018) has reported that more than 1.35 million people die every year on the world’s roads, making road traffic injuries a leading cause of death globally. Most of these deaths occur in low- and middle-income countries where rapid economic growth has been witnessed in recent years, in spite of COVID 19 pandemic, which interfered with global health and economies. In Kenya 3500 people die each year due to road crashes, while nearly 1000 are left with life threatening disabilities.

The purpose of this study was: To investigate major determinants that are associated with road traffic accidents which have also been identified by other researchers that have directly or indirectly contributed to accidents causation both in developed and in developing countries, particularly in Asia and Africa including Kenya. A systematic review was used to review the most current researches that have been conducted on road traffic accidents that caused deaths and injuries to significant road users. Literature search was conducted, using Google-scholar and Pub med. The review used 58 most current studies from a total of 120.

The study findings: Revealed that there is an increase in the number of vehicles praying on the roads, coupled with an increase of population and especially those using vehicles, and motorcycles. Intentional violation of traffic rules was reported. Poor implementation of road safety network, poor planning and design of road infrastructures were identified. Poor mechanical conditions of vehicles, over speeding, overloading, uncontrolled and mixed traffic environment were equally cited. Again, road “users” and drivers’ behavior, have significantly contributed to the increase of road traffic accidents, contributing to mortalities and morbidities. The commonly affected people are pedestrians and passengers who are between 15-29 years of age.

Conclusion: Factors contributing to accidents causation include; increased vehicles and vehicular use and human factor leading to intentional violation of traffic rules; bad roads, over-speeding and over-loading was identified to be associated with road traffic accidents. Likewise, use of unroadworthy vehicles, errors of other significant road users, poor implementation of road safety measures and poor planning and design of road infrastructures were also identified.

Recommendations: Sustainable road safety to be based on individual road user’s decision, geared towards personal responsibility, tailoring traffic environment to human characteristics by training and education, improving road network, control of speed, direction and mass to vulnerable road users.

Keywords: road traffic accidents; traffic injuries; morbidities and mortalities; sustainable safety

The WHO defined palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual” [1]. In other words, it is a holistic care that improves the quality of life of the patients as well as their families. Evidence from various studies reveal that more than 90% of the cancer patients spend most of their time in hospital during their terminal period and about 70% of them die in hospital settings without their nears and dears in front of them. These patients often get a curative care only and are usually devoid of the “total care’ that includes physical, social, psychological and spiritual support.

India is a resource poor country; with shortage of manpower, money and materials in healthcare. Therefore, to deliver palliative care at the grassroot level for the rural poor population of India, it should be delivered by a multidisciplinary team comprising of family members, community volunteers, social workers, spiritual leaders in addition to the doctors and nurses who can provide symptomatic care to the patient. A good example of this is the Neighbourhood Network of Palliative Care (NNPC) in Kerala which is the first WHO Collaborating Centre for Community Participation in palliative care.

Though with limited awareness and coverage, history of palliative care in india dates back to 20 years or mid- 1980s when people used to think that palliative care is for cancer patients only. So, the first facilities to deliver palliative care in India were within cancer centres at places like Ahmedabad, Bangalore, Mumbai, Trivandrum, and Delhi. Another milestone in the history of palliative care development in India was establishment of Indian Association of Palliative Care (IAPC). The first hospice in India, Shanti Avedna Ashram, in Mumbai, Maharashtra, was opened by Professor D’Souza in 1986. Can Support in Delhi was established in 1997 which was the first centre in North India to deliver home care palliative care services. The availability of morphine was again a big hurdle in India. The Narcotic Substances and Psychotropic Substances (NDPS) act of India in 1985 further added to the difficulty in the procurement of morphine leading to a remarkable drop in its use in the subsequent years. In 1998 Indian government gave instructions to all state governments to amend their narcotic regulations, but the response was not good. Various workshops were held in lot of states regarding this issue and among them Kerala showed a significant improvement in access to opioids. Two important events that contributed to the progress of palliative care were designation of the Institute of Palliative Medicine at Calicut, Kerala, as a WHO Collaborating Centre for Community Participation in Palliative Care and Long-Term Care in 2010 and of Pallium India’s Trivandrum Institute of Palliative Sciences (TIPS) as a WHO Collaborating Centre for Training and Policy on Access to Pain Relief in 2012 [2].

But inspite of increasing progress in the field of palliative care in India, only 1% of Indian population has access to it. India is rated lowest among all countries in the use of opioids. National programme for palliative care was formulated in 2012 but it is lost under lack of funds [3]. Need of an hour is to include palliative care in the primary health care so that it is accessible and affordable to all rich and poor. Not only the health care professionals but the general community should be made aware that palliative care is the continuum of care that should be started with the diagnosis of any long term or life limiting illness. Volunteers with leadership qualities should be included in the programme to enhance community participation and make the general community more receptive. The emphasis needs to be shifted from the quantity of life to the quality of life. Efforts have been started by the government and a lot of barriers have been overcome but still lot is needed to be done. The policies and programmes that are made need to be implemented stringently to bring about a change.

References

Inhalational/smoke burn is most fatal one in terms of acute laryngeal edema, acute lung injury, ARDS. This all are survival priority in time dealing matters and sometimes difficult to manage even in dedicated higher centre.

Skin and soft tissues burn has space to contribute by medical professionals, as ensuring time fashioned critical care services can maximize the survivability and reduce the morbidity and mortality. More than 40-50% burn are the major priorities of critical care.

Ideal Burn care management starts from zero hours of occurrence. ECF - ICF fluid, ions disequillibrium are starts just after burn which is very rare about the onset of physiological imbalace in any sort of injury/ diseases. Starling law of forces are the key factors for maintaining Ph, acid base balace and homeostasis which is disrupt just after burn within seconds. Parkland formula is very much useful for burn care. In recent burn care guidelines crystalloids and colloids (FFP, Albumin, plasma expander, Blood and blood products) are needed even in 1st 24 hrs of burn injury. Crystalloid induced dilutional coagulopathy are concerning factors in definitive care and recent guidelines practicing 2ml fluid instead of 4ml for initial regime of fluid. 1st 24 hrs focused care are the pivotal factors for recovery of burn patients. After 48-72 hrs of good urinary balance (0.5 ml/kg/ hr) and early prediction of sequential (Mechanical ventilation, pain care, sepsis control, lung care, partial parenteral nutrition, stomach and gut care) morbidity during the recovery process are important factors for good outcome.

Sometimes burn patients delays time to reach the proper care unit and got some mixed treatment and fluid care. This patients should manage by proper history taking of receiving fluids, consumption of time after incidence, percentage of burn, body wt, co morbidity, age of patient and respective physicians clinical eyes.

Good burn care by bottom way of top (patient care attendant, Nurse, paramedics, physiotherapy, attending duty doctor, administrator, consultant and patients legal guardian) is the ultimate hope for survival of whatever the percentage of burn. 20% burn can kill a patient by sepsis and more than 80% burn can survive with team care.

Histopathologic Implications of Transgender Surgeries

The gender transition process for many transgender individuals usually involves gender-affirming surgeries, such as phalloplasty, vaginoplasty and mastectomy. Thus, anatomical pathologists will find themselves interpreting more unique anatomical changes because of the increasing demand for these surgeries.

As far as the gender transition process is concerned, the field of anatomical pathology will continue to play a crucial role in the pre-operative assessment, intraoperative evaluation, and post-operative examination of specimens obtained from transgender surgeries. Histopathological analyses of tissue specimens are crucial for confirming successful surgical outcomes and diagnosing complications. Thus, Pathologists must be aware of the diverse anatomical variations emanating from gender-affirming surgeries and adapt their diagnostic approaches accordingly.

Standard diagnostic breast pathology criteria may not be completely applicable to mastectomy specimens from transgender surgeries; therefore, anatomic pathologists will need to collaborate with surgeons to establish comprehensive guidelines considering both diagnostic accuracy and the unique needs of transgender patients.

The creation of neo-vaginal and neo-phallic tissues in transgender surgeries introduces new considerations for anatomical pathology practice. Evaluating these reconstructed anatomical structures requires a good understanding of the surgical procedure and the ability to recognize and separate normal histological features from surgically induced changes. Standardized reporting systems will have to be developed to ensure communication between surgeons and pathologists, ensuring accurate interpretation of pathological findings.

Patient-Centered Approach to care

Transgender, individuals often face unique healthcare challenges such as stigmatization and discrimination; so it becomes imperative that anatomical pathologists should prioritize cultural competence and sensitivity in their interactions with transgender patients, ensuring that pathology reports and discussions are conducted with empathy, respect and confidentiality.

Suggestions for Education and Training

To navigate these evolving challenges, continuous education and training initiatives are essential for anatomical pathologists in the realm of transgender medicine. Pathology residency training programs and professional development courses should introduce transgender healthcare considerations that will enhance the skills and awareness of pathologists, to foster a more inclusive and competent pathology workforce.

Conclusion

The increasing prevalence of transgender surgeries requires a thoughtful evaluation and consideration of their impact on the practice of anatomical pathology. Pathologists must adapt their diagnostic approaches to accommodate the unique anatomical changes resulting from gender-affirming surgeries while maintaining a patient-centered focus. Collaboration between surgeons, pathologists, and educators is important to develop guidelines that ensure the delivery of accurate and culturally competent anatomical pathology services for transgender individuals.

References

Coleman E., et al. “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7”. International Journal of Transgenderism 13.4 (2012): 165-232.
Schechter LS and Berli JU. “Transgender Surgery: A Review and Update on Surgical Techniques and Outcomes”. Plastic and Reconstructive Surgery 137.3 (2016): 537e-552e.
Morrison SD., et al. “Surgical Training and Experience of U.S. Transgender Surgeons”. JAMA Surgery 151.5 (2016): 471-477.

Data about an individual social history and accomplishments circulate online rapidly. This makes potential collaborators anticipate the effects of cooperation with them on their business advancement and make informed decisions when needed.

People are interested in selling their products and services and buying others as necessary since no one can produce, own, or know everything. To do that, they select from the offerings of their providers. The professional must convey their actions in an enjoyable interaction with customers and partners, presenting the quality of their products and fulfilling customers’ needs. The customers quantify the worth of the offering and interaction with providers. Suppose they are delighted by this exchange of goods and services. In that case, they will maintain the relationship with those providers and talk with friends, loved ones, and other community members about their joyful collaboration. Provider reputation attracts new customers, determining the provider’s business continuity and expansion, ensuring a successful professional and social life.

An increase in investment return validates the client’s positive experience and predicts their loyalty.

No one wishes to collaborate with providers offering inferior services or products with deceptive interactions because that alters their emotional health and financial status. In these circumstances, the client looks for other contributors from the present, and that decreases provider investment return, which affects their business stability.

So, customer loyalty reflects the provider’s professionalism in creating, presenting, and selling products. The quality of offerings and interactions with collaborators and clients influences an individual work-life value in the community.

Provider professionalism is a key to attaining excellence in the virtual and real world. Expertise in a selected field, fast and effective handling of data in practice, communication skills with collaborators, and acting in line with social norms define professionalism.

In healthcare, emotional care investment for people suffering differentiates their work from others.

Insensitivity to people’s altered health dissatisfies the patient, his family, and other dear ones. It determines a low adherence to the therapy plan and poor clinical outcomes, making them look for another provider for the next episode of care. This action frustrates the medical team and decreases investment return, affecting business continuity and growth.

By contrast, kind-hearted work improves patient adherence to the therapy plan and clinical outcomes and maintains a pleasant collaboration that benefits providers and end users.

Customer loyalty reflects their preference to continue collaboration with a provider based on their experience and provider reputation that fast circulates online.

Client experience anticipates devotion or disloyalty to a provider. Each can be an esteemed professional in the community they serve or refused by the clients, according to their product quality and interaction with them.

Patient sentiment analysis using AI to integrate their touch points predicts the evolution of return on investment, which defines a business trajectory in a new, highly competitive digital medical market.

AI in Early Diagnosis and Predictive Analytics

Artificial intelligence's capacity to aid in early diagnosis and predictive analytics is among its most notable contributions to critical care. To detect trends and patterns that could indicate the start of serious illnesses, machine learning algorithms can sift through mountains of patient data, including imaging scans, laboratory results, and vital signs. Artificial intelligence systems can improve patient outcomes by detecting tiny changes in a patient's health status and alerting healthcare providers to probable issues. this enables early intervention and keeps patients well.

Furthermore, predictive analytics powered by AI can forecast patient deterioration, allowing healthcare teams to proactively allocate resources and tailor treatment plans to individual patient needs. This proactive method may lead to fewer adverse events and unnecessary treatment escalations, which could improve patient safety and satisfaction.

Personalized treatment and care coordination

AI technologies are also empowering healthcare providers to deliver personalized treatment and optimize care coordination in critical care settings. Algorithms powered by artificial intelligence may analyze data relevant to each patient, taking in to account their traits, medical history, and therapeutic response, to provide personalized treatment suggestions.in addition to better clinical outcomes, this individualized approach to therapy reduces the likelihood of side effects and superfluous interventions.

Moreover, AI-driven care coordination tools facilitate seamless communication and information sharing among multidisciplinary care teams, ensuring that all providers are equipped with up-to-date patient information and treatment plans. This enhanced coordination promotes continuity of care, reduces medical errors, and fosters a collaborative approach to critical care management.

Remote monitoring and telemedicine

The integration of AI in critical care extends beyond the hospital walls, enabling remote monitoring and telemedicine solutions that enhance access to specialized care and support patients in diverse geographical locations powered remote monitoring systems can continuously track vital signs and physiological parameters, providing real-time data to health care providers and triggering alerts in case of abnormal findings. this capability not only enables early intervention but also reduces the burden on in-person critical care facilities, particularly in underserved areas.

Furthermore, AI-driven telemedicine platforms facilitate virtual consultations, enabling critical care specialties to remotely assess and advise on complex cases, this approach expands access to expert care, promotes timely interventions, and improves patient outcomes, particularly in regions with limited access to critical care expertise.

Challenges and considerations

While the potential of AI in critical care is vast, there are significant factors and obstacles to consider. serious thought must be given to data security and privacy, the ethical consequences of making decisions with AI, and the necessity of rigorously validating AI algorithms. To fully realize AI promise in health care, it is vital to eliminate gaps in access to critical care solutions enabled by AI and to ensure fair deployment across varied patient groups.

Conclusion

To conclude Artificial intelligence is poised to revolutionize critical care by enhancing early diagnosis, enabling personalized treatment, facilitating remote monitoring, and optimizing care coordination Patient safety, privacy, and equity must be the priorities when healthcare organizations apply AI solutions, and the problems that come with this adoption must be addressed. with thoughtful integration and ongoing advancements in artificial intelligence. finally, We must ensure that the promise of AI in healthcare is used responsibly and ethically as we move into this improved future by acting as watchful stewards of ethical practice.

The recent epidemiological transition from Communicable Diseases (CD) to Non Communicable Diseases (NCD) has reiterated the theory that NCDS which was prevalent among the rich are no longer restricted to the rich only [4]. The NCDs have gripped the poor as well. The progress in reducing poverty in India from 2013-14 to 2022-2023 is highly encouraging. During this 9 period, in our nation, about 25 crores or 250 millions of individuals have exited from Multi Dimensional Poverty (MPI) [5, 6].

The basic strategy to reduce the impact of poverty on health is to reduce the Out of Pocket Expenditure (OOPE) on health expenses. The Ayushman Bharat Jan Arogya Yojana (AB-JAY) fulfills the criteria of this strategy. The second large scale intervention is the Ayushman Arogya Mandir (AAM) where the basic health units like sub centres are converted to Health & Wellness Centers (HWCs). These HWCs provide comprehensive services & AYUSH services are also an integral part of this intervention [7, 8].

Out of the components of AYUSH, the most cost effective, therapeutically active system of medicine with zero side effects is Homoeopathy of AYUSH. Masses can be covered easily with homoeopathy while benefiting from these three properties. Integration of this system while linking the public through the existing public health system of homoeopathy will reduce their family’s OOPE. This reduction will lead to reduction in poverty of the household [9].

Integration of this system will lead to a process in the body that addresses food security. Govern of India is currently distributing free food grains through the Public Distribution System, Pradhan Mantri Garib Kalyan Yojana & Antodaya Yojana. Whenever these households receive the free food grains, the homoeopathic medicines will help to optimize the benefits of these schemes through optimum utilization in the body. This way the trio of Availability, Accessibility & Utilization (AAU) the concept of food security will be complete [10, 11].

Consumption of these varieties of cereals, pulses by the poor households will also help to address nutrition security as reduction in OOPE on health will help them to purchase & consume locally produced green vegetables, green leafy vegetables & fruits. Currently, 10% of the total 130 million use Homoeopathy & hence, 10 million people in India can benefit from this integration [12].

References

Park JE and Park K. Text book of preventive & social medicine, 11th edition, M/s Banarasi Bhanot publishers, Jabalpur.
Singh M and Saini S. Conceptual Review of Preventive & Social Medicine, second edition, 2019-2020, CBS publishers & distributors Pvt Ltd.
Wagstaff A. Poverty & Health Sector Inequalities, Bull World Health Organ, 2002, 80:97-105. The World bank.
GOI, Home Ministry, SRS Bulletin on CBR, CDR, IMR (2022).
Chand R and Suri Y Multi. Dimensional Poverty in India since 2005-06, A discussion paper, NITI Ayog, UNDP, Jan (2024).
Poverty Alleviation Report, C. Rangarajan Committee (2014).
Pradhan Mantri Garib Kalyan Yojana, PMGKY, NIC, GOI, https://indiabudget.gov.in/pmgky
HWC. https://ab-hwc-nlp.gov.in>home>aboutus.ayushmanBharat-Health&Wellness
GOI, Ministry of AYUSH, NLEAM (2022).
IFPRI, International Food Policy Research Institute. https://www.ifpri.org>topic>foodsecurity.
National Food Security Act, GOI (2013). https://nfsa.gov.in
Popularity of Homoeopathy in India (2023). bjainpharma.com/blog/popularity-of-homoeopathy-in-India,

Mpox disease, caused by Mpox virus, a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae has an incubation period of 6 to 13 days but can range from 5 to 21 days. The symptoms are quite diverse and this makes a number of rash-associated illnesses close differential diagnosis. This study aims to review the common symptoms associated with the disease during outbreaks in Imo State between 2017 and 2023 and the implications for surveillance.

Surveillance data from the Surveillance Outbreak Response Management and Analysis System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS ® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance.

Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0-4 (32.5%). About one-fifth (21.2%, n = 49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%), (p>0.05). Modal age group was 20-24 (22.4%, n=11), 18% (9) were children under 14 years, p>0.05.

Fever was a constant presentation with 68.4% (n=158) and 65.3% (n=32) of suspected and confirmed cases respectively presented with varying degrees of fever. Other modes of presentation among the confirmed cases are conjunctivitis (12.2%, n=6), cough (16.3%, n=8), photosensitivity (14.3%, n=7), fatigue (36.7, n=18 and headache (45%, n=22). Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. Only 12.2% (n=6) presented with one form of lymphadenopathy contrary to literature. This might be associated with the clinical skills of the cadre of health workers who are responsible for surveillance activities at the LGA (district) level in the State. This study has been able to describe the symptomatology of Mpox during outbreaks between 2017 and 2023 Imo State. The findings have significant implications for capacity building of surveillance actors in order to improve early case detection and response.

Keywords: Mpox; Symptomatology; Outbreak; Surveillance

Lesson two (2). The acute phase is followed by a chronic process that we call "POSTCOVID SYNDROME". This phase of the disease has a duration of 18-24 months, and sometimes more. And it is the main danger for those who have had a mild, moderate or severe form of the course. For some patients, it has the appearance of mild discomfort.

Lesson three (3). "POSTCOVID SYNDROME" is dangerous for the sudden development of thrombosis and related complications. As shown by the analysis of the development of the pandemic in many countries, 80-85% of patients suffer this infection in mild to moderate severity. And only 15-20% of patients due to concomitant diseases require hospitalization and round-the-clock monitoring by medical personnel. During this period of the chronic phase of the disease, it is necessary to monitor the most informative markers of the possible development of thrombosis: the dynamics of D-dimers, prothrombin time, fibrinogen levels, and the number of platelets in the blood of those who have been ill.

In practice, such large-scale monitoring is not possible. As you know, the recommended treatment to prevent thrombosis is oral anticoagulants. And for detoxification, it is recommended to use plasmapheresis. However, both of these recommended treatments have a number of significant drawbacks and contraindications, especially with their long-term use.

Lesson Four (4). We offer an alternative method - "SYSTEM METHOD OF LEECHING” (SML). The proposed method is based on 30 years of experience in the use of SML in elderly people with multiple organ pathology and children treated at the Academy of Hirudotherapy in St. - Petersburg.

Our experience in the treatment of "POSTCOVID SYNDROME" in the period 2020-2023 has shown the high effectiveness of SML.

Lesson Five (5). There are convincing statistics on the high morbidity and mortality of doctors who worked in the "Red Zone" during the pandemic. First of all, we are talking about nurses and surgeons, that is, about medical personnel who have to contact the bodies of sick people for the longest time. At first glance, it seems that this is due to the violation of the epidemic regime by medical personnel.

However, the author argues that in this case, the factor of remote interaction of the "Aquasystem of a Sick Person" with the "Aquasystem of a Healthy Person" by means of wave radiation may play a role. As evidence, the author cites the discovery of Academician Kaznacheev V.P. and co-authors entitled: "The phenomenon of intercellular distant electromagnetic interactions in the system of two tissue cultures" (Number and date of priority: 122, dated 15.02.1966) and supplements this discovery with his own experimental results on humans, using ultraviolet irradiation of volunteers as a model.

Lesson six (6). Many of our patients note that during the pandemic they were sick 2-3 times.

This suggests that having been ill with one strain of coronavirus, the human immune system is not able to protect against other antigenic variants (strains) of coronavirus. These facts make you wonder, against which strains of coronavirus do you need to prepare a vaccine for the population?.

In addition, many materials have been proven and published on severe post-vaccination complications, including deaths or stillbirths in pregnant women who were vaccinated during pregnancy. In the author's article (Krashenyuk A.I. Pandemic "COVID-19 - POSTCOVID SYNDROME": A System Method of Leeching is a New and Effective Treatment. Journal of Virology Research & Reports, 2023, volume 4(2):1-12).

This problem is being discussed. And this topic is described in even more detail in the author's recently published book "COVID-19 - POSTCOVID SYNDROME". Ed. "ASTERION". SPb, 220p.

Lesson Seven (7) The problem of rehabilitation of convalescents. Since this is a long process that takes 18-24 months or more, the question arises, what to do, how to rehabilitate people? Our experience shows that the safest and most effective method is the use of the "SYSTEM METHOD OF LEECHING” (SML).

References

Krashenyuk AI. “The Renaissance of hirudotherapy in Russia: The end of XX and the beginning XXI century”. «5th International Meeting on Traditional & Alternative Medicine & International Conference on Acupuncture and Meridian Studies», Rome, Italy, 2019. Journal of Regenerative Medicine 8 (2019): 42.
Krashenyuk AI. “Clinical case of Conservative Leech Treatment of Neurinoma of the Brain”. Acta Scientific Medical Sciences 4.1 (2020): 108-110.
Krashenyuk AI. “Neurotrophic (Neural Stimulating) and Neuromediator Effects of Hirudo medicinalis. Pathogenetic Mechanism of Treatment of Diseases of the Nervous System of the Human”. Acta Scientific Medical Sciences 4.3 (2020): 01-06.
Krashenyuk AI. “Coronavirus COVID-19 - Theoretical and Practical Substantiations for Reducing Mortality from Complications”. Acta Scientific Medical Sciences 4.6 (2020): 115-123.
Krashenyuk AI. “Aquapathogenesis is the Nature of Human Diseases. Dynamic Hirudotests: New Possibilities of Integral Diagnostics of the State of Human Bodies and his Systems - Study of the Dynamism of the Human Aquasystem”. Acta Scientific Medical Sciences 4.10 (2020): 76-90.
Krashenyuk AI and Burkhonov AB. “Aseptic Necrosis of the Joints, As A Complications of “POSTCOVID SYNDROME” (Clinical Case)”. Journal of Clinical Case Studies, Reviews & Reports 4.3 (2022): 1-6.
Krashenyuk AI. “Hirudotherapy and Scientific Arguments Substantiation of Pathogenic Treatment “POSTCOVID SYNDROME””. J. Inter. Medicine Research & Reports 1.2 (2022): 1-10.
Krashenyuk AI. ““COVID-19”: Is there any legitimate optimism in the treatment of “POSTCOVID SYNDROME “and complication from vaccination?”2nd Edition of International Conference on TRADITIONAL MEDICINE, ETNOMEDICINE AND NATURAL THERAPIES. VIRTUAL EVENT. Tokyo, Japan (2022): 22-23.
Krashenyuk AI. ““COVID-19” - “POSTCOVID SYNDROME” Pandemic: Solutions of the Problem are Visible in the Application of Modern Hirudotherapy and Integrative Medicine”. Open Access Journal of Biomedical Science 4.3 (2022): 1907-1909.
Krashenyuk AI. ““COVID-19” - “POSTCOVID SYNDROME” Pandemic: How to Protect Doctors and Nurses in the “Red Zone” of Hospital?”. J. of Medical & Clinical Nursing 3.4 (2022): 1-9.
Krashenyuk AI. “"COVID-19” - “POSTCOVID SYNDROME" Pandemic: Complex Treatment with Medical Leeches, Including Detoxification”. Confirmation of the Validity of the Theory "HOMOTOXICOLOGY" of H. - H. RECKEVEG. Journal of Clinical Epidemiology & Toxicology 3.4 (2022): 1-7.
Krashenyuk AI. “"COVID-19” - “POSTCOVID SYNDROME" Pandemic: The Problem is solved by Information Medicine – Hirudotherapy”. PriMera Scientific Medicine and Public Health 1.4 (2022): 05-09.
Krashenyuk AI. Method of treatment by medical leeches. RUSSIA. Invention Patent No. 2787525. Application No. 2021136998. Priority of invention December 13, 2021 Date of state registration in the State Register of Inventions of the Russian Federation: 2023.
Krashenyuk AI. ““COVID-19” - “POSTCOVID SYNDROME” Pandemic: High Risks for Pregnant Women”. Acta Scientific Medical Sciences 7.2 (2023): 71-82.
Krashenyuk AI. “Pandemic “COVID-19 - POSTCOVID SYNDROME”: A System Method of Leeching is a New and Effective Treatment”. Journal of Virology Research & Reports 4.2 2023: 1-12.
Krashenyuk AI. “Pandemic “COVID-19 - POSTCOVID SYNDROME”. This name of pandemic allows us to better understand the meaning of the use of hirudotherapy in treatment”. “5th Edition of International Conference on Traditional Medicine, Ethnomedicine and Natural Therapies” Hybrid Event held on May 22-23, 2023 in Tokyo, Japan. Book of Abstracts “Traditional Medicine -2023” (2023): 52-53.
Krashenyuk AI. Pandemic “"COVID-19 - POSTCOVID SYNDROME". OBSERVATIONS AND CONCLUSIONS. EXPERIENCE OF LEECH TREATMENT"”. Monograph. St. Petersburg, Izd. ASTERION (2023): 218.
Krashenyuk AI. “Pandemic “COVID-19 - POSTCOVID SYNDROME”: was it possible to save the doctors and staff of the “Red zone” of hospitals from illness and death?”. Conference Program, Day 3, p.9. «3rd International Conference on Tissue Engineering & Regenerative Medicine», London, UK (2023).
Krashenyuk AI. “Pandemic “COVID-19 - POSTCOVID SYNDROME”: Hirudotherapy as an effective and Dominant monotherapy”. Webinar Program, Oral speakers, p.16.«3rd International Webinar on «Global Healthcare and Nutrition», Dubai, UAE (2023).

Can we have another suitable choice instead of cake in different delicious events, or can we at least use cakes that are less harmful? We have some suggestions in this regard: 1) Natural sugar sources obtained from fruit juices may be used instead of crystal sugar in cake formulations [3]. 2) Pawpaw Fruit Puree may be used in cake formulations as fat replacement [4]. 3) Cowpea (Vigna unguiculata) flour may be used instead of wheat flour [5]. 4) Vegetable and apple pomace which are rich of fibers may be used. Pumpkin is an essential vegetable and is a rich source of protein, vitamin A and C, antioxidant, beta carotenes, carbohydrates, minerals, flavonoids and phenols though low in fat and calories [6]. 5) Using cakes in smaller sizes, for example, using cupcakes instead of cakes in large size. 6) Mixing the fruits together and putting them in cake molds and then adding a substance like gelatin and making them like a cake and using them as birthday fruits instead of birthday cake. 7) Making cake-free boxes special for birthday, having places for candles. People can throw away these boxes after blowing out their birthday candles.

More other routes may be introduced in order to change birthday habits to healthier and happier ones. It is enough to test some of these routes in birthdays, ceremonies, etc. Let’s begin.

References

Bozorgnia M, Gharibzadeh S and Bozorgnia A. “Brief and Minimal Preventive Instructions to Maximize the Effectiveness”. Am J Biomed Sci & Res 20.1 (2023).
Drewnowski A and Schwartz M. “Invisible fats: sensory assessment of sugar/fat mixtures”. Appetite 14.3 (1990): 203-217.
Bilgicli N and Akbulut M. “Effects of different pekmez (fruit molasses) types on chemical, nutritional content and storage stability of cake”. Journal of Food Quality 32.1 (2009): 96-107.
Wiese TD and Duffrin MW. “Effects of substituting pawpaw fruit puree for fat on the sensory properties of a plain shortened cake”. HortTechnology 13.3 (2003): 442-444.
Oyeyinka S., et al. Cake production from wheat (Triticum aestivum) and cowpea (Vigna unguiculata) flours using date fruit as a sweetener (2014).
Khanam T., et al. “Nutritionally enric hed cake using vegetable and fruit waste: A review”. Journal of Pharmacognosy and Phytochemistry 8.3 (2019): 722-725.

Faith can provide us with stability and wealth when we follow the rules given to us by the teachings of God and his chosen disciples. Living in a clean environment and being fair, respectful, trustworthy, and honest can lead to a prosperous and fulfilling life. When we maintain our wholesome nature, we become closer to divine energy, which can significantly and positively influence our existence. Being mindful in our work and caring for ourselves and others reward us with better inner workings; its energy can align with the Universe’s positive energy and resonate with it, improving well-being. We must strive to create positive outcomes in all our endeavors.

Individuals must emphasize the benefits of reasonable work and a healthy lifestyle in a suitable environment to maintain and improve their welfare. When feeling unwell, taking the time to reflect on past actions and attitudes in daily interactions with others can help identify any harm caused and allow steps to be taken to rectify the situation. This can be a small step towards restoring the body’s functioning, as mental health is essential in governing all bodily functions.

God invites us not to make more mistakes. Errors cause harm to both the receiver and the person who created the error. The negative energy of the thoughts and emotions associated with these errors can also disturb the contributor’s mental and energetic state, leading to more or less clinically expressive disorders.

Healing human disorders means dealing with darkness and restoring light to the affected area; to do that, we need assistance with thought power. Considering divinity as an indefinite spring, our thinking expects support in troubled times; to receive this help, we must be diligent in our daily lives and struggle to align ourselves with the Universe’s positive energy. By doing so, we can refine our microcosm and achieve overall welfare.

People aspire to perfection but must have an appropriate configuration to achieve it. With dirty life arrangements, you can never be bright. By cleaning up our surroundings, purifying our thoughts, and engaging in proper work, we can attain a peaceful inner life that interrelates with divine energy.

Human sweethearts are changeable over time, and they want another one - a stable adoration that can support them through life’s ups and downs. God continuously sustains and reinforces them when they follow Its principles.

In today’s digital age, it has become increasingly important to have a basic understanding of different religions across the globe due to the rising movement of people. When managing medical disorders, it is necessary to approach discussions with patients regarding their religious beliefs appropriately. Medical teams must honour people's opinions on divine creation and human life. Furthermore, their relationship with the patients and their families should facilitate patients’ involvement in decision-making concerning their viewpoints and practices relating to the existing divine.

Saffron (Crocus sativus L.) is an aromatic plant with 3500 years of age. Saffron is often known as the most expensive medicinal plant. Iran currently produces one of the best saffron. Countries such as Australia, Canada, the United States of America, China, and some Central African countries also produce this plant [3].

Clinical research suggests that Saffron may be used as a preventive and therapeutic anti-inflammatory and antioxidant agent, regenerator of unsaturated fatty acids in the body, a free radical absorber and an anti- oxidative stress. Therefore, researchers recommend the consumption of saffron and its compounds in the diet [4, 5].

It is worth noting that one of the most important factors which increases alcoholism is the feeling of euphoria caused by the release of dopamine neurotransmitter in the brain after drinking alcohol. On the other hand, interest to ethanol consumption may be related to factors such as price, availability, and shape and beauty of glasses [6].

Based on abovementioned points, we recommend using healthy non-alcoholic drinks that can create the same happiness as alcohol. We specially offer saffron containing drinks that have beneficial therapeutic properties as well. Saffron aqueous extract has been able to increase dopamine in the brain of mice [7] and also it has been shown that saffron in young men increase the dopamine [8].

We suggest that producing saffron beverage in proper volumes and beautiful packages may be a good way to decrease alcohol consumption disadvantages as well as maintaining the happiness of drinking cool delicious drinks.

References

Yasin YJ and Banoub JAM. “Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016”. GBD 2016 Alcohol Collaborators. Lancet 392 (2018): 1015-35. In this Global Health. Lancet 392 (2018): 1684-735.
World Health Organization. Global status report on alcohol and health 2018. World Health Organization (2019).
Dai RC, Nabil WNN and Xu HX. “The history of saffron in China: From its origin to applications”. Chinese Medicine and Culture 4.4 (2021): 228-234.
Cerdá-Bernad D., et al. “Saffron against neuro-cognitive disorders: an overview of its main bioactive compounds, their metabolic fate and potential mechanisms of neurological protection”. Nutrients 14.24 (2022): 5368.
Nanda S and Madan K. “The role of Safranal and saffron stigma extracts in oxidative stress, diseases and photoaging: A systematic review”. Heliyon 7.2 (2021): e06117.
Di Chiara G. “Alcohol and dopamine”. Alcohol health and research world 21.2 (1997): 108.
Ettehadi H., et al. Aqueous extract of saffron (Crocus sativus) increases brain dopamine and glutamate concentrations in rats (2013).
Moghadam BH., et al. “Impact of saffron (Crocus Sativus Linn) supplementation and resistance training on markers implicated in depression and happiness levels in untrained young males”. Physiology & behavior 233 (2021): 113352.

Mental health is essential for work efficiency; processing data speed and rational response differentiate people. They must interact to sell their products and buy others’ goods since no one can own everything. Communication reflects an individual’s energetic mental state, influencing energy transmission through thoughts and words. Their power in the functioning of the human body was observed in clinical practice. Individual attitudes can inform us about rational or irrational data processing and the vibrational model of interrelated actions. Cool or kind-hearted work, adaptability, flexibility, and the ability to overcome barriers are some metrics for evaluating mental activity. Perception, analysis, and response to data tell apart people’s genetics, education, and networking. Usually, emotional distress results from unsafe interaction with others or one’s surroundings; it can manifest in mental health variances following functional abnormalities in fragile areas of the human body since the mind’s activity governs bodily functions. People’s vulnerability to deceptive interactions with others varies. The impact of such communications on mental activity is observed in their subsequent actions. Attenuated or explosive reactions toward others in different situations, uncontrolled emotions often accompanied by irregularities in heart function, a decrease in accomplishments, and social isolation are some common clinical manifestations of altered mental health. Poor sleep that frequently follows and exacerbates the disturbed mental health must be accounted for.

Words used, attitudes, and surroundings depict individual views; cultivating good habits enhances work and facilitates social acceptance. It is essential to advise individuals about the negative consequences of their exposure to improper collaborative work, working in an unhealthy environment, and adopting unsafe habits that may harm their health. By pondering all the factors influencing us, we can care for ourselves and others.

The relationship between stimulus intensity, duration, and response is sometimes linear in impacted regions. Variability in individual responses to the same stimulus characteristics predicts uncertainty, and doubt may limit coping with creativity.

In today’s digital age, artificial intelligence can detect mental disorders rapidly and provide suggestions for corrective actions promptly. By focusing on improving mental well-being, promoting self-care practices, and maintaining clean surroundings, individuals and communities can experience positive impacts on health and overall societal progress.

IT devices provide a variety of on-demand programs for education and entertainment. Discussions with loved ones, listening to preferred musical programs, watching movies, viewing art from famous artists, and exploring nature images relax and stimulate different brain areas, helping in recovery.

People’s actions illustrate their thinking; when it is not working correctly, it must be restored, and continuous efforts should be made to improve it. Their actions illuminate the thoughts and words’ power to change around and in the inner area, with outcomes that can surprise or sometimes prove anticipatory facts.

Migraine is defined as an episodic headache associated with certain features, such as sensitivity to light, sound, or movement or “a recurring syndrome of headache associated with other symptoms of neurologic dysfunction in varying admixtures” [6]. The symptoms of migraine are recurrent severe headaches, often accompanied by nausea, vomiting, and sensitivity to light and sound. It affects millions of people worldwide, making it one of the most common and disabling conditions worldwide [7]. There are different phases, including a premonitory phase, transient neurological symptoms (i.e., migraine aura), an intense headache attack, and a postdrome phase [8].

Pathophysiology

The pathophysiology of migraine is still not well understood. Few of the proposed mechanisms surrounding the onset of migraine headaches are given below:-

Genetic Studies

The genetic or the inherited component plays a very important role in the pathophysiology of Migraine. Studies have shown that individuals with a family history of migraines are more likely to experience migraines themselves, indicating a genetic predisposition to the disorder. Various genes and genetic factors have been implicated in migraine susceptibility, including those related to neuronal excitability, neurotransmitter function, and vascular regulation [9]. There is an unexplained but epidemiologically well-established predisposition that relates to methyl tetrahydrofolate reductase gene mutation C677T that is certainly overrepresented in migraine with aura [10]. The presence of aura seems to be associated, in rarer inherited cases, such as CADASIL or autosomal-dominant retinal vasculopathy with cerebral leukodystrophy, with structural protein dysfunction [11]. and perhaps with an embryonic syndrome that includes patent foramen ovale [12].

Neuropeptide studies

Activation of the trigeminal nerve triggers the release of signaling molecules including calcitonin gene-relate d peptide (CGRP), resulting in secondary cerebral vasodilation, plasma protein extravasation and mast cell degranulation, all contributing to symptoms of migraine. Although, this theory does not explain the pathophysiology of migraine, CGRP can be considered as the initial trigger of trigeminal nerve stimulation causing migraine headaches [10]. It is also apparent that the dilatation of blood vessels is the result of neuronal inflammation, not the cause of migraine headaches. The roles of 5-HT and CGRP have been well documented. CGRP is a potent vasodilator that causes pooling of blood in the cerebral vasculature parallel to decreased levels of 5-HT [11, 12].

5-HT receptors, especially 5-HT1B, 5-HT1D and 5-HT1F receptors play a crucial role in migraine [13]. 5-HT1F receptors are expressed in the CNS, including major regions of migraine pathophysiology such as cortex, hypothalamus, the trigeminal ganglia, trigeminal nucleus caudalis (TNC) and in low concentrations on the cerebral blood vessels like the Middle Cerebral Artery without vasoconstrictive properties [14-16]. Additionally, 5-HT1B, 5-HT1D, but not 5-HT1F, receptors were found on cerebral microvascular smooth muscles and all three subtypes were expressed on astrocytes. These findings, along with pharmacological evidence that selective 5-HT1F receptor agonists lack vasoconstrictive effect, prompted Cohen et al. to hypothesis that the function of this receptor subtype may be related to blood-brain barrier physiology rather than vascular contractility [17]. Triptans have been the drug of choice for migraine over the last three decades. These 5-HT1B and 5-HT1D receptor agonists act on the blood vessels and nerve endings in the brain to inhibit the release of vasoactive neuropeptides (CGRP and Substance P) by trigeminal nerve innervating the intracranial vessels and dura mater [18, 19]. But triptans are not recommended for individuals with history of cardiac and cerebrovascular diseases and those who are at risk for developing such diseases because of their vasoconstrictive action [20]. Besides having limited efficacy, triptans are contraindicated in pregnancy and breastfeeding women [21-23].

Thus, there arose a need to develop more selective treatment for migraines that lack any cardiovascular and cerebrovascular side effects. Drugs targeting neurons (trigeminal pathway) were suggested and 5-HT1F receptors were considered as a contemplated victim for it.

Pharmacology

Lasmiditan is the first of a new group of headache medicines that are being called the "ditans." Lasmiditan is unique as it is the only drug in its class which works specifically on the 5-HT_1F receptor as compared to triptans that primarily act via 5HT_1B/1D agonism. They do not cause vasoconstriction in contrast to triptans. It contains a pyridinoyl- piperidine scaffold instead of an indole group [24]. The mention of offsite interaction with the 5HT1F receptor suggests that there may be other mechanisms through which the triptans exert their therapeutic effects. The exact role of 5HT1F receptors in the context of migraines and triptan therapy is an area of ongoing research, and understanding these interactions may contribute to the development of more effective migraine treatments. It is important to note that while triptans can be effective for many people with migraines, they are not suitable for everyone, and their use should be discussed with a healthcare professional to ensure proper diagnosis and appropriate treatment [25]. The precise mechanism of action is not fully understood, but there are several proposed ways in which 5HT1F receptor activation may contribute to its activity in migraine treatment. Some of the effects associated with 5 HT 1F receptor agonist include decreased plasma protein extravasation, decreased c-fos expression, suppressed neuronal firing within the trigeminal nucleus caudalis, inhibition of CGRP release from perivascular fibres, direct anti nociceptive action.

While these proposed mechanisms provide insights into how Lasmiditan may work in treating migraines, it's important to note that the exact interplay of these effects and the overall mechanism of action are still subjects of ongoing research. As with any medication, individuals should consult with their healthcare providers for a thorough understanding of its benefits, potential side effects, and suitability for their specific condition [25, 26]. Lasmiditan is highly lipophilic and hence crosses the blood brain barrier which leads to central nervous system abnormalities [27].

Pharmacokinetics

Lasmiditan is administered orally with bioavailability of about 40 % [27]. Lasmiditan can be taken with or without food as the co-administration of drug and a high fat meal was not found to produce a clinically significant difference in exposure [28]. The median peak time to peak plasma concentration is 1.8 hours and the onset of action is 30 to 60 mins post ingestion [29]. The fact that Lasmiditan is primarily metabolized by non- CYP enzymes suggests that the influence of CYP inhibitors or inducers on its pharmacokinetics is unlikely. This can be advantageous in terms of drug interactions, as it reduces the risk of significant alterations in Lasmiditan levels when co-administered with medications that affect CYP enzymes. On the other hand, the “gepant” class of medications which includes Ubrogepant and Rimegepant, is metabolized by CYP3A4 enzymes. CYP3A4 is a major hepatic enzyme involved in the metabolism of various drugs, and its activity can be influenced by inhibitors or inducers. Therefore, when these “gepant” medications are used concurrently with strong CYP3A4 inhibitors or inducers, it can lead to significant changes in plasma concentrations, potentially affecting their efficacy and safety. In summary, the difference in the metabolic pathways of Lasmiditan and the “gepant” competitors contributes to variations in their susceptibility to drug interactions with CYP inhibitors or inducers. It is essential for health care professionals to be aware of these differences when prescribing or adjusting medication regimens to minimize the risk of adverse effects and ensure optimal therapeutic outcomes. Lasmiditan undergoes oxidation on the piperidine ring to form metabolites M7 and M18, as you mentioned, is a combination of M7 and M8 pathways. These metabolites are considered pharmacologically inactive, meaning they do not contribute significantly to the therapeutic effects of the drug. Regarding excretion, a small portion of the active drug of around 3% is excreted in the urine unchanged. This indicates that a minor fraction of the administered Lasmiditan is eliminated from the body without undergoing significant metabolism [30]. The majority of Lasmiditan is excreted in the urine as the metabolite S-M8, accounting approximately 66% of the total excretion. S-M8 is likely a metabolite formed through some specific metabolic pathway, and while it may be inactive, the elimination of the drug through this pathway contributes to its overall clearance from the body. Understanding the metabolism and excretion of the drug excretion of a drug is crucial for assessing its pharmacokinetic profile, potential drug interactions, and overall safety. It also provides insights into how the body processes and eliminates the drug, which can be important for dose adjustments and considerations in specific patient populations [30].

Adverse effects

Lasmiditan, being a CNS (central nervous system) depressant, can lead to significant adverse events when co-administered with other CNS depressants, such as alcohol. The potential for serious driving impairment is noted, and it's emphasized that patients should refrain from driving a motor vehicle for at least 8 hours after each dose of lasmiditan. This caution is crucial for patient safety, as impaired driving can pose risks to both the individuals taking the medication and others on road [31]. Alternative therapies such as rimegepant and ubrogepant are considered to have a high safety profile with relatively low adverse effects. Dizziness, a common adverse event reported in lasmiditan trials (16% to 18% of participants), is mentioned to occur at less than 2% for both ubrogepant and rimegepant. This suggests that these alternative medications may be associated with a lower incidence of dizziness, making them potentially more tolerable for some individuals [32]. Considering the potential for CNS adverse effects and driving impairment with Lasmiditan, healthcare providers may need to carefully assess individual patient profiles, consider alternative therapies, and provide appropriate guidance on driving restrictions and potential risks.

Abuse Potential

Lasmiditan is a schedule V controlled substance. This classification is determined based on its potential for abuse and the perceived risks associated with its use. In abuse potential studies, lasmiditan was compared with alprazolam, a Schedule IV controlled substance. The "drug liking" scores for lasmiditan were higher than placebo but lower than alprazolam, indicating a lower abuse potential compared to alprazolam. As a result, lasmiditan was classified as a Schedule V controlled substance, while alprazolam remained in the higher Schedule IV category. It's worth noting that the classification of a drug as a controlled substance is influenced by various factors, including its pharmacological properties, abuse potential, and safety profile. The Schedule V classification suggests a lower potential for abuse relative to substances in higher schedules. Drugs like, rimegepant and ubrogepant, are not controlled substances. This difference in regulatory classification may be attributed to variations in their pharmacological profiles and abuse potential.

Understanding the controlled substance status of medications is important for healthcare providers, as it affects prescribing practices, dispensing regulations, and patient education on the responsible use of these substances to mitigate potential risks associated with abuse or misuse [33].

Dosage and Administration

Lasmiditan is available in 50 mg and 100 mg tablets, and the recommended dosing is 50 mg, 100 mg, or 200 mg taken orally as needed for the acute treatment of migraine attacks. It's important to note that a second dose of lasmiditan has not been shown to be effective in clinical studies [34].

Comparison of Ditans with Triptans

Triptans, act primarily on 5HT1B receptor, exert their effects through vasoconstriction. However, their use is contradicted in patients with cardiovascular or cerebrovascular diseases due to this mechanism. Triptans’ efficacy varies, and approximately 40% of migraine attacks do not respond to them adequately. It is uncertain if there is significant CNS component to their efficacy, and the ability of some triptans to penetrate the blood brain barrier is limited. Lasmiditan provides a different mechanism of action compared to triptans.

It is highly lipophilic and capable of crossing the BBB, potentially acting in the central nervous system. This property distinguishes Lasmiditan from triptans and may contribute to its efficacy in migraine treatment. It's important to note that while the CNS effects of lasmiditan are observed, they don't necessarily prove that its efficacy against migraines is solely mediated in the CNS. There is preclinical and ex vivo evidence suggesting that lasmiditan may inhibit both PNS and CNS pain pathways, including the trigeminal nerve, through the modulation of neuropeptides and neurotransmitters such as CGRP and glutamate. The distinct pharmacokinetic and mechanistic features of lasmiditan make it an intriguing alternative for migraine treatment, especially in cases where triptans may not be suitable or effective. The ability to penetrate the BBB and potentially modulate both PNS and CNS pathways adds to the understanding of how lasmiditan may provide relief for migraine sufferers [35].

Drug Interactions

Lasmiditan administration is associated with mean decreases in heart rate, ranging from 5 to 10 beats per minute, which is higher than the decreases observed with a placebo (2 to 5 beats per minute). This indicates a cardiovascular impact of Lasmiditan [36]. Participants in phase III trials who reported taking concomitant heart rate-lowering medications, such as β-blockers, did not experience adverse reactions compared to other treatment participants. This suggests that, in clinical studies, the use of lasmiditan in combination with heart rate-lowering medications was generally well-tolerated [37]. Given its classification as a CNS depressant, caution is advised when using lasmiditan in conjunction with alcohol or other CNS depressant medications, including antiepileptic medications like valproic acid and topiramate used for migraine prophylaxis [38]. As with all drugs interacting with serotonin, there is a theoretical risk of serotonin syndrome with lasmiditan. Caution is recommended when using lasmiditan concomitantly with serotonergic drugs. A medical review of data from phase III studies assessed the risk of serotonin syndrome, and while five possible cases were identified, none were severe or serious, and they did not meet the Hunter Serotonin Toxicity Criteria. The risk of serotonin syndrome with lasmiditan is considered somewhat theoretical, and warnings are included out of caution. It's noted that alternative therapies, such as rimegepant and ubrogepant, do not carry the serotonergic risk associated with lasmiditan. The mechanism of action for rimegepant and ubrogepant involves CGRP signaling rather than serotonin agonism.

Understanding the cardiovascular effects and potential risks associated with lasmiditan is crucial for healthcare providers when making treatment decisions and counseling patients. Individual patient characteristics, medical history, and concurrent medications should be carefully considered to ensure the safe and effective use of lasmiditan for migraine treatment [30].

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