PriMera Scientific Surgical Research and Practice (ISSN: 2836-0028)

     Change in the lifestyle leads to several types of diseases in which knee OA is leading amongst all. According to global burden of disease published in the year 2000 shows that some specific jobs and occupations which involve physical labor have increased risk to develop OA of knee. Especially the jobs such as farmers, dock workers, mine workers etc. which require heavy weight lifting, squatting and kneeling have high chances to develop knee OA. In 2005, a study named ‘A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis’ shows that females are more prone to knee OA than men. Whereas a study in England, UK shows that reduced BMD and use of oral contraceptive pills may be associated with knee OA. A study conducted in the university of Boston, USA in the year 2010 showed that increase in the age leads to biological changes which reduces joint capabilities to cope with adversity such as oxidative damage, poor proprioception, muscle weakness and thinning of cartilage. Weakness of quadriceps muscle also leads to structural damage to the joint along with painful knee OA shown in the study ‘Is Quadriceps Muscle Weakness a Risk Factor for Incident or Progressive Knee Osteoarthritis?’ in the year 2011.

     A study named ‘Lifestyle changes in the management of osteoarthritis’ in the year 2001 reveals that exercise regimes for OA knee consists of both aerobic exercises and strengthening exercises with resistance of quadriceps muscles which helps to improve physical functioning along with pain reduction in the patients. The main aim is to increase balance, ROM, aerobic capacity and strength. A study conducted in 2010 showed that continuous sitting for two hours increases the risk of knee OA.

     Lifestyle modification helps to delay or prevent the onset of OA and also prevents many musculoskeletal disabilities. Exercises and weight reduction management are the two lifestyle changes for the management of OA. Several clinical trials support that knee strengthening and aerobic exercises delays disability and reduce pain. Along with this treatment, comorbidities like hypertension and depression also increase the risk of OA knee. So, therefore identifying the risk factors and uplifting the lifestyle could delay the onset of knee OA.

     Lifestyle refers to the characteristics of residents living in a region. It comprises day to day behavior and functioning of an individual’s physical activity, diet and occupation. It is a way practiced by groups, nations and people living in specific culture, geographical, political and religion. Quality of life and individual health are both associated with lifestyle. Alcohol consumption, drug abuse, malnutrition, stress and unhealthy diet depicts unhealthy lifestyle, which causes cardio-vascular diseases, hypertension, skeletal problems, metabolic diseases and overweight in the people. According to WHO, musculoskeletal condition is the major cause of disability and morbidity in 2017. Global Burden of Disease (GBD) has declared musculoskeletal conditions are having the highest contribution in global disability. Under musculoskeletal conditions Osteoarthritis (OA), back pain, neck pain, fracture and rheumatoid arthritis are the commonly prevailing disabling conditions. Out of which OA is the 10th most disabling condition in the developing world. Osteoarthritis refers to degenerative joint disease. In OA there is progressive destruction of articular cartilage, osteophyte formation and inflammation of synovium. It affects mainly the weight bearing joints of the body i.e., hip and knee. As per WHO, 9.6% and 18.0% of men and women respectively aged above 60 years are suffering from symptomatic arthritis. Out of which 80% of the population is suffering with OA along with restricted Range of Motion (ROM) and 25% of them cannot do majority of activities. Among all the population who complain of knee pain 80% of them shows knee OA. Globally, it is considered to be the 4th and 8th significant cause of infirmity in men and women respectively.

Keywords: telerehabilitation; rehabilitation; neck pain; shoulder pain; frozen shoulder; shoulder impingement; rotator cuff tear; fracture; chronic neck pain

Telerehabilitation is a way of providing physiotherapy in remote mode with increased satisfaction and success rates. Physiotherapy plays a major role in rehabilitation of such conditions by proper assessment and early intervention leading to a better quality of life for the patient. Neck and shoulder pain are quite increasing in number because of many reasons like poor posture, trauma, poor lifestyle, post-surgery complications. 13 articles were included in the scoping review related to rehabilitation of neck and shoulder related conditions respectively. After reviewing various related articles, it was concluded that better results were found in terms of decrease in pain, disability and improvement in terms of range of motion (ROM), posture, endurance, quality of life and patient satisfaction. Patients described better sense of security and adherence in telerehabilitation as compared to the conventional treatment provided.

Keywords: Artificial- intelligence; Sustainable Peace and Development; Human Rights-Legal personality- Health care- Insurance liability

Artificial Intellects or robots are becoming all-pervasive in the present modern society. Artificially Intelligence Technology has brought incredible change in the day to day lives of people around world. Large number of populations are familiar with AI technology like “chat-bots” and usage of “virtual personal assistants” like Apple’s Siri, Amazon’s Alexa; ok, Google and Microsoft’s Cortana. Where the whole world is relying on this AI technology in this context the present paper explores the impact of AI on Education, Amicable Conflict resolution, Economic stability, health sector, industry, Human rights protection, Fair and Speedy Justice - access to justice system. Recognition and protection of Human Rights are major elements for maintaining “sustainable peace and development” (UNSDG) of the society. Artificial Intelligence (AI) has huge impact on the improvement of health care systems apart from economic status of individuals, inequality in the communities as well as states and help to meet the United Nations’ Sustainable Development Goals. India’s policy think tank, the NITI Aayog paper on National Strategy on Artificial Intelligence is focused on leveraging AI for inclusive growth in line with the Government policy of Sabka Saath Sabka Vikas.

Keywords: Subclavian artery occlusion; upper extremity thrombosis; primary care

Subclavian artery thrombosis is a rare cause of upper limb ischemia resulting from occlusion of the upper extremity blood supply. The exact incidence or prevalence of subclavian steal syndrome is unknown, most literature reports the prevalence of SSS as between 0.6% to 6.4% [9]. Symptomatic presentation is quite rare and a high suspicion of index is required for its diagnosis in primary care setting. It is imperative to diagnose the condition early in order to avoid the complications. Possible catastrophic clinical consequences necessitate prompt rectification of the underlying disease and risk factors. Treatment modalities are often selected depending on the severity of clinical presentation, while modification of secondary risk factors in primary care is often sufficient among the asymptomatic patients. We report a case of a 70 years old female patient in primary care who presented with decreased appetite, intermittent diarrhea and 3 kg weight loss over 3 months and on physical exam discrepancy of blood pressure measurements was found in both arms. She was advised CT-angiogram which showed Subclavian artery thrombosis.

Keyword: Hand fractures; K-wire; JESS

Background: The fracture of the hand results in significant disability and leads to long term negative functional sequelae including loss of ability to work and live at pre injury level. Most of these fractures can be treated conservatively. However, conservative treatment has poor outcome in unstable, intra-articular and compound fractures, making operative means a necessity for such cases. Materials and Methods: A prospective randomized control study was undertaken in our institute consisting of 100 cases of intra-articular and juxta-articular fractures of the small long bones of the hand who were treated with either simple K-wiring versus K-wiring with external fixation over a period of 12 months from January till December 2020. The cases were evaluated for functional outcome at the end of 12 months of follow up. Results: 100 cases with 129 fractures of the metacarpals and phalanges of hand were randomized and treated with either K-wires or Joshi’s External Stabilisation System (JESS) fixator. The mean age of the cases was 31-40 years with male predominance. Motor vehicle accidents were the commonest cause of trauma. The operative time for JESS fixation was longer than K-wiring alone, which was statistically significant. Functional outcome was assessed based on Modified Mayo Wrist Score and ASSH-TAF scores. At the end of 12 months, JESS fixation had statistically and functionally better results. Discussion: The authors advocate the early management of hand fractures with JESS Fixation compared to K-wiring alone. The outcomes were also dependent on the age, gender and compliance of the patients.

Keywords: Shirahshula; Jaladhara; Shirodhara; Aswagandha; Anxiety; Stress; Depression; Primary headache

Shirodhara is a popular traditional Panchakarma treatment for balancing the Doshas and for improving the function of the brain, there by relieving headache and stress. Shirodhara induces a state of peaceful awareness that results in a dynamic psycho-somatic balance. The present study was conducted on 40 cases of primary headache. The treatment was continued for 15 days with the objective to evaluate clinically the efficacy of Jaladhara and Jaladhara with some herbal medicines in the management of Headache. These patients were divided into two groups of 20 patients each. It was observed that the patients of group B treated with Ashwagandha extract (500 mg OD) and Shirodhara with water showed significant improvement, whereas the group A treated with only Shirodhara with water also showed similar improvement.

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Gout, a common type of crystal arthropathy, predominantly present with episodic, acute, asymmetric, lower limb predominant arthritis, often starts from the first meta-tarso-phalangeal joint. But polyarticular symmetric hand joint involvement is also commonly found in clinical practice, predominantly in chronic untreated or inadequately treated cases. Here we present clinical images of two gout patients’ hands with deforming inflammatory polyarthritis of hand joints, multiple subcutaneous tophi, with few shows chalky like discharge and superficial ulceration. Both patients were old male with chronic disease courses and inadequately treated. Early diagnosis with adequate treatment, lifestyle modification can prevent this debilitating condition and patients suffering..

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Joint function losses that occur as a result of injury, healing and scarring of the cartilage tissue are varied. In this study, the contralateral joints of rabbits with complete cartilage loss were defined as the control group. Self-healing of similar cartilage losses and popular surgical methods were compared, and the results were examined histopathologically. As a result, it was determined that while autogenous full-thickness osteochondral cartilage transfer resulted in the best cartilage healing, the healed cartilage tissue without any intervention was superior to methods such as drilling and carbon fiber. We concluded that cartilage tissue must be “no men land” if lower than full thickness cartilage lesions. Cartilage must be protected any surgical impact instead of main mechanical articular problems must be focused.

Keywords: Cartilage Defects; Mosaicplasty; Cartilage debridement

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Coronary heart disease (CHD) is a multifactorial disease resulting due to accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium (the muscle of the heart) with oxygen and nutrients. The aim of the present study is to investigate association of epidemiological and clinical risk factors in the development of disease in CHD patients and their first degree relatives (FDRS) in comparison with controls. The aetiology of CHD is multifactorial. It is the result of interaction between genetic, lifestyle and environmental factors. Monitoring the epidemiology and clinical risk factors of CHD is an important component in the pathogenesis of CHD.

     In the peripheral nervous system, the mechanism ends up being very effective. The injury process triggers changes in the cellular phenotypes of Schwann cells (SC), axonal immaturation and activation of genes to stimulate neuronal survival and neurite growth, in addition to the influx of calcium responsible for stimulating neuroregeneration. The inflammatory process contributes to the secretion of SCs growth factors in addition to stimulating their mitosis to enhance the effect. Inflammation also promotes the elimination of myelin molecules and residues that are neuro-inhibitory and impede axonal regeneration. The SCs also have particularities for successful neuroregeneration. By losing axonal contact, they manage to remain active without the need for contact with the axons with an autocrine survival system. In case of extensive injuries and many local cell losses due to the injury mechanism, nearby veins have precursor cells for new ones to appear in the area and favor neuroregeneration. The SCs also participate in the elimination of myelin residues, being stimulated by the remnants of myelin residues degenerated in the environment after injury, together with the inflammatory response mediated by cytokines, chemokines, interleukins/interferons and necrosis factors, events that can be found during the Wallerian degeneration process. A series of responses and molecular interactions are reported in the literature and cannot be addressed in this opinion article due to its length [1-3, 6, 25-30]. However, it is important to highlight the possibility that many peripheral diseases without a specific etiology may have their origin through the activation of neuroregeneration mechanisms, culminating in changes in the central nervous system, in other words, a central pathological mechanism secondary to a peripheral process. The considerations will be carried out in the next topic. We must always think of all possible ways for the evolution of scientific knowledge to reach extraordinary levels.

Considerations On the Topic

     Due to the findings of the previous studies mentioned, we can consider the possibility of creating new terms for the subject of neuroplasticity. The change in central neuronal circuits after injury to the peripheral nervous system, as well as the onset of neuropathic pain and other clinical conditions mentioned, we can postulate that peripheral neuroplasticity can be both maladaptive and compensatory, triggering central changes that may lead to sequelae neurology for patients. For example, the development of trigeminal nerve neuralgia without previous damage, which can be explained by micro-stimuli that occur over time until the neuroplasticity process starts, either by genetic, inflammatory or cellular/molecular stimuli that modify the central neuronal circuits favoring the onset of pain. It is also possible to postulate that the mechanism of neuroplasticity and neuroregeneration does not occur in the central nervous system precisely to avoid more serious neurological complications/sequelae than the already installed lesion itself, with individuals who had this characteristic being eliminated by natural selection, or that we are still in an evolutionary process of the species so that these two mechanisms occur properly in the post-injury nervous system without harming the patient, this characteristic being positively selected in individuals.

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The mechanism of neuroplasticity begins in human intrauterine life and extends until the end of it. This phenomenon is complex, involving many intracellular pathways and has a compensatory and maladaptive outcome. When comparing central and peripheral neuroplasticity, it is possible to identify a difference between both. The peripheral neuroplasticity phenomenon ends up culminating in a successful neuroregeneration process, with pro-regeneration stimuli, while in the central nervous system, the phenomenon ends up being inhibited by neuro-inhibitory stimuli, interrupting the mechanism. Strategies for central neuroplasticity have been developed and are still being developed so that the mechanism is successful and culminates in a functional recovery due to some central nervous system injury. Analyzing both mechanisms, it can be deduced that neuroplasticity is something essentially beneficial that will provide a regeneration of the nervous tissue allowing a functional recovery. However, we must consider its complications that can be observed in the central nervous system after neuroplasticity provides tissue regeneration in the peripheral nervous system. Through this, we can infer some theories on the subject that will be shown at the end of this opinion article.

Understanding Neuroplasticity and The Types That Can Be Evidenced and Stated

     First, we must understand the concepts inherent to neuroplasticity and neuroregeneration, as well as their definitions. Neuroplasticity is related to the property of the nervous system to change its function and structure in order to remodel itself to the conditions that are imposed on it, whether physiological or pathological, and can promote functional recovery in a short or medium period of time. Neuroregeneration consists of the ability to generate new neurons, that is, to promote neurogenesis, establishing new connections and promoting long-term functional recovery. Therefore, the process of neuroregeneration must be linked to neurogenesis due to the mechanism of neuronal proliferation [2-6, 17, 18, 34].

     Although body tissues have a certain ability to regenerate and restore their previously established functionality, in the nervous system, especially in the central one, this does not occur adequately. Neurons have a finite number of multiplier cycles, which are more exuberant in intrauterine life and in children/young people and less expressive in adults and the elderly, but they can still be found in different regions of the brain, such as the dentate gyrus of the hippocampus. The cell division cycle can be found in two distinct moments, the first one being symmetrical and later, asymmetrical. Symmetric division is when the precursor cell gives rise to two other precursor cells, and so on. This phase is fast and quickly becomes asymmetrical, where the precursor daughter cell continues cycling and the precursor mother cell interrupts the cycle, becoming a young neuron that will go through a process of morphofunctional differentiation in the region where it is found to become in a mature neuron [2, 3, 6, 21, 25]. Axonal development can be evidenced by the expression of a wide range of genes, such as Kruppel-like factor 7 (KLF7) and Sox11, as well as activation of the Rapamycin (mTOR) pathway, which will trigger a series of intracellular signals [2, 3, 6, 22, 24].

     Neuroplasticity can be identified at various stages of human development. In the embryonic and postnatal period we have ontogenetic plasticity, an interaction between the genome and the environment capable of promoting an important variety in the human species. Then we have the critical period, when the nervous system is most susceptible to the environment, such as the development of vision in children. Related to the critical period, we can observe the presence of the imprinting mechanism, which can be called the short critical period evidenced by the ethologist Konrad Lorenz when being recognized as a mother by geese chicks, that is, just the gaze mechanism, made the recognition circuit stabilized instantly, without the need for time. An example of a critical period in humans can be seen in the speech development process, which can last until adolescence. In addition to these, neuroplasticity can be didactically divided into three large groups, called: Morphological Neuroplasticity, Functional Neuroplasticity and Synaptic Plasticity. However, success for a successful neuroplasticity that will provide a new connection is directly dependent on three steps and which area of the nervous system was injured. The first step is the distance between the stump proximal and distal to the lesion, the smaller the distance, the greater the success of the mechanism. The second stage is due to synaptic modulations, which can be called metaplasticity, which can be intense or weak and will depend on the stimulus that will be applied. The third step is related to excitatory or inhibitory signals from interneuronal GABAergic circuits that can promote changes in different neuronal firings [1-5].

     Studies were published with the aim of highlighting the types of neuroplasticity, explaining its adaptation and development. In the morphological neuroplasticity, dysgenesis of the corpus callosum was evidenced, resulting from a weak molecular stimulation towards the axonal fibers, which culminates in a malformation of the corpus callosum. Another example would be amblyopia after visual deprivation, resulting in a change in the pattern of ocular dominance [4, 5, 7-11]. Synaptic plasticity was reported as responsible for promoting communication and the flow of information in neuronal circuits, with the phenomena of Long-Term Potential (LTP) and Long-Term Depression (LDP) being described and having strong relationships with cyclooxygenase-2 (COX -2) and the p38 MAP kinase (p38 MAPK) [2-5, 11, 19].

     However, functional neuroplasticity is what we can use to formulate some theories and thoughts. Within this group, we can highlight the most macroscopically palatable subtypes. It has been demonstrated through experimental studies that functional neuroplasticity can exhibit clinical conditions found in patients. Focal dystonia was evidenced in young patients when compared to more adult patients, where they exhibited cortical increase in the area of representation of the hands. The tactile pattern in blind patients was also different depending on age, whose tactile information ended up being processed in the visual cortex. At this moment, we can observe a maladaptive character of the functional neuroplasticity evidenced by the clinical condition of focal dystonia and confirmed by the phantom limb syndrome of the Ramachandran study, while the processing of tactile information in the visual cortex shows a compensatory character of the functional neuroplasticity. Maladaptive neuroplasticity can be defined as the appearance of symptoms after their appearance, while compensatory neuroplasticity ends up causing the relief of symptoms after their installation in the nervous system [2-4, 7-11, 17, 18].

What Differes the Central Nervous System from the Peripheral in regard to Neuroplasticity and Neuroregeneration?

     After understanding the concepts of neuroplasticity and its differentiation from neuroregeneration, it is noteworthy that these two buttons have different behaviors depending on the region of the nervous system, with a higher success rate in the peripheral nervous system (PNS) and a lower one central nervous system (CNS) [2-4, 6, 20-22]. Such behaviors are due to a series of intracellular and molecular signals, reactions triggered by the local inflammatory response, ionic response, physical barriers and genetic response that make the process unfeasible in the CNS and viable in the PNS. However, complications can be evidenced in the CNS and PNS after the onset of neuroplasticity resulting from damage to both systems. In spinal cord trauma, dysfunctions were evidenced after alteration of neuronal circuits, such as autonomic dysreflexia, diaphragmatic dysfunction after degeneration of the frenetic nerve, among others. In the peripheral nervous system, however, it is possible to identify the formation of aberrant circuits, neuropathic pain, allodynia and the phenomenon of preferential motor reinnervation (PMR), in addition to the lack of myelin differentiation that ends up harming the process of peripheral neuroplasticity [1, 4, 6, 22, 28, 34-51].

     The neuroregeneration mechanism needs three pillars for the phenomenon to be successful. The first pillar is the genetic response triggered after neuronal injury, which may have a neuro-inhibitory or neuro-stimulatory character. The second pillar is the inflammatory response triggered after the initial injury. The third pillar is the molecular and cellular interactions for the adjustment of neuroregeneration. These three pillars work synchronously and together, providing neuro-inhibition and neurostimulation. In the central nervous system, the mechanism is, in a way, inhibitory and neuroplasticity can have a maladaptive character, while in the peripheral nervous system the phenomenon is stimulatory with a high success rate, however, it can have a maladaptive character in the central nervous system. secondary to peripheral nervous system injury, as previously reported [1-6, 20-22, 28, 50, 51].

     In central nervous system injuries, mainly related to mechanical trauma after spinal cord injury, the primary injury is the initial stimulus to trigger the neuroplasticity process in order to repair the injured circuit. However, the mechanism does not work properly. After the primary lesion, there is the appearance of a secondary lesion characterized by an inflammatory and cellular response, in addition to the activation of ion channels and gene expression. The ionic reaction triggered by increased cellular calcium influx increases reactive oxygen species and glutamate species triggering damage to genetic material, proteins and phospholipids, culminating in neurological dysfunction. The ionic response of calcium is responsible for the activation of genes associated with regeneration, however there is a stimulation of Phosphatase Tensin Homolog (PTEN) and Suppressor of Cytokine Signaling 3 (SOCS3) proteins that trigger inhibition of the neuroregeneration process by interfering in signaling pathways Janus Kinase/Signal Transducer and Transcription Activator 3 (JAK/STAT3) and Mammalian Target of Rapamycin Complex 1 (mTORC1). Deficient gene expression may be responsible for not adequately influencing neurogeneration, angiogenesis and cell adhesion/differentiation after vascular disruption and apoptosis after injury, such as the dysregulation of circRNAs. Hub genes, may have a neurotoxic character depending on oxidative stress and ischemia as reported for DNA DamageInducible Transcript 4 (DDIT4), or are responsible for the formation of gliosis through the RhoA pathway by stimulation of Transcription Activator-3 (STAT3), described for the Erzin gene (ERZ). Other physical barriers include the formation of cystic cavities and maturation of the glial scar [1-5, 45, 49, 52-57, 61]. The molecular response also has a great influence on inhibiting the reconstitution of circuits. Lipid peroxidation of oligodendrocytes is responsible for the release of neuro-inhibitory molecules. These cells do not support a long time away from the axons, suffering rapid degeneration, releasing such molecules. In addition, microglia have a lower phagocytic power compared to macrophages, contributing to the formation of gliosis. Chondroitin Sulfate Proteoglycan (CSPG) and Keratan Sulfate Proteoglycan (KSPG) molecules have been reported to inhibit the neuroregeneration process. Acrolein has been reported to cause neuropathic hyperreflexia, in addition to causing mitochondrial damage and triggering apoptosis. The Nogo family (NI250), mainly NogoA, are reported as the main family of neuro-inhibitory stimuli and are capable of interacting with several receptors, such as NgR1 and p75, inhibiting remyelination by activating the RhoA pathway. Myelin-associated glycoprotein (MAG) and oligodendrocyte myelin glycoprotein (OMgp) are also responsible for inhibiting remyelination through the same signaling pathway as NogoA. Versican (GSPG2) also prevents neuroregeneration by interactions between inflammatory leukocytes and inflammatory cells, favoring the recruitment of chemokines. Other molecules are also responsible for inhibiting neuroregeneration such as Ephrins (B3), semaphorins (4D and 3A) and NI-35 [1, 3-5, 47, 49, 54, 58-61].

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Arteriosclerosis often does not cause symptoms until the lumen of the affected artery is critically narrowed or is totally blocked. The symptoms of arteriosclerosis are highly variable and can range from no symptoms (in the early stage of the disease) to heart attack or stroke (when the lumen of the artery is critically blocked). Sudden cardiac death can also be the first symptom of coronary heart disease. As a plaque grows along the lining of an artery, it produces a rough area in the artery's normally smooth surface. This rough area can cause a blood clot to form inside the artery, which can totally block blood flow. As a result, the organ supplied by the blocked artery starves for blood and oxygen. The organ's cells may either die or suffer severe damage. Atherosclerosis can narrow the major arteries that supply blood to the legs, especially the femoral and popliteal arteries. These two arteries are affected in 80% to 90% of people with this problem. The reduced blood flow to the legs may result in a crampy leg pain during exercise called intermittent claudication. If blood flow is compromised severely, parts of the leg may become pale or cyanotic (turn blue), feel cold to the touch and eventually develop gangrene. There are various drugs which reduces plasma lipids but with potential side effects. Herbal medication like Green Cardamom has potential to lower bad cholesterol, i.e. LDL-cholesterol and raise good cholesterol, i.e. HDL-cholesterol. In this work we compared hypolipidemic effects of Niacin with Cardamom. Seventy five hyperlipidemic patients were selected for research work. They were divided in three groups. Group-I was on placebo, group-II was given 1.5 grams Niacin, and group-III was advised to use powdered Cardamom thrice daily for the period of two months. Their lipid profile was measured at start of research and then on day-60. After two months therapy group-II reduced total cholesterol 30.8 mg/dl and LDL cholesterol 12.1 mg/dl and increased HDL cholesterol 5.6 mg/dl. In group-III Cardamom decreased total cholesterol 7.2 mg/dl and LDL cholesterol 8.8 mg/dl. HDL cholesterol in this group increased 4.9 mg/dl. When results were compiled and analyzed biostatistically, these changes were significant. We conclude from the research work that Niacin has more effects on total cholesterol but effects of both drugs on LDL cholesterol reduction was almost same.

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The article considers the integration of modular solutions of therapeutic landscapes and interactive public spaces with a high degree of digitalization into the infrastructure of the city and special-purpose facilities, medical complexes and institutions. The article examines the role of the therapeutic function of therapeutic landscapes using a modular approach as a response to the challenges of time. It is important to combine growing technological capabilities with landscaping components. It is in this synthesis that the author sees the future development of the urban environment and the landscape of medical facilities.

Keyword: pattern; urban morphology; integrity; development; BIM for landscape; unique design; simulation algorithm; identity; utilities; technologies; innovations; design of alternatives; construction; competitive ability; potential; innovative development; municipal economy; community economy; urban semiotics; residential yards and gardens; county level; digital public spaces; neurorehabilitation; formation of man of today; scenario approach

     It has revealed that autonomic innervation represents 85-90% of innervation faced to sympathetic one. The mastery of the unmyelinated C fibers than faster conductors Aδ fibers, gives the eye more sensitivity as only hyperosmolarity or heat. In dry eye disease, even the inability of tear production, the stimulation of receptor neuro-activator as nicotinic acetylcholine receptor, or treatment via nasal route, alleviated this infirmity. In other hand, tear film homeostasis could be repaired via stimulation of parasympathetic fibers of trigeminal nerve.

     The surface of eye and lacrimal glands are exposed to air infection, and viruses of hand contact, which increase the risk of infection that land first the tear film. The resilience of tear film protect corneal and conjunctival epithelium, but its lipophilicity increases possibility of viruses to access the ocular surface. The prevalence of vision impairment has taken various origins like exaggeration of electronic surfaces use, some kinds to environment toxicity, chronic diseases and after surgical neuropathies as it could take birth even earlier as preterm birth. As high levels of glucose induced neurotoxicity, glia cells intervenes via glutamate, chemokines and pro-inflammatory cytokines, the retina of diabetic retinopathy is a thickening in retina, and cornea is useful for identifying neuropathy, as shown a deficiency in number of nerve’s fibers. About 57% of people with Down syndrome have visual problems, and analyzing visual acuity considered as the basis of an eye exam. Age-related macular degeneration, glaucoma, uncorrected refractive error, cataract, and diabetic retinopathy are the most abundant eye diseases.

     Many studies interested in developing eye drops holding drugs with high solubility in water and high retention on ocular surface, to repair the defects of corneal epithelium; and to prevent surgery laser usually used in high intraocular pressure and ocular pain. In other hand, while treating glaucoma, the drug subsistence remain a discomfort matter for the patients, as it guarantee only a short term eye protection; eye lenses have been proposed due their longer protection referring to higher rates of drug absorption they offered and their substitution into a drug source for the eye’s anterior chamber and the corneal layer.

     Between embarrassing health’s conditions of both males and females, males are prone to retinal detachment, and females are subject to inflammation. Dry eye disease is marked with high levels of inflammatory mediators IL-1β, IL-6, IL-10, IFN-γ, TNF-α and ‘matrix metalloproteinase’ MMP-9 mRNA expression in tears. During pregnancy, it has noticed that disorders of ocular as inflammatory demyelination and autoimmune disease provoking disorders of intraocular pressure, and falling blood pressure in cornea. While, thyroid eye disease begins with an inflammation until the fibrotic phase, this autoimmune perturbation when involved the extraocular muscles induce strabismus, the steady progress of the surgery of the horizontal strabismus, estimated with the motor and sensory success accomplished with adjustable suture. The surgery of strabismus with thyroid eye disease expected as successful with eye movements and senses.

     Patients practically undergo magnetic resonance imaging (MRI) and computed tomography (CT), to disclose neuro-ophthalmological and orbital conditions of the eye, via assessing orbital mass/malformation, abscess or thyroid eye disease, or identify white matter lesions inducing neuromyelitis optica spectrum disorder. Thyroid hormones as exerted a crucial role on neuro-sensorial development of the eye, the volume of the eye measured via a morphometric and stereological studies of the retina myelination and glial development of the optic nerve, remain crucial in eye diseases diagnosis. Strabismus identified using multiple technics as synaptophore, alternate cover-uncover test with or without prism, and the Krimsky test. Keratoconus, diagnosed by corneal tomography, this disease could aggravated with collagen or genetic alterations.

     Recently, doctors’ decision between pharmacological treatments and surgeries became obvious, and its success or failure are prejudged. Strabismus required a surgical intervention, but amblyopia could been corrected pharmacologically. In appropriate cases to surgery, the blind painful and neoplasms, the eye removal is lifesaving, but in other cases as glaucoma, trauma and inflammation surgery remain just a failure of treatment [1]. In some cases, like the pathology of acute angle-closure glaucoma, the doctors should immediately intervene to prevent vision loss and ophthalmology consultations to avoid post-operative complications. During surgery, the vital signs are mainly important to ensure the smooth completion of the operation like blood pressure, pulse rate and respiratory rate. For completing their job, the doctors would better prescribe a convenient treatment after surgery, as wound healing became a main step in surgical; a pH value close to 7, and Polyethylene glyco-lysozyme considered as a tissue adhesive after corneal surgeries with assured biosafety proven by absence of cytotoxic effects on epithelial cells, neither conjunctival epithelial cells.

     Interested in the movement of the eye from a departure point to another one, and as the arrangement of the eye identified with three fixations, spatial location, assessment of the saccade, and its landing point. One arrangement succeed in estimation of a shorter saccade amplitudes, and doctors keep as well the gaze necessary in the surgical interface. Recently, the importance of eye tracking use in surgical research has emphasized, spread among surgeons and used as an inspector of surgeon’s cognition, attention and the most abundant use while using laparoscope and the ability of Eye-tracking technology (ET) to precise the appropriate zoom according to the distance between the surgical monitor and the pupil. A study about eye-gaze data indicated the ability of an algorithm with a minimum of information sources and maximum of fault tolerance, to ameliorate the conditions of surgical activities and enrich their methods, while using instruments for tracking signals, which assure the best surgical condition [2]. ET reduces errors in real time of examinations and surgical operations, in a jumbled environment, and supervising key elements utilization accurately as well, during clinical anatomy. ET work as a vigil supervisor while monitoring surgical interfaces, laparoscopic zoom, validity of content, vigilance, fatigue and individual vigilance alike the vigilance of the whole team, and steering them with a feedback. ET technologies adding a mark of specification, limitations confronted by glasses to avoid data loss and algorithms used for assessment of gaze metrics [3]. To resume teams of medical and biological research have been debt to the equipment, and technologies performing their methods of work.

     Stress and anxiety of the surgery room, and careless of nurses in some countries, as the eye surgery could been realized with mere local anesthesia, whence the consciousness of the patient aggravated the sensation of fear. In order to earn the trust of patients, doctors work always harder to ameliorate the conditions and performance of their work. Trying to guarantee a safe hospital departure, doctors have developed a new method more secure for eye surgery before healing. To avoid long-term hospital stays and ensure eye protection in case the patient leave the hospital just after the surgery, the orbital rims of the eye have been sutured with a plastic eye shield, which accelerate the healing of operated open globe. Surgeons, to ensure a permanent healing of the injured globe fixed with the plastic eye shield during surgery, which offer extended protection even the patient careless of his health. To sum, fixation of a plastic eye shield during surgery relieves the doctor's conscience.

     Surgical teams confirmed that a surgical simulator is required for the performance of residents’ training, the generalization of surgical training of all residents will assure enhancement of competencies between residents, whilst, residents found difficulties in achieving within a time frame the residency program, which lead to a heaped surgical training in the last year. Such problems could only been solved with prolongation of the residency training, and providing simulator early in training to prevent a training end with least operations, which ensure professional teams in eye surgery with minimum errors.

     Performance of daily life routines remain the key way to prevent ocular diseases as the healthy nutrition, and exerting sport preserving a healthy lifestyle, which lead to preclude vision deficiency, and constitute a main key to prevent inflammation.

References

1. Chan SWS., et al. “A decade of surgical eye removals in Ontario: a clinical-pathological study”. Can J Ophthalmol 52.5 (2017): 486-493.
2. Thiemjarus S, James A and Yang GZ. “An eye–hand data fusion framework for pervasive sensing of surgical activities”. Pattern Recognition 45 (2012): 2855-2867.
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     Eye innervation analysis, has showed the multiplicity of nerves and the diversity of their particularities. The optic nerve “second cranial nerve” innervated retina, the sensory cells. The third cranial nerve; the oculomotor nerve play a major role in extrinsic motility of eyeball, while the pathetic nerve responsible for the extrinsic motility of the eye. Lacrimal nerve innervated cornea, it emerged from Willis ophthalmic nerve that constitutes a branch of trigeminal nerve. Retina and cornea deemed fundamental when studying eye surgery and the complexity of their innervations with multiple nerves from different sources makes the eye surgery more complex. It is evident that, eye diseases in case of neurodegenerative diseases exhibited a large spectrum of symptoms, as Apraxia of eyelid opening, increased blink rate, decreased spontaneous blink, decrease in corneal sensitivity and deposition of phosphorylated a-synuclein in retinal ganglion cells.

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The subiculum is still an understudied part of hippocampal pharmacy. According to histological terminology, the following layers are distinguished in the subiculum: molecular, pyramidal, multiform, perforating tract, tray, commissure of the arch, layers of dorsal and ventral fibers. In the presubiculum there are molecular, outer and inner small pyramidal, reticular, pyramidal and multiform layers. Parasubiculum contains molecular, pyramidal and multiform layers. II, the main layer, is formed by the perikarya of large pyramidal neurons. The dentate gyrus (parahippocampus) in the anterior part of the brain is located under the hippocampus proper, and in the posterior part it is medial to it. It consists of three layers. There are 9 types of neurons in these layers. The data presented in the article can serve as a fundamental basis for further study of the parts of the rat brain in normal and pathological conditions with further extrapolation of the obtained data to humans.
Keywords: subiculum; presubiculum; parasubiculum; dentate gyrus; hippocampus

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The aim of the present study was to examine the relationships between the Yo-Yo intermittent recovery test level 2 (YYIR2) performance and match-running performance across playing positions in elite youth soccer players. Participants were 129 players (age = 17.0 ± 0.8 years) from 11 professional soccer academy teams. A Global Positioning System was employed to analyze 26, 11-a-side matches for: total distance covered; distance covered high-intensity running (HIR, 3.6 to 4.4 m·s^-1), very high-intensity running (VHIR, 4.5 to 5.3 m·s^-1), sprinting (> 5.3 m·s^-1) and very high-intensity activity (VHIA, calculated as VHIR plus sprinting); distance covered by high power (HP, 20-35 W·kg^-1), elevated power (EP, 35-55 W·kg^-1), maximal power (MaxP, > 55 W·kg^-1) and MP≥35 (calculated as EP plus MaxP); and number of accelerations (> 2 m·s^-2) and decelerations (< 2 m·s^-2). The YYIR2 test was conducted within three weeks of the matches. When all players were included, the YYIR2 distance was positively associated with all match-running performance variables (r = 0.36-0.47, all P < 0.01). When each playing position was analyzed separately, the YYIR2 distance was significantly related to: total distance in central defenders (CD) (r = 0.47, P < 0.05); VHIA in all playing positions except CD (r = 0.49-0.69, all P < 0.05); MP≥35 distance in all playing positions (r = 0.52-0.82, all P < 0.05); and number of accelerations and decelerations in defenders (r = 0.53-0.83, all P < 0.05). These findings suggest that the YYIR2 is a valid test for the assessment of match-related physical fitness in elite youth soccer players regardless of playing position. However, the relationships between the YYIR2 and match running performance variables are playing position-dependent except for when the metabolic power approach (MP≥35) is employed.
Keywords: Association football; endurance fitness; field test; match analysis; young players

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In recent years, significant advances in molecular biology has facilitated emerging knowledge pertaining to genetics in sport science research. Specific regions of DNA are known to influence genetic polymorphism(s) and partly explain individual variations in response to exercise stimuli and diet. Following exhaustive exercise, certain genetic variations or polymorphisms have been associated with muscle damage indices and may influence muscular recovery. The purpose of this narrative review is to outline the transcription factors of co-activators of associated polymorphisms that appear to play a role in muscle recovery. We also highlight the potential interaction of gene expression and the impact of macronutrients. Several genes (ACE, ACTN3, CCL 2 (C> T), COL5A1, CKM (A> G) have been implicated in various aspects of skeletal muscle remodeling. Individuals with specific genotypes experience changes in muscle damage and recovery rates following exercise. The contribution of heritability to a specific phenotype is likely dependent and the modality, intensity, and duration of exercise. Future research is warranted to explore multigenetic characteristics to provide a deeper molecular understanding of recovery, adaptation and nutritional modulation that may allow the identification of individuals with a greater genetic predisposition, or with a greater risk of developing muscle injuries.
Keywords: Genetic; Athletes; Sports Performance; Nutrients

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Whiplash-associated disorders (WAD) occur when shifting and movement of energy, during a crash or collision, from acceleration-deceleration mechanism is transferred to the neck region. WAD is characterized by excessive extension-flexion movements, and/or excessive side bending of the head and neck, beyond the normal and regular range of motion.

     Motor vehicle collisions remain the majority of trauma responsible for WAD, nevertheless, other causes include contact sports injuries, falls, physical and domestic abuse, and other types of traumas.

     Clinical features and presentations are variable. In general, these includes neck pain, decreased range of motion at cervical spine, spasms, and tightness, headaches, arm(s) numbness or achiness, and other symptoms and signs depending on the extent of the insult. These range from fractures, joint dislocations, ligament tears, and even traumatic brain injuries/post-concussional syndrome, with its subsequent clinical sequalae.

     The trauma associated with WAD outcome can result in acute and chronic pain syndromes, functionality limitations and restrictions, psychological and psychosocial ramifications, financial crisis, unemployment, and in cases, even prolonged disability. This causes a significant economic burden on country.

     This review manuscript will review the latest in WAD approaches for interventional procedures. We base our review on relevant databases such as PubMed, Ovid-Medline, Embase, Web of Science, NIH website, Google Scholar, and the Cochrane Library. No Institutional Review Board permission was obtained since this manuscript does not directly involve animals or humans.

Keywords: Whiplash; whiplash-associated disorder; neck pain; chronic neck pain; motor vehicle collision; chronic pain syndrome; chronic pain; neck trauma

     What I want to transmit today in this article is that Western medicine is seeing the human being only in parts, and not in its entirety, because it still does not consider the energy part, and only the materialized part of the energy, which are the visible parts that we can see by the naked eye [4, 5].

     Therefore, when a patient is brought into the or for any surgical procedure, I often find that "I could still be treated medically instead of being rushed into the or for surgery”.

     In various articles I write, I always demonstrate the differences in point of view of Western medicine with traditional Chinese medicine, through the figure of the tree. In this tree, I explain that Western medicine is represented through the part of the tree that is above the earth, which we usually can see with the naked eye. This part is composed of the branches of the tree, which represent the different specialties of Western medicine, and the leaves that come out of each branch, represent each disease treated by each medical specialty [6, 7].

     All surgical pathologies that Western medicine is treating are at the “leaf” level of the tree, for example, when a patient has an esophagogastric hernia, Western medicine treats it by performing surgery to contain the contents in the stomach by making a ring so that reflux does not occur [8].

     However, if we analyze the figure of the tree, according to traditional Chinese medicine, all the symptoms that appear at the leaf level in the different medical specialties, are caused by alterations in the energy present in the “root” of the tree, which Western medicine still does not recognize its existence and therefore does not study and does not treat [6, 9].

     Just today I saw a woman aged around 62 who said she had undergone surgery on her knee and had her meniscus removed, because of she was suffering a lot of knee pain. In these cases, traditional Chinese medicine understands that the cause of knee pain is at the “root” of the tree, which are the energy deficiencies of the Kidney and Liver as I am showing in the article written by myself titled (2020) Why Patients with Knee Pain Still Have Symptoms Despite the Use of Anti-inflammatory Medications [10, 11].

     That is why I am saying that patients who are taken for surgery have not yet completed their clinical treatment, where they could still have a cure. Nowadays, we see many cases being taken, and they could still do a clinical treatment and solve the case. The example I can give is surgeries to correct hiatus hernia, where it is known that reflux occurs due to lack of energy in the fifth chakra or the Spleen-pancreas energy (that is responsible for the function of the stomach, breast, spleen, pancreas, thyroid), and when the patient replaces this energy (of the Spleen) and of the whole system that is also without energy (such as the energy of the Lungs, Kidney, Liver, Heart), the patient improves from reflux without having to undergo surgery, which is not entirely innocuous, as I reported in the article written by myself (2021) titled How Can We Treat Gastroesophageal Reflux Without Doing Surgery? In this article, I am demonstrating a patient with hiatal hernia who was submitted to hernia correction using surgery. In the surgery there was an intestinal perforation, leading to septicemia, kidney failure, and vision loss. The patient has been more than 8 years after surgery and she is still dealing with the serious complications caused by this surgery [8].

     Patients with any kind of abdominal pain have in common, energy deficiency inside the five internal massive organs causing the formation of internal Fire, that it is the cause of abdominal pain, in the energy level, as I am showing in the article written by myself (2022) titled Energy Alterations in Patients with Abdominal Pain [12].

     Even in patients with a brain tumor, there is a chance of avoiding surgery when the doctor pays attention to treating the “root” of the tree and not just the symptoms, which are the tumor itself. I say this because the son of a patient had a brain tumor and blurred vision. As I know that the majority of the world's population is without energy in the five massive internal organs (Liver, Heart, Spleen, Lung, Kidney), I sent the medicines by a friend ( the patient lives in London) so that it would fill the energy of these organs and what happened to this patient was that he improved with the use of highly diluted medications (according to the theory written by me ( 2020), titled Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine and also medications made based on crystals). In this theory, I am using Phosphorus to treat Liver, Sulphur to treat Heart, Calcarea Carbonica to treat Spleen, Silicea to treat Lung, Natrum muriaticum to treat Kidney [5, 13, 14].

     Even patients with hemorrhoids can be treated clinically without the need for surgery, as they all have in common the lack of energy in the five massive internal organs (Liver, Heart, Spleen, Lungs, and Kidney), and thus, by treating the “root” of the problem and associating some techniques of traditional Chinese medicine, patients improve immediately after the auriculotherapy session without the need for surgery. Usually when the patient with hemorrhoids who was submitted to surgery, they need to stay at home for about two weeks and with a lot of pain in the postoperative period, and cannot work during this period, as I am talking about in the article written by myself (2020) titled Chakras Energy Alterations in Patients with Hemorrhoids and How to Treat it without Surgery [15].

     I am saying this because all surgical procedures today are considered high risk, because even if the patients' exams are normal, what is altered in all patients today (even in newborn children), are in the energy level, characterized as this lack of energy in the five massive internal organs (Liver, Heart, Spleen, Lungs, and Kidney), leading to a state of immunodepression, as I am showing in the article written by myself (2022) titled Are Patients Without Surgical Risks Really Without Surgical Risk? in the second article also written by myself (2021) title Are We Vaccinating Immunocompetent or Immunocompromised People for COVID 19? [16-17].

     All these energy alterations inside the human body are due to the lack of energy caused by chronic exposure to electromagnetic radiation, due to the modernization of telecommunication globally, and for this reason, all surgical patients are at high risk for complications in the operative period or in the postoperative period, as the anesthetic drugs normally used are all highly concentrates medications. According to the Arndt-Schultz law, created in 1888 by two German researchers, the use of any highly concentrated medication can cause a drop in vital energy and this effect can cause stagnation of Blood inside the blood vessels or other complications such as thrombosis, myocardial infarction, strokes or even death of this patient [16, 18-20].

     To minimize all these complications when using highly concentrated medications in all these energy-deficient patients, all patients who went for a surgical procedure should first be submitted to the treatment of the lack of energy of the five massive internal organs, using highly diluted medications according to the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine using Phosphorus to treat the Liver, Sulphur to treat the Heart, Calcarea Carbonica to treat Spleen, Silicea to treat the Lungs and Natrum muriaticum to treat the Kidney, thus maintaining the energy to keep the Blood circulation normally, without causing so much energy drop, when being undergoing an anesthetic procedure [13, 16].

     The world population is not the same as in the past, as I am showing in the article written by myself (2021) titled Is the Population in the World the Same as in the Past? So, the clinical measurements used in the diagnosis and treatment of all these patients needs to be careful because of this drop of energy, depending on the type of medication we need to use in the surgical procedure, causing complications or even death of all these patients, independently on the type of diagnosis or the age group, as I am showing in the article also written by myself (2021) titled Energy Alterations and Chakras’ Energy Deficiencies and Propensity to SARS-CoV-2 Infection [21, 22].

References

1. Huang Wei Ling. “What Flexner Report did to Our Medicine After 100 Years of Implantation?". Acta Scientific Gastrointestinal Disorders 4.8 (2021) : 01-04.
2. Conselho Federal de Medicina. CFM.
3. Acupuncture Legal Status. News Medical Life Sciences. Available in: Acupuncture Legal Status (news-medical.net)
4. Huang Wei Ling. “Why Are Diabetic Patients Still Having Hyperglycemia Despite Diet Regulation, Antiglycemic Medication and Insulin?”. Int J Diabetes Metab Disord 4.2 (2019): 1-14.
5. Huang WL. “The Importance of Treating Energy Imbalances and Chakras Replenishment for Prevention and Treatment of Cancer”. Advances in Cancer Research & Clinical Imaging 3.1 (2020).
6. Huang Wei Ling. “Why Do Patients Still Catch Hospital Infections Despite the Practice of Infection Prevention and Control Programs?”. Acta Scientific Microbiol 1.4 (2018): 34-43.
7. Huang Wei Ling. “The Importance of Correcting Energy Imbalances and Chakras Energy Deficiencies in the Treatment of Patients with Glaucoma”. Clin Res Ophthalmol 2.2 (2019): 1-9.
8. Huang Wei Ling. “How Can We Treat Gastroesophageal Reflux Without Doing Surgery?". Acta Scientific Gastrointestinal Disorders 4.9 (2021): 10-11.
9. Huang Wei Ling. “Chakras’ Energy Deficiencies in Patient with Congestive Heart Failure”. On J Cardio Res & Rep 6.2 2021.
10. Huang Wei Ling. “Why Patients with Knee Pain Still Have Symptoms Despite the Use of Anti-inflammatory Medications”. International Journal of Orthopaedics Research 2.2 (2020): 21-27.
11. Huang Wei Ling. “What is Behind All Hernia Formations that We Need to Know?". Acta Scientific Clinical Case Reports 3.3 (2022): 01-03.
12. Huang WL. “Energy Alterations in Patients with Abdominal Pain". Acta Scientific Gastrointestinal Disorders 5.7 (2022): 38-48.
13. Huang Wei Ling. “Constitutional Homeopathy of Five Elements Based on Traditional Chinese Medicine”. Acta Scientific Medical Sciences 4.7 (2020): 57-69.
14. Huang WL. “How Can We Give Hope for Cancer Patients to Cure This Disease?”. TMR Cancer 4.4 (2021): 16.
15. Huang Wei Ling. “Chakras Energy Alterations in Patients with Hemorrhoids and How to Treat it without Surgery”. Surg Med Open Acc J 3.5 (2020).
16. Huang WL. “Are Patients Without Surgical Risks Really Without Surgical Risk?”. J, Surgical Case Reports and Images 5.3 (2022).
17. Huang WL. “Are We Vaccinating Immunocompetent or Immunocompromised People for COVID 19?”. J Vaccines Res Vaccin 7 (2021): 018.
18. LEESER O. “Support of homeopathy by the Arndt-Schulz law”. National Center for Biotechnology Information (1953).
19. Huang Wei Ling. “What Is Behind All the Pulmonary Thromboembolism That We Need to Know?”. MAR Pulmonology.
20. Huang Wei Ling. “What We Need to Know When the Patient has a Stroke with or without COVID-19?". Acta Scientific Neurology 4.8 (2021): 01-05.
21. Huang Wei Ling. “Is the Population in the World the Same as in the Past?". Acta Scientific Clinical Case Reports 2.6 (2021).
22. Huang Wei Ling. “Energy Alterations and Chakras’ Energy Deficiencies and Propensity to SARS-CoV-2 Infection". Acta Scientific Microbiology 4.4 (2021): 167-196.

     I am writing this article today because in my daily clinical practice, I come across patients who are often submitted to surgical procedures without being properly treated clinically and this I want to be discussing with you in this article.

     Western medicine, since the implementation of the Flexner report in 1910, has been considered “scientific”, only what can be seen or can be demonstrated through laboratory and/or radiological exams, and everything that cannot be seen with the naked eye, was considered “unscientific” by the medical community and this happens even today [1].

     However, in the face of so many changes on our planet, I live in Brazil, a country that considers acupuncture and homeopathy as medical specialties, which have been recognized by the Federal Council of Medicine since 1980 and 1995 respectively [2].

     I feel privileged to live in my country Brazil because I know that in many countries such as the United States, acupuncture and homeopathy are still not considered medical specialties, and in the US, acupuncture treatment is allowed to be made by medical doctors but also by nurses, nutritionists, psychologists, etc [3].

     Davy’s lectures were charismatic and explosive (sometimes literally, see the recreation of his exploding volcano demonstration here). And they were often poetic. Now, as the first edition of the Collected Letters of Humphry Davy is set to be published, it is perhaps time to take another look at one of Britain’s most renowned scientists.

     It has been almost six decades since CP Snow famously argued that there were “two cultures” of the arts and sciences. He thought that an unbridgeable chasm divided those who worked in these fields, that they had become so specialised they no longer had the language to talk to each other. Whether you think that this was true then or is true now, Davy – as a poet and a chemist – shows that any such chasm can be bridged.

     The Royal Institution, Davy studies became an axis indispensable for the study of the literary romantic generation in the United Kingdom, celebrated worldwide, though certainly not always because of its connection to the scientific profession.

     In this way, we elucidate how the possibility of these studies, together with the critical biographical account of Davy's literature, expand the theses on the stereotype of the narrative genre science, poetic production, and scientific nationalism.

     Humphry Davy was a pioneer in his professional area for sedimenting this permeability between genres but also for consolidating the profession of the experimental scientist, whose objective became the controlled investigation, under an institutional direction, of the available paradigms and your progress. At least for the public sphere, therefore, Davy had a contribution unique historical context, which involves enlightenment, in the face of an enlightened and moderately prosperous, of a scientific vocation related to the visible progress of technoscience. Likewise, the glorification of this professional function, in view of its persona public, contributed to the ideals of the modern scientist, a possible statement in the face of his original popularity and relationship with the public.

     Sir Humphry Davy fascinated rapturous crowds when he delivered his lectures in chemistry to the Royal Institution in London. In the late 1700s and early 1800s and in sumptuous surroundings, Davy would demonstrate – with whizzes and bangs – the latest chemical discoveries. His audiences were not just made up of fellow scientists but also poets and genteel ladies of the fashionable West End.

     His experiments with nitrous oxide, or laughing gas, and his invention of the miner’s safety lamp went down in history – but perhaps his greatest legacy is what he did for science communication and breaking down the barriers between the sciences and the arts.

References

1. Ungerstedt J., et al. “Clinical Outcomes of Adults with Systemic Mastocytosis: A 15-Year Multidisciplinary Experience”. Cancers (Basel) 1416 (2022): 3942.
2. Valent P., et al. “Updated Diagnostic Criteria and Classification of Mast Cell Disorders: A Consensus Proposal”. Hemasphere 5.11 (2021): e646.
3. Leguit RJ., et al. “The international consensus classification of mastocytosis and related entities”. Virchows Arch (2022).
4. El Hussein S., et al. “Systemic Mastocytosis and Other Entities Involving Mast Cells: A Practical Review and Update”. Cancers (Basel) 14.14 (2022): 3474.
5. Sciumè M., et al. “Target Therapies for Systemic Mastocytosis: An Update”. Pharmaceuticals (Basel) 15.6 (2022): 738.
6. Image 1 Courtesy: ASH.com.
7. Image 2 Courtesy: Science direct.

     Systemic mastocytosis is a heterogeneous disorder characteristically demonstrating mast cells with aberrant cytology and immuno-phenotype accumulated within diverse organs. The condition exhibits an anomalous pattern of neoplastic evolution.

World Health Organization (WHO) classification 2008 denominates distinct categories of mastocytosis as

• Cutaneous mastocytosis.
• Indolent systemic mastocytosis with minimal burden of mast cells and absence of cutaneous lesions.
• Systemic mastocytosis associated with clonal hematologic non mast cell lineage disease as myelodysplastic syndrome (MDS), myeloproliferative neoplasm(MPN), acute myeloid leukaemia(AML) or lymphoma.
• Aggressive systemic mastocytosis exemplifying diagnostic criteria of systemic mastocytosis, absence of mast cell leukaemia or incrimination of cutaneous surfaces.
• Mast cell leukaemia with mast cells configuring > 20% of nucleated marrow cells or an aleukemic variant with < 10% of circulating white blood cells as mast cells.
• Extra-cutaneous mastocytoma constituted of unifocal mast cell tumour demonstrating a non destructive neoplastic configuration.
• Mast cell sarcoma is articulated of unifocal neoplasm exhibiting a destructive tumour configuration and constituent mast cells delineating aggressive cytological features [1, 2].

References

1. Angelillo IF., et al. “Mothers and vaccination: knowledge, attitudes, and behaviour in Italy”. Bulletin of the World Health Organization 77.3 (1999): 224-229.
2. Antai D. “Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants”. BMC Infectious Diseases 9 (2009): 181.
3. Awosika D. “Access to immunization and other public health interventions through the pharmacists”. West African Journal of Pharmacy 23.1 (2012): 3-11.
4. Centers for Disease Control and Prevention (CDC). "Measles--United States, January 1 - April 25, 2008". Morbidity Mortality Weekly Report (MMWR) 57.18 (2008): 494-8.
5. Gherardi E. The Concept of Immunity. History and Applications. Immunology course Medical School, University of Pavia (2013).
6. Global Immunization Vision and Strategy (GIVS). Facts and figures April 2005. Geneva: WHO (2005).
7. Global immunization vision and strategy 2006-2015. Geneva: WHO (2005).
8. Kapoor R and Vyas S. “Awareness and knowledge of mothers of under five children regarding immunization in Ahmedabad, Healthline 1.1 (2010): 12-15.
9. Lee JW. “Child survival: a global health challenge”. Lancet 362 (2003): 262.
10. Odusanya OO., et al. “Determinants of vaccination coverage in rural Nigeria”. BMC Public Health 8 (2008): 381.
11. Orenstein WA, Papania MJ and Wharton ME. “Measles elimination in the United States”. Journal of infectious Diseases 189.Suppl 1 (2004): S1-3.
12. Sadoh AE and Eregie CO. “Timeliness and Completion Rate of Immunization among Nigerian Children Attending a Clinic-based Immunization Service”. J Health Popul Nutr 27.3 (2009): 391-395.
13. Siddiqi N., et al. Mothers? knowledge about EPI and its relation with age-appropriate vaccination of infants in peri-urban Karachi”. Journal of Parkistan Medical Association 60 (2010): 940-4.
14. World Health Organization. The Expanded Programme on Immunization (EPI) Survey (1991).
15. World Health Organization (WHO). Immunization (2013).

Background: The knowledge of mothers on immunization as a public health intervention that has greatly reduced mortality and morbidity globally is very vital as they play a great role in child care. Their ability to have the right knowledge will enhance their practice and attitude towards immunization. This study assessed the knowledge, attitude and practice of mothers on immunization and the impact of sociodemographic characteristics of children undergoing immunization. Objective: The aim of the study is to access the knowledge, attitude and practice (KAP) of mothers on immunization in Akure Ondo State, South West Nigeria. Method: A descriptive study was conducted on mothers of children born between 26^th September 2011 to 26^th September 2012. A household multi-stage sampling 48-item questionnaire study design was modified, adopted and administered. Consents of respondents were sought before the administration of questionnaires. IBM SPSS Statistics version 27.0.1.0 was used in analyzing the data. Results: The study showed that majority of respondent (89.6%) had an overall good knowledge while 5.2% each had fair and poor knowledge. But less than 60% and 3% reported for vaccination at the stipulated time and had negative attitude towards immunization respectively. Factors that affect the knowledge of mothers on immunization from the study are educational status, marital status, religion, geopolitical zone and her and/or the father of the child been immunized as children. Conclusion: This study revealed that respondents had high knowledge on immunization, however it doesn’t translate practice since some mothers did not complete their immunization schedule. There is a need for health promotion and education to sensitize mothers on the importance, objectives and benefits of immunization.

Keywords: Knowledge; attitude; practices; mothers; immunization

Clinical Case

     25-year-old male patient, one-pack-per-week smoker, with no other relevant history. He seeks medical advice for a 1-week left otodynia, associated with scanty yellowish otorrhea in addition to a rapidly growing left temporozygomatic swelling. No antibiotic treatment.

     Good condition on physical examination. Apyretic. Left ear: external auditory canal with mucopurulent secretions; dull, congestive tympanic membrane, without luminous shine and with punctiform attic perforation through which little purulent material comes out; no fetidness; no skin flakes. Myringosclerosis plaque (Fig. 3). Instrumental acoumetry with 256 Hz tuning fork; Weber lateralized to the left ear. Bilateral positive Rinne.

     Diffuse left temporozygomatic swelling (Fig. 1-2) measuring approximately 8 x 4 cm (A-P) and (L). Its upper limit occupies the entire left supra-auricular region, reaching the tail of the eyebrow and ipsilateral malar region; modified root of the Helix, facial asymmetry and effacement of the retroauricular sulcus, displacement of auricular pavilion. Soft and depressible. Mastoid with mild erythema.

Tomography

     Total occupation of mastoid cells on the left, bone erosion with soft tissue involvement. Collection at the level of temporal, zygomatic and left parietal bones. Septations. It measures 80 x 33 x 91 mm L, T and AP (Fig. 4-5). The laboratory study revealed a leukocytosis of 17,000 with neutrophilia (80%). Elevation of C-reactive protein 20 mg/dl, Hemoglobin 12.1 g/dl, Hematocrit 35.8%. Hospitalized patient with medical-surgical treatment. Puncture aspiration (Fig. 6) and surgical drainage. Ampicillin-Sulbactam 3 g every 6 hours, Ketoprofen 100 mg every 8 hours and Hydrocortisone 100 mg every 12 hours were administered. Due to the lack of an emergency block, mastoidectomy was not performed. The infectious process eroded the bone cortex of the temporal bone, dispersing pus between the cortex and the periosteum in the temporozygomatic region (Fig. 5). The causative germ was not isolated; empirical antibiotic therapy was sufficient. Chronic cholesteatomatous otitis media was ruled out; in its evolution, the eardrum was found to be normal with good shine and no collection in the tympanic box. Normal hearing. Control tomography with clear attic (Fig. 7).

We present a case of acute otitis media complicated by zygomatic-malar abscess in a 25-year-old patient with no previous medical/otorhinolaryngological history, who comes to consultation due to large left temporozygomatic swelling. Its atypical clinical presentation and the applied medical-surgical procedures are reported.

Keywords: Complicated otitis media; zygomatic abscess; temporozygomatic swelling; subperiosteal abscess

References

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Knowledge networks and organizational collaboration reflect a culture of success, transformational leadership and a climate of relationships around which relationships of trust, support, innovation and goals are generated. These are bi-directional and horizontal organizations with equity and solidarity. The objective of the present study is to establish the correlations between the factors, a non-experimental, transversal and exploratory study was carried out with a selection of 300 administrative staff, students and teachers from a public university in central Mexico. to structural model. The results show that there is a dependence relationship between goal climate and collaboration. Based on these findings, research lines related to trust as a determinant of knowledge networks and organizational collaboration are noted.

Keywords: Culture; institutionalism; leadership; network; collaboration

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Background: Electrical medical devices have become a crucial part of modern healthcare, aiding in diagnosis, treatment, and monitoring of various medical conditions. However, the exposure of the human body to electrical currents produced by these devices can cause adverse effects, ranging from mild tingling sensations to severe injuries, and even death.

Aim and objective: This systematic review aims to investigate the effect of exposure to electrical current produced by medical equipment on the human body.

Material and Method: The review included studies which investigated the effects of exposure to electric current in healthcare workers, patients, and the general public. The search was conducted using the following keywords: “medical equipment”, “electrical current”, “exposure”, “health hazards”, and “assessment”. The studies were identified through searches of electronic databases, including PubMed, Embase, and Scopus, using a predefined search strategy. After screening 1240 studies, 43 studies were included in the review. The studies evaluated a range of medical equipment, including electrosurgical devices, defibrillators, electrocardiographs, and magnetic resonance imaging machines.

Result and Discussion: The results of this systematic review indicate that exposure to electrical current produced by medical equipment can lead to a range of adverse effects. These effects include burns, tissue damage, nerve damage, cardiac arrhythmias, and even death. The severity of the effects was found to depend on the duration and intensity of the electrical current, the pathway of the current through the body, the electrical resistance of the body tissues, and the individual’s health status. Furthermore, the review identified several risk factors associated with electrical injuries, such as the presence of moisture or conductive materials on the skin, the use of metallic implants, and the proximity of the equipment to vital organs. The review also revealed that various safety measures, including proper equipment insulation, grounding, and the use of safety protocols, can minimize the risk of electrical injuries associated with medical equipment.

Conclusion: The study found that exposure to electric current can cause a range of health effects, including burns, cardiac arrhythmias, nerve damage, and even death. The review also found that the level of risk associated with exposure to electric current varies depending on the type of equipment and the individual’s susceptibility. Exposure to electrical current produced by medical equipment can have significant adverse effects on the human body. Therefore, healthcare providers and medical personnel must be aware of the risks associated with electrical medical devices and implement appropriate safety measures to prevent such injuries. Healthcare workers and patients with pre-existing medical conditions may be at higher risk of adverse health effects. Overall, the review highlights the need for improved safety measures and training programs to reduce the risk of exposure to electric current in healthcare settings. Further research is needed to better understand the mechanisms of injury and to develop more effective prevention strategies.

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Parasitic migration into the bile ducts is less common. Few cases of parasitic cholitis were reported despite Madagascar being a parasitic endemic country. Our goal is to report the case and stimulate the search for Gilbert's disease in free bilirubin cholitis. A 24-year-old Malagasy woman is hospitalized for febrile jaundice. She is not obese and had no history of vesicular lithiasis. The interrogation reveals the absence of deworming for several years. The clinical examination showed pain on palpation of the right hypochondrium. An abdominal ultrasound showed an intravesicular rail image and extrahepatic bile duct dilation. Biology revealed an elevation of alkaline phosphatase and gamma GT associated with an elevation of predominantly free total bilirubin. There was no anemia or eosinophilia. Blood culture series had come back negative as well as viral serologies (hepatitis A, B, C and HIV). The hemolysis balance was negative. Microscopic examination of the stool for KAOP showed the presence of numerous roundworm eggs. The diagnosis of parasitic cholitis is made associated with Gilbert's disease. The clinico-biological evolution is favorable after deworming associated with antibiotic therapy. A control abdominal CT scan was normal after a one-month setback.

Keywords: jaundice; bilirubin; abdominal ultrasound; Madagascar; parasitosis

     Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, tele-mentoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and tele-mentoring [3].

     Due to the limitation of special regions and unbalanced development of medical technology, many patients lost the best opportunity for operation. The idea of telesurgery robot was proposed for the first time to quickly and safely treat trauma patients in the rear hospital in the wartime. With the development of medical and remote communication technology, the demand of telesurgery has increased. Laparoscopic and endoscopic technology changed the previous operation mode that operated under direct vision. By presenting the operation vision through video images, tele-present surgery came into reality, and it was early used for remote surgery guidance and education of complex operation and emergency trauma cases [4].

     Patients far away from hospital, can consult with their doctors easily with teleconsultation and can reduce the number of hospital visits. Patients can have teleconsultation for follow-up.

     During the covid error, surgeons need to take care of surgical patients, and operate on covid-positive patients. Surgeons also take care of covid-positive non-surgical patients as the medical staffs are not enough to take care of the rising number of patients. Health-care personnel have to attend patients both personally and on-line. Many patients consult with medical professionals via tele-consultation, video-calling by using viber, messenger, etc...

     Doctors with busy schedule can have multidisciplinary meeting via online. Doctors perform continue medical educations in the form of webinars.

     Surgeons can also use video-calling to discuss about the patients during ward-round and also during operation. Surgeons from different places can collaborate without long travel.

     Surgeons can perform surgery and broadcast so that doctors from remote areas can view the live surgery on-line and can do questions and answers in real time.

     Senior surgeons can supervise the operations of juniors by video-call. Seniors can see both the intraoperative findings and the skills and handicrafts of juniors. Seniors can also do the tele-mentoring.

There are many advances and benefits, due to improvement of communication media.

     The biggest challenge of telepresence system at present is not to compromise the optimal balance of remote operation process due to excessive occupancy of available bandwidth when meeting the quality requirement of real-time medical image and video [4].

     Telesurgery benefits not only the developed countries but also the low and middle-income countries by facilitating in the areas of patient consultation, pre-operative preparation, operation and follow-up. It also aids in training of juniors, supervision of juniors, mentoring the juniors and collaboration between doctors. Doctors should make the best use of telesurgery to get quality care in medical practice.

References

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4. Shi-Bo Xia and Qing-Sheng Lu. “Development status of telesurgery robotic system”. Chinese Journal of Traumatology 24.3 (2021): 144-147.

     Telesurgery uses wireless networking and robotic technology to allow surgeons to operate on patients who are distantly located. This technology not only benefits today’s shortage of surgeons, but it also eliminates geographical barriers that prevent timely and high-quality surgical intervention, financial burden, complications, and often risky long-distance travel [1].

     Benefits of remote robot-assisted surgery are multiple. Geographic constraints will no longer determine the type of treatment the patient receives because of lack of surgical expertise. Ideally, any patient can receive the form of treatment more appropriate for his or her condition or more advantageous, such as new minimally invasive techniques. This may have an even more profound impact on developing countries, where healthcare is often provided by volunteers who do not necessarily have expertise in all fields of medicine and surgery [2].

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Human life is not only a matter of biology and biochemistry, it is also a cybernetic-information and bioelectronic construct that affects health, disease and human behavior. In this new bioelectronic paradigm, human cognition begins to emerge in the aspect of quantum processes taking place in an integrated circuit. In bioelectronic terms, an organism is understood as an integrated system made of biological piezoelectrics, pyroelectrics, ferroelectrics and semiconductors, filled with bioplasma and managed by quantum processes electronically using biocomputers.

The human biological system, apart from the biochemical way, uses the transfer of information by means of electromagnetic, acoustic, soliton waves, electric, electromagnetic, torsion (spin) fields and bioplasma. In stem cells, quantum processes play a significant role, it depends on them human psychophysical development. In the Universe, the primordial information "ingeneza" works, which is encoded in atoms. Each DNA atom is encoded with specific genetic information. Ingeneza programs are quantized and create all stages of development, cell, organism, biosphere and cosmos. Water molecules are carriers of information.

Keywords: stem cells; autism; quantum processes

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The objective of this paper was to specify a model for the study of intellectual capital formation. A documentary, retrospective and exploratory study was carried out with a selection of sources indexed to international repositories, considering the period from 2019 to 2022, as well as the search by keywords. The axes, themes, dimensions and categories of discussion were established in the research agenda, suggesting the extension of work towards other scenarios such as training and training.

Keywords: Institutionalism; agenda; entrepreneurship; talents; formation

References

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Virtual simulation experiment teaching can make up for the shortcomings of traditional physical experiments, but most of the current simulation software is two-dimensional, and the teaching effect is limited. This article uses Three.js3D technology, taking the "Saxon Bowl Sinking Experiment" as an example, and breaks through the plane constraints by constructing a three-dimensional model to achieve a three-dimensional, online, cross platform, real-time and interactive virtual simulation system. The system performs three-dimensional modeling of experimental equipment and processes, achieves three-dimensional simulation, and designs four types of experiments for users to explore the relationship between variables. Supported by virtual teachers, the system fully simulates the interactive scene between teachers and students offline. Video and voice add role switching, greatly increasing interest and observability. The application practice shows that the system can greatly improve the teaching effect during COVID-19 pandemic.

Keywords: Physical experiments; Stereoscopic simulation; 3D modelling; three.js; saxon bowl

.

I had the great fortune to study and work closely with outstanding Russian physicists Alexander Mikhailovich Prokhorov and Nikolai Gennadievich Basov. I have never ceased to be amazed at the manifestations of their genius, each time discovering new facets of the teachers' many talents.

     What is the first thing that comes to mind when they are no longer with us for more than 20 years and the acute emotions of parting have long since subsided? An incredibly developed sense of intuition, an amazingly quick ability to find the right solutions, a keen sense of the new, fundamentally important for the leap into the future, humanity. But a sense of the cutting edge of science, of the trends of its development, were perhaps central to the character of these phenomenal scientists. My task in this article is to add my colors to complement the images of these great scientists and citizens of Russia - Alexander Mikhailovich Prokhorov and Nikolai Gennadievich Basov [1, 2].

     Nowadays Simulation Training technology has developed much and I can help in designing cost effective "Simulation Training Centre." Simulation has many advantages, for it results in highly trained medical graduates who are less likely to make life-threatening or costly medical errors. Some of the advantages of simulation are listed in Employing medical simulation techniques can help move medical training from the old “See One, Do One, Teach One” method into a “See One, Practice Many, Do One” model of success. Virtual simulation can be used for clinical judgement training to students. Simulation-based teaching has proved to reduce risks to both patients and learners. It has also proved to be effective in both undergraduate and post graduate education as well as faculty development. Simulation can be used in the primary health care setting to improve confidence in performing life-saving skills, clinical skills, communication skills, and the quality of care for patients with chronic diseases such as diabetes mellitus and bronchial asthma. Such simulators as part task trainers, computer-based systems, virtual reality and the haptic system, simulated patients, simulated environment, and integrated simulators have been also used effectively to assess and evaluate clinical skills. Virtual simulation for Nursing provides students with a realistic, true-to-life clinical experience. The immersive virtual scenarios allow students to engage with 3D patients, testing their ability to recognize and analyse cues through unfolding visual and audio responses and by experiencing lifelike reactions. Students decide what actions to take for Nursing with the system adapting to student-driven decisions so they can see immediate cause and effect, strengthening their clinical judgment skills.

     There has been changes from time to time in medical education teaching methodology. Both Clinical Theory and Clinical Rotations is a must for learning students so that they can practice without compromising patient safety. Most of the medical institutions do not have simulation technology. Simulation teaching can be of two types one for teaching Communication, hands on skills and the other is to make clinical judgement. Simulation approach has to be customized as per project or training objectives. In developed medical institutions around the globe the healthcare providers candidates have to complete clinical rotations and simulation learning as well. How many Nursing colleges and medical colleges does have simulation curriculum? For example, In Paramedicine the paramedic licensing exam includes an integrated out-of-hospital simulation scenario where a candidate is required to effectively manage a simulated patient for 15 to 20 minutes. After initial licensing recurring competency assessments are often conducted through simulation activities. These assessments are meant to capture continued competence of providers. Drawing a quality standard on EMS simulation activities is vital since simulation-based assessments are utilized for determining provider competence and workforce readiness. Shortcutting this level of quality can negatively impact providers and ultimately patient safety.

 During emergencies, being READY is critical and can save lives. “IMMAST” Institute of Medical and Minimal Access Surgery Training (Mumbai, India) is providing simulation training on surgeries and allied health sectors. It is the only center of its kind in India that offers hands-on training on close to life models, using in-vivo and ex-vivo animal tissue, which perfectly mimic a live patient, in a re-created OT setting with top-of-the-line equipment. The hand-picked faculty at IMMAST enjoys national and international recognition in their respective surgical disciplines, and are bound by their passion for teaching. The center offers a plethora of surgical and medical education courses, spanning 16 surgical super-specialties, with hands-on practice, live transmissions, didactic lectures, and operative videos constituting basic as well as advanced levels of training." Sandor Medicaids Pvt Ltd (India, SARRC Countries) is committed to providing durable, affordable and comprehensive training Manikins and Turnkey Projects for Medical Intuitions that help our Physicians, Nurses and Paramedics to provide worldclass care. Pirogov Anatomy has introduced 3D virtual anatomy with case study for medical students and allied health sciences which is very important for any medical students to make clinical judgement. NMC policy in India makes mandatory that each medical institutions must have 3D anatomy dissection table in every medical college. The decision makers of Medical Institutions and Nursing Institutions need to understand that this is the time not to waste anymore. This is the time to get the resources for better training of Physicians, Nurses and Paramedics for the country. Then only we can hope for better care and patient safety.

Simulation can be used to resemble existing curricular material. The simulated scenarios are realistic enough to engage the students emotionally, thus providing a unique learning experience, where the high-fidelity simulator “patient” actually talks, breathes, blinks, and moves like a real patient. Simulation can be adapted to accommodate the need of various medical specialties such as anesthesia, emergency medicine and trauma, intensive care medicine, obstetrics, pediatrics, neurology and radiology as well as for the use of other professionals such as nurses, paramedics, and respiratory therapists. There are different simulations products available. An ideal simulation training center must have "Physical Simulators" and "Virtual Simulator”. Simulation laboratories are quite costly. A single high-fidelity physical simulator with its monitoring system and other necessary equipment may cost up to $200 000. Virtual Simulators can be cost effective as per training requirements. In addition, synthetic body fluids, replacement skins, bandages, syringes and other supplies are necessary to simulate the experience of treating real patients in a real hospital. The ability to practice without risk must be weighed against the cost of this new technology.

Geriatric care has to be popularized

     Life in geriatric care institutions and services is not very popular in India. This is not encouraged for a variety of reasons. Lack of social and family support is also a factor. The community needs to understand the need for care for the elderly. The rates of dependence on geriatric centers are increasing in India. The situation may arise where the children are abroad and the parents are at home. When relying on nursing homes, we need to think about whether our parents will get better care like home. Otherwise the situation of our parents will be miserable. Facilities and quality of care and maintenance should be ensured.

      Good service and quality care are the focus of aging care. Elderly routines, diets, current health status and previous knowledge, functional capacity, strengths and weaknesses are allessential for the smooth functioning of rehabilitation. Adverse conditions are such as sudden depression, uncontrolled functioning of the internal organs, ulcers, weight loss, etc. This will reduce the risk of future complications. The family should be informed at regular intervals about the care and if there are any significant problems. The Resident Assessment Form is an effective tool for valuing things in geriatric care centers.

Serve the elderly

     Policies are currently formulated by the National Policy of Older Persons and the National Program for the Elderly. However, there are no specific restrictions or guidelines for institutional managers on what to do in geriatric care facilities. This needs to be changed. However, the Standard Wise International India Association, a subsidiary of Standard Wise International, has launched a new initiative to evaluate and recognize geriatric care centers in India. This will lead to a broader vision of the elderly living in the country and new policy formulations. Special training Gerontology education and the number of people in need of long-term care are very limited in the country. Errors occur in areas where the elderly are cared for due to lack of education. We need to be trained to care for each other as we care for our parents. Once we all have to be there in any of the old age home because our culture is in a ongoing process of change. If there are hundred people in an old age home, instead of looking at a hundred people as one, they should take care of the needs of each one. Education is essential for this. Before ending I am just visualizing the concept of family it will be extolled in the pages of the history books from where the new generation will read and learn. We just try to foresee a better society then our vision will be clear and precise.

     The challenge facing the whole world, especially developing countries like India, foraging and their protection. According to the United Nations, the number of people over the age of 60 in the world is growing exponentially. Lack of knowledge and experience in geriatric care has affected our country. The number of elderly parents who are left alone without adequate care or support is increasing day by day. In the struggle to survive, the protection of parents becomes a burden to the new generation, or there are those who see it that way. Despite the rise of modern technology, the elderly are not getting much benefit. Social services have to be developed for the mental, physical and social health and wellbeing of the elderly, and innovative care styles. Awareness is also essential for a healthy life. When I started my social work studies, I was so much getting touch with one of my geriatric service center that really helped me to ponder once how can I help the aged people those who are rejected from the family. What I tried to say is that we can’t change this transforming world but we can save our aged people. Recently I heard there is a heavy scope in geriatric service from one of my friend that really helps me to rethink or run through my vision in geriatric advancements required in modern society.

References

1. Singh JA., et al. “World Health Organization Guidance on Ethical Considerations in Planning and Reviewing Research Studies on Sexual and Reproductive Health in Adolescents”. J Adolesc Health 64.4 (2019): 427-429.
2. Gupta SS., et al. “Gender power dynamics in rural area of India”. Int J Med Sci Public Health 6 (2017): 1473-1480.
3. Sawyer SM., et al. “The age of adolescence”. Lancet Child Adolescent Health 2.3 (2018): 223-228.
4. Yasmine Rola., et al. “Postponing Sexual Debut among University Youth: How Do Men and Women Differ in Their Perceptions, Values and Non-Penetrative Sexual Practices?”. Culture, Health & Sexuality 17.5/6 (2015).
5. Wirsiy FS., et al. “Prevalence and Associated Risk Factors of HIV among Pregnant Adolescent and Adolescent Mothers in the Kombo West District of Cameroon”. J Infect Dis Epidermiology 5 (2019): 074.
6. Rita Muso., et al. “Sexual and reproductive health knowledge of secondary school adolescents in Fako, Cameroon”. Pan Afr Med J 41 (2022): 340.
7. Maes C, Van Oosten J and Vandenbosch L. “Adolescents’ Digital Media Interactions within the Context of Sexuality Development”. In J. Nesi, E. Telzer, & M. Prinstein (Eds.), Handbook of Adolescent Digital Media Use and Mental Health; Cambridge: Cambridge University Press (2022): 135-161.
8. C Millanzi W. “Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia [Internet]”. Infectious Diseases; Intech Open (2022): 1541-1548.
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13. Ezumah Nkoli., et al. “Adolescents' Perceptions About Dating and Sexual Permissiveness in Ebonyi State, Nigeria: What Can Be Done to Enhance Adolescents' Sexual Health and Well-Being”. Frontiers in Reproductive Health 3 (2021).
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Most adolescents are sexually active, but the age at which they start having sexual intercourse varies between regions, and within a country. This study aims to assess the sexual behaviours and its consequences among unmarried adolescents in two secondary schools in Bonaberi-Ndobo, Douala, Cameroon. A cross-sectional study was carried out from January to February 2023 among 134 unmarried adolescents. The study population included all unmarried adolescent at St. BC and N.M.C who gave their consent and where able to take part in this study. Data was collected with the used of structured questionnaires and inputted in Microsoft excel and analysed using SPSS version 23. With a 5% confidential interval. Among the 134 study participants who responded to the questionnaire, majority 110(82.1%) were female. 68(50.7%) were aged between 12 to 17 years. All the study participants (100%) had knowledge on sexual behaviours, and the main source of information was from school (57.4%). 56.7% (78) reported that they have had sexual intercourse before and majority of them declared that they preferred vaginal sex (42.5%). 66.4% (89) did not use condom during sexual intercourse and about 19.4% have more than one sexual partners. 16.4% have once contracted a sexually transmitted infection, 9% have had an unintended pregnancy and 4.2% have repeated a class. All the study participants had knowledge on sexual behaviours. More than half of the study population have had sexual intercourse at least once and without the use of condoms. A non-negligible proportion of the adolescents had multiple sexual partners. Sexually transmitted infections and unintended pregnancies and school dropout were the main consequences of sexual behaviours as reported in this study.

Keywords: Sexual behaviour; consequences; adolescents; secondary schools

Findings and analysis

     Majority of the respondents are from the age of 40-45. This is a newly invented information by this research because the most of the middle aged women are affected psychos somatic disorder in the ages of 40-45. The reason is that the stated age is the initial stage of occurrence of the psycho somatic symptoms. There will not be any chances of misinterpreting on the basis of aging difficulties.

     The second major finding which is obtained in the type of the family, the type of nuclear and joint family is significant factors while dealing with psychosomatic disorder in middle aged women. The social interaction and family sharing are the important role in reducing the levels of stress in middle aged women because after 40 ages they will be more vulnerable to stress and social isolation within the family.

      The third aspect must be taken into account is that the marital status of the respondent. The majority of the respondents are married women because comparatively the married women are undergoing various stresses and worse life situations than unmarried women. It depends on the stress level through which each woman is facing in their day to day life.

     Another important thing is regarding the symptoms which are mostly affected with middle aged women. The back pain and joint pains are the initial symptoms in the psychosomatic disorder. The reason why is that pain is attributed to get relief from the stressful situations. The age will be negatively conceptualized by the middle aged women since they all have children those who are trying to settle themselves.

     There is another most visible symptom is that low energy and trouble in sleeping. The fact is that both of these symptoms are quite similar in its effect. Initially it will be started with sleeping disturbance which will direct to energy loss in day time. If the brain is not able to manage with stress then automatically brain shuts down the activity so mind and its function will be collapsed which will be affected the sleeping stimulation in human body.

     The anxiety and depression are the major cause of the psycho somatic disorder in middle aged women. The research mainly focused on the ratio of anxiety and depression which causes the possibility of the psycho somatic disorder. The important thing is that most of the respondents are affected with mixed anxiety and depression which gives high possibility of psycho somatic disorder especially in middle aged women due to the hormonal changes and menopause circle.

     As per the collected data 78% of respondents are having drastic improvements by the help of medication. The changes which is visible in the hospital where researcher has taken for the study, it is a categorical result of effectiveness of medication for the respondents.

     The family care and support are low approximately 70% of the respondent. The low family support and care for the women will be loosening their emotional well being from the family itself. The stress which comes from the family itself because the majority of them is married and house wives, the stress in the family easily affects the women those who are mid life. So if there is stress factors in the family there will be chances likely to affect middle aged women with psycho somatic disorder.

Interventions

     The therapies and counseling can change their thoughts and consciousness in a better way. The majority of the respondents are benefited by the counseling and therapies in the hospital. If the therapies and counseling should be taken as a serious part in their life then which will be useful so here in the hospital this will be ensured in a right way. There are drastic improvements in patients for middle aged women those who come with psycho somatic disorder which will help to refresh and purify their distress into positive way.

     The last major finding is an unresolved question whether the psychiatric medicine is having any side effects or not. Here researcher has no valid answer to question because there may be chances of side effect but not that much dangerous thing. Another typical situation of self treatment of the respondents will cause serious psychiatric issues in the future life.

Rising suggestions

     Barriers to middle-aged women?s mental health fell into two main themes including increased life concerns and physical and psychological tensions. The two sub-categories of the first theme included having mental concerns and increased burden of roles. The second main theme also consisted of two categories including perceived undesirable physical changes and perceived undesirable psychological changes. So here researcher would like to write aside some suggestion to the respondents and the people those are in the psycho somatic condition.

To the middle aged women

• Try to increase the social interaction which will help to reduce the stress level.
• Mediation, breathing exercises and yoga will help the middle aged women to concentrate the concrete life situations and they can remove the negativities and can lead a stress free life.
• The spirituality plays an important role which will help the women to relocate themselves in a comfortable place and they become more reflective which will reduce the stress factors in life.
• The self care techniques can be used which will give new realm of life pattern that will nourish positive mental health and stress free life. the self care techniques are following as love pets, listening music, gathering with friends etc. these all will give positive feedback in the life and will give relaxation from the family stresses.

To the Family

• The family care and the support are the inevitable factors that give remarkable changes in middle aged women which will balance the stress level in the menopause period of the women. the hormonal changes can be easily controlled by the love and care from the partner and family members.
• To attend a family counseling which will help to cope up with the patient those who are having difficulties of adjustment in the family.

Conclusion

     Menopause and the postmenopausal period are very important landmarks in a woman?s life since she will spend more than a third of her life during these periods without significant endogenous estrogen production. Menopause is a physiological process, which takes place universally in all women who reach midlife. Midlife is a period of transition for both men and women. It brings about changes in women and it has an implication on women?s health. Menopause may be viewed as a transition of women from middle age to old age. Menopause is not just cessation of menstruation it is depletion of ovarian follicles leading to decrease in ovarian hormones. Natural menopause occurs after 40 years of age and has no underlying pathologic cause. Menopause is considered premature or late when it occurs before 40 years and after 55 years, respectively. The commonest age range is at which women experience menopause after 40 to 50 years. Though menopause is a normal physiological phenomenon, but women at menopausal and postmenopausal age get a variety of symptoms like irritability, lethargy, depression, forgetfulness, weight gain, insomnia, joint and muscle pain and constipation. The most of the psychosomatic symptoms are similar as the menopausal period of the women. Another important thing is that unbalanced stress level of the women which are contributing to psycho somatic condition.

     The study findings revealed that majority of the postmenopausal women had one or more of the psychosomatic problems with the most common being fatigue, muscle and joint pain, irritability, anxiety and depression. Women experience such problems due to reduction of the ovarian function. Thus, women need to recognize these symptoms early and seek timely medical care. It is the dilemma that every middle aged women are vulnerable to psycho somatic disorder. After the completion of the research I would say “NO” because when over stress and menopausal difficulties are come together where there is a high possibility of psychosomatic disorder. The environment of the middle aged women has a vital role of leading a mentally free and happy life with family.

      As the result of entire study on psycho somatic disorder in middle aged women come to a one word of conclusion is that menopausal period of women should be treated well and supported physically and mentally by the family members and it is the social concern to women because being a mother is the most challenging and most rewarding position so respect women when they come in the midlife through which we will love our mother then we all become the most beautiful person in the world.

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This article is a sum up of my research paper entitled “A Study on Psycho Somatic Disorder in Middle Aged Women: Symptoms, Causes and Interventions”. What is psychosomatic disorder which is not common because most of the middle aged women considered as if something related to age but it?s not that Psychosomatic disorder is a psychological condition that leads to physical symptoms, often without any medical explanation. It can affect almost any part of the body. People with the disorder tend to seek frequent medical attention, becoming frustrated with no diagnosis. Behavioral therapy and stress reduction may help.

     The analysis of data of my study reveals the certain significant aspects while turned as the major findings of the study. This study consists of all the major findings that were derived during the analysis of data collected. It is an indented version of data under analysis. Here, each aspect has been treated partially and only the relevant and significant findings have been emphasized. The details of the findings are given below.

     The psychosomatic disorder in middle aged women and its symptoms, cause and interventions was the subject of the research was done in various psychiatric hospitals in Karnataka state India. The respondents were from the respective hospitals so the major findings will be the approximated value of the respondents from Karnataka and the border places of Kerala.

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Molecular markers have over the years permitted the rapid identification, phylogenetic classification and antimicrobial resistance profile of microbial taxa as compared to the traditional culture method. Through molecular analysis of 16S rRNA gene, this study investigated the molecular and genetic differences that exist between E. coli isolated from local scavenging chicken in relation to their pathogenicity and antimicrobial resistance. Our analysis revealed that E. coli samples from the two different housing systems showed significant genetic diversity and we postulated that this is attributable to the pressure created by vaccines and antimicrobial drugs. The different genetic patterns corresponded to different antimicrobial susceptibility patterns and prevalence of virulence genes. Thus, the 16SrRNA gene can also be used as a molecular marker to indicate the antimicrobial resistance and pathogenicity of chicken.

Keywords: Pathogenecity; 16SrRNA; free-ranged chicken

References

1. Gender Dysphoria in the DSM-5: The Change in Terminology.
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Elites from around the globe have been obsessed with population control as far back as recorded history. It has always been about keeping “them” in power with a small group of servants and a manageable slave class. Surprising it was a faction within the United States that assumed the mantle of this death cult, and had the means to carry off genocidal plans. There are many variations on a theme of population control, but the latest one involves encouraging children as young as two years of age to cut off their ability to reproduce under the guise of gender diversity. It is a corporate driven phenomena and in hindsight it will be seen as one of the causes of a failed nation.

Keywords: Gender dysphoria; population control; trans-gender; Gender Identity Disorder; New World Order; Pandemic treaty; birth control; human chorionic gonadotropin; Drag Queen Story Hour

References

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Introduction: Cervical epidural steroid injections (CESI) have been frequently used since long time for diagnosis and treatment cervical radiculopathies. cervical epidural corticosteroid injection helps in reducing swelling and inflammation of the compressed nerves, hence improving pain for several days to months or longer which leads to help delaying or avoiding the need for surgery.

In this retrospective observational study, we aim to compare clinical efficacy of Dexamethasone vs Triamcinolone in the management of chronic neck, shoulder and arm pain due to herniated intervertebral disc in the cervical region.

Methodology: a retrospective observational study of 1 year follow up was performed in 100 patients of either sex complaining of chronic neck pain with signs of cervical radiculopathy. Patients were divided into 2 groups of 50 each. Those in Group A received Injection Dexamethasone sodium phosphate 12mg and in Group B received Injection Triamcinolone acetonide 40mg in the cervical epidural space under fluoroscopy guidance. All the patients were monitored before the procedure and post-procedure for 4 h following epidural injection and subsequently followed by at the 10 days, 1 month, 3 months, 6 months, 8 months, 10 months and 1 year on telephonic conversation. The primary outcome was to measure the intensity of pain using Visual Analog score (VAS) score of 0-10.

Result: The mean VAS score in both the group A and B pre-procedure was 8.6 and 8.78 respectively and Mean VAS scores were significantly improved to 2.16 and 1.90 respectively post-procedure during 1 year follow up with p value of 0.76. hence from mentioned quantitative data it can be stated that there is no statistically significant difference in the efficacy of both the drugs used in cervical epidural injection.

Conclusion: Based on the results, this retrospective study strengthens the existing evidence that dexamethasone can produce equivalent pain relief to triamcinolone for the treatment of cervical radiculopathy. Though the need for more research studies to prove that Dexamethasone can be used an effective alternative to Triamcinolone continues.

References

1. Jing Y., et al. “Prevalence and Characteristics of Adrenal Tumors in an Unselected Screening Population: A Cross-Sectional Study”. Ann Intern Med 175.10 (2022): 1383-1391.
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6. Image 1 Courtesy: Webpathology.com.
7. Image 2 Courtesy: Science direct.

     Adrenocortical carcinoma is an exceptionally discerned, malignant, endocrine, epithelial tumour emerging from adrenal cortical cells. The heterogeneous neoplasm may be engendered due to overexpression of IGF2 and is associated with significant mortality. Majority of neoplasms appear as sporadic lesions although may demonstrate diverse syndromic settings. Prognostic outcomes are contingent to age of incriminated subject, clinical representation, tumour stage, precise histological variant and molecular or genomic characteristics of the neoplasm.

     Additionally designated as adrenal cortical carcinoma (ACC), conventional subtype of adrenocortical carcinoma, adrenal cortical adenocarcinoma or malignant adrenal cortical tumour, the neoplasm configures around ~6.8% of primary adrenal neoplasms. Median age of disease occurrence is ~55 years although no age of disease emergence is exempt. A bimodal distribution of disease is encountered with peak occurrence within first decade and fifth decade. Caucasians are commonly implicated. A female preponderance is observed with male to female proportion of 1:1.5 - 2.5. Adrenocortical carcinoma is predominantly sporadic although ~10% instances arise within syndromic settings (1,2).

References

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     Physical pain in children has been identified by multiple evidences of research as a source of discomfort among children that can even limit their reception of other medical treatment. In this study, effort is made to highlight the role of physiotherapy in psychological pain management in children and how it helps in improving pain management for better treatment and rehabilitation.

     The current study examined evidences of literature from over 30 authoritative sources made up mostly of authoritative journals in the medical field of physiotherapy with specific focus on paediatric physiotherapy. The research sought to extract evidence of the different needs of children when it comes to pain management and how physiotherapy practice can be effectively deployed in the management of pain among children both from a psychological and physical point of view.

     The findings of the research highlighted the important role that physiotherapy with specific focus on psychological capabilities of physiotherapist to identify pain in children and effectively manage it. This was noted to assist children in their rehabilitation process post injury including but not limited to the positive uptake of other treatment such as surgery.

Keywords: physiotherapy; psychology; paediatric physiotherapy

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Examined and treated 1246 patients with complicated diabetic foot syndrome (DFS) for the period from 2010 to 2015 (326 patients - a comparison group, 888- main groups - representative) and of 32 patients in the Development of Sepsis. Found that in patients with pyonecrotic processes of DFS in which surgery is performed in an ambulatory, ABT can be administered in the tablet forms. Patients of groups II-III the one should remember that in the presence of sensitivity to multiple antimicrobials, use sequence - from the weaker to the stronger, and at the risk of MRSA – linezolid, daptomycin. With the development of sepsis - drugs of choice are fluoroquinolones of III - IV generation, carbapenems, and the presence of MRSA – linezolid, daptomycin or vancomycin. Suggested tactics of ABT contributed to the reduction of length of hospitalization, with an average of (31,4±1,8) to (19,4±2,3) patient days (t=3,32; P<0,05), and the reduction of postoperative mortality from 7,5 to 3,8% (x2=6,74; P<0,05).

Keywords: diabetic foot syndrome; sepsis; antibiotic therapy

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This is the era of Artificial Intelligence, where AI models are growing fast for making critical decisions for several predictive models. Here AI is giving solution to the medical practices for diagnosis as well as prognosis with its increasing intelligence to simplify the ambiguity and complexity in data to carry out clinical decisions. Several research studies have truly demanded the need of AI-based systems and how to enhancing their capabilities to help medical practitioners. However, instead of giving highest effort for making most accurate AI based models, still now assessing the magnitude and impact of human trust on AI technology demands substantial attention. In the last decade many AI based CAD models were developed which hardly could persuade the experienced medical practitioners to accept the machine-specified decisions. In this research work, it was attempted to interpret and explain a supervised AI model built using XGBoost on Lung cancer detection by using XAI (Explainable AI) tools - two post-hoc methods (LIME and SHAP) and one ante-hoc method, to provide satisfactory explanations to medical practitioners, thereby minimize the AI risk factor in implementation of the model and reinforce the trust to the medical experts and patients in accepting such model. In this paper, the results of all three XAI tools were illustrated using heatmaps to select important input bi- omarkers that contributed more in detection of the benign or malignancy state of the pulmonary nodules. Finally the supervised AI model was rebuilt using only those important input features and it was found out that the metrics like specificity, precision, the AUC of the newer model under the ROC curve were giving better result in prediction of lung cancer nodule state. It is a study to explore how XAI tools highlight the contributions of input features in an AI model and how that AI model’s performance can be fine-tuned based on the outputs of XAI mechanism.

Keywords: AI; LIME; Pulmonary nodules; SHAP; XAI; XGBoost

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3. Harfouch RM., et al. "Therapeutic approaches for covid 19: Challenges and successes". Annals of Clinical and Analytical Medicine (2021): 228-233.
4. Alhouri Ali., et al. "Possible side effects of using detergents during the Covid19 pandemic in Syria". Ann. Clin. Cases 1.4 (2020): 1023.
5. Harfouch Rim M. "Cytokine Storm syndrome in COVID-19 patients: Characteristics And diagnosis". Journal of Clinical Epidemiology & Toxicology 2.4 (2021): 1-3.
6. Harfouch RM., et al. "Epidemiology of COVID-19 in the most pandemic Countries: A review article”. Acad. J. Biotechnol 9.1 (2021): 021-027.
7. Harfouch Rim. "Multiple organs failure in COVID-19 patients". Authorea Preprints (2022).
8. Desforges M., et al. “Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system?” Viruses 12.1 (2019).
9. Harfouch Rim. "Effect of SARS-COV2 virus on nervous system and mental health". Authorea Preprints (2022).
10. Matschke J., et al. “Neuropathology of patients with COVID-19 in Germany: a post-mortem case series”. Lancet Neurol 19.11 (2020): 919-29.
11. Jarius S., et al. “Cerebrospinal fluid findings in COVID-19: a multicenter study of 150 lumbar punctures in 127 patients”. J Neuroinflammation 19.1 (2022): 19.
12. Coolen T., et al. “Early postmortem brain MRI findings in COVID-19 non-survivors”. Neurology 95.14 (2020): e2016-27.
13. Thakur KT., et al. “COVID-19 neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital”. Brain 144 (2021): 2696-2708.
14. Lou JJ., et al. “Neuropathology of COVID-19 (neuro-COVID): clinicopathological update”. Free Neuropathol 2 (2021): 2.
15. Jiang T., et al. “Angiotensin-(1-7) is reduced and inversely correlates with tau hyperphosphorylation in animal models of Alzheimer's disease”. Mol Neurobiol 53 (2016): 2489-2497.
16. Kehoe PG., et al. “Angiotensin-converting enzyme 2 is reduced in Alzheimer's disease in association with increasing amyloid-beta and tau pathology”. Alzheimers Res Ther 8 (2016): 50.
17. Leng F and Edison P. “Neuroinflammation and microglial activation in Alzheimer disease: where do we go from here?”. Nat Rev Neurol 17.3 (2021): 157-72.
18. Abate G, Memo M and Uberti D. “Impact of COVID-19 on Alzheimer’s disease risk: viewpoint for research action”. Healthcare (2020).
19. Wang WY., et al. “Role of pro-inflammatory cytokines released from microglia in Alzheimer’s disease”. Ann Transl Med 3.10 (2015): 136.
20. Chen F., et al. “The COVID-19 pandemic and Alzheimer’s disease: mutual risks and mechanisms”. Transl Neurodegener (2022).

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a life-threatening disease, especially in elderly individuals and those with comorbidities. The predominant clinical manifestation of COVID-19 is respiratory dysfunction, while neurological presentations are increasingly being recognized. SARS-CoV-2 invades host cells primarily via attachment of the spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor expressed on cell membranes. Patients with Alzheimer’s disease (AD) are more susceptible to SARS-CoV-2 infection and prone to severe clinical outcomes. Recent studies have revealed some common risk factors for AD and COVID-19. An understanding of the association between COVID-19 and AD and the potential related mechanisms may lead to the development of novel approaches to treating both diseases. It is important to understand the mechanisms by which SARS-CoV-2 invades the central nervous system (CNS) and the associations and potential shared factors between COVID-19 and AD.

Keywords: COVID-19; Alzheimer’s disease; correlation; mechanism of action

References

1. Peired AJ., et al. “Sex and Gender Differences in Kidney Cancer: Clinical and Experimental Evidence”. Cancers (Basel) 13.18 (2021): 4588.
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3. Smith PS., et al. “Characterization of renal cell carcinoma-associated constitutional chromosome abnormalities by genome sequencing”. Genes Chromosomes Cancer 59.6 (2020): 333-347.
4. Durak D., et al. “Spontaneous rupture of a renal cell carcinoma associated with fatal bleeding”. Maedica (Bucur) 9.3 (2014): 275-7.
5. Ata-ur-Rehman R., et al. “Clinical Presentation of Renal Cell Carcinoma”. J Ayub Med Coll Abbottabad 27.2 (2015): 326-8.
6. Rectenwald R. “A case study of back pain and renal cell carcinoma”. J Chiropr Med 7.1 (2008): 24-7.
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8. Richa Chauhan. “This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited”. Hosting by Science Repository (2023).
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10. Kim WB., et al. “Spontaneously ruptured renal cell carcinoma during hemodialysis in two patients with end-stage renal disease”. Korean J Urol 52.12 (2011): 865-7.
11. Zakieldahshoury M, Gad HA and Ahmed S. “Spontaneous rupture of renal cell carcinoma in pregnancy: a case report”. Gynecol Obstet Reprod Med (2022): 1-3.

Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney, presentation as spontaneous rupture and hemorrhage is rare, it presents as acute abdominal pain and is diagnosed with a computed tomography scan (CT), which is the most common modality used for diagnosis, a variety of causes have been described such as neoplasm, vascular abnormalities, and renal parenchymal diseases, RCC was reported in up to 26% of causative etiology. A rare case with spontaneous rupture of renal cell carcinoma in 40 years old male patient, presented with left flank pain for 3 weeks with massive retroperitoneal hemorrhage, patient was resuscitated and a left nephrectomy was done.

     When KPI is being applied to healthcare organizations, it measures the degree of how much improvement in the outcome of healthcare providers. We all know that what gets measured gets improved. Healthcare leaders should establish a system of quality and performance metrics to control and improve overall healthcare quality; poor quality not only adversely affects patient outcomes, but also affect budget and profits.

     For improving healthcare services, indicators should cover healthcare service capability to achieve organization goals and resources with special standards covering patient safety, risk management, and integrated health services, which makes it important to comply with standards and correct performance safely and at an acceptable cost by society, so that it leads to continuous improvement of healthcare outcomes and conformity with the expectations.

     We can define healthcare operational excellence as building sustainable competitive standards through operation management, to improve the quality of patient healthcare at different health departments from primary care to intensive care, rehabilitation care and home care. Competitive, visionary healthcare leaders and policy planners are required to transform the daily health dynamics into sustainable, well-established services.

     An excellence model in Saudi Arabia has been started for few years now. Due to the importance of sustaining quality and organizational excellence, the role of the government sector is being supported by different governmental and private organizations.

Reference

1. Joint Commission International Accreditation Standards for Hospitals. 7th Edition (2021).
2. Khalifa M and Khalid P. “Developing Strategic Health Care Key Performance Indicators: A Case Study on a Tertiary Care Hospital”. Procedia Computer Science 63 (2015): 459-466.
3. Barnawi O Maryam. “Organizational Excellence Models Failure and Success Factors of Organizational Excellence and Challenges Mitigation”. Open Journal of Business and Management 10 (2022): 2915-2938.

     Key Performance Indicators (KPI) are measures that organizations use to determine and track their progress to meet its strategic goals. KPIs provide a measurement tool at all departmental levels and are considered as a scale by which organizations can keep score and the success of their outcome. KPI implementation reinforces the organization’s mission, vision, strategic planning and timeline of professional performance.

     In response to the competitive healthcare environment, organizations are continuously searching for practical standard tools and methods to improve their performance outcome. Not only shows improvements made over time within the organization departments, but it also measures performance by comparing results against other similar organizations.

Item measurement theory - how to measure the unmeasurable?

     The components of the quality of life cannot be observed directly. The value of the quality of life can be measured indirectly by asking a series of questions, which are asked to the patient in a different form. Responses are converted to numerical scores which are then combined to obtain "scale scores" or combined to obtain domain scores or other statistically calculated summary scores.

     The European urological guideline strongly recommends monitoring the treatment effects of BPH patients using validated questionnaires. The answers received as feedback have a role in the direction in which the further treatment of the patient will take place.

     The International Prostate Symptom Score (IPSS) questionnaire is the most used to determine the severity of lower urinary tract symptoms associated with BPH. The first seven questions refer to these symptoms, and the final sum categorizes patients with mild, moderate, and severe LUTS, so further treatment takes place in that direction. The eighth question refers to the quality of life associated with living with those symptoms and is important to ask because it reflects the patient's subjective perception of the symptoms associated with the disease. Often, due to this subjectivity, patients who have mild or moderate LUTS have an extreme impairment of the quality of life and vice versa. Thus, this parameter strongly suggests to us how to direct the therapeutic approach to the patient.

     The Benign Prostatic Hyperplasia Impact Index (BII) questionnaire measures the magnitude of change in an individual's BPH-LUTS impact over time. The BII is easy to understand, capturing the clinically relevant impacts of BPH related to urinary problems. It has 4 questions, is easy to understand and validated.

     The Overactive Bladder Questionnaire (OAB) - short form (SF) has a total of 19 questions in 2 domains: 6 related to distressing symptoms and 13 related to health quality. Calculated separately, a higher score on the symptom scale indicates greater symptom severity and a higher score on the QoL scale indicates better QoL, so they are inversely related to each other.

     The long form of the Male Incontinence Questionnaire has 23 questions on LUTS and related QoL. The short form of 11 questions covers 2 domains: the first one related to micturition - 5 questions and 6 questions related to incontinence. The advantage is in Separate consideration of frequency, nocturia and impact on daily life.

     The SF-36 is a generic or general questionnaire in over 10000 items in a PubMed search. It consists of two dimensions - physical and mental. There is no exact balance between the two components’ different approaches in the interpretation of the total result. its validity may be questioned due to the biased amount of data.

The goals in assessing QoL in BPH patients

     The latest studies more comprehensively analyze the role of BPH in characterizing the quality of life, but also in relation to the cost-benefit of therapeutic options. For this purpose, combined questionnaires are used, general ones relating to health, disease-specific and general ones analyzing the economic moment.

     The QUALIPROST study is of relatively recent date and is a prospective, longitudinal, multicenter, open-label study conducted in outpatient urology clinics to evaluate change in quality of life (QoL) and symptoms in patients with lower urinary tract symptoms/benign prostatic hyperplasia. (LUTS/BPH) in current clinical practice by use of IPSS and BII questionnaires. Improvements in QoL and symptoms were equivalent to the medical treatments most widely used in real-life practice for the treatment of patients with moderate or severe LUTS.

     Due to the aging population, the prevalence of BPH is expected to increase dramatically. There is an emerging need to develop and implement effective interventions to improve the QoL and psychological well-being of patients with BPH. A holistic approach in the management of BPH in each individual patient is needed for these goals.

     This analytical approach provides additional evidence for current therapeutic options for the management of LUTS/BPH and should help further inform decision-making regarding treatment strategies in this patient population.

     Benign prostatic hyperplasia (BPH) is a condition that results in lower urinary tract symptoms (LUTS) leading to significant deterioration in patients' quality of life (QoL). BPH affects QoL by inducing psychological stress in patients due to anxiety and worsening their social function. The more severe the symptoms of BPH, the lower the QoL becomes. However, the QoL of BPH patients whose symptoms worsen due to aging has been shown to be significantly reduced. In the last few years, there has been an increasing trend of analyzing the effect of BPH symptoms on QoL and the most widely used therapeutic strategies.

     The definition of quality of life was given by the WHO in 1947, but the first 5 papers with an analysis of these keywords in the Medline database appeared until 1973. From 1974, the number of professional papers that give an overview of the quality of life of patients began to grow exponentially, so that in the last decade there has been almost no professional communication that does not address this issue as a conclusion.

     Measuring QoL is important from a clinical and regulatory perspective. Physicians may be interested in knowing the impact their care has on patients. They could use measures of QoL to monitor and follow their patients over time, or before and after a specific intervention, such as surgery.

     Contemporary research in arts therapies [1] brings evidence that integrating arts practice with neuroscientific discoveries are effective methods to support mental and physical health. Biological and ecological sciences join human health issues. Alltogether scientists and artists foster « one health » philosophical and epistemological concepts.

     The human society faces a critical period of multiple challenges with traumatic consequences for many populations. Arts and arts therapies offer a powerful lever for emotional regulation, thus being at the core of care, healing and well-being. As we are writing these lines, the 2023 International Conference of the European Federation of Art Therapy [2] « Growing*Together », held on 15-17 June in Riga, just closed and the conference « Arts for the Well-Being of All : New Horizons for Research » is going on at the Edge Hill University’s Research Centre for Arts and Well-Being, 20-21 June 2023, in collaboration with WHO and NHS. The time has come for effective integrative reflexion and action in health research, policies and practice, based on the fondamental creativity of the human being as part of the living and non-living world.

References

1. Journal of Applied Arts & Health 6.2 (2015).
2. EFAT.

     Sensitive, vulnerable and so fragile, humans are constantly seeking for apraisal and well-being. Ancient traditions all arround the planet teach us how our senses, emotions and thinking contribute to foster the individual and community esthetic sensibility in collaborative ways of belonging, attachement, security.

     Contemporary medical practice integrates some of the arts therapies’ methods – music in anesthesia and surgery, palliative care or rehabilitation, visual arts in chronic diseases such as cancer, diabetis, sclerosis…, dance and drama in education and social work. The mental health area uses expressive and creative techniques as powerful complementary treatments. Sensible arts experiences help healing. We need arts as a regulator of our body-mind fonctioning, thus preventing destabilization, unbalance and illness.

References

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     Microspheres are tiny sphere-shaped particles with sizes under 200 nm. The analysis focuses on the microspheres of its qualities, forms, preparation, outcomes, and application of process variables. This article discusses a cutting-edge drug delivery technology.

     It overcame a number of issues with other dosing forms. The various kinds of microspheres are employed in a variety of ways to increase therapeutic efficacy and bioavailability. Investigations are being done into how process factors affect drug release, drug trapping, and particle size. Microspheres are typically free-flowing powders made of synthetic polymers that are naturally biodegradable. A medication is located in the centre of a microsphere, where it is protected by a unique polymeric membrane.

keywords: Microspheres; Drug Delivery; Particle Size; Controlled Release

References

1. Balwan WK and Kour S. “Lifestyle Diseases: The Link between Modern Lifestyle and threat to public health”. Saudi J Med Pharm Sci 7.4 (2021): 179-84.
2. Chattu VK., et al. “The global problem of insufficient sleep and its serious public health implications”. In Healthcare 7.1 (2018): 1.
3. Elflein J. Number of deaths attributable to tobacco worldwide in 2019, by region and sex (2023).
4. Elflein J. Share of adults worldwide satisfied with their sleep in 2020, by country (2023).
5. Macia L, Galy O and Nanan RKH. “Modern Lifestyle and Health: How Changes in the Environment Impacts Immune Function and Physiology”. Frontiers in Immunology (2021): 4516.
6. Man AW, Li H and Xia N. “Impact of lifestyles (diet and exercise) on vascular health: oxidative stress and endothelial function”. Oxidative medicine and cellular longevity (2020).
7. Tobaldini E., et al. “Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence”. Nature Reviews Cardiology 16.4 (2019): 213-224.
8. WHO. Alcohol (2022).
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10. Wilson N., et al. “Achieving healthy and sustainable diets: a review of the results of recent mathematical optimization studies”. Advances in Nutrition 10.Supplement_4 (2019): S389-S403.

     Modern lifestyle has increased the risk of various physical and psychological health problems. The unhealthy lifestyle of people in the modern world has exposed them to various illnesses, disabilities and even deaths. The various metabolic diseases that are a result of these modern lifestyles are obesity, hypertension, cancer, cardiovascular problems, diabetes and other health problems. A proper discussion of the impact of the various aspects of the modern lifestyle on our health has been done in the below article. It has been found that millions of deaths across the globe are occurring due to the choices of the modern lifestyle. Hence, it is only important to make appropriate changes to the modern lifestyle to reduce the negative impact on health. Regular exercise, a balanced diet and improved sleep patterns are some of the effective steps that can be taken to improve health outcomes.

Keywords: Lifestyle; health; diseases; sleep; diet; smoking

References

1. Preston CA., et al. “Reduction of "callbacks" to the ED due to discrepancies in plain radiograph interpretation”. Am J Emerg Med 16.2 (1998): 160-2.
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The aim of this study is to investigate the matching between emergency department and discharge diagnosis as well as how investigations affect accurately of emergency department diagnosis. One of the primary consequences of inconsistent diagnosis is the prolongation of hospital stays. The process of diagnosis entails identifying the illness that is the source of a patient's symptoms and warning signs. Investigations, the physical examination, and the history all play a significant role in making a successful initial diagnosis. The study was conducted retrospectively over a seven-month period in 2019 including four in-patient specialties: orthopedics, surgery, and medicine. All patients that entered the emergency room during the study period. The diagnostic accuracy was shown to be considerably higher in the younger age group when the adult patients were divided into groups by age (19-62 years versus 65 years or above, p value less than 0.001). 74% of diagnoses at admission completely or partially matched diagnoses at discharge. Traumatized cases and young people had significantly superior diagnosis accuracy, according to data. Improvements in ED diagnostic definitely needed, particularly for nontrauma situations, young patients, and the elderly. Patient history and clinical examination are the two tools that one may use to increase the accuracy of an ED diagnosis. Diagnoses such as chest illness, hip fracture, and injuries to the finger, leg, or foot were considered partial matches. Simple tests available in the ER were frequently ineffective at improving diagnostic accuracy.

Keywords: Emergency diagnosis; Traumatized cases; ER; investigations

Introduction

     Electronic Medical Records (EMRs) have become widely adopted across healthcare systems in both the United States and Latin America. These digital repositories contain comprehensive patient data, including medical history, diagnoses, laboratory results, medication records, and demographic information. Extracting this vast amount of data and integrating it with advanced technologies such as neural networks presents an opportunity to derive actionable insights for improving prognostic care.

Scope of Extracting Vital Patient Informatics
Improved Treatment Decision-Making

     Extracting EMR data and feeding it into neural networks enables healthcare providers to analyze large datasets and identify patterns that may be crucial for accurate prognostic care. By utilizing machine learning algorithms, physicians can gain access to predictive models capable of assisting in treatment decisions, risk assessment, and prognosis evaluation.

     These models can provide evidence-based recommendations tailored to individual patients, optimizing clinical outcomes.

Personalized Interventions

     The extraction of EMR data allows for the identification of specific patient characteristics, such as genetic predispositions, lifestyle factors, and comorbidities. Neural networks can integrate these factors with clinical data to create personalized intervention strategies for disease management. This individualized approach enhances patient engagement, adherence to treatment plans, and overall therapeutic efficacy.

Enhanced Healthcare Outcomes

     Utilizing EMR data with neural networks promotes population health management by analyzing large-scale patient data to identify disease patterns, risk factors, and potential outbreaks. By leveraging this information, healthcare systems can develop preventive strategies, optimize resource allocation, and improve patient outcomes on a broader scale.

Challenges and Considerations
Data Privacy and Security

     When dealing with sensitive patient data, ensuring privacy and security is of utmost importance. Adequate measures must be implemented to protect patient information and comply with existing regulations and ethical guidelines.

 Data Quality and Standardization

     EMR data extraction relies on accurate and standardized data entry. Inconsistent or incomplete data may lead to biased results and inaccurate prognostic models. Efforts should be made to improve data quality and establish standardized protocols for data collection and storage.

Health Inequality and Accessibility

     While extracting EMR data for neural networks shows promising potential, it is essential to consider health inequalities and accessibility issues prevalent in both the United States and Latin America.

     Efforts should be made to bridge the digital divide and ensure equitable access to technology and healthcare services.

 Conclusion

     Extracting EMR data and leveraging neural networks hold significant potential for enhancing prognostic care in the United States and Latin America. By utilizing machine learning algorithms, healthcare providers can improve treatment decision-making, develop personalized interventions, and achieve enhanced healthcare outcomes. However, challenges such as data privacy, quality, and accessibility must be addressed to fully harness the potential benefits of this approach. Further research, collaboration, and investment are necessary to optimize the utilization of EMR data for neural networks in clinical care in both regions.

 References

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Electronic Medical Records (EMRs) hold a wealth of valuable patient information that, when properly extracted and analyzed, can significantly contribute to improving prognostic care for patients in both the United States and Latin America. This paper explores the potential of extracting EMR data and leveraging neural networks to enhance clinical care and support disease management in these regions. By examining the scope of extracting vital patient informatics, we highlight the benefits of utilizing EMR data to augment prognostic care, including improved treatment decision-making, personalized interventions, and enhanced healthcare outcomes.

     The recommendation issued by the World Health Organization in 1981 and the resolutions regulating the subsequent merchandising code for breast milk substitutes aim at standardizing the rules for advertising and inappropriate promotion of these products, including: infant formula, baby bottles, pacifiers, and supplementary food products.

     Despite the efforts to bring forward these regulations at national levels, it has been very difficult for most countries to create legal bodies enabling actions to be taken in defense of the rights of mothers, fathers, and families to access reliable information about infant nutrition. This information must be free from the influence of aggressive marketing campaigns and merchandising for these substitute products. These campaign strategies continue to influence the decisions on food and nutrition of babies, reducing or even causing an early halt of breastfeeding, which would otherwise widely benefit babies and their mothers’ health and nutrition in the short and long term.

Commercial influence in decisions about infants’ nutrition

     In contrast to the aforementioned breastfeeding figures, the state of the baby formula industry shows its increasing profit worldwide. In 2019, this market achieved a total worldwide income of 70.6 billion USD.

The 2023 Lancet series on the topic of breastfeeding, describe the multilayered and highly effective strategies of baby formula manufacturers to address the parents, health professionals, and policymakers. These include:

• Presenting their products – with little or no supporting evidence – as answers to common infant health and developmental challenges in ways that systematically undermine breastfeeding;
• Using digital platforms to substantially extend the reach and influence of marketing; and
• Lobbying governments in an effort to prevent the strengthening of breastfeeding protection laws and to challenge food standard regulations.

Code dissemination and further action

     After more than 40 years since the promulgation of the international code for commercialization of breast milk substitutes, the WHO with the support of civil societies like the IBFAN network (International baby food action network), held the first world congress on the code in Geneve in June 2023. They proposed several goals, such as: the creation of policies and strengthening mechanisms to coordinate and manage these policies. Thereof, countries would finally acknowledge the mandatory character of the code making it into legislation. Thereafter, it is possible to subdue the conflicts of interest created by the food industry within the health system through health professionals and the ongoing advertising broadcasted across mass media, social networks, and other communication platforms on the internet.

     IBFAN is committed to continue supporting breastfeeding and overseeing the observance of the code as we continue to advocate for the unobstructed advancement of the implementation of the code. Likewise, we seek to promote public policies that favor breastfeeding. We overall seek to work in accordance with the conclusions and recommendations expressed by the countries participating in the Geneve forum which became a milestone in policymaking to support breastfeeding.

     To conclude, the way to achieve dissemination and promotion of breastfeeding is still complex. Nevertheless, there are more foreseen actions and awareness by many to get the necessary support of governments, the civil society, and health professionals to gain the needed knowledge on this subject and its successful implementation in the public and private areas.

     Similarly, we need to bear in mind that it is also relevant to address individuals, a key factor to foster breastfeeding aiming to overcome the fear and lack of confidence experienced by mothers in their own capacity to breastfeed. These limitations are induced by baby food campaigns that seem to take advantage from their doubts and also attempt to convince mothers of the impossibility to breastfeed bringing forth ideas like an alleged failure in milk production. Actually, such events are absolutely possible to reverse and many of them are merely untrue. These beliefs prevent achieving successful breastfeeding, and totally surmountable and essential to SAVING MORE BREASTFEEDING as well. Therefore, we will continue to support mothers and their babies in this life period of utmost importance for nutrition, both at public and individual levels.

     “Less than half of the world’s infants and young children (aged 0–36 months) are breastfed as recommended; a third of all neonates received pre lacteal feeds during the first 3 days after birth and only one in two neonates are put to the breast within the first hour of life”.

     These reduced figures in breastfeeding commonly respond to the extended promotion of infant formula and infant milk. There are many ways that advertisement for breast milk substitutes impact mothers’ choice to breastfeed their babies and to continue breastfeeding during the first two years of the child’s life.

Value intelligence is defined as; The ability to engage in a range of behaviors that call for the use of specific skills such as language and social skills, It possesses a set of characteristics that enable it to communicate and adapt to the values and attitudes of individuals from different cultures. Value intelligence is also defined as; The ability that allows individuals to understand and interact positively with a wide range of values, It can be said that value intelligence is the ability to find a new useful product, or to develop a valuable service for the value system in which the individual lives, and it includes a number of skills that enable its owner to solve problems facing him, in addition to being a biological possibility that interacts with environmental factors. Here it must be noted that value intelligence does not only mean cognitive understanding of value differences, but it includes several components: motivation, behavior, In addition to knowledge, therefore, we find that individuals who have value intelligence have effectiveness regarding new value situations related to value differences, and this is what is known as behavioral value intelligence. Which determines the totality of practices, actions and behaviors that the individual performs in relation to life situations, especially those related to the value side, and we also find those who enjoy intelligence and have the motivation and ability to interact with new value concepts. This is what is known as the value-motivational intelligence, which constitutes the main engine for the individual's practice of the intelligent side and uses it to identify the total value attitudes surrounding him and interacts with the incubating environment with all its cultural variables. They are also more capable of adapting and interacting with people of different cultures, and they have a desire to ask many questions, to be constantly exposed to new situations, and to feel pleasure when communicating with individuals from different cultures and to increase their value experiences. This is what is known as the value-cognitive intelligence that is based on the love of exploration, inquiring and diving into an ocean of questions that may not end at times, as they express depth in the levels of intelligence related to individuals within the framework of different cultural systems. Over the ages, human societies have been concerned with the development of their institutions in all economic, social and value fields, and the development of their intellectual and value skills, which has led to a kind of mixing of values. Educational institutions such as schools and universities are a meeting point for individuals from different backgrounds, especially since the educational institution as a whole is the first organizational entity in the educational process. It has occupied great interest in all countries of the world, especially as it is an effective tool that contributes to the progress and development of nations. Therefore, many countries have paid great attention to improving the level of universities by improving educational programs and their curricula, as well as paying attention to the academic aspect and faculty members, developing their personal experiences and knowledge in learning strategies in general, and drawing inspiration from renewable knowledge in particular. The success of the educational process in universities has been largely linked to the success of the faculty member, who is the leader in the educational process and is responsible for implementing the educational mission and educational policies within the walls of the educational institution. By making decisions and applying educational laws with the help of educational specialists, including administrators and educational leaders, and following up students in their academic achievement and urging them to be knowledgeable and knowledgeable and research in order to achieve educational goals with their correct goals, As well as his role in cooperating with his colleagues in exchanging educational experiences. The university environment may consist of diverse cultures and the culture of the majority prevails, which may affect the sub-cultures of students. Therefore, the faculty member’s possession of value intelligence is an effective factor in the success of the educational process, through his ability to Communication and adaptation with people from different cultures.

Today, the world is witnessing major changes in all areas of economic, social, political, intellectual and educational life, especially in the field of information and communication, which has facilitated friction between different cultures. Intelligence is an important factor in successfully dealing with modern developments brought about by globalization and the communications and information revolution, which in turn; It has multidimensional effects on the content of the value framework surrounding man. New mechanisms were developed for patterns of human behavioral interaction, as well as new perceptual values and judgments that shook the value legacies, which in turn embraced human thought, awareness and culture throughout contemporary history. The concept of intelligence is one of the most controversial concepts due to the multiplicity of its topics and definitions. This concept has been associated with the necessities of success in life, especially since individuals differ in the percentage of each type of these intelligences they have. One of the most important types of intelligences that scholars and researchers in management science and social psychology have paid attention to is value intelligence. Which appeared as an inevitable necessity as a result of the convergence of civilizations and the diversity of values that took many patterns in our societies as a result of the great technological development that we are witnessing in the current century. Culture is also the thread that connects a person to himself and others, and that the interactions and behavior of individuals involve, in essence, a cultural relationship. In light of the different cultures, we find that there are similarities and differences in light of these multiple cultures, which culture in turn works to create a suitable environment for living together in light of the diversity of values. Therefore, culture is responsible for shaping the value structure of each human society. It is what shapes the economy and determines the political system. It is also developed and has a dynamic interaction. Value intelligence refers to a group of abilities related to situations that are characterized by value diversity Value intelligence also comes as a form of intelligence that focuses on understanding, management, and behavior in situations characterized by value diversity There is no doubt that individuals from multiple environments and cultures differ in their intelligence, and they can develop types of these intelligences to an appropriate level through the availability of adequate support from the environment or culture in which they live.

References

1. Hu H and Chung CC. “Biopharmaceutical Innovation System in China: System Evolution and Policy Transitions (Pre-1990s-2010s)”. Int J Health Policy Manag 4.12 (2015): 823-829.
2. Wang B., et al. “Model-Based Discovery and Development of Biopharmaceuticals: A Case Study of Mavrilimumab”. CPT Pharmacometrics Syst. Pharmacol 7 (2018): 5-15.
3. Ebbers HC., et al. “The Role of Periodic Safety Update Reports in the Safety Management of Biopharmaceuticals”. Eur J Clin Pharmacol 69 (2013): 217-226.
4. International Conference on Harmonisation (ICH). E2C(R1): Clinical Safety Data Management: Periodic Safety Update Reports for Marketed Drugs. ICH, Geneva (2005).
5. International Conference on Harmonisation (ICH). Final concept paper periodic safety update reports for marketed drugs. E2C(R2) and gap and potential improvement analysis of ICH E2C, E2E and E2F ICH, Geneva (2010).
6. Rathore AS., et al. “Role of Knowledge Management in Development and Lifecycle Management of Biopharmaceuticals”. Pharm Res 34 (2017): 243-256.
7. Rathore AS and Winkle H. “Quality by Design for Biopharmaceuticals”. Nat Biotechnol 27.1 (2009): 26-34.
8. Torkko M., et al. “The Utilization of Quality KPIs in the Pharmaceutical Industry”. J Pharm Innov 9.3 (2014): 175-82.
9. Long Z and Mao J. “Research on the Listed Pharmaceutical Manufacturing Companies Performance Evaluation System”. In: Qi E, Shen J, Dou R, editors. The 19th international conference on industrial engineering and engineering management. Berlin Heidelberg: Springer (2013): 165-73.
10. Gunn III GR., et al. “From the Bench to Clinical Practice: understanding the challenges and uncertainties in immunogenicity testing for biopharmaceuticals”. Clinical and Experimental Immunology 184.2 (2016): 138-46.
11. Gallucci S and Matzinger P. “Danger Signals: SOS to the Immune System”. Curr Opin Immunol 13 (2001): 114-9.
12. Schellekens H and Casadevall N. “Immunogenicity of recombinant human proteins: causes and consequences”. J Neurol 251.suppl.2 (2004): 114-9.
13. Li J., et al. “Detection of low-affinity anti-drug antibodies and improved drug tolerance in immunogenicity testing by Octet ((R)) biolayer interferometry”. J Pharm Biomed Anal 54 (2011): 286-94.
14. Lofgren JA., et al. “Comparing ELISA and surface plasmon resonance for assessing clinical immunogenicity of panitumumab”. J Immunol 178 (2007): 7467-72.
15. Jahn EM and Schneider CK. “How to systematically evaluate immunogenicity of therapeutic proteins regulatory conditions”. N Biotechnol 25 (2009): 280-6.
16. Klee GG. “Human anti-mouse antibodies”. Arc Pathol Lab Med 124 (2000): 921-3.
17. Erickson J., et al. “End-to-end collaboration to transform biopharmaceutical development and manufacturing”. Biotechnol Bioeng 118 (2021): 3302-3312.
18. Schaber SD., et al. “Economic analysis of integrated continuous and batch pharmaceutical manufacturing: A case study”. Industrial and Engineering Chemistry Research 50.17 (2011).
19. Khanal O and Lenhoff AM. “Developments and opportunities in continuous biopharmaceutical manufacturing”. MABS 13.1 (2021): 1903664.
20. Rathore AS and Shareef F. “The influence of domestic manufacturing capabilities on biologic pricing in emerging economies”. Nat Biotechnol 37.5 (2019): 498-501.

Over the last couple of years, biotechnology has been giving many leads in different areas of production. In the pharmaceutical industry, it has led to many discoveries and innovations by birthing vaccines, killing microbes using antibiotics and developing many products of pharmaceutical importance. Having served and still serving as an alternative to the chemical approach of drug discovery and development in pharmacy, it is conspicuous that the application of biotechnology in the production and development of biopharmaceuticals could serve as a breakthrough in the development of novel pharmaceuticals. This paper aims to (i) identify and shed light on certain areas which are currently posing a threat to the development and use of biopharmaceuticals and those which may likely have a crippling effect on biopharmaceuticals in the future (ii) suggest and/or provide solutions to these problems, and (iii) identify promising areas for subsequent researches on the seemingly vast benefits of biotechnology in modern healthcare.

Keywords: Biopharmaceuticals; Biotechnology; Anti-drug Antibody; Healthcare

Practice patterns regarding glasses use vary among students for a variety of reasons. The level of awareness about the importance of eye health and the need for spectacles can significantly impact practice patterns. Lack of awareness about the potential impact of uncorrected refractive errors on academic performance and eye health can be a significant barrier to adopting spectacles. Wearing spectacles can sometimes be associated with a negative self-image or social stigma. Students, especially adolescents, may also fear being teased or bullied by their peers, leading to reluctance to wear spectacles. The cost of spectacles can be a significant factor affecting practice patterns among students in developing countries. Many families in these countries may require more financial resources, and purchasing spectacles for their children might be considered a lower priority than other essential needs such as food, housing, or education. A multi-pronged approach is necessary to address the challenges associated with attitudes and practice patterns toward wearing spectacles. Educational institutions, eye care professionals, parents, philanthropic organizations, and society should collaborate to create an environment that supports and encourages students to embrace spectacles for refractive error correction. School-wide initiatives, including awareness campaigns, regular vision screenings, and providing free spectacles, particularly for economically challenged students, can play a pivotal role in identifying students with refractive errors and promoting early intervention. Students' perspectives should be given high importance when designing refractive error programs. The low self-esteem and stigmas associated with spectacle use among students can be effectively addressed through health and education information, allowing students to use spectacles and improve their quality of life.

Correcting refractive errors in children poses many challenges when left undetected and untreated. Spectacles have long been a trusted instrument for correcting refractive problems for students in academics and daily activities. This fact is essential to comprehend students' attitudes toward wearing glasses and their practice patterns to overcome potential obstacles and encourage the widespread use of correct spectacles. Cultural norms, personal preferences, peer influence, self-perception, and individual experiences often influence attitudes toward spectacle use among students. Many students understand the advantages of wearing spectacles and have a positive attitude toward them. They recognize that spectacles can improve their eyesight, enhance academic achievement, and simplify daily tasks. However, some students may not prioritize their visual health or understand the value of wearing spectacles. They might be unaware of how visual impairment affects their ability to focus on class or their overall well-being. Unfortunately, stigmatizing refractive problems can occasionally lead to negative opinions about wearing spectacles. Students may be reluctant to take advantage of the corrective benefits of spectacles due to concerns about being seen as "unattractive," which can make them feel self-conscious. Females are more likely than boys to stigmatize wearing spectacles because they tend to believe that females who wear spectacles are not ideal marriage candidates. They may also feel that wearing glasses hinders their participation in extracurricular activities. Peer pressure and the desire to fit in can influence students' opinions about wearing spectacles. Some students may choose not to wear spectacles if doing so is stigmatized or considered uncool by their peers to avoid teasing or exclusion. On the other hand, positive peer experiences or role models who wear spectacles can influence children to accept vision correction.

References

1. Slone RM., et al. “Orthopaedic fixation devices”. Radiographics : a review publication of the Radiological Society of North America, Inc 11.5 (1991): 823-847.
2. Schmal H., et al. “Flexible fixation and fracture healing: do locked plating 'internal fixators' resemble external fixators?”. Journal of orthopaedic trauma 25.1 (2011): S15-S20.
3. Hadeed A, Werntz RL and Varacallo M. “External Fixation Principles and Overview”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing (2022).
4. Lowe JA. “Internal fixation for fractures”. For the American association of orthopaedic surgeons. Orthoinfo (2019).
5. Archampong EQ, Naaeder SB and Ugwu B. “Baja's Principles and Practice of Surgery, Including Pathology in the Tropics”. Volume II. 5th Edition; Chapter 53 (2015): 1130.
6. Ciancia S., et al. “Osteoporosis in children and adolescents: when to suspect and how to diagnose it”. European Journal of Pediatrics 181.7 (2022): 2549-2561.
7. Bell JM., et al. “Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy”. The Cochrane Database of systematic reviews 1.1 (2017): CD010899.
8. Coleman RE. “Clinical features of metastatic bone disease and risk of skeletal morbidity”. Clinical cancer research: an official journal of the American Association for Cancer Research 12.20 Pt2 (2006): 6243s-6249s.
9. Berruti A., et al. “Incidence of skeletal complications in patients with bone metastatic prostate cancer and hormone-refractory disease: predictive role of bone resorption and formation markers evaluated at baseline”. The Journal of Urology 164.4 (2000): 1248-1253.
10. Zore Z., et al. “Surgical treatment of pathologic fractures in patients with metastatic tumours”. Collegium antropologicum 33.4 (2009): 1383-1386.
11. Scolaro JA and Lackman RD. “Surgical management of metastatic long bone fractures: principles and techniques”. The Journal of the American Academy of Orthopaedic Surgeons 22.2 (2014): 90-100.
12. Wuennemann F., et al. “[Radiologic diagnosis of pathologic fractures]”. Der Radiologe 60.6 (2020): 498-505.
13. Lin AJ., et al. “Treatments and Sequelae of Pediatric Pathologic Proximal Femur Fractures Due to Benign Bone Cyst”. Journal of pediatric orthopaedics 42.6 (2022): e661-e666.
14. Tomaszewski R., et al. “Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children”. Archives of Orthopaedic and trauma surgery 142.4 (2022): 615-624.
15. Avenell A, Mak JC and O'Connell D. “Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men”. The Cochrane Database of systematic reviews 4 (2014): CD000227.
16. Matsubara H and Tsuchiya H. “Treatment of bone tumour using an external fixator”. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association 24.1 (2019): 1-8.
17. McLatchie G, Borley N and Chikwe J. “Oxford Handbook of Clinical Surgery”. 4th edition (2017): 558-62.

Fixators are internal or external rigid equipment that acts as stabilizing frames to hold broken bones in their proper anatomical positions while they heal. The application of a fixator is a complex procedure that is done in the operating theatre by orthopaedic and trauma surgeons. Fixators may be temporary or permanent, however, they are often indicated in fractures. Fractures may simply be understood as a partial or complete break in the continuity of bones. They may be caused by trauma, fractures due to overuse, infections and diseases that weaken the bones. The latter is most common in children and physiologically in some women who have attained menopause. This paper however shades more lamplight on the use of fixators in the treatment of fractures that are non-traumatic in young adults. These fractures have a rather pathologic course in their aetiology.

Keywords: Pathologic Fractures; Internal; External; Fixators; young adults; adolescents; orthopaedics; bone cancer

Reference

1. Thompson IM., et al. “Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter”. N Engl J Med 350.22 (2004): 2239-46.
2. Rönningås U., et al. “Prostate-specific antigen (PSA) and distress: - a cross-sectional nationwide survey in men with prostate cancer in Sweden”. BMC Urol 19 (2019): 66.
3. Barry MJ. “Clinical practice. Prostate-specific-antigen testing for early diagnosis of prostate cancer”. N Engl J Med 344.18 (2001): 1373-7.
4. National Cancer Institute (NIH). Prostate-Specific Antigen (PSA) tests.
5. Ankerst DP and Thompson IM. “Sensitivity and specificity of prostate-specific antigen for prostate cancer detection with high rates of biopsy verification”. Arch Ital Urol Androl 78.4 (2006): 125-9.
6. Charles Schmidt. New study once again cast doubts on PSA screening. Harvard Health Blog. April 18, 2018. New study once again casts doubt on PSA screening - Harvard Health
7. Ananya Mandal. PSA false positive and false negative results. Medical Life Sciences News, Jan 2, 2023. PSA False Positive and False Negative Results (news-medical.net).

Background: Prostate-specific antigen (PSA) testing has long been used as a screening tool for prostate cancer. However, it is not without its limitations. In some cases, men may receive a false-positive PSA result, which can lead to unnecessary anxiety and concerns about their risk of developing cancer.

Aim: This study aims to reveal and discuss the case of a patient with a false-positive PSA value of 100 ng/mL.

Discussion/Conclusion: Depending on PSA assays as an all-seeing eye in detecting and screening for Prostate Cancers (PCa), may not be completely reliable. Studies have found its sensitivity and specificity questionable. Although current studies have put the borderline values between 4ng/mL and 10ng/mL, many studies have found PCa biopsy-positive cases at values lower than 4ng/mL and negative cases at values greater than 10ng/mL. Nevertheless, the concept of overtreating and overdiagnosis was also touched on.

The Importance of Rational Antibiotic Use

     Nosocomial and community-based ease of infection is a serious consideration in the postoperative management of patients in this region. Likewise, CS deliveries carry an increased risk of complications associated with infection compared to vaginal deliveries [2]. SSIs, endometritis, and urinary tract infections are common post-operative complications that can lead to increased morbidity, healthcare costs, and antibiotic resistance [3]. To mitigate these risks, the rational use of antibiotics is essential. Rational antibiotic use involves selecting the appropriate antibiotic, optimizing the dosage regimen, and considering factors such as the patient's health status, local resistance patterns, and cost-effectiveness [4].

Pattern of antibiotics prophylaxis

     Currently, International guidelines provide recommendations for antibiotic prophylaxis in CS. These guidelines emphasize the importance of selecting antibiotics with appropriate spectra of activity against common pathogens, administering the antibiotics at the optimal time, and limiting the duration of prophylaxis. However, adherence to these guidelines can vary, and it is essential to evaluate the compliance with international guidelines in different healthcare settings [4].

     This variation in compliance may result in varied patients’ outcome that may be positive or negative. In Nigeria, some hospitals in the federal capital give 2g single dose intravenous ceftriaxone or other potent cephalosporin intra-operatively as its sole prophylactic measure, without any other complications in the theatre, no further antibiotics are given. Whereas, while the intra-operative prophylactic ceftriaxone is given, routine intravenous antibiotics are continued for 24 hours post-operatively and then orals subsequently for 7-10 days, in Bauchi State, Nigeria. Sadly, at the moment, there are no comparative studies between these two states in Nigeria. However, a study conducted in Sudan at Elquatainah Teaching Hospital where similar practices as those of Abuja and Bauchi State were compared. Cost wise and pharmaceutically speaking, not prescribing post-CS antibiotics were found to reduce expenditure and general work load. But the medical repercussion was not examined in that study [5].

     That notwithstanding, several studies have investigated the adherence to international guidelines for antibiotic prophylaxis in CS in various African countries. For example, a study conducted at Mulago National Referral Hospital in Uganda implemented a randomized clinical trial to assess the timing of antibiotic administration in CS. The study found that administering antibiotics before the skin incision significantly reduced the risk of postoperative infections. This research highlights the importance of following evidence-based guidelines to optimize patient outcomes [6].

     Another study conducted in Lusaka, Zambia, examined the antibiotic prescribing patterns and prevalence of SSIs in CS deliveries. The study found that the most commonly prescribed antibiotics were the third-generation cephalosporin, ceftriaxone, and a triple combination therapy of benzylpenicillin, gentamicin, and metronidazole. The prevalence of SSIs was 6.0%, with factors such as the level of education, type of CS, and oral antibiotics post-CS influencing the risk of infection. These findings highlight the need for targeted interventions to improve antibiotic prescribing practices and reduce the prevalence of SSIs [7].

     As regards targeted interventions, another study conducted at AL Ain Hospital in UAE amongst 807 women; found that there was a significantly low rate (1.4%) of SSI following CS. All women diagnosed with SSI had wound discharges within 30 days of the operation. More important, was the common denominator they identified amongst these women. That’s, they all had prolonged pregnancies. This was thus now tabled as a targeted risk for SSI after CS, and as thus subsequent patients fitting this profile ought to be on longer antibiotics regimens [8].

Implementing Guidelines for Rational Antibiotic Use

     Like earlier mentioned, about the variation in approach in Abuja and Bauchi state in Nigeria, there are also intra-hospital variations in antibiotics utilization in CS. A study conducted at Elqutainah Teaching Hospital in Sudan implemented a hospital guideline for the rational use of prophylactic antibiotics in ECS. The intervention involved withdrawing metronidazole dosage forms from prophylactic antibiotics according to international guidelines. The study found that this intervention significantly reduced the overuse of antibiotics and medication costs while maintaining patient safety [5].

     While this approach has been found to be effective in this hospital in Sudan, there are no searchable evidences for its implementation or trial in other areas in Sudan, north Africa or in the Africa region as a whole. Similar tales can be told about many other rational approaches. Also, the study also went on to show the vital role of clinical pharmacists in the development of rationale guidelines for antibiotics in obstetrics and gynaecological clinical practice, in this case, prevention of SSIs following CS.

     Furthermore, when selecting antibiotics for prophylaxis in CS, several factors need to be considered. These factors include the local epidemiology of pathogens and their antibiotic resistance patterns, the patient's individual risk factors, the surgical procedure's specific characteristics, and the available resources and infrastructure. Adapting international guidelines to the local context is crucial to ensure the effective prevention of postoperative infections.

     Understanding the local epidemiology of pathogens and their antibiotic resistance patterns is essential for selecting appropriate antibiotics. Studies have shown variations in pathogen profiles and resistance patterns across different African regions. For example, a study conducted in Nigeria found that Staphylococcus aureus and Escherichia coli were the most common pathogens isolated from SSIs in CS, with high rates of resistance to commonly used antibiotics. These findings emphasize the need for local surveillance and tailored antibiotic recommendations.

     However, it is worth of note that individual patient risk factors, such as obesity, diabetes, and immunosuppression, should be considered when selecting antibiotics for prophylaxis. These risk factors can increase the likelihood of postoperative infections and may require broader-spectrum antibiotics or extended prophylaxis durations. Integrating patient-specific risk stratification into antibiotic prescribing practices can help optimize outcomes and reduce unnecessary antibiotic use.

Surgical Procedure Characteristics

     The type of CS procedure, whether elective or emergency, can influence the choice and duration of antibiotic prophylaxis. Elective CS procedures are considered clean surgeries with lower infection risks, while emergency CS procedures carry a higher risk due to potential contamination. Tailoring the antibiotic prophylaxis regimen based on the specific surgical procedure characteristics can help ensure adequate coverage while minimizing unnecessary antibiotic exposure.

Resource Constraints and Infrastructure

     Resource constraints and infrastructure limitations pose challenges to antibiotic selection and administration in many African healthcare settings. Limited access to certain antibiotics, inadequate laboratory facilities for culture and sensitivity testing, and suboptimal healthcare infrastructure can impact the choice and availability of antibiotics. It is crucial to consider these factors when implementing guidelines for rational antibiotic use and explore strategies for optimizing antibiotic stewardship in resource-limited settings.

Strategies for Optimizing Antibiotic Use

     To promote rational antibiotic use after CS in Africa, several strategies can be implemented at various levels of healthcare delivery.

Education and Training

     Education and training programs targeting healthcare professionals involved in CS deliveries can enhance their knowledge and awareness of rational antibiotic use. Providing evidence-based guidelines, conducting workshops, and promoting continuous medical education can help improve antibiotic prescribing practices and increase adherence to guidelines.

Antibiotic Stewardship Programs

     Formulating antibiotic stewardship programs specific to CS deliveries can be an effective approach to optimize antibiotic use. These programs can involve multidisciplinary teams, including clinical pharmacists, infectious disease specialists, obstetricians, and microbiologists. The programs can focus on implementing guidelines, monitoring antibiotic prescribing patterns, providing feedback to healthcare providers, and promoting appropriate antibiotic use.

Surveillance and Monitoring Systems

     Establishing surveillance and monitoring systems for SSIs and antibiotic resistance can provide valuable data for guiding antibiotic prescribing practices. These systems can help identify trends, detect outbreaks, and evaluate the effectiveness of interventions. Regular monitoring and feedback to healthcare providers can facilitate continuous improvement in rational antibiotic use.

Collaboration and Partnerships

     Collaboration and partnerships between healthcare facilities, professional organizations, and policymakers are crucial for promoting rational antibiotic use. Sharing best practices, implementing standardized protocols, and advocating for policies that support evidence-based antibiotic prescribing can contribute to reducing the burden of SSIs and antibiotic resistance after CS.

Conclusion

     The rational use of antibiotics after CS in Africa is essential to mitigate the risk of postoperative infections and combat antibiotic resistance. Adhering to international guidelines, considering local epidemiology and resistance patterns, individual patient risk factors, surgical procedure characteristics, and resource limitations are key factors in optimizing antibiotic use. Implementing strategies such as education and training, antibiotic stewardship programs, surveillance systems, and collaboration can contribute to improving antibiotic prescribing practices and ultimately improving patient outcomes. By prioritizing rational antibiotic use, Africa can address the unique challenges associated with CS deliveries and pave the way for sustainable healthcare practices.

Recommendations

• Africa faces unique challenges in the rational use of antibiotics after CS, including variations in pathogen profiles, limited resources, and infrastructure constraints. As such, Africa should conduct more internal studies and develop more locally adapted strategies.
• Adapting international guidelines to the local context is crucial for effective prevention of postoperative infections.
• Multidisciplinary collaboration and partnerships are essential for promoting evidence-based antibiotic prescribing practices.
• Education and training programs, antibiotic stewardship initiatives, and surveillance systems can contribute to optimizing antibiotic use after CS in Africa.
• Rational antibiotic use after CS plays a vital role in reducing the burden of SSIs and combatting antibiotic resistance in the region. As such, the utilization of antibiotics should not be unfairly played down in bids to rationalize its use, instead this should be evidence based and more strategic.

References

1. Sway A., et al. “Burden of Surgical Site Infection Following Cesarean Section in Sub-Saharan Africa: A Narrative Review”. International Journal of Women’s Health 11 (2019): 309-318.
2. Gelaw KA., et al. “Surgical Site Infection and Its Associated Factors Following Cesarean Section: A Cross-Sectional Study from a Public Hospital in Ethiopia”. Patient Safety in Surgery 11 (2017): 18.
3. Jasim HH., et al. “Incidence and Risk Factors of Surgical Site Infection among Patients Undergoing Cesarean Section”. BMC Infectious Diseases 12.46 (2017): 113-6.
4. Azizi M., et al. “Comparing the Effectiveness of Broad-Spectrum Antibiotic Prophylaxis with Single Agent Antibiotic Prophylaxis to Prevent Post-Cesarean Section Infection”. Hormozgan Medical Journal 20 (2017): 287-292.
5. Suliman SM, Yousef BA and Hamadelnil AA. “Impact of guidelines implementation for the rational use of prophylactic antibiotics in elective cesarean sections at Elqutainah Teaching Hospital”. J Family Med Prim Care 9.1 (2020): 162-167.
6. Dlamini LD., et al. “Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections”. BMC Pregnancy Childbirth 15 (2015): 91.
7. Kasanga M., et al. “Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia”. Pharmacology & Pharmacy 13 (2022): 313-330.
8. Alnajjar MS and Alashker DA. “Surgical site infections following caesarean sections at Emirati teaching hospital: Incidence and implicated factors”. Sci Rep 10.1 (2020): 18702.

     The increasing global rates of caesarean section (CS) deliveries have raised concerns about the rational use of antibiotics to prevent post-operative infections. In Africa, CS is a common surgical procedure, accounting for a significant portion of the surgical workload [1]. This is even now more prevalent as CS has been seen as one of the most appropriate means for emergency deliveries in cases of obstetric emergencies presenting with hopes of fetal viability [1].

     However, the appropriate use of antibiotics after CS is crucial to minimize the risk of surgical site infections (SSIs) and reduce the burden of antibiotic resistance. Nosocomial and community-based SSIs are a serious challenge in Africa too, in combination with a sad rise in antimicrobial resistance (AMR) [1]. So, a balance needs to be struck.

     The aim of this short review is thus to explore the rational use of antibiotics after CS in Africa, taking into account the unique challenges and considerations in the region.

References

1. Williams CH, C Houchins and MD Shanklin. “Pigs susceptible to energy metabolism in the fulminant hyperthermia stress syndrome”. BMJ 16 (1975): 411-413.
2. Charles H Williams. “Malignant hyperthermia: A runaway thermogenic futile cycle at the sodium channel level”. Advances in Bioscience and Biotechnology 5.3 (2014).
3. Charles H Williams. “Malignant hyperthermia: Evaluation of “Organon” 9426 in Malignant Hyperthermia Susceptible Pigs”. Open Journal of Molecular and Integrative Physiology 5.2 (2015).
4. Charles H Williams. “A Review of the Factors Affecting the Incidence of Malignant Hyperthermia in the Greater Kansas City Area”. Advances in Bioscience and Biotechnology 5.5 (2014).

The pigs used in these experiments were raised from the initial five pigs reserved as breeding stock in January 1969 from stock at the Arlington Farm, UW. They were challenged with 3% Halothane in O₂ and identified as MH susceptible whenever the rear legs became extended and appeared to be in rigor. The Halothane challenge was stopped and the animals spontaneously recovered and were raised for breeding stock. The two males and three females were raised in UW Swine Barn A under Leo’s supervision. Unfortunately, when they reached 225-240 lbs. in weight, they were hauled off to the UW slaughter house. Leo found them missing and called the slaughter house and recovered one male and two females that had not been slaughtered. We relocated the MH breeding stock to the UW Sheep Farm so there could not be any other possible confusion with other pigs in Swine Barn A. I moved the key MHS breeding animals to Sinclair Research Farm at MZZOU in 1973 when I relocated to MIZZOU for a new research position. Later in 1982, the entire stock of MHS susceptible breeding animals were moved to TTUHSC at El Paso, TX. They were housed on a pig farm near El Paso, TX.

One reason for little attention is that a clinician can not see the occlusion. If you can not see then you can not treat. Dentists use older techniques to mark the occlusal contact areas of the teeth however they rarely obtain a complete oral picture making it easy to neglect essential problems. Occlusion is also an essential element for implant longevity. If the “bite” isn’t even then the bone attached implant health is jeopardized. Closing the jaws in harmony is an essential element for a long term life because choice of food coupled with chewing efficiency controls what we purchase and ingest. Nutritional supplements such as powdered foods are used as a substitute to masticating actual fruits and vegetables. Basically a sound occlusion is essential to food selection and digestion. There are no substitutions to properly functioning dentitions. Our health depends on it.

Dental occlusion is a neglected factor in dentistry. Oftentimes it is spoken about yet it is not comprehensively addressed by the dental profession. Why is its practical application not addressed? The occlusion is the coming together of the upper and lower jaws in harmony.

References

1. Sartelli M., et al. “Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study”. World J Emerg Surg 14 (2019): 34.
2. Sartelli M., et al. “Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study)”. World J Emerg Surg 10 (2015): 61.
3. Linder MM., et al. “The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis”. Der Chirurg 58.2 (1987): 84-92.
4. Luise M and Müller A. “Peritonitis-Index-Altona: PIA II: Entwicklung eines prognostischen Indices an 567 Fällen”. Hamburg (1987): 52.
5. Kologlu M., et al. “Validation of MPI and PIA II in two different groups of patients with secondary peritonitis”. Hepatogastroenterology 48.37 (2001): 147-151.
6. Salluh JI and Soares M. “ICU severity of illness scores: APACHE, SAPS and MPM”. Curr Opin Crit Care 20.5 (2014): 557-565.      
7. Revenig LM., et al. “Report of a Simplified Frailty Score Predictive of Short-Term Postoperative Morbidity and Mortality”. J Am Coll Surg 220.5 (2015): 904-911.
8. Das K., et al. “Comparison of APACHE II, P-POSSUM and SAPS II scoring systems in patients underwent planned laparotomies due to secondary peritonitis”. Ann Ital Chir 85.1 (2014): 16-21.
9. Tolonen М., et al. “Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study”. Langenbecks Arch Surg 401.5 (2016): 611-617.
10. Grynchuk AF, Grynchuk FV and Polianskiy IIu. “A scale for predicting postoperative septic complications at acute peritonitis”. Clinical and experimental pathology 2.56 (2016): 50-53.

     Prediction of postoperative complications, which determine the result and consequences, is an important element in the choice of treatment tactics for acute peritonitis management what makes it possible to apply preventive measures. Many methods which are based on taking into account various indicators have been proposed for this. However, none of these methods have sufficient recognition. The most famous and recognized scales are PIPAS [1], WSES Sepsis Severity Score [2], Mannheim Peritonitis Index [3], Peritonitis Index Altona [4], Combined Peritonitis Score [5]. These scales assess only the degree of organ dysfunction, the severity of AP and the possibility of patient’s death. But these scales do not assess the risk of certain complications.

     APACHE, SAPS, SOFA, etc. are suggested to be used to predict the effects of treatment. However, these scales are nonspecific, in addition, the scales predict only the possibility of death of patients [6-8].

     Most prognostic scales determine the risk of complications only during or after surgery. This limits the possibility of justified prevention of complications already during preoperative preparation. Only separate scales make it possible to make predictions before the operation [9-10].

     Many scales specific to certain causes of peritonitis have been proposed. These include Peritonitis Severity Score, Boey Score, Jabalpur Index, Hacettepe Score, PULP Score, etc. However, this does not solve the problem as a whole.

     A large number of scales have been created for various types of comorbidities. But only some such scales are universal enough and easy to use.

     So, the prognostic problem for acute peritonitis has not been solved. Therefore, the problem of developing an informative prognostic universal scale remains relevant.

References

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Obesity is a global health challenge with few pharmacologic options. Whether adults with obesity can achieve weight loss with once weekly Semaglutide at a dose of 0.5-1.0 mg as an adjunct to lifestyle intervention has not been confirmed. Method: This is a clinical case report of a 29-year-old female, who tried weekly Semaglutide with lifestyle intervention. We conducted a baseline mental and physical health, and we did a biweekly follow up with her. This was over 6 months period starting from September 2022 until March 2023. Consent: Written informed consent has been obtained from the patient. Results: Our participant was able to lose 16.3 % of her body weight in 6 months, dropping her body weight from 74.3 kilograms to 61.2 kilograms, with a decrease in her body mass index from 29.3 to 23.9. With a significant improvement in mental and physical health, particularly, an improvement in her depression, generalized anxiety, and ADHD symptoms. Conclusion: In participants with overweight or obesity, 0.5-1.0 mg of Semaglutide once weekly plus lifestyle intervention was associated with sustained, clinically relevant reduction in body weight.

Keywords: Obesity; Semaglutide; weight loss

References

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4. Bagdasarian N, Rao K and Malani PN. “Diagnosis and treatment of Clostridium difficile in adults: a systematic review”. JAMA 313.4 (2015): 398-408.
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7. Neal MD., et al. “Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease”. Ann Surg 254.3 (2011): 423-429.

Toxic megacolon is defined as an acute non-obstructive inflammatory condition with dilatation of the bowel causing septicemia and peritonitis. The cut off point for the bowel dilatation is taken as 6cm and above with loss of haustration on imaging. The exact cause of toxic megacolon is still debatable but several postulations have been laid down. The etiology of toxic megacolon can be divided into several factors such as inflammatory, autoimmune, tumors and others. Toxic megacolon carries a high morbidity and mortality with delayed interventions. The incidence increases with age with male preponderance.

References

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4. Gupta A, Roebuck DJ and Michalski AJ. “Biliary involvement in Hodgkin’s disease”. Pediatr Radiol 32 (2002): 202-4.
5. Barbado FJ., et al. “Fever of unknown origin: a survey on 133 patients”. J. Med 15 (1984): 185-92.
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10. Han WS., et al. “Spontaneous resolution of vanishing bile duct syndrome in Hodgkin’s lymphoma”. Korean J Hepatol 11 (2005): 164-168.
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13. Ripoll C., et al. “Idiopathic cholestasis associated with progressive ductopenia in two patients with Hodgkin’s disease”. Gastroenterol Hepatol 25 (2002): 313-315.
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22. Liangpunsakul S, Kwo P and Koukoulis GK. “Hodgkin’s disease presenting as cholestatic hepatitis with prominent ductal injury”. Eur J Gastroenterol Hepatol 14 (2002): 323-327.

Liver involvement in Hodgkin's lymphoma is common and is caused by hepatic infiltration, biliary obstruction by lymphoma, hepatitis, sepsis or complications of chemotherapeutic treatment. Jaundice caused by the vanishing bile duct syndrome related to Hodgkin's lymphoma is very rare. The mechanism is poorly understood but a paraneoplastic effect seems most likely as liver biopsy and imaging study the absence of lymphoma cells in liver. We describe a 13-year-old man with vanishing bile duct syndrome and Hodgkin's lymphoma who was treated successfully with chemotherapy. The markedly elevated serum Bilirubin levels completely normalized. Our case demonstrates that although dosing of chemotherapy in this situation can be very difficult, a good clinical outcome is possible, which makes the attempt at curative treatment worthwhile.

Keywords: Hodgkin’s lymphoma; jaundice; vanishing bile duct

References

1. Ananda Balayogi Bhavanani. Yoga in health care. Conference Paper in Research Gate (2012).
2. G Kirkwood., et al. “Yoga for anxiety: A systematic review of the research evidence”. British Journal of Sports Medicine 39.12 (2005): 884-891.
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4. Nilesh Gajjar. “Effect of yoga exercises on achievement, memory and reasoning ability”. International Journal for Research in Education (IJRE) 1.1 (2012).       
5. Health and Fitness Travel. Why is Yoga So Good for You?.
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Yoga is the science and art of living healthily. Yoga seeks inner perfection as it helps unite the body, mind, and spirit, creating amazing life harmony. Yoga can improve health and happiness in many ways. Yoga is one of many strategies to live a healthy and peaceful life, but it may be most effective when combined with a nutritious diet, regular exercise, and great relationships. This practice is suitable for many religions, races, and nationalities because it emphasises overall wellness in the individual and community.

Keywords: Yoga; healthy; body; mind; peaceful life

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Dental occlusion refers to closure which is assumed to be uneventful. But most closure is uneven because there are many facets on the teeth that may not coincide with one another so that a malocclusion develops. A disharmony can become harmonious by self adjustment which may be natural or the opposing jaws may never reach a harmonious state. It is up to the dentist to reach that decision however many do not look for disharmonies because there are few measuring systems to assess occlusal pathology. Often the pathology is an attempt by a patient to self adjust by grinding and gnashing their teeth. They never reach an occlusal harmony. That is the responsibility of the dental clinician but if the dentist does not see nor measure the disparities in the occlusal dynamic then the pathology remains and the oral health declines over time. Dentistry as a profession needs more education on the occlusion and better ways to assess the biting pathologies that exist in most people. An often used analogy is to a smooth running auto mobile where the wheels are properly balanced and aligned. First the teeth and then the jaws. It is worth a “look”.