PriMera Scientific Surgical Research and Practice

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.

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].

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.

References

Androulaki M, Frangedaki E and Antoniadis P. “Optimization of public spaces through network potentials of communities”. Procedia Manufacturing 44 (2020): 294-301.
Ferdani D., et al. “3D reconstruction and validation of historical background for immersive VR applications and games: The case study of the Forum of Augustus in Rome”. Journal of Cultural Heritage 43 (2020): 129-143.
Jens K and Gregg JS. “How design shapes space choice behaviors in public urban and shared indoor spaces-A review”. Sustainable Cities and Society 65 (2021).
Lai LW., et al. “Property rights & the perceived health contribution of public open space in Hong Kong”. Land Use Policy 107 (2021).
Lak A., et al. “A framework for elder-friendly public open spaces from the Iranian older adults' perspectives: a mixed-method study”. Urban Forestry & Urban Greening 56 (2020).
Lambe S., et al. “Developing an automated VR cognitive treatment for psychosis: game Change VR therapy”. Journal of Behavioral and Cognitive Therapy 30.1 (2020): 33-40.
Lu X, Wang X and Wu R. “Urban Garden Landscape Design Based on VR Technology and Internet of Things System”. Microprocessors and Microsystems (2020).
Pawlowski CS., et al. “Will the children use it?-A RE-AIM evaluation of a local public open space intervention involving children from a deprived neighbourhood”. Evaluation and program planning 77 (2019): 101706.
Richardson EA., et al. “The role of public and private natural space in children's social, emotional and behavioural development in Scotland: A longitudinal study”. Environmental research 158 (2017): 729-736.
Senda M. “Safety in public spaces for children's play and learning”. IATSS research 38.2 (2015): 103-115.
Timperio A., et al. “Features of public open spaces and physical activity among children: findings from the CLAN study”. Preventive medicine 47.5 (2008): 514-518.
Wei ZHU, Jiejing WANG and Bo QIN. “Quantity or quality? Exploring the association be-tween public open space and mental health in urban China”. Landscape and Urban Planning 213 (2021).
Krasilnikova E. “Integration of therapeutic landscapes into green urban infrastructure”. International Landscape Practical Conference «The comfortable environment - the health of the nation. Creating therapeutic gardens in the urban structure» 248 (2021): 12-18.
Vardanyan K. “Landscape greening as a resourse for hygienization of the medical environment according to the research data of microclimate and noise in children’s hospitals of Yerevan”. International Landscape Practical Conference «The comfortable environment - the health of the nation. Creating therapeutic gardens in the urban structure» 248 (2021):18-23.

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

Chan SWS., et al. “A decade of surgical eye removals in Ontario: a clinical-pathological study”. Can J Ophthalmol 52.5 (2017): 486-493.
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.
Gil AM., et al. “Eye Tracking Use in Surgical Research: A Systematic Review”. Journal of surgical research 279 (2022): 774-787.

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

Huang Wei Ling. “What Flexner Report did to Our Medicine After 100 Years of Implantation?". Acta Scientific Gastrointestinal Disorders 4.8 (2021) : 01-04.
Conselho Federal de Medicina. CFM.
Acupuncture Legal Status. News Medical Life Sciences. Available in: Acupuncture Legal Status (news-medical.net)
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.
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).
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.
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.
Huang Wei Ling. “How Can We Treat Gastroesophageal Reflux Without Doing Surgery?". Acta Scientific Gastrointestinal Disorders 4.9 (2021): 10-11.
Huang Wei Ling. “Chakras’ Energy Deficiencies in Patient with Congestive Heart Failure”. On J Cardio Res & Rep 6.2 2021.
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.
Huang Wei Ling. “What is Behind All Hernia Formations that We Need to Know?". Acta Scientific Clinical Case Reports 3.3 (2022): 01-03.
Huang WL. “Energy Alterations in Patients with Abdominal Pain". Acta Scientific Gastrointestinal Disorders 5.7 (2022): 38-48.
Huang Wei Ling. “Constitutional Homeopathy of Five Elements Based on Traditional Chinese Medicine”. Acta Scientific Medical Sciences 4.7 (2020): 57-69.
Huang WL. “How Can We Give Hope for Cancer Patients to Cure This Disease?”. TMR Cancer 4.4 (2021): 16.
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).
Huang WL. “Are Patients Without Surgical Risks Really Without Surgical Risk?”. J, Surgical Case Reports and Images 5.3 (2022).
Huang WL. “Are We Vaccinating Immunocompetent or Immunocompromised People for COVID 19?”. J Vaccines Res Vaccin 7 (2021): 018.
LEESER O. “Support of homeopathy by the Arndt-Schulz law”. National Center for Biotechnology Information (1953).
Huang Wei Ling. “What Is Behind All the Pulmonary Thromboembolism That We Need to Know?”. MAR Pulmonology.
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.
Huang Wei Ling. “Is the Population in the World the Same as in the Past?". Acta Scientific Clinical Case Reports 2.6 (2021).
Huang Wei Ling. “Energy Alterations and Chakras’ Energy Deficiencies and Propensity to SARS-CoV-2 Infection". Acta Scientific Microbiology 4.4 (2021): 167-196.

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).

References

Acar Z, and Acar P. “Organizational culture types and their effects on organizational performance in Turkish hospitals”. Emerging Markets Journal 3.3 (2014): 1-15.
Anicijevic N. “The mutual impact of organizational culture and structure”. Economy Annals 58.198 (2013): 35-60.
Carreon J. “Human Development: Governance and Social Entrepreneurship”. Mexico: UNAM-ENTS (2016).
Cruz O, Arroyo P and Marmolejo J. “Technological innovations in logistics: inventory management, information systems and outsourcing of operations”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 165-178.
Dugloborskyte V and Petraite M. “Framework for explaining the formation of knowledge intensive entrepreneurial born global firm: Entrepreneurial, strategic and network based constituents”. Journal of Evolutionary Studies in Business 2.1 (2017): 174-202.
Escobar R. “Neural networks, cognitive processes and behavior analysis”. International Journal of Behaviorism 2.1 (2014): 23-43.
Garcia C. “The knowledge network in a university with a system of professional practices and administrative technological social service”. Foundations in Humanities 14.27 (2013): 135-157.
García C., et al. “Governance of the actors and networks of technological innovation”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 79-94.
Garcia C, Soto ML and Miranda M. “Knowledge networks around coffee growing in a HEI in central Mexico”. Interconnecting Knowledge 2.4 (2017): 15-32.
Hernandez A and Valencia R. “Innovation instruments: social networks in the internalization of micro, small and medium-sized Mexican companies”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 47-66.
Huilan C, Liu S and Onderati F. “A knowledge network and mobilization framework for lean supply chain decision in agri -food industry”. International Journal of Decision Support System Technology 9.4 (2017): 1-15.
Jabar M, Sidi F and Selamar H. “Tacit knowledge codification”. Journal of Computer Science 6.10 (2010): 1141-1147.
Mendoza E, Ramírez L and Atriano R. “Use of media and technologies in the creation of an innovation system for the common good”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 95-114.
Nielsen B. “Synergies in strategies alliances: Motivations and outcomes of complementary and synergistic knowledge networks”. Journal of Knowledge Management Practice, 43, (2002): 1-10.
Omotayo O and Adenike A. “Impact of organizational culture on human resource practices: a study of selected Nigerian private universities”. Journal of Competitiveness 5.4 (2013): 115-133.
Quintero M., et al. “A review of the state of the art on SMEs. What about innovation studies?”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 31-43.
Robles C., et al. “Culture of quality and innovation in microenterprises”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 11-30.
Saansongu E and Ngutor D. “The influence of corporate culture of employee commitment to the organization”. International Journal of Business and Management 7.22 (2012): 1-8.
Sales J, Quintero M and Velázquez E. “Adaptation versus innovation: the formation of industrial districts from peasant communities”. Santa Cruz Atizapan and Chiconcuac. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 181-199.
Simpson O. “Motivating learners in open and distance learning: Do we need a new theory of learner support?”. Open learning 23.3 (2008): 159-170.
Storga M, Mostahari A and Stankovic T. “Visualization of the organization knowledge structure evolution”. Journal of Knowledge Management 17.5 (2013): 24-40.
Vázquez C., et al. “Government support for innovation, technology and training for small and medium-sized companies in Mexico”. In M, Quintero., Sales, J. and Velázquez, E. (Coord.). Innovation and technology challenges for its practical application in companies (2016): 67-78.
Wu S, Tuo M and Xiong D. “Network structure detection of analysis and Shanghai stock market”. Journal of Industrial Engineering & Management 8.2 (2015): 383-398.

References

Alberts B., et al. Molecular Biology of the Cell (4th ed.). New York: Garland Science (2002).
Ahlbom A., et al. “Epidemiology of health effects of radiofrequency exposure”. Environ Health Perspect 112.17 (2004): 1741-1754.
American Psychiatric Association. Electroconvulsive Therapy (ECT) (2018).
Adair RB and Guevara MA. “Chronic pain and electrical stimulation: An update”. Neuropsychology Review 29.3 (2019): 279-288.
Babington J. “On the effects produced by the electrical currents on the human body”. The Lancet 98.2517 (1871): 158-159.
Bjordal JM., et al. “Low-level laser therapy in acute pain after wisdom tooth extraction”. Photomedicine and laser surgery 24.2 (2006): 151-157.
Bikson M., et al. “Generalized physiological effects of transcranial electrical stimulation”. In Transcranial electrical stimulation (2013): 69-92.
Bikson M., et al. “Safety of transcranial direct current stimulation: evidence based update 2016”. Brain Stimulation 9.2 (2013): 641-661.
Celik, H., et al. “The effect of transcutaneous electrical nerve stimulation on pain and function in patients with chronic low back pain”. Journal of Physical Therapy Science 29.11 (2017): 1781-1786.
Chou S and Gahukamble DB. “Microcurrent electrical stimulation: a review”. Physical therapy 90.1 (2010): 2-15.
Chen J., et al. “Electrostimulation for wound healing: a review”. BioMed research international (2014): 987390.
Chen X., et al. “High-frequency alternating current exposure affects physiological responses”. Journal of biomedical engineering 1.1 (2016): 18-24.
Chen R, Zhang Z and Cheng X. “The effects of electrical stimulation on muscle strength, endurance, and power”. Journal of Strength and Conditioning Research 22.3 (2008): 823-829.
Di Piazza M, Nitsche MA and Paulus W. “Modulating function and plasticity in the human brain with transcranial electrical stimulation”. Neuropsychologia 76 (2015): 17-25.
Dos Santos JF., et al. “Electrical stimulation of the heart: current state of the art”. Journal of Cardiovascular Electrophysiology 19.9 (2008): 955-963.
Finnerty O., et al. “The effects of electrical stimulation on heart rate and blood pressure”. Journal of Medical Engineering and Technology 37.2 (2013): 102-109.
Geddes LA, Ropper AH and Goldman L. “Principles of electric shock: physiology and management”. Neurocritical care 25.2 (2016): 401-409.
Goldsmith R, Bullard MJ and Kramer LC. “Electric current and the human body: can low-level exposure affect health?”. Environmental health perspectives 115.11 (2007): 1670-1676.
Husain MM and Rush AJ. “Electroconvulsive therapy for depression”. New England Journal of Medicine 364.15 (2011): 1437-1444.
Institute of Electrical and Electronics Engineers. Electromagnetic Interference (EMI) (2015).
Koh S., et al. “Electrical injury-induced oxidative stress and inflammation”. International Journal of Molecular Sciences 20.13 (2019): 3109.
Kong Y, Chen X and Wang X. “Effects of electrical current on the cardiovascular system”. Journal of Electromagnetic Biology and Medicine 38.1 (2019): 5-12.
Lurie KG, Zipes DP and Levine JA. Electrophysiology of the Heart (1st ed.). Philadelphia: Saunders (2006).
Lee YJ., et al. “Effectiveness of transcutaneous electrical nerve stimulation (TENS) for chronic low back pain: a meta-analysis”. Physical therapy in sport 17.2 (2016): 95-102.
Li J, Wang X and Zhang Y. “The effects of electrical stimulation on heart function in patients with heart failure”. BioMed research international (2018): 7402971.
Li Y., et al. “Electromagnetic interference caused by transcutaneous electrical nerve stimulation devices: a review”. Journal of medical systems 40.10 (2016): 321.
Lippold OC and Redfearn JWT. “Changes in cerebral blood flow and electroencephalographic activity during the application of direct current to the human brain”. British Journal of Anaesthesia 36.10 (1964): 875-880.
Miller RE and Wible J. “Electrical current interaction with the human body: A review”. Journal of Electromagnetic Biology and Medicine 36.1 (2017): 1-10.
Nguyen HT Shirazi M and Barnard J. “Transcutaneous electrical nerve stimulation (TENS) for pain management in adults”. Journal of Pain Research 10 (2017): 715-725.
Poreisz C., et al. “Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients”. Brain research bulletin 72.4-6 (2007): 208-214.
Phan ML., et al. “Transcranial direct current stimulation (tDCS) for enhancing cognition in healthy individuals: A systematic review”. Journal of Neural Transmission 119.2 (2012): 121-130.
Pancholi CM., et al. “The effects of electrical stimulation on the human body”. Current Neurology and Neuroscience Reports 15.6 (2015): 47.
Sato A, Radeljic S and Takeo S. “Transcranial electrical stimulation for chronic pain management”. Pain Research and Management 18.2 (2013): 63-68.
Shiozawa P, Fregni F and Boggio PS. “Transcranial direct current stimulation for obsessive-compulsive disorder: a systematic review”. Neuropsychopharmacology 38.4 (2013): 573-586.
Salahuddin A, Ali MN and Shafie AA. “The effects of electrical stimulation on the human body: A review of current knowledge”. BioMed research international (2017): 9194250.
Shen X., et al. “Extremely low-frequency magnetic fields increase oxidative stress and alter gene expression related to the regulation of cell growth and metabolism in human brain cells”. Bioelectromagnetics 31.4 (2010): 291-299.
Saha B., et al. “Transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates working memory performance: evidence from bi-hemispheric tDCS”. Clinical Neurophysiology 122.11 (2011): 2076-2080.
Tuttle RE. “The electrical properties of the heart”. Physiol Rev 68.3 (1988): 569-592.
Thorne R and Farley J. “Effects of electrical currents on the human body”. Journal of Electrophysiology 23.3 (2015): 231-237.
Wang Y., et al. “Electrical stimulation for pain management: A review of the current state of the literature”. Neural Regeneration Research 12.4 (2017): 619-626.
Wang Y, Zhang J and Cheng X. “The effects of electrical stimulation on pain tolerance and pain symptoms in individuals with chronic pain”. Pain Medicine 14.8 (2013): 1131-1139.
Wang Y, Li X and Zhang Y. “Skin irritation caused by transcutaneous electrical nerve stimulation: a review”. Journal of medical systems 43.12 (2019): 748.
Zhu X., et al. “Transcranial direct current stimulation over left DLPFC modulates the neural activity in the contralateral homologue and visual cortex during working memory tasks”. Neuropsychologia 51.8 (2013): 1557-1564.

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.

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

Acosta J. “Leadership and innovative entrepreneurship in new technology-based companies. A case study based on a knowledge management approach”. Journal of Advanced Leadership Studies 1.1 (2012): 5-13.
Adams S. “Academic framework of public security policies”. Journal of Transdisciplinary Social Work 50.1 (2020): 1-8.
Ardevol A. “Framing theory in communication research. Origins, development and current situation in Spain”. Latina Magazine of Social Communication 70 (2015): 423-450.
Carreon J. “Models of fixed effects of diffuse variables in the formation of intellectual capital”. International Journal of Engineering Research & Development 5.9 (2019): 1-7.
Carreón J., et al. “Specification of a digital entrepreneurship model for human development through the intensive use of information and communication technologies”. Rural Perspectives 13.25 (2015): 123-155.
Clark S. “Specification a model of intellectual capital”. International Journal of Economics and Management Studies 10.3 (2020): 1-3.
Datta B. “Assessing the effectiveness of authentic leaderships”. International Journal of Leaderships Styles 9.1 (2015): 62-75.
De la Fuente J, Vera M and Cardelle M. “Contributions of the psychology of innovation and entrepreneurship to education in the knowledge society”. Electronic Journal of Research in Educational Psychology 10.28 (2012): 941-966.
Duarte T and Ruíz M. “Entrepreneurship: an option for development”. Scientia 15.43 (2009): 326-331.
Garcia C. “Specification a model for study of entrepreneurship”. Advances Research Journal of Multidisciplinary Discoveries 49.1 (2020): 1-4.
Godson O. “The influence media ownership and control on media agenda in Nigeria”. IJHSSE 1.7 (2014): 36-65.
Harper S. “The leader coach: a model of multi style leaderships”. Journal of Practical Consulting 4.1 (2012): 22-31.
Korstanje ME. “Academic framework of knowledge management”. International Journal of Engineering Technology and Management Research 7.2 (2020): 1-6.
Kumar M and Jain S. “Leadership’s management: principles, models and theories”. Global Journal of Management and Business Studies 3 (2013): 309-318.
McCleskey A. “Situational, transformational and transactional leaderships and leadership’s development”. Journal of Business Study Quaterly 5.4 (2014): 117-130.
McCombs M and Valenzuela S. “The agenda setting theory”. Information Notebooks 20 (2007): 44-50.
Melchar D and Bosco S. “Achieving high organization performance through servant leaderships”. Journal of Business Inquiry 9.1 (2010): 74-88.
Meru O and Ogbonna I. “Transformational vs transactional leadership’s theories: evidence in literature”. International Review of Management and Business Research 2.2 (2013): 355-361.
Organization for Economic and Cooperation Development. Statistic for coronavirus SARS CoV-2 and COVID-18 disease in the country (2022).
Panamerican Health Organization. Statistic for coronavirus SARS CoV-2 and COVID-19 disease in the Americas. New York: PAHO (2022).
Rivera D, Punin M and Calvo D. “Agenda setting in the Ecuadorian press: The Universe, The Mercury, The Commerce and The Telegraph”. Latina Magazine of Social Communication 68 (2013): 209-244.
Secretaria de Salud. “Statistic for coronavirus SARS CoV-2 and COVID-19 disease in Mexico”. CDMX: SSA (2022).
Sánchez J, Cagiano V and Hernández V. “Entrepreneurship competencies in university education”. International Journal of Developmental and Educational Psychology 1.2 (2011): 19-28.
Villegas E. “Specification a model of intellectual capital”. International Journal of Economics & management Studies 10.1 (2018): 1-2.
Weaver D. “Thoughts on agenda setting, framing and priming”. Journal of Communication 57 (2007): 142-147.
Wepner F. “Entrepreneurship as a factor of social mobilization”. Nómadas 36 (2012): 1-6.
World Health Organization. Statistic for coronavirus SARS CoV-2 and COVID-19 era in the world. Gynevra: WHO (2022).

References

Xu Yifan. “Design and Implementation of Middle School Physics Simulation Experiment Based on Virtual Reality (in chinese)”. Hunan University (2014).
Benesha J., et al. “Are You for Real? Engineering a Virtual Lab for the Sports Sciences Using Wearables and IoT”. Proceedings 49.1 (2020): 110.
Elfakki AO, Sghaier S and Alotaibi AA. “An Efficient System Based on Experimental Laboratory in 3D Virtual Environment for Students with Learning Disabilities”. Electronics 12.4 (2023): 989.
Wang Liang and Liu Dongfeng. “Interface design and implementation of 3D virtual physics experiment simulation platform (in chinese)”. Computer Technology and Development 24.09 (2014): 238-240.
Zhang Wenmiaoyun and Chen Zhaoxi. “Optical experiment simulation based on Python and its application in medical physics teaching (in chinese)”. Modern Computer 718.10 (2021): 134-136.
Cao Fujun and Wang Dayong. “Simulation of physical experiments with EWB software (in chinese)”. Journal of Tangshan Normal University 02 (2005): 42-43+69.
Mystakidis S and Lympouridis V. “Immersive Learning”. Encyclopedia 3.2 (2023): 396-405.
Guo Tiezheng, Zheng Yifeng, Chen Wei, et al. “Simulation experiment construction and teaching of cricket system based on Unity3D (in chinese)”. Laboratory Research and Exploration 41.03 (2022): 187-192.
Xiong Yanfan and He Xiwu. “Research on the Application of VR Technology in the Practical Teaching of Industrial Network Technology Specialty (in chinese)”. Electronic Components and Information Technology 4.02 (2020): 167-168.
Feng Jiao., et al. “Design of flight simulation system based on Three JS (in chinese)”. Computer Measurement and Control 28 .02 (2020): 216-219.
Ge Yan, Feng Wanting and Liu Hongyan. “Design and development of virtual experiment based on Unity3d (in chinese)”. Heilongjiang Science 9.24 (2018): 30-31.
Ferrão J., et al. “Environment-Aware Rendering and Interaction in Web-Based Augmented Reality”. Journal of Imaging 9.3 (2023): 63.
Minopoulos GM., et al. “A Medical Image Visualization Technique Assisted with AI-Based Haptic Feedback for Robotic Surgery and Healthcare”. Applied Sciences 13.6 (2023): 3592.
Song Xiaopeng., et al. “Fluid Mechanics Simulation Experiment Based on WebGL (in chinese)”. Physics Experiment 40.08 (2020): 36-39.
You Liang Huang and Ming Quan Zhou. "Design and Development of the Virtual Acupuncture Training Using WebGL". Advanced Materials Research 2534 (2013): 756-759.
Jin Xing., et al. “Construction of virtual simulation workshop based on Three JS (in chinese)”. Automation Appl 09 (2021): 78-80+83.
Joon Yun, Jin Zhongxian and Joongheon Kim. “3D modeling and WebVR implementation using Azure Kinect, Open 3D, and Three.js (in Korea)”. Proceedings of the Korean Communication Society Academic Conference (2020).
Zhong Shuheshan., et al. “Study on the sinking time of Saxon bowl (in chinese)”. Physical Experiment 41.02 (2021): 37-42.
Wang Jianxing. “Research on virtual 3D display based on Three JS (in chinese)”. Science and Technology Horizon 205.19 (2017): 68+80.
Yu Yuefan and Zhou Xiaoyun. “Development of virtual simulation experiment system for space teaching based on VR technology (in chinese)”. Laboratory Research and Exploration 41.08 (2022): 123-127.

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.

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.

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.

Reference

Ahuja Niraj. “A Short Text Book of Psychiatry”. 7th edition, Jaypee Brothers Medical Publishers Pvt. LTD (2011).
Bahman To?ghi. “A Study of the Relationship Between Stress and Psychosomatic Disorders”. Department of Consulting, Bushehr Branch, Islamic Azad University (1990).
Chandrashekhar CR and Math SB. “Psychosomatic disorders in developing countries; current issues and future challenges, current opinion in Psychiatry”. RELX Group Publishers 19.2 (2006): 201-6.
Engel GL. “The concept of psychosomatic disorder”. J Psychosom Res (1967).
Fava GA. “The psychosomatic spirit”. Lipowski’s legacy, Psychother Psychosom (1999).
Hunter MS. “Psychological and somatic experience of menopause: A prospective study”. The London journal 52.3 (1990): 357-67.
Kaplan. “Comprehensive Text Book of Psychiatry”. Seventh edition, Lippincott Williamsand Wilkins (2000).
Lipowski ZJ. “Psychosomatic medicine Past and present”. Can J Psychiatry 31.1 (1986): 2-7.
Miller JB. “Towards new psychology of women”. 4th edition, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association (1990).
Nagabhushana D., et al. “Stress related disorders – A review”. ed., Jiaomr, Pearson Publications (2004).
Pert CB, Drehert HE and Ruff MR. “The psychosomatic network: Foundations of mind-body medicine”. Alternative Ther Health Me 4.4 (1998): 30-41.
CB Pert, HE Dreher and MR Ruff. “The Psychosomatic Network: Foundations of Mind-Body Medicine”. Cornell university 4.4 (1998): 30-41.
Shekar K, Prameela Rajaram and Rameela sheakhar. “Women and Mental Health”. ed., Mubarak A.R, National Institute of Mental Health and Neuroscience (2004).
Sweeting HN. “Explanations for Female Excess Psychosomatic Symptoms in Middle Aged Women”. West PB, Der GJ. BMC Public Health 7 (2007): 298.
Wittkower ED. “Historical perspective of contemporary psychosomatic medicine”. INT J Psychiatry Med 5.4 (1974): 309-19.

References

AMA passes first policy recommendations on augmented intelligence.
An introduction to explainable AI with Shapley values.
The Global Burden of Disease 2004 Update, WHO.
Hancock, M., Pylidc , MIT.
Rathe A. Random Forest vs XGBoost vs Deep Neural Network, Kaggle.
Zhu P and Ogino M. “Guideline-based additive explanation for computer-aided diagnosis of lung nodules”. In Interpretability of Machine Intelligence in Medical Image Computing and Multimodal Learning for Clinical Decision Support (2019): 39-47.
Singh A, Sengupta S and Lakshminarayanan V. “Explainable deep learning models in medical image analysis”. Journal of Imaging 6.6 (2020): 52.
Lucieri A., et al. “Achievements and Challenges in Explaining Deep Learning based Computer-Aided Diagnosis Systems”. arXiv preprint (2020).
Ahmed ZU., et al. “Explainable artificial intelligence (XAI) for exploring spatial variability of lung and bronchus cancer (LBC) mortality rates in the contiguous USA”. Scientific reports 11.1 (2021): 1-15.
Siddhartha M, Maity P and Nath R. “Explanatory artificial intelligence (XAI) in the prediction of post-operative life expectancy in lung cancer patients”. Int J Sci Res 8 (2020).
Bartczak M and Partyka M. Chapter 8 Story Lungs: eXplainable predictions for post operational risks.
Venugopal VK., et al. “Unboxing AI-radiological insights into a deep neural network for lung nodule characterization”. Academic radiology 27.1 (2020): 88-95.
Zhou B., et al. “Learning deep features for discriminative localization”. In Proceedings of the IEEE conference on computer vision and pattern recognition (2016): 2921-2929.
Selvaraju RR., et al. “Grad-cam: Visual explanations from deep networks via gradient-based localization”. In Proceedings of the IEEE international conference on computer vision (2017): 618-626.
Lundberg SM and Lee SI. “A unified approach to interpreting model predictions”. In Proceedings of the 31st international conference on neural information processing systems (2017): 4768-4777.
Shrikumar A, Greenside P and Kundaje A. “Learning important features through propagating activation differences”. In International Conference on Machine Learning (2017): 3145-3153.
The Cancer Imaging Archive (TCIA) Public Access, LIDC-IDRI.
Tulio Ribeiro M, Singh S and Guestrin C. "Why Should I Trust You?": Explain- ing the Predictions of Any Classifier. arXiv e-prints (2016): arXiv-1602.
He H., et al. “ADASYN: Adaptive synthetic sampling approach for imbalanced learning”. In 2008 IEEE international joint conference on neural networks (IEEE world congress on computational intelligence) (2008): 1322-1328.

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

Bates DW., et al. “Big data in health care: using analytics to identify and manage high-risk and high-cost patients”. Health affairs 33.7 (2014): 1123-1131.
Denny JC and Spickard A. “Mining electronic health records: towards better research applications and clinical care”. Nature Reviews Genetics 14.6 (2013): 395-405.
Haque SN and Ali NM. “Leveraging electronic medical records for improving healthcare: a systematic review”. Journal of Medical Systems 44.12 (2020): 1-14.
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academies Press (US) (2001).
Panch T, Mattie H and Celi LA. “The "inconvenient truth" about AI in healthcare”. NPJ Digital Medicine 2 (2019): 77.
Weng SF., et al. “Can machine-learning improve cardiovascular risk prediction using routine clinical data?”. PLoS One 12.4 (2017): e0174944.
World Health Organization. Health in the Americas: regional outlook, country profiles. Pan American Health Organization (2013).

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.

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.

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

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.
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.
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.
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.
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.
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.
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.
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.

One of the predators, who actually was and may never have stopped being a Nazi is global financier and convicted felon George Soros [10]. His plan, which is shared by many in these elite circles, was to shut down every part of the economy in the first world, and de-industrialize the USA. The collapsing borders, super-inflation, total elimination of fossil fuels (unless it comes from perhaps British Petroleum or those in league with the globalists), and collapse of the world food supply (mass starvation). All this so a corporate UN coordinated world government can come in and act as saviors. It is a decarbonizing agenda, an anti-terraforming religion where carbon dioxide will be removed from the atmosphere in the name of being Green. Green was intended to be the new anti-human, anti-science religion used to isolate, control and eventually eliminate as much as 80% of the human population on the planet, for the carbon they really want to remove is us. If Green were really “Green” why are we outsourcing our energy needs to China where slaves are many and human rights are few. Those batteries for electric cars require cobalt mined by exploited African children. Who do you think are making all those Chinese solar panels (yes, they make most of them)? How about a million Uyghur Muslim slaves incarcerated because of their religion - at least until someone with money needs an organ that matches one of the slaves, be they Muslim or Fallon Gong practitioners. It’s called Green Washing or environmental virtue signaling.

By 2026, there will be more than three Chinese males for every female aged 15-29, thanks to their policy of sex-selective abortion. The Chinese gender gap is fueling the trafficking of poor women, who are being kidnapped or lured into China and forced to be prostitutes or slave-brides. This is an unspoken driver of Chinese policy.

A massive global death cult has been lurking for decades for the moment to strike. They actually believe(d) they could transcend carbon-based life and have their consciousness transferred to some silicon-based life-form. In the short term, their plan is to neutralize the USA with a civil war/economic collapse while China takes over the South China Sea including Taiwan.

Whether you personally believe in malevolence, Satan [11] or nasty inter-dimensionals is your choice, but the globalists believe in them and most have sold their proverbial souls [12] for something they already had and now they have created a covenant with the losing team. The weird thing is on some level they know it, but can’t stop themselves so they push forward with their deranged game plans to create a transhuman world where most humans have been eliminated and they want this all to happen by 2030 according to their own published agenda [13].

A world that will be free of poverty and hunger because we won’t be in it, but those who remain will own nothing, be happy and eat bugs - again, this plan has been cooking for the last century. The globalists’ desire to be top dogs on a prison planet is so intense their wish may actually be granted, but not on this Earth. That seems to be the way a benevolent universe works, you get what you want, eventually, but it may not be exactly how you planned it out. Be that as it may, there also seems to be a lot of malevolence tolerated at certain levels and layers of our reality undoubtedly to stir the evolutionary pot for the benefit of all. Nevertheless, what goes around comes around, so if true, you don’t trade your future for temporary misuse of power as seductive as it may be. It is a poor choice, but some insist on learning the hard way, yet even in their insanity, the lessons they offer benefit the whole.

Medical Tyranny and Soft Kill weapons

Fluoride seems to have been the first foray into medical tyranny to control populations. The historical use of fluoride for behavior control probably started in the Soviet gulags in the 1930’s but Nazi Germany was quick to apply same in their prison camps as the mineral makes humans apathetic and easy to dominate - stupid and docile. The propaganda campaign in the USA was so convincing that fluoride was essential for preventing tooth decay that anyone who questioned its use in the water supply, even though fluoride is more poisonous than lead, was considered a nut case. The book The Fluoride Deception is well researched and goes over this in detail [14].

The practice and paradigm of fluoridating municipal drinking water demonstrated that the public would accept drinking poison if the government insisted it was a public health measure being done for the benefit of citizen’s well-being - “Fur Ihre Sicherheit” - it’s for your safety a common Nazi reframe. This poison is still universally defended by the dentists who will willingly put the most poisonous non-radioactive element on the periodic table in your mouth, mercury amalgam fillings, and call it silver. The mercury is constantly leeching out and you breathe it in and swallow it too.

During WW II, the biowarfare activities of the Japanese were particularly atrocious. As many as 3000 allied troops lost their lives in places such as the infamous Unit 731 testing biologics and untold number of civilians when these agents were released in Asia. The USA covertly granted the scientists involved immunity not unlike Operation Paper Clip [15].

Blame it on the fluoridated water, but we have allowed ourselves to be experimented on far too easily and without holding anyone accountable. There is no freedom without accountability. In 1950, the U.S. Army sprayed the bacteria serratia marcescens in San Francisco from a boat(s) in the bay - Operation Sea Spray and continued till 1969. There was at least one documented death from the infections that followed.

Infantile paralysis or polio didn’t exist until the heavy use of various pesticides the most notable being DDT, which is required to weaken the immune system so a previously benign stomach virus could start causing paralysis. But the government had encouraged and required the liberal use of DDT, and it was used everywhere and on almost everything (still is in certain parts of the world). Nevertheless, a virus and only a virus would be blamed for what was actually an illness caused by a pesticide or else there would be great liability to both the government and industry. So fear of a virus was ginned up - sound familiar? The mass vaccination campaign (Polio) initially gave 98 million Americans a retrovirus infection, a simian virus (SV40), now known to be causally related to several types of cancer. Now it seems genetic sequences from SV40 are in the mRNA bioweapon for COVID.

Don’t misunderstand what is written here… an enterovirus causes the illness but it needs a toxic co-factor in most cases. If the truth of the toxic cause of polio was known, and the government held accountable for infecting millions with a cancer-causing retrovirus, we would not be where we are today. The first mass vaccination program for polio in the USA, now called the Cutter Incident, gave 200,000 children polio. To convince the public the polio vaccine program was working, the definition of polio was changed so that one had to be paralyzed for at least 60 days to be classified as polio - most cases resolved before 60 days and of course they knew that. It made the vaccine look very effective. Today, the definition of what is a vaccine has been redefined to accommodate a hard to sell, problematic gene-transfer therapy that makes the human body create a pathogenic protein (forever in some people), potentially sterilize [16] many recipients and inflame their hearts [17]. Make the human body produce a pathogenic spike protein - what could go wrong?

Oh, and the definition of “Gain-of-Function” was changed as well, so the reader can decide if that made Dr. Fauci look any more credible. Especially, when it was found he wanted EcoHealth Alliance to spray more virulent corona virus in Wuhan caves to infect the local population (the Pentagon refused to fund the project - maybe because it was an act of war?) [18].

Made in the USA

By masking biowarfare programs as public health measure producing vaccines these fools were able to get around restrictions. The Department of Defense (DoD)/DARPA admitted to operating 46 biolabs in Ukraine, for public health of course - but pay no attention to the fact we operate these labs all over the world…. “we are the good guys.” In 2012, DARPA developed their ADEPT:PROTECT project that would use gene-encoded vaccines to stop a pandemic (they would create?). There was no WARP speed program - they had already been working on this for ten years before Trump announced WARP speed. Moderna got its first contract in 2013, but it was the DoD that came up with the idea of mRNA vaccines - this whole thing has been a military operation from the get go. By 2015, the peer reviewed literature had articles announcing the enhanced CoV2 was ready to be used (on the human population). It was never a China-virus, the Wuhan lab was just enhancing what was created in the USA. With the first week thousands of pregnant women were taking this vaccine. Never have we given experimental vaccines to pregnant women and in the past medicine went out of its way to protect pregnant women from as much as possible and certainly not interventions that would upset their immune systems, but medicine was now neutered - only Pharmakeia existed and was in full control.

The polio outbreak showed that you could herd the sheep (humans in this case) into a slaughter house if there was an invisible enemy and a virus is perfect for that because one can use fear to get populations to turn to their government to protect them from this invisible enemy. If you have control of the media, you can also implement a divide & conquer strategy, so if you can turn men against women, blacks against whites, heterosexuals against the LGBQTs, established populations against imported immigrants by the millions - all of that causes people to turn to their governments for interventions. Do you think those funding Critical Race Theory to Drag Queen Story-Time want harmony? No, they want culture wars and civil wars.

In the USA, if one disagreed with the narrative the media, the Department of Justice or FBI would label that individual either a domestic terrorist or white supremacist/racist regardless of their skin color. It was part of the plan to blame the destruction of the USA on white supremacists, but ponder this one example - the City of Oakland California is deeply beset with crime and violence, but I would challenge you to find even one white supremist in Oakland. Those behind the tyrannical cult we have been subjected to are not super-intelligent, but few realize they get their power from public acquiescence whose perceptions they have to control. Yes, the cult has a lot of financial resources and many deluded minions who will blindly do their bidding, but they are weak - only the weak censor. The censorship was a desperate move to control perceptions. But the censorship surrounding COVID killed tens of thousands.

So, with a virus, you can stop people from gathering, organizing and if you can digitize a population, you can control who is talking to whom and where. If you can get people to school online or do their work online the government can listen to everything everyone is saying and writing and buying. The excuse is that it is Fur Ihre Sicherheit to protect against the invisible enemy. It also keeps people lonely, isolated, and depressed. People will buy into solutions before they know anything about the consequences of that solution, so you can mandate lockdowns without proper science supporting same, injections that have not been adequately tested, or vaccines that are known to cause harm for the greater good of someone’s bottom-line.

Infectious Disease Skullduggery

This is not a comprehensive tome of infectious disease skullduggery, but in 1955 it has been reported that the CIA conducted an open-air biological warfare experiment near Tampa, Florida and environs with the Pertussis bacteria. It was alleged that the nasty endeavor tripled the whooping cough infections in Florida to over one-thousand cases and caused whooping cough deaths in the state to increase 12-fold over the previous year [19].

In 1966, the U.S. Army released Bacillus globigii into the tunnels of the New York City Subway system, as part of a field experiment called A Study of the Vulnerability of Subway Passengers in New York City to Covert Attack with Biological Agents. The Chicago subway system was also subject to a similar experiment by the Army [20].

Bacillus globigii was used to simulate an attack with anthrax, but as it turned out, now we know this bacteria is a human pathogen [21].

The USA government conducted many radiation experiments on the unwary, MKULTRA drug experiments on the unknowing, torture experiments on the incarcerated, but again…this is not meant to be a comprehensive list. By the time U.S. President Eisenhower left office with his infamous speech beware the “military-industrial-complex” we were being lead into unending military conflicts, often initiated by false flag events such as the Gulf of Tonkin incident that was used to start the Vietnam war.

Men in Black

In the 1950s, the CIA had split into two factions. The western faction was almost exclusively in control of anything that had to do with ETs - I don’t mention this to be sensational. In the years that followed the military-industrial paradigm evolved and became inclusive of many multinational corporations, investment houses and banks, which benefited from this arrangement leading to where we have massive corporate interests, such as Black Rock/Vanguard, which span the globe and whose shareholder-ships are networked among a very small oligarch class.

While President Roosevelt avoided a coup, President John F Kennedy did not, and was assassinated (1963) in a coordinated plot managed by the CIA’s E. Howard Hunt. Lyndon B. Johnson was Vice-President and was fully aware of the planned elimination of JFK as was the infamous director of the FBI, J Edgar Hoover. Apparently, America decided to explore the dark side and so begin unending wars and skullduggery around the globe. But I doubt this could have been possible without the cooperation of the press in covering up the facts of the event. Why was Kennedy assassinated?

Kennedy wanted the USA back on the gold standard, he wanted the CIA dismantled, he never wanted the USA to get entangled in Viet Nam. Unbeknownst to Kennedy, the CIA had become far more than the “CIA” they were literally the Men in Black in matters extraterrestrial and if the CIA was threatened it also threatened the cover being used in such matters and the monopoly of information the CIA had on this information. Kennedy had a vision for the space program, but his vison was not shared by those using NASA as a front organization for their secret space program (they were back engineering crashed vehicles probably with the help of low-vibrational ETs, but that is speculation). Just days before his murder, Kennedy signed an agreement with Kurschev to cooperate on moon exploration and signed an executive order requesting the CIA share what they knew about UFO’s to make sure there were no accidents from confusing UFOs with an aggressive act by either side. The CIA had no intention of sharing anything with anyone and certainly wasn’t going to let the chief executive tell them what to do even if that meant making him “wet.”

Meanwhile, the secret biowarfare facility located on Plum Island off the coast of Connecticut was developing an enhanced version of the Borrelia bacteria (Lyme disease) under the directorship of former German SS-officer and microbiologist Eric Traub - Gain of Function research. This organism with increased virulence now infects 20% of the world’s population. Be that as it may, the virulence of the organism was not robust enough for the globalists.

The fall-guy set-up to take the blame for the JFK assassination was CIA asset Lee Harvey Oswald, who strangely enough was mixed up in a virus gain-of-function program for the purpose of developing a weapon that would kill Fidel Castro. Oswald knew too much and was expendable, so he was a convenient “patsy.” Mary Sherman, the scientist running the program, was murdered. It is still speculation whether there was a link to this apparent effort to create a deadly virus and the subsequent identification and possible enhancement of the HIV virus.

Maurice Hillerman, one of the world’s most prominent virologists of his time and a Vice President of Merck, was recorded boasting, “So we brought African Greens in and I didn't know we were importing the AIDS virus at the time.” Merck switched from Indian rhesus to green monkeys because the rhesus monkey were full of retroviruses including SV40. Was HIV just due to sloppy virology, or was HIV, once identified, manipulated and chosen as a bioweapon. A weapon that must have been a big disappointment as it took far too long to kill its victims. Intentional or not, in all likelihood it was introduced in the USA via the Hepatitis B vaccine trials that exclusively recruited gay men in New York, San Francisco and Los Angeles. The bottom-line is that vaccineologists in the 20th century were creating invasive medical interventions with no clue as to what they were doing and as a result murdered many. Or did they know what they were doing?

The situation in Africa is a little less clear, starting in 1957 [22], oral polio vaccines were administered by the Wistar Institute and given to “hundreds of thousands of Africans.” As with almost all vaccines there was no follow-up. The FDA has archived vaccines from that period and if they forensically looked at them to see if HIV was present, they have not told anyone. That would eliminate the conspiracy theories, but it would also implicate the whole vaccine program as a very problematic, unethical and sloppy endeavor to say the least.

Big Pharma, in the USA, was able to get unconditional liability protection from lawsuits related to adverse events from their vaccines in 1986. Safety was no longer their concern as the responsibility of vaccine safety was now the responsibility of the U.S. Government. So, there was an explosion of vaccines required for children, and a mysterious increase in sudden infant death syndrome, chronic health conditions and a formerly rare neurological disorder called autism. Autism is a post-vaccination encephalitis but the connection between vaccines, mercury, aluminum (found in ~ 80% of vaccines at toxic levels), acetaminophen and autism was deliberately covered up by agencies of the U.S. Government. When the CDC had the objective data the vaccines were connected to autism their response was to shred the data. A high-level whistleblower came forward and disclosed this but no one in government did anything - no hearings, no investigation - nothing. This was the subject of the documentary “Vaxxed.”

Big Pharma was already well on their way to capturing regulatory agencies and politicians. No one in the upper echelons of government would dare reveal what they knew, and they never did; however, that silence empowered the eugenics cult. The U.S. Government never met their obligations under the 1986 Vaccine Act and ignored all safety issues even as they pushed the mantra, “Safe & Effective” so that by the time CoV2 showed up the population was good and indoctrinated. Health & Human Services (HHS) already had decades of blowing off their responsibilities for vaccine safety and few seemed to care.

SARS -1, the predecessor to SARS-2 (CoV2) arrived on the scene in 2002, and in all likelihood was a test run. The reason one does not here about it anymore is that is has no natural host, and therefore not in circulation. If there is no natural host, then where did it come from? Is there wet market in the Wuhan virology lab? CoV2 was a made in the USA, but was sent to the Wuhan Virology Lab for enhancements that became illegal to do in the U.S.

There is strong circumstantial evidence that A/H1N1, the so-called novel Mexican Swine flu event of 2009 was neither Mexican nor novel, but a genetically engineered creation from the USA. The virus included genetic bits of North American human, avian and swine flus and Eurasian swine flu —the virus had not been detected in any pigs except those in a single herd in Canada [23]. A variant of A/H1N1 broke out in India in 2015, but has apparently not been a player since. No natural host.

Had there been a sincere and honest attempt to flesh out the origins of these viruses, again we would not be where we are today. While A/H1N1 was very infectious, the virus was no more problematic than the normal flu virus and has vanished. It may have just been a test run for a future release.

The destruction of the World Trade Center on 9/11, was another coup d’état this time by the NeoCon faction of the New World Order set. It greatly empowered them to have been able to get away with that event. Firing a missile into the Pentagon, but telling everyone it was a 757 jet, the overt demolishing of WTC 7 (no plane hit this building), and clear evidence WTC 1 & 2 were demolished. It was carried off by traitors within the USA in conjunction with several middle eastern countries. Much could be said here about the horrors unleashed post-coup d’état, but no one in officialdom would dare speak the obvious truths. It really set the stage for what would be coming soon enough. And what was that?… the continued NeoCon agenda to take over Eastern Europe (in violation of the agreement made with Gorbachev that there would be no expansion into Eastern Europe [by NATO] if the Warsaw Pact was dissolved).

The attempt to scare the world with the Zika virus was a really big flop. They would not make that mistake again. So quick to blame a relatively benign virus for the clusters of microcephaly in Brazil. However, too many found out fairly quickly that the pocket of mothers in Brazil who gave birth to children with microcephaly were vaccinated with DTP while pregnant and while drinking larvicide laden tap water at the same time. So, that attempt to scare the world had to be shut down immediately because a vaccine was clearly implicated. At the same time a sentinel paper was published - a retrospective look (using matched controls) at 30 years of DPT use in Africa showing in increased overall mortality 10-fold, so it was very important to shut down any interest in looking at the safety and efficacy of the DPT [24].

Which brings us to CoV2, and the announcement by Dr. Fauci in 2017, that a surprise outbreak was imminent. The plot was apparently hatched as far back as 1999, at the University of North Carolina. In the subsequent years numerous white papers, such as SARS 2025-2028, [25] the pandemic war games, such as Event 201, [26] which were priming both the media and the public. Finally, they would have the event that would allow them to bring in their great reset of the world economy and cull the population at the same time. Key players in multiple governments had already been compromised, regulatory agencies had been captured, and Big Pharma along with Big Tech were in total control of conventional media outlets.

Yet, CoV2 virus was not an infectious disease hellion. It took out the old and the infirm just like influenza does every year, so the hype had to go into overdrive, which the PCR tests accomplished cycled so high clean swabs would test positive. It was critical the number of deaths for CoV2 to be very high in order to generate the fear to justify what would come next. So, despite long standing rules for data collection and reporting, successfully used for years by all hospitals, medical examiners, coroners, and physicians, suddenly CDC changed the way they wanted deaths reported. Had they used the normal criteria the mortality figures would have had to be revised down 90%. The very people within government who might have sounded the alarm that we were being manipulated into a bio-security state based on false information were compromised as many of them would be able to earn millions of dollars from the licensing of the mRNA technology. It has been determined that almost half of all PCR results were false positives, which if nothing else calls into question the clinical trials used to validate the “vaccine.” [27] As an aside, we have never had a vaccine that makes the human body create a pathogen in a controlled way for an uncontrolled duration. The Spike protein is a significant pathogen - a loaded weapon if you will with no assurance it would control the outbreak.

What happened next was 50 countries panicked and were cajoled into signing secret agreements with Pfizer essentially putting them into receivership in exchange for the injections and monetary assistance from the World Bank and the International Monetary Fund [28]. An agreement to remain secret for 50 years. Any criticism of the injections or of Pfizer would be forbidden, Pfizer would not only direct the global response but also the response individual countries would have so a worldwide extermination system could be initiated. The Federal Drug Administration (FDA) now under operational control of the Department of Defense (DoD) even asked a federal court to allow them 55 years to hold onto the data they relied on to give Emergency Use Authorization for the Pfizer injection. There can only be one reason for this request, and that is the FDA/DoD didn’t want anyone to see that the Pfizer data showed that at best, one would have to inject 22,000 people to potentially prevent one death. No need to point out the Wuhan A strain was no longer in circulation. I am also sure they didn’t want anyone to see that there were more deaths in the injected group than in the control group.

The lack of early prevention and treatment protocols, and the persecution of anyone trying to treat COVID patients prior to hospitalization was not a form of treatment nihilism, it was a well-organized, well-funded conspiracy to make sure nothing would interfere with an injection rollout. Never have sick patients been turned away from hospitals and told to come back when their lips were blue.

All the big players were deeply, corruptly and maliciously in bed with Pharma, so would lose billions if it were found off-patent drugs could treat COVID. The FDA, under the direction of the Department of Defense (DoD), illegally exercised emergency use powers, and was a willing ally in the suppression of treatments known to be effective against the virus, such as something as benign as vitamin D. In some countries physicians were arrested for prescribing Ivermectin. Then injections were illegally marketed to children as well after the FDA advisory panelist said "We're never gonna learn about how safe the vaccine is until we start giving it," said panel member Dr. Eric Rubin. "That's just the way it goes." No Dr. Rubin… that is not the way it goes [29]. When you ignore safety, you tend to ignore whether the injection even works, and while the “science” is moving forward, unfortunately deluded technocrats were not [30]. The FDA stopped being a regulatory agency and became part of the other alphabet agencies to promote the “vaccine.” They saw their role was to get a needle in every arm, in everyone in every country - it was choreography to dance to the edicts of the DoD.

Pfizer now had the power to silence governments, maximize profits and power. Military bases, National Parks - just a few of the items signed over [31]. Big Tech and Pharma had bled out multiple governments to create this giant one world government monster with Pfizer calling the shots - literally. The human infestation would be eliminated with the silent, obedient consent of governments around the world.

Original Antigenic Sin

But there were problems. The injection was going to kill too many too fast (as intended) even though many of the injections were expired and ineffective (they were thawed for too long) and many blanks were shipped to many locations to mitigate the number of adverse events anticipated. Nevertheless, the body count increased as well hidden as those bodies may have been. They had to buffer the rollout of the injection because again it was supposed to have come on the scene after billions were already dead from CoV2 and few would be left to ask important questions.

One question was why give a non-sterilizing vaccine to everyone possible in the middle of a pandemic…all that would do is prolong the length of illness by pumping out a multitude of variants, which is exactly what took place. They were called variants because they had a different spike protein than the one the injection was having the human body manufacture, and so the efficacy of the injections started falling into the single digits [32]. This was all predicted well in advance, but the injections were rushed for socio-political reasons not medical/scientific reasons. Compare and contrast what took place in Gibraltar vs. Africa.

Africa, a heavy user of hydroxychloroquine (HCQ) - taken by millions - by the end 2021, the vaccination rates in 20 African countries wasn’t even close to coming out of the single digits.

Overall the African vaccination rate was around 6%, but for some reason the “experts” were mystified as to why there is so little COVID in Africa [33]. On the other hand, perhaps the most vaccinated country on the planet was Gibraltar where there is a 100%+ vaccination rate and yet cases of COVID were so high Christmas 2021, was canceled. Unintentionally, they proved boosters don’t work. In Singapore, with at 94% vaccination rate, cases and mortality spiked to record levels, and in Ireland, where 92% of the adult population is vaccinated, cases and mortality doubled [34]. England was the only country, worldwide, that seemed to keep accurate records of its deaths by vaccination status (at least for a while). The COVID vaccines used in England (mRNA & DNA vector vaccines Pfizer, Moderna, and Astrazenica) do not significantly reduce COVID mortality, but did result in greatly increased all-cause mortality [35]. Specifically in England, if you are under 60 and you get injected, you are twice as likely to die. As the months went by the mortality of the injected only increased.

The mortality from COVID in an African country, such as Zaire was 0.6 per 100,000. Almost no one received the injection. In the USA the mortality was 1000 per 100,000. There should be no need to read one more word if you understand the obvious implications of that last sentence. Even before President Trump announced he had taken HCQ, the drug was disappearing and countries were removing it from over-the-counter status and requiring prescriptions. Someone didn’t want HCQ to be around, and studies were being conducted with near lethal doses of HCQ in late-stage patients (no zinc, no azithromycin) - it was as if someone deliberately wanted to destroy any chance HCQ might have to help treat COVID patients. Then perhaps one of the most momentous medical frauds in history took place - both the New England Journal of Medicine and the Lancet simultaneously published completely fabricated, fictional articles that concluded HCQ was not efficacious. What someone(s) had the power to fund fraudulent studies, compromise the world’s top medical journals, and then get the Federal Drug Administration (FDA) to pull the emergency use authorization (EUA) for HCQ? Apparently, that was the FTX group. Even after the papers were retracted the FDA did not reinstate the EUA. This brings up the problem that there is no FDA - the DoD took over the FDA regarding all things COVID.

However, those who successfully destroyed the possibility of using HCQ for COVID weren’t done - they went after Ivermectin, but not with the same success. First and foremost, data from 19 countries that participated in the World Health Organization (WHO) sponsored African Programmed for Onchocerciasis Control (APOC), from 1995 until 2015, were compared with thirty-five (Non-APOC) - in other words, APOC countries are on Ivermectin. That may be why they had almost a 30% lower mortality from COVID than non-APOC countries [36]. But what took place in India was even better. Two provinces took opposite stands. Tamal Nadu followed WHO recommendations and had the same dismal stats that the USA had, but Uttar Pradesh supplied Ivermectin to its population and 97% of the cases were eliminated. Uttar Pradesh has 2/3rds the population of the USA.

Despite the data on Ivermectin, leaders from Australia to Austria actually believed the COVID injections worked and the unvaccinated were spreading CoV2 - they probably still believe it. Ignore the fact there are no unvaccinated in Gibraltar. Are these leaders psychotic or, following orders from the Fauci/Francis Collins/Gates/Bio-Pharmaceutical-Military complex? They wanted us to panic with each new variant, so they could continue to lock-down, take people to camps, and have the ability to inject humanity multiple times a year forever [37] …that was always the plan.

This was not the greatest public health disaster the USA had ever seen; this was done on purpose but when events deviated from what was projected the cabal scrambled to salvage the situation as best they could. So, insane medical rituals that had no foundation in science or medicine were pushed - the less than worthless cloth masks, the quarantining of health asymptomatic adults and children, the meaningless six feet social distancing (the pulled that out of their rear-ends).

Remember, those that expired were very old, fat and had multiple medical problems. There was never any credible reason to keep children from attending school and most lost two full years of education they will never be able to make up. Suicides increased, along with obesity and delays in treatment for medical problems that cost lives. The burden was on the poor who didn’t have jobs where they could work from home, while the elite rich got richer.

It doesn’t take a degree in immunology to understand that if you occupy the body’s immune system making a spike protein that is no longer connected to the circulating variant, not only is the vaccine worthless, it perniciously lowers one’s ability to deal with the actual viral infection one may get in the real world, because one’s immune system is busy making antibodies to something that is not present and may be oblivious to an actual virus invading the body. The CoV2 infection has a very low risk of myocarditis, but it is there. The injection had the body make massive amounts of spike protein, and the amounts the injection was having the body make caused significant myopericarditis. The FDA actually asked that prospective studies be done but they were never done by manufacturers. One such study has the actual risk is about 2.8% or about 3 people out of every 100. Conservative estimates have the risk at 1:<2000 (for context the Swine flu vaccine from the late ‘70’s was pulled when it was found the risk of a neurological disorder Guillain-Barre was 1:100,000).

The population continued to be told “Safe & Effective” and the usual “one in a million (side-effects).” There was 20 years of data showing corona viruses can cause heart disease, so one case of myocarditis should have shut the “vaccine” program down. But instead of pulling the vaccine the CDC went to work pushing the idea that the “vaccine” induced myocarditis was mild. It is just there is no such thing as mild myocarditis, in fact 20% of those that die within a day of receiving the “vaccine” have myocarditis [38]. There is only one solution…immediately end the worldwide vaccination program and try to help people repair their immune systems. But compromised, well-paid “experts” will never acknowledge this solution. There is just too much money to be made giving everyone more “vaccines.”

Then there is this insane group-think that needs to be overcome, because there are people in government, medicine and academia that have been so indoctrinated that if something is a vaccine it is safe & effective - end of story - they shut out objective reality at all costs. Even the government’s own VAERS vaccine adverse event reporting system produced a massive death safety signal. VAERS recognized for under reporting adverse events by 99-fold still produced a massive death safety signal, but between the corruption and group think it was ignored.

The response to this inconvenient data was to order people to get more and more worthless injections that would do nothing but cause side-effects. Yet the presence of so many un-injected showed how robust natural immunity is, still promoting natural immunity could put one on a terrorist watch list. They needed as many as possible to be injected as often as possible before the public became aware of the hidden sequalae of the injections. The control group had to be eliminated, or rounded up and terminated - at least that is what they wanted to happen.

Obviously, this story is not over. On their way out the globalists will do whatever they think they can get away with to undermine and collapse civilization, including more bioweapons, they know their future is bleak and would sooner take as many with them as possible. But all stories end sooner or later, and when the story of the New World Order ends, it will look nothing like what its proponents had in mind. So, fight for freedom of knowledge, and in place of deceit, intolerance and prejudice fight for the possibilities of understanding, truth and acceptance. For that is the reality humanity is moving towards no matter how hard those who dish out their cruelties try and stop this change. Change is inevitable - it is the only Universal constant.

Pharmakeia a false hope and deception of false peace, false healing, and a false future.

“The Armenian genocide was not a mistake; Holodomor was not a mistake; the Final Solution was not a mistake; the Killing Fields was not a mistake; the Great Leap Forward was not a mistake. Name your genocide it was not a mistake - that in includes the Great Democide of the 2020’s, to imply otherwise is to give “them” the out they are seeking.

“It was not botched; it was not bungled; it was not a blunder; it was not incompetence; it was not lack of knowledge; it was not spontaneous mass hysteria. The planning occurred in plain sight; the planning is still occurring in plain sight.

“The philanthropaths bought the science; the modelers projected the lies; testers concocted the crisis; the NGOs leased the academics; the scientists fabricated the findings; the mouth-pieces spewed the talking points; the organizations declared the emergency; the governments erected the walls; the departments rewrote the rules; the governors quashed the rights; the politicians passed the laws; the bankers installed the control grid; the stooges ordered the money; the DoD placed the orders; the corporations fulfilled their contracts; the regulators approved the solution; the laws shielded the contractors the agencies ignored the signals; the behemoths consolidated the media; the psychologists crafted the messaging; the propogandists chanted the slogans; the fact-chokers smeared the dissidents; the censors silenced the questioners; jack-boots stomped the dissenters; the tyrants summoned; the puppeteers jerked; the puppets danced; the colluders implemented; the doctors ordered; the hospitals administered; the menticide is scripted; the bamboozled leaded; the totalitarianized bullied; the COVIDians tattled; the parents surrendered; the good citizens believed and forgot.

“This was calculated; this was formulated; this was focused grouped; this was articulated; this was manufactured; this was falsified; this was coerced; this was invective; this was denied.

“We were terrorized; we were isolated; we were gas lite; we were dehumanized; we were wounded; we were killed. Don’t let them get away with it. Don’t let them get away with it. Don’t let them get away with it.”

---- by Margaret Anna Alice.

The world now knows, thanks to 46 Pages FOIA’ed emails between CDC managers, Dr. Fauci, Dr. Collins, and White House, NIH, HHS, that they all knew about vaccine-induced myocarditis and thrombotic thrombocytopenia in early 2021, despite that over 80% of the emails were redacted [1].

Every American citizen must be given access to this complete set of unredacted communications, and the guilty must be prosecuted in a special court arranged by the victims’ families.

We are still in the midst of the greatest worldwide psychological operation (Psy-Op) in the history of man. Not that long ago we were hunter-gatherers where family, purpose, cooperation and community where paramount to survival. We were never wired to withstand the level of psychological manipulation we have been experiencing the purpose of which was to invert reality so we could easily be led to slaughter. It has split our realities, and now we have two separate realities co-existing in the same space-time. The splitting of these two realities is inevitable, the only question is how will it happen.

It takes about 2 years, on average, for citizens in the United States of America (USA) to recognize they are being poisoned, for captured regulatory agencies to make some token inadequate attempt to fix the problem.

Now, who captured most of these agencies that are meant to regulate and protect… well, the obvious answer is Big Pharma - nothing new and no big surprise. Agencies developed mercantile relationships with the very companies they were supposed to be regulating - kind of an economic Stockholm Syndrome. Pharma cares about one thing - profits, and we have let this psychopathic entity run policy in multiple countries. Yet, does someone control Big Pharma like the military? Or is it Big Pharma that is in control of the military?

Maybe they just work hand and hand, because what we saw take place in the last few years is a Globalist military run operation where everyone seemed to be controlled by a central source… “Operation Lockstep?” if you will… even though the population was kept in the dark. After all, you just don’t announce there has been a Bio-Military coup of the US Government (along with many other countries) and expect the population will be ok with that. When it came to COVID, the FDA (Federal Drug Administration) was MIA, the Centers for Disease Control (CDC) was but rubberstamping because on a practical level there was no more CDC - they became the propaganda arm of Pharma prevaricating their dark little hearts out to the public. The FDA existed in name only when it came to COVID… it was all a military operation perhaps in cooperation with China’s 5th Column war to take down the USA. The CDC actually had the Public Relations firm for Pfizer/Moderna embed themselves inside the CDC. The CDC is a regulatory agency it is not supposed to be marketing the very things they are supposed to be regulating. But then they have been doing just that for all vaccines for decades and few complained. You never have the same entity in charge of promoting, distributing (that also owns patents) on vaccines also be in charge of safety - that is a recipe for disaster.

It was an out-in-the-open fact that the NIH was funding Gain-of-Function research at the Wuhan lab [2]. In 2015, a paper was published, A SARS -like cluster of circulation bat coronaviruses shows potential for human emergence. This study clearly states that the authors conducted Gain-of-Function research on bat coronaviruses in order to make them infectious to primary human airway epithelial cells. Ralph Baric (University North Carolina) and colleague, Zhengli-Li Shi were very much engineering the CoV2 virus in Wuhan to make sure that virus was highly infectious to humans. So, literally everything that came out of Fauci’s mouth and the rest of the government was gas-lighting.

Western Civilization, was targeted for destruction and subjected to an intense propaganda campaign to create a permanent global government, but beneath the Psy-Op a spiritual war. Not being tangential here, but one can’t ignore these Macro disease issues - the spiritual sickness component of all this and expect to understand the Micro disease issues, such as how does one deal with the myocarditis the bioweapon causes. Part of this spiritual war is to destroy the experiment called the USA - a Constitutional Republic where rights were given by God. That doesn’t work for the imperialistic New World Order group. The USA was always the thorn in their side and had to be destroyed and they got very far along in doing so, too far it seems. Gates and Zuckerberg have poured in millions upon millions into the public education system in the USA but students have only been getting dumber and dumber, so one has to assume all that money was not to improve education but destroy it. You don’t want your future slaves to be educated - indoctrinated absolutely - but not educated. The dumbing down of Americans was by design.

Nature, the creative spark of life, is an anathema to this group of misanthropes who pretend they care about the environment. We are just useless eaters and bottom-feeders to them to be exploited and killed, but humanity must know the enemy to end this. If we don’t’ face this head-on then Pharma will take over the world and will make sure, for example, you can’t travel if you are over 14 and not taking a statin drug.

It was easy to lose faith in humanity when it was so obvious millions were being encouraged to illegally come to the USA (weaponized immigration) and bring one of the bio-weapons being used to destroy us from the inside. Not CoV2 but Fentanyl. Because journalists (the legacy press), was captured and carried water for these enemies and traitors, the failsafe that would have prevented all this was removed. Without the media CoV2 would have just been another flu like illness that primarily affected the elderly and those with multiple co-morbidities. Remember how the flu completely disappeared in 2020? The media truly was the virus and also made sure you didn’t know the USA was being invaded as policy - globalist United Nations policy.

Yet, the flu never disappeared it was just called COVID to juice the numbers in a case-demic extraordinaire (PCR tests cycled so high clean swabs would be positive). We actually saw our hospitals become de facto euthanasia factories inappropriately putting patients on ventilators and pumping them full of the deadly drug Remdesivir (what nurses called “Run-Your-Death-is Near”). I always wondered if all the videos of dancing nurses was their way of telling the public that hospitals were not being overwhelmed with COVID patients. But there was no science supporting the use of Remdesivir and it was well known as a deadly drug that was killing Ebola victims in a drug trial and its use was halted. But the regulatory gatekeepers were all compromised, fired or had resigned in disgust. The hospitals received a 20% payment bonus if they used the drug. A $500,000 hospital bill would generate an extra $150,000 if Remdesivir was used. Putting a patient on a ventilator earned the hospital $40,000. A lot of money to help hospitals make choices about priorities (wink, wink).

Media organizations played a central role, especially Big Tech IT companies, in stifling anything that wasn’t the approved narrative. Mainstream scientists, many leading experts in their field, working in prestigious institutions, and some medical journal editors themselves were all silenced, while others were paid off. Where was all the billions coming from to create fabricated research critical of effective early interventions such as hydroxychloroquine (HCQ) and Ivermectin? How much did the New England Journal of Medicine and Lancet get from FTX (the criminal crypto group) to publish articles so obviously flawed they would have been the cause of expulsion from any academic center that still had any integrity. FTX was critical in funding the attacks on effective early interventions with the resultant loss of life.

FTX, backed by elite investors like BlackRock (Rockefeller Foundation) and Sequoia Capital, rapidly became one of the biggest crypto exchanges in the world… laundering and stealing investor funds to bankroll the Neo-Con proxy war in Ukraine, and the Democrat party to name two pet projects. Laundering money to the “right” people, Bankman-Fried had Wall Street and the media in his pocket while he practiced effective altruism (aka deceit that makes one look like a moral leader). But it was just another Ponzi scheme that was funding favorite New World Order players. It happened right out in the open. Bankman-Fried’s mother was apparently responsible for running major voter harvesting operations in the 2020 election, so the FTX group was a critical component of a fraudulent government and its fraudulent economy. Yet, maybe FTX’s implosion was all part of a bigger scam to allow a centrally controlled digital currency to come to the fore.

Wonder why it was so important to keep the conflict in Ukraine going with no efforts at peace negotiations? Yeah, it was a money laundering operation and they never wanted it to end even if the end was an all-out nuclear holocaust. Few knew Ukraine was the playground for the dark ones - the local population didn’t know any more than USA citizens knew their country is actually the headquarters of the dark ones and that our Constitutional Republic vanished years ago. Drug trafficking, sex trade, organ harvesting, etc. all taking place in Ukraine without any interference until the Russian invasion. Just an aside… don’t invest with anyone who looks and smells like they can’t afford a bar of soap.

Pandemic/Scamdemic

Decades of pandemic preparedness protocols were trashed so a psychotic, pip-squeak, criminal mastermind could enrich himself, and his loyal following (loyal because he controlled their NIH grants). It seems, based on the FOIA documents Fauci may have been telling the CIA what to do not the other way around. We were literally in the middle of a Godfather movie, but it wasn’t Don Corleone calling the shots but dog torturer, vivisectionist, Don “I am the Science.” There was some truth to that statement though, because this one man literally was the point man for distributing $10’s of billions of dollars to academic and research institutions throughout the world, so he had almost complete control of the “science.” This was a very dark, pernicious situation, for example, if a research team finds out that it is very dangerous to inject vaccines that contain aluminum (80% of vaccines contain aluminum) that research team will be defunded and journals will be told not to print their research papers.

Eighty-six percent of the world was shut down for an infection that had a 0.035% mortality from 0 to 59 years of age, 0.095% mortality for the post 60 set [3]. If you are younger than 20 the fatality rate was 0.0003%. Clearly, this is below fatality rates from the flu and yet this was the emergency that allowed them to bypass safety studies and force/coerce people to get an experimental injections that had never been used before and lie about what they would do. They even lied about saying the “vaccine” would prevent transmission and infection and of course was safe and effective as they say all vaccines are…safe and effective became an indoctrination mantra. Most vaccines do not have adequate safety studies despite what we have all been led to believe. This was not just regulatory maleficence - this was about trashing the U.S. Constitution and murdering as many as possible in the process.

The median/mean age of death from COVID holds steady at 82 years of age. Seventy percent of the mortality in the USA were in the elderly with six or more underlying medical conditions. If it were not going to be COVID it would have been something else as they were already beyond the average life expectancy. Over the last three years no healthy child in the USA died from a CoV2 infection… not a single healthy child.

Well, we weren’t supposed to be alive to discuss any of this, but the criminal “reset” plan failed out of the starting gate because CoV2 was supposed to have killed billions and the jab was supposed to finish off as many survivors as possible. Too many people were left alive asking inconvenient questions. One of the few true responsibilities of a government is to protect the integrity of the nation’s border, but the so-called “open border” was intended to bring in a replacement population, because the rest of us were supposed to be already dead or dying.

If you can’t define the enemy you can’t defeat your enemy

One of the things that makes fleshing out these events important is medicine as we have known it will not survive - the population is losing and will soon lose completely any trust in Public Health institutions and modern medicine in general, and that trust won’t be coming back any time soon nor should it. Evidence Based Medicine (EBM) was destroyed during the last few years and public health decisions were being made on plausibility, as in how much money is it plausible to make if we force deadly injections on the public that don’t even work and lock them down?

Modern medicine decided to follow a dark agenda and became a dark influence. While COVID may have been a Hail Mary for the dying paradigm of the Bio-Military-Pharmaceutical complex to maintain control it still caused a lot of death and suffering. They will try and regroup if we don’t all wake-up. I will assume that post financial collapse the money to fund many of these shenanigans just won’t be there to fuel the murder. The lockdown fetishism imposed on us was an import from China as part of their 5^th column attack to destroy our economy, but it was also the agenda of the NWO/WEF set.

Human history has been replete with invasions, attacks, trade wars, etc. It seems like raging war on each other was chosen to be the primary operational paradigm on this planet. For the most part they were driven by the need to eat, have land to grow food, trade routes, etc. I am not assigning blame and after all it was the crucible of our modern civilization, which I have to say has not turned out so well. Today, war is machine - unending on anything and everything be it COVID, drugs, terrorism, Afghanistan - it doesn’t matter. The population is never told the real reasons for war, which is to wash money out of our hands and into the hands of this group of dark elites. So, war is never over, there is always another and it never stops.

Alexander the Great wanted to take over the world, but even he wouldn’t recognize modern war even though he was a one-man wrecking crew. Even the Roman Empire was less about cruelty, power and greed than what human kind now experiences. In the 1200s CE, the Mongol hoard pieced together the largest contagious empire the world had ever seen and unlike the plethora of wars that preceded it, this was being driven by power, cruelty, brutality without honor and greed. Energetically, Earth was being beset upon by a dark energy that was not home grown, it was only present because there were enough humans who held these negative traits for this energy to become interested in feeding off of them and the havoc they could reap. The generation of fear is key to its survival or presence on this planet - fear (the opposite of love) is the gasoline this dark force runs on.

What does any of this ancient esoterica have to do with what we are experiencing today where the USA government, the largest empire in modern times, has become vicious, incompetent, utterly corrupt and under the control of agendas pushed from elsewhere.

They know they are lying; we know they are lying; they know we know they are lying

The Southern border of the USA was in full operational control by traitors inside the USA and that control was to keep the boarder wide open and lie about it - it is a weaponized invasion. The American people didn’t understand their country had been taken over. Since it seems politicians lie and can’t stop themselves from lying, the public lost the ability to know big lies from small lies - call it some kind of desensitization but it produced an apathy that only empowered the cabal. Institutionalized lying is a major factor that enables LIERS-IN-CHIEF to carry out their illegal, immoral and criminal practices of institutionalized discrimination, retaliation, defamation, and intellectual harassment.

Deception is the modus operandi of the dark ones, which is why free speech had to be eliminated in their playbook. Puppets are never told the true reasons for doing what they are doing, only the upper tier of puppets are made privy to some of this information. For example, the CIA hitman who murdered Marylin Monroe was told she was sleeping with Castro and leaking to him things JFK had whispered to her under the sheets. Normand Hodges said he carried out 37 assassinations for the USA between 1959-1972.

Follow the Money

Jumping ahead in this story to address one of the top puppets, Peter Daszak, who is a perfect example of how this dark energy turns the like-minded into its puppets. Can you believe that a scientist funded by the U.S. government could possibly create a virus on purpose to release it and then hype up a resulting infectious disease crisis all for profit and power? Daszak’s Eco-Health Alliance was essentially a front group for a faction of the CIA.

“Daszak reiterated that, until an infectious disease crisis is very real, present, and at an emergency threshold, it is often largely ignored. To sustain the funding base beyond the crisis, he said, we need to increase public understanding of the need for MCMs (medical countermeasures) such as a pan-influenza or pan-coronavirus vaccine. A key driver is the media, and the economics follow the hype. We need to use that hype to our advantage to get to the real issues. Investors will respond if they see profit at the end of process, Daszak stated.”

The above paragraph is from page 73 of Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities Through Ongoing Public and Private-Sector Partnerships - published by the National Academy of Sciences in 2016 [4].

How did we get here?

We know so little about the true history of mankind on this planet - the great civilizations that have waxed and waned long before recorded modern history [5]. Regardless of the time or place, oligarchs of the civilizations that we do know about have been obsessed with over-population going back to at least the days of Plato (Plato [De republica, V] and Aristotle [De republica, II, vi]). While, there are some areas on the planet that have too many humans in the same space or in the wrong place, over-population itself is a myth perpetuated to help the ruling class maintain control - it is about wealth transfer. Even though most of humanity is not aware of the full extent of what has been going on, open war has been declared by those who want to repress and command with the purpose of keeping the rest of us unconscious, keep us from being inquiring beings, keep us from knowing how strong the human spirit is or exploring what we are capable of becoming. This is the emotional grid they want to impose. They want to keep us small, controlled so they can feed off of our assets and energies. They are literally deranged fools whose minds have been warped by their greed and the covenant they have made with forces that have always lied to them and continue to lie to them. This struggle is not new and is addressed in fable and parable by many of the world’s ancient texts, but this is not speculation of what has happened in the far past, this is about what is happening now and why.

Lose your Spirit and you have lost everything … Lionel Richi (singer/song writer)

It is problematic that humans think they are nothing more than evolved mammalian primates (apes). Yes, those are the bodies we use, but we are spiritual beings having a human experience, not just naked apes that aspire to be spiritual. Spirit is not the enthusiasm you have for your local high school football team. It would behoove us all to try and understand what spirit is because there have been those trying to kill you for having one. There are juicy energies and powers connected with being human - a subject humans are almost completely unaware; however, there are those who know about these hidden features of the human experience and want those energies and powers for themselves. Without belaboring the point, tyranny can only be imposed if the population believes they are nothing more than their animal bodies limited to their five senses. Tyranny runs on fear and it is much harder to scare someone who is not completely tied to what their five senses tell them reality is all about. Tyranny cannot exist where there is freedom of speech so it is really easy to tell who the “bad” guys are…they censor and don’t want freedom of speech.

Where this Timeline starts

In a timeline that starts in 1933, although the darkness got its foothold long before that, a group of bankers hatched a plot to replace U.S. President Franklin Roosevelt with someone who was more in line with these entrenched institutions and the systemic ideologies that do not want democracies to exist. These dark ones were still drunk on their success from being able to create the Federal Reserve. There was no coup d’état because their point man, retired Marine Corps General Smedley Butler, betrayed them. So, the banking cabal shifted all their attention to Germany.

That same year the Public Health Service of the USA began its infamous Tuskegee Experiment on poor black males in Alabama. An experiment that lasted 40 years, and only ended in 1972 because of a leak to the press. Under the guise of receiving free health care, the victims were watched to see what the ravages of syphilis would do to them and their families. No Nuremberg trial held, no accountability - but if you are an American apparently, it’s okay to say you were just following orders if caught and it’s all mea culpa and asking for amnesty.

The lessons of the last century have not been completely understood, and now humanity is in that awkward place where there is a reckoning with these poorly understood experiences that have been swept under the rug. However, the rug is now gone and it would behoove the world to recognize the players of our immediate past for who they really were. For example, Adolf Hitler was probably the greatest teacher of hate the 20^th century had ever seen. Intolerance was intense in the western world a century ago, and he filled the calling others had prepared for someone with this intention and influence. He had other options for his life, which he closed down early.

Bringing up Hitler or suggesting we are unduly influenced by energies we can’t perceive - many will just tune out, but that is merely a reflection of how indoctrinated we have all become. Indoctrinated by negative energies that have kept us trapped for millennia in deception, delusion, fear and wars, and part of that indoctrination was to convince us we were powerless to change any of this. Rather sad that the megalomanic leading this was again a German national, Klaus Schwab. One would have thought we were done with that part of our history.

In one sentence this is what WW II was about…Hitler, like Schwab, was merely a tool for large international corporations and banks that were funding him to implement a top-down feudal economy in Europe that would hopefully expand worldwide and reign for a 1000 years or as long as they had the slaves to feed into the system. Yet, their tool became too unstable, too unpredictable and too uncontrollable as he tried to take over the entire planet. The globalists were still able to use him as a pretext for the NATO/European Union (EU) paradigm to control Europe. Now, with both the inspiration for Hitler and much of his financial support coming from inside the USA, it was no surprise that Operation Paperclip brought so many Nazi scientists and technocrats to the USA after the kinetic war was completed (~30,000 Nazis). The American Nazis; although, they did not call themselves Nazis, brought their assets back while Hitler himself, a deletant compared to the fools who have made war against us today, was allowed to retire to South America [6].

The eugenicists in America (and to some extent England) were a great influence and inspiration to the Nazi regime and in fact it was a part of the defense used in the Nuremberg trials to justify the programs they implemented. But there were other influencers as well, and they may still be present today. The upper tier of Nazidom were deeply into the dark side of occult esoterica. The swastika itself was an ancient symbol of the universe so what the Nazi’s did was use that symbol rotating to the left or counter-clockwise - a symbol of a devolving universe, not an evolving universe shown when it rotates to the right [7].

This symbol drew in those worldwide who knew what it meant (rotating counter clockwise), which is why, for example, dead Tibetans were reported to have been found among the casualties in WW II… sorcerers perhaps enlisted to help with dark rituals. Rituals are really important to the puppets of darkness as it provides them with a sense of power. They are now flaunting some of their rituals in the open, just to name three - the weird closing Olympic ceremony in London 2012, which heralded a plague that would put many in hospital [8]. In late 2021, the rapper Travis Scott’s Astroworld performance was not only overtly satanic but murders (human sacrifices?) took place during the performance. In 2022, the overtly satanic advertisements of Balenciaga.

It would surprise many to find out just who these puppets of darkness have been and currently are. For example, Madeleine Albright, former Secretary of State, was celebrated when she passed in 2022, despite being a mass murderer. She publicly announced the sanctions that were imposed on Iraq that killed over half a million children were worth it. Research who has attended the ceremonies at Bohemian Grove (Northern California) where they worship the false deity Molech, and you may be surprised [9]. Then there is the Bilderberg/Davos group and their High Priests (that is literally what they call themselves) - a smarmier group of international corporate scum and villainy you will never find. The World Economic Forum (WEF) is just a front group for these power crazed psychopaths who draw into their circle those who are in synch with them (the Law of Attraction), and they may not all be human, which is almost a guarantee.

Consider the possibility that we are part of a universe replete with life and intelligences of all types and strips be they seen or unseen - trillions upon trillions of conscious beings to a greater or lesser degree. It is regrettable that humans are so unaware, and so misinformed about our participation in the cosmos and we are even less aware of non-humans in the affairs of our lives and our planet. Some seem to be divinely angelic; some are more like predatory parasites.

As questionable as the influence of these low vibrational “others” might be, they probably weren’t responsible for the descent of certain governments into satanic, murderous, pedophile networks used to control and manipulate those that entered the halls of power. Pedophilia is the sick glue that holds their system together. The dark ones know children, especially young children, are closer to Source and by defiling them, by being brutal and cruel one is showing God that you are a counterion - an angry counterion. Why would you want to show God you are an angry counterion? Seems counter-intuitive, but foolish humans believed the promises made to them about personal power and wealth, so for the weak minded… that apparently is all it takes, an unfortunately there are many with weak minds.

This is beyond mere corruption; world governments had been bled out from the inside by these global predators. In fact, international banks, working with Pfizer, successfully executed a planetary coup against the nation-state. Pfizer is the most criminally fined corporation in America that admitted in front of the EU that they never tested the COVID injection to see if it would stop transmission or infection. Of course now we know it doesn’t.

Understanding Biomedical Waste

Biomedical waste encompasses various materials generated during healthcare activities, including hospitals, clinics, laboratories, and research facilities. These waste materials can include sharps (needles, scalpels), pathological waste, pharmaceuticals, chemicals, and contaminated materials. It is essential to segregate and handle these wastes appropriately to minimize risks.

Hazards of Improper Biomedical Waste Management

When biomedical waste is improperly handled, it can lead to infections and diseases spreading among healthcare workers, waste handlers, and the general public. As a result, untreated biomedical waste can pollute water, soil, and air, posing long-term health hazards and environmental pollution.

Segregation and Collection

Effective waste management begins with proper segregation at the source. Healthcare facilities should implement color-coded containers for different types of waste to ensure correct segregation. This includes separate bins for sharps, infectious waste, pharmaceutical waste, and general non-hazardous waste. Trained staff should collect and transport these segregated wastes to designated storage areas.

Safe Handling and Storage

Biomedical waste should be handled with caution to minimize the risk of injuries and infections. Healthcare workers and waste handlers must utilize personal protective equipment (PPE) such as gloves, masks, and goggles while handling potentially hazardous waste. Secure and labelled storage areas with restricted access should be in place to prevent unauthorized handling and ensure proper containment.

Treatment and Disposal Methods

Biomedical waste requires appropriate treatment before final disposal to neutralize any potential hazards. Common treatment methods include incineration, autoclaving, microwaving, and chemical disinfection. The choice of treatment method depends on the type and volume of waste. After treatment, the waste can be safely disposed of in designated landfill sites or through authorized waste management services.

Training and Education

Proper biomedical waste management relies on the knowledge and commitment of healthcare professionals, waste handlers, and support staff. Regular training sessions and educational programs should be conducted to raise awareness about the importance of waste segregation, handling protocols, and safety measures. This helps ensure compliance with regulations and fosters a culture of responsible waste management.

Conclusion

Effective biomedical waste management is vital for protecting public health, minimizing environmental pollution, and ensuring the safety of healthcare workers and waste handlers. By implementing proper segregation, safe handling practices, and appropriate treatment and disposal methods, we can mitigate the risks associated with biomedical waste. It is a collective responsibility of healthcare institutions, government bodies, and individuals to prioritize and invest in comprehensive biomedical waste management systems, thereby creating a safer and healthier environment for all.

References

Monzón T., et al. “Bone grafts in oral implantology”. Rev Méd Electron [Internet] 36.4 (2014).
García M., et al. “Use of autologous bone grafts and biomaterials in patients with alveolar atrophy”. Matanzas. Rev.Med.Electron. [Internet] 41.6 (2019): 1424-1437.
Fischer T., et al. “Grafting of biological materials: synthetic bone grafts versus xenografts in maxillary sinus elevation”. Quintessence 6.1 (2018).
Bustamante CD., et al. “Tibial bone grafting in oral and maxillofacial surgery: indications and description of the technique, purpose of three cases”. Int. J. Odontostomat 15.1 (2021): 286-292.
Sanzana-L., et al. “Clinical and histological evidence of soft tissue regeneration from a porcine collagenous matrix. Case Report”. Int. j interdiscip. Dent. [Internet] 15.1 (2022): 79-83.
García C, Cabrera C and Santa P. “Autogenous dentin graft applied for residual rim preservation. Bravo Clinical Case Report”. Mexican Dental Journal 23.3 (2019): 182-191.
Díaz HI., et al. “Onlay bone grafting. Presentation of a case”. Medicevic 21.4 (2015).
Martínez A., et al. “Bone grafts and biomaterials in oral implantology. Bone grafts and bone substitutes in implant dentistry”. Advances In Odontostomatology 34.3 (2018).
Estrade DM. How to Transform Extracted Teeth into An Autologous Bone Graft in a Single Dental Appointment, The Surgical Tribune, French edition (2015).
Soung-K., et al. “In-Woong Um Autogenous teeth used for bone grafting: a comparison with traditional grafting materials”. Oral Surg Oral Med Oral Pathol Oral Radiol 117 (2014): e39-e45.
Avila-OG., et al. “Effect of alveolar ridge preservation after tooth extraction: a systematic review and meta-analysis”. Journal of Dental Research 93.10 (2014): 950-958.
Joseph YK Kana., et al. Evaluation of gingival biotype in the aesthetic zone: visual inspection vs. direct measurement 14.3 (2010): 236-243.
Botero JE and Bedoya E. “Determinants of Periodontal Diagnosis”. Rev. Clin. Implantol periodontics. Rehabil. Oral 3.2 (2010): 94-99.
Afonso P., et al. “External root resorption: a case report”. AMC [Internet] 19.4 (2015): 381-388.
García Gargallo M, Yassin García S and Bascones Martínez A. “Techniques for alveolar preservation and alveolar ridge augmentation: A review of the literature”. Av Periodon Implantol 28.2 (2016): 71-81.
Ugalde M. Classification of malocclusion in the anteroposterior, vertical and transverse planes 3 (2007): 97-109.
Romero M, Veloso C and Krupp S. “Evaluation of bone quality at dental implant sites with computed tomography”. Acta odontologica Venezolan 54.2 (2016).
Sánchez L., et al. “Use of autogenous dentin as graft material in oral surgery”. Cient. Dent 16.2 (2019): 155-160.

More scientific validation today indicates that most cancer patients have experienced some sort of trauma. Any kind of trauma, subtle or strong, average or accentuated, puts us on the path of fight and flight response. The body becomes reactive, and the body becomes a chemical factory, reacting. Such development of reaction is what we call cancer.

This has been backed by the tremendous work of a German doctor, Dr. Hamer. His belief was that when an unexpected, distressing event / trauma occurs, the biological program, called cancer is triggered.

Being sensitive to emotions and psychology, disappointments, depression, hurt, pain, suffering, resentments, and harbored hatred, all such emotional and psychological toxins and imbalances influence and impact our wellness.

The body's defense mechanism primarily goes out of hand, ungoverned, and instead of protection, it can kill, if not checked, well in time.

All kinds of such influences on us disturb our immunity, immunoglobulins, T-cells, our B-cell secretion, they disturb our digestion, process of absorption of nutrients, and elimination of toxins.

All this becomes a force multiplier effect and of course, then that develops into cysts, lumps, and knots which then keep growing, crowding the organ, and then of course begin to migrate and spread within the body.

Even while stressful life events are challenging to predict or prepare for, their potential connection to breast cancer development could give new perspectives into the disease's prevention and therapy.

Our bodies release the hormone cortisol when we are under stress. The stress hormone cortisol has been associated with an increased risk of breast cancer.

Additionally, stress can hinder our bodies' ability to combat cancerous cells. Neurotransmitters like norepinephrine are released when the body is under stress, which stimulates cancer cells.

Chronic stress exposure has been associated with adverse adjustments in the body's homeostasis. Telomere shortening caused by stress may affect cellular aging and have negative effects on health. This is how stress can cause cancer of the breast.

Controlling stress factors using a variety of self-learned coping mechanisms or seeking professional help to deal with unpleasant emotions early on should undoubtedly have a positive impact on women's health.

So drop your anxieties, dissolve your fears, let your insecurities get dwindled.

The emotional and psychological catharsis of screaming, crying, recreation, laughing, dancing, joy, reminiscing happiness, the joy of the past along with lots of rhythmic, calming, tranquilizing and regulated breaths, optimal movement and clean green nutrition, can certainly begin to heal and harmonize.

Among the medical fraternity, a famous scientist, Bruce Lipton, who has won many coveted awards, has mentioned in his popular book, The Biology of Belief, that “Your belief can change your Biology”.

Reportedly, many patients who suffered, benefitted by this understanding and simply by applying mental attitude, optimism, affirmations and faith. No wonder, Dr. Bruce Lipton has gained a lot of credibility.

Dr. Mickey Mehta says, your faith can change your physiology, breath can change your hormonology, meditation and prayers can change your emotion and psychology.

With optimism, faith and belief, begin to believe that you are whole, and healing and you will become whole and healed.

This faith elevates the mood and so turns the biochemistry, which in turn secretes happy hormones. Therefore, we can say, that Faith is happiness.

Your intentions, emotions, energy translates amavish (poison) to amruta (nectar).

Maintaining a general healthy pH balance in the body is fundamental for overall health. pH disturbances, defined as considerable deviations from the normal pH range, can have a variety of effects on the body's restoration and homeostasis. Mood conditions, emotional make up and your psychological ill effects can keep your body in the acidic zone and this can increase chances and be a cause of cancer.

This can lead to a disturbance in the circadian rhythm. The circadian rhythm is a natural, endogenous process that regulates the sleep-wake cycle and occurs approximately once every 24 hours. This internal clock is regulated by external cues like as light and darkness and is critical in regulating a variety of physiological functions such as hormone secretion, metabolism, and immunological function.

The circadian rhythm affects the release of hormones like cortisol, which regulates metabolism and the immune system. Circadian rhythm disruptions may have a direct impact on hormone balance, potentially influencing systems related to cancer development.

Maintaining a regular sleep-wake cycle, limiting light exposure at night, and adopting healthy sleep habits are all techniques that may assist sustain a healthy circadian rhythm.

The relationship between attitude, optimism, and food biochemistry involves the interaction of psychological and physiological components.

While the impact of attitude and optimism on food biochemistry is complex, there are a number of ways in which mental and emotional states can influence eating behaviour and, thus, the body's response to food.

Mind - body connection - The notion of the mind-body connection acknowledges the interaction of psychological and physiological variables.

Dr. Hamer has indicated achieving high success rates in last stage cancer patients with a form of mind - body healing.

Positive attitudes and optimism have been related to overall well-being, including enhanced mental health. A good attitude may influence healthy lifestyle choices, including eating choices, which can have a positive impact on biological processes.

Stress and cortisol level - Stress levels can be influenced by one's attitude and optimism. Chronic stress is linked to higher cortisol levels, a hormone involved in metabolism and energy management. Changes in eating patterns caused by stress may contribute to changes in blood sugar levels and metabolic processes.

Dopamine release - Dopamine is a neurotransmitter that has been linked to pleasure and reward. Dopamine release can be enhanced by positive experiences and attitudes. Food selection and eating, particularly delicious and fulfilling foods, can also cause dopamine release, altering the biochemistry of reward and satisfaction.

Emotional eating - Eating habits can be influenced by one's attitude and emotions. Some people may indulge in emotional eating, which is when they utilize food as a coping method for stress or bad feelings. Emotional eating can lead to the consumption of certain foods, which can have a variety of impacts on biochemistry, including changes in neurotransmitters and hormones.

Nutrient absorption - Chronic stress, for example, has been linked to alterations in gastrointestinal function and may impact nutrient absorption.

Inflammation and immune system - Reduced inflammation and improved immune function have been linked to positive attitude and optimism. Chronic inflammation has been linked to a variety of health problems, including metabolic abnormalities. Positive emotional states may help to balance the inflammatory response and improve overall immunological function.

Promoting longevity, immunity, and vitality can contribute to overall well-being and may play a role in prevention of cancer and other fatal diseases.

There have been a lot of studies conducted by the likes of Deepak Chopra, Baba Ramdev's Patanjali Research Foundation and findings of Sadhguru and Sri Sri Ravi Shankar Ji, Maharishi Mahesh Yogiji and other scientists of the world which includes Elizabeth Blackburn's findings on telomeres which state that good mood, faith and optimism are the causes of longevity, immunity and vitality.

Here are some broad principles that may contribute to longevity, immunity, and vitality, with a focus on cancer prevention:

Include Food For Gods - Healthy, wholesome and well balanced food supplies critical nutrients for energy, immunological function, and tissue repair.

This can be attained better with the use of plant-based foods. VEGETARIANISM is the ideal way to great health and well-being.

Consuming sattvik foods that are high in vital nutrients with a variety of seasonal and regional fruits and vegetables. These foods are high in antioxidants, vitamins, and minerals, which promote overall health and may protect against certain cancers.

It is important to be instinctive and eat only when hungry. Following the circadian rhythm and going by the cycle of eating is good for health.

The father of medicine, Hippocrates, has said, “Let thy food be thy medicine and thy medicine be thy food”.

Food can neutralize stress because food is an agent, a healing agent.

VEGETABLES cleanse you; FRUITS heal you; NUTS, SEEDS AND DRY FRUITS fortify you; and HERBS regulate you.

Arjun ni chaal, Giloy, Dashamula, Punarnava, Guggulu are the suggested and recommended herbs where a lot of research has been done for their curative properties. They have zero side effects if you take pure herbs and use them.

Adjuvants like cinnamon, nutmeg, cardamom, turmeric, black pepper, cloves and kadhas also have anti inflammatory and curative effect. They aid in repair, restoration, regeneration, revival and rejuvenation.

Weight management is important as being overweight or obese puts one at risk for a variety of malignancies. Adopting a nutritious sattvik dietary intake and engaging in regular physical activity can help with weight management.

Optimal movement therapy and postures in poetry on a regular basis with the right breathwork has been linked to a lower risk of several types of cancer.

Prioritising sleep routine and getting a good night’s sleep is ideal for balancing our unit rhythm. It determines the rhythm of our heart or it's better to say that the heartbeat determines that rhythm too.

So our unit rhythm when gets synchronised with the universal rhythm, the cosmic rhythm, our circadian rhythm remains harmonised and hormones behave well.

The most important factor for the same is rest. Rest, generally, we address it as sleep but sleep need not be restful. Sleep also is an art. It's a matter of a way of life, where you can literally breathe out, the moment the hour, the day, the days, the week, the weeks, the month, the months, the year, the years, the life and the lives lived till date. So breathing it all out and sleeping like a baby and waking up like a daisy is when maximum healing happens.

Sleep deprivation or poor sleep quality might have an impact on the immune system.

On the other hand, good sleep helps to restore other body clocks, like biological clocks, restoration, repair, rejuvenation.

Different brain neurons are activated by deep breathing, signaling the body to relax. Being stressed out and erratic, irregular breath, impacts breath management. Better breath management can neutralize stress.

Calming down, getting collected, slowing down, stopping, and stilling the mind with yoga, breath or meditation are other ways to signal body to relax.

Keeping in touch with a mental health professional for controlling stress and having a MD vaidya supervision would be beneficial as all this can aid in the creation of healthy coping strategies and a plan to lessen stress which helps in releasing endorphins, dopamine, serotonin, and oxytocin.

This life is an ocean that keeps moving, there will be high tides, there will be low tides, there will never be any steadiness. This unsteadiness causes stress.

The art of surfing this ocean is so important so that we can cope with the stress, meet the stress, re-create ourselves, and break the pattern of stress.

Being calm in the storm is an art, it's not easy, yet it can be achieved. So, we have to learn to be happy within and be fulfilled within.

Observe silence and meditation because these are the things that can bring back order. Make sure that we laugh with our friends and family, and make sure that we share a strong bond with our beloveds including parents and grandparents.

Dr Joe Dispenza has said that your mind can heal the body. The mismanagement of emotions and the hormones of stress is what begins to create their condition. That constant state of panic and stress is an imbalance that happens in our brains. It’s what causes our diseases.

If we learn how to change our thoughts, the mind can heal the body. It happens all the time — it’s called “spontaneous remission,” and even people with stage 4 cancer can be totally cured - Dr. Joe Dispenza.

When your mind and brain functions become coherent, they create an electromagnetic field for cleansing the environment, harmonising the environment and vitalizing the inner and outer environment.

Today, every leading hospital chain of the world, especially in the first world countries, have introduced lifestyle functional medicine, life coaching, integrating complementary medicine, because the findings of the last two decades and more says that all the pillars of lifestyle, which means nutrition, movement, breath, meditation, sleep, laughter, sports, outdoor environmental engagement and social engagements don’t just prevent but cure and heal all diseases.

Resistance to diseases certainly grows with recreation. So dance, music therapy, poetry, and singing are also extremely important to aid the healing process.

These are all healing quotients and they uplift, upregulate, and upscale our immunity to a big extent. So kindly restore, repair, revive, and rejuvenate using different therapies. Cancer neutralized… creativity Mickeymized!!

References

Abdullaev RYu., et al. “Dynamics of markers of carbohydrate metabolism during anti-tuberculosis therapy in patients with tuberculosis in combination with diabetes mellitus”. Tuberculosis and lung diseases 97.1 (2019): 12-17.
Belyaeva EN., et al. “Factors predisposing to the development of extensive drug resistance of Mycobacterium tuberculosis”. Medical Alliance 4 (2017): 51-56.
Brazhenko NA, Brazhenko ON and Kegticheva AV. “The influence of chronic obstructive pulmonary disease on the quality of life of patients with tuberculosis”. Tuberculosis and lung diseases 96. 5 (2018): 6-13.
Vaniev EV., et al. “Difficulties in managing a patient with pulmonary tuberculosis with multidrug resistance of the pathogen and concomitant pathology”. Tuberculosis and lung diseases 94.7 (2016): 56-60.
Vasilyeva IA., et al. “Tuberculosis combined with HIV infection in countries around the world and in the Russian Federation”. Tuberculosis and Lung Diseases 95.9 (2017): 12-25.
Vasilyeva IA., et al. “Tuberculosis in institutions of the penal system in European countries and the Russian Federation”. Tuberculosis and Lung Diseases 96.5 (2018): C6-13.
Gelberg IS., et al. “The significance of some aggravating factors factors in the development of the tuberculosis process and the effectiveness of therapy for MDR-TB”. Recipe. Appendix (2018): 230-233.
Gelberg IS., et al. “Risk factors for the development of multidrug-resistant tuberculosis”. Kursk scientific. - practical. Vestn. "Man and his health". 1 (2015): 17-22.
Gelberg IS., et al. “Multidrug-resistant tuberculosis in alcohol-abusing patients is an important problem of modern phthisiology”. Tuberculosis and lung diseases 11 (2015): 10-15.
Kolpakova TA., et al. “Medical and social characteristics and adherence to treatment of patients with multidrug-resistant tuberculosis in a hospital setting”. Medicine and education in Siberia 3 (2015): 27.
Nesterenko AV., et al. “Efficiency of treatment of tuberculosis in pregnant women in comparison with patients with tuberculosis without pregnancy”. Tuberculosis and Lung Diseases 96.11 (2018): 52-59.
Nikolayan LT and Harutyunyan TM. “Experience in providing anti-tuberculosis care in psychoneurological institutions of Armenia”. Tuberculosis and lung diseases 97.1 (2019): 60.
Provotorova SV., et al. “Incidence of socially dangerous diseases of convicts held in correctional institutions of the penitentiary system of the Lipetsk region”. Tuberculosis and lung diseases 97.8 (2019): 14-21.
Shafer YuA and Gelberg IS. “Results of treatment of patients with pulmonary tuberculosis discharged from the hospital with destruction of lung tissue”. Yu.A. Shafer, I.S. Gelberg. Introduction of new approaches in the fight against M/XDR-TB in Belarus”: materials of the International Scientific Research. practical conf. Minsk, November 13-14, 2014. Republican Scientific and Practical Center “Pulmonology and Phthisiology”; edited by G.L. Gurevich [and others] (2014): 127-129.

Objective: To determine the role of aggravating factors in the development of destructive pulmonary tuberculosis and to develop a model for predicting the probability of closure of decay cavities in patients with destructive forms of pulmonary tuberculosis.

A prospective study was conducted cohort study. Patients admitted to the hospital of the Grodno Regional Clinical Center “Phthisiology”, as well as to the Republican Tuberculosis Hospital “Novoelnya” were examined. Depending on the prevailing aggravating factor, patients are divided into 10 groups. In addition, 2 more groups of patients with XDR MBT were formed. The results obtained indicate a significant negative impact of aggravating factors on the formation of destructive processes in the lungs. Patients with TB accompanied by diabetes mellitus, ADS, CNRD, patients arriving from places of detention and with the presence of several factors simultaneously should be considered more significant for this factor.

The results obtained indicate that the frequency of formation of destructive forms of tuberculosis in MDR-TB depends on a number of aggravating factors. The most significant in this regard: diabetes mellitus, several factors at the same time, ADS, patients arriving from places of detention, CNRD. Factors such as contact and gastrointestinal morbidity do not have a significant impact on the formation of destruction in the lungs in MDR-TB.

In the presence of XDR-TB, the highest frequency of destructive forms is observed (over 70%), reaching 76.0% in patients with XDR-TB in combination with ADS.

In order to develop a mathematical model for predicting the probability of closure of decay cavities in patients with destructive forms of pulmonary tuberculosis, studies were carried out on 105 patients with pulmonary tuberculosis, who had different patterns of destruction of lung tissue.

As a result of the study, it was established that prognostically important signs of the likelihood of closure of decay cavities are: clinical form, number of cavities, dependence on alcohol, and timing of abacillation.

When Z ≥ -1.304, closure of the decay cavity is predicted within 6 months of chemotherapy. If Z< -1.304 - the decay cavity does not close within a given period, the risk of developing gross morphological, sometimes irreversible changes increases.

Keywords: destructive tuberculosis, risk factors for tuberculosis, multiple and extensive drug resistance of Mycobacterium tuberculosis, long-term results, prognosis

References

Adamski A. “The role of music in the process of educating children and adolescents”. In: Czubala D, Grzybek G. (eds). Around upbringing. Ed. AT H. Bielsko-Biała (2003).
Adamski A. “Movement, play, music as a factor activating the child's personality”. In: Child in the world of play Edited by M. Dymarowa. Ed. Impulse. Kraków (2004).
Adamski A. “Computer and Internet in psychological research”. In: Computer science in education and culture. Collective work under edited by Andrzej Mitas. Cieszyn (2005): 84-90.
Adamski A. “Computer and psychomotor hyperactivity”. In: Computer science in education and culture. Collective work under edited by Andrzej Mitas. Cieszyn (2005): 91-97.
Adamski A. “The role of bioelectronic processes in shaping human sensory perception and mental functions”. ed. University of Silesia. Katowice 2006. Adamski A. Psychological dimension of time and space in human ontogeny. Ed. Compal. Bielsko-Biała (2007): 127.
Adamski A. “Perception of music, its dimension in art and quantum psychology”. Ed. Compal, Bielsko-Biała (2008).
Asyngier Kozieł A. “Theater - child – education”. Pedagogical Quarterly (2003).
Baran Z. “The therapeutic function of art and the child's personality”. Education in Kindergarten 4 (1966): 189-198.
Burowska Z. In contemporary systems of music education".
Cybulska J and Piskorek. “Artistic creativity of a preschool child. Ed., School and Pedagogical”. Warsaw (1976).
Dalcroze EJ. “Rhythmics and modern art of movement”. In: (ed): Wojnar I., Education through art. Transl. A. Kruz. PWN. Warsaw (1965).
Dennison PE and Dennison GE. “Edu-Kinesthetics In- Depta”. The Seven Dimensions of Intelligence Ventura, CA: Educational Kinesiology Foundation (1990).
Dziamska D. “Education through movement”. Ed. WSiP. Warsaw (2005).
Drzewicka A. “Child and theatre”. Ed. WSiP. Życie Szkoła (2001): 10.
Fręś JA. “Theater education in high school”. Assumptions - methods - promotions. Teacher Training Center. Branch in Katowice, Katowice (1990).
Galijska E. “Diagnostic and therapeutic aspects of using music in medicine”. Polski Tygodnik Lekarski 26 (1981): 34-45.
Gniewkowski W. “Creative gymnastics”. by R. Laban. Education in Kindergarten 5 (1985): 76-83.
Hannaford C. “Clever moves that sharpen the mind”. Ed. Medic. Warsaw (1995).
Hentig H. “Introduction to the 2004 education plan”. In: Ministry for Culture, Youth and Sport Baden-W rtemberg (2004): 7-19.
Jaczewski A. “Biological and medical bases of development and upbringing”. Ed. PZWL. Warsaw (1998).
Jakubiec S. “Children's aesthetic activity in the integrated teaching system”. Ed. Impulse. Kraków (2006).
Juszczyk S. “Man in the world of electronic media - opportunities and threats”. Ed. University of Silesia in Katowice. Katowice (2000).
Klöppel R and Vliex S. “Rhythmics in education and therapy”. PWN. Warsaw (1995).
Koziełło D. “Dance and psychotherapy”. Ed. KMK. Promotions. Poznań (2002).
Kopacz M. “The influence of music therapy on reducing the level of aggression in adolescents”. Psychoterapia 4 (1997): 45
Krawicewicz E. “Educational functions of art”. In: Pedagogy. Ed: Goldewska J. PWN. Warsaw (1974).
Kuźmińska O and Popielowska H. Dance, rhythm, music. AWF Poznań, (1995).
Laban R. “Modern educational dance”. London: McDonald/Evans (1948).
Lindsay PN and Norman D. “Human information processing processes”. PWN. Warsaw (1984).
Loba-Wilgucka U. “Fun with song”. Poznań (1992).
Marszałek C. “The role of dance in child development”. Wychowanie w kindergarten 2 (1999): 105.
Michałowski S. “Art as creative inspiration during educational meetings and dialogues”. Ed. Impulse. Kraków (1996).
Morawski S. “The threefold educational function of art”. Ed. Aesthetics. Warsaw (1963).
Obuchowicz-Caban A. “Therapeutic functions of music”. Art and Education (1996): 20-23.
Nartkowska H. “Raising a hyperactive child”. Warsaw: Nasza Księgarnia (1986).
Popek S. “Creative activity of children and youth”. Ed. WSiP. Warsaw (1988).
Potacze V. “Making music in kindergarten”. Education in Kindergarten 4 (1998): 297.
Przystańńska - Kaciczak M Child and music. PWN. Warsaw (1974).
Rudziński W. Science of musical rhythm Kraków: PWM (1987): 112.
Sherborne V. “Developmental movement for children”. Cambridge: Cambridge University Press. London (1990).
Sherborne W. “Development movement for children”. PWN. Warsaw (2003).
Szafraniec S. “Between art and therapy. Search areas”. In: Child and art, support, therapy. Edited by: Mirosława Kapnik and Katarzyna Krasoń Ed. University of Silesia Katowice (2003): 103-139.
Śliwerski B and Piekarski J. “Alternative education”. New theories, research models and reforms Ed. Impuls Kraków (2000).
Śliwerski B. New contexts (for) alternative education of the 21st century, Kraków (2001).
Sloboda J. Musical mind. Cognitive psychology of the musician PWN. Warsaw (2002).
Stadnicka J. “Therapy of children with music, movement and speech”. In S and P. Warszawa: (1998).
Starosta W. “The importance of physical activity in maintaining and improving human health”. "Lider" 4 (1997): 3-13.
Steiner R. “Education without fear: Steiner's pedagogy”. Community Educational Association. Warsaw, 1992.
Suchodolski B. “On aesthetic education”PWN. Warsaw (1969).
Szuman S. “On art and aesthetic education”. PWN. Warsaw (1975).
Uchyła - Zroska J. “Art expressed in speech and song”. In: Music in education and upbringing Ed: Danel-Bobrzyk H. Ed. University of Silesia in Katowice. Katowice (1999).
Wach A. “Computer games - innocent fun or a threat?”. Media Education 1 (2000): 28-32.
Warszawski R. “How I cured my child of dyslexia”. Ed. Paragraph. Toruń (2002).
Welhan J. “Values of music and movement classes”. Education in kindergarten 2 (1999): 102.
Wojciechowska A and Bielańska A. Amerta Movement, or "Philosophy of moss" in the therapy of mentally ill people, Psychoterapia 1 (2001): 116.
Wojnar I. Theory of aesthetic education. Warsaw. Ed. "Żak" (1995).
Wołoszyn S. General consideration. Outline of pedagogy. Ed. Suchodolski B. PWN. Warsaw (1966).
Vygotsky L. Psychology of art. PWN. Warsaw. (1984).
Zawadzki R. Psychology and creativity. Ed. WSiP. Warsaw (2005).
Żebrowska M. “Developmental psychology of children and adolescents”. PW N. Warszawa (1973).

References

Lipusch N. Initial Coin Offerings - A Paradigm Shift in Funding Disruptive Innovation (2018).
Amsden R and Schweizer D. “Are Blockchain Crowdsales the New “Gold Rush”? Success Determinants of Initial Coin Offerings”. SSRN Journal (2018).
Kaal WA and Dell’Erba M. Initial Coin Offerings: Emerging Practices, Risk Factors, and Red Flags (2017).
Alshater MM., et al. “Initial Coin Offerings: A Hybrid Empirical Review”. Small Bus Econ (2023).
Bellavitis C, Fisch C and Wiklund J. “A comprehensive review of the global development of initial coin offerings (ICOs) and their regulation”. Journal of Business Venturing Insights. 15, (2021): e00213.
Li J and Mann W. “Initial Coin Offerings: Current Research and Future Directions”. In: Rau, R., Wardrop, R., and Zingales, L. (eds.) The Palgrave Handbook of Technological Finance. Springer International Publishing, Cham (2021): 369-393.
Moxotó AC, Melo MPA and Soukiazis E. Initial Coin Offering (ICO): a systematic review of the literature (2021): 4177-4186.
Sadok H, Sakka F and El Maknouzi ME. “Artificial intelligence and bank credit analysis: A review”. Cogent Economics & Finance 10.1 (2022).
Ackermann E, Bock C and Bürger R. “Democratising Entrepreneurial Finance: The Impact of Crowdfunding and Initial Coin Offerings (ICOs)”. FGF Studies in Small Business and Entrepreneurship (2020): 277-308.
Adhami S, Giudici G and Martinazzi S. “Why do businesses go crypto? An empirical analysis of initial coin offerings”. Journal of Economics and Business 100 (2018): 64-75.
Huang W, Meoli M and Vismara S. “The geography of initial coin offerings”. Small Business Economics 55 (2020): 77-102.
Amsden R and Schweizer D. “Are Blockchain Crowdsales the New “Gold Rush”? Success Determinants of Initial Coin Offerings”. SSRN Journal (2018).
Sadok H and El Maknouzi MEH. “The regulation of virtual currencies in comparative perspective: new private money or niche technological innovation?”. Journal of Money Laundering Control 24.4 (2021): 712-724.
Howell ST, Niessner M and Yermack D. Initial Coin Offerings: Financing Growth with Cryptocurrency Token Sales (2018).
Dimitropoulos G. The Law of Blockchain (2020).
El Maknouzi ME and Sadok H. “Regulation of virtual currencies in the United Arab Emirates: accounting for the emerging public/private distinction”. Development Studies Research 8.1 (2021): 346-355.
Zetzsche DA., et al. “The ICO Gold Rush: It’s a Scam, It’s a Bubble, It’s a Super Challenge for Regulators”. SSRN Journal (2017).
El Alami A, Sadok H and Elhaoud N. “Cloud computing & the organizational performance different approach of assessment”. 2015 International Conference on Cloud Technologies and Applications (CloudTech), Marrakech, Morocco (2015): 1-5.
Landau ean-P and Genais A. “Cryptocurrencies”. Ministry of Economy and Finance (2018).
Financial Stability Board: Crypto-asset markets: Potential channels for future financial stability implications (2018).
Benkhayat A, Manouar A and Sadok H. “Firm business strategy and IT strategy alignment: A proposal of a new model, 2015 Xth International Scientific and Technical Conference "Computer Sciences and Information Technologies" (CSIT), Lviv, Ukraine (2015): 172-178.
Hinman W. Digital Asset Transactions: When Howey Met Gary (Plastic), https://www.sec.gov/news/speech/speech-hinman-061418
International Monetary Fund: Global Financial Stability Report April 2018: A Bumpy Road Ahead (2018).
Demertzis M and Wolff GB. The economic potential and risks of crypto assets: is a regulatory framework needed? (2018).
Deng H., et al. The Regulation of Initial Coin Offerings in China: Problems, Prognoses and Prospects (2018).
Momtaz PP. Initial Coin Offerings. SSRN Journal (2018).
Benedetti HE and Kostovetsky L. “Digital Tulips? Returns to Investors in Initial Coin Offerings”. SSRN Journal (2018).
Liu Y and Tsyvinski A. Risks and Returns of Cryptocurrency (2018).
Sadok H. “How can inclusive growth be enabled from financial technology?”. International Journal of Business Performance Management 22 (2021): 2-3.
Mahboub H and Sadok H. Implementing enterprise digital transformation: a contribution to conceptual framework design, Nankai Business Review International 14.1 (2023): 35-50.

This was a contributing factor to the continuation of the calls that accompanied the Arab feminist struggle through multiple stages, to expand women’s and gender studies, as educational curricula and academic research multiplied in the region. The beginning was in Palestine through the Women’s Studies Program in 1994, then the program was transformed in 1988 into The institute grants a master’s degree in gender and development, and starting in 2014 it became the first institute to offer a bachelor’s-level program in women’s studies.

As a result of this first Arab experience; Several Arab universities have offered various programs offering diplomas and master's programs in women's and gender studies, and this reflects an optimistic idea about some Arab universities, and the extent of their interest in women's issues and developing them academically and scientifically.

Despite the importance of the scientific content provided by Arab academic institutions on women’s and gender studies, they continued to face challenges represented by the nature of the negative social and political environments, limited resources, inequality at the institutional or development and training levels, and security unrest in some countries.

In addition to the need for these studies to be further supported and developed on a quantitative and objective level, after the fragility of some established research centers led to the production of research dealing with women and gender, which would be accepted by governments and some influential and controlling parties in them, such as women’s rights in religion, or the influence of Enlightenment ideas on the role of women in the public sphere, or by focusing on the role of women in social protection programs, or refraining from teaching feminist movements locally and not paying attention to them as they deserve, and being content with teaching their models in the West or in the regions of Southeast Asia.

Developing Arab research centers concerned with gender studies after diagnosing the strengths and weaknesses and in a way that is consistent with women’s needs across multiple stages, especially in Arab countries that are witnessing political and social transformations, will help provide a solid scientific description of the reality and problems of Arab women, as well as provide scientific solutions, through research. Solid academic studies reflect the quality of research effort produced by both women and men.

It will also make Arab universities think tanks that provide scientific advice to decision-makers in the region to improve the situation of women in light of their priorities and needs, especially with regard to the conditions of women who are victims of armed conflicts, women (refugees and displaced women), marginalized women in the countryside and slums and non-urban areas, women who are victims of terrorism and extremism, as well as issues Related to the reality of women locally in light of the specificity of each Arab country, as well as the larger issue; The issue of cultural and societal reform and the rejection of discriminatory religious discourse.

Thus, it remains relaxed and enjoys a false cognitive peace. Therefore, there is no protection against the roaring current of thought except by taking refuge in the cognitive ruptures.

Hence, this hypothesis starts from a basic principle, which is that the moon witnesses a phased state of absence, darkness, and eclipse in its aspects, and it may extend to all its aspects during a period of its life, and just as the matter applies to modern administrative institutions, a leader may decide an organizational decision regarding an administrative issue, and that decision may be correct, but conclusively, we find that there is a dark side in that decision, so the next leader comes to remove that darkness, which may surround an aspect of communication or decision-making. Or attention to employees or incentives and rewards.

However, a rivalry may arise whose origin is undesirable organizational jealousy between the leaders who assume the leadership of the institution, based on the fact that each leader tries hard to prove his capabilities and the effectiveness of his capabilities, burning everything green and dry in order to obtain the loyalty of his employees, forgetting or ignoring the interest of the public institution under which he works and breathes in its achievements. Which may fade and the flame of its fire may be extinguished at the nearest crossroads.

The full moon hypothesis in leadership confirms that leadership based on the influence that enchants and attracts employees to work willingly with the leader and his ideas, constitutes the basis that guarantees the success and effectiveness of the administrative institution and its efficiency by keeping the leadership axes subject to criticism and doubt and a constant feeling of inadequacy and weakness, thus making the institution’s employees, especially those who are At the middle management level, they live in a state of brainstorming and constant thinking about solving emerging problems that the human will cannot restrain.

But good management, management, and work within the state of group dynamics may help in achieving the desired goals within a leadership characterized by the perfection of its axes, the quality of its performance, and the implementation of its tasks and duties to the fullest extent.

I go back to saying that the full moon hypothesis in leadership is suitable to be extended to the rest of the things through which we live, so that this hypothesis does not remain limited only to administrative institutions, but rather extends to include the individual, the family, and society as a whole, so as to ensure a state of creative interaction between its components.

Many pharmaceutical interventions do more than advertised. For example, one can’t wean cold-turkey off of SSRI’s even when substituting a serotonin analog, such as saffron, because SSRI’s do more than what they claim to do - they do far more than just inhibit serotonin reuptake. SSRIs such as Prozac, seem to hijack dopamine receptors to name one [3].

While the public is/was told mRNA is ephemeral in the body, a truth, what was not told was billions were being injected not with mRNA but modRNA, which is not ephemeral and it is no secret that it is programmed to make more than just the spike protein as per Pfizer’s own documentation:

“Self-amplifying mRNA (saRNA): saRNA is a platform that uses a much larger molecule because not only does it encode the antigen of interest, but four additional proteins. These extra proteins allow the cell to make more copies of the mRNA, resulting in more protein being expressed from a smaller dose” [4].

This bears repeating... these injections do not deliver natural mRNA but a modified version with extended stability which causes the cells of the body to produce unnatural proteins in addition to the spike protein but the true purpose of these proteins and what they are creating is unknown and on a practical level their presence is undisclosed. Be that as it may, the injection is clearly a gene-therapy and should have been labeled and regulated as such.

In the spring of 2020, the definition of vaccine was changed from something that would reduce infection and transmission to something that would reduce hospitalization, or the severity of the disease after receiving multiple injections - that violated the CDC’s own published rules on what a vaccine is supposed to be [5]. The public was lied to by saying it was a vaccine when it was an “experimental gene-therapy“ as per Moderna and BioNTech’s own filings - at least until April of 2020. They called it a vaccine so people would take it, because vaccines are the sacred cows of conventional medicine and everyone is preprogrammed to believe they are all “safe & effective,” because an authority figure told them it was and most in the First World have been carefully conditioned to concede our common sense or discernment to authority figures.

The manufacturers could legally lie about safety because in 2018 the legal definition of an adverse event was changed to being only something the medical literature or medical consensus had previously noted was an untoward sequelae of that injection. It would not have mattered if the injection gave every recipient myocarditis if that was not previously delineated - it would not be an adverse event.

While few are aware the injections are making multiple proteins this fact is clearly spelled out by Pfizer itself. Granted Pfizer has zero to no credibility for anything they write or say, but they seem to be very transparent about revealing the injection is making “these extra proteins.” They are admitting to four additional proteins; however, there may be many more unintended, and undisclosed proteins being made. Pfizer very much wanted to keep their clinical data sealed for 75 years, so they had a lot to hide.

What are these extra proteins and what are they doing in the human body and what could go wrong? How about death?

Note the words “self-amplifying,” because one might correctly assume that these other proteins are critical to self-amplification. Is there a connection between, for example, these never-seen-before massive clots found in so many deceased jab victims and these self-amplifying bio-nano machines?

War on humanity became fully operational but not recognized as such because there were no helmets, guns, bombs or bullets. Need proof? A systematic review of autopsy findings in deaths after Covid-19 injections revealed that 73.9% of those deaths were caused by or significantly contributed to by the Covid-19 injections [6].

Perusing the Moderna patent issued in April of 2023 (US patent number 11,622,972 B2) entitled: Lipid nanoparticle compositions and methods for formulating same, you can see that that these stealth nanoparticles are chock full of plastic polymers many of which are carcinogenic and toxic Phthalates. Phthalates are most often used as plasticizers that allow plastics to be more flexible, durable and long lasting. If the COVID injection were actually a vaccine these chemicals would be (and should have been) labeled as adjuvants or excipients, and subjected to safety evaluations.

Of course, safety gets side-stepped when no one even bothers to look or evaluate for same, and this is by design. It was already known many Phthalates are toxic endocrine disrupters, and should never have been allowed in these injections without adequate safety considerations, but ipso facto…safety is not a consideration in today’s captured regulator environment. Phthalate exposure alone is responsible for 100,000 deaths in America every year with a societal cost of almost $40 billion a year [7]. Why do you think testosterone levels have been crashing to use but one example?

Hydrogels

Complex organic polymers are called Hydrogels. Hydrogel-forming natural polymers include recognizable proteins such as fibrin and collagen. The Pfizer Lipid nanoparticles [8] are the constituents of hydrogels and again the question is what is being made by these constituents?

Remember the spike protein is a pathogen. So, it is of interest that the CoV-2 spike protein S1 alone induces fibrin(ogen) resistance to fibrinolysis. So, just the massive production of the spike protein alone by the cells of the human body could be causing these massive clots being seen today in those who have experienced post-injection thrombi that the body cannot destroy [9]. We have all heard the reassurances that mRNA does not affect DNA so not to worry your genome is safe, and indeed mRNA does not affect DNA, but modRNA has a direct effect on DNA [10].

At the very least injected breastfeeding mothers and organ donors who underwent the COVID-19 injection almost certainly transfer worrisome modRNA, adenoviral DNA, spike protein, and or anti-platelet factor-4 antibodies (vaccine induced thrombotic thrombocytopenia or VITT) to their close contacts [11].

VITT are these weird elongated clots pulled from the vaccinated dead. Platelets are activated in a novel and deadly manner to create an immune complex hydrogel. This is accomplished by platelet-activating anti-platelet factor 4 (PF4) antibodies. It is still a mystery as to what sets this off. No one is accusing the spike protein, but if not the spike protein could it be one of the many additional proteins the modRNA is instructing the cells to create? Or is it the undisclosed presence of Graphene oxide (GO) known to self-assemble?

Injecting modRNA, which does not seem to degrade in many - i.e. it is not ephemeral - could have serious repercussions on over-all mortality post injection, to say the least, by the pernicious disruption of the human genome. To believe, and this is about faith not science, that biopolymer particle (BP) vaccine technology is a benign intervention ready for prime time for a whole host of potential conditions is the height of arrogance and hubris in the face of the mounting death toll in the countries most heavily Injected.

Fear is the Mind Killer

Providing some additional background context, the Gain-of-Function work that created CoV2 was funded by the United States Government and approved by Anthony Fauci. The bagman was Peter Daszak of Eco-Health Alliance, who as of this writing is still getting millions in NIH grants. Yet, the apparent deliberate release of the CoV2 virus must have been big disappointment as it was hoped it would have killed billions and the injection, called a vaccine, was only meant to do clean-up. Since CoV2 didn’t perform as hoped the roll-out of the injection had to be moderated as not to draw too much attention to the death toll or those asking too many questions given there were too many still alive to ask those questions, so certain batches were not as problematic as others. Never evaluated to see if it would stop transmission or infection, because that was never the intention of the jab - the intention was democide. One need look no further than Canada to prove that point - those with vaccine injuries are being offered free euthanasia. Now, we all know the jab neither stopped transmission nor infection. The mass indiscriminate use of the modRNA vaccine was catastrophic but then wasn’t it meant to be?

It was also imperative any options for early treatment be extinguished lest that interfere with the injection roll-out, so hydroxychloroquine and ivermectin were demonized, while hospitals were being incentivized to literally murder COVID patients by intubation and the use of the ineffective and deadly drug Remdesivir. Unsupportable medical protocols were strictly enforced. Admitting a patient and labeling them a COVID patient was worth $11K to the hospital, $39K if they were intubated. Using Remdesivir and Versed as the only pharmaceutical protocol gave hospitals a 10 percent bonus on the total bill, so by using Remdesivir a typical $500K hospital bill would garner an extra $150K for the hospital. That is why all other treatments were forbidden.

Truly, this was probably the single greatest crime against humanity in the modern history of mankind. The world was told what they were going to do in 2015, but the world was asleep. At the end of February 2024, Russia submitted a 2,000-page report to the United Nations documenting the bio-security deep state and pharma manufactured the COVID event naming influential figures within the US political landscape who orchestrated the Covid-19 pandemic as part of a global domination strategy. Among those named as participants in this scheme are Hillary Clinton, Barack Obama, Joe Biden, and George Soros, implying their involvement in a conspiracy against humanity. This is really the overlooked big picture, there were a colluding set of conspirators both in industry and in the public sector that orchestrated the plandemic, and well planned it was. No one was allowed to question anything because it had been decided everyone would get the injection.

These individuals must be exposed lest they take matters into their own hands to hide their crimes in the chaos they are still very much capable of creating. For example, thousands of foreign military or para-military combatants were brought through the open boarder into the United States just waiting for the word to activate and pillage, rape and destroy United States citizens inside their own country. Then again, it could just be that new and improved infectious bio-weapon Bill Gates seems to be so anxious to unleash. The crime was not committed solely by Big Pharma, they were just the arms dealers - the crime is what allowed them to be arms dealers - this ongoing war on humanity itself - that is the crime. This is beyond the scope of this perspective but the elites want a return to feudalism with a vastly reduced planetary population -an 80 to 90 percent reduction. These individuals are detached from reality, but have never suffered the consequences.

The first patent [12] on CoV2 was back in 2002, but in 2019 Moderna filed four patents that had previously been rejected, “Because of concern for the reemergence or a deliberate release of the SARS coronavirus, vaccine development was initiated.” That is only something you say because you know what the plan is - no different than when Fauci announced in 2017 that Trump would face a surprise infectious disease outbreak...surprise? If anyone announced their local bank would experience a surprise robbery don’t you think that person would be a prime suspect?

In the fall of 2019, the WHO announced it would conduct a worldwide exercise to be ready for the release of a “rapidly spreading pandemic due to a lethal respiratory virus…which would impose additional preparedness requirements”. The “criminals” announced in advance what they were going to do and no one seemed to care but for literally a handful of individuals that were dismissed as conspiracy theorists. Did the lethal respiratory virus exercise also include distributing the virus to multiple locations around the world? Because it is clear this infection did not come from a wet-market in December of 2019. CoV2 circulating for months before that. Release implies intention and distribution; it does not imply an accident of happenstance. One could infer the WHO was actually involved in its release and the so-called exercise may have been far more than just an exercise.

Then came the diabolically dishonest cover-up. The distrust in government and public health edicts has grown exponentially as a result. More dangerous than CoV2 was the shutdown of free-speech, and of course self-righteous politicians and technocrats who knew nothing about the actual science were eager to censor, terminate, or delicense anyone who didn’t agree with the narrative they were pushing. The government used proxies to silence those asking inconvenient questions or had information that would expose the narrative. The FBI and DHS were meeting weekly with the high-tech platforms to make sure those platforms took down or suppressed information they disagreed with. Meanwhile, “I am the Science” Anthony Fauci’s emails from January 2020 showed he was well aware the NIH was funding Gain-of-Function research in Wuhan; nevertheless, the public was told the opposite (the least of his crimes). It is doubtful he will ever be prosecuted for anything, because in the United States there is now a two-tier system of justice where what is called lawfare is used to minimize anyone who threatens the elite’s plan for world dominance. If this is allowed to continue the judicial system in the United States will collapse and take the rest of the country with it.

Physicians could have stopped this tragedy but in the United States 85 percent of physicians work for institutions and those that knew better still feared more about their employment than doing the right thing. This is what happens when you have the corporate practice of medicine. So, modern conventional medicine went down a very dark path created 100 years ago by the Rockefeller Foundation. There was a pernicious turn from science to scientism, which is a non-evidence-based mix of scientific dogma and magical thinking that is meant to serve those in control or wanting to be in control.

Considering the rush is on to completely bypass informed consent and aerosolize this technology [13] it is critical to understand and expose the insanity of how this democide was carried out - an understanding that has yet to happen, so its instigators are still at it and are desperate for the next wave of infectious disease genocide they have up their sleeves if for no other purpose than to cover their tracks from their crimes related to COVID.

The public has been bombarded with distractions, from UFO’s, Drag Queen Story Time, George Floyd, January 6^th, the drug and slave trade on the deliberately open southern border, DEI, men having babies, the climate change hoax, and unending wars in multiple locations. This was all orchestrated to invert reality so that the real crime would not be noticed - that a colluding set of misanthropes caused this all to happen. These conspirators knew the plandemic was coming and played their roles to make sure it took place. This information has been in the public domain now for over a decade, as per Peter Daszak’s 2015 presentation to the National Academy of Science:

“Daszak reiterated that, until an infectious disease crisis is very real, present, and at an emergency threshold, it is often largely ignored. To sustain the funding base beyond the crisis, he said, we need to increase public understanding of the need for MCMs (medical counter- measures) such as a pan-influenza or pan-coronavirus vaccine. A key driver is the media, and the economics follow the hype. We need to use that hype to our advantage to get to the real issues. Investors will respond if they see profit at the end of process, Daszak stated” [14].

But it goes back farther to 2005 when Ralph Baric gave the DARPA lecture: “Synthetic Coronaviruses. Biohacking: Biological Warfare Enabling Technologies. June 2005 Washington DC: DARPA/MITRE sponsored event”.

Why are we still debating where the virus came from?

Ralph Baric, the scientist who made the weaponized CoV2 virus, at the University of North Carolina, actually published the treatment for the bioweapon in 2010: Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture [15].

No surprise that the creator of the Gain-of-Function virus would have a countermeasure if for no other reason than his own protection. The public has been conditioned for years to accept fear-based narratives without questioning them and to surrender their own discernment for whatever the authority says is going on and what should be done. Combine that with the assault on our I.Q.’s with toxins, such as fluoridated water, pesticides, and a poor educational system to the point where we couldn’t see the information under our noses - the elites were fearless in their ability to pull off this great democide and will try again if they are not exposed.

References

Yuyang Lei., et al. “SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE 2”. Circulation Research 128 (2021): 1323-1326.
The release of CoV2 did not cause a pandemic as planned, but a criminal cabal decided to run with it nevertheless. It affected the very old with multiple co-morbidities, the obese and the medically compromised just like the flu does every year. The flu itself mysteriously vanished during this plandemic, because the cabal needed to count flu victims as COVID victims - essentially almost anyone dying of anything was counted as a COVID victim. The planning component of the plandemic was out in the open in both the medical literature and in plenary sessions, such as Event 201. The script of Event 201 (October 19, 2019) was the exact script run 3 months later in December of 2019 and later in 2020, including the lockdowns and other restrictions, which caused far more morbidity and mortality than the virus itself. No healthy child succumbed to COVID, which was almost non-existent on the continent of Africa where millions take ivermectin and hydroxychloroquine as part of their routine malaria prophylaxis or iverm ctin as part of the African Programme for Onchocerciasis Control (APOC).
Fu-Ming Zhou., et al. "Corelease of Dopamine and Serotonin from Striatal Dopamine Terminals". Publishing in Neuron 46.1 (2005): 65-74.
https://www.pfizer.com/science/innovation/mrna-technology
There was no evidence the “experimental gene-therapy” would either make one less ill or reduce hospitalizations. Further, the FDA said one would not be counted as immunized until 2 weeks after the second injection. So, one was counted as unvaccinated until 2 weeks post the second injection. One did not have an adverse event post vaccination unless the medical literature already listed that adverse event as a risk from that injection.
Hulscher N., et al. “A Systematic Review of Autopsy Findings in Deaths after COVID-19 Vaccination”. Lancet preprints SSRN.
Trasande L., et al. “Phthalates and attributable mortality: A population-based longitudinal cohort study and cost analysis”. Environmental Pollution 292.Pt A (2022): 118021.
Nonclinical Evaluation Report BNT162b2 [mRNA] COVID-19 vaccine (COMIRNATYTM) Submission No: PM-2020-05461-1-2 Sponsor: Pfizer Australia Pty Ltd (2021).
Grobbelaar LM. “SARS-CoV-2 spike protein S1 induces fibrin(ogen) resistant to fibrinolysis: implications for microclot formation in COVID-19”. Biosci Rep 41.8 (2021): BSR20210611.
Aline Marnef and Gaëlle Legube. “m6A RNA modification as a new player in R-loop regulation”. Nature Genetics 52.1 (2020): 27-28.
Halma M, Rose J and McCullough P. “Inadvertent Exposure to Pharmacologically Designed Lipid Nanoparticles Via Bodily Fluids: Biologic Plausibility and Potential Consequences”. Preprints (2024): 2024021267.
The timeline of the various patents going back two decades is well detailed in: Covid 19 and Anthony Fauci Dossier by David Martin.
Suberi A., et al. “Polymer Nanoparticles Deliver Mrna to The Lung for Mucosal Vaccination”. Science Translational Medicine 15.709 (2023): eabq0603.
From page 73 of Rapid Medical Countermeasure Response to Infectious Diseases: Enabling Sustainable Capabilities Through Ongoing Public and Private-Sector Partnerships - published by the National Academy of Sciences in (2016).
Aartjan J. “Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture”. PLoS Pathog. Nove 6.11 (2010): e1001176.

Introduction: Curcumin, is a natural polyphenol product found in turmeric, and it has primary anti-inflammatory and antioxidative properties. It modulates several molecules in the cell signal transduction pathway to exert the therapeutic benefits. It is widely used to treat multiple medical illnesses and has shown many health advantages. Bromelain, an enzyme obtained from pineapple is shown to promote tendon healing through anti-oxidant and immunosuppressive effects. This study is conducted to assess the effectiveness of Fortend, a drug consisting of MicroActive Curcumin, Epigallocatechin gallatoe Bromelina with Coenzyme Q10, Manganase and Selenium in treating Lateral Epicondylitis (LE).

Materials and Methods: This was a non-controlled, non-randomized retrospective observational clinical study. Records of all patients that were treated for LE in multiple centres between 1st April 2022 to 30th June 2023 with elbow disorders were assessed for eligibility. The inclusion criteria of the study are patients who have been diagnosed clinically to have LE through history, physical examinations and special tests and have been offered at least one course of Fortend. The exclusion criteria include patients with connective tissue disorders, previous history of surgery to the elbow, incomplete follow-up records and/ or without consent. One course of treatment consists of taking one tablet of Fortend per day for 20 days consecutively and a maximum 2 courses are offered based on clinical response. Patients were followed up at 1 month, 3 months and 6 months after initiating Fortend. The outcomes were assessed using Visual Analog Score (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: A total of 260 patients that fulfilled the inclusion and exclusion criteria were selected for the study. VAS were 6.9±1.0 at first baseline, 5.6±0.8 at 1month (p=0.03), 3.8±0.6 at 3 months (p<0.001) and 1.7±0.7 at 6 months (p<0.001). DASH scores were 57.8±3.8 at baseline, 41.5±5.8 at 1 month (p<0.001), 26.5±4.6 at 3 months (p<0.001) and 14.6±3.2 at 6 months (p<0.001).

Discussion: Fortend has anti-inflammatory and anti-oxidative properties. It is being used widely in the world to treat many medical illnesses and can be used to treat tendinopathy. This study has shown that the use of Fortend in lateral epicondylitis yields promising results with fast recovery and minimal tolerable side effects. In addition, patients also can avoid any form of injections or surgery for lateral epicondylitis which has inconsistent results.

Conclusion: Fortend is a safe and effective adjunct to conservative treatment of lateral epicondylitis to relieve pain and improving function.

Keywords: Fortend; Tennis Elbow; Anti-inflammatory; Anti-oxidative; Pain

References

Gross Tur R, Reyes Saborit A and Oris Martínez L. “Perceived quality of life and adherence to treatment in patients with end-stage chronic kidney disease”. Rev. inf. scientist 100.3 (2021): e3458.
Ojeda Ismael M., et al. “Quality of Life in Hemodialyzed Patients in the Commune of Chillán Viejo”. Rev. nefrol. dial. transpl 39.4 (2019): 242-248.
Real Delor RE., et al. “Quality of life and sarcopenia in adult patients with chronic renal failure”. Rev. Nac. (Itauguá) 14.1 (2022): 30-45.
López Pérez A., et al. “Health-related quality of life in patients with diabetic foot treated with heberprot-P”. Medical center record 17.2 (2023): 234-246.
López Catalán., et al. “Relationship between health-related quality of life and sociodemographic determinants in adults from Cuenca, Ecuador”. Economy and Politics Magazine, Epub 29 (2019): 62-84.
Dantas Jales R., et al. “Auriculotherapy in the control of anxiety and stress”. Sick global 20.62 (2021): 345-389.
Moura C de C., et al. “Quality of life and satisfaction of students with auriculotherapy in the covid-19 pandemic: a quasi-experimental study”. Rev Bras Enferm 76 (2023): e20220522.
León Martínez CA., et al. “Music therapy as a therapeutic modality that regulates emotions in pre-retirees”. Electronic Medicenter 25.1 (2021): 92-106.
Saldías Fernández M Angélica., et al. “Between physical activity and quality of life: National Health Survey”. Public health Mex 64.2 (2022): 157-168.
Rodríguez Medina DA., et al. “Is the Psychophysiological Stress-Relaxation Response the same in all Cancer Survivor Patients?”. Psychological investigation report 12.3 (2022): 86-101.
Lorca P Luz A., et al. “Functional results of a prehabilitation program in elective colorectal cancer surgery”. Rev. cir 74.3 (2022): 276-282.
Jiménez SJ, Ugas VD and Rojas DC. “Effects of a Pulmonary Rehabilitation Program with emphasis on respiratory muscle training and recreational activities in a group of patients with COPD”. Rev. chil. ill I breathed 33.2 (2017): 85-90.
Martínez GG, Guerra DE and Pérez MD. “Chronic kidney disease, some current considerations”. Multimed 24.2 (2020): 464-469.
Díaz Armas MT., et al. “Epidemiological behavior in patients with terminal chronic kidney disease in Ecuador”. CCM 22.2 (2018): 312-324.
Marín Prada MC., et al. “Mortality of chronic kidney patients of working age in Cuba”. Cuban Med Rev 60.2 (2021): e1530.

The major industrialised countries have significantly contributed to global warming with unprecedented magnitude. It is worth noting that the major polluters are; China, India, and United States of America including Brazil. These countries have many industries which emit their affluence to the atmosphere, inform of ‘black carbon dioxide and methane gases’. This has led to global warming and climate change. Melting of junks of ice in North Pole and Alaska increased the volume of water in seas and oceans of the world thus causing unprecedented floods. Again, the widespread use of fossil fuel, and episodes of wild fire has significantly damaged the environment and contributed to global warming and climate change.

The world’s energy systems are still dominated by fossil fuels. However, it is imperative that countries scale down the use of fossil fuel usage to save the planet earth. Again, carbon dioxide usage should be taken out of the power sector by phasing out coal facilities. There is a dire need to increase the uptake of renewable energy around the world. Limit global warming to 1.50C and reduce greenhouse emissions. The said countries have promised to reduce fossil fuel and industrial pollution by 25 to 30 percent by 2030. It is easier to say but are we likely to witness tangible action?

Global actors need to institute actions to limit climate change, and avoid unacceptable risks to global health. Fund initiatives for climate change and implementation public health measures to reduce number of deaths from cancer, respiratory and cardiovascular diseases that are caused by air pollution, risks from extreme weather events, infectious disease, diminishing water supplies, and food insecurity. Public health specialists have a fundamental role in leading by example, primarily by: a) Raising awareness of the health effects of climate change and the potential health co-benefits of low carbon pathways. b) Contributing to the development and implementation of measures to limit climate change and protect people in workplaces, and communities; c) Working to minimize the environmental impacts on health systems, while improving health services.

So, why have I utilized a quote in relation to sex attributed to Marilyn Monroe? Simply, I thought it was an interesting lead in discussing the natural facets of sexual health; nonetheless, a topic which can be an uncomfortable conversation, for many.

From a clinical standpoint, sexual health is a crucial part of our physical, emotional, and mental well-being. The balance of hormones, the physical state of our bodies, and the clarity of our minds collectively support our sexual health. Though in contrast, it is important to be educated on how the impact of a poor diet, lack of exercise, sleep deprivation, stress, environmental factors, toxins, and hormonal imbalances can negatively impact our sexual health.

First, it is crucial to maintain a healthy lifestyle to support sexual function. Eating healthy foods and fueling your body with the nutrients it needs will improve your overall well-being. It is also important to exercise regularly. Aerobic exercises increase blood flow to the genitals, which can, in turn, increase libido for women and improve erectile function for men. Cardio exercise also helps reduce stress and anxiety, both of which are major libido killers.

According to the National Institutes of Health (NIH), obesity and inactivity have led to an increasing number of individuals with sexual dysfunctions (43% of women; 31% of men). Based on research, even insignificant amounts of exercise can drastically improve sexual functioning.

Second, stress can easily be a libido killer. Whether it be difficult family matters, work deadlines or bills, your body undergoes a series of changes when stressed. Commonly known as ‘fight or flight’ responses, stress can increase your heart and breathing rate, blood pressure, and decrease non-essential bodily functions, like your sex drive.

According to VeryWellMind.com, stress management techniques can include:

Aromatherapy, to promote a sense of relaxation.
Meditation can have a wide range of physical and mental benefits including stress reduction.
Guided Imagery, which is a relaxation technique using your imagination to help lower stress, pain, or other negative feelings. The most basic technique is to close your eyes and imagine being in a place that is relaxing.
Journaling, to express your thoughts and feelings. This has proven benefits in managing stress and coping with mental health conditions.
Progressive muscle relaxation, which helps reduce muscle tension and general mental anxiety.

Other health related initiatives to focus on are to attain sleep, stay hydrated and obtain the appropriate vitamins, minerals, and varying nutrients. Personally, I like to walk outside to acquire sunlight for a natural source of Vitamin D. I make sure I incorporate foods rich in Vitamin C like strawberries, tomatoes, and red and green peppers. I also integrate Black Cumin Seed (to help reduce inflammation, promote immunity and energy metabolism); Turmeric (to support digestion, arthritis, and allergies); Broccoli (calcium source for strong bones, fiber, and healthy metabolism); Spirulina (to improve cholesterol and triglyceride levels, reduce blood pressure, and lower fasting blood sugar levels); and Cayenne Pepper into my diet.

I take a packet of ‘RESTORE’ daily, from The ROOT Brands®, to help with inflammation and assist my body’s immune system. I also detox daily, with ‘Clean Slate,’ to support the removal of toxins, heavy metals, and environmental pollutants. It is important to note, heavy metals can affect your circulation and blood flow, hormonal balance, fertility, and oxidative stress, which can also negatively affect your sexual function.

Clearing toxins from the body can help clear the mind, which plays a crucial role in also having, and/or sustaining a healthy sex life. For more information on those specific products, check out www.therootbrands.com/purelivingroot.

Regarding hormones, overall sexual motivation is influenced by testosterone, estrogen, progesterone, oxytocin, and vasopressin, among others. Although hormonal levels fluctuate regularly, long-term imbalances can lead to a myriad of symptoms and conditions, which can negatively affect your sexual health. Hormonal imbalances can also be a sign of an underlying health condition, or a side effect of certain medications. For this reason, people who experience recurring symptoms of hormonal imbalances should speak to their primary care physician, or OB/gyn, for hormone testing.

The bottom line is, we are responsible for managing the health of our body’s ability to function at optimal levels; whether physical, mental, emotional, psychological, or sexual. Therefore, we should work to sustain as much health and longevity as possible, to live the best life we can for ourselves, our families, and our partners.

Background: Personal hygiene deficiency has been found to be a serious public health problem and people often affected are school children. These have been attributed to inadequate knowledge of personal hygiene and its practices. Personal hygiene is the science of healthy livings and embraces all those day to day activities that contribute to health and wellbeing of an individual. The diseases that arise due to deficiency of personal hygiene remain one of the major public health concerns, particularly in developing countries.

Objective: To assess the level of knowledge and practice about personal hygiene among secondary school children.

Methods: This was a Descriptive type of cross-sectional study. It was conducted from July 2023 to September 2023. Data were collected using self-administered structured questionnaire consisting of information about socio-demographic data and information about knowledge and practice about personal hygiene. The data were processed by computer and statistical analysis of data was carried out by using SPSS (Statistical Package for Social Science). A total of 115 participants participated in the study.

Result: Result showed that among 115 respondents’ majority were in class six and nine (28.7%). Most of the respondents were female (55.7%), 23.7% were 12 years old and all respondents were Muslim.97.4% knew about the relation between personal hygiene and health. Most of them 97.4% take bath every day and 100.0% brush their teeth every day. 78.3% respondents clean hair regularly and most of them 86.1% cut nails every week. Majority 75.7% respondents have the idea about use of clean clothing/undergarments/bed sheets. More than half 60.9% students do not forget to wash hand before having meal/ after defecation. Majority 85.2% respondents drink enough water daily (at least 1.5-2 liter) and most of them 99.1% have idea about the importance of pure drinking water. 93.9% respondents have regular habit of passing stool and urine. Majority 94.8% respondents have the knowledge to take enough vegetables, fruits, water regularly to avoid health problems and 77.4% knew that holding back urine can cause urinary tract infection and holding back of stool can cause constipation.

Conclusion: Personal hygiene is not an isolated behavior; instead it varies from person to person according to different factors. Intervention programs raising the awareness and importance of personal hygiene among school children through coordinated education measures by parents, teachers and media will be helpful to impart these early in life. Attention should be given for the monitoring and evaluating personal hygiene practices among children.

Keywords: Knowledge; practice; personal hygiene

Introduction

Over 1.9 million children of school age in the United States are tormented by a problem with side effects so serious that over 29% of them exit school before secondary school graduation (Ahmann et al., 2018). "Avery," a composite drawn by the specialist, is one of those understudies: Fifteen-year-old Avery, an eighth-grader at the nearby center school, is depicted as a brilliant, shrewd, disordered, hasty youngster. Kept down in kindergarten for adolescence and held in the 3rd grade to a great extent because of impulsivity, Avery is as yet attempting to defeat a standing of being wild.

Quickly flustered and having a limited ability to focus, Avery has a low disappointment resistance. His couple of companions are frequently furious with him. Different children could do without having him as a component of their helpful work-gatherings.

Each school year has been a battle for him scholastically with Avery scarcely passing, partially, because he neglects to record tasks or complete them or even to turn in tasks in the wake of completing them. Persistently baffled, frequently feeling that everybody is against him, Avery challenges his educators and invests energy consistently in the key's office for hollering out in class or for offering situationally improper remarks. Avery does not plan to disrupt the norms or to cause problems; it just consistently appears to happen to him. The drug he takes helps some yet he would rather not take it and doesn't believe that different children should be aware of it. He needs to go to secondary school one year from now, yet Avery doesn't know if he can hang on that long; furthermore, he is terrified of the change: "If I am scarcely making it in center school, how might I handle secondary school?" The reality of the situation is that Avery truly doesn't feel like he has a place or fits in at school or elsewhere.

"Avery" is a composite of understudies recognizable to this analyst. For youngsters like him, incorporating scores of thousands with ADHD, the impacts of dissatisfaction, discipline, dismissal, disappointment, and disarray over the years are combined and crushing. Research has shown that understudies determined to have ADHD are at an outrageous gamble for scholastic disappointment. The review demonstrates that understudies with ADHD are three to multiple times as possible as the normal understudy to drop out of school.

Scholastic and social disappointment for understudies with ADHD is unavoidable and total, making it extremely challenging to keep on remaining in school and register (Anastopoulos et al., 2018). Understudies with ADHD ordinarily experience difficulty with concentrating, and putting together, as well similarly as making sure to finish scholastic responsibilities. They experience difficulty with peer connections, are frequently youthful, and show a failure to sort out what to do in friendly circumstances or to alter their conduct given social criticism. Their associations with grown-ups are frequently stressed by their pugnacity and impulsivity. However, considering this large number of side effects/deterrents for scholarly achievement, an amazing 65% of the understudies with ADHD truly do figure out how to move on from secondary school and many alumni with good grades (Anastopoulos et al., 2021). The capacity to conquer weakening troubles brings up the issue: How do so many understudies with ADHD effectively complete their kindergarten through twelfth-grade insight notwithstanding the entanglements from ADHD, which frequently remember for going negative encounters at school?

While much consideration in momentum research has been dedicated to understudy dropouts in the general and minority populaces, incorporating quitters both with and without ADHD, there has been less spotlight on distinguishing those elements or conditions that urge ADHD in Students 6 understudies with ADHD to remain in school. Wolin and Wolin (1993) supported research on the effective elements in the existence of understudies, proposing specialists ought to examine people who have effectively conquered pessimistic obstructions. This is such a review. The capacity of specific understudies with ADHD to continue in school, particularly when the school climate is much of the time the most overpowering test these understudies have, seems perplexing (DuPaul et al., 2017).

The understudies' industriousness calls the inquiry: What variables urge understudies to remain in school and prevail despite the impediments introduced by the side effects of ADHD?

Problem Statement

Over 1.9 million young kids experience the ill effects of ADHD, the indications of which put them at a high gamble of exiting school. However, regardless of encountering rehashed and ongoing social dismissal and scholastic disappointment and disappointment, 1.2 million of these understudies will procure their secondary school recognition. Many of these understudies will likewise go on onto school or professional school, some proceeding with ADHD side effects and issues. A survey of the writing demonstrates that while the concentration in this space exists, insufficient is known or perceived in regards to the elements which add to scholastic accomplishment for youths and youthful grown-ups with ADHD, explicitly the impact of locus of control, adapting capacity, and grown-up help. An unmistakable comprehension of what upholds and spurs understudies with ADHD to succeed scholastically doesn't exist, nor is there an intensive comprehension of individual characteristics or of alleviating factors that cultivate the understudies' scholarly achievement (Dvorsky et al., 2017). This study looked for replies to questions in regards to medications which were seen by understudies with ADHD to be scholastically strong.

Literature Review

ADHD is an undeniably pervasive neurological condition that causes or fuels many learning, social, and enthusiastic issues for the two understudies and grown-ups. ADHD is assessed to influence 3-5% of all young youngsters, for certain examinations recommending an event pace of 10-20%.

Somewhere in the range of 1.59 and 2.1 million understudies in America have this issue, ordered to the American Psychiatric Association (Ewe, 2019). The center issues of ADHD-Impulsivity are hyperactivity, impulsivity, and absence of constancy. The center issues of ADHD-Inattention will be obliviousness and mental gradualness or drowsiness in performing perceptual-engine speed assignments. People may likewise have a combination of absentmindedness and impulsivity.

ADHD as a problem has center signs in consideration guidelines, action level regulation, and impulsivity. The key areas, which are attributes of the problem, are having extreme trouble with accomplishment in school, regardless of whether learning handicaps are available; introducing rebellion, hostility, and other solitary ways of behaving; and, dismissal by peers. Measurably, these key area highlights of ADHD place people with the problem at a basic gamble of exiting secondary school before graduation (Jansen et al., 2019). Measurements shift marginally for certain examinations showing that somewhere in the range of 35 and 40% of understudies with ADHD truly do leave school early and without a certificate. Battles looked by understudies tested by consideration deficiencies, if joined by hyperactivity, have been very much archived in late writing. This is especially obvious with what Aust (1994) alludes to as the "staggering social/passionate and instructive aftermaths of having ADHD."

Research demonstrates that one explanation ADHD kids are challenging to raise and instruct is because as little youngsters, they oftentimes display over the top (in recurrence and ADHD in Students 8 force) ways of behaving like hissy fits and tenacity. Guardians keep up with the fact that kids and young people with ADHD require significantly more observation and management than their non ADHD peers.

Youngsters with ADHD are accounted for to be m metal clumsy and to have a higher occurrence of issues, for example, inadvertent poisonings and genuine actual wounds because of their impulsivity (LaCount et al., 2018). More established kids with ADHD frequently foster attendant or existing together ways of behaving like hostility (verbal and physical), lying, insubordination, taking, delinquency, as well as expanded paces of wretchedness, uneasiness, a d lead or oppositional messes. An 8-year follow-up investigation of the scholarly results of kids analyzed as having ADHD confirmed that more than 29% had been held in somewhere around one grade, more than 39% had been suspended something like once, and more than 10% had been authoritatively ousted from school.

Learning is frequently fundamentally impacted by ADHD. 25% of youngsters determined to have ADHD have correspondence or learning handicaps. A little less than half of the understudies with ADHD show standards of conduct related to lead jumble and oppositional disobedient confusion. Different investigations show that as many kids with ADHD become older, their side effects frequently increase due, partially, to long periods of social, enthusiastic, and scholarly disappointment (Lefler et al., 2021). The appearance of youthfulness can bring new, unexpected issues. Puberty in America, even without a problem like ADHD, can be a troublesome time for both the juvenile and his/her loved ones. For most youths and their families, the young years are regularly a blend of fierce and quiet times. For youngsters tested by restraint problems, nonetheless, the violent piece of pre-adulthood, in combination with their hasty, disobedient characteristics and reduced by crap or social associations, can introduce snags that have never survived.

More than 49% of the understudies determined to have ADHD flop somewhere around one grade year in school and more than 29% of all understudies determined to have ADHD never complete secondary school. For those understudies with ADHD who in all actuality do remain in school, it is frequently challenging for them to keep up with fitting ways of behaving and to finish school tasks (Malmqvist, 2018). School is a battle for these understudies, and one of the most difficult scholastic battles for most understudies with ADHD is powerlessness or trouble with getting coordinated and remaining as such. Similarly, studies have shown that ADHD understudies naturally experience issues taking more time for their behavior, an ordinary characteristic Rotter (1966) considered an outer locus of control. Moreover, understudies with ADHD are regularly occupied and frequently proclaim remarks improperly, whether at home or in the study hall. As an outcome of these qualities, the understudies may over and over baffle or estrange instructors, peers, and guardians. These understudies, thus frequently feel that they are not upheld by educators at school.

Life at home with an ADHD relative is frequently distressing. For guardians, the subsequent strain of nurturing a kid with ADHD can bring about the conceivable reduced ability to parent suitably. This reduced limit can introduce another deterrent for the understudy and consequently present one extra region for the understudy where the backing is not accessible (McCoach et al., 2020). Steady with the family frameworks hypothesis, a family's effect on making or it is significant to support specific perspectives and ways of behaving. Guardians who are overpowered with nurturing a kid with ADHD can become focused on themselves. Unpleasant guardians are, thus, bound to deliver worried youngsters than non-stressed guardians.

This isn't to infer that everyday life is the reason for ADHD, as exploration demonstrates that ADHD is a neurological problem. Notwithstanding, in searching for factors that support scholarly accomplishment for understudies with ADHD, the examination proposes that there is a connection between a parent's capacity to adapt to pressure and the capacity of the youngster to adapt to pressure (Mochrie et al., 2020). How understudies return quickly from rehashed demoralization in the scholarly setting and how they remain focused to move on from secondary school is the focal point of this review, which inspected the understudies' scholastic progress in school from the perspective of the develops (locus of control, adapting abilities or capacities, and grown-up impacts). Information in regards to the effective variation of these understudies to distressing life conditions will add to the assemblage of information concerning deterrent intercessions for ADHD understudies as well as different understudies' incomparable high struggle classes.

Recommended Solutions

Intercession in the kindergarten or preschool years is a fundamental part of future scholastic achievement. The improvement of an interior locus of control and the development of one's adapting abilities ought to be started as soon as could be expected (Mohammad Hassani et al., 2018). Understudies endure pointlessly as a result of the absence of help by the school staff in a few regions, including how to assemble connections. In the early years, the ADHD understudy needs intercession as training for oneself about the confusion.

Such training can diminish social issues and forestall the fallout of decimating social marking which can happen. Immediate, centered mediation with the understudy with ADHD seems essential (Moore, et al., 2017).

Immediate, centered mediation seems essential as demonstrated by data from this review and others, ADHD understudies are frequently ignorant ADHD in Students 11 about the effect of their way of behaving on others and are commonly not deliberate in their activities, basically not in their initial years when intercessions can be best.

Past the need for schooling about the confusion, relational help on getting ready for the burdens that nurturing such a youngster makes is required. Guardians should be regularly reminded exactly how significant their job as a steady, predictable parent is: they need to know the crucial and basic nature of their inclusion (Pinho et al., 2019). Guardians need support about the positive future results as they battle with the consistent stress of kid raising. Guardians need

additional help from school guides in general training about ADHD and ADHD assets, as well as functional assistance with the association of the home and school plans whenever wanted.

Acknowledgement of the fundamental effect of having (and living with) somebody with ADHD is fundamental in laying out help and mediation plans.

The issue of drugs and their suitability ought to be a conversation right off the bat in the youngster's school profession. The viability of prescription is imperative. The quick and positive nature of the viability provided an opportunity to stop and ponder the potential hindrances of deferring drugs for kids with ADHD (Sacchetti et al., 2017). Prescription empowers understudies to tune in, learn, and make and keep companions. The capacity to find success in school and to associate with peers brought about an expansion in the confidence of the understudy. The deficiency of social help and individual confidence while guardians are choosing to permit drug treatment might take the kid a long time to recuperate.

Grown-ups who work with understudies, particularly key grown-ups, for example, instructors, should be intermittently helped to remember the effect of their mentality, words, and activities on the understudies. Educators and instructors who show concern and caring establish a lifetime positive connection. The individuals who do the contrary have a lifetime of adverse consequences. Educators who have had the accomplishment of empowering and creating in danger understudies, like those with ADHD, ought to be used by their school areas to share their educational procedures and study hall techniques with other school staff as a feature of a locale's ongoing proficient turn of events (Safer, 2018). Schools every day should be favorable to dynamic in the destruction of the badgering that happens at the school through prodding and verbal abuse. For understudies who don't have a sort of buffering home climate, the impacts of negative collaborations are possibly significantly really obliterating.

Grown-up experts who act negatively need mediation from their bosses. Such mediation could incorporate re-instruction, checking of execution, or thought of another call. Managers who permit experts to go on in places of power and impact youngsters ought to likewise be considered responsible for any inexcusable way of behaving (Scheithauer et al., 2017). Grown ups who are not equipped for non-emotionally diverting kids who are acting up or are oppositional ought not to be working with young people. The dependable pessimistic impacts of such a way of behaving concerning grown-ups who are paid to sustain and direct youngsters during the K-12 years is possibly disastrous.

Conclusion

The variables that help scholarly accomplishment for understudies are their characteristics of adapting and an interior locus of control, alongside an assurance to succeed which increments as they grow up (Weyandt, 2017). A few understudies encounter deficient companionship support all through their whole K-12 years. Understudies' schools do not show the ability to plan understudies for scholarly progress in their initial years. Understudies report being in homerooms with educators who deride, disparage, humiliate, alarm, push, and hammer them.

More data on ADHD is right now accessible to schools than was accessible when these ADHD in Students 13 understudies were in their rudimentary years. A review ought to be started to decide whether educators and school guides are presently better prepared to address the issues of understudies with the side effects of ADHD.

References

Ahmann E., et al. “A Descriptive Review of ADHD Coaching Research: Implications for College Students”. Journal of Postsecondary Education and Disability 31.1 (2018): 17-39.
Anastopoulos AD., et al. “Rates and patterns of comorbidity among first year college students with ADHD”. Journal of Clinical Child & Adolescent Psychology 47.2 (2018): 236-247.
Anastopoulos AD., et al. “A randomized controlled trial examining CBT for college students with ADHD”. Journal of Consulting and Clinical Psychology 89.1 (2021): 21-33.
DuPaul GJ., et al. “College students with ADHD and LD: Effects of support services on academic performance”. Learning Disabilities Research & Practice 32.4 (2017): 246-256.
Dvorsky MR and Langberg JM. “Predicting impairment in college students with ADHD: The role of executive functions”. Journal of Attention Disorders 23.13 (2019): 1624-1636.
Ewe LP. “ADHD symptoms and the teacher–student relationship: a systematic literature review”. Emotional and Behavioral Difficulties 24.2 (2019): 136-155.
Jansen D., et al. “The implementation of extended examination duration for students with ADHD in higher education”. Journal of Attention Disorders 23.14 (2019): 1746-1758.
LaCount PA., et al. “Efficacy of an organizational skills intervention for college students with ADHD symptomatology and academic difficulties”. Journal of Attention Disorders 22.4 (2018): 356-367.
Lefler EK., et al. “Unique considerations in the assessment of ADHD in college students”. Journal of clinical and experimental neuropsychology 43.4 (2021): 352-369.
Malmqvist J. “Has schooling of ADHD students reached a crossroads?”. Emotional and Behavioral Difficulties 23.4 (2018): 389-409.
McCoach DB, Siegle D and Rubenstein LD. “Pay attention to inattention: Exploring ADHD symptoms in a sample of underachieving gifted students”. Gifted Child Quarterly 64.2 (2020): 100-116.
Mochrie KD., et al. “ADHD, depression, and substance abuse risk among beginning college students”. Journal of American college health 68.1 (2020): 6-10.
Mohammadhasani N., et al. “The pedagogical agent enhances mathematics learning in ADHD students”. Education and Information Technologies 23.6 (2018): 2299-2308.
Moore DA., et al. “Educators' experiences of managing students with ADHD: a qualitative study”. Child: care, health and development 43.4 (2017): 489-498.
Pinho TD., et al. “Predictors and moderators of quality of life among college students with ADHD”. Journal of attention disorders 23.14 (2019): 1736-1745.
Sacchetti GM and Lefler EK. “ADHD symptomology and social functioning in college students”. Journal of Attention Disorders 21.12 (2017): 1009-1019.
Safer DJ. “Is ADHD really increasing in youth?”. Journal of attention disorders 22.2 (2018): 107-115.
Scheithauer MC and Kelley ML. “Self-monitoring by college students with ADHD: The impact on academic performance”. Journal of attention disorders 21.12 (2017): 1030-1039.
Weyandt LL. “An ADHD primer”. Routledge (2017).

Introduction

Adenoid hypertrophy represents an enlargement of the adenoid tissue and can be a common condition in children. While this condition is more prevalent in children, it has been reported to regress with age. Due to age related adenoid deterioration, this condition can resolve on its own; however, it can lead to serious complications. The main symptom is obstruction of the nasopharynx, which can lead to mouth breathing, snoring, and sleep apnea. Adenoid hypertrophy can also cause recurrent upper respiratory infections, sinusitis, otitis media with effusion, and hearing loss. In some cases, adenoid hypertrophy can be severe enough to cause sleep disruption, which can lead to behavioral problems and learning difficulties. Adenoid hypertrophy is usually diagnosed by clinical examination or imaging, and the treatment is the surgical removal of the adenoid gland.

The complications that emanate from the blood supply to the adenoid are very low. However, in exceptional cases where there is an obstruction of the Eustachian tube, surgery may be considered to relieve the obstruction and improve hearing. The mainstay of treatment for adenoid hypertrophy is the surgical removal of the adenoid gland (adenoidectomy). Adenoidectomy can be performed using different techniques, including cold steel dissection, bipolar electrocautery, Coblation, or laser ablation. The choice of surgical technique is dependent on the surgeon's preference and experience.

Alternative remedies apart from surgical procedures have been explored and one such is the use of natural supplements. This is a significant finding because it shows that there are alternative treatments available for adenoid hypertrophy, without the need for surgery. The use of natural supplements is effective in reducing the size of the adenoid gland and alleviating the symptoms associated with adenoid hypertrophy. The deficiency of vitamins and minerals is a common cause of adenoid hypertrophy. As a preventative measure, it is important to ensure that the diet is rich in these nutrients. Supplementation with vitamins and minerals can also help to reduce the symptoms of adenoid hypertrophy.

Case Study (full)

Background: Preliminary results showed a 4-year-old male with Primary diagnosis of hypertrophy of the adenoid gland but also signs of eczema and always long-lasting colds accompanied a lot of mucus discharge that were occurring every month. Oftentimes, he was also constipated. Parents reported he was snoring at night and that they have planned an ENT procedure (adenoid removal) in 4 months.

Method: He was put on functional medicine gut healing protocol including elimination diet and inflammation reducing supplements, also using Proprietary blend 1 drops 1 drop B.I.D. He then slowly increased within 2 months to 3 drops B.I.D.

Results: In less than a month, his skin was without any signs of eczema, and his stool was normal. He had not caught a cold in 2 months.

Legend

Proprietary blend 1: silica, vitamin c, and trace minerals.

Proprietary blend 2: N-acetyl L tyrosine, anhydrous caffeine, L theanine, velvet bean seed, pine bark, curcumin, and vitamin d.

Proprietary blend 3: black seed oil, resveratrol, turmeric, raspberry ketone, apple cider vinegar, aloe Vera, and d-ribose

A minor one was reported after 2 months, but without any episodes of snoring. Snoring is completely resolved. He had an ENT exam in 2 months, checking his adenoid status. No adverse effects were reported.

Silica

Silica is a naturally occurring substance that is found in many foods and is also available in supplement form. It is necessary for the formation of collagen and helps to keep connective tissues, such as skin, bone, and tendons, healthy. Silica is also involved in the absorption of calcium and magnesium and helps to maintain healthy bones. Silica supplements are often used to treat osteoporosis, as they can help to strengthen bones. Silica is also sometimes used as a treatment for Alzheimer's disease and dementia, as it has been shown to improve cognitive function in some people. Silica can be toxic in large doses and should not be taken in supplement form if you are pregnant or breastfeeding.

Silica, in the form of silicon dioxide, is found in many foods. Foods high in silica include oats, barley, wheat, and rice. Silica is also found in leafy green vegetables, such as spinach and kale. Silica supplements are often made from horsetail extract, which is a plant rich in silica (EFSA Panel et al., 2018). Silica supplements are available in tablet, capsule, and powder form. As a food additive, silicon dioxide (E 551) is used as an anti-caking agent and flow regulator (EFSA Panel et al., 2018). It is found in salt, spices, dried soups, soup mixes, potato chips, corn chips, and other snack foods. Silicon dioxide is also found in some chewing gums and is used as a polishing agent in some toothpaste (EFSA Panel et al., 2018). Silicon dioxide is considered to be safe when used in food and cosmetics.

The deficiency of silica in the body can lead to several health problems, such as osteoporosis, Alzheimer's disease, and dementia. Silica supplements are often used to treat these conditions. Silica can also help to improve cognitive function in some people. Nanotechnology, an emerging field of cutting-edge technology utilizes physicochemical properties of nanomaterials as a means to control their size, surface area, and shape to generate different nanoscale-sized materials. According to Park et al. (2018), nanotechnology that uses silica decorated in silver inactivates the Influenza A virus (IFV-A). In a study done by Park et al. (2018), it was found that Ag30-SiO2 particles, which are silver nanoparticles decorated on silica, were able to reduce the infection that IFV-A caused on the cells.

Evidence of Silica/Silicon Dioxide for the Prevention or Treatment of Adenoid Hypertrophy

One study by Ivkovic et al. (2004), used a dietary supplement of zeolite to test the effect on immunodeficiency in 61 patients. The zeolite, TMAZ, was given at doses of 1.2 or 3.6 grams per day for 6-8 weeks. The study found that the group supplemented with 3.6 grams of TMAZ per day had increased CD4+ and CD19+ lymphocyte counts and decreased CD56+ cell count. The group supplemented with 1.2 grams of TMAZ per day had increased CD3+ cell count and reduced CD56+ lymphocyte count. There were no adverse effects to the treatment reported in either group. This study provides evidence that zeolite, specifically TMAZ, has immunomodulatory effects in humans and could potentially be used as a treatment for adenoid hypertrophy. According to Mastinu et al. (2019) zeolite is an antioxidant and anti-inflammatory agent. It is also a detoxifying agent. These properties could be beneficial in the treatment of adenoid hypertrophy. The exact mechanisms by which zeolite works are still unknown, but further research in this area is warranted. Based on the symptoms of adenoid hypertrophy, it is reasonable to expect that TMAZ would be effective in reducing enlarged adenoids. This is because TMAZ has anti-inflammatory and immune-modulating effects, which would be beneficial in reducing the symptoms of adenoid hypertrophy. Park et al. (2018) conducted a study, which found that Ag30-SiO2 particles, which are silver nanoparticles decorated on silica, were able to reduce the septicity on Madin-Darby Canine Kidney cells by IFV-A. Furthermore, the study found that the main antiviral action of Ag30-SiO2 elements emanates from interacting with viral constituents positioned at the membranes. Consequently, Ag30-SiO2 particles result in a nonspecific damage to different IFV-A constituents and form effective techniques to inactivate IFV-A. The antiviral property of nano silica has latency to be used to develop a new treatment for adenoid hypertrophy.

Vitamin C

Vitamin C is a water-soluble vitamin and needs to be taken in through diet or supplements, as the body cannot produce it. Vitamin C is found in many fruits and vegetables, including oranges, strawberries, kiwifruit, bell peppers, broccoli, and spinach. It is also found in some meats, such as liver and chicken. Vitamin C has many functions in the body and is essential for the growing and repairing tissues. It is also an antioxidant, meaning it helps protect cells from damage. Vitamin C is involved in the production of collagen, which is a protein that helps form connective tissue, such as skin, tendons, and ligaments. It is also necessary for the absorption of iron from food.

A lack of vitamin C can cause scurvy, which is an ailment characterized by fatigue, muscle weakness, joint pain, and bleeding gums. A vitamin C deficiency can also cause anemia, as it is necessary for the absorption of iron. In severe cases, a lack of vitamin C can lead to death. Taking too much vitamin C is not typically harmful, as the body will expel any excess in the urine. However, taking very enormous doses of vitamin C (excess of 2000 mg per day) can result in diarrhea, nausea, vomiting, and stomach aches (Gao et al. 2021).

Vitamin C aids the production of some neurotransmitters, such as noradrenaline and dopamine. It is also involved in the production of cortisol, a stress hormone. Vitamin C has several functions in the body, including aiding in the absorption of iron, boosting the immune system, and acting as an antioxidant. According to a 2021 study, high doses of vitamin C improved the oxygen support position and reduced the mortality rate in patients with Coronavirus disease 2019 (Gao et al. 2021). The study included 76 patients, 46 of whom were given high doses of vitamin C, and 30 who received standard therapy. The results showed that the high-dose vitamin C group had a lower risk of mortality than the standard therapy group (HR=0.14, 95% CI, 0.03- 0.72) (Gao et al. 2021). In addition, the high-dose vitamin C group had a better oxygen support status than the standard therapy group (63.9% vs 36.1%). The study also found that there were no safety actions linked with high-dose vitamin C remedy (Gao et al. 2021). Overall, Vitamin C is available in supplement form and can be taken orally. It is also found in many topical products, such as creams and serums.

Evidence of Vitamin C for the Prevention or Treatment of Adenoid Hypertrophy

Grebe et al. (2006) conducted a study on 10 healthy, untreated patients to test the hypothesis that endothelial dysfunction in OSA is related to oxidative stress. This research found that after an intravenous injection of 0.5 g of vitamin C, vasoreactivity improved in people with OSA to a level comparable to that tested in the control subjects. These results suggest that oxidative stress is liable for the endothelial malfunction in OSA and that antioxidant techniques, like vitamin C, must be exploited for the intervention of OSA-related cardiovascular infections. Vitamin C may thus have the potential as a preventative or treatment option for adenoid hypertrophy, which can obstruct the airway and lead to OSA. The study provides an evidence base for further research into the use of vitamin C for adenoid hypertrophy.

Asfora (1977) conducted a study to determine the influence of Vitamin C in treating common colds. The study found that when patients received 6.0 g of Vitamin C daily, the length of their colds was significantly reduced. The study also found that when the treatment began within 24 hours of the first symptoms, patients often did not develop the full cold. The findings suggest that Vitamin C can be used as a preventative or treatment option for adenoid hypertrophy. The study provides an evidence base for further research into the use of Vitamin C for adenoid hypertrophy.

Kim et al. (2015) sought to determine the effect of vitamin C in the production of epidermal ceramide in keratinocytes. The research found that vitamin C does stimulate the production of epidermal ceramide. Furthermore, the study found that vitamin C also increases the activity of S1P phosphatase, which is an enzyme responsible for the hydrolysis of sphingosine-1-phosphate (S1P). This finding suggests that vitamin C may improve overall epidermal barrier function. Drawing from the study, adenoid hypertrophy may be improved with vitamin C supplementation due to the stimulation of ceramide production. Ceramide production is important for the maintenance of epidermal barrier function, and thus, vitamin C may help to improve the symptoms associated with adenoid hypertrophy.

Trace Minerals

The role of trace minerals in human health is essential, as they are involved in many biochemical processes. More than 75 trace minerals are utilized in the proprietary blend, which is often found in foods such as meats, poultry, fish, and grains. However, the body does not store these minerals; therefore, a constant daily intake is necessary. Although the body requires trace minerals in small amounts, they play a vital role in many processes including being a key component for enzymes, supporting a multitude of biochemical reactions, and normal growth and development. The most important trace minerals are iron, zinc, chromium, copper, iodine, manganese, and selenium.

Iron embodies a vital constituent of several proteins and enzymes and is necessary to form red blood cells and lean muscular components. A lack of iron can lead to anemia, which is a condition characterized by fatigue, weakness, and pale skin. Chromium is involved in insulin function and glucose metabolism. A lack of chromium can lead to increased blood sugar levels. A lack of copper leads to anemia, osteoporosis, and joint pain.

Manganese is a key component of many enzymes and possesses antioxidant remunerations for a variety of metabolic purposes. It also supports bone development and wound healing. Selenium is a critical element of many selenoproteins, which contributes to reproduction, thyroid hormone uptake, DNA synthesis, and defense from oxidative harm and septicity. A lack of selenium can lead to goiter, hypothyroidism, and Hashimoto's disease. Iodine is a key constituent of the thyroid hormone. A deficit can have harmful implications on the development of the brain and can cause cognitive impairment and mental retardation in a child.

Evidence of Trace Minerals for the Prevention or Treatment of Adenoid Hypertrophy

The role of trace minerals in human health is essential, as they are involved in many biochemical processes. Selenium (Se), zinc (Zn), and copper (Cu) are trace minerals that have antioxidant properties and contribute to the immune system. Se, Zn, and Cu levels are decreased in patients with adenoid hypertrophy. The research aimed to estimate the Se, Zn, and Cu measurements in children with adenoid hypertrophy and to investigate the relationship between these trace elements and C reactive protein (CRP), white blood cells (WBCs), and adenoid size.

60 children participated in the study, 30 healthy children (Group 1) and 30 children with adenoid hypertrophy (Group 2). The Se, Zn, and Cu levels were measured in the plasma of all participants. The adenoid size was assessed by computed tomography (CT) in Group 2. The CRP and WBC levels were measured in both groups. The mean plasma Se, Zn, and Cu levels were considerably lower in Group 2 than in Group 1. There was a positive relationship between Se and Zn (r=0.276, p=0.033). The mean adenoid size was significantly larger in Group 2 than in Group 1 (p<0.001). The CRP and WBC levels were considerably higher in Group 2 than in Group 1 (p<0.001). This study shows that Se, Zn, and Cu levels are decreased in children with adenoid hypertrophy. The use of natural supplements containing these trace minerals may help to improve the antioxidant status and reduce inflammation in these children.

Chen et al. (2013) examined the relationship between Obstructive sleep apnea (OSA) and oxidative stress in 44 subjects. The subjects were between 3 and 12 years of age and had adenoid hypertrophy. The study found that OSA was associated with increased oxidative stress. The study also found that the use of natural supplements containing antioxidants, such as Se, Zn, and Cu, could help to reduce oxidative stress and improve OSA. The findings of the study show a higher plasma concentration of Se, Zn, and Cu in the OSA group than in the control group. The adenoid size was significantly correlated with the plasma concentration of Se, Zn, and Cu. The use of natural supplements containing these trace minerals may help to improve the antioxidant status and reduce inflammation in children with adenoid hypertrophy. Thus, the use of natural supplements containing Se, Zn, and Cu may help to reduce the symptoms of adenoid hypertrophy and improve the quality of life in these children.

In conclusion, silica, vitamin C, and trace minerals show promise as a proprietary blend for the treatment of adenoid hypertrophy in a 4-year old male. While more research is needed to confirm the efficacy of this blend, the current evidence suggests that it may be an effective treatment for adenoid hypertrophy. The case study shows that not only can this alternative treatment help reduce the size of the adenoid gland, but it can also help with other conditions such as eczema and constipation.

Reference

Arıkan T., et al. “Plasma Selenium, Zinc and Copper Levels in Children with Adenoid Hypertrophy”. Turkish Journal of Clinical Biochemistry 16.3 (2018): 141-149.
Asfora J. “Vitamin C in high doses in the treatment of the common cold”. Int J Vitam Nutr Res 16 (1977): 219-234.
Chen PC., et al. “Blood trace minerals concentrations and oxidative stress in patients with obstructive sleep apnea”. The journal of nutrition, health & aging 17.8 (2013): 639-644.
EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS)., et al. “Re‐evaluation of silicon dioxide (E 551) as a food additive”. EFSA Journal 16.1 (2018): e05088.
Gao D., et al. “The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study”. Aging (Albany NY) 13.5 (2021): 7020-7034.
Geiger Z and Gupta N. Adenoid Hypertrophy (2019).
Kim KP., et al. “Vitamin C stimulates epidermal ceramide production by regulating its metabolic enzymes”. Biomolecules & Therapeutics 23.6 (2015): 525.
Mastinu A., et al. “Zeolite clinoptilolite: Therapeutic virtues of an ancient mineral”. Molecules 24.8 (2019): 1517.
Park S., et al. “Inactivation of influenza A virus via exposure to silver nanoparticle-decorated silica hybrid composites”. Environmental Science and Pollution Research 25.27 (2018): 27021-27030.

General Causes of Asthma

Although it isn't apparent why some people become asthmatic and others do not, the mix of genetic and environmental variables is likely to be the cause of this. Asthma symptoms and signs may be triggered by encounters with numerous irritants and allergens (Ahmed & Turner, 2019). Airborne irritants include pollen, dust, spores, excrement, respiratory problems, cold air, harmful emissions, and irritants like cigarette smoke, emotional reactions, anxiety, sulfites, and p-phenylenediamine. When stomach acids flow into your esophagus, it's known as gastroesophageal reflux disease.

Signs and Symptoms

Children with asthma have a wide range of symptoms. Acute asthma episodes may occur just a few times a year; they may also arise exclusively at particular periods, such as while you're exercising. Children who have asthma often have symptoms such as difficulty of breath, wheezing while exhaling, difficulty sleeping, wheezing bouts, and coughing that are worsened by a respiratory disease, such as the cold or flu. All of these are indications and symptoms of Asthma (Beasley & Asthma, 2014). Increasing demand for a quick-relief inhaler is another clue that your asthma may be becoming worse. As assessed by the peak flow meter, asthma symptoms become more frequent and severe, increasing difficulty breathing. Those with exercise-induced asthma, for example, may have more severe symptoms when the air is chilly and dry. Asthma in the workplace is brought on by exposure to airborne irritants such as chemical vapors, gasses, or dust particles (Beasley et al., 2015). Pollen, mold spores, cockroach dung, or skin and dried saliva produced by dogs are common allergens that cause asthma attacks.

Case Study Presentation

This case study is about a young female patient of seven years with asthma who were taking Ventolin and Flixotide daily and saw her condition deteriorating. A chronic inflammatory illness, asthma affects children, adolescents, and adults. More than 20 million kids have been asthmatic in the United States alone. Asthma is caused by inflammation, irritation, and narrowing of the airways that transport air into and out of the lungs. Muscles around airways constrict, and mucus production inside airways rises beyond the ordinary. The respiratory and immunological systems fail to develop properly, resulting in this condition (Bush & Saglani, 2010). Breathing heavily, coughing, breathlessness, and chest tightening are symptoms. There is no treatment for asthma; however, medicines and lifestyle adjustments may help alleviate symptoms. Asthma may be diagnosed by medical history or a physical examination. Up to one third of kids with this condition get rid of it by reaching early adulthood, despite being more common in youngsters.

Risk Factors Associated with Asthma

Environmental allergens, viral infections, air pollution, cigarette smoke, and obesity are all risk factors for asthma. Asthma may be prevented by avoiding allergies, modifying one's diet, and increasing exposure to microbes. Once identified, a doctor will devise a treatment strategy to alleviate symptoms and reduce the risk of asthma attacks (Bush et al., 2017). Short-acting beta2-agonists (SABAs) inhaled into the lungs quickly relax the tight muscles surrounding the airways because there is no cure for this disease and reduce the body's inflammatory response by controlling medicines such as corticosteroids. Although this disease can be treated with medications, novel treatments are being investigated. Asthma treatment options that don't rely only on prescription.

Literature Review of the Case Study

Dyspnea, medication dependency, and a lack of social integration are just a few asthmatic children who face problems. Human health-related quality of life (HRQL) encompasses a wide range of subjective experiences linked to a person's physical and mental well-being and their capacity to cope with illness, disability, and impairment (Dharmage et al., 2019). When developing a questionnaire, the content validity is affected by the item selection method utilized. Although some published articles may imply differently, this knowledge is still insufficient when determining children's thoughts on HRQL via the focus group technique. Asthma-specific HRQL components were identified via in-depth focus group interviews with children in elementary school, which were used to gather data for this article. Individualized HRQL instruments for pediatric asthma will be developed using the components. Individualized devices are meant to identify and offer meaningful information for the specific needs of each person (Gans & Gavrilova, 2020). Asthma-specific HRQL tools are primarily used for research and cannot yet be used in therapeutic settings.

The airways and lungs of youngsters with asthma are easily inflamed when subjected to certain stimuli, such as cold or pollen or other breathing disorders. Adults who have asthma may find it challenging to participate in sports, schoolwork, and sleep. An asthma episode in a kid with uncontrolled asthma may be life-threatening (Guilbert et al., 2014). Even though asthma in children isn't different from asthma in adults, treating it may be particularly challenging. Emergency room visits, hospitalizations, and lost school days are linked to the disease. Unfortunately, there is no treatment for childhood asthma, and it may persist until adulthood. Your child's symptoms may be controlled, and lung damage can be avoided with proper therapy. You may see your child's chest and sides constricting as they try to breathe in the most severe instances (Feng et al., 2020). A rapid heartbeat, excessive perspiration, and tightness in the chest are all possible symptoms your kid is experiencing. It is best to seek immediate medical attention for any youngster who must stop mid-sentence in hopes of catching their breath and inhaling through the abdomen.

Diagnosis of the Case Study

Your kid may need the following tests to determine the health of the lungs (spirometry). Adult-specific tests are utilized to detect asthma in children. Spirometry evaluates how fast and how considerable air they can breathe out into a child's lungs. Lung examinations may be done during relaxation, after exercise, and while consuming asthma medication. Bronchoprovocation is another lung examination. A spirometry assessment shows how your lungs respond to various stimuli, including workouts or chilly air. Test for nitric oxide exhaled (Kuiper et al., 2005). The number of nitric oxides in an expelled breath sample from your kid may be measured by your doctor if the identification of asthma is questionable following lung function testing. Whether your kid has asthma, nitric oxide testing may help you evaluate if steroid therapy is the best course of action. However, the current asthma tests aren't reliable for children under five. Your pediatrician will use the information you and your kid offer concerning symptoms if your child is under eighteen. After months or even years of watching signs, a diagnosis may not be possible.

Discussion on the Case Study

Asthma control is now the primary aim of worldwide recommendations for asthma care. Inhaled steroids are an effective treatment for most asthma patients. However, some people are still unable to get their symptoms under control despite receiving proper asthma treatments. Nearly half of asthmatic children in the United States were uncontrolled in a multicenter study. A systematic assessment should be performed when treating children with uncontrolled Asthma (Maciag & Phipatanakul, 2020). This evaluation must involve first reconfirming the appropriateness of an asthma diagnosis and then assessing for any concomitant disorders that may impact one's ability to manage asthma. An asthma diagnosis might be tricky. Your kid's doctor will consider the frequency and severity of your child's symptoms and any prior medical conditions. Investigations to rule out other diseases and determine the most probable cause of the symptoms may be required for your kid. A variety of juvenile illnesses might generate similar symptoms to asthma. To make matters more complex, these ailments are often associated with asthma. Your kid's doctor will have to figure out whether your child is experiencing the result of asthma, something unrelated to asthma, or the combined effects of asthma and something else. Children with severe asthma may benefit from using Anti-IgE, a medication that works by lowering levels of the antibody IgE in the blood (Nakagome & Nagata, 2020). The efficacy of this chemical in treating asthma has been established in several published research. To open swollen airways, quick-relief medicines are available. In the event of an asthma attack, or if your kid's doctor advises it, quick-relief drugs may be administered to provide immediate, short-term relief of symptoms. Short-acting beta-agonists are examples of quick-relief medicines. An asthma attack may be quickly alleviated using these inhaled bronchodilators—both orally and intravenously (Pijnenburg & Fleming, 2020). People living with asthma may use these drugs to reduce the inflammation of their airways. Prednisone and methylprednisolone are two examples. Because of the potential for significant side effects, these medications are only prescribed for the short-term treatment of severe asthma symptoms.

Create an asthma action plan with your child's doctor. If your kid has severe asthma, this may be a vital element of their therapy. An asthma plan of action might be a valuable tool to assist you and your kid identify when long-term medication adjustments are necessary. Acquaint yourself with the warning symptoms of an asthma attack, and know what to do if one arises. A hand-held gadget may be used by youngsters who have sufficient coordination and knowledge to test their breathing ability (Pijnenburg et al., 2015). When peak flow measures exceed a certain threshold, having an asthma action plan in writing might help you and your kid recall what to do next. For example, the action plan may employ peak flow data and symptoms to identify your kid's asthma in various levels of severity. Each of the three zones corresponds to a different management level of symptoms. At first, you may not be able to pinpoint precisely what's bothering your kid. Signs should be closely monitored, and your doctor should coordinate medication adjustments.

Treatment of Asthma

A proprietary mix of one drop was prescribed, with two in the morning and two at night. After a few weeks, she began experiencing daytime mucus flow from her nose, and her parents noticed some mucus in her feces, despite their regular consistency. She started coughing up more mucus during the night after they upped her dosage from 2 to 3 drops twice a day. For a week or two, I went through these episodes. Parents were told to reduce their daughter's medication dosage, but at the same time, her condition improved. Her feces returned to normal, free of mucus, and she began sleeping better (Rabe et al., 2004). There was no longer any wheezing noted. During the following two months, she saw an improvement in her sleep and general function, and she no longer required Ventolin. Her pulmonologist also reduced her inhalation corticosteroid dosage to the bare minimum.

The intensity of your child's asthma dictates the first course of therapy. Controlling your child's asthma symptoms such that they are minimal or non-existent is the ultimate objective of asthma therapy. To achieve these goals, people with asthma must learn to manage their symptoms and treat an asthma attack while it is still in the process while minimizing the usage of quick-relief inhalers like albuterol and dealing with minimum or no adverse effects from the drugs they are taking. Asthma medications are tailored to each kid based on their age, symptoms, asthma triggers, and what works best to keep their condition in check (Ramratnam et al., 2017). Asthma symptoms in children under the age of 3 may warrant a wait-and-see attitude by the doctor. This is because the long period influences of asthma treatment on newborns and young children are not known. A newborn or toddler with severe wheezing may be given a medicine to test if it helps alleviate their symptoms.

Swelling in your child's airways is reduced with long-term, preventative treatments. For the most part, these drugs must be taken daily. The following are examples of long-term pain management medications: Fluticasone, budesonide, beclomethasone, and other inhaled corticosteroids are examples of this class. It may take a few days to a few weeks for these drugs to fully affect your youngster. The effects of long-term usage of these drugs on children's development are modest, although they have been reported. Controlling asthma in most circumstances is more beneficial than risking adverse effects. These include zileuton and other drugs taken orally (Schneider et al., 2017). For up to 24 hours, they may help alleviate symptoms of asthma. Inhalers that combine two or more medications. Corticosteroids and long-acting beta agonists are included in these drugs. Fluticasone and salmeterol, budesonide and formoterol, and fluticasone and vilanterol are a few of the medications in this class. Asthma episodes have been connected to long-acting beta-agonists in some instances. Therefore, LABA drugs should always be administered to a youngster with a corticosteroid inhaler. Only severe cases of asthma that have not responded adequately to previous treatments should be treated with these combo inhalers.

Preventive Measures against Severe and Uncontrolled Asthma

It's essential to limit your child's contact with asthma allergens as much as possible if she has the condition. They must identify the triggers that cause you to cough, gasp, and struggle for air. There is no treatment for asthma, but there are ways to keep it under control and avoid an attack. To begin, you must determine what causes the child's asthma symptoms to flare up since specific asthma triggers may start a chain reaction of symptoms. Allergens, air pollution, and chilly air are among them (Teach et al., 2015). For many weeks, keep a journal of your child's asthma symptoms. Describe how both physical and psychological factors impact their asthma. When they have an asthma episode, go back over your journal to identify what may have caused it. Molds and cockroaches, two major asthma causes, may not be readily apparent. Consult with an asthma expert to learn about allergy testing options. Avoid them at all costs.

To avoid an asthma attack while exercising in cold, humid, or dry air, children need to take precautions. Take your asthma medication as prescribed by your physician regularly by utilizing an asthma inhaler, including albuterol, before exercising. Allergens (items you're allergic to) should be avoided if you suffer from allergies or asthma. For a short time, exposure to allergens might cause your airways to become inflamed, rendering an asthma attack more probable (Toskala & Kennedy, 2015). Ensure that you are not exposed to smoke, including cigarettes, perfume or lamps, fires, or fireworks. Stay away from public areas that allow smoking, and don't smoke in your own house or automobile! Seek assistance if you want to stop smoking. Asthma is usually worsened by smoking.

The flu virus may worsen your asthma symptoms for days or weeks, so get vaccinated every year. Asthma increases your risk of flu-related hospitalization and comorbidities, such as pneumonia. Immunotherapy (allergy injections) may avert allergy symptoms and keep asthma from worsening if your doctor detects that you have allergies (Mutius & Smits, 2020). Allergy shots are injections of allergens into the skin that a doctor gives regularly.

Conclusion

This girl's case illustrates the need for a thorough differential diagnosis before determining that asthma is the root cause. Doctors should be alerted to the potential of additional airway obstructions if their patient's asthma is not responding to therapy. Because of this, we strongly advocate the idea of verifying a patient's diagnosis before attempting more costly treatments for uncontrolled asthma. Severe asthma might be challenging to control. Several medicines are now available to assist people with this illness, and experimental drugs are constantly being developed. Understanding the alternatives available and taking into account a patient's specific circumstances is essential to managing severe asthma. Both the disease pattern and individual choice must be taken into account. Bronchial thermoplasty was chosen as a treatment option for this patient because he indicated a strong preference not to add any other drugs to his current asthma regimen. For each patient, individualized therapy demands determining which of the current or forthcoming choices the most excellent fit.

References

Results: His mom and dad, and coaches stated that he showed substantial progress in his ability to maintain attention and follow directions, as well as in his ability to complete particular school projects and remain focused during his basketball and soccer games. On days when he does not participate in sports, he will often take a proprietary mix of two capsules in the morning and a second capsule in the afternoon. He takes the Proprietary mix of two capsules without a meal and has seen a considerable improvement in his ability to concentrate as a result of the supplement.

There have been no known adverse effects.

Case Study No. 2

Patient's Gender: Male.
Twelve-year-old boy.

History: The mother states that after her son had the M.M.R. vaccination when he was one year old, he regressed and experienced a significant drop in appetite that lasted for nearly four years, as well as being hyperactive and preoccupied. In 2018, he was diagnosed with hyperactivity disorder (ADHD).

His treatment/method began at the age of twelve when he began using a Proprietary blend of 1, 5 drops B.I.D. He was diagnosed with ADHD.

Result: He claims that his "head feels clearer and less confused, that he has been trying to concentrate and focusing considerably better, that he sleeps better, and that it is easier to get out of bed in the morning" He claims that he is sleeping for longer periods of time and that he is feeling less hectic.

Follow-up is scheduled for six months.

Supporting literature

People with ADHD may struggle to pay attention and control impulsive actions (doing things without thinking about the implications) or being highly active, as shown in the two scenarios. ADHD is a chronic disorder that affects millions of children and often continues into maturity (Banaschewski et al., 2017). ADHD is characterized by a variety of long-term difficulties, such as difficulty focusing, hyperactivity, and impulsive behavior. ADHD may lead to low self-esteem, troubled relationships, and poor academic performance in children. As people get older, they may see a reduction in the symptoms. Some people fail to completely recover from their ADHD symptoms. Children, on the other hand, may learn to use successful strategies. ADHD symptoms often occur at an early age and become more noticeable whenever a child's environment changes, such as when they start school (Tong ET AL., 2020). The majority of cases are discovered between the ages of three and seven; however, they may also be discovered later in life. When ADHD is not detected as a child, it is often diagnosed in maturity. Even though the manifestations of ADHD usually improve with age, some people who were diagnosed with the illness as children continue to struggle (Tong ET AL., 2020). Additional challenges, including sleeping and anxiety problems, may be present in people with ADHD. In children, ADHD becomes the most frequently diagnosed psychiatric abnormality. It is more common in boys than in females.

Epidemiology

ADHD, as characterized by the D.S.M. standards, is among the most prevalent mental diseases in children and adolescents and has an epidemic incidence on a global scale of 5.3 percent. The implementation of the tighter ICD-10 research standards results in reduced prevalence estimations of 1-2%. As per the DSM-IV criteria, ADHD affects roughly 2.5 percent of the senior population. Among clinical populations (3-4: 1), Men have a higher incidence than women, according to epidemiological studies. An economically disadvantaged position is linked to ADHD, regardless of the fact that worldwide diagnosis rates have risen considerably in recent decades.

Rising diagnostic rates are therefore related to better diagnosis or an improvement in functional disability instead of an actual rise in incidence.

Increased motor excitement, lack of attention, and lack of impulse control are common characteristics of individuals with ADHD. The modern definition of ADHD, as described by the American Psychiatric Association's DSM-IV-TR (American Psychiatric Association 2000), is relatively recent. However, a review of historical literature indicates that youngsters exhibiting signs of attention deficit, restlessness, and recklessness have been recorded by a number of writers throughout the past 200 years (Tong ET AL., 2020). A continuing trend of inattention and hyperactivity-impulsivity that affects overall functioning or growth is characteristic of attention deficit hyperactivity disorder (ADHD). Individuals who have ADHD have a recurring tendency of the following side effects:

Inattention is defined as a person's failure to stay focused, maintain discipline, or stay on task, and it is not triggered by opposition or a lack of comprehension. Hyperactivity is characterized as a person who seems to walk around constantly, even if it is not desired, or who fidgets, bangs, or talks excessively. Adult hyperactivity might take the form of extreme restlessness or inappropriate talking.

Impulsivity is defined as a person's proclivity to act without thought or to battle with self control. Impulsivity can also be characterized as a need for immediate pleasure or an unwillingness to endure it. Somebody who is impulsive may cause problems for others or make key decisions without considering the long-term consequences.

Many healthy children are inattentive, restless, or impulsive at some time in their life (Rsov, 2019). Preschoolers are notorious for their short attention spans and inability to concentrate on a single activity for long periods of time. Even among older adolescents and teens, the number of interests influences focus and concentration. Hyperactivity works in a similar way. Youngsters are inherently lively, and they may keep going long after their guardians have worn out. Furthermore, many children are born with a greater degree of activity compared to others. Children must never be labeled as suffering from ADHD just because they are not like their classmates or siblings (Tong ET AL., 2020). Teenagers who have difficulties in the classroom but get along really perfectly when they are at home or even with their peers are most likely experiencing anything other than ADHD. This is similar for youngsters who become hyperactive or distracted at home yet still have no effect on their academics or friendships.

Symptoms

Symptom levels fluctuate throughout sectors of life and environmental stresses. In this regard, circumstances requiring focus, patience, and impulse management are frequently the earliest in which symptoms manifest (e.g., Classroom conduct, assignments, activities in the chair circle, etc.). However, substantial motor disturbance under four years is difficult to discern from normal activity. Furthermore, novelty, particular high incentive or reward anticipation, and powerful external behavioral controls might alleviate symptoms in specific instances (RÍsovÁ, 2019), but not permanently. The absence of symptoms within a constrained observational circumstance does not exclude the diagnosis. Inattentiveness increases in youngsters of elementary-age as outside pressures rise.

Inattentiveness, poor planning abilities, and impulsivity frequently linger throughout adolescence. Adults with ADHD may have more severe emotional disturbance symptoms, such as lower frustration endurance, impatience, and mood changes.

Longitudinal investigations have indicated a progressive decrease of main symptoms. G generally, roughly 5-15% of individuals meet the clinical definition for ADHD in maturity, despite 70% having chronic symptoms or impaired functioning (RÍsovÁ, 2019); however, results vary substantially between studies owing to methodological discrepancies and other factors. Comorbid illnesses may overshadow ADHD within the medical picture. Insufficiency in early infancy, parental psychopathology, intense core manifestations, and concomitant mental diseases (especially conduct problems and clinical depression) constitute risk variables for a poor course and longevity of ADHD (RÍsovÁ, 2019).

ADHD is linked to poor psychosocial functioning and perceived health-related standard of living. ADHD kids are four substantially less likely than their classmates to graduate from college and have a poorer socioeconomic level (Schug et al., 2015). Many of their engagements are tumultuous (10, 12). Their delinquency risk is increased by 2-3(Cortese, 2020). Their lifespan likelihood of suicide is fourfold greater compared to their peers; the degree of ADHD is significantly connected to the prevalence of suicidal behavior. The 50% rise in deaths among people with ADHD throughout all age categories is due to their accident-proneness, notably in motor vehicle accidents(Cortese, 2020).

It is natural for youngsters to have problems concentrating and acting at one point or another(C.D.C., 2020). Furthermore, individuals experiencing ADHD do not merely grow out of such habits. The symptoms remain, may be intense, and can create trouble in class, at home, or with colleagues.

A youngster with ADHD might.
Be daydreaming a lot.
Misplace or lose belongings a lot.
Squirm or fidget.
Speak too much (C.D.C., 2020).
Make foolish errors or take needless risks.
Have a difficult time rejecting temptation.
Having problems taking turns.

Running head: ADHD 8 ix. Having problems connecting with others.

Clinically meaningful functional psychosocial disability has to be evident in several situations, such as at home, school, or job, in order to diagnose the illness (Sears & Zierold, 2017). Such fundamental indicators are dimensionally dispersed over a continuum within the overall population, with the higher end defining medically significant ADHD symptoms.

Approximately 75% of people experiencing ADHD also have another mental condition (Forns et al., 2014), while 60% have several comorbid mental illnesses, which might impact prognosis and demand particular treatment strategies (Banaschewski et al., 2017). Anxiety illnesses, tic abnormalities, and oppositional-defiant disorder (O.D.D.) begin earlier during child development.

The onset of depression and severe behavior problems usually occurs after the completion of elementary schooling and the start of puberty. In adolescence generally these disorders are connected with drug addiction and dependency, as well as the emergence of personality problems. ADHD affects around one in 4 kids, and more than 50 % of people with ADHD experience chronic depression (Lee et al., 2018). Comorbid disorders typically develop in successive phases with age, especially when comorbid disorders are distinct risk variables for subsequent mental illness progression. As a result, the age-dependent advancement of comorbidities frequently takes place in distinctive sequential stages, especially since comorbid abnormalities are specialized risk variables for the growth of additional mental disorders.

Pathophysiology
Genetics

ADHD runs in families. ADHD becomes five to 10 times more likely among first-degree families. According to twin research, 70-80% of phenotypic variation is hereditary (Tran & Miyake, 2017), sometimes in combination with environmental influences (epigenetic alterations of gene expression owing to particular environmental circumstances) (Banaschewski et al., 2017). The remaining variation is described by non-twin environmental variables. Shared environmental impacts are secondary. The etiology of ADHD has been linked to genes producing receptors and transporters for catecholaminergic and serotonergic neurotransmitter pathways. Common variations (variations with a prevalence greater than 5%) account for about 40% of genetic diversity (Banaschewski et al., 2017) but only slightly raises the risk.

The nicotinic and glutamatergic processes, as well as genes that affect brain growth and synaptogenesis, all play a role in ADHD etiology. There are also some genetic disorders linked to ADHD symptoms, such as fragile X syndrome, microdeletion 22q11 syndrome, tuberous sclerosis, and Williams-Beuren syndrome (Tran & Miyake, 2017).

Environmental risk variables

ADHD has been linked to many environmental variables in epidemiological research. Environmental toxins (organophosphates, P.C.B.s, lead) (Banaschewski et al., 2017), adverse psychosocial settings (severe poverty, maternal hostility), and dietary variables (maternal tension, smoking or drinking in pregnancy, reduced birth weight, preterm) are among the most important (Vrijheid et al., 2016). Many of these potential environmental risk variables have yet to be proved causal: The reported relationships could be attributable to confounding elements and selection influences. Moreover, ADHD may cause greater exposure to particular environmental elements. Multiple research has demonstrated that unfavorable mother-child relationships may generate (but not create) early childhood ADHD abnormalities and that maternal aggression adversely impacts symptoms later in life (Banaschewski et al., 2017). Contrary to popular belief, confounding variables do not account for the ADHD-related relationships with lower birth weights, preterm, and lead exposure (Vrijheid et al., 2016). Confounding elements appear to play a role in the relationships between ADHD and early exposure of the mother to stress and cigarettes. On the other hand, the causal significance of severe early childhood impoverishment has been demonstrated.

Neuropsychology

Research has demonstrated that various neuropsychological deficits in executive (inhibitory regulation, cognitive skills, planning abilities) and non-executive functions (stimulation and arousal modulation (Banaschewski et al., 2017), temporal processing, remembering, and reaction-time variation) in group comparisons. A sensitivity to postponed rewards, as well as impaired behavioral regulation and error encoding systems, influence motivational systems and learning procedures. Behavioral regulation and error processing systems are also decreased. Due to the small impact sizes, such abnormalities and their pattern are also shared with healthy control participants (Pellow et al., 2011). Only around 50% of ADHD sufferers have neuropsychological damage. It is still unclear if the related anomalies are causative or merely epi-phenomenal to the etiological pathways.

Anomalies in the structural and functioning of the brain

Gray matter is destroyed excessively, leading to a 3-5% loss in total brain volume. The development of the cortical regions, especially the prefrontal regions, is retarded. The gray matter is harmed more than the white matter. Prefrontal, basal ganglia, and cerebellar volume decreases correlate with the intensity of ADHD manifestations. Prefrontal development is slowed. The severity of these anomalies varies by brain area and client type. ADHD symptoms persisting into maturity correlates with such neuroanatomical defects. Within the prefrontal cortical regions the anterior cingulate gyrus, plus related parietal, striatal, as well as cerebellar regions, functional M.R.I. indicates hypoactive activity trends (Pellow et al., 2011).

Diagnostic evaluation

The diagnosis of ADHD involves a multi-step process. There is no singular examination to diagnose ADHD, and the symptoms of anxiety, depression, sleeplessness, and learning problems overlap with those of ADHD (Felt et al.,2014). A medical checkup, including ear and eyesight exams, is one stage in the process. When diagnosing ADHD, parents, teachers, and occasionally the kid is asked about their child's background.

One of the most important aspects of the diagnostic examination is the complete developmental and familial background (Pellow et al., 2011). Children and adolescents have their present medical manifestations and severity evaluated by their parents or even other people who connect with them. Observations from diverse sources should always be examined. In maturity, the individual becomes the major source of information, while data from relatives or other parties (e.g., school records) might be valuable (Pellow et al., 2011). Organized or semi structured conversations and checklists may help clinicians make clinical judgments, while disorder-specific questionnaires can help patients understand how teachers and families see them. Symptoms have to significantly hamper the client's productivity or social competence to be diagnosed (Li et al., 2020). The intensity of the main symptoms of ADHD/HKD is not only dependent on age or developmental stage. Questionnaires and checklists provide for easy, systematic, and consistent data gathering but might give deceptive results. If there are any differences in the patient's evaluation, extra information could be collected via the cellphone (e.g., from instructors or caretakers) or in person.

People filling out surveys are generally hesitant to offer unfavorable replies about children, or they might possess other emotional motives.

Psychological exams may be used to help answer particular differential-diagnostic queries. Considering the disorder's basic symptoms, 50% of all ADHD patients have appropriate cognition testing results (Li et al., 2020). One should eliminate diminished intellect by using a legitimate intelligence examination (e.g., WISC or CFT-20R for a preliminary analysis). Testing for thyroid illness, vision and hearing problems, organic sleep abnormalities, and drug-induced illnesses might aid in the examination of fundamental somatic illness or for the diagnostic process. ADHD is commonly misdiagnosed as a behavioral problem or melancholy. The basic symptoms of ADHD (poor attention, impulsivity, hyperactivity) should be distinguished from the dissocial and violent characteristics of conduct disorder (Monro et al., 2013). A loss of concentration and increased irritation might be attributed to a depressed mood disorder rather than a persistent expression of ADHD. Attachment disturbances, schizophrenia, and bipolar prodromes are many other uncommon clinical diagnoses.

Treatment

ADHD is usually treated as an outpatient. Whenever outpatient therapy fails because of poor cooperation, family finances, difficult drug modifications, or imminent school dismissal, partial or complete inpatient therapy might be required (Pellow et al., 2011). Other causes for inpatient therapy include difficult differential diagnoses or a heavy comorbidity load. There is no evidence that unsaturated fatty acid supplements have any impact on the basic manifestations of ADHD (32). No additional dietary measures are typically therapeutic.

The value of neurofeedback in a multimodal treatment approach is unknown. There aren't enough trials with high-quality learning regimens. These studies would definitely outperform other methods. Along with these therapies, medication (Muñoz et al., 2020) is an important part of treating ADHD (Muñoz et al., 2020). Several meta-analyses, such as the National Institute of Excellence's, have shown the effectiveness and tolerance of stimulant medication. A recent Cochrane study questioned the effectiveness of methylphenidate.

ADHD may be treated in numerous ways. However, evidence shows that multimodal treatment is optimal for many youngsters (Pellow et al., 2011). This entails combining different therapy modalities. Medication and counseling may help many ADHD symptoms. Therapists, physicians, educators, and parents must work closely together (Muñoz et al., 2020).

Medication. Stimulants remain the most often given ADHD treatments, despite concerns regarding overuse. They may reduce hyperactivity and enhance attention span. Inhibitors of impulsive behavior work on dopamine receptors within the brain. ADHD treatment may be pharmacological, nonpharmacological (Pellow et al., 2011), or both (Monro et al., 2013). These include stimulants (amphetamines and methylphenidate) and non-stimulants (atomoxetine, clonidine, and guanfacine extended-release). Stimulants are often considered first-line therapy. Following the discovery of an amphetamine molecule around 1937 and the F.D.A. authorization of methylphenidate around 1955, several research has been conducted regarding pharmacotherapy for ADHD.

Patient 1 began with 10 drops of Proprietary Mix 1 during the morning and evening hours. He began taking the Proprietary Blend 2 pills after three months. He began by taking one Proprietary mix 2 capsules each day, but after two weeks, he increased to two Proprietary blend 2 capsules in the morning and two in the afternoon. Inpatient 2, He waits 30 minutes before starting the exercises with them. At the age of twelve, he started utilizing a Proprietary mix of 1, 5 drops B.I.D. as a treatment/method. He was given an ADHD diagnosis.

Efficacy and Effectiveness

A meta-analysis10 of double-blind R.C.T.s demonstrated that ADHD medications outperformed placebo in reducing clinicians' ratings of lack of attention, restlessness, and impulsivity (KAREEM ET AL., 2019). The stimulating impact sizes were bigger compared to those observed in short-term R.C.T.s of psychiatric medicines in a number of different diseases. At the collective level, amphetamines outperformed methylphenidate, atomoxetine, and guanfacine. A greater reaction to amphetamines was shown in 28% of patients, whereas methylphenidate was seen in 16% of patients through crossover R.C.T.s (Muñoz et al., 2020). In case 1, the patient's mom and dad, and coaches stated that he showed substantial progress in his ability to maintain attention and follow directions, as well as in his ability to complete particular school projects and remain focused during his basketball and soccer games. On days when he does not participate in sports, he will often take a proprietary mix of two capsules in the morning and a second capsule in the afternoon. Inpatient 2, He claims that his "head feels clearer and less confused, that he has been trying to concentrate and focusing considerably better, that he sleeps better, and that it is easier to get out of bed in the morning"

He claims that he is sleeping for longer periods of time and that he is feeling less hectic.

References

Diagnosis

The diagnosis of this neuropathy necessitates a thorough medical examination to determine the different etiologies (Lehmann et al., 2020). Treating peripheral neuropathy is not always straightforward. Patients are referred for evaluation of peripheral neuropathy and have cervical myelopathy or bilateral lumbosacral radiculopathy (Siao & Kaku, 2019). Sometimes patients with multiple sclerosis come to be referred for evaluation of peripheral neuropathy since they present with numbness in the feet and gait imbalance (Siao & Kaku, 2019). One of the outstanding presentations of this neuropathy is symmetrical numbness of the feet with or without numbness of the hand (Siao & Kaku, 2019).

Clinical patterns

The first step in diagnosis is recognizing specific patterns that a patient with this neuropathy presents. These patterns are determined mainly by the signs and symptoms a patient with this disease portrays. Lehmann et al. (2020) proposed five clinical practices that could help doctors diagnose this neuropathy. The first pattern involves a slow progressive, distal symmetric, and primarily sensory neuropathy (Lehmann et al., 2020). This presentation is seen mainly in diabetes, chemotherapy, and alcoholic neuropathy patients. This patient needs limited evaluation when determining the diagnosis. The second pattern is slow and long-standing neuropathy, characterized by foot and muscle wasting (Lehmann et al., 2020). Patients with this neuropathy are limited, and diagnosis used to be focused on genetic testing (Lehmann et al., 2020). The third pattern is the onset of neuropathy with or without proximal involvement. Patients with this clinical presentation suggest that the neuropathy was acquired from an immune-mediated condition (Lehmann et al., 2020). Physicians here need to focus more on antibody testing. The fourth pattern involves rapid disease progression, neurological pain, multifocal symptoms, and autonomic dysfunction (Lehmann et al., 2020). This possible neuropathy with this presentation is amyloidosis, vasculitis, or paraneoplastic (Lehmann et al., 2020). Diagnosis of these three neuropathies required a patient to provide a detailed clinical history. The final pattern is sensory ataxic, which is related chiefly to sensory neuronopathy (Lehmann et al., 2020). Patients with this neuropathy present with a sense of vibration and proprioception (Lehmann et al., 2020).

Some patients with this neuropathy also portray some muscle strength. The diagnosis of this neuropathy involves the evaluation of mitochondrial and autoimmune disorders.

Clinical History

The diagnosis of this disease begins with a detailed history that includes family, occupation, and a list of medical uses (Siao & Kaku, 2019). Family history includes ethnic background, parent and sibling details such as the presence of possible inherited neuropathies, and consanguinity (Siao & Kaku, 2019). Social history consists of the residential area where the patient was currently residing, sexual history, alcohol and drug use, sexual orientation, and disease history (Siao & Kaku, 2019). The medical examination starts with a detailed history of symptoms, occupational and family history, and physical and neurological exam. Different patterns presented by this condition help build differential diagnoses based on how they present themselves. This presentation helps identify the etiology and helps the doctors know which treatment plan they will use to treat this neuropathy. After a detailed history has been recorded, the next vital step in evaluation is conducting a quantitative test.

Tandem Gait Testing

Tandem gait is one of the physicians' examinations (Margolesky & Singer, 2017). This test is widely used to screen patients with vestibular and neurological disorders (Cohen et al., 2017). Ordinary healthy people without neurological disorders; however, this performance decreases with time (Cohen et al., 2017). Individuals with neurological diseases cannot perform this test while their eyes are closed (Cohen et al., 2017). However, the test lacks a standard guide that could help researchers determine the sensitivity of abnormal tandem gait evaluation for peripheral neuropathies and neurodegenerative diseases (Margolesky & Singer, 2017).

Nerve Biopsy

Doctors perform another neurological test to determine if the patient has peripheral neuropathy: a nerve biopsy, M.R.I., and spinal tap. Nerve biopsy is one of the most recommended diagnoses for this neuropathy (Luigetti et al., 2019). Many neuropathies in the past produced peculiar lessons that were easily identified in the biopsy (Luigetti et al., 2019). Nerve biopsy helps diagnose dysimmune and vasculitic neuropathies (Luigetti et al., 2019). However, it is not effective in detecting inherited neuropathies. Genetic testing is highly recommended in diagnosing patients with peripheral neuropathies that result from inheritance (Lehmann et al., 2020). Current genetic testing includes NGS, which detects D.N.A. variants associated with peripheral neuropathy (Bacquet et al., 2022).

Neurological Examination

Evaluating the degree of nerve damage is essential in determining a particular clinical pattern (Lehmann et al., 2020). The doctor stimulates a nerve to assess if it will produce action potential (Rudin, 2019). The doctor will record the time from when a nerve stimulation occurred to when the action will be made and the magnitude produced (Rudin, 2019). These measures predict the extent to which this neuropathy has damaged the nerve. The two common neurological examinations are E.M.G. and N.C.S. An electromyogram (E.M.G.) is considered the standard for diagnosing this neuropathy (Jia et al., 2019). E.M.G. and N.C.S. confirm that the patient suffers from peripheral neuropathy, not other mimics like distal myopathy (Lehmann et al., 2020). They are also used to assess nerve damage's primary mechanism, such as demyelinating or axonal (Lehmann et al., 2020). These two tests are also used to determine which nerves are unaffected.

Peripheral Nerve Imaging

Ultrasound can be used to diagnose peripheral neuropathies. Ultrasound is used for patients suspected that they have an immune-mediated neuropathy. This neuropathy is primarily characterized by increased nerve cross-section, which can be imaged by an ultrasound (Lehmann et al., 2020). With nerve ultrasound, M.R.I. can view nerve segments that electromyography cannot access (Telleman et al., 2021). Nerve imaging helps to determine which nerves will be a target for biopsy examination (Lehmann et al., 2020).

Blood Tests

These laboratory tests are usually done to check if the patient has insufficient vitamins, toxic elements, or evidence of immune reaction. Blood tests are specific to the type of peripheral neuropathy; hence the doctor will first evaluate the clinical presentation of the neuropathy before ordering a blood test. Standard blood tests include folate and Vit. B12 levels, Hepatitis B and C, Lyme disease, HIV/AIDS, and antibody reaction tests (Lehmann et al., 2020).

Laboratory tests also include renal function, HbA1c, glucose level, liver function, and thyroid tests (Lehmann et al., 2020). Research has shown that deficiency of vitamin B12 can cause this neuropathy (Mallet et al., 2020). The shortage of this vitamin has also been linked with diabetes, one of the risk factors that elevate a person's risk of acquiring peripheral neuropathy (Mallet et al., 2020).

Case Study I

Patient: Male.
Age: 61-year-old.

History: A 61-year-old male, currently a union boilermaker and a steelworker since the late 70s, with pre-diabetes, hypertensive, peripheral neuropathic nerve pain, degenerative disc disease, and disc herniation. Experienced long-term exposure to environmental toxins including arsenic, lead, tungsten, antimony, thallium, cadmium, cesium, nickel, niobium, rubidium, titanium, and other heavy metals (working in a boilermaker, refinery, and steel mill). His symptoms included brain fog, sciatic pain, lumbar spine pain, and inability to sleep due to pain, and sitting and standing for long periods would cause pain and lower his quality of life. His medications consisted of Lotensin, Hydrochlorothiazide, Fenofibrate, and Vitamin D.

Treatment/Method: He started on ten drops of Proprietary blend 1 B.I.D.

Legend

Proprietary blend 1: silica, vitamin c, and trace minerals.

Proprietary blend 2: N-acetyl L- tyrosine, anhydrous caffeine, L-theanine, velvet bean seed, pine bark, curcumin, and vitamin d.

Proprietary blend 3: black seed oil, resveratrol, turmeric, raspberry ketone, apple cider vinegar, aloe Vera, and d-ribose

Results: After administering Proprietary blend 1, he noticed significant improvement in mental clarity, 90% improvement in neuropathic foot pain, and experienced improved quality of sleep.

Discussion
Patient Diagnosis

The patient suffers from a toxic neuropathy caused by exposure to harmful chemical substances like lead, arsenic, tungsten, antimony, thallium, cadmium, cesium, nickel niobium, rubidium, titanium, and other heavy metals.

Working in the boilermaker, refinery, and steel mill leads to chronic exposure to these toxic chemicals. Chronic and acute exposure results in nervous system disorders, immune system disorders, cancer, skin lesions, birth malformations, vascular damage, and kidney and G.I. dysfunction (Eskut & Koskderelioglu, 2021). Heavy metals result in neurotoxicity using oxidative stress, dysregulation of cell signaling, cell membrane disruption, and impairment of neurotransmission (Eskut & Koskderelioglu, 2021).

Heavy mental and Neurotoxicity

Lead toxicity is one of the significant causes of polyneuropathy characterized by wrist drops. The arsenic neurotoxic mechanism has not been proved, but researchers suggest it occurs through glutathione conjugation and oxidative methylation (Eskut & Koskderelioglu, 2021). Arsenic causes polyneuropathy, which does not cause multi organ involvement (Valappil & Mammen, 2019). Acute thallium poisoning results in seizures, mental disturbance, polyneuropathy, and memory impairment (Wang et al., 2021).

Prevention and Treatment for Peripheral Neuropathy

Different strategies have been proposed to prevent and treat peripheral neuropathies. There is no specific treatment for peripheral neuropathy as other underlying conditions in the body cause it. To manage it, treating the underlying conditions and their symptoms is the most used treatment plan to improve its symptoms. These underlying conditions are assumed to be the key triggers of peripheral neuropathy; hence keeping them under check improves the conditions and speeds recovery.

Nutritional Treatment of Peripheral Neuropathy

Nutrition regimens have shown evidence that they can treat peripheral neuropathy. There are proprietary nutritional blends used to treat and enhance symptoms of this condition: Silica, vitamin C, trace minerals, black seed oil, turmeric, L-tyrosine, anhydrous caffeine , and other nutrients. The patient was administered a proprietary blend composed of silica, vitamin c, and trace elements in this case study. Vitamin C Edobor's (2021) research on Wistar rats with diabetic peripheral neuropathy showed that administration of vitamin C reduces pain in them. Vitamin is a dietary supplement and an essential micronutrient vital for biological processes. Vitamin C has antioxidant activities that help overcome oxidative stress caused by reactive oxygen species (ROS) (Edobor, 2021). Most heavy metals damage the cell through oxidative stress. However, the administration of vitamin C helps cells counter oxidation stress through antioxidation. This treatment helps in managing pain in a patient with neuropathies. Pain is one of the significant symptoms of peripheral neuropathy that decreases the quality of life (Abdelrahman & Hackshaw, 2021). Evidence has shown that pharmacological treatment is ineffective in managing patients that result from peripheral neuropathy (Abdelrahman & Hackshaw, 2021). Huff et al.'s (2020) study shows that vitamin C is vital for myelinating Shawn cells in the (PNS) peripheral nervous system. This myelination results in the PNS nerves' saltatory conduction of electrical activities (Huff et al., 2020). Shawn cells also play a vital role in nerve regeneration after an injury. Huff et al. (2020) study used the mouse to illustrate how maternal vitamin C results in hypomyelination in the early development of infant mice. Vitamin C regulates periaxin and M.B.P. (Huff et al., 2020).

Zinc Supplements

Zinc is an essential micronutrient that has been used to treat a variety of sickle cell, neuropathic pain, muscle degeneration, and alcoholic liver disease (Abdelrahman & Hackshaw, 2021). Zinc deficiencies have been linked with immune suppression, apoptosis, and D.N.A. damage. The deficiency of trace elements like zinc also elevates the risk of an individual acquiring diabetes and diabetic conditions like diabetic neuropathy (Liu et al., 2014). The mechanism in which zinc is used to treat neuropathic pain since it plays a vital role in regulating oxidative stress. Zinc stimulates metallothionein synthesis by acting as a gene and expression protein (Liu et al., 2014). Mouse research has shown that zinc increases the mRNA transcript of proteins translated to produce metallothionein. Metallothionein is a powerful antioxidant that reduces oxidative stress that heavy metals have caused. When administered zinc supplements, rats with induced diabetic neuropathy showed reduced pain (Abdelrahman & Hackshaw, 2021). Metallothionein is also an anti-inflammatory agent which reduces neuropathy pain by reducing the pressure on the nerve endings (Abdelrahman & Hackshaw, 2021).

Vitamin B

This vitamin is one of the essential vitamins the body requires for biological processes. Vitamin B6, B1, B12, and B9 play a vital role in biological processes like immunity, R.N.A., D.N.A. synthesis, and metabolism (Abdelrahman & Hackshaw, 2021). Patients that have deficiencies in vitamin B12 have been shown to exhibit signs of lower and upper neuron dysfunction (Staff & Windebank, 2014). These patients also exhibit cognitive dysfunction (Staff & Windebank, 2014). Vitamin B6 has been shown to increase nerve conductance in rats with diabetic neuropathy (Abdelrahman & Hackshaw, 2021). Research has shown that vitamin B12 reduces neuropathy pain (Abdelrahman & Hackshaw, 2021).

Vitamin D

No research has provided a precise mechanism in which vitamin D reduces pain in neuropathies. Neuropathy pain has been treated with vitamin D in patients with type II diabetes (Abdelrahman & Hackshaw, 2021). One study proposes that vitamin D reduces pain in neuropathies by regulating cytokines (Abdelrahman & Hackshaw, 2021). Cytokines are a potent inflammatory mediator which results in acute or chronic inflammation. Inflammation increases the pain in neuropathies since it increases pressure on nerve endings. Vitamin D regulating cytokines will result in a reduction of inflammation.

Aluminosilicate

This regimen is used to treat or prevent neuropathies that result from toxic agents. Aluminosilicate is an adjuvant for zeolites which is a vital element due to its detoxification properties. Zeolite properties help the body detoxify harmful components like heavy metals consumed from the environment. Detoxification reduces pain in the peripheral nerve (Justia Patent, 2012). Silica reduces the pain in patients with neuropathies by removing heavy metals from cells. This removal results in a reduction of oxidative stress hence relieving the pain.

Conclusion

Peripheral neuropathies occur when there is damage to the nerves of the PNS. Damage to these nerves reduces dysfunction in motor and sensory functions. Individuals suffering from peripheral neuropathy tend to experience mild to severe symptoms, which continue to be severe as time goes by. Some of the symptoms of this condition include lack of coordination, paralysis, gradual numbness, and sharp pain. Several etiologies have been identified to be the cause of this neuropathy. These etiologies include diabetes, toxins, infections, autoimmune disease, and specific cancer. Individuals with these conditions tend to portray an elevated risk of acquiring peripheral neuropathy. Diagnosis of this neuropathy is not straightforward, and the doctor needs to follow standard protocols to determine if the neuropathy affects the patient. The doctor must conduct a detailed clinical history and perform quantitative tests to confirm and resolve the severity of the condition. Current treatment strategies focus on treating the etiology after the doctor. Antidepressants, anesthetics, and narcotics are some of the recommended pharmacological therapies for treating neuropathies. The medicines are also used to relieve the symptoms of peripheral neuropathy. Research has been increasing to find other more effective methods than pharmacological therapies. Nutritional supplements, including vitamins, herbal products, and trace elements, effectively manage pain in these neuropathies (Abdelrahman & Hackshaw, 2021). Extensive research on mouse models has illustrated their efficacy and mechanism in pain management. There is a significant need to translate these researches into a clinical setting to determine their efficiency in human beings and how they will help patients manage pain due to peripheral neuropathy.

References

Abdelrahman K and Hackshaw K. “Nutritional Supplements for the Treatment of Neuropathic Pain”. Biomedicines 9.6 (2021): 674.
Bacquet J., et al. Molecular diagnosis of inherited peripheral neuropathies by targeted next-generation sequencing: molecular spectrum delineation (2022).
Edebor TF. “Vitamin C Attenuates Hyperalgesia, Peripheral Nerve Degeneration and Reversed Paw Numbness in a Wistar Rat Model of Diabetic Neuropathy”. African Journal of Biomedical Research 24.1 (2021).
Eskut N and Koskderelioglu A. “Neurotoxic Agents and Peripheral Neuropathy”. Neurotoxicity - New Advances (2021).
Huff T., et al. “Vitamin C regulates Schwann cell myelination by promoting D.N.A. demethylation of pro-myelinating genes”. Journal of Neurochemistry 157.6 (2020): 1759-1773.
Justia Patent. “Prevention or treatment of painful polyneuropathies by administration of an aluminosilicate”. The U.S (2012).
Liu F., et al. “Zinc Supplementation Alleviates Diabetic Peripheral Neuropathy by Inhibiting Oxidative Stress and Upregulating Metallothionein in Peripheral Nerves of Diabetic Rats”. Biological Trace Element Research 158.2 (2014): 211-218.
Staff N and Windebank A. “Peripheral Neuropathy Due to Vitamin Deficiency, Toxins, and Medications”. CONTINUUM: Lifelong Learning in Neurology 20 (2014): 1293-1306.
Siao P and Kaku M. “A Clinician's Approach to Peripheral Neuropathy”. Seminars in neurology 39.5 (2019): 519-530.
Telleman J., et al. “Ultrasound scanning in the diagnosis of peripheral neuropathies”. Pract Neurol 21.3 (2021): 186-195.
Valappil A and Mammen A. “Subacute Arsenic Neuropathy: Clinical and Electrophysiological Observations”. Journal of Neurosciences in Rural Practice 10.03 (2019): 529-532.
Wang T., et al. “Early diagnosis, treatment, and outcomes of five patients with acute thallium poisoning”. World Journal of Clinical Cases 9.19 (2021): 5082-5091.
Callaghan B., et al. “Diabetes and obesity are the main metabolic drivers of peripheral neuropathy”. Annals of Clinical and Translational Neurology 5.4 (2018): 397-405.
Cohen H., et al. “Tandem walking is a quick screening test for vestibular disorders”. The Laryngoscope 128.7 (2017): 1687-1691.
Eggermann K., et al. “Hereditary Neuropathy”. Dtsch Arztebl Int 115.6 (2018): 91-97.
Jia Y., et al. “Lumbar Spinal Cord Activity and Blood Biochemical Changes in Individuals with Diabetic Peripheral Neuropathy During Electrical Stimulation”. Frontiers In Neurology 10 (2019): 222.
Lehmann H., et al. “Diagnosis of peripheral neuropathy”. Neurological Research and Practice 2.1 (2020): 20.
Luigetti M., et al. “Sural nerve biopsy in peripheral neuropathies: 30-year experience from a single center”. Neurological Sciences 41.2 (2019): 341-346.
Mallet M., et al. “The Role of Oxidative Stress in Peripheral Neuropathy”. Journal Of Molecular Neuroscience 70.7 (2020): 1009-1017.
Margolesky J and Singer C. “How tandem gait stumbled into the neurological exam: a review”. Neurological Sciences 39.1 (2017): 23-29.
Rudin N. “Electrodiagnostic Testing”. Pain (2019): 173-176.

Since their discovery, the targeted transport of substances into various organs, including the brain, has been accomplished with the help of nanoparticles. The primary pathophysiological alteration in most illnesses involving the brain has been identified as neurodegeneration (Armstrong & Okun, 2020). Despite modern science's constant attempts to provide a medicinal or surgical cure, the results have failed. Many older adults continue to experience clinical concerns related to Alzheimer's and dementia (Mathis et al., 2020). Despite its remarkable effectiveness, the blood-brain barrier (BBB) still poses a significant obstacle to the efficient therapy of many illnesses (Delamarre & Meissner, 2017). Alzheimer's disease is characterized by dementia common, a progressive disease characterized by mild memory loss, potentially leading to loss of communication ability. Parkinson's disorder affects the nervous system leading to stiffness with balance and coordination loss. Similarly, Amyotrophic sclerosis, a nervous system disease, affects the brain's nerve cells, thus causing loss of muscle control (Mathis et al., 2020). Even with the numerous triumphs achieved with surgeries and extremely evasive techniques, their clinical acceptance is constrained because of conflicting worries about their long-term benefits due to the possibility of damaging the blood-brain barrier.

Recently, millions of people have been affected by neurodegenerative diseases globally (Tambasco, Romoli & Calabresi, 2018). Researchers have shown that a mix of an individual's genetic makeup and environmental circumstances can contribute equally to increasing the risk for NDs, even if age is the most critical risk factor for developing all NDs (Bloem, Okun & Klein, 2021). The severity and timing of neurodegeneration also heavily depend on the local environment, despite the expression of specific genes responsible for NDs (Delamarre & Meissner, 2017). Recent research has shown that many other disorders may accompany a single neurodegenerative illness. Therefore, the severity of NDs depends purely on the nature and stage of the disease; in some cases, they may even be life-threatening (Mathis et al., 2020). These disorders thus impair numerous elements of human functioning and impede the capacity to accomplish simple and complex tasks since the brain regulates several bodily functions. While the majority of these conditions proceed without remission, some treatments aim to lessen symptoms, relieve any pain that may be present, and restore balance and mobility (Vázquez- Vélez & Zoghbi, 2021). This review comprehensively discusses the numerous NDs (Parkinson's disease, Amyotrophic lateral sclerosis, and Alzheimer's disease with the case study), their alternative treatments and the effectiveness of integrated approaches for management.

Parkinson’s disease
Introduction

Parkinson's disease (PD) is a common neurodegenerative disease characterized by postural instability, resting tremors, and rigidity (Jankovic, & Tan, 2020). The clinical symptoms and some of the therapeutic targets have been found to alter the progressivity of this disease. Typically, early symptomatic phases of PD are when treatment decisions are made to reduce disability resulting from the earliest motor signs and symptoms, avoiding motor problems later on, and, ideally, decreasing the disease's course (Bloem, Okun & Klein, 2021). Other stages of treatment have different goals, such as managing motor problems, preventing falls, treating dementia and psychosis, and finally, delaying the damage to self-sufficiency (Jankovic, & Tan, 2020). Moreover, the reflection of medicine changes is considered highly influential during the first 3-5 years to become linked to motor problems, which can include unpredictable on-off swings and dyskinesias, as well as a shortening of the antiparkinsonian effect's duration. Tysnes & Storstein, (2017) asserts that an increasing concern with the non-motor characteristics identified in Parkinson's disease, includes pain, sleep disorders, and neuropsychiatric symptomatology.

Nevertheless, non-pharmacological treatments for this condition may include psychosocial counselling, work-related therapy, speech, and physiotherapy (Bloem, Okun & Klein, 2021). Surgical therapies have also become crucial, mainly due to subthalamic nucleus stimulation. This white paper seeks to conduct a comprehensive review of Parkinson's disease and patient case studies presented with the disease and discuss the alternative to the treatments and the effectiveness of integrated approaches to treatment (Bloem, Okun & Klein, 2021).

History and Epidemiology

Parkinson, in 1817 described Parkinson's disease as a neurological syndrome, although his fragments of Parkinsonism were still in earlier descriptions. Also, the earliest reports of PD can be found in traditional Indian writings dating from 1000 BC and ancient Chinese sources. According to estimates based on healthcare utilization, incidences of Parkinson's disease range between 5 and 35 new PD cases yearly (Simon et al., 2020). Between the sixth and ninth decades of life, the incidence multiplies by 5 to 10 times (Tysnes & Storstein, 2017). Age is also seen to associate with the development of Parkinson's disease. Studies have shown that Parkinson's disease prevalently rose from less than 1% among men and women aged 45–54 to 6%, according to the meta-analysis of four North American groups (Tysnes & Storstein, 2017). In the next two decades, the prevalence of PD is predicted to more than double as the world's population ages. In addition to this rise, the societal and financial costs associated with PD will rise unless better cures, treatments, or preventative measures are found.

PD Risk Factors
Environmental factors

Although numerous research studies have identified the environmental factors contributing to PD, most findings have yet to be deemed conclusive. Water-borne risk factors and pesticide exposure impacts have received the majority of attention (Vázquez-Vélez & Zoghbi, 2021). The Geo-Parkinson study investigated such correlations among the five European nations and discovered a high proportion of pesticides containing manganese in patients' brains during a necropsy examination (Simon et al., 2020). Hence, it is hypothesized that even a little pesticide exposure can significantly raise the risk of developing PD (Simon et al., 2020). A meta- analysis of environmental risk factors for PD development shows that individuals living in rural areas and getting their water from wells are more likely to develop PD (Chen, Li & Liu, 2020). Therefore, the potentiality of developing PD is said to associate with exposure of pesticide.

Genetic Risk Factors

Genetic factors are also deemed major type of risk factors leading to PD development besides environmental exposures (Marinus et al., 2018). Despite PD accounting for a slight percentage of cases, it may also give a firm and precise understanding of the underlying mechanisms (Delamarre & Meissner, 2017). Since the disease is linked to several protein products, it has been established that different genes can influence how the disease manifests (Delamarre & Meissner, 2017). SYN gene mutations are thought to speed up the beginning of the disease in both people and animals. Moreover, findings shows that these mutations can cause dopaminergic neuronal degeneration, a reduction in motor function, and muscular atrophy (Delamarre & Meissner, 2017). However, research indicates that PTEN-induced kinase produces essential PINK1 protein which is majorly associated with causing containment in oxidative stress occurring in the mitochondria (Marinus et al., 2018). Moreover, PINK1 genes cause PD in the same way that SYN genes do. However, a critical genetic component has been applied since PINK1 gene is purported to cause PD (Chen, Li & Liu, 2020). Based on these findings, it has been established that mutations in the genes SYN independently cause the beginning of PD (Chen, Li & Liu, 2020).

Oxidative Stress

Oxidative stress refers to a phenomenon that causes the disparity in creation and accumulation of volatile oxygen species in tissues and cells (Delamarre & Meissner, 2017). Dopamine-producing neurons in the nigrostriatal system have been identified as the main cause of PD (Marinus et al., 2018). The role of unstable free radicles in the degeneration of nerve cells is among the triggers for PD that is gaining popularity (Chen, Li & Liu, 2020). Reactive oxidative species (ROS), often known as free radicals, are byproducts of chemical reactions that mainly occur in the mitochondria (Vázquez-Vélez & Zoghbi, 2021). The amount of ROS generated under some circumstances may surpass the capacity of the cleanup systems thus the inability to contain the disease (Vázquez-Vélez & Zoghbi, 2021). Typically, oxidative stress is the name given to this process and thus due this failure, the highly volatile oxidative types combine with other stable molecules (Delamarre & Meissner, 2017).

Pathophysiology

Parkinson's disease pathophysiology involves the demise of dopaminergic neurons because of the changes in biological actions within the brain concerning PD (Marinus et al., 2018). Several mechanisms have been developed in response to the death of neuronal cells in PD. Diverse hypothesized causes for neuronal death in PD are available some of which include; Lewy body aggregation, and blood-brain barrier disruption (Chen, Li & Liu, 2020). One of the main factors contributing to neuronal death in Parkinson's disease is protein oligomerization (Simon et al., 2020). Alpha-synuclein is more prevalent in the brain of PD patients and due to their insolubility, it clumps and form Lewy bodies within the neurons (Simon et al., 2020).

Moreover, heat-shock proteins help in refolding proteins that are prone to aggregations because of its favorable effect on Parkinson's disease (PD) when overexpressed (Delamarre & Meissner, 2017). These findings support this process. Reduced DNA repair appear to be closely related in ways that include alpha-synuclein (Tysnes & Storstein, 2017). Alpha-ability synucleins usually facilitate in the overall DNA repair process which is known as non-homologous end joining the double-stranded DNA breaks (Tysnes & Storstein, 2017). Simon et al., 2020) asserts that Lewy bodies, forms when alpha-synuclein aggregates in the cytoplasm, lower the nucleus levels of the protein, which in turn increases DNA double-strand breaks and raise programmed cell’s death within the neurons.

PINK1 and Parkin complex is thought to be the cause of mitochondrial malfunction in Parkinson's disease because it has been demonstrated that it promotes the autophagy of mitochondria (Vázquez-Vélez & Zoghbi, 2021). The protein can build up on the surface of damaged mitochondria in addition to being routinely carried inside the mitochondrion (Marinus et al., 2018). According to Marinus et al. (2018) these genes are assumed to be altered in Parkinson's disease, restraining the interruption of injured mitochondria, resulting to aberrant mitochondrial role and shape, and eventually cell death. However, the accumulation of mitochondrial DNA alterations has also been observed, signifying that this mechanism of neuronal death can be that susceptible with aging (Tysnes & Storstein, 2017).

Clinical Features and Diagnosis

The disease has distinctive neuropathological changes in the brain changes. Researchers have identified six neuropathological disease phases as PD stages (Tysnes & Storstein, 2017). Stage one and two of the disease according to Marinus et al. (2018). are usually the pre- symptomatic stages, in these stages the inclusion of bodies is restricted to the medulla oblongata and the olfactory anterior part of the nucleus. Substantia nigra and the forebrain nuclei are obstructed as the disease gets worsened within stages 3 and stage 4 (Vázquez-Vélez & Zoghbi, 2021). It is claimed that individuals usually begin to display clinical symptoms of the condition at this stage (Bloem, Okun & Klein, 2021). Individuals begins to show clinical signs of the illness at this point, and the process proceeds to last stage that is stages 5 stage 6 which is characterized by a wide range of clinical symptoms (Bloem, Okun & Klein, 2021). Although there may be problems in many other nervous system activities, motor disturbances typically characterize the clinical symptoms of PD (Vázquez-Vélez & Zoghbi, 2021). The dopaminergic medication may trigger or worsen some of the signs, symptoms thus can be divided into motor and non-motor symptoms (Delamarre & Meissner, 2017). A common sign can be bradykinesia, characterized by a delay at the beginning of intended actions and an advanced decrease in the speed and plenty of repetitive movements. These characteristics are prerequisites for PD diagnosis in addition to muscular rigidity and postural instability (Delamarre & Meissner, 2017).

The bradykinesia may cause an expressionless visage and reduced handwriting amplitudes (micrographia) (Bloem, Okun & Klein, 2021). A resting pill-rolling gentle of tremor of the hands is the most predominant limb tremor, affecting about 80% of people. (Tysnes & Storstein, 2017). The propensity of the thumb and index finger to come into touch and move in a rotary motion is known as "pill rolling." Typically, the tremor involves the legs, and other types of tremors which might occur (Vázquez-Vélez & Zoghbi, 2021). Bloem, Okun & Klein, (2021) estimates that more than half of the patients have speech abnormalities like quiet or rushed talking. Dystonia is another motor sign of PD, a continuous muscular contraction characteristically convoyed by atypical postures, motions, or both (Delamarre & Meissner, 2017). Most dystonic symptoms are connected to medicinal and surgical therapy, which may occasionally be a pre-diagnostic sign in PD. For non-motor symptoms, autonomic function disturbances and cognitive, sensory, and sleep disturbances have been commonly reported (Delamarre & Meissner, 2017).

Case Study

Choosing effective therapeutic interventions for every patient with their respective diseases for decades has become an issue due to fluctuating and advanced natural conditions and the required evaluation of numerous sources with the latent application to patient supervision (Tambasco, Romoli & Calabresi, 2018). However, this section provides a case study for a PD patient and further emphases on current available suggestion for the pharmacological treatment of PD motor symptoms. Therefore, to ascertain alternative treatment and integrated approaches toward PD management, we will look at the case scenario below.

A 63-year-old male having a 4-year history of Parkinson's disease had been referred to the movement disorders outpatient clinic due to deterioration of the condition. His medication consists of levodopa/benserazide 200mg/50mg. The patient started on two capsules of a proprietary blend.

No. 1, once in the morning and once at night, for three days. He then increased the dosage by one drop every three days and built up to 10 drops twice daily. No. 2, one capsule in the morning and afternoon for ten days. He then increased to two in the morning and one in the afternoon and added one sachet of proprietary blend. No.3 to his diet, one in the morning. He also started taking six drops twice daily of proprietary blend. However, after one-month, cardinal symptoms of Parkinson's disease would be, resting tremor and muscle stiffness signifying slight decrease. In addition, his quality of sleep improved, as well as his gait. His medications have not changed.

Treatment and Management of Parkinson's disease

Medication is known as the most popular therapy for PD. The intention is to remedy the dopamine insufficiency, which is the root of the symptoms (Tambasco, Romoli & Calabresi, 2018). Pharmaceutical therapy is typically initiated as symptoms interfere with daily activities or become incapacitating (Armstrong & Okun, 2020). Several treatments may be used basing on the patient's age, reactions, and symptoms towards a particular medication. However, finding the ideal medicine combination for each patient can frequently take some time (Armstrong & Okun, 2020).

The most efficient medication for treating PD is levodopa, a precursor to dopamine in the body (Delamarre & Meissner, 2017). Levodopa is mostly inactive; dopamine is formed when levodopa is decarboxylated, which has both medicinal and harmful consequences. The drug is quickly absorbed from the small bowel after oral administration thanks to the transport mechanism for aromatic amino acids (Armstrong & Okun, 2020). After an oral dose, concentrations of drug in the blood peak within 0.5 and 2 hours later. The pH of gastric juice, the pace of stomach emptying, and the amount of time the medication is visible to the digestive intestinal mucosa all affect how quickly and how much absorption takes place (Tambasco, Romoli & Calabresi, 2018). Typically, levodopa may be less readily absorbed if food amino acids compete for absorption sites in the small bowel; thus, taking this drug with meals delays absorption as well as lowers peak plasma concentrations (Bloem, Okun & Klein, 2021). The drug is primarily decarboxylated into dopamine in the brain's striatum, in the presynaptic joints of dopaminergic neurons. The dopamine generated is what gives the medication its therapeutic impact on PD (Armstrong & Okun, 2020). Levodopa drug is often administered in clinical practice along with a peripherally acting aromatic l-amino acid decarboxylase inhibitor with poor CNS penetration, such as carbidopa (Tambasco, Romoli & Calabresi, 2018). If it is taken alone, it will substantially decarboxylated by enzymes present in the intestinal mucosa, thus only a small amount of the drug will remain intact and probably only few penetrates to the brain by less than 1%. Dopamine concentrations in the bloodstream cause nausea by activating the chemoreceptive trigger zone in the brainstem (Vázquez-Vélez & Zoghbi, 2021). The amount of initiated levodopa remaining will not be metabolized thus they are available to pass the blood- brain barrier increases with peripheral decarboxylase inhibition, lowering the likelihood of gastrointestinal side effects (Bloem, Okun & Klein, 2021). Carbidopa 25 mg/levodopa 100 mg is the dosage of carbidopa with levodopa that is most frequently recommended as a result. With this formulation, dose regimens of three or more pills daily offer most people satisfactory decarboxylase inhibition (Tambasco, Romoli & Calabresi, 2018).

In the aforementioned case study, it is seen that the major symptoms the patient presented were resting tremor, rigidity (muscle stiffness), and Bradykinesia. However, as the literature and research findings mentioned, bradykinesia and rigidity are among the typical clinical features associated with Parkinson's disease (Delamarre & Meissner, 2017). Patient experienced a spontaneous loss of movement in the case of bradykinesia. The patient experienced rigidity because of resistance to movement due to an opposing muscle. However, rigidity as a symptom comes about when the opposing muscles' delicate balance is hampered in response to the signals originating from the brain (Armstrong & Okun, 2020). Typically, tremor, as a primary symptom associated with PD, takes the arrangement of a rhythmic movement of the forefinger and the thumb. It is also seen that the patient had not changed his medication and maintained his levodopa/benserazide 200mg/50mg dose (Armstrong & Okun, 2020). Since the drug relieved the symptoms one month after administration, it proves that levodopa is an effective drug that many patients with PD can use (Tambasco, Romoli & Calabresi, 2018).

Alternatives to PD Treatment and Management

The effectiveness of levodopa drugs does not limit the inclusion of other treatment models and approaches for the disease. Due to the continued vigorous research, researchers are finding more alternative treatments that can be used to cure PD through clinical trials and drug development other than the known ones (Simon et al., 2020). Recent research findings have highlighted drugs such as Bromocriptine, Ropinirole, and pramipexole as other drugs primarily for PD symptoms (Tambasco, Romoli & Calabresi, 2018). These integrated approaches are dimmed effective in action and less associated with adverse effects. Dopamine-Receptor Agonists, unlike levodopa, have effectively treated PD since they do not require enzymatic translation to active metabolites (Armstrong & Okun, 2020). Additionally, Dopamine-Receptor Agonists do not hinge on the functional capacities of the neurons and are thus considered a better alternative treatment for Parkinson's disease (Delamarre & Meissner, 2017). COMT inhibitors have been identified as a relatively recent class of medications for treating PD (Bloem, Okun & Klein, 2021). It is associated with the catabolism of Levodopa and dopamine. COMT produces the pharmacologically inactive substances 3-O-methyldopa (from levodopa) and 3-O-methoxy tyramine by transferring a methyl group from the donor S-adenosyl-l-methionine (from dopamine) (Bloem, Okun & Klein, 2021).

However, an AAD inhibitor, such as carbidopa, increases the quantity of levodopa, which is methylated by COMT, while decreasing dopamine production (Tambasco, Romoli & Calabresi, 2018). The main therapeutic effect of COMT inhibitors is to prevent the conversion of levodopa to 3-O-methyl-dopa in the peripheral nervous system, which prolongs the plasma half- life of levodopa and increases the proportion of each dose that reaches the central nervous system (Delamarre & Meissner, 2017). According to Tysnes & Storstein,( 2017), Selegiline, Rasagiline, and selective monoamine oxidase-B inhibitors are further PD treatment options. Selegiline is a selective MAO-B inhibitor that inhibits the enzyme irreversibly at low to moderate dosages (Tysnes & Storstein, 2017). Selegiline has been used for many years to treat the symptoms of Parkinson's disease. However, the ability of selegiline to suppress the striatal synthesis of dopamine is thought to be the basis of its effectiveness (Simon et al., 2020).

In people with early or mild PD, selegiline is typically well tolerated. Selegiline may exacerbate levodopa therapy's negative motor and cognitive consequences in patients with more severe PD or underlying cognitive impairment (Bloem, Okun & Klein, 2021). Amphetamine and methamphetamine are two of the selegiline metabolites which can have adverse side effects, including anxiety and insomnia. Rasagiline is a monoamine oxidase-B (MAO-B) inhibitor that also inhibits dopamine breakdown without producing unfavorable byproducts (Vázquez-Vélez & Zoghbi, 2021). Tablets containing rasagiline are recommended for treating PD symptoms and signs, both as initial therapy without the addition of treatment for moderate PD (Delamarre & Meissner, 2017). It may be helpful as a supplement for levodopa users with dose-related fluctuations and dyskinesias. Amantadine, an antiviral agent that is also used to treat influenza A, is a different therapy option that can be used. It also functions as an antiparkinsonian (Tambasco, Romoli & Calabresi, 2018). It is the first line antidyskinetic qualities have been linked to its effects on NMDA receptors, even though memantine, an NMDA receptor antagonist that is closely related, does not appear to have the same effect.

In addition to symptoms’ regulation of PD through clinical treatments, it would be advantageous to develop other therapies which, when combined, modify the process of degeneration that governs PD. Current research strategies are based on mechanical approaches such as energy metabolism, oxidative stress, environmental triggers, excitotoxicity, and detections related to the genetics of PD (Armstrong & Okun, 2020). The approaches also seek to address PD by assessing and ascertaining various risk factors associated with PD. For example, it would be more effective to manage PD when medical practitioners can seek to address ecological risk factors such as contact to toxic chemicals and pesticides (Tysnes & Storstein, 2017), Also, integrated approaches to address psychological factors such as stress through counseling are imperative to provide prevention against PD. More discoveries are coming up to offer a genetic solution if an individual has an inherited PD gene (Vázquez-Vélez & Zoghbi, 2021). Finally, observing a healthy and balanced diet is another measure that can be implemented to prevent physiological issues and cases of oxidative stress, which may accelerate the likelihood of developing PD (Bloem, Okun & Klein, 2021). Adopting these alternatives offers great betterment because they contain and manage them instead of treating them. Ideally, preventing a disease occurrence is termed more cost-effective than treatment (Armstrong & Okun, 2020). Also, since individuals will be prevented from developing the disease, there will be fewer reported cases of PD susceptibility for the future generation.

Amyotrophic Lateral Sclerosis
Introduction

Amyotrophic Lateral Sclerosis (ALS) refers to classic neurodegenerative condition which involves gradual degenerations of the motor neurons in the brain and spinal cord. Though it involves numerous levels of functional entities that alternate in different directions before convergence of the functional defining ALS disease development, tracing the evolving nature of ALS highlights critical measurement of individual variances which underpins this form of ailment (Masrori & Van Damme, 2020). ALS may begin as a single entity and develop into a complex disease. However, nothing is known about how these disparate elements ultimately function together to define the course of ALS (Masrori & Van Damme, 2020). Many theories have been put out; however, there hasn't been any agreement between the opposing philosophical camps.

History and Epidemiology

Most ALS cases are sporadic linked by cortical and spinal motor neuron degeneration (Longinetti & Fang, 2019). Baseball player Lou Gehrig was identified with ALS in 1939 by a French neurologist Jean-Martin Charcot originally described the condition in 1869. It resulted to a widespread awareness of the condition in the country (Masrori & Van Damme, 2020). It is sometimes referred to as Charcot disease after Jean-Martin Charcot, who first described it, and motor neuron disease (MND) since it was considered as one among the five diseases that often affect cells in the motor neurons (Mathis et al., 2020).

In the 1990s, about 1.5 and 2.7 documented ALS cases in Europe and North America. Current research has demonstrated that the disease frequency did not show any growth for the past ten years, as the prevalence rate is still remains at 2.7/100,000, and the prevalence of ALS was 0.32/100,000 of 2008 (Goutman et al., 2022). Whereas some research has demonstrated a balance in the ratio, many investigations have revealed an increase in the risk among the males to be higher than that of females (Goutman et al., 2022). Nonetheless, 64 years old accounts as the median age through which ALS begins, with a range of 50 to 65 years. Just 5% of the cases begin before the age of 30 (Mathis et al., 2020). The prevalence of this condition is particularly prominent in elderly individuals 80 years of age and older, and data suggests that the increase is due to variations in care.

ALS-associated risk factors

Exposure to environmental toxins, agriculture chemicals, dust/fibers/fumes, heavy metals, solvents, diet, and physical activity have been associated with developing ALS in patients according to the previous epidemiology (Obrador et al., 2020). Individuals prone to smoking are at higher risk for ALS through inflammation, oxidative stress, and neurotoxicity caused by the heavy metals present in the cigarette (Obrador et al., 2020). Similarly, people engaged in more physical activities are at risk for ALS than the general population. Genetic profiles promoting physical fitness hold a proportional correlation between ALS and physical activity (Mahoney et al., 2021). In other words, a genetic profile altered by exogenous factors which promote physical fitness increases an individual's susceptibility to ALS. However, the results from the beneficial vascular risk profile in patients and their relatives have been found to have supported this concept (Mathis et al., 2020). Researchers have conveyed an abridged frequency that corresponds to coronary heart disease which increases the risk to ALS due to physical fitness (Obrador et al., 2020). Additionally, age is another factor associated with ALS where the risk increases with age. Thus, the disease is common among people of age 40-60 years. However, as age progresses, it is observed that men are more slightly are risk of developing ALS than women (Andrew et al., 2021). In another research conducted, findings showed genetic factors as one of the common risk factors accelerating ALS (Andrew et al., 2021). Of the samples collected, it was observed that those presented with ALS symptoms had a medical history of inherited ALS.

Pathophysiology

The degeneration and the demise of upper and lower motor neurons, the reactive gliosis replacement of dead neurons accounts as the hallmarks of ALS (Lian et al., 2019). Spinal motor neurons have a regressive axonal damage characterized with secondary myelin pallor which greatly rise with aging (Dorst, Ludolph & Huebers, 2018). Although they affect the entire spinal cord, these alterations are more pronounced in the brainstem and upper spinal cord. The motor strip shows abnormal immunoreactivity to GFAP (Lian et al., 2019). The ALS motor cortex generally exhibits the astrocytic gliosis within the deeper levels at the gray matter and the parts of subcortical white matter (Dorst, Ludolph & Huebers, 2018). The lysosomal marker CD68 also demonstrated that microglia activation and active macrophages account for most of the glial reply at the spinal tracts.

ALS affects spinal motor neurons and the brainstem motor neurons. From the autopsy of ALS patients, it can be detected that the loss of motor neurons and atrophic motor neurons alters the general cell’s mechanism (Soriani & Desnuelle, 2017). As a result, the ventral roots are slimmed due to the loss of large myelinated fibers within the motor nerves hence denervating the atrophy of the affected muscles (Dorst, Ludolph & Huebers, 2018). ALS impacts both brainstem motor neurons and ventral horn spinal motor neurons. Motor neuron loss and atrophic motor neurons with a basophilic appearance are seen during autopsies of ALS patients, pointing to a programmed cell process (Lian et al., 2019). The motor neurons' ventral roots thinning and loss of their big myelinated fibers cause denervation atrophy with signs of re-innervation in the affected muscles. In addition to the normal clinical symptoms of the disease, ALS causes spongiform alterations in the neocortex accompanied by neuronal loss in the amygdale, hippocampus, and frontal (Soriani & Desnuelle, 2017). The non-motor ALS pathological findings include the demyelination of the posterior columns and the decreased myelinated sensory fibers density (Soriani & Desnuelle, 2017).

Clinical Features and Diagnosis

Manifestations of the phenotypical ALS are categorized into four typical groups: PMA with pure LMN involvement, and limb-onset ALS, and PLS with pure UMN involvement (Mathis et al., 2020). These categories are defined by amalgamation of limb motor neuron (LMN) and the upper motor neuron (UMN). However, the union between UMN and LMN impairment affects the brainstem and several spinal cord innervation sites thus accounting for the primary clinical hallmark of ALS (Obrador et al., 2020). In a study, Limb-onset ALS is seen as the main kind, 70% cases were reflected among patients where 25% had a bulbar onset, and the remaining 5% had respiratory involvement (Obrador et al., 2020). Patients with ALS suffer distal or proximal localized muscle weakness in both their upper and lower limbs (Dorst, Ludolph & Huebers, 2018). Asymmetrical initial symptoms that progress to generalized weakness and muscular atrophy are typical. Most patients experience spasticity, which impairs manual dexterity and walking, as well as bulbar and respiratory symptoms (Dorst, Ludolph & Huebers, 2018). Symptoms such as emotional lability with excessive yawning have been detected in many patients. Only 5% of individuals with respiratory impairment typically exhibit severe limb or bulbar symptoms (Soriani & Desnuelle, 2017). Some individuals, however, exhibit respiratory failure that corresponds to type 2. Type 2 respiratory failure is well known as the nocturnal hypoventilation, characterized by orthopnea, dyspnea, anorexia, disturbed sleep, morning headaches, poor attention, and prickliness in mood swings (Lian et al., 2019). In the early stages of limb-onset ALS, muscular atrophy is typically found in some parts of forearms, shoulders, hands, proximal thigh, and sometimes it may extend to the foot muscles down the lower limbs (Lian et al., 2019).

Treatment and management

Treatment for ALS can help to reverse the damage of the disease or prevent symptoms. However, the Food and Drug Administration has approved three medicines which can be used for treating this disease. Riluzole drug has been examined to reduce severe ALS, it is administered orally with an effectiveness of three to six months (Soriani & Desnuelle, 2017). Despite its effectiveness, Riluzole is associated with adverse effects such alterations in liver function, nausea, and dizziness. Edaravone is another drug of choice which is administered through the vein in the arm or as a pill orally (Obrador et al., 2020). These medicinal drugs are given daily for two weeks in a month according to research and that it helps in reducing ALS symptoms (Lian et al., 2019). Sodium phenylbutyrate and taurursodiol as recently approved medicine helps to restore or enhance the motor activities in ALS patients. In addition to the clinical treatment for ALS, other approaches for management have been deployed (Dorst, Ludolph & Huebers, 2018). For instance, inclusion of different therapies such as occupational, physical and psychological therapies all together are essential in lessening associated symptoms of ALS. Additionally, nutritional and social support can encompass as they are termed as effective preventive approaches.

Alzheimer’s disease
Introduction

Alzheimer's disease (AD) accounts to about 80% of cases of late-life cognitive dysfunction caused by degenerative condition of the brain. There is a widespread notion that dementia only occurs as a normal byproduct of aging (Weller & Budson, 2018). Dementia, however, affects the cognitive brain processes of perception, memory, thought, and language, severely limiting the capability to carry out daily functions (Burke et al., 2018). Even while dementia is not a definite result of aging, the risk of having it rises dramatically with age. Dementia and Alzheimer's disease are the primary causes of illness related to mortality in the old people, adding to the burden of non-communicable diseases worldwide (Weller & Budson, 2018).

History and Epidemiology

Neuronal cell death causes Alzheimer's, the dying cells sets on in the entorhinal cortex in the hippocampus (Juźwik et al., 2019). The disease was first identified in 1901 when German doctor Alois Alzheimer saw patient Auguste D. Oskar Fischer, a psychiatrist, and neuropathologist evaluated 12 instances of dementia simultaneously and gathered more clinical signs and symptoms and neuropathological evidence of the condition (Olivari et al., 2023). Later, in 1990, Levy and Frangione identified mutation as the root cause of amyloid protein buildup in the walls of the cerebral vessels in AD patients, which resulted in hemorrhages in the brain and early death (Juźwik et al., 2019). Since then, research on AD has advanced as scientists now look for the most efficient alternative and comprehensive treatment for the condition.

Epidemiological data on AD shows that the disease primarily affects older people. Alzheimer's illness usually affects old people due to their characteristic weak immune, globally the prevalence reported accounts to about 24 million (Eratne et al., 2018). It is therefore expected to rise heavily by the year 2050. It was estimated that 4.5 million Americans aging 65 and older were affected by clinical Alzheimer's disease in 2011 (Lane, Hardy & Schott, 2018). After the age of 65, the prevalence of Alzheimer's disease duos with five-year interval with less than 1% increase before age 65 and about 6% per year after age 85 (Hampel et al., 2018). The World Health Organization (WHO) estimates that there are presently 35.6 million individuals living with dementia worldwide, this figure is expected increase every 20 years to reach 115.4 million by 2050 (Liguori et al., 2019). Also, it is anticipated that over 5 million Americans had AD in 2013; by 2050, that number is expected to triple. Over $225 billion was spent on Alzheimer's patients in the United States in 2010 (Armstrong, 2019). According to the Centers for Disease Control and Prevention (CDC), AD is said to be the 6th leading disease that causes death. Even though much time, money, and effort are being put into understanding the pathophysiology and effective care for Alzheimer's and other forms of dementia, initial disease diagnosis is still a significant challenge (Caruso et al., 2019). Through delaying of AD and other forms of dementia within a year, it is expected that by 2050, less than nine million cases will be accounted for which suggestively reduces the disease's burden.

Risk factors

Alzheimer's disease is accompanied by various menace factors ranging from environmental, physiological, and genetic factors, which are suggested as common causes of AD and other dementias (Hampel et al., 2018). However, other risk factors include; diabetes and heart disease, can also accelerate prevalence and incidence of AD. Conversely, a recent cohort study has demonstrated that gout disease can potentially reduce the risk of developing the disease.

Genetic risk factors

Based on family history of dementia, intermittent mutations in genes impacts the amyloid within the brain. Apolipoprotein E are among the commonly identified genetic factors associated with AD (Caruso et al., 2019). Evidence shows that the risk of developing AD from a family history of dementia varies depending on the kind of familial link, the phase of the illness starts (Hampel et al., 2018). A person's chance of having AD rises by 10–30% if they have a first- degree relative who has dementia (Armstrong, 2019). Moreover, in the case of two or more persons are affected with the late-onset AD risk will be higher as compared to the overall population. The biggest genetic risk factor for late-onset AD is APOE (Lane, Hardy & Schott, 2018). Thus those persons carrying one or both e4 alleles is considered to have a 2- to 3-fold higher chance of acquiring Alzheimer's disease than non-carriers. Race, gender, and vascular risk factors alters the association's strength.

Physiological risk factor

Stress, age, gender, hypertension, and coronary disease are all physiological risk factors for AD. Researchers have discovered more about the association between stress and AD, which indicates that psychological stress is a major risk factor for AD (Weller & Budson, 2018). Age- related cognitive loss may be sped up by the persistent stress linked to elevated cortisol levels (Burke et al., 2018). In another study, it is evident that glucocorticoids are typically released in reaction to stress (Weller & Budson, 2018). Regarding age, research findings show that AD progresses with age, where the disease is primarily prevalent in older people (Caruso et al., 2019). However, several studies demonstrate gender, in addition to age, also has an imperative role as a risk factor for developing AD, suggesting that the prevalence of AD is more common among women than men (Eratne et al., 2018). However, inconsistencies have been observed in studies related to the incidence of AD between males and females, incidence of AD studies conducted in the United States shows no significant difference between men and women (Weller & Budson, 2018).

Environmental factors

Apart from genetic and psychological factors, current studies have sparked interest in investigating toxicity exposure to environment as the primary potential risk factors accounting for AD increase (Hampel et al., 2018). Smoke, pesticides, and air pollution are the examples of such potential factors within the environment. Exposure to air pollution and pesticides can accelerate the likelihood of developing coronary and heart-related health conditions, possibly increasing the risk of AD (Weller & Budson, 2018).

Pathophysiology

Alzheimer's disease is primarily build up by neurofibrillary tangles and the aberrant neurotic plague. Such plaques are usually spherical microscopic lesions having an extended axonal tail with an extracellular amyloid beta-peptide core (Lane, Hardy & Schott, 2018). Alpha, beta, and gamma-secretases work as proteases to cleave the beta-amyloid peptide from APP, amyloid precursor protein is a transmembrane protein that produces the beta-amyloid peptide (APP) (Caruso et al., 2019). Typically, alpha- or beta-secretase will cleave APP, and the resulting minute pieces are not harmful to neurons (Hampel et al., 2018). Rising in the beta- amyloid 42 leads to the aggregation amyloid which probably harms neurons. Amyloid buildup usually surrounds within the body parts including cerebral, meningeal, and gray matter arteries (Lane, Hardy & Schott, 2018). Multifocal gray matter deposits combine to produce plaques, which are milliary structures (Caruso et al., 2019). Hyper-phosphorylation of tau occurs since there is an aggregation of extracellular beta-amyloid causing the formation of tau aggregates, it is frequently seen in the cerebral cortex.

Clinical features and diagnosis

An asymptomatic period is experienced from the beginning of biochemical changes within the brain and the appearance of clinically related symptoms of AD (Juźwik et al., 2019). Research findings report memory impairment as a common hallmark of AD. The deterioration of other cognitive functions encompasses a memory decline (Weller & Budson, 2018). However, symptoms develop progressively with initial symptoms of AD include; executive dysfunction and visuospatial abnormalities, behavioral changes and language deficit are usually symptoms which appears in the later stages of the disease (Juźwik et al., 2019). Diagnostic and Statistical Manual (DSM) states that clinical assessment of AD has reflected the significant cognitive impairment within the cognitive areas like complex attention, memory, executive function, language, and perceptual-motor function (Armstrong, 2019).

Treatment and Management

There are now various pharmacologic therapies used to treat AD. For people with moderate to severe AD, melamine is one of the therapies which function as a non-competitive N- methyl-D-aspartate receptor antagonist (Weller & Budson, 2018). The second type involves giving patients with mild, severe AD inhibitors such as donepezil, galantamine, and rivastigmine to medicate them (Lane, Hardy & Schott, 2018). For people who choose alternative therapy, there are several possibilities besides these two programs. Examples include the nutritional supplement huperzine A, which has been shown to improve daily activities and memory (Hampel et al., 2018). Inhibitors and interventions for the main risk variables are used in the majority of standard AD treatments. BACE 1 successfully serves as an AD intervention by limiting the rate of A production. Researchers like Weller and Budson (2018) consider the use of unproven non-steroid anti-inflammatory medications and omega-3 fatty acids, such as fish oil, in the management of risk factors. According to Weller and Budson (2018), these supplements have been shown to have cardiovascular advantages over the past ten years, and two randomized control trials have shown that fish oil can help memory and thinking in MCI patients. The tiny sample size used in these investigations was their lone drawback.

Conclusion

PD is indeed a neurodegenerative movement disorder; its management is very challenging owing from the changing phenomenology leading to long duration (Vázquez-Vélez & Zoghbi, 2021). The case study shows that PD is a condition associated with older patients who may experience rigidity, tremor, and bradykinesia symptoms (Tysnes & Storstein, 2017). It has been demonstrated that as many other alternatives are essential in the treatment and management of PD, levodopa remains the most effective drug that can be used. The key root to the successful management of patients with PD is based on the available treatment evidence (Tysnes & Storstein, 2017). Amyotrophic Lateral Sclerosis (ALS) is a classic neurodegenerative condition where motor neurons in the brain and spinal cord gradually degenerate (Obrador et al., 2020). Though it involves numerous levels of functional entities that alternate in different directions before convergent functionally defining ALS disease development, the constantly evolving nature of ALS highlights a critical dimension of individual variances that underpin this ailment (Lane, Hardy & Schott, 2018). AD is one of the most prevalent types of dementia, mainly present in older people. According to the literature, the condition is designated as one among the neurodegenerative sicknesses that is progressive and incurable (Caruso et al., 2019). Its prevalence rises sharply from time to time with advancing age and the absence of effective treatments. An in-depth discussion has been given on AD's psychological, emotional, and biological elements, symptoms, and diagnosis (Caruso et al., 2019). It has been established that controlling risk factors and using inhibitors are the most prevalent therapies for the disease.

Natural Ingredients and supplement

According to Cohen et al. (2020), natural ingredients and dietary supplements are substances taken in the body to boost wellness and health to an individual. These dietary supplements form the blocks for body-building substances. Dietary supplements can be in the form of pills, tablets, liquid, or capsules. These products are added to the diet but are not considered food substitutes. Dietary supplements are widely available in a natural settings such as food stores, groceries, pharmacies, and online stores. Cohen argues that most dietary supplements are taken for health purposes to improve an individual's general body health and wellness. According to Jagim et al. (2019), the joint dietary supplement is minerals and vitamins such as vitamin C, botanical supplements such as plant products and herbs, and substances extracted from natural sources such as omega-three fatty acids. However, researchers indicated that makers of dietary supplements are not legally allowed to conclude that dietary supplements can cure, treat or diagnose people until proven medically accepted by a recognized physician. Nevertheless, makers of dietary supplements can say they contributed to health and wellness for individuals. In the United States, dietary supplements are no longer regulated in the same way as medicine and can be sold even without research on how it works on the human body.

Historically, they used natural ingredients and supplements as herbal medicine to prevent illness, relieve fever, cure infections, and heal wounds. Makers of dietary supplements can prepare substances used to treat constipation and ease pain through traditional formulas. According to the research, natural ingredients can have similar health impacts as conventional medicine, while some herbs and plants may have no impact on human health or may be harmful. For example, supplement such as beta-carotene and vitamin E does not lower the prevalence of heart diseases as claimed. Natural ingredients and supplements are critical in facilitating nourishment of a person's body and maintaining a healthy body. The supplement can be gotten by taking a variety of food sourced from natural sources. When the supplement is taken together with food, it can be absorbed easily in the bloodstream and directed to various body parts to initiate healing wellness. According to research, healthcare providers advises people to eat a variety of diet rich in minerals to keep their body strong and able to fight illness. For example, people are advised to take foods such as vegetables, fruits, lean meat, and fish since they constitute natural supplements that provide the body with the micronutrients required in the body. Nevertheless, there are various natural sources where dietary supplements can be extracted. Numerous sources are discussed below.

Water

A dietary supplement is a vital element to individual health. Water is taken to supplement the diet but cannot be taken as food alone. Water is a compound made up of hydrogen and oxygen. According to Ngunyen et al. (2021), water contains minerals and other carbon-based particles dissolved together. Water as a whole protects the tissues and body organs from drying. The dissolved substance may undergo a chemical reaction in the body to bring wellness and good health to humans. For example, nanoparticles such as graphene oxide, graphene, and carbon nanotubes dissolved in water can be used to adsorb steroid hormones to incorporate in membrane composites. Therefore, despite the fact that water is a purely natural compound, dissolved substances can be used to improve body wellness in the long run. Water is used as a dietary ingredient but does not heal illness. Nevertheless, water can intensify an illness if it contains impurities such as lead and other heavy metals. Ngunyen argues that nanoparticles can affect the adsorption by changing g the shape, structure, conformation, and geometry to influence the surface are of colloidal instability. Basically, all living organisms require water for survival. Water can be taken before or after the meal to supplement the diet. According to the survey conducted by Geological survey, our bodies comprise approximately 60% water. Therefore, water must be taken regularly to increase wellness. In the process of drinking water, our body has a special mechanism to extract minerals present in water to improve health and overall body wellness. For example, spring water is rich in magnesium, sodium, calcium, and other important minerals used to strengthen bones and teeth. For this reason, healthcare providers encourage people to drink water regularly to improve their health wellness. Nevertheless, studies have shown that natural ingredients such as water impact health and wellness. Discussed below are some of the impacts of taking water as a dietary supplement on overall health and wellness.

Water Protect Body Organs

Water acts as a quenching agent and protects body organs such as joints, spinal cord, and tissues. According to Luo et al. (2020), it protects body organs by producing selenium-doped quantum dots that effectively ameliorate spinal cord injury and recreates strong bones. Water components help maintain moisture within the body tissues to maintain body wellness. In addition, maintaining a hydrated body helps protect sensitive areas such as the brain, blood, and bones. Most body parts move freely during movement. Therefore, water acts as a lubricant between bones and a cushion between the joints. Thus, water is an important dietary supplement for maintaining health wellness.

Water Helps during Excretion of Waste

When food is taken into the body, it has broken down into small particles that can be absorbed in the body. Water dissolves important nutrients to be absorbed in the body. However, not all food particles are absorbed in the bloodstream. Therefore, water enables the body to excrete some of this waste, either inform of sweat or urea (Ahsan et al., 2018). Therefore, water helps maintain homeostasis for good and wellness in the body. Healthcare providers encourage people to drink more water as a dietary supplement to support body organs responsible for removing waste from the body. For example, kidneys require a lot of water to facilitate blood filtration. Blood impurities can endanger someone's life. Therefore, when water is taken as a supplement in the diet, it can help to maintain body wellness.

Water Aids in Digestion

When water is taken as a supplement, it plays a significant biological function. According to Jain et al. (2020), water helps break down food to allow nutrients to be absorbed in the bloodstream. Therefore, water is a crucial compound taken as a supplement in the human body. Typically, food is taken through the mouth inform of large chunks that cannot be taken directly into the bloodstream. Water helps soften and break down food particles into manageable sizes that can be absorbed in the small and large intestines. When water is combined with food, it forms a heavy porridge-like substance. When this solution passes through the colon and ilium, water is absorbed in the body, leaving a solid substance to be excreted in the form of stool. Therefore, water is a natural ingredient used to supplement diet to help maintain health and body wellness in the long run.

Turmeric

Turmeric is a natural flowering plant of the ginger family, used as a dietary supplement (Ayman et al., 2019). The plant contains active components such as curcumin, proven scientifically to possess health benefits. For instance, its components can improve heart health and prevent cancer and Alzheimer's. According to Bradford (2013), turmeric has been recognized by healthcare providers as a natural inflammatory and health-promoting product. Most people use turmeric to spice food to improve health stability. Turmeric contains a variety of compounds that can be used to serve a medicinal purpose. Curcumin is the primary anti- inflammatory health component found in turmeric. Evidence deduced that curcumin found in natural turmeric facilitates weight loss and reduces obesity-related diseases. Health statistics indicate increased obesity and overweight patients in healthcare centers (Grassi et al., 2019). However, when turmeric was discovered, obesity and overweight-related diseases have decreased spontaneously. Curcumin contains a chemical substance characterized by anti- inflammatory activity to burn excess fat and oil.

The recent scientific approach shows that curcumin directly interacts with the adipose tissues to minimize chronic inflammation incidence. Scientist indicates that curcumin prevents macrophage infiltration and suppress the nuclear factor that triggers inflammation. Curcumin reduces the inflammatory incidence by destroying pro-inflammatory adipokines growth. Therefore, turmeric is an essential dietary supplement with health benefits and can improve overall individual wellness.

On the other hand, turmeric can reduce Alzheimer's disease (AD). AD is a common neurodegenerative disorder among older adults (Tang, 2017). In the modern days, AD prevalence has been detected among the elderly community, demanding immediate action to save the community. AD prevalence can be reduced by developing efficient pharmacotherapies from natural ingredients. Healthcare providers have identified turmeric as a potential source for therapies to reduce the incidence. Tang argues that medicinal treatments for this condition target the symptoms associated with the condition rather than modifying the disease progress in the human body. However, research indicates that natural ingredients such as turmeric may contain compounds that can suppress AD conditions. Curcumin, a product extracted from turmeric, has demonstrated treating AD. Curcumin prevents the formation of amyloid and attenuates clearance of bind copper, lowers cholesterol in the blood, and modifies the microglial activities. Therefore, physicians will probably develop an effective natural therapy to cure AD using natural ingredients with continued research.

Consequently, turmeric can also be used to reduce cancer intensity. According to Unlu et al. (2016), curcumin, a product extracted from roots of a turmeric plant, was traditionally used by Chinese and Indians for medicinal purposes. Laboratory test indicates that curcumin has antioxidant, anti-inflammatory, and anti-cancer properties. However, there is no clear medical evidence that explains the findings. However, curcumin usage has been known for favorable results in reducing cancerous growth in the long run. Nevertheless, turmeric compounds also facilitate the treatment of cardiac fibrosis. Fibrotic genes are responsible for the immediate response to damage by cardiovascular diseases. Curcumin compound constitutes an extensive biological phenomenon that can stabilize heart conditions. The product helps to regulate blood pressure and heartbeat developed by cardiac fibrosis. According to Gorabi et al. (2020), healthcare providers have affirmed the role played by curcumin in the human body amid suppressing heart failure conditions. In general, turmeric is a natural ingredient with unlimited benefits for human health. According to Kocaadam et al. (2017), the turmeric plant is grown in Iran, Malaysia, India, and China held with great importance. Traditionally, people have been using turmeric to spice and for medicinal reasons. Thus, turmeric is a natural dietary ingredient that has numerous health advantages. Curcumin, a turmeric compound, is used as an antioxidant, anti-inflammatory, and anti-cancer and has no known side effects on human health.

Resveratrol

According to Galiniak et al. (2019), resveratrol can be considered a stilbenoid, a natural phenol, and phytoalexin that can be extracted from numerous plants under certain conditions plan is under attack by fungi or bacteria. Some familiar sources of resveratrol include; peanuts, mulberries, blueberries, and raspberries. Resveratrol can be found in grapes' skin and seeds and food sources such as peanuts, wine, and berries. Resveratrol is a natural supplement that impacts health and wellness in numerous ways. When resveratrol is taken in the body, it can treat cancer, reduce aging, act as an anti-inflammatory, and be used against glycation. In addition, resveratrol can treat and control diabetes and its complications.

Nevertheless, researchers have termed resveratrol a double-edged sword due to its health benefits. Resveratrol is compound that belongs to the polyphenol group made up of two phenol rings linked by Ethylene Bridge. Researchers have documented over 70 sources of this compound abundant in grapes, skins, and seeds. However, the compound can also be found in wine in discrete amounts. According to Salehi et al. (2018), resveratrol is used in cognitive performance and as a memory aid. Cognitive performance is the ability to acquire knowledge, reasoning, and manipulation of information. Therefore, resveratrol is used to improve thinking and make informed decisions. Resveratrol is a natural supplement that can help to improve reasoning and personal wellness in the long run.

In addition, resveratrol can also be used to impact older people's health conditions by treating Alzheimer's disease (AD). According to Sawda et al. (2017), the amyloid hypothesis suggests that continuous deposition of the central nervous system among the aging can result in AD. Therefore, resveratrol acts as a therapeutic agent for AD. According to the research, long- term use of resveratrol compounds can help to moderate mild AD. Therefore, resveratrol is an essential natural ingredient that can improve health and wellness. Nevertheless, research also indicates a direct relationship between resveratrol compound and ovarian hormone release. The release of progesterone, oxytocin, and progesterone are influenced by resveratrol. This is an important role this compound plays as it can be used to increase fertility rate and conception. Lastly, resveratrol can also be used to trigger cancer. Many people have become vulnerable to cancerous cells across all ages in the recent century. Evidence suggests that the style of living contributes to cancer and inflammatory growth. Healthcare providers have tried medicinal ways to treat cancerous cells, which may not respond appropriately. Therefore, physicians have recommended natural cancer treatment using the resveratrol compound found in grapes. Thus, natural ingredients and supplements can impact health and body wellness.

Raspberry Ketones

Raspberry ketones are a natural phenolic compound that forms the aroma compound of raspberries. According to Lim et al. (2021), numerous diseases are linked to oxidative stress that can be treated using the natural compound extracted from raspberries. Research indicates that raspberry ketone has numerous pharmacological functions. Essentially, raspberries are cheap natural compounds but can impact human health and improve individual wellness. Raspberry ketone compound is used to impact weight loss and cure obesity. Studies indicate that approximately 70% of the total population in the US are at weight and obesity compromise. The prevalence of weight-related diseases has heightened in the last few years due to changes in lifestyles. The majority of people spend the most time on a computer without undertaking any exercise. For this reason, healthcare providers have recommended people to develop a habit of taking raspberries as a supplement since they can impact health and stabilize body conditions.

In addition, raspberry ketone can be used to treat Alzheimer's disease. According to Huang et al. (2018), raspberry ketone is sometimes referred to as rheosmin, a compound that gives typical raspberries their distinct smell. Claims show that this compound has health benefits but is not scientifically tested and approved. Physicians advise older people to take more fruits that produce raspberry ketone compound or take an extracted compound directly into their body in the form of supplements. The compound indices increased acetylcholine level, which refreshes the brain tissues. Therefore, the compound is ideal in treating AD, which is associated with old age. Consequently, the raspberry ketone compound has been used as an over-counter weight loss supplement in the last few decades. According to Li et al. (2022), raspberry ketone has gained popularity in health due to positive responses to reduce weight loss and obesity treatment. Still, it lacks scientific support for its use for medicinal purposes. Therefore, we can deduce that natural ingredients and supplements can impact health and wellness.

Monk Fruit

Monk fruit is an herbaceous perineal vine grouped into gourd families. The fruit originated from southern China, where the locals used it as traditional therapy. Monk fruit sweeteners lower sugar intake while providing maximum enjoyment of food taken together. Monk fruit is a natural ingredient with numerous health benefits. Tey et al. (2017) argue that monk fruit can be used as a non-nutritive sweetener that controls body weight and manages glycemic. However, few studies demonstrate energy compensation derived from insulinemic and glycemic responses. Unlike other no-calorie sweeteners, monk fruit is an exclusive sweet with natural sugar that does not add cholesterol levels to the body. Therefore, monk fruit can be used intensively to manufacture beverages and soft drinks such as dairy products, candies, condiments, and desserts. In addition, monk fruit compound cab is used in baked goods due to its stability under high temperatures. Therefore, monk fruit may have myriad uses. Thus, the user can tailor the need to their specification. Nevertheless, monk fruit can also be used to trigger hormonal balance. The compound demonstrates effects when tested in the presence of glucose. The higher the monk fruit constituents, the higher the energy released. Therefore, we can conclude that natural ingredients taken as food supplements can improve individual wellness.

Monk fruit generally does not catch peoples' attention as it is not colorful as other fruits such as apples. However, in the modern days, people's attention is drawn close due to its health benefits. Monk fruit is ideal for patients with devoted foods with chemical sugar and the diabetes community. Research shows that monk fruit can boost food in the diet by adding natural sweetness. The makers of monk fruit sweeteners extract compounds from dried fruits to make natural sweeteners. The research shows that the extracted compound is approximately 150 times sweeter than the table sugar with no calories and does not raise sugar levels in the blood. Therefore, physicians recommend that people consume monk fruit sweeteners rather in large portions and take fewer table sugar-containing chemical substances.

Black Seed Oil

Black seed oil can be referred to as an herbal ingredient extracted from the Nigella Sativa plant initially found in western Asia and Eastern Europe. The compound is known for its powerful medicinal properties to treat a wide range of health conditions. According to kooti et al. (2016), black seed oil can be used in common treatments such as inflammatory conditions, asthma, rheumatoid arthritis, diabetes, and digestive diseases. The compound can also be consumed as a food supplement to improve wellness and health. Heath-wise, black seed oil helps reduce condition prevalence by eliminating the chemical compound in the body that causes diseases. The product demonstrates therapeutic properties due to thymoquinone that forms the primary bioactive compound vital in the oil. Extensive research has been conducted to understand elements that make up this compound and link it to pharmacological actions. The major explored parts include; anti-cancer, antidiabetic, antimicrobial, anti-inflammatory, bronchodilator, and other essential areas. Therefore, the present review shows a relationship between black seed oil and health.

Research shows natural compounds are far much better than artificial compounds used as remedies for various health conditions. This is because black seed oil is made up of natural compounds, while artificial medicine is made up of chemical compounds that can leave damage to the body. Research shows black seed oil is healthy for human consumption regardless of health conditions. Therefore, we can conclude that black seed oil can be used to maintain good health and wellness (Majdalawieh et al., 2015). In addition, recent research has proven a potential herb to treat Covid-19. Studies show that covid-19 is caused by acute respiratory syndrome coronavirus. The Nigella Sativa plant contains antiviral and antioxidant compounds that can treat coronavirus infection. In addition, black seed oil contains antihistaminic compounds that help the body maintain a good condition to fight against infectious diseases. Covid-19 has been recognized as a global pandemic as it can spread rapidly over a short period. Therefore, a natural control method is highly advisable to ensure that patients recover quickly without any bodily harm or leaving traces. Therefore, Nigella sativa is a natural ingredient that can control adverse conditions caused by immunomodulatory and antiviral diseases.

Apple Cider Vinegar

Apple cider vinegar is a vinegar extracted from fermented apple juice and is commonly used in salad dressing, food preservatives, and marinades. According to Gopal et al. (2019), apple cider vinegar has been validated scientifically fit for remedy. The research shows that there exists an unequivocal antimicrobial activity in apple cider vinegar which is used to treat myriad disease-related conditions. Therefore, apple cider vinegar can treat antimicrobial-related and inflammatory conditions. The global growth in antibiotic resistance has forced scientists to go for natural products as an alternative to control microbial conditions that can put human health in danger. Thus, apple cider vinegar is a natural ingredient but helps maintain good health.

According to Halima et al. (2018), the consequences of obesity can lead to a severe metabolic syndrome characterized by cardiovascular risk factors such as hypertension, glucose intolerance, and dyslipidemia. Research shows that a diet spiced with natural antioxidants such as apple cider vinegar is essential in reducing weight and controlling obesity-related conditions. When a study was conducted, apple cider vinegar showed a high correlation with obesity which shows the compound can trigger the condition. On the other hand, apple cider vinegar can control blood sugar levels. High lipid profiles and the associated glucose homeostasis can increase cardiovascular diseases. Therefore, adding apple cider vinegar as a supplement to the diet may help to improve wellness and health.

Aloe Vera

Aloe Vera is a tender plant species grouped in the genus Aloe. The plant has been used for medication for a couple of centuries. Researchers have extensively studied the therapeutic function found in this plant. There is numerous recognized therapy for the aloe Vera plant. They include; antibacterial, antiviral, hepatoprotective properties, immunoregulative function, and anti-cancer therapies. There are numerous traditional therapeutic uses for aloe Vera such as treating skin-affected burns, cuts, and insect bites, and used to enhance the digestive system due to impacts associated with anti-inflammatory and antimicrobial. Many researchers have been validating traditional usage for aloe Vera rather than expounding on its uses. Aloe Vera is a natural plant taken as an herbal to treat illness.

Aloe Vera species are distributed across Africa and Asia or any other tropical climate zone. Research deduced that Aloe Vera could treat skin affected by various conditions such as skin cancer and other microbial-related conditions. Ideally, Aloe Vera can effectively treat genital herpes, lichen planus, burn, inflammation, and wound healing. Nevertheless, Aloe Vera provides some promising outcomes when taken orally. However, the weakness is that dermatologists have not proven its effectiveness meticulously. In addition, Aloe Vera can be used as an antioxidant that increases nutritional value for food and increases shelf-life for food stored. Therefore, Aloe Vera can be used widely in cosmetic shops, pharmaceuticals, and the food industry to enhance wellness (Hęś et al., 2019). Antioxidant substance prevents substance oxidation that degenerates chemical compound that triggers food degradation. Aloe Vera has become one primary antioxidant compound necessary for food products. Lastly, Aloe Vera can be used to treat gastroesophageal reflux diseases. The plant product provides an effective treatment to maintain the required gut health. Aloe Vera is associated with numerous health benefits required to maintain wellness. They include; accelerating healing of the wound, lowering sugar levels, reducing constipation, helping in treating canker sores, and having antioxidant properties.

Restore

Restore is a substance designed to regulate body conditions to support and restore energy and gut microbiome. Importantly, restore contains all the natural antioxidants, antifungal, anti- inflammatory, and other essential health ingredients. Therefore, these ingredients help the body support microbiome and develop a robust immune system. Ideally, restore plays all the roles played by natural ingredients in one basket. Restore helps in the digestion of carbohydrates to provide the energy required in the body.

Conclusion

Natural ingredients and supplements are found in abundance in various natural settings. Therefore, makers of natural ingredients must have unique knowledge to extract the required natural ingredients from the right plan. Otherwise, one may be at risk of confusing the right plant to source these ingredients. Natural ingredients and supplements affect health and wellness by treating diseases, reducing the intensity of a condition, maintaining homeostasis, and controlling weight-related conditions.

References

Body

Early in history, adversaries started trying to harvest disease for reasons of war; however, they often went through challenges in making an effective disease as a tool of war. Naturally occurring diseases that kill people, plants, and animals are the beginning point for such chemical or biological weapons (Inglesby et al., 1999). These diseases were derived from fungi, toxins, and bacteria. Non-contagious and contagious diseases like anthrax and plaque can be turned into biological; weapons. During medieval times, military commanders tried to harm their enemies by contaminating their water supplier with carcasses of humans and animals that died from dangerous infectious diseases or, like early stated, throwing bodies over walls of enemy cities (Boscarino et al., 2003)). In current warfare, nations have used diseases sparingly. The most known case goes back to World War II when the imperial Japanese army unleashed cholera, plaque, and typhoid diseases on the China civilians, killing several thousand. To use biological compounds today, aircraft bombs, missiles, rudimentary delivery systems, and artilleries can be used (Cieslak, 2001). The delivery of aerosol chemical and biological compounds using ultra-fine particles that could be inhaled poses a significant risk of many causalities. Attacking the human population can also be done using deliberate food supply contamination because infections occur easily and quickly by ingesting. Abrasions and cuts on the skin's surface could also be a route for exposure to multiple infections of biological attacks.

The susceptibility of chemical and biological compounds to meteorological conditions like ultraviolent rays can quickly cause death. It complicates the ability to execute an effective chemical weapon attack (Al-Agamy, 2011). Compounds can be hardened against some meteorological complications, but shifting according to the direction of the wind can still blow the agent away from the target. Nevertheless, these weapons can be used strategically and tactically. Tactically, a command post can be attacked with a non-contagious biological disease to take an adversary down in military leadership. A strategic attack can target even a large metropolitan area with a contagious disease (Whitby & Rogers, 1997). Eventually, a pandemic could bring down so many people that the military can no longer be sustained since they are not getting enough supplies such as ammunition, food, and other necessities. Targeting civilians deliberately completely goes against the Geneva convention principle of war. However, the devastating impacts of biological warfare could be because of multiple reasons that find using biological and chemical weapons attractive (Warner et al., 2011). Others might include the ability to offset their enemy nuclear or conventional military power with biological weapons. The technicality and ease with which these weapons can be acquired compared to nuclear weapons makes it easy to create a biological weapon covertly. One of the research questions broaches this issue of the proliferation problem.

The possible integration of advanced technology in chemical and biological weapons interest and programs of sub-national actors in this warfare could create quantitative and qualitative proliferation quandaries (Szinicz, 2005). The rate of discovering the science in life for the last few years is astonishing, from the knowledge of altering genetic material artificially to the human genome and disease pathogenesis besides transferring it from one organism to another. Therefore, genetic engineering can be used to make diseases resistant to medical treatment and vaccines, making the effects even more contagious and lethal. With technological development, scientists cab also fabricates segments of disease materials to make biological weapons (Szinicz, 2005). Revolution in life science shows that there is no sign of abatement. Many quality-of-life and life-saving enhancing developments will emerge from laboratory science in years to come. Still, potential abuse of new equipment and technologies and knowledge about malevolent goals will always be present.

A drastic change from the traditional practices of acts of violence started to instigate sympathy for a party's political reason. In the past couple of years, two sequences in terrorist activities have realized a possibility that some people will turn into biological weapons as their best method of going to war (Szinicz, 2005). The initial trend is some groups' proven intention to cause the highest number of causalities with absurd methods of attacking. Secondly, it is the growth in incidents where a terrorist is planning to use biological attacks by obtaining biological agents, trying to reproduce and use them on civilians. Currently, attacks that show a clear indication of biological warfare are atypical. For instance, the 2001 anthrax attack is a good example (Szinicz, 2005). At some point, taking advantage of the developed technology, some groups might overcome the technical challenge to attack a significant number of civilians using biological weapons. At that point, the number of deaths and injuries from the attack could be significantly high.

Two main international accords were designed to contend with the risk of biological or chemical weapons at a nation-state level. The deliberate use of biological weapons was so vile that the international community burned its use in the Geneva convention, consequently outlawing using poisonous gas (Stokes & Banderet, 1997). The components of the proliferation regime are the "Biological and Toxin Weapons Convention (BWC)," which prohibited the production, development, and use of deadly weapons. In contrast to these laws, the Soviet Union ramped its biological and weapon programs and hid them inside commercial activities. They also engineered multiple diseases like plague, smallpox, and Marburg, diseases that nullified vaccines and treatments (Russell et al., 2003). Many of these activities and facilities are now engaged in peaceful studies with foreign experts, trying to establish commercial activities. Still, the country's refusal to allows people from outside into military institutions concerned that remnants of biological weapons have not been destroyed.

Moreover, United States intelligence has highlighted biological proliferation worries about Russia, Syria, and North Korea. However, Iraq is the only country confirmed to have had biological weapons programs ongoing in recent times (Ritchie & Owens, 2004). In the last few decades, the international community had conveyed a group of professionals to analyze what could have been done to monitor BCW. The dual-use method of biological gear and materials, besides the difficulty in distinguishing legal defence practices from illegal offensive, is amid the obstacles experienced (Ritchie & Owens, 2004). Talks about creating a legally binding monitoring process that had begun earlier, culminating in a draft agreement that the United States refused, stating that it was not enough to establish a treaty of compliance, which could compromise important defense prosperity and information.

The character of biological warfare is now going through a significant alteration. These changes are derived from society and science, very parallel developments. Biological security is shifting from weapons of mass demolition to a sphere of info conflict where targeted small- scale attacks might have a huge impact on the victims (Richards et al., 1999). Future biological wars might even use the same strategies to exact confusion and shock on their counterparts using a mere threat of casualties, increasing the previous disadvantage of biological and chemical warfare (Richards et al., 1999). Rapid advancements in science and biology may be widened to defend against these attacks. The element of surprise is important for during an attack using biological weapon, and fairly easy to achieve. The small amount of the toxic compound needed for an attack, will spray several miles to the target group making the weapon more difficult to detect while using aerosols. The uncertainty nature of manifesting symptoms can mask the beginning of an outbreak and enhance a possibility that they catch more people adversely not prepared.

In the current era, large-scale partisan battles will be affected by equipped scuffles but will include humanity at large. Encounters of psychological manipulation will intensify, while secluded conflict may be a reality (Reyna, 2004). Fear of a health predicament can be why a whole nation goes into chaos, opening up the country to external risks. For instance, an epidemic of contagious disease can compel people to live and work in a digital domain where they will be subtle to technical breakdowns and cyberattacks (Ramesh & Kumar, 2010). However small, it is clear that biological attacks will still reach their effects at a tactical equal by changing the aim for biological weapons ways from the combat military towards the whole community (Ramesh & Kumar, 2010). To bring an authentic physical consequence, an incomplete number of attacks may need a basis in the real action of a devastating landscape. Considering this, the achievement of future biological attacks in the risk zone conflict is dependent on stressing the significance that the toxic substance appears contagious, which will initiation doubts of enormous spread.

Because of the target method of operation, future biological warfare may surround most of the challenges that prevented biological weapons from getting to strategic impact from the past (Hedén, 1967). Large deployment and production of biological toxins may be useless. Placement on an enormous gage to get to a strategic advantage on the battleground required that weaponized compounds were ecologically friendly. They had to be paired with a transfer scheme that could yield a massive explosion (Koblentz, 2003). This element was a challenge to keep toxic weapons a secret besides demanding a considerable investment in infrastructure. In difference, since even minor eruptions can cause strategic impacts, future bioweapons production can be produced in academic or industrial molecular biology as long as these conveniences are open to international inspection.

Moreover, the armamentarium of biological weapons will widen its range of valuable biological compounds. Many definitive plans in biological combat have been limited to ordinary compounds such as pathogens, with the help of the “Soviet Union” near to its end. This has reduced the range of pathogens so that countermeasures could be well premeditated. This disadvantage is now being counterbalanced on a protection scale by the gradual expansions in biology and technology (Inglesby et al., 1999). Animal cells and infectious agents can now be built from as simple as a laboratory. Biological weapons in biotech are improving, and the determination of such operation could vary and include palpable developments of armaments. However, manipulation can be extensive and contain mutation primer that allows move from animals to people or a nucleus that codes nonlethal effects. It might even be possible to paradigm functions for overdue signs, allowing wide distribution from one person to another (Inglesby et al., 2002). Therefore, the victims will seek medical services in places where medical services are offered. Such prolonged attacks would cause a quarantine, and other efforts for coordinating responses to a crisis difficult.

Fundamental studies on food insecurity are subtle for surrogate and economic biological warfare. Conflict on shared resources in some nations is a commonplace. Food security, human health, and environment management are consciously threatened, globally and regionally, by simple water reserves (Marchant et al., 2011). Other constituents are within the model of a real-world view of food security and biotechnology, waterlogging, salinization, and over-cultivation (Mauroni, 2007). Deliberately contaminated herbicides, food, pesticides, and using arable land to produce food is another component of food insecurity. Moreover, emerging and new plant infections affect agriculture sustainability and food security, increasing malnutrition in a country rendering its people susceptible to human diseases. Deliberate release of pathogenic and harmful organisms that destroy an enemy's reserves and cash crops comprises an effective biological warfare weapon (Noy, 2004). Warfare involving herbicides and biological agents is anticrop warfare that results in famine, the decimation of agriculture- based economy, malnutrition, and food insecurity.

On large-scale attacks, self-protection may not be needed any longer. Using classic weapons, biological weapons have rested on conditions that must be prevented or treated for the enemy's military (Petro et al., 2003). Keeping the outbreak targeted and small may surround this issue. Moreover, compounds with high morbidity and high lethal content, and easily containable toxins can be advanced in the laboratory of a more benign to be more contagious (Bazarkina, 2019). Recent developments in biology may also ease the outbreak restraint. Though still argued as to its viability, this cannot be exempted from that increase in the accessibility of information on people gene disparity that could target precise individuals, ethnic grouped based on their genes. As an extra safety precaution, an attacker may fix for a large-scale vaccine in contrast to an attack by a pathogen (Harris & Paxman, 2002). The Covid pandemic has shown that a vaccine can be manufactured quickly. Ironically, if the enemy escapes attributing while giving a timeline vaccine for the affected, the attacker might be successful in creating great publicity on their side of the conflict.

Factors previously discussed all led to dissolving the tension made by biological war challenging to practice. However, one aspect that may retain its character as an obstacle contrary to organic attacks; is their morals when focused against civilians. This challenge may be heightened in current battles of the aspect (Franklin, 2018). Realistically, if a biological attack is bound to happen, it is vital to ensure that someone else gets the fault. Bringing mix- up about the initials of a prompted contagious occurrence could be the answer to planned accomplishment. The attribution and accountability can be problematic by changing the making of bioweapons from the state government to individually industry (Patel et al., 2019). The current global economy, where international tech firms are used as cover for the production of chemical and biological are increasingly getting connected with huge research organizations and nongovernmental institutions, provides a perfect condition to develop biological and chemical weapons under biomedical research (Patel et al., 2019). One may have to foresee that future antagonist will blend nonstate and state actors using biological and chemical weapons to their advantage.

A biological weapon is unique in its delayed effects and visibility. These two factors allow the military to cause confusion and inculcate fear among their victims besides escaping undetected (DiGiovanni, 1999). An attack using a biological weapon would cause fatal deaths or sickness in large numbers and create panic, anxiety, and uncertainty. Its objective is disruption of economic and social activities, impairment of military response, and breakdown of a government authority. Evident in the anthrax attacks in the aftermath of the World Trade Centre attacks, the occurrence of a few numbers' infections could create a substantial psychological impact until people feel vulnerable (DiGiovanni, 1999). Choosing biowarfare compounds is dependent on the technical, economic, and financial capacities of an organization or state. Ebola, smallpox and anthrax are the most used biological weapons because they have a devastating reputation for causing horrific sickness (DiGiovanni, 1999). Images of law enforcement personnel and doctors in full gears for protection alone could cause widespread public panic, anxiety, and distractions.

Today, attacks using biological weapons are possible. The public and the medical community should be familiar with control measures and epidemiology to increase the likelihood of a reasoned and calm response if an outbreak occurs (Ganesan et al., 2010). Moreover, the principle that enables clinicians to develop strategies against such attacks is essential as the health community system considers the issue a proliferation (Ganesan et al., 2010). Further knowledge through education emphasizes recognizing that vulnerability is both necessary and timely. Prevention rest on developing a firm hold on the global norm, rejecting the development of any biological weapons (Cooper, 2006). This implies that early prompt and detection treatment of signs is a secondary measure. The medical society plays a significant role in secondary measures by taking part in reporting and surveillance, thus providing information that biological warfare is being used. Consequently, continued studies to improve surveillance and research for enhanced effective response plans, therapeutic compounds, and diagnostic capabilities will strengthen prevention measures.

Conclusion

In conclusion, it is a warning; it is crucial to keep a civil and stable tactic when entering a different era of preparedness. Over vigilance amid most government agencies to biological and chemical warfare can be risky in itself, carrying vulnerability that a relative natural outbreak of pathogens can cause lockdowns, which prevent other elements of protection, risk attenuating the response, and proving financially costly once a risk arises. Discovery out with high and fast accuracy what instigated a set of diseases and suspicion before it becomes critical will be effective. Ramping intelligence in medicine tries to include the frontline method and tops molecular biology professionals with prominent significance. Finally, the role of tertiary prevention by reducing disability from diseases caused by biological weapons should not be forgotten. While BWC is ready to help affected nations, medical help must be prepared to go through sequelae should an unthinkable happens.

References

Al-Agamy MH. “Tools of biological warfare”. Research Journal of Microbiology 6.3 (2011): 193.
Balmer B. “Britain and Biological Warfare”. Basingstoke: Palgrave Macmillan 10 (2001): 9780230508095.
Boscarino JA, Figley CR and Adams RE. “Fear of terrorism in New York after the September 11 terrorist attacks: implications for emergency mental health and preparedness”. International journal of emergency mental health 5.4 (2003): 199-209.
Burger M. “Secrets & Lies: Wouter Basson and South Africa’s Chemical and Biological Warfare Programme”. Penguin Random House South Africa (2012).
Cieslak TJ. “Medical consequences of biological warfare: the ten commandments of management”. Military medicine 166.12 (2001): 11-2.
Cooper M. “Pre-empting emergence: the biological turn in the war on terror”. Theory, culture & society 23.4 (2006): 113-135.
DiGiovanni JrC. “Domestic terrorism with chemical or biological agents: psychiatric aspects”. American Journal of Psychiatry 156.10 (1999): 1500-1505.
Ganesan K, Raza SK and Vijayaraghavan R. “Chemical warfare agents”. Journal of pharmacy and bioallied sciences 2.3 (2010): 166-78.
Harris R and Paxman J. “A higher form of killing: the secret history of chemical and biological warfare”. Random House Trade Paperbacks (2002).
Hedén CG. “Defences against biological warfare”. Annual Reviews in Microbiology 21.1 (1967): 639-676.
Inglesby TV., et al. “Anthrax as a biological weapon: medical and public health management”. Jama 281.18 (1999): 1735-1745.
Inglesby TV., et al. “Anthrax as a biological weapon, 2002: updated recommendations for management”. Jama 287.17 (2002): 2236-2252.
Koblentz G. “Pathogens as weapons: the international security implications of biological warfare”. International security (2003): 84-122.
Marchant GE., et al. “International governance of autonomous military robots”. Colum. Sci. & Tech. L. Rev 12 (2011): 272.
Mauroni AJ. “Chemical and biological warfare: a reference handbook”. ABC-CLIO (2007).
Noy S. “Minimizing casualties in biological and chemical threats (war and terrorism): the importance of information to the public in a prevention program”. Prehospital and disaster medicine 19.1 (2004): 29-36.
Petro JB, Plasse TR and McNulty JA. “Biotechnology: impact on biological warfare and biodefense”. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 1.3 (2003): 161-168.
Ramesh AC and Kumar S. “Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents”. Journal of Pharmacy and Bioallied Sciences 2.3 (2010): 239.
Reyna VF. “How people make decisions that involve risk: A dual-processes approach”. Current directions in psychological science 13.2 (2004): 60-66.
Richards CF., et al. “Emergency physicians and biological terrorism”. Annals of emergency medicine 34.2 (1999): 183-190.
Ritchie EC and Owens M. “Military issues”. Psychiatric Clinics 27.3 (2004): 459- 471.
Russell AJ., et al. “Biomaterials for mediation of chemical and biological warfare agents”. Annual review of biomedical engineering 5.1 (2003): 1-27.
Stokes JW and Banderet LE. “Psychological aspects of chemical defense and warfare”. Military Psychology 9.4 (1997): 395-415.
Szinicz L. “History of chemical and biological warfare agents”. Toxicology 214.3 (2005): 167-181.
Warner J., et al. “Analysis of the Threat of Genetically Modified Organisms for Biological Warfare”. National Defense Univ Washington Dc Center for Technology and National Security Policy (2011).
Whitby S and Rogers P. “Anti‐crop biological warfare‐implications of the Iraqi and US programs”. Defense Analysis 13.3 (1997): 303-317.

How zeolite can completely get hydrolyzed

As revealed by studies, zeolite constantly undergoes complete hydrolysis, and this process encompasses many perspectives or steps (Hasegawa et al., 2010; Wheatley et al., 2014). The first and most notable condition is this procedure incorporates the assembly-disassembly-organization-reassembly technique. Compared to conventional ones, this approach has proved to produce new zeolite that is somewhat pure and reliable (Hasegawa et al., 2010; Wheatley et al., 2014). To effectively accomplish this perspective allow for the formation of the stated components, there is a need to begin the exercise by including materials with appropriate physical and chemical properties as failure to do so will deter the whole process. While researchers consider various properties to necessitate complete hydrolysis the leading ones are the existence of multiple conditions, including "double four rings" and preferentially accommodative materials (To et al., 2006; Mintova et al., 2013). Then reassemble and organization of zeolites rely on the prevailing conditions and the general expectation, especially as the final product. Material scientists and technicians have portrayed many reasons to ascertain whether the mentioned component can effectively get hydrolyzed. The most fundamental one is how it behaves insolvent and other liquids (Mintova et al., 2013; Shamzhy et al., 2014). Based on the provided information, the most commonly employed technique to necessitate hydrolysis is reassembling the layered species to lead to a relatively uniform reaction (To et al., 2006; Hasegawa et al., 2010). The associated components or materials efficiently undergo chemical transitions to form a specified condition with such an occurrence.

Still, regarding complete hydrolysis, zeolite usually undergoes controlled desilication, resulting in mesoporous components (Hasegawa et al., 2010; To et al., 2006). As revealed by academic scholars, this approach helps to strengthen the applicability of the stated chemical material. In most circumstances, the process allows for hydrolysis and other related incidences by lifting restrictions occasioned by various metrics and factors, particularly diffusion limitations (Wheatley et al., 2014; Mintova et al., 2013). Throughout various investigative studies, academic advocates mentioned how incorporating the above-stated conditions enhances the whole procedure as it modifies the ratio of Silicon and Aluminum (Hasegawa et al., 2010; Wheatley et al., 2014). The success of the entire process mainly relies on the number of alkaline solutions used, with the best outcome being experienced with optimum alkaline-based states. Based on this description and highlight, one can easily depict how zeolite can effectively get hydrolyzed when the required ratio of Silicon and Aluminum is integrated into the system (To et al., 2006; Hasegawa et al., 2010; Wheatley et al., 2014). Compared to other materials or elements, it is evident through constant exploration how including the Si and Al play an essential role in optimizing the process of neutralizing chemicals that otherwise produce zeolite and other chemical compounds.

Although the primary function of various elements such as micropore confinements and micro-solvation, there is a high chance that "siliceous zeolite chabazite" can be formed by integrating alkaline-based hydrolysis (Mintova et al., 2013; Wheatley et al., 2014). Throughout this process, there is always a need to incorporate Sodium Hydroxide to catalyze the formation of a given product effectively. Besides, complete hydrolysis of zeolite entirely depends on collective efforts that mainly involve reaction-related initiation. As depicted by academic professionals, this situation is occasioned by the formed Q3 defects and other occurrences (Wheatley et al., 2014; Shamzhy et al., 2014). Based on similar scholarly research, complete hydrolysis undergoes enhancement by solvating the Sodium ion cation with sufficient liquids, mainly water. Capturing the procedure or development involves including reliable hydration surroundings and natural treatments in zeolite pores (Hasegawa et al., 2010; To et al., 2006; Mintova et al., 2013). Through such a perspective, the hydrolyzed materials will exhibit the required physical and chemical properties as their hydrolysis, synthesis, and break-downs follow the correct procedure.

Steps that were taken to Hydrolyze zeolite

Based on available information, researchers have initiated many mechanisms used to hydrolyze, synthesize, and break-down zeolites into functional components (To et al., 2006; Mintova et al., 2013). High contents of various elements like Aluminum and Silicon in coal fly ash have forced scientists and technicians to study whether zeolites can be hydrolyzed from those materials. The process can be used as the first step towards obtaining high-quality components and enhancing their application, especially from a real-life situation (Mintova et al., 2013; Hasegawa et al., 2010). Although the technique got undertaken in the ancient period, its incorporation in the contemporary world will necessitate the production of suitable zeolites. To effectively heighten the whole process and necessitate upward trends, there is a need to commence the exercise by dissolving fly ash that includes making complex depolymerization- related reactions. As depicted by academic scholars, this occurrence is to release various elements, particularly Aluminum and Silicon that are presented in the form of solutions through what we call the dissolution process (To et al., 2006; Mintova et al., 2013). Regardless of smooth transition during hydrolysis, it is worth noting how the whole procedure is hampered with or depends on several metrics such as agitation conditions, alkaline concentrations, existing atmospheric pressure, and temperature. With this step, researchers insisted on a need to include optimum water content.

According to scholarly evidence, this situation is based on the condition that zeolites building blocks rely on hydration and cationic components (Mintova et al., 2013; Wheatley et al., 2014). One can quickly ascertain how water plays an essential role in determining the general whereabouts of hydrolyzed zeolites and related compounds. Such a liquid also helps to fill the voids created displayed by various devices throughout hydrolysis and synthetic reaction. At this stage, it is essential for those engaged in this practical work to increase the water content (Mintova et al., 2013). Doing the stated condition depresses critical growth and ensures the hydrolyzed components have the required physical and chemical characteristics (Mintova et al., 2013; Hasegawa et al., 2010). This situation occurs for many reasons, with the first and most prevalent being the efficiency of water in deterring growth and necessitating consistent chemical conditions. While the whole process directly contradicts diverse researchers, especially around hydrolysis, it is depicted through investigative studies how integrating enough water in the system heightens crystal growth rate occasioned by enhanced colloidal silica-based dissolution rates (To et al., 2006; Hasegawa et al., 2010). With the presence of this liquid or rather conditions at this stage, there are also increased water contents that, when effectively accommodated at the mentioned section, enhances various occurrences, including purity and yield of the eventual or final products (Hasegawa et al., 2010; Mintova et al., 2013). Compared to the previous hydrolysis and synthesis that led to the production of diverse materials and components, complete hydrolysis of Aluminum and Silicon to produce zeolites entirely depends on the prevailing water content. Its incorporation deters endless complications during the whole process.

Another notable practical metric during the above-stated stage is the time or duration of the whole process and reaction (To et al., 2006; Hasegawa et al., 2010). Based on the available information, this condition is an essential factor that directly determines the general transition of the provided materials into excellent and high-quality zeolites that can easily improve people's well-being (Wheatley et al., 2014; Mintova et al., 2013). Its incorporation is, in this regard, based on the fact that the intended products are always in a metastable section and hence can easily transition to various zeolites. This situation mainly occurs whenever there is a need to react against the associated changes or transformation. Studies have shown how the intended products will gradually form denser phases occasioned by constant reactions (To et al., 2006; Mintova et al., 2013). To enhance this section's general whereabouts, it is usually advisable for those engaged in experiments to rearrange sodalite cases in varied structural categories as failure to do so could necessitate a reversed reaction and will compromise with the production process. Based on the depictions by Ostwald and other academic scholars, the eventual groupings should get rearranged regularly to strengthen the formation of stable forms. In most circumstances, the eventual or the needed products are usually characterized by a relatively denser structure (Mintova et al., 2013; Hasegawa et al., 2010). Based on this description and highlight it is evident that the success of the whole process will depend on how well an individual will determine the most reliable or appropriate crystallization timeframe as doing so will generate metastable phases (Wheatley et al., 2014; Mintova et al., 2013).

The synthesis time is also followed by determining the best temperature for the reaction (To et al., 2006; Mintova et al., 2013). As revealed by studies, the stated metric is one of the leading physical parameters constantly investigated in the general hydrolysis of zeolites and related materials. Based on academic studies, this condition and highlight relies on its immense effect, especially on the eventual products and the process-related kinetics (Hasegawa et al., 2010; Wheatley et al., 2014). For example, based on available information, increased crystallization temperature heightens zeolites' growth and general progression occasioned by the high kinetic energies that directly strengthen the vibration of particles. This explanation and allegation instantly reveal the interconnection between time and temperature, especially in a chemical and physical reaction (To et al., 2006; Wheatley et al., 2014). With such a perspective, one can easily depict how during the process, an increased temperature increases what we call crystallization time and vice versa. Such a depiction and description can easily get explained using the law of kinetics how the procedure can lead to various occurrences, including increased crystal growth and nucleation. This incidence will enhance how coal fly ash gets converted into zeolite components with given optimum conditions that include reliable time and temperature (Mintova et al., 2013; Wheatley et al., 2014). As revealed by other academic professionals, temperature plays a vital role in the crystallization stage by initiating Ostwald ripening perspectives and allowing for proper and timely synthesis (To et al., 2006; Mintova et al., 2013). Throughout the process, it is evidence that an increase in temperature necessitates the production of higher Silicon components than Aluminum ones, and the reverse is valid for a temperature decrease.

In addition to considering temperature and time, the next step that should get followed to present a hydrolyzed zeolite entirely is the agitation that encompasses mixing (Wheatley et al., 2014; To et al., 2006). As depicted by academic advocates, this procedure increases the homogeneity of the mixture, especially in process-based metrics. Incorporating such a condition also necessitates uniformity that eventually guarantees quality and reliable experiments or productions (Hasegawa et al., 2010; Mintova et al., 2013). This development should occur in agitated vessels to allow for proper and consistent operation as this heightens mixing and hence efficiency and effectiveness. In most cases, studies have shown how presenting or somewhat using unmixed systems results in unpredictable results, including the production of highly concentrated products (To et al., 2006; Hasegawa et al., 2010). In addition to this description and highlight, the general information has revealed how using unmixed products like Aluminum, Sodium Hydroxide, and Silicon leads to the presentation of products that cannot be easily separated in the vessels thereby compromising the whole process (Geboers et al., 2011). Based on the provided information, such conditions may also necessitate the formation of various zeolite phases that could otherwise be of low quality. Throughout the crystallization procedure, the efficiency of the eventual zeolite products will entirely depend on many factors, with the first and most prevalent one being how mixing will enhance the transportation of nutrients to the ever-growing crystals that get always situated on the surface (Mintova et al., 2013; Wheatley et al., 2014). However, it is worth noting that there is a need to effectively study the system and make reliable decisions as mechanical agitation may have devastating consequences on specified attributes such as particle size-related distribution, crystal sizes, and precursor gels (Hasegawa et al., 2010; Shamzhy et al., 2014; Wheatley et al., 2014). With such a condition, relying on the most relevant selection will necessitate mixing and synthesizing materials to form hydrolyzed zeolites.

Besides the above steps and exhibitions, other procedures can get followed to entirely or somewhat produce a hydrolyzed zeolite (Hasegawa et al., 2010; Wheatley et al., 2014). While previously academic scholars relied on polyhedral condensation procedure, depolymerization, and complex polymerization to present the best outcome, individuals in the contemporary world have shifted towards other modernized and most flexible techniques that strengthen production as well as lead to efficient and reliable products (To et al., 2006; Hasegawa et al., 2010). Within these metrics, the respective personality advocated for the following three leading steps to form hydrolyzed zeolites: dissolution of Aluminum and Silicon, condensation procedure, and building block-related connections or linkages (Geboers et al., 2011; Wouters et al., 2001). Although it is regarded by scientists and technical personnel that proper and reliable hydrolysis could follow diverse methods and produce a similar outcome or depictions, the three stated procedures are perceived by many as the most efficient and effective in dealing with the prevailing situation (Hasegawa et al., 2010; Mintova et al., 2013). Besides this depiction and condition, before initiating the process and necessitate effective execution, the exercise needs to be conducted by ascertaining the anticipated findings and whether the targeted mechanisms can lead to recommendable depiction. The first and most prevalent step of this process allows forming a precursor gel. Such a formation is usually characterized by various incidences, particularly feedstock precursors-related depolymerization. Regardless of many outcomes, this condition helps develop what is referred to as Silicon polymers (To et al., 2006; Wheatley et al., 2014). At this phase, the eventual products contain monomeric species accompanied by TO4 or tetrahedra. The following phase encompasses complex procedures that directly differ with "zeolite to zeolite" conditions.

Based on explorative investigations, this situation arises due to constant formation of monomeric species through regular depolymerization and polymerization developments that mainly rely on semi-regular structures (To et al., 2006; Wheatley et al., 2014). To effectively necessitate the process and lead to the production of appropriate materials or compounds, one must continue by joining "hydrated cat-ionic" devices together as doing so plays an essential role in balancing structure's charge-based deficiency (Hasegawa et al., 2010; Wheatley et al., 2014). These conditions, if effectively accommodated, form simplified SBU and aluminosilicates through crystallization. Contrary to the expectation, the resulting compounds always contain "6- membered and 4-membered rings" that strengthens the whole process (Wheatley et al., 2014). This mechanism is followed by forming semi-structured materials, especially in the precursor gels, where its success depends on how well the stated membered components could join. Once nuclei of various elements like zeolites have effectively been produced, immense crystallizations could happen instantly. This explanation and highlight directly deduce the importance of combining different mechanisms and building blocks to form high-quality zeolites that can easily withstand various environmental conditions like high pressure and temperature (To et al., 2006; Hasegawa et al., 2010). Like another chemical and physical process, forming hydrolyzed zeolites through relevant processes depend on specific parameters or metrics, including temperature, pressure, water content, and agitation.

References

To J., et al. “Formation of Heteroatom Active Sites in Zeolites by Hydrolysis and Inversion”. Angewandte Chemie International Edition 45.10 (2006): 1633-1638.
Hasegawa Y., et al. “Influence of Acid on the Permeation Properties of NaA-type Zeolite Membranes”. Journal of Membrane Science 349.1-2 (2010): 189-194.
Mintova S, Gilson J and Valtchev V. “Advances in nanosized Zeolites”. Nanoscale 5.15 (2013): 6693-6703.
Wheatley P., et al. “Zeolites with continuously Tuneable Porosity”. Angewandte Chemie 53.48 (2014): 13210-4.
Geboers J., et al. “Efficient Hydrolytic Hydrogenation of Cellulose in the Presence of Ru-loaded Zeolites and trace Amounts of Mineral Acid”. Chemical Communications 47.19 (2011): 5590-5592.
Shamzhy M., et al. “Germanosilicate Precursors of ADORable Zeolites obtained by Disassembly of ITH, ITR and IWR Zeolites”. Chemistry of Materials 26.19 (2014): 5789-5798.
Wouters B, Chen T and Grobet P. “Steaming of Zeolite Y: Formation of Transient Al Species”. The Journal of Physical Chemistry B 105.6 (2001): 1135-1139.

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.

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.

References

Hannah A. Eichman in Jerusalem: a Report on the Banality of evil (1963).
Hannah A. The Human Condition, Macmillan N.Y (1969).
Aristotele. Etica Nicomachea [Nicomachean Ethics]. J Bywater (ed.), Milan (2000).
Urs von BH and Creatusest H. Jaca Book. Milan (2010).
Zygmunt B. Liquid Life (2005).
Zygmunt B. Parasitic Capitalism. Rome-Bari (2009).
Ernst B. The Principle of Hope (1994).
Noam C. Failed States: the Abuse of Power and the Assault on Democracy (2006).
Albert E. The World As I See It (2007).
Sigmund F. The Discomforts of Civilization. Turin (1971).
Sigmund F. The Future of Illusion. Turin (1971).
Sigmund F. L’interpretazione dei sogni [The Interpretation of Dreams] (1991).
Romano G. The End of the Modern World (1957).
Romano G. Europa. Compito e destino [Europe. Task and Destiny] (2004).
Jurgen H. The Divided West (2014).
Immanuel K. Perpetual Peace: A Philosophical Sketch (2007).
Maynard KJ. Economic Possibilities for Our Grandchildren (1991).
Paul K. End This Depression Now (2012).
Thomas KS. The Structure of Scientific Revolutions (1996).
Blaise P. Thoughts. Milan (1994).
Fabrizio P. Cooperative Competition. Milan (2011).
Fabrizio P. E’ tutta un’altra Storia: Ritornare all'uomo e all'economia reale [Totally another History] (2013).
Fabrizio P. Society, the Foundation of the Economy. Scholars’ Press (2016).
Richard P. The Crisis of Capitalist Democracy (2010).
Ilya P. La Fin des certitudes. Temps, chaos et les lois de la nature (1996).
Robert P. Social Capital and Individualism (2004).
Reich RB. Supercapitalism: The Transformation of Business, Democracy, and Everyday Life (2008).
Martin R. Our Final Century? Will the Human Race Survive the Twenty-First Century? (2003).
Jean-Jaques R. Origin of Inequality. Milan (2009).
Bertrand R. The Scientific Outlook (2009).
Amartya S. Development as Freedom. Oxford University Press (1999).
Amartya S. The Theory of Moral Sentiment (2010).
Richard S. The Craftsman. Yale University Press (2008).
Richard S. The Culture of New Capitalism. Yale University Press (2007).
Emanuele S. Techne. The Roots of Violence. Milano (2002).
Pitirim SA. Social and Cultural Dynamics (1975).
Pitirim SA. The Crisis of Our Age (1941).
Michael S. The Next Convergence: The Future of Economic Growth in a Multispeed World (2011).
Joseph S. The price of inequality: How today’s divided society endangers our future (2012).
Raymond T. The Hand: A Philosophical Inquiry in Human being. Edinburg University Press (2003).
Arnold TJ. Civilization on Trial (1949).
Arnold TJ. Mankind and Mother Earth: A Narrative History of the World (1984).
Giambattista V. La Scienza Nuova The New Science (1722).
Richard W and Kate P. The Spirit Level: Why Greater Equality Makes Societies Stronger (2010).
Pezzani F. “The Banality of Evil”. Bus Eco J 8 (2017): 295.

References

Bäckryd E., et al. “Evidence of systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and plasma”. Journal of Pain Research 9 (2016): 1-13.
Barke A., et al. “Central nervous system mechanisms of Fibromyalgia and widespread chronic pain”. Scandinavian Journal of Pain 4.1 (2013): 1-7.
Blier P, Gobbi G and Turcotte J-E. “Fibromyalgia, depression, and antidepressants”. Journal of Clinical Psychiatry 75.8 (2014): e736-e742.
Clauw DJ. “Fibromyalgia: A clinical review”. Journal of the American Medical Association 313.15 (2015): 1547-1555.
Clauw DJ and Häuser W. “Fibromyalgia and related conditions”. Mayo Clinic Proceedings 89.5 (2014): 728-738.
Cohen H, Neumann L and Shore M. “The relationship between Fibromyalgia and major depressive disorder”. International Journal of Psychiatry in Clinical Practice 4.2 (2000): 15-21.
Crofford LJ. “Adverse effects of chronic opioid therapy for chronic musculoskeletal pain”. Nature Reviews Rheumatology 11.5 (2015): 26-334.
D'Ambrosio F., et al. “The role of anxiety in fibromyalgia syndrome”. Current Rheumatology Reviews 11.2 (2015): 109-115.
Derry S, Moore RA and Gaskell H. “Topical NSAIDs for acute musculoskeletal pain in adults”. Cochrane Database of Systematic Reviews 2014.9 (2014): CD007402.
Derry S., et al. “Topical lidocaine for neuropathic pain in adults”. Cochrane Database of Systematic Reviews 2015.7 (2015): CD010958.
Fitzcharles M-A and Yunus MB. “Fibromyalgia's clinical concept has changed in the past 20 years”. Pain Research and Treatment (2012): 1-7.
Hauser W, Bernardy K and Uçeyler N. “Treatment of fibromyalgia syndrome with gabapentin and pregabalin—A meta-analysis of randomized controlled trials”. Pain 154.10 (2013): 1799-1806.
Hauser W., et al. “Postinfectious and chronic fatigue syndromes: Clinical experience from a specialized center for treating CFS/ME”. Der Nervenarzt 88.6 (2017): 624-633.
Hauser W, Petzke F and Sommer C. “Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran in fibromyalgia syndrome: A systematic review with meta-analysis”. Rheumatology 49.4 (2010): 716-726.
Hauser W., et al. “Guidelines on the management of fibromyalgia syndrome - A systematic review”. European Journal of Pain 18.2 (2014): 111-140.
Hauser W and Wolfe F. “Diagnosis and diagnostic tests for Fibromyalgia (syndrome)”. Rheumatic Diseases Clinics of North America 41.2 (2015): 319-333.
Hewlett S., et al. “Self-management of fatigue in rheumatoid arthritis: A randomized controlled trial of group cognitive-behavioral therapy”. Annals of the Rheumatic Diseases 70.6 (2011): 1060-1067.
Hudson JI and Goldenberg DL. “Psychological aspects of Fibromyalgia”. Current Opinion in Rheumatology 1.2 (1986): 192-197.
Lachaine J., et al. “An economic evaluation of duloxetine in patients with Fibromyalgia”. Current Medical Research and Opinion 31.1 (2015): 97-109.
Hauser W, Bialas P and Welsch K. “Psychiatric comorbidity in patients with fibromyalgia syndrome: A selective literature review”. Journal of Psychosomatic Research 79.2 (2015): 135-147.
Hauser W and Fitzcharles M-A. “Facts and myths pertaining to Fibromyalgia”. Dialogues in Clinical Neuroscience 20.1 (2018): 53-62.
Hauser W, Sarzi-Puttini P and Fitzcharles M-A. “Fibromyalgia syndrome: Under-, over-and misdiagnosis”. Clinical and Experimental Rheumatology 37.Suppl 116 (2019): 90-97.
Hayes SM, Kohler M and Lauzon S. “Understanding the complex interplay between depression, anxiety, and chronic pain in women”. Depression and Anxiety 35.5 (2018): 465-480.
Kashikar-Zuck S., et al. “Depression and functional disability in chronic pediatric pain”. Clinical Journal of Pain 17.4 (2001): 341-349.
Lai C-H. “Major depressive disorder: Gender differences in symptoms, life quality, and sexual function”. Journal of Clinical Psychopharmacology 35.6 (2015): 608-616.
Mannerkorpi K, Nordeman L and Cider Å. “Fibromyalgia: An update on treatment options with a focus on pharmacological approaches”. Current Opinion in Rheumatology 29.3 (2017): 167-173.
Martinez-Lavin M. “Biology and therapy of Fibromyalgia: Stress, the stress response system, and Fibromyalgia”. Arthritis Research & Therapy 21.1 (2019): 1-10.
Morasco BJ., et al. “The relationship between PTSD and chronic pain: Mediating role of coping strategies and depression”. Pain 154.4 (2013): 609-616.
O'Brien CP. “Addiction and dependence in DSM-V”. Addiction 108.5 (2013): 866-867.
Perrot S., et al. “The fibromyalgia syndrome”. Handbook of Clinical Neurology 145 (2017): 375-401.
Rizzi M., et al. “A systematic review and meta-analysis of usual treatment versus psychosocial interventions in Fibromyalgia”. Journal of Psychosomatic Research 126 (2019): 109796.
Salaffi F., et al. “The relationship between Fibromyalgia and major depressive disorder: A comprehensive review”. Current Psychiatry Reviews 16.4 (2020): 54-273.
Schiepers OJG, Wichers MC and Maes M. “Cytokines and major depression”. Progress in Neuro-Psychopharmacology and Biological Psychiatry 29.2 (2005): 201-217.
Thieme K., et al. “Psychological interventions for chronic pain: A review of current evidence”. Current Opinion in Supportive and Palliative Care 12.2 (2018): 163-168.
Turk DC, Wilson HD and Cahana A. “Treatment of chronic pain: Patients with Fibromyalgia”. Journal of the American Medical Association 306.6 (2011): 590-598.
Wolfe F., et al. “Two thousand sixteen revisions to the 2010/2011 fibromyalgia diagnostic criteria”. Seminars in Arthritis and Rheumatism 46.3 (2016): 19-329.
Yunus MB. “Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes”. Seminars in Arthritis and Rheumatism 44.5 (2015): 595-596.

References

Afshar K., et al. “Reducing antibiotic use for uncomplicated urinary tract infection in general practice by treatment with uva-ursi (REGATTA)–a double-blind, randomized, controlled comparative effectiveness trial”. BMC complementary and alternative medicine 18.1 (2018): 203.
Dar MA., et al. “Extensive phytochemistry, comprehensive traditional uses, and critical pharmacological profile of the great mullein: Verbascum thapsus L”. The Natural Products Journal 9.3 (2019): 158-171.
Ebrahim AA., et al. “Nutritional significance of aloe vera (Aloe barbadensis Miller) and its beneficial impact on poultry”. World's Poultry Science Journal 76.4 (2020): 803-814.
Estiasih T, Kuliahsari DE and Widayanti VT. “Increasing health benefit of wild yam (Dioscorea hispida) tuber by red mold (Angkak) Fermentation”. In IOP Conference Series: Earth and Environmental Science, IOP Publishing 515.1 (2020): 012055.
Gágyor Ildikó., et al. “Herbal treatment with uva ursi extract versus fosfomycin in women with uncomplicated urinary tract infection in primary care: a randomized controlled trial”. Clinical Microbiology and Infection 27.10 (2021): 1441-1447.
Ghazizadeh J., et al. “Historical Course of Neuropsychiatric Effects of Lemon Balm (Melissa officinalis L.) as a Medicinal Herb”. Pharmaceutical Sciences (2021).
Go CC., et al. “Potential role of xylitol plus grapefruit seed extract nasal spray solution in COVID-19: case series”. Cureus 12.11 (2020).
Gumbo JR and Nesamvuni CN. A Review: Spirulina a source of bioactive compounds and nutrition (2017).
Hannan M., et al. “Black cumin (Nigella sativa L.): A comprehensive review on phytochemistry, health benefits, molecular pharmacology, and safety”. Nutrients 13.6 (2021): 1784.
Khanal M., et al. “Extract of Aloe vera (Aloe barbadensis Miller) Enhances the Growth, Protein Contents, and Gastrosomatic Index (GaSI) of Common Carp Cyprinus carpio”. Journal of Nutrition and Metabolism (2021).
Kim T, Kim JH and Oh SW. “Grapefruit seed extract as a natural food antimicrobial: A review”. Food and Bioprocess Technology 14.4 (2021): 626-633.
Loolaie M., et al. “Peppermint and its functionality: A review”. Arch Clin Microbiol 8.4 (2017): 54.
Mphahlele MM., et al. “Expected benefits of genomic selection for growth and wood quality traits in Eucalyptus grandis”. Tree Genetics & Genomes 16.4 (2020): 1-12.
Nadeem A., et al. “Verbascum Thapsus (Mullein) Versatile Polarity Extracts: GC-MS Analysis, Phytochemical Profiling, Anti-bacterial Potential and Anti-oxidant Activity”. Pharmacognosy Journal 13.6 (2021).
Nazerieh H, Ardebili ZO and Iranbakhsh A. “Potential benefits and toxicity of nanoselenium and nitric oxide in peppermint”. Acta Agriculturae Slovenica 111.2 (2018): 357-368.
Parit SB., et al. “Nutritional quality and antioxidant activity of wheatgrass (Triticum aestivum) unwrap by proteome profiling and DPPH and FRAP assays”. Journal of food science 83.8 (2018): 2127-2139.
Ribeiro AT., et al. “24-Epibrassinolide mitigates nickel toxicity in young Eucalyptus urophylla ST Blake plants: nutritional, physiological, biochemical, anatomical and morphological responses”. Annals of Forest Science 77.1 (2020): 1-19.
Ryu JH and Kang D. “Physicochemical properties, biological activity, health benefits, and general limitations of aged black garlic: A review”. Molecules 22.6 (2017): 919.
Samuelson R., et al. “The effects of lavender essential oil on wound healing: A review of the current evidence”. The Journal of Alternative and Complementary Medicine 26.8 (2020): 680-690.
Sánchez-Rodríguez L., et al. “Impact of gastrointestinal in vitro digestion and deficit irrigation on mantioxidant activity and phenolic content bioaccessibility of “Manzanilla” table olives”. Journal of Food Quality (2020).
Sharma L, Chandra M and Ajmera P. “Health benefits of lavender (Lavandula angustifolia)”. Int. J. Physiol. Nutr. Phys. Educ 4.1 (2019): 1274-1277.
Singletary K. “Turmeric: potential health benefits”. Nutrition Today 55.1 (2020): 45-56.
Soni RA, Sudhakar K and Rana RS. “Spirulina–From growth to nutritional product: A review”. Trends in food science & technology 69 (2017): 157-171.
Świąder K, Startek K and Wijaya CH. “The therapeutic properties of Lemon balm (Melissa officinalis L.): Reviewing novel findings and medical indications”. J. Appl. Bot. Food Qual 92 (2019): 327-335.
Padhan B and Panda D. “Potential of neglected and underutilized yams (Dioscorea spp.) for improving nutritional security and health benefits”. Frontiers in pharmacology 11 (2020): 496.
Zawistowski J., et al. “Garlic grown from air bulbils and its potential health benefits”. Advances in plant phenolics: from chemistry to human health (2018): 315-328.

The case study's data was collected using a standard form, and three broad groupings were identified: naturalistic studies, comparative cohort studies, and randomized controlled studies. Additional information was recorded about the sample's socio-demographic features, the study's inclusion criteria, the key outcomes used, and the environment. Female Age: 62, developed adrenal fatigue and blood sugar issues, and was diagnosed with chronic fatigue in 2013. She had trouble with mental focus, anxiety, and high blood pressure.

After the initial outbreak of ME/CFS in Los Angeles in 1934, the condition has experienced a number of modifications in terms of nomenclature and case definition, including being dubbed 'benign ME', 'chronic Epstein-Barr virus syndrome', and 'postviral fatigue syndrome'. The CDC published the ME/CFS criteria in 2003, which encompassed both ME and CFS clinical symptoms. The ICD system exemplifies the complexities of such confusing terms. The World Health Organization categorized ME as a neurological illness in 1969, but the ICD-10 (2016) and ICD-11 (2019) categorized ME and CFS as distinct illnesses, with tiredness (MG22) being excluded. As a result, ME/CFS is poorly defined. The term "myalgia Nervosa" was coined by Dr. S. Freud to suggest a psychiatric etiology, while the original term "neurasthenia" denoted an organic neurological ailment. Until recently, the cause of ME/CFS was a contentious issue. In 2015, the IOM proposed a new name, SEID, and related criteria, which eschewed the stigma associated with "fatigue". The study's sample size ranged from 15 to 498 people, and it used a range of classifications. Only three of the 2075 patients tracked with organic exclusion in the 19 trials died, and one of them was caused by an unconnected physical disease. The authors conclude that ME/CFS is difficult to comprehend and treat for both patients and health care providers, and question the prevalent socio-cultural narratives surrounding academics' and physicians' views on ME/CFS and their victim-blaming tendencies.

Richman and Jason discovered that the medical establishment still credits mental and psychological reasons for ME/CFS, while patients with ME/CFS generally ascribe their condition to a still unknown biological etiology. Further qualitative research is needed to understand marginalization experiences. The literature review has highlighted the causes of Chronic Fatigue Syndrome, which is a long-term condition that affects a variety of bodily systems. It can affect people of any age group, and symptoms may appear gradually over months or years.

References

Aruna A. Significant impact of Nutrition Garden/Home Garden reflected on iron and vitamin status of the rural families (PhD. Thesis) (1997).
Afghanistan Health Survey Report 2018.
Demographic and Health Survey Report 2017-2018.
National Family Health Survey, India -5, 2019-2021.Ministry of Health and Family Welfare, Govt. of India.
Subhasree Roy and Shoba Suri. 2021 Global Nutrition Report – India’s Nutrition Profile and how to meet Global Nutrition Targets- Health Express (2021).
The UNICEF/WHO/WB Joint Child Malnutrition Estimates (JME) group released new data for 2021.
Vijaya Khader, R Sathiadhas and H Mohammad Kasim. “Role of Women in Fisheries in Coastal Ecosystem of Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu”. J. Res. ANGRAU 33.1 (2005): 53-59.
Vijaya Khader, R. N. Kumar, J. Lakshmi, K. Dhanapal, H. M. Kasim, R. Sathiadas and N. S. Sudhakar. 2004. Studies on Fisher Women in the Coastal EcoSystem of Andhra Pradesh, Karnataka, Kerala and Tamil Nadu, World Fish Center, Global Symposium on Gender and Fisheries Seventh Asian Fisheries Forum, P.No.69-79, Penang, Malaysia.
Vijayakhader and P Ashlesh. “Home-based low-cost energy protein-rich preparations using Horse gram (Dolichos Biflorus) for vulnerable groups”. Indian Oil Palm Journal 46 (1998): 13-17.
Vijayakhader and K Umamaheswari. To study the effect of feeding malted food on the nutritional status of vulnerable groups: accepted for publication in the International Journal for Biotechnology and Molecular Biology Research 4.4 (2012): 35-36.
Vijaya Khader. “Rural Women as Entrepreneurs in Mushroom Cultivation”. Indian Farming (1994): 18-21.
Vijayakhader and Kavitha. “Anthropometric measurements of preschool children in the rural areas of Tenali division”. Asian Journal of Psychology and Education 26.1-2 (1993): 35-40.
Vijaya Khader. “Impact of Women’s supplementary incomes as families’ Nutritional status”. The Indian Journal Social Work 60.3 (1999): 368-378.
Vijayakhader and K Aruna. “Operational feasibility of RPO supplementation to pre-school children in Anganwadi centers of ICDs Project”. Natural Product Radiance, and 7.4 (2008): 310-313.
Yasoda Devi P and Vijayakhader. “Therapeutic food supplementation in ICDS projects of Andhra Pradesh”. Every man’s science 39.3 (2004): 160-167.

There are a host of imaging modalities available today for diagnosis of diseases, including ultrasonography (which includes endoscopic ultrasonography), X-ray, CT, MRI, PET CT and PET MRI, with modifications and advances being made in these modalities rapidly over the years.

So once imaging helps in diagnosing a pathological process like a tumor in a patient, there is an option in today's world to do preoperative imaging to plan the surgery. The surgeon can decide the technique, the approach, plan the surgery and may even get to look at software generated images of outcome of the surgery before the actual surgery. The surgeons can also get intra-op imaging assistance, where they can get imaging of the field of operation live during the surgery, or they can map a 3D CT or MRI image onto the patient, and conduct the operation. These intra-op imaging solutions are becoming popular in neurosurgery, oncosurgery, cardiology, ENT and orthopaedics. For intra operative imaging, a host of imaging devices are being used, including ultrasonography machines, simple x-ray machines, C-arms and more complex 3D scanners, CT and MRI machines.

More advanced solutions employ augmented reality and computer vision to guide the surgeon live during the operation, help identify the structures in the operative field and track the surgical instruments and patient's anatomy live during the procedure, thus making the operation safer, more precise, with fewer complications. Imaging helps in modifying a surgery after it is done, for example a surgeon can go in and redo the surgery with wider excision if there is a residual tumor found on an intraoperative MRI scan.

Then there is post op imaging available to monitor the progress of a patient after a surgery so that immediate post-operative complications can be treated or avoided; and for follow up of patients if required.

In this age, surgeons need to make themselves aware of the advances in various imaging modalities and augmented reality solutions that can help them in their practice, and the pros and cons of using them. Also they need to assess the cost versus benefit to the patient and hospital and decide if it is worth procuring the same.

With on-going research and collaborations in the field of imaging, artificial intelligence and augmented reality, there are problems emerging in designing and standardizing the equipments or solutions for the operating room, and integrating them to the actual surgical procedure. We can expect a lot of changes in the way surgeries are conducted in the future and we look forward to solutions that will be available in all big and small centres, so that people across the world can benefit from these advances.

Medical care was hospital-centric, because the system was never about healthcare but disease-care with no one actually looking into what was driving disease at its root level nor doing anything about it. Disease-care was about profits and what was called “Standard-of Care” was not evidence based but actually determined by Big Pharma/3^rd party payer economic parameters. Hospitals and physicians make money on procedures and proceed they did.

Legal immigration into the US of physicians and nurses became very difficult and restrictive even while the country was flooded by the extremely poor, uneducated and the mentally and physically unsound by design because the occupied government of the US wanted to bring it all down so a global socialist totalitarian government would emerge from the ashes with only a small fraction of the human population left alive. Unknown to the public, the US had become a colony of globalist bankers, and our military became their enforcers. The red-letter day was the CIA coup of 11/22/1963, ancient history to most Americans, but even by then most were good and apathetic by the neurotoxic fluoride in their tap water.

Destabilization projects, such as the transgender movement, and the open border were run by the CIA and/or DARPA right up to the collapse. The US had spread its military all over the world but not for the benefit of peace but for control agendas and to covet the resources of others.

The manpower shortage increased as healthcare workers were illegally mandated to take the COVID jab, which killed some outright, but the sequalae of jab with its ability to increase IgG4 [1] (which turns down the immune system creating tolerance to things that should not be tolerated like cancer cells and other infections) and unrelenting production of spike proteins destroyed the lives and careers of many as they became increasingly ill from cardiovascular disease to Turbo cancers.

The lack of appreciation that a democide was taking place was astonishing. The mod-mRNA bioweapon continued to be recommended even though it was known it did the exact opposite of what it is being promoted to do. This was an attack on the West, because China did not use mod-mRNA on their population nor a Spike Protein based vaccine. The bottom-line was a massive increase in the population of those with Vaccine Acquired Immune Deficiency (VAIDS) right up to the collapse in an already chronically sick society on the verge of a healthcare collapse thanks to pesticide drenched corporate controlled slop that was sold as food.

Event 201 (in 2019) was an exercise to create a control grid when CoV2 was released, it was not a medical conference. The purpose was to help destroy the sovereignty of countries but especially the US. COVID was a staged biological attack, in part used to take down President Trump; although, it had been planned for years. Essentially, nothing the public was told was real [2] and US citizens were murdered by the response (ventilators) - the USA had the highest mortality of any country. Lockdowns and school closures all done for a lie inappropriately using the PCR test to create the scamdemic.

Americans went to sleep after WW II, and while they slept the globalist/Deep State/Shadow government was funding the destruction of the American family and the unraveling of American society. Americans were sold nihilism by their own government for decades leading up to the collapse. They wanted us hating ourselves and each other, they kept creating events to take our rights away, and they wanted us dependent on them. We were to obey them as if they were our Big Parent, so if they said take deadly untested jabs that was only meant to harm we hated ourselves so much we would take those deadly jabs over, and over and over. We let them redefine what it meant to be a man, to be a woman and we were not to have families as it would hurt the climate. In a sense, COVID was a blessing because it woke people up. Standing six feet apart, or having to wear a worthless mask walking in a restaurant, but you could take it off when you sat down, or wearing masks on planes unless you were eating peanuts or drinking - these things started to wake people up.

Americans started asking questions, Americans started to do their own research and learn what their government was really all about and it wasn’t what they had been taught it was. They learned about the Tuskegee experiment, for example, where the government just watched poor black farmers in Alabama die of syphilis over decades with no treatment offered. Americans wanted more control over their lives and in so doing learned that something was not right with the government of the USA. The government’s response to this was to censor, cancel, imprison whomever they could. Their push for censorship really caused the sleepers to awaken.

We were trusting of those who did not deserve or earn that trust and we didn’t hold them accountable. We were so easy to experiment on … too easy, and experiment they did, because that was all we meant to the government besides sources of money, we were just experiments to them.

Even the US military was taken over as it was clear certain factions had gone rogue/woke/global and were not only spraying neurotoxic aluminum from the skies (chemtrails), but ran the COVID response behind the public’s back and the infamous three letter agencies were completely subservient to military orders.

The public was almost completely unaware there was a break-away government that was not only facilitating a democide but keeping to themselves advanced technologies back-engineered from others - all part of the build back better plan once they culled the population.

As many as the COVID jab killed and is still killing, it was still just a test to see how much people would take…would humanity allow lockdowns and stupid medical rituals that had no basis in reality; allow their economies to be destroyed; would they take injections over and over and over that had no efficacy? Well, they got their answer and the plan was to release a really lethal infection when they thought the moment was right. Right up to the collapse no one was held accountable for anything.

Recipe for Disaster

A pre-COVID study [3] found that every 10 additional primary-care physicians per 100,000 people was associated with a 51.5-day increase in life expectancy. That doesn’t sound impressive but it proved the point that decentralized, accessible, comprehensive, community-based services could save lives, but saving lives was never on the table, making money was what was on the table, and exercising control was on the table.

COVID protocols made that loud and clear as hospitals were financially incentivized to diagnosis as many as possible with COVID (because that diagnosis brought in extra compensation), only use Remdesivir and put patients on ventilators. Following that protocol earned an extra $40K for using a ventilator and a 20% bonus on the total bill, so a typical half-a-million dollar bill would get a $150K bonus.

Close to 90% of physicians were employed by institutions and those institutions were almost completely dependent on the government to cover operational costs. The remaining solo or small-group medical practices were either selling out to hospital systems or being replaced by concierge offices - Harley Street medical care some might label it, which was great for those that could afford it, but not an option for the masses.

Many turned to urgent-care centers, which were fine for basic minor acute ailments, but often just put band-aids on medical conditions that required a through work-up by an experienced clinician knowledgeable in the arena of chronic health problems.

The fee-for-service model in the US made it impossible to compensate health care providers who assisted patients in preventing illness. Doing procedures was the way to make money in medicine, but most primary care physicians only do a few minor procedures and not on a regular basis. Vaccines became the procedure used by pediatricians to make money. In the USA, no physician was compensated for keeping a patient’s A1C in normal ranges - for example… disease care only was what was incentivized. There is no profit in the cure.

The medical labor shortage in the US created a two-tier compensation system where travel nurses and Locum physicians would often make multiple times what normal staff would get paid… it caused issues. EMRs (electronic medical records) which were supposed to make data sharing and documentation easier did the opposite. Providers were spending 30% plus of their time documenting into EMRs, and for those practices that could afford to hired medical scribes to do the heavy lifting, so to speak - but it increased costs while doing little to improve care or sharing of information.

Then there was the unfunded burden of providing free medical care to the weaponized border invasion - free because the illegals had no money, no insurance and no jobs. The US government became the largest child sex trafficking organization in the world. The mentally ill traitors who ran the US (not said lightly) lost 500 thousand children and most of them are now deceased. “Lost?” - they were given away to exploiters, predators, satanists and perverts.

The worldwide pedophile cult used blackmail to control decision makers or influencers in all aspects of society and they always needed fresh children. The NWO was a death cult bent on destroying free will and body autonomy.

Vast numbers of convicted criminals were stewarded into the US presumably to disassemble society [4]. At least 425,000 criminals - the largest group convicted for assault, but murderers and rapists not far behind. Now, eventually, the nature of reality steps in and says what you have been doing can’t continue. Gutless and treasonous leaders of the Border Patrol just cared about their jobs and pensions (not unlike the physicians who kept putting COVID victims on ventilators and dishing out the deadly drug Remdesivir). Why would the US Government allow hundreds of thousands of children to be sex trafficked and murdered?

It was done in the open and yet they just kept doing it. It was by design and all about control and the misuse of power, but the sick “elites” that use, abuse and murder these children need fresh victims. That last paragraph bears repeating - this alone was enough to bring down the wrath of Nature and it did.

The economy was no longer profitable from a boots-on-the ground level so print, print and print the money the Federal Government did, and they couldn’t stop using their magic money printing machine. But doing so combined with American hegemony caused the US to lose its reserve currency status. The printing of fiat currency in the face of a 35 trillion dollar deficient, which was never going to be paid down, caused a few problems one might say.

Forty percent of the US didn’t make enough money to even pay taxes and all because the government intervened in how people lived… it was evil incarnate.

There were other systemic problems. The first was the massive financial debt often required to become a physician and it often took decades to pay down that debt. These debt-ridden physicians wanted a secure job so they would rock the boat at their own peril and they were well aware of that fact so, the vast majority didn’t ever rock the boat. That worked out well for the Industrial-Medical complex to have so many physicians in a type of servitude. Of course, if you asked a physician if they were a slave of Big Pharma they would deny such, ah… not knowing they were slaves made them the best slaves.

With apologies to my ex-collogues, medical students were not chosen because they were critical thinkers… they were usually great memorizers, regurgitators and test takers, but critical thinkers they were not - based on my own experience about 5% of each medical school class would be critical thinkers. So, physicians were trained to practice consensus/institutional medicine… you do what you are told to do for any particular condition by agencies and professional societies riddled with conflicts of interest and whatever you do.. don’t ask too many questions.

I will give you an example… the American College of Obstetrics and Gynecology (ACOG) had some of the tightest unequivocal guidelines to protect pregnant women when it came to taking or injecting into their bodies something that carried even the slightest risk to the developing fetus - at least until COVID when they and many other physician associations and societies were bribed with millions of dollars to promote an experimental genetic intervention that went against everything ACOG stood for previously. But the slaves obeyed or lost their jobs. Some lost their Board certifications and some even lost their licenses.

A critical thinker with morals would pause and look at the available data (critical thinkers often seek out the actual studies and research when evaluating a new or different recommendation). However that would often put a physician in conflict with health agencies or professional societies whose sole existence was dependent on the largesse from Big Pharma and surrogates. Physician societies were loyal to the source of their income. Professional societies did a lot of damage to the practice of medicine and had blood on their hands for sure. Medical boards were weaponized against any physician who tried to object or practice against the narrative. They didn’t care if all your patients on Ivermectin recovered from COVID - you stepped out of line and you had to repent. Medicine became a tool of totalitarian control, the running dogs, if you will, of a globalist death cult.

Now, physicians are usually risk adverse anyway. Most wanted to become doctors not because they were healers nor had any interest in learning how to be a healer but because it was safe… the steps to become a physician were all laid out, and a handsome salary awaited them at the end of their academic travail. It was a great job for the risk adverse - but just a job with a lot of built-in security and nothing more. The many unknowns and uncontrollable parameters of the scary business world were no longer their concern.

So, as the collapse took place the status of the US healthcare system was revealed as a total failure with little value for the money spent [5].

The “Affordable Healthcare Act” (ACA), otherwise known as “Obamacare,” was a scam. Under ACA healthcare became less accessible not more accessible. It was mostly equitable as almost everyone had less than stellar healthcare options. Among the first world countries the USA had the lowest life expectancy, but the highest rate of preventable and treatable mortalities for all ages even as more money was spent on healthcare than in any other first world nation (16%+ of the gross domestic product [GDP]). When it came to COVID-19 metrics the US had the most excess deaths of any first world country. The USA always had the worse infant mortality, mostly due to the bloated vaccine schedule during the first year of life causing infants to have neurotoxic levels of aluminum, but that is another topic. COVID didn’t improve the USA’s abysmal infant mortality numbers. In the USA, from a list of only 25 conditions, 40 % of American children had one or more chronic disease [6].

Americans were “legally” fed propaganda by their own government and the US Government illegally censored those who were counter to their agendas. Meanwhile corporations were allowed to feed the public increasingly toxic, ultra-processed and nutritionally bankrupt foods laced with seed oils, toxic food colorings, high fructose corn syrup and Americans washed it down with fluoridated water - an element more toxic than lead and proven to lower IQs. The USA was the most highly fluoridated country in the world as well as the sickest first world country.

Obviously, a genocidal health collapse agenda as well as an economic one was being imposed to bring down the entire Western system, but specifically the USA, which didn’t need a lot of help as the level of corruption was unsustainable, but there were those who thought they could control the events they were creating and guide them in their favor to create a corporate totalitarian world government. Soros, a former Nazi, may have had a grudge against the USA and wanted it destroyed, so everything he funded was to cause disharmony and demoralize (understatement). There were other philanthropaths and “controligarchs” whose names are all too familiar who were allowed to buy up, buy off, and buy down anything and anyone they wanted.

Back in the USSR

When the USSR collapsed so did their healthcare system, so it is prudent to review what Russia went through in this regard. The USSR had universal free healthcare - the first in the world to have same. Everyone was equal, but as we all know, some are more equal than others - it really depended where you lived. The care one would get in a remote village was not the care one would get in Moscow, but the point is there were no medical deserts as existed in many first world countries. However, in the first ten years after the fall of the USSR there was a significant deterioration of healthcare along with all the other social safety nets.

Essentially, the disenfranchised - the elderly, the sick and disabled were thrown to the curb. Like in pre-collapse USA, the majority of citizens in USSR took only marginal responsibility for their own health. In the US most citizens did little to object to the bankrupt and toxic diets they were fed laced with thousands of chemicals and pesticides outlawed in other first world countries. Why? The misguided and unchecked industrialization of the food supply along with completely captured regulatory agencies whose modus operendi was to allow untested chemicals into the food supply until someone proves them unsafe when it should have been more like Europe where new chemicals must be proven safe before entering the food supply. US citizens were trained to be far too trusting of authority so if the government allowed the slop to be sold it must be ok’ish, but it was not okay and Americans were under the delusion that governmental agencies were protecting them.

In the US, when state psychiatric hospitals were closed (starting mid 20^th century), as they needed to be for they were snake pits, but what was supposed to have taken place was the reciprocal opening of community mental health clinics - that never happened. So the previous residents of these horrible hospitals were thrown out on the street and created a caste system in a country that previously had none. They created the homeless “no-see’ems.” They were just ignored as if they weren’t there. There were a few private psychiatric hospitals that as a rule did not take insurance and cost several tens of thousands of dollars per month, so not a viable replacement.

In the USSR, there was an extensive network of primary care clinics that even served remote areas fully staffed with many types of healthcare workers. So, even though medical practice was controlled centrally, there was a decentralized application of healthcare. It worked well until the 1970’s when funding for this system was cut back and a partial fee-for-service system was implemented. With increasing bureaucratic and economic inefficiencies, coupled with shortages of medicinal drugs and technologies, life expectancy that had been on par with the US began to drop.

Post collapse, Russia adopted a hospital-centric system just like the USA, which increased costs and inefficiencies. Funds allocated by the state barely covered payrolls, and those payrolls were at rock bottom levels - essentially a minimum wage regardless of how much education and degrees one might have had. Drugs were paid for out-of-pocket, and bribes were used to facilitate better care. Private clinics for the middle-class folks were allowed and a 3^rd party payer system developed to insure those that could afford such coverage. About a third of Russians paid completely out of pocket for their health care. Even so, private healthcare still had/has only a minor footprint in Russia.

Disease-care came to the fore, with little to no attention paid to preventive care or public health [7]. HIV spread rapidly because prevention was not a priority. Just as COVID corrupted most US physicians who remained silent when they should have sounded an alarm just so they could keep their jobs, the USSR had a throng of healthcare workers who had been trained to take advantage of a system they were comfortable milking and oligarchs were fine with the status quo if it benefited them. Even if there had been a healthcare Moses… walking Russia’s healthcare workers around for 40 years in Siberia to break that conditioning was not an option.

So, as unsustainable as the pre-1970 Soviet healthcare system was, it got replaced by a muddled mess. After 1992 many rural facilities closed. As previously noted, the US spent over 16% GDP (pre-collapse) for the worse healthcare outcomes in the developed world. Russia spent 3.2% GDP on health in (2016), whereas EU countries on average spent 7.2% of GDP on health in 2014 [8]. Normally the more a country spent on health care the better the outcomes except for the US, where the more spent the worse health became, but that was mostly due to the fact Americans were being intentionally poisoned. Again by design - didn’t matter how much money was spent when the system was designed to keep the population sick.

For example, those in the upper echelons of the US Government who wanted to know if vaccines caused autism (vaccine encephalitis) had known for decades and did nothing. If it had not been for the collapse in 2025, very likely the US Government would have collapsed in 2035 when half the boys would have been diagnosed with autism if trends remained steady.

Medical education in the US was truncated to make sure physicians knew nothing about nutrition or how to diagnosis and treat most metabolic disorders. Environmental medicine was not taught and if there was a nutrition course, which most medical schools did not have, on average it lasted 2.5 hours.

In the 1990’s Russians saw a drop in their standard of living and an increase in morbidity in most classes of diseases, including previously curable diseases, which were considered almost completely eliminated in the Soviet period. Active cases of tuberculosis showed up and syphilis increased 30-fold. The incidence of cardiovascular disease [9] tripled and cancer doubled [10]. Obviously, the socio-economic issues in the immediate post collapse period played a role in this and the resultant socio-psychological stressors in adapting to new economic realities without a constructive social policy to go along with the changes.

Without funding the previous Soviet healthcare system collapsed and the medical care that was provided was very basic, i.e. the quality of care provided was greatly reduced. The trends of increased disease mortality didn’t start to reverse until the turn of the millennium, and that was due to the improved socio-economic situation and by 2006 a national plan was implemented to update and upgrade medical technologies and interventions. Infant mortality fell by three-fold between 2005 and 2019.

Back to the Future

Heralding what would take place a few months later with hospitals - by the summer of 2024, dozens of rural colleges and regional campuses were closing their doors. After the cyber-attack in 2025, 50% of hospitals closed, most of the medical schools closed, (the few that didn’t had very small class sizes) and 3^rd party payers (one of the biggest scams ever perpetrated on the American public) vanished. Food accessibility was a problem with many market closures - most high-end markets survived because they catered to those with resources, still there were many empty shelves. Small family farms became very popular along with local farmer markets. There was some bartering but it was not a big part of the new economy.

The US government was revisioned but it didn’t happen overnight. Military bases closed all over the world and troops came home, but the USA had been the world’s “BAD GUY” for a very long time and no one came to its aide. Canada fared better as they made an alliance with the EU.

Several states made regional alliances as they could not shoulder the increased responsibilities and costs by themselves. Rural hospitals took the biggest hit as they were so dependent on the payments from the government (CMMS). The loss of these rural hospitals created problems especially given the mass exodus into rural areas from the big cities.

The year 2026 was a much less traumatic year as the survivors adapted to a new society [11].

In early 2025, most physicians were thrown out on the street as their institutions closed - the actual number of MD’s involved in healthcare crashed never to return. Private parties stepped forward to keep some of the major hospitals in limited functionality; nevertheless, healthcare in the US changed forever, which ultimately was a good thing.

No longer were people being restricted to what 3^rd party payers would or wouldn’t pay for, so they gravitated to therapies they found were the most efficacious and cost effective. However, the high morbidity and mortality during the transition was inevitable and many passed much sooner than they would have. Those dependent on medications that were no longer available had a very rough go - and that included hormone replacement therapies.

On the positive side, efficacious cancer therapies that had been repressed by the medical cartel came to the fore because the medical cartel was defeated. The bloated vaccine program that had been “approved” without safety testing disappeared and not surprisingly the ignored epidemic of chronic illness among our children started to lift and autism rates dramatically fell. The sick obsession with encouraging children to change their gender was history and the hospitals that performed these disturbing operations went out of business.

Americans were asked to be responsible for their own health, to eat right, get exercise, and drink clean water (no fluoride). But few knew how to be responsible for their own health as they didn’t even know what was required to be healthy. Overcoming the miseducation and indoctrination created by the corporations was a non-trivial matter. Big-Ag, Big-Chem and Big Pharma, that ran roughshod over regulatory agencies, academia and the education system itself, were neutralized.

The food supply had been mostly slop - full of toxic seed oils, chemical dyes, pesticides, high fructose corn syrup and aspartame - Americans thought this was food. Other countries did not and many American brand foods were banned in other countries, for example Frosted Flakes, Rice Krispies, Wheat Thins, Honey Bunches of Oats, etc… all banned in Japan just to name one country.

A decentralized system of independent contractors, a medical corps, which were akin to the Barefoot Doctors from mid 20^th century China, started to be deployed but it took a couple of years for that program to get up and running. Many nurses signed up, but everyone needed to be trained and that didn’t happen overnight. Many had been involved in the treatment-centric disease care medical paradigm controlled by pharmaceutical companies and the Rockefeller Foundation, and they had to be reeducated because a lot of what was taught previously was not only a lie but was standard-of-care only because it benefited a corporation.

Initially, there were only about four of these peripatetic healthcare workers per 100K people, which was woefully inadequate. After some time there were 10 per 100K and then eventually more, because many more were needed. They worked under umbrella organizations that lent guidance and offered support and training. This was all about basic healthcare and education about diet and lifestyle. Literally, Americans changed the way they ate along with other lifestyle choices and those that didn’t truncated their lifespan.

The relatively low-tech medical corps became very successful in serving the basic medical needs of their local communities, infections fell and life expectancy came back up. They operated on a sliding scale. Preventive medicine was the primary focus, unlike the previous paradigm where it was just given lip service. Funding to initiate the program came from private philanthropic efforts. This was how the MS-Self Help centres started in the UK. A trust was created called the Oxygen Trust and it opened six centres. These eventually grew to 60 and hyperbaric oxygen became the primary treatment in the UK for MS patients by MS patients. Still, it all started with private philanthropy.

When it got up and running the medical corps reached everyone and was, at its center, universal healthcare at its best because the training in survival medicine was stellar. Artificial intelligence greatly aided in making correct diagnostic and therapeutic decisions as well. Medical corps providers were trained in appropriate algorithms but they also had the benefit of big-data analysis at the touch of the screen on their portable communication devices.

The peripatetic medical corps became the core of the new healthcare system where prevention was the main focus. Therapies using light, color and sound replaced many drugs. Big Pharma had literally created faux disease issues just so they could sell their wares regardless of whether those drugs were appropriate or even worked. Big Pharma was not missed.

There has to be a morning after

Obviously the event just described has yet to happen, and most of those reading this essay will do so after the event not before, so what was the purpose here? The purpose was to be a way-shower, to point a way forward that will work the best in a very difficult transition. It took 15 years for the Russian healthcare system to start to right itself when the Russian economy improved. We can’t count on an economy that would support a healthcare system resembling anything from the past, and it would behoove us to not be caught with our surgical scrubs pulled down, because it will cost lives that didn’t have to be lost.

Often one has to hit rock bottom before real and viable changes are made in one’s life, and that moment is nigh as I write this. All the bizarre revelations that were brought to the surface during the transition - the level of corruption, perversion and blackmail that was core to how the occupied government of the US was operating helped people realize how unlovely our society became. In a sense, we were given a second chance - as I write this the question is what will we do with this second chance?

References

Gelderloos AT., et al. “Repeated COVID-19 mRNA vaccination results in IgG4 class switching and decreased NK cell activation by S1-specific antibodies in older adults”. Immun Ageing 21.1 (2024): 63.
The American main stream media became propaganda arms of Big Pharma - for example, Anderson Cooper of CNN was being paid $12 million a year but $10 million was from Pfizer, but the public didn’t know that was who he was really working for.
Sanjay Basu., et al. “Association of Primary Care Physician Supply with Population Mortality in the United States, 2005-2015”. JAMA Intern Med 179.4 (2019): 506-514.
https://www.foxnews.com/politics/tens-thousands-illegal-immigrants-sexual-assault-homicide-convictions-roaming-us-streets
https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024
https://www.nschdata.org/browse/survey/results?q=10458&r=1
Not to be confused with the public health system in pre-collapse USA, which wasn’t about public health but control. Real public health is about clean water, air, nutrition, etc.
Shishkin S. “How history shaped the health system in Russia”. Lancet 390.10102 (2017): 1612-1613.
The increased incidence of cardiovascular disease was believed to be grossly underestimated.
Ivanov VN and Suvorov AV. “Modern Development Problems of Russian Healthcare-Part 1”. Studies on Russian Economic Development 32.6 (2021): 631-639.
The crash and then the cyberattack, which was meant to put the final nail in the coffin with the economy in it, regrettably turned into a mass casualty event.

Objective: The objective of this study was to evaluate independent and dual association of body mass index (BMI)-for-age percentile and waist circumference (WC) with metabolic syndrome (MetS) among sub-Saharan Black African boys and girls.

Materials and Methods: A total of 624 boys and girls aged 10-19 years were included in the study. Study participants were measured for BMI-for-age percentile, WC, Systolic blood pressure (SBP), impaired or diabetic fasting blood sugar (FBS) level and elevated levels of total cholesterol (T-Chol), triglyceride (TG), low-density lipoprotein (LDL) as well as low level of high-density lipoprotein (HDL).

Results: There was a significant variance (P-value=0.003) in the median BMI-for-age percentile among boys without (n=207; 23.8) and boys with (n=34; 44.2) MetS. This difference was more pronounced (P-value=0.00001) among girls without (n=365; 64.8) and those with (n=18; 82.9) MetS. A notable difference in WC (P-value=0.0004) was observed among girls without and with MetS. Positive and significant correlations between BMI-for-age percentile and SBP were noted among boys (r= +0.37, P-value<0.00001) and girls (r= +0.23, P<0.00001) without MetS, though the correlation was insignificant but still stronger among boys (r= +0.29, P-value=0.09) than girls (r= +0.11, P=0.68) with MetS. The correlation between WC and SBP was only significant among boys with MetS (r= +0.34, P-value<0.049). Stronger, negative and significant correlations were observed between BMI-for-age-percentile and FBG among girls (r= -0.67, P=0.002 for girls) than among boys (r= -0.42, P-value=0.01 for boys). Also stronger, negative and significant correlations existed between WC and FBG among girls (r= -0.62, P=0.006) than among boys (r= -0.39, P-value=0.02). Among those with MetS, the correlation between WC and TChol was stronger, positive and significant among girls (r= +0.54, P-value=0.02) but negative and insignificant among boys (r= -0.16, P-value=0.36). Both BMI-for-age percentile and WC were responsible for significant changes in FBS mostly among girls (R2=0.49, F-ratio=7.29, P-value=0.006) than among boys (R2=0.20, F-ratio=3.94, P-value=0.03).

Conclusions: Our results indicate that, elevated SBP BMI and WC may contribute more to MetS among boys while Diabetes, BMI and WC may do so among girls in Black Africa. There appears to be different interplay between these components of MetS through different mechanisms among boys and girls.

Keywords: Black African Adolescents; Body Mass Index; Sex; Metabolic Syndrome; Sub-Saharan; Waist circumference

References

Abbas, Khizar., et al. “A Blockchain and Machine Learning-Based Drug Supply Chain Management and Recommendation System for Smart Pharmaceutical Industry”. Electronics 9 (2020): 852.
Shi Jianfeng, Yi Dian and Kuang Jian. “Pharmaceutical Supply Chain Management System with Integration of IoT and Blockchain Technology (2019).
Sylim Patrick., et al. “Blockchain Technology for Detecting Falsified and Substandard Drugs in the Pharmaceuticals Distribution System (Preprint)”. JMIR Research Protocols 7 (2018).
Kim Henry and Laskowski Marek. Towards an Ontology- Driven Blockchain Design for Supply Chain Provenance (2016).
Pandey Prateek and Litoriya Ratnesh. “Securing E-health Networks from Counterfeit Medicine Penetration Using Blockchain”. Wireless Personal Communications 117 (2021).
Premkumar Anitha and C Srimathi. Application of Blockchain and IoT towards Pharmaceutical Industry (2020) 729-733.
Jabbar S., et al. “Blockchain-enabled supply chain: analysis, challenges, and future directions”. Multimedia Systems (2020).
Ben Fekih R and Lahami M. “Application of Blockchain Technology in Healthcare: A Comprehensive Study”. In: Jmaiel M., Mokhtari M., Abdulrazak B., Aloulou H., Kallel S. (eds) The Impact of Digital Technologies on Public Health in Developed and Developing Countries. ICOST 2020. Lecture Notes in Computer Science, Springer, Cham 12157 (2020).
Peter Gonczol., et al. Blockchain Implementations and Use Cases for Supply Chains-A Survey (2020).
Fernando E., et al. “Success factor of implementation blockchain technology in pharmaceutical industry: a literature review”. In: 6th International Conference on Information Technology, Computer and Electrical Engineering (ICITACEE), IEEE (2019): 1-5.
Huang Y, Wu J and Long C. “A Practical Blockchain System for Drug Traceability and Regulation”. In Proceedings of the 2018 IEEE International Conference on Internet of Things (iThings) and IEEE Green Computing and Communications (GreenCom) and IEEE Cyber, Physical and Social Computing (CPSCom) and IEEE Smart Data (SmartData), Halifax, NS, Canada (2018).
Chitre M., et al. “Monitoring Counterfeit Drugs using CounterChain”. In Proceedings of the 2019 International Conference on Advances in Computing, Communication and Control (ICAC3), Mumbai, India (2019).
Shu H., et al. “An Efficient Certificateless Aggregate Signature Scheme for Blockchain-Based Medical Cyber Physical Systems”.
Kim M., et al. “A secure charging system for electric vehicles based on blockchain”. Sensors 19 (2019): 3028.
Gräßer F., et al. “Aspect-based sentiment analysis of drug reviews applying cross-domain and cross- data learning”. In Proceedings of the 2018 International Conference on Digital Health, Lyon, France (2018): 121-125.
Daniela Bagozzi CL. 1 in 10 Medical Products in Developing Countries Is Substandard or Falsified (2017). https://www.who.int/news-room/detail/28-11-2017-1-in-10-medical-productsin-developing-countries-is-substandard-or-falsified
The Guardian. 10% of Drugs in Poor Countries Are Fake, Says WHO (2017). https://www.theguardian.com/global-development/2017/nov/28/10-of-drugs-in-poor-countriesare-fake- says-who
Bryatov S and Borodinov A. “Blockchain technology in the pharmaceutical supply chain: Researching a business model based on Hyperledger Fabric”. In Proceedings of the International Conference on Information Technology and Nanotechnology (ITNT) (2019).
Funding HR. 20 Shocking Counterfeit Drugs Statistics (2017). https://healthresearchfunding.org/20-shocking- counterfeit-drugs-statistics/
Soundarya K and Pandey P, Dhanalakshmi R. “A Counterfeit Solution for Pharma Supply Chain”. EAI Endorsed Trans. Cloud Syst (2018).
Jamil F., et al. “A Novel Medical Blockchain Model for Drug Supply Chain Integrity Management in a Smart Hospital”. Electronics (2019).

Background: In the realm of pharmacology, a significant and urgent issue confronting us today is the rampant spread of counterfeit drugs. Pharmaceutical companies have faced increasing challenges in tracing products along the supply chain over the last decade, providing an entry point for counterfeiters to infiltrate markets. The proliferation of fake medications poses a serious threat to global public health, resulting in adverse effects. According to the World Health Organization, some countries experience as much as 30% of medication sales attributed to counterfeits. In less developed nations, the problem is even more severe, with one in ten medicines being identified as fraudulent or non- compliant. The detection of these counterfeits is complicated due to their intricate journey through networks, creating vulnerabilities. To effectively combat forgery, a comprehensive approach is imperative to monitor the entire delivery process. The utilization of efficient blockchain technology holds the potential to authenticate medications and safeguard public health.

Methods: This proposal introduces a pharmaceutical supply chain management system utilizing advanced Hyperledger Fabric technology to securely store medication records in a network. The framework addresses the issue of counterfeit drugs by establishing a drug ledger that meticulously records all network transactions, thereby establishing an intelligent healthcare ecosystem within the supply chain. Central to this system are smart contracts, essential components that confer specific access rights to the drug ledger. These contracts ensure that only authorized entities have control over access to sensitive information. Through the integration of Hyperledger Fabric and smart contracts, the system aims to create a supply chain characterized by transparency, resistance to tampering, and efficiency, effectively combating counterfeit drugs and enhancing the integrity of medication distribution. Ultimately, these improvements contribute to bolstering patient safety and optimizing healthcare outcomes.

Results and Conclusion: Ensuring confidentiality at the chain code layer is achieved through user-specific access controls in Attribute-based access control (ABAC). To evaluate the framework's performance, the blockchain benchmarking tool, Hyperledger Caliper, quantifies crucial metrics such as transactions per second, transaction idleness, and asset usage. This process provides valuable insights into the efficiency and effectiveness of the system.

Keywords: Private Blockchain; Hyperledger fabric; Supply chain; Chain code; Access control

This report mention that offset inbalances of hip arthroplasty could be leading deep gluteal syndrome (DGS) related with neglected piriformis tension and further fibrosis. It could be listed as a late complication after hip replacement surgery. Posterior approach of hip arthroplasty compromised pirfiormis integrity which is performed tenotomy and than repaired will be leading comorbidity of this situation.

Material And Methods: A 65-year-old male, who underwent bilateral Total hip arthroplasty in 2004, applied to the our outpatient clinic with progressive hip and leg pain during sitting which is started to complain since 2017.

Prifomis and facet injections and radio-frequency blocks were applied to the patient at least twice. The complaints that increased but could not sitting more than 15 minutes than deceased office working forced to retirement.

The patient has not benefited from conservative treatments like injection, block therapy, physical therapy fro 6 years. EMG findings of the patient with nonspecific findings on MRI support obturator impingement syndrome.

Surgical Technique: Arthroscopic piriformis release was performed via posterior proximal portal and accessory proximal portal lateral decubitus position or prone position. The piriformis tendon is separated from insertion which is near the gluteus medius neighborhood with a total tenotomy. Neurolysis performed from obturator foramina output to external rotator site.

Result: The patient was mobilized painlessly two hours after the operation. All hip movements was actively free. During the sitting, the pain completely disappeared. The first week he was allowed to work in the office. The exercise was carried out without weight for three weeks, and then we started weight lifting and active resistive exercises. After the tenth day of stretching and ROM exercises, strengthening exercises were made. After the first three weeks of exercise, the pain gradually decreased. In the third and sixth months, the complaints were observed to completely diminished than the patient clinical follow-up was terminated.

Conclusion: Arthroscopic tenotomy and decompression therapy in Piriformis syndrome are safe and effective method. Arthroscopic piriformis release results consistently showed improvement pain and function and lowest incidence of complications. Priformis should be well evaluated in long-term ipsilateral sciatalgia in patients undergoing hip prosthesis, and arthroscopic tenotomy should be considered a safe option in patients who do not respond to conservative treatment related DGS.

Background: Retinopathy of prematurity (ROP) is a Vasoproliferative disorder of the eye affecting preterm infants and is a leading cause of preventable blindness. Vitamin A -retinoids and their active metabolite, retinoic acid has highly potent antiangiogenic activity by inhibiting VEGF expression at the neovascularization phase. Objectives: To evaluate preventive effect of vitamin A on ROP. Materials and method: This randomized controlled trial study was conducted in the Neonatology Department of Dhaka Shishu Hospital among the preterm neonates of 32-34 completed weeks of gestation and also those neonates whose 1st ROP screening showed peripheral avascular zone irrespective of gestational age from July 2018 to June 2020. Initially 228 preterm neonates were enrolled in this study. Among them 164 preterm neonates were randomly allocated in vitamin A group (82) and control group (82). Vitamin A group received vitamin A drop perorally (5000 IU/Kg/day), added to their enteral feeds as soon as minimal feeding was introduced and continued from starting point to 4 weeks and dose of vitamin A also adjusted with multivitamin drop when vitamin A group had to be given multivitamin drop. Control group had been given multivitamin drop from 2 weeks of age. Out of these, 6 neonates died, 1 neonate shifted to another hospital and 9 neonates did not come for follow up after discharge. So finally, 148 neonates were completed this study. Results: This paper shows oxygen therapy 53.9% in vitamin A group and 76.4% in control group with highly significant (p<0.01) difference found between two groups. Septicemia 36.8% in vitamin A group and 55.6% in control group with significant (p<0.05) difference found between two groups. Study shows ROP present 48.8% in vitamin A group with oxygen therapy and 78.2% in control group with oxygen therapy which was statistically highly significant (p<0.01). Research shows ROP present 64.3% in vitamin A group with septicemia and 85% in control group with septicemia which was statistically significant (p<0.05). Conclusion: Vitamin A supplementation prevents retinopathy of prematurity in preterm babies.

Keywords: Vitamin A; Retinopathy of prematurity; Pre-term baby

Aims: The article describes the impact of various prognostic elements (CRP, age, duration of symptoms, operator skills, US examination) on the selection of operative method for patients with acute cholecystitis, and consequently displays the suggested preoperative scoring system.

Methods: The retrospective survey included patients operated for acute gallbladder inflammation during the period 2019-2023. Patients were divided into three groups: age (below 30, from 30-60, and above 60), CRP value (CRP<50mg/l, 50-100mg/l, CRP>100mg/l), duration of symptoms (below 3 days, 4-7 days, over 7 days), US examination (wall thickness 2mm, 4mm, more than 4mm), operator skill level (less than 50 operations a year, from 50-70 annually, over 70 annual operations). Each prognostic element was relevantly assessed, and resulted in the elaboration of preoperative scoring system for the laparoscopic cholecystectomy (LCH).

Results: During the indicated three years period 339 patients were operated; of those, 46.6% underwent the laparoscopic method, while 14.2 % needed conversion. Average CRP value in patients with LCH was 84.6mg/l, while the traditional open method indicated 125.5mg/l. Average duration of symptoms in LCH amounted to 2.7 days, and in traditional open method 4.1 days. Mean age of patients treated with laparoscopic method was younger (58.3 years), while the US examination both in LCH and the traditional open method indicated average wall thickness of 2-4 mm. Most LCH operations were performed by operators with over 70 performed annual operations. Screened patients over 60 years of age, CRP values exceeding 100mg/l, and duration of symptoms in excess of 7 days indicated significantly increased number of conversions, resulting in decisions for immediate open method cholecystectomy. Experience level of the operator significantly affected the percentage of conversions and consequent decisions for immediate open cholecystectomy (p<0.01). Each element was statistically evaluated and scored from 1-3, and the results were used in devising a scheme for preoperative classification of patients – preoperative scoring system (PSS).

Conclusion: Preoperative scoring system represents valuable reference for the operator in selecting the method of operation for patients with acute cholecystitis. Whilst any patient exceeding the PSS 11 is not suitable for LCH since there is almost 100% probability of conversion, the patients with PSS ranging from 5-9 are likely material for the LCH.

Background

The main disadvantage of conventional Bassini hernioplasty is that it involves forceful approximation of the groin tissues associated with tension on the suture line, which leads to increased postoperative pain, longer hospital stay delay in resuming regular physical activity, and higher recurrence rate. New techniques of tension free repair have many advantages, including decreased tension, reduced postoperative pain, decreased analgesic consumption, faster return to normal physical activity and lower incidence of recurrence. Tension free techniques are divided into open (Trabucco) and endoscopic (laparoscopic TAPP and TEP). This study was undertaken to investigate the advantages and disadvantages of conventional and laparoscopic hernioplasty.

Patients and methods

During the period 2018-2019, 28 patients, 24 men (85,7 %) and 4 women (14,3 %), underwent endoscopic hernia repair at our department. During the same period, the open tension-free technique was used in 423 patients, 388 men (84,9 %) and 44 women (10,2 %). The mean age of laparoscopic and open tension group was 55 and 52 years, respectively. The techniques were compared in terms of operating time, hospital stay, postoperative pain, analgesic usage, recurrence rate, return to normal physical activity, and complications. Follow up examinations were scheduled at one month, six months, one year and five years after surgery.

Results

The operating time in laparoscopic hernioplasty is significantly longer than in tension-free hernia repair, yet there is no statistically difference between the two techniques as concerns the length of hospital stay. In patients undergoing laparoscopic hernia repair, return to normal physical activity was significantly less, analgesics during the first three postoperative days, and reported significantly lower level of pain assessed by the visual analogy scale. On follow-up examination at five years after surgery one recurrence (3,6 %) was found in both groups. There was no significant difference between the groups in terms of normal physical activity.

Conclusion

Tension-free hernioplasty is the method of choice in the treatment of adult patients with groin hernia. Laparoscopic hernia repair has its advantages and drawbacks. It is considerably more expansive than the tension-free approach, but its use is fully justified in adults with hernia recurrence.

References

Asare‐Marfo D., et al. Prioritizing countries for biofortification interventions using country‐level data (2014).
Graham RD, Welch RM and Bouis HE. “Addressing micronutrient malnutrition through enhancing the nutritional quality of staple foods: principles, perspectives and knowledge gaps”. Advances in Agronomy 70 (2001): 78-142.
Asare‐Marfo D., et al. Prioritizing countries for biofortification interventions using country‐level data (2014).
HarvestPlus. Our history (2018).
Garcia‐Casal MN., et al. “Staple crops biofortified with increased vitamins and minerals: considerations for a public health strategy”. Annals of the New York Academy of Sciences 1390 (2017): 3-13.
HarvestPlus. Biofortification Progress Briefs (2014).
Mejia LA, Dary O and Boukerdenna H. “Global regulatory framework for production and marketing of crops biofortified with vitamins and minerals”. Annals of the New York Academy of Sciences 1390 (2017): 47-58.
Pingali PL. “Green revolution: impacts, limits, and the path ahead”. Proceedings of the National Academy of Sciences 109 (2012): 12302-8.
Garcia‐Casal MN., et al. “Staple crops biofortified with increased micronutrient content: effects on vitamin and mineral status, as well as health and cognitive function in the general population”. Cochrane Database of Systematic Reviews 8 (2016): 1465-858.
Swamy., et al. “Compositional Analysis of Genetically Engineered GR2E “Golden Rice” in Comparison to That of Conventional Rice”. Journal of Agricultural and Food Chemistry (2019).
KH Brown. “The Importance of Dietary Quality versus Quantity for Weanlings in Less Developed Countries: A Framework of Discussion”. Food and Nutrition Bulletin 13 (1991): 86-92.
Howarth E Bouis and Ross M Welch. “Biofortification—a Sustainable Agricultural Strategy for Reducing Micronutrient Malnutrition in the Global South”. Crop Science 50, no.2 (2010): S-1-S-13
Devendra Kumar Yadava, Firoz Hossain and Trilochan Mohapatra. “Nutritional security through crop biofortification in India: Status & future prospects”. Indian J Med Res 148.5 (2018): 621-631.
Mayer AB., et al. A food systems approach to increase dietary zinc intake in Bangladesh based on an analysis of diet, rice production and processing (2011).

A Complex Diagnostic Picture

Diagnosing anosognosia can be complex due to its symptoms frequently overlapping with those of other severe mental illnesses. Sometimes, there is mild confusion or forgetfulness about the need for medication; in other cases, there is a refusal to recognize any problem. Tools such as the Positive and Negative Syndrome Scale (PANSS) or neuroimaging methods (e.g. CT scans have assessed stroke-related impairments. However, no single diagnostic instrument is foolproof. Clinicians often rely on direct interviews, behavioral observations, and collateral information from family members or close friends.

Intervention and the LEAP-ON Model

One evidence-informed method of collaborating with patients experiencing anosognosia is adapted from the “LEAP” approach (Listen, Empathize, Agree, and Partner). This framework encourages clinicians to refrain from confrontation and instead focus on building rapport through empathetic listening. It entails validating the patient’s perceptions, even if they differ dramatically from clinical reality. The goal is not to prove the patient “wrong” but to earn trust and open pathways for collaboration.

An additional dimension— “ON,” or Open-to-resistance and Navigate patient’s decision—recognizes that patients with anosognosia might resist treatment but can still benefit from a carefully calibrated therapeutic alliance. By acknowledging a patient’s constructs—how they interpret events and experiences—clinicians can gently navigate decision-making without alienating the individual. The onus is on the therapeutic relationship to guide and support rather than to demand and coerce.

Balancing Legal and Ethical Considerations

There are instances when the severity of anosognosia and related mental health symptoms calls for more stringent measures, such as involuntary treatment. This step should be taken only after careful clinical judgment and compliance with local legal standards. While involuntary treatment can sometimes be lifesaving, it also carries ethical implications. The nuanced challenge is to protect the patient from harm while fostering a degree of autonomy that respects their dignity. Where possible, collaborative approaches and shared decision-making build greater trust and can reduce the need for coercive interventions.

Looking Ahead

Awareness of anosognosia is growing among mental health professionals, yet gaps in education and practice still exist. Persistent misconceptions—such as viewing refusal of treatment simply as “defiance”—risk hindering effective care. More widespread training in nuanced communication strategies and better integrating mental health services into primary care can help detect anosognosia earlier, improve patient adherence, and reduce relapse rates.

Individuals with anosognosia are not merely “in denial”; they face a profound neurological and psychological barrier to recognizing their conditions. By combining empathy, evidence-based strategies like LEAP-ON, and—if needed—legal safeguards, we can maximize treatment effectiveness and uphold the patient’s best interests. As we advance our knowledge of anosognosia and its intersection with various psychiatric and neurological disorders, forging a compassionate, patient-centered approach will remain crucial for achieving enduring improvements in mental health outcomes.

References

Lysaker P., et al. “Insight in Schizophrenia Spectrum Disorders: Relationship with Behavior, Mood, and Perceived Quality of Life, Underlying Causes and Emerging Treatments”. World Psychiatry 17.1 (2018): 12-23.
Montero H. “Anosognosia: How to Treat the Lack of Insight in Mental Health”. Psychology & Psychological Research International Journal 3.5 (2018): 1-4.
Chao L and Kawasaki A. “Anosognosia: Delusions and Unawareness in Psychosis”. Journal of Psychiatric Practice 23.4 (2019): 256-264.

Nanotechnology (the mechanics of Quantum Theory) is science, engineering, and technology conducted at the nanoscale, which is about 1 to 100 nanometers (1 billionth of a meter) on the metric scale and involves imaging, measuring, modeling, and manipulating matter at this length scale (10 ^-9). Therefore, nanotechnology, nanoscience and nanobiology involve the ability to see and to control individual atoms and molecules “the internal movement of matter with a certain external cause” (Tudor 227) at the nanoscale. The focus of this discussion is on the “miracles” described in the Judeo/Christian Old Testament and the Christian New Testament. This paper postulates that God, Jesus, the heavenly angels, and their human emissaries (Moses, Aaron, Elijah, the disciples/apostles) harnessed and applied similar scientific techniques (albeit far advanced beyond what mankind has done today) to accomplish what are often referred to as “miracles” (secular “magic”). Therefore, what we in the religious communities have long referred to as “miracles” (as are recounted throughout Holy Scripture and non-canonical Scriptures) were actually the result of advanced technologies applied.

In the case of most of the Biblical “miracles,” the creation, restructuring and/or replication of physical matter were conducted at the atomic and molecular levels (10 ^-9). However, one in particular may have been conducted at the giga scale (10 ⁹) when “…the sun stood still in the midst of heaven, and hasted not to go down about a whole day.” (Joshua 10:13). Nonetheless, this discussion proposes that these extraordinary events, manifestations of Divine intervention, were all accomplished in either of two ways: (1) A force of energy - referred to in Scripture as the Holy Spirit -- was tapped, harnessed, calibrated and channeled directly by way of Divine Word - the voices/ commands of God and Jesus -- to the intended target and (2) A force of energy - the Holy Spirit - was tapped, harnessed, calibrated and channeled indirectly by way of conduits such as rods, by way of Divine and human hands and the human body to the intended target. As the reader will come to realize over the discussion of this Theory, the ways in which these supernatural events came about sometimes overlap. Moreover, not all of the Biblical “miracles” will be discussed here.

Keywords: Nanoscience; Nano-biology; Nanotechnology; Nano-medicine, Biblical Miracles; Holy Spirit; Quantum Mechanics

The next phase in the history of medicine is assumed to be that of “laboratory medicine”, as described and accepted by historians of medicine across the world. “In 1848, a new medicine, “laboratory medicine,” made its appearance in Paris under the leadership of Louis Pasteur, Claude Bernard, and the Societe de Biologie” [4].

Prior to the overarching social presence of modern medicine, or what is regarded internationally as hospital medicine, Rosenberg observes, “Both physician and educated layman shared a similar view of the manner in which the body functioned, and the nature of available therapeutic modalities reinforced that view” [5]. Moreover, as Rosenberg argues, “as this world changed and provided data and procedures increasingly relevant to the world of clinical medicine, it gradually undercut that structure of cognitive framework and personal interaction which characterized therapeutics at the end of the century” [6].

What Rosenberg wanted to argue about is fairly described in an important textbook of internal medicine. It suggests that we are living in an era of “bio-medicalization” or “techno-medicine”. To quote:

The hospital is an intimidating environment for most individuals. Hospitalized patients find themselves surrounded by air jets, button, and glaring lights; invaded by tubes and wires; and beset by the numerous members of the health care team – hospitalists, specialists, nurses, nurses’ aides, physician’s assistants, social workers, technologists, physical therapists, medical students, house officers, attending and consulting physicians, and many others. They may be transported to special laboratories and imaging facilities replete with blinking lights, strange sounds, and unfamiliar personnel; they may be left unattended at times; and they may be obligated to share a room with other patients who have their own health problems. It is little wonder that patients may lose their sense of reality [7].

In such a milieu, the doctor is often the only tenuous link between the patient and the outside world and “may make a stressful situation more tolerable” [8]. S/he becomes both a scientific person and a healer. Roy MacLeod has argued that, “Medicine, in its conceptual, professional and political dimension, is both shaping and shaped by the cultural circumstances that surround it, and that give it at any time its particular character” [9]. A common culture of medicine – sustained by the image of science as the universal agent of progress, and scientific medicine as its instrument – became the hallmark of European empires throughout the world [10]. The success of western medicine was facilitated by the expansion of hospitals to the non-European world.

We have a come a long way from “hospital medicine”, then “laboratory medicine” to “techno-medicine”, and then to “precision medicine”. Now we have entered the phase of AI-assisted medicine with new cutting edge technology and artificial intelligence.

Regarding precision medicine it is observed – “A goal of precision medicine [1] is to stratify patients in order to improve diagnosis and medical treatment. Translational investigators are bringing to bear ever greater amounts of heterogeneous clinical data and scientific information to create classification strategies that enable the matching of intervention to underlying mechanisms of disease in subgroups of patients. Ontologies are systematic representations of knowledge that can be used to integrate and analyze large amounts of heterogeneous data, allowing precise classification of a patient. In this review, we describe ontologies and their use in computational reasoning to support precise classification of patients for diagnosis, care management, and translational research” [11].

The Age of AI in Medicine

In the Bulletin of the American College of Surgeons it is observed that “AI is the study of algorithms that give machines the ability to solve problems, recognize words and visual aspects within images, and make predictions based on statistical inferences. When it comes to medicine, AI is able to review large amounts of data from patient records, radiological scans, or surgical videos, and use that information to detect, classify, and predict” [12].

One article in the New England Journal of Medicine (NEJM) has addressed the ethics of relational AI [13]. To quote at length from the article:

November 2022 marked an inflection point in the public’s experience with artificial intelligence (AI), when ChatGPT, a “large language model” (LLM), chatted with millions of people in everyday English. Previously, AI had primarily taken the form of predictive analytics that produced numerical predictions — for example, “this patient has a 68% chance of requiring intensive care within the next 24 hours”. In contrast, LLMs belong to a new class of AI called generative AI (GenAI) and generate natural language, the medium in which humans communicate with each other. GenAI is thus relational AI, which is qualitatively different from predictive AI. Inasmuch as “the medium is the message,” GenAI’s relational nature raises additional ethical questions beyond the already-daunting ethics surrounding predictive AI [14].

Another article observes the issue in this way – “The interpretation of medical images — a task that lies at the heart of the radiologist’s work — has involved the growing adoption of artificial intelligence (AI) applications in recent years. This article reviews progress, challenges, and opportunities in the development of radiologic AI models and their adoption in clinical practice. We discuss the functions that AI-based algorithms serve in assisting radiologists, including detection, workflow triage, and quantification, as well as the emerging trend of the use of medical-imaging AI by clinicians who are not radiologists” [15].

To conclude, we are at a threshold moment for shaping the nature of medical care in the near and distant future. The most crucial choices confronting the medical community are not technical but ethical: the paramount fiduciary responsibility is to all humans and to the persistence of medicine as a moral and human profession [16].

Foot Notes

Erwin H. Ackerknecht, Medicine at the Paris Hospital, 1794-1848 (Baltimore: Johns Hopkins Press (1967): 15.
Ibid., 15.
Andrew Wear. “Introduction”. in Medicine in Society: Historical Essays, ed., Andrew Wear (Cambridge: Cambridge University Press (1998): 1-13.
Ackerknecht, idem, xiii.
Charles Rosenberg. “The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America”. Perspectives in Biology and Medicine, summer 20.4 (1977): 485-506.
Ibid, 497. For a nice and detailed analysis of medicine and patronage system in 18th-century England see, N. D. Jewson. “Medical knowledge and the patronage system in 18th century England”. Sociology 8.3 (1974): 369-85. Jewson comments. “Perhaps the most immediately striking feature of the 18th century pathology was the general lack of agreement about the causes of illness and the effectiveness of therapies”. 171.
Dennis L Kasper., et al. Harrison’s Principles of Internal Medicine, 19th edition, vol. 1 (New York, Chicago: McGraw Hill Education (2016): 5.
Ibid.
Roy MacLeod. “Introduction”. in Disease, Medicine and Empire: Perspectives on Western Medicine and the Experience of European Expansion (London, New York: Routledge (1988): 1-18.
Ibid, 3.
Melissa A Haendel, Christopher G Chute and Peter Robinson. “Classification, Ontology and Precision Medicine”. N Engl J Med 379.15 (2018): 1452-1462.
Jim McCarttney. “AI Is Poised to “Revolutionize” Surgery”. Bulletin of the American College of Surgeons (2023).
Ida Sim and Christine Cassel. “The Ethics of Relational AI – Expanding and Implementing the Belmont Principles”. N Engl J Med 391.3 (2024): 193-196.
Ibid., 193.
Pranav Rajpurkar and Mathew P Lungren. “The Current and Future State of Interpretation of Medical Images”. N Engl J Med 388 (2023): 1981-1990.
Ida Sim and Christine Cassel. “The Ethics of Relational AI - Expanding and Implementing the Belmont Principles”. N Engl J Med 391.3 (2024): 193-196.

We go along with Aristotelian ethicists in maintaining that the well-being of a human being, in cultivation of virtues to avoid extremes in his actions and feelings, is dependent on many factors such as his psycho-physical health on the one hand and favorable socio-political conditions on the other. However, we should not forget Plato who meaningfully points out the hindrance to humans’ aspiration for well-being as they naturally target pleasure or profit in their actions and feelings and in pursuit of such targets, they often experience conflict with each other or even in their own mental lives. With the result, they suffer from various health issues especially mental health issues.

Fortunately, in many instances of health issues humans do receive timely interventions of health professionals to help them regain physical and mental health. Alongside, howsoever unfortunately with increasing commercialization of health services in the contemporary industrial world, we happen to notice some behavioral contradictions in the interventional practices of health professionals such as between psychiatrists and psychologists. They appear to work in isolation from each other.

Psychiatrists prescribe medications, which do not need any justification for benefits particularly when it comes to cure mental health disorders as these medications provide immediate and critical relief to patients all over the world. The relief is far ranging in cases from serious disorders like schizophrenia, personality disorders to milder disorders like depression, anxiety as psychiatric medications serve as a keystone in the diverse management of psychiatric conditions. Though these psychiatric medications play an important role in largely managing symptoms, they are not to be looked upon as a lifelong necessity because they do not serve the purpose of making the patient independent mentally. We realize the significance of psychiatric medications for patients but at the same time factors influencing the decisions to reduce or discontinue their use for patients and the critical phase during mental health illness where psychological interventions can be included for long term mental health management ethically need to be taken into consideration.

The importance of psychiatric medications possibly begins with the first line of defense when mental health symptoms are out of control of the person involved, meaning he is not conscious or stable enough to manage and respond to the abnormalities. In such cases, medications like antipsychotics, antidepressants, mood stabilizers and anxiolytics help manage and regulate neurochemical imbalances, enabling the patient to regain functional stability. For example, selective serotonin reuptake inhibitors (SSRIs) have proven scientifically effective in treating major depressive disorders by enhancing serotonin levels in the brain.

It is well proven that medications can be lifesaving for patients in cases of acute psychiatric crises, such as psychotic episodes or suicidal ideations and on the other hand it they are used for the purpose of reducing the severity of symptoms that hinder a patient’s ability to engage meaningfully in psychotherapy, thus creating a stable foundation for psychological interventions like Dialectical Behaviour Therapy (DBT), Cognitive Behavioural Therapy (CBT), etcetera.

Additionally, scientifically backed up research on biological components of many psychiatric disorders highlights the presence of genetic predispositions, structural brain abnormalities and neurochemical imbalances leading to mental health conditions. Psychiatric medications target these biological factors, providing a crucial element in a holistic treatment approach to patients.

However, recognizing the right time to discontinue psychiatric medications typically arises when the patient achieves sustained symptoms remission and stability. This often requires a minimum period of symptoms control, approximately a month to a year depending upon the diagnosis and individual differences in terms of self-determination and mental strength. It happens basically when the treatment goals such as improved mood, reduced anxiety, or cessation of psychotic symptoms are considerably met that psychiatrists may evaluate the potential for reducing the medications and eventually stop them for the well-being of patients.

The disturbing trend is that this is the book definition, making it look like a simple procedure to reduce or discontinue psychiatric medications, which hardly matches with the real-world medical practices. It is true that reducing or stopping of medicines not only depends on improvement in symptoms but the patient’s will to get better without any medication support. Choosing this path is very difficult for patients in general as humans tend to seek pleasure and avoid pain thus leaving the patient vulnerable to get addicted to psychiatric medications because such medications enhance his mood without his sincere efforts. That is also why it is important to stop giving or taking psychiatric medications on a time best suited for the well-being of the patients.

Abruptly stopping psychiatric medications can trigger relapse or withdrawal symptoms. It is good for the patient to follow a structured tapering plan under psychiatric supervision, gradually reducing his doses to minimize adverse effects. He is well advised to remain under monitoring for symptom recurrence. It is important to note here that it is a complex process that needs collaborative inputs from the psychologist as well as the patient himself apart from the consulting psychiatrist. The reason being psychiatrist’s decision needs to be tailored according to the individual’s unique clinical history, diagnosis, and personal preferences.

At this stage, the role of psychologists - post-medication – first, in relapse prevention, mainly working with the patient on identifying early warning signs, developing coping mechanisms and creating crisis management plans to safeguard mental health, second in enhancing the self- efficacy of the patient by making him take control of his mental health through self-awareness, problem-solving skills and emotional regulation, assumes immense significance. The effective play of this role helps in long term resilience and reduces future reliance on medications.

The psychologists employ various therapies which are scientifically proven to equip patients with coping skills that address underlying emotional and cognitive patterns. For instance, Dialectical Behavioural Therapy (DBT) enhances emotional regulation and interpersonal effectiveness while Cognitive Behavioural Therapy helps the individuals recognize distorted thinking.

While medications work on the biological components of the mental illnesses, and manage symptoms present in the human body, some psychotherapies delve into root causes too as the illnesses seen today may be an outcome of an event that happened in the immediate or remote past or even childhood. In such cases, therapies like psychodynamic approach, trauma-focused therapy, schema therapy, etcetera work for the overall well-being of the patient concerned. Though these therapies are way more time consuming than therapies like CBT or DBT but are more effective in the long run and particularly when there are past roots connected to the illness.

It is true that when it comes to physical illnesses, usually patients can use the structured plan of health professionals in medications and care for themselves. The reason being, a human being’s physical body is still easy to study especially with the help of technological advancements that are coming up. On the other side, the human brain is complex and the human mind is nearly impossible to study for medical purposes. Hence, more individualized care is needed in the field of mental care with a focus on individual differences in relation to reactions to medications, tolerance, and capability to leave medications for good on time. Though medications work in managing the symptoms but in the long run they can take away the patient’s freedom to feel emotions on his own, to trust his own capability to deal with stressful situations and broadly his independence to breath freely in the sensory world.

We admit that psychiatric medications serve as vital tools in stabilizing mental health conditions, often acting as the first step toward recovery. However, they are most effective when they are integrated into a broader, holistic treatment plan that also includes psychotherapy. Recognizing when to move from medication reliance to psychological assistance requires careful consideration. Collaboration among healthcare providers for the long-term well-being of patients is of crucial importance. By embracing this integrated approach, patients can be helped to achieve not only symptoms relief but also deeper self-understanding and resilience, ultimately leading to their sustainable mental health much needed to cultivate virtues in living a life of well-being in the world. In fact, humans including health professionals and patients require each other’s meaningful presence and support to attain well-being in their lives. If we do not help or cooperate with each other, we fail in our basic human duty to attain the telos of being human, that is to live a life of flourishing – a life of true well-being - in the world.

A Structured and Collaborative Approach

The initiative began with communication between Gopalganj Eye Hospital and Training Institute and primary health workers at community clinics. These health workers were crucial in mobilizing patients and ensuring smooth operations during the eye camps. Instead of setting up camps in schools or temporary locations, venues were carefully chosen in Union Parishad offices—Bangladesh’s smallest rural administrative and local government units—near community clinics. This strategic selection enabled local government representatives to take ownership of the initiative and actively participate in promoting eye health within their constituencies.

Once the venues were selected, the primary health workers spearheaded a community-wide campaign to inform people about the upcoming eye camps. Posters, word-of-mouth communication, and announcements in public spaces were used to maximize outreach. This grassroots mobilization proved instrumental in ensuring a high turnout, particularly among elderly individuals and marginalized groups who often face barriers to accessing healthcare.

The Eye Camp Process: A Comprehensive Model

On the day of the eye camp, the process was systematically organized to ensure efficiency and effectiveness. Primary health workers registered patients upon arrival, documenting their socio-demographic information, which would later facilitate follow-ups. This registration method significantly improved over traditional eye camps, where patient records were often incomplete, making it difficult to track their medical history.

A medical team from Gopalganj Eye Hospital and Training Institute arrived to conduct examinations following registration. Mid-level ophthalmic personnel performed initial vision tests, checked blood pressure, and measured blood sugar levels. These preliminary assessments helped identify patients at risk for other systemic diseases and ensured that those needing surgical intervention were stable.

Next, ophthalmologists conducted detailed eye examinations to diagnose various conditions. Patients diagnosed with cataracts, chronic dacryocystitis, and other treatable conditions were selected for surgical intervention, provided their blood pressure and blood sugar levels were within the normal range. Those with uncontrolled hypertension or diabetes were advised to seek medical treatment before undergoing surgery to minimize complications. Additionally, patients with suspected retinal diseases were referred for specialized evaluation.

Patients with refractive errors other than presbyopia were referred to the hospital for refraction and further evaluation. Patients with only presbyopia were evaluated and provided reading glasses free of cost.

Ensuring Access to Surgical and Postoperative Care

One of the significant challenges of traditional eye camps in Bangladesh has been ensuring that referred patients reach the hospital for further treatment. Typically, organizers transport patients in a single batch, and those who miss this opportunity often do not receive the care they need. Moreover, post-surgical follow-up remains a challenge, leading to unaddressed potential complications.

To resolve these issues, the Gopalganj Eye Hospital and Training Institute, with support from Sightsavers, arranged free transportation for referred patients. This ensured all eligible individuals could reach the hospital safely and without financial burden. Postoperative follow-up was conducted at the hospital, but primary health workers from the community clinics played a crucial role in ensuring that patients attended their follow-up visits. These health workers maintained communication with the focal person at the hospital regarding eye camp-related patient issues, facilitating better coordination and ensuring no patient was lost to follow-up. This innovation significantly improved patient compliance and reduced the risk of complications.

Community Ownership and Sustainability

Beyond treatment, these community-integrated eye camps fostered awareness about preventive eye care. Health workers educated patients on diabetes management to prevent diabetic retinopathy, proper eye hygiene, and protective measures to reduce infections and injuries. This holistic approach aligns with Bangladesh’s broader vision of universal health coverage and preventive healthcare.

The involvement of Union Parishad offices and community clinics ensured that the program was not just a temporary intervention but a sustainable model for the future. Local representatives, health workers, and community leaders became stakeholders, increasing accountability and ensuring long-term commitment to improving eye health.

A Call to Action: Expanding the Model Nationwide

The success of this initiative in Gopalganj presents a strong case for scaling up this model across Bangladesh. Government bodies, NGOs, and healthcare providers should consider adopting this structured approach, integrating eye camps within the community clinic framework. This model not only enhances accessibility but also ensures that eye care services become a continuous and structured effort rather than one-off interventions.

Bangladesh has made significant progress in reducing preventable blindness, but to sustain this progress, community-driven solutions are necessary. Integrating eye camps into community clinics is not just an improvement—it is an essential evolution in our approach to eye healthcare.

Now is the time to institutionalize this model and expand its reach. We urge policymakers, healthcare leaders, and donor organizations to invest in community-based eye care programs. By doing so, we can bring quality eye care to the doorsteps of those who need it most, ensuring that no one loses sight due to a lack of access.

References

Abraham J, Logeswari P and Silambarasan J. “Synthesis of Silver Nanoparticles Using Plants Extract and Analysis of Their Antimicrobial Property”. Journal of Saudi Chemical Society 19.1 (2015): 311-317.
Akiyama T and Saito G. “Nanomaterial synthesis using plasma Generation in liquid”. Journal of Nanomaterials 15 (2015): 21-22.
Allen KJ, Gurrin LC and Constantine CC. “Iron-overload-related disease in HFE hereditary hemochromatosis”. N Engl J Med 358 (2008): 221-30.
Arowora KA., et al. “Effects of green-synthesized silver nanoparticles from Azadirachtaindica on growth performance and liver function parameters in male albino rats”. Cell Biol Dev 7 (2023): 28-34.
Arowora K., et al. “Evaluation of Serum Biochemical Parameters in Male Wistar Rats Administered with Azadirachta Indica Silver Nanoparticles”. Asian Journal of Science, Technology, Engineering, and Art 2.3 (2024): 462-475.
Asha R., et al. “Cytotoxicity and Genotoxicity of silver nanoparticle in human cells”. American Chemistry Society of Nanopartice 3 (2009): 279-290.
Asrani SK., et al. “Burden of liver diseases in the world”. Journal of hepatology 70 (2019): 151-171.
Ayo VI., et al. “Effect of Lactuca sativa supplemented diet on Poloxamer 407 inducedhyperlipidemic albino rats (Rattus norvegicus)”. Asian J Nat Prod Biochem 21 (2023): 67-78.
Bamedi M, Fakour SR and Iadiza MAR. “Periodontal Diseases and Recently Applied Nano-Technology: A Review Article”. Health 9 (2017): 345-51.
Charity UO, Emmanuel DP and Sor-Aniabari RB. “Growth performance of wistar rats fed graded level of piper umbellatum linn(cow-foot) leave meal”. European Journal of Agriculture and Food Science (2022).
David L, Moldovan B and Vulcu A. “Green synthesis, characterization and anti-inflammatory activity of silver nanoparticles using Black elderberry fruits extract”. Colloids Surf B 122 (2014): 767-777.
Doumas BT and Watson WA Bigg. “Albumin standards and the measurement of serum albumin with bromcresol green”. Clinical ChimActa 31.1 (1971): 87-96.
Georgii V., et al. “Green synthesis of silver nanoparticles using waste products (apricot and black currant pomace) aqueous extracts and their characterization”. Advances in Materials Science and Engineering (2020).
Huma Y., et al. “Green synthesis of silver Nanoparticles and their applications as an alternative antibacterial and Antioxidant agents”. Materials Science and Engineering 112 (2020).
Jain D Daimab., et al. “Synthesis of plant mediated silver nanoparticles using papaya fruit extract and Evaluation of their antimicrobial activities”. Digest Journal of Nanomaterials and Bio Structures 4 (2009): 723-727.
Kim SH., et al. “Antibacterial activity of silver-nanoparticles against Staphylococcus aureus and Escherichia coli”. Korean Journal of Microbiology and Biotechnology 39 (2012): 77-85.
Lain M., et al. “Intelligent liver testing, working to Improve patient outcome in liver diseases”. Journal of applied Laboratory medicine 5.5 (2020): 1090-1100.
Muhlfeld C, Gehr P and Rothen-Rutishauser B. “Translocation and cellular entering mechanism of nanoparticles in the respiratory tract”. Swiss Medical weekly review 138 (2008): 387-391.
Nel AE., et al. “Understanding biophysicochemical interactions at the nano-biotechnology interface”. National Mater 8 (2009): 543-557.
Panda BB., et al. “In vitro biosynthesis and genotoxicity bioassay of silver nanoparticles using plants”. Toxicology Invitro 25 (2011): 1097-1105.
Reitman S and Frankel SA. “Colorimetric method for the determination of serum glutamic oxalacetic and glutamic pyruvic transaminases”. American Journal Clinical Pathology 28.1 (1957): 56-63.
Schlebusch H., et al. “Normbereiche der Aktivitätenklinischwichtiger Enzyme [Standards in the activities of clinically important enzymes]”. Dtsch Med Wochenschr 99.15 (1974): 765-6.
Schleh C., et al. “Size and surface charge of gold nanoparticles determine absorption across intestinal barriers and accumulation in secondary target organs after oral administration”. Nano-toxicology 6 (2012): 36-46.
Szasz G. “Reaction-rate method for gamma-glutamyltransferase activity in serum”. Clin Chem 22.12 (1976): 2051-5.

References

Agiriga JC. “Determination of particle sizes of the ashes of some wood parts”. Wood and Fiber Science 43.3 (2019): 53-102.
DeMiejer M, Thurich K and Militz H. “Comparative study on penetration characteristics of modern wood coatings”. Wood Science and Technology 32.6 (2010): 347-365.
Emmons. Heat of Reaction during Pyrolysis of Wood Combustion and Flame 32.1 (2013): 79- 86.
Enell, Mastral AM, Garcia T and Callen MS. “Effect of Ca-Si-Al Element proportion in the formation of Aluminosilicate Minerals and Detoxification of PAHs in Biomass Fly Ash from incineration during the hydrothermal process”. Energy and Fuel 35.11 (2008): 921-945.
Fritze H. “Effect of cadmium-containing wood ash on the microflora of coniferous forest humus”. Resource Technology 37.12 (2001): 173-178.
Griggs TR, Smith K and Mage D. “Fuel combustion air pollution exposure and health. The situation in developing countries”. Annual Review of Energy and Environment 18.1 (2016): 66-242.
Haglund. “Different formation mechanism of PAH during combustion under different temperatures”. Atmospheric Environment 89.15 (2018): 69-87.
Hickey M and King. “Preservation, Protection and Modification of Wood Composites”. Wood and Cellulose Chemistry 54.1 (2001): 519-549.
Jansen PA. Microscopy techniques for material Science: An Introduction to TEM, SEM and AEM- Springer (1997): 527.
Lattimore B, Smith CT and Titus BD. “Environmental factors in wood fuel production. Opportunities, risks, criteria and indicators for sustainable practices”. Biomass Bioenenergy 33.10 (2016): 365-392.
Okmanis M., et al. “Determination of optimum levels of Nitrogen, Phosphorus and Potassium of oil palm tree ash after combustion”. Bragantia 74.3 (2016): 247-254.
Onwuka CE. “Biomass fly ash.Some aspects of characterization and environmental impacts”. Journal of Environmental Science, Computer Science and Engineering & Technology 35.3 (2014): 921-937.
Palviaainen M and Finer L. “Long- term effects of wood fly ash fertilization on runoff water quality from drained peat land forests”. Journal of Environmental Quality 31.1 (2012): 946-953.
Rothman N, Ford D and Tager IR. “The effect of smoke inhalation on lung function and airway responsiveness in wild land”. American Journal of Industrial Medicine 31.2 (2015): 102-309.
Smith K and Liu Y. “Indoor air pollution in developing countries. Epidemiology of lung cancer”. Fire Management Notes 44.1 (2019): 6-8.
Udonwu EA, Ojiakor DE and Hart CA. “Global environmental distribution and human health effects of polycyclic aromatic hydrocarbons”. Journal of Chemical Information and Computer Science 15.3 (2011): 81-135.

As a result of high cost of fossil fuel and upsurge use of wood as an alternative source of fuel for domestic cooking and growing concern about the health risk associated with this practice, warranted the combustion and harvest of fly ash from selected fire woods such as African Oil Bean (Ugba), African Velvet Tamarind (Icheku), African Mango (Ugiri), African Pear (Ube), Mango (Mangoro) and African Bread Fruit (Ukwa) commonly used in Oru Community, Ahiazu-Mbaise, Imo State, South East Nigeria. Characterization of their fly ashes was carried out in order to determine the woods that generate lesser pollutants into the atmosphere. The woods fly ash were generated and analyzed for Heavy metals, Polycyclic Aromatic Hydrocarbons (PAHs), Morphology and Mineral contents. Heavy metals (Nickel, Zinc, Chromium, Manganese, Cadmium and Lead) were analyzed using Atomic Absorption Spectrophotometer (AAS), 16-priority PAHs were analyzed using Gas Chromatography-Mass Spectrometer (GC- MS), Minerals were determined using X-ray Diffractometer (XRD) and Scanning Electron Microscope (SEM) was used to determine the morphology of the fly ashes. The results obtained showed low concentrations of heavy metals in the fly ash of the woods, which were below W.H.O permissible limit (2.0mg/kg) except lead (Pb) and zinc (Zinc) that recorded high concentrations in all the fly ashes. PAHs concentrations across the fly ashes recorded an average value range from (0.02 mg/kg - 0.21 mg/kg) which was below USEPA permissible exposure limits (0.02 mg/kg - 0.5 mg/kg). Total PAHs concentrations recorded in woods fly ash were between (0.02 mg/kg and 4.63 mg/kg). Icheku wood fly ash recorded the highest total concentration of PAHs (4.63 mg/kg) while Ube wood fly ash, had the least (0.2 mg/kg). Highly carcinogenic PAHs such as Benzo (b) Fluoranthenene, Benzo (a) Pyrene, Benzo (k) Fluranthene, Chrysene, Dibenzo (G,h) anthracene and Indeno (1,2,3 c-d)were not detected in the woods fly ash. For minerals, mangoro fly ash recorded the most abundant essential mineral (24.97%) phosphorus content while Ugba fly ash recorded the lowest essential mineral (16.21%) sodium content. Aluminum and lithium, which are non- essential mineral elements, were found in the woods fly ash. SEM analysis in the woods fly ash recorded results of the range of particle sizes. Ugba (16 µm - 66 µm), Icheku (16 µm -200 µm) Ugiri (10 µm - 33 µm) Ube (36 µm -76 µm) Mangoro (20 µm - 60 µm) and Ukwa (33 µm - 86 µm). Icheku fly ash recorded the largest particle size range(16 µm - 200 µm) which is above the USEPA threshold value range (10 µm - 100 µm) for woods fly ash inhalation while Ugiri fly ash recorded the lowest particle size range (10 µm - 33 µm). From the SEM results, constant exposure to the woods fly ash could possibly lead to lungs inflammation and other respiratory diseases especially that of Ugiri wood. The best woods in relation to Heavy metals concentrations, PAHs, Particle sizes and Minerals are Ugba and Mangoro wood and are recommended for wood fuel. Other woods like Ube, Ukwa and Ugiri are also recommended for usage but under strict regulation, while Icheku wood should be rarely used since it contains very high concentrations in all the parameters analyzed in this study.

Keywords: Fly Ash; Biomass (wood); Oru; Ahiazu-Mbaise (Imo State)

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

Quick Links

About PSSRP