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Background: Skin and soft tissue infections (SSTIs) are common presentations in the emergency department. However, this is less common after contact with contaminated saltwater or freshwater. This review presents the diagnosis and management of water-related soft tissue sepsis in this vulnerable and difficult-to-treat subgroup of necrotizing soft tissue sepsis. Methods: A summative literature overview is presented regarding bacterial and fungal SSTI after contact with contaminated water, with practical diagnostic and management aspects. Results: The literature indicates that these wounds and infections remain difficult to treat. An approach using appropriate diagnostic tools with both medical and surgical management strategies is provided. Conclusions: SSTIs due to water contamination of wounds involve unusual organisms with unusual resistance patterns, and require a nuanced and directed diagnostic approach with an adaptation of the usual antibiotic or antifungal selection to achieve a successful cure, along with aggressive debridement and wound care.

Background: Reconstructive surgery of the different parts of the face is a challenge for the surgeons who perform it. Despite its current rise, studies of series of patients treated by these procedures are few.Objective: to characterize the face repair surgery in patients seen in a repair surgery consulting room.Methods: descriptive study, of a series of cases, at the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos. Patients who received reconstructive surgery of different facial structures, in the period January 2015 to December 2019 (N = 21) attended in the repair surgery consultation were studied. For this series, age, sex, skin color, diagnosis, cause, type of anesthesia and surgical technique were analyzed.Results: men and white skin color predominated. The auricle was the most frequently affected structure; consequently, the most commonly used techniques were the Filatov tube and Dieffenbach retroauricular, combined. Local anesthesia was used in almost all cases. The largest age group was 18-35 years (13 patients), with more than 50% of the total. Patients aged 60 and over were affected by lesions derived from carcinomas.Conclusion: The series presented shows that reconstructive surgery can solve different health and aesthetic situations, sometimes both in the same patient, with techniques of minimal surgical risk, a short time and favorable results.

Fundamento: el tabaquismo se considera una epidemia de carácter universal y una grave carga para el individuo, la familia y la sociedad. Objetivo: determinar la prevalencia de tabaquismo en pacientes con enfermedad pulmonar obstructiva crónica. Métodos: se realizó un estudio de serie de casos, en el Hospital Dr. Gustavo Aldereguía Lima, de la provincia de Cienfuegos, en las salas de Medicina Interna, en el período de septiembre de 2017 a enero de 2018. Las variables de estudio fueron: edad, sexo, escolaridad, ocupación, procedencia, tabaquismo, cantidad de cigarros fumados diariamente, cantidad de años fumando, enfermedad pulmonar obstructiva crónica, hipertensión arterial, diabetes mellitus, insuficiencia renal crónica, cardiopatías isquémica, accidente vascular encefálico y cáncer. Se utilizó como instrumento de recogida de información el cuestionario utilizado por el proyecto CARMEN (Conjunto de Acciones para Reducir las Enfermedades no Transmisibles). El instrumento se aplicó de forma individual y el análisis estadístico de la información se realizó en el paquete estadístico SPSS. Resultados: prevalecieron los fumadores del sexo masculino (79,5 %), con más de 12º de escolaridad (68,4 %), de procedencia rural (76,5 %). Representan el mayor por ciento los pacientes que llevan fumando más de 40 años (51,8 %) y que consumen hasta una cajetilla diaria (68,5 %). Dentro de las enfermedades crónicas que coexistieron con el tabaquismo prevaleció la hipertensión arterial (64,8 %). Conclusiones: la prevalencia de tabaquismo en los pacientes con enfermedad pulmonar obstructiva crónica es alta a pesar de las consecuencias negativas que tiene para la salud.

Foundation: tobbacoism is considered an epidemic of universally spread and a burden for the individual, the family and the society. Objective: to determine the prevalence of tobbacoism in patients with obstructive chronic pulmonary disease. Methods: A cross descriptive study was done at the University General Hospital Dr. Gustavo Aldereguía Lima. Cienfuegos, at the internal medicine wards from September 2017 to 2018. All the patients who voluntarily wished to participate, the simple was constituted with 80 patients. The variables studied were age, sex, scholarship, occupation, precedence, tobaccoism, number of cigarettes smoked daily, years smoking, obstructive chronic pulmonary disease, high blood pressure, diabetes mellitus, renal chronic failure, ischemic cardiopathies, stroke and cancer. It was used the questionnaire of the CARMEN (Group of Actions to reduce non-transmissible diseases) project instrument for collecting information. The instrument was applied individually and the statistical analysis was done by the SSPS package. Results: male smokers prevailed (79,5 %), with more than senior high school scholarship (68,4 %), of rural orygen (76,5 %). They represent the highest percentage of patients who have been smoking for more than 40 years (51,8 %) and consume up to a box of cigarettes a day (68,5 %). Among the chronic diseases which co-existed hypertension prevaled. Conclusion: the prevalence of tobaccoism in patients with obstructive pulmonary disease is high in spite of the negative consequences for health.

Rhino-orbital cerebral mucormycosis is a rare, potentially fatal fungal infection that usually affects diabetic and immunocompromised adults. Recently, an increase in the frequency of this infection in children has been reported, especially in neutropenic patients and premature babies. In this article, we are reporting a case of rhino-orbital cerebral mucormycosis in a 4-year-old girl with a newly diagnosed diabetes mellitus. Tissue biopsy, fungal culture, and imaging were used to confirm the diagnosis. The infection was successfully treated with combined surgical debridement and antifungals.

Abstract Background The incidence of Type 2 diabetes is increasing worldwide and diabetes is four times more common among ethnic minority groups than among the general Caucasian population. This study reflects on the specific issues of engaging people and evaluating interventions through written questionnaires within older ethnic minority groups. Methods The original protocol set out to evaluate an adapted version of the X-PERT® patient program http://www.xpert-diabetes.org.uk/ using questionnaires and interviews. Results Questionnaires, even verbally completed, were unsuccessful and difficult to administer as participants found the questionnaire structure and design difficult to follow and did not perceive any benefit to completing the questionnaires. The benefits of attending the course were also poorly understood by participants and in many cases people participated in coming to the course as a favour to the researcher. Engaging participants required word of mouth and the involvement of active members of the community. Conclusion Peer led courses and their evaluation in older ethnic minority communities needs a very different approach for that in younger Caucasian patients. A structured approached to evaluation (favoured by western educational system) is inappropriate. Engaging participants is difficult and the employment of local well known people is essential.

Abstract Background Vascular endothelial growth factor (VEGF) is a signal protein, induces cell proliferation, and enhances the permeability of the endothelial cells. VEGF-A gene is highly polymorphic, with different near-gene variants at varied frequencies linked with altered VEGF protein expression, type 2 diabetes mellitus (T2DM) susceptibility, and associated microvascular complications. The present study aimed to investigate the role of two genetic variants of VEGF-A, − 583C > T (rs3025020) and + 936 C/T (rs3025039), for predicting mixed microvascular complications in T2DM. This case–control study was performed on 26 T2DM patients with mixed microvascular complications and 26 apparently healthy individuals, as a control group. Clinical, neurological, funds examinations, and biochemical laboratory investigations were conducted on all groups. The serum level of VEGF-A was measured using ELISA. Genotyping of VEGF-A was performed by real-time PCR allelic discrimination system. Results Serum level of VEGF-A was significantly increased in T2DM with mixed complications. T allele of VEGF-A rs3025020 showed higher frequency among T2DM patients with mixed complications than in control group [OR 2.67; 95% CI 1.03–6.91; p = 0.04], while CT genotype and T allele of VEGF-A rs3025039 had a high frequency in mixed complication group [OR 4.08; 95% CI 1.32–17.44; p = 0.01 and OR 4.02; 95% CI 1.52–10.63; p = 0.004, respectively]. Conclusion VEGF-A increased the level contributed in the pathogenesis of mixed diabetic microvascular complications. T allele of VEGF-A rs3025020, CT genotype, and T allele of VEGF-A rs3025039 had the highest frequency in mixed diabetic microvascular complications, so they were considered risk genes for mixed diabetic microvascular complications.

Abstract Background Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. There are pocket studies on CBHI scheme with different coverage in Ethiopia and there is no pooled study on CBHI enrolment coverage in Ethiopia for better understanding the scheme and decision making. The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. Methods The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. Result Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97 (95%CI: 41.68, 69.77) in earlier (2016–2017) studies than recent 37.33 (95%CI: 24.82, 50.77) studies (2018–2020). Conclusion The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. The finding of the study helps national decision making for CBHI scheme service improvement. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. Trial registration The protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762 .

Objectives: The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO4) on short- and long-term outcomes in preterm neonates born less than 32 weeks gestation. Methods: Single-center retrospective cohort study of 229 neonates born between 24 and 32 weeks gestation was conducted from January 2018 through December 2018 in a level III neonatal care unit in Kuwait. Antenatal MgSO4 exposure was collected from the medical records, and the indication was for neuroprotection effect. Brain MRI was done on 212 neonates (median gestational age 36 weeks), and brain injury was assessed using the Miller’s score. Neurodevelopmental outcome was assessed by Bayley-III scales of infant development at 36 months corrected age (N = 146). The association of exposure to MgSO4 with brain injury and neurodevelopmental outcomes was examined using multivariable regression analysis adjusting for gestational age at MRI and variables with p value

ObjectiveThe present manuscript aims to describe an international, electronic-based, user-friendly and interoperable patient registry for monogenic autoinflammatory diseases (mAIDs), developed in the contest of the Autoinflammatory Diseases Alliance (AIDA) Network.MethodsThis is an electronic platform, based on the Research Electronic Data Capture (REDCap) tool, used for real-world data collection of demographics, clinical, laboratory, instrumental and socioeconomic data of mAIDs patients. The instrument has flexibility, may change over time based on new scientific acquisitions, and communicate potentially with other similar registries; security, data quality and data governance are corner stones of the platform.ResultsAIDA project will share knowledge and expertise on mAIDs. Since its start, 118 centers from 24 countries and 4 continents have joined the AIDA project. Fifty-nine centers have already obtained the approval from their local Ethics Committees. Currently, the platform counts 337 users (122 Principal Investigators, 210 Site Investigators, 2 Lead Investigators, and 3 data managers). The Registry collects baseline and follow-up data using 3,748 fields organized into 21 instruments, which include demographics, patient history, symptoms, trigger/risk factors, therapies, and healthcare information for mAIDs patients.ConclusionsThe AIDA mAIDs Registry, acts both as a research tool for future collaborative real-life studies on mAIDs and as a service to connect all the figures called to participate. On this basis, the registry is expected to play a pivotal role in generating new scientific evidence on this group of rare diseases, substantially improving the management of patients, and optimizing the impact on the healthcare system. NCT 05200715 available at https://clinicaltrials.gov.

Various in vitro models using primary and established 2- and 3-dimensional cultures, multicellular tumor spheroids, standardized tumor slice cultures, tumor organoids, and microfluidic systems obtained from tumor lesions/biopsies of head and neck cancer (HNC) have been employed for exploring and monitoring treatment options. All of these in vitro models are to a different degree able to capture the diversity of tumors, recapitulate the disease genetically, histologically, and functionally and retain their tumorigenic potential upon xenotransplantation. The models were used for the characterization of the malignant features of the tumors and for in vitro screens of drugs approved for the treatment of HNC, including chemotherapy and radiotherapy as well as recently developed targeted therapies and immunotherapies, or for novel treatments not yet licensed for these tumor entities. The implementation of the best suitable model will enlarge our knowledge of the oncogenic properties of HNC, expand the drug repertoire and help to develop individually tailored treatment strategies resulting in the translation of these findings into the clinic. This review summarizes the different approaches using preclinical in vitro systems with their advantages and disadvantages and their implementation as preclinical platforms to predict disease course, evaluate biomarkers and test therapy efficacy.

Objective: The study objectives were aimed to highlight the areas where public awareness is needed to enhance preventive practices among the public. Hence, to avoid the spread of virus in public settings. In addition, the study has provided compelling data and evidence on the coronavirus disease-2019 trend for health policymakers to make strategic decisions. Introduction: The coronavirus disease-2019 is a highly contagious respiratory disease caused by severe acute respiratory syndrome coronavirus type-2. The disease has spread across the globe. In Afghanistan, thousands of confirmed cases with hundreds of deaths have been reported. In addition, due to insufficient healthcare workforce, insecurity, fragile healthcare infrastructure, low coronavirus disease-2019 vaccination and low testing capacity, the true nature of the pandemic is unlcear. Method: An online survey of the general population in Afghanistan was conducted from April-May 2021. Convenience sampling technique was used to recruit the respondents. Social media platforms were used (WhatsApp, Twitter and Facebook Messenger) to disseminate the electronic survey instrument. Written informed consent was taken from the participants before the filling questionnaires. Data collection was guided through a self-administered questionnaire developed by the researchers according to the World Health Organization guidelines. The sample size was calculated using EPI software. The inclusion criteria were being 18 years or older and having access to the Internet to fill out the online questionnaire. IBM SPSS Statistics version 25.0 was used for analysis. Descriptive statistics (frequencies, percentages) and bi-variable (chi-square) analyses were done. A p value of

IntroductionAcademic institutions have a duty to equip health professional students with the requisite research skills to ensure the implementation of evidence-based practice. This study aims to determine the perceptions of pharmacy students and alumni toward research after completing Undergraduate Research in Pharmacy Courses (URPCs) at the College of Pharmacy–Qatar University (CPH–QU).MethodsA cross-sectional survey was conducted. All CPH-QU alumni (n = 238), and all third- and fourth-year professional students who had completed at least one URPC at the time of conducting the study (n = 42) were approached. The questionnaire contained items relating to research experience and perceptions of significance, confidence in conducting research, actual and anticipated outcomes, and motivation for future research. A Theoretical Domains Framework informed the development of selected items.ResultsThe response rate was 72.1% (202/280); however, the usable rate was 95.5% (193/202). The participants gave positive responses relating to their perceptions of research significance {Median = 5.0 [Interquartile range (IQR) = 1.0], Minimum–Maximum = 1–5}, confidence in conducting research [Median = 4.0 (IQR = 1.0), Minimum–Maximum = 1–5], actual and anticipated outcomes [Median = 4.0 (IQR = 1.0), Minimum–Maximum = 1–5], and motivation for future research plans [Median = 4.0 (IQR = 1.0), Minimum–Maximum = 1–5]. The majority of participants perceived non-confidence in using data analysis software [72 (39.4% non-confidence)] and a high proportion of participants were non-confident in conducting data analysis [45 (24.6% non-confidence)]. More than half reported publishing at least one peer-reviewed article [99 (54.4% agreement)] from their courses and were highly motivated to consider post-graduate degrees in pharmacy [132 (73.3% agreement)].ConclusionsIncorporating URPCs into CPH–QU curriculum has potentially improved students and alumni's perceptions of research. Action is needed to improve confidence in different aspects of research.

IntroductionAdmission to medical school is one of the most competitive entry points in higher education. Medical school admissions committees need accurate and precise screening tools to select among well-qualified applicants. This study explores data from a cohort of graduated medical students over 6 years to offer a critical perspective on predictive validity in medical school admissions.MethodsA retrospective cohort study of 160 students was performed to identify the predictive validity of admission criteria for medical students to predict academic performance over 6 years for a cohort of all students enrolled in the medical program during the academic year 2013–2014.ResultsThe main results indicated that there was a statistically significant positive correlation between the admission criteria and Students’ performance in Year 1, Year 4, B.Sc. (Bachelor of Medical Science) exam, and Medical Doctor (MD) exam across the 6 years of the medical program, except for the English Test, which showed that there was no significant correlation with average MD exam scores for students who enrolled directly in Year 1. The results related to students who were admitted to the Foundation Program showed that there was no significant correlation between high school Grade Point Average (HSGPA) and their academic performance in Year 1, Year 4, B.Sc. exam, and MD exam. The overall results related to all study samples indicated that all predictor variables correlate significantly with all outcome variables (academic performance), and the results showed that Science test scores demonstrated 27.7, 15.0, 19.7, and 12.6% of variation in Students’ performance in Year 1, Year 4, B.Sc. exam, and MD exam, respectively.ConclusionScience test scores were found to be more predictive of academic performance compared to other predictors. Not all the admission criteria used for student selection are good indicators of their achievement in the medical program. It is recommended that other valid and reliable admission tools, such as the multiple mini-interviews and the questionnaire for a candidate’s suitability to follow a problem-based learning curriculum, should be considered.

Abstract Colon cancer is among the most common types of cancer with adenocarcinomas being the most common type. Herein we report a young patient who presented with primary colonic squamous cell carcinoma without risk factors. To the best of our knowledge, this is the youngest patient with such diagnosis worldwide.

Abstract This article reported a case of intestinal tuberculosis (ITB)in a young patient. ITB could mimic many other diseases such as inflammatory bowel diseases (Crohn’s disease), abdominal lymphoma, and others which make it difficult to differentiate; hence, many ITB patients could get mis‐diagnosed and suffer wrong treatment consequences.

Abstract A 32‐year‐old female patient with a history of iron deficiency and mental retardation, presented with chronic constipation and painful defecation related to a massive colorectal lithobezoar. She was successfully treated with laxatives and daily rectal enema.

Abstract Malignant nerve sheath tumors (MPNSTs) are rare sarcomas tumors which rarely present as intrapelvic mass and are hard to diagnose clinically. We present a 29‐year‐old male patient presented with acute urinary retention and was diagnosed with large intrapelvic mass. After complete surgical resection, the histopathology confirmed the diagnosis of low MPNST.

Abstract A 58‐year‐old right‐handed man presented to our tertiary care center with gliosarcoma (GS) infiltration through the dura, skull, and soft tissue. Patient had a previous history of right temporal GS, with four intracranial surgeries prior to presentation. A multidisciplinary approach was used to treat the lesion and perform reconstruction.

Abstract Multiple sclerosis is a disease that affects the central nervous system, resulting in various symptoms such as vision, physical activity, and stability. Central positional vertigo as initial multiple sclerosis symptoms are a rare case. It increases the attention of doctors to follow accurate measurements to diagnose multi sclerosis regarding the initial symptoms.

Abstract The perforation of the right‐sided colonic diverticulitis (RSCD) is a rare surgical emergency with highly variable clinical presentations. The preoperative distinction between acute appendicitis and perforated diverticulitis represent a dilemma for surgeon. The laparoscopic repair is a feasible method instead of ileocecectomy in selected cases.

Background: Excessive use of portable electronic devices causes neck flexion and the emergence of text neck syndrome (TNS). This study aims to explore the prevalence of TNS among medical students during the COVID-19 lockdown in Iraq. Methods: A prospective cross-sectional web-based study was conducted from 1st to 20th March 2021 at the faculty of medicine, Diyala University, Iraq. A self-administered questionnaire was distributed among the medical students using Google Form through social media (WhatsApp group). The semi-structured questionnaire included the sociodemographic, the valid smartphone addiction scale-short version (SAS-SV), and the neck disability index (NDI). Univariate, bivariate, and multiple logistic regression were used to analyze the data. SPSS version 16. The statistical significance is considered at less than 0.05. Results: Out of 273 medical students included in the study, 59.3% were males, unmarried (88.3%), and from the 1st year (21.6%). The mean age of students was 21.27 ± 1.74 years. The prevalence of text neck syndrome was 64.5%. About two-thirds (61.5%) of students were addicted to their smartphones and used them more than five h/daily (63.7%). Factors associated with neck disability were the students who did not warm up neck muscles before using the smartphone (OR = 8.796, 95% CI: 1.724 to 24.884), addicted to the smartphone (OR = 6.803, 95% CI: 3.455 to 13.397), experienced increase in daily hours using the smartphone during the COVID-19 related quarantine (OR = 5.370, 95% CI: 2.523 to 11.427), maintained smartphone use five hours and more daily (OR = 2.818, 95% CI: 1.422 to 5.587), had neck pain (OR = 2.876, 95% CI: 1.356 to 6.098), the female gender (OR = 2.756, 95% CI: 1.221 to 6.221), and those who did not have a frequent break when using the smartphone (OR = 2.693, 95% CI: 1.329 to 5.454). Conclusion: In conclusion, the prevalence of neck disability was high among the surveyed medical students. Addiction and excessive smartphone use with a lack of attention to warm up the neck muscles before usage was the most prominent predictors of neck disability.

Background: International efforts to confront the COVID-19 pandemic are joining forces by accelerating the pace of vaccination. This study aims to explore the attitude and the intent to get vaccinated against COVID-19 among healthcare providers (HCPs) in Iraq. Methods: A cross-sectional survey was conducted in January 2021 using web-based facilities to access the respondents. The data were collected through a semi-structured and self-administered questionnaire, including sociodemographic and close-ended questions related to attitude and intention toward COVID-19 vaccination. Bivariate and multivariate logistic regression were recruited to predict variables. The statistical significance is considered at less than 0.05. Results: Data of 209 HCPs with a mean age of 45.12 (± 6.37) years have undergone final analysis. Most of the HCPs were males (112, 53.6%) and nurses (110, 52.6%), who had close contact (64.6%) with COVID-19 patients, and forty percent have been infected with COVID-19. Overall, 115 HCPs (58.0%) reported intention to get vaccinated compared to 94 (42.0%) who declined vaccination. Variables associated with intention to get vaccinated among HCPs were high attitude toward COVID-19 vaccination (odds ratio (OR) = 1.740, 95% confidence interval (CI): 0.799, 3.786), aged less than 45 years (OR = 3.713; 95% CI: 1.647, 8.367), married (OR = 2.155; 95% CI: 0.984, 4.720), highly educated (OR = 2.657; 95% CI: 1.202, 5.871), doctors (OR = 3.153; 95% CI: 1.428, 6.963), contracted with COVID-19 (OR = 4.119; 95% CI: 1.623, 10.455), directly engaged in management of COVID-19 patients (OR = 3.962; 95% CI: 1.569, 10.005), and had lost a close relative due to COVID-19 (OR = 5.698; 95% CI: 1.506, 12.564). Conclusion: The urgent need to improve the COVID-19 vaccine uptake rates among Iraqis requires a positive attitude and a high vaccination rate among HCPs.

Several guidelines endorsed the indefinite use warfarin or heparin-containing products for acute venous thromboembolism (VTE) treatment and secondary prevention and discouraged the use of direct oral anticoagulants (DOAC) for patients diagnosed with antiphospholipid syndrome (APS). However, adequate anticoagulation despite warfarin therapy remains a challenge in APS patients. Using DOACs in APS patients is seen in clinical practice, despite the lack of evidence to support their use in this population. In this case series, we aim to evaluate the safety and effectiveness of apixaban use in nine patients with primary or secondary APS at King Abdulaziz Medical City (Riyadh, Saudi Arabia). All patients presented with APS and received apixaban with or without concomitant antiplatelet. Three patients had double positivity, and two patients had triple positivity of antiphospholipid antibodies (aPL). Some patients tolerated apixaban during the follow-up period, but recurrent VTE and stroke were reported in some of them. Bleeding complications were evident in some cases as well. In conclusion, warfarin remains the best choice to prevent VTE recurrence in patients with APS. On the other side, apixaban use in patients with APS may have some safety and effectiveness concerns evidenced by VTE recurrence and bleeding complications. The safety and effectiveness of utilizing apixaban in APS patients need to be assessed in well-controlled randomized trials.

Patients with neurocysticercosis, a common infection of the central nervous system caused by Taenia solium , have been reported to develop neuropsychiatric complications. We report a unique case of recurrent psychosis caused by neurocysticercosis in a 37-year-old El Salvador immigrant woman and discuss the underlying pathophysiological mechanisms of the complications. We reviewed published case reports of neurocysticercosis that presented with psychotic features and compared their diagnostic evaluation, the underlying pathophysiology of complications and treatment regimen with our case. This review concludes that neurocysticercosis should be considered in the differential diagnosis of patients presenting with psychosis with a history of residence in an endemic area.

Renal cell carcinoma with inferior vena cava tumor thrombus can be misdiagnosed as an inferior vena cava thrombosis if not evaluated carefully with imaging. We describe a case of renal cell carcinoma with inferior vena cava tumor thrombus that was initially misdiagnosed as an inferior vena cava thrombosis due to a possible hypercoagulable state. After 7 months of anticoagulation therapy with no improvement, a right radical nephrectomy and thrombectomy was performed without cardiopulmonary bypass, and a diagnosis of papillary renal cell carcinoma with a level-IIId tumor thrombus was confirmed with no presence of a bland thrombus. We demonstrate the complexity of identifying and treating renal cell carcinoma with venous tumor thrombus and the importance of differentiating between a malignant thrombus and a bland thrombus.

Stroke is associated with a high disability and fatality rate, and adversely affects the quality of life of patients and their families. Traditional Chinese Medicine (TCM) has been used effectively in the treatment of stroke for more than 2000 years in China and surrounding countries and regions, and over the years, this field has gleaned extensive clinical treatment experience. The Phosphatidylinositol 3 kinase (PI3K)/protein kinase B (AKT) pathway is important for regulation of cell migration, proliferation, differentiation, and apoptosis, and plays a vital role in vascularization and oxidative stress in stroke. Current Western medicine treatment protocols for stroke include mainly pharmacologic or mechanical thrombectomy to restore blood flow. This review collates recent advances in the past 5 years in the TCM treatment of stroke involving the PI3K/AKT pathway. TCM treatment significantly reduces neuronal damage, inhibits cell apoptosis, and delays progression of stroke via various PI3K/AKT-mediated downstream pathways. In the future, TCM can provide new perspectives and directions for exploring the key factors, and effective activators or inhibitors that affect occurrence and progression of stroke, thereby facilitating treatment.

Abstract COVID‐19 is a mysterious disease presented in different ways, so we have to deal with each patient nowadays thoroughly, including COVID‐19 testing as routine test. The Case report discusses the rare finding of COVID‐19 in CSF of GBS patient.

Background: Vitamin K is crucial for neonates to prevent bleeding disorders. Raising awareness of vitamin K use would show positive outcomes. This study aimed to assess the knowledge and attitude of prophylactic use of vitamin K for bleeding disorders in neonates among doctors working in the Department of Obstetrics and Gynecology at Haj El-Safi Hospital, Sudan. Methods: A descriptive cross-sectional study was conducted in February 2019, involving 36 doctors selected by convenience sampling. Data were collected by an interview-based questionnaire designed to measure the knowledge level of doctors toward vitamin K deficiency classification and interactions, guidelines availability and adherence, and parents counseling. Data were analyzed and presented in tables. Results: The doctors involved in this study were 36, including 7 registrars, 6 medical officers, 23 house officers, mostly aged 20–25 years (n=29), and female (n=27). The level of knowledge about the classification of vitamin K deficiency and the interaction of vitamin K with other drugs among doctors was mostly good (n=14 and n=15, respectively). Registrars were the most in the good category (n=6, and n=7, respectively). Most doctors (n=23) were aware of vitamin K guidelines, while only 15 have continuous adherence, 16 of doctors counseled parents about the importance of prophylactic vitamin K. Conclusion: The level of knowledge towards prophylactic vitamin K use in neonatal bleeding disorders among doctors in the Department of Obstetrics and Gynecology at Haj El-Safi Hospital is good.

Coronaviridae is a large family of enveloped, positive-strand RNA viruses that has plagued the world since it was discovered in humans in the 1960s. The recent severe acute respiratory syndrome coronavirus (SARS-CoV)-2 pandemic has already exceeded the number of combined cases and deaths witnessed during previous SARS-CoV and Middle East respiratory syndrome-CoV epidemics in the last two decades. This narrative review focuses on genomic mutations in SARS-CoV-2 and their impact on the severity and progression of COVID-19 in light of reported data in the literature. Notable SARS-CoV-2 mutations associated with open reading frames, the S glycoprotein, and nucleocapsid protein, currently circulating globally, are discussed along with emerging mutations such as those in the SARS-CoV-2 VUI 202012/01 variant in the UK and other European countries, the 484K.V2 and P.1 variants in Brazil, the B.1.617 variant in India, and South African variants 501Y.V2 and B.1.1.529 (omicron). These variants have the potential to influence the receptor binding domain, host–virus fusion, and SARS-CoV-2 replication. Correlating these mutations with disease dynamics could help us understand their pathogenicity and design appropriate therapeutics.

Abstract Choosing a treatment approach of Cesarean section scar pregnancy is challenging and requires making women aware of material risks inherent in the different approaches that they perceive as having potential impact on their live or quality of life.

Abstract Heterotopic pregnancy (HP) describes the simultaneous presence of two pregnancies at different implantation sites. Usually, one pregnancy is intrauterine and the other one is ectopic. The incidence of HP after assisted reproductive technologies reaches 1:3900, but is very rare after a spontaneous pregnancy, with a reported incidence of 1 to 30,000 pregnancies. Due to its rarity, complex clinical picture, and laboratory findings, it is challenging to diagnose HP. We present a case of spontaneous HP diagnosed in the first trimester by ultrasound (US) and magnetic resonance imaging (MRI) and subsequently managed successfully. We present an analysis of the clinical and laboratory findings as well as imaging, including MRI that we used to diagnose the condition. Additionally, we performed a literature review. Conclusions HP is a very rare condition frequently faced in obstetrics, gynecology, and emergency departments that requires a high index of clinical suspicion. US remains the imaging modality of choice in diagnosing a HP, however, in some cases, an MRI with a reported safety in the first trimester, can be used to provide additional information over US.

Abstract This report describes a case of 45 years old male patient who tested positive for COVID‐19 presented to the emergency department on March 2021 complaining of fever, cough, runny nose, and shortness of breath. The patient denied any history of nausea or diarrhea who has eventually developed favipiravir‐induced nephrotoxicity.

Abstract The burden of postpartum depression (PPD), an important but largely neglected cause of maternal morbidity, is often increased by the presence of common co-morbidities, such as postpartum haemorrhage (PPH). Additionally, stress and the absence of social support can amplify PPD risk. Understanding the relationship between these conditions will help identify at-risk women and allow prompt intervention. Using a prospective cohort design, we recruited 72 women who had experienced PPH and another 72 women who had not within 24 h of delivery to assess the risk of PPD among them. The cumulative incidence of PPD among all participants was 15.3% (19/124). There was insufficient evidence to suggest that women with PPH have a higher risk of PPH than women without PPH (OR: 1.32; 95% CI: 0.55–3.13). Poor social support and high perceived stress increased the risk of PPD. We recommend screening for PPD among women with high perceived stress and low social support.

Abstract Background Acute myeloid leukemia (AML) is a clonal disorder arising from the differentiation arrest of myeloid precursor and malignant proliferation of a bone marrow derived, self-renewing stem or progenitor cells inside the bone marrow (BM) and blood due to numerous genetic mutations. Some mutations can also adjust DNA methylation and may play a critical function in pathogenesis in Cytogenetically Normal Acute Myeloid Leukemia (CN-AML). Somatic mutations in DNMT3a were pronounced in approximately 20% and ∼30–35% of overall AML and CN-AML, respectively. Most DNMT3a mutations in AML have been observed to be heterozygous, A missense mutation, R882, located inside Hot spot exon 23, has been found to be the maximum common mutation. This is a preliminary study conducted on 20 adult Egyptian patients newly diagnosed as AML where Sanger sequencing of Hotspot Exon 23 of DNMT3a gene was performed on their initial bone marrow samples and were followed up to 3 months post-induction therapy. Only De Novo AML patients were included in our study. Results Our results revealed that overall DNMT3a mutations were present in 25% of our patients, 10% having the R882 (rs147001633) mutation being 5% R882C and 5% R882H. Immunophenotyping analysis among Mutated DNMT3a (R882 and Non R882) and Wild DNMT3a revealed that AML markers exhibited no significant differences except for myeloperoxidase positivity which was significant among the groups (0.050). Regarding cytogenetics, only one case of the mutated DNMT3a had positive FISH inv (16), where the rest were FISH negative. After 28 days of induction, 75% of all our patients achieved complete response (CR), 20% achieve partial response (PR) out of which 75% are DNMT3a mutated. After 3 months follow-up, 10% of all patients faced mortality where 5% was DNMT3a wild type (died due to treatment-related mortality) and 5% was R882 mutated DNMT3a. Conclusion DNMT3a mutations are present in 25% (5/20) of our AML patients, with 10% (2/20) having the R882 mutation being 5% (1/20) R882C and 5% (1/20) R882H. R882 mutation is associated with resistance to chemotherapy, and poorer outcomes, highlighting its poorer prognostic significance in AML.

Abstract Background Many kinds of orchids have significant health benefits although adequate research on their biological functions is yet to be carried out. This study investigated the paracetamol‐induced liver damage–protecting effect of epiphytic Aerides odorata methanol extract (AODE). Methods The protective effects of AODE were studied by analyzing its effect on liver function parameters, messenger RNA (mRNA) expression, and tissue histopathological architecture. The results were confirmed by ligand–receptor interaction of molecular docking and multitarget interaction of network pharmacological analyses. Results AODE significantly (p

Abdifatah Abdullahi Jalei,1 Abdifetah Ibrahim Omar,1,2 Shafie Abdulkadir Hassan,1 Yahye Sheikh Abdulle Hassan,1 Nur Rashid Ahmed1,2 1Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia; 2Jamhuriya Research Center, Jamhuriya University of Science and Technology, Mogadishu, SomaliaCorrespondence: Abdifatah Abdullahi Jalei, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia, Tel +252617000684, Email Jeele301@gmail.comIntroduction: Reference intervals (RIs) are crucial for the accurate interpretating of laboratory test results in clinical settings, serving as benchmarks for evaluating individual health status. This study investigates the influence of sex and age on common liver function tests (LFTs) and renal function tests (RFTs) in healthy adults in Mogadishu, Somalia.Methods: A community-based cross-sectional study was carried out from October 2022 to January 2023 on a randomly selected sample of 255 healthy participants from Mogadishu, Somalia. Approximately 5 mL of whole blood was collected from each participant and processed screening of hepatitis B and C, and human immunodeficiency virus, and then biochemical analyses were conducted for common liver and kidney parameters.Results: The study found significant sex and age-related differences in the measured LFTs and RFTs parameters. For LFTs, males had higher levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) compared to females (ALT: 11.5 vs 7.5 U/L; AST: 25.5 vs 19.1 U/L; both p < 0.001). Age-related differences were also observed, with individuals aged 30 and above had higher levels of ALT and AST compared to those aged 18– 29 (ALT: 10.9 vs 8.5 U/L; AST: 24.3 U/L vs 21.0 U/L, both p < 0.001). For RFTs, males had higher levels of creatinine (0.9 vs 0.7 mg/dL), urea (23.1 vs 16.1 mg/dL), and uric acid (5.2 vs 4.2 mg/dL) than females, all with p < 0.001.Conclusion: The study established population specific RIs for common liver and renal function parameters and revealed significant variations across sex and age groups. These findings underscore the importance of developing and using local RIs to ensure accurate clinical interpretation and effective patient management. Further research with larger sample sizes and in diverse regions of Somalia is highly recommended.Keywords: reference intervals, liver function tests, renal function tests, Mogadishu, Somalia

Abstract Background Vitiligo is classified as an acquired chronic depigmentation disorder that includes the destruction of epidermal melanocytes. It affects 0.5–1% of the population all over the world. Wnt signaling pathway is vital in melanocytes differentiation and development. WIF-1 is an antagonist of the Wnt signaling pathway; it hinders Wnt from binding its receptors. The present study aims to detect WIF-1 expression in vitiligo skin and if it relates to the disease's severity. Results This case–control study included 70 subjects: 35 vitiligo patients and 35 healthy controls. Skin WIF-1 expression was estimated using quantitative real-time PCR. Assessment of the vitiligo disease activity score and vitiligo area severity index score was determined. WIF-1 expression showed significant elevation in the skin of vitiligo patients compared to the healthy control group. Conclusion Overexpression of WIF-1 may participate in the pathogenesis of vitiligo; hence, it should be a future therapeutic target.

Abstract Background High fat-fructose diet is a proinflammatory diet that increases risk of hepatocytes and myocytes steatosis and fibrosis. Finding anti-inflammatory strategies to fight these harmful effects is paid attention to nowadays. This study compared the effects of two widely anti-inflammatory interventions—metformin and intermittent fasting on myocytes and hepatocyte injury induced by proinflammatory diet and tracking possible underlying mechanisms. In this work, rats fed high fat-fructose diet were subdivided into untreated group, treated by metformin, and/or intermittent fasting. Results Metformin (300 mg/kg/day) and intermittent fasting (3 days/week) specially their combination for 4 weeks showed significant improvement in insulin resistance, lipid profile, antioxidants (p

Abstract Background Despite Africa’s significant infectious disease burden, it is underrepresented in global vaccine clinical trials. While this trend is slowly reversing, it is important to recognize and mitigate the challenges that arise when conducting vaccine clinical trials in this environment. These challenges stem from a variety of factors peculiar to the population and may negatively impact adverse event collection and reporting if not properly addressed. Methods As a team of clinical researchers working within the MRCG (Medical Research Council Unit The Gambia), we have conducted 12 phase 1 to 3 vaccine trials over the past 10 years. In this article, we discuss the challenges we face and the strategies we have developed to improve the collection and reporting of adverse events in low-income settings. Outcome. Healthcare-seeking behaviors in the Gambia are influenced by spiritual and cultural beliefs as well as barriers to accessing orthodox healthcare; participants in trials may resort to non-orthodox care, reducing the accuracy of reported adverse events. To address this, trial eligibility criteria prohibit self-treatment and herbal product use during trials. Instead, round-the-clock care is provided to trial participants, facilitating safety follow-up. Constraints in the healthcare system in the Gambia such as limitations in diagnostic tools limit the specificity of diagnosis when reporting adverse events. To overcome these challenges, the Medical Research Council Unit maintains a Clinical Services Department, offering medical care and diagnostic services to study participants. Sociocultural factors, including low literacy rates and social influences, impact adverse event collection. Solicited adverse events are collected during home visits on paper-based or electronic report forms. Community engagement meetings are held before each study starts to inform community stakeholders about the study and answer any questions they may have. These meetings ensure that influential members of the community understand the purpose of the study and the risks and benefits of participating in the trial. This understanding makes them more likely to support participation within their communities. Conclusion Conducting ethical vaccine clinical trials in resource-limited settings requires strategies to accurately collect and report adverse events. Our experiences from the Gambia offer insights into adverse event collection in these settings.

Introduction: Emergency medical services (EMS) are minimally developed in many African countries. We sought to document the achievements and challenges faced by the National Ambulance Service (NAS) of Ghana during its 20-year nationwide expansion, and to understand how well it is providing access to previously unserved, remoter areas. Methods: Data routinely collected by NAS from 2004 to 2023 were analyzed, including structure and capacity (number of stations, ambulances, employees) and utilization and process of care (number of patients served, demographics, medical conditions, response site). Per population indicators of capacity and utilization were compared across Ghana's 16 regions. Results: From 64 emergency medical technicians (EMTs) and nine ambulances in 2004, NAS has grown to 3,473 EMTs and 356 ambulances. From covering three cities in 2004, NAS now has at least one station in each of Ghana's 261 districts. From transporting 205 patients in 2004, NAS transported 38,393 patients in 2022. There have been interruptions due to financial restrictions, with numbers of patients transported per year in 2017–2019 decreasing by over 50% from the prior peak (n = 20,236 in 2014). In 2022, there were 1.13 ambulances per 100,000 people and 0.33 transports/100,000/day. Most (81.3%) transports are inter-facility transfers. Among Ghana's 16 regions, there is moderate variation in utilization from 0.16 to 0.50 transports/100,000/day. However, the three lowest-income, remoter regions currently have utilizations of 0.16, 0.30, and 0.37 transports/100,000/day, mostly near the National average of 0.33. Conclusion: Despite periodic limitations due to finances, the NAS has expanded to cover all of Ghana's 261 districts and has largely achieved geographic equity. Sustainability has been aided by having a training school directly under NAS's control, assuring a steady supply of EMTs. Challenges include assuring financial stability and increasing utilization for emergencies at the scene, in addition to the current high utilization for inter-facility transfer.

الملخص: اهداف البحث: هدفت هذه الدراسة إلى تقييم التأثيرات السامة على الخلايا الحية لمستخلص من أوراق نبات العطرة وجسيمات الذهب النانوية الحيوية المصنعة بطريقة التوليف الاخضر لتكوين غسول الفم لاستخدامه كبديل لغسولات الفم التجارية. تم استخدام (الخلايا الليفية الجلدية البشرية من الاجنة) في هذه الدراسة التي أجريت في المختبر، لأن خصائصها كانت متطابقة تقريبًا مع خصائص الخلايا الليفية اللثوية البشرية. طرق البحث: في هذه الدراسة، تم دراسة التوليف الأخضر لـجسيمات الذهب النانوية الحيوية باستخدام مقتطفات من أوراق نبات العطرة كوسيلة مستدامة واقتصادية. بعد ذلك، وباستخدام مجموعة من التقنيات التحليلية، تم تقييم الخواص الفيزيائية والكيميائية، مثل المجهر الإلكتروني النافذ و حيود الأشعة السينية و ومطياف الامتصاص المرئي فوق البنفسجي، وبالتالي استغرقت الاستعدادات والتقنيات التحليلية لتكوين جسيمات الذهب النانوية وقتًا قصيرًا يبلغ حوالي عشرة أيام. وقد استخدمت الدراسة الحالية ٣-[٤,٣-ثنائي ميثيل ثيازول-٢-ييل]-٢,٥ بروميد ثنائي فينيل-تترازوليوم (سمية التترازوليوم لموسمان) لدراسة التأثيرات السامة للخلايا لمستخلص أوراق نبات العطرة مع جسيمات الذهب النانوية الحيوية لنفس النبات باستخدام خط الخلايا القياسية المشتقة من الخلايا الليفية البشرية. النتائج: تم استخدام جرعات مختلفة (١٠٠٠، ٥٠٠، ٢٥٠، ١٠٠، ٥٠، ٢٥، ١٢,٥، ٦,٢٥، و ٣,١٢٥ ميكروجرام/مل) من جسيمات الذهب النانوية لنبات العطرة لتقييم السمية الخلوية، وقد دلت النتائج على تأثيرات سامة خلوية قليلة (أقل من ٢٠٪ سمية تقريبًا). وقد لوحظ مستوى عالٍ من التوافق الحيوي بين جسيمات الذهب النانوية لنبات العطرة والخلايا الليفية البشرية الطبيعية. الاستنتاجات: أظهر غسول الفم المصنوع باستخدام جزيئات الذهب النانوية الحيوية من مستخلص أوراق نبات العطرة المصنع بطريقة التوليف الاخضر, مستوى عالٍ من التوافق البيولوجي وله سمية خلوية منخفضة. لذلك، يمكن أن تكون تركيبات غسول الفم العشبية بمثابة بديل قابل للتطبيق لغسولات الفم الكيميائية. Abstract: Objective: This study aimed to assess the cytotoxic effects of an extract from Pelargonium graveolens leaves and green-synthesized gold nanoparticles (AuNPs) in a mouthwash when used as a substitute for commercial mouthwashes. Human dermal fibroblasts from neonates (HDFn) were used in this study that done in vitro, because their characteristics were nearly identical to those of human gingival fibroblasts. Method: In this study, the green synthesis of AuNPs using extracts from P. graveolens leaves was investigated as a sustainable and economical method. Then, using a range of analytical techniques, the physicochemical properties were evaluated, such as transmission electron microscopy (TEM), X-ray diffraction (XRD), and ultraviolet visible absorption spectroscopy (UV–Vis), so the preparations and analytical techniques of P. graveolens gold nanoparticles (AuNPs) take little time is about 10 days. The current study used the 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl-tetrazolium bromide Mosmann's Tetrazolium Toxicity (MTT) to study the cytotoxic effects of P. graveolens leaf extract with P. graveolens gold nanoparticles (AuNPs) utilizing a human fibroblast-derived standard cell line. Results: Various doses (1000, 500, 250, 100, 50, 25, 12.5, 6.25, and 3.125 μg/mL) of P. graveolens AuNPs were used to assess cytotoxicity, demonstrating little cytotoxic effects (approximately below 20% toxicity). A high level of biocompatibility was observed between the P. graveolens AuNPs and normal human fibroblasts. Conclusion: The mouthwash made using green synthetic AuNPs obtained from P. graveolens leaf extract show high level of biocompatibility and has low cytotoxicity. Therefore, herbal mouthwash formulations can serve as a viable substitute for chemical mouthwashes.

Abstract Background Technology is poised to bridge the gap between demand for therapies to improve gait in people with Parkinson’s and available resources. A wearable sensor, Heel2Toe™, a small device that attaches to the side of the shoe and gives a sound each time the person starts their step with a strong heel strike, has been developed and pre-tested by a team at McGill University. The objective of this study was to estimate feasibility and efficacy potential of the Heel2Toe™ sensor in changing walking capacity and gait pattern in people with Parkinson’s. Methods A pilot study was carried out involving 27 people with Parkinson’s randomized 2:1 to train with the Heel2Toe[TM] sensor and or to train with recommendations from a gait-related workbook. Results A total of 21 completed the 3-month evaluation, 14 trained with the Heel2Toe[TM] sensor, and 7 trained with the workbook. Thirteen of 14 people in the Heel2Toe group improved over measurement error on the primary outcome, the 6-Minute Walk Test, (mean change 66.4 m) and 0 of the 7 in the Workbook group (mean change − 19.4 m): 4 of 14 in the Heel2Toe group made reliable change and 0 of 7 in the Workbook group. Improvements in walking distance were accompanied by improvements in gait quality. Forty percent of participants in the intervention group were strongly satisfied with their technology experience and an additional 37% were satisfied. Conclusions Despite some technological difficulties, feasibility and efficacy potential of the Heel2Toe sensor in improving gait in people with Parkinson’s was supported.

Abstract Background Breast cancer (BC) is the most prevalent cancer and the leading cause of cancer-related deaths in women globally. Cysteine protease cathepsin-B has been implicated in various human malignancies and is involved in malignancy progression and metastasis. This study aimed to evaluate the circulating levels of cathepsin-B, interleukin-6 (IL-6), and CA15-3, a cancer antigen, as biomarkers for tumors in women with both localized and metastatic BC. The study employed a case-control design, enrolling 108 participants categorized into three groups: healthy individuals, those with localized BC, and those with metastatic BC. The relative mRNA expression of cathepsin-B in blood samples was assessed using qRT-PCR. Additionally, serum levels of IL-6 and CA15-3 were quantified using ELISA. Results The relative mRNA expression of cathepsin-B, IL-6 levels, and CA15-3 levels were significantly higher in metastatic BC cases than in localized BC cases and the control group (p-value

Abstract Background The number of patients seeking medical care is increasing, necessitating more access to primary healthcare services. As several of these patients usually present with complex medical conditions, the need for interprofessional collaboration (IPC) among health professionals in primary care is necessary. IPC is essential for facing the increasing and challenging healthcare demands. Therefore, the facilitators of and the barriers to IPC should be studied in the hope that the results will be used to promote such endeavors. Objectives This study aimed to explore the perspectives of different health professionals regarding the facilitators of and the barriers to IPC in the primary healthcare settings in Qatar. Methods A qualitative study using focus groups was conducted within the Primary Health Care Corporation (PHCC) in Qatar. Several health professionals were invited to participate in the focus groups. The focus groups were uniprofessional for general practitioners (GPs), nurses, and dentists, while they were interprofessional for the other health professionals. Focus groups were audio-recorded and transcribed verbatim and validated by the research team. The data were analyzed by deductive thematic analysis using the “Gears” Conceptual Model as a coding framework. Results Fourteen focus groups were conducted involving 58 participants (including 17 GPs, 12 nurses, 15 pharmacists, 3 dentists, and 11 allied health professionals) working in PHCC in Qatar. The findings revealed a spectrum of factors influencing IPC, categorized into four main domains: Macro, Meso, Micro, and individual levels, with each accompanied by relevant barriers and facilitators. Key challenges identified included a lack of communication skills, insufficient professional competencies, and power imbalances, among others. To address these challenges, recommendations were made to implement dedicated training sessions on IPC, reduce hierarchical barriers among different health professionals, and enhance the effectiveness of existing systems. Conversely, it was emphasized that projects and campaigns focused on IPC, alongside the development of enhanced communication skills and the presence of supportive leadership, as essential for facilitating effective IPC in PHCCs. Conclusion The interplay between the meso, macro, micro, and individual levels highlight the significance of a multifaceted approach to interventions, aiming to enhance the successes of IPC. While initiatives like interprofessional education training are underway, numerous challenges persist before achieving improved collaboration and more efficient integration of IPC in the PHCC setting.

Computed tomography (CT) multi-detector array has been heavily utilized over the past decade. While transforming an individual’s diagnosis, the risk of developing pathogenesis as a result remains a concern. The main aim of this institutional cumulative effective dose (CED) review is to highlight the number of adult individuals with a record of CED ≥ 100 mSv over a time span of 5 years. Further, we aim to roughly estimate both incidence and mortality life-attributable risks (LARs) for the shortlisted individuals. CT studies performed over one year, in one dedicated trauma and emergency facility, were retrospectively retrieved and analyzed. Individuals with historical radiological CED ≥ 100 mSv were short-listed. LARs were defined and established based on organ, age and gender. Out of the 4406 CT studies reviewed, 22 individuals were found with CED ≥ 100 mSv. CED varied amongst the short-listed individuals, with the highest CED registered being 223.0 mSv, for a 57-year-old male, cumulated over an average study interval of 46.3 days. The highest median mortality risk was for females, 214 per 100,000 registered for the age group 51–60 years. While certain clinical indications and diseases require close follow-up using radiological examinations, the benefit-to-risk ratio should be carefully considered, particularly when CT is requested.

الملخص: أهداف البحث: تم مؤخرا اقتراح مشاركة البروتين المفرز الناجم عن ونت-1 (ويسب1/سي سي إن 4) في العديد من التفاعلات مع الالتهاب. ومع ذلك، فإن دوره في التهاب المفاصل الروماتويدي لا يزال موضع جدل. تم الإبلاغ عن الارتباطات بين التهاب المفاصل الروماتويدي الذي تم تشخيصه بشكل سيئ وعدد من العلامات الكلاسيكية المستمدة من الديموغرافيا والكيمياء الحيوية. تهدف هذه الدراسة للبحث في موثوقية وفعالية تركيزات مصل ''سي سي إن 4''، وجزيء التصاق الخلايا الوعائية -1، وماتريكس ميلوبروتيناز-3، وعامل تحفيز مستعمرة الخلايا المحببة في المراقبة والتقييم لتوقع التهاب المفاصل الروماتويدي وتلف العظام وارتباطهما بمسار المرض. طريقة البحث: قامت الدراسة بتحليل 128 مريضا مصابا بالتهاب المفاصل الروماتويدي، بما في ذلك 68 تم تشخيصهم حديثا، و60 تم تشخيصهم مسبقا، و60 كمجموعة مراقبة. تم قياس مستويات العلامات الحيوية باستخدام مقايسة الممتص المناعي المرتبط بالإنزيم، وتم قياس المعلمات المخبرية الروتينية مثل المعلمات المصلية والسريرية والكيميائية الحيوية والدموية. تم جمع بيانات الديموغرافيا والقياسات البشرية والأعراض السريرية من خلال المقابلات والاستبيان، وتم استخدام درجة نشاط المرض المشترك 28 لتحديد نشاط المرض. النتائج: أشارت النتائج إلى ارتفاع معنوي في تراكيز أربعة مؤشرات حيوية في مجموعة التهاب المفاصل الروماتويدي مقارنة بالعينة السليمة. كما تم تسجيل تراكيز مرتفعة في المرضى الذين يعانون من ارتفاع، مقارنة مع المرضى المعتدلين والمنخفضين، وفقا لحالة نشاط ''المرض المشترك 28 إي إس آر''، باستثناء عدد الوحيدات، ونسبة الهيماتوكريت، ومستوى اليوريا. علاوة على ذلك، تم تسجيل ارتباط إيجابي بين مستوى ''سي سي إن 4'' وقيم جزيء التصاق الخلايا الوعائية -1، ماتريكس ميلوبروتيناز-3، عامل تحفيز مستعمرة الخلايا المحببة، درجة نشاط ''المرض المشترك 28 سي آر بي'' ودرجة نشاط ''المرض المشترك 28 إي إس آر''. مستويات العلامات التنبؤية الثلاثة (''سي سي إن 4'' وجزيء التصاق الخلايا الوعائية -1 وماتريكس ميلوبروتيناز-3) كانت مرتفعة في المرضى غير المعالجين، في حين أن مستوى عامل تحفيز مستعمرة الخلايا المحببة لم يظهر أي فرق. الاستنتاجات: تشير هذه البيانات إلى أنه يمكن استخدام ''سي سي إن 4'' بشكل موثوق لتحديد النشاط والاستجابة العلاجية المتعلقة بالتهاب المفاصل الروماتويدي، مما يؤدي إلى تشخيص التهاب المفاصل الروماتويدي مبكرا. Abstract: Background: The involvement of Wnt-1-induced secreted protein-1 (WISP1/CCN4) in several inflammatory reaction has recently been proposed. Nevertheless, this protein's involvement in rheumatoid arthritis (RA) remains debated. Associations between poorly diagnosed RA and several classical markers derived from demography and biochemistry have been reported. Aim: We sought to investigate the reliability and effectiveness of serum concentrations of CCN4, vascular cell adhesion molecule-1 (VCAM-1), matrix melloprotenase-3 (MMP-3), and granulocyte-macrophage colony-stimulating factor (GM-CSF) in monitoring and predicting RA and bone damage, and their correlation with RA disease course. Methods: The study analyzed 128 patients with RA, comprising 68 newly diagnosed and 60 previously diagnosed patients, as well as 60 controls. Biomarker levels were measured with enzyme linked immuno-sorbent assays. Routine laboratory parameters such as serological, clinical, biochemical, and hematological parameters were additionally measured. Demography, anthropometry, and clinical symptom data were collected through interviews and a questionnaire. The joint disease activity score 28 (DAS28) was used to determine disease activity. Results: Concentrations of four biomarkers were significantly higher in the RA group than the healthy controls. Elevated biomarker concentrations were also observed in patients with high, rather than moderate or low, DAS28-ESR activity status, except for monocyte count, hematocrit (%), and urea level. Furthermore, CCN4 level positively correlated with VCAM-1, MMP-3, and GM-CSF levels, DA-S28-CRP and DAS28-ESR. The levels of three predictive markers, CCN4, VCAM-1, and MMP-3, were elevated in non-treated patients, whereas GM-CSF level showed no difference. The highest area under the curve was 73.3% for CCN4, with 93.3% sensitivity and 64.7% specificity. Conclusion: Our data suggest that CCN4 can be reliably used to indicate activity and therapeutic response associated with RA, thus facilitating earlier RA diagnosis.

Farah Abdullahi Ismail,1 Yasir Khalif Ali,1 Ahmed Mohamed Ali,2 Ibrahim Mohamed Hirsi,1 Naima Abukar Ali,1 Mohamed Mukhtar Kassim,1 Farah Ali Ahmed,1 Mohamed Nur Ali1 1Pediatric Department of Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 2Department of Infectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Farah Abdullahi Ismail; Ahmed Mohamed Ali, Email Farahbucul96@gmail.com; ahmedorey22@gmail.comAbstract: Congenital rubella syndrome (CRS) is a serious condition with a high rate of morbidity. It is currently a rare disorder, especially in developed countries, because of universal vaccination campaigns. However, it remains a public health concern in developing countries. Here, we report a case of congenital rubella syndrome in a mother who did not receive any prenatal care or had a known history of vaccination. He is a term male infant, and the infant’s positive rubella IgM confirmed the diagnosis. The baby had a bilateral cataract, convulsions, Patent ductus arteriosus (PDA)-related cardiomegaly, and bilateral hearing loss. The only known preventive measure for congenital rubella syndrome is vaccination.Keywords: congenital rubella syndrome, vaccine, prenatal care

Abstract Background ART in women with endometriosis is associated with poor quality of the retrieved oocytes and lower fertilization and pregnancy rates, reflecting that endometriosis may influence fertility by altering the quality of both the oocyte and embryo quality and also by impairing the endometrial receptivity. On comparing endometriosis-affected patients to healthy counterparts, many differences were demonstrated at the endometrial level. Thus, choosing the appropriate method of embryo transfer is of utmost importance, particularly for patients with advanced endometriosis. Objective The aim of the present study was to compare the reproductive outcomes between fresh and frozen embryo transfer cycles in women with advanced endometriosis. Material and methods A retrospective cohort study was conducted in the period from January 2018 until December 2021 for patients recruited from two IVF centers, Alexandria, Egypt. Careful review of paper and electronic medical records of infertile women (primary, relative, or secondary infertility) aged 18–37 years who were diagnosed with advanced endometriosis by means of laparoscopy and were scheduled for ICSI followed by either fresh embryo transfer (group I) or freeze-all embryos and deferred embryo transfer (group II) of day 5 embryo(s) was included in the study. Results Two-hundred and eleven women were eligible and included in the study. Women in each study group were matched regarding baseline characteristics. Clinical pregnancy, implantation, and ongoing pregnancy rates were statistically significantly higher in the group of frozen embryo transfer (p

Abstract Background To date, there is a lack of studies conducted on males with secondary azoospermia as a potential cause of male infertility who had previously fathered children through natural conception. The current study aims to investigate the potential causes of secondary azoospermia as a presentation of male infertility as well as the prognostic factors that can impact sperm retrieval rate (SRR) while undergoing microdissection testicular sperm extraction (microTESE). Results Thirty two patients were recruited from the andrology outpatient clinic from August 2023 till January 2024. The mean age of the patients was sixty-two years old. All patients had varicoceles. Twenty seven patients (84%) had palpable varicocele grade 2 and 3 on both sides. Further multivariate logistic regression analysis of the significant factors in the univariate regression revealed that younger age (OR 0.7, 95% C.I. 0.7-1.0, p = 0.03) and having a history of coronary artery disease (CAD) were predictable factors for negative TESE outcome (OR 123.1, 95% C.I. 3.2-4748.5, P = 0.01). Conclusion It appears that the etiopathogenesis of secondary azoospermia are multifactorial. Varicocele and CAD are major factors to be considered. Future studies should be implemented deploying larger pools of patients suffering from the same condition to affirm the findings of this primary study.