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Abstract This study extends the concept of cracking to self-gravitating, spherically symmetric compact objects in modified $$f(R, \varphi )$$ f ( R , φ ) theory of gravity, where R represents the Ricci scalar, and $$\varphi $$ φ is the scalar potential. In this regard, we consider spherically symmetric spacetime characterized with an anisotropic matter to detect the instabilities of self-gravitating compact objects via cracking and overturning. Further, we construct the general framework to observe the cracking and overturning points by applying the local density perturbation technique to the configuration governed by barotropic equation of state. The effectiveness of this approach is assessed by analyzing its results on the data of Her X-1, SAX J1808.4-3658, and 4U 1820-30 respectively. It is concluded that cracking points appear in the different interior regions of these three stars. Significantly, this study illustrates the effectiveness of the cracking approach by highlighting the regions sensitive to localized density disruptions, offering valuable insights into the structural behavior of compact stars within a modified gravity framework.

Abstract In this article, we discuss several compact objects (GW 190814, PSR J0952-0607, PSR J0030+0451, PSR J0740+6620, GW 170817, PSR J1614-2230, PSR J2215+5135, and 4U 1608-52) to predict their masses and radii. A generalized polytropic stellar model within the framework of general relativity is derived by employing the Buchdahl-I metric. All the physical quantities such as energy density, radial, and tangential pressure are well behaved, continuous and no singularity is observed. The obtained results are compatible with observational data for compact objects under consideration. The physical stability of this model is determined by using generalized hydrostatic equilibrium condition, energy conditions, causality conditions and Herrera’s cracking technique. We observe that our model fulfills all of the requirements for being a physically realistic model.

Abstract This paper discusses the phenomenon of evolving spherically symmetric cluster of stars in the presence of an exotic matter. To discuss evolutionary mechanism, we use the Starobinsky model of f(R) gravity as exotic matter and the structure scalars as evolutional parameters. We study various evolution modes such as isotropic pressure, quasi-homologous evolution, density homogeneity, and geodesic nature. The stability of homogeneous density of baryonic and non-baryonic matter is discussed using dissipation, tidal forces, anisotropic pressures, expansion and shear-effects. It is observed that the dark matter has remarkable impact on the evolutionary changes. Also, it is shown that the dissipation factor produces density inhomogeneity in expanding clusters with shear effects. We observe that high curvature geometry enhances quasi-homologous evolution in the presence of shear. We use star Her X-1 as test star to discuss physical behavior of Starobinsky model. It is found that the density of dark matter overcomes the density of matter for large values of dark matter parameter n.

Abstract In this article, we explore the Yukawa modification of the Casimir wormhole within the framework of f(R) gravity. To accomplish this, we adopt an approach proposed by Garattini (Eur Phys J C 81:824, 2021), wherein the original Casimir source is modified by a Yukawa term in three distinct scenarios. We utilize these Yukawa Casimir energy densities to assess the feasibility of traversable wormholes. The resulting shape function satisfies the criteria for traversability under the specified parameter values. Furthermore, we scrutinize the energy conditions and the violation of the null energy conditions suggests the presence of exotic matter within the Yukawa Casimir wormholes. Additionally, we analyze the embedding procedures for the wormhole geometry.

Abstract We consider recently constructed black holes in the Einstein SU(N)-non-linear sigma model and study the Joule–Thomson expansion and observable characteristics. We calculate Joule–Thomson coefficient, inversion curves and isenthalpic curves to investigate the heating and cooling phases in $$T-P$$ T - P plane of the considered model. Our findings reveal distinct behavior of these black holes different from those reported in existing studies. Notably, inversion curves vanish in the heating regions, resulting in the black holes consistently remaining in the cooling phase. Additionally, we investigate the impact of the flavor number N on the Joule–Thomson expansion of these black holes. We observe that employing higher values of enthalpy and flavor number N extends the ranges of isenthalpic and inversion curves but the black holes remain in cooling phase. We also study the shadow and visual characteristics of the these black hole focusing on its illumination by two theoretical models of static accretion. We analyze that higher flavor numbers have high peaks of observed intensities and it shifts to smaller impact parameter which leads to smaller images.

Introduction and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) formerly known as Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease. Identifying MASLD risk factors could help early intervention and reduce the burden of the disease. Previous studies investigated the association between sarcopenia and NAFLD. Several trials were published after the last meta-analysis with indecisive results. This is an updated meta-analysis which aims to assess the association between sarcopenia, MASLD, and MASLD-related fibrosis. Materials and Methods: Relevant trials published on PubMed, Web of Science, Scopus, and Cochrane Library databases until October 2022 were included. We included studies in which skeletal mass index (SMI) or sarcopenia was compared between patients with and without NAFLD now MASLD. Also, studies comparing fibrosis between MASLD patients with and without sarcopenia were included. Data were pooled as odds ratios (ORs) and 95 % confidence intervals (CIs) using Review Manager Software. Results: A total of 25 studies were included. The incidence of sarcopenia was significantly higher in MASLD than controls (OR, 1.25; 95 % CI, 1.08-1.44; P = 0.003). SMI odds showed no significant difference between MASLD patients and controls (OR, 1.02; 95 % CI, 0.91-1.15; P = 0.7). MASLD patients with sarcopenia had higher odds of fibrosis than MASLD patients without sarcopenia (OR, 1.49; 95 % CI, 1.03-2.14; P = 0.03). Conclusions: Sarcopenia increased MASLD's probability and was associated with a higher probability of liver fibrosis in MASLD patients. However, SMI had no predictive value of MASLD occurrence.

In this manuscript, we investigate the properties of Casimir wormholes within the framework of extended teleparallel gravity, incorporating the Generalized Uncertainty Principle. Both the Casimir effect and the Generalized Uncertainty Principle (GUP) originate from the concept of a fundamental minimum length. Our analysis explores the geometric and physical traits of these wormholes, examining two distinct GUP constructions namely the Kempf, Mangano, and Mann (KMM) model and the Detournay, Gabriel, and Spindel (DGS) model and their corresponding equations of state. We find that the resulting wormhole solutions exhibit anisotropic effects and violate the null energy condition, implying the presence of exotic fluid. By employing volume integral techniques, we compute the quantity of exotic fluid, providing new insights into the nature of these wormholes. Our study sheds light on the implications of GUP-corrected Casimir wormholes for our understanding of gravity and the structure of spacetime.

We consider black holes with quintessence matter and cloud of strings to study shadow, optical appearance and stability by using the extended generalized uncertainty principle. We first evaluate the relations for modified Hawking temperature, heat capacity, equation of state and remnant mass for the considered model and then plot these relations in order to analyze the quantum correction effects on the stability of the black holes. In the visual plot of specific heat, we observe critical regions where the black hole transitions from being thermodynamically stable to unstable and vice versa. Moreover, we also observe that the regions of stability and instability are not uniform across, suggesting that extended generalized uncertainty principle plays a vital role in thermodynamic properties. We also investigate the silhouette and optical properties of the Lovelock black hole, particularly analyzing illumination with two theoretical models of static accretion. We observe that different values of Lovelock coupling constants significantly influence the size of image and intensities of the black hole.

Introduction and Objectives: Hepatorenal syndrome (HRS) is a serious complication of cirrhosis treated with various medications. We aim to evaluate terlipressin and albumin's effectiveness and safety compared to albumin and noradrenaline in adult hepatorenal disease patients. Materials and Methods: Clinical trials from four databases were included. Cochrane's approach for calculating bias risk was utilized. We rated the quality evaluation by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included the following outcomes: serum creatinine (mg/dl), urine output (ml/24 h), mean arterial pressure (mmHg), reversal rate of HRS, mortality rate, blood plasma renin activity (ng/ml/h), plasma aldosterone concentration (pg/ml), urine sodium (mEq/l), and creatinine clearance (ml/min). Results: Our analysis of nine clinical studies revealed that the noradrenaline group was associated with higher creatinine clearance (MD = 4.22 [0.40, 8.05]), (P = 0.03). There were no significant differences in serum creatinine levels (MD = 0.03 [-0.07, 0.13]), urinary sodium (MD = -1.02 [-5.15, 3.11]), urine output (MD = 32.75 [-93.94, 159.44]), mean arterial pressure (MD = 1.40 [-1.17, 3.96]), plasma renin activity (MD = 1.35 [-0.17, 2.87]), plasma aldosterone concentration (MD = 55.35 [-24.59, 135.29]), reversal rate of HRS (RR = 1.15 [0.96, 1.37]), or mortality rate (RR = 0.87 [0.74, 1.01]) between the two groups (p-values > 0.05). Conclusions: Noradrenaline is a safe alternative medical therapy for HRS.

Abstract In this manuscript, we use the conformal killing vectors to solve the Einstein–Maxwell field equations in the background of modified $$f({\mathcal {G}})$$ f ( G ) gravity. We consider the observational data for four different stars namely $$PSR~J1614-2230$$ P S R J 1614 - 2230 , $$PSR ~J1930+327$$ P S R J 1930 + 327 , $$Cen~X-3$$ C e n X - 3 and $$Vela~X-1$$ V e l a X - 1 respectively. By using the data, we derive the physical parameters from the matching criteria using conformal killing vectors and the exterior Bardeen geometry. Furthermore, several physical properties of compact stellar structures are examined in order to achieve the physical validity and stability for considered models. The graphical analysis including energy density, pressure components, equation of state parameters, and energy conditions are examined. Moreover, the equilibrium conditions through Tolman–Oppenheimer–Volkoff equation and stability criteria through adiabatic index for the charged stellar structure study are investigated. It is worth noting that all of these compact objects are physically viable and stable under conformal motion in context of Bardeen geometry for two different models of $$f({\mathcal {G}})$$ f ( G ) theory of gravity. Conclusively, the results show that f(G) gravity with Bardeen model may provide more massive stellar objects as compared to general relativity.

Abstract This paper investigate the impacts of local density perturbations on the stability of self-gravitating compact objects by utilizing cracking technique within the context of f(R, T) gravity, where R and T represent the Ricci scalar, and the trace of energy–momentum, respectively. To achieve this, we developed the hydrostatic equilibrium equation for spherically symmetric spacetime with anisotropic matter configuration and subsequently applied the Krori–Barua spacetime coefficient. Subsequently, the hydrostatic equilibrium equation of the configuration is perturbed by employing the local density perturbations to the system, while considering a barotropic equation of state. To ascertain the validity of the proposed technique, we applied it to several compact stars, including, Her X-1, SAX J1808.4-3658, 4U 1820-30, PSR J1614-2230, Vela X-1, Cen X-3, and RXJ1856-37 and found that all the considered stars exhibit cracking or overturning. This study conclusively highlights the significance of the cracking technique in providing valuable insights into the stability analysis of self-gravitating compact objects.

Abstract This paper investigates the concept of cracking and overturning to analyze the impact of local density perturbations on the stability of self-gravitating compact objects in the framework of $$f(R,\phi , X)$$ f ( R , ϕ , X ) theory of gravity, where R, $$\phi $$ ϕ , and X denote the Ricci scalar, scalar potential, and kinetic term, respectively. In this context, we developed the hydrostatic equilibrium equation for spherically symmetric spacetime with anisotropic matter configuration and subsequently employed the Krori Barua technique. We then perturb the hydrostatic equilibrium state of the configuration by employing the local density perturbation technique, while taking into account the barotropic equation of state. To validate this technique, we employed it on different compact stars namely, Her X-1, SAX J1808.4-3658, 4U 1820-30, PSR J1614-2230, Vela X-1, and Cen X-3, and found that all stars exhibit cracking or overturning for a specific range of model parameters. Conclusively, this study emphasizes that the proposed cracking technique provides significant insights into the stability analysis of self-gravitating compact objects.

Abstract We propose a logarithmic parametrization form of energy density for the scalar field dark energy in the framework of the standard theory of gravity, which supports the necessary transition from the decelerated to the accelerated behavior of the Universe. The model under consideration is constrained by available observational data, including cosmic chronometers data-sets (CC), Baryonic Acoustic Oscillation (BAO) data-sets, and Supernovae (SN) data-sets, consisting of only two parameters $$\alpha $$ α and $$\beta $$ β . The combined CC+BAO+SN data-sets yields a transition redshift of $$z_{tr}=0.79^{+0.02}_{-0.02}$$ z tr = 0 . 79 - 0.02 + 0.02 , where the model exhibits signature-flipping and is consistent with recent observations. For the combined data-sets, the present value of the deceleration parameter is calculated to be $$q_{0}=-0.43^{+0.06}_{-0.06}$$ q 0 = - 0 . 43 - 0.06 + 0.06 . Furthermore, the analysis yields constraints on both the parameter density value for matter and the present value of the Hubble parameter, with values of $$\Omega _{m0}=0.25849^{+0.00026}_{-0.00025}$$ Ω m 0 = 0 . 25849 - 0.00025 + 0.00026 and $$H_{0}=67.79_{-0.59}^{+0.59}$$ H 0 = 67 . 79 - 0.59 + 0.59 km/s/Mpc, respectively, consistent with the results obtained from Planck 2018. Finally, the study investigates how the mass of a black hole evolves over time in a Universe with both matter and dark energy. It reveals that the black hole mass increases initially but stops increasing as dark energy dominates.

Abstract In this study, we explore several new characteristics of a static anisotropic hybrid star with strange quark matter (SQM) and ordinary baryonic matter (OBM) distribution. Here, we use the MIT bag model equation of state to connect the density and pressure of SQM inside stars, whereas the linear equation of state $$p_r =\alpha \rho -\beta $$ p r = α ρ - β connects the radial pressure and matter density caused by baryonic matter. The stellar model was developed under a background of f(Q) gravity using the quadratic form of f(Q). We utilized the Tolman–Kuchowicz ansatz (Tolman in Phys. Rev. 55:364–373, 1939; Kuchowicz in Acta Phys Pol 33: 541, 1968) to find the solutions to the field equations under modified gravity. We have matched the interior solution to the external Schwarzschild spacetime in order to acquire the numerical values of the model parameters. We have selected the star Her X-1 to develop various profiles of the model parameters. Several significant physical characteristics have been examined analytically and graphically, including matter densities, tangential and radial pressures, energy conditions, anisotropy factor, redshirt, compactness, etc. The main finding is that there is no core singularity present in the formations of the star under investigation. The nature of mass and the bag constant $$B_g$$ B g have been studied in details through equi-mass and equi- $$B_g$$ B g contour. The maximum allowable mass and the corresponding radius have been obtained via $$M-R$$ M - R plots.

Abstract The objective of this manuscript is to investigate the traversable wormhole solutions in the background of the $$f(R, \phi )$$ f ( R , ϕ ) theory of gravity, where R is the Ricci scalar and $$\phi $$ ϕ is the scalar potential respectively. For this reason, we use the Karmarkar criterion for traversable static wormhole geometry to create a wormhole shape function. The suggested shape function creates wormhole geometry that links two asymptotically flat spacetime regions and meets the necessary requirements. The embedding diagram in three-dimensional Euclidean space is also discussed in order to demonstrate the wormhole configurations. For our current analysis, we choose the suitable values of free parameters for $$f(R, \phi )$$ f ( R , ϕ ) gravity models to discuss the wormhole geometry. It can be observed that our proposed shape function provides the wormhole solutions with less amount of exotic matter. It can be noticed that energy conditions especially null energy conditions are violated for all considered models. The violation of energy conditions indicates the existence of exotic matter and wormhole geometry. It is concluded that the shape function acquired through the Karmarkar technique yields validated wormhole configurations with even less exotic matter correlating to the chosen $$f(R, \phi )$$ f ( R , ϕ ) gravity models.

A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

Background and aims: Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities. Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis. Results: We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively. Conclusion: We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.

In this research, we present a comprehensive framework that uses a complexity factor to analyze class I generalized relativistic polytropes. We establish class I generalized Lane–Emden equations using the Karmarkar condition under both isothermal and non-isothermal regimes. Our approach considers a spherically symmetric fluid distribution for two cases of the generalized polytropic equation of state: 1) the mass density case μo and 2) the energy density case μ. To obtain numerical solutions for both cases, we solve two sets of differential equations that incorporate the complexity factor. Finally, we conduct a graphical analysis of these solutions.

Abstract In this article, we aim to investigate some cylindrically symmetric solutions in a very well known modified theory named as $$f(R, \phi , X)$$ f ( R , ϕ , X ) theory of gravity, where the terms R, $$\phi $$ ϕ and X are clarified as Ricci Scalar, scalar potential, and kinetic term respectively. For this purpose, we consider the cylindrically symmetric space-time to discuss the cylindrical solutions in some realistic regions. We further discuss six distinct cases of exact solutions using the field equations of $$f(R, \phi , X)$$ f ( R , ϕ , X ) modified theory of gravity. Furthermore, we set some suitable values of $$U_0$$ U 0 and $$\alpha $$ α in $$f(R, \phi , X)=R+\alpha R^2 - V(\phi )+ X$$ f ( R , ϕ , X ) = R + α R 2 - V ( ϕ ) + X for the investigation of well-known Levi–Civita and cosmic string solutions. The Energy conditions are also investigated for all different cases and observed that null energy conditions are violated, which is the indication of the existence of cylindrical wormholes.

Aim The outbreak of COVID-19 pandemic in January 2020 affected largely the elective operating for non-urgent surgical pathologies, such as hernias, due to periodical cancellations of the operating lists on a worldwide scale. To the best of our knowledge, the long-term impact of the COVID-19 pandemic in relation to the emergency hernia surgery operative workload and postoperative outcomes remains largely unknown. Methods Retrospective research of admission, operation and inpatient records of all patients who underwent emergency surgery over a 2-year period (2019-2020) was done. Results An 18% increase in terms of emergency hernia surgery operating volume, with a 23% increase of visceral resections due to unsalvageable herniated content strangulation was found. Overall morbidity did not increase during the pandemic period and there was no postoperative mortality or occurrence of COVID-19 related complications. Conclusion Emergency operative management of acutely symptomatic hernias can be safely performed even during the COVID-19 infection peak waves; hernia taxis should be reserved only for patients unfit or unwilling to undergo upfront surgery

Informed policy and decision-making for food systems, nutritional security, and global health would benefit from standardization and comparison of food composition data, spanning production to consumption. To address this challenge, we present a formal controlled vocabulary of terms, definitions, and relationships within the Compositional Dietary Nutrition Ontology (CDNO, www.cdno.info) that enables description of nutritional attributes for material entities contributing to the human diet. We demonstrate how ongoing community development of CDNO classes can harmonize trans-disciplinary approaches for describing nutritional components from food production to diet.

Hemosuccus pancreaticus is a rare but potentially torrential and life-threatening cause of acute upper gastrointestinal bleeding. It is described as an intermittent hemorrhage from the major duodenal papilla via the main pancreatic duct. Peripancreatic pseudoaneurysm following chronic pancreatitis is a common underlying etiology. However, gastroduodenal artery pseudoaneurysm-related hemosuccus pancreaticus remains exceedingly rare in the etiological spectrum of upper gastrointestinal bleeding. We hereby delineate a rare case of hemosuccus pancreaticus associated with gastroduodenal artery pseudoaneurysm in a patient who initially presented with abdominal pain and hematochezia. He was successfully managed with coil embolization without recurrence or sequelae. Furthermore, we conducted a search of the MEDLINE (PubMed and Ovid) database for relevant studies on hemosuccus pancreaticus published between inception and September 15, 2021. The available clinical evidence on causes, presentation patterns, diagnosis, and management was analyzed and summarized. This article highlights the rarity, the intermittent nature of hemorrhage, and the lack of a standardized diagnostic approach for this elusive disease. Clinicians should remain cognizant of hemosuccus pancreaticus, especially in patients presenting with symptoms and signs of intermittent gastrointestinal bleeding and abdominal pain. Prompt diagnosis carries paramount importance in saving patients from repeat hospital admissions and disease-associated morbidity and mortality. Conventional angiography with coil embolization may constitute an effective treatment strategy.

Intestinal ischemia results from diminished perfusion of the colon resulting in tissue hypoxia. Anecdotal reports suggest that cocaine-induced intestinal ischemia has the highest mortality and longer length of stay among the vasoconstrictors. The present study aimed to summarize the available studies in the literature to assess the effect of routes of consumption on the outcomes of cocaine-induced intestinal ischemia. We conducted a systematic search of MEDLINE from inception through October 2019. Studies of cocaine-induced intestinal ischemia were included if data were available on comorbidities, mortality, and hospital length of stay (LOS). The study’s primary outcomes were mortality and need for surgery, while secondary outcomes included the hospital length of stay, LACE index, and hospital score. Statistical tests used included linear and binary logistic regression. STATA 2015 was used, and P < 0.05 was statistically significant. Of the 304 studies, 8 case series and 45 case reports (n = 69 patients) met the inclusion criteria. Different routes of cocaine use had similar mortality odds and the need for surgery for intestinal ischemia. Hospital LOS showed significant difference among the subgroups. Readmission scores (LACE and hospital score) were higher for intravenous and smoking than ingestion and intranasal use ( P < 0.05). In conclusion, different routes of cocaine use appear to have similar mortality odds for intestinal ischemia, which vary significantly among the different routes of cocaine consumption for the length of stay and readmission scores. Prompt recognition of the route of cocaine use is vital to improve the outcome. Large-scale and well-designed observational studies are needed to investigate this topic further.

Cholestatic liver diseases (CLDs) encompass a variety of disorders of abnormal bile formation and/or flow. CLDs often lead to progressive hepatic insult and injury and following the development of cirrhosis and associated complications. Many such complications are clinically silent until they manifest with severe sequelae, including but not limited to life-altering symptoms, metabolic disturbances, cirrhosis, and hepatobiliary diseases as well as other malignancies. Primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) are the most common CLDs, and both relate to mutual as well as unique complications. This review provides an overview of PSC and PBC, with a focus on preventive measures aimed to reduce the incidence and severity of disease-related complications. Keywords: Biliary tract diseases, Primary sclerosing cholangitis (PSC), Primary biliary cholangitis (PBC), Cirrhosis, Inflammatory bowel disease (IBD), Metabolic bone disease, Pruritus, Prophylaxis

Coronavirus 2019 disease (COVID-19) has created major impacts on public health. The virus has plagued a large population requiring hospitalization and resource utilization. Knowledge about the COVID-19 virus continues to grow. It can commonly present with gastrointestinal symptoms; initially, this was considered an atypical presentation, which led to delays in care. The pandemic has posed serious threats to the care of anorectal diseases. Urgent surgeries have been delayed, and the care of cancer patients and cancer screenings disrupted. This had added to patient discomfort and the adverse outcomes on healthcare will continue into the future. The better availability of personal protective equipment to providers and standard checklist protocols in operating rooms can help minimize healthcare-related spread of the virus. Telehealth, outpatient procedures, and biochemical tumor marker tests can help with mitigation of anorectal-disease-related problems. There is limited literature about the clinical management of anorectal diseases during the pandemic. We performed a detailed literature review to guide clinicians around management options for anorectal disease patients. We also highlighted the health challenges seen during the pandemic.

Rectal bleeding is a known complication of transrectal ultrasound-guided prostate biopsy. It is usually mild and resolves spontaneously. However, massive life-threatening hemorrhage can also rarely occur in this setting, potentially presenting a therapeutic conundrum. We hereby delineate the case of a patient who experienced severe intermittent lower gastrointestinal bleeding following a transrectal ultrasound-guided prostate biopsy. Traditional tamponade methods failed to control the hemorrhage. Subsequently, an urgent flexible sigmoidoscopy revealed an anterior rectal wall prominence with biopsy punctures as the possible source of bleeding. Endoclip was successfully applied at the bleeding site, achieving permanent hemostasis. The patient had an uneventful recovery and was discharged from the hospital. While the use of endoclipping has been widely reported in gastrointestinal endoscopy, its application remains exceedingly rare in this group of patients. To our knowledge, this case represents only the third report of endoclipping alone to treat massive rectal bleeding follwing a prostate biopsy procedure. In addition, we systematically review published medical literature to evaluate endoscopic techniques aimed at managing this important complication. This article illustrates that endoscopic therapy may present an efficient, noninvasive method to deal with severe post-biopsy rectal hemorrhage. Therefore, prompt consultation with the gastroenterology service should be advocated.

Colonic diverticular bleeding is an established cause of painless acute lower gastrointestinal hemorrhage. Colonoscopy, performed within 24 hours of presentation, is the usual initial diagnostic procedure in such patients. In order to improve the diagnostic and therapeutic yield of urgent colonoscopy, adequate colon cleansing is required in patients with signs and symptoms of ongoing bleeding. We hereby delineate the importance of rapid bowel preparation with a very-low-volume novel 1 L polyethylene glycol ascorbate solution in the setting of acute severe colonic diverticular bleeding. The 1-L regimen may demonstrate similar efficacy to that of traditional higher volume preparations and it can substantially reduce the time for bowel preparation. Therefore, it can be considered for bowel purge when colonoscopy has to be rapidly planned in critical patients. This article further illustrates that the endoscopic technique using epinephrine followed by direct hemoclipping may be added to the armamentarium for acute colonic diverticular hemorrhage as the first treatment, especially in elderly patients with multiple comorbid conditions. While ample evidence surrounding the efficacy of the clipping method persists in the literature, rapid bowel preparation with 1 L polyethylene glycol ascorbate solution’s imperativeness to achieve hemostasis with direct hemoclipping remains elusive.

Jejunal Dieulafoy’s lesion is an exceedingly rare but important cause of gastrointestinal bleeding. It frequently presents as a diagnostic and therapeutic conundrum due to the rare occurrence, intermittent bleeding symptoms often requiring prompt clinical action, variability in the detection and treatment methods, and the risk of rebleeding. We performed a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases regarding jejunal Dieulafoy’s lesio from inception till June 2020. A total of 136 cases were retrieved from 76 articles. The mean age was 55 ± 24 years, with 55% of cases reported in males. Patients commonly presented with melena (33%), obscure-overt gastrointestinal bleeding (29%), and hemodynamic compromise (20%). Hypertension (26%), prior gastrointestinal surgery (14%), and valvular heart disease (13%) were the major underlying disorders. Conventional endoscopy often failed but single- and double-balloon enteroscopy identified the lesion in 96% and 98% of patients, respectively. There was no consensus on the treatment. Endoscopic therapy was instituted in 64% of patients. Combination therapy (34%) with two or more endoscopic modalities, was the preferred approach. With regard to endoscopic monotherapy, hemoclipping (19%) and argon plasma coagulation (4%) were frequently employed procedures. Furthermore, direct surgical intervention in 32% and angiographic embolization was performed in 4% of patients. The rebleeding rate was 13.4%, with a mean follow-up duration of 17.6 ± 21.98 months. The overall mortality rate was 4.4%. Jejunal Dieulafoy’s lesion is still difficult to diagnose and manage. Although the standard diagnostic and therapeutic modalities remain to be determined, device-assisted enteroscopy might yield promising outcomes.

Islam is the only religion that illuminates the length and breadth of this world with the light of this religion and by freeing man from man’s slavery, man should be made accountable only to God Almighty. At the time of advent of Islam, the world was under the perpetual siege of atrocities and inhuman conduct. The then two superpowers namely Caesar and Cesar were maintain the culture of might is right and had not left any room open for ending the status quo because it suited their aims and objectives. The condition of Arab peninsula was no different from the other parts of the world. It was also stuck in a quagmire of oblivion and darkness. This was when a personality emerged on the firmament of the world and changed the whole system .He freed man from man’s slavery and made man prostrate only before Allaha Almighty. When he took up cudgels against the prevailing world order, the whole world turned against him. He even had to leave his home and hearth in the quest. Hazrat Muhammad (S.A.W) mustered his poverty- stricken army and trained them with his military strategies. Following which they said army put an end to the shenanigans of certain Arab mischievous in Arab peninsula in a way that a lasting peace spread not only in that peninsula but also straddled from Hadramauwt to Makkah and from the borders of Persia to Rome .To point to consider here is that what were those military strategies that helped him do away with the pharaohs of those times۔ Hence, it is also need of the time to understand that Hazrat Muhammad (S.A.W.) was not only the Rehmat –ulil –Alameen and an epitome of wisdom and intellect but as also sent as a harbinger of peace by Almighty Allaha. Although he bore the atrocities of Makkans on the streets of Makkaha for thirteen years; was not allowed to pray within Baitulah; was pelted in Taif, yet he did not even respond those atrocities eith curses let alone with bows or arrows . Having said that, the focus of this article is solely upon the military strategies of Hazrat Muhammad S,A.W. in different battles rather than the peaceful propagation of religion.

With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions.

Many people like binge-watching. It means watching 2-4 episodes in one sitting. Various reasons have led young adults to binge-watch, which has grown very popular. This study's main objective is to check the effects of binge-watching on psychological and physical health. Under the theoretical framework of uses and gratifications, the researchers use a quantitative approach and convenient sampling techniques to collect data from all ages and genders in Pakistan. The online survey was conducted conveniently to collect the sample from the population. Focused on 300 participants, the study received 386 participants. The data indicates binge-watching is driven by Enjoyment, relaxation, escape from boring routines, diversion from stressful events, loneliness relief, parasocial contacts, and cliffhanging episodes. Results show Netflix is the most popular. Furthermore, results conclude that loss of control over content consumption, increased feelings of loneliness, disruption of a healthy sleep cycle, procrastination, and feeling stressed out or anxious are some health impacts that binge-watchers might face in the aftermath of binge-watching. Future Recommendations include the study being done with a qualitative technique for more in depth analysis of effects of binge watching on health. [ABSTRACT FROM AUTHOR]