Over the past decades, Afghanistan has encountered several serious healthcare difficulties. One of these occurrences, a lethal endemic of Crimean Congo Hemorrhagic Fever (CCHF), hit Afghanistan in 1998. A broad assessment of the literature reveals a number of characteristics that put the people of Afghanistan at a very high risk of developing CCHF. First off, the nation's poor healthcare system is now ill-equipped to handle difficulties of this kind. Medical institutions and healthcare personnel lack the necessary tools to correctly diagnose, treat, and prevent CCHF. Second, a significant percentage of people is ignorant about the vector's propagation and methods of control. Afghanistan has a major agricultural industry, and as a result, many individuals are active in caring for animals and handling cattle, which can result in the spread of the CCHF virus. Finally, during the past 20 years of the republican government of Afghanistan after the initial tenure of the Taliban's government as a result of the Afghan war, a sizable number of Afghan refugees returned to Afghanistan from Pakistan, a nation where CCHF is endemic. This increased Afghanistan's vulnerability. This literature review identifies probable causes of high-risk CCHF and offers suggestions that Afghan policy-makers may desire to take into account in order to ameliorate the existing situation.
Abdominal cocoon which is also called as sclerosing encapsulating peritonitis is one of the rare cause of the gastro intestinal obstructions. It can cause complete encapsulation of the bowel by forming a thin layer around the bowel or partial encapsulation of the bowel in few cases. This condition is mostly seen in females than in males. We came across a rare case of abdominal cocoon in a 23 year old female patient presented with severe abdominal pain, vomiting’s and constipation since 2-3 days. She has a history of LSCS 2 months ago and suffered with recurrent suture site infections since the surgery. She was on medications like pain killers, antibiotics, anti emetics and antispasmodics. After all the laboratory investigations she was diagnosed with abdominal cocoon and complete enterolysis of the bowel through laprotomy with jejunostomy (on POD-3) was performed. She was recovered after 1 week.
Psoriasis, an autoimmune and chronic inflammatory disease of the skin, can leave the patient in agony with its distressing infection episodes. Palmoplantar psoriasis is a chronic variant of psoriasis that characteristically affects the skin of the palms and soles and produces significant functional disability. It features hyperkeratotic, pustular, or mixed morphologies. Palmoplantar psoriasis is a variant of psoriasis and accounts for 3–4% of total cases of psoriasis. Though historically difficult to treat, recent studies on biologic therapies have shown promising results for the treatment of palmoplantar psoriasis. This activity describes the pathophysiology, evaluation, and management of palmoplantar psoriasis and highlights the role of the interprofessional team in the care of affected patients. The homoeopathic system of medicine offers a wide range of medicines that can have a beneficial role in managing cases of psoriasis as depicted in the previous studies. 1. Identify the trigger factors and aetiology for palmoplantar psoriasis. 2. Describe the mental and physical presentation of a patient with palmoplantar psoriasis. 3. Summarize the out of treatment and management options available fin homeopathy for palmoplantar psoriasis. 3. Review interprofessional team strategies for improving care coordination and communication to enhance outcomes for patients affected by palmoplantar psoriasis. 4. Review of recurrence of palmoplantar psoriasis. A distinct case of Palmoplantar psoriasis treated with homoeopathic remedies of ultrahigh potentised dilution has been presented here. The evidence-based illustrations were done before and after the treatment and the periodical objective assessment of the lesions with psoriasis area and severity index (PASI) calculation to ascertain the prognosis. The causal attribution of outcome to the treatment was evaluated using Modified Naranjo Criteria for Homoeopathy (MONARCH) tool. Marked improvement was found in the psoriatic lesions evidenced photographically and the PASI scores showed significant reduction affirming the same. The MONARCH score (+10) suggested that the clinical improvement was likely attributable to the homoeopathic treatment. This evidence-based case report suggests a beneficial role of homoeopathy in the treatment of palmoplantar psoriasis.
McCune-Albright syndrome is a genetic condition that affects your skin, bones and endocrine system (endocrine organs). It causes scars on bones, skin pigmentation and elevated function of growth-regulating hormonal glands. This can be mild in few people and quite severe to life-threatening in others. This syndrome can affect any age group of people like children, adults and old population due to some genetic mutations. These mutations can be sudden and unpredictable. We have come across a rare case called McCune-Albright syndrome where a 19-year-old female presented with chief complaints of lump in left breast associated with pus discharge sine a week. There have been changes in the skin and there is no history of retraction of nipple and any swelling in axilla, neck and opposite breast. Patient has gone to the doctor when she found a lump one month back, doctor has advised some of the diagnostic tests but she completely ignored and after one month she came to the hospital and has been admitted in the general ward. She was treated with vitamin supplements, antibiotics, antacids, NSAIDS.). The surgery procedure is simple mastectomy of left breast. This is done due to the fibro adenoma present in left breast. The patient was recovered in 10 days.
Snakebites are uncommon but potentially life-threatening events that can result in a range of clinical manifestations, often dependent on factors such as the snake species, venom potency, and bite location. While snakebites affecting limbs and exposed body parts are more frequently encountered, snakebites directly to the tongue represent a rare and intriguing clinical scenario. This case report presents a unique case of snakebite to the tongue, emphasizing the significance of early recognition, appropriate medical intervention, and the need for comprehensive snakebite education, even in regions with low snakebite incidence.
Cataract remains the most common cause of blindness worldwide and surgery is the only option to get rid of a cataract. Good anaesthesia is an essential requirement for performing safe cataract surgery. Peribulbar block using regional anaesthetic is the most common technique of administrating anaesthesia for cataract extraction. The study aimed to know the relationship between the axial length and the minimal effective volume of the peribulbar block. The study was done in a hospital based in the rural area of Panipat. It was a cross-sectional study done on patients who underwent cataract surgery and met the inclusion and exclusion criteria of the study. The patients were divided into two groups based on axial length and were given peribulbar block using 2% lignocaine with 1500 IU of hyaluronidase of 6 ml and 8 ml. The subsequent doses of the block were given in those in which adequate response was not present. The study includes 100 patients divided into two groups. The patients in group 1 had axial lengths between 21-23.99 mm and the second group included patients with axial lengths of 24-26.99 mm. In group 1 the volume of peribulbar block given was higher than that in group 2. The maximum number of patients in group 1 (34) were given an 8 ml block and those in group 2 were given a 6 ml of block. The study had a p-value of 0.02. In our study, we found that axial length has a negative correlation with the volume of the peribulbar block. It was also seen that there was an increase in IOP with more amount of local anaesthetic used in the peribulbar block.
8–13% of women in the reproductive age group are affected by Polycystic ovary syndrome (PCOS) and around 70% of cases stay undiagnosed worldwide. It is one of the most common causes of infertility nowadays. Polycystic ovarian morphology, hyperandrogenism, and ovulatory dysfunction are traits of PCOS. Insulin resistance is the primary finding in the pathophysiology of PCOS. Vitamin D is a fat-soluble vitamin that can be found as a dietary supplement. Hypovitaminosis is a risk for glucose intolerance so it has been found that supplementing vitamin D in females with PCOS lowers insulin resistance, total testosterone, and androstenedione levels and improves pressure profiles. Obese PCOS patients have been found to have lower vitamin D levels than PCOS patients who are not obese. This review aims at the pathophysiology of PCOS and the role of Vitamin D supplementation in PCOS patients. A literature search was performed to identify all relevant studies on PubMed, Google Scholar, Crossref, Medline, and Cochrane. The keyword used were; “Vitamin-D”, “Polycystic ovary syndrome (PCOS)”, “fertility”, “insulin resistance”, and “androgen hormones”. All relevant articles including review articles, original articles, case series, and case reports were reviewed. It was found that Vitamin D supplementation has beneficial effects on reproductive outcome, metabolic abnormalities and regulating menstrual cycle in PCOS patients. Understanding importance of Vitamin D level in treating PCOS patient is of great clinical significance in preventing disease progression.
The aim of the present study is the Evaluation, preparation, and description of chitosan nanoparticles and bioavilibility enhancement of rivaroxaban. Preparation of Rivaroxaban nanoparticles (RB-NPs) were prepared by the ionic gelation method. Different parameters were studied for evaluation, Preparation & description of nanoparticles. The results of the present study showed that the formulation F7 showed the significant results for all the selected parameter as compared to the other formulations. The formulation F1, F5, and F6 showed the highest production yield (52.5, 52.35, and 52.35% respectively) and F7 showed the significant production yield (51.85%), zeta-potential (23.63 mV), entrapment efficiency (99.87), particle size (316.12±2.14 nm) and poly disparity index (0.32). Nanoparticles are solid colloidal drug carriers ranging from 10—1000 nm in diameter and are composed of synthetic, natural or semi-synthetic polymers encapsulating the drug molecule.
Reverse osmosis (RO) is a water purification process that uses a partial permeable membrane to remove ions, unwanted molecules and larger particles from drinking water. In reverse osmosis, an applied pressure is used to overcome osmotic pressure, a colligative property that is driven by chemical potential differences of the solvent, a thermodynamic parameter. In the process of reverse osmosis the amount of water that is drained is a concern area for the people using the R.O. filtration device in their household because it wasted about 70% of the water to purify just one liter of water. This R.O. waste water can be utilized for various purposes such as washing vehicle like car bike etc, cleaning toilet this study is aimed to assess the knowledge reverse osmosis waste water utilization among general public at Indore. 1.To assess the pretest knowledge regarding reverse osmosis (R.O) waste water utilization among general public. 2. To assess the posttest knowledge regarding reverse osmosis waste water utilization among general public. 3. To evaluate the effectiveness of structured teaching program on reverse osmosis (R.O) waste water utilization among general public. H1- there will be significant difference between pretest and posttest knowledge who received structured teaching program regarding the utilization of waste R.O water. Quantitative, pre-experimental, one group pretest posttest design was adopted for the study. Total of 60 general public selected by using simple randomized sampling technique was used. Structured knowledge questionnaire. Data was analyzes using descriptive and inferential statistics. In the pre-test majority of the sample (44 out of 60, 73.3%) had inadequate knowledge and in the post-test, majority (54 out of 60, 90%) had adequate knowledge regarding reverse osmosis. A paired‘t’ test was done and it showed a‘t’ value of 22.34 at 0.05 level of significance, this indicates the effectiveness of structured teaching programme in enhancing the knowledge of the general public. There was no association found between the mean pre-test knowledge of the general public. There was no association found between the mean pre-test knowledge scorer with the selected socio-demographic variable such as age (χ2 = 8.643), gender (χ2 = 4.455), education qualification (χ2 = 4.706), Occupation (χ2 = 2.531), number of family member (χ2 = 5.653) and previous knowledge about reverse osmosis filter water (χ2 =0.393). There is a significant difference between the mean pre-test and post-test knowledge score among general public regarding reverse osmosis waste water utilization.
Geographic Information System (GIS) is usually carried out to catch, investigate, control, and store to give any kind of geological information. The blend of planning, information base innovation, and factual examination is all that all GIS implies and that is the purpose for its utilization in structural designing. In the development business, it is utilized in the underlying stage (preliminary stage), during spatial situating that will be settled cautiously with checking GIS innovation generally utilized attributable to its potential for offering extraordinary or new ways for settling the issue identified with ecological which bring about the diminishing expense, quality improvement for projects. GIS programming resembles a multitasker that permits so numerous information plans utilized in development improvement permitting structural architects to give out information to numerous organizations in the necessary arrangement while keeping up with information unwavering quality GIS permits to reuse, oversee, share, examine information easily in this manner overseeing time and assets.
Containment measures to limit COVID-19 spreading profoundly impact children around the globe, especially in low- and middle-income countries such as Indonesia. The aim of this case series study is to uncover the impact that COVID-19 measures have on Indonesian children with cancer and their families. A case series study was conducted in July 2021. Investigators identified three children diagnosed with cancer at an Indonesian referral hospital and studied their medical records. Caretakers were interviewed inside the hospital by an independent interviewer using a semi-structured questionnaire. This study presents three children with cancer and their families. Access to proper healthcare was hindered during COVID-19 pandemic due to mobility restrictions, medical staff shortage, limited chemotherapy and blood products availability, postponed medical procedures, and delayed or modified treatment administration. Financial hardships resulted because caretakers lost their jobs due to lockdowns and medication costs were no longer fully covered by health-insurance. Children and their relatives suffered from mental health issues. Anxiety, depression, stress and loneliness were caused by the fear of receiving suboptimal cancer treatment, serious concerns about financial difficulties, and restricted social interactions. All families believed that COVID-19 measures worsened their children’s survival chances. COVID-19 measures adversely impact children with cancer and their families in Indonesia, and most likely in other low- and middle-income countries as well. Disruptions in timely and adequate childhood cancer treatment administration may importantly deteriorate survival chances. Governments and policymakers should take these indirect effects into account to protect vulnerable children and their families.
The Coronavirus disease 2019 (COVID-19) pandemic rapidly spread across continents causing widespread mortality. Older adults, especially those with underlying diseases, are more susceptible for COVID-19 infection. Due to this concern, reverse quarantine was adopted as a protective strategy. This can lead to several psychological and physical detrimental effects. Aims:1). To assess the mental health status (depression and anxiety) among elderly people in the community during the COVID-19 pandemic.2) To assess the impact of COVID-19 pandemic restrictions and mental health issues on quality of life. This is a descriptive cross-sectional study among older adults (>60 yrs) residing in urban community in Central Kerala, India. Of the 200 patients, more than half had moderate to high levels of anxiety and a poor social support. Depression was seen in only 1/4th of patients and that was significant in older women. Mean knowledge about COVID was below 80%. Social support was inversely associated with anxiety and depression. Anxiety and depression significantly affected QOL scores. This study emphasizes on the need for better mental health programmes tailored for our geriatric population. Joint multidisciplinary action plans with focus on enhancing social support can improve the quality of life of this vulnerable group.
The commonest diagnosis of a cystic mass in the pelvis is ovarian cyst, here we report a case of cystic degeneration of broad ligament fibroid mimicking as a ovarian cyst. A 45-year-old lady presented with abdominal discomfort. On evaluation, a pelvic mass of 20 weeks size of varying consistency was noted. Ultra sonogram and Magnetic Resonance Imaging gave a differential diagnosis of right sided broad ligament fibroid and ovarian cyst. Anticipating possible ovarian mass owing to its size, laparotomy was performed and noted a large false broad ligament fibroid which has undergone cystic degeneration. Total abdominal hysterectomy and bilateral salpingo-oopherectomy was performed, however a differential diagnosis of ovarian mass should always be made before surgery.
The manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, are mainly characterized by respiratory symptoms. However, cardiac manifestations such as acute myopericarditis have been reported to be associated with COVID-19 infection. A 29-year-old female patient presented with a 2-day history of fever, cough, runny nose, and myalgia, and tested COVID-19 positive at Penang General Hospital, Pulau Pinang, Malaysia. On day 2 of admission, the patient complained of acute onset central chest pain, radiating to her back, associated with cold sweat, shortness of breath and generalised body ache. On examination, tachycardia and tachypnoea were elicited. The serial electrocardiography (ECG) showed persistent non-specific sinus tachycardia. Troponin T level was elevated at 99 ng/L (normal <15 ng/L) and creatine kinase (CK) was at 10990 U//L (normal: <190 U/L). Her chest radiograph revealed cardiomegaly and otherwise clear lung field. CT pulmonary angiogram demonstrated evidence of bilateral pleural effusion and pericardial effusion and ruled out pulmonary embolism. The diagnosis of myopericarditis was established based on clinical, electrocardiographic, radiological, and biochemical findings. She was treated successfully with IV morphine, oral colchicine, ibuprofen, and oxygen therapy. A follow-up echocardiogram 10 weeks post-COVID demonstrated complete resolution of pericardial effusion, with an election fraction of >70%. COVID-19 patients may develop severe cardiac complications such as myopericarditis. Clinicians should have a high index of suspicion of COVID-related myopericarditis in COVID-19 management. Further study should be implemented to investigate the association between COVID-19 and myopericarditis.
Cesarean scar ectopic pregnancy is one of the rarest of all ectopic pregnancy increase in number of cesarean section leads to increase in number of cesarean scar ectopic pregnancy. Early diagnosis and prompt management help in reducing mortality and morbidity occuring due to scar ectopic pregnancy. We are reporting a rare case of cesarean scar ectopic pregnancy G5P3L3D1 with period of gestation 7 weeks 3 days with previous all 4 deliveries by cesarean section. Cesarean scar ectopic pregnancy are life threatening as they pose a great risk of maternal hemorrhage as the patient vital are the stable patient managed medically with injection Methotrexate.
Despite being a lesser-known group of cereal grains, millets boast a rich nutritional and nutraceutical profile. Often mischaracterized as sustenance for the underprivileged, millets provide an impressive array of nutrients, rivalling many mainstream cereals. Notably, they offer substantial amounts of energy, carbohydrates, and protein, and even surpass other cereals in their content of fats, calcium, iron, dietary fiber, and Vitamin E, including both tocopherols and tocotrienols. Their remarkable phytochemical composition, which includes phenolic acids, flavonoids, catechins, phytic acid, and phytosterols, has captured the attention of researchers. It's been documented that the dietary fiber and phenolic compounds present in millets are instrumental in mitigating various health ailments, including diabetes, cardiovascular issues, and cataract development. These phytochemicals are also recognized for their antioxidant and antimicrobial attributes.
Cardiovascular disease remains the leading cause of mortality all over the world. Mortality from acute myocardial infarction (AMI) has decreased since the introduction of primary percutaneous coronary intervention (PCI). Left ventricular (LV) thrombus is a common complication after acute myocardial infarction (MI). One of the most feared complications is the occurrence of thromboembolic events (mostly cerebrovascular accidents) due to left ventricular (LV) thrombus formation. We present a 65 yrs old male with right traumatic foot ulcer, scheduled for right foot SSG. His ECG showed anterior wall ischemic changes. Echocardiogram showed akinetic LV apex, EF: 47%, with an organised LV apical clot of 1.5×1.4cm. Cardiologist opinion was obtained and he was put on oral nitrates, beta blocker and statins. Surgery was done under right popliteal sciatic nerve and fascisa iliaca block. Intraoperative period was uneventful. Postoperatively, serial ECG and Trop I was done on 1 and 4 POD and was found to be normal. He was discharged on 4 POD, with advice to follow up with cardiologist.
Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure.
Abdominoplasty is generally performed with admission of the patient for one night. It is a usual beautifying technique. It is reported that abdominoplasty can cause death and morbidity. For performing abdominoplasty numerous anaesthesia techniques are reported. Morbidly obese patients with compromised heart ailment undergoing abdominoplasty pose exceptional challenges to the anaesthesiologist. It is necessary to use the anaesthetic procedure such that it causes minimal haemodynamic instabilities with supreme safety for the patient. In this case report a 53-year-old male, morbidly obese patient with a body mass index (BMI) of 43.8 Kg/m, belonging to American Society of Anaesthesiologist (ASA) grade IV, and overhanging abdomen till the level of knee, with ventricular bigeminy, severe pulmonary hypertension, obstructive sleep apnea and chronic kidney disease is described. Abdominoplasty of this patient was performed under combined spinal-epidural anaesthesia. The implications of combined spinal-epidural anaesthesia were that the hemodynamic parameters such as heart rate, respiratory rate, non-invasive blood pressure, SpO2 were stable during the procedure and no complications were observed post-operatively. The results were excellent with speedy recovery.
Adenomatoid odontogenic tumor (AOT) is an uncommon benign epithelial odontogenic tumor frequently involving the maxillary anterior region. It presents as an encapsulated slow growing lesion displacing the roots of associated teeth. The histopathological findings are characteristic and aid in diagnosis of this entity. We present a case of a 28 year old female who developed an expansile swelling in the anterior maxillary region which was reported as an Adenomatoid Odontogenic Tumor (AOT) post-surgical excision. This article discusses the hamartomatous vs true neoplastic nature of AOT along with histopathological findings.
