Background: Cognitive impairment has become a major public health concern as the prevalence increases rapidly with increasing age. This study was set to determine the risk factors for impaired cognitive function in elderly patients accessing care in a primary care clinic in south-eastern Nigeria Methods: This was a hospital-based cross-sectional study conducted at the General Out-patient Clinic, Federal Teaching Hospital, Owerri. A total of 252 eligible and consenting patients aged 65 years and above, were recruited into the study by systematic sampling method. Data were collected using a researcher-administered questionnaire, and nutritional status and cognitive function were assessed using Mini Nutritional Assessment and Mini-Mental State Examination respectively. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Tests of association between the independent variables and outcome were conducted using logistic regression and a p-value of <0.05 was considered as being statistical significant. Results: The overall prevalence of cognitive impairment among the respondents was 23.4%. Mild cognitive impairment had a prevalence of 15.5%, while severe cognitive impairment (dementia) had a prevalence rate of 7.9%. Cognitive impairment was found to be independently associated with increasing age (OR= 2.349, 95% Cl = 1.513-3.648, p-value = 0.0001), gender (OR = 2.097, CI = 1.015 – 4.336, pvalue = 0.046), educational level (OR= 0.569, 95% CI= 0.399 – 0.810, p-value= 0.002), and tobacco use (OR= 1.980, CI = 1.095 – 3.579, p-value = 0.024). Conclusion: The prevalence of impaired cognitive function was found to be high among the study population. Consequently, the risk factors identified from this study that were associated with cognitive impairment must be satisfactorily addressed. Keywords: Cognition, elderly, function, impairment.
Despite increasing interests in arts-based interventions, there remain limited or no evidence on its effectiveness, implementation strategies, and long-term impact within school settings. Thus, this study investigated school-based arts mental health prevention programs for adolescents. The study adopted the systematic review approach. The study adopted the Preferred Items Systematic and Meta-analysis (PRISMA) was used to select seventeen (17) final selected literature. The databases consulted include ScienceDirect, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and MEDLINE. Findings showed that programs adopted include addressing adolescents’ psychological, emotional, behavioral, and social challenges. Results showed that arts-based intervention is the commonest in the literature, incorporating creative forms such as painting, music, dance/movement, drama, and integrative arts. Findings showed that school-based arts mental health prevention programs employ structured, participatory, therapeutic, and educational intervention approaches. The findings showed that there is generally positive effect of school-based prevention programs on adolescents’ mental health challenges. However, the outcomes are varying and diverse. Results showed that implementation success is influenced by organizational, contextual, professional, and resource-related factors. Findings showed that there are different positive results from participations in school-based arts mental health prevention programs. The study concludes that school-based arts mental health prevention programs contribute positively to the improvement of adolescents’ emotional wellbeing, psychological resilience, social connectedness, self-awareness, coping capacity, and mental health literature. The study implied that government should design policies that promote preventive and school-based arts mental health interventions.
Background: Pyogenic granuloma is a benign reactive vascular lesion commonly affecting the oral cavity. Although usually involving the gingiva, lesions arising from the buccal mucosa are uncommon and may mimic oral malignancy. We report a case initially presenting in a Family Medicine clinic in Qatar where the clinical presentation raised significant concern for oral squamous cell carcinoma. Case Presentation: A 28-year-old South Asian male presented to a Family Medicine clinic with a painless rapidly enlarging right buccal mucosal mass of one month's duration. The patient reported daily tobacco chewing for five years and had a family history of oral cancer. Clinical examination revealed a pedunculated erythematous vascular lesion measuring approximately 3 × 3 cm. Given the rapid growth and cancer risk factors, an Urgent Suspected Cancer referral was initiated. The patient was assessed by the Oral and Maxillofacial Surgery team within two days and underwent excisional biopsy. Histopathological examination confirmed pyogenic granuloma. Follow-up demonstrated complete healing without recurrence. Conclusion: Pyogenic granuloma may closely mimic oral squamous cell carcinoma, particularly in patients with established risk factors. This case highlights the important role of Family Medicine physicians in Qatar in the early recognition and referral of potentially malignant oral lesions. Keywords: Pyogenic granuloma; Buccal mucosa; Oral lesion; Oral cancer; Tobacco chewing; Family Medicine; Primary Care; Qatar.
The Biopist™ is a thermally activated endoscopic device that allows for simultaneous tissue sample and electrocoagulation. It allows for controlled biopsy collection while cauterizing the tissue to prevent bleeding and is introduced using an endoscope's operating channel. The device is intended for tissue coagulation and histological sample in the bronchial and gastrointestinal tracts. A crucial component of preclinical safety examine is establishing the suitability of medical devices for interaction with biological systems prior to clinical usage, a process known as biocompatibility assessment. The aim of this study was to evaluate the biocompatibility of the Biopist™ by assessing it’s in vitro cytotoxicity, in vivo skin sensitization and in vivo acute systemic toxicity. Each study was done in accordance with both the ISO 10993 standards and the OECD GLP Guidelines. The L929 cell line was used for in vitro cytotoxicity testing, according to ISO 10993-5. There were no undesirable effects on cell morphology or viability based on the cell studies performed. The Maximum Sensitivity Test (as defined in ISO 10993-10) for sensitivity to skin was performed on a group of guinea pigs. All guinea pigs exhibited no evidence of edema, erythema, or delayed hypersensitivity to the test device. The evaluation of acute systemic toxicity involved the assessment on the Swiss albino mice and consisted of the administration of polar and non-polar extracts made in compliance with ISO 10993-11 and also ISO 10993-12. No gross pathology, aberrant clinical symptoms, death, or morbidity were noted during observation period. Based on the research, it was determined that the BiopistTM fulfilled ISO 10993's biological safety requirements. The findings shown that the device had no cytotoxic, sensitizing, or acute systemic toxic effects for the particular endpoints assessed. Keyword: Biocompatibility, Cytotoxicity, Skin sensitization, Acute systemic toxicity, Biopist™, and Preclinical evaluation
Background: Asymptomatic bacteriuria (ASB) is a common bacterial infection during pregnancy and may lead to serious maternal and fetal complications if left untreated. Early identification and treatment are essential to reduce the risk of pyelonephritis, preterm labor, and adverse neonatal outcomes. Limited data are available regarding the prevalence and antimicrobial susceptibility patterns of ASB among pregnant women in Palestine. Objective: To determine the prevalence of asymptomatic bacteriuria among pregnant women attending antenatal care at Ramallah Governmental Hospital, identify associated risk factors, characterize causative bacterial pathogens, and evaluate antimicrobial susceptibility patterns. Methods: A descriptive cross-sectional study was conducted among 113 pregnant women attending the antenatal clinic at Ramallah Governmental Hospital, Palestine. Clean-catch midstream urine samples were collected and processed using standard microbiological procedures. Bacterial isolates were identified using conventional biochemical methods, and antimicrobial susceptibility testing was performed using the disk diffusion method. Sociodemographic and behavioral factors associated with ASB were analyzed statistically. Results: Among 113 pregnant women, 38 (33.6%) had significant bacteriuria. Escherichia coli was the predominant isolate (71%), followed by Staphylococcus aureus (29%). Significant associations were observed between ASB and socioeconomic status (P = 0.024), direction of genital washing (P < 0.001), bathing and underwear-changing frequency (P < 0.001), and sexual activity frequency (P < 0.001). Nitrofurantoin, Amikacin, and Imipenem demonstrated the highest sensitivity rates (100%). Conclusion: ASB was common among pregnant women attending Ramallah Governmental Hospital. Personal hygiene practices and sexual activity were significantly associated with infection risk. Nitrofurantoin demonstrated excellent antimicrobial activity and may be considered an effective first-line option for treatment. Routine screening programs should be incorporated into antenatal care services in Palestine. Keywords: Asymptomatic bacteriuria, pregnancy, urinary tract infection, antimicrobial susceptibility, Escherichia coli, Palestine.
Castleman’s disease is a rare, benign lymphoproliferative disorder of uncertain cause. It most commonly involves the chest, abdomen and neck; involvement of the limbs is distinctly uncommon. We report a 24- year-old woman who presented with a slowly enlarging, mildly painful swelling over the posteromedial aspect of the right elbow of one year’s duration, associated with tingling along the inner aspect of the arm. There were no fever, weight loss, night sweats or swellings elsewhere. Examination revealed a firm, lobulated, mobile swelling about six by four centimetres over the medial aspect of the right elbow, with several smaller adjacent swellings; there was no generalised lymph node enlargement or organ enlargement. Ultrasonography showed multiple enlarged lymph nodes in the epitrochlear and medial arm region, the largest measuring about thirty-five millimetres, with increased internal blood flow. Fine-needle aspiration suggested a granulomatous and necrotising lymph node inflammation, raising the possibility of tuberculosis; however, a cartridge-based nucleic acid amplification test for tuberculosis was negative. Routine blood tests were largely within normal limits. The lymph node mass was completely removed surgically under regional anaesthesia. Histopathological examination was consistent with Castleman’s disease of the mixed type. The patient recovered well after operation. This case highlights an unusual peripheral location of unicentric Castleman’s disease and its ability to mimic tuberculous lymphadenitis, an important consideration in regions where tuberculosis is common. Complete surgical excision is both diagnostic and curative for unicentric disease and is associated with an excellent outcome. Castleman’s disease should be considered in the differential diagnosis of a firm, vascular, regional lymph node swelling of the limb, particularly after an infective cause has been excluded. Keywords: Castleman’s disease; unicentric Castleman’s disease; epitrochlear lymphadenopathy; lymphoproliferative disorder; giant lymph node hyperplasia; surgical excision.
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, arising from the interstitial cells of Cajal. Small bowel GISTs are less frequent than gastric tumors and more often display high-risk histological features. Spontaneous perforation is a rare, life-threatening complication, reported in fewer than 2% of cases, and constitutes a surgical emergency associated with peritoneal tumor dissemination and adverse oncological outcome. Case Presentation: A 62-year-old woman presented with a one-day history of sudden-onset, severe, diffuse abdominal pain associated with nausea and vomiting. Examination revealed a rigid, board-like abdomen with generalized peritonism. Contrast-enhanced computed tomography demonstrated an exophytic, heterogeneous jejuno-ileal mass with central necrosis, intraperitoneal free gas, and free fluid, raising suspicion of a perforated small bowel neoplasm. Emergency exploratory laparotomy revealed generalized purulent peritonitis and a firm, exophytic tumor arising from the mesenteric border of the small bowel with a discrete perforation and surrounding haemorrhagic necrosis. En-bloc segmental small bowel resection with primary end-to-end jejuno-ileal anastomosis was performed after copious peritoneal lavage. Histopathology showed epithelioid tumor cells arising from the muscularis propria with haemorrhage, necrosis, and ulceration; immunohistochemistry demonstrated diffuse CD117 positivity, confirming epithelioid GIST. Conclusion: Perforated small bowel GIST is a rare cause of acute abdomen that is seldom diagnosed preoperatively and demands prompt surgical intervention. Emergency en-bloc resection with an intact pseudocapsule, thorough peritoneal lavage, and primary anastomosis where feasible remain the cornerstones of management. Perforation itself confers high-risk status irrespective of tumor size or mitotic index, mandating adjuvant imatinib therapy and structured long-term surveillance.
ackground: Type 2 diabetes mellitus (T2DM) is fundamentally characterised by a progressive, inexorable decline in pancreatic beta-cell function superimposed on peripheral insulin resistance. Although initial management relies on lifestyle modifications and non-insulin antihyperglycemic therapies, a substantial proportion of patients eventually require exogenous insulin to achieve and maintain optimal glycemic targets. Aims: This review synthesises current clinical evidence, international consensus guidelines, and recent therapeutic breakthroughs to provide an operational framework on the clinical triggers ("when"), physiological rationales ("why"), and practical algorithms ("how") of initiating insulin therapy. Methods: A comprehensive literature search of electronic databases, including PubMed, MEDLINE, and Embase, was conducted to identify English-language, peer-reviewed literature, clinical guidelines, and landmark trials concerning insulin therapy in T2DM. This review evaluates data from foundational clinical trials (UKPDS, ACCORD, ADVANCE, and the GRADE study) alongside current consensus recommendations from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Literature tracking clinical thresholds for initiation, comparative data on traditional insulin regimens (basal, biphasic, basal-bolus), and Phase 3 clinical trial data for once-weekly basal insulins and digital health technologies published between 2019 and 2026 were extracted and evaluated. Conclusions: Overcoming clinical inertia requires proactive clinician intervention, structured patient education to address psychological insulin resistance, and the early adoption of advanced monitoring technologies. Timely and tailored implementation of insulin therapy remains a cornerstone in altering the long-term microvascular and macrovascular trajectory of patients with T2DM. Keywords: Type 2 Diabetes Mellitus; Insulin Initiation; Basal Insulin; Clinical Inertia; Hypoglycemia.
Background: Inappropriate blood transfusions pose a significant challenge in resource-limited rural hospitals, where unpredictable demand, limited donor pools, and logistical constraints strain blood inventories. KIMS, Narketpally a highway-adjacent tertiary care hospital instituted a restrictive transfusion protocol to optimize blood component utilization without compromising patient safety. Methods: A prospective audit was conducted over 12 months in the Department of Transfusion Medicine. The protocol mandated packed red blood cell (PRBC) transfusion only for patients with hemoglobin (Hb) < 7 g/dL or clinically justified exceptions. All requests from emergency, surgical, critical care, and medical wards were screened against protocol criteria. Data on component utilization, rejection rates, and oneweek clinical outcomes were systematically recorded. Results: Over 12 months, 10,000 blood component units were processed. A total of 6,200 PRBC units were issued to 2,750 patients, while 3,200 requests were rejected for not meeting protocol criteria. Of 2,530 FFP requests, 1,750 were approved and 730 declined. No patient whose request was declined experienced hemoglobin-related deterioration or bleeding during follow-up, demonstrating the protocol’s safety. Conclusion: A restrictive transfusion protocol significantly reduced inappropriate blood component use in a resource-limited setting without adverse clinical outcomes. Regular audits and clinician sensitization were key to sustained protocol adherence, affirming this strategy as safe, cost-efficient, and operationally viable. Keywords: restrictive transfusion protocol; blood component utilization; packed red blood cells; hemoglobin threshold; transfusion audit; resource-limited hospital; patient blood management; transfusion medicine.
Hodgkin lymphomas are neoplasms involving lymph nodes and extra-nodal sites. Bone marrow infiltration at diagnosis occurs in about 10% of cases, often correlating with extensive disease and cytopenias. Without peripheral lymphadenopathy, lymphoma B-symptoms can easily mimic infections. A 58 years old male presented with single swelling in left lateral neck since 9 months ,fever (on& off) since 7months, weight loss > 10kgs & generalized weakness. FNAC suggested a granulomatous lesion, raising suspicion for tuberculosis. Hence the patient was initiated on Anti-Tubercular Therapy. In the follow-up visit patient’s symptoms still persisted. Consequently, a core biopsy was submitted for histopathological examination (HPE), which indicated a lymphoproliferative disorder. A subsequent excisional biopsy revealed a diagnosis of Hodgkin’s Lymphoma of the Nodular Sclerosis subtype, which was further confirmed by Immunohistochemistry (IHC).This case highlights the importance of early bone marrow examination in patients with unexplained fever and cytopenias, emphasizing the need to carefully distinguish lymphoma from tuberculosis in high burden regions. Keywords: Anti-tubercular therapy, Bone marrow examination, Haematological malignancy, Histopathological diagnosis, Hodgkin lymphoma, Immunohistochemistry, Reed-Sternberg cell, Tuberculosis.
Background: At less than 1% of all ectopic pregnancies, cervical ectopic pregnancy (CEP) is a very uncommon type of ectopic gestation. Due to the significant danger of major hemorrhage, which frequently requires a hysterectomy if left untreated, early detection is essential. Early identification and fertilitypreserving treatment techniques have been made possible by advancements in transvaginal ultrasonography and serum beta-human chorionic gonadotropin (β-hCG) monitoring. Case Presentation: We report the case of a 26-year-old gravida 2 para 1 live 1 woman with a prior lower segment cesarean section who presented with vaginal bleeding and a positive urine pregnancy test. Transvaginal ultrasonography revealed an empty uterine cavity with a gestational sac located within the cervical canal, consistent with cervical ectopic pregnancy. Her initial serum β-hCG level was 3034.14 mIU/mL. After counseling regarding medical and surgical options, the patient opted for conservative medical management. A multidose methotrexate regimen was administered, with serial monitoring of βhCG levels demonstrating a progressive decline to non-pregnant levels within four weeks. The patient experienced no major complications. Notably, she conceived spontaneously six months later and is currently continuing a viable intrauterine pregnancy under regular antenatal surveillance. Conclusion: In hemodynamically stable individuals, conservative medical care with multidose methotrexate can be a safe and successful fertility-preserving strategy. This case further emphasizes the significance of early detection of cervical ectopic pregnancy. Improved reproductive results and a considerable reduction in maternal morbidity are achieved with prompt detection and tailored care. Keywords: Cervical ectopic pregnancy, methotrexate, conservative management, fertility preservation, β-hCG
ntroduction: A ranula is a benign mucous cyst arising from the sublingual gland. Although it is not a common lesion—particularly in children, where infectious processes are frequent—it can easily be mistaken for lymphadenopathy. Early recognition in Primary Care prevents unnecessary treatments and reassures families. Case Presentation: An 8-year-old boy attended the Primary Care clinic because his mother had noticed a small lump under the mandible three days earlier. Initially, she did not pay much attention, as the patient had recently suffered from a common cold and she assumed it was an enlarged lymph node. Neck examination was normal. On oral inspection, the physician observed a translucent, fluctuant lesion on the floor of the mouth, consistent with a simple ranula. The child was asymptomatic. He was referred to ENT for further evaluation. Discussion: Ranulas may resemble other common pediatric conditions, leading to misdiagnosis and inappropriate use of treatments, particularly antibiotics. Careful oral cavity examination is essential. The family physician plays a key role in recognizing these lesions and guiding families appropriately. Conclusion: Ranula should be included in the differential diagnosis of sublingual or submandibular masses in children. A thorough oral examination in Primary Care can prevent diagnostic errors and facilitate appropriate management. Keywords: ranula, mucocele, pediatric oral lesions, primary care, sublingual gland.
Background: Uterine rupture is a rare but catastrophic obstetric emergency, most commonly associated with previous uterine surgery. Spontaneous rupture in an unscarred uterus is exceptionally uncommon, particularly in association with Müllerian anomalies such as uterus didelphys. These anomalies significantly increase maternal and fetal morbidity due to delayed diagnosis and atypical clinical presentation. Case Presentation: We report a case of a 27-year-old primigravida with six months of amenorrhea who presented with sudden onset abdominal pain of two days’ duration, associated with vomiting. During clinical examination, the patient collapsed and required immediate cardiopulmonary resuscitation. Emergency bedside ultrasonography revealed moderate hemoperitoneum with uterine rupture. The patient underwent emergency exploratory laparotomy, which revealed uterus didelphys with rupture of the right uterine horn extending from the cornual end to the upper cervix. Approximately 1500 mL hemoperitoneum was evacuated. A dead male fetus weighing 378 g was delivered, and excision of the ruptured horn was performed. The postoperative course was uneventful following intensive care management. Conclusion: Spontaneous rupture of a gravid horn in uterus didelphys during the second trimester is exceedingly rare and often presents as a diagnostic challenge. Early recognition, rapid resuscitation, and prompt surgical intervention are critical to maternal survival. Keywords: Hemoperitoneum; Müllerian anomaly; Second trimester; Uterus didelphys; Uterine rupture.
Background: Physical inactivity and excess adiposity are well-established contributors to poor glycemic control in type 2 diabetes mellitus (T2DM). Data on self-reported physical activity (SRPA) and adiposity patterns among T2DM patients with high mean HbA1c in urban South Indian private clinic settings remain limited. Objectives: To determine SRPA levels, BMI-based general obesity, and visceral obesity (by bipolar bioelectrical impedance analysis), and to assess their association with glycemic status in T2DM patients with high mean HbA1c. Methods: A cross-sectional study was conducted among 300 T2DM patients attending a private diabetes clinic in a South Indian city. SRPA was assessed using a WHO questionnaire-based tool. Adiposity was evaluated by BMI (general obesity) and bipolar bioelectrical impedance analysis (visceral obesity). Glycemic status was assessed by fasting blood glucose (FBG), postprandial blood glucose (PPBG), and HbA1c. Statistical analysis included descriptive statistics, chi-square test, Pearson's correlation, and binary logistic regression. Results: The mean HbA1c was 9.4 ± 1.6%. Majority (68.3%) were physically inactive by SRPA criteria. General obesity (BMI ≥25 kg/m²) was present in 71.7% and elevated visceral fat (≥10 units) in 63.3% of participants. Physical inactivity, general obesity, and visceral obesity were each significantly associated with poor glycemic control (p<0.001). On logistic regression, physical inactivity (OR 2.84, 95% CI 1.74– 4.63) and elevated visceral fat (OR 2.31, 95% CI 1.42–3.76) were independent predictors of high HbA1c. Conclusion: Physical inactivity and adiposity — both general and visceral — are prevalent and independently associated with poor glycemic control in South Indian T2DM patients. Structured lifestyle interventions targeting these modifiable risk factors are urgently warranted. Keywords: Type 2 diabetes mellitus, self-reported physical activity, adiposity, HbA1c, bioelectrical impedance analysis.
Introduction: Rickets is a pediatric skeletal disorder caused by defective bone mineralization, primarily due to vitamin D deficiency, resulting in bone deformities and impaired mobility. Conventional management includes supplementation of vitamin D and calcium, but complementary approaches are increasingly explored. Yoga Prana Vidya (YPV), an energy-based healing modality, has shown promise in integrative health care. Case Presentation: This case report documents the application of YPV healing in a 2-year-old female child diagnosed with rickets, presenting with bent knees, brittle bones, and difficulty in standing or walking. Her parents approached two certified YPV healers who conducted daily sessions for 90 days, employing psychotherapy, chakra cleansing especially lower chakras and group healing. Results: Progressive improvement was observed within six weeks, with the child able to stand and walk without discomfort by the end of three months. Parents reported complete recovery, with sustained improvements in mobility and bone alignment. Conclusions: This case highlights the potential of YPV healing as a supportive intervention in pediatric rickets, complementing conventional care. While anecdotal, the findings suggest scope for further controlled studies to evaluate YPV’s role in bone health and pediatric rehabilitation. Keywords: Rickets, Vitamin D deficiency, Yoga Prana Vidya System ®, YPV ®, Pediatric Complementary Healing therapy.
Background: Neonatal hypoglycemia is one of the most common metabolic disorders affecting newborns, particularly those with low birth weight (LBW), very low birth weight (VLBW), small for gestational age (SGA), prematurity, and infants born to diabetic mothers. Following birth, neonates experience an abrupt interruption in maternal glucose supply. This metabolic transition, coupled with immature gluconeogenesis, limited glycogen stores, and increased cerebral glucose demand, predisposes high-risk neonates to hypoglycemia. Methods: This prospective observational study was conducted over 20 months in a tertiary care center and included 150 high-risk neonates, predominantly from socioeconomically disadvantaged tribal populations. Serial blood glucose monitoring was performed at predefined intervals. Results: Among the study population, 30% of neonates developed hypoglycemia, while 70% remained normoglycemic. Extremely low birth weight (ELBW ≤1000 g) infants demonstrated a 100% incidence of hypoglycemia. Significant associations were observed between hypoglycemia and birth weight (p = 0.006), gestational size (p = 0.0028), and neonatal sepsis (p < 0.0001). Sepsis was present in 38.46% of neonates and showed a strong correlation with hypoglycemic episodes. No significant association was found with maternal gravida status. Conclusion: Neonatal hypoglycemia remains a significant concern in LBW and VLBW neonates, particularly among ELBW, SGA, and septic infants. Early identification, routine glucose monitoring, and timely intervention in high-risk groups are essential to prevent adverse neurological outcomes and improve neonatal survival. Keywords: Neonatal hypoglycemia; Low birth weight (LBW); Very low birth weight (VLBW); Extremely low birth weight (ELBW); Small for gestational age (SGA); Preterm neonates; Sepsis; Glucose homeostasis; Intrauterine growth restriction (IUGR); Neonatal outcomes.
Vestibular dysfunction commonly impairs balance, gait, and functional mobility, thereby increasing the risk of falls and reducing quality of life. This study aimed to evaluate the influence of age and gender on balance impairment in individuals with vestibular dysfunction. A cross-sectional observational study was conducted among 100 participants diagnosed with vestibular dysfunction. Balance performance was assessed using the Balance Evaluation Systems Test (BESTest), Dizziness Handicap Inventory (DHI), Functional Gait Assessment (FGA), and Timed Up and Go (TUG) test. Statistical analysis included one-way ANOVA, independent t-tests, and regression analysis. Balance impairment significantly increased with advancing age, with older adults demonstrating poorer performance across all balance measures (F(4,95)=5.87, p=0.001). Females reported comparatively higher DHI scores; however, no statistically significant gender differences were observed in objective balance measures, including BESTest, FGA, and TUG scores (p>0.05). Regression analysis identified age as a significant predictor of balance impairment, whereas gender did not demonstrate a significant independent association. The findings suggest that ageing has a substantial impact on balance dysfunction in individuals with vestibular disorders. These results highlight the importance of age-specific rehabilitation strategies to improve balance performance and reduce fall risk in this population. Keywords: Vestibular dysfunction, Balance impairment, Gender differences, BESTest, Dizziness Handicap Inventory, Functional Gait Assessment.
Introduction Vitamin B12 (cobalamin) is a vital nutrient involved in numerous biological functions, including DNA synthesis, red blood cell production, and neurological function. While deficiencies in vitamin B12 are well-documented, elevated vitamin B12 levels are relatively uncommon and often raise clinical concerns regarding their significance and appropriate management. Elevated levels can result from benign factors such as supplementation but may also indicate serious underlying conditions, including liver disease, kidney dysfunction, hematological disorders, and malignancies. This literature review synthesizes current research on the causes, clinical implications, and management of elevated vitamin B12 levels in primary care.
Background: Haemorrhoids (Piles) and anal fissures are common anorectal disorders causing pain, bleeding, and impaired quality of life. Conventional management includes dietary modification, pharmacotherapy, and surgery. Complementary approaches such as biofield energy healing are increasingly explored. Objective: To document the clinical course and outcomes of a patient with piles treated using Yoga Prana Vidya (YPV) healing protocols alongside lifestyle modifications. Methods: A 35-year-old male presented with anal fissure symptoms including pain, itching, and bleeding. He had a history of alcohol use and irregular lifestyle. Medical consultations provided partial relief. His wife referred him to a certified YPV trainer. Daily 30 minutes healing sessions were conducted for 60 consecutive days using specific YPV protocols targeting the rectal region and associated chakras. Results: Within 8 sessions, symptoms reduced by 20%. By the end of two months, pain and itching resolved, and alcohol intake decreased. Follow-up after 3 ½ years confirmed sustained recovery, with no recurrence of symptoms. Patient reported improved lifestyle, emotional balance, and spiritual growth through meditation and gratitude practices. Conclusion: This case highlights the potential role of YPV biofield healing as an adjunct to conventional management of anorectal disorders. Integrating mind-body-spirit practices may enhance recovery, reduce recurrence, and improve holistic wellbeing. Controlled studies are recommended to validate efficacy. Keywords: Anal fissures, Piles, Haemorrhoids, Yoga Prana Vidya System®, YPV®
Cerebral fat embolism syndrome (CFES) is a rare but potentially fatal complication of long-bone fractures that may initially present with isolated neurological deficits. We report a 25-year-old polytrauma patient with femoral shaft fracture, distal radius fracture, and Grade II open tibia-fibula fracture following a road traffic accident. He was initially hemodynamically stable and neurologically intact but developed acute confusion and right-sided hemiparesis 26 hours after injury despite normal oxygen saturation and unremarkable CT brain imaging. Respiratory deterioration occurred later, requiring short-term ventilatory support. MRI brain revealed multiple bilateral punctate diffusion-restricted lesions producing the characteristic “starfield” pattern diagnostic of CFES. Petechial rash subsequently appeared, completing the classical triad. The patient was managed with intensive supportive care, corticosteroids, antibiotics, and staged orthopaedic fixation after physiological stabilization. He demonstrated complete neurological recovery and satisfactory fracture healing at follow-up. This case highlights the importance of early MRI evaluation and timely supportive management in suspected CFES with normal initial CT imaging. Keywords: cerebral fat embolism syndrome; pulmonary fat embolism; fat embolism syndrome; polytrauma; femoral shaft fracture; neurological deterioration; MRI starfield pattern; respiratory insufficiency; damage control orthopaedics; hemiparesis
