Search results for “Management”

The Risk Factors, Complications, Management Strategies and Predictors of Morbidity & Mortality Among Pediatric Patients Presenting with Severe Diarrhea at Muhimbili National Hospital’s Emergency Medicine Department

Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.

Characterization of People Receiving 2-Drug Regimens (2DR) for HIV Management in Italy

Objective To describe the clinical features and real-world treatment of people living with human immunodeficiency virus (PLHIV) using fixed-dose or free combinations of 2-drug regimens (2DR) of antiretroviral therapy (ART). Design Italian retrospective cohort study. Methods Data were extracted from PLHIV who initiated or switched to 2DR: Group 1 (fixed dose), Group 2 (free combination). Results Group 1 was younger and more predominantly male, and had shorter time from AIDS-defining diagnosis to 2DR-ART and from diagnosis to baseline, a lower prevalence of resistance, and fewer comorbidities than Group 2. Median baseline viral load was <50 copies/mL in both groups, but Group 1 had a higher mean due to outliers. The most common ART classes before switching to 2DR were Integrase Strand Transfer Inhibitor (INSTI)-based (48.97%), Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based (22.73%), and Protease Inhibitor (PI)-based (16.53%). Distribution varied: Group 1: INSTI-based (53.13%), NNRTI-based (24.31%), and PI-based (15.04%); Group 2: INSTI-based (29.41%), PI-based (23.53%), and NNRTI-based (15.29%). After switching, Group 1 was on dolutegravir/lamivudine (79,33%) and dolutegravir/rilpivirine (20,67%); Group 2 mostly on INSTI-PI (52.81%), followed by NNRTI combinations, mainly with doravirine (19.10%). Duration of ART after switching was shorter in Group 1. Conclusion Italian PLHIV on 2DR fixed-dose combinations were younger, virologically suppressed individuals at baseline, with a shorter lead time from diagnosis, lower prevalence of resistance and lower comorbidity rate compared to those on free combinations. These findings underscore an unmet need for 2DR fixed-dose combinations, as the free combinations were predominantly utilized for more challenging populations.

Bridging Gaps in Blood Transfusion Services through Collaborative Healthcare Systems in Cameroon: The Cornerstone University Blood Management System version 1.0

The rising need for structured and efficient blood transfusion services in low-resource settings has driven the adoption of collaborative blood transfusion management systems (CBTMS). This study explores the functionality and impact of the Cornerstone University Blood Management System version 1.0 (CUBMS vs 1.0) in Cameroon. This study was an exploratory research design which used a system interface analysis, comparative case reviews from four countries, and literature synthesis, to reveal that CUBMS improves accessibility, data management, inventory control, emergency responsiveness, and community engagement. Despite infrastructural challenges in rural regions, the system can enhance efficiency, transparency, and safety in blood services. The success of CBTMS in Cameroon is linked to digital infrastructure, training, and culturally relevant community engagement. The Ministry of Public Health of Cameroon should prioritize the nationwide implementation of CBTMS, ensuring consistency in digital health tools.

Ecosystem-Based Fishery Management of Antarctic Krill (Euphausia superba) to Support Baleen Whales and other Predators Production Adapted for Potential Climate Change Effects

Antarctic krill is an important component of the zooplankton production in the Southern Ocean and is a major food source for baleen whales. The role of commercial fishing and predation by whales on Krill abundance has been investigated here using the innovative ecosystem-based fishery management, EBFM which maintains the krill to whale food web ecosystem stability. The literature indicates the Krill fishery may have been overfished, so it was reduced to the current annual upper limit of 0.62 million tonnes for support other predators of krill, such as seals, penguins and flying sea birds. However, recent literature suggests a moderate reduction in krill catch in the Antarctic Peninsula area due to its importance for whale migration to temperate areas. The Peninsula area catch was estimated to be reduced by about 10% due to additional concerns about climate change effects on krill abundance in the Southern Ocean, reducing overall catch to 0.556 million tonnes, moderately higher than the maximum taken in 2022. Hence, the krill biomass fishing was reduced to allow for predation by baleen whales and other predators, giving a full ecosystem-based fishing mortality similar to that previously estimated to maintain krill production in the Southern Ocean.

Burden of Unintentional Childhood Injuries in Pre-School Children (2-6yrs) and Knowledge of Primary Caregivers on Early Management: A Descriptive Observational Study in Urban Slums of Bhubaneswar, Odisha

Background Injuries, particularly unintentional ones, are a neglected public health concern and are preventable or avoidable. Children in urban slums are especially vulnerable due to hazardous living conditions, inadequate supervision, and lack of safe sojourns or play areas. Since these injuries result in seeming spontaneous recovery, appropriate care being initiated by the primary care giver is questionable. Objective To assess the burden of unintentional injuries of unintentional injuries in pre-school going children aged 2-6 years in urban slums of Bhubaneswar, Odisha. To compare the knowledge of the 1st level care post-injury among the primary care givers against standardized prescribed care. Methods A cross-sectional descriptive observational study was conducted for over 2 years in urban slums under the Bhubaneswar Municipal Corporation (BMC), the capital city of Odisha. A total of 285 children aged 2-6 years, whose mothers consented to participate, were included in the study. Data regarding the type of injury and its management, as well as, associated socio-demographic factors, were collected using a pre-designed, pre-tested questionnaire. Descriptive statistics was used to derive the burden of unintentional injuries in children. The knowledge of the 1st level of care to be given after the common injuries was assessed among all the primary caregivers to detect the treatment and care gap. Results The majority of primary respondents were mothers aged 21-30 years (82.1%), The frequency of an episode of unintentional injury (occurrence in last 3 months) in the study population was found to be 58%. The most common type of injury reported was skin lacerations or tears, common site being in the upper and lower limbs. Males were more affected as compared to females (54.64 %) The reporting of unintentional injuries among the children was found to have significant association with the occupation of the father. Fathers who were unemployed or working as unskilled labor, their child’s probability of reporting an unintentional injury was found to be high, with p value coming to be statistically significant. Conclusion The study highlights the complex interplay of sociodemographic factors influencing unintentional injuries among children in urban slums and the need to create awareness among the primary caregivers, about the immediate management, so that chronic complications may be averted. It is difficult to avert injury as this age group is agile and nowadays supervision is challenging. Still, the knowledge of management would not just empower the caregiver, but also the growing child, who can attend to their younger siblings or themselves, whenever they get injured next. Further research with larger sample sizes is warranted to validate these findings and develop effective prevention strategies.

Development of Municipal Decision-Making Strategies as Management Tools to Combat Waterborne Diseases

Waterborne diseases pose a significant global public health threat, particularly in sub-Saharan Africa, where frequent outbreaks occur. These diseases stemming from contaminated drinking water, poor waste management, and insufficient hygiene contribute to high morbidity and mortality in children under 5 years old. A study addressed waterborne diseases in N'Djamena, Chad's 3rd and 9th districts, through decision-making strategies. The research employed various methods, including a household survey using questionnaires, workshops, semi-structured interviews, and focus group discussions. Additionally, documentary research provided essential data for analysing the situation of diseases in the community. Epidemiological data from 2019- 2022 indicated a substantial prevalence of diseases such as diarrhoea, dysentery, skin infections, typhoid, abdominal pain, and malaria, with notable mortality, especially among children. Among surveyed households, 50% believed the consumed water was contaminated, attributing it to faecal matter, while 28% and 22% linked the diseases to inadequate hygiene and unsanitary conditions, respectively. The study advocates for comprehensive strategies, including improving water treatment efficiency, implementing safe waste management, promoting hygiene, and vaccination. Active involvement of all stakeholders, with municipal authorities leading, is crucial for effective implementation and combating waterborne diseases.

Molecular Diagnosis in Clinical Management and Diagnosis of Thyroid Cancer

The prevalence of thyroid cancer is rapidly increasing worldwide, majorly due to overdiagnosis and overtreatment methods of differentiated thyroid cancer. The emergent and potent preclinical models, high-throughput molecular techniques, and genetic expression microarrays have delivered deeper insights into understanding the molecular features in oncogenesis. Thus, molecular markers have become a promising tool in managing thyroid cancer for differentiating benign and malignant tumors, prognosis, recurrence, and determination of novel therapeutic targets. In differentiated thyroid cancer, molecular markers are majorly utilized for guiding the development of indeterminate thyroid nodules on fine needle aspiration (FNA) histologies. Dissimilar to this, in advanced thyroid cancer, molecular markers permit targeted treatment of a modified signaling cascade. Determining causal mutation of targeted kinase receptors in advanced thyroid cancer can depict a promising treatment strategy with mutation-targeted tyrosine kinase inhibitors to reduce progression and eradicate mutation effects when conventional methods fail to manage. This review will focus on the molecular landscape and discuss the impact of molecular markers on the prognosis, treatment, and surveillance of differentiated and anaplastic thyroid cancer.

Hybrid Limited Shoulder Surgical Management (HLSSM) Sayed Issa's Hybrid Shoulder Arthroscopic-Open Surgical Management

Introduction The idea of HLSSM2 is to get the least easy surgical intervention, as arthroscopic surgery begins with examining the shoulder joint, and the location and size of the lesion are determined, then open over the lesion with an open surgical approach that is very limited for surgical repair; not using arthroscopic instruments but conventional surgical instruments in the second step. Figure 1 Figure 1.   Methods Clinical experience with this technique consists of 44 cases over a period of thirty-one months, this study was from September 2020 to May 2023. All cases were done as outpatients and under general anesthesia. Results The mean duration of the operation was 35 minutes, and the minimum duration was 25 minutes. There was no major nerve or vascular injury in all cases. This technique is simple, safe, and good cosmetically satisfactory for all patients after full recovery about three months after the procedure, and it is cost-effective. One 43-year-old female patient suffered pain and stiffness during the first six months after surgery and was not very satisfied, she did not stop visiting us till now, she was not happy because of shoulder pain and tenderness. Conclusion It can be used by experienced hand surgeons in shoulder arthroscopy and in Mini Lateral Shoulder Approach (MLSA)3, especially in countries where shoulder arthroscopic release and repair with suture anchors are expensive4 or not available. This technique is not very simple but is available, safe, cosmetically satisfactory, and cost-effective.

Improving Effective Screening and Management of Obesity in an Urgent Care Clinic

Background Nearly 40% of the adult population in the United States are considered obese by current standards, which equates to approximately 93 million people. Obesity is a chronic disease that is linked to more than 40 other diseases, including hypertension, heart disease, stroke, diabetes, and at least 13 distinct types of cancers. The direct and indirect costs of obesity have been estimated at up to $210 billion annually. Local Problem In Cumberland County, North Carolina, 34% of the adult population was considered obese. The aim of this quality improvement study was to increase effective care (screening, patient engagement, and referral to treatment) in adult patients with a BMI greater than 30 kg/m2 to 75% within 90 days. Methods A rapid cycle plan-do-study-act framework was used to evaluate four focus areas concurrently over 8 weeks with a small test of change completed in each 2-week cycle. Interventions An expanded screening with a checklist, shared decision-making tools (SDMTs), and a referral to treatment checklist were implemented. Activities from the team engagement plan were initiated. Results The effective care of patients increased by 42 percentage points while engaging both the patients and the staff. Conclusions Utilizing standardized communication, SDMTs, checklists, and management plans improved effective care while motivating and enabling patients to take control of their care and make sustainable lifestyle changes that enhance overall health.

A Newer Approach in the Management of Cough: A Review on Levodropropizine

Safe and effective antitussive therapy remains a significant area of unmet need for cough management. Antitussive drugs are commonly used cough suppressants and include centrally acting (opioids and non-opioids) cough suppressants and peripherally acting antitussives. Authors searched PubMed, Google Scholar and additional studies from reference lists via cross-referencing to identify studies assessing levodropropizine for the treatment of cough. Of the 748 studies identified, 13 were included. Recent clinical evidence, guideline recommendations and findings from this review suggest that levodropropizine is a peripheral antitussive which reduces cough intensity, frequency, and nocturnal awakenings in children and adults and provides better efficacy outcomes with a more favourable risk/benefit ratio compared to centrally acting antitussive agents which pose greater safety concerns and present an unacceptable risk–benefit profile. This review is aimed at Indian primary care physicians for making effective cough management decisions where the clinical evidence needs to be translated to clinical practice. Key Messages The usage of currently available centrally acting antitussive agent is greatly limited by their central depressing action and frequent side effect. The findings of this review indicate that levodropropizine is an effective antitussive agent and well tolerated in the management of cough in patients of all ages.

Dual Energy Computed Tomography and Effect on the Management of Uric Acid Renal Calculi

Attenuation differences from 2 x-ray sources allow differentiation and characterization of stone types with similar radiation dose compared to single-energy CT scan. The difference is shown in colours, allowing preoperative prediction and management of stones. We determined the effect of DECT-KUB on urological management of patients with uric acid stones since it was first introduced in our centre. 50 patients with uric acid stones were selected from 2 year groups, each with 25 patients and their urological managements were reviewed retrospectively. We concluded that DECT-KUB is an accurate way of determining the chemical characteristics of renal calculi and can alter patients’ management. It has gained wide acceptance among clinicians in our centre and is now widely used to plan urological management of patients with renal calculi. Based on urological management comparison of patients who presented in the year 2011 with uric acid stones and patients in the year 2020, we concluded that patients with uric acid stones based on DECT-KUB findings can start dissolution therapy instead of surgical extraction or lithotripsy prior to biochemical analysis results become available. Although utility of DECT-KUB is widely accepted among clinicians in our centre it may not be available worldwide and this is the limiting factor in its universal use.

Risk Management: Emerging critical issues during the hospital administration of drug therapy

Interruptions during pharmacological therapy in a hospital ward can be a source of error. We therefore considered two Operating Units of a hospital by asking the following questions: are the nursing staff who administer drug therapy at the set times able to do so with maximum concentration and without interruptions? If yes, how? If not, why and what for? Furthermore, are there organizational and non-organizational improvement strategies so that nurses are less interrupted during therapy and therefore do not cause adverse drug events that could cause harm to the patient? The results that emerged from the data analysis make us reflect considerably on how much interruptions during therapy are to be paid attention to as a problem to which solution proposals can be found.

Integrated Management of Sclerotinia Sclerotiorum, An Emerging Fungal Pathogen Causing White Mold Disease

Sclerotiniasclerotiorum, the causal agent for white mold (Sclerotinia stem rot), is a devastating fungal pathogen. Currently, Sclerotinia is most commonly managed using the chemical fungicide which can lead to Sclerotinia resistance development, impacting biodiversity and interfering with key ecosystem services. In this regards, field experiments were conducted during 2017-18 planting seasons to evaluate the efficacy of different components viz. sawdust burning, stable bleaching powder, fungal and bacterial bio-control agents, chemical fungicide Rovral 50 WP and integration of different components for the management white mold disease of bush bean, mustard and garden pea in three different locations viz. in the field of Plant Pathology Division, Bangladesh Agricultural Research Institute, Joydebpur, Gazipur, Regional Agricultural Research Station (RARS), Burirhat, Rangpur and RARS, Ishurdi, Pabna, respectively. The results showed that different treatments displayed varying levels of effectiveness against the disease. All the treatments gave satisfactory reduction of white mold disease development and increased plant growth as well as yield of bush bean, mustard and garden pea. Among the treatments, integration of saw dust burning + soil amendments with Trichoderma based bio-fungicide + bacillus based bio-control agents + application fungicide Rovral 50 WP is the best treatment which reduced 97.49%, 77.72%, 72.26% white mold disease incidence and 84.61%, 81.14%, 71.01% white mold disease severity of mustard, bush bean and garden pea, respectively and increasing plant growth parameter as well as 52.16%, 27.74%, 36.97% yield of mustard, bush bean and garden pea, respectively. Application of only fungicide Rovral 50 WP also better treatment in reduction of white mold disease incidence and disease severity and increasing plant growth parameter as well as increasing yield of mustard, bush bean and garden pea. Soil amendment with fungal or bacterial bio-control agents also gave satisfactory results in reduction of white mold disease incidence and disease severity and increasing plant growth parameter as well as increasing yield of mustard, bush bean and garden pea. It could be concluded from the obtained results that integration between bio-control agents as a soil treatment and foliar application chemical fungicide might be useful as a good tool for controlling white mold disease caused by S.sclerotiorum and obtained higher yield of bush bean, mustard and garden pea under field condition.

Adopting a Wider Approach for Fisheries Management

Many marine and freshwater fisheries are now in a very poor state, and many fish stocks are close to collapse. There is a need to manage fisheries more carefully, especially since fishing can affect other aspects of the environment. It is also important to reduce the adverse effects of climate changes upon the marine and freshwater environments, fishes, and other animals, and the need to manage other human activities taking place in the sea, to improve the marine environment and protect the wildlife and the fishing activities. Marine pollution, includes human waste materials, chemicals and plastics, and there is also noise and substrate vibration, from industrial and other activities that may affect both the abundance and quality of fishes and other marine animals. This paper deals with fisheries management, and environmental protection, and concludes that fishermen, fisheries scientists, fisheries managers and environmental interests must work closely together, if fishes are to be adequately protected, and fisheries are to be better managed. It describes current systems of management. It especially draws attention to the importance of moving towards an ecosystem-based approach to fisheries management. Such an approach aims to manage all those human activities that have an impact upon the marine environment and its life forms.

RETRACTED: Development of Biorational Management Package of Root Knot Nematode Disease of Country Bean

This article has been retracted on 10 November 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2639-3166.jar-25-5841) A field experiment was conducted with a view to test the efficacy of Tricho-composts and integration of Tricho-composts, poultry refuse (PR), neem oilcake (NOC), saw dust burning (SDB) with chemical nematicide Furadan 5G (Carbofuran) for controlling root knot nematode of country bean through which growers will be benefited. The root-knot nematode infested soils were treated with Tricho-compost-1 @ 2 kg/pit, Tricho-compost-2 @ 2 kg/pit, Tricho-compost-1 @ 2 kg/pit + Furadan 5 G @ 20 g/pit, Tricho-compost-2 @ 2 kg/pit + Furadan 5 G @ 20 g/pit, poultry refuse @ 5-6 kg/pit + Furadan 5 G @20 g/pit , neem oil cake @ 500 g/pit + Furadan 5 G @ 20 g/pit and saw dust burning + Furadan 5 G @ 20 g/pit. It was revealed that all the treatments performed well in reducing root-knot nematode infestation and increasing plant growth and yield country bean compared to farmers’ practices. Among the treatments, integration of poultry refuse with Furadan 5G or Trichoderma based bio-fungicides Tricho-composts with Furadan 5G or neem oil cake with Furadan 5G are the best treatments in reducing root-knot nematode infestation and increasing plant growth as well as yield of country bean. Soil treatment with only Tricho-composts or integration of saw dust burning with Furadan 5G also performed better in reduction of root knot nematode disease and increasing plant growth as well as yield of country bean.

Retraction Note: Development of Biorational Management Package of Root Knot Nematode Disease of Country Bean

Challenger and Propose Novel Methods and Techniques for Prevention, Prognosis, Diagnosis, Imaging, Screening, Treatment and Management of Lung Cancer

Using samples of small cell lung tumors, a research team led by biologist Dr. Raymond discovered two new ways to induce tumor cell death. By activating ferroptosis, one of two subtypes of tumor cells can be targeted: first, iron-dependent cell death due to oxidative stress, and second, oxidative stress. Therefore, cell death can also be induced in a different way. Both types of cell death must be caused by drugs at the same time to eliminate the majority of the tumor mass. It is currently in clinical trials for cancer treatment. Auranofin, which inhibits the production of protective antioxidants in cancer cells, has been used to treat rheumatoid arthritis for decades. Future clinical trials using this combination therapy will determine the extent to which this targeted treatment option improves the prognosis of small cell lung cancer patients. It is currently in clinical trials for cancer treatment. Lung cancer is the leading cause of cancer death in the United States. Despite evidence of molecular abnormalities in biological specimens, progress in this disease is hampered by the lack of diagnostic markers useful for clinical practice. The majority of patients with lung cancer are still diagnosed at an advanced stage, when prognosis is poor. This article reviews new strategies being studied for the early detection of lung cancer. These strategies involve new methods of imaging (including low-dose computed tomography CT scanning), DNA analysis, and proteomic-based techniques. These strategies have not only improved our understanding of lung cancer but show promise in offering better survival to patients with this deadly disease. Of paramount importance in the search for methods of early detection is the need for the identification of the ideal population to screen, a multidisciplinary approach, and validation of promising techniques.

A Review of Attempts to Improve Cow Fertility Through Reproductive Management: Estrous Synchronisation

This review focused on the various methods for controlling estrous cycles in well-managed dairy cows. Because up to 70% of dairy cows may stay non-pregnant after an AI procedure, an effective approach for identifying and reinseminating open cows is essential for dairy herds to achieve optimal reproductive performance. Overall, well-managed dairy farms with effective estrus detection programs inseminate 50% or more of non-pregnant cows after behavioral estrus is detected. Cows not detected in estrus are admitted in a resynchronization of ovulation procedure to receive a timed AI (TAI) service to avoid a long interbreeding interval. In Egypt, a widely used program involves starting the Ovsynch protocol (GnRH-7 d-PGF2-56 h-GnRH-16 to 20 h-TAI) 32 days after an initial AI, regardless of pregnancy status. Previous studies have proven that there was no difference in pregnancy/artificial insemination (P/AI) between Ovsynch+P4 and Presynch-Ovsynch, both protocols were equally effective in improving the fertility of cows with a CL 15 mm. The review also addressed different methods for synchronization of ovulation and different factors affecting the selection of the management program.

The factors for Limited use of Gastric Emptying Scintigraphy in the Management of Diabetic Gastroparesis

A practice review discusses factors limiting the use of gastric emptying scintigraphy in diabetic gastroparesis, including protocols, access, and patient preparation, with suggestions to improve utility.

A Case Report on Challenging Management of Multiple Neoplasms in Elderly

Multiple primary malignancies especially in the head and neck region is no longer a rare occurrence and the prevalence is increasing. They were described as synchronous when the malignancies present within 6 months of another or metachronous tumors if the subsequent malignancy presents 6 months later. Many etiologies had been hypothesised including similar carcinogens exposure, genetic susceptibility and mutation, immunodeficiency or treatment of the index tumor. Among the hypotheses, the most accepted theory was field cancerisation in which the occurrence of multiple primaries in the aerodigestive tract was due to persistent exposure of similar carcinogens through inhalation or oral intake . However the co-incidence of thyroid and aerodigestive malignancies is relatively low. Hereby we would like to report a case of a 74 years old lady with known esophageal squamous cell carcinoma presented with metachronous laryngeal squamous cell carcinoma and papillary micro carcinoma of thyroid.

Risk Management and Organizational Resilience: Analysis of the Italian Scenario During Covid-19 Pandemic, with A Look at the Challenges of Technology and Sustainability

The Coronavirus emergency represents an epochal challenge for all world health organizations. In these times of profound destabilization of healthcare organizations, become urgent some thoughts on how to deal with the organization and re-engineering process as well as on concepts, relatively new, such as "resilience" and "business continuity". The company management need having to predict, design and plan a profound process of change in their Clinical and Corporate Governance. With the implementation of phases 2 and 3 of management of the pandemic and the coexistence of doctors and citizens with the new Coronavirus, it has become a priority to develop territorial models of assistance to established or suspected Covid patients, starting with the creation of monitoring networks based on the model of the “sentinel” general practitioner. One of the main concerns of Healthcare, since the beginning of the Covid-19 emergency has been to get closer to the citizen-patient. It is therefore necessary to find stimuli to restart with new methods of care, new health and social-health services, moving the current care paradigm for Covid-19 from the hospital to the territory, optimizing the constituent elements of the districts, primary care and general practice in a multidisciplinary approach.

Sustainable Municipal Solid Waste Management - A case study of Kanpur, India

Municipal solid waste generation and disposal is a problem not only in India but all over the world. Presently majority of such waste is being dumped indiscriminately over vacant lands causing problems of odor, methane generation leading to air pollution, leaching effect polluting ground water and runoff polluting water bodies. Technological options are available to treat this solid waste and convert it into usable products but the biggest problem is its segregation preferably at the source of generation or even at the disposal area. Municipal solid waste generated in India consists of 15 percent non biodegradable which has high calorific contents and can be converted into power generation. Remaining 85 percent is degradable which can either be converted into compost or bio fuels. Under the present context, sustainable municipal waste management strategy needs to be evolved and put in place with effective implementation to address the issue of environmental pollution. An attempt has therefore been made by the authors of the present paper to take up a case study of Kanpur, India for managing such wastes having sustainable approach. The authors have worked out trends of population starting from the year 1951 and projected to 2051. Similarly waste generation trends established on the lines of population. An effort has also been made as to how much compost, bio fuel and power can be generated along with economic value to make it sustainable on a time scale.

Management of Plastıc Bronchıtıs in Chıldren: A Case Report and Lıterature Revıew

Plastic bronchitis (PB) is a rare disease characterized by the presence of mucofibrinous plugs which may occlude and conform the shape of tracheobronchial tree. These casts are exteremely cohesive. Most common presenting symptoms include cough, fever and dyspnea and if the cohesive casts occlude the airway totally life-threatening complications and even death may occur. The aim of treatment is to remove the casts and adress the symptoms. In this study a 6-year-old boy with PB is presented. In addition to medical treatment obstructing casts were removed via rigid bronchoscope. It is aimed to review the clinical and radiographic features and choices of treatment in this disease.

Management of Fruit Flies Using Environmentally Safer Pesticide (Spinosad) in Shendi, Sudan

The fruit flies of familyTephritidae are considered as serious pests of Mango in Sudan. They cause substantial damage to Mango in all Mango production areas. The application of various pesticides appeared to be ineffective. Therefore, this study was carried out to investigate the efficacy of Spinosad as new promising control measure to the fruit flies. This study was carried out at Shendi area, River Nile State during the period from April 2012 to August 2014, where Pheromone and food bait traps were used for detection and monitoring the fruit flies species in the study area. Spinosad (0.24g\L) was applied as a partial spraying pesticide. Results indicated that; the application of Spinosad highly decreased the fruit flies numbers. The average number of fruit flies collected in April was (947.22 and 1001.67) for the treated and untreated orchards respectively. The numbers of fruit flies in the treated orchards had decreased gradually during May, June, July and August, 904.7, 760.22, 609.6 and 452.7, respectively, but in untreated orchards for the same months had increased to 1003.67, 1103.67, 1336.67and 1468.67 respectively. However, the infestation level in mango fruits in the treated orchards was found to be 2% compared with 64% for untreated one.

Patient Safety and Clinical Risk Management for General Practice

General practitioners are the first contact between the person, the family and the community with the health system. The philosopher and epistemologist K. Popper (1902-1994) recommended the need to register errors, in order to know them, catalog them and therefore prevent them. J.Reason in 1963 introduced the systemic approach to the study of errors with the theory of latent errors. The knowledge of the causal factors, or which in any case contribute, of possible errors, as well as of the latent gaps in the system, is a fundamental prerequisite for the construction of paths aimed at improving the quality of assistance, structures and organizational aspects.

Geoscience and Remote Sensing on Horticulture as Support for Management and Planning

The importance of horticulture around the large cities, called green belt (GB), or proximity food production area is related to its contribution to the provision of food as well as its role on social, cultural and ecological aspects. Geoscience and Remote sensing (GRS) are tools that should aid in gathering and updating the information to develop science-based management plans of this areas. Recently, the improvement in terms of spatial, temporal and radiometric resolutions has changed the performance and the approach to the horticulture remote sensing. In this work, we make a brief review on the literature exploring the use of GRS techniques in horticulture, and future trends in order to exploit the available techniques for efficient crop management in the way to improve territorial planning and management. Specifically we found a lack of academic production in this area. In addition we examine the importance of this landscape areas from different points of view (food security, health, ecology, etc.). A systematic revision of published studies on remote sensing on horticulture including different platforms, sensors and methodologies are briefly presented. Finally some aspect related with future trends are discussed.

Interdisciplinary Orthodontic and Surgical Management of Class III Malocclusion in Adult Patients

The treatment of class III malocclusion differs depending on the age of the patient. In adult patients, alternatives include either orthodontic dentoalveolar compensation treatment or a combined ortho-surgical approach. The aim of this paper is to present the orthodontic and surgical treatment of a 24 year old adult patient with increased anterior face height, a class III skeletal pattern and mandibular asymetry. Previous orthodontic treatment with removable appliances obtained a 1 mm overbite and overjet. Intraorally, class III molar relationship was observed, proclined upper incisors, retroclined lower incisors and a deviated lower midline. The main complaint was facial esthetics which required surgical intevention. After pre-surgical orthodontic preparation the maxilla was repositioned by a Le Fort I osteotomy and the mandible was set back using the Obwegeser-Dal Pont method. Final assesment revealed both functional and esthetic dentofacial results. A combination of orthodontic treatment and orthognathic surgery is often required in adult patients with dental malocclusion and skeletal discrepancies.

Knowledge and Practice for Bio-Medical Waste Management among Healthcare Personnel at Kabgayi District Hospital, Rwanda

Background Globally, about 10 to 25% of the volume of bio-medical waste from hospitals and healthcare institutions presents a serious health risks to patients, healthcare personnel, and anybody who comes in contact with it. The waste management practices in Rwanda healthcare facilities are poor and need improvement. Objectives To assess the knowledge and practices regarding bio-medical waste management among healthcare personnel at Kabgayi district hospital in Southern Province of Rwanda. Materials and Methods A cross-sectional study design was conducted. A total of 200 healthcare personnel were selected randomly out of 400 target population including doctors, nurses, social workers, and cleaners. Structured questionnaire was used to collect data. Descriptive analysis using frequency and proportions were used. Chi-Square test was used to determine the association between the variables and level of significance was set at p ≤ 0.05. Results The study found that about half (49.0%) of healthcare personnel had good knowledge about waste management. We found that the majority of healthcare personel 133(66.5%) had poor practices towards bio-medical waste management. The factors associated with good practice were better knowledge on bio-medical waste management (p=0.013) and older age group (p=0.001). Conclusion/Recommendations The level of in both knowledge and practice towards bio-medical waste management among healthcare personnel was low. Continuing education and training programmes and short courses on bio-medical waste management should be carried out to improve the knowledge and practices towards bio-medical waste management among healthcare personnel.

Resource Management Domains of Kharif and Rabi Season Fallows in Central Plateau Region of India: A Strategy for Accelerated Agricultural Development

Over last few decades, acreage of total fallow lands (Kharif and Rabi seasons) in India has remained almost unchanged around 25Mha. The acreage of Kharif (summer) and Rabi (winter) Fallows in Madhya Pradesh (MP) are 1.98Mha and 5.51Mha, respectively. In the semi-arid agroclimatic zones of the states, Fallow-Wheat/Gram/Indian-Mustard cropping systems are practiced. After harvest of Kharif rice, kodo-kutki, maize or sorghum, farmers generally practice post-rainy season Rabi fallows in the sub-humid regions, south of Narmada River. Kharif fallowing is largely the result of the inability of the farmers to make planting dates independent of monsoon forecasts, and make efficient use of rain water. It appears that factors responsible for Kharif and Rabi fallows are distinctly different and a general consequence of distinctly different soil moisture regimes prevailing in the two crop seasons. Kharif and Rabi fallows have two distinct resource management domains. Whereas, Kharif fallows can be tackled with “PMP-dry seeding” agronomy, production constraints of Rabi fallows can be substantively tackled by shifting from tilled to zero-till agriculture with residue management to make efficient use of the conserved rain water. Some irrigation support will prove useful to tackle mid-season droughts in both situations. Conservation agricultural practices can significantly improve and stabilize crop yields in black soils and other associated soils of in the semi-arid tropics region of the Central India.

Surgical Site Infection in Cesarean Section Operation: Risk and Management

Cesarean sections (CS) are one of the most commonly performed surgical procedures worldwide. There is great variability in the percentage of cesarean sections between countries, varying from 3% to 42.9%5. In the US, approximately 32% of deliveries occur through a cesarean section. Overall, a drastic increase in cesarean section rate has been reported reaching its highest level at the present time. In Brazil, considering the types of births by live births from 2006 to 2016, the national percentage of cesarean section was 52.37%. The variability in this percentage can still be perceived within Brazilian territory. The highest cesarean rate occurred in the Southern region, representing 58.33% of births, while the lowest rate occurred in the Northern region, with 41.79%. It is possible to see the steady increase in the percentage of CS over time, from 45.01% in 2006 to 55.39% in 2016.

High-Resolution SD-OCT and EDI-OCT in the Evaluation and Management of Multifocal Serpigenoed Choroditis

Purpose To describe spectral domain optical coherence tomography (SD-OCT) and enhanced depth image OCT (EDI-OCT) findings of multifocal serpiginoid choroditis (MSC) , including affected layer of retinal involvement, changes at the vitreoretinal interface, and response to therapy. Methods A retrospective review of 20 eyes (14 patients) with MSC. Each patient underwent a complete ophthalmologic examination, fundus photography, fundus autoflorecence (FAF) and OCT imaging of the affected retina at the initial visit and on each follow-up. Results In acute stage, SD-OCT showed hyperreflective areas involving the outer retinal layers which include retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with choroidal and intraretinal layer cells infiltrate. EDI-OCT showed increase choroidal thickness. As the lesions began to heal, irregular, knobby elevations of outer retinal layers appeared (RPE, POST, IS/OS junction, and ELM could not be distinguished) with significant decrease in choroidal and intraretinal cells. On complete healing, loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan and absent of the choroidal and intraretinal cells and continous hyperreflactivity of the choroid (increased penetrance). Conclusion SD-OCT and EDI-OCT provides high-resolution detail regarding ultrastructural changes in vitreoretinal interface, outer retina and choroid during the course of the lesion. Serial SD-OCT and EDI-OCT also provides further insight into response to therapy by observing choroidal and intraretinal cells.

Geomatic Tools for Water Management in a Community Irrigation System, Cruz del Eje, Córdoba.

An integral and efficient management of water for irrigation requires the adoption of new technologies to respond to the challenges imposed by the agricultural sector, in particular to stabilize production through the adequate use of water resources. In this sense, it is vital to characterize and know the amount of area which is under irrigation in such agricultural systems. In this paper we show the use of satellite information data in a GIS environment with the objective of characterizing the productive areas under irrigation in Cruz del Eje, Córdoba, Argentina in 3 types: A) irrigation region B) irrigable area and C) actually irrigated area. Multitemporal image indices and segmentation were used for this characterization and then maps of these 3 types of agricultural land cover were generated. Additionally, we present simple satellite images processing and classification procedures to increase the knowledge about the land cover over this irrigated area. Finally, we discuss how this geographically explicit information generated could be useful for the decision-making process on current irrigated areas and on the potential of productive systems through community irrigation systems.

Design Support to steer Creative Wicked Problem Solving Processes with Knowledge Management and Artificial Intelligence

As the complexity of building tasks and requirements increases, designers often find themselves confronted with interdisciplinary problems that go beyond the specific challenges and methods of architecture. The iterative nature of the design process results in a continuous exchange between creative, analytical and evaluative activities, through which the designer explores and identifies promising design variants. The ability to compare and evaluate relevant reference examples of already built or designed buildings helps designers to assess their own design and informs the design process.

Insight into Management Issues modeling for Perfect Business Simulation

In this paper, I try to focus on widely growing field of Management Science; and that, “Modeling of Management Issues “. Now days Business Simulation techniques are used to earn more profit from Business and this is only issues control future course of actions properly. By using models we can predict & control future course of action & situation. Modeling is not a new subject. It’s oldest technique, but widely used in Physical Sciences, like Chemistry, Physics, Electronics, Engineering field, But it’s again become vital after some time in Life Sciences, like Botany, Zoology, Bio-Chemistry, Bio-Tech and Medical field problem modeling and now in current world it’s also become very vital in Information Technology and Management subjects. Here one question is always arise, why such a modeling is needed, and where and when needed, and answer of this simple question is, considering some simple problems like ‘ to find out the width of a river (But your are not allowed to cross it), find out the temperature (but you are not allowed to use thermometer), means try to find out any Quantity or parameter/variable without existence or entity of that, and if virtual situation satisfied by using modeling technique, we implement that virtual model for actual situation. In last I want to conclude modeling is the heart of any branch of Education, weather its science, Arts, Commerce, Medical, Information Technology, Engineering or Management and in summaries form I want to say this paper is nothing but one of the theoretical model, which is for modeling of Management issues for perfect Business Simulation.

Health Literacy and Osteoarthritis Self-Management

Background: Osteoarthritis is a disabling joint disease with no known cure that negatively effects life quality among high numbers of aging adults. Aim: To examine the concept of health literacy as a potentially overlooked, but highly salient, disease correlate among this older chronically disabled group. Method: A literature search using the key terms osteoarthritis and health literacy was conducted using the major data bases. Results: Although almost no work has focused on health literacy and osteoarthritis, the concept of health literacy is clearly linked to health status and health outcomes. Varying from marginal to high, health literacy is not always assessed or recognized as being clinically relevant, however, despite a large volume of related literature. Conclusion: Acknowledging the possible role of limited health literacy in the context of osteoarthritis disease progression, and applying carefully tailored directives for overcoming any related health literacy limitations may offer a novel approach for improving the outcomes for older people with this condition.

Skills Required to Head Physician for the Management of Staff. Emotions in the Organizational Context

This short paper aims to identify the key skills required for personnel management that makes it possible a peaceful business climate and a level of excellence in services rendered. Are analyzed particularly emotional skills like e.g. mindfulnessa

The Efficacy of Behavior Management for Depression in Dementia Patients: A Systematic Review and Meta-Analysis

Overview: Dementia is a serious brain disease that impacts negatively in several areas of patient’s functioning. Depression has a strong link with dementia and is part of the behavior and psychological symptoms (BPSD). Behavior management for depression is recommended as a first-line psychological treatment for dementia patients. However, there are no systematic reviews examining the efficacy of behavior management for depression in dementia. Objective: To examine the efficacy of behavior management (BM) for depression in dementia patients. Methods: Five electronic databases were searched (1999 to 2015) for randomized controlled trials (RCTs) which were selected according to eligibility criteria. Data was pooled, quality assessment was completed, and a meta-analysis was performed. Results: This review included ten randomized controlled trials. In the four studies where behavior management was a focused intervention, no significant treatment effect was observed (standardized mean difference SMD -0.20; 95 % CI -0.96 to 0.56). In the remaining six studies in which behavior treatment was involved as a component, the analysis showed a trend favored the intervention, but it was not significant (SMD -0.12; 95 % CI -0.25 to 0.01). Conclusion: There is no evidence for behavior management alleviating depression in dementia patients. Future research examining the efficacy of specific behavior management techniques for milder forms of dementia and multimodal interventions are recommended.

Management of Arthrofibrosis of the Knee after an Arthroscopic Meniscectomy with Paralytic Shellfish Poisoning Toxin. Case Report.

Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.

New Pain Management Procedure after Total Knee Arthroplasty: Gonyautoxins are Safe and Effective after A Single Intra-Articular Infiltration

Objective To evaluate the effect of a single intraarticular dose of Gonyautoxins for pain control after Total Knee Arthroplasty (TKA). Subjects 30 consecutive patients with osteoarthritis with Kellgren & Lawrence level of two or more, who required TKA, were enrolled. Methods Subjects receive a single intra-articular infiltration of 40 µg dose of Gonyautoxins, immediately after TKA wound closure. The pain was measured with the Visual Analog Scale (VAS). Additionally, the range of motion at 12, 36, and 60 hours and hospital stay length were recorded. Results were compared to the 2014 TKA cohort. Results 25 patients (83.33%) achieved successful pain management. All patients achieved complete flexion ≥90° 60 hours after surgery and 24 patients achieved full extension before hospital discharge. The median VAS pain score for each evaluation period was ≥2. The 25 Gonyautoxins treated patients who achieved successful pain management had a median VAS pain score of 0 after 36 and 60 hours. Conclusions Gonyautoxins are safe and effective in pain management after TKA when used as a single intra-articular dose. This protocol shows adequate pain control in TKA, reducing discharge to 3 days and greater range of motion, improving the post-operated patient experience.

“That Which is Measured Improves”: A Theoretical and Empirical Review of Self-Monitoring in Self-Management and Adaptive Behavior Change

Current psychological treatment approaches that rely on time-intensive, face-to-face psychotherapy are not capable of meeting the demand for mental health services. Mental health interventions that promote self-regulation and self-management of symptoms will play an increasingly important role in the well-being of millions of individuals. Self-monitoring is a core assessment and intervention component of many mental health interventions and an obligatory first step in the self-regulation process. The present paper reviews prominent theories of self-regulation and describes classic studies spanning clinical, social, cognitive, and personality psychology, which identify potential mechanisms underlying self-monitoring. At the empirical level, we describe the use of self-monitoring across a range of behavioral interventions directed at mental health and physical outcomes, identify factors that influence the effects of self-monitoring, and suggest ways in which technology can be incorporated into these interventions to improve the reach of psychological interventions.

Biopsychosocial Path Model of Self-Management and Quality of Life in Patients with type 2 Diabetes

Objectives: The present study investigated biopsychosocial predictors (HbA1c, self-efficacy, and social support) of self-management and health-related quality of life among patients with type 2 diabetes. Methods: 160 adults referred to the Iranian Diabetes Society participated in this study. Participants completed General Self-Efficacy Scale, Perceived Social Support, Diabetic Self-care Behaviors scale, and D-39 (diabetics’ quality of life). Results: Data were analyzed with SPSS-19 and Lisrel 8.8, utilizing statistical path analysis. Results revealed significant positive correlations between self-efficacy and social support subscales, self-care and health-related quality of life. Also, HbA1c had not correlation with HRQOL. The final path model fitted well and showed that direct self-care paths with (β = 0.24) and indirect social support with (β = 0.32) had the most effects on health-related quality of life. Conclusions: The results confirmed the theoretical model and scientific evidence for providing psychological solution to promote quality of life in patients with type 2 Diabetes.

Epidemiology and Management of Seasonal Influenza Outbreaks in Long-Term Care Facilities in the Health Service Executive East Area of Ireland During the 2013-2014 Influenza Season.

We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.

Medical Management of Sexual Assault Survivors at an Academic Medical Center

Sexual assault is a serious problem in the United States. It is crucial that the medical management of these patients is adequate. The Centers for Disease Control and Prevention (CDC) provides guidelines for appropriate management of these patients. The purpose of this study is to evaluate medical management of survivors of sexual assault at an academic medical center and identify opportunities for improvements in care. We conducted a retrospective, chart review study of patients aged 12 years and older presenting at an academic medical center following sexual assault or rape between 2009 and 2013. Descriptive statistical tests were used to analyze the data. A total of 29 females and 5 males were identified. The majority of patients presented to the medical center within 24 hours of sexual assault or rape and typically presented to the emergency department. Empiric treatment for infections were 8.8% for Hepatitis B, 29.4% for human immunodeficiency virus, 20.6% for gonorrhea, 17.6% for chlamydia, and 8.8% for trichomonas. Among women of reproductive age, 28.0% were provided with emergency contraception. This study found inconsistency in the medical management of sexual assault survivors. Among this small sample size, many patients were not provided with recommended medical treatments. With this knowledge, the medical center plans to implement institutional guidelines and a corresponding order set in the computerized prescriber order entry system to standardize the medical management of sexual assault survivors and educate healthcare professionals. Future studies are warranted to evaluate the impact of standardized guidelines and order set implementation.

Management of Locally Advanced and Metastatic Pediatric Nasopharyngeal Carcinoma. Experience of Children Cancer Hospital – Egypt

Background. Nasopharyngeal carcinoma (NPC) is a rare disease in the pediatric age group; it represents 1% of all pediatrics malignancies, however, it is the predominant malignancy arising in the nasopharynx in this age group. Although NPC is a chemo-radiosensitive disease yet, the optimal dose of radiotherapy and optimal timing of chemotherapy is still not standardized. Methods. This is a retrospective study including all the newly diagnosed pediatric NPC who were diagnosed and treated at the Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to December 2012. All imaging studies (e.g., CT or MRI scans) were reviewed by a senior head and neck radiologist for proper staging and assessment of tumor response. Patients were staged according to AJCC staging system. Modified version of the Response Evaluation Criteria in Solid Tumor (RECIST) was used to assess response. Results. Twenty-six patients were diagnosed and received treatment as NPC in CCHE. Median age was 12 years (range 7.8-17 years). There was a male predominance. Eleven patients (42.3%) were stratified as stage 4, and 11 (42.3%) as stage 3. All patients received 3 cycles of neo-adjuvant chemotherapy followed by concurrent chemo-radiotherapy. IMRT was used to deliver radiotherapy in all patients. The overall response rate (CR and PR) to induction therapy was 73%, 19.3% had SD, while 7.7% had PD. By the end of the study, 18 patients (69.2%) were alive in CR, 5 patients (19.2%) had PD, and 3 patients (10%) lost for follow up. The Mean duration of follow up was 35 months, range 5-66 months. The 3 year OS and EFS and rates were 84.6% and 69.3 % respectively. OS for M0 was 91.3% and for M1 33.3% with statistical significance (p =0.032). Conclusion. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy using IMRT lead to good clinical end results with limited toxicity. Metastatic disease at presentation was identified as the adverse prognostic factor.

Management of Absent Capsular Support with a new Intraocular Lens Design

Purpose: To describe a new intraocular lens that can be implanted in case of rupture of the posterior capsule and lack of capsular support. Methods: This experimental study was carried out on ten Flanders rabbits. The right eye of each rabbit underwent intra capsular lens extraction and two peripheral iridectomies, and the new lens was implanted with an optic rest in the posterior chamber. Additionally, the haptics rest in the angle of the anterior chamber through peripheral iridectomies. Main outcome measures were lens stability inside the eye and complications regarding this technique. Results: Intraocular lenses remained in a stable position with only a mild inflammatory reaction; four eyes developed hyphema that disappeared 10 days after surgery. Conclusion: The new lens design has good intraocular stability when posterior capsular support is absent and only produced minimal inflammation inside the eye.

Haematological Disturbances in Dengue Haemorrhagic Fever - its Pathogenesis and Management Perspectives

Haemorrhage is common to both dengue fever (DF) and dengue haemorrhagic fever (DHF). Thrombocytopaenia is exceedingly common, while prolonged partial thromboplastin time and reduced fibrinogen concentration are the other abnormal haemostatic indices evident from early in the disease course. These haematological abnormalities correlate better with the timing and severity of plasma leakage rather than the clinical haemorrhagic manifestations. Blood products including prophylactic platelet transfusions are hardly required in the management of DHF. Judicious fluid therapy is the most effective intervention to prevent complications and bleeding in DHF. Concealed haemorrhage is an important complication requiring early recognition and blood transfusions to improve outcomes. Understanding the pathogenesis of coagulopathy and the significance of altered haemostatic indices, and its co-relation to disease severity and phase of DHF, is essential for appropriate interventions particularly when DHF co-exists in patients on mandatory anticoagulation for prosthetic heart valves and atrial fibrillation.

The Potentials of Antioxidant Micronutrients in the Management of Metabolic Syndrome

There is increasing evidence of the prevalence manifestations of metabolic syndrome worldwide. Metabolic syndrome is a cluster of abnormalities characterized by hypertension, central obesity, insulin resistance, endothelial dysfunction, dyslipidemia and oxidative stress. All these alterations predispose individuals to type 2 diabetes and cardiovascular disease that are major contributing factors to earlier mortality among people. The investigation of food nutrients that could reverse the features of metabolic syndrome is an important aspect for dietary-based therapies that may ameliorate the burden of the disorder. Antioxidant micronutrients are of great interest due to the recent described association between obesity, cardiovascular alterations and oxidative stress. These antioxidant nutrients are also being considered in the management of metabolic syndrome due to their potential benefits on hypertension, insulin resistance and hypertriglyceridemia since growing evidence has emerged that point to a causal link between oxidative stress and metabolic syndrome. Thus, dietary antioxidant supplements could have favourable effect on the attenuation and prevention of the manifestations of metabolic syndrome traits. Therefore, the present review focuses on the importance of antioxidant micronutrients in the treatment and management of metabolic syndrome.

Conjunctival Resection for Mooren's Ulcer Refractory to Medical Therapy: A Case Report

Purpose To report a rare case of Mooren’s ulcer in a healthy young male without systemic autoimmune disease, and to highlight the effectiveness of conjunctival resection as therapy for cases unresponsive to medical management. Case report A 34-year-old immunocompetent male presented with progressive peripheral corneal ulceration in the left eye. Extensive systemic and infectious evaluations, including rheumatologic, immunologic, and microbiological testing, were unremarkable. Human leukocyte antigen genotyping was DR17(03)-negative and DQ2-positive. Rheumatological evaluation yielded no definitive systemic diagnosis. Despite immunosuppressive therapy with adjuvant medications, the epithelial defect and stromal inflammation persisted. The patient underwent conjunctival resection, resulting in marked reduction in inflammation, rapid re-epithelialization, and structural stabilization of the cornea. Histopathology of excised conjunctiva showed nonspecific inflammation without granulomatous changes, vasculitis, or neoplastic features. During follow-up, patient remained in remission with visual acuity preserved at 6/6 bilaterally and no recurrence. Conclusion Mooren’s ulcer is rare but vision-threatening. Early recognition, comprehensive evaluation, and timely surgical intervention can be vision-saving. This case highlights the role of a multidisciplinary approach and supports conjunctival resection as a useful adjunct in refractory disease. Long-term follow-up is essential.

Integrating Analgesic Doses and Pain Trend Analysis: A Novel Clinical Support System

Background Prescribing appropriate analgesics with optimal dosages based on patients' pain severity is challenging, especially when multiple painkillers are involved. Tracking and analyzing the effectiveness of analgesics and their dosages over time is crucial for pain management. Existing systems lack the ability to integrate analgesic equivalent doses with temporal trends in pain scores, hindering effective decision-making. Methods We developed a Clinical Support System that calculates the daily oral morphine equivalent dose and analyzes trends in consumed equivalent doses of analgesics. The system provides a graphical user interface that displays medication prescriptions, actual medication usage, and pain scores. It offers features such as correlating analgesic drug usage with pain intensity, trend analysis of analgesic drug usage and pain intensity, and identification of effective oral morphine equivalent doses. Results The system overcomes previous barriers in drug analysis by providing real-time calculation of oral morphine equivalents and trend analysis of pain duration. It assists physicians in prescribing appropriate and safe medication dosages, enhancing medication safety for patients. Conclusions Our clinical support system offers a comprehensive solution for analyzing trends in consumed equivalent doses of analgesics. It integrates medication prescriptions, actual usage, and pain scores, providing decision-making support for pain management.

Toward Better Care for Sickle Cell Disease in Nigeria: A Review of Challenges and Interventions

With more than 150,000 affected infants annually, Nigeria bears the largest burden worldwide of sickle cell disease (SCD), making it a significant public health concern. The management of SCD in Nigeria is challenging, despite advancements in medical research and increased knowledge. This review examines the numerous issues surrounding SCD in the nation, including the financial burden on affected families, the lack of specialized care facilities, the absence of newborn screening programs, the sociocultural stigmatization of SCD, and restricted access to high-quality healthcare. Additionally, inadequate public health education and a lack of coordinated national policies result in delayed diagnosis and suboptimal treatment outcomes. We also highlighted recent efforts and recommendations aimed at improving early detection, comprehensive care, and community support. Addressing these challenges through expanded health education and enhanced healthcare infrastructure is essential to reducing morbidity and mortality associated with SCD in Nigeria.

Potential use of Ginger (Zinger officinale Rose) Extracts as Biopesticide against Myzuspersicae Sulzer (Hemiptera, Aphididae) on Pepper Crops

Chemical insecticides have been the primary method used by farmers to control pests. However, their negative environmental impacts, harmful effects on beneficial insects and human health, and prohibition in organic farming systems have driven the search for natural alternatives with insecticidal properties. These alternatives provide a safer and more sustainable way to control insect pests. Medicinal plants and their constituents play an important role in pest management. For example, ginger (Zingiber officinale) extracts contain bioactive compounds with insecticidal activities. The objective of this work was to track the population of the green peach aphid (Myzuspersicae) on pepper crops in a greenhouse, identify the active ingredients in ginger extracts, and evaluate the insecticidal effects of three concentrations of ginger-derived aqueous and essential oil extracts against M. persicae on pepper plants under laboratory and greenhouse conditions. The results demonstrate that M. persicae grows rapidly on pepper crops under greenhouse conditions, reaching high densities on leaves. The ginger extract contains two active ingredients with insecticidal effects against this pest. The significant reduction in aphid (M. persicae) populations indicates that Z. officinale aqueous extract (150 mL/L) and essential oil (2 mL/L) have strong potential for the biological control of this pest under greenhouse conditions. Thus, the use of ginger plant extract emerges as a promising alternative for reducing M. persicae infestations on pepper plants.  

Efficacy of Neemraj and Beauvitech on Abundance and Distribution of Arthropod Pests in Soil and Hydroponically Grown Strawberry

Strawberry is a commercially important crop which has gained global significance in terms of production and consumption. The strawberry farmers have been faced with economic losses due to attack from arthropod and phytophagus pests. To overcome this challenge, management of pests is important with reduced impact on beneficial organisms and the environment. Use of non-chemical approaches as an alternative to insecticide driven management is highly gaining popularity. Identification of the non-chemical production for management of strawberry pest such as entomopathogenic fungi and botanicals is critical. The need for compatibility of entomopathogenic fungi in crop production techniques with other insecticides to enhance efficacy is required. The interaction between these control agents could be synergistic, additive or even antagonistic. Synergistic interactions usually lead to enhanced effectiveness of the microbial control agents while reducing the adverse effects of the pesticides in combination. In this review a description of the compatibility of entomopathogenic fungus Beauvaria bassiana and botanical neem in strawberry pest management is given. The experiment involved five treatments: Neemraj, Beauvitech, Neemraj and Beauvitech, Ampligo and control. These treatments were allocated in a completely Randomized design in two separate greenhouse setups one with soil and other with pumice. The treatments were replicated four times. The data was subjected to analysis of variance (ANOVA) using the general linear model (GLM) procedure of the statistical analysis system (SAS) program, version 9.1. Tukey’s (HSD) test at P≤ 0.05 was used to separate significant means. The combination of Neemraj and Beauvitech was most effective in the management of pests in both hydroponics and soil grown media. Pest populations were reduced significantly as follows; thrips, Frankliniella spp 2.1, red spider mites Tetranychus species 11.5, tarnished plant bug Lygus species 3.0, there was 0% cricket Gryllus species damage and 0 number strawberry weevil in hydroponics cultures while in soil culture pest mean populations were: thrips 5.6, spider mites Tetranychus species 18.2, strawberry weevil (Otiorhynchus species) 7.0, tarnished plant bug 3.0 and there was 13.8% cricket Gryllus species damage on strawberry plants.

The Journey from Personalized Medication to Customized Nutrition

The journey from personalized medicine to customized nutrition represents a significant paradigm shift in healthcare, emphasizing the holistic method for a person's or girl's well-being. in this transition, the know how of the unique genetic makeup , metabolic profile, and way of lifestyles elements of everybody will become paramount. customized medicinal drug has long centered on tailoring scientific remedies to the genetic and physiological traits of sufferers, optimizing efficacy, and minimizing detrimental effects. Now, custom-designed nutrients increase this idea further, recognizing that weight reduction plays an essential function in health and disease prevention. Key to this evolution is the mixing of advanced technology together with genomics, metabolomics, and microbiomics, allowing the suitable identification of dietary styles and nutritional requirements tailored to a person's particular desires. This summary explores the trajectory of this adventure, highlighting the pivotal characteristic of interdisciplinary collaboration among healthcare professionals, nutritionists, and researchers. With the useful resource of leveraging slicing facet generation and records-pushed strategies, personalized vitamins keep the promise of revolutionizing knowledge we method nutritional interventions, moving some distance from generalized guidelines towards targeted strategies tailored to all people's precise organic make up and way of life. expertise, traumatic conditions which include accessibility to this technology, ethical issues, and the desire for sturdy, proof-primarily based practices remain. In conclusion, the shift from customized treatments to personalized nutrient expertise is a transformative generation in healthcare, empowering people to take proactive management of their health through tailor made nutrition interventions. This summary underscores the importance of endured studies and collaboration in figuring out the entire functionality of personalized vitamins in selling health and well-being.

Water Quality Analysis on Public and Household Water Sources – A Case Study of Sunyani-West District, Fiapre

Access to potable and quality water in most rural communities is low such that over 2.2 billion people worldwide are negatively affected. The increasing population in Fiapre and the inconsistent water supply by the Ghana Water Company Limited (GWCL) have forced most residents to resort to alternative groundwater sources such as boreholes, wells, etc. Yet, many residents use these sources of water unaware of the quality of the water and its potential health implications. This study assessed drinking water quality in Fiapre by calculating its Weight Average Water Quality Index (WAWQI) and investigating potential risk factors associated with contamination through a cross-sectional study and laboratory analysis of various physicochemical and microbiological water quality parameters. WAWQI was used to compute parameters using 10 factors including pH, electrical conductivity, temperature, TDS, phosphate, chloride, total hardness, nitrate, alkalinity, and faecal coliform. The findings revealed that the pH level of water, phosphate concentration, and fecal coliform count surpassed the recommended thresholds set by the World Health Organization (WHO) for safe drinking water. Although levels of electrical conductivity, TDS, nitrate, total hardness, and chlorine kept changing from one water source to another, the difference was not significant apart from phosphate and fecal coliform which shows a significant difference between the sachet water sources and other water sources (P<0.05). The study outcomes demonstrated that the overall water quality is predominantly categorized as good to fairly good, with the highest Water Quality Index (WQI) value reaching 87.84% and the lowest recorded at 54.81%. Therefore, to improve the water quality in the municipality, local management agencies should pay attention to the microbiological quality of the water sources. The study recommends regular handwashing practices, hygienic surroundings of the water source, and drinking water treatment to reduce the possible risk factors associated with the contamination of the water sources.

Monitoring of Insect Species Richness and Abundance in Sudan Semi-arid Ecosystem (Case study: Khartoum State/Sudan)

Sudan's ecological landscape is characterized by various zones, including deserts, semi-deserts, and savannas, which host a diverse array of forests, rangelands, and numerous plant and animal species. However, the sustainable management of these resources is becoming increasingly challenging due to human activities and the impacts of climate change. This article presents the results of a research project focused on monitoring and documenting biodiversity in Sudan's semi-arid regions, particularly emphasizing insect diversity. Insects are vital for maintaining ecosystem health through processes such as nutrient cycling, decomposition, pollination, and acting as natural predators to pests. Field surveys were conducted across three Sudanese states—North Kordofan, Gezira, and Khartoum—to assess the diversity of flora and fauna. Specifically, El Rawakeeb semi-arid land in Khartoum state was investigated, which comprised three sites with varying soil elevations: a hilly site at 420 meters above sea level, a flat site at 416 meters, and a valley site at 411 meters. Researchers utilized direct collection methods and butterfly nets to gather insect specimens, which were subsequently preserved and identified for further analysis. Diversity indices, including Simpson’s Diversity Index, Shannon-Wiener Index, and Margalef Richness Index, were computed to compare the biodiversity of these sites, along with metrics for evenness and species richness. Permanova analysis was carried out for insect variation between the study sites. A total of 1541 insect specimens were gathered from El Rawakeeb, encompassing 34 species distributed across 21 families and 9 orders. The order Lepidoptera exhibited the greatest number of species (35.29%), followed by Coleoptera (20.59%). The orders Neuroptera, Orthoptera and Thysanoptera recorded the fewest species (2.94% each). From the hilly site, 514 insect specimens were collected, representing 9 orders, among which Hymenoptera included 4 species, while Lepidoptera had 3 species, and Odonata, Orthoptera, and Thysanoptera each had 1 species. The highest individual counts were recorded for Copriniklobe (dung beetle), Dacus longistylus (fruit fly), Camponotussp. (carpenter ant), and Anax ephippiger (dragonfly). In a flat site, 484 insect specimens were collected, classified into 15 species, 12 families, and 7 orders. The highest individual counts were noted in four species: Onthophagusnuba (dung beetle), Dacus longistylus (fruit fly), Camponotussp. (carpenter ant), and Anax ephippiger (dragonfly). In a valley site, 543 insect specimens were collected, categorized into 17 species, 16 families, and 9 orders. Insect Diversity in three research sites. Simpson's Diversity Index revealed varying levels of insect diversity across the three sites. The valley site exhibited the highest diversity level with an index score of 0.857, followed by the flat site at 0.826, and the hilly site at 0.819. The Shannon diversity index of 2.22 indicated the highest diversity among the three sites, suggesting a relatively diverse insect community. The relative abundance of insects was greatest in the valley site at 35.24%, followed by the hilly site at 33.35%, and the flat site at 31.41%. The Margalef Richness Index indicated a moderate level of richness in the insects collected from the three locations. Certain insect species were found in some sites but were absent in others. The PERMANOVA revealed notable variations among the three study sites (F = 2.24, p-value = 0.035).

Diagnostic Performance of Smear Microscopy and Xpert MTB/RIF Versus MGIT Culture in Republic of Congo

In the Republic of the Congo, tuberculosis (TB) remains a major public health concern. Although the GeneXpert MTB/RIF assay is the WHO-recommended first-line diagnostic test, smear microscopy is still used for treatment monitoring and in facilities where molecular testing is limited. Evaluating the diagnostic accuracy of smear microscopy compared to GeneXpert and MGIT culture is essential to guide diagnostic strategies and strengthen TB control in the country. A cross-sectional study was conducted among 92 presumptive pulmonary TB patients at Makelekele Hospital. Sputum samples were analyzed by smear microscopy, GeneXpert MTB/RIF, and MGIT culture. Sensitivity, specificity, positive and negative predictive value were calculated for smear microscopy and GeneXpert, using culture as the reference standard. Culture detected more Mycobacterium tuberculosis than microscopy (49% vs. 32%, P<0.001). Smear microscopy showed a sensitivity of 58% (95% CI: 43–71%) and specificity of 92% (95% CI: 80–97%). GeneXpert detected more MTB (62% vs. 49%, P<0.001) with a sensitivity of 98% (95% CI: 89–100%) and specificity of 72% (95% CI: 58–83%). GeneXpert showed superior sensitivity for TB detection, while microscopy remained specific. Expanding GeneXpert testing across the Republic of the Congo will improve TB management.

Vulnerabilities in Environment and Health Due to Climate Change and Extreme Hydrological Events: Determinants for Risk Reduction

This short communication/mini-review immensely emphasizes human health to explicate and elucidate management of the global scourge associated with the determinants and impact of vulnerabilities to extreme hydrologic events and climate change in the absence of risk reduction and their concomitant sequelae. The most effective approach for risk reduction associated with biodiversity, environmental, and health vulnerabilities due to climate change and extreme hydrological events, an ecological framework must take into cognizance exposure, vulnerability, and resilience. This framework emphasizes the significance of understanding the inextricable linkage between ecosystems and human communities are exposed and susceptible to hazards, sensitivity to these hazards, and capacity to cope, adapt and recuperate. Risk reduction incorporates structurally attenuating exposure, strengthening resilience, and sustainably enhancing overall vulnerability management. Extreme weather and climate-associated incidents impinge on human health with consequential morbidity, mortality and socioeconomic challenges and constraints. Climate change and extreme event have altered the frequency, intensity, geographic distribution, and propensity as drivers for change in the future. The indicted variables include hydrological events, such as precipitation, floods and droughts as well as heat waves, wildfires, global warming, extreme temperatures, and hurricanes. The pathways inextricably-linked with extreme events to economic dissipation, human health prognosis and outcomes remain inexplicably diverse and complex; and thus, difficult to predict due to their emergence and reemergence from local, societal and environmental factors which influence disease burden.

Effectiveness of The Luo Yuan Technique in Patients with Hyperuricemia, Case Report

Significance This case report describes the alternative management of hyperuricemia through acupuncture using the Luo Yuan technique. Case presentation A 53-year-old Mexican man was diagnosed with secondary hyperuricemia. The patient began to experience arthralgia in the metatarsophalangeal joint of the first toe on his left foot after consuming a high amount of purine-rich foods, with a 10-year history. The symptoms were sporadically controlled with the use of colchicine and indarzone. In a six-element blood chemistry test, serum uric acid was 8.7 mg/dL before acupuncture treatment and 8.3 mg/dL at the end of treatment, without applying dietary restrictions on purine consumption. Conclusions and relevance This report demonstrates the potential efficacy of acupuncture at the Luo and Yuan points of the Spleen and Stomach meridians in reducing elevated blood uric acid levels. This suggests its potential as an alternative treatment for patients with hyperuricemia and other metabolic disorders.

Artificial Intelligence in Healthcare: Enhancing Efficiency, Ensuring Equity, and Restoring Empathy

Artificial Intelligence (AI) is emerging as a transformative force across many sectors, with healthcare representing both one of the most promising and most challenging areas of application. This review summarizes current and future applications of AI in healthcare, focusing on its potential to improve diagnosis, therapy, chronic disease management, and overall patient care, while also alleviating physicians’ workload. Recent literature demonstrates that AI systems can reduce diagnostic errors/delays by mitigating cognitive biases, support imaging and pathology through improved accuracy and speed, and prevent prescribing errors by integrating pharmacogenomic and clinical data into decision-support systems. In chronic disease management, AI-powered wearable devices enable continuous monitoring and early detection of conditions such as atrial fibrillation, thereby reducing the risk of stroke and long-term disability, particularly in elderly people. Therapeutic applications include AI-driven drug discovery, personalized oncology, and tailored medicine that integrates multi-omics and lifestyle data. Beyond direct medical intervention, AI contributes by automating routine tasks, optimizing workflows, and facilitating greater patient–clinician interaction. Despite these benefits, significant challenges remain, including issues of data quality, privacy, security, equity, and the need for transparency and trust in “black box” systems. Looking ahead, the integration of multimodal data, digital twins, and robotics is expected to advance more comprehensive, equitable, and human-centered care. We conclude that, when applied ethically and responsibly, AI should not replace clinicians but rather serve as a powerful partner that enhances medicine by restoring empathy and humanity.

Extended Bioethics as a Response to Global Biological Consciousness

Humanity is persistently threatened by global pandemics- exemplified by the Black plague, the Spanish flu, and COVID-19, which reveal a continual absence of concern in real-time prevention. To forecast biological threats in the future and spur proactive human response, the term Global Biological Consciousness (GBC) is introduced.GBC requires an Extended Bioethics, a dynamic ethical framework for conscious management mediated by GBC. This perspective will enable preventive actions and will seek global biological resilience through the algorithmic responsibility of AI and systemic justice, as will be explained in the work. The GBC, through Extended Bioethics, will provide an ability to analyze biological data as it occurs using AI and quantum computing, expect outbreaks before they happen and attenuate their effects, here creates a new ethical contract for all humankind as they co-exist in a biological world.

Impact of Agricultural Land Use Practices on Water Quality in Lubigi Wetland

Wetland encroachment due to agricultural land use practices (LUPs) adversely affects water quality in wetlands mainly through agricultural runoff. This study was conducted in Lubigi wetland in Uganda to (1) determine the effect of the agricultural LUPs on water quality and (2) understand the relationships between different water quality indicators and different agricultural LUPs existing in the wetland. The eight LUPs included in this study were perennial crops i.e. banana farming and sugarcane farming, annual crops i.e. maize farming and tomato farming, livestock farming which included a mixture of cows, goats, and sheep, undisturbed dense natural vegetation, reference wetland and the river. Water samples collected from the different LUPs were analyzed in the laboratory for selected physicochemical and biological water quality parameters. The water samples were analyzed for a variety of properties, including pH, electrical conductivity, total hardness, Ca-hardness, Mg- hardness, and concentrations of dissolved oxygen, calcium, magnesium, fluoride, total nitrogen, nitrates, ammonium, phosphates, potassium, total coliform, and Escherichia coli (E. coli), chemical oxygen demand, biological oxygen demand, total organic carbon, total dissolved solids, chlorides, sulphates, total phosphorus, and turbidity levels. The results suggested that the different LUPs influenced several water quality parameters. Dissolved oxygen was lowest in banana fields and the river at 2.57 mg/L and 3.44 mg/L respectively than other LUPs which limits survival of aquatic organisms. Biological oxygen demand, chemical oxygen demand and total organic carbon were high in the river water with values = 69.67 mg/L, 351.67 mg/L, 117.33 mg/L respectively indicating high organic pollution. We detected nutrient pollution in water from tomato and sugarcane fields which showed high concentrations of nitrates. The concentration of ammonium in river water (10.40 mg/L) was high, indicating nitrogen contamination. In all LUPs, Escherichia coli and total coliforms had high counts exceeding 2000 CFU/100mL which indicated elevated microbial pollution from livestock waste and agricultural runoff. Cluster analysis revealed distinct clusters influenced by varying water quality parameters. These findings show that agricultural LUPs in Lubigi wetland are significantly contributing to water pollution through microbial contamination, nutrient, and organic matter accumulation, which increases the potential for eutrophication and renders the water unsafe for drinking and domestic use. Implementing best management practices (BMPs) is essential for the sustainable use and management of the wetland.

Global importance of supporting the krill to whale component of the pelagic food web associated with migrations following deep sea seamounts

The main diet of baleen whales is krill in the Arctic, Antarctic and during migrations in the Atlantic, Pacific and Indian Oceans. Hence, the aim of this paper is to quantify the global importance of the krill to baleen whale component of the pelagic food web and possible feedback loops. That was undertaken by comparing the results of Ecopath Models in the Antarctic and Arctic Oceans and to migration areas in the North Atlantic and Alaska, was well as the large Seamount area from the Antarctic and Arctic. Biological production transfer is the essential component of the prey to predator pelagic food web, which maintains the production of predators. The importance of sustaining global baleen whale migrations is to support ecosystem production by whale defecation contribution to nutrient recycling. It is important to sustain krill and fish abundance in whale migration feeding areas using ecosystem-based fishery management (EBFM) fishing rates. It was shown by the literature that migrations tended to followed deep-sea seamounts, and baleen whale defecation and nutrient cycling at seamounts led to the effects of nutrient upwelling by deep sea currents at seamounts. Hence, it is suggested seamounts be protected as important marine ecosystems. Therefore, those processes indicate sustaining krill and whale abundance is likely to support global marine ecosystem stability in open ocean migration areas.

A Case of Postoperative Hematoma Mimicking Giant Hydrocele

Background In adult males, non-communicating hydroceles are non fluctuant scrotal swellings that are formed when there is an imbalance of fluid secretion and absorption between the parietal and visceral layers of the tunica vaginalis. Giant hydroceles are a rare manifestation and have previously been classified as hydroceles that drain more than 1000 mL of fluid. In this report, we describe a case of a giant hydrocele requiring surgical management and highlight a review of the literature. Case Presentation A 34-year-old male presented with complaints of large right-sided scrotal swelling, accompanied by scrotal discomfort. Ultrasound of the right testicle revealed a large hypoechoic space with a complex collection and posterior displacement of the testicle, indicating a possible hydrocele. The patient was taken to the operating room for a right hydrocelectomy. Approximately 2 liters of fluid were drained from the sac.  Discussion Hydroceles are defined as straw-colored fluid collections within the parietal and visceral layers of the tunica vaginalis. Giant hydroceles, defined as fluid collections within the tunica vaginalis exceeding 1000 mL, are rare and the management of such cases is sparsely documented in the literature. While most asymptomatic fluid collections resolve spontaneously, larger collections with inflammatory changes within the testicular wall may require surgical intervention, either laparoscopic or open. 

Soil Fertility Dynamics and Xanthomonas Wilt Incidence in Enset (Ensete Ventricosem) Based Farming at Chencha, Southern Ethiopia

Enset (Ensete ventricosum) is a vital food security crop cultivated in South and South-western parts of Ethiopia. However, enset production and the farming families have been threatened by Xanthomonas wilt and its spread in the farming system. Thus, this study was conducted to investigate the soil fertility and plant management practices association on the incidence of Enset Xanthomonas wilt. Data on soils fertility and diseases from enset based farming clustered into inner, outer and outfield farm zone were sampled and surveyed. The result indicated that soil chemical properties significantly (p≤0.05) varied from inner to outfield farm zone. Significantly maximum nutrients store revealed in inner enset farm zones. Disease incidence reduced from inner to the outfield enset farm zone. Disease prevalence and disease incidence scored 28.5% and 11.6%, respectively depending on altitude and genotypes. Soil fertility levels in the enset inner and outfield plots were varied purposely to cultivate enset products as kocho, bulla or amicho (cooking type). The variations in soil fertility and Xanthomonas wilt incidence was associated with management practices applied for desired enset products. Therefore, management practices in enset based farming, soil fertility and location of enset planting zones found to be major indicators for disease incidence addressing to device control interventions.

Comparative Study of Deep Learning Techniques for Detecting Corn Plant Leaf Diseases Using Transfer Learning

Plant leaf diseases pose significant threats to crop yield and agricultural sustainability, making early and accurate detection crucial for effective disease management. In current years, deep neural network (DNN) techniques have shown remarkable potential in the field of image classification, including plant disease detection. The study aims to investigate the performance of two popular deep learning architectures, namely, VGG16 and InceptionResNetV2, for the detection of tomato plant leaf disease. The proposed methodology involves acquiring a diverse dataset comprising high-resolution images of healthy and diseased leaves from the target crops. Preprocessing techniques such as image augmentation and normalization are applied to enhance the generalization ability of the models and mitigate overfitting. Transfer learning is employed to initialize the deep learning architectures with weights pre-trained on large-scale image datasets to accelerate convergence and improve the models' performance in limited data scenarios. To evaluate performance of proposed networks various metrics such as validation and test accuracies, precision and recall, F1 score, and the area under the curve (AUC) are considered. From the investigations, the classification accuracy of the finest architectures is as follows: 99.8 percent for VGG16 and 99.4 percent for InceptionResNetV2 on Corn Leaves. The results suggest that the models developed during the investigation phase to identify the leaf disease were superior to any existing Deep Neural Networks (DNNs).

Health Practitioner Burnout, Safety Implications, and Programmatic Fixes: A Systematic Literature Review of Current Literature Reviews—200 Proof*

High rates of workplace psychological stress and burnout have been chronic among Healthcare Practitioners. Research shows that Healthcare Practitioner psychological stress / burnout is related to poor quality of care and a high probability of making medical errors and mishaps resulting in harm to patients and even workers themselves. In response, relatively impactful programs have been developed to address Practitioner burnout. To derive a better understanding of the subject and inform best practices and policy regarding the problem and its fixes, this article reports findings from a novel study of a systematic (PRISMA-based) literature review of current (circa ~10 years <) literature reviews; or a distillation of reviews already at 100 proof then undergoing a further distillation into a review of 200 proof.* This study employed a grounded theoretic qualitative methodology to iteratively generate and enumerate descriptive themes from the study’s literature review articles. This article reports on what is currently known regarding the precipitants of Health Practitioner Burnout, Burnout itself, its relationship to Safety lapses and mishaps, and Programmatic Interventions (i.e., Fixes). The primary conclusion is that Health Practitioners are the foundation of healthcare organizations and key to quality care and management / leadership should be concerned for their wellbeing; and this article provides a general blueprint in terms of addressing burnout and safety. Study Limitations and Future research are also discussed.

Parasitological Examination of Fecal Samples from Sheep, Goats, and Cattle at the Techiman Slaughterhouse

This study investigates the parasitological examination of faecal samples collected from sheep, goats, and cattle at the Techiman Slaughterhouse. Initially, 341 samples were collected, which were subsequently sorted to 327 for analysis due to the loss of data for 14 samples. The primary aim was to identify the prevalence of parasitic infections and assess the health implications for livestock and public health. The samples were analyzed using qualitative and quantitative parasitological techniques, including flotation and sedimentation methods, to detect nematode and cestode eggs. Descriptive statistics were used to summarize the data and the prevalence of each parasite type. The findings reveal significant levels of parasitic infections, particularly strongyle ova and Moniezia expansa, highlighting the need for better management practices in livestock health.

Profile of Patients Who Died During One Year in the Pneumophthisiology Department of the Hospital National Ignace Deen CHU in Conakry

Introduction Mortality is one of the most important demographic phenomena in public health, and its rate is the primary indicator of a population's state of health. The aim of this study was to describe the profile of patients in the pneumo-phthisiology department of the Hospital National Ignace Deen CHU in Conakry. Methodology This was a retrospective descriptive study lasting one year, from 01 January to 31 December 2023, on 176 records of hospitalized patients who died in the pneumophthisiology department of the Ignace Deen National Hospital. Results A total of 1043 patients were hospitalized during our study period, 176 of whom died, giving a mortality rate of 16.87%. The mean age of the deceased patients was 49.57±18.8 years, with a male predominance (sex ratio=1.93). Clinical signs on admission were dominated by dyspnoea (70.45%) and chest pain (61.36%). Tuberculosis was the most common diagnosis with a frequency of 42.61%, followed by TB/HIV co-infection with a frequency of 22.16%. The average length of hospitalization was 8.79 days. Probable cause of death was dominated by respiratory distress (54.44%) and decompensated anaemia (32.95%). Conclusion Mortality in the pneumo-phthisiology department of the Ignace Deen National Hospital remains high. Anemia and respiratory distress were the most common diagnoses of severity, hence the need to improve management of these probable causes of death.

Internal Jugular Phlebectasia; A Challenging Neck Mass in Children

Cystic neck masses are uncommon in children, and a minority of them are soft. Internal jugular vein phlebectasia (IJVP) is a rare cause of soft neck cysts. It presents usually as a unilateral soft neck mass of changing size. In most cases it is unilateral, right sided and predominantly in males. Imaging study modalities are diagnostic and helpful for observation and follow up. In the vast majority of cases, it decreases in size with time requiring only conservative treatment. However, surgery might be necessary in large or complicated phlebectasia. IJVP is underdiagnosed or misdiagnosed especially in pediatrics, with few cases documented in medical literature. To improve awareness of presentation and management-plan of this rare case, the authors present an extremely rare case of huge left internal jugular phlebectasia in a 14 year-old boy worsened and complicated over years of wait and see approach that needed surgical treatment.

Primary Healthcare Services and Health-Related Quality of Life of Older Persons with Non-Communicable Diseases: A Narrative Literature Review

In response to the rising burden of non-communicable disease (NDC), the World Health Organization (WHO) developed tools to enable early detection and management of NCDs in Primary Healthcare centers (PHC). Globally, the prevalence of NCDs remains alarmingly high with 41 million deaths annually. Of these, 17 million people die before the age of 70, and 86% of these premature deaths occur in low-and middle-income countries. This narrative review aimed to assess the effect of PHC services on health-related quality of life (HRQoL) of older persons with NCDs, to critically analyze the potential of the existing literature in informing improvements in PHC services. We searched various databases (PubMed, Springer, Scopus, and ScienceDirect) for relevant literature. Peer-reviewed articles on the influence of PHC services on HRQoL among older persons with NCDs written and published in English between January 2013 and May 2024 were considered. The review indicates that effective PHC services are linked to good HRQoL. However, PHC services are sub-optimal and poor in low- and middle-income countries, hence more health interventions are essential to improve PHC services to enhance HRQoL of older persons.

Exercises Pursued by Older Adults with Osteoarthritis and Their Structural Impacts are Hard to Uncover; a Scoping Review of Selected 1970-2024 Studies

Persons with osteoarthritis often have signs of reduced muscle strength. Some studies suggest that this strength could be improved with exercise. However, does this form of therapy improve the disease status as assessed by improvements in cartilage viability, a hallmark of the disease? This brief describes the possible usage of exercises in general, plus those known to improve strength and function, and reduce pain and whether structural impacts that favor or impede disease regression have been observed in this context among the older osteoarthritis adult population. Since exercise may also do harm, rather than good in osteoarthritis management if excessive, contra indicated, or suboptimal, what is the consensus in this regard in 2024?

Understanding Inherited Bleeding Disorders: Genetic Mutations in Blood Coagulation Factors and Regulatory Proteins

Hereditary thrombotic diseases, or inherited bleeding disorders, are a group of genetic conditions that disrupt normal blood coagulation. These diseases result from mutations in genes encoding blood coagulation factors or other regulatory proteins, impairing the body's ability to regulate bleeding and clotting. The most common inherited clotting disorders are hemophilia A and B, which are associated with deficiencies in clotting factors VIII and IX, respectively. Von Willebrand disease (VWD) is another prevalent disorder characterized by a deficiency or dysfunction of the Von Willebrand factor, a protein essential for coagulation. Additionally, the Factor V Leiden mutation is linked to an increased risk of blood clots. The prevalence of inherited coagulation disorders varies significantly by region and subpopulation. It is estimated that 5,000 to 10,000 male newborns are born with hemophilia A or B each year. Von Willebrand disease is much more common, affecting about 1% of the global population. The Factor V Leiden mutation is found in significant percentages of certain populations, with 3–8% of Caucasians being carriers. While antithrombin deficiency is more common in some areas, the incidence of other inherited clotting disorders, such as Factor XI, protein C and S deficiencies, and VWD, varies widely worldwide. This study discusses the incidence of inherited clotting disorders and their impact on affected individuals and their families. It also covers new advancements in disease management, alternative therapy approaches, and contemporary diagnostic techniques, aiming to improve diagnoses, treatments, and outcomes for patients with hereditary clotting disorders.

Investigating The Connection Between X-Linked Dominant Hypophosphatemic Rickets Syndrome and Endodontic Periapical Lesions: A Case Report

Vitamin D deficiency is known to affect bone healing 1. In this case report, the potential link between vitamin D, calcium, and phosphorus deficiency and periapical lesions is explored, offering fresh insights into the complex relationship between systemic health and dental pathology. This pathology is caused by a mutation in the PHEX gene on chromosome X, which encodes a protein necessary for vitamin D synthesis and phosphate reabsorption, which are essential for the mineralization of bone and teeth 23. A 25-year-old man with rickets and vitamin D deficiency presented to our clinic with recurrent abscesses in multiple teeth. Radiographic imaging revealed periapical lesions on multiple teeth with advanced endo-perio lesions on teeth 26 and 16, and a negative cold test on all his teeth. Despite successful endodontic treatment, the patient’s compromised metabolic healing raised concerns about the prognosis. This case report highlights the intricate interplay between vitamin and mineral deficiencies and dental health, emphasizing the need for cautious management and long-term follow-up.

Chute and Conduit-Tubular Carcinoma Breast

A brief case communication discusses a rare breast carcinoma subtype, summarizing pathology features, imaging, and considerations for surgical and adjuvant management.

Osteoarthritis in Older Adults: Is More Emphasis on Managing and Mitigating its Stressful Ramifications, and Enhancing Coping, and Self Efficacy Cognitions Indicated?

Efforts to mitigate or prevent painful disabling osteoarthritis have been pursued for more than a century with limited success. This current overview briefly summarizes how selected beliefs and behaviors, including coping and stress management approaches are potential mediators or moderators of osteoarthritis pain and its overall common adverse prognosis and outcome. Published data housed predominantly in PUBMED, PUBMED CENTRAL, SCIENCE DIRECT, and GOOGLE SCHOLAR sites and pertaining to selected aspects of the literature of current interest, cumulative results reported as of May 30, 2024, show a modest to strong rationale exists for considering the abovementioned factors in efforts to reduce pain and enable daily functions. Accordingly this line of research should be continued, and translated clinically without undue delay, especially in the face of increases in the aging population and osteoarthritis prevalence and undue suffering.

Automated Grassweed Detection in Wheat Cropping System: Current Techniques and Future Scope

Wheat is a staple grain crop in the United States and around the world. Weed infestation, particularly grass weeds, poses significant challenges to wheat production, competing for resources and reducing grain yield and quality. Effective weed management practices, including early identification and targeted herbicide application are essential to avoid economic losses. Recent advancements in unmanned aerial vehicles (UAVs) and artificial intelligence (AI), offer promising solutions for early weed detection and management, improving efficiency and reducing negative environment impact. The integration of robotics and information technology has enabled the development of automated weed detection systems, reducing the reliance on manual scouting and intervention. Various sensors in conjunction with proximal and remote sensing techniques have the capability to capture detailed information about crop and weed characteristics. Additionally, multi-spectral and hyperspectral sensors have proven highly effective in weed vs crop detection, enabling early intervention and precise weed management. The data from various sensors consecutively processed with the help of machine learning and deep learning models (DL), notably Convolutional Neural Networks (CNNs) method have shown superior performance in handling large datasets, extracting intricate features, and achieving high accuracy in weed classification at various growth stages in numerous crops. However, the application of deep learning models in grass weed detection for wheat crops remains underexplored, presenting an opportunity for further research and innovation. In this review we underscore the potential of automated grass weed detection systems in enhancing weed management practices in wheat cropping systems. Future research should focus on refining existing techniques, comparing ML and DL models for accuracy and efficiency, and integrating UAV-based mapping with AI algorithms for proactive weed control strategies. By harnessing the power of AI and machine learning, automated weed detection holds the key to sustainable and efficient weed management in wheat cropping systems.

Edpidemiology, Clinical Profile and Short- Term Outcome of Hypertensive Crisis in N'Djamena (Chad)

Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.

Syphilis and Beyond: A Comprehensive Analysis of Associated Infections and Comorbidities in a Five-Year Retrospective Study in the United Arab Emirates (2018-2022)

Objectives This study explores the clinical characteristics, associated infections, and management outcomes of syphilis within a specific population over the years 2018 to 2022. With a focus on the frequency, clinical manifestations, and co-infections of syphilis, the research addresses a critical gap in understanding the nuanced dynamics of this sexually transmitted infection and its impact on public health. Methods The study employs a retrospective analysis of data collected from 2018 to 2022, utilizing three key serological tests (Syphilis AB, RPR/VDRL, and TPHA) to characterize syphilis infections within the population. Clinical manifestations and associated infections, including HIV, HBV, HCV, Chlamydia, Gonorrhea, and HPV, are systematically assessed. Treatment rates and re-infection patterns are also analyzed, providing a comprehensive overview of syphilis epidemiology within the studied timeframe. Results The frequency of syphilis, particularly indicated by the Syphilis AB test, exhibited a marked increase in 2020, reaching 96%, suggesting a heightened frequency within the population. RPR/VDRL test results demonstrated consistent frequency, emphasizing the persistent presence of active syphilis infections. Clinical manifestations, such as chancre, skin rashes, alopecia syphilitica, and lymphadenopathy, displayed dynamic patterns over the study years. Co-infection rates varied, with fluctuations observed in HIV, Chlamydia, Gonorrhea, and HPV, while HBV and HCV showed infrequent but stable frequency. The management of syphilis cases demonstrated commendable treatment rates, but an increase in re-infection rates in 2021 highlights the need for continued vigilance. Conclusion This study provides a comprehensive evaluation of syphilis epidemiology, clinical characteristics, and associated infections within the studied population. The results offer valuable insights into the dynamic nature of syphilis and its co-infections, informing public health initiatives and interventions. The findings contribute to our understanding of the epidemiological landscape and underscore the importance of sustained efforts in both prevention and treatment to curb the transmission of syphilis and its associated infections. The study, however, calls for continued vigilance and research to address the evolving trends and challenges in syphilis management within the specified population.

Comparative Study On ‘Dietary Education’ In Japan And Korea: From The Latest Nutritional Knowledge Perspective

According to the Japan’s National Health and Nutrition Survey, trends in the intake of vegetables and fruits (1999-2018), which are considered effective in preventing lifestyle-related diseases, are far below the target value; In the under-50 age group, less than 30% achieved the target vegetable intake of 350g, and less than 15% achieved the target fruit intake of 200g 53. Against such background, it has become a challenge to nurture children's ‘self-management ability’ that leads to spontaneous and healthy dietary habits 16. Until now, almost all research on ‘Dietary education’ has been conducted in the field of nutrition, focusing on accumulating nutritional knowledge by explaining each nutritional component and its function. However, it is difficult to nurture spontaneous and healthy dietary habits simply through repeated nutrition-based education. It can be said that the pedagogical approach of this paper has made it possible to pursue from a broader perspective that influences food choices. Research on ‘nutrition transition’ points out “worldwide obesity dynamics and their determinants” based on “a shift in the broader patterns of dietary habits (Western-style diet) and corresponding nutrition-related diseases” 42. Nutrition transition research 5040 has a broad and holistic perspective on food and health, making it easy to understand nutrition. The purpose of this paper is to pursue how to nurture the ‘self-management ability’ for spontaneous and healthy dietary habits, based on these latest nutritional knowledges. Because nutrition transition is a global phenomenon, the author choses to use broader methods of international comparative research. Comparisons lead to discoveries and value creation. This can be said to have the greatest significance in comparative research.

Potential of Energy Efficiency and Conservation Measures in Residential Buildings in Ghana (Case Study of Student Hostel)

Promoting responsible energy usage in student hostels and residential buildings plays a crucial role in ensuring sustainable development. By implementing cost-efficient strategies for managing and conserving energy, both students and homeowners can not only reap economic and social benefits but also mitigate the adverse environmental effects associated with energy consumption. Unfortunately, student hostels and residential buildings in developing countries like Ghana are falling behind in the adoption of energy efficiency and management practices, thereby missing out on valuable implementation opportunities. This study investigates the potential for energy efficiency and conservation measures in student hostels, specifically the GETFUND hostel of the University of Energy and Natural Resources in Ghana. The hostel's monthly energy consumption is approximately 64,929.458kWh, which translates to $5,667.20. The objectives of the study include analysing the current electricity consumption pattern, identifying energy misuse, and recommending measures to save energy, as well as calculating the financial benefits of implementing energy management practices. The methodology employed is an energy audit approach. The results of this study can contribute to overall energy conservation efforts in Ghana and may be applied to other university residence halls in sub-Saharan African countries with similar climatic and energy-use characteristics. In a broader sense, the primary objective of this study is to enhance the energy efficiency of the GETFUND hostel and minimize energy wastage, resulting in substantial financial savings.

A Study on Nutraceuticals

Hippocrates trusted foodstuff, maybe medicine, and healthcare management, administration, and costing are important. Nutraceuticals, derived from "nutrition" and "pharmaceutical," cover differing healing areas like “antagonistic-hard, cold and cough, sleep difficulties, digestion, cancer prevention, osteoporosis, blood pressure, cholesterol management, pain relievers, depression, and diabetes”. “Stephen De Felice”, “founder of the Foundation for Innovation in Medicine, created the term in 1989”.Functional foods, like milk and orange juice, supply health benefits that surpass food, in the way that a better lifestyle and a lower risk of ailment. Nutraceuticals, in another way, involve fortified dairy products like milk that help avoid or cure illnesses and disorders apart from anaemia.Conventional arrangements like Solvents extraction , Soxhlet distillation ,maceration and “Non conventional designs” like ‘Microwave assisted origin’, Ultrasound Assisted Extraction are used to restore the bioactive material from plants for nutraceuticals.”The Indian Health and Dietary Supplement Association” supports drug, nutraceutical, herbaceous, and direct selling energies by categorising them based on chemical arrangement, food type, and conventional arrangement.This paper gives a brief review on nutraceuticals ,its history , its market trend , extraction techniques , benefits and its applications .

Hodgkin's Lymphoma In Low-Income Countries: Experience Of Togo

While highly curable in developed countries, Hodgkin's lymphoma (HL), remains a significant challenge for resource-limited ones. This study aimed to describe the profile of HL in Togo. This was a retrospective, descriptive study conducted at the Clinical Hematology Department of the Campus University Hospital Center in Lomé, Togo. It focused on patient records diagnosed with HL between January 1, 2006, and December 31, 2022. Various variables such as age, gender, histological type of HL, Ann Arbor stage, prognostic classification, therapeutic protocol used, and patient outcomes were examined. The annual incidence of HL was 1.5 with a mean age of 38.7 years (range 12-63). Lymph node enlargement was the primary clinical sign (100%). Histologically, classical HL was found in 21 patients (87.5%). Staging was conducted for 16 (66.7%) patients, among whom 11 (66.7%) were at an advanced stage, and 6 (37.5%) had an unfavorable prognosis. The ABVD protocol was used in 13 patients (54.2%), receiving between 1 and 6 cycles. One patient achieved complete remission (4.1%), three deceased (12.5%), and 17 (71%) were lost to follow-up. Hodgkin's lymphoma prognosis remains unfavorable with low remission rates in Togo. Improving the technical facilities will ensure better management of this lymphoma.

White Eared Kob (Kobuskobleucotis, Lichtenstein and Peters, 1854,) in Ethiopia; Migration Status, Potential Anthropogenic Threats and Conservation Directives from an Ecotourism Perspectives

The Trans boundary protection of migratory species is a common argument for international cooperation. Ecotourism supports these activities through long-term commitment from international conservation organizations, all interest groups and various political entities. However, due to anthropogenic influences and inadequate understanding of species ecology, sustainable conservation of migratory species is often challenging. Therefore, this review article evaluates the migration status, potential anthropogenic threats, and conservation directives from the perspective of ecotourism of the white-eared kob (Kobuskobleucotis, Lichtenstein and Peters, 1854). Ethiopia. Kobus kobleucotis migrate through the Boma-Gambella border ecosystems of Ethiopia and South Sudan at certain times of the year. This migration is anonymous and requires an understanding of the overall ecology of the species. Currently, the white-eared Kob population exceeds half a million, making it the second largest migration in Africa, after the wildebeest migration in the Serengeti, Tanzania. Kobs occur in groups of five to forty depending on sex and age and are nocturnal but inactive on the hottest days. Rich grasslands and permanent water sources are the preferred habitats for the species. However, the decline in grassland potential, frequent hunting, expanding settlements, changes in land use and land cover are potential threats to the white-eared kob in Gambella National Parks. Therefore, understanding the total ecological, anthropogenic and behavioral variables that influence the movement and status of the species is the ultimate parameter for conservation activity. Furthermore, entire migration corridors require sustainable management by balancing stakeholder interests and rural community development through nature-based tourism. It is also noted that solid economic and environmental incentives through nature-based tourism require adequate protection in Gambella and the surrounding regions.

Ebstein's Anomaly With Right Atrial Thrombus in 23 Years Old Man at Reference National Teaching Hospital of Ndjamena: A Case Report.

Ebstein’s anomaly is a rare congenital heart disease. It is usually associated with other congenital defects, particularly atrial septal defect/patent foramen ovale (PFO). We report here the case of Ebstein's disease revealed in a 23-year-old adult admitted for palpitations and exertional dyspnoea. He was in heart failure. The EKG showed atrial flutter . Cardiomegaly was present with a cardiothoracic index of 0.7. On echocardiography, the apical displacement of the tricuspid septal leaflet was 15 mm/m2 , the Celermajer index was Grade 3.  There was a large thrombus floating in the right atrium. While awaiting surgical management, the patient was being treated with diuretics, digitalis and anticoagulants.

A Trio Study Showing Novel Gene Mutation In LAMB3 Causing Junctional Epidermolysis Bullosa (Intermediate/ Severe)

Background Junctional epidermolysis bullosa (JEB) is a type of Epidermolysis Bullosa, a group of genetic conditions that cause the skin to be very fragile and to blister easily. It is categorized into: the Herlitz type and the Non-Herlitz type. JEB is inherited in an autosomal recessive pattern. Most common genetic mutations associated are LAMB3, COL17A1, or LAMC2, and LAMA3 genes. Case presentation This study reports a consanguineous couple, carriers for pathogenic variant LAMB3 gene, with an affected child with a homozygous mutation in the LAMB3 gene causing Herlitz type of Junctional epidermolysis Bullosa/ Non-Herlitz type of junctional epidermolysis bullosa. Furthermore, prenatal diagnosis for the Gravida also showed the same pathogenic variant. Conclusion For autosomal recessive genetic conditions, it is advisable to perform a Trio whole-exome sequencing or next-generation sequencing to detect the genes associated with the disease. Depending on the type of variants involved prenatal diagnosis for the next pregnancy and treatment or management (if available) options can be offered/discussed.

Barriers to Managing Childhood Obesity in the General Practice Amidst of the Double Burden of Malnutrition: A Sri Lankan Perspective

Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries.  Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community.  In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach.  While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems. Childhood obesity is on the rise, mostly in the low-income regions in South Asia including Sri Lanka. Simultaneously, undernutrition also continues to be an ongoing public health issue. The coexistence of childhood obesity with undernutrition has resulted in a double burden of malnutrition in these countries. Management of obesity in a community already affected by undernutrition is a challenging situation. At present, management of childhood obesity occurs as a hospital-based lifestyle modification intervention which cannot address all tiers in the community alike. Although national level multifaceted strategies are in place, implementation is limited due to financial constraints. In this context, the general practitioners can be considered as an important group of medical professionals who can reach families in the community. In many households in Sri Lanka, an overweight child is considered as normal and well-nourished in comparison to an underweight child. Unhealthy eating habits and force feeding have become norms in the society. Changing mindsets of people need significant time and commitment. General practitioners, in the community would be able to achieve this target through effective communication based on a nutrition sensitive approach. While uplifting the infrastructure facilities, steps have to be taken to update the knowledge and communication skills of the general practitioners on managing childhood obesity in a community affected with double burden of malnutrition. The well-equipped GP is an asset to modify the attitudes and thinking patterns of parents with regard to child nutritional problems.

Assessment of Reproductive Performances and Sex Ratio of Newborn in Cross Breed Dairy Cattle of Hawassa City, Ethiopia

Reproductive performance is an essential trait of cows in dairy cattle. The effect of different factors on reproductive performances and sex ratio difference in dairy cattle were not well documented in Ethiopia. In this research, cross-sectional study was conducted from December 2021 to June 2022 in Hawassa city to assess reproductive performances and effect of breeding methods on sex ratio difference of newborn. Questionnaires and observational study were used to collect data. In this study, the mean+SE of age at first service was 17.53+0.035 with difference of relatively one month from onset of puberty. The mean number of services per conception was higher in animals breed naturally (1.87+0.056) as compared to AI (1.69+0.049). Higher conception rate of 74.26% was obtained in age group of <4years as compared to old age >6years at rate of 4.11% with statistically significant difference (P<0.05). Animals with medium level of milk production (15-20L/day) more conceived to first service 43.14% than higher milk production group (20-25L/day) with 35.59%. The presence of reproductive problems significantly affect conception rate to first service with higher conception rate of 54.47% in negative animals and 22.41% in animals with reproductive problems. Conception rate was increased with increasing number of services in both breeding types. Sex of newborn was not significantly affected by breeding methods used and difference in the study area. Generally this research found that reproductive performances and use of AI in the study area were satisfactory even though age, level of milk production and presence of reproductive health problems had significant impacts on performances. In order to sustain and improve reproductive performances age, reproductive health problems and breeding management should be considered. Therefore, reproductive health management and application of AI for genetic improvement should be well practiced to improve dairy cattle reproductive performances.

Human Immunodeficiency Virus Drug Resistance (HIVDR) and Baseline Characteristics among Antiretroviral Therapy (ART) experienced Children and Adolescents under the care of Chidamoyo Christian Hospital in Hurungwe, Zimbabwe

Introduction Human Immunodeficiency Virus (HIV) remains a persistent global public health challenge. In 2020, approximately 37.9 million individuals were living with HIV globally, including 1.7 million children <15 years old, with a global HIV prevalence of 0.8% among adults. A larger portion of people living with HIV are found in low-and middle-income countries, and Sub-Saharan Africa (SSA) is home to about 68% of people living with HIV in the world. Strikingly, with increased uptakes in PMTCT, challenges in ART programs, and high viremia among children and adolescents in SSA, the success rate of ART might be quickly compromised, with possible HIVDR emergence, particularly after years of paediatric ART exposure. Therefore, monitoring ART response in children and adolescents in terms of HIVDR patterns and other socio-economic determinants of disease progression might help achieve better treatment outcomes at individual levels. At a programmatic level, this can guide further optimization of treatment options for SSA especially Zimbabwean rural where there is paucity of information on HIVDR prevalence in children and adolescents. Methods We enrolled 89 children and adolescents experiencing virologic failure from Chidamoyo Christian Hospital in Hurungwe. We managed to amplify all the 89 using nested PCR and 32.5% (29) had resistance to at least one ART drug and analysis was done using the 29 samples. Results Among the 89 participants with virologic failure,29 were resistant to at least one of their ART drugs. 39.2% of males and 23.07% of females had HIV-1 with resistance to at least one medication. Among 29 participants with HIVDR mutations, the prevalence of at least one HIVDR mutation to protease inhibitors (PIs), Nucleotide Reverse Transcriptase Inhibitors (NRTI), and Non-Nucleotide Reverse Transcriptase Inhibitors (NNRTI) were 6.47% ,46.76% and 46.76% respectively. Of the 29 participants who had HIVDR 19 (65.5%) had resistance to a drug they were currently taking and they needed to be switched to a better effective ART regimen Conclusion Use of HIVDR testing in guiding and monitoring development of HIVDR at the start of ART or at 1st failure can be very important in treatment options and patient management.

Gastric Pneumatosis: the tale of two late preterm infants with Necrotizing Enterocolitis

Gastric pneumatosis though rare, when seen is cause for concern. It has been associated with fulminant necrotizing enterocolitis (NEC) and gastric outlet obstruction, although other associations have been identified. It is not to be confused with pneumoperitoneum and can be managed conservatively as it is not always a harbinger of intestinal perforation. This case report highlights gastric pneumatosis which occurred in association with necrotizing enterocolitis in two late preterm infants. NEC accounts for 5.4% of our Neonatal Intensive Care Unit admissions, however these are the first two cases of gastric pneumatosis seen in the history of our unit. It is crucial for clinical staff to be cognizant of this pathognomonic sign so that cases are not missed, and for the feeding policy that governs the management of late preterm infants to be revisited. That which specifically predisposes a baby with NEC to developing gastric pneumatosis remains unknown and warrants further research.

A Review on Response of Root System Architecture and Root Phenotypic for Biotic And Abiotic Stress

Root is has great role for plant adaptation and productivity of the agricultural crops as well as other plants by exploiting the soil resource thus, important for plant growth and development or main growth factors. Root system architecture is made up of structural features which exhibits great role in response to environmental stress, and critical to plant growth and development with sufficient root growth. Root system architecture has a central role in crop plants’ response to abiotic (soil microorganisms) and abiotic stresses like water stress, mechanical impedance. Root morphology can be affected by nutrient availability, osmotic stress, salinity, and light. Phenotyping root is one of the drought management tools as roots are more prone to drought conditions and play a significant role in the plant’s life by extracting soil resources from deeper soil layers to carry on several metabolic functions in the plant’s body and its phenotyping helps to understand different root traits. Understanding interactions between roots and their surrounding soil environment is important to increase root growth, which can be improved through root phenotyping. In addition, knowing of the development and architecture of roots, as well its plasticity, holds thus great role for stabilizing the productivity under suboptimal conditions in the root environment

Camel Brucellosis in Ethiopia: Seroprevalence and Associated Risk Factor

Camels are a significant source of income for nomadic populations in many developing countries, including Ethiopia. Camels are well adapted to dry and semi-dry regions, providing income, food security, and transportation. However, camel production and productivity are constrained by infectious diseases, such as brucellosis, which is a highly infectious bacterial disease that affects camels and humans worldwide. Brucellosis causes significant economic losses due to abortion, low herd fertility, and decreased milk production. In Ethiopia, the prevalence of camel brucellosis varies depending on factors related to the host, agent, climate, and management system, with a reported prevalence ranging from 0.5% to 11.9%. Accurate diagnosis of camel Brucellosis is essential for herd-based screening of animals. Although culturing the pathogen is the preferred method for diagnosis, serological tests such as Rose-Bengal plate test (RBPT), Enzyme-linked immunosorbent assay (ELISA), and Complement fixation test (CFT) and polymerase chain reaction (PCR) assays have been developed. Implementing effective diagnosis and surveillance systems to control the spread of brucellosis in animals and humans is very important, on top of awareness campaigns, vaccination programs, and suitable laboratory establishment recommended. Continued research is essential to maintain the health and productivity of camel populations, particularly in pastoral areas where camels play a significant role in the livelihood of communities. Therefore, the present paper views the seropositive prevalence and potential risk factors associated with camel brucellosis in Ethiopia.

GIS Based Approach for Analysis of Habitat Suitability and wildlife conservation for African Buffaloes (Syncerus caffer) at Dhati Welel National Park, Ethiopia

Wildlife management is a crucial issue to maintain the sustainability of an ecosystem whereas habitat suitability analysis is very important for better conservation and management of species like the African Buffalo. Therefore, the effort of this study was to analyze habitat suitability for African Buffalo (Syncerus caffer) by employing GIS at Dhati Welel National Park, Ethiopia. The study employed five datasets include: land use land cover (LULC), elevation, slope, settlements, and rivers. In this study, the Analytic Hierarchy Process (AHP) and weight overlay analysis methods were applied using IDRISI 17 and ArcGIS 10.5 software. Each dataset was integrated using GIS and AHP to rate the individual classes of each factor and weigh the influence of one factor against the other, to determine the weighted contribution of importance to the habitat suitability. As result, the consistency ratio was 0.03 and found with acceptable limits. Then, the weighted overlay tool was applied to calculate the final habitat suitability map of the African Buffalo based on the influence value. The result indicates, 35.3 % (362.7 km2) of the study area was optimal for the African Buffalo habitat. Therefore, according to the results of the finding more areas of Dhati Welel National Park are suitable for the African Buffalo habitat based on the factors employed in this study. So that, this indicates the area is important for conservation from habitat loss and fragmentation.

Primary Leiomyosarcoma of the Thyroid; a Case Report and a Review of Recent Literature

A case report of primary thyroid leiomyosarcoma with literature review. It discusses diagnostic pitfalls, histologic criteria, and management options.

Disability and prognostic factors of MS severity: An Algerian cohort study

Background The evolution of multiple sclerosis (MS) is highly variable. Predicting this evolution at the beginning of the disease will help in the therapeutic management. The objective of this study was to describe the clinical characteristics and to identify early predictors of long-term disability among MS patients in Algeria. Methods We performed a descriptive and retrospective study of 400 MS patients followed over a 4-years period from July 2012 to July 2016 in the neurology department of Mustapha Bacha hospital in Algiers. The following parameters were systematically assessed for each patient: Age at onset, gender, relapses, initial demyelinating event, interval between first and second attack, residual deficit after first attack, onset of the progressive course, time of assignment of the successive scores of irreversible disability and type of disease modifying therapies. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 4 and 6. Results During the follow-up of this cohort of MS patients, a total of 144 (36%) and 83 (20%) patients reached EDSS scores 4 and 6 respectively. The median times from the onset of MS to assignment of a score 4 and 6 was 10 years and 19 years, respectively. Using the MSSS severity score, and after univariate analysis we identified several risk factors predictive of disease severity. These included male sex (P= 0.002), age of onset ≥ 40 years (P= 0.001), pyramidal (P= 0.0001), cerebellar (P= 0.002), and poly-symptomatic (P=0.0001) onset of the disease, incomplete recovery after the first attack (P= 0.0001), a high number of attacks during the first 2 years (P= 0.04) and the progressive form (P=0.001), and all these factors were correlated with a high MSSS score. However, prognostic factors in the multivariate binomial logistic regression analysis were limited to pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack, and progressive onset. Conclusion On the whole, the early predictive factors of disability in MS among Algerian patients were age of onset over 40 years, pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack and progressive form at onset. To increase the generalizability of findings, a national MS registry is strongly recommended, as well as long-term follow-up epidemiological studies.

Distribution and Conservation Challenges of Diurnal Large Mammals in Bayo Community Managed Forest, Salamago Woreda, South Omo Zone, Southern Ethiopia

An ecological study on diurnal mammals was carried out in Bayo Community Managed Forest located in Salamago Woreda, South Omo Zone. The objective of the study was to investigate the distribution and conservation challenges of diurnal large mammals in the study area. Based on the habitat type and topography of the study area, total of 11 transect, i.e 7 in forestland, and 4 in Wooded Grassland were laid to collect the data. Besides direct methods, indirect methods such as faecal droppings, fresh tracks, carcass or shell count, den (burrow), hair, and digging were used. Questionnaire and focus group discussions were also used to assess anthropogenic threats in the study area. Data were analyzed using descriptive statistics, SPSS and QGIS software. A total of 20 species of diurnal large mammals belonging to six orders and eight families were identified. The species identified were Cercopithecus pygerythrus, Cercopithecus aethiops, Papio anubis, Erytherocebus patas, Cercopitheus neglectus, Colobus guereza, Equus quagga, Traglaphus strepsiceros, Traglaphus imberbis, Traglaphus scriptus, Medagua guentheri, Sylvicapra grimma, Kobus ellipsiprymnus defessa, Syncerrus caffer, Potamochoerus larvatus, Phacochoerus africanus, Hylochoerus meinertzhageni, Hystrix cristata, Orycteropus afer, and Phataginus temminckii smutus. Seasonal variation in the between habitat types (χ2 = 4.849, df= 1, p<0.05). Totally, 685 and 600 mammals were counted during wet and dry seasons, respectively. On habitat basis, 683 and 602 animals were recorded in forestland and wooded grassland habitats, respectively. Major threats in the study area include poaching, fire, grazing, fuelwood extraction, population growth, habitat modification, overharvesting of resources and invasive species. About 98.44% of respondents had a positive attitude towards Bayo Community Managed Forest. The interference of local community has had the impact on mammal’s species. Habitat based mammals’ management involving participation of Woreda and Zonal Government is recommended for sustainable. The local government should promote the study area and provide appropriate support for its conservation.

Sophomoric and Skeletal-Chondroblastoma

A case commentary discusses a skeletal chondroblastoma with atypical features. It highlights imaging, pathology, and management considerations.

A Tandem of Rare Complications Due to Stent Infection

This report details sequential rare complications arising from a vascular stent infection. Clinical course, microbiology, and imaging are outlined, with emphasis on early recognition and multidisciplinary management. Lessons for device surveillance and antimicrobial stewardship are highlighted.

Evaluation of Growth and some Growth Analysis Components in Sugar beet Genotypes Grown under Low Nitrogen Fertilizer Levels in Khartoum State- Sudan

This investigation was carried out at the Demonstration Farm of the College of Agriculture- University of Bahri during 2018/2019 winter season to evaluate growth (morphological) and growth analysis (physiological) components in some sugar beet (Beta vulgaris L) genotypes under different nitrogen levels to know how well sugar beet plant performs during the growing season, Thus, to provide information to assist producers in identifying and introducing superior genotype and good management of nitrogen application in AlKadro area. The experiment was laid out in split plot design. The genotypes used were namely, Blaladi. Strube Sudan 01/14, Strube Sudan 02/14, Strube Sudan 04/14, Strube Sudan 05/14 and Strube Sudan 06/14, and the nitrogen levels were viz, 0, 80 and 120 kg urea per ha; applied twice (at the sowing and then 4 weeks after sowing). The evaluated components were; leaf number/plant, leaf area index (LAI), root length, root diameter, fresh and dry weight of foliage/plant, fresh and dry weight of root/plant; all determined at 5 terms. While Crop Growth Rates (CGR), Relative Growth Rate (RGR) and Net Assimilation Rate (NAR); determined at different periods of growth (intervals). The analysis of variance (ANOVA) revealed that at 4 weeks after sowing (WAS): leaf number (14.33- 17.03) , root length (19.05 – 21.75 cm), root diameter ( 7.93- 8.40 cm) foliage fresh ( 186.93 – 292.06 g) and dry ( 69.00 – 94.10 g) weight per plant, root fresh (72.66 – 108.88 g) and dry weight ( 12.54 – 22.08 g) per plant differed significantly (P≤ 0.05); at 7 and 10 WAS leaf number (22.39 -35.73 and 26.91 – 38.47, respectively), LAI ( 3.725 -5.645) , fresh and dry root weight per plant ( 586.78 – 913.81an 189.06 – 326.43 g, respectively) differed significantly; at 13 WAS: dry foliage weight ( 69.00 – 94.10 g), LAI ( 2.603 – 4.744), root diameter (10.09 – 11.92 cm) differed significantly; at 16 WAS only dry foliage (44.34 – 73.48 g) weight reflected significance. All other cases reflected insignificant differences among the evaluated genotypes. Moreover, all the studied components reflected insignificant differences among the nitrogen fertilizer levels and likewise genotype x nitrogen interaction (G x N) at the 5 sampled terms. Nevertheless, CGR, RGR and NAR displayed insignificant effect on the studied components in the evaluated periods.

Seasonal ARIMA model for Covid-19 pandemic Prediction in the United States

The COVID-19 pandemic has had a profound impact on global health and economies. The pandemic continues to spread and accurate forecasting of its spread is essential for the effective management of healthcare systems and the development of effective policies. The development of forecasting models for COVID-19 has become increasingly important as the pandemic continues to evolve. In this paper, we will summarize the Covid-19 pandemic in the United States state by state. And then, we utilize the temporal data of coronavirus spread from January 18, 2020 to January 29, 2023. Finally, we model the evolution of the COVID-19 outbreak and perform prediction using ARIMA and time series forecasting models on some selected states.

Research Achievements of Hot Pepper (Capsicum Species) and it Agro-Ecological Requirements in Ethiopia a Review

Hot pepper is an important spice and vegetable crop in Ethiopia. Its production is constrained by a number of problems among which climatic condition is the primary. The amount rain fail temperature humidity the solanaceous groups of vegetables including hot pepper generally are sensitive to environmental conditions. The amount of rain fall required depends on the altitude of the environment, wind speed sunshine hour, which in turn is influenced by a number of genetic and environmental variables. In the absence of any other production constraints, suitable climatic condition and yield of hot pepper are closely related. Pepper, like other crop produces well when it is grown in good environmental condition. Farmers produce hot pepper in different environment without considering the suitable environment. The yield of hot pepper varies year to year; this indicates that pepper crop need intensive care and management for high return per unit area and also appropriate environmental condition. So in order to produce good hot pepper with the required amount of capsaicinoid content it is butter to grow at temperature range of 17.5-28oc. at low altitude hot environment give high capsaicinoid content and in high altitude / Low humidity and high temperatures will cause abscission of buds, flowers and small fruits.