Background: The liver is the most common solid organ injured in blunt trauma. Mortality from hepatic trauma depends on the degree of injury. Management of liver trauma has changed through the last three decades with a significant improvement in outcomes, especially in blunt trauma, due to improvements in diagnostic and therapeutic tools. Aim of study: To assess the outcome of non-operative management of blunt trauma with liver injury and to compare its outcome with operative management. Materials and Methods: A prospective study that was conducted in Al-Yarmouk Teaching Hospital during the period of two years from 1st of January 2019 till end of December 2020. It included 62 patients who were admitted to the emergency room with blunt thoracoabdominal trauma with evidence of grade I - V liver injury. They were divided into two group: Operative and non-operative group. Results: In this study, 32.3% of study patients were treated conservatively. Prevalence of operative option of management was increasing significantly with increasing grade of liver injury to reach 100% in patients with grade V liver injury. About complication, 80.9% of patients who underwent operations had complications in comparison to 20% of those who were treated conservatively. Mean for duration of hospitalization was significantly higher in patients who managed surgically than that in those who managed conservatively. Conclusion: Non-operative management of blunt hepatic trauma of low grade represents a safe and effective therapeutic approach with high success rate and decreasing morbidity, mortality, complication and hospitalization.

Neurofibromatosis is an autosomal dominant disease with a wide variety of clinical manifestations. Neurofibromas are the characteristic lesions present in the patients. This disorder is associated with important anaesthetic considerations, mainly when neurofibromas occur in cervical region, leading to restricted neck movement, difficult laryngoscopy and tracheal intubation. We report the anaesthetic management of 37 year old patient K/C/O Neurofibromatosis with large neurofibromas in cervical region posted for open cholecystectomy under general anesthesia. We performed a brief review of literature with the aim of optimizing the anaesthetic management and reducing the number of complications associated with the systemic manifestations of this syndrome.

Incidence of Scoliosis is approximately 2% and higher in females. Therefore, anaesthesiologist should be familiar with its implications for safe anaesthetic management [1]. Such patients present unique challenges for administration of regional anaesthesia. Reporting one such case with a successful outcome using pre procedural Ultrasound spine for spinal and epidural anaesthesia. A 48 years female patient of height 138 cm, P2L2 diagnosed with abnormal uterine bleeding secondary to leiomyoma with grade III scoliosis and post burn contractures involving neck, was posted for elective total abdominal hysterectomy. Patient underwent surgery successfully under Epidural anaesthesia after accessing spine by ultrasonography for identifying point of insertion, depth of epidural space & needle trajectory [2]. Ultrasound is boon for accessing spine in patient with difficult spinal anatomy and pregnancy for deciding correct spinal interspace and successful outcome with fewer attempts.

Kyphoscoliosis is generally idiopathic and female dominant disease and the prevalence can vary between 0.3-15.3%. Anesthesia for both adult and pediatric patients with scoliosis can present a variety of challenges. Severe spine curvature disorders are commonly associated with multiple pathophysiological challenges to an Anesthetist. These factors are mostly related to the reduced vital capacity and chest wall compliance, along with the misalignment of axes and limitation in neck movement. Careful assessment and planning of alternative strategies by experienced anesthesiologists, appropriate positioning, and proper use of rescue devices can significantly improve the chances of successful intubation.

To assess hepatic metastases between traditional non-contrast phase (NCP), portal venous phase (PVP), and virtual non-contrast phase (VNC) reconstructed from Dual Energy Computed Tomography (DECT) performed in subjects with breast cancer. Methods: Hepatic metastatic lesions from breast cancer in consecutive, pre and post-contrast DECT examinations were retrospectively assessed by 2 experienced readers. Lesions were measured in single longest dimension (SLD) for each phase (NCP, PVP, VNC) and the mean difference was assessed by Kruskal-Wallis test.  One reader also assessed contrast to noise ratio (CNR) of the lesions compared to the liver for each phase with difference also assessed by Kruskal-Wallis test. Results: 87 hepatic metastatic lesions were assessed in 23 eligible subjects. SLD was greater for NCP (mean 2.14 cm) compared to PVP (mean 1.94 cm)(p<.001). The difference between VNC and PVP was also significant (2.09 cm vs. 1.94 cm)(p<.001), however, the difference between NCP and VNC was not significant (p=.25). Mean lesion CNR was 3.19 on PVP, 2.65 on VNC, and 1.21 for NCP, all of which were significantly different.  Conclusions: VNC may be an adequate substitute to NCP in accurately assessing and measuring hepatic metastases from breast cancer.

Breast cancer is a genetic disease caused by the accumulation of mutations in neoplastic cells and is responsible for the highest morbidity. The aim of this study is to determine the amino acids in the blood serum samples of breast cancer patience. In this study, blood serum samples from 45 breast cancer patient and 32 healty individual were used. The amounts of amino acids were determined by HPLC.  It was observed that, while the level of valine, tryptophan, glycine, histidine, thronine, proline, cysteine and asparagine were increased on the other hand leucine, isolatinine, phenylalanine, methionine, lysine, alanine tyrosine, glutamic acid, aspartic acid, arginine, glutamine and serine were decreased in the serum of cancer patients compared to the control group (p<0.001). When amino acid levels of the untreated and treated breast cancer groups were compared, it was observed that the amount of lysine and aspartic acid decreased significantly (p<0.001), while the amount of tryptophan increased (p<0.037) for the patients having cancer treatment. Changes in the amounts of other amino acids are statistically insignificant. Aspartic acid and arginine levels were significantly increased in non-breastfeeding breast cancer patients compared to breast-feeding patients (p<0.05), while the changes in other amino acid levels were statistically insignificant (p>0.05). Detailed studies are required to use the amino acids as biomarker for diagnising the breast cancer.

Sjögren syndrome is chronic, systemic autoimmune disease characterized by lymphocytic infilteration of the exocrine glands. It is an elaborate involvement of the lacrimal and salivary glands which eventually lead to keratoconjuctivitis sicca and xerostomia. It may occur in two forms- primary and secondary. Secondary is associated with another autoimmune disease, most commonly rheumatoid arthritis. International classification criteria for Sjögrens syndrome include ocular symptoms, oral symptoms, ocular signs, histopathology, salivary gland involvement and sialography. The classification requires four of the six items, one of which must be positive minor salivary gland biopsy or positive antibody test.

Introduction: Internal or external hemorrhoidal disease can be diagnosed through clinical history and complete proctological examination, making it possible to find associated anorectal disorders. Objective: To evaluate the association of hemorrhagic hemorrhoidal disease with other anorectal diseases. Materials and Method: The reports of 743 were retrospectively analyzed recto sigmoidoscopies in patients with hemorrhoidal disease associated with a history of recurrent anal bleeding were analyzed. Results: The presence of hemorrhoidal disease was observed in concomitance with other anorectal diseases, such as: perianal fistula, anal fissure, polyps and rectal adenocarcinoma. Conclusion: The authors conclude that there is a need for a diagnostic investigation, in view of hemorrhoidal disease associated with hematochezia for the correct diagnosis of associated anorectal diseases, given the relative incidence of diseases with malignant behavior.

COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), leading to acute respiratory distress syndrome among suffered patients manifested through severe hypoxemia and ventilation-perfusion VA/Q mismatch. This study aims to evaluate the effectiveness of INO, Almitrine and INO + Almitrine combined in terms of improvement in PaO₂/FiO₂ (mmHg) ratios and arterial or venous blood gases profile were analyzed before and after rescue therapy. Various databases were searched for collection studies and only 18 studies of interest were included in this review. Initially, baseline parameters (PaO₂/FiO₂ ratios, pH, PaCO₂, PaO₂, SpO₂ and echocardiographic parameters like velocity-time integral of the left ventricular outflow tract (VTI LVOT), Cardiac index, Tricuspid Regurgitation (TR) peak velocity, Left Ventricular (LV) eccentricity index and finally RV/LV surface ratio) were assessed. They were compared after INO (10 ppm), Almitrine alone (2,4,8 and 12 µg/kg/min) and INO (10 ppm) + Almitrine (8 µg/kg/min) combined. After rescue therapy significant rise of PaO₂/FiO₂ (mmHg) ratios from 146 mmHg to 255 mmHg in one study and 79 mmHg to 117 mmHg in another was observed and arterial or venous blood gases profile was also improved from baseline of value (pH = 7.30, PaCO₂ = 48 mmHg, PaO₂ = 102 mmHg, bicarbonate = 28 mmoL/L and So₂ = 97%) to (pH= 7.32, PaCO₂ = 46 mmHg, PaO₂= 180 mmHg, bicarbonate = 28 mmol/L and So₂ = 99%) after INO and Almitrine combined therapy. Similarly, the cardiac parameters on echocardiography were also under normal reference values after rescue therapy validating the effectiveness of rescue therapy (INO + Almitrine) in treating COVID-19 induced ARDS.

Objective: To evaluate the effect of electroacupuncture involving the lumbosacral region for patients with Neurogenic Bowel Dysfunction (NBD) secondary to Spinal Cord Injury (SCI). Materials and Methods: 10 cases received electroacupuncture therapy from February 2020 and February 2022. Patients were evaluated at baseline and week 4. The outcomes including Neurogenic Bowel Dysfunction score (NBD score), mean anal canal resting pressure, mean maximum systolic pressure, initial sensory threshold and maximal sensory threshold during anorectal manometry. Adverse events were recorded. Results: 12 SCI patients were recruited in this trial. Significant differences between baseline and week 4 after treatment with respect to mean NBD score (14.62 vs. 7.06, p <0.001), mean maximum anal canal resting pressure (32.11 cmH2O vs. 50.94 cmH2O, p <0.001) , mean maximum systolic pressure (56.02 cmH2O vs. 71.33 cmH2O, p <0.001) , mean initial sensory threshold (49.08 ml vs. 33.29 ml, p <0.001) and mean maximal sensory threshold (220.84 ml vs. 179.21 ml, p <0.001), respectedly. No patients reported adverse events. Conclusions: Electroacupuncture is effective and safe for SCI patients with NBD.

Introduction: Introduction of the research: It included addressing the development of the five-a-side football game since its inception until now. And the development that took place in the world. And about the features and physical characteristics of the game, As for the research problem: there is a low level of physical preparation, especially for my explosive power and agility, through the apparent slowness of the attack, The aim of the research is to know the effect of the auxiliary tools in developing some of the physical aspects and my running skills with the ball and the accuracy of the short pass of the futsal players. Materials and Methods: The research sample, the tools used in the experiment, the exploratory experiment, the preparation of the curriculum, the pre-tests and the main experiment, the post-tests and the statistical methods. Result: it included showing, analyzing and discussing the results of the experimental and control sample. Conclusions and Recommendations: conclusions and recommendations reached by the researchers: There is a positive development for the experimental research sample in some physical aspects, my running skills with the ball and the short handling accuracy of the futsal players. Using auxiliary tools during training because of their effective role in developing the physical and skill aspects.

The Successful Treatment Depends on Careful Diagnosis. The Role of Orthodontist in Orthognathic Surgery Cases Is to Evaluate the Skeletal Problem, Identify and Quantify the Same. There Are Various Cephalometric Analysis to Evaluate the Orthognathic Surgery Cases Such as Cephalometric Analysis for Orthognathic Surgery (COGS), Quadrilateral Analysis, Arnett Analysis, Burstone and Legan Soft Tissue Cephalometric Analysis, etc. All These Analysis Were Based on Hard Tissue References with the Paradigm Shift to Soft Tissue. It Is Very Difficult to Do So Many Analyses for Each Case. There Are Many Common Overlapping Parameters in These Analysis. The Commonly Used Analysis Are Burstone's Cephalometric Analysis for Orthognathic Surgery (COGS), Dipaolo's Quadrilateral Analysis, Arnett's Soft Tissue Cephalometric Analysis (STCA). Hence, An Attempt Is to Combine the Overlapping Parameters of These Three Analysis and Composite Cephalometric Analysis for Orthognathic Surgery (CCAOS) Is Arrived and Is Presented.

Right ventricular pacing is considered a non-physiological modality; the wavefront of depolarization slowly spreads from the lead tip to the rest of the myocardium, creating morphological alterations of the QRS complexes that make it difficult an electrocardiographic diagnosis of myocardial infarction. During His bundle pacing the electrical impulse travels through the normal conduction system, as a result, paced ventricular complexes show morphological features that are completely superimposable to basal ECG. This peculiarity allows to appreciate the electrocardiographic alterations consequent to a previous heart attack or to an acute coronary syndrome. Below, we introduce a clinical case of PMK recipient in which the upgrade to HB pacing unmasked a previous infero-lateral myocardial infarction. 

Nutrition is an important component of patient management in ICU. Proper nutrition leads to proper protein and calorie intake, electrolyte balance, maintainance of gut flora, gut motility and overall wellbeing of the patient. However, if feeding is not done correctly, it may lead to major catastrophy. Food can act as a foreign body, if instead of oesophagus goes to trachea, may chock the larynx and may lead to major mishaps. We report management of a cyanosed and pulseless elderly patient, who was fed papaya, but due to impaired airway reflexes and drowsy state papaya chocked his upper airway.

The ongoing global problem of concern is the Coronavirus Disease 2019 (COVID-19) caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). With the sudden explosion of the disease, no drugs were experimentally proven in its management. This meta-analysis assessed the role of favipiravir in the management of COVID 19 disease, its efficacy and safety. A comprehensive search of databases including PubMed, Medline, Cochrane, Embase, Google scholar, Lancet, Elsevier and other modalities of search like website searching and citation tracking was made. Out of 687 articles identified, 8 articles were taken for the meta-analysis after several stages of exclusion. Out of the 8 studies selected, the results of 4 studies were in favor of favipiravir, while other 4 studies were against the efficacy of favipiravir. The result of our statistical analysis was that RR = 0.9276 (95% CI; 0.6718 to 1.3944) for the effect of favipiravir on mortality reduction in COVID 19 patients. Favipiravir treatment in the early phase of infection (viral replication phase) have shown significant reduction in the viral load and good clinical recovery. It also prevents the progression of disease to critical stage by controlling the infection adequately in the early phase itself. But when the stage of viral replication has passed, there is no role of favipiravir in the management of the COVID 19 disease. Favipiravir has no significant effect on mortality reduction in COVID 19 patients.

A number of categories of materials are available for chairside CAD/CAM restorations that have demonstrated predictability and longevity. These materials include esthetic and high-strength ceramics. Composite resins for both final and temporary restorations and newer nanoceramics that offer ease of handling and a glossy surface finish. Each category of materials has unique features designed for specific clinical applications.

Acute Undifferentiated Febrile syndromes (such as fever-rash, fever-myalgia, fever-arthralgia, fever-hemorrhage and fever-jaundice) have overlapping etiologies, which makes their diagnosis and management even more challenging. The purpose of this article was to describe the clinical, laboratory, serological and radiological features of Enteric Fever as a cause of Acute Undifferentiated Febrile Illness among the patients admitted in the Department of Medicine at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. the mean age of the study participants suffering from enteric fever was found to be 28.1 days. Among all the patients of enteric fever, only 19% of the individuals suffered from arthralgia various 38% of the individual suffered from myalgia, 22% of the individuals presented with nausea and vomiting and 6% of the individuals had the retrobulbar pain at the time of admission.

Palmar–plantar erythrodysesthesia, also known as hand–foot syndrome (HFS), can occur with a variety of cytotoxic chemo drugs including fluoropyrimidines, cytarabine, liposomal doxorubicin and taxanes. It often presents as painful erythemas and desquamation of the skin involving the palms of the hands and the soles of the feet. Three cases are presented of patients who received multiagent chemotherapy regimens containing docetaxel that developed an atypical presentation of HFS on the dorsal aspect of the hands and feet. Dorsal HFS improved with supportive care or dose reduction.

Background: Anti-neutrophil cytoplasmic antibody associated vasculitis is a paucity immune systemic small-vessel vasculitis. Objective: If left untreated it carries substantial burden of morbidity and mortality. We report here a case of ANCA-Associated Vasculitis with spontaneous intra cerebral haemorrhage and hypertrophic pachymeningitis. Materials and Methods: CT scan revealed intra cerebral haemorrhages and a dura based intracranial granuloma. Rheumatoid factor and anti-nuclear antibody were negative. Serum PR3 ANCA tested positive with high titer 77.8 IU/ml (negative < 5) and serum MPO ANCA was 1.5 (negative < 5). There was no renal and pulmonary involvement. Result: Keeping high index of suspicion and approach through clinical, radiological and serological parameters, we could diagnose the patient in a nine-day stay at the hospital and initiate specific therapy. Discussion and Conclusion: Anti-neutrophil cytoplasmic antibody associated vasculitis may present with uncommon manifestations like intracerebral haemorrhage and/or hypertrophic pachymeningitis and a high index of suspicion is required for early diagnosis and prompt treatment to prevent adverse outcomes.

Background: Dyslipidemia is one of the leading causes of death in both developed and developing countries. In addition, mortality is high in elderly people and patients diagnosed with sepsis. In our study, we aimed to examine the relationship between mortality and dyslipidemia in elderly patients with a diagnosis of sepsis. Materials and Methods: This retrospective study included geriatric patients with sepsis treated in the medical intensive care unit of Adana City Training and Research Hospital. Eighty-eight patients were enrolled in the study. Results: Higher APACHE II levels were predictive of adverse clinical outcomes. LDL, HDL and TG levels were not a predictor of adverse clinical outcomes. Conclusions: This is the first study to evaluate the relationship between baseline lipid profile and mortality in the geriatric patients with sepsis group. To make a clearer recommendation; there is a need for multicenter, prospective studies with large patient groups.

Introduction: Ichthyosis a keratinization disorder, the skin becomes dry and scaly, might like fish appearance. The keratinization process cells in the stratum corneum are changing shape and number of cells. The process of epidermal differentiation is abnormal due to mutations of certain genes in various types of ichthyoses. Etiology genes identified as important in ichthyosis has increased. These genes cause changes in barrier function in the stratum corneum. The most common ichthyosis is ichthyosis vulgaris and has a fairly good prognosis. The rare and highest severity ichthyosis is harlequin ichthyosis and has a poor prognosis because of its high morbidity rate. The number of genes identified and shown to cause ichthyosis in human patients has reached eleven. Barriers function in the stratum corneum as an underlying pathogenetic mechanism. Discussion: The skin barrier in the stratum corneum can occur in three main components, namely the intercellular lipid layer, cornified cells and keratin/filaggrin degradation products. The first ichthyosis consensus conference was held to establish a consensus on the nomenclature and classification of inherited ichthyosis and an international consensus on the classification of inherited ichthyosis was achieved. The end product of the fully differentiated epidermis is the stratum corneum, which is composed of terminal keratinocytes called corneocytes, which are surrounded by an intercellular matrix. Corneocytes are enriched by protein, while the intercellular cellular matrix consists of a hydrophobic membrane enriched with keratin lipids. Corneocytes are thought to have good water resistance and retention properties in the stratum corneum, while their intercellular matrix has permeability barriers to water loss. The normal stratum corneum is desquamated regularly and is not visible. 1 The process of epidermal differentiation is complex and not fully understood. This disorder can be caused by many aspects and stages of this process can cause disruption of the stratum corneum and abnormal scales. Conclusion: Currently there are more than 20 variants of ichthyosis based on ethiology. In general, ichthyosis is divided into hereditary ichthyosis and acquired ichthyosis. Hereditary ichthyosis itself is divided into 2 major groups, namely syndromic hereditary ichthyosis and non-syndromic hereditary ichthyosis.

Preventive chemotherapy is the use of medicines, either alone or in combination, to prevent malaria infections and their consequences. It includes chemoprophylaxis, Intermittent Preventive Treatment of Infants (IPTI) and pregnant women (IPTp), Seasonal Malaria Chemoprevention (SMC) and Mass Drug Administration (MDA). These safe and cost-effective strategies are intended to complement ongoing malaria control activities, including vector control measures, prompt diagnosis of suspected malaria and treatment of confirmed cases with antimalarial medicines. In this article, we describe the chemoprphylaxis recommended for the special population groups. In addition, we also discuss the challenges and opportunities that lie ahead of us in order to tackle malaria.

Scrub typhus is an acute febrile illness caused by orientia tsutsugamushi, transmitted to humans by the bite of the larva of trombiculid mites. It affects people of all ages. After an incubation period of 6-21 days, onset is characterized by fever, headache, myalgia, cough and gastrointestinal symptoms. A primary papular lesion which later crusts to form a flat black eschar, may be present. If untreated, serious complications may occur involving various organs. Laboratory studies usually reveal leukopenia, thrombocytopenia, deranged hepatic and renal function, proteinuria and reticulonodular infiltrate. In this article we intend to describe the epidemiological and clinical profile of the patients suffering from scrub typhus as a cause of acute undifferentiated febrile illness.

Approximately 20% of patients with newly diagnosed colorectal cancer present with distant metastatic disease. Ca rectum with brain metastasis is relatively rare in oncological practice. We describe a rare case of a 73-year-old patient presenting with persistent severe headaches and weakness right upper limb found to have a solitary brain metastasis from primary rectal cancer.