Articles

Endoscopic procedures in patients with comorbidities such as Ischemic Heart Disease (IHD), respiratory compromise, or anticipated difficult airways present considerable anaesthetic challenges. Intubation and positive pressure ventilation, although standard, can be detrimental in such patients due to risks of sympathetic stimulation, barotrauma, or prolonged recovery. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) is gaining attention as a method to maintain oxygenation without intubation. We share our clinical experience using THRIVE during upper endoscopic procedures to avoid intubation in 10 high-risk patients, demonstrating its feasibility, safety, and clinical benefits.

Introduction and background: Hydatid disease (HD) is a parasitic infection caused by the larval form of Echinococcus granulosus. It is endemic in regions with widespread livestock farming and close human-animal contact. Although the liver and lungs are the most frequently involved organs, rare cases of primary subcutaneous hydatid cysts have been reported, especially in the absence of visceral involvement. Gluteal localization is extremely rare and may be misdiagnosed due to its nonspecific presentation.Case presentation: We report the case of a 25-year-old woman who presented with a gradually enlarging, painless swelling over the lateral aspect of her right buttock, noted over five months. There were no systemic symptoms, and she had no history of trauma or prior medical conditions. Physical examination revealed a well-circumscribed, fluctuating, non-mobile mass measuring 5 × 4 cm with no overlying skin changes. Laboratory results were within normal limits. Ultrasound imaging revealed multiple well-defined cystic lesions in the subcutaneous tissue. Chest X-ray and abdominal ultrasound excluded hepatic or pulmonary hydatidosis. A diagnosis of primary subcutaneous hydatid cyst was made. The patient underwent pericystectomy under spinal anesthesia. Intraoperatively, typical hydatid features were noted, and the cyst cavity was thoroughly irrigated with hypertonic saline. Postoperatively, Albendazole therapy (400 mg twice daily) was administered for three months. There were no signs of recurrence during 6 months of follow-up.Discussion: Primary soft tissue hydatid cysts are rare and can mimic benign soft tissue tumors or abscesses. In endemic regions, such lesions should be carefully evaluated using imaging and clinical suspicion. The diagnosis is typically made through imaging, and definitive treatment includes surgical excision with careful handling to prevent dissemination, accompanied by pre- and postoperative anthelmintic therapy to minimize recurrence.Conclusion: This case highlights the importance of considering hydatid disease in the differential diagnosis of gluteal masses, especially in endemic areas. Prompt diagnosis and combined surgical and pharmacologic therapy can lead to excellent outcomes without recurrence.

The most prevalent monogenic blood illness is sickle cell disease (SCD), which affects millions of people globally and around 100,000 Americans.

As time goes on, more and more people are using drugs in dangerous ways. This rising percentage of people abusing drugs is leading to an increase in violent behaviors connected to them. The present article will summarize and present cases of mass violence caused by drugs, displaying the harm they may cause if not regulated properly. A literature search of JSTOR, AJPH, IJERPH, Journal of Addictive Reviews, Journal of Addiction Research and Therapy, Google Scholar, CDC, CNN, New York Times, Detroit News, and ABC News was conducted from February 16, 2023, to November 03, 2024. In 2016, 56.2 million people died worldwide. There are an estimated 10,000 people who are killed each year in the United States as a direct result of drugs. Worldwide, 70 million people were diagnosed with a drug use disorder. In the global general population, 0.3%-0.6% of people are diagnosed with this disorder. 10%-69% of people in prison are diagnosed as well. From 1995 to 2000, 41% of violent crimes committed against college students and 38% of violent crimes committed against non-students were committed by an offender thought to be on drugs. Drugs have a clear connection to mass violence, and further regulation is needed for the benefit of public health and safety. 

Background: Plain X-rays are frequently utilized as diagnostic radiological procedures. However, their usefulness can change based on the situation, such as rib fractures. Moreover, the lack of a uniform procedure in medical facilities, poor image quality resulting from operator error or insufficient training, financial incentives, and insurance reimbursement regulations can all contribute to an overuse of X-rays. Aim: This study presents the changes in the use of X-rays over the past five years (2019-2023) in the Oman Ministry of Health institutions and identifies interventions that assist in the improvement of the quality of care and patient satisfaction. Methods: The study used a mixed-method design, integrating quantitative (retrospective cross-sectional) and qualitative data collection and analyses. Quantitative data were collected from the Nabdh Al-Shifa and the annual health report over five years. Focus group interviews were used for Qualitative data collection. Results: a positive core relationship exists between population size and use of X-rays, and there were underlying contributing factors for over X-rays. The rate at which X-ray consumption has increased over the last two years has been deemed reasonable based on several variables, such as shifts in clinical practice or population growth. Conclusion: This study demonstrated that patients aged from 0-4 years had the highest X-ray utilisation service rate over the past five years, which raises concerns about the long-term risks associated with repeated radiation exposure. Clinical rotations and appropriate training for physicians at primary health care institutions, and strategies to reduce the significant financial implications, are recommended to address the high rate of X-ray utilisation.

This work aims to verify the various uses of AI in chemical settings and the benefits and risks of using this innovative technology.AI tools make it possible to have a powerful instrument in study or research, as well as in various chemical disciplines.After a review of some interesting scientific literature related to some interesting uses of AI and the risks involved, the results of an experimental project involved the use of a famous free AI CHATBOT (question and answer).The articles reported are involved with some benefits of AI use, but also related to the specific risks.Crucial in this world is that the results provided must be the right ones, without relevant error or the so-called “hallucinations”.The results of a specific experimental project using a free AI chatbot show errors in providing one. Chemical structure: The final human control of the AI results can be a useful method to use in a safe way for this technology today.

Background: Repair of a large ventral hernia is a challenge for surgeons. Component Separation Technique (CST) is a novel technique for closure of the midline with live tissues without undue tension. This can further be reinforced by a prosthesis. We wanted to see the outcome of mesh-reinforced open Anterior Component Separation (ACS) for large complex ventral hernia repair. We aimed to see the duration of surgery, hospital stay, Surgical Site Occurrence (SSO), and recurrence within the first year after surgery.Materials and methods: We analyzed data of patients operated from January 2014 to January 2024 for a period of 10 years in three centers. There were 13 patients with divarication of recti without any previous surgery. Rest 44 patients had either incisional hernia or port site hernia. All patients had defect sizes more than 8 cm. Open bilateral anterior component separations were done to achieve midline closure. Medium-pore soft Prolene mesh was used to reinforce the midline closure by an on-lay technique. Patients were followed up to 1 year after surgery to assess efficacy and complications of the procedure.Results: The average operating time was 73 ± 12 min. Hospital stay was 3 to 7 days, mean was 5.3 days. Surgical site occurrence was 14%. These include seroma formation, major wound infection, and abscess formation. There was no flap necrosis nor mesh removal. There was no recurrence within one year of follow-up after surgery. Conclusion: Open mesh Anterior Component Separation (mACS) is an easy and effective way of treating large and complex ventral hernia. Operating time is substantially less than posterior component separation. Reinforcement with mesh reduces recurrence.

This comprehensive review examines the impact of Artificial Intelligence (AI) on family medicine, focusing on its potential to improve diagnostic accuracy, optimize treatment, and enhance administrative efficiency. Analyzing literature from 2019 to 2024, the study highlights the use of AI applications, including machine learning, natural language processing (NLP), and clinical decision support systems (CDSS), in streamlining workflows, predicting health risks, and personalizing patient care. Key findings reveal significant benefits like reduced diagnostic errors, automated documentation, and proactive management of chronic conditions. However, considerable challenges remain, including algorithmic bias, data privacy concerns, limited explainability of AI outputs, and disparities in implementation across healthcare settings. Ethical considerations—such as equity, clinician autonomy, and patient trust—are emphasized as essential for the sustainable integration of these practices. The review concludes that while AI holds transformative potential for family medicine, its future success depends on collaborative design with clinicians, rigorous validation in primary care, and the establishment of ethical frameworks to ensure equitable and patient-centered adoption.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of illness and death worldwide, and inhalers are often used to manage its symptoms. However, patients’ ability to use inhalers correctly is crucial for the effectiveness of treatment.  Incorrect technique can lead to poor management of the disease and limit the effectiveness of the medication. This study aimed to assess the inhalation technique of patients with COPD who visited a teaching hospital in Chitwan.Methodology: A descriptive cross-sectional study was conducted among patients with COPD who had been using a dry powder inhaler through a rotahaler device for at least 1 month and were attending the Medicine and Respiratory OPD of the teaching hospital in Chitwan. A convenience sampling technique was used to select a total of 103 participants. An observational checklist was used to assess inhalation technique, and a structured interview schedule was used to collect socio-demographic information. Descriptive statistics were used to analyze the obtained data in SPSS version 20 for Windows.Findings: The mean age of the 103 respondents was 70.1 ± 9.56 years, and 62.1% of them were female. While 78.6% had observed a demonstration of the inhalation technique, only 5.8% of the respondents performed the inhalation technique correctly, and 94.2% performed it incorrectly. Only 22.3% of the participants were able to perform at least one critical step of the inhalation technique. The most commonly observed errors included placing the mouthpiece between the lips and teeth (20.4%), breathing out through the mouth (21.4%), and inhaling the powder forcefully and deeply (26.2%).Conclusion: Patients with COPD attending the teaching hospital in Chitwan exhibited incorrect inhalation technique, which can affect the effectiveness of medication and disease management. Healthcare providers should emphasize critical steps and common mistakes to ensure that patients receive maximum benefit from their medication.

Background: Platelets are increasingly recognized as important inflammatory markers. This study explores the association between platelet indices and disease severity in ulcerative colitis (UC).Objective: To evaluate platelet parameters in patients with newly diagnosed UC and assess their correlation with disease severity indices.Methods: A cross-sectional observational study was conducted at IMS & SUM Hospital, Bhubaneswar, between October 2022 and September 2024. A total of 62 newly diagnosed UC patients aged over 18 years were included. Disease severity was evaluated using Truelove and Witts (TLW) criteria, Mayo Disease Activity Index (Mayo DAI), and Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Platelet count, mean platelet volume (MPV), platelet distribution width (PDW), platelet mass index (PMI), and platelet large cell ratio (PLCR) were measured. Statistical analysis included Pearson correlation, ROC curves, and sensitivity/specificity assessment.Results: The majority of patients were male (81%) with a mean age of 28.2 years. A significant positive correlation was observed between platelet count and disease severity by UCEIS (r = 0.32, p = 0.015) and Mayo DAI (r = 0.35, p = 0.009). PMI showed strong correlations with UCEIS (r = 0.45, p = 0.001) and Mayo DAI (r = 0.48, p < 0.001). MPV was inversely correlated but showed weak significance. PLCR also showed significant correlations. ROC analysis revealed platelet count (AUC = 0.815) and PLCR (AUC = 0.729) as good predictors of disease severity.Conclusion: Platelet parameters, particularly PMI, PLCR, and platelet count, may serve as accessible, non-invasive biomarkers for assessing disease severity in UC. Further studies with larger cohorts are warranted.