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Globally, evidence-based healthcare practices are the most dependable framework for effective healthcare decisions and practices. In all nations, financial resources, people, and time are always insufficient. Healthcare professionals should recommend healthcare interventions that have been proven to be safe, effective, and affordable. All healthcare professionals must be creative to be involved in the creation and compilation of trustworthy evidence to support the decrease in morbidity and mortality of communicable and non-communicable diseases, particularly in developing nations. Regretfully, most developing nations still exhibit weaknesses and barriers to promoting health research and evidence-based healthcare. Evidence indicates that developing countries contribute 1% - 2% of health research activities to address global health problems and challenges. As a result, many individuals in these nations continue to have below-average health conditions. The lack of creativity, innovation, and motivation to gain health research competencies for healthcare professionals causes all these issues. Creativity and innovation are the foundations for the effective implementation of evidence-based healthcare. Surprisingly, no researchers have explored how creativity and innovation heighten evidence-based healthcare practices. The primary objective of this project will be to foster pathways and explore the creativity that advances health research abilities among healthcare professionals to improve evidence-based healthcare practices in resource-limited healthcare settings.

Pulmonary Embolism (PE) can present with symptoms resembling pneumonia, creating a diagnostic challenge, particularly in patients with comorbidities. We report the case of a 67-year-old male who presented with cough, hemoptysis, shortness of breath, fever, and pedal edema. Initially diagnosed with consolidation based on chest X-ray findings, he was treated with antibiotics. However, persistent symptoms prompted further evaluation, leading to the diagnosis of PE with pulmonary infarction and deep vein thrombosis on computed tomography pulmonary angiography and Doppler ultrasound. This case highlights the need to consider PE in the differential diagnosis of consolidation, particularly in high-risk individuals, to avoid delays in appropriate management.

This work aims to describe the chemical-physical properties of various GELS used as galenic forms in hospital pharmacy practice. After an overview of the excipients and method used three preparations are reported. LAT GEL is used as an anesthetic in an emergency (pediatry ) in treating little Traumatic lacerations of the skin and scalp, calcium gel is used as an antidote for fluoride acid burns, and Lidocaine viscose 2% oral gel is used in some pathological conditions like severe esophagitis in onco - hematological patients after radiotherapy or chemotherapy. The galenic role in the situation of some drug shortages was also analyzed.

Plant extracts and their constituents have a long history as antifungal agents, but their use in biotechnology as preservatives, due to the increasing resistance of fungi to fungicides, has been rarely reported in Libya. The aim of this study is to evaluate the antifungal activity of ethanol extract and water extract of the wild native plant Artemisia herba-alba against two genera of mold fungi Aspergillus sp. and Rhizopus sp. This mold fungal causes significant damage to crops in the field or during storage. In this study, a hot ethanol extract was prepared using a device Soxhlet, and water extract hot as well as a cold ethanol extract and cold-water extract aqueous extract three concentrations (25% - 50% - 75%) of plant extracts were used on the tested fungi. All extracts showed an effect on the tested fungi. The concentrations of (75% - 50%) of the extracts had an effect on the tested fungi, while most concentrations of 25% of the extracts did not record any effect on the tested fungi. The hot ethanol extract of the Artemisia herba-alba plant was more effective than the other extracts. Aspergillus sp. was recorded with the highest inhibitory zone (0.73 mm).  

Background: CT-guided lung biopsy is routinely performed minimally invasive procedure. Imaging findings in the lung can have a broad differential diagnosis; therefore, it is indicated for definitive determination of pulmonary nodules or masses. Post-biopsy complications are common with most of them manageable in daycare. As pneumothorax is the most common complication, frequency and severity of pneumothorax with assessment of risk factors and follow-up for resolution is necessary.Methods: A prospective evaluation of 123 biopsies with automated coaxial biopsy of 18 gauge was done. Post-biopsy pneumothorax was evaluated for its incidence and resolution. The studied risk factors were; patient age, sex, lesion location, lesion size, shortest pleural lesion depth, traversed lung parenchymal distance, presence of emphysema, fissure penetration, needle thoracic wall angle, and lesion characteristics.Results: Reported immediate post-procedural pneumothorax was 22% with 19% of mild, 4% of moderate and 2.4% of severe cases. 51.9% of cases showed resolution within 24 hours. The intervention was required in only 4.8% of biopsy cases. A significant p - value of pneumothorax with the nodule depth increased traversed lung parenchymal distance, acute needle angle, fissure puncture, and presence of emphysema was seen. Emphysema was an independent variable in pneumothorax in multivariate analysis.Conclusion: Pneumothorax is an unamenable consequence of CT-guided lung biopsy and a cautious approach should be kept in view of the variables that are associated with it to reduce its incidence and severity in patients.

Euthanasia has long been a contentious topic. Societal acceptance and legalization of euthanasia have increased over the past decades but still lag behind that of physician-assisted suicide (PAS). Euphemisms such as “death with dignity” have facilitated the integration of PAS into end-of-life discussions with reduced stigma. We hypothesize that the persistent use of the term “euthanasia” hinders open, compassionate communication about this practice, particularly among healthcare professionals who adhere to the ethical principle of nonmaleficence. To address this issue, we propose the adoption of euphemisms, such as “eumori,” meaning “good death,” similar to the terminology used in (PAS). These proposed terms mitigate the negative connotations associated with euthanasia. This approach serves as an initial yet significant step toward reframing euthanasia within the context of end-of-life care. Further research and dialogue are essential to explore and address other barriers to broader acceptance of euthanasia as a viable end-of-life option.

Background: Preterm Birth (PTB) is the largest direct cause of neonatal mortality and the second leading cause of under-five mortality following pneumonia. Although there are studies conducted before, the magnitude of PTB remains a major issue in most developing countries including Yemen. Therefore, this study aims to assess the prevalence and associated factors of premature birth among newborns delivered in Jiblah University Hospital in Ibb governorate, Yemen.Objectives: No studies have previously been conducted about preterm labour in Jiblah University Hospital in Ibb governorate, Yemen.Methods: This retrospective observational study was conducted in the Department of Obstetrics & Gynecology, Jiblah University Hospital in Ibb Governorate, from 1 December 2023 to 29 February 2024.Results: A total of 1350 pregnancies, 252 (18.67%) were preterm deliveries and 1089 (80.66%) were full-term deliveries at Jiblah University Hospital, Ibb. Our study shows the distribution of participants based on socio-demographic factors. The data that out of the total 252 female participants, with ages mean ± std = 27.43 ± 6.34 roughly 18.67% experienced preterm deliveries. Our study demonstrates that several factors are significantly linked to preterm birth, including the number of siblings, blood pressure, gravida, and abortion number, where the Chi-square p - value was < 0.05. On the other hand, the results from the logistic regression analysis indicated the predictive potential of certain socio-demographic factors in relation to preterm birth. Conclusion: In this study, the number of siblings, blood pressure, gravida, and abortion number are the risk factors for premature delivery. Recognizing the most common risk factors for PTB will help to increase awareness about high-risk pregnancy, improve the preventive measures of preterm risk factors, and modify preterm care protocol in nurseries. 

Aim: This prospective study reports the acceptance testing of the Symbia Intevo Bold SPECT/CT scanner (Siemens Healthineers), recently installed at SQCCCRC, University Medical City, Muscat, Oman, before its clinical implementation.Materials and methods: The acceptance tests were performed using a Low Energy High Resolution (LEHR) collimator and Technetium-99m (Tc-99m) as the radioactive source, following the manufacturer’s protocols. The tests included physical inspection, peaking and tuning, intrinsic and extrinsic uniformity calibration, intrinsic energy resolution, and planar spatial resolution without scatter. Key performance parameters such as full-width at half-maximum (FWHM), system sensitivity, and count rate performance were evaluated.Results: All critical acceptance tests, including intrinsic energy resolution, energy calibration (symmetric curve), and extrinsic uniformity with the LEHR collimator, were completed and met the required specifications. System sensitivity and count rate performance were within the expected ranges, confirming the system’s readiness for clinical use.Conclusion: The Symbia Intevo Bold SPECT/CT system passed all performance tests successfully. The acceptance testing validated the system’s optimal performance following international standards, ensuring its suitability for clinical operations.

Forensic science has significantly changed the way investigations into crimes occur by providing an approach to crime solving that is grounded in science. Since developments in investigative methods have a direct impact on litigation, its role has become increasingly important in the nation in recent years. The remarks, difficulties, and possible uses of forensic technology in the Indian legal system are discussed in this paper. By looking at case studies, legal frameworks, and forensic technology, this study emphasizes the increasing relevance of forensic science for sustaining justice, enhancing the accuracy of investigations, and overcoming problems with the use of forensic evidence in courts.

Introduction: Research provides a framework for Anesthesia residents who are critical thinkers who approach clinical practice with an open mind. The goal of this study was to determine current attitudes regarding performing research during residency as well as perceived obstacles to doing so. A resident physician should be ready to face the challenges of the growing technology, tons of journals published in different portals, and increasing sophistication of the health care delivery system. Practice-based learning, systems-based practices, and medical knowledge are the vital core directly affected by strong research skill set. Methods: The study was done through a survey of all 15 current residents in Vicente Sotto Memorial Medical Center Anesthesia Resident. They answered a 13 self-administered survey, which was adopted from previous similar research. Data was collected for 1 week to give time to the busy schedule of the resident. Results: Respondents cited that the lack of time in balancing clinical and research responsibilities is the most common obstacle encountered by 86.7% of respondents. Researchers feel they have inadequate research skills and a lack of time in balancing responsibilities between family and work was among the most common answers by the respondents. 2nd prevalent barrier to research during residency was a lack of mentoring. Conclusion: The top barriers to research are lack of time and inadequate access to research mentors. These barriers can be addressed to optimize the current research environment for residents. Anesthesia residents identified several critical aspects that they believe are obstacles to research. These findings can be used by programs to overcome hurdles and increase the inclusion of research into residency training.

The global menace of cancer requires supplementary treatments beyond standard medical approaches for effective medical intervention. The Ketogenic Diet (KD) composed of high fats combined with moderate proteins and low carbohydrates has become popular as a metabolic therapy for cancer. The anti-cancer mechanism of KD works through metabolic stress induction in cancer cells, reduced insulin and IGF-1 signaling pathways, improved mitochondrial function, inflammation, and immune regulation. Standard cancer treatments receive enhanced outcomes through KD synergistic action which simultaneously decreases treatment-related side effects. To achieve optimized treatment outcomes in cancer, ketogenic diet practitioners need to use personalized nutritional planning in combination with metabolic tracking and exogenous ketone supplements. It is essential to find solutions for diet adherence issues and nutrient deficiencies because they determine KD’s effectiveness as a cancer treatment. The fight against cancer needs sustained and multipronged clinical research and validation to establish the proper implementation of this method.

Methylenetetrahydrofolate Reductase (MTHFR) is an important enzyme of the folate cycle, which is required to convert 5,10-methyltetrahydrofolate into 5-methyltetrahydrofolate (5-methylTHHF). 5-methyl THF is a methyl group donor for several cellular methylation processes. It also donates methyl group for the conversion of homocysteine into methionine, the higher concentration of which is toxic. MTHFR gene C677T polymorphism is clinically important polymorphism and the variant MTHFR (A222V) enzyme has reduced activity, hence increasing the requirement for folic acid. Less conversion of folate to 5-methyl-THF due to C677T polymorphism results in a higher plasma concentration of homocysteine (hyperhomocysteinemia). Individuals having C677T polymorphism are susceptible to various diseases, including reproductive problems like male infertility, polycystic ovary syndrome, Recurrent Pregnancy Loss (RPL), Preeclampsia (PE), placental abruption, and adverse pregnancy outcomes. MTHFR C677T polymorphism mimics folate deficiency, and folate is required for DNA synthesis, repair, methylation, and proper chromosome segregation, and all these processes are important for foetal growth and normal development. Methylation and demethylation processes control the gene expression of about 45% of human genes. Impaired methylation influences the expression of genes involved in the regulation of hormones, spermatogenesis, and oogenesis. In males, oxidative stress damages sperm DNA decreases sperm motility, and may impair fertilization capability. In pregnant women, hyperhomocysteinemia increases oxidative stress and inflammation within the placenta, which causes damage to placental tissue, impairs its function, and disrupts foetal development. Further, hyperhomocysteinemia (HHcy) is embryotoxic and neurotoxic and is responsible for congenital anomalies in the foetus. This review supports the idea that MTHFR C677T polymorphism is associated with an increased risk for male infertility, PCOS, RPL, PE, and congenital anomalies. This review may provide a clue toward a better understanding of the correlation between the MTHFR C677T polymorphism and its detrimental effects on human reproductive health.

Bartholinitis, or Bartholin's gland abscess, is a relatively common gynecological condition among women of reproductive age. Its annual incidence is estimated at approximately 0.5 per 1,000 women, which corresponds to a lifetime cumulative risk of about 2%. The condition primarily affects patients between 20 and 50 years old, with a peak frequency observed between 35 and 50 years.After menopause, due to the natural involution of the gland, Bartholin's cysts and abscesses become less frequent, although they can still occur. Moreover, in women over 50, the appearance of a new mass in the gland region should prompt caution, as it may, in rare cases, indicate a carcinoma of the Bartholin's gland or an adjacent vulvar cancer. Therefore, for patients over 40 presenting with a newly emerged cyst or abscess, clinical guidelines recommend performing a biopsy or excision to rule out malignancy. We present the case of a 50-year-old woman with no significant medical history, who was urgently referred to the gynecological emergency department due to confusion, unexplained fever of 40 °C, and resistant leucorrhoea following a week of corticosteroid antibiotic therapy. Clinical examination revealed a large, tender right vulvar mass, indicative of an acute Bartholin's abscess. The patient exhibited signs of septic shock and was admitted to the ICU. Following a diagnosis of sepsis, broad-spectrum antibiotic therapy was initiated, alongside fluid resuscitation and norepinephrine support. Surgical drainage of the abscess confirmed the presence of E. coli. The patient's condition improved rapidly, and she was discharged on postoperative day 8 with no complications. This case underscores that while Bartholin's abscess is typically benign, severe complications, including septic shock, can occur—especially in patients over 50. The appearance of a new Bartholin's region mass in older women should prompt consideration of malignancy, necessitating biopsy or excision. Recent studies compare various therapeutic approaches including simple incision and drainage, Word catheter placement, marsupialization, silver nitrate application, and complete gland excision. Each method has its advantages and drawbacks, with marsupialization offering lower recurrence rates and higher patient satisfaction in many instances. 

Background: The amygdala is a core structure in the mammalian brain that processes emotion and memory. Its complex neuronal composition and intricate microcircuit mechanisms play key roles in behaviors such as fear, anxiety, and reward. The diversity of neuronal types and the dynamics of these microcircuits provide the neural foundation for the encoding and extinction of fear memories.Aim: This is a retrospective review article summarizing recent research on the amygdala and fear behavior in mice, which is of significant importance in helping people to comprehensively understand and recognize that the amygdala is the core regulator of fear behavior.Methodology: An extensive and systematic search of electronic databases (Medline, PubMed, Web of Science) using keywords related to the amygdala and the technologies involved in the study such as “mouse amygdala,” “basolateral amygdala (BLA),” “central amygdala (CeA),” “fear extinction,” “fear learning,” and “microcircuits.” Articles meeting the selection criteria were included as candidate references.Results: By integrating recent findings from optogenetics, chemogenetics, and single-cell sequencing, this review reveals the interactions between glutamatergic projection neurons and GABAergic interneurons in the amygdala, the functional division between subnuclei, and the neural basis of cross-brain area coordination. Additionally, it discusses the technical challenges in amygdala research and future directions, providing theoretical support for understanding the pathophysiology of emotional disorders.Conclusion: The amygdala is intimately linked to emotional health, playing a critical role in understanding the mechanisms underlying the development of psychiatric disorders such as anxiety, depression, addiction, and post-traumatic stress disorder (PTSD). Despite advances in methodologies such as in vivo calcium imaging, neural circuit tracing, and electrophysiological techniques, which are progressively uncovering the underlying mechanisms of amygdalar regulation of emotional behaviors, the intrinsic microcircuitry of the amygdala remains highly complex. Significant gaps persist, necessitating further exploration and refinement to elucidate unresolved aspects of its functional architecture and behavioral modulation.

Background: The health professional appears to be concerned given the number of questions surrounding the patient’s post-transplant survival, patient selection method, and the continuous search for scores that reflect their reality and reconcile the results they desire with the patient’s expectations. It is from these considerations that the present work was born with the purpose of understanding the reality of patients hospitalized for hepatocellular carcinoma and what adherence to the Model For End-Stage Liver Disease (MELD) criteria meant in Brazil. Methods: This study is a discrete, univariate time series on emergency hospitalizations that occurred between 2000 and 2018, in the city of São Paulo, Brazil. Python version 3.11 was the software used for statistical treatment and analysis of the time series. Results: There were 6887 hospitalizations for malignant neoplasm of liver and intrahepatic bile ducts, in the period 2000-2006, of which 2898 were elective and 3915 (56.85%) were urgent in the period. There was an increase of 63.97% in the number of emergency hospitalizations in relation to the period 2000-2006 and 2007-2013. To highlight, in 2013 there were 1270 emergency admissions, which represented an increase of 109.22% in relation to the number of emergency admissions in 2006. The contingency correlation analysis demonstrated a significant association between the variables in which the chi-square value was 82.18, the p-value was 1.24 x 10-19, and the critical value was 3.84 with one degree of freedom. There was a 123.65% increase in the number of hospitalizations for chronic hepatitis, not elsewhere classified, between the periods 2000-2006 and 2007-2013. The chi-square value of the contingency association was 221.22, with a p-value of 4.90 x 10-50, a critical value of 9.488, with a significance level of 5% and one degree of freedom. The study showed an increase in hospitalizations of 21.88% for alcoholic liver disease between the periods 2000-2006 and 2007-2013. In the period 2000-2006, there were 21330 hospitalizations, 19224 of which were urgent (90.13%). In the period 2007-2013, there were 25997 hospitalizations, of which 22,802 (87.71%) occurred urgently. The chi-square value was 68.95, the p-value was 1 x 10-16, and the critical value was 3.84, with one degree of freedom. Conclusion: The MELD score, as it is sensitive to the patient’s severity, selects those who are at an advanced stage of the disease for liver transplantation. In this scenario, patients do not necessarily have access to outpatient services and begin to attend them regularly when MELD identifies the advanced stage of the disease, opening a gap between prevention, treatment, and rehabilitation.

Background: Studies explored the therapeutic role of agents inhibiting RAS in epilepsy. Fewer studies addressed the electrophysiological changes associated with angiotensin converting enzyme inhibitors (ACEIs) in terms of sustained seizures (status epilepticus). Sodium valproate (SVPA), a broad-spectrum anticonvulsant, has been associated with adverse cardiac events upon long-term use, in contrast to the beneficial role of ACEIs in cardiovascular disorders.  This work explored the potential effects of ramipril, an ACEI, compared to SVPA, on the behavior, and electrophysiology of the brain and heart in a rat model of status epilepticus. The dose dependent pattern of the presumed ramipril activities was investigated. Methods: Adult male rats were assigned into seven groups, controls, IP pyridostigmine (36 mg/kg)-induced status epilepticus (PISE), oral SVPA (5 mg/kg), and three groups receiving oral ramipril at respective doses of 5 (R5), 10 (R10), and 20 mg/kg (R20). Rat behavior was assessed using Racine’s motor convulsion scoring for 10 minutes.  Blood pressure was recorded, and electroencephalography (EEG) and electrocardiography (ECG) were performed on the sedated rats 24 hours after recovery. Results: Despite the partial behavioral improvement of motor convulsions with R5 and R10 exhibited epileptogenic activity, as indicated by the increased relative power of fast and slow gamma waves and total EEG power. R10 triggered arrhythmia and cardiac ischemia as indicated by absence of P wave, along with ST elevation and tall T wave, slowed heart rate and prolonged QRS, QTc, and RR intervals. Conclusion: PISE was resistant to sodium valproate and ramipril. Ramipril at low and moderate doses induced epileptogenic activity and, especially at moderate dose, precipitated cardiac ischemia and arrhythmia. SummaryThe debatable role of ramipril in epilepsy was studied in a rat model of pyridostigmine-induced status epilepticus, compared to sodium valproate. Increasing ramipril doses did not resolve status epilepticus in rats. Instead, low and moderate doses exhibited epileptogenic activity, opposite to high dose ramipril and sodium valproate. Blood pressure was dose-dependently reduced with ramipril. Electrocardiography showed evidence of cardiac arrythmia and ischemia, especially with the moderate ramipril dose. The behavioral and EEG indices correlated with systolic blood pressure and ECG changes.

VACTERL (V: Vertebral anomalies, A: Anal malformation, C: Cardiac defect, TE: Tracheoesophageal malformation, R: Renal anomalies, L: Limb anomalies) is a cluster of congenital malformations. It is a rare association with sporadic and non-random occurrence where multiple organs are affected due to developmental defect during blastogenesis (2-4 weeks of gestation), where abnormal structures are derived from the embryonic mesoderm. Multiple environmental and genetic factors have been implicated. We report the successful management of a patient  with VACTERL association born to a mother through an emergency cesarean section due to fetal distress.

Purpose: The purpose of this study was to investigate whether a different indocyanine green lymphography formula can reduce the severe pain encountered during this investigation.Methods: Indocyanine green ICG lymphography frequently induces severe and intolerable pain in patients. It is very important to develop a relatively painless lymphography method. This helps reduce patients’ apprehension during examination. Our center conducted randomized control groups of 60 patients with limb lymphedema. Cases were divided into experimental and control groups. Patients in the experimental group were injected with indocyanine green solution containing 5% glucose, while patients in the control group were injected with indocyanine green solution with sterile water.VAS scores were recorded pre-injection, during, and at 10, 20, and 30 minutes post-injection. We recorded possible side effects, e.g. skin redness, itching, subcutaneous bleeding, bruising, severe allergic reactions, and other complications within 24 and 48 hours after imaging, and analyzed the pain score data. Results: The average pain score of the experimental group was 0-3 points, while the control group was 6-8 points. Disease staging was accurately assessed based on imaging results . No other serious complications occurred.Conclusion: Pain can be significantly reduced by the new modality. This method does not affect lymphography results and imaging quality, and there are no obvious serious complications.

Citrus sinensis is a rich source of bioactive compounds  and has attracted attention due to its medicinal benefits. Historically regarded as agricultural waste, orange peel is rich in flavonoids, polyphenols, tannins, and essential oils with antibacterial, anti-inflammatory, and antioxidant qualities. The phytochemicals in Citrus sinensis peel were used as natural reducing and stabilizing agents in the green synthesis method used in this work to create silver nanoparticles (AgNPs). This method is an environmentally friendly alternative to conventional nanoparticle production, eliminating the need for hazardous chemicals. Based on the study’s results, green-synthesized silver nanoparticles derived from Citrus sinensis peel extract offer a sustainable and biocompatible substitute for biomedical applications. The pharmaceutical and healthcare industries may find therapeutic uses for them due to their exceptional antibacterial, antioxidant, and anticancer properties.