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The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally. Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.

Background: The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Aim: To clarify and figure out food habits and different lifestyle pattern among a sample of Palestinian women attending the nutrition center in the Gaza Strip. Methods: A cross-sectional study involved 116 women were randomly chosen by purposive census sampling. They aged 25 to 60 years with a diagnosis of obesity. The data collected by interview questionnaire that included social factors, lifestyle habits, and health/disease history. Results: Age group variable has distributed significantly (p=0.024), (31.0%) of morbid obese were ≥35 years group compared to (13.5%) of morbid obese amongst the younger group. The higher intakes of legumes (OR: 2.134, P=0.003), nuts (OR: 3.917, P=0.019), eggs (OR: 6.840, P=0.009), fast foods (OR: 4.461, P=0.005), and soda drinks (OR: 2.230, P=0.004) were the risk factors linked to the increased risk of morbid obesity. Moreover, the higher intakes of legumes (OR: 8.439, P=0.011), eggs (OR: 6.900, P=0.041), chips (OR: 5.049, P=0.012), sugar (OR: 2.068, P=0.011), and fast foods (OR: 3.029, P=0.025) are risk factors of chronic diseases. Conclusion: The study identified several lifestyle factors and improper dietary habits associated with obesity among women in Gaza city. There is a great need to change these habits to avoid the increased risk of obesity. Gene-environment interaction can explain the high incidence of obesity. A national plan of action to overcome obesity is urgently needed to reduce its economic and health burden

The childhood obesity is increased more than three folds in last two decades in developed world. There is nutritional transition seen in the developing world including India. The westernization in diet of the Indian population along with prosperity brings the brunt of overweight and obesity. This has future implications of liver diseases, heart diseases, hypertension, hyperlipidaemia, insulin resistance; malignancies. Mumbai is the prosperous city and an economical capital of India. Also, the rampant use junk food, common outdoor eating’s, no grounds to play for children make the high likelihood that the prevalence of obesity to be higher than rest of the country. It can profoundly affect children’s physical health, social, and emotional well-being and self-esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of the entire family. Treating and preventing childhood obesity helps protect the child’s health and has tremendous impact on child’s Physical and academic performance. And hence we at Aastha Bariatrics took initiative and launched ECHO... for a change (‘E’radicating ‘C’Hild ‘H’ood ‘O’besity), a pan Mumbai campaign against childhood obesity. This campaign was done in 15 high schools across Mumbai, which covered in total of 9000 students.

Objectives: Natural disasters confront individuals, communities and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters it is timely to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community. Method: An evaluation of literature related to the psychological impact of natural disasters, treatment efficacy and government strategies to confront the social and psychological impact of natural disasters for the period 1983-2016 was undertaken. Results: Epidemiological studies following natural disasters despite the use of differing psychological measures demonstrate significant psychological morbidity - anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%) and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy variability. Conclusions: The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social and economic consequences of these events has resulted in the development and implementation of government policies to confront the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance developing strategies to ensure effective evaluated psychosocial interventions are available across at-risk communities.

The well recognized white adipose tissue is an endocrinal organ secreting various hormones and this article simply indicates to the physiologic concepts brown fat tissues (BAT) which are extremely active endocrine organs and play various metabolic active roles in intermediate metabolism. The physiologic function of Brown adipose tissues contributes to energy-producing parts of the cell. Its amount is rare up to approximately one hundred and thirty gram and implies important characteristics for mammals. An increase in energy expenditure could be an aim by activation of BAT, seems futurity to reduce body weight that needs a vast majority of fundamental research to facilitate its occurrence [1]. Brown fat tissue generates heat and has valuable importance for human metabolism [2,3]. Brown fat tissue is decreased in overweight and obese people and possibly activating brown fat tissue might help for reducing weight and weight-related metabolic disorders like insulin resistance.

Oxygen therapy is the main supportive treatment in hypoxemic respiratory failure and has traditionally been delivered using low and high flow devices. However, the maximal flow rates that these devices can deliver are limited because of the insufficient heat and humidity provided to the gas administered. Low flow devices such as the nasal cannula, conventional face mask and reservoir bag deliver a flow rate of up to 15 L/min by administering more variable oxygen fractions (FiO2), depending on the patient’s respiratory pattern, peak inspiratory flow and characteristics of the devices. Conventional high flow devices, such as venturi type masks, utilize a constant flow of oxygen through precisely sized ports, entraining the ambient air, using the Bernoulli principle, providing a more constant inspired oxygen fraction. However, they are less tolerated than nasal cannulas because they are less comfortable and the insufficient humidification and heating of the gas delivered [1]. In the last two decades, new devices have been developed to administer high humidified and heated flow through a nasal cannula (HFNC) that also allows the delivery of oxygen with a known FiO2 up to 100%. In the literature, this technique has also been called mini CPAP (continuous positive airway pressure), transnasal insufflation, high nasal flow ventilation, high flow oxygen therapy, and high flow nasal cannula oxygen therapy [2]. It is considered that high flow nasal cannula has certain benefits compared to those of oxygen therapy previously detailed. HFNC manages a flow of more than 30 L/min, which is able to surpass the peak inspiratory flow of the patient, being able to reach values ​​between 60-80 L/min depending on the flow used. The gas source, which may be delivered by an air/oxygen blender, fans, or a flow generating turbine, is connected by an active humidifier to a nasal cannula and the FiO2 can be adjusted independently of the flow. From a clinical point of view, there is some confusion between venturi and high flow nasal cannula devices. In the literature, both have been considered as high flow oxygen therapy devices. In our opinion this is not appropriate because the high nasal cannula flow is much more than a simple system for administering oxygen therapy [3]. Venturi-type masks provide the patient with a gas mixture with a controlled FiO2, but do not exert additional benefits on the ventilator mechanics of the patient. Nevertheless, HFNC allows the delivery of a high flow, which can also add oxygen therapy, providing a series of physiological effects that imply an active treatment to respiratory failure. Effects related to HFNC include the following: 1. Delivery of higher and more stable FiO2 values, ​​because the flow delivered is greater than the patient’s inspiratory demand. 2. The anatomical dead space decreases by washing the nasopharynx, consequently increases alveolar ventilation. This improves the thoracoabdominal synchrony. 3. Respiratory work decreases because it acts as a mechanical stent in the airway and markedly attenuates inspiratory resistance. 4. The gas administered is warmed and humidified, improving mucociliar clearance, reducing the risk of atelectasis, improving ventilation perfusion and oxygenation ratio. 5. There is a CPAP-like effect. The dynamic positive espiratory airway pressure generated by HFNC reaches a value between 6-8cmH2o depending on the flow and the size of the cannula. This positive pressure distends the lungs and ensures their recruitment. 6. Pulmonary end-expiratory volume is higher with HFCN than with conventional high-flow oxygen therapy. 7. In addition, the technique is considered easy and simple for the medical staff and nurses, and can be used in different areas (emergency, hospitalization, critical care unit, weaning centers) and even at home [4]. Currently available evidence has demonstrated that HFNC therapy is an alternative for the treatment of acute hypoxemic respiratory failure, hypercapnic respiratory failure, acute heart failure, as rescue therapy preventive therapy in post-extubation respiratory failure and in specific conditions such as bronchoscopy [5]. We believe that high-flow nasal cannula treatment should not be confused with high flow oxygen therapy of venturi masks. According to detailed mechanisms of action, HFNC is not limited to being only an oxygen therapy system but also behaves as a true treatment that can be used in different clinical scenarios, generating physiological benefits that result in the reduction of respiratory work. In addition, in venturi type masks, the air is not humidified and complications such as dryness and nasal pain are common, generating a poor tolerance to oxygen therapy. The benefits of proper humidification and heating of the gas delivered with HFNC therapy allow better comfort and tolerance of the patient with easy adherence to the treatment. All this contributes to making HFNC be considered a technique of choice in patients with hypoxemic respiratory failure. The growth in its use associated with easy acceptance for patients and the expansion in its application show us that HFNC is a promising therapy.

The shoulder is the greatest movable joint in the human body. Its anatomical design allows a wide range of motion in all directions, leading to an insubstantial balance between stability and mobility. Conservative treatments are suggested by a number of authors for restoring the scapular dyskinesis. However, this condition can be overlapped by other clinical findings. Therefore, comprehensively analysing individual biomechanical rationale is central to design the ideal rehabilitation regimen to overcome scapular dyskinesis by restoring the scapular thoracic rhythm and preventing the associated problems. This study presents a brief clinical series of three patients with shoulder pain due to the alteration of their scapulahumeral rhythm and highlights a comprehensive examination and follow up an evidence-based rehabilitation algorithm to regain pain free functional ability in daily routine life.

Since December 2019, an outbreak of novel corona virus disease was reported in Wuhan, which has subsequently affected more than 160 countries worldwide. The ongoing outbreak has been declared as a pandemic by WHO, a global public health emergency. Several countries are successfully fighting with the pandemic by taking strict measures like nationwide lockdown or by sequestering the areas that were suspected of having risk of community spread. The corona virus pandemic has upended our educational system worldwide [1-3]. The academic calendar all over the world has been disturbed as a result of lockdown. Even after lockdown it would take probably many more months for universities, colleges and schools to reinstate. Caught in the turmoil, some parts of urban Indian education system have turned towards delivery of education via internet or online education. The NCAER skills report 2018 discussed the immense potential of online learning, conversely as complementary to more traditional methods. Centuries old, lecture based approaches, institutional biases, and outmoded classrooms changed. Covid 19 has become an impetus for educational institutions worldwide to search for innovative solutions in a relatively short duration. In the prevailing situation, online education is turning out as an alternative to traditional modes [2,4,5]. Contemporary/E-learning prepares students across all curriculum and learning stages with skills and potential to flourish in a rapidly changing and interlinked world. It connects students and engages their sense of inquisitiveness. E-teachers know and understand the needs and talents of their students. They are trained, flexible and select from a wide range of effective teaching strategies based on need. The new learning environment and resources galvanize students to be leaders of their independent learning. Thus students collaborate and use critical and creative thinking to solve complex problems and become apprehensive and sentient global citizens [4-6]. In physiotherapy, apart from traditional institution based learning, there implies a need for technological inputs and E-learning as a need to develop critical, creative thinking and reasoning. These technological arrays do provide better concepts and understanding regarding academics and practice [6]. As physiotherapy is advancing and growing in academics, research and practice, the need for an interlinking platform through which learning becomes unconditional and globally accessible was never addressed. Covid- 19 lockdown and strategies imposed us to think apart from institutional mode, ostensibly got a worldwide acceptance. Research suggests that online learning has been shown to increase retention of information, and take less time. On average, students retain 25% - 60% more information when learning online compared to only 8% - 10% in a classroom. E-learning requires 40-60% less time to learn and understand than in a traditional setting, because students can learn at their own pace, re-reading, skipping or accelerating through concepts as they choose. Contemporary learning or E-learning at present situation is intended to have the desired effect such as physical distancing, schedule flexibility, cost effective, fast learning, course variety, boost memory, reasoning and innovative teaching [2,4]. Adoption of online learning will continue to persist post pandemic, and how such a shift would impact the worldwide education market should be studied. Some believe that the unplanned and rapid move to online learning with no training, insufficient bandwidth, and inadequate preparation will result in a poor user experience that is deleterious to sustained growth [5,8]. The current crisis has acted as a thwack to encourage digital education among physiotherapy institutions. However, to achieve its prospective in the long run, physiotherapy institutions and universities should implement a digital platform, training as well as a curriculum regulation. “We believe that, the integration of information technology, E-learning in education will be further accelerated and eventually transpire to an integral component of physiotherapy education and practice”.

With the invention of the stethoscope, in the early 1800s, a better diagnosis of heart and lung disorders was opened up. Through the stethoscope's 200-year history, there has been a significant development of the stethoscopy from the use of the simple monaural earpiece to the binaural stethoscope, followed by the electronic stethoscope, which, together with other studies, has enabled a thorough diagnosis of these disorders. Here is a glimpse of this story. The cross-border investigation Far back in time, it has been clear that the function of the heart and lungs played an important role in maintaining life. By tapping with the finger (percussion) and putting the ear to the patient's chest (auscultation), it could hear sound from the body telling about the patient's condition, especially about the presence of fluid or air-filled organs. Auscultation is already described in the Corpus Hippocraticum, in the Diseases II section [1]. The doctor puts the ear to the chest of a patient with water sores, to hear the pain as a wine vinegar from the lungs - or the doctor grabs the patient about the shoulders, shakes him and places his ear to his chest to hear in which side his pleuritis is sitting. Since then, auscultation seems to have been partially forgotten, although it has probably been known by Ambroise Paré and William Harvey [2]. It was not until the late 1700s that it became an important diagnostic aid, just like the pulse clock and the medical thermometer [3 p. 277]. Here, Joseph Leopold Auenbrugger (1722-1809) is considered to be the father of the modern physical examination, which is based on percussion. Percussion he performed by knocking direcly on the thorax with the finger or cupped hands. His discovery of the percussion sounds from the chest during inhaling and exhaling originates from his work in 1760 at the Vienna Military Hospital [4]. In 1761, His little book on thoracic percussion revealing thoracic diseases appeared in 1761 [3p.271], which in 1808 was translated into French by the Parisian physician Jean Nicolas Corvisart des Marets (1755-1821). This contributed to the French doctors starting to use percussion and ausculation more routinely [5]. The limitation of simple auscultation was the fact that the sound was weak and incomplete and therefore there was a need for improved sound quality. In addition, the direct contact with the patient's body could seem insulting

Introduction: A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its’ management. Patient description: A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fistula and a large impacted stone were found. Separation of the fistula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful. Discussion and Conclusions: Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.

COVID-19 pandemic soon apparently proved to be havoc and a great stressor. During such a stressful time, mental health is in threat. Here, we intend to review the presenting problems/ symptoms as shared in psychiatry helpline of a Teaching Hospital in eastern Nepal during the second week of lockdown and to reflect on to emotional, including mood problems. It is an institute based period observation noted for all psychiatry helpline calls during 1 week of lockdown days of COVID-19. Their concerns and problems were listened and symptoms clarified by a consultant psychiatrist to help them as far as possible through the telephonic conversation. Maintaining the confidentiality, basic information were noted down in a semi-structured proforma to record certain socio-demographic and clinical information (including mood and other emotional symptoms). We received 102 helpline calls of 60 clients for psychiatry in 1 week, from 14 districts. More patients being discussed were males (35/60), average age being 34.15 (15 - 70) years. More patients were regular follow-up cases with some new issues (24/60) and 18/60 each were new clients and regular follow-up cases. Majority had exacerbated symptoms in the wake of COVID-19 as: emotional (47/60; mood 24/60, anxiety/worry 23/60) symptoms along with disturbed sleep (32/60); treatment/service issues (31/60) and changed routines. Most common mental problems were Bipolar affective disorder, Psychosis, Anxiety and Depression and advices included Antipsychotics, Benzodiazepines, Antidepressants, along with some Psycho-education. Most common concerns were about OPD service, worsening symptoms and local unavailability of medicines. Many had mood and emotional symptoms in this stressful time, both simple amenable to telephonic advices and severe requiring to be called to emergency service.

Introduction: Fractures of both the anterior and posterior pelvic ring are common injuries in polytrauma and the elderly that extend beyond those of simple low-impact trauma. While conventional X-rays predominantly show the ventral aspect of the injury, computed tomography often detect additional fractures of the sacrum. A large number of these fractures are B-injuries by AO, mainly compression fractures at an advanced age. In addition, the prevalence of pelvic insufficiency fractures caused by osteoporosis rather than subsequent to an obvious trauma is increasing, with such an injury often associated with pain that impairs mobilization. The standard sacroiliac screw fixation is often characterized by loosening and thus failure of the osteosynthesis especially in osteoporotic bone of elderly patients. Method: A new alternative surgical minimal invasive technique, the “iliosacral bridging”, stabilizes the fractures of the sacrum with an internal fixation from S1 pedicle of the uninjured side to the ilium on the affected side. The combination of this internal fixation with the standard single sacroiliac screw on the injured side allows an immediate full weight bearing and pain free mobilization. We present a case series of 8 patients. Results: The clinical and radiological analysis analogous to the pelvic-outcome-score brought forward that 2 patients showed an excellent and 2 patient a good result. The other 4 patients achieved sufficient results. Conclusions: The “iliosacral bridging” we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries

The use of cell phones has remarkably increased in the last two decades with several pros and cons. The negative consequences of cell phones on mental health have not been studied widely. Aggression, in this regard was a completely neglected area. The present study, therefore, was carried out to investigate the relationship between cell phone use and aggression and to further identify the moderating roles of gender and marital status between cell phone use and aggression. The inquiry included 500 young adults from Rawalpindi, Pakistan. Buss and Perry Aggression Questionnaire was administered. It was hypothesized that there would be a strong positive relationship between cell phone use and aggression. It was further hypothesized that gender and marital status would be significant moderators between cell phone use and aggression. The results supported the hypotheses on significant differences and made a significant contribution in the existing scientific literature.

Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.

Age estimations process is not standardized worldwide. However, there is a wide agreement about the most suitable methods currently available. Up until now, the procedure of creating expert reports and to implement quality assurance in age estimation are variable. Aim: The aim of this paper was to examine expert age estimation reports from around the world and identify the similarities and shortcomings present, which will help in providing recommendations to improve the reporting to reach standardization in expert age estimation reports. Methods and Material: A questionnaire was developed to explore whether there is a universal consensus in writing age estimation reports. Countries participated in the survey were: Afghanistan, Australia, France, Indonesia, Italy, New Zealand, Norway, Paraguay, Saudi Arabia, Spain, Switzerland, United Arab Emirates, United Kingdom, and the United States of America. Areas investigated by the survey included: Information about the individual in question and the entity requesting the assessment, if age interval is given along with if statistics were described in the report, if population reference data are used and reported and finally if the format of the report is standardized within each country. Results: The results of this survey suggest that there is a high degree of individual variation in age estimation reports, sometimes even within the same country. While the majority of participants report the main findings, some important information is still missing. The statistical information remains extremely varied. Conclusion: Although a resolution is not obvious, it is hoped that this study will promote further research and discussion on reporting age estimation. International guidelines on quality assurance in age estimation reports are urgently needed. Information to be reported should be specified on an international level and the exact report format to be used could be left to the national societies.

This study provides an update to a previous study exploring time to restoration of adjudicative competence within an Outpatient Competence Restoration Program (OCRP). Authors examined the probability of restoration for individuals referred for outpatient competence restoration in the U.S. capital, and revisited the requirements of American Law, taking a closer look at how programmatic changes improve restoration and encourage adherence. Competence to stand trial remains a critical screening function of the judicial system to ensure that defendants have a basic understanding of courtroom procedures. Competency restoration is therefore an attempt to protect both the integrity of the system and the rights of defendants. Aggregate data from the OCRP’s previous four years of competence restoration efforts were reviewed for demographic characteristics, restoration rates, and time to restoration. Poisson regression modeling identified probability differences in restoration between sequential restoration periods. Since our initial analysis, the DC OCRP has been successful in restoring 97 of 345 participants (28.1%), with referral rates increasing from year to year. 39.2% are now restored after the 3rd round of competency restoration. Poisson regression modeling of individuals attaining competence during six successive restoration periods showed that differences for the first five rounds of restoration were not statistically significant (p = 0.418). In the 6th round, however, the difference in percentage of restored participants was statistically significant compared to previous rounds (irr = 0.32; p = 0.0001). We discuss the policy implications, especially those that suggest that the DC OCRP has improved its ability to restore competence beyond the 1st round of restoration.

Background: Varicocele therapy is a controversial issue. No single approach is adopted as the best therapeutic option. Testes get blood supply from testicular artery, cremasteric artery and artery to the vas deference. So ligation of testicular artery in the abdomen do not cause ischemia to the testis. This was already demonstrated in many studies. Classical Palomo varicocelectomy also consists of open ligation of testicular vessels in the retroperitoneum. En mass ligation of testicular vein and artery is technically easy and fast in laparoscopic varicocelectomy (LV). Chance of missing some veins are also less. Henceforth recurrence is also less. Recurrence and post-operative complications are high when only testicular vein is ligated by laparoscopy in the retroperitoneum. We wanted to see the outcome of laparoscopic varicocelectomy by mass ligation technique. Methods: 56 patients of symptomatic varicoceles were included in the study from the outpatient services. Symptomatic varicoceles of grade 2 to grade 3 were operated from January 2012 till January 2019 over a period of 7(seven) years in Jahurul Islam Medical college Hospital. The patients were selected for dull pain and ugly veins not for infertility. All were operated by laparoscopy with en-mass ligation of testicular vein and artery in the retroperitoneum. They were followed up for a period of six months after surgery. We collected all the data in a retrospective manner. Results: The average operation time was 27±3 minutes. Average post-operative hospital stay was 32±7 hours. There were no technical failures requiring conversion to open varicocelectomy. There was no incidence of hydrocele formation nor testicular atrophy. One patient of bilateral varicocele had 50% reduction of his varicocele. We considered this a recurrence. All other patient had complete reduction of varicocele. One patient developed hemo-peritoneum due to dislodgement of hemo-clip, which required laparotomy. He did not require any further surgery for his varicocele. Conclusion: Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. Plastic hemo-lock should be used rather than titanium heom-clip for ligation of testicular vessels. There is no incidence of testicular atrophy or any adverse effect on testis.

Background: Cyclophosphamide is used for the treatment of malignant and non-malignant diseases, but, it induces oxidative damage and disturbance in the antioxidant defense system. Zinc oxide nanoparticles (ZnO NPs) are used in biomedical applications and consumer products. ZnO-NPs are protected cell membranes against oxidative damage, decrease free radicals and malondialdehyde (MDA) levels, and increase the antioxidant enzyme levels. Objectives: The present aimed to evaluate the ameliorative effect of Zn-O nano-particles on oxidative damage and disturbance in the antioxidant defense system induced by cyclophosphamide in male albino rats. Materials and Methods: 24 adult male albino rats were randomly divided into 4 groups (6 rats of each). Group I (Control group): Received 0.2 ml saline /day i.p. injection for 14 days (day by day), group II, (nZnO group): Received nZnO (5 mg/kg/day) b.w., intraperitoneally for 14 days, Group III (CP group): Received CP (20 mg/kg/day) b.w, day by day for 14 days by intraperitoneal injection, Group IV (CP + ZnO NPs group): Received nZnO group: Received nZnO (5 mg/kg/day) b.w., intraperitoneally for 14 days, plus CP (20 mg/kg/day) b.w., day by day for 14 days by intraperitoneal injection. After 24-hr from the last treatment, all animals were anesthetized using light ether. Blood, lungs, and liver samples were taken and prepared for biochemical measurements. Results: Individual treatment of zinc oxide nanoparticles and CP induced liver cytochrome b5, cytochrome C reductase, and glutathione S-transferase (GST) compared to the control group, while CP increased P450. The combination of nZnO and CP prevents the elevation of cytochrome b5, P450, cytochrome C reductase, and GST compared with the CP treated group. Zinc oxide nanoparticles and CP increased liver thiobarbituric acid reactive substances (TBARS). The combination of nZnO and CP prevents the changes in TBARS concentrations compared with the CP. Injection of CP to rats reduced the activities of serum glutathione reductase (GR) and catalase (CAT) as compared with the control group. However, combination treatment of rats with nZnO and CP increased the activities of these enzymes compared with those treated with CP alone. Zinc oxide nanoparticles and CP increased serum and lung TBARS, while decreased glutathione (GSH) concentration compared to the control group, with more pronounced changes by CP. The combination of nZnO and CP prevents the changes in TBARS and GSH concentrations compared with the CP. Conclusion: It can be concluded that CP induced oxidative stress and disturbance in the antioxidant defense system. Treatment of rats with zinc oxide nano-particles and CP together attenuated the oxidative damage and disturbance in the antioxidant defense system induced by CP. So, Patients treated with CP advised to take nZnO to prevent the side effects of chemotherapy. Further studies are necessary to evaluate the amelioration effect nZnO and other nano-particles against oxidative stress induced by CP in different doses and experimental models.

The Meckel’s diverticulum (MD) is the most common anomaly of ductus omphaloentericus that surgeon encounters in clinical practice. The accurate incidence is unknown because most patients with the Meckel’s diverticulum are asymptomatic. Most studies report an incidence of about 2%. Approximately 4% of patients with the Meckel’s diverticulum become symptomatic. A 10 years old boy, was sent from regional hospital. His symptoms started the day before he was hospitalized and represented as gastrointestinal bleeding, lower abdominal pain and four times vomiting, without fever. Ultrasound and X-ray of the abdomen were normal. Blood findings showed: RBC 3,19, hemoglobin 0,95, hematocrit 0,27. During a physical examination abdomen was palpatory soft, with no presence of the pain. Digital rectal examination showed blood. A scintigraphy pathologic scan showed a focal lesion of the right hemi abdomen consistent with the Meckel’s diverticulum.Patient was treated byLaparoscopic-Assisted Transumbilical Extracorporeal Resection of the Meckel’s Diverticulum.

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.