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The concurrent emergence of dengue fever and the COVID-19 pandemic posed significant challenges to India’s healthcare system, particularly in Western Rajasthan, a region characterized by its arid climate and unique socio-demographic conditions. This study aimed to investigate the clinical and molecular characteristics of dengue during the COVID-19 pandemic, focusing on trends, diagnostic challenges, and serotype distribution. Conducted at Dr. S.N. Medical College, Jodhpur, in 2021, the study included 550 dengue-positive patients confirmed via rapid diagnostic tests and further analyzed using Dengue NS1 antigen and IgM antibody ELISA. Molecular characterization was performed using RT-PCR for serotyping.The results revealed a male predominance (72.36%) and a higher incidence in the 21–30-year age group (39.09%). Urban areas accounted for 67.73% of cases, with significant NS1 and IgM positivity (p = 0.042 and p = 0.004, respectively). Most cases (86.91%) were managed outpatient, though IgM positivity was significantly higher among hospitalized patients (19.19%, p < 0.001), indicating severe or prolonged infections. Platelet counts were above 100,000/mm³ in 86.91% of cases, with only 0.37% showing critically low counts (< 20,000/mm³). Seasonal analysis showed a peak in October (n = 325), correlating with post-monsoon vector breeding. Serotyping identified DENV2 as the dominant strain (97.42%), associated with severe dengue manifestations, including Dengue Haemorrhagic Fever (DHF).The study highlights the dual burden of dengue and COVID-19, emphasizing the need for enhanced vector control, improved diagnostic strategies and public health interventions during overlapping outbreaks. The predominance of DENV2 underscores the importance of serotype-specific surveillance and preparedness to mitigate future dengue epidemics in the region.

Background: Obesity is a significant health risk linked to hypertension and heart-related disorders in adolescents, impacting their future well-being . Since, the present work is to determine the body constitute including percentage of body fat correlates with cholesterol level which associate with Body Mass Index. Methods: This cross-sectional work was held in 120 college girls aged 19-23 years of Bhavan’s Tripura College of Science and Technology, Anandanagar at West Tripura. Anthropometric measurements such as standing height, body weight, sub scapular and triceps skinfolds, waist &hip circumference were collected. These records were used to calculate Body Fat Percentage (%BF) and Fat Mass (FM). Waist and Hip ratio (WHR) and Body Mass Index (BMI). FM, %BF and biochemical studies such as serum cholesterol level were also used to measures the body fat composition. Results: According to the present study, 53.33% of girls have a normal BMI, 8.83% are underweight, 31.67% are overweight, and 6.67% are obese. WHR results indicate that 54.17% of participants are classified as obese and 45.83% as non-obese. Out of 114 (95%) girls with normal cholesterol levels of 16 (13.33%) students are pre-hypertensive and 10 (8.33%) students are hypertensive. Out of 38 overweight and 8 obese students 13.34% are in pre or hypertensive. Based on WHR, 65 (54.17%) female students are obese; out of 65 obese students, 12 (10%) and 7 (5.83%) female students are pre-hypertensive and hypertensive, respectively and this value is statistically significant (p value < 0.05). Out of 55 (45.83%) no-obese students 8 (6.67%) girls are pre-hypertensive and 5 (6.67%) girls are hypertensive. According to BMI female students who are overweight or obese (5%) also have excessive blood cholesterol.Conclusion: This study expressed clear evidence of correlation in BMI, serum cholesterol level and Hypertension. These results are important for epidemiological studies to identify the cardiovascular risk in obese adults and help to solve a health problem of present Youngers in their future life. This study serves as an early health warning for female college students.

Multiple stab wounds are a critical forensic indicator, frequently linked to violent assaults, homicides, or self-inflicted injuries. These penetrating injuries result from sharp-edged weapons such as knives, daggers, or other pointed instruments. The depth, size, and severity of the wounds depend on factors including the type of weapon used, the force applied, and the anatomical location of impact. Forensic examination of stab wounds is essential in determining the manner of death—homicidal, suicidal, or accidental. Detailed analysis of wound characteristics, such as depth, trajectory, and associated injuries, aids in crime scene reconstruction. Additionally, identifying defensive wounds can indicate victim resistance, further supporting forensic interpretations. A meticulous forensic autopsy, including weapon analysis and internal organ assessment, is crucial in establishing the cause of death. These findings play a vital role in medico-legal investigations, providing key forensic evidence that supports legal proceedings and ensures justice.

Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers  over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included  were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke  compared to amlodipine.

Cystoid Macular Oedema (CMO) is a condition characterized by fluid accumulation in the macular region of the retina, leading to the formation of cyst-like spaces. This edema often results in visual impairment and is associated with various ocular and systemic conditions, including surgery, inflammation, or medication use. The authors present a case where Cystoid Macular Oedema (CMO) occurred after commencing topical bimatoprost in a pseudophakic patient with primary open angle glaucoma. The macular oedema was treated effectively with a combination of non-steroidal and steroidal topical drops. This case report shows a possible correlation between bimatoprost and CMO, in a patient with no recent confounding risk factors known to contribute to CMO . The recommendation from this report is that all patients treated with topical bimatoprost drops should have a baseline macula OCT examination and a repeated OCT examination 8 weeks after initiation of treatment, to facilitate early detection of CMO.

Background: Acral Fibromyxoma (AFM) is a rare benign soft tissue tumour which is described as a fibromatous and myxoid tumour of skin and soft tissue. Case details: A 40-year-old  male presented to the Dermatology outpatient department with swelling over the wrist of one year duration. The swelling was associated with mild pain, and it gradually increased in size to reach its present size. Cutaneous examination revealed a 2x2 cm mobile, cystic to firm, non-tender swelling over the dorsum of the right wrist. Based on its location and clinical features, it was provisionally diagnosed as a ganglion cyst  and excision biopsy was done. Histology showed stellate-shaped cells in a myxoid background with round to oval nuclei having a small, inconspicuous nucleolus. Acral fibromyxoma presents a distinct histopathology including a myxoid stroma and spindle-shaped cells, which are essential for accurate diagnosis and management.

Background: In addition to being used to keep babies clean and comfortable, baby care products may also include hazardous substances that are harmful to the baby’s health. To safeguard the health of new-borns, it is crucial to understand the potential toxins included in baby care products.Objective: This paper focuses on the very bothering aspect of baby care products. The objective of this study is to identify and summarise the effect of toxicants present in baby care products including their source, exposure, toxicity, and adverse effects on infants.Methods: Utilizing several internet databases including various open source, including PubMed, Scopus, and research gate, a thorough literature search was carried out. The review covered articles that were written in English and published in last fifteen years. Studies reporting on the sources, effects, and potential exposure pathways of toxicants found in infant care products have been included.Result: The study deals with a list of harmful toxicants like phthalates, asbestos, parabens, heavy metals, sodium laurel sulphates, etc., and their sources and modes of exposure. Exposure to toxicants such as phthalates, asbestos, parabens, heavy metals, and sodium laurel sulphates can lead to cancer, developmental disorders, and endocrine disruption.Conclusion: It can be concluded that baby care products are having adverse effects on infants, on their skin or health, or in other ways. To avoid the same, the root cause of it should be avoided, which is the inclusion of toxicant chemicals in such baby care products. Parents and caretakers should be aware of the dangers of toxicant chemicals in baby care products and use non-toxic products to protect their babies' health, while manufacturers should use safer components. Government and authorized agencies should enforce restrictions.

Introduction: The rise in cesarean section rates globally has led to a growing population of women with uterine scars, necessitating more targeted obstetric care in subsequent pregnancies. These women are faced with the decision of attempting vaginal delivery after cesarean section (VBAC) or opting for an elective repeat cesarean section. The likelihood of a VBAC depends on various factors both maternal and fetal, gathered in two known scores Grobman and Zhang, utilizing them could make VBAC successful and more widely attempted.  This study aims to validate the prognostic of these scores in a Moroccan population.Objectives:•    Validate the international predictive scores (Grobman and Zhang) for the probability of a successful VBAC in the Moroccan population.•    Explore additional criteria specific to the Moroccan population and develop a simplified VBAC score.  Results:•    Out of 2,973 women with a cesarean history, 313 attempted  TOLAC, 79% of these attempts were successful VBAC.•    The characteristics of successful VBAC included lower BMI, previous vaginal birth, lower estimated fetal weight, younger maternal age, and more favorable cervical conditions at admission.•    The Grobman and Zhang scores showed good predictive accuracy, with both models achieving 82.2% accuracy.•    When dividing women into groups based on predicted success (using both Grobman and Zhang scores), significant differences were found in success rates across different probability categories.Conclusion: Both Grobman and Zhang’s models were effective in predicting VBAC success in the Moroccan population, with a slight preference for the Zhang model. However, further research is needed to validate these models in clinical practice. It could involve developing a more population-specific model.

Melanoma is a highly malignant neoplasm arising from melanocytes, which are melanin-producing neural crest cells primarily located in the basal layer of the epidermis, making cutaneous melanoma the most common subtype. However, melanocytes are also found in other anatomical locations, and primary non-cutaneous melanomas, though rare, have been documented. Due to the aggressive nature of this malignancy, it carries a poor prognosis, particularly because it tends to metastasize to various, often atypical, sites. Recognizing these variable presentations is essential for timely diagnosis. Here, we report a rare case of metastatic brain melanoma in a young female and review the relevant literature, highlighting the importance of imaging in identification.

Background: To enhance the duration of sensory anaesthesia and to prolong the duration of post-operative pain relief during spinal anaesthesia, various adjuvants have been tried along with local anaesthetic agent. The present study was undertaken to evaluate and compare the onset and duration of sensory block, motor block and duration of post-operative pain relief by using intrathecal 0.5% Hyperbaric bupivacaine with fentanyl 25µg versus only 0.5% Hyperbaric bupivacaine selected groups.Methods: We enrolled 70 ASA Ι & ΙΙ patients undergoing surgeries below umbilicus level for our Prospective Randomized trial. Those who met our inclusion criteria were randomized using simple random sampling technique, after obtaining informed consent. Patients in Group A received fentanyl 25µg with 0.5% Hyperbaric Bupivacaine and patients in Group B received only 0.5% Hyperbaric Bupivacaine intrathecally. Parameters like onset and duration of sensory and motor block and postoperative pain relief were observed. In postoperative period, VAS score was monitored & time for rescue analgesia was noted, when VAS exceeded 5 or above.Results: It was found that Patients in Group A had significantly prolonged duration of postoperative analgesia as compared to Group B (Z value 17.35). Results of Onset & Duration of sensory and motor block were suggesting insignificant result. Post-operative complication was insignificant in our study.Conclusion: Addition of Fentanyl 25µg with 0.5% Hyperbaric Bupivacaine in Spinal anaesthesia have insignificant effect on duration of sensory and motor blockade and prolongs postoperative pain relief.

Gilbert’s Syndrome (GS) is a hereditary disease that can cause hyperbilirubinemia due to a mutation in the promoter of the UGT1A1 gene, which causes a decrease in uridine diphosphate glucuronyltransferase enzyme activity. Polymorphisms in the UGT1A1 gene are associated with induced hyperbilirubinemia by Tyrosine Kinase Inhibitors (TKI) in Chronic Myeloid Leukemia (CML). We report a case of patient who developed hepatotoxicity when treated on Imatinib and subsequently diagnosed with Gilbert’s syndrome. Eight months after initiating Imatinib, the patient developed conjunctival jaundice and signs of hepatotoxicity with increase in liver enzymes and hyperbilirubinemia with elevated level of unconjugated bilirubin. Gilbert’s syndrome was suspected in the presence of predominantly unconjugated hyperbilirubinemia and a prior history of transient episodes of jaundice. Genetic testing revealed homozygosity for the UGT1A1 TA7 (*28) polymorphism. Imatinib was stopped due to continuous increase of aminotransferases and hyperbilirubinemia and restarted after improvement of Liver Function Tests (LFTs) with a reduced dose of 200 mg/day but LFTs worsted again, and the patient was switched to Dasatinib 100 mg/day, without hepatic cytolysis and a mild persistent hyperbilirubinemia after a follow up of 20 months.Patients with an unexplained rise in serum bilirubin levels on Imatinib therapy should be screened for the genetic UGT1A1 polymorphisms.

Background: Postmenopausal bleeding (PMB) is bleeding from the genital tract after 12 months of amenorrhea in a woman over the age of 50, or 24 months if below the age of 50 years, in 10% of women presented with PMB, the cause is endometrial cancer.Purpose: To assess the clinical presentation types and outcomes of diagnostic measures provided for women presenting with PMB at Saad Abu-Alela Hospital, Khartoum, Sudan.Methodology: It was a descriptive, cross-sectional study conducted at Saad Abu-Alela Teaching Hospital in the period from January to December 2022.An interview questionnaire was used for data collection. Fifty-nine (59) postmenopausal women were included in this study, age, parity, risk factors, duration of bleeding, duration of menopause, ultrasound findings, and hysteroscopy findings were recorded.Results: The majority of study participants were aged between 50-54 years, menopause duration was most 1-4 years, most of the participants were educated and medically free, DM and HTN, and most of the participants were multiparous. Duration of PMB ranged between weeks in a third of cases and up to more than a year in some cases, amount of bleeding was mild in more than half. Ultrasound is used to assess the endometrial thickness and other findings, also hysteroscopy and biopsy or Dilation and curettage and hysterectomy.Conclusion: The ultrasound and endometrial biopsy via inpatient hysteroscopy and dilatation and curettage were the best tools for evaluation of (PMB), benign conditions were the most frequent outcome and endometrial cancer.

Scoliosis is a condition of abnormal lateral curvature of the spinal column greater than 10 degrees as measured by Cobb’s angle. The two main groups of scoliosis are idiopathic scoliosis and non-idiopathic scoliosis. The diagnosis of an idiopathic scoliosis is made if a non-idiopathic one has been excluded. Idiopathic adolescent scoliosis is a more common form. Neuromuscular scoliosis, which is a type of non-idiopathic scoliosis, is characterized by diverse muscular and neurological impairments. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic cases.

The integration of artificial intelligence (AI) technology into various fields, particularly healthcare, has demonstrated considerable potential in improving efficiency and accuracy. However, the potential risks associated with unprofessional or inappropriate use of AI cannot be overlooked. The current landscape of healthcare demonstrates a growing reliance on AI tools, which is expected to expand in the future. The existing literature highlights the effectiveness  of various AI applications, including chatbots, in specific medical domains. This study aims to review relevant literature in the pharmaceutical and galenic fields while evaluating a prominent AI chatbot provider. Based on the findings, this article presents critical considerations for researchers and practitioners. A thorough assessment of the benefits and risks associated with AI technologies is essential as these tools become increasingly prevalent in pharmaceutical practices.

Background: Methemoglobinemia is an uncommon hematological condition in which hemoglobin contains iron in an oxidized (Fe³+) state with limited oxygen-carrying ability. It can be congenital or acquired. Anesthetic management of methemoglobinemia poses a great challenge, as there is a risk of refractory hypoxemic crisis in the perioperative period. Case: Here, we present a case of a 24-year-old female with congenital methemoglobinemia who presented with gallstone disease for laparoscopic cholecystectomy under general anesthesia. She had a deficiency of cytochrome B5 reductase, which contributed to 26% of methemoglobin levels on co-oximetry. Despite taking considerable precautions to avoid hypoxemic episodes and metabolic acidosis, an episode of desaturation happened at the end of the procedure, which was managed with intravenous methylene blue. The patient recovered without any hypoxemic insult. Conclusion: Anesthetic management of patients with moderate (20% - 30%) methemoglobinemia can be successful with extreme precautions to avoid events that can increase the methemoglobin levels and adequate preparation and availability of intravenous methylene blue.

Malignant neoplasms of the external auditory canal, middle and inner ear are rare. This anatomically complex region generates complicated three-dimensional specimens that can be a challenge for macroscopic and microscopic assessment [1]. The most common cause of malignancy involving the EAC and temporal bone is extension of cutaneous malignancy of pinna. Rare occurrences have been described in association with CSOM and sporadic cases arising in previously irradiated fields for the treatment of other head and neck cancers. The tissue diagnosis is relatively straightforward; however staging is a complex task that is best approached with consideration of clinical, radiological, and pathological findings [2].

Polymer Electrolyte Membrane Fuel Cells (PEMFCs) operating in Dead-Ended Anode (DEA) mode present a promising alternative to traditional flow-through systems by simplifying design and reducing costs. However, their efficiency and durability are challenged by transient phenomena such as water accumulation, nitrogen buildup, and carbon corrosion throughout operation. This review investigates the dynamic behavior of DEA PEMFCs under dynamic operating states, aiming to improve their efficiency. By analyzing purge cycle optimization and transient response characteristics, we identify strategies to mitigate hydrogen loss, maintain voltage stability, and extend stack lifetime. The key findings indicate that precise purge scheduling and effective water management are critical for optimizing performance, with dynamic models providing insights into time-dependent processes. This study underscores the potential of DEA PEMFCs for high-efficiency applications provided transient effects are effectively managed.

Introduction: Bronchoscopy could lead to local spread of pre-existing infection, spread of infection from one patient to another if the bronchoscope is disinfected inadequately, or, isolation of microorganisms from bronchoscopic specimens in a patient who is clinically not infected, i.e., pseudo-infection. This study is one such investigation of an outbreak of bronchoscopic pseudo-infections in a tertiary care hospital.Materials and methods: Bronchoalveolar lavage (BAL) samples were inoculated onto MacConkey Agar and 5% Sheep Blood Agar and incubated at 37 °C overnight. The growths obtained on culture media were processed for identification and antimicrobial susceptibility on Vitek 2 Compact as per manufacturer’s instructions. To investigate the outbreak, 5 mL - 10 mL of sterile water was flushed through the channels of disinfected bronchoscope and collected in a sterile container. The samples were centrifuged and inoculated onto MacConkey Agar and 5% Sheep Blood Agar. The growths obtained were further processed similarly as the BAL samples were processed. Environmental swabs collected from the bronchoscopy unit were also processed as the procedure mentioned above.Results: Bronchoalveolar lavage of 3 patients in a period of 1 week were contaminated with multidrug resistant Klebsiella pneumoniae. Two out of five bronchoscope fluid samples were also contaminated with Klebsiella pneumoniae. Among the swabs collected from bronchoscope unit, Klebsiella pneumoniae was isolated from the detergent box of the endowasher. Conclusion: The risk of propagation of infection via a bronchoscope can be evaded by proper reprocessing and improving the sterilization practices. 

Rationale: Pulmonary Arterial Hypertension (PAH) is a progressive vascular remodeling disease with elevated pulmonary vascular resistance that is lethal. While therapeutic progress was recently made with endothelin, nitric oxide, and prostacyclin pathway-based therapy for the treatment of PAH, the disease is currently incurable with a high cost of morbidity and mortality. Sotatercept, a new activin receptor IIA-Fc fusion protein, may prove to be a game-changer as a therapeutic agent for the treatment of PAH by regulating the growth factor signaling aberration of PAH.Methods: It is a narrative review of evidence for the drug Sotatercept for Group 1 PAH from a systematic literature search for clinical trials, mechanism studies, and regulatory data up to 2024. Pivotal clinical trials such as PULSAR, SPECTRA, STELLAR, and ZENITH were evaluated for efficacy, safety, and comparative results.Results: Sotatercept is a TGF-β family member ligand trap that rebalances activin/BMP signaling to target vascular remodeling. Clinically, striking effects were shown with exercise (40.8 m improvement in STELLAR 6MWD), pulmonary hemodynamics (PVR reduction of 146-240 dyn·s·cm-5 in PULSAR), as well as clinical measures (76% reduction of composite morbidity/mortality through ZENITH). On the background with an acceptable drug safety profile of predominantly hematologic effects, as well as injection site reaction, benefits were achieved. Comparison with analyses implies at least similar, if superior in some dimensions, efficacy of current PAH therapies.Conclusion: Sotatercept is a new therapeutic option for PAH as the first drug to act on the activin/BMP pathway. With its strong effect on several clinically relevant end points, it is a “fourth pillar” of PAH therapy. Clinical trials will determine its place in the algorithm, ascertain other combinations, and potentially identify its utility for other types of pulmonary hypertension.

Objectives: Hospitalization following a head injury is associated with high rates of disability that have a strong correlation with depression, anxiety, and low self-esteem. Well-being is related to life satisfaction, quality of life, happiness, personal growth and flourishing, competence, self-acceptance, positive relationships, and autonomy. The well-being of patients and their primary caregivers is important when a patient is left with impaired mobility after neurosurgery. The aim of this study is to examine whether the well-being of patients and their primary caregivers will differ before and after neurosurgery, and whether well-being differs between patients with motor disability (WMD group) and those without, compared to those who are not - NMD group (non-motor disability).Methodology: 123 patients and their main caregivers were recruited. Of these, 62 were in the before neurosurgical group, 31 Patients and 31 caregivers. 61 in the after neurosurgical group, 30 Patients and 31 caregivers, of which there are 16 from WMD group and 15 from NMD. Main outcome measures: Two analyses of Variance (ANOVA) were conducted: for WMD and NMD separately. The results reveal a significant decrease in wellbeing for both, patient and main caregivers, but a stronger decline in well-being was observed among WMD, as indicated by a larger effect size (η² = 0.74) compared to the NMD (η² = 0.38). In addition, no significant effect between group and time of measurement was found, indicating that the decrease in wellbeing was not different among patients compared to their main caregivers. Conclusion: The findings highlight the multifaceted impact of neurosurgery on well-being, particularly for patients who remain with motor disabilities and their primary caregivers.The decline in well-being after neurosurgery highlights the need for improved social support and the importance of developing treatment programs that can help ease the process of coping with these phenomena and provide appropriate support for both patients and their primary caregivers.