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Although the classical surgical treatment methods of chronic venous insufficiency are successful to relieve perfectly the cause (reflux) and result (varicose veins), the new ablation techniques such as endogenous laser ablation therapy (EVLT), radiofrequency (RF) and foam ablation come into currency more and more with their advantage of being performed with only local anesthesia. However, these techniques, still have the potential for residual saphenofemoral reflux due to incomplete ablation of all side branches of the saphenofemoral junction. As an alternative technique ligation + foam sclerotherapy is not only comfortable like EVLT or RF but also safe and effective as much as classic stripping.

Pulmonary embolism (PE) is an age-related disorder which is potentially fatal, but frequently misdiagnosed. However, the true prevalence of pulmonary embolism is unknown. Inaccurate estimates of PE prevalence might, in part, be attributable to underrecognition of atypical presentations of this disorder. If true prevalence is unknown, the positive predictive values of both typical and atypical symptoms and signs of PE will be unreliable. The negative predictive value of those parameters will, likewise, be unreliable. The aim of this review is to make clinicians more aware of atypical manifestations of PE, thereby increasing the likelihood of correct diagnosis and, hence, ascertainment of the true prevalence of PE. The range of atypical manifestations was explored by a literature search, using MEDLINE from 1946 to February 2019, and EMBASE, from 1947 to February 2019, and Pubmed, from February 2014 to February 2019, using the search terms atypical, uncommon, unusual, pulmonary embolism, lung embolism, pulmonary thromboembolism. This search revealed atypical presenting features such as non pleuritic retrosternal pain, abdominal pain, atypical breathing patterns, pulmonary oedema, Dressler’s syndrome, atypical radiographic manifestations, atypical electrocardiographic features, manifestations associated with oxygen saturation of 95% or more, coexistence of acute myocardial infarction and pulmonary embolism, coexistence of thoracic aortic dissection and pulmonary embolism, neurological manifestations other than stroke, paradoxical embolism, acute venous thrombosis of atypical location, and pulmonary embolism with normal D-dimer levels.

Dissecting aortic aneurysm with ST segment elevation, and pulmonary embolism with ST segment elevation are two of a number of clinical entities which can simulate ST segment elevation myocardial infarction. Objective: The purpose of this review is to analyse clinical features in anecdotal reports of 138 dissecting aortic aneurysm patients with STEMI-like presentation, and 102 pulmonary embolism patients with STEMI-like presentation in order to generate insights which might help to optimise triage of patients with STEMI-like clinical presentation. Methods: Reports were culled from a literature search covering the period January 2000 to March 2020 using Googlescholar, Pubmed, EMBASE and MEDLINE. Reports were included only if there was a specification of the location of ST segment elevation and an account of the clinical signs and symptoms. Search terms were “ST segment elevation”,”aortic dissection”, “pulmonary embolism”, “myocardial infarction”, and “paradoxical embolism”. Fisher’s exact test was utilised for two-sided comparison of proportions. Proportion was calculated for each group as the number of patients with that parameter relative to the total number of patients assessed for that parameter. Findings: There were 138 patients with aortic dissection, 91 of whom were either fast-tracked to coronary angiography (81 patients) or fast-tracked to thrombolytic treatment (10 patients). There were 47 patients managed with neither of those strategies. There were 102 patients with pulmonary embolism, 71 of whom were fast tracked to coronary angiography, and 31 who did not receive that evaluation. Compared with their dissecting aortic aneurysm counterparts, those dissecting aortic aneurysm patients initially managed by percutaneous coronary intervention or by thrombolysis were significantly (p = 0.0003) more likely to have presented with chest pain, and significantly (p = 0.018) less likely to have presented with breathlessness. The preferential fast-tracking to coronary angiography prevailed in spite of comparable prevalence of back pain in fast tracked and in non-fast tracked subjects. Use of transthoracic echocardiography was also comparable in the two subgroups of dissecting aortic aneurysm patients. Pulmonary embolism patients fast tracked to percutaneous coronary intervention were significantly (p = 0.0008) more likely to have presented with chest pain than their pulmonary embolism counterparts who were not fast-tracked. The prevalence of paradoxical embolism was also significantly (p = 0.0016) higher in fast-tracked patients than in counterparts not fast-tracked. Cardiac arrest was significantly (p = 0.0177) less prevalent in fast-tracked pulmonary embolism patients than in pulmonary embolism patients who were not fast-tracked. Preferential fast-tracking to coronary angiography prevailed in spite of the fact that prevalence of documented deep vein thrombosis was comparable in fast-tracked subjects and in subjects not fast-tracked. The prevalence of use of transthoracic echocardiography was also similar in fast-tracked pulmonary embolism patients vs counterparts not fast tracked. Overall, however, transthoracic echocardiography had been utilised significantly (p = 0.007) less frequently in dissecting aneurysm patients than in pulmonary embolism patients. Conclusion: Given the high prevalence of STEMI-like presentation in aortic dissection there is a need for greater use of point-of-care transthoracic echocardiography to mitigate risk of inappropriate percutaneous coronary intervention(which might delay implementation of aortic repair surgery) and inappropriate thrombolysis(which might precipitate hemorrhagic cardiac tamponade) (75) during triage of patients presenting with ST segment elevation simulating ST segment elevation myocardial infarction (STEMI). Furthermore, during triage of patients with STEMI-like clinical presentation, the combined use of point-of -care echocardiography and evaluation for deep vein thrombosis will facilitate the differentiation between acute myocardial infarction, STEMI-like aortic dissection, and STEMI-like pulmonary embolism. Among STEMI-like patients in whom DAA has been ruled out by point of care TTE, fast tracking to PCI might generate an opportunity to identify and treat paradoxical coronary artery embolism by thrombectomy. Thereby mitigating the mortality risk associated with coronary occlusion. Concurrent awareness of PE as the underlying cause of paradoxical embolism also generates an opportunity to relieve the clot burden in the pulmonary circulation, either by pulmonary embolectomy or by thrombolysis. Above all, frontline clinicians should have a greater awareness of the syndrome of STEMI-like presentation of aortic dissection and STEMI-like pulmonary embolism so as to mitigate the risk of inappropriate thrombolysis and inappropriate percutaneous coronary angiography which seems to prevail even in the presence of red flags such as back pain (for aortic dissection) and deep vein thrombosis(for pulmonary embolism). 

Evaluation of semen characteristics is an important and prior for semen preservation. The aim of this study was to collection and evaluation of indigenous buck semen in the coastal region of Bangladesh. The semen was collected from bucks through artificial vagina method. The colour, odour, volume, viscosity, mass activity, consistency, concentration and individual sperm motility were analysed and recorded after collection from pre-selected four bucks. The colour and odour of all buck (B) semen were creamy white to milky white and fishy smell, respectively. In this study, we found that the average volume of B-1, B-2, B-3 and B-4 were 0.74, 0.98, 0.42 and 0.60 ml, respectively. The average grading of viscosity of B-1, B-2, B-3 and B-4 were 3.2, 3.8, 2.6 and 3.0, respectively. The average grading of mass activity of B-1, B-2, B-3 and B-4 were 3.6, 3.2, 2.4 and 3.4, respectively. The consistency of B-1, B-2, B-3 and B-4 were 4.2, 4.8, 2.8 and 4.0, respectively. The concentration of B-1, B-2, B-3 and B-4 were 1.58, 1.94, 0.62 and 1.54 ×109 per ml of semen volume. The average percentage of individual sperm motility of B-1, B-2, B-3 and B-4 were 81, 71, 66 and 80%, respectively. Viscosity, mass activity, consistency, concentration and individual sperm motility were significantly (p < 0.05) correlate with each other. It may be concluded that the data about semen of the bucks are in acceptable level for preservation. Further study will be designed for the evaluation of viability and motility of sperm before and after freezing as liquid semen.

To prepare the population to provide first aid for thermal burns in emergency situations, algorithms for modern didactics of the educational topic “Thermal burns” are proposed. The following educational issues are highlighted: 1) Local exposure to high temperature. Burns. Kinds. Classification according to the depth of the lesion; 2) Rules for determining the area of burns; 3) Signs of thermal burns; 4) The concept of burn disease; 5) First (pre-hospital emergency) aid to burnt people; 6). Domestic burns from boiling water; 7) Features of burns in children; 8) Treatment of burns; 9) Prevention of thermal burns.

WhatsApp, a widely used instant messaging application, has become a valuable source of digital evidence in forensic investigations. This review article explores the forensic analysis techniques, challenges, and future directions associated with WhatsApp. It covers the extraction and analysis of data from various sources, including mobile devices, cloud backups, and network traffic. The article discusses the challenges faced by forensic examiners, such as encryption, data volatility, and the need for proper validation of tools. It also highlights the importance of keeping up with the latest updates and changes in WhatsApp’s features and security measures. The future directions for WhatsApp forensics are explored, focusing on the development of more advanced and efficient analysis techniques, the need for standardization, and the importance of international cooperation in addressing cross-border investigations. This review provides insights for forensic examiners, researchers, and legal professionals involved in cases requiring WhatsApp evidence.

Males and females are different in their interactional behavior, their way of suffering, and their way of expressing themselves. It is therefore supposed that they react differently in group settings. This includes the degree to which they experience burdens and side effects of group psychotherapy. The objective of the study was to explore side effects of group psychotherapy in relation to gender. Seventy one patients in cognitive behavioral group psychotherapy were assessed with the UE G scale (unwanted events in groups). Burdens or side effects were reported by 98.6% of patients, severe and extremely severe burdens by 43.7% of patients. The highest average scores were found for “I was afraid not to know how to proceed in the future (1,34)”, “I realized how complicated everything is (1,32)”, “I have experienced the ongoing group therapy as burdensome (1,29)”, and “I have learned that group therapy is not my thing (1,01)”. Males score higher in their global judgement that group therapy was burdensome. There were no further significant differences in any of the specific items. The data suggest that side effects are a regular companion of group psychotherapy. A major negative effect of group psychotherapy is demoralization because of the observation of other patients, their problems and problem explanations. This is the same for both sexes. Research is needed on how to minimize burdens for patients.

Introduction: Current pediatric residents spend less time in the neonatal intensive care unit (NICU) and as a result, resident exposure to neonatal pathophysiology has decreased. Engaging learners efficiently while balancing clinical demands is challenging. Practices to enhance adult education include integration of problem centered learning into the demands of daily life in an environment in which learners feel safe asking questions and expressing themselves. Methods: With this principal in mind, we developed a curriculum to enhance resident and medical student education during busy NICU rotations. The curriculum was case-based, available on-line and facilitated by neonatology faculty and fellows. A template designed to be concise and interactive was used to create and present the cases. After the case vignette, the template prompted medical students and residents to generate a differential diagnosis, order a diagnostic workup and narrow the diagnosis. Discussion of the diagnoses occurred at the conclusion of the cases; however, the template discouraged didactic lectures. Results: In two years, cases were viewed 2,362 times. Facilitators and learners rated the quality and utility of the cases favorably overall. Cases took approximately 20 minutes to complete. Approximately 57% of survey respondents reviewed 1-2 cases per week and 9.6% reviewed 3-5 cases per week. Discussion: A template with a concise and consistent format to construct and present cases allows for the creation of a curriculum that can be incorporated into a clinically demanding service and may enhance clinical teaching and learner engagement.

The primary objective of this study was to detect the success and short-term survival rate of dental implant prosthetic therapy. The valuation of a possible relationship between the general and local clinical conditions of the patients (presence of risk factors and type of dental implant-supported prosthesis) and the satisfaction perceived by the patient, with success and survival of implant devices was investigated.The sample trial consisted of 23 patients, for a total of 50 dental implants supporting a prosthetic therapy. Preliminarily, an analysis of averages and frequencies of the anamnestic data was presented, as numbers and percentages. The implant success rate was calculated by assessing whether the implants fulfilled the success criteria defined by the Pisa Consensus Conference. The ANOVA test was used to check whether there was an association between the success of the implant device, the anamnestic data collected, and the type of prosthesis supported by the implants. Finally, the survival rate was calculated using the Kaplan - Meier method.The 2-year success rate of 50 implants was assessed at 98%. The 2-year survival rate was 97%. Finally, sex, age, compensated diabetes, a smaller and equal number of cigarettes per day (10 per day), the BOP, and the type of titanium dental implants supported by prosthesis, do not determine a change in success and are therefore not adequate parameters to predict the outcome of implant success. Following the results obtained, it is appropriate to continue the research by expanding the clinical observation times in order to obtain more solid scientific and clinical evidence.

As per report of WHO [1] (World Health Organization), air pollution (ambient/outdoor and household/indoor air pollution) kills an estimated seven million people worldwide every year largely as a result of increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer and acute respiratory infections. Data of WHO shows that 9 out of 10 people breathe air containing high levels of pollutants. World Health Organization is working with countries to monitor air pollution and improve air quality. From smog hanging over cities to smoke inside the home, air pollution poses a major threat to health and climate. More than 80% of people living in urban areas and around 91% of the world’s population live in places where air quality levels exceed WHO limits, with developing and under-developed countries suffering from the highest exposures, both indoors and outdoors [1]. While outdoor air pollution comes from the motor vehicles, burning of fossil fuels and other industrialization activities, indoor air pollution is the result of tobacco smoke and burning fuel for cooking & heating. Furniture and construction materials also emit such pollutants. Both outdoor and indoor air pollution are harmful to the human health.