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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.

Background: Nutritional awareness among caregivers plays a crucial role in ensuring optimal pediatric health and development. This study assesses the level of nutritional awareness among caregivers and examines its association with demographic factors.Objectives: This study aimed to assess the knowledge and awareness of caregivers regarding dietary advice and complementary feeding for children under five years at Wad-Albasheir Family Health Center, Um-Bada locality.Methods: A cross-sectional study was conducted among caregivers in selected healthcare facilities. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Descriptive statistics and chi-square tests were used to evaluate associations between variables.Results: The majority of caregivers demonstrated moderate awareness (60%), while 22.5% had low awareness and 17.5% had high awareness. A significant association was observed between education level and awareness (p < 0.05). Employment status also influenced awareness levels, with employed caregivers showing higher knowledge scores.Conclusion: Nutritional awareness is a key determinant of pediatric health. Strengthening educational programs targeting caregivers can improve child nutrition outcomes.

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.

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.

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.

Self-talk is a pivotal psychological technique within sports psychology that significantly influences an athlete’s performance and mental resilience. It involves the process of athletes engaging in internal dialogue to achieve specific psychological objectives such as enhancing motivation, improving focus, and managing stress. This technique encompasses various forms of self-directed communication including positive affirmations, instructional reminders, and motivational statements. Understanding the different types of self-talk and their effects is essential for athletes, coaches, and sports psychologists who aim to develop effective mental strategies for athletic success.

The action of modern emergency care for patients with AP, on the one hand, requires a wait-and-see period, which is unacceptable in cases of rapidly progressing inflammation. On the other hand, it uses methods that do not take into account the features of the disease mechanisms. All this creates conditions for an excess of complications and treatment failures. The accumulated facts on this problem indicate the need to revise the principles of treatment. Consequently, the most important initial step in this direction seems to be the correction of professional views in accordance with the classical provisions of medical science.

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.

Bifurcation analysis and Multiobjective Nonlinear Model Predictive Control (MNLMPC) calculations were performed on a model of circadian oscillations of the Period (PER) and Timeless (TIM) proteins in Drosophila. The MATLAB program MATCONT was used to perform the bifurcation analysis. The optimization language PYOMO was used along with the state-of-the-art global optimization solvers IPOPT and BARON for the MNLMPC calculations. The bifurcation analysis revealed oscillation causing Hopf bifurcations while the MNLMPC calculations revealed the existence of spikes in the control profiles. Both Hopf bifurcation points and the control profile spikes were eliminated using an activation factor involving the hyperbolic tangent function.

Left ventricular thrombus (LVT) is a life threatening complication following acute coronary syndromes but in modern era its incidence has reduced since the introduction of primary percutaneous intervention. LVT is associated with higher morbidity and mortality due to its thromboembolic events and major adverse cardiac events (MACE). This is a case report of 30-year-old male  who presented with acute abdomen and left ventricular thrombus. CECT abdomen revealed superior mesenteric artery (SMA) thrombosis and echocardiography revealed severe ventricular dysfunction (ejection fraction, EF<30%) with global hypokinesia and LVT. SMA thrombosis is fatal and if left unattended can lead to intestinal ischemia and gangrene, hence immediate intervention is warranted. This patient had undergone emergency laparotomy under general anesthesia for the resection of gangrenous jejunal segment with mucous fistula . This case report discusses perioperative management considerations in such cases.