Background: The journey of pregnancy and childbirth embodies a critical period in a woman's life, impacting both maternal and child well-being. Understanding maternal status during and after labor beyond 28 weeks of gestation holds significant clinical relevance, given its implications for obstetric management and outcomes. Objective: This study aimed to assess maternal status during and after labor beyond 28 weeks of gestation at a tertiary hospital. Methods: A cross-sectional descriptive observational study was conducted at Mymensingh Medical College Hospital from March 2019 to August 2019. The study included pregnant women with fetal malpresentation from 28 to 42 weeks of gestation admitted to the labor and antenatal ward. A total of 50 participants were purposively sampled. Data were collected using a structured questionnaire and analyzed using SPSS version 16. Ethical approval was obtained, and informed consent was obtained from all participants. Results: The study revealed a diverse age distribution among mothers, with the majority falling within the 26-30 age bracket (40.0%). Parity distribution showed a significant proportion of mothers with four or more children (40.0%). Prolonged labor emerged as the most common complication (6.0%), followed by obstructed labor (4.0%). Maximum vaginal deliveries occurred at 28-31 weeks of gestation, while cesarean sections were predominant at or above 36 weeks. Cesarean section exhibited the highest survival frequency (100%), followed by vaginal delivery (90%) and assisted breech delivery (80%). Postpartum hemorrhage was the most common maternal morbidity (6.0%). Conclusion: In conclusion, our study sheds light on maternal demographics, labor complications, delivery modes, and perinatal outcomes at a tertiary hospital. The age distribution revealed diversity, with most mothers aged 26-30. Many were multiparous, underscoring the importance of obstetric history. Prolonged labor was predominant, emphasizing the need for vigilant monitoring. Cesarean sections were common after 36 weeks, ensuring higher survival rates. Despite benefits, postpartum hemorrhage posed a significant concern. This highlights the necessity for comprehensive obstetric care to improve maternal and neonatal outcomes. Further research is imperative to refine maternal-fetal care in tertiary settings.

In the month of February 2024, India lost a budding actor in the name of Suhani Bhatnagar who was a part of the popular movie ‘Dangal’. She was only 19 years of age. Unfortunately, she had ‘Dermatomyositis’, a rare inflammatory disease. She was treated with steroids but in vain. It is here that the article focuses on the use of homoeopathy of AYUSH in this rare disease. Homoeopathy has already proved its efficacy during the COVID 19 pandemic where it subdued the inflammation in the body. Thereafter, the disease could not progress to the lungs. Applying the concept of anti inflammatory approach, homoeopathy can deal with the issue of ‘Dermatomyositis’. It is to be noted that along with the homoeopathic medicines, all other supportive therapies like fluid management, temperature management & blood circulation management. At the end of the article, a homoeopathic protocol is mentioned that can be used in this rare disease.

Introduction: Head trauma is a major public health problem and a major cause of morbidity and mortality, particularly in young adults. Objective: To clarify the interest of computed tomography in the management of cranioencephalic trauma in the radiology and medical imaging department of the CHU GT. Methods: This was a retro and prospective study of 5 months ranging respectively from January to March 2010 on 103 cases, from August to November 2010 on 12 cases and concerned 115 patients who came for a CT scan in a context of traumatic brain injury. Results: The average age was 26.6 years with extremes from 4 years to 65 years. The sex ratio was 4.7%. Road accidents accounted for 80.9% of cases. All patients with computed tomography abnormalities, fractures of the vault represented 74.1% of cases, the base with 17.2% and in 8.5% of cases the fracture concerned both the vault and the base. The linear fracture interested the arch in 39.6% of cases. Pericerebral lesions were dominated by meningeal hemorrhage and extradural hematoma with 63.2% and 22.8% of cases. Hemorrhagic edema accounted for 81.7% of intracerebral lesions and in 12% of cases, intracerebral lesions were associated. Based on these data 48.3% of patients were operated on in neurosurgery. The mortality rate was 7.8%. Conclusion: CT remains the examination of choice in the management of craniocerebral trauma.

Drug addiction is a complicated neurobiological illness that alters a person's brain and behaviour to the point that they are unable to control their need to consume drugs. Here researcher finds out a few objectives. These are, to state the present scenario of drug addicts from the perspective of India and explain the government initiative to prevent drug addiction. The researcher will conduct this research through the documentary analysis method. The researcher’s main intention is to observe the current situation in India regarding drug addiction as well as how much government initiatives are able to control the structure. Since the younger generation is primarily responsible for leading India and positioning it as a developed nation, developing nations like India need to raise awareness to end this out-of-control situation.

Introduction: Gallbladder disease is one of the most common conditions affecting the digestive tract. Autopsy reports have shown a prevalence of gallstones ranging from 11-36%, with cholecystitis being one of the most prevalent complications. Although cholecystoenteric fistulas are rare, with an incidence of 0.15-0.5% among patients undergoing cholecystectomy, they can present significant diagnostic and therapeutic challenges. The transverse colon is the second most common site for these fistulas after the duodenum. A high degree of suspicion is required to diagnose it preoperatively. Here, we present a noteworthy case of a 65-year-old male patient with a fistula between the gallbladder and transverse colon, complicated by severe adhesions and a large stone, underscoring the complexities associated with this condition. Case Presentation: The patient had a history of hypertension and gallbladder stones when he was admitted during the COVID-19 pandemic with acute cholecystitis. Two years later, he had an elective laparoscopic cholecystectomy and, during surgery, the surgical team noticed significant adhesions around the gallbladder. Further inspection during dissection of the gallbladder bed revealed a fistula between the transverse colon and the gallbladder, and a single large stone was identified. The patient’s surgical procedure was successful, and his postoperative recovery was uncomplicated. Conclusion: A fistula between the gallbladder and transverse colon is a rare complication of gallbladder disease, and the transverse colon is the second most common cholecystoenteric fistula after the duodenum. The presence of a fistula is usually a late sequence of chronic gallstone disease that requires appropriate diagnosis and correct treatment. In this case, the surgery was complicated by extensive adhesions around the gallbladder with an adjacent colon and a large stone with a fistula noted between the transverse colon and the gallbladder. However, through careful planning, correct surgical procedures, and skilled surgical expertise, the patient’s condition after surgery lacked complications. This case focuses on the importance of addressing all possible complications of gallbladder disease and adjusting surgical procedures accordingly.

Introduction: The pharmacy-led discharge medication delivery to bedside (Med-to-bed) service in a tertiary care Johns Hopkins Aramco Healthcare (JHAH) hospital aims to optimize medication management during patient transitions from admission to discharge, especially for those with chronic conditions. The service entails the direct delivery of discharge medications to patients at the pharmacy following their discharge from inpatient wards, accompanied by comprehensive medication counseling. The pharmacy-led Med-to-Bed service aims to reduce patient wait times and improve overall clinical outcomes. Methods: This article highlights common challenges in medication reconciliation and post-discharge prescription fulfillment, highlighting the need for standardized protocols and improved hospital adherence to ensure seamless care transitions. It also discusses future considerations for optimizing the Med-to-Bed service, including proposed pharmacy renovations, installing a dedicated robotic dispensing system, and providing private spaces for patient counseling during medication pickup. Additionally, the proposal suggests deploying more pharmacy staff to address delayed discharge orders and making systemic enhancements to the EHR system to streamline prescription pickup. Result: The successful implementation of the proposed pharmacy-led Med-to-Bed service demonstrates the efficacy of interdisciplinary collaboration among nurses, physicians, and pharmacists. Through this collaborative approach, the Med-to-Bed service has shown tangible improvements in operational efficiency and patient outcomes, underscoring its potential to transform healthcare delivery models. Conclusion: Overall, this proposed model provides valuable insights into the transformative impact of integrated care initiatives like the Med-to-bed service in tackling complex medication management and enhancing quality patient care in hospitals.

The aim of this study is to find out the effect of phenylhydrazine on creatinine clearance, hence GFR and the relationship between GFR and aldosterone. Sixteen 16 male Wistar rats weighing 200 – 250 grams were randomly divided into four groups namely: Group 1 – Normal control Group 2 - Hematinic group (Fes): fed normal rat chow + tap water + ferrous sulphate (using an oral gavage at 75mg/kg bw); Group 3 - Anemic -treated group (AFes): administered Phenylhydrazine (PHZ) intraperitoneally for two consecutive days to induce anemia at a dose of 40mg/kg bw + normal rat chow + tap water + ferrous sulphate at 75mg/kg bw. Group 4 (Anu) – Anemic control group: administered Phenlyhydrazine (PHZ) intraperitoneally at a dose of 40mg/kg of bw + normal rat chow + tap water (as in group one). After 15 days, blood and urine samples were collected into sterile sample bottles for analysis. There was a significant (P<0.01, P<0.01, P<0.05) increase in aldosterone levels between Anu, control, Fes and AFes respectively. There was a significant (P<0.001) decrease in control compared with Anu. There was also a significant (P<0.01, P<0.001) decrease in Fes with AFes and Anu. Anu creatinine clearance was also significantly (P<0.001) lower than AFes. Phenylhydrazine intoxication led to a reduction in creatinine clearance and an increase in aldosterone levels, confirming a negative correlation (r= 0.9956, P<0.01) between aldosterone and creatinine clearance. Also, ferrous sulphate tends to reduce the extent to which aldosterone levels increased hence narrowing the margine and or reducing the significance of the correlation.

प्राचीन काल में हिमाचल के मंडी जिले में, समुद्र तल से 9000 फुट की ऊंचाई पर स्थित, पराशर ॠषि की तपोस्थली रही पराशर झील में एक तैरता हुआ द्वीप है। ऊंचे पहाड़ों के मध्य में स्थित इस झील पर आने वाले पर्यटक इस तैरते हुए द्वीप को देखकर हैरान रह जाते हैं, क्योंकि ये द्वीप झील में अपनी जगह लगातार बदलता रहता है। हालांकि, ज्योतिष, आयुर्वेद, वनस्पति विज्ञान, भूविज्ञान, जल-विज्ञान और कृषि सहित, ज्ञान के चौदह क्षेत्रों के विशेषज्ञ महान ॠषि पराशर के लिए इस तैरते हुए द्वीप का निर्मांण करना कोई कठिन काम नहीं रहा होगा। आज भी श्रीनगर की विशाल डल झील में बहुत से ऐसे तैरते हुए द्वीप बनाए जाते हैं और उनका उपयोग सब्जियाँ उगाने के लिए किया जाता है। सम्भव है कि प्राचीन ऋषियों ने, जो ऋषि पराशर के समकालीन रहे होंगे, कश्मीर में तैरते हुए सब्जियों के खेत बनाने की लंबे समय से चली आ रही कला का आविष्कार किया होगा। प्राचीन ऋषियों ने न केवल अपने आश्रमों और स्थलों में तैरते द्वीप जैसी रहस्यमय कलाकृतियों का निर्मांण किया, बल्कि उन्होंने इन स्थलों को रहस्यमय नाम भी दिए जो आने वाली पीढ़ियों के लिए सुराग या संकेत के रूप में काम करते रहें। पराशर झील में तैरते हुए द्वीप का नाम टहला है, जो राजस्थान के अलवर जिले की उस बस्ती का नाम भी है, जहाँ से सरिस्का टाइगर रिजर्व के कठिन पहाड़ी क्षेत्र में प्रवेश करने का मुख्य मार्ग हो कर गुजरता है। जब पांडवों को अपने निर्वासन के अंतिम वर्ष के दौरान अज्ञातवास में छिपे रहना था, तो सरिस्का जंगल के उबड़-खाबड़ इलाके ने उन्हें सुरक्षित आश्रय प्रदान किया था। इस सफल प्रयास में पराशर ॠषि ने तथा उनके पुत्र और वेदों के रचेता मुनि वेद व्यास ने पांडवों की सहायता की थी, तथा महर्श्री पराशर का धाम भी सरिस्का के प्रवेश मार्ग पर टहला के समीप ही स्थित है।

Breast cancer is a common disease worldwide, with over two million cases reported in 2018. Various therapy modalities use biological characteristics that influence treatment and outcomes to provide individualized care. Some biomarker advancements, such as hormone receptors, vascular endothelial growth factors, and HER2/neu receptors, have significantly contributed to the biological characterization of breast cancer. Triple-negative breast cancer is defined as malignancies that do not express hormone responsiveness or HER-2. Approximately 12% of women with breast cancer will have triple-negative illness, which is more common among non-Hispanic black women regardless of age, but is detected at a younger age than other subtypes. Women with triple-negative illness are more likely to be diagnosed at a later stage (stage III or IV). The pathogenesis of breast cancer is complex and poorly understood, however many risk factors are known. This cross-sectional study spanned from 2010 to 2022. In this study, the prevalence of triple-negative breast cancer in archived breast cancer cases at Federal Medical Centre Yenagoa, Bayelsa State, was analyzed using the Haematoxylin and Eosin Staining Technique on breast cancer samples collected over the study period. This study, done at Bayelsa State's Federal Medical Centre Yenagoa, analyzed 178 breast specimens. Ninety-six percent (96%) of the patients were IDC, and 5% were TNBC. The average age at presentation was 48.21 years, with 59.1% of patients being under 50 years. 40% of the patients exhibited HER-2/neu positive, and 65% had estrogen receptor (ER) positivity. The study was conducted in a single medical institution, and specific types of lesions were not included. Other potential limitations include comparing findings with various techniques and diagnostic protocols.

This study aims to analyze the impact of transactional leadership style and digital competence on the performance of State Civil Apparatus (ASN) in the era of the digital revolution, with employee motivation as an intervening variable. This study uses a quantitative approach with a sample of 110 ASN from the State Civil Apparatus (ASN) at the Semarang City Transportation Service agency. Data was collected through an online questionnaire and used Structural Equation Modelling (SEM) to analyze. Outcome of the study show that transactional leadership has a positive impact on employee motivation and ASN performance. Digital competency has been proven to have a significant impact on improving ASN performance, both directly and through increasing motivation. Employee motivation acts as a partial mediator in the relationship between transactional leadership, digital competence, and ASN performance. These findings emphasize the importance of aligning transactional leadership styles with developing ASN digital competencies in facing the challenges of the digital revolution. The practical implications of this research include recommendations for leadership development programs and digital competency training for ASN, as well as strategies for increasing employee motivation in the context of government digital transformation.

Introduction: It is undeniable that the NPC plays a crucial role in the development process of nations; “because maternal and neonatal deaths, which hinder economic growth and cause global losses in productivity, can be avoided thanks to ANC, which is all the more effective if it is early and regularly repeated. This consultation effectively contributes to avoiding “complications of pregnancy and its consequences, which are a major challenge for the health of women of childbearing age; and the leading global cause of morbidity, disability and mortality in this target, especially in developing countries. This research seeks to determine the repercussions and explanations explanations of the beginning late arrival of women to prenatal consultation. Method: This study is quantitative of the cross-sectional descriptive correlational type, carried out at the MAZIBA health and maternity center, more precisely in the Bonhomme district, in the commune of Matete, city of Kinshasa, in the Democratic Republic of Congo, during the period from January 29 2022 to April 8, 2023. It used the survey method, combined with the interview technique and a survey questionnaire as the data collection instrument. Results: The late onset of CPN remains a major public health issue in the study region. The late arrival of pregnant women at the CPN is influenced by different variables such as neglect, fatigue, distance, lack of financial means, high cost of care, poor reception, lack of space, lack of chairs or benches. The consequences linked to late arrival at the ANC are on two levels: the consequence for the pregnant woman and for the fetus. In the pregnant we obtained an average of 18.7% and 31.3% in the fetus. This study demonstrated that there is a significant statistical relationship between It also appears that there is a significant statistical relationship between personal, socio-economic, organizational, cultural factors and the consequences in the fetuses (p = 0.00. P=0.01, and p=0.00). Conclusion: Thus, healthcare professionals have the opportunity to provide ongoing education on the importance of starting prenatal care visits early to avoid adverse pregnancy outcomes, taking into account all the elements mentioned.

Still many Yogyakarta water polo athletes experienced problem moment do shot or shooting, especially problem lies in the player's mentality. Study This aim for know-how influence between method Internal imagery and external imagery training for water polo shooting among Yogyakarta water polo athletes. Study This use method experiment with 2x2 factorial design with use technique collection of pre-test and post-test data on imagery exercises (internal and external) and level concentration (high and low). Population study is player DIY water polo team. Sample study this determined with purposive sampling technique consisting of 30 athletes. For know level concentration done test measurement with using test grid concentration. Internal imagery and external imagery exercises were carried out each exercise is done 6 times for 30 minutes. Ability athlete's shooting accuracy done with use 5 meter penalty shooting test. Data analysis techniques using two way Analysis of Variance (Anova) at level significance (α) 0.05. Research result show that: 1) exists difference between internal imagery and external imagery training (p = 0.010 < 0.05) then method more internal imagery exercises Good rather than external imagery. Group players who have concentration tall more appropriate if trained with internal imagery, meanwhile group players who have concentration low more Good If trained with external imagery.

Background: Fractional exhaled nitric oxide (FeNO) has emerged as a potential tool for managing asthma in children, but its precise role remains under investigation. Objectives: This systematic review aims to comprehensively evaluate the current research on FeNO's utility in managing pediatric asthma. Methods: We conducted a systematic search of electronic databases like PubMed, MEDLINE, Science Direct, and Scopus. Two independent reviewers screened and extracted data from eligible studies. Results: Sixteen studies including 4612 participants in total and more than half of them 2558 (55.5%) were males—were included in our data. Intermediate FeNO levels had a higher yearly hospitalization rate than those with low or high FeNO levels. FeNO can be a predictive marker as one study found that FeNO levels of more than 35 ppb have the highest risk of developing respiratory disease in the future. Regarding the benefits of FeNO-guided therapy, the use of FENO in conjunction with GINA guidelines for ICS titration can help reduce daily ICS doses and treatment costs. FeNO was found reliable as an asthma biomarker only in children with concomitant aeroallergen sensitivity. Conclusion: The evidence for the effectiveness of FeNO-guided asthma care in children is critical. The effect of FeNO-guided treatment on pharmaceutical use is unclear. Any benefits in illness control must be balanced against the risk of increased drug use, particularly ICS, as higher rates were frequently observed in children with FeNO-guided monitoring. There is an obvious need for larger, longer-term research to address these problems before making firm recommendations for routine therapeutic use.

Advocacy has been made for varied teaching strategies towards enhancing the cognitive attainment of students particularly at high schools. Much has not been done on the engagement of learners in laboratory activities for practical physics. We investigated the effect of laboratory activities on students’ performance in practical physics in selected secondary schools focusing on group and individual activities. Two research questions and one hypothesis guided the study. It is a quasi-experimental design using pre-test and post-test with experimental groups. The instrument used was a researchers developed performance test tagged “Practical Physics Performance Test (PPPT). A reliability coefficient of r=0.77 was obtained using Kuder-Richardson KR-21 method. The experiment was conducted for a period of six weeks after which the posttest was administered to the three groups. Research questions were answered using mean and standard deviation. The null hypothesis was tested using Analysis of Covariance (ANCOVA). The result revealed that students taught practical physics using group laboratory activity performed significantly more than students that were taught practical physics using individualized and lecturing activities. Teachers are therefore required re-strategies on how best to involve students into group laboratory activities during practical physics instructions to facilitate high level cognition. Sub-group approach that are monitored by the teacher with hybrid of fast and slow learners can be adopted.

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disorder, while multiple sclerosis (MS) is a prevalent chronic inflammatory demyelinating disease of the central nervous system. The coexistence of these two conditions is rare. Thus, patients with NF1 may exhibit signal abnormalities on brain imaging, referred to as focal areas of signal intensity (FASI), which can mimic lesions seen in MS and complicate the differential diagnosis. We present the case of a female patient suffering from progressive paraparesis, accompanied by urinary disorders and coordination disorders of the upper limbs. Neurological examination revealed a pyramidal syndrome and a cerebellar syndrome, with an Expanded Disability Status Scale (EDSS) score of 7.5. Additionally, the skin examination showed multiple café-au-lait spots larger than 15 mm and numerous diffuse neurofibromas. Brain magnetic resonance imaging showed white matter lesions typical of MS, and isoelectrofocalization of cerebrospinal fluid proteins revealed positive oligoclonal bands. The diagnosis was primary progressive multiple sclerosis associated with neurofibromatosis type 1. The aim of this case report is to document the association of these two conditions and discuss the challenges in differential diagnosis and treatment, as early diagnosis of MS is crucial to prevent further disability in patients with NF1.