Repeat caesarean sections increase the possibility of maternal morbidity. Worldwide, the need for a trial of labor after caesarean delivery is gaining more ground in selected cases. Here, we report a case of an unbooked 37-year-old multigravida, with a history of five (5) previous lower-segment caesarean sections who presented in spontaneous labor. A live male baby of 2900 grams was delivered following episiotomy. Post-partum, she was observed with normal findings and a serial follow-up ultrasound scan showed normal uterine contours and surrounding structures. As the evidence for the practice of vaginal delivery in women who underwent 2 or more previous LSCS are still fewer, this report intends to highlight the possibility of successful vaginal birth after multiple caesarean sections putting into consideration the optimal care of the parturient. The term ''V-back" was coined from the Roman numeral 'v' meaning five (5), the case here has had five (5) previous lower segment cesarean sections come "back" for spontaneous vaginal delivery.

Increase in private and commercial car ownership in Cameroon like in most developing countries of the world have not kept pace with road infrastructural development. As a consequence, traffic disorder, congestion, late arrival at job sites and increasing number of accidents are some of the social costs road users have to pay. It is against this background that this study sets out to investigate traffic and mobility challenges in Mamfe municipality. This study made use of secondary and primary data sources. The secondary data were gleaned from published and unpublished documents. Primary data were sourced using a convenient sampling technique where 136 questionnaires were administered to 8 sampled communities in Mamfe municipality. Supplementary data were obtained via field observations, interviews and collection of way points using a GPS. After processing and presenting the data, results revealed that key causes of mobility challenges in Mamfe were; traffic jam (25%) inaccessibility to neighbourhoods (19.8%) and insecurity (15.2%). Also, consequences of mobility challenges, were noted to be; drop in transporters incomes (31%) resulting from traffic jam and increase fuel prices, late arrival at work (27%) and a slow turn-over of economic activities (trade and commerce) representing 33% of respondents scores. More so, traffic jam was notice to be very high in the rush hours of the morning between 7:20am to 10:05am. In the evening rush hours between 3:00pm to 9:00pm. Strategies to reduce mobility challenges were basically infrastructural-base (increase road sizes, construct more roads and rehabilitation of dilapidated ones, and a proper road designation). This study recommends private sector participation in the development, provision, maintenance, public-private partnership and modernisation of transport infrastructure and services. These are all lacking in the study area which if effectively implemented will boost urban mobility in the town of Buea and beyond.

Primary factors considered that influence inflation movement can experience significant changes due to the COVID-19 pandemic. This research focuses on examining macroeconomic factors which influence the inflation rate in Saudi Arabia which is critical for development and adjusting a suitable policy response. Saudi Arabia’s changing inflation trends are also affected by its internal and external factors including domestic demands, net spending of Government, and liquidity along with exchange rate movements and imported inflation. This research paper focuses on providing insights regarding previous studies conducted on this topic by adopting different approaches. The approach utilized in this study reflects mainly non-oil revenues like value-added tax along with levies related to expatriates on inflation. ARDL (Autoregressive Distribution Lag Model) has been applied instead of the Vector Error Correction model considering its robustness for 40 quarter sample sized integrated in this study. From the results, it has been confirmed that the inflation Movement in Saudi Arabia is more inclined to external factors than domestic factors.

Dental anxiety is a common problem, affecting up to 58% of people. It can range from mild discomfort to severe phobia, which can make it difficult or impossible to get necessary dental care [1]. Anxious, fearful, or uncooperative behavior in children can make it difficult for dentists to provide them with the care they need. This can lead to missed appointments, delayed treatment, and even dental neglect [2]. Hypnosis is a non- pharmaceutical treatment that can be effective in reducing dental anxiety. It works by helping people to relax and focus their attention, which can reduce the perception of pain and anxiety [1].

Introduction: Spinal epidermoid accounts for < 1% of all primary cord tumor. This rare benign lesion may be congenital or acquired. Invagination of epidermal elements into the neural tube during embryonic period leads to the development of epidermoid cyst. Case Presentation: A 2 year old girl presented with a spontaneous intergluteal swelling with dermal sinus and lower limbs weakness. The lumber MR demonstrated an intradural lesion from L3 to L5 levels that compressed cauda equine or nerve roots. MR findings were compatible with an epidermoid cyst with dermal sinus without any coexistent spinal dysraphism. The patient underwent microsurgical laminectomy from L3 to L5, tumor was resected and sent for histopathological examination. A pearly white tumor was found and histopathology revealed an epidermoid tumor. Post-operative Magnetic Resonance Imaging (MRI) finding was total removal. Conclusion: Diagnosis of spinal epidermoid cyst is often delayed due to its obscure presentation. Here, we presented spinal lumber intradural epidermoid cyst with dermal sinus which was treated successfully with microsurgical total resection with preservation of spinal stability and neurological function. Post-operative follow up with MRI is helpful.

The opioid crisis in Southwest Nigeria has significantly increased, with socioeconomic factors such as lack of healthcare access, unemployment, and poverty exacerbating the problem. The review explores the interactions between biological variables, cutting-edge technologies, financial constraints, and environmental factors that contribute to drug abuse and substance use disorders. It also analyzes the major classes of opioids and distinguishes between medicinal and non-medical uses. The epidemic has negative impacts on personal well-being, healthcare infrastructure, and societal cohesion. The research suggests a multifaceted strategy, including interventions and policy implications. It suggests reducing poverty as a first step in treating the underlying causes, increasing access to mental health services, early detection and intervention programs, and public awareness initiatives to prevent disease. Medication-assisted treatment (MAT) is also emphasized as a recovery strategy. The evaluation advocates for policy changes, tighter guidelines for opioid prescriptions, and public awareness initiatives to inform people about opiate abuse risks and encourage cautious use.

Background: Lower back pain (LBP) is the most frequent medical condition requiring rehabilitation in most countries, and it is also the most common medical issue among individuals with disabilities. Numerous illnesses, such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and psychological disorders, can induce back pain that is not related to the spine. Objective: To determine the disability prevalence among patients with chronic non-specific low back pain Materials and Methods: The cross sectional observational study was conducted in the Department of Physical Medicine and Rehabilitation, Dhaka Medical College & Hospital, Dhaka. Total 103 cases diagnosed individuals with chronic non-specific low back pain after fulfilling enrollment criteria was enrolled in this study. Question about sex life (ODI-8) was asked at the end of the interview. Disability refers to impairment, activity limitation and participation restrictions that may occur with a health condition. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds with or without referred leg pain. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: Prevalence of the disability more than half (52.4%) of the patients had severe disability, 27(26.2%) had moderate, 14(13.6%) had crippled and 8(7.8%) had minimal disability. Conclusion: The prevalence of severe disability in Chronic Non-Specific Low Back Pain was 52.4%. The duration and severity of pain are significantly correlated with impairment.

Infections due to antimicrobial-resistant microorganisms have become widespread in recent years. Thus, searching for novel antimicrobial agents to combat such pathogens has become crucial. The current study aimed to evaluate the antimicrobial, antiplasmodial, and immunomodulatory activities of the extracts of endophytic fungi isolated from Psidium guajava. Isolation, identification, fermentation, and extraction of the secondary metabolites of the fungal endophytes were carried out following standard procedures. The extracts were subjected to High-Performance Liquid Chromatography-Diode Array Detector (HPLC-DAD) analysis to detect their bioactive components. The Antimicrobial activity and Minimum Inhibitory Concentration of the fungal extracts were evaluated against pure cultures of Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Salmonella typhi, and Klebsiella pneumonia using Agar well diffusion and Agar dilution method respectively. The acute toxicity study (LD50) was carried out using Lorke’s method. The extracts were tested in vivo in mice for antiplasmodial activity against Plasmodium berghei and in vitro against Plasmodium falciparum using Peter and Reyley's curative test method and WHO standardized micro-test system with modification respectively. The immunomodulatory activity of the extracts was evaluated by cyclophosphamide-induced myelosuppression (hematological parameters). Active extracts were further subjected to Delayed-Type Hypersensitivity Response (DTHR) and Haemagglutination Inhibition Assay using Sheep Red Blood Cells as antigens. The result showed Alternaria sp. (PGL1, PGL2, PGL3), from P. guajava. The HPLC-DAD analysis revealed the presence of bioactive compounds previously reported to have antimicrobial, antiplasmodial, and immunomodulatory properties. The fungal extracts exhibited varying degrees of antimicrobial activity. The LD50 of the fungi extracts was>5000 mg/kg in mice. The extracts at 100 and 200 mg/kg body weight in mice showed varying degrees of antiplasmodial activity. Growth of P. berghei was significantly (p<0.001) inhibited, curative effect ranges from 59.09 – 100%. Schizont maturation of P. falciparum isolates was inhibited and the highest level of inhibition was observed at 1 mg/ml (p<0.05). The fungal extracts reversed the effect of cyclophosphamide-induced reduction in total white blood cell counts and % neutrophil. This study showed that the tested plant harbors species of endophytic fungi that contain numerous secondary metabolites. The endophytic fungi showed prophylactic, immunostimulatory, and antiplasmodial activities, which can be exploited to develop antimicrobial, antiplasmodial, and immunomodulatory agents.

Background: Hypertension (HTN or HT), also known as high blood pressure or arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. Blood pressure is expressed by two measurements, the systolic and diastolic pressures. Purpose/Aim: To investigate the usefulness of C-reactive protein and ESR as biomarkers for the diagnosis of hypertension among hypertensive patients attending gwakor primary health centre. Methods: The study investigated the levels of ESR and CRP among hypertensive subjects. Qualitative and semi quantitative C-reactive protein was carried out on serum and ESR was also done using whole blood. Result: Of the 200 subjects recruited for the study the age distribution of C-reactive protein seropositivity among the study subjects shown that the age between 21-30 had a seropositivity 1(5.6%) with a total Number of 18 within the group, and the age group between 31-40 shown a seropositivity of 5(9.8%) with total number tested within the age group 51, also the age range between 41-50 shown a seropositivity of 6(24.0%) with total number tested to be 25, and the age range between 51-60 had no seropositivity with total number tested were 4, while >60yrs showed 2(100.0%) with total number tested were 2. the highest number of seropositivity observed was in the age range of >60yrs and above, followed by 41-50 with 24%. The highest value observed among the age group of >60yrs was not surprised because this age group are prone to degenerative diseases because of age related conditions as individual aged as shown in table 4.1. The difference observed among the age distribution of CRP seropositivity among the study subjects showed a significance difference which was statistically significant. The sex distribution among the study subject showed that men had seropositivity of 10(19.6%) with a total number of 51 tested, while female showed 4(8.2%) with total number of 49 tested. Conclusion: The findings in this study confirmed that CRP and ESR are good inflammatory markers in the management of hypertensive patients, also CRP is a more sensitive and specific marker compared to ESR, and it also reveal that as individual is aging the risk of developing hypertension is high because elderly people are more expose compared to younger persons.

West Asian region is viewed as the most significant region from a variety of perspectives. The area has long served as a strategically important, commercially significant, politically active, and culturally sensitive focus of international affairs. Thus present study will try to examine the comparative analysis between India’s trade relations with the World with special focus on GCC & Non-GCC countries of West Asian region since 1991. The paper comprises the nations of Bahrain, Iran, Iraq, Jordan, Kuwait, Israel, Lebanon, Oman, Qatar, Saudi Arabia, United Arab Emirates (U.A.E.), Yemen, Egypt, etc. Additionally, the study seeks to identify areas of convergence in India's exports within the region, shedding light on the intricate economic interdependencies that have shaped India's relationship with West Asian countries. By doing so, it aims to provide insights into strategic alignments, economic synergies, and potential growth avenues. Understanding these convergence points is crucial for formulating informed policies and strategies that align with India's broader economic and geopolitical objectives.

This research aims to examine the influence of local revenue and general allocation funds on the human development index. This research uses a quantitative approach with a simple regression analysis method. This research uses samples in the form of districts/cities in East Java Province. The type of data used in this research is secondary data. The secondary data used comes from the Directorate General of Financial Balance and the Central Statistics Agency. The period of this research is 2019 to 2021. The results of this research show that there is an influence between local original income and general allocation funds on the human development index.

Background: Low back pain (LBP) is recognized as a major public health problem around the world and is one of the most frequently discussed health conditions among medical professionals, particularly in the field of nursing. In addition to the nature of nursing work, body mechanics and life style factors, nurses’ socio-demographic characteristics plays a significant role in the causation of this condition. As a result, the purpose of this study was to investigate the socio-demographic characteristics of nurses so that policymakers and healthcare practitioners could gain a better understanding into the mitigation of LBP among nurses. Methodology: This descriptive cross-sectional study was conducted among 80 nurses working at Mugda Medical College Hospital, Dhaka, Bangladesh. Face to face interview was conducted through a self-administered questionnaire which had three parts relatable to socio-demographic profile, screening of musculoskeletal problems and pain intensity. Both descriptive and inferential statistics was applied through SPSS to measure the socio-demographic characteristics of nurses and other major variables. Results: Results showed that the mean age and BMI was 37.53 years and 26.77, respectively. Further, 1.68 person, 82754.72 Bangladeshi taka and 16.17 years were found as the mean number of children, family monthly income and working experiences of nurses, respectively. BMI, marital status, number of children and working experiences were found to be significantly (p<.05) associated with the low back pain. Conclusion: Regardless of socioeconomic status, all nurses experience some level of low back pain. However, BMI, marital status, job years, and the number of children all have an impact on the development of low back pain in nurses.

Background: CLL is an adult leukemia presented with a clonal accumulation of lymphocytes. Immunophenotypic changes can be effective in predicting clinical course, the survival of patients, and determining first-line treatment. Methodology: The current research used lymphoma data obtained from El-Obeid Oncology Center. Included were details pertaining to lymphoma patients who received their diagnoses between January 2018 and January 2020. One hundred patients, including sixty-one with CLL and forty-nine without, made up the full coverage sample. Immunohistochemistry and molecular analyses were conducted on a subset of individuals. Additionally, several patients underwent flow cytometry analysis for some CD markers as well as microRNA prediction. Results: CD19 was shown to be positively expressed in all CLL patients studied (100%), while 88% of non-CLL patients also showed the same expression. Ninety-three percent of the CLL patients and nine percent of the non-CLL patients examined showed CD5-positive expressions. Only 16.7% of CLL patients and 66.7% of non-CLL patients tested positive for CD22. Among the CLL patients studied, 92.3% showed CD23 positive expressions, while no non-CLL patients did. Every single patient with CLL and every single patient without CLL tested negative for CD38. We observed the presence of FMC70 in 16.7% of the analyzed CLL samples and in two out of the three non-CLL cases. We evaluated the predictive significance of microRNA in a cohort of 12 patients, finding that around 83% showed positive expression. Conclusion: CLL is more prevalent in Sudan than the reported global epidemiology and more common among elder men than non-CLL variants. According to the molecular prognostic markers, CLL has bad prognostic indicators.

Background: Uterine rupture is linked to high rates of maternal mortality, especially in developing countries. Thus, this study aimed to evaluate the factors contributing to uterine rupture and the resulting neonatal outcomes in Sudan. Methodology: This study comprised of a series of 26 women presented with uterine rupture to the department of maternity at El-Obeid Teaching Hospital, El-Obeid, North Kordofan state, Sudan. The patients presented within one-year time. Results: In this particular group of patients, the neonatal population exhibited the following distribution: 19.2% (5 out of 26) were classified as Alive and well (WA), 23% (6 out of 26) required admission to the neonatal intensive care unit (NICU), 46.2% (12 out of 26) presented with Fresh Still Birth (FSB), and 11.6% (3 out of 26) displayed manifestations of Macerated Still Birth (MSB). Conclusion: Various factors can impact the outcomes of neonates following uterine rupture, such as the availability of facilities and demographic factors. The majority of newborns delivered showed unfavorable conditions.

This paper investigates the heat transfer of multi-layer coated tools. An analogous coating layer technique is used to compare multi-layered coated tools to mono-layer coating tools and develop a heat transfer model for mono-layered coating tools. The equivalent heat capacity, density, and thermal conductivity of the coating are determined based on the geometric size, initial conditions, and boundary conditions, given the tool rake face temperature. The heat transfer efficiency of the multilayer coating is significantly influenced by the coating layers, the thickness of the layer, and the coating material. The results show that the equivalent coating layer approach is suitable for calculating coating temperature enhancement in the cutting heat transfer. The calculation of cutting temperatures for multilayer-coated tools was conducted and subsequently compared to experimental findings, revealing an error margin of around 10%. The findings of this study indicate that analytical models are also suitable for modelling cutting temperatures in multi- layer coating designs.