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.

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।

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.

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: 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.

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.

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.

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.

This research aims to determine the effect of dual role conflict and work stress on employee performance directly and indirectly through organizational commitment at the Central Java BKKBN agency, Semarang City, and Regency Work Area. The population used in this research is all employees who work in the Central Java BKKBN working area of Semarang City and Regency. Sampling will use purposive sampling, with the sample selection criteria being female married or married employees. Based on this sampling, the research sample size was 80 respondents. The primary data used was obtained through a research questionnaire. The data analysis technique used is the Structural Equation Model Partial Least Square (SEM-PLS). The research results show that multiple-role conflict has a significant negative effect on organizational commitment, and work stress negatively and significantly impacts organizational commitment. Multiple role conflict has a negative and significant effect on employee performance, work stress has a negative and significant impact on employee performance, and organizational commitment has a positive and significant effect on employee performance. The results of the mediation test show that organizational commitment can mediate the impact of multiple role conflicts on employee performance, and organizational commitment can mediate the effect of work stress on employee performance.

Drawing upon the progressively evolving theoretical frameworks and methodologies for housing adaptation tailored to the needs of the elderly, this study explores the enhancement of age-friendly living spaces through the integration of smart home technologies. A novel, multidimensional framework is introduced, integrating the elements of "elderly individuals, living areas, functional spaces, and technologies," fostering a comprehensive application of technology in elderly care. This approach aims to scrutinize the seamless integration of technological advancements into the daily lives of the elderly from a multidisciplinary perspective. The study delves into the effectiveness and adaptation strategies of smart home systems across three pivotal scenarios: daily living, health monitoring, and safety measures. It underscores the pivotal role of smart home technologies in elevating the well-being of the elderly. By implementing sophisticated smart solutions, such as voice commands and streamlined operations, these technologies empower seniors to effortlessly manage lighting, climate control, and security systems within their living spaces, fostering a customized, intelligent living ambiance. This initiative not only propels the application of smart home systems in the lives of the elderly but also ensures a safer, more comfortable, and autonomous lifestyle.

This report aimed to discuss aesthetic rehabilitation utilizing monolithic zirconia restorations to produce a homogeneous and pleasing smile in a patient with facial asymmetry. A patient had a previously failed root canal treatment RCT for maxillary anterior teeth, resulting in midline shift and slightly stained teeth, with many remaining roots causing functional and aesthetic concerns. The treatment plan involved monolithic computer-aided designed/computer-aided manufactured zirconia restorations to enhance his natural teeth appearance. Excellent aesthetic satisfaction was observed during the follow-up visits, resulting in self-happiness, self-esteem, and confidence.

Since ancient times, humans have used animal skin in their daily lives to create shelters and clothing. They have also developed special techniques to preserve animal hides for a long time after slaughter, such as salting and cooling. Skin is an ideal environment for microorganisms to inhabit due to its temperature and moisture content. According to our knowledge, many factors, including pH, temperature, salt concentration, nutrition, etc., influence bacterial growth. Therefore, many bacteria can thrive in a wide range of NaCl concentrations, from 1% to 20%, and are classified accordingly. Despite the high concentration of NaCl in the soak liquor used in the preparation of leather, numerous bacterial species can readily grow and produce lipolytic and proteolytic enzymes as a form of metabolic activity. Lipolytic and proteolytic enzymes have negative effects on leather and leather products, including spotting, disagreeable odor, discoloration of the resultant leather, and consequentially significant economic losses. To overcome this obstacle, a variety of preventative measures have been implemented, including salting, the use of antibiotics, plant extracts (essential oils), and, more recently, electric currents.

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.

The present study examines the leadership responsibilities undertaken by leaders inside private Islamic universities. The present study was directed by a singular research issue, specifically focusing on the leadership role of leaders inside private Islamic religious universities in their efforts to enhance the quality of education. The present investigation is characterised as a qualitative study employing a case study design. The study was conducted at the Nahdlatul Wathan Islamic College (STAI NW) in Samawa, Sumbawa Besar Regency, located in the province of West Nusa Tenggara. Data gathering strategies encompass several methods such as interviews, observation, and documenting. In the interim, the process of data analysis was conducted utilising a series of established techniques, namely data reduction, data display, data condensation, and conclusion drawing/verification. This study demonstrates that in order to enhance the educational standards, the chairman of STAI NW Samawa undertakes various primary responsibilities, including: 1) managerial duties; 2) Developing academic quality and sustainability; 3) Fostering campus entrepreneurship; 4) providing motivation; and 5) optimising the allocation of responsibilities among lecturers and staff members. The findings of this research have the potential to enhance the significance of leadership within the framework of private Islamic religious universities.