Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) causes covid-19 disease. The disease is a multisystem and mosaic disorder that demonstrates extra pulmonary manifestations involving liver and other organs. Elevated blood bilirubin levels have been associated with poor covid-19 disease outcome. However, discrepancies prevail in these findings. The study aimed to evaluate the association between serum total bilirubin and direct bilirubin levels and clinical outcome of covid-19 infection. Materials and methods: This was a retrospective cross-sectional study. Data was obtained from medical records of patients admitted at Mount Kenya Hospital, Nyeri which was the designated county facility for diagnosis, treatment and management of covid -19 disease in Nyeri, Kenya. Data was obtained from patients’ files admitted between 01/04/2021-30/09/2021. Inclusion criteria: Positive covid -19 patients tested with real-time quantitative reverse transcription polymerase chain reaction test (rqRTPCR) and patients with serum total bilirubin and direct bilirubin levels done at admission. Exclusion criteria: Positive rqRTPCR covid-19 patients with incomplete medical records, positive covid-19 patients tested using rapid antigen test, patients with comorbidities, and pregnant women. Categorization of liver injury based on bilirubin levels: severe liver injury >5× ULN, moderate liver injury 3–5x ULN and mild liver injury 1–2x ULN. Categorical data were presented as frequencies and the chi-square test was applied to test for associations. P-value < 0.05 was considered statistically significant. Results: There was no statistical significance between serum levels of total bilirubin (P=0.390), direct bilirubin (P=0.272) and covid-19 clinical outcome (survival or non-survival) and severity. Conclusion and Recommendations: Serum total bilirubin and direct bilirubin levels has no significant association with covid-19 disease outcome and severity and thus are not reliable prognostic markers in our setting and in patients without preexisting comorbidities. The role of serum total bilirubin and direct bilirubin in prognosis of covid-19 be studied further to evaluate more mechanistic explanation.

Objective: (1) To identify and characterize bacterial isolates causing blood stream infection in children. (2) To determine the antibiotic sensitivity pattern of isolates obtained. Materials And Methods: Study design: Descriptive study. Study population: Blood samples collected from pediatric patients aged upto 12 years who are admitted in Government Medical College Kottayam, with clinical features of blood stream infection. Sampling methodology: The sample size of suspected blood stream infection is 345. All pediatric patients with clinical features suggestive of blood stream infection in the study period satisfying inclusion and exclusion criteria will be included in the study. The identification of bacterial pathogens and antimicrobial susceptibility tests were done by conventional and automated methods like VITEK system. Results: Out of 345 study sample population, 46 were culture positive, of which 21(45.7%) were Gram negative isolates and 20(43.4%) were Gram positive. Major isolates obtained were Klebsiella spp (15%), Methicillin Resistant Coagulase negative Staphylococci (15%), followed by Staphylococcus aureus (13%), Coagulase negative Staphylococci (8%) and Acinetobacter baumannii (8%). Klebsiella pneumoniae was resistant to most of the antibiotics tested except meropenem. All isolates of Coagulase negative Staphylococci and Staphylococcus aureus were susceptible to vancomycin and linezolid. Conclusion: Gram negative organisms were predominant pathogens in blood stream infections. Klebsiella pneumoniae, Coagulase negative Staphylococci, Staphylococcus aureus were the most commonly isolated pathogens. Amikacin along with the third generation cephalosporins should be used for empirical treatment of Gram negative sepsis. Vancomycin and linezolid can be used for Gram positive pathogens.

Leishmaniasis is a tropical infection transmitted to humans by the female sandfly (Phlebotomus argentipes). Leishmaniasis is widely prevalent in the Eastern states of India namely Bihar, Jharkhand, Uttar Pradesh and West Bengal having a hot and humid climate.

The burden of diabetes mellitus (DM) is a major challenge worldwide. This health problem has drawn attention, especially in Saudi Arabia, which is expected to be among the top five countries in 2030. The socioeconomic changes in KSA in recent decades resulted in changes in eating habits and lifestyle patterns. Diet is a modifiable factor that can prevent or delay the incidence of T2DM. Therefore, the relationship between diet and DM is crucial to deliver recommendations. Treatment of DM can only be effective if adequate attention is given to appropriate nutrition. Therefore, the Saudi Diabetes Clinical Practice Guidelines (SDCPG) (2021) recommended developing a nutrition therapy plan for each patient to achieve the treatment goals registered nutritionists provide for all individuals with DM. That is why a panel of 6 experts, a Saudi task force, gathered to develop an explicit, evidence-based consensus for nutrition therapy for T2DM people. An initial concept proposal was obtained. The proposal was divided into several topics discussed in September 2022. A literature review was carried out. The literature search was completed in March 2023. A drafted report was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval (i.e., above 80%). The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated in June 2023. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

The emergence of Carbapenem-resistant Enterobacteriaceae (CRE)is a public health concern worldwide. It is associated with increased mortality due to limited antibiotics available to treat CRE infections. The aim of this study was to understand the epidemiology of CRE infections, associated mortality, and available treatment options. All patients with CRE isolated in blood culture were identified between December 2011 and October 2019. Risk factors and mortality associated with each risk factor at 14 and 30 days were determined.55 cases of CRE bloodstream infections were isolated, with a median age of 56 years. Eighty-four percent of patients received treatment in the ICU. All cases were caused by Klebsiella pneumonia. The rate of resistance to the tested antibiotics was as follows: meropenem 92% (50/54), imipenem 75% (40/53), etrapenam 95% (19/20), Amikacin 71% (37/52), cotrimoxazole 73% (40/53), Gentamicin 47% (25/53) and colistin 7% (3/41). Major risk factors associated were the presence of a urinary catheter (84%), central venous catheter (78%), mechanical ventilation (74%) and post-surgery (67%). Mortality at 14 days and 30 days was 41%, and 52%, respectively. Univariate analysis showed that 14 days mortality was higher in patients with central venous catheter (P=0.01). Charlson's comorbidity index was associated with an increased risk of death at 30 days (P=0.04). There was no statistically increased survival in those treated with combination therapy at 30 days (P=0.5). The mortality of CRE infections seems to be high and optimal therapy is not yet well defined. Combination therapy is not associated with increased survival in this cohort of patients.

Health informatics has revolutionized the way healthcare professionals collaborate and deliver care, with significant implications for patient outcomes. This abstract explores the impact of health informatics on the collaboration between radiologists, laboratory technicians, pharmacists, and physicians, and its influence on patient outcomes. The abstract provides an overview of the role of health informatics in facilitating communication, information sharing, and decision-making among these healthcare professionals. It also discusses the potential benefits and challenges associated with integration of health informatics in collaborative care, and highlight the importance of leveraging technology to improve patient safety, treatment efficacy, and overall healthcare quality. The review concludes that, the professions of radiologists, laboratory technicians, chemists, doctors, and patient outcomes have all been significantly impacted by health informatics. Healthcare practitioners are now able to make better decisions thanks to the increased efficiency and accuracy of diagnostic imaging and laboratory tests brought about by the integration of technology and data management systems. Electronic prescribing and medication management systems have improved collaboration between chemists and doctors, guaranteeing safe and efficient pharmaceutical use. The application of health informatics has also helped patients receive more individualized care, better communication, and access to health information. All things considered, the use of health informatics has changed the way that healthcare is delivered and may continue to enhance patient outcomes in the future.

Magnesium supplements have been effective for modulating process of bile resistance, decrease oxidative stress and systemic inflammation. Current study was designed to functionally evaluate the MgO nanoparticle supplementation in an acute liver injury rat model. The animals were randomly divided into five groups. All groups were administrated with CCl4 to induce hepatic injury except of negative control group which received only vehicle. CCl4 administration is followed by MgO nanoparticles in the concentration of 150 and 300 mg/kg in low dose and high dose treated group respectively except of standard control group. After 21 days of treatment, the animals were sacrificed to collect blood and liver samples. Serum levels of bilirubin, AST, ALT and ALP were determined. Liver sample was also subjected to RNA isolation by Trizol method followed by the cDNA synthesis and Real Time PCR. In addition, lipid profile was also assessed. The data obtained was analyzed by one way analysis of variance (ANOVA). The results showed that levels of bilirubin, AST, ALT and ALP were significantly elevated in positive control group while MgO treated groups, somehow, had normal ranges of these enzymes. Furthermore, the qPCR results showed that the expression of Farnesoid X receptor (FXR), transcriptional regulator of the bile salt export pump (BSEP) and sodium taurocholate cotransporting polypeptide (NTCP), is reduced in positive control group, while nanoparticles treated groups had normal expression of these genes. In conclusion, our data showed that MgO nanoparticles possess hepatoprotective activity against hepatic injury.

The second-to-fourth digit (2D:4D) ratio is a sexually dimorphic trait that has previously been reported to be associated with socio-behavioral characteristics. This study examined the relationship amongst 2D:4D ratio, sex, and socio-behavioral characteristics among undergraduate medical students at Enugu State University of Science and Technology. A quantitative descriptive cross-sectional study design was adopted and a sample size of 120 was calculated using the Taro-Yamane formula. Convenience sampling method was utilized and the majority exhibited positive socio-behavioral characteristics such as emotional control and stress management abilities. There was a significant difference in the personality traits (conscientiousness and openness) between the male and female population at P<0.050. However, there were no significant differences between the left and right digit ratio among the male and female population as P>0.050 in each case. Also, there was no significant difference in the level of executive functions (emotional control, inhibition control, and stress intolerance) among the male and female populations as P>0.050 in each case. There was a significant negative correlation between the right-hand 2D:4D digit ratio and level of conscientiousness among the population with (r=-0.196) at P<0.050. However, no significant association was found between personality traits and executive functions. There was no significant difference between the participants’ digit ratio and gender. However, the male right-hand 2D:4D digit ratio was significantly associated with conscientiousness among the population. Additionally, no significant correlation was found between the participant’s digit ratios and their executive functions (emotional control, inhibition control, and stress tolerance).

Background: Menopause induces hormonal changes, including decreased estrogen levels, which can impact lipid metabolism and increase the risk of cardiovascular diseases in women. Objective: This comparative observational study aimed to assess the correlation between menopause and lipid profiles in women aged 35-65 years attending the General Health Check-up OPD at World College of Medical Sciences and Research in Jhajjar, Haryana, India, from January 2020 to December 2022. Methods: A total of 252 apparently healthy women, divided into premenopausal (n=126) and postmenopausal (n=126) groups, were included. Lipid profiles, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol (VLDL-C), were measured. Data were statistically analyzed using an independent t-test with significance set at p < 0.05. Results: In the study of 126 postmenopausal women, mean lipid profiles demonstrated notable values: total cholesterol (TC) at 191.59±35.78 mg/dl, triglycerides (TG) at 143.44±72.39 mg/dl, high-density lipoprotein cholesterol (HDL-C) at 45.01±9.99 mg/dl, low-density lipoprotein cholesterol (LDL-C) at 116.43±31.79 mg/dl, and very-low-density lipoprotein cholesterol (VLDL-C) at 28.69±14.48 mg/dl. Among 128 premenopausal women, mean lipid profiles were: TC 164±35.03 mg/dl, TG 125.52±65.84 mg/dl, HDL-C 41.66±7.66 mg/dl, LDL-C 96.95±31.78 mg/dl, and VLDL-C 25.10±13.17 mg/dl. Postmenopausal women exhibited significantly higher TC, TGs, LDL-C, and VLDL-C, alongside elevated cardiac risk ratios (TC/HDL and LDL/HDL), compared to premenopausal women Postmenopausal women displayed significantly higher mean levels of TC, TG, LDL-C, and VLDL-C compared to premenopausal women. Additionally, cardiac risk ratios, TC/HDL and LDL/HDL, were elevated in the postmenopausal group. Surprisingly, HDL-C levels were also significantly higher in postmenopausal women. Conclusions: Menopause is associated with unfavorable alterations in lipid profiles, including increased TC, TG, LDL-C, and VLDL-C, along with elevated cardiac risk ratios. However, HDL-C levels were unexpectedly higher in postmenopausal women. These findings underscore the importance of monitoring lipid profiles during the menopausal transition to address cardiovascular health concerns effectively.

The impact of interdisciplinary collaboration on patient care in various fields such as pharmacy, administration, psychology, radiology, and nursing cannot be overstated. The integration of knowledge and expertise from these diverse disciplines has significantly improved the quality of care provided to patients, leading to better health outcomes and overall patient satisfaction. One of the key benefits of interdisciplinary collaboration is the ability to bring together different perspectives and approaches to problem-solving. In a healthcare setting, this can be particularly valuable as it allows for a more comprehensive understanding of a patient's needs and challenges. The value of interdisciplinary collaboration lies in its ability to leverage the unique expertise and perspectives of professionals from different fields, thereby fostering a more holistic and comprehensive approach to problem-solving. Interdisciplinary collaboration has the potential to generate fresh perspectives and comprehension across boundaries between disciplines. Multidisciplinary study that is new can cross borders of disciplines to address complex and referred to as vicious issues facing culture.

This case report describes the non-surgical root canal treatment (RCT) of two cases with a periapical lesion associated with maxillary and mandibular anterior teeth of male patients who complained of swelling associated with pus drainage and pain. The obturation of both maxillary and mandibular central incisors was done by using lateral condensation and epoxy resin-based sealer, followed by composite resin filling as a permanent restoration. Clinical and radiographic re-evaluations at 4 months and 7 months for maxillary and mandibular teeth respectively revealed progressing bone healing, particularly in a maxillary region. This case report shows that an appropriate diagnosis in combination with RCT as a conservative non-surgical approach can lead to the complete healing of a large lesion without invasive treatments.

Background: Dentures are removably inserted dental prosthetics that fill up tooth gaps. There are many types of dentures, including complete, partial and implant-supported dentures. As long-term supports for tooth replacements, dental implants have significantly changed the treatment philosophies of conventional prosthodontics. However, the success and durability of these prosthetic devices may be impacted if a person seeking denture implants has diabetes. Diabetes affects the body in many ways, including the mouth's oral health. Immediate dentures have many benefits, including better oral functions, preservation of lower facial height, preservation of tooth sockets, improvement of aesthetics, and replication of natural teeth's shape, form, and location by artificial teeth. Diabetes mellitus has been reported to be associated strongly with the oral health. The higher glucose microenvironment prolongs healing of tooth extraction sockets. Thus, encouraging the healing of tooth extraction sockets is crucial from a therapeutic perspective for people with diabetes mellitus. Methods: An electronic search of English peer-reviewed dental literature on PubMed, Science Direct and Google Scholar was conducted to identify all publications reporting on how diabetes affect dentures until August 2023. Overall, 977 publications were found through an electronic and manual search, out of which 130 articles were selected after screening based on title and abstract. A total of 52 publications passed the second review phase after assessment for eligibility, from which 24 studies were excluded after full-text screening. Finally, a total of 28 studies were selected. A total of 10 articles were found to match our eligibility criteria to the full and were included in the final systematic review. Conclusion: Diabetes negatively impacts implanted dentures' success and longevity, leading to complications like Candida infection, poor bone integration, peri-implantitis, and compromised healing. Larger clinical trials are needed to understand diabetes's impact on implant therapy outcomes. Clinicians should assess patients' overall health, monitor glycemic control, maintain oral hygiene, and perform regular maintenance for optimal outcomes.

International Humanitarian Law (IHL) states that armed separatists are parties to the conflict. Hence, IHL applies to both armed separatists and government forces with equal force. Ambiguity comes in at the level of Cameroonian law, where armed separatists have been arrested and charged with the offences of terrorism and secession without consideration that there are parties to the conflict. The aim of this paper is to determine the status of armed separatist in NW and SW regions of Cameroon for the proper applicability of the law. This paper shall also examine whether the right to self -determination nullifies the offences of secession and terrorism within the context of the conflict in Cameroon. In order to attain the above objectives, doctrinal and analytical methodology has been adopted. The paper concludes that terrorism and secession are distinct offences under Cameroonian Law and the right to self-determination appears to be too abstract to shield these offences. To this end, it is recommended that they should be a clear line between secession, terrorism and self-determination. Equally, the law should clearly define the procedure for self-determination.

Every minute of every day, a baby is born. Most babies are easily seen to be a girl or a boy. Imagine how confusing it must be when we don’t know the sex of a newborn? This is rare and it can be very upsetting for parents. During the present study, a total of 47 individuals with unassigned sex were enrolled for chromosome study. These 47 individuals in different age group were categorized into three groups namely ambiguous genitalia, Intersex and Hypospadias. In Ambiguous genitalia group, a total of seventeen individuals were enrolled for chromosome study. Of these, thirteen individuals reared as males were found to have 46, XY karyotype. In the remaining four cases reared as female sex, three were found to have 46, XX karyotype and one which was phenotypically a female was found to have 46, XY karyotype. In Intersex group, a total of fourteen individuals were enrolled for chromosome study. Of these fourteen cases of Intersex reared as male sex by their parents, thirteen were found to possess 46, XY karyotype where as one cases was found possessing 46, XX. In Hypospadias group, a total of sixteen individuals were enrolled for chromosome study and were found to have 46, XY karyotype. The purpose of the present study was to find out the chromosomal sex in these individuals. The study is first of its kind from Jammu region of Jammu and Kashmir, India.

Background: Substance Use Disorders (SUDs) impose significant challenges not only on individuals grappling with addiction but also on the caregivers who provide support and care. The caregiving role is associated with multifaceted burdens that require understanding and targeted interventions. Recognizing the diverse dimensions of caregiver burden is crucial for offering effective support. Objective: The study aimed to find out the caregiver burden in substance use disorder patients, examining severity and socio-demographic correlations, contributing insights into effective support strategies. Methodology: The cross-sectional observational study took place at Sylhet MAG Osmani Medical College's Psychiatry Department and a private psychiatric and drug rehabilitation center in Sylhet from September 1, 2018, to August 31, 2020. The research focused on substance use disorder patients and their caregivers, involving 50 eligible patients selected through inclusion and exclusions criteria. Diagnoses followed DSM IV criteria. Socio-demographics were gathered via semi-structured questionnaires. Caregiver burden was assessed using the Bengali Zarit Burden Interview (ZBI) scale through approximately hour-long interviews, with 1-2 daily. Ethical procedures encompassed informed consent and confidentiality assurance. Result: The study included 50 male participants. Patients mean age was 31.92 (±8.21) and caregivers mean age was 41.68 (±12.89). Mainly, caregivers were mothers (40%) and wives (34%). Caregivers experiencing moderate to severe burden were 58%, mild to moderate burden were 26%, and severe burden were 16%. Mean ZBI score was 48.22±13.55. Higher burden correlated with illiteracy, low family income, excessive drug spending, prolonged substance use, and multiple drug usage. Alcohol users faced more burden than other substance users. Female caregivers, younger age, and housewives experienced heightened burden. No burden links were found with marital status, habitat, religion, family type, or drug administration method. Conclusion: This study concluded that Substance use heightens caregiver burden, notably among female, young, and housewife caregivers. Addressing these trends is vital for effective care of substance use disorder patients.