Introduction: Signing against medical advice (SAMA) or discharge against medical advice (DAMA) is a fairly common occurrence among patients presenting to trauma with extremity fractures. The study aims to report the reasons for SAMA among these patients. Materials and Methods: This was a retrospective study of 105 admitted patients and later SAMA at the trauma centre of the Usmanu Danfodio University Teaching Hospital (UDUTH), Sokoto, Nigeria between February 2023 and December 2024. The study criteria included all patients with extremity fractures. The reason for SAMA within or more than 24 hours of admission includes the type of fractures (closed fracture, poly-trauma, multiple fractures or open fracture), financial, preference to traditional bone setting or proximity to home. The data analysis was done using SPSS Version 23. Results: There was a total of 105 patients in the study who SAMA. The SAMA prevalence was 3.7%. There were 90 (85.7%) males and 15 (14.3%) females. The mean age of patients was 32±19.55 (range 2 to 85). The most frequent age affected was 25 (9 patients) and the most involved age group was from 20 to 40 years with 54 (51.4%) patients. Eighty-one (77.1%) patients have SAMA within the first 24 hours of admission while 24 (22.9%) SAMA after 24 hours of admission (p-value <0.0001). There were 70 (66.7%) with closed fractures, 19 (18.1%) with polytrauma, 11 (10.5%) with multiple fractures, and 5 (4.8%) with open fractures. The reasons for SAMA were due to financial factors in 66 (62.9%) patients, preference for traditional bone setting (TBS) in 28 (26.7%) patients, and due to being closer to home in 11 (10.5%) patients. Conclusion: This study shows majority of patients had SAMA within the first 24 hours and occurred commonly among younger age groups, male gender, in patients with financial issues, preference for TBS, and closed fractures.

This study documents the diversity of epiphytic lichens inhabiting crop trees in the lowlands of Pathanamthitta district, Kerala, India. A total of 32 lichen species were identified, with 12 crustose and 20 foliose forms. The family Caliciaceae was the most prevalent, with eight recorded species. Notably, foliose lichens exhibited reduced thallus size and smaller lobes compared to typical growth patterns. Parmotrema praesorediosum was the sole exception, displaying larger lobes than the other collected foliose specimens. The study identified Areca catechu and Cocos nucifera as the tree species supporting the highest lichen diversity. The findings are crucial for understanding lichen biodiversity in anthropogenically modified habitats and will establish a foundational baseline for conservation and ecological monitoring in the agro-forestry systems of the Western Ghats biodiversity hotspot.

This article revisits Souvenirs d’autrefois (1916) by Martin Jérôme, a little-known memoir written by a Métis politician and public servant in early twentieth-century Manitoba, Canada. Far from a nostalgic recollection, the text is analyzed here as a civic intervention, a political, cultural, and linguistic act that anticipates contemporary debates on multilingual coexistence and linguistic justice. To interpret Jérôme’s work, the article introduces the concept of relational bilingualism, a framework that foregrounds language as a lived, asymmetrical, and historically embedded practice shaped by memory, place, and affect. Unlike institutional models based on legal symmetry, relational bilingualism emerges through negotiation, vulnerability, and community transmission. Through close reading and historical contextualization, the article positions Jérôme alongside other contemporaries such as Lionel Groulx, Donatien Frémont, Adrien-Gabriel Morice, and A.-H. de Trémaudan, mapping the intellectual and ideological field of francophone Western Canada. The final sections explore the enduring relevance of Jérôme’s vision for present-day debates on official bilingualism, digital archives, education, and Métis media. Manitoba, often seen as peripheral, appears here as a microcosm of global struggles around memory, reconciliation, and linguistic pluralism. Comparative perspectives from postcolonial contexts such as Algeria, Lebanon, or New Zealand help frame Jérôme’s narrative as part of a broader inquiry into how minoritized communities sustain language and identity in multilingual societies. By tracing the entanglements of language, land, and memory, this article argues that Jérôme’s bilingual modernity is not only historically significant, but theoretically generative: it offers a grammar of relational belonging that resonates beyond Canada’s borders.

The study assesses the variation in depth along the main channel of Otamiri River, in Rivers state, Nigeria. Quasi-experimental (field survey) research design was adopted for the study, as it involves observation on the morphometry parameters of the tributaries of Otamiri river. Primary data were collected through tape, ranging pole, float, and Stopwatch, while drainage maps and topographic map become secondary sources of data. The sample frame for this study is total length of all tributaries of Otamiri-river basin, in the study area. The total length of the tributary streams is 320 kilometers, the data were collected at interval 1 kilometre since total length is 320 kilometres, then 320 divide by 1, therefore the sample frame is 320 Sampling Station. Analysis of variance (ANOVA) was used in testing the various conjectural statements at 5% level of significance for acceptance or otherwise. Findings revealed that, there is variation in a significant variation in the depth along the main channel of the Otamiri river basin in the Southern Nigeria. From the findings, it was inferred that geomorphic and morphometric variations exist both with the main trunk of the Otamiri river as well as the major tributaries. These variations could be a function of temporal variation in the input factors as well as process modifications along the river channel and its basin area. Thus, the researcher recommends, adequate and periodic channelization through dredging of the downstream River channel as to improve channel capacity in order to reduce the menace of flooding that causes displacement of settlement and other human meaningful activities within the area concerned.

Monkeypox otherwise known as Mpox is a zoonotic disease caused by monkeypox virus which belongs to the genus Orthopox virus of the family Poxviridae; a large and diverse family of enveloped double stranded DNA viruses that replicate in the cytoplasm of infected cells. First discovered in 1958 with confirmed case first described in 1970, Monkeypox remains a reoccurrence especially in West African countries such as Nigeria. It occurs primarily in tropical rainforest areas of central and West Africa and is occasionally exported to other regions. There are two distinct genetic clades of the monkeypox virus: the central African (Congo Basin) clade and the West African clade with the earlier historically causing more severe disease and was thought to be more transmissible. In recent times, the case fatality ratio has been around 3–6%. Mpox is transmitted to humans through close contact with an infected person or animal, or with material contaminated with the virus. Clinical presentation resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Mpox typically presents clinically with fever, rash and swollen lymph nodes and may lead to a range of medical complications. The gold standard method of diagnosis is by polymerase chain reaction (PCR) method with others including viral culture, antibody testing and electron microscopy. This review x-rays the pathogenesis, risk factors, clinical presentations, associated complications, laboratory diagnosis, prevention and management of Mpox highlighting the need for utilization of an integrated approach that include immunization, antiviral treatments, and public health policies tailored to high-risk populations in combatting the disease. The need for training and retraining of Laboratory Scientists and personnels to acquire improved diagnostic skills desired in order to effectively control and reduce the impact of Mpox is highly needed.

Background: Chronic hepatitis B (CHB) is a significant global health burden, Patients with CHB are at increased risk of developing cirrhosis, liver failure and hepatocellular carcinoma (HCC). Even in asymptomatic state, there may be much progression of necroinflammation and fibrosis in liver in many patients specially in patients with elevated HBV DNA with normal alanine aminotransferase. Liver biopsy is the gold standard for fibrosis evaluation but has limitations, necessitating non-invasive alternatives like transient elastography in CHB patients with elevated DNA and normal ALT. Objective: This study aims to assess the correlation between TE and liver biopsy findings in CHB patients with elevated HBV DNA and normal ALT, evaluating TE's diagnostic accuracy in detecting significant fibrosis. Methodology: A cross-sectional study was conducted at the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from June 2019 to February 2020. Forty CHB patients (HBsAg positive >6 months, ALT <40 IU/L, HBV DNA >2,000 IU/mL) underwent TE and percutaneous liver biopsy. Fibrosis stages were evaluated using the METAVIR scoring system. TE findings were correlated with histological fibrosis using Pearson's correlation test, with statistical analysis performed via SPSS version 23. Results: The mean age of patients was 30.20 ± 8.3 years, with a male predominance (75%). TE classified 77.5% of patients as having F0-F1 fibrosis and 22.5% as F2 fibrosis. Histological analysis identified 57.5% with F0-F1 fibrosis and 42.5% with significant fibrosis (F2-F4). TE and biopsy findings showed a positive correlation (p<0.001). The receiver-operating characteristic (ROC) curve for TE demonstrated an area under the curve (AUC) of 0.774, with a cut-off value of 5.9 kPa yielding a sensitivity of 70% and specificity of 91% for detecting significant fibrosis. Conclusion: TE shows a strong correlation with liver biopsy findings in CHB patients with elevated HBV DNA and normal ALT, demonstrating its potential as a reliable, non-invasive alternative for fibrosis assessment. Utilizing TE in clinical settings could enhance early detection and management of liver fibrosis, reducing the need for invasive biopsies.

Diabetes Mellitus, a chronic metabolic disease caused by defective insulin secretion by pancreatic β-cells or the inability of insulin-sensitive tissues to respond to insulin, is on the rise globally, particularly in low-middle income countries, leading to complications. Chronic hyperglycemia in DM is associated with organ and tissue damage, malfunction, and failure, as well as the development of microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular diseases) problems. As a result, this review x-rays the risk factors, aetiology, epidemiology, associated complications with key emphasis on the underlying mechanisms and pathophysiology, current laboratory diagnosis using conventional and novel biomarkers, as well as current trends in the management of type 2 diabetes mellitus (T2DM), highlighting the need for a combined approach in management viz-a-viz lifestyle management along with pharmacological approaches as crucial to achieving success.

Laboratory diagnostics are indispensable to modern healthcare, yet the integrity of test results can be compromised by medication-related interference (MRI), a significant and underappreciated threat to patient safety. Erroneous laboratory data stemming from MRI can precipitate a cascade of clinical errors, including misdiagnosis, delayed or inappropriate treatment, and unnecessary additional testing. This review offers a practical, evidence-based guide for the key professionals’ integral to the laboratory testing process: nursing technicians, clinical pharmacists, and laboratory specialists. We systematically explore the foundational mechanisms of interference, classifying them into physiological (in vivo) effects, where a drug's pharmacodynamic or toxic action genuinely alters analyte levels, and analytical (in vitro) effects, where a drug or its metabolite directly disrupts the assay methodology. The review examines the vulnerabilities of common analytical platforms—spectrophotometry, immunoassays, enzymatic methods, and chromatography—to such interferences. A substantial compendium details clinically significant MRIs caused by major drug classes, with a particular focus on the profound and dangerous impact of high-dose biotin supplementation on immunoassays. The central aim of this guide is to delineate the distinct yet synergistic roles of the multidisciplinary team. It highlights the nursing technician's pivotal role in the pre-analytical phase, the clinical pharmacist's expertise in proactive drug identification and management, and the laboratory specialist's critical function in result validation and interference investigation. By elucidating the complexities of MRI and championing a framework for robust interprofessional collaboration, this guide seeks to arm healthcare teams with the knowledge and strategies required to protect the integrity of laboratory data, thereby enhancing clinical decision-making and safeguarding patient safety.

Infertility is a prevalent medical disease affecting between 8% and 17.5% of couples globally, with a male factor accounting for nearly half of all cases of infertility among couples. Infertility is a reproductive system disorder characterized by the failure to conceive following at least 12 months of frequent unprotected sexual intercourse. It may be primary or secondary in nature. Most countries still struggle to provide equal and fair access to fertility care, particularly in poor and middle-income countries. Hormonal imbalances such as a high prolactin level otherwise called hyperprolactinemia can induce infertility in males. Hyperprolactinemia is a frequent endocrine illness that can cause severe morbidity. It can be caused by a variety of factors, including drug use, hypothyroidism, and pituitary problems. Depending on the origin and effects of hyperprolactinemia, patients require treatment that takes into account the underlying cause, age, gender, and reproductive status. This study examined the biological and metabolic roles of prolactin, as well as the pathophysiological mechanisms and controls that drive male hyperprolactinaemia, laboratory diagnosis, and treatment.

Clinical chemistry is an area of laboratory medicine that deals with the analysis of body fluids for diagnostic, therapeutic, and research purposes. Modern laboratory practice in industrialized nations has long progressed beyond piecework manual techniques and uses completely automated systems with minimum human intervention, allowing many tests to be performed by analytical machines with the minimal need of an analyst. Nevertheless, there is need for understanding the basic instruments used in clinical chemistry laboratory especially in resource limited settings where there is unavailability of advanced instruments. This review x-rayed the common and basic instruments in clinical chemistry highlighting the underlying principles, maintenance and storage.

Predictive logistics is undergoing a transformation due to the presence of Artificial Intelligence (AI). It changes supply chains from a reactive, reaction-to-disruption model to a data-driven and proactive model. AI allows companies to predict demand more accurately than ever before by leveraging machine learning and real-time analytics, create optimal routes in real time, and optimize inventory by using AI. Studies find that the implementation of AI is capable of reducing forecasting errors by 20–50 percent and the cost of logistics by up to 15 percent. Another effective synergy is the combination of AI-based logistics data with Customer Relationship Management (CRM) systems will allow hyper-personalized marketing. This establishes a customer-response loop that enhances customer interaction and efficiency in the operations. This paper will discuss how AI can bring the best value to the logistics operation, the marketing personalization, the economic impact, and the integration of the systems that have traditionally been siloed, which leads to the argument that AI is best useful in bringing these functions together. There are difficulties that come with the transformation. This paper critically reviews the burning ethical issues in the recent past, such as data privacy, algorithmic bias, and workforce displacement, and concludes that the transparent and accountable adoption of AI is not only an ethical necessity but also a vital element of sustainable and competitive advantage.

Increase in the demand for consumer electrical and electronics equipment which is driven in part by the rate of technological advancements invariably gives rise to more products requiring the use of circuit boards. This paper analyses the manufacturing process of printed circuit board (PCB), disposal of waste PCBs at the end-of-life and how it affects the environments. Legislation on production and waste disposal was also be examined with specific interest in how these laws affect production and sustainable alternative ways to manufacture PCBs. Research into new types of environmentally friendly printed circuit boards, with particular interest in the recycle and re-use of the boards and components respectively and the life cycle assessments (LCA) which analyses the entire life phase of PCBs. In conclusion, the paper confirms the possibility of developing an environmentally friendly circuit board as an alternative to PCB.

Background: Prolonged hypertension is believed to affect brain structure due to chronic vascular stress. Objective: To assess the correlation between hypertension duration and changes in brain volumes using 3D MRI. Methods: This cross-sectional study involved 100 hypertensive individuals aged 30–60 years. Brain volumes (gray and white matter) were measured using 3D MRI. Pearson correlation analysis was used to evaluate associations with hypertension duration. Results: Strong negative correlations were found between hypertension duration and both gray and white matter volumes (r = -0.49 to -0.56, p < 0.001). Conclusion: Longer duration of hypertension is associated with reduced brain volume, reinforcing the need for early detection and sustained management of blood pressure.

The present study provides a qualitative and quantitative account of the rhetorical use of metadiscourse markers in Chomsky’s On Nature and Language, claiming that interaction is an essential component of persuasion in social fields in general and in linguistic discourse in particular. Persuasion, therefore, relies on effective argument and writer-reader interaction as writers are uncertain when dealing with human subjects and data, on one hand, and unable to draw on empirical demonstration or trusted quantitative methods (Hyland, 2000). As a result, writers use language to engage their readers by positioning, persuading and including them as discourse participants (Hyland, 2019). Chomsky’s linguistic discourse received several studies, however, writer-reader interaction as an integral component of the construction and attainment of ethos was marginalized and overlooked. Accordingly, the study hypothesizes that metadiscourse plays an essential role in Chomsky’s persuasive discourse. Moreover, the study addresses the question of how metadiscourse is deployed to engage and persuade the reader, on one hand, and to create a credible persona, on the other hand. The study identified 4,724 instances of metadiscourse in a corpus of 38,183 words. This is a frequency of one every 8 words. It also shows that instances of interactional metadiscourse are significantly greater than interactive ones, and the most frequent categories are engagement markers (35.9), hedges (27.1), transitions (18.7) and boosters (16.1).

This paper focuses on the interdisciplinary teaching design of high school mathematics under the STEM education concept, and takes the exponential function as a specific example to demonstrate the research. It presents an interdisciplinary teaching design that integrates science, technology, engineering, and other disciplines with the content of exponential functions in high school mathematics, covering five aspects: selecting learning content, analyzing students’ characteristics, setting learning objectives, implementing the learning process, and conducting learning evaluations. Through this teaching design, it aims to cultivate students’ interdisciplinary thinking and ability to solve practical problems, providing a reference for the development of high school mathematics teaching and the improvement of students’ comprehensive qualities.