Introduction: A comprehensive systematic review and meta-analysis reported that chronic kidney disease (CKD) has a worldwide prevalence of around 13.4%, underscoring its emergence as a global health concern [1,2]. Alongside CKD, patients are often affected by multiple co-morbidities such as hypertension, diabetes, and cardiovascular disorders [2-4] Methodology: A prospective observational study was conducted over six months in the Department of Nephrology at Karuna Medical College Hospital, Chittur, Palakkad. The study enrolled adult participants aged 18 to 70 years with moderate to severe chronic kidney disease (CKD). Patients were classified into CKD stages G1, G2, G3a, G3b, G4, and G5[5] Results: Table 1 shows the association of CKD stages across various demographic factors, BMI, and comorbidities. There was no statistically significant association between age and CKD stages. Among 188 patients maximum cases were observed in CKD stage V (34.57%), followed by CKD stage IV (27.65%). Table 3 shows that a higher number of patients were prescribed cilnidipine (27.4%), followed by telmisartan (19.0%), and the lowest number of patients were prescribed metolazone (1%), vasopressin (1%), and verapamil (1%). Table 4 shows that a higher number of patients were prescribed insulin (32.25%), followed by linagliptin (28.0%), and the lowest number of patients were prescribed voglibose (0.53%). Conclusion: This study emphasized the complexities involved in treating patients with chronic kidney disease (CKD), particularly when co-existing health conditions are present. It provided valuable information on current clinical practices and foundational data relevant to managing such patients.

This study emphasizes the importance of creating an outcome-based question bank using Bloom's Taxonomy as a framework, with an example drawn from the subject of Zoology and the course Biosystematics. A sample question bank was developed and utilized to generate multiple assessment question sets. The findings highlight that a question bank designed with Bloom's Taxonomy is a valuable tool in Outcome-Based Education (OBE). It facilitates systematic evaluation, enhances conceptual clarity, identifies slow learners, and fosters critical thinking, continuous learning, research, and innovation.

Background: Endometriosis is a chronic inflammatory condition affecting women of reproductive age, with a notably higher prevalence in those experiencing infertility. Given this association, the study aimed to assess how socio-demographic and clinical factors relate to the severity of endometriosis based on laparoscopic findings in infertile women. Aim of the study: The aim of the study was to evaluate the association between socio-demographic and clinical factors with the severity of endometriosis based on laparoscopic evaluation in infertile women. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at CARE, BIRDEM General Hospital, Dhaka (July 2013-June 2015) involving 127 infertile women. Data were collected regarding sociodemographic characteristics and clinical factors using a structured data collection sheet. BMI was calculated from weight and height and included in the data collection sheet. Laparoscopic diagnosis and staging used the Revised American Fertility Society criteria. Data analysis employed SPSS 20 (descriptive statistics, t-tests, chi-square tests). Results: In a study of 127 infertile women, Stage I endometriosis was most common, with Stage IV less frequent. Older age was linked to Stage I (p=0.016), and upper-class women had a higher prevalence (p=0.003). Lower BMI was associated with Stage IV (p=0.043). Severe stages, especially Stage IV, were significantly linked to dysmenorrhoea, menorrhagia, dyspareunia, and chronic pelvic pain. Conclusion: Socioeconomic background, age, BMI, and symptom profiles may serve as valuable indicators of endometriosis severity in infertile women undergoing laparoscopic evaluation.

Background: Arsenical keratosis, a chronic skin disorder resulting from prolonged exposure to inorganic arsenic, poses a significant public health challenge in arsenic-endemic regions like Bangladesh. Characterized by hyperkeratotic lesions, particularly on the palms and soles, the condition is a known precursor to skin cancer. Current treatment options offer limited efficacy, necessitating the exploration of alternative therapies. Objective: This study aimed to investigate the dose-dependent cytotoxicity of Nigella sativa seed extract and assess its therapeutic potential in the management of palmar arsenical keratosis. Methods: Conducted over 17 months, this observational study involved 32 patients diagnosed with moderate to severe palmar arsenical keratosis from two high-risk unions in Chuadanga, Bangladesh. Nigella sativa seed extract ointment was formulated and applied topically. The primary outcome was the reduction in the size of keratotic nodules, measured before and after 12 weeks of treatment using vernier slide calipers. Arsenic levels in patients’ water and nail samples were analyzed using a modified silver diethyldithiocarbamate method. Statistical analyses were performed using paired t-tests and Pearson correlation. Results: Topical application of Nigella sativa seed extract resulted in a statistically significant 72.8% reduction in mean lesion size (from 55.4 ± 29.8 mm² to 15.1 ± 10.8 mm²; p < 0.0001). No significant correlation was found between lesion size reduction and duration of arsenic exposure (r = -0.28), duration of lesion appearance (r = -0.17), or arsenic concentration in drinking water (r = -0.19). Patient adherence to treatment was high (mean adherence: 94.0 ± 6.6%), and only one case of mild, transient local irritation was reported. Conclusion: The findings demonstrate that Nigella sativa seed extract exhibits dose-dependent cytotoxicity against hyperproliferative keratinocytes, making it a promising, well-tolerated topical therapeutic for palmar arsenical keratosis. Compared to previous treatments, this natural formulation offers superior efficacy and minimal side effects, warranting further investigation through larger clinical trials.

Background: Chronic dacryocystitis is a common condition caused by an obstruction in the nasolacrimal duct, leading to excessive tearing, recurrent infections, and discomfort. The condition is often managed through dacryocystorhinostomy (DCR), which can be performed via two primary techniques: external DCR and endoscopic endonasal DCR. The external approach, a well-established procedure, requires an incision over the lacrimal sac, while the endoscopic technique offers a minimally invasive alternative with no external incision. The effectiveness, complication rates, and recovery times of these two methods are subjects of ongoing debate. Objective: This study aims to compare the outcomes of external versus endoscopic endonasal DCR in the management of chronic dacryocystitis. Methodology: An observational study was conducted at the Department of Ophthalmology, a tertiary hospital in Dhaka, from January 2024 to January 2025. A total of 30 patients diagnosed with chronic dacryocystitis were divided into two groups, with 15 undergoing endoscopic DCR and 15 undergoing external DCR. Demographic data, preoperative complications, and postoperative outcomes were recorded and analyzed using statistical methods to assess the efficacy of both approaches. Results: No significant differences were found between the two groups in terms of age, gender distribution, or preoperative complications. However, the mean duration of surgery was significantly longer in the endoscopic group (60.5 ± 7.9 minutes) compared to the external group (53.1 ± 6.2 minutes) (p = 0.042). Postoperative results revealed that 76.7% of the endoscopic group and 83.3% of the external group had patent drainage systems, with no statistically significant difference in epiphora rates or sac patency between the groups. Bleeding complications were mild to moderate, and no significant differences in severity were observed between the two techniques. Conclusion: Both external and endoscopic endonasal DCR are effective for treating chronic dacryocystitis, with comparable outcomes in terms of epiphora resolution, sac patency, and complications. While the endoscopic technique showed a longer surgical duration, the two approaches yielded similar results in postoperative follow-ups. The choice of technique should be guided by individual patient factors, surgeon expertise, and patient preferences, as both methods offer satisfactory results in chronic dacryocystitis management.

Background: Abnormal uterine bleeding in peri- and postmenopausal women often raises concern for underlying pathology such as endometrial hyperplasia or carcinoma. This study aimed to evaluate the correlation between endometrial thickness on transvaginal ultrasonography and histopathological findings in postmenopausal bleeding. Aim of the study: The aim of the study was to evaluate the correlation between endometrial thickness on transvaginal ultrasonography and histopathological findings in postmenopausal bleeding, identifying predictive relationships for clinical assessment. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh, from June 2022 to May 2023, including 65 postmenopausal women with vaginal bleeding. Transvaginal ultrasonography (TVS) was performed to measure endometrial thickness, followed by fractional curettage for histopathological analysis at the Department of Pathology, DMC. Data were analyzed using SPSS version 26, and patients were categorized by endometrial thickness (≤5 mm or >5 mm), with statistical significance set at p < 0.05. Results: Among 65 postmenopausal bleeding patients, 58.5% had endometrial thickness >5 mm (mean 9.1 ± 6.1 mm). Histopathology showed 70.8% had abnormal findings, mainly endometrial hyperplasia (47.8%). A significant association (p = 0.001) was found between endometrial thickness and pathology, with >5 mm thickness linked to hyperplasia, carcinoma, and polyp, and ≤5 mm thickness linked to atrophy. Conclusion: Endometrial thickness on transvaginal ultrasonography is a significant predictor of endometrial pathology in postmenopausal bleeding, aiding in clinical assessment.

Chronic Obstructive Pulmonary Disease (COPD) is a common, progressive lung condition which significantly impacts the quality of life. Despite the existence of clinical guidelines, irrational prescribing patterns, remain common. Analysing prescription patterns and evaluating drug use can identify issues with prescribing patterns and provide valuable guidance to medical professionals. This study thus aims to analyse the prescribing practices of patients with COPD in order to determine areas for improvement, rationality, and adherence to guidelines. A prospective observational study was conducted among 113 COPD patients. Data on demographics, clinical status, and treatment (drug type, dosage, frequency, duration, and route of administration) were collected. WHO core prescribing indicators were applied along with analysis of drug classes, fixed drug combinations, and rescue medications. Majority of patients were between the ages of 61 and 75. 46.8% of individuals had a history of smoking, and 67.2% of cases had comorbidities. Of the 608 medications provided, 43% dealt with comorbidities and 57% targeted COPD. The most commonly utilized medications were bronchodilators (38.8%), corticosteroids (16.45%), and antibiotics (18.75%). In 72.5% of cases, beta-2 agonists were prescribed. ICS and combination mucolytics were preferred. The prescribing pattern reflected rational COPD management. According to this study, the most commonly prescribed drug classes for the treatment of COPD are bronchodilators, corticosteroids, and antibiotics. There is a visible overuse of antibiotics and brand-name prescriptions, which deviates from WHO core prescribing indicators. Ongoing prescription audits and educational interventions can thus promote rational drug usage and improve patient outcomes in the treatment of COPD.

Contemporary advancements in clinical dental implant replacement of teeth emphasize the modification of titanium surfaces to enhance osseointegration. These modifications employ both additive techniques, such as bioactive coatings, and subtractive processes, including acid etching and grit-blasting. Objective: The present clinic-radiographic study was conducted to evaluate clinical and radiological parameters around a conventional SLA coated and a CaP-coated sandblasted, large-grit, acid-etched (SLA) surface implants during the first year after placement. Materials and Methods: The clinical study was conducted on 20 patients who were randomly assigned to one of two groups: a control group and a test group. In the test group, dental implants coated with calcium phosphate nanocrystals were placed in the prepared osteotomy site. In contrast, the control group received standard implants without any coating, which were placed similarly. The patients' soft tissue and hard tissue health were evaluated and recorded at regular intervals - 1 month, 3 months, 6 months, and 1 year post-implant placement. A statistical analysis was then performed. Results: Plaque Index, Gingival Index, and Modified Sulcular Bleeding Index Crestal bone level were evaluated and showed no statistically significant result when observed on the mesial and distal aspects at 1-year but a statistically significant difference was found in pocket probing depth and densitometric analysis to assess the bone density (mesial, distal and apical) 1-year post implant placement. Conclusion: While the calcium phosphate-coated implants showed a notable reduction in crestal bone loss compared to the control group, this difference didn't reach statistical significance. However, a statistically significant difference was observed in the densitometric analysis, which showed an increased bone density (mesial, distal, and apical end) around Calcium Phosphate Coated Implants.

This study investigated the impact of skill acquisition programs on employment rates among Nigerian graduates. Using graduates from the Department of Entrepreneurship at the University of Benin as a case study, 150 respondents who graduated between the 2017/2018 and 2022/2023 academic sessions were randomly selected to determine their current employment status and whether they needed or acquired additional skills beyond their academic degrees to secure employment. A structured questionnaire created through Google Docs was administered via WhatsApp and email. The data was analysed using frequency distribution, mean scores, Pearson chi-square goodness of fit, and Pearson correlation at a 95% confidence level. Results showed that out of 120 respondents who completed the questionnaires, 78 of them (65%) were self-employed, 20 of them (17%) were on paid employment, while 22 respondents (18%) were unemployed. Out of the 22 unemployed respondents, 12 of them (10%) claimed they had no additional skills besides their degrees, while 10 of them (8%) said they were undergoing apprenticeship/skills acquisition programmes. Statistical analysis revealed a positive correlation between skill acquisition and graduate employability. The study also highlighted the prevalence of hard skills acquisition among graduates and suggested that Nigerian graduates should acquire relevant skills besides their academic degrees to increase their employability. It is recommended that all Nigerian universities incorporate hard and soft skills learning programs in their curricula to improve the employability of graduates in the 21st century

Objectives: To assess the predictive value of Pediatric Early Warning Scores (PEWS) for identifying respiratory deterioration in children presenting to the emergency department. Methods: A thorough search across four databases identified 455 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, 36 full-text articles were reviewed, with 5 studies ultimately meeting the criteria for inclusion. Results: We included five studies with a total of 155,836 children and 87,424 (56.1%) were males. PEWS has been demonstrated to significantly enhance clinical outcomes by enabling early recognition of patient deterioration, allowing for preemptive action. It has shown potential as a predictive tool for hospitalization, particularly in identifying children at risk of severe outcomes. PEWS also aids clinicians in prioritizing patient care, escalating care more effectively, and making informed decisions regarding the need for intensive monitoring or transfer to specialized care units. Conclusion: PEWS is a valuable tool in pediatric emergency and critical care, with significant potential to improve patient outcomes by facilitating the early detection of deterioration. However, to maximize its benefits, PEWS should be integrated into a broader clinical assessment and decision-making framework, complemented by other diagnostic indicators and clinical judgments. Future research should focus on refining the scoring system to enhance its sensitivity and specificity, tailoring its application to effectively address different pediatric conditions.

Rabindranath Tagore, a visionary philosopher and educator, emphasized the vital role of physical education and sports in promoting peace and social cohesion. His unique approach integrated physical development with intellectual and emotional growth, aiming to create well-rounded individuals who could actively participate in and enhance the well-being of society. Tagore’s educational institutions, such as Visva-Bharati, embodied his philosophy, where physical activities were not merely recreational but were seen as essential for holistic human development. Present research explores Tagore’s thoughts and actions on the integration of physical education and sports with his broader ideals of peace, humanism, and global harmony. Present article examines how his educational practices and the role of sports in his pedagogy provided insightful learning in the overall character and personality development of children. Further, the current review explored the significance of physical training and sports culture in Tagore’s childhood and later life. This investigation highlights how he infused physical education and sports through his literary work on poem, poetry, music and drama. Through this exploration, the present article emphasizes the relevance of Tagore's ideas in contemporary discussions on peace, education, and the role of sports in promoting global unity.

The Traveling Salesman Problem (TSP) is a well-known combinatorial optimization problem with significant applications in logistics, transportation, and network design. Efficiently solving this problem requires a careful balance between exploration and exploitation while addressing challenges such as premature convergence and stagnation in local optima. To tackle these issues, numerous algorithms from different perspective have been designed and developed. Among them, Simulated Annealing (SA) is a widely used meta-heuristic approach for solving TSP due to its ability to escape local optima and explore a broad solution space. However, conventional SA can still become trapped in local minima, leading to suboptimal solutions. In this paper, we propose an enhanced SA algorithm that incorporates self-escape mechanism to improve the solution quality of the TSP instances. The self-escape mechanism dynamically identifies trapped routes and facilitate better exploration and diversification. Specifically, the self-escape mechanism introduces a local search refinement process, allowing solutions to effectively escape local optima. Simulation results on benchmark TSP instances demonstrate that the proposed algorithm outperforms conventional SA in terms of solution accuracy. The findings suggest that self-escape mechanism can significantly enhance the effectiveness of SA by preventing premature convergence in complex optimization problems.

Most urban centres in the sub-Sahara African countries have been experiencing a rapid increase in their population, Cameroon inclusive. It is partly explained by the presumed better living conditions and urban expectations. Once there, migrants are faced with different realities of high living cost, unemployment, increased house rents, poor sanitation amidst others. In an effort to cope with these prevailing conditions, the migrants becomes vulnerable to indecent lifestyles, and environmentally unsafe zones exposing them to all sorts of risks. Substantial literature exist on rural-urban migration but coping strategies to the social and environmental dilemma in the urban milieu remains elusive. This paper, therefore, sets out to fill this knowledge gap through an in depth investigation of the resilient measures adopted by the urban poor and the legal provisions for a safety and healthy living styles in urban Yaounde as prescribed by the law. To attain the objective, secondary data were collected from archival documents in the regional delegations of town planning and ministerial departments in charge of housing. Also, urban planning policies and Council Development Plans for the various councils in Yaounde were exploited including the exploration of relevant websites. Primary data were obtained via a sample of 200 inhabitants in the seven Sub-divisions in the town of Yaounde. This was achieved through the use of a purposely structured questionnaire. Interviews (N=10) Focus group discussions (N=5) and direct field observations were other relevant sources of primary data. Spatial data were collected with the use of a GPS for localisation and exploitation of GIS software for other relevant cartographic data. Content and quantitative analysis were used. Results indicated that poverty is the main driver to social and environmental vulnerability which is manifested in different forms. The non-respect of legal provisions and prolonged administrative tolerance expose the urban poor indecent socio-environmental conditions. The scenario in most cases have resulted to a significant and unexpected loss of lives and destruction of valuable property. Glaring examples include the most recent Mbankolo disaster in November 2023 that resulted to the loss of over 100 lives identified, homelessness, and loss of property with far reaching effects. This study strongly recommends urgent proactive disaster measures, such as the resettlement of the vulnerable population in risky neighbourhood, exploitation of relevant cartographic data provided by the National Institute for Cartography (NIC) especially the modelling of risk areas amongst others. In fact, such scenarios should be treated as a matter of urgency and should even become part of government’s emergency plan of action, not only for the city of Yaounde but for the country as a whole.

Objectives: To systematically review and synthesize available clinical and experimental evidence on the effects of beta-blockers in the treatment of acne vulgaris. Methods: A thorough search across four databases identified 412 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 209 publications, of which 29 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. Results: We included 5 studies with a total of 205 patients and 140 (68.3%) were females. The findings consistently indicated beneficial effects in the management of non-inflammatory acne lesions, post-acne erythema, and acne scarring—particularly when used in conjunction with fractional CO₂ laser therapy. Across all studies, the treatment was well tolerated with no significant adverse effects reported. Conclusion: Topical beta-blockers, especially timolol maleate 0.5%, represent a promising adjunct in the treatment of acne vulgaris. Their clinical effectiveness, safety, and affordability make them a compelling option, particularly for patients unresponsive to or intolerant of standard therapies. Further randomized trials are necessary to validate their role and establish standardized treatment protocols.

This review article discusses the critical role of social services in helping families care effectively for long-stay patients following discharge from hospital. Conscious that there are complexities that surround long stay patients, the article evaluates how integrated social service interventions promote coordinated care, improve patient discharge planning, and close the gap between hospital and home environment. Such important factors as communication, cultural competence and allocation of resources are discussed to point out their influence on the families’ willingness to support patients after discharge. The research shows that high social support systems enhance health outcomes, decreases readmission rate, and makes the transition to community care easier. However, such persistent barriers; including lack of funding, lack of staff, and systemic fragmentation impede the effectiveness of social services. Through the identification of these barriers, the review highlights the need for improved collaboration between healthcare providers, social workers and community organisations. It requires further studies to shed more light on the dynamics of social services and their effects on patients and families experience, which in the end would call for policies that favor creation of equitable access and comprehensive support mechanisms for long-stay patients and caregivers.