Congenital Hypothyroidism is a rare but serious malformative pathology, subject to congenital screening in several countries around the world. its impact once omitted is serious and irreversible. The form with agenesis of the thyroid gland called athyreosis can be associated with several malformations, cardiac, renal or skeletal. Patients living with athyreosis most often have symptoms of chronic hypothyroidism, which can be attributed either to a FT3/F4 ratio that is too low or a defect in the peripheral deiodation of T4 to T3. We report the case of a young girl with athyreosis who maintains a refractory hypothyroidism syndrome.

Background: single pill combinations is proved to achieve patient compliance and hence better blood sugar control and less occurrence of complications of type two diabetes. Objectives: to assess the outcome of fixed dose combination management of diabetic patients by monitor blood glucose and HbA1c, renal function test and body weight, and test its significancy in regard to the previous management. Methodology: Prospective follow up study carried out for a period of 28 weeks, combined pills of pioglitazone 30mg with glyburide 2mg as a single dose drug taken before breakfast-and dapagliflozin 10mg combined with 1000mg metformin as a single dose taken at dinner, measurement of fasting blood sugar, HbA1c, blood urea , creatine and weight and renal function test and weight were done at the start of the study and then repeated 28 weeks later, compliance was assessed using Morisky Medication Adherence Scale (MMAS-8) with 3 level Likert scale. Results: The eligible subjects who were involved in the study were 72, their mean blood sugar and HbA1c at start of the study was 302.09, 10.40respectively, mean blood urea and creatinine 41.34, 0.72respectively, mean weight was 80.03 kg, by the end of the study period all the reading was reduced to the following levels: , 198.33, 8.43, 40.67, .69 in the same previous order, apart from the mean weight which showed an increase to 81.82. While compliance was increased from score of 6 up to score of 8. Conclusion: Drug combination and single pills have assured compliance and hence blood sugar control and have a negative impact on the occurrence of complications.

Background: Gestational diabetes mellitus is a common metabolic complication of pregnancy and is associated with significant maternal and neonatal morbidity. The rising prevalence of gestational diabetes, particularly in low- and middle-income countries, poses increasing challenges for obstetric and neonatal care. Maternal hyperglycemia alters intrauterine metabolic conditions, potentially leading to adverse delivery outcomes and early neonatal complications. Objective: To evaluate the impact of gestational diabetes mellitus on mode of delivery, maternal complications and early neonatal outcomes in a tertiary care hospital setting. Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Rangpur Medical College and Hospital, Bangladesh, from January to December 2025. A total of 150 pregnant women were enrolled, including 75 with gestational diabetes mellitus and 75 without gestational diabetes. Maternal socio-demographic characteristics, obstetric outcomes and early neonatal outcomes were recorded. Data were analyzed using descriptive statistics and chi-square tests. Results: Women with gestational diabetes had higher rates of caesarean section (52.0% vs. 32.0%), pregnancy-induced hypertension (18.7% vs. 8.0%), preterm delivery (21.3% vs. 9.3%) and polyhydramnios (10.7% vs. 2.7%). Neonates born to mothers with gestational diabetes showed increased macrosomia (22.7% vs. 8.0%), neonatal hypoglycemia (18.7% vs. 4.0%) and neonatal intensive care unit admission (24.0% vs. 9.3%). Conclusion: Gestational diabetes mellitus significantly increases the risk of adverse maternal and early neonatal outcomes. Early detection and comprehensive management strategies are essential to reduce associated morbidity.

Unreinforced masonry (URM) structures in less developed areas are at great risk from the rapid flow of water resulting from flash floods. This study investigates how susceptible unreinforced masonry walls are to the loads produced by flash floods via testing, simulating, and gathering field measurements of existing URM structures. Rather than simulate everything on the computer, the study compiled and reviewed published documents that reported results pertaining to performance trends of different wall configurations, as well as slenderness ratio, strength of mortar, and other boundary conditions, and developed an understanding of performance trends among URM walls. The earliest damage begins with the combined action of hydrostatic and hydrodynamic pressure, which has the greatest effect on slender walls with weak mortar. Walls that contained more reinforced concrete or brick demonstrated better performance, with longer crack propagation before catastrophic failure and higher critical flow rates before cracking. The assessment of fragility determined that the likelihood of a catastrophic failure increases greatly when the water flow velocity exceeds a certain threshold, and that how the structure is designed (geometry) and what it is made of (material quality) are two of the key factors in determining the likelihood of failure during a flash flood event. The results of this study indicate the need to develop new methods for designing and selecting retrofitting systems that will improve the level of flood resistance for masonry structures in areas susceptible to flooding.

The digital transformation of healthcare has underscored the critical role of managerial technological competency in enhancing organizational performance. This study examined the influence of technological competency on healthcare management outcomes in public and private healthcare institutions in Enugu State, Nigeria. Employing a quantitative cross-sectional survey design, data were collected from 198 healthcare managers, including administrators, departmental managers, unit heads, and health information officers, using the Technological Competency and Healthcare Management Questionnaire (TCHMQ). Descriptive statistics, Pearson correlation, and multiple regression analyses were conducted using SPSS to explore relationships between competency dimensions digital literacy, data analytics, technological integration, cybersecurity awareness, and digital leadership and healthcare management outcomes, including operational efficiency, service quality, decision-making, staff productivity, and innovation. Findings revealed that managers exhibited high levels of digital literacy, technological integration skills, and digital leadership, while cybersecurity awareness and data analytics competence were moderately high. A strong positive relationship (r = .68, p < .001) was observed between technological competency and healthcare management outcomes. Multiple regression analysis indicated that competency dimensions collectively predicted 55% of the variance in healthcare management outcomes, with digital leadership, digital literacy, and technological integration emerging as the most influential predictors. The study concludes that managerial technological competency is a critical enabler of effective healthcare management, enhancing efficiency, service quality, decision-making, productivity, and innovation. It recommends targeted training, capacity building, and policy support to strengthen managerial digital skills, particularly in leadership, system integration, data analytics, and cybersecurity. These findings provide evidence-based guidance for improving healthcare management performance in low- and middle-income contexts.

Digital transformation has become a defining feature of twenty-first century economic and social development. Access to digital infrastructure, digital skills, and technology-enabled learning environments increasingly determines participation in labour markets, innovation systems, and civic life. Despite global advances in connectivity, Sub-Saharan Africa continues to experience some of the widest digital inequalities worldwide. Within the region, disparities in educational infrastructure, teacher digital competence, and socio-economic conditions shape uneven patterns of digital inclusion. This study investigates the educational determinants of digital inclusion in Nigeria, situating the analysis within broader Sub-Saharan African digital trends. Using a quantitative research design, data were collected from a Cochran-determined sample of 384 respondents across three geopolitical regions through a multistage sampling procedure. Descriptive statistics, one-way ANOVA, multiple regression analysis, and mediation modelling were employed to examine regional disparities and the predictive role of educational variables. Findings reveal statistically significant regional differences in digital inclusion, with the South-West recording the highest digital inclusion scores and the Northern region the lowest. Teacher digital competence emerged as the strongest predictor of digital inclusion, followed by ICT resource availability and device ownership. Mediation analysis confirmed that teacher competence significantly mediates the relationship between regional location and digital inclusion. Socio-economic status was not a statistically significant predictor once educational variables were included in the model. The study concludes that bridging regional digital inequalities requires sustained investment in teacher professional development, school ICT infrastructure, reliable electricity, and digital curriculum integration. Policy interventions must prioritise human capital development and regionally targeted digital equity strategies to promote inclusive digital transformation across Nigeria and Sub-Saharan Africa.

Background: Maximal oxygen uptake (VO₂max) is widely recognized as the gold-standard indicator of cardiorespiratory fitness and an essential determinant of endurance performance, clinical prognosis, and physiological adaptation to training. VO₂max can be quantified directly through laboratory-based gas exchange analysis or indirectly estimated using field-based performance tests. Despite widespread application of both approaches, uncertainty persists regarding their comparative accuracy, validity, and reliability in athletic populations. Objective: To systematically compare laboratory-based (direct) and field-based (indirect) methods of VO₂max assessment with respect to measurement accuracy, criterion validity, and test–retest reliability in athletes. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Peer-reviewed studies comparing directly measured VO₂max obtained via graded exercise testing and open-circuit spirometry with estimates derived from field-based protocols (e.g., Bruce protocol adaptations, Cooper 12-minute run, Yo-Yo Intermittent Recovery Test, and multistage shuttle run tests) were included. Methodological quality, validity coefficients, reliability indices, and estimation errors were extracted and synthesized. Results: Laboratory-based assessments consistently demonstrated superior accuracy and served as the criterion reference standard. Direct measurement showed minimal technical error and high reproducibility under standardized conditions. Field-based tests exhibited moderate-to-high criterion-related validity (typically r = 0.70 – 0.90) and good-to-excellent reliability when protocols were standardized. However, systematic over- or under-estimation and prediction error were frequently reported, particularly when regression equations were applied beyond their validated populations. Conclusion: Direct laboratory measurement remains the most accurate and valid method for assessing VO₂max in athletes. Nevertheless, field-based tests provide reliable, cost-effective, and ecologically valid alternatives for large-scale screening and sport-specific monitoring when laboratory testing is impractical. Selection of assessment method should therefore consider the required level of precision, available resources, and contextual application.