Background: Early ambulation is a vital component in orthopedic recovery following lower-limb fractures. Limited mobility and poor lifestyle practices can prolong hospitalization and lead to secondary complications. Structured teaching programs (STPs) enhance patient knowledge and adherence to self-care practices that promote recovery. Objectives: 1. To assess the pre- and post-test knowledge on early ambulation and lifestyle modification among orthopedic patients. 2. To evaluate the effectiveness of an STP on early ambulation and lifestyle modification. 3. To compare pre-test and post-test knowledge scores. 4. To determine the association between post-test knowledge and selected demographic variables. Methods: A quantitative, non-experimental descriptive design was adopted at SRM Medical College Hospital & Research Centre (SRM MCH & RC). Sixty patients with lower-limb fractures were selected by non-probability purposive sampling. A structured questionnaire assessed demographic variables, knowledge on early ambulation, and lifestyle practices. The intervention consisted of an STP using flashcards and interactive sessions. Data were analyzed using descriptive and inferential statistics (paired t-test and chi-square). Results: Pre-test results revealed 51.7 % of participants had inadequate knowledge and 48.3 % had moderate knowledge. Post-test results showed 73.3 % had adequate knowledge and 26.7 % moderate knowledge. The mean pre-test score was 5.60 ± 1.75, increasing to 11.70 ± 1.95 after the intervention, with a mean difference of 6.10 (t = 47.904, p < 0.001). Gender was significantly associated with post-test knowledge (χ² = 6.270, p = 0.012). Conclusion: The structured teaching program effectively improved patients’ knowledge and lifestyle behaviors related to early ambulation following lower-limb fractures. Continuous patient education is recommended to enhance postoperative recovery and prevent complications.

This composite indicator is a measure which outlines quality life and health status of Navi Mumbai traffic police. Traffic workers face a complex working environment of air pollution, persistent noise, heat, ergonomic, and operational stress, with which is related to poor health outcomes. The cross-sectional study will be based on convergent evidence offered by Indians regarding their triangulation of subjective and objective findings of 400 personnel, which will have been estimated. Main measures are spirometry, audiometry, musculoskeletal, mental health screen, and WHOQOL-BREF quality of life tool which is related to onsite exposure monitoring (PM, noise, heat). The estimated health outcome indicates that the pulmonary dysfunction will be high, hearing loss due to noises, musculoskeletal conditions would occur and the quality of life would be compromised. Exposure outcome associations shall be uncovered using analytics to inform a matrix of the locally viable interventions that are based on evidence. The anti-honking imposition, heat control, the duty rotation, the organized personal protection equipment initiative, and the regular health examination are some of the recommendations that could be adopted. The proposed systematic review (assessment plan) aims to assist in the formulation of the policies and occupational risks mitigation, as well as health outcomes of the force based on one-divisional health dashboard.

Poly-(D, L-lactic-co-glycolic) acid (PLGA)-loaded nedaplatin nanoparticles (PLGA-NDP) were prepared. The details of the preparation and characterisation of PLGA-loaded Nedaplatin nanoparticles formed and optimised by the double emulsion technique and Box–Behnken design with poly-(D, L-lactic-co-glycolic) acid as a polymer and polyvinyl alcohol (PVA) as surfactant agents were investigated. The morphology and elemental distribution, physical state, internal structure, encapsulation efficiency, and release profile were examined through sequential tactics such as Scanning Electron Microscopy-Energy Dispersive X-ray, Dynamic light scattering, Thermogravimetric analysis- Differential thermal analysis, Fourier-Transform Infrared Spectroscopy, UV-VIS spectroscopy, and in-vitro drug release study, respectively. Four factors at four levels were used in the Box-Behnken design to calculate the central point. The interaction between these factors significantly enhanced the results. The response of the optimised condition provided an accurate prediction, and the experiment was conducted further. The design was validated, and satisfactory agreement was observed between the predicted and experimental values. The obtained results provide evidence of a new geometric construction of PLGA-loaded nedaplatin nanoparticles with enhanced efficiency when compared to the reported research articles related to nedaplatin in cancer studies. Therefore, these findings and techniques are useful for the preparation of NPs.

Background: Huge bladder diverticulum can mimick ovarian tumour most especially in postmenopausal women thus leading to a presentation at a gynaecological clinic. Case Reported: We report a case of a 58-year old P7+0 (6Alive) postmenopausal woman who presented at the gynaecological unit of a private facility in Akure, Ondo State with progressive abdominal swelling of 5years duration. She was earlier seen by a physician who requested for an Abdominal CT scan. She then presented with the report which did not comment on the ovaries. Considering the peak incidence of invasive epithelial ovarian cancer which usually occurs at 50-60 years of age and the small risk of false negative result in imaging study, an abdomino-pelvic ultrasound was ordered which suggested a huge bladder diverticulum. The case was co-managed with the gynaecological and urology team and she subsequently had exploratory laparotomy and open diverticulectomy with a successful outcome. Conclusion: Huge bladder diverticulum in women can present to gynaecological clinics most especially in the postmenopausal period, a high index of suspicion coupled with necessary investigations will be required to effectively manage.

Background: Acute respiratory distress in pregnancy is a life-threatening condition which contributes significantly directly or indirectly to maternal death. Case reported: This was that of a 20-year old G1P0+0 who presented with sudden onset of difficulty with breathing with no associated fever, neither cough nor chest tightness at a gestational age of 34weeks+4days having been referred from a private facility where she has had antibiotics and was nebulized without any success. She was not a known asthmatic and laboratory and radiological investigations carried out did not reveal any pathological cause. She was managed as a case of acute respiratory distress due to diaphragmatic compression and was subsequently delivered of a live male neonate who weighed 2.4kg and with good Apgar scores. Mother continued to improve following delivery and was discharged home on the 5th day of admission.

Conclusion: Acute respiratory distress in pregnancy can be due to hormonal changes in pregnancy coupled with diaphragmatic compression from the gravid uterus as the pregnancy advances. A high index of suspicion is required after ruling out pathological causes, this should be followed by immediate delivery to prevent maternal death.

Background: To evaluate cerebroplacental ratio in pregnancy with IUGR. Methods: This is a prospective observational study conducted at Department of Obstetrics and Gynecology, SMS Medical College & attached Hospital Jaipur from April 2021 till May 2022 on 65 women admitted in the Department of Obstetrics and Gynecology, SMS Medical College, Jaipur. After applying inclusion and exclusion criteria and taking informed consent, routine investigation and ultrasonography was done and fetal doppler was studied and cerebroplacental ratio was studied

Results: From all our cases we has studied Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy were calculated and results combined arriving to an conclusion that UA PI was 37.14% sensitivity, 86.67% specificity, 76.47% positive predictive value, 54.17% negative predictive value and accuracy of 60%. The MCA PI has 22.86% sensitivity, 100% specificity, 100% positive predictive value, and 52.63% negative predictive value and accuracy of 58.63%. The CP Ratio calculates through (MCA PI/ UA PI) has sensitivity of 37.14%, specificity 100%, positive predictive value 100%, negative predictive value 57.69% and accuracy of 66.15%.

Conclusion: Abnormal CP ratio is a better predictor of adverse perinatal outcome in IUGR. Doppler ultrasound plays a significant role in the management of growth restricted fetuses by early identification and thus helps in line of management and obstetrical surveillance.

This paper aims to make a comparative study of survival to MSK in pediatric leukemia based study of individual data for 300 children in Iraq.A retrospective study was conducted in different hospitals in Iraq where all medical records from 20-1-2019 to 4-2-2022 were reviewed for children under the age of 14 years as 300 children were included in this study, distributed in two groups (No MSK involvement, 200 children, and MSK involvement 100 children. Data and demographic information about children suffering from Lekima were collected from different hospitals in Iraq, where the data was designed and collected in this retrospective study by collecting 300 children distributed into two groups. Patients' information, including blood preparation, blood chemistry, ALL, and the year of diagnosis, were recorded. immunophenotyping of cell surface markers was additionally used to differentiate subtypes (i.e., AML from ALL, and T-cell ALL from B-cell ALL) Risk classification was based on NCL of patients aged 1 to 14 years and was enrolled WBC values less and higher than 109 * 50 Of 300 childhood leukemia cases, 100 (33.3 %) children had MSK involvement at initial presentation. MSK involvement was more likely in children with acute lymphoblastic leukaemia than acute myeloid leukemia (p < 0.05).Hematologic abnormalities were less frequent in the MSK involvement group (p < 0.05). The absence of peripheral blast cells was significantly higher in the MSK involvement group.

Demographic information and data were collected from different hospitals in Baghdad, Iraq, where 500 women patients were collected. The aim of the research is to conduct a cross-sectional study to find out the type of relationship between the use of epidural analgesia during labor and the negative outcomes of newborns in Iraq. It was concluded in this study the use of epidural anesthesia leads to a negative impact on the method of delivery, in addition to the standards of newborn mothers, and epidural anesthesia has become a general method intended to reduce pain in patients' women during labor, and it can extend to newborns at childbirth. 500 patients were included and distributed into two groups (with epidural 200 patients and without epidural anesthesia 300 patients), and this study was conducted on women aged between 25 to 35 years in Iraq. The use of epidural anesthesia is a major and important factor in relieving pain during labor for pregnant women in Iraq. This effect may vary depending on the condition in which epidural anaesthesia is provided Although epidural anaesthesia is considered safe from a health point of view, it may generate some negative effects, especially in the mother, including the presence of a high temperature in addition to that, a decrease in blood pressure.

We read with interest the article by Du, et al., on metabolomic changes and homeostatic regulation in three TYMP-deficient patients assessed by targeted and non-targeted metabolomic techniques applied to serum and skin fibroblasts [Du, J. et al., 2023]. The results were compared to those of three m.3243A>G carriers and four healthy controls [Du, J. et al., 2023]. Specific changes in nucleosides, bile acids, and steroid metabolism have been found in the plasma of MNGIE patients [Du, J. et al., 2023]. In skin fibroblasts mitochondrial dysfunction, decreased cholesterol metabolism and decreased fatty acid biosynthesis and degradation have been found [Du, J. et al., 2023]. The study is excellent but has limitations that should be discussed.

The first limitation of the study is that secondary changes in mtDNA caused by TYMP deficiency have not been examined [Du, J. et al., 2023]. Since TYMP variants can cause multiple mtDNA deletions, mtDNA point mutations, and even mtDNA depletion due to defective mtDNA replication and since the secondary mtDNA defects vary between the types of TYMP variants but also between patients carrying the same TYMP variant, each individual MNGIE patient represents a unique phenotype that also concerns the metabolic profile.

A second limitation is that the current medications that the included patients were regularly taking were not provided. Since all included patients were multimorbid, it is very likely that they all received regular medication. Since medications can strongly influence the blood composition of metabolites examined in the index study, it is imperative to be aware of them and to include them in the discussion of the results.

A third limitation is that dependence of serum metabolite composition on the underlying mutation was also not considered in the discussion. Differences  between  MNGIE  patients1/2  and patient-3 could simply be due to the different genetic defects. Differences between MNGIE patients and MELAS patients can be explained simply by the different mutated genes.

Primary breast squamous cell carcinoma (SCC) is an extremely rare malignancy tumour. Reported case of this diseases only less than 0.1% of all breast carcinomas. SCC of the breast have aggressive histological features at presentation, and have poor outcomes or poor prognosis. Management therapy of primary breast SCC does not differ from other common breast cancer. Because this is a rare disease, the standard therapy has not been established and may involve surgery, chemotherapy, hormonal therapy and radiation therapy. Clinical trials are needed to improve patient’s outcome. This case of primary breast squamous cell carcinoma is reported in a 52-year-old women from Indonesia who presented with a lump in the left breast.