Introduction: A high-risk pregnancy is the result of a disease present before pregnancy. Neurofibromatosis type 1 is a rare disease during pregnancy, autosomal dominant, with a mutation in the NF1 gene, on chromosome 17q11.2.

BCC is the most common skin cancer (75%) in humans and the most common malignant tumor in the Caucasian population. The literature recognizes that 95% of BCCs are easy to treat surgically; however, when surgery is contraindicated due to patient or lesion-related conditions pharmacological and destructive therapies are reasonable alternatives. New therapeutic modalities, such as combined therapy, have been proven successful in the treatment of locally advanced and difficult-to-treat BCCs.

Background. Acquiring recognized accreditations is critical for healthcare organizations to demonstrate their competency and credibility. However, the journey can be daunting and time-consuming. Organizations striving to earn and maintain multiple accreditations with different requirements, standards, timeframes, and processes face significant logistical challenges. Integrating an automated accreditation platform facilitates the process.

Anatomical variations of the mandibular canal (MC) such as bifid MC (BMC) and trifid MC (TMC) have been largely reported in the scientific literature. They are characterized by two or three accessory canals running roughly parallel to MC. BMC and TMC are incidentally detected during routine dental radiography, and their thorough understanding is necessary to the practitioner to avoid complications during dental procedures. This paper aims to review BMC and TMC and to provide basic knowledge for dental clinical procedures.

Background: Tuberculosis (TB) remains a significant public health concern globally, with a disproportionate burden on females, particularly in India. This case series analysis explores the challenges and complications faced by 3 deceased females with TB, underscoring the need for tailored interventions.

Streptococcus suis is a zoonotic pathogen predominantly associated with occupational or dietary exposure to pigs or pork products. While cases are frequently reported from Southeast Asia, reports from India remain scarce. This case report highlights the clinical presentation, diagnosis, and management of S. suis meningitis in an immunocompetent individual from South India.

Introduction: Atypical leiomyomas are diagnosed histologically, showing pleomorphic atypical tumor cells with low mitotic counts and no coagulative necrosis. Surgical treatment is indicated when abnormal uterine bleeding or symptoms related to the size of the leiomyomas, infertility, or recurrent gestational loss are presented.

Kallmann Syndrome (KS) is a rare genetic disorder characterized by hypogonadotropic hypogonadism (HH) and anosmia or hyposmia due to a defect in the migration of gonadotropin-releasing hormone (GnRH) neurons and olfactory nerve fibers during embryonic development. This syndrome, first described in the 20th century, encompasses a complex interplay of genetic mutations affecting neuronal migration and neuroendocrine regulation. The condition presents a broad spectrum of clinical manifestations, from delayed or absent puberty to infertility, and is frequently associated with additional non-reproductive anomalies, such as sensorineural hearing loss, renal agenesis, or cleft palate. The genetic heterogeneity of KS involves several implicated genes, including KAL1, FGFR1, PROKR2, and CHD7, among others. Diagnostic evaluation typically requires a multidisciplinary approach, integrating genetic testing, hormonal assessments, and neuroimaging to confirm the diagnosis and evaluate associated anomalies. Therapeutic strategies primarily focus on hormonal replacement therapy to induce and maintain secondary sexual characteristics and fertility treatment options for individuals seeking reproductive outcomes. Emerging treatments and the potential use of gene therapy are under investigation, offering new hope for targeted interventions. This review aims to provide a comprehensive overview of Kallmann Syndrome, highlighting its pathophysiology, clinical spectrum, diagnostic challenges, and evolving therapeutic landscape.

Gastrointestinal stromal tumors are derived from the intersticial cells of cajal, most of them manifest with non- specific symptoms. A 62 old year male patient complained of right lower abdominal tenderness, surgical procedure revealed a tumor in the cecum. Complete resection was performed. Histology showed a GIST of the cecum. Accordingly , rare tumors of the cecum including GIST should be considered in the differential diagnosis of appendicitis.

Background: Intestinal obstruction due to abdominal cancer is a common clinical problem, with an overall incidence ranging from 3% to 15%, with colorectal cancer and ovarian cancer being the most frequent. The diagnosis of this condition primarily relies on the patients established history of abdominal oncological disease, as well as radiological and laboratory tests, which are key factors in decision-making regarding the choice between conservative or radical treatment. The importance of these decisions has led to the need for the development of new evaluation strategies to guide treatment in this group of patients.

Background: A variety of surgical techniques have been proposed for abdominal wall closure in patients with stoma with the aim of reducing the incidence of surgical site infection. However, the ideal skin closure technique has not yet been determined. Surgical site infection was one of the most common postoperative morbidities of ileostomy and colostomy reversal and although several skin closure procedures have been developed to reduce the rate of surgical site infection and its associated comorbidities, the incidence rates nationally and internationally range between 2% and 41% and it has been reported that it can increase costs, prolong hospitalization time and affect the patient s quality of life.

Posterior shoulder dislocation is a rare and often misdiagnosed case, and returning the stability of the shoulder and preventing recurrent dislocations are key in improving patients quality of life. A 67-year-old male presented with pain, stiffness, and deformity in his right shoulder for the past month. Shoulder and upper arm were in adduction and internal rotation, and abnormal mass of the humeral head was palpated on the posterior shoulder. Shoulder range of motion was severely limited. Modified McLaughlin procedure was performed, followed by immobilization for 2 weeks after surgery. The patients mid-term outcome following the modified McLaughlin procedure showed normal shoulder function, with no pain or limitations. This result is likely due to the more stable bony fixation achieved through bone-to-bone union provided by the modified McLaughlin procedure. There were no signs of nerve injury, and no avascular necrosis was observed on the shoulder radiograph.

ST-Elevation Myocardial Infarction (STEMI) remains a leading cause of cardiovascular mortality worldwide, with significant regional disparities. In Mexico, despite advances in healthcare systems and the availability of reperfusion therapies, STEMI continues to contribute substantially to cardiovascular-related deaths. This article reviews the mortality rates associated with STEMI in Mexico, focusing on epidemiological trends, barriers to optimal care, and regional healthcare inequalities. Key factors influencing outcomes include delayed diagnosis, limited access to percutaneous coronary intervention (PCI), socioeconomic determinants, and regional variability in healthcare infrastructure. Strategies to mitigate these challenges, such as strengthening prehospital care, expanding reperfusion networks, and addressing healthcare inequities, are discussed. This review underscores the urgent need for nationwide efforts to optimize STEMI management and reduce associated mortality.

Ebsteins anomaly is a rare congenital heart defect characterized by the apical displacement of the septal and posterior leaflets of the tricuspid valve, resulting in atrialization of the right ventricle and significant hemodynamic disturbances. This anomaly often presents with a spectrum of clinical manifestations, ranging from asymptomatic cases to severe heart failure and cyanosis in neonatal life. The diagnostic process has been significantly enhanced by advancements in echocardiography, magnetic resonance imaging (MRI), and electrocardiographic techniques, enabling early detection and detailed assessment of structural abnormalities.

Bilateral renal lithiasis, characterized by the presence of kidney stones in both kidneys, poses significant clinical challenges. This condition is associated with a higher risk of chronic kidney disease (CKD), kidney tubular injury, metabolic disorders, and diminished health-related quality of life (HRQoL). Patients with bilateral stones experience more frequent stone events, a younger age of onset, and a higher prevalence of metabolic abnormalities such as elevated blood pressure and serum glucose. Demographic factors, including socioeconomic status, race, age, and gender, further influence the impact of this condition, with nonwhite ethnicities and lower-income groups reporting worse HRQoL. Untreated bilateral renal lithiasis significantly increases the risk of CKD progression, while advanced surgical approaches like bilateral synchronous percutaneous nephrolithotomy offer effective and safe management options. Addressing this condition requires a multifaceted approach that considers both medical interventions and social determinants of health.

Laparoscopic cholecystectomy has become the gold standard for the treatment of acute cholecystitis due to its minimally invasive nature, which significantly reduces patient recovery times and postoperative complications. This case series presents four cases of acute cholecystitis, each managed successfully via laparoscopic cholecystectomy, without conversion to open surgery. The clinical outcomes and intraoperative findings underscore the effectiveness of laparoscopic techniques, even in complex cases such as empyema, gangrenous cholecystitis, and perforation with abscess formation. The discussion includes a review of the relevant literature, highlighting the advantages of early laparoscopic intervention in acute cholecystitis and addressing the challenges posed by severe inflammation. This case series emphasizes the importance of laparoscopic surgery as the preferred treatment modality for acute cholecystitis.

The achievement of the Minimum Service Standards (MSS) indicators in the Emergency Department of the Hospital is still not optimal so that the services provided are not as expected. This study aims to explore the situation related to the input, process, and output of the implementation of MSS for emergency services at Priscilla Medical Center Hospital. This study uses a qualitative design with a case study approach. The research time is from September to November 2023 at the Emergency Department of Priscilla Medical Center Hospital. Data collection techniques are carried out through in-depth interviews, forum group discussion (FGDs), and document reviews. The results of the study indicate that the quality indicator policy at Priscilla Medical Center Hospital does not cover all MSS indicators, the quality of human resources is good but the number of general practitioners is not sufficient, facilities and infrastructure are not fully in accordance with standards, and monitoring and evaluation has not been running well. Planning, organizing, implementing and controlling the implementation of MSS in the Emergency Department of Priscilla Medical Center Hospital has not been optimal. The output results show that patient mortality =24 hours is still high.

Penile artery blockage is a vascular disorder that may result in erectile dysfunction, profoundly impacting a patients quality of life and psychological health. This thorough analysis examines the epidemiology and clinical importance of penile artery blockage, highlighting its significant effect on patients sexual health. The theoretical framework examines the definition of penile artery blockage, analyzes contributory risk factors, addresses probable consequences, and provides contemporary therapy techniques. The discussion section assesses the application of phosphodiesterase inhibitors as a treatment modality for patients with penile artery blockage, including insights into their mechanisms of action, effectiveness, and safety profile. The finding underscores the significance of a tailored strategy for managing this illness, with phosphodiesterase inhibitors as a beneficial alternative.

Bile duct injuries (BDIs) are critical complications of surgical interventions involving the biliary tract, primarily occurring post-cholecystectomy. With an incidence of 0.3%–0.6%, BDIs represent a substantial clinical challenge, and approximately 400 cases are reported annually in the United States. Hepaticojejunostomy is the recommended treatment due to its efficacy in achieving durable biliary drainage with minimal stenosis. However, outcomes can be adversely influenced by factors such as biliary peritonitis, localized inflammation, sepsis, and the timing of repair. BDIs are more common in women in their forties, correlating with the higher incidence of cholelithiasis in this demographic.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that primarily affects motor neurons, leading to muscle weakness and eventual paralysis. Although the precise mechanisms driving ALS are not yet fully elucidated, emerging evidence suggests a crucial role of neuroinflammation and mitochondrial dysfunction in disease progression. Microglia, the brains resident immune cells, play a central role in the neuroinflammatory response and undergo metabolic reprogramming during ALS, shifting from a homeostatic state to an inflammatory one. This reactivity is linked to mitochondrial dysfunction, which impairs energy production but allows microglia to maintain a pro-inflammatory phenotype through alternative pathways, such as glycolysis. This interaction between mitochondrial metabolism and microglial function exacerbates neuroinflammation, contributing to neuronal damage and accelerating ALS pathology. Mutations in genes like C9ORF72, SOD1, and TARDBP, commonly associated with ALS, also affect cellular processes such as RNA metabolism and mitochondrial function, further worsening the effects of the disease. This review explores the role of microglial mitochondrial metabolism in ALS, highlighting its importance in disease progression and identifying potential therapeutic targets to modulate neuroinflammation and metabolic dysfunction to slow ALS progression.

Bladder injuries are classified into extraperitoneal (EP), intraperitoneal (IP), or combined types. Mechanisms of injury vary, with blunt trauma, predominantly from motor vehicle accidents, accounting for 60–85% of cases, and penetrating injuries, such as gunshot wounds, comprising 15–51%. Evaluation includes clinical assessment, cystography, and CT imaging, supplemented by cystoscopy for iatrogenic cases. Management strategies range from conservative catheterization to surgical repair, depending on injury type and severity. EP injuries, the most common type (63%), are frequently associated with pelvic fractures, whereas IP injuries (32%) typically result from blunt trauma to a distended bladder. Conservative management with catheter drainage suffices for most EP injuries; however, IP injuries necessitate surgical intervention to mitigate risks such as sepsis and peritonitis. Outcomes are influenced by concomitant injuries, which are often more critical than the bladder injury itself.

From a neuropsychological perspective, normotensive hydrocephalus NPH is characterized by cognitive impairment associated with the compression exerted by ventricular dilatation on the cingulate cortex and fronto-striatal circuits. The Rey-Osterrieth Complex Figure Test (ROCFT) is a neuropsychological assessment measure widely used by clinicians and researchers because of the wide variety of cognitive information it allows to estimate. We present the case of young male patient with refractory structural epilepsy secondary to a childhood brain injury resulting from a metastasis of a renal tumor. Referred to Neuropsychology for behavioral changes and cognitive impairment; presenting atypical performance in the copying phase of the ROCFT. Failures in visual integration and coding of the ROCFT copy show that, in cases of NPH, brain structures such as the cerebellum and posterior cingulum can also be compromised by the compression exerted by the cerebral hemispheres as they move due to ventricular dilatation. Failures in integration, planning, rotation and displacement of ROCFT elements have been reported in patients with secondary psychotic conditions and posterior cingulate tumors. Failures in visual integration associated with NPH may be related to the involvement of more postero-caudal brain structures such as the cerebellum and posterior cingulum or to secondary psychosis.

Large-volume paracentesis (LVP) is a cornerstone in the management of refractory ascites in cirrhotic patients, but it is associated with significant hemodynamic complications, including paracentesis-induced circulatory dysfunction (PICD). Current guidelines advocate for the use of albumin to mitigate these risks; however, its high cost and limited availability have prompted the exploration of alternative therapies such as midodrine, an a1-adrenergic agonist with vasoconstrictive properties. This study aims to compare the efficacy and safety of midodrine versus albumin in maintaining hemodynamic stability and preventing PICD post-LVP. We conducted a prospective, randomized trial involving patients with refractory ascites, evaluating hemodynamic parameters, renal function, and clinical outcomes. Our findings suggest that midodrine offers a cost-effective alternative to albumin with comparable efficacy in volume restitution, although certain patient subgroups may benefit more from specific interventions. Further research is warranted to optimize patient selection and treatment protocols.

Aortic dissection is a life-threatening condition characterized by the separation of the layers within the aortic wall, leading to a false lumen with the potential for severe complications, including rupture, malperfusion, and death. The management of aortic dissection has evolved significantly, with hybrid therapies emerging as a promising approach, particularly for complex cases involving extensive aortic involvement or high surgical risk. Hybrid therapies combine open surgical techniques with endovascular interventions to optimize outcomes by leveraging the strengths of both modalities. This article provides a comprehensive review of the current state of hybrid therapies in aortic dissection management, including their indications, technical considerations, and clinical outcomes. We explore the role of hybrid procedures in both acute and chronic phases of aortic dissection, focusing on scenarios such as aortic arch and thoracoabdominal involvement. Additionally, we discuss patient selection criteria, advances in imaging for procedural planning, and the challenges of long-term surveillance. By synthesizing recent evidence, we aim to highlight the potential of hybrid approaches to improve survival and reduce morbidity in this complex patient population.

Menopause is an encompassing neuroendocrine aging process, marked by declining sex hormones, particularly estradiol, with significant consequences for cognitive brain function that will affect every woman who lives long enough to enter the phase. This critical review examines recent neuroimaging studies investigating the underlying biological mechanisms of cognitive changes during menopause, focusing on estrogen receptor density in the brain. Advanced neuroimaging techniques, such as 18F-fluoroestradiol (18F-FES) Positron Emission Tomography (PET), have provided novel insights into the distribution and density of estrogen receptors across different menopausal stages. Key findings reveal that estrogen receptor (ER) density in the brain increases progressively over the menopause transition, independent of age and plasma estradiol levels. Notably, higher ER density is associated with poorer memory performance and predicts mood and cognitive symptoms in postmenopausal women. These results suggest a potential compensatory mechanism in response to declining estrogen levels, offering a neurobiological explanation for cognitive changes observed during menopause.

Background: Burn injuries can range from minor injury up to life-threatening medical problems. Scars and contractures of varying degrees may develop on a healed burn patient, causing problems in functional and aesthetic components. Surgery is indicated on contracture patients with limited range of motion on the affected limb. Aims : This study aims to report a-33 year old female patient with popliteal contracture following a gas explosion at her home six months ago. Case Presentation: The patient presented with diffused desmogen contracture of the left popliteal with limited range of motion, and hypertrophic scar tissue in some parts of her body, such as the posterior side of both thighs and both lower leg. The patient is unable to walk normally because her left knee cannot be straightened following the burn trauma. Surgical procedure was done to excise the contracture, and split thickness skin graft harvested from the hypertrophic scar of posterior left thigh was used to close the defect. Result: Patient achieved satisfactory result following surgery. The patient demonstrated improved knee function, with the ability to walk normally without assistive device. Conclusion: Closing defect after excision of contracture using skin graft from hypertrophic scar tissue offers the patient a good chance for release contracture without the risk of additional scar tissue.

Introduction: Midfacial fractures are among the most severe injuries encountered in emergency settings due to the risk of functional impairment and facial deformities. The Le Fort classification remains the most commonly used system for categorizing these fractures. Treating Le Fort II fractures is particularly complex due to the involvement of the orbital and nasal bones, along with the critical need to restore proper occlusion. Achieving pre-trauma occlusion is often the most difficult aspect of treating facial fractures. Case Presentation: This study reported a 28-year-old Asian male was brought to the Emergency Room of Bali Mandara General Hospital by a bystander following a motorcycle accident in which he struck a pedestrian. He was diagnosed with Le Fort I-II and a right orbital floor fracture. The patient underwent surgery, including open reduction and internal fixation using miniplates and screws. The procedure successfully restored the patient’s occlusion, and no reported postoperative complications. Discussion: The diagnosis of Le Fort fractures is based on patient history, physical examination, and imaging studies. Identifying a pterygoid fracture is essential for diagnosing all types of Le Fort fractures. Prompt definitive treatment is critical to prevent long-term facial deformities. Conclusion: Achieving proper occlusion is a marker of accurate alignment in managing facial fractures. Emphasizing functional restoration and deformity prevention significantly improves patient recovery and results.

Cleft lip and palate patients require multiple surgeries from childhood to adulthood to improve both function and aesthetics. Primary surgery may not completely resolve a cleft, residual scarring, asymmetry, nose deformity, or palatal fistula, can sometimes remain, leading to insecurity and social withdrawal. This study reports five cases of patients aged 7-13 years old with prior cleft lip and palate surgeries, treated with autologous materials for lip, nasal, or palatal repair, based on individual needs at Bali Mandara General Hospital, Denpasar, Bali, Indonesia. The first two patients had functional lips but were dissatisfied with scars and poor lip contour. Treatments included dermis-fat grafts, fat transfer injections, and/or scar revision. The third and fourth patients had Pittsburgh Type V palatal fistulas with nasal leakage and hypernasal speech, managed with dermis-fat grafts to close the fistulas. The fifth patient had a nasal deformity due to absent of primary correction and underwent nasal dorsal augmentation with a dermis-fat graft. All patients expressed improved appearance, function, and confidence postoperatively, with no complications during follow-up. Autologous materials such as autologous fat grafting and dermis-fat are reliable, versatile approach, and cost effective for improving lip contour, closing oronasal fistulas, and correcting nasal deformity

Background: Post burn contracture of the neck is one of the most common sequeles. The management of neck contracture is challenging because of both functional limitations and aesthetic apperance distortion of the patient. Besides affecting neck movement, neck contracture can also influence lower face function. Aims : This study aims to report a-31 year old female patient with post burn contracture of the neck, following a kerosene lamp explosion that resulted in flame burn. Case Presentation: The patient presented with a severe broad type neck contracture with complaints of limited range of motion in her neck and restricted mouth movement, accompanied by drooling caused by lower lip retraction, making it difficult to close her lower lip completely Surgical procedure was performed without excision of scar tissue. Multiple Z-plasty incisions were used to distribute the soft tissue and release the contracture. Result: Patient achieved satisfactory result after surgery. The patient was followed up seven months and one year after surgery with improvement of her symptoms. Conclusion: Multiple Z-plasty is a safe and realible procedure for releasing post-burn neck contracture. It serves as an effective surgical technique for treating post-burn neck contractures, allowing patients to avoid the need for grafts and preventing additional wounds from donor site harvesting.

Introduction. Open fractures of the tibial shaft are mostly the result of high-energy trauma, the incidence is 17 to 21 per 100,000 inhabitants, represent 2% of all fractures and 36.7% of all long bone fractures in adults. More than 15% of tibial shaft fractures are classified as open, representing the most common open long bone injuries. The reported incidence of nonunion or delayed union of tibial shaft fractures after intramedullary nailing (IMN) ranges from 16% to 36%. Infection can complicate any stage of the fracture healing process and may contribute to nonunion in up to 38% of cases. Case: A 64yo female with open fracture of the tibial shaft G-A II, initially treated with external fixators, then 3 internal fixations with IMN were performed at different surgical times due to complication of septic nonunion, managed with local and systemic antibiotics and tissue coverage. Discussion: Some orthopedic surgeons prioritize bone union as the main treatment goal in septic nonunion and advocate retaining the implant with surgical cleaning and debridement of devitalized tissue, followed by suppressive intravenous antibiotic therapy. Conversely, others consider eradicating the infectious process as the most critical stage of treatment. Conclusion: Pseudoarthrosis is one of the most devastating problems in orthopedic surgery. We consider it a priority to identify the pathogen associated with the nonunion for specific local and systemic antibiotic therapy associated with aggressive debridement surgery and stable fixation.

Introduction: Mechanical intestinal obstruction is a common surgical condition with a wide range of causes, including intrinsic intestinal problems such as intestinal invagination. This condition is extremely rare in the adult population and is mostly caused by neoplasms. The clinical presentation, although varied, is typically gradual and nonspecific. Among intestinal neoplasms, inflammatory fibroid polyps (IFPs) are very rare, constituting less than 0.1% of gastrointestinal tract polyps. Case Presentation: We present a 48-year-old female patient who presented with abdominal pain lasting for 1 month, with a 4-month history of constipation. A CT scan showed findings suggestive of pseudo-obstruction secondary to intestinal invagination. After an emergency laparotomy, histopathological analysis reported a Vanek tumor in the terminal ileum. Discussion: Intestinal intussusception in adults is a rare condition, often caused by benign tumors that act as lead points. Inflammatory fibroid polyps (IFP), commonly located in the ileum, are such tumors. The symptoms are typically nonspecific, making early diagnosis challenging. In the presented case, a laparotomy was performed to address the obstruction and resect the tumor, which was histologically confirmed as an IFP. This case highlights the importance of considering these tumors in the differential diagnosis of adult intussusception and the need for timely surgical intervention. Conclusion: IFPs should be considered in the differential diagnosis of adult intussusception, especially in cases of chronic, non-specific symptoms and intestinal obstruction.

Cardiogenic shock remains a critical condition characterized by profound myocardial dysfunction leading to end-organ hypoperfusion and high mortality rates despite advances in supportive therapies. While traditional management focuses on inotropes, vasopressors, and mechanical circulatory support, recent evidence suggests that metabolic modulation could provide additional benefits. Dipeptidyl peptidase-4 (DPP-4) inhibitors, primarily used in type 2 diabetes mellitus, have demonstrated cardioprotective effects through pleiotropic mechanisms, including anti-inflammatory, endothelial-protective, and metabolic-modulating actions. This review examines the potential utility of DPP-4 inhibitors in the context of cardiogenic shock, emphasizing their mechanisms of action, experimental and clinical data, and the feasibility of integrating these agents into the current therapeutic paradigm. We highlight gaps in knowledge and propose directions for future research to determine the clinical efficacy of DPP-4 inhibitors in this high-risk population.

Artificial Intelligence (AI) and Machine Learning (ML) are revolutionizing critical care. In the Intensive Care Unit (ICU), timely and accurate decisions are crucial. AI and ML can enhance decision-making by predicting adverse events, personalizing treatment plans, and improving diagnostic accuracy. Early warning systems, powered by AI, can detect conditions like sepsis and acute respiratory distress syndrome early on. AI-driven decision support systems provide real-time recommendations, optimizing resource allocation and ensuring adherence to best practices. While AI offers significant benefits, challenges like data privacy, bias, and ethical considerations must be addressed. Ensuring transparency, accountability, and fairness in AI algorithms is essential. The future of AI in the ICU is promising. Advancements in AI and ML, coupled with collaborative human-AI approaches can further improve patient outcomes. By addressing ethical concerns and fostering responsible AI development, healthcare providers can harness the power of AI to optimize critical care.

The modified Fontan procedure, a pivotal surgical intervention for patients with single-ventricle congenital heart defects, has drastically improved survival rates and quality of life for individuals who would otherwise face limited options. Despite these advancements, patients with modified Fontan physiology experience a unique set of hemodynamic challenges that require vigilant long-term follow-up. The Fontan circulation, characterized by passive venous return to the pulmonary arteries without a ventricular pump, predisposes patients to a variety of late complications, including Fontan-associated liver disease (FALD), arrhythmias, protein-losing enteropathy (PLE), thromboembolic events, and systemic venous hypertension. This review aims to evaluate the outcomes and long-term complications associated with modified Fontan patients, emphasizing the importance of early detection, multidisciplinary care, and individualized management strategies. The article explores current evidence on surveillance protocols, pharmacological treatments, and surgical interventions, as well as emerging therapeutic options like Fontan conversion, catheter-based therapies, and heart transplantation. This comprehensive analysis seeks to provide healthcare providers with a roadmap for optimizing care and improving the long-term prognosis of these patients.

Background Burns are one of the most common injuries resulting from heat or radiation, electricity, and chemicals. Bali Mandara General Hospital is a new government hospital operated in October 2017. The hospital implemented the Ministry of Health Regulation’s Guideline which applies the Emergency Management of Severe Burns to manage burns cases. Aim The current study aims to determine the epidemiological burn patients at Bali Mandara General Hospital, and emphasize the importance of burn management strategies. Methods A hospital-based, single-center, and retrospective study was conducted from November 1st, 2017 to June 30th, 2022 at Bali Mandara General Hospital. Demographic and clinical information were extracted from hospital medical records. Data is collected and analyzed using Microsoft Office Excel and SPSS Statistic version 26. Correlation between ABSI score and length of hospital stay were examined. Results A total of 142 burn patients were included in this study; including 56 (39,43%) moderate – severe burn patients, 35 (62.50%) are male and 21 (37.50%) female, out of which are 33 (82.5%) patients with burn time-admission gap < 24 hours. The major proportion of burn patients are adults (18-65 years old) - 110 (77.46%) patients with an average age of 27±17.72 years. The most common total body surface area (TBSA) of burn ranged from 1 to 10%. The major proportion of moderate – severe burn patients are adults (42 patients, 38.18%). There were 40 (71.42%) patients undergoing surgical procedure. Scald and flame contributed equally for the amount of moderate to severe burns (21 patients, 37.50%). Average length of hospital stay was 8.3 days, ranging from 3 to 15 days. Seventeen (42.50%) patients have low mortality risk. Spearman’s correlation between ABSI score and length of stay resulted in a coefficient of 0.48, indicating a moderate correlation.

Introduction Trauma is a major cause of morbidity and mortality, often accompanied by maxillofacial injuries in a significant portion of patients. Maxillofacial trauma represents a serious public health problem and their epidemiology varies between populations. Bali Mandara General Hospital is a new government hospital operated in October 2017, that provides care for plastic surgery patients, including maxillofacial trauma patients. The current study aims to investigate the pattern of maxillofacial traumatic injuries, and management of maxillofacial traumatic injuries by our plastic surgery service. Methods A hospital-based, single-centered study was conducted from January 1st, 2018 to December 31st, 2022 at Bali Mandara General Hospital. Medical records of maxillofacial patients undergoing surgical procedure were retrospectively reviewed Data is collected and analyzed using Microsoft Office Excel and SPSS Statistic version 26. Results A total of 107 maxillofacial patients who received treatment for maxillofacial trauma in the departments during the study period were included; 76 (71.02%) are male and 31 (28.97%) female. The majority of patients belonged to the 21-30 years age group (27 patients, 25.23%). The mean age for the group was 32.26±17.31 years, ranging from 1 to 83 years. Soft tissue injuries (64; 29.63%) and maxilla fracture (35; 16.20%) were the two most common site of maxillofacial injuries. The most common associated injuries was upper extremity injuries (11; 30.56%), followed by lower extremity injuries (9; 25.00%). The most common surgical management were ORIF (61; 28.64%) and debridement (54; 25.35%). Conclusion Young age and males were predominantly affected. Maxillary fracture was the most frequent maxillofacial fracture. Maxillofacial trauma was often associated with upper extremity injuries. ORIF was the most surgical common management.

The gut microbiota plays a pivotal role in maintaining metabolic homeostasis and immune regulation, with its dysregulation increasingly recognized as a critical factor in the pathogenesis of liver diseases. This review explores the intricate interplay between gut microbial composition and liver health, focusing on the gut-liver axis as a key mediator. The disruption of gut barrier integrity and subsequent translocation of microbial products, such as lipopolysaccharides and short-chain fatty acids, contribute to the progression of liver disorders, including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), and cirrhosis. The review also examines the implications of microbial dysbiosis in liver inflammation, fibrosis, and hepatocarcinogenesis, highlighting the diagnostic potential of microbiota profiling and biomarkers. Finally, emerging therapeutic strategies, such as probiotics, prebiotics, fecal microbiota transplantation, and precision microbiome editing, are discussed as promising avenues for intervention. Understanding the bidirectional relationship between the gut microbiota and the liver offers novel insights into disease mechanisms and opens the door for innovative therapeutic approaches in hepatology.

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality worldwide. Anemia, commonly encountered in patients with AMI, is associated with worsened outcomes due to impaired oxygen delivery to ischemic myocardium. Blood transfusion is often considered in this clinical scenario, yet its indications remain controversial due to potential risks such as volume overload, inflammatory reactions, and prothrombotic effects.

Electrical injuries, often caused by high-voltage currents from sources like arc flashes or ignited clothing, frequently result in extensive burns, particularly to the hands. The upper extremities, being common contact points for electrical injuries, are susceptible to severe tissue damage, including burns, nerve, muscle, and vascular damage. High-voltage electrical burns often require surgical intervention, with an emphasis on restoring both function and form. This study aims to compare the effectiveness of two free flap techniques—Anterolateral Thigh (ALT) and Superficial Circumflex Iliac Artery Perforator (SCIP)—in the reconstruction of hand burns resulting from electrical injuries. Authors conducted a literature review based on cases from the burn unit at Pertamina Central Hospital, Jakarta, focusing on two patients who underwent reconstruction using the ALT and SCIP free flaps. The ALT free flap, characterized by its versatile and reliable tissue coverage, was utilized in one case, while the SCIP free flap, known for its thin and pliable tissue, was employed in the other. The study reviews the anatomy, advantages, and limitations of each flap, considering factors such as functional outcomes, aesthetic results, donor site morbidity, and surgical complexity. Both techniques were shown to offer significant benefits in reconstructing complex burn injuries, with the ALT flap providing robust coverage and the SCIP flap offering superior contour and functional outcomes for smaller defects. The findings underscore the versatility of both flaps in electrical burn reconstruction, highlighting the importance of choosing the appropriate technique based on the size and location of the defect. This study contributes valuable insights into the selection of free flap techniques for reconstructing hand injuries caused by electrical burns, aiming to optimize patient outcomes in terms of both functionality and aesthetics.

Diabetes mellitus is a chronic condition that affects the metabolism of carbohydrates (glucose) in the body. According to data from the 2018 Basic Health Research (Riskesdas), there was a 2.1% increase in the prevalence of diabetes mellitus in Indonesia. The objectives of this study are: 1) To determine the antidiabetic activity of ethanol extract from Karas Tulang leaves in Wistar strain rats modeled for diabetes mellitus induced by alloxan, and 2) To perform phytochemical screening of the ethanol extract of Karas Tulang leaves (Chloranthus erectus).The research method utilized an experimental design with four groups of Wistar strain white rats. The phytochemical screening conducted included tests for alkaloids, saponins, flavonoids, and tannins using the thin-layer chromatography (TLC) method. Based on the results of the phytochemical screening tests, it was found that Karas Tulang leaves contain alkaloids, saponins, flavonoids, and tannins. The effectiveness of the antidiabetic activity was analyzed using SPSS through statistical tests, including normality, homogeneity, Kruskal-Wallis, and Mann-Whitney tests. Based on the statistical test results, it was concluded that the ethanol extract of Karas Tulang leaves at doses of 50 and 100 mg/kgBW is effective in reducing blood glucose levels.

Budd-Chiari syndrome (BCS) is a rare but life-threatening condition characterized by obstruction of hepatic venous outflow, leading to hepatic congestion, portal hypertension, and potential liver failure. While pharmacological and interventional approaches play a significant role in its management, surgical intervention remains a cornerstone for cases refractory to less invasive measures. This review explores the surgical strategies employed in the treatment of BCS, ranging from shunting procedures, such as portosystemic shunts, to advanced techniques like liver transplantation. Emphasis is placed on patient selection criteria, perioperative considerations, and long-term outcomes. Additionally, the evolving role of minimally invasive and hybrid approaches in this domain is analyzed. By synthesizing current evidence, this article aims to guide clinicians in optimizing the surgical care of BCS patients.

Cardiac amyloidosis (CA) is a life-threatening, infiltrative cardiomyopathy characterized by the extracellular deposition of amyloid fibrils within myocardial tissue. This pathological process results in progressive diastolic and, ultimately, systolic dysfunction, leading to heart failure and associated morbidities. CA predominantly arises from two amyloid types: immunoglobulin light chain (AL) amyloidosis and transthyretin amyloidosis (ATTR), which can be either hereditary (ATTRv) or wild-type (ATTRwt). Given the heterogeneity of clinical manifestations, early diagnosis remains challenging but critical for optimizing patient outcomes. Advanced imaging modalities, including cardiac magnetic resonance (CMR) and bone scintigraphy, alongside tissue biopsy and genetic testing, have revolutionized diagnostic accuracy. Recent advances in targeted therapies, particularly transthyretin stabilizers and RNA-based therapies, are reshaping the clinical landscape. This review aims to elucidate the complex pathophysiology of cardiac amyloidosis, discuss the latest diagnostic criteria and techniques, and evaluate current and emerging therapeutic approaches. Through a comprehensive analysis, this article underscores the importance of early recognition and multidisciplinary management to improve prognosis and quality of life in affected individuals.

Breast reconstruction is a cornerstone of post-mastectomy care, aiming to restore the breast’s form and appearance while enhancing patients’ psychosocial well-being. The procedure can be performed using implant-based or autologous tissue techniques, each tailored to the patient’s medical profile, treatment plan, and preferences. Implant-based reconstruction, involving saline or silicone implants, offers shorter recovery times and is often preferred in patients without planned postmastectomy radiation therapy. Autologous tissue reconstruction, including techniques like the DIEP and latissimus dorsi flaps, provides natural contours and greater durability, particularly beneficial for patients undergoing radiation therapy. Advancements such as nipple-sparing mastectomy, acellular dermal matrices, and minimally invasive approaches have improved surgical outcomes and patient satisfaction. However, complications—ranging from implant-related issues like capsular contracture to donor-site morbidity—highlight the need for comprehensive preoperative planning and a multidisciplinary approach. Breast reconstruction remains a highly individualized process, emphasizing patient-centered care to optimize oncological safety, aesthetic outcomes, and quality of life.

The reconstruction of lip defects poses a surgical challenge, especially when malignancies affecting the oral commissure require extensive excisions leading to considerable tissue loss. Optimal reconstruction methods must restore functionality, maintain aesthetics, and harmonize with adjacent tissues. The Karapandzic flap, introduced in 1974, provides a neurovascular myocutaneous technique that safeguards essential structures while preserving lip mobility and sensation. This report emphasizes the reconstruction of a substantial lip defect subsequent to the excision of basal cell carcinoma utilizing the Karapandzic flap. The technique offers benefits such as a single-stage procedure, maintenance of vascular and nerve networks, and enhancement of oral function with increased lip mobility. Notwithstanding possible drawbacks like temporary microstomia and asymmetry of the oral commissure, the Karapandzic flap provides enhanced functional and aesthetic results relative to alternative techniques. This method proficiently targets the intricate musculature at the oral commissure, delivering a substantial functional reconstruction while circumventing the rigidity and diminished sensation linked to alternative techniques. The Karapandzic flap is a dependable and effective method for reconstructing substantial lip defects, including those affecting the oral commissure. Although early postoperative microstomia may arise, it generally ameliorates with time, rendering this technique a commendable option for attaining optimal functional and aesthetic outcomes in lip reconstruction.

Compartment syndrome is a critical condition characterized by elevated pressures within constricted myofascial compartments, leading to vascular compromise, hypoxia, and potential irreversible injury. While commonly affecting the forearm and lower leg, compartment syndrome of the hand is rare and poses unique diagnostic and therapeutic challenges. The pathophysiology involves increased intracompartmental pressure from various etiologies, such as trauma, edema, or external compression, culminating in a cycle of ischemia and worsening edema. Rhabdomyolysis, defined by rapid muscle tissue degradation and release of intracellular components into the bloodstream, is intricately linked to compartment syndrome, with each condition potentially exacerbating the other. Elevated serum creatine kinase and myoglobin levels are hallmark diagnostic markers of rhabdomyolysis.

Background: Schistosomiasis is a water-borne tropical parasitic disease that is of a major public health problem. It is one of the neglected tropical diseases that are prevalent in the developing nations with poor health resources, especially sub-Saharan Africa and Nigeria in particular. Objective: The aim of the study was to determine the relationship between the socio-economic indicators and prevalenceof urinary schistosomiasis among primary school children in Ndokwa East Local Government Area of Delta State, Nigeria.

Acute pancreatitis (AP) is an inflammatory disease of the pancreatic parenchyma, resulting from the premature activation of pancreatic zymogens, with local and systemic repercussions. It represents one of the main causes of hospital admission for gastrointestinal pathologies, with predominant etiologies such as biliary (32-49%) and alcohol consumption (20-31%). Management depends on the severity and complications present. Although open laparotomy was historically used, minimally invasive techniques have demonstrated superiority in terms of clinical outcomes. Surgical options include open, percutaneous, laparoscopic and endoscopic necrosectomy, the selection of which depends on factors such as the availability of resources, surgical skills and the clinical condition of the patient.

Un hombre de 24 años con antecedentes de vapeo intenso desarrolló múltiples quistes pulmonares y un posterior neumotórax espontáneo bilateral, que culminó en la muerte. Las imágenes iniciales indicaron daño quístico probablemente causado por la inhalación prolongada de compuestos tóxicos presentes en los cigarrillos electrónicos, como diacetilo y acetato de vitamina E. Este caso destaca el posible vínculo entre el vapeo y las enfermedades pulmonares crónicas que pueden progresar a complicaciones graves, lo que contribuye al debate en curso sobre los riesgos asociados al vapeo y subraya la necesidad de realizar más estudios sobre sus efectos a largo plazo.

The World Health Organization (WHO) indicates that more than 11 million people sustain burns each year, leading to 180,000 deaths. A burn is a condition caused by heat, chemical agents, electrical currents, or other forces that damage tissue. Burns primarily affect the skin, but they may also involve deeper structures, such as bones and muscles. Upon combustion, the skin relinquishes its fundamental functions, including protection against environmental threats, infections, moisture loss, and thermal regulation. It is imperative to select the most appropriate therapy based on the burns stage, the patients health, and the burns etiology. Personalization and interdisciplinary collaboration are crucial for the effective treatment of burn victims. This comprehensive study consolidates and analyzes the available treatment modalities, highlighting recent advancements in topical therapies, wound debridement, dressings, skin grafting, nutritional support, pain management, and scar tissue treatment.

Necrotizing enterocolitis (NEC) is a severe inflammatory bowel condition that causes intestinal tissue ischemia in premature newborns, mainly due to their underdeveloped intestinal and immune systems. NEC develops through both maternal and infant-related factors, including weak immune defenses, reduced transfer of maternal immunity, and various molecular factors such as epigenetics and blood vessel development. Feeding problems are the earliest sign, often accompanied by breathing pauses, slow heart rate, and unstable body temperature. Initial treatment is focused on bowel rest, nutritional support, and antibiotics. Surgery becomes necessary in about 30% of cases, especially in younger patients. Preventing NEC is crucial for reducing complications, medical costs, and long-term developmental problems that affect both quality of life and healthcare resources.

Inferior alveolar nerve block (IANB) is widely used for performing painless intraoral treatments. In rare cases, ophthalmic complications (OCs) such as diplopia, amaurosis, mydriasis, ptosis, etc., may occur. Despite being uncommon and usually transient, OCs may lead to stressful situations, and dentists should be aware of them in order to prevent them. The aim of this review is to highlight these OCs related to the IANB.

The TITAN trial, a phase III, randomized, double-blind, placebo-controlled study, evaluated the efficacy and safety of apalutamide in combination with androgen deprivation therapy (ADT) for patients with metastatic castration-sensitive prostate cancer (mCSPC). The trial included 1,052 patients randomized to receive apalutamide or placebo plus ADT, with primary endpoints of overall survival (OS) and radiographic progression-free survival (rPFS). Results demonstrated that apalutamide significantly improved OS and rPFS, with a 35% reduction in the risk of death (HR, 0.65; 95% CI, 0.53–0.79; P<0.001) at a median follow-up of 44 months. Health-related quality of life (HRQOL) was maintained during treatment. Adverse events more common in the apalutamide group included rash (27.1%), hypothyroidism, and ischemic heart disease, but these were manageable. The TITAN trial established apalutamide plus ADT as an effective and well-tolerated treatment option for mCSPC, offering significant survival benefits while preserving quality of life.

BRASH syndrome is an underrecognized yet potentially life-threatening clinical entity characterized by the interplay of bradycardia, renal failure, AV-node blockade, shock, and hyperkalemia. This syndrome represents a complex feedback loop where the synergistic effects of hyperkalemia and atrioventricular nodal blocking agents precipitate severe bradycardia, exacerbating renal perfusion and resulting in acute kidney injury. This further amplifies hyperkalemia, perpetuating a vicious cycle that can culminate in cardiogenic shock and multiorgan dysfunction. Despite its significance, BRASH syndrome is often misdiagnosed as isolated hyperkalemia or primary heart block, leading to delays in appropriate management. Early recognition and a systematic approach to its pathophysiology are essential for targeted treatment. The present review synthesizes current knowledge on the pathogenesis, diagnostic criteria, and evidence-based management strategies for BRASH syndrome, emphasizing the importance of tailored therapeutic interventions to break the cycle of deterioration. Additionally, we discuss emerging insights into its pathophysiology and highlight gaps in the literature requiring further investigation.

University students on Mexicos north-central border continue their vocational training activities at higher education institutions just over three years into the COVID-19 pandemic. Various studies indicated health effects in this period, mainly with considerable increases in anxiety, depression, suicidal ideation, somatic symptoms, social dysfunction and tobacco or substance use in the face of confinement and little social contact of young people, even considering the advent of virtuality and social networks. The variable development of social skills in the forms of communication and conflict resolution has been a relevant factor in the post-pandemic period, identifying needs for analysis that enable adjustments in psychosocial support for the youth population. The aim of the study was to analyze the relationship between the social skills and the perception of general health of 138 university students through a non-probabilistic sampling by voluntary subjects with informed consent. Three validated instruments of social skills, general health and anxiety were applied with a cross-sectional non-experimental quantitative methodology with statistical correlation analyses. The perception of general health symptoms such as depression, somatization, and social dysfunction was associated with the social skills and anxiety of college students.

Physical activity is any form of physical movement that requires the expenditure of energy produced by the body, such as activities carried out during work and daily activities. Lack of regular physical activity increases the risk of non-communicable diseases such as decreased cardiopulmonary capacity, muscle strength and endurance in activity, flexibility, and decreased immunity. Exercise is a form of physical activity that is structured and performed with goals such as improving fitness, health, or physical performance. Physical activity includes any form of body movement that involves muscle contraction and energy expenditure, whether done formally as usual sports activities. Researchers conducted sports activities in the form of Pilates exercises. Pilates exercise is a mind-body exercise that focuses on stability, flexibility, strength, muscle control, posture and breathing. Exercise can be mat-based. Pilates exercise can produce statistically significant improvements in abdominal endurance, muscle flexibility, and endurance of the human body. The benefits of Pilates exercise can increase the strength of the heart and lung muscles, increase flexibility and fitness, improve immunity and can improve posture correction. The aim of this study was to know the impact of pilates exercise to health related fitness and lung capacity.

Diabetes mellitus is a significant public health problem, with a predicted increase in the number of patients in Indonesia reaching 28.6 million by 2045. Diabetes self-care is important to prevent complications and improve patients quality of life. This analysis aims to clarify the concept of diabetes self-care and its activities in patients with diabetes mellitus. The methods used include literature searches in various databases to define diabetes self-care and analyses of attributes, case examples, and consequences of self-care practices. Results showed that diabetes self-care involves a healthy diet, physical activity, blood sugar monitoring, and medication adherence. Implications for practice emphasize the importance of self-care management education for diabetes patients to improve glycemic control and prevent complications, as well as the need for support from health professionals and families in the process of managing this disease.

A 32-year-old man presented with myalgia, polyarthritis, hearing problem, sneezing, erythematous rash, episcleritis for one month. As serum creatinine was high, renal biopsy was done; it was compatible with pauci immune glomerulonephritis. Blood c-ANCA was positive; and, both anti-glomerular basement membrane antibody and p-ANCA were negative. Therefore, he was diagnosed as a case of Wegener’s Granulomatosis with rapidly progressive glomerulonephritis, and treated with corticosteroids, cyclophosphamide and rituximab. Hemodialysis was initiated shortly after immunosuppressive treatment as serum creatinine was rising. He developed dyspnea and low SaO2 due to acute respiratory distress syndrome (ARDS). Total WBC count was low (2.1X109 /L). He was successfully treated with continuous positive airway pressure (CPAP).

Primary cutaneous apocrine carcinoma is a rare adnexal malignancy, often presenting a diagnostic challenge due to its resemblance to metastatic ductal carcinoma of breast. We report the case of an 82-year-old male with a painless, progressively enlarging swelling in the left axilla over a year. Clinical impression was a sebaceous cyst. Following an excision biopsy, histopathology demonstrated a well-circumscribed, unencapsulated neoplasm in the dermis with apocrine differentiation. The hallmark feature of decapitation secretion was observed. Immunohistochemical studies with GCDFP 15, CK7, ER, PR, HER2 and S100 antigen supported the diagnosis. The patient underwent complete excision and is doing fine without recurrence since January 2024. This case highlights the importance of meticulous morphological and immunohistochemical evaluation to distinguish primary cutaneous apocrine carcinoma from metastatic ductal carcinoma of breast.