Timely treatment of thyroid disease during pregnancy is important in preventing adverse maternal and fetal outcomes. Thyroid abnormalities are very often subclinical in nature and not easily recognized without specific screening programs. Even mild maternal thyroid hormone deficiency may lead to neurodevelopment complications in the fetus. The main diagnostic indicator of thyroid disease is the measurement of serum thyroid-stimulating hormone and free thyroxine levels. Availability of gestation-age-specific thyroid-stimulating hormone thresholds is an important aid in the accurate diagnosis and treatment of thyroid dysfunction. Pregnancy-specific free thyroxine thresholds not presently available are also required. Large-scale intervention trials are urgently needed to assess the efficacy of preconception or early pregnancy screening for thyroid disorders. Accurate interpretation of both antepartum and postpartum levels of thyroid hormones is important in preventing pregnancy-related complication secondary to thyroid dysfunction. This article sheds light on the best ways of management of thyroid dysfunction during pregnancy in order to prevent any possible maternal or fetal complication.

Background: Cardio respiratory fitness in childhood is an important predictor of morbidity and mortality in adulthood. Overweight and Obesity are the major health concerns that the adolescents are facing globally. Obesity is the root cause for various cardiovascular, metabolic and musculoskeletal disorders that are life threatening ailments. There are no studies that have documented the cardio respiratory fitness in adolescent girls of Hyderabad. The objective of this study is to know the Cardio respiratory endurance (VO2max) among normal, overweight and obese adolescent girls of Hyderabad. To find the changes in VO2max with increase in body fat mass. Materials & Methodology: This is a cross sectional study involving 60 girls with an age group of 14-16 years and were categorized into 3 groups (n=20) based on their BMI and WHR. All three groups were assessed for Cardio respiratory fitness using 20m shuttle run test. Results: The data was analyzed using ANOVA and (P< 0.05) in all the 3 groups. This suggests the significant difference of VO2max in all the 3 groups. Conclusion: VO2 max was higher in normal group which suggests a good cardio vascular profile. VO2 max in overweight was better than obese group and less than in control group. VO2 max was poor in obese group indicating that increase in fat mass has a negative relationship with cardio respiratory fitness and the low VO2max is associated with many cardiovascular risk factors in later life.

Background
Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth.

Methodology
In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth.

Findings
The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care.

Conclusion
By listening to women’s experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers’ wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.

Urinary incontinence (UI) is a bothersome symptom with population studies suggesting a prevalence of 13.1% in women and 5.4% in men. While a significant cohort of patients with this complaint may ultimately require surgical management to achieve complete continence, a number of non-surgical measures exist to improve symptoms and quality of life. A range of guidelines exist on this topic, including those published by the European Association of Urology (EAU), the International Continence Society (ICS), the American Urological Association (AUA) and the UK’s National Institute for Health and Care Excellence (NICE). The aim of our study is to provide an overview of the initial assessment of patients with UI including history taking, examination and basic investigations. Our review outlines non-surgical management strategies for UI, including conservative measures, behavioral and physical therapies and drug treatment. We shall also examine the above guidelines and present a narrative ove...

Previous research has suggested that consuming alcohol mixed with energy drinks (AMED) increases overall alcohol consumption. However, there is limited research examining whether energy drinks are unique in their effects when mixed with alcohol, when compared with alcohol mixed with other caffeinated mixers (AOCM). Therefore, the aim of this survey was to investigate alcohol consumption on AMED occasions, to that on other occasions when the same individuals consumed AOCM or alcohol only (AO). A UK-wide online student survey collected data on the frequency of alcohol consumption and quantity consumed, as well as the number of negative alcohol-related consequences reported on AO, AMED and AOCM occasions (N=250). Within-subjects analysis revealed that there were no significant differences in the number of alcoholic drinks consumed on a standard and a heavy drinking session between AMED and AOCM drinking occasions. However, the number of standard mixers typically consumed was significan...

Національний підручник підготовлено професорсько-викладацьким складом кафедр терапії медичних закладів післядипломної освіти. У ньому наведено сучасні уявлення про захворювання внутрішніх органів, їх епідеміологію та етіопатогенез, класифікації, клінічну картину, діагностику і диференціальну діагностику, профілактику й лікування з урахуванням чинних стандартів та американських, європейських і вітчизняних протоколів з надання медичної допомоги. Уперше в навчальній літературі описано сучасні аспекти організації терапевтичної допомоги в умовах реформування, особливості інтенсивної терапії, паліативної медицини та медицини надзвичайних станів, інфекційних хвороб і фтизіатрії, акцентовано увагу на запобіганні побічній дії лікарських препаратів та немедикаментозних методів лікування, подано методи променевої, ендоскопічної діагностики та радіаційної медицини, розкрито аспекти клінічної імунології, імунопрофілактики і трансплантології, медичної генетики й інформатики, клінічної неврології, психології та протидії насильству в сім’ї, які трапляються у практичній діяльності лікарів-терапевтів широкого профілю. Кожен розділ підручника містить тестові завдання для самоперевірки й контролю засвоєння знань.
Для лікарів-інтернів зі спеціальності «Внутрішні хвороби», а також для студентів старших курсів медичних університетів і клінічних ординаторів, резидентів, слухачів закладів післядипломної освіти, лікарів-практиків терапевтичного профілю.

Background: Anaemia in pregnancy is the leading medical disorder in developing countries like India. Women with severe anemia in labor is a challenging situation for the obstetrician with increased maternal and perinatal morbidity and mortality. It has multifactorial etiology, Main cause of anemia in obstetrics is iron deficiency. There are specific risks for the mother like preterm labour pain, IUGR baby, preeclampsia, antepartum haemorrhage, sepsis etc and the fetus such as prematurity, low birth weight, birth asphyxia etc. Aim and Objectives: To determine the socio-demographic variables and also the maternal and perinatal outcomes of pregnant women admitted to labour room with severe anemia (Hb <7gm%) late in pregnancy. Results: It was seen that out of 50 severely anemic women, 82% had Hb between 4-7 gm% and 18% had Hb < 4gm%. Severe anemia is seen in 82% unbooked patients and only in 18% booked patients. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, mortality in anemic group as compared to non anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admission, low birth weight among the anemic group as compared to non anemic group. Conclusions: Severely anemic women reporting in labor had significantly high maternal and perinatal morbidity and mortality. Even a minor blood loss is much devastating for such patients. Extrapolating our observations, it can be said that a close vigilance, anticipation of complications and appropriate care and interventions during labor and puerperium will help in improving outcomes in these severely anemic women. Awareness and education on early antenatal bookings, regular iron intake and continuous antenatal care should be the goal in tackling anemia in pregnancy.

Background Hepatitis B virus is a public health problem in the world. It is a major cause of chronic hepatitis, cirrhosis, and hepatic cellular carcinoma. The presence of a confirmed HBsAg result is indicative of ongoing HBV infection. This study aims to assess the sero-prevalence and associated factors of the hepatitis B virus among pregnant women in North West Ethiopia. Methods and Materials An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital from January to July 2017. A consecutive 338 pregnant women attending the antenatal clinic were included. A structured questionnaire was used to assess hepatitis B virus infection associated factors and some socio-demographic characteristics. A 5 mL of venous blood was collected from each study participant and plasma was separated and analyzed using a rapid HBsAg kit and further confirmed by double sandwich ELISA. The data were analyzed using SPSS software version 24. Results The mean age of the study pa...

Background-The global prevalence of diabesity is alarming, this rising epidemic leads to social, clinical, economic burden and it plays an important role in depression. There is a triangle relationship between diabetes, obesity, and depression. Both diabetes and obesity increase the prevalence of depression as well as depressed patients are also prone to develop diabetes mellitus and obesity. Jacobson progressive muscle relaxation technique (JPMRT) helps in achieving deep state of mental and physical relaxation thus reducing anxiety and depression in various conditions. This is the first study conducted on diabesity patients who are at high risk of depression. The aim of this study was to determine the effect of Jacobson progressive muscle relaxation technique on depression in diabesity patients Materials and methods-30 diabesity patients were randomly assigned into two groups-Experimental group underwent JPMRT (n=15), for 8 weeks, 3 times a week. Control group (n=15) were under their routine oral hypoglycemic drugs. Pre and post intervention values of depression were measured using BDI-II scale. Result-The data analysis was done using Mann-Whitney U Test to calculate BDI-II scores between the experimental and control groups and Wilcoxon Signed Ranks Test for pre and post BDI-II within group. The results have shown that there is a significant reduction in depression in experimental group compared to controls since Z value is-4.609 and its p-value 0.000 is less than 0.05. Conclusion: Jacobson Progressive Relaxation Technique is effective in reducing depression in diabesity patients.

Background: Nonalcoholic fatty liver disease (NAFLD) is an emerging treat which may be taken as hepatic counterpart of metabolic syndrome. NAFLD is the earliest manifestation of metabolic syndrome and hence the need for devising the best screening tool for NAFLD that is cheap, simple and reliable. Here in this study we compare two important screening tools for NAFLD-ultrasonography and NAFLD fibrosis score. Methods: This was a hospital based non-interventional observational study. After applying necessary inclusion and exclusion criteria, the study population was assessed in detail with set proforma and relevant investigations. The association of co-morbidities with ultrasonography and NAFLD fibrosis score was assessed. The agreement between ultrasonography and NAFLD fibrosis score in detecting hepatic fibrosis was assessed and reasons for discrepancy if any were also noted. Results: Mean age of the study population of 377 was 43.8 years. Asymptomatic hepatomegaly was the single most common clinical sign. Significant association was noted between presence of co-morbidities and severity of fibrosis in ultrasonography and NAFLD fibrosis score. Fibrosis score had fair agreement with ultrasound and the factors which produced significant fibrosis score in those detected to have mild fibrosis with ultrasound were increasing age and body mass index Conclusions: NAFLD fibrosis score is a cheap screening tool applicable to majority of susceptible population. Even though score has many advantages over ultrasound the clinical applicability is still debatable due to its slight overestimation of fibrosis. NAFLD fibrosis score is excellent as a screening tool but doubtful as a diagnostic one.

When bodies and minds cease to function in silence, everyday lives get disrupted and self-understandings unsettled. We wonder whether we are ill, what ails us, and how it will affect the immediate or long-term future. Through the theoretical lens of liminality, experiences of illness have been described in terms of uncertainty and affective destabilization. In the context of healthcare, liminality is countered by a search for causal explanations, diagnoses, and effective treatment. Little attention has been directed towards how the liminality of illness/disease is managed as patients and medical professionals interact.

This article reviews the usual methods used to treat amyotrophic lateral sclerosis (ALS) in the West, then discusses some alternative treatments that are being used by practitioners of Traditional Chinese Medicine (TCM). The paper concludes by suggesting that some TCM methods, such as tai chi and qigong, should be considered for the treatment of ALS in conjunction with the current Western methods.

Bubble continuous positive airway pressure (bCPAP), a noninvasive respiratory support modality used to manage newborns with respiratory distress, provides continuous pressure that helps prevent derecruitment of alveoli, increasing the lungs' functional residual capacity, and thus decreasing the work of breathing. bCPAP can be used to manage various respiratory conditions in the newborn. In this prospective study, we describe our experience using bCPAP therapy as the primary respiratory support in a level III neonatal unit in Amman, Jordan. In addition to reporting therapeutic indications, durations, and side effects, we aimed to identify areas requiring improvement in bCPAP therapy in our population. Patients and methods: This prospective observational study investigated the usage of bCPAP in the management of respiratory distress in newborns admitted to a Jordan University Hospital in Amman. The newborns were followed until discharge. The patients' demographic and clinical data were recorded. Results: A total of 143 babies (mean gestational age, 36±2.7 weeks; mean birth weight, 2,770±1,800 g) were included. All received bCPAP as the primary respiratory support. The most common underlying cause of respiratory distress was transient tachypnea of the newborn (42%), followed by prolonged respiratory transition (34%). The therapy success rate was 93.7%; only nine infants failed bCPAP. The most common side effect was physical facial injury. Conclusion: The use of neonatal bCPAP therapy is well established in Jordan University Hospital. The area of potential improvement was the low rate of bCPAP use as a primary respiratory support in extremely premature infants.

Background: Neonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It is a single intervention of birth asphyxia. Over 1.2 million African babies are supposed to die in the first four weeks of their life and many of them in the first 24 hours of birth in Sub-Saharan Africa. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. However, there is limited evidence on midwives' and nurses' knowledge of neonatal resuscitation in the study area. Therefore, this study aimed to assess the knowledge of midwives and nurses about neonatal resuscitation and its associated factors. Methods: This facility-based cross-sectional study was done on 427 midwives and nurses, who were selected using simple random sampling technique. Data were collected on facility type, availability of essential equipment, socio-demographic characteristics, working unit, professional experience, in-service training, and knowledge of neonatal resuscitation. First-degree holder midwives collected the data using a pre-tested face-to-face interviewer-administered questionnaire. Bivariate and multivariate logistic regression was used to analyze the association between the dependent and independent variables. Results: The study showed that 9.8% of the study participants had good knowledge about neonatal resuscitation. Factors significantly associated with knowledge of neonatal resuscitation were being trained on newborn resuscitation (AOR = 3.79, 95% CI: 1.73, 8.32), being unmarried (AOR = 2.36, 95% CI: 1.11, 5.02), holding bachelor sciences degree or above (AOR = 2.67, 95% CI: 1.11, 6.47), and working under West Hararghe health institutions (AOR = 0.30, 95% CI: 0.10, 0.88). Conclusion: The study participants had low knowledge of neonatal resuscitation. Being unmarried, holding bachelor sciences degree or above, being trained on neonatal resuscitation, and working under West Hararghe health institutions were factors associated with the knowledge of the study participants on neonatal resuscitation.

Excerpt from Chapter 1: Copyright © 2004-2021 by Dr Alex Vasquez. Published most recently in Inflammation Mastery, 4th Edition (InflammationMastery.com) and Textbook of Clinical Nutrition and Functional Medicine.    All rights reserved and enforced. See update/overview 14Aug2021 at HealthyThinking.substack.com

Introduction: Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients' hospitalization, produces extra costs and even death. This study aimed to assess medication administration error (MAE) and associated factors among nurses in referral hospitals of Ethiopia. Methods: Institutional-based, cross-sectional study design was used, and 422 study participants were selected using a simple random sampling method. Data were collected using a semi-structured and pre-tested self-administered questionnaire and observational checklist. The collected data were analyzed using descriptive and analytical statistics and binary logistic regression was done to identify factors associated with medication administration errors. P-value ≤ 0.05 was considered statistically significant. Results: Four hundred fourteen participants with a response rate of 98.1% were involved and 54.3% were females. The median age was 30 with IQR (28-34) years and the majority of them (83.8%) had BSc qualification in nursing. The prevalence of MAE in this study was 57.7% and 30.4% of them made it more than three times. Wrong time (38.6%), wrong assessment (27.5%), and wrong evaluation (26.1%) were the most frequently perpetuated medication administration errors. Significant association between medication administration errors and lack of training [AOR=2.20; 95% CI (1.09, 4.46)], unavailability of guideline [AOR=1.65; 95% CI (1.03, 2.79)], poor communication when face problem [AOR=3.31; 95% CI (2.04, 5.37)], interruption [AOR = 3.37, 95% CI (2.15, 5.28)] and failure to follow medication administration rights [AOR=1.647; 95% CI (1.00, 2.49)] was noticed. Conclusion: MAE was high in the study area as compared to studies from

Background: One of the global milestones in medicine is e-Health-which is about leveraging on ICT to deliver efficient health care services to citizens. Nigeria with poor infant and maternal indices, poor physical infrastructures and scarce health practitioners is expected to leverage on the potentials of e-health to strengthen the country's health service delivery by fully adopting the right policy framework for ICT in the health.

Objective & Aim: Frequency of coexístanse of elevated lipid profile and blood pressure are higher. Among modifiable cardiovascular risk factors elevated blood lipid profiles and basic hypertension appear to coexist and all amongst the major modifiable risk factors. The main aim of the study was to evaluate the correlation between basic essential hypertension and serum lipid profile. Methods: For this observational study 110 adult hypertensive patients and same number of controls with normal blood pressure were selected. After taking patients consent demographic details like age, weight, height were documented in a predesigned pro forma. Serological test was sent for identify total cholesterol (TC), serum triglycerides (TG), Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). Results: It was observed that the mean age of study group and control group was 48.7±8.1 and 49.2±7.2 years respectively. It has also been observed that mean weight was slightly more as compare to control group. It was found that lipid profile like triglyceride; total cholesterol and LDL cholesterol were higher in hypertensive group as compared to that control group. Among the hypertensive subjects most frequently occurring abnormality was elevated TC followed by elevated LDL. With other lipid abnormalities, these abnormalities rather than in isolation, however often occurred together. Conclusion: This observational study reveals that, among newly diagnosed hypertensives elevated lipid profile is coexistent. As both elevated blood pressure and serum lipid profile is considered as risk factors of severe coronary artery disease thus between BP and blood lipids biologic interrelations may impact the systems severely.

Persian Father of Medicine, Avicenna (or Abu Ali Ibn Sina) and his Canon of Medicine (Arabic: القانون في الطب‎ al-Qānūn fī aṭ-Ṭibb) is an encyclopedia of medicine in five books compiled by Persian philosopher Avicenna (Ibn Sina) and completed in 1025. It presents an overview of the contemporary medical knowledge, which had been largely influenced by Galen

The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world, and was used as a medical textbook through the XVIII century in Europe. It is still used in Unani medicine, a form of traditional medicine practiced in India.

Book 3 is arranged from head to toe covering the function and diseases of each organ.


Book 3 is arranged from head to toe covering the function and diseases of each organ.

L'article s'intéresse aux effets de l'évaluation chiffrée de la qualité des pratiques en médecine générale. La mise en perspective des réformes concernant la médecine générale libérale en France montre que le déploiement progressif de dispositifs d'encadrement de la pratique connaît aujourd'hui un tournant métrologique décisif. Nous en envisageons le retentissement sur les généralistes à partir de deux études originales consacrées aux soins préventifs. Les critiques et formes de résistance professionnelles sont examinées, avant d'approfondir l'expérience et les arguments des praticiens qui consentent à la mesure du travail médical, voire s'en saisissent, pour apprécier les inflexions en cours du modèle professionnel comme de la gouvernance de la médecine libérale.

The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is applicable in all clinical emergencies for immediate assessment and treatment. The approach is widely accepted by experts in emergency medicine and likely improves outcomes by helping health care professionals focusing on the most life-threatening clinical problems. In an acute setting, high-quality ABCDE skills among all treating team members can save valuable time and improve team performance. Dissemination of knowledge and skills related to the ABCDE approach are therefore needed. This paper offers a practical "how-to" description of the ABCDE approach.

Introduction: Infertility places a huge psychological burden on infertile couples, especially for women. Greater knowledge of the factors affecting fertility may help to decrease the incidence of infertility by allowing couples to avoid certain risk factors. The aim of our study was (1) to assess the knowledge and attitudes of infertile and fertile Saudi participants on infertility, possible risk factors, and social consequences; and (2) to determine the practices of infertile Saudi couples to promote their fertility before having them attend an in vitro fertilization (IVF) clinic. Methods and materials: We conducted a cross-sectional study on 277 fertile participants from outpatient clinics and 104 infertile patients from the IVF clinic at King Abdulaziz Medical City between June 24, 2012 and July 4, 2012, using a previously validated interview questionnaire. Descriptive and analytical statistics were applied with a significance threshold of P # 0.05. Results: A generally poor level of knowledge (59%) and a neutral attitude (76%) toward infertility were reported by participants. Mistaken beliefs commonly held by the study participants regarding the causes of infertility were Djinns and supernatural causes (58.8%), black magic (67.5%), intrauterine devices (71.3%), and contraceptive pills (42.9%). The healer/ Sheikh was reported as the primary and secondary preference for infertility treatment by 6.7% and 44.2% of IVF patients, respectively. Compared with fertile patients, IVF patients were significantly less likely to favor divorce (38.5% versus 57.6%; P = 0.001) or marriage to a second wife (62.5% versus 86.2%; P , 0.001), if the woman could not have a baby. The patients with infertility had more favorable attitudes toward fertility drugs (87.5% versus 68.4%; P = 0.003) and having a test tube baby (92.4% versus 70.3%; P , 0.001). Child adoption was accepted as an option for treatment by the majority of IVF patients (60.6%) and fertile outpatients (71.5%). Alternative treatments previously practiced by the IVF patients to improve fertility include practicing Ruqia (61%), using alternative medicine (42%), engaging in physical exercise (39%), eating certain foods (22%), and quitting smoking (12%). Conclusion: These findings have implications for health care providers regarding the reluctance that couples experiencing fertility problems may have, at least initially, to accept some interventions required for the couple to conceive.

According to the World Health Organization (WHO)’s “First Global Report on Antibiotic Resistance”, and the U.S. Centers for Disease Control & Prevention (CDC&P), the spread of “superbugs” - bacteria that have changed in ways that render antibiotics ineffective against them
- is a serious and growing threat around the world. Once common treatments for everyday intestinal and urinary tract infections, pneumonia, infections in newborn, and diseases like gonorrhea are no longer working in people. Thus, in 2013, 2 million people in the U.S. were infected with antibiotic-resistant bacteria, and 23,000 of them die each year as a result. Superbugs are bacteria-resistant to one or more antibiotics, and they make it difficult to treat or cure infections that once were easily treated. The antibiotic has lost its ability to control or kill bacterial growth. The bacteria can even grow in a sea of antibiotics because the antibiotic does not touch them. The bacteria have acquired the ability to destroy the antibiotic in order to protect themselves. They have developed a gene for resistance to, say, penicillin, and that gene protects them. A genetic mutation might enable bacteria to produce enzymes that inactivate antibiotics. Or, a mutation might eliminate the target that the antibiotic is supposed to attack. Bacteria may have developed resistance to five or six antibiotics so, in treatment, we do not know which one to choose or whether it will be effective. The bacteria have accumulated resistance by developing new genes. In other words, genetics is working against us!

Introduction: Healthcare systems in Africa suffer from neglect and underfunding, leading to severe challenges across the six World Health Organization (WHO) pillars of healthcare delivery. We conducted this study to identify the principal challenges in the health sector in Africa and their solutions for evidence-based decisions, policy development and program prioritization. Methods: The study was conducted as part of a recent African Epidemiological Association Meeting in Maputo, Mozambique with participants drawn from 11 African countries, Cuba, Portugal and the United Kingdom. Participants were divided into 10 groups, consisting of 7 to 10 persons each. Brainstorming approaches were used in a structured, modified nominal group process exercise to identify key challenges and strategies to mitigate healthcare service challenges in Africa. Identified challenges and solutions were prioritised by ranking 1-5, with 1 most important and 5 being least important. Results: The first three challenges identified were inadequate human resources (34.29%), inadequate budgetary allocation to health (30%) and poor leadership and management (8.45%). The leading solutions suggested included training and capacity building for health workers (29.69%), increase budgetary allocation to health (20.31%) and advocacy for political support and commitment (12.31%). Conclusion: The underdeveloped healthcare systems in Africa need radical solutions with innovative thought to break the current impasse in service delivery. For example, publicprivate initiatives should be sought, where multinational companies extracting resources from Africa might be encouraged to plough some of the profits back into healthcare for the communities providing the workforce for their commercial activities. Most problems and their solutions lie within human resources, budget allocation and management. These should be accorded the highest priority for better health outcomes.

Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute ischemic stroke for 10 years. The application of this drug is considered safe and effective. However, alteplase is also associated with side effects. The author is reporting on an unusual side effect of angioedema that is triggered by alteplase. Angioedema occurs through alteplase according to this study at a frequency of 5.88% (95% confidence interval: 0.98% to 28.76%). In this case immunoglobulin G was slightly increased. The relative risk to get an angioedema compared between the two genders is elevated in men 3.3 (95% confidence interval: 0.15% to 71.90%; P = 0.4423), who were 3.3 times more likely to suffer than women. The use of angiotensin-converting-enzyme (ACE) inhibitors is considered a possible risk factor for the occurrence of angioedema with concomitant administration of tissue plasminogen activator. The angioedema may occur with use of alteplase at any time, so treatment with this drug must always be carried out in intensive care and doctors must be ready for intubation if necessary.

Coronavirus (Covid19) as an infectious disease caused by a newly discovered coronavirus. It is an ongoing pandemic disease. After an outbreak of a mysterious pneumonia in late December 2019 in Wuhan, Hubei, China, the disease characterized by fever, dry cough, fatigue, and occasional gastrointestinal symptoms according to World Health Organization. Almost 400 world scientists gathered from 11-12 Febuary2020 at WHO's Geneva Headquarters to discuss the current level of knowledge about the COVID-19 virus (transmission route, epidemiological studies, natural history of the disease, researches on its origins) and also in identifying new strategies to prepare the world for future outbreaks, including clinical management, infection prevention and control measures in both individuals and healthcare workers, candidate therapeutics and vaccines. Here, we investigate the Nigeria outbreaks, socioeconomical impact including clinical management, infection prevention and control measures in individuals and healthcare workers, candidate therapeutics and vaccines .

Coping is expending conscious effort to solve personal and
interpersonal problems, and seeking to master, minimize or tolerate
stress or conflict. Religious coping is an effort to understand and
deal with life stressors in ways related to the sacred, which includes
prayer, congregational support, pastoral care, and religious faith.
Religion is an integral part of most of the peoples’ life and it may
be defined as a set of beliefs, attitudes, and practices pertaining to
supernatural power, whether that power is force, gods, sprits, ghosts
or devils [1]. Religion strengthens coping [2]. People use religious
methods of coping to find meaning, gain control, gain comfort
and closeness to God, gain intimacy with others and closeness to
God; and to achieve a life transformation. Empirical studies have
demonstrated that many people turn to religion as a resource in
their efforts to understand and deal with the most difficult times
of their lives. Research also clearly demonstrates that religion can
be an invaluable factor in the process of instilling and facilitating
positive coping, psychological well-being, and resilience in religious
clients

Persian Father of Medicine, Avicenna (or Abu Ali Ibn Sina) and his Canon of Medicine (Arabic: القانون في الطب‎ al-Qānūn fī aṭ-Ṭibb) is an encyclopedia of medicine in five books compiled by Persian philosopher Avicenna (Ibn Sina) and completed in 1025. It presents an overview of the contemporary medical knowledge, which had been largely influenced by Galen

The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world, and was used as a medical textbook through the XVIII century in Europe. It is still used in Unani medicine, a form of traditional medicine practiced in India.

Book 2 (the Materia Medica) of the Canon alphabetically lists about 800 "simple" medical substances that were used at the time. The substances are simple in the sense of not being compounded with other substances. The first part gives general rules about drugs and a treatise on what was called "the science of powers of medicines". The second part is a list of 800 simple floral, mineral, and animal substances. Each entry contains the substance's name, its criteria of goodness (which sometimes describes how the substance is found in nature), and its nature or primary qualities. Next are listed one or more of 22 possible general actions, followed by specific properties listed according to a grid of 11 disease types. Finally, potential substitutes for the substances are given.The Canon contains seven rules for experimenting with new drugs, taken partly from Galen.
1 "The drug must be free from any acquired quality"; for example from being exposed to heat or cold or stored in close proximity to other substances.
2 "The experiment must done on a single, not a composite condition"; in other words it should not be tested on a patient who has complex or multiple illnesses.
3 "The drug must be tested on two contrary conditions"; a drug may act directly on a disease but also it may be effective against a different disease by relieving its symptoms.
4 "The quality of the drug must correspond to the strength of the disease...it is best to experiment first using the weakest [dosage] and then increase it gradually until you know the potency of the drug, leaving no room for doubt."
5 "One should consider the time needed for the drug to take effect. If the drug has an immediate effect, this shows that it has acted against the disease itself."
6 "The effect of the drug should be the same in all cases or, at least, in most. If that is not the case, the effect is then accidental, because things that occur naturally are always or mostly consistent."
7 "Experiments should be carried out on the human body [...] the quality of the medicine might mean that it would affect the human body differently from the animal body..."

This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed.

Strukturelle Gewalt ist eine unsichtbare Form, die immer wieder zu Gewalt und Krieg führt. Derzeit im Ukraine-Konflickt.
Die ausserhalb der Ukraine leben, erleben seit 8 Tagen Krieg.
Die Menschen in der Ukraine erleben das Ende von 8 Jahren Krieg in der Ukraine.
Andreu Ginestet ist seit 2003 als Mediator und Friedensvermittler in der NATO tätig und konnte viele A-Kriege abwenden.
Die Ursache von Gewalt und ihr Zusammenhang mit der Epigenetik wird hier in diesen Dokument sehr anschaulich erklärt.
Letztlich ist jeder Mensch aufgerufen, die wirksame, harmonische Ordnung der Schöpfung zu respektieren und bedingungslos in Liebe zu leben, indem er hilft und schenkt, um ein Mitschöpfer zu sein.
Die Ära des Wettbewerbs im getrennten Denken vom  "Wir"-Denken im Kampf  "Ich" gegen das "Du" geht zu Ende und wird zu einem paradiesischen Wohlbefinden für alle durch Bewusstheit und Empathie, in liebevoller Interaktion - Mit-Einander - Für-Einander - Neben-Einander, zum Wohlsein Aller.

Viel Spaß beim Lesen und fragen Sie sofort nach, wenn Ihnen etwas unverständlich erscheint.

Persian Father of Medicine, Avicenna (or Abu Ali Ibn Sina) and his Canon of Medicine (Arabic: القانون في الطب‎ al-Qānūn fī aṭ-Ṭibb) is an encyclopedia of medicine in five books compiled by Persian philosopher Avicenna (Ibn Sina) and completed in 1025. It presents an overview of the contemporary medical knowledge, which had been largely influenced by Galen.

The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world, and was used as a medical textbook through the XVIII century in Europe. It is still used in Unani medicine, a form of traditional medicine practiced in India.

Avicenna begins part one by dividing theoretical medicine and medical practice. He describes what he says are the "four causes" of illness, based on Aristotelian philosophy: The material cause, the efficient cause, the formal cause, and the final cause.

Material Cause Avicenna says that this cause is the human subject itself, the "members or the breath" or "the humours" indirectly.
Efficient Cause The efficient cause is broken up into two categories: The first is "Extrinsic", or the sources external to the human body such as air or the region we live in. The second efficient cause is the "Intrinsic", or the internal sources such as our sleep and "its opposite-the waking state", the "different periods of life", habits, and race.
Formal Cause The formal cause is what Avicenna called "the constitutions ; the compositions". According to Oskar Cameron Gruner, who provides a treatise within Avicenna's Canon of Medicine, this was in agreement with Galen who believed that the formal cause of illness is based upon the individual's temperament.
Final Cause The final cause is given as "the actions or functions".

In the thesis on General Physiology or "The Faculties of the Body", Avicenna separates life into three different categories: Vegetable, Animal, and Human. He contrasts Galen's view that the brain is the "chief seat of sentient life" with Aristotle's view that the heart is the source of all the body's faculties, saying that if physicians considered the matter carefully they would agree with Aristotle that the heart was the ultimate source of all the faculties, even if (for example) the brain is where the rational faculty manifests itself.

Book 5 (the Formulary) lists 650 compound drugs,[2][7]:23-24 attributing them to various Arabic, Indian and Greek sources. Avicenna added his own comments, highlighting differences between recipes from different sources, and sometimes giving his own recipe. He also gave his opinion of the effectiveness (or ineffectiveness) of some remedies, and gave details of where particular ingredients came from and how they were prepared. He favoured proven remedies which had been tested through experience, cautioning that compounds could have unexpected or much stronger effects than might be expected from the effects of the individual components.