Thoraco-brachial outlet syndrome is little known to the general public. However, it is a relatively common pathology, which generally corresponds to nerve compression in the neck and shoulder region. They would involve compression of the lower trunk of the brachial plexus sometimes of the subclavian vessels as these structures cross the thoracic outlet. The diagnosis is difficult, and gives rise to frequent medical errors and the methods have not been well established. Treatment includes physiotherapy, painkillers and, in the most complex cases, surgery due to mechanical stress. We report the case of a 39-year-old patient suffering from poorly systematized pain in the right upper limb associated with paresthesia and cramps and edema. The radiological assessment revealed a SDTB per supernumerary cervical rib with partial compression of the subclavian artery and vein. She benefited from a resection of the supernumerary rib and release of the crossing followed by physiotherapy. The surgical excision of this rib resulted in complete indolence the day after the operation, lasting one year later. The aim of this article is to present the surgical procedure for this pathology and the interest of which is to recall the physiopathology, the diagnostic means, the indications and the therapeutic strategy.

Background: In India, the prevalence of diabetes is constantly rising in both urban and rural settings. The innovation of newer drugs and the combination of available drugs to treat diabetes has also been increasing. So, this study aimed to understand the practice of clinicians and their perspective towards prescribing appropriate oral hypoglycemic agents for individuals diagnosed with type 2 diabetes mellitus (T2DM) in India. Methods: This cross-sectional survey was conducted among diabetologists who provided consent to participate in the survey on their prescription pattern of oral hypoglycemic agents for management of T2DM individuals. Results: Majority of physicians preferred sitagliptin and dapagliflozin fixed dose combination (FDC) (84.42%) for T2DM individuals with high-risk. The experts also mentioned the FDC reduces time in range (40.04%) when sodium glucose cotransporter-2 inhibitors (SGLT2i) and Dipeptidyl peptidase-4 inhibitors (DPP4i) FDC was given. Sitagliptin and dapagliflozin combination therapy was given majorly to newly diagnosed T2DM individuals with cardiovascular risk (CV risk) (67.07%). Sitagliptin and dapagliflozin FDC for 16 weeks reduces 1.5 to 2% of glycated hemoglobin (HbA1c) (40.63%). Conclusion: Sitagliptin and dapagliflozin FDC was effective for T2DM individuals with high-risk and for newly diagnosed T2DM (and with CV risk). The combination also showed benefit in reducing blood pressure and weight loss when compared to SGLT2 inhibitors monotherapy. Hospitalization rate and CV risk was reduced in individuals who take sitagliptin and dapagliflozin FDC.

Immune dysregulation has been observed in the majority of the infective and non-infectious respiratory illnesses with impact on the natural course of illness in pediatric to geriatric age groups. Immune regulation between Th1 and Th2 is altered and reversal of proportion between these two differential cells and ultimately homeostasis, with predominance Th2 cells will increase susceptibility for recurrent illnesses; is typically documented in pediatric age groups with first respiratory infection during early neonatal period with respiratory viral etiologies. Apart from recurrent childhood infections, pediatric cases with immune dysregulation will have recurrent wheezing in childhood and are prone for development of childhood asthma in adolescent age groups; if immune dysregulation does not restore in time. In adults, respiratory illnesses due acute viral infective etiology will cause immune dysregulation as documented after coronavirus, influenza and respiratory syncytial virus infections. Immune dysregulation has also been documented in chronic respiratory illnesses such bronchial asthma, chronic bronchitis and COPD. Immune dysregulation will cause recurrent exacerbations in these inflammatory conditions. Pidotimod is an immunomodulator which will work as an immunostimulant molecule due to its unique pharmacological actions on antigen presenting cells, and have novel action on immune cell proliferation and differentiation. In spite of three decades of research of this novel drug Pidotimod, still; it is less used as of today for respiratory ailments in spite of need of a molecule with an immunomodulatory effect for prevention and or cure of illnesses; and modification of natural course of recurrent or relapsing course of chronic illnesses. COVID-19 pandemic has taught us many pathways of immune dysregulation which evolved during natural course of disease and now documented with respiratory viral illnesses such as RSV; and its long-term impact as long covid presenting due to immune dysregulation occurred as a natural course in recovered cases. It’s unclear whether long covid is reversible as of now, but the majority of symptoms have been resolved and shown response to versatile molecules such as steroid, multivitamins, L-arginine, Paxlovid, beta blockers with variable results and long-term outcomes. Pidotimod can be used in acute COVID-19 illness without pneumonia and comorbidities in stable cases in outdoor settings, and also; considered as potential option in long covid cases with recurrent respiratory infections. In this review we have discussed basic aspects of Pidotimod, and its role in immunomodulatory effects in acute and chronic respiratory illness which have shown positive outcomes.

Radiological phenotypes are radiological patterns or observable characteristics of COVID19 pneumonia. Various phenotypic classifications have been reported in literature. CT severity radiological phenotypes are widely used and universally accepted radiological phenotypic methods. Radiological CT severity phenotypic differentiation has documented very crucial role in initial assessment and during triaging of these cases in indoor and outdoor setting. Typical COVID-19 lung parenchymal involvement described as predominant ground glass opacities (GGOs) and consolidations in peripheral and subpleural portion of any lobe, predominantly involving lower lobes. Atypical Radiological patterns in COVID-19 has been documented as bronchopneumonia, multifocal consolidations, necrotizing pneumonia, cavitations with GGOs with or without consolidations. In present case report, 43-year male, presented with acute febrile respiratory illness with acute hypoxic respiratory failure documented as oxygen saturation of 80% at room air with tachypnea and respiratory distress. HRCT thorax was showing Pleural based, peripheral, central, multifocal patchy, confluent & ill-defined GGOs and consolidations in bilateral lung fields in upper, middle and lower lobes. These typical radiological features suggestive of bronchopneumonia like radiological pattern which was very unusual for typical COVID-19 radiology. His laboratory parameters have shown abnormally raised inflammatory markers like CRP, Ferritin, LDH, D-Dimer and IL-6. Importantly, his random blood sugars were raised with abnormally raised HbA1c levels to label as diabetes mellitus. He was diagnosed with diabetes mellitus this time with COVID-19 illness without use of steroids. He was treated with standardized COVID-19 management institutional protocol with combination of low molecular weight heparin, methylprednisolone, remdesivir, meropenem and teicoplanin. Patient required BIPAP support with higher oxygen requirement with nasals canula for one week due to advanced radiological disease with more anatomical involvement. We have documented successful treatment outcome with use of rational treatment in timely by predicting disease severity with use of composite analysis of clinical, laboratory and radiological markers of illness. Transient hyperglycemia is known to occur and reported after COVID-19 illness due to virus induced inflammatory response and pancreatopathy with beta cell dysfunction. Transient hyperglycemia can be easily managed with insulin during hospitalization and oral anti-diabetic agents after discharge for few weeks. Dietary and lifestyle modification will help in majority with complete reversal of abnormally high sugar levels with restoration of normal HbA1c levels to non-diabetic range.

Sporadic COVID-19 cases will be predicted to occur in coming few years ahead as observed in previously known influenza virus related pandemics. Herd immunity due to natural infection and hybrid immunity after COVID-19 vaccination has played crucial role in waning of this pandemic. COVID-19 pneumonia has a very ‘typical’ radiological presentations, observed globally; classified as GGO and consolidations involving peripheral parts of lung, bilateral disease, predominantly pleural based areas initially and involves central portions as disease process advances. Such radiological presentations are never documented in history before this pandemic, which has helped in suspecting COVID-19 illness in cases with negative microbiological results initially and such illness were classified as SARI (severe acute respiratory illness). Cases with typical radiological features for COVID-19 with RT PCR positive results were defined as case of COVID-19 illness. Both the clinical scenarios were managed with similar protocol during hospitalization. COVID-19 case burden has significantly decreased in last one year since declaration of end of pandemic by WHO and now we are in post pandemic phase. Since beginnings of pandemic, many corona virus variants were emerged with variable infectivity, virulence, pathogenesis, mortality and morbidity. As pandemic is over, cases are rarely observed with lung involvement, COVID RT PCR testing, HRCT reporting’s in line with pandemic protocol and requirement of resources to treat these cases are less required and utilized today. In present case report, 32-year male, presented in outdoor unit with history of acute febrile respiratory illness with dry cough, high grade fever and chest tightness and chest discomfort of acute onset. HRCT thorax documented Pleural based, peripheral, unifocal or solitary opacity with predominant GGOs in right lower lobe with normal left lung. He is treated in indoor unit in line with community acquired pneumonia protocol and observed clinical worsening with four-fold raised in inflammatory markers. Oxygenation is worsened and raised IL-6, CRP and LDH has given clue to think towards COVID-19 etiology. Thorat swab for COVID-19 RT PCR is positive and managed according to protocol for COVID-19 illness. This is the only observed COVID-19 pneumonia case in last six months, in which; clinical-radiological patters were typical of pandemic illness of second wave of COVID-19 illness due to delta variant. Our case is the sporadic case reported with all clinical features of pandemic illness. We have suspected COVID-19 etiology in spite of ‘atypical unilateral lung involvement’ due to worsened clinical features and abnormally raised inflammatory markers with poor response to standard treatment protocol for community acquired pneumonia. High index of suspicion is must, and; timely interventions with use of rational treatment including remdesivir, heparin & steroids combination during hospitalization has documented successful outcome. We recommend COVID-19 RT PCR testing in all community acquired cases nonresponding to standard guidelines to have timely diagnosis and treatment. Sporadic cases rare to occur, and they do occur for few years ahead of this end of pandemic due to virus variant, and we must quote ‘rare things are not rare to happen’.

This paper presents the green synthesis of iron nanoparticles (FeNPs). Iron sulfate served as the substrate and henna extract as the reducing agent in the synthesis of FeNPs. FeNPs were analyzed using a variety of techniques, including UV-visible spectroscopy, nano zeta-sizer analysis, and Fourier transform infrared spectroscopy (FTIR). By using UV-visible spectroscopy, the electron transition band of iron oxide, or the peak at 291 nm, was found to be the source of the FeNPs. The characteristic bands of iron oxide were detected at 790 by FTIR. These bands are associated with the stretching vibration of Fe-O at 1022 and 1516 cm-1. to determine how applying different combinations of nano-fertilizers affects the growth and yield of fenugreek. The experiment consisted of nine treatments. The results demonstrated that T8 performed better than the other treatments in terms of all elements of vegetative development and yield contents. The T8 yields plant height of 43.12 cm, fresh weight of 30.41g, dry weight of 2.44g, seed weight of 5.09g, and pod weight of 7.39g with an increase rate of (55.56, 82.97, 162.36, 105.24, and 122.59)%.

Background: Today, obesity is a serious health issue that is growing around the world. Almost 500 million adults worldwide were obese, and 1.5 billion were overweight, according to a World Health Organization (WHO) report. This number is estimated to increase in the years to come. Objective: To evaluate the prevalence of obesity and overweight among medical students at the Shendi University College of Medicine and its relationship to demographic parameters. Materials and Methods: A cross-sectional descriptive-analytic study was conducted on medical students of the faculty of medicine at Shendi University, and a sample of students was systematically randomly collected. Data was collected by using an open and closed questionnaire. Direct measurement of weight and height, then the calculation of BMI. Also, direct measurement of waist and hip, then the calculation of WHR. Results: 43% of the students were classified as average. 26% of people were overweight, and 21% were obese. In other words, the study discovered that women are more likely than men to be overweight or obese. According to the findings, those who live in urban areas gain weight noticeably more than people who live in rural areas. Regarding the behavioral aspect, there was a substantial relationship between those with a positive family history of obesity and those who are of normal weight, as well as a positive relationship between those who ate more than two meals each day. Conclusions: University students frequently engage in risky health behaviors, so it's important to educate them on how to prevent them, especially when it comes to topics like exercise and nutrition. For the sake of their health and the health of future generations, prospective healthcare professionals must adopt the proper eating habits and a healthy lifestyle. We advise modifying BMI to account for fat distribution and coexisting diseases to gain a thorough understanding of the current situation.