Inguinal hernia repair is one of the most common procedures performed in general surgery. Approximately 20 million hernia surgeries are performed every year worldwide. Conventionally, hernial repair is carried out with the open Lichtenstein technique; however, laparoscopic and robotic inguinal hernia repairs have been developed as a minimally invasive alternative to the classic Lichtenstein repair. The prosthetic mesh can be placed by totally extraperitoneal and transabdominal pre-peritoneal approaches. Choosing the best technique for repairing an inguinal hernia is a challenge because the available data are contradictory. However, a growing number of studies have claimed that robotic-assisted hernia repair is not only feasible and safe, but it is associated with outcomes that are comparable to those obtained with laparoscopy and open surgery, including shorter hospital stay, and fewer complications. The aim of the review article is to provide an overview of the current practice of inguinal hernia repair, with a focus on the advances in robotic-assisted inguinal hernia repair, as well as the advantages and disadvantages of this surgical procedure compared to the laparoscopic technique in view of the current reports in the literature.

Karishma

Background and Aim: Second and third-generation supraglottic airway devices (SADs) are increasingly used in laparoscopic surgeries due to their improved oropharyngeal seal and gastric drainage. This study evaluated and compared the clinical efficacy of the Ambu AuraGain (AAU) and the i-gel in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized comparative study, 80 adult patients (ASA I and II) were randomly assigned to two groups (n=40 each): Group A (Ambu AuraGain) and Group G (i-gel). The primary objective was to compare oropharyngeal leak pressure (OLP). Secondary objectives included insertion time, ease of insertion, success rate, fiberoptic view of the glottis, and postoperative complications. OLP and peak airway pressure (PAP) were measured at various intervals, including during carboperitoneum. Results: The mean OLP was significantly higher in Group A than in Group G, both after insertion (32.9 ± 3.45 vs. 26.53 ± 1.61 cm H2O; p<0.001) and after deflation of carboperitoneum (34.15 ±2.9 vs. 28.2 ±1.71 cm H2O; p<0.001). The margin of safety (OLP–PAP) was significantly higher in the AAU group at all times (p<0.001). However, the i-gel was significantly faster to insert (14.8 ±2.94 vs. 22 ± 3.74 seconds; p<0.001) and easier to place (100% easy vs. 37.5% easy; p<0.001). Fiberoptic alignment was significantly better in the i-gel group, with 70% achieving a Grade 4 view compared to 29% in the AAU group (p<0.001). Postoperative complications were low and comparable between groups. Conclusion: Ambu AuraGain provides a superior oropharyngeal seal and a higher safety margin against leaks during laparoscopic surgery compared to i-gel. Conversely, i-gel is superior in terms of ease of insertion, speed, and anatomical alignment with the glottis, making it a better conduit for fiberoptic-guided intubation. Keywords: Ambu AuraGain, i-gel, Laparoscopic cholecystectomy, Oropharyngeal leak pressure, Supraglottic Airway device.

Journal of scientific innovations in anesthesiology

Dignity therapy (DT) is an evidence-based psychotherapeutic approach originally designed to alleviate emotional and existential distress in patients with terminal illnesses. While dignity therapy has been well documented in palliative care, emerging perspectives suggest that its principles such as promoting autonomy, meaning, and self-worth can be beneficial for persons with severe mental illness (SMI) who often experience stigma, identity loss, and existential suffering. Although severe mental illness and terminal illness are distinct conditions both may involve the profound psychological and existential challenges that affect personal dignity. This paper explores the philosophical foundations and therapeutic benefits of dignity therapy, with a particular focus on its potential application in mental health settings. It highlights the significance of preserving dignity in psychiatric care and emphasizes the need for compassionate, personcentered mental health support tailored to the lived experiences of the person with severe mental illness.

Karishma

Background: Uterine leiomyoma is the most common benign smooth muscle tumor of unknown aetiology. Progesterone may contribute to leiomyoma growth through the induction of B-cell lymphoma-2 (BCL-2) protein in leiomyoma cells. This study aims to determine the patterns of Bcell lymphoma-2 (BCL-2) and progesterone receptor (PR) expression in uterine leiomyomas seen at LTH, Ogbomoso, over a five-year period using immunohistochemical techniques.Methods: This was a hospital-based retrospective study of histologically diagnosed leiomyomas in the histopathology department of a teaching hospital between January 2012 and December 2016. A total of 141 cases of uterine leiomyomas were semi-quantitatively analysed immunohistochemically for PR and BCL-2 antigens. Results: Immunohistochemical analysis showed that out of 141 cases studied, 74 (52.5%) and 118 (83.7%) were positive for BCL-2 and PR, respectively. Among the 141 cases, 23 (16.3%) were negative for both PR and BCL-2. There was a moderate positive correlation between the immunohistochemical expression of BCL-2 and PR antigens, with a p-value < 0.001 (Pearson correlation = 0.563). Conclusion: This study showed that the majority of women with leiomyomas expressed both progesterone receptor and B-cell lymphoma-2 antigens. Therefore, selective women with leiomyomas could benefit from progesterone receptor modulators instead of undergoing invasive procedures such as myomectomy or hysterectomy.

Karishma

Urolithiasis, the process of urinary stone formation, entails the presence of compact masses like whewellite, brushite, and urate within the urinary system. Gout, characterized by inflammatory arthritis, emerges from the accumulation of urate (MSUM) crystals. In vitro, examinations focusing on the growth of whewellite (COM), brushite (CHPD), and urate (MSUM) crystals on glass slides present a cost-effective approach for gaining valuable insights into urolithiasis and gout. These studies not only delve into crystal growth patterns but also investigate the potential inhibition of crystal growth through the application of plant infusions, thereby laying the foundation for further extensive research in these domains.

Dr. salman ahmed

Background: Water distribution systems within healthcare facilities are complex ecosystems that can harbor opportunistic pathogens, posing a significant risk to patient safety. Ensuring the microbiological quality of water requires rigorous monitoring and a deep understanding of the entire system, from source to point-of-use. This study undertakes a comprehensive statistical analysis of microbiological data from a healthcare facility’s water treatment and distribution network to identify contamination hotspots, evaluate the efficacy of critical treatment barriers, and map potential contamination pathways. Methods: This retrospective case study analyzed heterotrophic plate count (HPC) data collected from 29 distinct sampling points throughout a healthcare facility’s water system. The points represented various stages, including municipal source water, intermediate treatment steps (softening, ultrafiltration, reverse osmosis), storage tanks, and multiple points-of-use. Non-parametric statistical methods were employed due to the non-normal distribution of microbial data. A Kruskal-Wallis test with Dunn's post-hoc analysis was used to compare microbial loads across all sampling points. A focused Mann-Whitney U test was performed to assess the performance of the ultrafiltration (UF) unit. Results: The analysis revealed significant variability in microbiological quality throughout the system (Kruskal-Wallis, p<0.0001). One point-of-use and a pre-UF exhibited high median microbial counts and extreme variability, indicating chronic contamination and potential biofilm proliferation. Critically, the ultrafiltration unit failed to demonstrate a statistically significant reduction in microbial load between the pre-filter. Conclusion: The data reveals variability in microbiological levels across the water system, suggesting that the ultrafiltration barrier's performance is a significant factor influencing downstream water quality. The data points to systemic issues, likely involving widespread biofilm, that compromise water quality at the points-of-use.

Mostafa eissa

Will discuss how the German giant Lidl plans to take expansionary steps in a Mexican or Norwegian market to add to its success records in the European and North American markets. Lidl began modestly in 1973 with a small shop that runs three members and offers 500 products to 10,500 stores in 29 countries. Lidl has many pros, plus the disadvantages to consider when evaluating the components available in each country, both the pros and cons of this analysis will be reviewed using PESTLE, five- force models, internal value-activities, international business being able to. Accordingly, the next targeted expansion decision will be made.

Mohamed sorogy

Service quality is a key factor for success in any hotel. Many researchers have conducted studies on service quality, but only a few studies have been conducted on internal service quality (ISQ) in general, and in the hotel industry in particular. Since there is no general agreement among researchers on the measurement of ISQ, many studies have used SERVQUAL instrument to measure the employees’ perceptions of ISQ. The purpose of this study is to explore the influence of ISQ on employee’s job satisfaction in five-star hotels in Jordan. The current study was carried out by measuring the data gathered through a seven-point Likert scale. The quantitative survey method was applied, and therefore the SERVQUAL instrument was used to measure ISQ, and the Job Satisfaction Survey (JSS) was used to measure job satisfaction. Data obtained from a sample of 238 respondents drawn from 14 five-star hotels in Jordan were analysed with the SPSS software based on descriptive statistics. The study’s findings indicated that the ISQ of five-star hotels in Jordan has a significantly positive influence on an employee’s job satisfaction. These findings support the hypothesis that there is a positive relationship between ISQ in the hotel industry and industry employees’ job satisfaction.

Mukhles m. al-ababneh

Febrile convulsions have been defined as any convulsion associated with a fever of more than 38 oC without central nervous system infection in a child aged six months to five years. Febrile convulsion can be divided into two groups of simple and complex seizures. This study aimed to determine the prevalence of febrile convulsions in Libyan children and to investigate the associated risk factors related to this type of seizure in children. 120 cases of febrile convulsions with one day - 12 years old were collected during from April to August 2022. A study has conducted in the Pediatrics Hospital in Bayda City, Libya about the prevalence of febrile convulsions in children, the data collection tool was a self-designed pre-tested validated questionnaire including general information such as age, gender, family history, and admission to the hospital. In addition, data such as body temperature, recurrent convulsion attacks, the condition of hospital admission, discharge status, the treatment in-hospital and out-hospital. The collected data were analyzed by using descriptive methods. Among the 120 children, the majority of the cases were aged between two years and five years old. The gender prevalence rate in this study was 55.0% in males and 97 of the children were hospitalized due to simple febrile seizure (80.8%), 92 of the cases with no family history of febrile convulsions (75.0%) and respiratory tract infections is the main cause of febrile convulsions. In conclusion, this study indicated that respiratory tract infections is the most common cause of febrile convulsions among Libyan children, however, a large sample study is needed to support this issue in Libya.

Mediterranean journal of pharmacy and pharmaceutical sciences

The use of performance feedback in the workplace has gained popularity over the years, yet school heads have been challenged in providing it to teachers. In the initial interview, they shared that evaluation results can impact teachers’ motivation, and that feedback should be done carefully. However, they failed to clearly articulate a specific mechanism that had been applied in this vital role. Also, no studies have provided clear detail on the feedback mechanism used by school heads in the past. For this reason, a study explored the feedback mechanisms employed by school heads in conveying the performance evaluation results to teachers. This study employed a narrative inquiry, and interviews were conducted with five school heads and five teachers who were chosen purposively for this research. Responses were recorded using a voice recorder. These responses were transcribed and analyzed using thematic narrative analysis. Based on transcripts, the study identified six emergent themes, such as conversational (one-on-one), relational, reflective, technical, reinforcing, and properly situated mechanisms in conveying performance evaluation results to teachers. Thus, a new feedback mechanism framework was developed.

Manuel caingcoy

Smartphones are constantly changing in today's world, and as a result, security has become a major concern. Security is a vital aspect of human life, and in a world where security is lacking, it becomes a concern for mobile users' safety. Malware is one of the most serious security risks to smartphones. Mobile malware attacks are becoming more sophisticated and widespread. Malware authors consider the open-source Android platform to be their preferred target as it came to lead the market. State-of-the-art mobile malware detection solutions in the literature use a variety of metrics and models, making cross-comparison difficult. In this paper various existing methods are compared and a significant effort is made to briefly address android malwares, various methods for detecting android malwares and to give a clear image of the progress of the android platform and various malware detection classifiers.

Jebin bose s

India’s economic system has undergone significant changes in recent years reflecting globalization and changes in national policies. This paper provides a comprehensive analysis of India’s economic growth, focusing on imports and exports. The study explores the key drivers of economic expansion, including trade liberalization, trade agreements, and technological advancement. It also explores the impact of international trade and geopolitical events on business models. It assesses the role of policy measures such as the Goods and Services Tax (GST), the Make in India initiative, and various free trade agreements in generating economic benefits. The paper also assesses the trade balance and its impact on India’s economic stability and growth. The paper concludes with recommendations for improving the market, including diversifying entrepreneurs, investing in infrastructure, and strengthening the domestic economy. The review provides insights to policymakers, businesses, and academics who want to understand and harness India’s economic potential in the global economy

Dr gedam kamalakar

The current study explores creative cultural tourism as a new model of the relationship between cultural heritage and tourism. Cultural heritage with its tangible and intangible components represents an essential part of culture tourism. Many changes have been happened in tourism due to new forms of consumption patterns, tourism activities, and tourism products. These changes require shifting from traditional culture tourism to creative cultural tourism as a new concept of cultural heritage. Tourists face many problems in the traditional culture tourism which is a form of mass tourism, thus, creative cultural tourism came to solve these problems. In addition, this study explains the transformation from traditional culture tourism to creative culture tourism.

Mukhles m. al-ababneh

The development of science and technology proves once again how infinite human needs are. The concentration of the population in large cities, on the one hand, accelerates the process of urbanization and affects the level of development of the state. On the other hand, the state of the environment has a negative impact on urban ecology. From ancient times the population has been striving to create favourable conditions for themselves and such a process is still going on, especially when the negative consequences of this are clearly felt in the health of the population living in cities. Solving this problem is one of the main tasks of urboecology. The development of modern methods of geo-ecological monitoring of the ecological condition of cities, especially in areas with high industrial specialization. The development of measures to improve the health of the population in ecologically critical areas is of a great importance today. To this end, this article discusses in detail the industrialized Navoi region and its urban and ecological situation, the factors affecting it.

Mediterranean journal of pharmacy and pharmaceutical sciences

Market trends indicate that natural health products are being used to maintain health as well as prevent and treat many medical conditions. A recent Canadian survey showed that 71% of the Canadian population have used a natural health product. Among these, many reports that they take natural health products on a daily basis. This review emphasizes on Canadian post-market surveillance system that apply to natural health products for human use. The public's perception is that the natural health products are all-natural, safe and effective, but there is still a wide variety of harms linked with these products. The post-market surveillance system is the monitoring window to observe and control the adverse effects of using natural health products. There are many activities involved in the post-surveillance to ensure the quality of the approved natural health products. Despite the fact that post-market surveillance plays a very important role in eliminating and/or reduce the risk of using natural health products, there are still some challenges and more work to be done to improve the outcome of the post-market surveillance of the natural health products.

Mediterranean journal of pharmacy and pharmaceutical sciences

Dietary supplements are extensively consumed, but irrational use is a health hazard. Pharmacy students, being future healthcare providers, can facilitate rational use. The present study evaluated the knowledge, attitudes, and practices of pharmacy students at Srinivas College of Pharmacy, Mangalore, about dietary supplements and their role as an advocate, in addition to mental health correlations. 250 students selected through stratified random sampling took part in a cross-sectional mixed-methods study. A 30-question instrument (Cronbach's alpha=0.85) measured demographics, dietary supplement usage, knowledge, attitude, practices, and mental health was evaluated with the depression, anxiety, and stress Scale-21 (DASS-21). The data were collected during January-March 2025 and were analyzed with the chi-square test, logistic regression, and Pearson correlation tests. 35.0% (n=88) used dietary supplements regularly, with a preference for multivitamins (50%) and protein supplements (30%). Knowledge was moderate (60% risk aware), attitudes favorable (70% in favor of counseling), but practice restricted (25% informed peers). Everyday use of dietary supplements escalated stress probability (OR=2.5, 95% CI: 1.8-3.4, p<0.001), with correlation (r=0.38, p<0.01). In conclusion, students have promise as dietary supplement champions but require additional training to close knowledge-practice gaps and mitigate mental health risks. Curriculum and policy interventions are needed to enhance students' abilities in encouraging rational dietary supplement use and identifying potential mental health effects.

Mediterranean journal of pharmacy and pharmaceutical sciences

Abstract This paper evaluates the Ethiopian VAT tax type based on ten good tax principles that are: Equity and Fairness, Certainty, Convenience of payment, Economy in collection, Simplicity, Neutrality, Economic Growth & Efficiency, Transparency & Visibility, Minimum tax Gap, Appropriate Government revenue. The findings of this evaluation revealed VAT which six principles are under positive effect in Ethiopia meets of six Conon of the good tax system. Those are: Certainty for taxpayers, Convenience at the time of payment, neutrality, economic growth and efficiency, transparency and visibility, appropriate government revenue. Finally, the author suggests recommendation that could be used by the government in general and tax authorities in particularly in the preparation of future tax proposal reform and issuance of any directive, proclamation, rule, and procedure which is going to implemented need to encapsulate this Canon as Guiding route to improve service delivery and alleviating problem emanated from shortcoming from the administration.

Dereje lemma lalisho

Stability studies ensuring the maintenance of product quality, safety and efficacy throughout the shelf life are considered as pre-requisite for the acceptance and approval of any pharmaceutical product. These studies are required to be conducted in a planned way following the guideline issused by ICH, WHO and or other agencies. Importance of various methods followed for stability testing of pharmaceutical products, guideline issued for stability testing and other aspects related to stability of pharmaceutical products have been presented in a present review.

Prachi barbhaiya

Objective: To explore unusual association between Turner Syndrome (TS) and Hypopituitarism in a Tunisian cohort. Methods: We reported 6 patients with TS associated to Hypopituitarism, including three familial cases except the fourth sister who showed only a TS phenotype. Biochemical analysis, resonance magnetic imaging and cytogenetic analyses were performed. Results: The average age of our patients was 17.2 years (11-31 years). They were all referred for short stature and pubertal delay, except for the fourth sister who presented spontaneous puberty with the integrity of the pituitary axis and the presence of an X ring chromosome. Karyotype analysis showed monosomy in 3 cases and a mosaic TS in the 3 remaining cases, including one patient with abnormal X chromosome structure. Somatotropic and corticotropic deficiencies were confirmed in 2 sporadic cases while the gonadotropic and thyrotropic axes were spared. In contrast; familial cases were consistently affected by the integrity of the corticotropic axis. MRI showed pituitary hypoplasia in all familial cases and pituitary stalk interruption syndrome in only one sporadic case. No correlation was found between the chromosome formula and the anterior pituitary involvement. Conclusion: Co-segregation of congenital Hypopituitarism with pituitary hypoplasia and X chromosome aberrations could imply a molecular anomaly of transcription factors responsible for the differentiation and development of pituitary cells such as PROP1, POUF1, Hesx1, Lhx3, Lhx4. The etiopathogenic link between X chromosome abnormalities and the occurrence of Hypopituitarism remains unclear; however, the progress of molecular biology may clarify the interrelation between transcription factors and sex chromosome segregation abnormalities.

Mariam moalla

Industry 5.0 is still a developing concept, but it is expected to leverage a range of advanced technologies to facilitate human-machine collaboration and enable more customized and sustainable manufacturing.This research paper tried to discuss the opportunities and challenges in the implementation of Industry 5.0. It primarily explored the need to transform from Industry 4.0 to Industry 5.0. The research paper further studied the technologies needed for the implementation on Industry 5.0 and also the principles of Industry 5.0.

Dr. kishor bholane