Volume 8.
Issue 10.

Adult inguinal hernia incarceration represents a significant surgical emergency associated with increased morbidity, risk of bowel ischemia, and potential mortality when treatment is delayed. Despite advances in elective hernia repair techniques, incarcerated inguinal hernias continue to present substantial clinical and epidemiological challenges, particularly among elderly patients and individuals with delayed healthcare access. This research and review article adopts an epidemiological approach to evaluate incidence patterns, determinants, and surgical implications of adult inguinal hernia incarceration through a comprehensive synthesis of contemporary literature. The study examines demographic trends, risk factors contributing to incarceration, management algorithms, emergency intervention strategies, and outcomes associated with different surgical approaches. Particular attention is given to factors influencing bowel resection rates and emergency operative decision-making. The findings indicate that age, delayed presentation, hernia duration, comorbidities, and bowel compromise significantly influence clinical outcomes. Contemporary evidence also demonstrates the growing role of manual reduction techniques and laparoscopic surgery in selected emergency settings. The article highlights the importance of early diagnosis, risk stratification, and evidence-based management protocols to reduce complications and optimize patient outcomes. The study contributes to a deeper understanding of incarcerated inguinal hernia epidemiology and provides a framework for improving emergency surgical care.

Contest preparation in bodybuilding and fitness combines a high protein intake, restricted carbohydrate and fiber intake, and a sustained energy deficit, and each of these features alters the substrate reaching the colonic microbiota. The objective of this review was to systematize the mechanisms through which the gut microbiota links macronutrient metabolism, short-chain fatty acid synthesis, and the inflammatory response in athletes and to map dietary interventions onto these mechanisms. Peer-reviewed publications from 2021 to 2026 were analyzed in a structured narrative review, with first-hand consulting practice in bodybuilding and fitness as the applied lens. The evidence forms a chain of five links. A diet low in fermentable fiber shifts colonic fermentation toward proteolysis and reduces the butyrate supply to colonocytes, so the epithelial barrier faces peak training load, heat, and dehydration with fewer resources. Increased permeability allows bacterial endotoxin to enter, thereby sustaining systemic inflammation and potentially impeding recovery. Tolerable fiber, cooked vegetables, fermented foods, protein-source switching guided by tolerance, spice polyphenols, hydration and adequate energy availability act on separate links of this chain, with athlete-specific evidence of uneven depth. Strength and physique athletes remain the least studied group. Support of short-chain fatty acid synthesis during contest preparation therefore emerges as a task of sports medicine, and the proposed chain offers a framework for dietary design and for longitudinal research.

Medical education is widely recognized as a demanding academic and professional environment that may negatively affect students’ psychological well-being. Medical students are exposed to multiple potential stressors, including intensive academic workloads, examinations, clinical responsibilities, sleep disturbances, financial concerns, interpersonal difficulties, and uncertainty regarding their future careers. Evidence from systematic reviews and meta-analyses indicates that anxiety, depression, psychological distress, and burnout are common among medical students worldwide. A global meta-analysis of 69 studies involving 40,348 medical students estimated the prevalence of anxiety at 33.8% (95% CI: 29.2–38.7%). Similarly, a systematic review and meta-analysis including 167 cross-sectional studies and 116,628 medical students reported a pooled prevalence of depression or depressive symptoms of 27.2% (95% CI: 24.7–29.9%). Suicidal ideation was identified in 11.1% of students across 24 cross-sectional studies involving 21,002 participants.

The burden of psychological distress varies considerably between studies because of differences in geographical location, academic stage, assessment instruments, definitions, and study methodology. Academic pressure, clinical exposure, inadequate sleep, limited social support, and difficulties accessing mental-health services are repeatedly identified as important contributors. The COVID-19 pandemic further intensified several of these challenges. This review summarizes current evidence regarding the global burden of stress and related psychological problems among medical students and discusses major risk factors, consequences, and possible institutional strategies for prevention and support.

Background: Malaria in pregnancy remains a major public health challenge in Sierra Leone, contributing significantly to maternal and neonatal morbidity and mortality. While Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a proven intervention, adherence remains suboptimal. Perceptions of IPTp including beliefs about benefits, risks, and acceptability are critical determinants of uptake. However, limited research has explored these perceptions among pregnant women in urban Sierra Leone, particularly in the Western Area Urban District.

Objective: To examine the perceptions of pregnant women attending antenatal clinics in the Western Area Urban District regarding IPTp, including perceived benefits, risks, safety concerns, and acceptability.

Methods: A mixed-methods study was conducted among 422 pregnant women attending six selected ANC facilities in Freetown between July and September 2025. Quantitative data were collected using structured questionnaires assessing perceptions of IPTp benefits, risks, and acceptability. Qualitative data were collected through semi-structured in-depth interviews (n=12) and focus group discussions (n=5 groups, 6–10 women each) to explore lived experiences, beliefs, and social norms. Quantitative data were analysed using descriptive statistics and chi-square tests; qualitative data were analysed thematically using a framework approach.

Results: Among 422 participants, 68.5% (n=289) perceived IPTp as beneficial for preventing malaria in pregnancy, and 62.1% (n=262) believed it was safe for both mother and baby. However, 37.4% (n=158) expressed concerns about side effects, and 28.7% (n=121) reported fear of harm to the unborn baby. Only 54.3% (n=229) perceived IPTp as highly acceptable. Perceptions were significantly associated with knowledge level (p<0.001), provider counselling (p=0.002), and previous experience with IPTp (p=0.008). Qualitative analysis revealed three major themes: (1) trust and acceptance grounded in provider confidence and awareness of malaria risks; (2) fear and scepticism driven by side effects, misinformation, and cultural beliefs; and (3) social influences, including partner and community norms, shaping acceptability.

Conclusion: Perceptions of IPTp among pregnant women in the Western Area Urban District are mixed, with significant proportions expressing safety concerns and fear of side effects. Addressing these perceptions through culturally sensitive health education, improved provider communication, and community engagement is essential to improve IPTp acceptability and adherence. Interventions should target both individual beliefs and broader social norms.

Introduction: During the COVID-19 pandemic, numerous extrapulmonary manifestations were the subject of study and research. The relationship between the kidney and COVID-19 attracted particular interest given the frequency of acute kidney injury observed.

Objectives: To determine the characteristics of SARS-CoV-2 infection in dialysis and kidney transplant populations and to describe the clinical, biological, and histological renal manifestations associated with SARS-CoV-2 infection.

Materials and Methods: This was a retrospective descriptive study conducted in the Nephrology Department of CHU Bab El Oued over a 2-year period, from February 2020 to February 2022. We studied the characteristics of COVID-19-related acute kidney injury in patients requiring hemodialysis, the histological renal manifestations associated with SARSCoV-2 infection, and the incidence and characteristics of COVID-19 infection in dialysis patients (hemodialysis and peritoneal dialysis) as well as in kidney transplant recipients.

Results: Eighty patients with renal failure associated with COVID-19 infection were managed with hemodialysis at our center. Thirty-six patients (45%) were dialyzed for acute kidney injury, while 44 patients (55%) already had chronic kidney disease at the stage of extrarenal replacement therapy. The majority of these patients (40 patients, 62%) were hospitalized in the intensive care unit. Most patients were intubated and ventilated (56 patients, 69%), with a high mortality rate of 76% (60 patients). Five patients underwent renal biopsy for renal involvement concomitant with or following COVID-19 infection. Renal histology revealed three cases of membranous nephropathy, one of which was associated with focal segmental glomerulosclerosis, and two cases of IgA nephropathy, one of which was associated with tubulointerstitial nephritis. Among chronic hemodialysis patients in our department, 10 patients (37%) were infected with SARS-CoV-2, presenting with a mild form in the majority of cases (6 patients, 60%). Four patients (40%) presented with severe respiratory distress syndrome, and 3 patients (30%) died. In peritoneal dialysis, 8 patients (32%) were infected with COVID-19, with 100% mild forms and no hospitalization. In the kidney transplant population, 24 transplant recipients (24%) were infected with COVID-19; 18 patients (75%) had mild forms, and only 6 patients (25%) presented with more or less severe forms with complications such as diabetes and graft function deterioration.

Discussion: Renal failure was associated with severe forms of COVID-19 (the majority of hemodialysis patients were hospitalized in the intensive care unit), with significant mortality. Renal involvement during COVID-19 can affect all compartments (glomerular, tubulointerstitial, and vascular). COVID-19 infection in kidney transplant recipients was not particularly more severe despite the immunosuppressed state.

Conclusion: As a newly emerging disease, the characteristics of renal involvement during COVID-19 infection, like the majority of systemic manifestations (cardiac, cerebral, digestive, etc.), have been derived from various studies and experiences from different centers worldwide but remain far from being well-labeled and codified.

A 37-year-old man from a consanguineous family presented with diffuse bone pain, recurrent fractures, and a waddling gait. Laboratory workup revealed severe hypophosphatemia (17 mg/L), markedly elevated alkaline phosphatase, hypercalciuria three times above normal, glycosuria, tubular proteinuria (450 mg/24h), nephrocalcinosis, and hyperchloremic metabolic acidosis. Bone imaging revealed diffuse demineralization, vertebral compression fractures, and a honeycomb appearance of the vertebrae ("beehive" aspect). The association of chronic hypophosphatemia, hypercalciuria, nephrocalcinosis, and tubular proteinuria pointed toward a clinical diagnosis of Dent disease. Genetic analysis was not feasible locally, as no genetic testing for hereditary nephropathies is currently available in Algeria and export of blood samples is restricted; a private send-out to CERBA (France) was cost-prohibitive for the patient. The diagnosis therefore remains purely clinical. This X-linked disorder (mutations in CLCN5 or OCRL) combines hypercalciuria, nephrocalcinosis, low-molecular-weight proteinuria, and incomplete Fanconi syndrome. Chronic hypophosphatemia is responsible for severe osteomalacia. Management relies on oral phosphate supplementation, acidosis correction, and treatment of hypercalciuria (low-salt diet, thiazide diuretics).

Tuberculosis (TB) is a chronic infectious disease caused byMycobacterium tuberculosis and remains one of the leading causes of death worldwide, particularly in developing countries like Indonesia. This study aims to determine the knowledge, perceptions, attitudes, motivations, and behaviors related to TB prevention in the community.

This research method used a descriptive observational research design with a cross-sectional approach. The survey and questionnaire distribution were conducted among the people of Semarang City to determine their sociodemographic characteristics, knowledge, perceptions, attitudes, motivations, and behaviors related to TB prevention. A sample of 64 respondents was selected based on inclusion and exclusion criteria. Data were analyzed descriptively using tables and narratives.

The results of the study showed that from the sociodemographic characteristics data, the majority of respondents were women (70.3%) and most were in the young productive age group of 17–25 years (31.5%). The majority of respondents' education level was high school (56.25%), while the most common occupation was housewives (35.94%). In addition, the majority of respondents (60.94%) had a history of contact with TB sufferers, indicating a potential risk of transmission in the immediate environment. The results showed that the level of knowledge of respondents regarding TB was mostly high (53%, 82.81%), with an average value of 8.14. Public perception was also in the good category (27%, 42.19%) with an average value of 33.9, although there was still a small number of respondents with low perception (6.25%). The majority of respondents' attitudes were positive towards TB prevention efforts, namely 29 (45.3%) with an average of (33.92), while the respondents' motivation was classified as good, namely 32 (50%) with an average of 37.92, which indicates a strong drive to take preventive measures. Respondents' behavior in TB prevention was also good, namely 37 (57.81%) with an average of 38.09.

In general, it can be concluded that the people of Semarang City have good knowledge, perceptions, attitudes, motivations, and behaviors regarding TB transmission prevention. However, a small group still has low levels of TB transmission in several variables that require attention. Therefore, ongoing health education efforts and community-based TB health promotion are needed to ensure the understanding and implementation of preventive behaviors are evenly distributed across all levels of society, as well as government support for early detection and TB control efforts, in an effort to achieve TB elimination by 2030.

A 55-year-old woman with a 4-year history of mediastinal adenopathy of unknown etiology presented with progressive cutaneous lesions, severe hypercalcemia (120 mg/L), and acute kidney injury (serum creatinine 70 mg/L). Angiotensin-converting enzyme levels were markedly elevated (98 U/L). Kidney biopsy revealed acute tubulointerstitial nephritis without granulomas. The diagnosis of sarcoidosis was established, and prompt corticosteroid therapy led to spectacular improvement of renal function, normalization of serum calcium, and complete resolution of cutaneous lesions. Corticosteroid-induced hyperglycemia required transient insulin therapy. This case illustrates that the absence of granulomas on kidney biopsy does not exclude sarcoidosis, and that early recognition can prevent progression to chronic kidney disease.

Background: Antiphospholipid syndrome (APS) in pregnancy is a complex and clinically important problem. The venous and arterial thromboses characteristic of the syndrome, caused by circulating antiphospholipid antibodies, lead to a range of pregnancy complications and adverse outcomes, which calls for improved treatment strategies.

Objective: to optimize the treatment of antiphospholipid syndrome in pregnant women.

Materials and Methods: The study included 56 pregnant women with APS, who were divided into two groups. The groups were comparable in age, parity, and obstetric and somatic pathology but differed in the treatment received. The comparison group (conventional management) comprised 18 pregnant women with APS, all of whom received standard APS therapy, including anticoagulants, antiplatelet agents, and glucocorticoids. The main group comprised 38 pregnant women with APS, all of whom received systemic enzyme therapy and plasmapheresis in addition to standard therapy. A separate control group consisted of 30 women with uncomplicated pregnancies.

Results: After 30 days, the conventional therapy group showed elevations compared with controls in von Willebrand factor (by 17.7%), the platelet aggregation index (by 24.1%), the total platelet aggregation index (by 26.2%), soluble fibrin monomer complexes (SFMC; by 55.3%), and early fibrin degradation products (EFDP; by 45.6%) (p<0.05). The platelet disaggregation index decreased by 18.5% and antithrombin III activity by 14.3% (p>0.05). Under conventional therapy, hemostatic parameters changed in different directions during treatment; overall, however, these changes aggravated the disturbances present at baseline. In the main group, treatment produced a more pronounced shift toward normalization of the studied parameters. Significant differences from conventional therapy were found for SFMC (29.7%), EFDP (23.3%), and prothrombin time (14.0%) (p<0.05).

Conclusion: Systemic enzyme therapy combined with plasmapheresis and low-molecular-weight heparin in pregnant women with APS results in near-complete normalization of hemostatic parameters.