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With increasing awareness of the mental health issues among the clergy and seminary students, it is important to explore possible interventions to help address their mental health concerns. This pilot study examined the impact of Christian meditation and biofeedback on levels of stress, anxiety, and depression of seminary students. Participants of this study included 20 theology students from two seminary campuses. Participants were of various ethnic backgrounds and had an average age of 31. At the beginning of the study, participants were randomly assigned to practice either Christian meditation or biofeedback for 4 weeks, three times per day, and to keep a log of their practice times. The results from the paired samples t-tests indicated that both Christian meditation and biofeedback significantly reduced the levels of stress, anxiety, and depression experienced by the participants. ANCOVA indicated that neither intervention was more effective than the other. Seminaries, churches, and pastoral care groups should look into these interventions as a good source to help their clergy cope with stress, anxiety and depression.

COVID-19 pandemic soon apparently proved to be havoc and a great stressor. During such a stressful time, mental health is in threat. Here, we intend to review the presenting problems/ symptoms as shared in psychiatry helpline of a Teaching Hospital in eastern Nepal during the second week of lockdown and to reflect on to emotional, including mood problems. It is an institute based period observation noted for all psychiatry helpline calls during 1 week of lockdown days of COVID-19. Their concerns and problems were listened and symptoms clarified by a consultant psychiatrist to help them as far as possible through the telephonic conversation. Maintaining the confidentiality, basic information were noted down in a semi-structured proforma to record certain socio-demographic and clinical information (including mood and other emotional symptoms). We received 102 helpline calls of 60 clients for psychiatry in 1 week, from 14 districts. More patients being discussed were males (35/60), average age being 34.15 (15 - 70) years. More patients were regular follow-up cases with some new issues (24/60) and 18/60 each were new clients and regular follow-up cases. Majority had exacerbated symptoms in the wake of COVID-19 as: emotional (47/60; mood 24/60, anxiety/worry 23/60) symptoms along with disturbed sleep (32/60); treatment/service issues (31/60) and changed routines. Most common mental problems were Bipolar affective disorder, Psychosis, Anxiety and Depression and advices included Antipsychotics, Benzodiazepines, Antidepressants, along with some Psycho-education. Most common concerns were about OPD service, worsening symptoms and local unavailability of medicines. Many had mood and emotional symptoms in this stressful time, both simple amenable to telephonic advices and severe requiring to be called to emergency service.

Acute carbon monoxide (CO) poisoning is caused by the inhalation of large quantity of CO within short time leading to morbidity and mortality. In this study, a total of eighteen (18) rabbits were divided into three (3) groups of six (6) animals each. The first group first group was poisoned with CO and labelled carbon monoxide death (CD). The second group of animals was killed prior to exposure to CO and labelled disguised death (DD), while the third was the control group (CG). The vitreous humour samples were collected from all the animals using standard methodologies. The vitreous humour total protein and albumin were estimated while its globulin content and albumin/globulin ratio were derived mathematically. Pearson correlation analyses were used to establish relationships between vitreous protein profile components and the acute graded carbon monoxide concentrations. Results indicated a significant increase (P<0.05) in vitreous total protein and globulin of the studied groups. This observation was more pronounced in the CD group of animals. Therefore the marked elevation of vitreous total protein and globulin may serve as a useful tool in the confirmation of death due to carbon monoxide poisoning.

Background: The burden of depression as a mental disorder has continued to increase and constituting an enormous public health concern among all age groups. A number of socio-demographic, and other factors including a stressful and rigorous academic programme or curriculum such as the one run in most medical schools could contribute to the occurrence of depression among medical students. AIM: To determine the socio-demographic and other factors associated with depression among medical students in the University of Port Harcourt. Methodology: This study was a descriptive cross-sectional study. Appropriate sample size was calculated and the stratified random sampling method was used to select the subjects. A well-structured open ended self-administered socio-demographic questionnaire was administered to the students. The Zung Self-Rated Depression Scale was used to assess the depression status of each respondent. The data were analyzed via descriptive and analytical methods. Results: The prevalence of depression among the medical students was 5.3%. Fourteen students (4.6%) were mildly depressed while only two respondents had moderate depression. Year 3 had the highest prevalence with 10.5% followed by final year with 5.3%, while the only 2 cases of moderate depression were found among students in year 2 of their medical programme. Two hundred and seventy-one respondents (88.8%) were found to have good knowledge of depression, 32 (10.5%) were found to have average knowledge of depression and 2(0.7%) had poor knowledge of depression. Conclusion: Depression does occur among medical students at the University of Port Harcourt albeit low, and was associated with a number of socio-demographic and other factors. The present medical curriculum and programme should be sustained and more efforts at making it less stressful and academically friendly, be made to further reduce the current rate of psychological stress and depression among the students.

Potter syndrome (PS) is a term used to describe a typical physical appearance, which is the result of dramatically decreased amniotic fluid volume secondary to renal diseases such as bilateral renal agenesis (BRA). Other causes are abstraction of the urinary tract, autosomal recessive polycystic kidney disease (ARPKD), autosomal dominant polycystic kidney disease (ADPKD) and renal hypoplasia. In 1946, Dr Edith Potter characterized this prenatal renal failure/renal agenesis and the resulting physical characteristics of the fetus/infant that result from oligohydramnios as well as the complete absence of amniotic fluid (anhydramnios). Oligohydramnios and anhydramnios can also be due to the result of leakage of amniotic fluid from rupturing of the amniotic membranes. The case reported below, concerns of stillborn boy with potter syndrome.

Due to laparoscopic cholecystectomy there is increase in the bile duct injuries. It was 0.2% to 0.4% during open opposed to 0.6% to 0.8% during laparoscopic. Included in the study were 22 patients, 19 patients with two redo operated upon. Between Feb. 1999 to Nov2017 and 3 referral cases. The treatment options were end to end anastomosis and hepaticojejunostomy. Regarding the injuries, according to Stresberg there were 2A .4D injuries with injury in the lateral aspect of the ducts, 8 E1, with hepatic stump > 2cm., 5 E2 with hepatic stump < 2cm. The three referral cases were choledochodoudonostomy E1, and E2. They were treated with si ligation of cystic in two cases, anastomosis in seven cases. The remaining fifteen cases with hepaticojejunostomy .Conclusions: The risk is more proximally. After complex injuries diversion is the best while with simple end to end was acceptable. The insertion of stents has to be individualized according to the situations of each patients and the experience of each surgeon.

The issues investigated in the current study pertain to selected psychological aspects of human functioning in long-term stress conditions. Results of the analyses performed in this study have submitted evidence to confirm the hypothesis in which it is stated that staying on the sea for a long time is a difficult situation which contributes - to a greater or smaller extent - to starting the stress process in sailors. The role of interpersonal competencies that has been found most distinct; high level of this variable contributed to reducing both anxiety and the feeling of loneliness. It has been evidenced in the research that the skill of good functioning in varied social groups, which results from high level of development of several traits including: openness, spontaneity, responsibility, and sensitivity, becomes particularly important in long-term difficult situations in which there is little possibility of eliminating the real menace. Another conclusion to be inferred from the research is the one confirming the theoretical suggestion in which the importance of ‘ego strength’ in modifying the course of stress process is emphasised. This personality dimension has turned out to constitute the factor capable of protecting an individual against increase in both anxiety states and the feeling of loneliness during sea isolation. Another issue considered in the current study pertains to defining the role of ‘family variable’ in mediating the course of stress process under conditions of long-term task isolation. The analyses have confirmed the hypothesis in which it was assumed that sailors functioning in family systems characterised by high level of integration and quality, experience lower emotional costs during a voyage. Generally, it may be claimed that - according to the research results of the study - ‘family variables’ may constitute a significant predictor of both the ‘quality’ of a man’s functioning and personal costs he experiences in long-term stress conditions.

This study presents the frequency of old myocardial infarctions (OMI), and the frequency of unrecognized myocardial infarction (UMI) in elderly people in a forensic material. It was also examined if predisposing factors of UMI could be identified. Of special interest was also to investigate the value of the police’s records as a source for medical information in a forensic setting. The study is based upon medico-legal autopsies of persons above the age of 60 at the time of death during the period 1999-2003. The study included 325 cardiovascular deaths. Of these, 166 died from OMI. UMI accounted for 123 of these (74%). Most UMI were located in the interventricular myocardial septum and left anterior wall (>60%), but no significant differences could be found between UMI and recognized MIs (RMI). No obvious reason could be found as to why the UMI remained unrecognized. Police records were inferior to the hospitals records, regarding medical information to the pathologist, with information about cardiac disease in about 60%, and with information about OMI in 11-17%. Hospital records supplying information about OMI were found in half the cases. It is concluded that unrecognized myocardial infarction is not uncommon among elderly persons, and with a high risk of sudden death. More emphasis should be put in recognizing OMI in ECGs to attempt to reduce the risk of sudden cardiac death.

Background: Anxiety and depression are under reported, underdiagnosed mental illness in health worker in Nepal especially during COVID pandemic. The study was carried out as an observational study on nurses in Nepal. In this study we attempted to assess the incidence and impact of depression and anxiety in nurses who are working upfront in different hospitals during this crisis. Objective: The purpose of the study is to assess the prevalence of anxiety and depression among nurses in Nepal during COVID pandemic who are working in various hospitals. Method: A cross-sectional non-probability purposive sampling with observational analysis was carried out and the sample was collected from nurses working in different hospitals. Prevalence of anxiety and depression was assessed using a structured and validated questionnaire. Anxiety was assessed with the Hamilton Anxiety Scale (HAM-A), General Anxiety Disorder Questionnaires (GAD) with a cut-off score for various levels of anxiety while Hamilton Depression Rating Scale (HAM-D) was used to assess depression. Result: The analysis of these different scales revealed that disabling anxiety prevailed at highest (43.6%) in nursing staff according to HAM-A scale. Moderate anxiety also seemed to be higher (> 20%) in GAD questionnaire. Conclusion: This is the first study carried out in Nepal that investigates the mental health of nurses who are working in the frontline in this COVID pandemic situation. The study revealed that our nurses who have given their life in the line are suffering from serious mental health problems. 

Purpose: To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair. Background: the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair. Patients: The study was carried out at the faculty of medicine – Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling. Results: Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%), same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins). Conclusion: Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction

The main purpose of the present study was to find out the differences on suicidal ideation, hostility, hopelessness and negative self-evaluation among heroin addicts with comorbid depression. After reviewing the literature, it was hypothesized that heroin addicts with high depression may have high scores on variable of suicidal ideation, hostility, hopelessness, and negative self-evaluation as compared to those with low depression. The sample was consisted of 60 males from Low-socioeconomic status (SES) (34 of them were screened as having high scores on the variable of depression and 26 were screened as low scorers). Siddiqui Shah Depression Scale (Siddiqui & Shah, 1997) and Urdu version of Suicide Probability Scale (Cull & Gill, 1982) was administered. To compare heroin addicts with high and low depression on various variables, t - test was applied. The research findings showed that heroin addicts with mean age of 30 years (range 20 to 40) having the mean duration of heroin dependence of 10 years with high depression were significantly high on the variable of suicidal ideation, hostility and hopelessness ((p < .05) as compared to those with low depression. And there was no significant difference on the variable of negative self-evaluation for both groups (p > .05). So it was concluded that services for patients with Heroin addiction should include periodic screening for suicidal behavior along with psychiatric treatment and psychosocial support.

Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.

This paper focuses on the mental health burden on medical and healthcare residents during the 1st wave of COVID-19 pandemic crisis in 2020 describing the activities of a mental health service for residents (NAPREME) in a public university, UNIFESP, Sao Paulo, Brazil; and a preliminary study showing an increasing of depressive symptoms and depression among residents. Data is related to the screening interviews of medical residents and healthcare multi-professional residents who sought the mental health service from March to December 2020. A comparison was conducted with the same period in 2019 (covering a period when Covid-19 was not affecting the Brazilian population). There was a 22% demand increase in 2020. Of the total amount who sought treatment: 23% were medical residents, 22% nursing residents, and the remaining distributed among other professions; and 58% were first year residents and 34% second year. Data from the BDI questionnaire showed some variance between the two years: the mean score for 2020 was 24.67 (± 7.86) which is in the depression range, higher than the mean score of 19.91 points in the previous year (± 10.15) which is only in the depressive symptoms range (p < 0.005). In the pandemic period there was an increase in residents with depression from 49% to 70%. Depression, anxiety, stress and burnout syndrome were observed, demanding psychological and psychiatric care for this population. Assessment of residents’ mental health will continue during 2021, during the 2nd wave of COVID-19 and an additional analysis will be conducted along the year.

Nothing without risk. As cholecystectomy is one of the most common procedures, any minor risk will be a mass volume. This study was to define the magnitude of that risk. In the study were 1486 patients between Feb. 2009 and April. 2018. Open in 292 (19.6%), 1194 (80.4%) laparoscopically, 1086 [91%] completed so and 108 (9%) converted. There were 18 (1.2%) with bile duct injury. 1 (0.3%) in the open group and 17 (1.4%) in the laparoscopic group. 9 diagnosed during surgery, 4 with jaundice, 2 early and 2 late, 5 with leak. Statistically the operative injury is insignificance in the 2 groups (P<0.3). The jaundice was significantly high in the laparoscopic group of patients (P<0.045). Also the bile leak (P<0.028). The same for morbidity (P<0.01. The revers was for mortality (P<0.04). Conclusion: The incidence of CBD injury in the literature is less than the actual rate. Laparoscopic interventions have a higher rate of injury and the proximal ducts are at higher risk.

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities. Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.

Background/aim: Amitriptyline belongs to class of known as tricycline antidepresant (TCA) that is being used to treat anxiety and depressive states. It may help improve mood and feelings of well-being, relieve anxiety and tension, help to improve sleep and increase energy level. The study investigated the effect of amitriptyline on learning and memory using eighteen (18) healthy Swiss mice of both sexes weighing 16 – 25 g. Method: The animals were divided into three (3) groups consisting of six (6) animals each. Group 1 served as the control group, Group 2 was administered with amitriptyline at a dose of 3 mg/kg body weight dissolved in 3 mls of distilled water, and used to test for learning, while Group three was also given similar administration like Group 2, but used to test for memory. All the animals were tested for learning and memory performance using Novel object recognition task and Morris water maze test. Results: The results obtained from the Novel object recognition task showed that there was a significant decrease (p < 0.05) in total object approach in acquisition trial of amitriptyline treated group when compared to the acquisition trial of the control group. There was a significant decrease (p < 0.05) in retention trial of amitriptyline group when compared to retention trial in the control group. There was a significant decrease (p < 0.05) in total duration exploring objects in acquisition trial of amitriptyline treated group when compared to the acquisition trial of the control group. There was a significant increase (p < 0.05) in total duration exploring objects in retention trial of amitriptyline treated group when compared to the retention trial of the control group. There was a significant decrease (p < 0.05) in the index of habituation of amitriptyline treated group when compared to the control group. The index of discrimination showed a significant increase (p < 0.05) in amitriptyline treated group when compared to the control group and a significant decrease (p < 0.05) in amitriptyline group when compared to the control group. In the Morris water maze test, Day 1 – 3 were for acquisition training, day 4 – 6 reversal training, day 7 the probe trial day and day 8 the visible platform day. During acquisition training in the Morris water maze test, there was no significant difference in Swim latencies in day 1 and 2. However in day 3, there was a significant increase (p < 0.05) in swim latency of group compared to control group and a significant decrease (p < 0.05) in swim latency of amitriptyline treated group compared to the control group. During reversal training in day 1, 2 and 3, there was no significant difference in swim latency among the three groups. Results for the retention quadrant in the probe trials showed a significant decrease (p < 0.01) in amitriptyline group when compared to the control group. Conclusion: Results suggest that amitriptyline impairs learning and memory functions.

In homicide cases, knowledge about time of death is important as it directs police investigation towards the discovery of authorship, including or excluding suspects of a crime, and determining nature of death. In Brazil, entomological evidence is still neglected by official forensic organizations and for this reason cases using insects to estimate post-mortem interval (PMI) are still rare. Dipteran specimens collected and analyzed by the staff of Criminalistics Institute (CI) from São Paulo State, Brazil, made it possible to elucidate circumstances of the death, including suspects to the crime scene, in five occurrences involving discovery of cadavers. In all cases, blowflies were collected and were identified as belonging to species Chrysomya albiceps (Wiedemann, 1819), Chrysomya megacephala (Fabricius, 1794), Chrysomya putoria (Wiedemann, 1830), Hemilucilia semidiaphana Rondani, 1850 and Lucilia eximia (Wiedemann, 1819) (Diptera: Calliphoridae), while only in one case Sarcophagidae (Diptera) flies were also collected. PMI estimate was calculated taking into account laboratorial developmental rate data of mentioned species on the environmental temperature on which bodies and insects were exposed, along with comparisons to field research previously conducted in those areas. Based on larval age and behavior, the course of the investigation had changed, pointing to the crime author (case I), as well as the nature of the crime (cases I-III) and associated suspects to the criminal act (cases IV-V). Results show how promising is the use of entomological evidence during investigations of violent deaths.

1. The concept of wounds. 2. Classification of wounds. 3. Signs of wounds. 4. Factors affecting the course of the wound process. 5. Phases of the wound process. 6. Types of wound healing. 7. Features of wounds in children. 8. First (first emergency) help. 9. Complications of wounds. 10. Specific bite wounds. Notion Treatment. Complications. 11. Snake bites. First aid. 12. Arthropod bites. First aid. Wounds are called traumatic violation of the integrity of the skin or mucous membranes with possible damage to the deeper tissues.

Pieces of evidence have continued to emerge, demonstrating the extensive efficiency and effectiveness of the DNA database in assisting criminal investigations around the world. Therefore, the present study aimed to determine the awareness level on the prominent role of Forensic DNA Database on Crime Investigation in Nigeria: a case study of Benin City. In conducting this research, a total of 458 questionnaires were distributed around Benin City between the periods of 12th January 2020 to 21st March 2020, with a particular focus on security agents and students. The questionnaire comprised of three main categories: Socio-demographic characteristics, Information about the National Forensic DNA Database, and Information about DNA evidence, and Nigeria Criminal Justice system. For the analysis of data collected; the statistical tool used was also Statistical Package for Social Sciences, version 22 for windows. Responses were compared using chi-square and presented as counts and percentages. In determining the level of awareness, the following responses were obtained. Of the total population: 53.28% had no idea about forensics, 19.21% were uncertain and 27.54% knew about forensics. The same trend was observed with Forensic DNA profiling, 42.14% did not know, 22.27% were uncertain and 35.59% demonstrated good knowledge of Forensic DNA profiling. On the knowledge about the National Forensic DNA Database, 48.47% had no knowledge, 22.27% were uncertain and 29.26% were knowledgeable about it. The result of the present study revealed that the awareness level of the forensic DNA Database was found to be inadequate.

This study provides an update to a previous study exploring time to restoration of adjudicative competence within an Outpatient Competence Restoration Program (OCRP). Authors examined the probability of restoration for individuals referred for outpatient competence restoration in the U.S. capital, and revisited the requirements of American Law, taking a closer look at how programmatic changes improve restoration and encourage adherence. Competence to stand trial remains a critical screening function of the judicial system to ensure that defendants have a basic understanding of courtroom procedures. Competency restoration is therefore an attempt to protect both the integrity of the system and the rights of defendants. Aggregate data from the OCRP’s previous four years of competence restoration efforts were reviewed for demographic characteristics, restoration rates, and time to restoration. Poisson regression modeling identified probability differences in restoration between sequential restoration periods. Since our initial analysis, the DC OCRP has been successful in restoring 97 of 345 participants (28.1%), with referral rates increasing from year to year. 39.2% are now restored after the 3rd round of competency restoration. Poisson regression modeling of individuals attaining competence during six successive restoration periods showed that differences for the first five rounds of restoration were not statistically significant (p = 0.418). In the 6th round, however, the difference in percentage of restored participants was statistically significant compared to previous rounds (irr = 0.32; p = 0.0001). We discuss the policy implications, especially those that suggest that the DC OCRP has improved its ability to restore competence beyond the 1st round of restoration.