Semaglutide and tirzepatide have reshaped incretin-based therapy from a predominantly glucose-lowering approach into a broader platform for managing type 2 diabetes, obesity, and selected cardiovascular, kidney, and obesity-related comorbidities. Semaglutide is a GLP-1 receptor agonist, whereas tirzepatide is a dual GIP/GLP-1 receptor agonist, so the two drug families should be discussed together but not treated as pharmacologically identical. In the UK, Ozempic is licensed for adults with insufficiently controlled type 2 diabetes, Wegovy for weight management and cardiovascular risk reduction in selected adults with overweight or obesity, and Mounjaro for type 2 diabetes and weight management. The strongest evidence supports major reductions in glycated haemoglobin and body weight, with semaglutide additionally showing cardiovascular and kidney outcome benefits in selected populations and tirzepatide showing especially strong weight-loss efficacy and emerging benefit in obesity-related comorbidity pathways. Safe use requires careful product selection, gradual titration, attention to co-prescribed insulin or sulfonylureas, counselling on gastrointestinal effects and dehydration, awareness of pancreatitis and gallbladder warnings, reproductive counselling, and clear peri-operative communication. For UK and Qatar practice, a safer prescribing model combines structured baseline assessment, active review during dose escalation, medication reconciliation that detects private prescribing, and bilingual patient education to reduce avoidable harm. [1-6].

Old age, a structuring phase and pivotal period in the overall dynamics of human existence, and the final stage of this process, is marked by a series of profound trans-formations of a biological, neurobiological, psychological, and social nature. It is rich with all the ages that have passed, but it is fundamentally regressive, as it integrates all these transformations, which have a real impact on the elderly person, who becomes essentially fragile and vulnerable; they impact their relationship to time, to their body, and to their imminent death. Our paper offers a psychopathological analysis of the experience of time and the awareness of finitude in aging Cameroonians. Drawing on insights from clinical psychology, psychopathology, and health psychology, it explores the clinical challenges related to the shrinking future, death anxiety, and the defense mechanisms mobilized in the face of finitude, which is a progressive loss of self-integrity and the need to re-evaluate one's life. The paper also highlights specific clinical manifestations observed in aging individuals, such as existential depression and late-onset anxiety, often mistakenly confused with neurocognitive disorders. Contextualized clinical vignettes will also illustrate Cameroonian sociocultural realities. Finally, the clinical and public health implications will be discussed, particularly regarding prevention, differential diagnosis, and psychological support for aging.

Sentinel lymph node (SLN) biopsy has emerged as a cornerstone technique in modern gynecologic oncology. It enables accurate nodal staging while minimizing surgical morbidity associated with systematic lymphadenectomy. Over the past two decades, extensive clinical trials and prospective studies have validated its diagnostic accuracy, safety profile, and prognostic value. This comprehensive narrative review examines anatomical foundations, technical aspects, oncologic outcomes, histopathologic ultrastaging, indications by tumor type, limitations, controversies, and future perspectives. Evidence indicates that SLN mapping achieves high sensitivity and negative predictive value across several gynecologic malignancies, particularly vulvar, endometrial, and early-stage cervical cancers. Integration of fluorescence imaging, standardized algorithms, and molecular pathology has further strengthened its clinical utility. SLN biopsy now has progressively modified surgical staging strategies over the past two decades to ward precision surgical staging and individualized patient care.

Marchiafava-Bignami disease is a rare neurological condition characterised by necrosis and demyelination of the corpus callosum, usually associated with chronic alcoholism and/or malnutrition. The clinical manifestations of Marchiafava-Bignami disease are diverse and often non-specific. The diagnosis of Marchiafava-Bignami disease is based on magnetic resonance imaging results, which reveal significant and symmetrical damage to the corpus callosum. We report the case of a 63-year-old man with chronic alcoholism who had been experiencing symptoms of confusion for several days. Brain CT imaging revealed diffuse and complete damage to the corpus callosum, characteristic of a severe form of Marchiafava- Bignami disease.

Shoulder pain is a common symptom in primary care. Impingement syndrome is one of the most common diagnoses for shoulder pain. The condition is caused by one or more tendons in the rotator cuff being pinched. The diagnosis is often made clinically. Treatment can be pain-relieving tablets, physiotherapy, and/or subacromial corticosteroid injection, depending on the duration of the pain. The purpose of this study was to evaluate the effect of physiotherapy or no treatment compared with corticosteroid treatment, possibly followed by physiotherapy. The research questions were: 1. How does the long-term prognosis [1 year] differ for patients with impingement syndrome treated with corticosteroid injection compared with physiotherapy or no treatment. 2. Are the Swedish National Board of Health and Welfare's treatment recommendations followed, i.e., physiotherapy and corticosteroid injection? The study was conducted as a retrospective medical record review. The study included 92 patients who had sought care at Cityhälsan Söder primary care center in Sweden due to shoulder pain, where the diagnosis after medical examination became impingement syndrome. All included patients were of working age. The patients were divided into two main groups: those who had received one or more corticosteroid injections and those who had not received any corticosteroid injection. The medical records were reviewed for one year forward from the date the patient was diagnosed with impingement syndrome. Patients who had not sought care for the same symptoms more than 1 year after diagnosis were considered cured of the shoulder pain. Those who had persistent symptoms and continued to seek care after one year were not considered cured. The result suggests that corticosteroid injection for patients with impingement syndrome has a favorable effect in the short term. The treatment does not worsen the long-term prognosis. The study indicates that we should continue to offer patients with this condition

Depression is a common but often underdiagnosed co-morbidity in patients with dementia, leading to significant negative impacts on quality of life, cognitive decline, and caregiver burden. Due to overlapping symptoms and communication difficulties, diagnosis presents a formidable challenge in the primary care setting. This review outlines the epidemiology, clinical presentation, and diagnostic hurdles of depression in dementia, with a focus on practical, primary care-centric approaches. It discusses the application of validated screening tools, clarifies clinical features that distinguish depression from apathy, and details the role of the multidisciplinary team. This review provides a practical framework for Primary Care Physicians, including a clinical algorithm and a toolkit of screening instruments, to improve diagnostic accuracy and patient outcomes.

The influence of different artisanal refineries in the Niger Delta region is still a significant health, economic and environmental setback. Consequently, the present study comparatively examined the lung function and body mass index changes in operators of artisanal refineries (OAR) in Rivers State, Nigeria. This cross-sectional survey adopted a multi-stage sampling technique (including purposive and snowball tools) to recruit 203 (including 120 OAR-exposed and 83 non-OAR exposed) consenting and apparently healthy adult male and female subjects. With the use of the automated spirometer, the basic pulmonary function indices were recorded from the study subjects. Quantitative data obtained from the subjects were subjected to statistical analyses using the Statistical Package for Social Sciences (SPSS) version 21.0. The result showed that the male control subjects had raised levels of FVC, FEV1 and FEV1/FVC compared to those of the male OAR subjects; although, only those of FEV1 were significant (P<0.0.5). Notably, the FEV6 of the male OAR was markedly (P<0.05) elevated compared to that the male control. Again, the FEV1/FVC level in the female OAR group was found to be significantly (P<0.05) raised compared to their female control counterparts. In conclusion, the operators of artisanal refineries may thus be predisposed to some forms of restrictive respiratory disorders with time.

Background: Regional anesthesia using femoral perineural catheters (FPC) represents a cornerstone technique for postoperative pain management after major knee surgery. While nerve stimulation has traditionally guided catheter placement, ultrasound (US) guidance offers potential advantages through direct visualization of anatomical structures, theoretically improving safety, precision, and analgesic efficacy. Objective: To compare the analgesic efficacy, safety profile, and technical parameters of FPC placement under ultrasound guidance versus traditional nerve stimulation (NS) in patients undergoing major knee surgery. Methods: We conducted a prospective, randomized, single-center study at Douéra University Hospital, Algeria, including 92 patients (aged 18-80 years, ASA I-III) scheduled for major knee surgery (total knee arthroplasty, ligament reconstruction, or arthrolysis). Following informed consent, patients were randomly allocated to receive FPC placement using either ultrasound guidance (US group, n=46) or nerve stimulation (NS group, n=46). The primary outcome was pain intensity assessed using the Visual Analog Scale (VAS) at rest every 6 hours for 48 hours and during mobilization at 48 hours postoperatively. Secondary outcomes included procedure duration, local anesthetic consumption, complications, functional recovery parameters, and patient satisfaction scores. Results: Eighty-five patients completed the study protocol (NS=42, US=43). Baseline demographic and clinical characteristics were comparable between groups. VA score at rest were similar from hour 0 to hour 36 postoperatively. At 48 hours, the US group demonstrated significantly lower pain scores both at rest (1.95±1.1 vs 2.48±1.2; p=0.004) and during mobilization (3.37±1.0 vs 4.02±1.1; p=0.008). Procedure duration was significantly shorter with ultrasound guidance (4.9±1.0 vs 5.5±1.1 minutes; p=0.01). No major complications occurred in either group.

Supernumerary ovaries are exceptionally rare congenital anomalies defined by the presence of functional ovarian tissue entirely separate from the normal ovaries. Although usually asymptomatic, they may give rise to cysts, endometriosis, or neoplasms, with tumors arising from supernumerary ovaries reported only in a limited number of cases. We present the case of a 49-year-old woman who presented with right-sided pelvic pain and was found to have two contiguous cystic masses in the right latero-uterine region, distinct from the eutopic ovaries, which appeared normal on imaging. MRI suggested benign multiloculated cystic formations, but the markedly elevated CA-125 level [13 469 U/mL] raised suspicion for malignancy. Exploratory laparotomy revealed two cystic formations connected to the uterus by a vascularized cord, consistent with a supernumerary ovary. Histopathology confirmed a benign serous cystadenoma, and peritoneal cytology and biopsies were negative. This case illustrates the diagnostic challenges posed by ectopic ovarian tissue, particularly when tumor markers are misleadingly elevated and imaging cannot establish the origin of the mass. Awareness of this rare anomaly is essential to avoid misdiagnosis and to guide appropriate surgical management.

Referral systems represent the structural link between different tiers of health care, ensuring patients receive appropriate, timely, and continuous management. Effective referral mechanisms prevent fragmentation, duplication, and inequity while optimizing limited specialist resources. In the Gulf and Middle East, fast-growing populations, epidemiologic transitions, and significant digital-health investments have reshaped how referrals operate. This review synthesizes evidence from Saudi Arabia, the United Arab Emirates (UAE), Qatar, Oman, Bahrain, Jordan, and Lebanon, examining referral models, common bottlenecks, and emerging innovations. Across the region, digital transformation through national health information exchanges (HIEs) has advanced rapidly, yet persistent challenges remain, particularly in gatekeeping, interoperability, workforce training, and governance. The review concludes with policy and research recommendations aligned with the World Health Organization (WHO) Eastern Mediterranean Region (EMRO) strategy for people-centered integrated health services.