''Good health and well-being" (SDG3) is one of the 17 integrated sustainable development goals (SDG) adopted by the United Nations in 2015. When it comes to health and well-being, pharmaceuticals play a vital role. Pharmaceutical waste and contaminants of emerging concern (CEC) produced during the manufacturing, supply, usage and disposal of drugs, chemicals and personal care products can significantly affect the environment. Some serious global problems have been attributed, at least partly, to the prevalent practices in this sector. With increased awareness, regulations and corporate environmental responsibility, the pharmaceutical industry is making efforts toward sustainability through measures like green production, green technology, improved supply chains, collaborations and strategic partnerships. However, the need is still felt for additional measures to be incorporated into the practice like a circular economy, based on the 4Rs (reduce, recycle, reuse, recover); Artificial Intelligence (AI) can be used to recognise the best way to obtain maximum yield with minimum cost from available resources in an environment-friendly manner for the benefit of society; encouraging the use of renewable energy and promoting research focused on environmental supportive and profitable measures. The journey towards sustainable pharma is complex and requires collaboration across the entire value chain from all the stakeholders, but the benefits to society, the environment and the industry are profound and far-reaching.

Background/Aim: Non-pharmacological interventions play a crucial role in managing labour pain and facilitating labour progression. The counter-pressure technique is a commonly utilised method purported to alleviate pain and enhance cervical dilation during childbirth. However, its effective-ness remains a subject of debate, necessitating further investigation. This study aimed to evaluate the efficacy of the counterpressure technique in managing labour pain and influencing labour progression among women in labour. Method: A randomised controlled trial was conducted involving participants in active labour. The intervention group received the counterpres-sure technique, while the control group received standard care. Pain levels, uterine contractions and cervical dilation were assessed and compared between the two groups. Results: Analysis revealed no significant difference in pain levels or uterine contractions between the intervention and control groups. However, there was a significant increase in cervical dilation in the intervention group compared to the control group (p = 0.034, Cohen's d = -0.586). Conclusion: Despite the counterpressure technique's limited impact on pain relief and uterine contractions, it significantly facilitated cervical dilation during labour. These findings contribute to understanding of non-phar-macological interventions in childbirth and underscore the importance of evidence-based approaches to labour management. Further research is warranted to elucidate the underlying mechanisms of the counterpressure technique and optimise its implementation in clinical practice.

Background/Aim: Preeclampsia, a significant cause of maternal morbidity and mortality, is linked to increased cardiovascular risks. Catestatin regulates cardiovascular function which indicates its usefulness in understanding pathophysiology of preeclampsia and its severity. Aim of this study was to evaluate association of catestatin in preeclamptic women and control non preeclamptic women and assess its association with presence and severity of preeclampsia. Methods: A case-control study at Al-Zahraa Teaching Hospital, Iraq, performed from January to December 2023 involved 90 pregnant women: 30 with severe preeclampsia, 30 with mild preeclampsia and 30 healthy controls. Inclusion criteria were preeclamptic pregnant women at 27-40 weeks of gestation and age ranging from 20-40 years and similar non-eclamptic controls. Exclusions were smokers, chronic drug users and those with chronic illnesses. Data collection included general and clinical information, BMI, vital signs, examinations and laboratory tests including serum catestatin. Results: Catestatin levels varied significantly among severe preeclampsia, mild preeclampsia and control groups. Average catestatin level in severe preeclampsia group was markedly lower at 29.01 ng/mL, compared to 43.67 ng/mL in mild preeclampsia and 59.96 ng/mL in controls. The diagnostic performance of catestatin for severe preeclampsia was notable, with a cutoff point of ≤ 37.165 ng/mL, sensitivity of 80 % and specificity of 83.3 %, highlighting its potential as a critical biomarker in preeclampsia evaluation. Conclusion: Catestatin level was significantly lower in sever preeclampsia compared to mild and control group, which may indicate its association with preeclampsia. Lower catestatin in sever preeclampsia suggest its inverse relation with preeclampsia severity.

Electrical burns cause devastating injury with major soft tissue loss and pose a major threat to life. The damage caused by electrical injuries can extend to deeper tissues, causing exposed soft tissues such as tendon and nerve. The rectus abdominis muscle is a donor of musculocutaneous flap due to the well-known blood supply and high vascularity. The rectus abdominis pedicled flap can be either performed transversely or vertically oriented. The drawback of both of these techniques is the insufficient coverage particularly when used for wide or circular defects. Crescent-shaped rectus abdominis musculocutaneous (CRAM) flap is an innovation that is intended to be used for coverage of circumferential defects with extensive soft tissues exposed as can be seen in the defect caused by electric burn injury. In this paper, cases of high-voltage electrical injury at different anatomical regions which were successfully reconstructed with CRAM flap are presented. Overall, CRAM flap was a reliable flap resulting in well-vascularised soft tissue coverage and acceptable functionality.

Orthognathic surgery is a procedure used to correct facial deformities and jaw bone misalignment. The use of technology, specifically virtual surgical planning (VSP), has become increasingly prevalent in preoperative planning for orthognathic surgery. High-resolution computed tomography (CT) imaging has enabled computer-aided modelling. Artificial intelligence (AI) implementation has transformed orthognathic surgery methodology. This article highlights the latest market trends and modern-day advancements in the field, including the conventional and surgery first approach for orthognathic surgery. The use of computer-aided surgical simulation (CASS) in VSP for orthognathic surgery was studied. The different software used for orthognathic surgical planning and the detailed protocol followed during the surgery, including the preoperative procedure were discussed along with utilisation of 3-dimension cone-beam computed tomography (3D CBCT) images for surgical planning. The implementation of VSP with CASS had significantly enhanced the accuracy and efficiency of orthognathic surgery for dentofacial deformity correction. The use of technology allowed improved preoperative planning, resulting in better outcomes for patients. The study of different software for orthognathic surgical planning and the protocol followed during surgery has provided valuable insight into the surgery. The continued advancement of technology in orthognathic surgery is promising for the field and for the patients.

Continuing to improve services to students while studying on campus, lecturers and all elements at the university need information about triggers of environmental stress among medical and health sciences students. Thus, the purpose of this study was to explore triggers of environmental stress among medical and health sciences students in the university through bibliometric analysis by analysing the network visualisation, overlay visualisation and density visualisation on the topic. Bibliometrics analysis was used in assessing related topics. The data sources were based on online searches via https://app.dimensions.ai/. Data was collected on 3 December 2023. The literature followed the Preferred Reporting Items for System-atic Reviews and Meta-Analyses (PRISMA) flowchart. Data were analysed using VOSviewer and further analysed and reviewed by co-occurrence and co-authors. Four major themes of environmental stress were found in this study: 1) The internal situation in the university; 2) External situations outside of the university; 3) Comfort situation during the study; 4) Aca-demic process. Environmental stress factors related to internal situation in the academic situation were academic stress, air pollution, anxiety in the academic process, COVID-19, depression, fear, medical student, nursing student, physical activity, school regulation, smoking and uncertainty of study. From the visualisation and density visualisation, it can be seen that the academic process related to the duration of study was a trending theme discussed in several papers related to triggers of environmental stress among students in the university. All elements of the university especially policy makers should pay attention to this problem to reduce the risk of stress while students are studying.

Acute mesenteric ischaemia (AMI) is a serious disease with mortality between 50 and 80 %. Oxidative stress plays a major role in the pathophysiology of AMI. AMI should be considered for any acute abdominal pain that requires analgesia with morphine and for which no other obvious aetiology is found. CT is the main diagnostic procedure to confirm the diagnosis of AMI. There is no specific diagnostic biomarker for AMI that can be used in routine practice. AMI is an urgent diagnostic and therapeutic situation. Treatment of AMI includes a protocol combining digestive rest, curative anticoagulant, antiplatelet, antibiotic therapy, arterial revascularisation to salvage viable bowel and resection of necrotic digestive segments. The strategy of revascularisation depends on the mechanism of arterial occlusion, the morphological appearance of the lesions and the indications for exploratory laparotomy. Endovascular and open surgical techniques can be combined and complemented. Open surgical revascularisation is indicated in case of failure or impossibility of endovascular revascularisation and in case of need for laparotomy. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality of AMI. The emergence of endovascular approaches and modern imaging techniques is developing and providing new treatment options. A multidisciplinary approach based on early diagnosis and treatment is necessary.

Background/Aim: Functional dyspepsia, erosive and non-erosive gastroesophageal reflux disease (GERD) present a major health burden, adversely effecting quality of life. A range of factors are hypothesised to have a positive and negative influence on these diseases. This study aimed to explore the risk factors of functional dyspepsia, gastrointestinal reflux disease and non-erosive reflux disease and its subgroups. Methods: A cross-sectional study was conducted at Combined Military Hospital (CMH), Lahore, Pakistan, from January to June 2024. Two hundred and twenty-two patients were included and interviewed to fill a tri-section questionnaire comprising a self-designed comprehensive health survey, food frequency questionnaire, gastroesophageal reflux disease questionnaire (GERD-Q), Rome IV criteria and hospital anxiety and depression scale (HADS). Results: Participants consisted of 70 controls, 38 GERD, 24 non-erosive reflux disease, 56 functional dyspepsia and 24 overlap reflux-dyspepsia syndrome patients. Subgroups included symptomatic and asymptomatic erosive oesophagitis, epigastric pain syndrome, postprandial distress syndrome and overlap syndrome. Older age, higher body mass index (BMI), male gender, low vegetable and yogurt intake, smoking, frequent red meat, high tea/caffeine intake, no postprandial exercise and a short dinner sleep interval were risk factors for GERD and symptomatic erosive esophagitis. Low BMI, female gender and anxiety were strongly associated with functional dyspepsia and non-erosive reflux disease. Conclusion: Age, BMI, gender, tobacco, anxiety, depression, dietary habits and food frequencies are significant risk factors of dyspepsia and reflux disease.

Disseminated cryptococcosis is an infrequent fungal illness primarily observed in immunocompromised individuals, particularly among those with human immunodeficiency virus (HIV). In this report, a case where the initiation of antiretroviral therapy revealed a previously hidden Cryptococcus infection in an HIV-positive male who also had COVID-19 is presented. A 30-year-old male with a medical history of HIV sought medical attention at the Emergency Department due to the presence of a widespread, non-itchy skin rash along with severe difficulty breathing. Diagnosis of unmasking immune reconstitution inflammatory syndrome (IRIS) associated with disseminated cryptococcosis, all while testing positive for COVID-19 was made based on clinical presentation and performed analyses. COVID-19 management guidelines were strictly adhered to and treatment included the administration of steroids, amphotericin B and fluconazole. Additionally, empirical coverage for Pneumocystis carinii pneumonia (PCP) was initiated. Regrettably, the patient's clinical condition deteriorated in the following days, ultimately resulting in his passing. The ongoing pandemic has understandably prioritised the diagnosis of COVID-19 by healthcare providers, sometimes overshadowing the exploration of alternative diagnoses. It is crucial to maintain a heightened clinical suspicion for opportunistic infections, especially among immunocompromised individuals, particularly those with HIV.

Background/Aim: Hypertension is a consequence of a neuromodulatory imbalance and is directly associated with cardiovascular diseases. Oxidative stress constitutes an intermediate pathophysiological mechanism for hypertension and cardiovascular disease. Evidence suggests that there is a proportional relationship between diets high in antioxidants and a reduced risk of cardiovascular events. A high antioxidant diet could scavenge the free radicals and other toxic radicals offering better protection to the cardiovascular system. The primary study objective was to evaluate the impact of dietary supplementation with fruit extract capsules on markers of oxidative stress and antioxidant capacity in hypertensive and normotensive individuals; a secondary objective was to evaluate the impact of dietary supplementation on insulin resistance, markers of inflammation and haemodynamic variables in treated hypertensive and normotensive patients. Methods: This clinical trial comprised 30 hypertensive patients and 29 normotensive volunteers. Study participants received placebo capsules for 4 weeks, then fruit extract capsules (blueberry, cranberry and pomegranate), one capsule of each per day for 4 weeks. Blood pressure was measured at baseline, after the use of placebo and antioxidant capsules. Catalase, thiobarbiturate acid reactive substances (TBARS), superoxide dismutase (SOD), carbonyl and ferric-reducing antioxidant powder (FRAP) were used to evaluate oxidative stress. Results: The mean age among hypertensive participants was 49.3 ± 9.3 years. Catalase increased in both groups; reduction of TBARs, FRAP and carbonyls occurred in the hypertensive group. A significant intragroup difference in homeostatic model assessment of insulin resistance (HOMAir) was noted between normotensive and hypertensive individuals at different times. No significant difference occurred regarding inflammatory cytokines, adipocytokines and haemodynamic data after antioxidant consumption. Conclusion: The study results suggest that supplementation with fruit capsules rich in antioxidants for 4 weeks significantly reduces oxidative stress in hypertensive patients. Studies with a larger number of patients are needed to confirm the findings.