Background: Rectovaginal fistulas (RVFs) are abnormal, epithelialized communications between the posterior vaginal wall and the anterior rectal wall, most commonly resulting from obstetric trauma. They can lead to significant physical and psychological morbidity. Objective: To describe the clinical presentation, management strategies, outcomes, and preventive measures in patients with obstetric RVFs treated at HMA Hospital, Marrakech. Methods: A retrospective study of 10 patients with obstetric RVFs managed over a one-year period (November 2023 – November 2024). Data collected included patient demographics, obstetric history, clinical features, diagnostic findings, surgical techniques, and postoperative outcomes. All patients underwent transperineal repair using Musset’s technique, with colostomy performed when indicated. Results: Obstetric RVFs accounted for 66.6% of all RVFs operated on in the department. Mean patient age was 29 years; six patients were primiparous. Deliveries occurred at home (3), in maternity centers (3), and hospitals (4). Surgical repair was performed in all patients using Musset’s technique; nine patients received a left iliac colostomy. Postoperative recovery was uneventful in nine patients. One recurrence occurred in a patient who initially refused colostomy; she was successfully reoperated. Conclusion: Obstetric RVFs predominantly affect the lower two-thirds of the vagina. Surgical repair is highly effective, preventing major complications and facilitating patient reintegration. Prevention through patient education, prenatal care, and improved obstetric services remains essential.

Sustainable management of fisheries plays a key role in ensuring food security, ecological stability, and socioeconomic sustainability of the world. The conventional methods of monitoring and evaluation are not always sufficient because of the inability to achieve high accuracy, time, and species-specificity. The recent development of molecular and genomic technology has revolutionized the ability to measure, monitor, and preserve aquatic biodiversity in a more precise manner than ever before. Genomics, transcriptomics, and proteomics have become the central activities in the dissection of the genetic architecture of fish populations, which has made it possible to identify adaptive traits, as well as population structures, that are important in the management of stocks. The DNA barcoding and environmental DNA (eDNA) methods have transformed the concept of species identification and biodiversity monitoring that enabling non-invasive detection of rare, cryptic, or endangered species. The application of population genetics and genomic selection can again assist in defining the management unit and informing breeding programs that will improve resilience and productivity. Having all these molecular advancements leads to the creation of ecosystem-based management that incorporates genetic information into policy frameworks that enhance conservation, traceability, and sustainability. Fisheries genomics continues to be extended with the integration of the multi-omics platform with the advanced bioinformatics and artificial intelligence that allows predictive and adaptive management strategies to respond to environmental change. All molecular and genomic technologies are a revolutionary direction of sustainable, information-driven fisheries management, which combines the preservation of the ecological environment with human nutritional requirements.

Postoperative peritonitis (POP) is a serious complication of abdominal surgery, associated with high morbidity and mortality despite advances in diagnosis and treatment. The objective of this study was to describe the diagnostic, therapeutic, and outcome aspects of POP in the visceral surgery department of Avicenne Military Hospital in Marrakech. A retrospective study was conducted on 30 cases collected between January 2020 and December 2024. All patients included had undergone reoperation for confirmed peritonitis following abdominal surgery. The mean age was 47.9 years, with a balanced sex ratio. Major comorbidities included diabetes, obesity, and neoplastic diseases. The predominant causes were anastomotic leakage (43.3%) and visceral perforation (30%). Diagnosis was based on abdominal pain, fever, leukocytosis, and computed tomography (CT). Treatment involved early surgical reintervention, peritoneal lavage, and appropriate antibiotic therapy. Observed mortality remained significant, influenced by the timing of diagnosis, multiorgan failure, and patient condition. POP remains a major medico-surgical emergency requiring a multidisciplinary approach, early detection, and optimized treatment to improve survival.

The Amitābha Sūtra, one of the central scriptures of Mahāyāna Buddhism, presents a profound vision of reality grounded in both metaphysical and soteriological insight. From a philosophical perspective, the Pure Land (Sukhāvatī) is not merely a transcendent realm but a symbolic manifestation of pure consciousness, where being and awakening coincide. This paper explores the metaphysical structure of the Amitābha Sūtra through the lenses of Buddhist ontology and phenomenology, emphasizing the dialectical relationship between emptiness (śūnyatā) and luminous awareness (prakṛti-prabhāsvara). It further examines the soteriological implications of faith, vow, and practice (śraddhā, praṇidhāna, caryā) as modes of transformation leading from conditioned existence to the realization of the unconditioned. By situating the Amitābha Sūtra within a comparative philosophical framework, this study argues that its vision of “pure consciousness” contributes not only to Buddhist metaphysics but also to a universal philosophy of transcendence and liberation. The inquiry thereby bridges textual exegesis and philosophical reasoning, revealing the enduring relevance of Pure Land thought to contemporary reflections on being, mind, and salvation.

Nepal's revised building codes NBC 105:2020 (Seismic Design of Buildings in Nepal) and NBC 205:2024 (Ready-to-use Detailing Guideline for low rise RC Building without masonry infill) represent critical advances in seismic safety following the devastating 2015 Gorkha earthquake. This study provides the first comprehensive multi-municipal assessment of implementation barriers and socio-economic impacts across five municipalities in Peak Ground Acceleration (PGA) 0.35g zones. Using mixed-method research combining surveys of 245 construction professionals, cost analysis of 30 building projects, and quality assessments, we quantify implementation challenges and their economic implications. Our findings reveal substantial technical expertise gaps, with only 31.83% of respondents demonstrating adequate code awareness. Construction costs increased by 10.98% (NPR 3,160 to NPR 3,505 per sq ft), while training quality directly correlates with compliance rates (90% for comprehensive training vs. 50% for minimal training). We recommend differentiated regulatory frameworks distinguishing residential and commercial construction requirements, coupled with targeted capacity building programs. These evidence-based insights inform policy interventions to balance seismic safety enhancement with construction sector viability in earthquake-prone developing regions.

In Ngandajika (Democratic Republic of Congo), farmers still prefer to grow local varieties, accusing improved varieties of being susceptible to disease, demanding nutrients, and requiring excessive labor. They also criticize these varieties for having large rachises and few grains, requiring labor-intensive shelling, without considering several advantages offered by different improved varieties, such as earliness, yield, and the quality of by-products, including flour consistency. Local varieties are less productive (yield less than 1 ton of maize grain/ha) than improved varieties, whose production exceeds 1.9t/ha when manually weeded and hoeed three times, namely 15, 30, and 45 days after sowing. In the strategy to increase the yield of maize cultivation, the Musangana variety, which is one of the most cultivated varieties, was chosen and the impact of the frequency of manual weeding on the growth and dry grain yield of maize during the 2021-2022 growing season was evaluated; the trial was conducted in the open field at the MPOYI group under a Latin square design comprising four complete random blocks and comprising 4 elementary plots representing the experimental treatments. The treatments consisted of (T0) treatment not receiving weeding, (T1) treatment receiving weeding once, (T2) treatment receiving weeding twice and (T3) treatment receiving weeding three times. The results show a higher yield (1.9t/ha) of dry grains of maize with manual weeding having received weeding three times during the entire growing cycle, followed by 1.5t/ha obtained with those of manual weeding having received weeding twice during the entire growing cycle and 1.1t/ha with manual weeding having received weeding once during the growing cycle. The lowest average is 0.3t/ha on the manual weeding not having received weeding during the entire growing cycle.

Background: Non-medical oocyte cryopreservation (NMOC), also known as elective egg freezing, has become an established reproductive option that enables women to preserve fertility for social or personal reasons. Assessing women’s knowledge and attitudes toward NMOC is critical for enhancing awareness, supporting informed decision-making, and refining counseling practices. Objective: This literature review synthesizes current evidence regarding women’s knowledge, attitudes, and influencing factors related to NMOC, with particular emphasis on gaps identified among Saudi women. Methods: A systematic search was performed in PubMed, Medline Plus, Web of Science, and Google Scholar for studies published from 2020 to 2024. Of the 260 articles initially identified, 23 met the inclusion criteria. Each study was analysed based on its aim, setting, sample size, and key findings. Thematic synthesis was used to organize results into four main areas: knowledge and attitudes toward NMOC, factors influencing women’s decision-making, factors affecting attitudes, and sources of information. Results: The findings indicate that most women possess limited knowledge of NMOC, particularly concerning optimal age, success rates, and medical procedures. However, attitudes toward NMOC are generally positive, especially among highly educated, employed, and medically trained women. Variables such as age, marital status, education, income, fertility awareness, and cultural or religious beliefs significantly influence both knowledge and attitudes. Online resources and healthcare professionals are the primary sources of information shaping women’s understanding. Conclusion: Although global awareness of NMOC is increasing, significant gaps remain, particularly among Saudi women. Future research and culturally tailored educational initiatives are necessary to improve women’s reproductive literacy, facilitate informed choices, and support equitable access to fertility preservation counselling.

Background: Alpha-feto-protein producing gastric adenocarcinoma is a rare and aggressive subtype of gastric cancer, associated with poor prognosis. Case Presentation: We report the case of a 66-year-old female with a history of hypertension and hypothyroidism who presented with severe anemia and abdominal pain. Initial imaging revealed a gastric lesion. Serum Alfa-Fetoprotein (AFP) was requested due to a suspicious lesion seen on initial liver imaging, and it was markedly elevated (>9000 ng/mL), raising suspicion for AFP-producing gastric cancer versus liver infarction due to venous thrombosis. Endoscopic biopsy of the gastric lesion confirmed Enteroblastic gastric adenocarcinoma. Subsequent MRI abdomen demonstrated hypermetabolic activity in the gastric lesion and in the abdominal lymph nodes without distant metastasis. Given her frailty and reluctance to undergo intravenous chemotherapy, she was offered oral chemotherapy (Capecitabine). Conclusion: Here, we present a case of AFP- producing gastric adenocarcinoma, a rare tumor that has not previously been reported from the Middle Eastern region, to the best of our current knowledge.

Background: RC pathology includes tendinopathy, partial- and full-thickness tears, and subacromial-subdeltoid bursitis, are a leading cause of shoulder pain and functional loss in active adults. HR-US is an easily accessible and dynamic imaging modality with the capability of conducting tendon-specific assessment with a high degree of accuracy. Nevertheless, variability in operator performance combined with patient positioning is a clinical limitation. Objectives: The aim of this study was to establish the diagnostic performance of HR-US as a first-line imaging modality in the diagnosis of RC pathologies and compare the accuracy with MRI using a standardized scanning protocol based on ESSR guidelines. Methods: In this retrospective cross-sectional study, a total of 283 patients aged between 20 and 65 years with complaints of shoulder pain, stiffness, or trauma were examined in several diagnostic centers in Sudan from 2021 to 2024. Examinations were performed using high-frequency linear transducers (7.5-12 MHz) on a unified HR-US protocol. MRI was used as a reference standard. Statistical analysis was made using SPSS, version 23, and diagnostic indices of sensitivity, specificity, accuracy, PPV, and NPV were calculated; p < 0.05 was considered significant. Results: HR-US obtained a sensitivity of 90.6%, specificity of 94.6%, for full-thickness tears, with an overall diagnostic accuracy of 92.6% and excellent correlation with MRI (r = 0.718, p < 0.001). The modality showed strong diagnostic performance for supraspinatus and infraspinatus lesions and proved superior to MRI in the detection of partial subscapularis tears in many cases. Standardized examination protocols greatly decreased inter-operator variability and improved reproducibility. Demographic analysis yielded strong associations of RC pathology with age and gender. Conclusion: HR-US is a reliable, accurate, and inexpensive first-line modality for diagnosing rotator cuff disorders. If performed in a standardized and tendon-specific protocol, HR-US diagnostic precision is comparable to MRI, while the former offers real-time dynamic assessment and is more accessible. It is worth integrating into routine diagnostic pathways, in particular in resource-constrained settings, for early diagnosis and evidence-based clinical decisions.

Mandatory disease reporting by radiologists is a critical yet inefficient component of public health infrastructure. Current manual, disruptive, and unidirectional processes create a significant administrative burden for clinicians and deliver data that is often delayed and fragmented for public health agencies. This manuscript examines these workflow inefficiencies through a business process analysis, which identified key pain points including context switching, manual data entry, and a fundamental lack of systems integration. To address this, we propose a modernized framework based on the adoption of structured SNOMED CT AU coding, HL7® FHIR® standards, and API-driven interoperability. The proposed model automates reporting through event-driven triggers within radiologists’ existing systems, ensuring timely and accurate data transfer. Furthermore, it introduces a critical bi-directional feedback loop, providing clinicians with confirmation and valuable outcome data. The implementation of this integrated framework can transform mandatory reporting from a bureaucratic task into a seamless byproduct of care delivery. This promotes a collaborative partnership between clinical care and public health, ultimately enhancing the timeliness, efficiency, and overall efficacy of population health surveillance.

Manufar wannan takarda ita ce nazartan yadda ‘yan siyasa suke amfani da abubuwa na ɓatanci ga abokan hamayyarsu na siyasa. Tunanin wannan takarda ya taso ne duba da yadda ‘yan siyasa suka mayar da wannan abu tamkar in babu shi to siyasar ma ba za ta yiwu ba. Wannan ya sa aka ga dacewar a shiga cikin ayyukan adabi na rubutaccen zube a gani shin ‘yarfe’ yana da asali ne tun kafuwar siyasar jam’iyyu ko kuwa bai daɗe da samuwa ba? An yi nazarin yarfe a cikin tarihin siyasa da aka kundace a cikin ayyukan rubutaccen zube. An ɗora binciken kan ra’in ‘Tarihanci’ inda ya yi jagorancin zaƙulo tarihin yarfe a harkokin siyasar ƙasar Hausa. Takardar ta gano cewa, yarfe abu ne da ya ginu a cikin siyasar jam’iyyu tun daga farkon lamari. Bugu da ƙari, har yanzu ana amfani da shi domin neman ƙarin mabiya da kuma shafa wa abokan hamayyar siyasa kashin kaji, wanda hakan kan taimaka ga samun nasara ko faɗuwa a zaɓe.

Background: Lipids are essential in many facets of life, and the ABO system is the paramount system in the transfusion process. This research seeks to correlate serum levels of total cholesterol, triglycerides, HDL-C, LDL-C, and ABO blood type in healthy Sudanese adults. Methods: A cross-sectional community-based study was undertaken in Khartoum State, Sudan, from March 2020 to August 2021. Two hundred healthy people were enlisted, including 50 from blood group A, 50 from blood group O, 50 from blood group B, and 50 from blood type AB. The blood lipid profile was assessed using an auto chemistry analyzer, and statistical analysis was conducted using SPSS version 25. Results: A significantly elevated serum cholesterol level (p value = 0.004) and triglycerides (p value = 0.000) were seen across various blood types, with the AB blood group exhibiting the highest levels of both serum cholesterol and triglycerides. There exists a positive link between serum cholesterol levels and age in blood groups O, B, and AB, with correlation coefficients of r=0.399 (P=0.004), r=0.431 (P=0.002), and r=0.403 (P=0.004), respectively. A positive association exists between serum triglycerides and age in blood groups A and O, with coefficients r=0.463 (P=0.001) and r=0.408 (P=0.003), respectively. There exists a significant association between LDL-C and age in blood groups B and AB (r=0.385, P=0.006; r=0.463, P=0.001, respectively). Conclusion: Individuals with the AB blood group have elevated serum cholesterol and triglyceride levels compared to other blood groups, with a positive association shown between age and cholesterol, triglycerides, and LDL-C across various blood types.

The act of forging seals and documents of state agencies and organizations for the purpose of fraudulent appropriation of property constitutes a serious form of crime, simultaneously infringing upon administrative management order and threatening the security of property relations. In Vietnam, this conduct is primarily governed by Article 341 of the Penal Code in conjunction with provisions on the offense of fraud. However, practical challenges remain in delineating the boundary between forgery and fraud, particularly when forged documents are employed as instruments of misappropriation. This article examines the Vietnamese criminal law framework and contrasts it with the experiences of selected jurisdictions such as the United States, China, and Singapore, thereby identifying both commonalities and differences in the constituent elements of offenses and applicable sanctions. On this basis, the study proposes orientations for improving criminal legislation and judicial practice in Vietnam.

Inappropriate long-term use of Proton Pump Inhibitors (PPIs) is a public health challenge. It is uncertain if this "implementation gap" is driven by knowledge deficits or other behavioural barriers. This study aimed to quantify systematic de-prescribing protocol (SDP) use and identify barriers to PPI de-prescribing among Internal Medicine (IM) and Gastroenterology (GI) physicians. A cross-sectional survey was conducted among 310 physicians (IM, GI) from three Indian states. A validated questionnaire assessed knowledge, self-efficacy, barriers, and use of an SDP (the primary outcome). A multivariable logistic regression model, robust for clustering, identified predictors of SDP use. Physician knowledge was high (mean 3.7/4.0), but a "knowledge–implementation gap" was evident: 85.2% agreed de-prescribing was "crucial," yet only 28.4% used an SDP. Gastroenterologists (40.0%) were twice as likely as IM physicians (20.0%; p=0.0002) to use an SDP. In the adjusted model, GI specialty (aOR 2.59) and higher self-efficacy (aOR 1.82) were the strongest predictors. The highest-rated barriers were 'Patient resistance/anxiety' (78.0%) and 'Consultation time constraints' (69.2%). In this cohort, PPI over-prescription appears driven by implementation failure and clinical inertia, not knowledge deficits. This is associated with low self-efficacy and barriers like patient anxiety and time pressure. The specialty disparity suggests confidence, not just knowledge, is key. Interventions must pivot from education to systemic solutions targeting these behavioural barriers.

Nanotechnology has become the revolutionary movement in terms of promoting the global agenda of sustainable development to make innovations on the frontiers of materials science, environmental engineering, biotechnology and renewable energy. The tunable physicochemical properties, the high surface reactivity, and multifunctionality of nanoparticles are central to the development of sustainable solutions to the complex problems of resource scarcity, energy requirement, environmental degradation and human health. This review is a comprehensive study of multidisciplinary uses of nanoparticles in ensuring sustainability in various fields such as clean energy production, pollution mitigation, precision agriculture, green manufacturing, and biomedical uses. It is devoted to the latest successes of environmentally friendly production routes, in particular, bioinspired and waste-based nanoparticles, in accordance with the principles of green chemistry and the idea of a circular economy. The review also addresses the role of the nanoparticle-enabled technologies towards the United Nations of the Sustainable Development Goals (SDGs) by increasing energy efficiency, environmental stability, and sustainable production. Using materials innovation and sustainability science, this paper provides valuable critical reflections on how nanotechnology can make the transition to a more fair, low-carbon, resource-saving future. The discussion has pointed out the necessity of having a cross-disciplinary approach and regulatory vision to ensure a safe and ethical use of nanomaterials in sustainable systems.