Cephalic duodenopancreatectomy (CDP), also known as the Whipple procedure, is a major surgery performed on the pancreatobiliary junction. It is mainly indicated for cancers of this region, as well as for certain benign tumors or chronic pancreatitis. Despite technical advances, this procedure remains associated with high morbidity, with postoperative complications such as pancreatic or digestive fistulas, gastroparesis, hemorrhage, infections, and, in the long term, pancreatic insufficiency. A retrospective study conducted in the Department of Visceral Surgery at the Avicenne Military Hospital of Marrakech between 2017 and 2021 analyzed 35 cases of CDP. The average age of patients was 62 years, with a male predominance. The main indications were: Vaterian ampulloma (45.7%), Adenocarcinoma of the pancreatic head (34.3%), Adenocarcinomas of the distal bile ducts (11.4%), And a few rare cases of duodenal or cystic tumors. Most tumors were well-differentiated (74%). The Child reconstruction technique was used in 65.7% of cases, while pancreaticogastric anastomosis was performed in 34.3%. The postoperative mortality rate was 11.4%, mainly due to hemorrhagic shock. Early complications occurred in 42.8% of patients, predominantly gastroparesis (17.1%) and hemorrhage (8.6%). The results are consistent with those reported in the literature. The study emphasizes the importance of thorough preoperative assessment, close postoperative monitoring, and an experienced surgical team to reduce complications and improve prognosis.

Hodgkin's disease or Hodgkin's lymphoma is a rare malignant hemopathy characterized by the presence of Reed-Sternberg cells. It is a lymphoid disease that the cause remains unknown. Subdiaphragmatic localized forms are rare and represent 6 to 13% [4-6]. The revelation of these forms by acute intestinal intussusception is exceptional, and attested by very few data published in the literature. We report the case of a 70-year-old patient with a rare case of subdiaphragmatic Hodgkin's lymphoma revealed by acute intestinal intussusception.

Cystic tumors of the pancreas are a rare entity, accounting for approximately 15-20% of pancreatic cystic lesions, largely due to advances in imaging techniques. The most common types of pancreatic cystic tumors are intraductal papillary mucinous tumors (TIPMP) and mucinous cystadenomas (CM), while serous cystadenomas (CS) and solid pseudopapillary tumors (TPPS) are less frequent. This study aims to report the experience of the General Surgery Department at the Avicenne Military Hospital in Marrakech regarding the diagnostic and therapeutic management of cystic tumors of the pancreas.

Aim: The aim of this observational study was to evaluate the relationship between neck pain and fatigue levels among individuals engaged in desk-based occupations. Methodology: Neck pain–related disability was assessed using the Neck Disability Index (NDI). Fatigue levels were measured using the Fatigue Severity Scale (FSS) and the Visual Analogue Fatigue Scale (VAFS). A total of 20 office-based workers (13 females, 7 males) participated in the study. The mean age of the sample was 31.30 years. The mean height was 1.64 ± 7.6 m, and the mean weight was 63.4 ± 9.8 kg. Participants completed the NDI, FSS, and VAFS questionnaires through a survey method after providing written informed consent. Results: A statistically significant negative correlation was found between NDI and VAFS scores (Pearson’s r = –0.45421, p = 0.0037). Higher neck disability was associated with greater fatigue levels. Mean scores for individual FSS items ranged from 2.76 to 4.37. Conclusion: The study demonstrated that greater neck disability is associated with increased fatigue among desk-job workers. These findings highlight the importance of posture correction, ergonomic modifications, and early screening to reduce neck-related disability and fatigue in individuals engaged in prolonged sitting occupations.

This paper examines how designers engage with sustainable materials through a practice-based methodology that integrates reflection, experimentation, and material understanding. It repositions sustainability not as a static design objective, but as a dynamic, iterative process that emerges through the act of making. By engaging with renewable, bio-based, and waste-derived materials, the research demonstrates how creative practice fosters ecological literacy and responsible production. Drawing upon design research and case-based evidence, this study argues that sustainability evolves from experiential learning, material dialogue, and systemic thinking rather than prescriptive frameworks. The outcomes emphasize the designer’s evolving role as a mediator between creativity, ecology, and technology.

Introduction: Primary tonsillar tuberculosis is exceptional even in endemic country like Morocco. the diagnosis was ‘not evocable on clinical signs because of their non specificity, diagnosis made after surgery and histological analysis.no primary location been found on radiological pulmonary exam. Case report: Herein, we report the exceptional case of a primary tonsil tuberculosis discovered in a 12 years child .no specific local or general symptom was observed. confirmation made by histology. Actually, the child is doing well under therapy. conclusion: primary tonsillar tuberculosis is exceptional, only histology can confirm the diagnosis. Thus, must make us keeping in mind this eventual diagnosis, particularly in pediatric population, every time symptoms are not specific.

This paper analyzes the effects of tariff policies on international trade flows and national competitiveness between 2018 and 2024, a time of revival of protectionism, the COVID-19 crisis, and a general surge in supply-chain disruptions. Using harmonized data sources provided by the WTO, UNCTAD, World Bank, and IMF, we implement a two-way fixed-effects gravity model in order to provide a rigorous assessment of the effect of tariff changes on trade flows between developed and developing economies. To help counter the possibility of endogeneity, we create a weighted tariff shock variable and apply system GMM regressions. We further expand the study with multidimensional measures of competitiveness such as export sophistication, logistics efficiency, and innovation capacity in order to confirm the consistency of our findings. The findings are consistent with the conclusion that increased tariffs reduce the performance of exports, and the negative effect is most pronounced in developing economies that are defined by a small industrial base and low technological potential. On the other hand, those economies that have high regional trade relations and sophisticated digital infrastructure have greater resilience to tariff shocks due to diversifying supply chains and updating technology. In our analysis, we find that there are always negative impacts on the performance of exports due to higher tariffs, but the most negative impacts were observed in developing countries that are not technologically developed and whose industrial bases are small. This paper provides practical policy advice on the need to balance short-term industrial security with long-term economic sustainability in a more globalized economy.

Background: Sportspersons often suffer from traumatic dental injuries, which can have significant impact on their appearance and physical health. Thus, immediate evaluation is critical for early management as there are no strict guidelines regarding the usage of preventive strategies. Hence present study conducted to assess the prevalence of traumatic dental injuries (TDI) among sportspersons. Material and Methods: A cross-sectional study was conducted among professional sportspersons in various sports academies in Haryana. Total sample size was 363. Data collection was carried out with the help of self-structured proforma containing sociodemographic details, knowledge, attitude, and practices and traumatic dental injuries were recorded using Ellis and Davis (1970) classification. Chi-square test was used to find out the difference between variables. Binary logistic regression applied to test the association between traumatic dental injuries and various sociodemographic and dental factors. Results: The prevalence of traumatic dental injuries was found to be 10.5%. Central and lateral incisors were the most commonly affected teeth with Ellis Class I and II injuries. Female Sportspersons and those involved in contact sports exhibited a higher susceptibility to traumatic dental injuries. The study also revealed a low level of knowledge and attitude among sportspersons towards treatment and management. Conclusion: The burden of traumatic dental injuries was higher among female sportspersons and those playing contact sports. There is requirement to create awareness among sportspersons to mitigate the effect and to reduce the incidence of traumatic dental injuries.

The BRICS block, which includes Brazil, Russia, India, China and South Africa, has become a unified economic bloc that is busily reshaping the frontiers of world governance. Representing more than forty percent of the global population and a growing portion of world GDP, BRICS expresses a different vision of multilateralism, which systematically asserts itself on the normative and institutional dominance of the Western order. This paper conceptualizes BRICS as a norm-entrepreneurial alliance that has the goal of transforming the world orders on finance, trade, and development cooperation without compromising the values of state sovereignty, policy autonomy, and South-South solidarity. This study is based on constructivist international relations theory and global political economy of institutional change to provide a complete analysis. The qualitative discourse analysis of BRICS summit declarations in 2009-2023 and policy communiqués lies in the quantitative evaluation of trade, investment, and financial-flow indicators retrieved by the World Bank, IMF, and UNCTAD. As the analysis has shown, BRICS has played a tangible role in the spread of multipolar governance norms, and it has also helped to introduce parallel institutions, including the New Development Bank and the Contingent Reserve Arrangement. Nevertheless, the capacity of BRICS to initiate a significant change is limited by internal disparities in economic power, political frameworks, and strategic ambitions between the members. The results indicate that although BRICS has a potential to promote a more inclusive and equitable international order, it is unable to do so because of profound disparities among members in economic strength, political structures, and strategic interests. BRICS exemplifies the irony of global change of shaking the existing power order and at the same time relying on it to maintain stability- the multi-faceted nature of reform and continuity that characterizes the modern age of global change. It is important to recognize this duality to comprehend the way international governance is changing in the modern multipolar and highly contested world.

Clear cell renal cell carcinoma (ccRCC) is the most common and aggressive subtype of renal cancer, accounting for approximately 75% of all kidney malignancies in adults. Despite advances in diagnosis and therapy, the molecular mechanisms underlying ccRCC progression remain incompletely understood. MicroRNAs (miRNAs), as post-transcriptional regulators of gene expression, play critical roles in cancer initiation, progression, and metastasis. This study aimed to identify key dysregulated miRNAs and their target genes involved in ccRCC pathogenesis using an integrative in-silico bioinformatics approach. Three Gene Expression Omnibus (GEO) datasets (GSE116251, GSE95384, and GSE6357) were analyzed through the GEO2R tool to identify differentially expressed genes (DEGs) and miRNAs (DEMs) using |logFC| > 1 and adjusted p-value < 0.05 as thresholds. Overlapping miRNAs were determined using the Venny tool, and their corresponding target mRNAs were predicted through TargetScan. Functional annotation and pathway enrichment of DEGs were performed using the DAVID database, while protein–protein interaction (PPI) networks were constructed through STRING. The miRIAD and OncomiR databases were employed to elucidate miRNA–gene interactions, and the OncoLnc database was utilized for survival analysis. Our analysis revealed several dysregulated miRNAs, including miR-155-5p, miR-210-3p, and miR-21-5p, along with key tumor-related genes such as VHL, PBRM1, SETD2, TP53, and PTEN, which significantly influence ccRCC prognosis. Functional enrichment analysis demonstrated that these genes are involved in critical oncogenic pathways, including the cell cycle, p53 signaling, and PI3K–Akt pathways. In conclusion, this study provides a comprehensive bioinformatic framework that highlights novel miRNA–gene interactions potentially involved in ccRCC progression. The identified molecules may serve as valuable biomarkers for diagnosis, prognosis, and targeted therapy in renal cancer, supporting further experimental validation and clinical investigation.

The world financial system is growing more volatile, and it is questionable whether the conventional reserve currencies will remain as strong as ever. This paper will look at whether the euro can meaningfully challenge the U.S. dollar’s dominance as increasing economic volatility and the appearance of new competitors like the Chinese Yuan raise this question. This paper uses a qualitative and descriptive-quantitative approach based on empirical data provided by the IMF and BIS alongside the contributions of the hegemonic stability theory, network effects, and institutional trust to study the dynamic nature of global reserve currencies. It determines the competitiveness, credibility, and limitations of key reserve currencies. The results indicate that the dollar has fallen from above 70 per cent of the world reserves to approximately 58 per cent as at mid-2024. The euro has retained a consistent portion of about 20 per cent of the world reserves, with strong legal systems and effective monetary policy, but its expansive impact is limited by the fractured fiscal system and political disintegration of the Eurozone member states. The Yuan holds approximately 4 per cent of the global reserves. Despite China’s financial influence is increasing globally, the international role of the Yuan remains limited because of China’s capital controls, managed exchange rates, and financial transparency issues. This paper concludes that there is no single currency that will take the lead in the future. Rather, the world is becoming multipolar in terms of reserve systems where the dollar, euro, Yuan, and selected digital currencies co-exist.

One of the core texts of Mahāyāna Buddhism, the Larger Sukhāvatīvyūha Sūtra, presents a deep existential and moral worldview based on compassion (karuṇā). The sutra offers a dynamic ethical framework in which compassion serves as both the ontological foundation of existence and the route to emancipation, far from being purely devotional. Moral behavior is changed into a soteriological process of self-transcendence through the vows of Amitābha Buddha, where the limited human situation opens up to boundless life (amitāyus). This study investigates the sutra's ethical philosophy using the dialectical interplay between self-power (jiriki) and other-power (tariki), revealing how compassion bridges the conflict between individual agency and universal salvation. The Larger Sukhāvatīvyūha Sūtra combines Buddhist moral theory with existential contemplation to present a vision of human fulfillment based on relationship and altruism. The thesis contends that the sutra's ethical vision goes beyond ceremonial piety to provide a universal philosophy of compassionate being applicable to both Buddhist and modern moral

Background: Thyroid carcinoma initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases. Spinal cord compression from an epidural metastatic lesion as a first symptom is extremely rare. One would expect such a presentation to occur much later in the course of the disease. Case presentation: We report an unusual case of a 57-year-old-woman with the complaint of back pain for one year. A process was detected at the corpus of L5-S1 to S3 vertebra, by the sacrococcygeal MRI. Conclusion: Spinal metastasis as initial finding is very rare in the patients with FTC. However, prognosis is quite well with total tumor resection and adjuvant treatment. This cancer type must be kept in mind for differential diagnosis and must be screened in the patients with spinal tumors.

Acquired Immunodeficiency Syndrome (AIDS) remains a major global health concern. This study explores awareness, public attitudes, and misconceptions about HIV/AIDS within a general community. A survey of 100 participants aged 18–50 years was conducted using structured questions to assess knowledge of HIV transmission routes, perceptions of openness, and social stigma. Results indicate that awareness of sexual transmission is high, but misconceptions about other transmission modes persist. Nearly half of respondents believe individuals with HIV should not disclose their status, reflecting ongoing stigma. The findings emphasize the need for continuous educational efforts to promote accurate knowledge and foster a supportive environment for people living with HIV/AIDS (PLHIV).

Background: People living with HIV (PLHIV) experience balance impairments due to neuropathy, muscle weakness, and central nervous system alterations, which increase fall risk. While most studies focus on level walking, there is limited information about motor control adaptation during gait on inclined surfaces. Objective: To determine whether postural sway while walking differs between PLHIV at risk of falls and those not at risk during flat and inclined surfaces. Methods: Thirty-two PLHIV (21 fall risk; 11 non–fall risk) completed walking trials at 0% and 8% incline. The Activities-specific Balance Confidence (ABC) Scale classifies fall risk. Postural sway parameters (RMS and centroidal frequency) were captured with accelerometers. A 2 × 2 mixed MANOVA compared groups and conditions. Results: A significant main effect of incline was observed (F(6,25) = 2.980, p = .025, partial η² = .417). Sway RMS and sagittal RMS were greater on level ground than on the incline (p < .001). No significant group differences or interactions were found. Conclusion: Inclined walking reduced sway amplitude while slightly increasing sway frequency, suggesting adaptive neuromuscular control. Incline walking may create a rigid or frizzing postural strategy in PLHIV regardless of fall-risk status. These findings highlight the importance of incorporating environmental challenges into fall-risk assessments and interventions.