American Journal of Medical and Clinical Research & Reviews

Breast Conserving surgery is a suitable option for early breast carcinoma in a conservative society of middle income country - early experiences

Afrina Sharmin — 2025-07-15

Introduction: Breast conserving surgery now a days are most common preferred surgery for breast cancer patients other then mastectomy . Oncoplastic Surgery can be a safer, more cost effective alternate to conventional BCS owing to its higher rate of negative surgical margins and better cosmetic results. In Asian countries, the rate of Breast conservation surgery is low and the cause are multifactorial such as availability and accessibility of investigation, infrastructure ,oncology and pathological support and surgeon’s choice. Aim is to elucidate the surgeons’ perspective while choosing between BCS and mastectomy, in women oncologicaly eligible for BCS.

Methods: A retrospective study in Z.H.Sikder Women’s Medical College Hospital,a single Centre based study by reviewing patient’s medical records from August 2021 to July 2023 was conducted. Percentage of patient agreed for breast conservation surgery along with mean tumor size, type of cancer and different surgical procedures with postoperative complication was assessed.

Results: A total of 199 patients were eligible for BCS but 75.87% patients showed unwillingness to go for BCS. 48 patients responses were included who underwent for BCS. The mean age of the participants was 43 years and of the 48 patients in the study, 46 had unilateral and 2 had bilateral BC. 74.37 % of patients tumor size was 1-2 cm . 5 patients received NACT; none achieved a complete clinical response. Majority of (73.9%) of tumor biology shows ER, PR positive and HER 2 negative. 36 patients diagnosed with IDC and second common cancer id ILC . Breast conservation surgery was the commonest surgery to remove the cancer and 27 patients had WLE and glandular repair. 21 patients required level II oncoplastic techniques. No major complications or local recurrences were observed.

Conclusions: Implementing breast-conserving surgery as the standard of care breast cancer patients where appropriate. Breast-conserving surgery is not only safe, but also highly beneficial in terms of aesthetics, body image, and quality of life. Adoption of these techniques into practice can increase indications of BCT and requires a team approach for best success.

Preimplantation Genetic Testing for Aneuploidy (PGT-A) on Blastocyst Quality, Vitrification Timing, and IVF Outcomes: A Comparative Study

Roya Rozati — 2025-07-01

Background: Preimplantation genetic testing for aneuploidy (PGT-A) is increasingly applied in assisted reproductive technologies, particularly among individuals with advanced maternal age or a history of recurrent pregnancy loss. By enabling the selection of chromosomally normal embryos, PGT-A may improve implantation rates and pregnancy outcomes following the initial embryo transfer. This study aims to compare ICSI outcomes, blastocyst quality, and vitrification timing between PGT-A and control groups to assess the reproductive outcomes

Methods: A retrospective cohort study was conducted at a MHRT Hospital and Research Center, Hyderabad, involving patients undergoing Intracytoplasmic Sperm Injection (ICSI) cycles between March 2022 and March 2025. The study included 52 PGT-A and 52 control patients, with Baseline characteristics, embryological parameters, blastocyst quality, vitrification timing, and reproductive outcomes were assessed. The PGT-A group included embryos that underwent aneuploidy testing via trophectoderm biopsy. Blastocyst expansion, inner cell mass (ICM) quality, trophectoderm (TE) grading, and vitrification day were compared between the two groups.

Results: Patients in the PGT-A group were older and had higher rates of primary and female-factor infertility. Hormonal profiles and oocyte retrieval outcomes were comparable between groups. The PGT-A group was older (mean age 36.2 vs. 33.7 years) and had higher proportions of primary infertility (71.15% vs. 59.61%) and female infertility (61.53% vs. 42.3%). Both groups had more or less similar oocyte retrieval numbers, but the Control group had more prior ICSI cycles. Regarding blastocyst quality, the PGT-A group exhibited higher proportions of grade 3 and grade 6 blastocysts, with a better ICM grade (B) and TE grade (A). The Control group had a higher proportion of grade 4 blastocysts. Additionally, more embryos in the Control group were vitrified on Day 5 (76.92% vs. 61.53%), while the PGT-A group showed a higher proportion vitrified on Day 6 (38.46% vs. 23.07%), these differences did not translate into superior clinical outcomes. The cumulative live-birth rate was slightly lower in the PGT-A group (75%) compared to controls (83.69%). Secondary outcomes, including biochemical, clinical, and ongoing pregnancy rates, were also lower in the PGT-A group. Singleton and twin birth weights were marginally reduced in the PGT-A cohort.

Conclusion: PGT-A is associated with higher-quality blastocysts, particularly in terms of ICM and TE grading. It also influences vitrification strategies, with PGT-A embryos more likely to be vitrified on Day 6. These findings suggest that PGT-A may improve embryo quality, potentially enhancing ICSI outcomes, especially in older women or those with recurrent implantation failure. However, further studies are necessary to refine patient selection criteria and evaluate cost-effectiveness and ethical concerns associated with PGT-A.

The Hidden Light in the Therapeutic Space: From Ancient Mystical Wisdom to Contemporary Therapeutic Transformation

Julian Ungar-Sargon — 2025-07-20

This paper explores the application of Or HaGanuz (Hidden Light), a foundational concept in Jewish mystical tradition, to contemporary therapeutic practice. Drawing on the evolution of this concept from Midrashic origins through Zoharic development to Chassidic psychology, particularly as articulated in the Me'or Einayim of Rabbi Menachem Nachum of Chernobyl, this analysis proposes a framework for understanding and facilitating therapeutic transformation that transcends conventional biomedical paradigms. The paper argues that the "hidden light" within patients—representing their deepest potential for healing and transformation—becomes accessible through therapeutic approaches that combine rigorous clinical practice with contemplative awareness, sacred listening, and recognition of the divine-human encounter inherent in healing relationships. This framework offers clinicians practical tools for accessing deeper dimensions of therapeutic engagement while maintaining clinical integrity and evidence-based practice.

Increasing Hospital Performance and Cost Management: A Systematic Approach Review and Meta-Analysis Study

Adel Ahmed Alfayez — 2025-07-20

Introduction: Enhancing hospital efficiency while managing costs demands collaborative efforts and strategic interventions. This research evaluates existing evidence to identify effective strategies for improving operational performance without compromising patient care quality.

Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Studies published between 2015 and 2024 were extracted from PubMed, Scopus, and Google Scholar, yielding 400 records. After screening, 30 high-quality studies were included. Statistical analysis was performed using IBM SPSS Statistics (version 29.0) to calculate pooled odds ratios (OR = 0.25, 95% CI: 1.22–1.27, p < 0.0001).

Results: The study found a number of ways to lower costs, including telemedicine (25%), Plan-Do-Study-Act cycles (35%), lean management (20%), digital workflows (22%), EHR systems (28%), and automation tools (25%). Subgroup analysis showed smaller hospitals benefited most from telemedicine, while larger hospitals gained from digital solutions. Heterogeneity was moderate (I² = 43.45%), with variations based on hospital size and geographic location.

Conclusion: This research underscores the transformative potential of evidence-based interventions in optimizing hospital efficiency. By integrating strategies like telemedicine and process improvement cycles, hospitals can achieve sustainable cost management and better patient outcomes. Policymakers should prioritize ongoing evaluations to adapt strategies to evolving healthcare demands.

A Capacidade do Tribunal De Recurso (Máximo Tribunal De Justiça) Na Preparação Jurídico De Timor-Leste (2025)

Alexandre Gentil Corte-Real de Araújo — 2025-07-04

Introdução: Com base no artigo, 118.^o da Constituição República Democrática Timor-Leste, os Tribunais são explicitamente apresentado como “órgãos de soberania”, nos do art. 67.^o da CRDTL, os tribunais devem ser considerados com titulares independentes do poder do Governo por Direito constitucional próprio. Assim, à função básica dos tribunais é a de preservar o Estado de direito a justiça. E este é função do poder judiciário de aplicar e interpretar as leis a fim de resolver os litígios de forma que possam os surgir ao seu abrigo de implementação. As decisões judiciais têm de ser consideradas como vinculativas e suficientes por si só na prática de aplicação do tribunal de recurso em Timor-Leste por leis.

Objetivos de Pesquisa: Para apresentar aos cidadãos que os nossos países que ainda preparado de funcionar e existem o supremo tribunal, mas a lei está a permitir para ser existir no futuro, nos termos alínea a) do n^o 1.^{o no} art. 123.^oConstituição de Timor-Leste e para introduzir melhor sob a capacidade e função dos tribunais que existente em Timor-Leste, nomeadamente a capacidade do supremo tribunal da justiça que as leis estão atribuídas, e vão ser ajudar também os cidadãos começam a ter mais conhecimentos de cada órgão de soberania no país.

Metodologia da Pesquisa: Servir-se o método de revisão da literatura ou metodologia dedutiva, são as referências de leitura dos autores nos livros na biblioteca, revistas científicas, artigos, pesquisas no campo, por meio de internet e as ideias, opiniões do nosso jurista na implementação.

Conclusão: Os cidadãos podem perceber melhor as tantas decisões que normalmente dadas pelo tribunal recurso na qualidade com supremo tribunal da justiça sob a sua matéria no âmbito em que uns cidadãos querem apresentam o recurso ao tribunal de recurso. Em Timor-Leste deste supremo tribunal da justiça em discussão por lei que existe, apenas o tribunal de recurso de acordo com a Lei no futuro vai ser realizado melhor citado por (Corte Real AG., et al, 2025).

A Framework for Transformative Healthcare Practice

Julian Ungar-Sargon — 2025-07-04

Contemporary healthcare finds itself at a crossroads. While technological advances have revolutionized our capacity to diagnose and treat disease, something essential seems missing from the healing encounter. Patients report feeling like numbers rather than persons, while healthcare providers experience unprecedented levels of burnout and moral distress (1,2). This disconnect suggests that our current paradigms, rooted in scientific reductionism and Cartesian dualism, may inadvertently fragment the very human experiences they seek to heal.

This essay proposes an integrative framework that honors both scientific rigor and the sacred dimensions of healing. Rather than abandoning evidence-based medicine, we argue for expanding our understanding of what constitutes evidence to include the profound ways that meaning, relationship, and transcendence influence health outcomes. Drawing from diverse fields—neuroscience, medical anthropology, trauma research, and theological scholarship—we outline twelve interconnected themes that could transform healthcare practice while maintaining its scientific foundation.

The framework we present here emerged from years of clinical practice working with patients whose suffering exceeded the boundaries of conventional diagnostic categories. Time and again, we encountered individuals whose healing required not just medical intervention but restoration of meaning, connection, and hope. These encounters forced us to grapple with fundamental questions: What does it mean to heal? How do we honor both the biological and spiritual dimensions of human suffering? Can medicine embrace mystery without abandoning rigor?

Literature Review Outline: Fasting, Endothelial Dysfunction, and Autoimmune Diseases

Adawi Mohammad — 2025-06-24

Intermittent fasting (IF) has emerged as a promising non-pharmacological intervention to mitigate cardiovascular risk and systemic inflammation in patients with autoimmune diseases. This review explores the mechanistic links between IF and improved endothelial function, with a focus on oxidative stress reduction, immune modulation, and metabolic reprogramming. Evidence from in vitro, animal, and early-phase human studies indicates that IF enhances nitric oxide availability, reduces pro-inflammatory cytokines, and promotes vascular protection through ketone body production and autophagy. While benefits such as improved flow-mediated dilation and decreased markers of vascular inflammation have been observed, significant challenges remain regarding the variability of fasting protocols, individual response, and the scarcity of long-term randomized controlled trials. Tailored fasting strategies, supported by omics approaches and circadian alignment, may provide a valuable adjunct in managing cardiovascular complications in autoimmune populations. Further research is essential to clarify the safety, efficacy, and personalization of IF regimens in this context.

Central Venous Pressure Catheter Malposition from Right Internal Jugular Vein into the contralateral innominate vein: A Rare complication

Vishnu Datt — 2025-07-20

CVCs are inserted for many different indications in cardiac surgery and ICU. These include administering drugs (anaesthetic and vasoactive agents, antibiotics, chemotherapy), monitoring central venous pressure (CVP)or hemodynamic monitoring, measurement of central venous oxygen saturation (SCVO2), renal replacement therapy, total parenteral nutrition, poor peripheral venous access, cardiac catheterization, and transvenous cardiac pacing. Despite the level of skill of the operator and the use of ultrasound guidance, CVC placement can result in CVC malposition.

Easy and uncomplicated catheterisation, free aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the IJV catheter. Though, placement of a catheter through the RIJV is associated with the lowest incidence of malposition.

Ultrasound, ECG guidance, real-time X-ray imaging, surgical confirmation either by palpation in SVC or visualized in the RA, and saline injection test are definite confirmation and dramatically increase the successful placement of needles, guidewires, and catheters, but significant numbers of catheter misplacements can still occur, particularly if operators are not fully proficient in such techniques. A case of RIJV inserted CVP catheter malposition has been reported in 57 years old, 61 kg and 155cm height with short and thick neck patient presented with triple vessel CAD posted for OP-CABG surgery. Postoperative Chest X-Ray revealed a right sided CVP line catheter malposition in the contralateral innominate vein. Even though, the malposition of the CVP catheter inserted via RIJV is less frequently reported.

Potential Health Risks Associated with Cosmetics and Personal Care Products: An Overview

Satyapriya Roy — 2025-07-20

Cosmetics are substances used on the face or body to enhance look. They purify, enhance beauty, encourage attractiveness, and change how the body looks. The history of humanity and civilization parallels the idea of beauty and cosmetics. Women utilize a variety of cosmetic products, notably those related to skincare, hair, fragrances, oral hygiene, and nails, all of it can contain harmful substances that are terrible for our health. This study employs an integrated method for reviewing the literature, as outlined by Whittemore and Knafl, 2005. This study links potential health issues documented in the scientific literature to the primary hazardous chemicals found in cosmetic items. In the composition of cosmetic products, the cosmetic industries are currently using more chemicals with preservative activity, surfactants, perfumes, stains, etc. These compounds improve the quality, characteristics, and durability of cosmetics; however, many of them are poisonous to humans and pose health hazards, it might vary in severity from a mild allergic reaction to a deadly intoxication of dangerous substances, such as talc, parabens, mineral oil, triethanolamine, coal tar dye, phthalates, scent, lead, arsenic, nickel, cadmium, and mercury, are found in most cosmetic goods. Over time, the body's bioaccumulation of these dangerous chemicals and metals has been linked to several health issues such as cancer, developmental and reproductive abnormalities, contact dermatitis, hair loss, lung damage, aging, skin diseases and reactions, allergies, and nail damage. Inhaling perfumes, deodorant, nail polish, scented powder, etc., or absorbing through the penetration of toxic chemicals from body creams, moisturizers, cleansers, eye shadow, etc. are two ways that dangerous chemicals and metals can enter the body. Another way is by oral consumption of metals and compounds found in lip balms, glosses, lipsticks, etc.

Accepting changing workplaces for inclusive quality education for pluralistic populations in host countries

Susan Anne Smith — 2025-07-04

Adult learning theories aim to be a process; thus, the growth of populations in Australia and globally must investigate the learning needs from a constructivist perspective. Constructivism has a reflexive and contextual knowing perspective as self-determination. In European and Australian literature, organisations must understand the growing and changing populations. How can a democratic society offer learning through training for a pluralistic population in a host country?

The business model offers an understanding of people's cultural norms, habits, and traits to understand others. Literature from Google searches for the descriptions originated in several learning titles such as curriculum, fairness, and inclusive training.

Cultural sensitivity and normative commitment are training needs for immigrant people who need curricula to help retain individuals. Implications are that many educational sectors that attract immigrant people for profit must understand that resilience belongs to others' values.

The Influences Related with the Frequency of Neonatal Suffocation in Babies at the Maliana Hospital Timor-Leste (2025)

Carlos Boavida Tilman — 2025-07-04

Introduction: Perinatal suffocation is considered one of the major causes of brand-new deaths and neurological sequelae in babies, resulting from maternal-fetal conditions or complications during childbearing. The description by the Maliana Hospital showed that 201 babies died after birth and that 151 died at the age of 0-6 days and 8 died aged 7 to 28 days.

Research Objective: To analyze the issues related with the frequency of neonatal suffocation at the Maliana Hospital, Municipality of Bobonaro Timor-Leste.

Research Methodology: Reconducted a descriptive and analytical study of quantitative approach, collecting a sample of 100 records of babies of mothers with risk issues and used the Network of Reflection on Register of the midwife and the medical doctor.

Research Results: As motherly risk influences, 61% of mothers have parity higher than four broods, and maternal pathologies in the sample include Hypertension 37%, Preeclampsia/Eclampsia 25%, Anemia 25% and Diabetes 13%. Regarding the Hypertension, with mild degree 63%, and severe 38%; Preeclampsia/severe eclampsia 60% and mild 40%; in the degree of Mild Anemia (7 to 9 g/dl) 88%, and severe (<7g/dl) 12%; Type I Diabetes is 54% and Gestational Diabetes 46%; finally, premature membrane rupture is found in 51% of the sample. As for fetal risk issues for neonatal suffocation, polyhidrosis 30%, Man Condon 13%, Infection 31%, Weight <1500 grams 13%, Inadequate weight for gestational age 28%. In the risk influences on associated with delivery, we verified Forceps Delivery 13%, Prolapse of the cord 9% and Short Umbilical Cord 8%. In the evaluation of APGAR indices at the 1 minute verified or severe in 48 babies 62% and mild 39%; at 5^aminute, the APGAR Index was grave at 59% and 41%, lastly, it was found that in the APGAR index at 10 minutes, then Gave classification decreased 4%, and leave or moderate 7%. At 10 minutes 89% of the sample.

Conclusion: Hospitals, health centers and Integrated Family in SISCa, should promote the four minimum visits for pregnant women, in order to create a program of activities, such as home visits to define the rich influences of mothers. Pregnant women need to deliver with midwives and mothers in a controlled and safe environment to reduce the brand-new and post-neonatal mortality rate according to government by Ministry of Health program (Tilman CB., et al, 2025).