Introduction: This study aimed to showcase the innovation process and strategy applied and implemented in the Ministry of Health and Prevention (MOHAP) – United Arab Emirates as a case and how it is helped in coping with the changing environment in the field of healthcare. Methods: A comprehensive review of literature was conducted to provide an overview of the current research on the topic, particularly focusing on the MOHAP innovation strategy. Results: MOHAP's innovation system has established a supportive environment that has enabled employees to create numerous innovative projects and ideas. Discussion: This, in turn, has led to an improvement in the services provided to the customers. Furthermore, it's worth noting that MOHAP is consistently striving to enhance their innovation system. Conclusion: The strategy and processes implemented brought innovation in the organisation to new levels of functioning. It is essential to acknowledge and foster such continuing processes of innovation, rather than exclusively focusing on innovations as externally created 'things' that await 'implementation.'

Background: Hypoxia, or low oxygen, is a condition that is characteristic of solid tumours, including cervical cancer. Hypoxia is associated with worse survival in this disease and supports tumorigenic characteristics of stemness, survival, metastasis and angiogenesis, as well as immune resistance. Aims: In this work, we aimed to determine the prognostic significance of a previously derived in vitro eight-gene hypoxia signature in cervical cancer, and to investigate the interplay between the hypoxic and immune features of the cervical tumour microenvironment (TME). Subjects and Methods: The 240 patients with cervical squamous cell carcinoma obtained from the Cancer Genome Atlas Pan-Cancer study were first given a hypoxia score and an immune score (IS) and subsequently subjected to survival analysis. CIBERSORTx was also applied to determine the fractions of immune cells residing in the hypoxia high versus hypoxia low patient groups. Results: We show that the eight-gene hypoxia signature is predictive of worse prognosis in patients with cervical cancer and is associated with a less immunogenic TME. Furthermore, by combining the hypoxia score with an IS to stratify patients based on both their hypoxic and immune status, we achieve an enhancement in survival prediction, with the hypoxia high/immune low subgroup of patients showing the worse probability of overall and disease-specific survival. Conclusions: It is clear from this work that the interplay between the hypoxic and immune microenvironment can contribute to cervical cancer patients' survival. Furthermore, patients with tumours that are both highly hypoxic and immune deprived should be considered for hypoxia-targeted therapy when planning treatment modalities to improve survival.

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Background: An important component of the mother-and-baby-friendly birthing facility is respectful maternity care (RMC) during delivery. Aims and Objectives: The objectives of this study were to identify resident doctors' and staff nurses' opinions on the provision of RMC at their workplace, to explore the association between opinion on RMC and respondent's characteristics, and to explore the perceived barriers. Materials and Methods: A facility-based observational, descriptive study of the cross-sectional design was thus conducted among 78 resident doctors and staff nurses posted in the labour room of the study hospital. Data were collected by a predesigned, self-administered questionnaire. Variables included were demographic, service related and opinion on prevalent RMC practice at the respondents' workplace. SPSS version 17 was used for data analysis. Results: Providers' mean age was 30.5 years, and the mean work experience of 3.1 years. About two-thirds of the respondents were resident doctors and 83.3% were female. More than 60% of providers were trained on RMC. Providers reported desirable practices on most items related to RMC except in providers introducing themselves to women, allowing birthing companions and allowing women to assume the position of choice. Opinion about RMC was significantly associated with training status. Uncooperative women were considered the most important barrier to providing optimum RMC. Conclusion: It can be concluded from this study that training providers can reinforce good practices related to RMC and improve the quality of care at birth.

Background: Bladder cancer is the most common malignancy of the urinary tract. Pre-operative tumour staging and grading play a significant role in treatment planning and prognosis estimation for bladder cancer. Aims and Objectives: This study aims to evaluate the utility of multiparametric-magnetic resonance imaging (mp-MRI) in detecting and staging bladder cancers and hence its role in final management. Materials and Methods: A total of 40 patients with documented urinary bladder mass undergoing mp-MRI before transurethral resection of bladder tumours for primary bladder cancer were identified and compared with post-operative histopathological reports. The data were collected and analysed using SPSS software. Results: The mean age in the study population was 53.68 ± 13.2 years, including 7 (17.5%) females and 33 (82.5%) males. Twenty-three (57.5%) of our patients had muscle invasion on the MRI pelvis. In muscle-invasive urothelial carcinoma, there were significantly more patients with Vesical Imaging-Reporting and Data System (VIRADS) 3, VIRADS 4 and VIRADS 5 than in non-muscle invasive urothelial carcinoma. The proportion of patients with VIRADS 1 and VIRADS 2 on MRI pelvis was significantly lower in muscle-invasive urothelial carcinoma than in non-muscle-invasive urothelial carcinoma (P = 0.0001). Histopathology and muscle invasion on the MRI pelvis agree well in the current study (κ = 0.742; P = 0.0001). There was an overall concordance rate of 87.5% and an overall discordance rate of 12.5% between histopathology and muscle invasion on the MRI pelvis. The sensitivity, specificity, area under the curve, positive predictive value, negative predictive value and diagnostic accuracy of the mp-MRI scan were 87.5%, 87.5%, 0.88, 91.3%, 82.35% and 87.50%, respectively. Conclusion: The mp-MRI and VIRADS scoring is an effective comprehensive tool with satisfactory sensitivity, specificity and diagnostic value for detecting muscle invasiveness of primary bladder cancer. We recommend VIRADS scoring for all bladder cancer patients for better pre-operative staging and overall management.

Background: Untreated dental problems can have a negative impact on the health and well-being of affected individuals, and delayed treatment would lead to serious oral problems. The outbreak of COVID-19 has shut down many dental care services, and this has deferred dental treatment for many. Assessing the effect of pending dental treatment will clarify the role and importance of dental services in maintaining and controlling oral health. Aims and Objectives: This study was carried out to explore the impact of COVID-19 on pending dental treatment among United Arab Emirates (UAE) residents. Assessing the importance of dental services, studying patients' self-management of symptoms, comparing the most affected categories, and determining the demand of developing a forward strategy in case of a future pandemic. Methodology: A cross-sectional study was designed using a pre-tested questionnaire published in an online survey among UAE residents that included participants from all seven emirates. Consent was conducted from each participant after ensuring anonymity and confidentiality. The collected responses were tabulated and subjected to statistical analysis. Appropriate tests of significance were used, and a P< 0.05 was considered statistically significant. Results: The analysis showed about 34.2% of the participants had pending dental treatment due to COVID-19. The most deferred treatment was orthodontic treatment by 18.6% of participants. The commonly affected oral region was the teeth, where toothache was the most reported oral symptom. Conclusion: The findings showed that the pandemic had a significant impact on the dental health of UAE residents due to postponed treatment. It is suggested to raise the level of awareness and the shifting of the dental care paradigm to preventive strategies has to be developed according to the new guidelines focusing on reducing the risk factors of oral cancer. The new strategies emphasise dental health promotion, topical fluorides and nutritious diet. Oral health messaging and actions should be incorporated in pediatric offices and primary health-care facilities. Moreover, allocate mandatory periodic dental checkups for compromised patients. Dentists should consider alternative strategies to address these deferred treatments during such pandemics.

Background: Silver nanoparticles (AgNPs) are extensively used in numerous engineering and biomedical fields. Inhaled nanoparticles can induce lung inflammation and translocate into secondary organs including the liver. However, the possible impact of these nanoparticles on the liver received only scant attention, especially following intratracheal (i.t.) instillation in an animal model of hypertension. Aims and Objectives: Here, we evaluated the hepatotoxicity and mechanism of action of polyethylene glycol (PEG)-coated AgNPs in a mouse model of hypertension. Materials and Methods: Mice were made hypertensive (HT) by inserting osmotic minipump infusing angiotensin II (ANG II) or vehicle (control) normotensive (NT). Either saline (control) or PEG-AgNPs (0.5 mg/kg) were i.t. instilled on days 7, 14, 21 and 28 post-ANG II or vehicle infusion. Twenty-four hours after the last exposure (day 29), lung histopathology and several markers of liver function, inflammation, oxidative stress, DNA damage and apoptosis were evaluated in all mice. Results: In comparison with either saline-treated HT group or PEG-AgNPs-treated NT group, lung histology of PEG-AgNPs-treated HT mice showed more focal areas of widening of interalveolar septae with inflammatory cells consisting mainly in macrophages and neutrophil polymorphs. In PEG-AgNPs-treated HT mice, the activities of lactate dehydrogenase, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase and alkaline phosphatase in plasma were increased, compared with either saline-treated HT or PEG-AgNPs-treated NT mice. Similarly, markers of hepatic oxidative stress (lipid peroxidation, glutathione and catalase), inflammation (interleukin [IL]-6, IL-1 β and tumour necrosis factor α), DNA damage (8-hydroxy-2′-deoxyguanosine) and apoptosis (cleaved caspase-3) were significantly increased in PEG-AgNPs-treated HT mice, compared with either saline-treated HT or PEG-AgNPs-treated NT mice. Conclusion: Our data provide novel evidence on the aggravation of liver damage following pulmonary administration of PEG-AgNPs in hypertension through mechanisms involving inflammation oxidative stress, DNA damage and apoptosis.

Background: Before starting the coronavirus vaccination drive in children, it is necessary to know about the knowledge, attitude and perceptions of the parents regarding vaccinating their children. This study aimed to explore the knowledge of the parents of children aged <12 years on coronavirus infection and vaccine and to assess their beliefs and attitude about COVID vaccination amongst the 0–11 years of age group. It also aimed to find out the factors to prefer government facility for COVID vaccination. Materials and Methods: An observational, descriptive, hospital-based cross-sectional study was conducted by interviewing parents who attended Medical College, Kolkata, during November–December, 2021. The data were analysed with the Statistical Package for Social Sciences (SPSS). Results: A total of 106 respondents were interviewed (50.9% males and 49.1% females). All the respondents heard about coronavirus disease and vaccines, almost everybody knew how to prevent transmission of the virus. 56.6% respondents were aware of the correct age group for vaccination and 77.4% considered the vaccines to be safe. Regarding the factors amongst parents to prefer government facilities, significant associations were found with the level of education, employment status, number of children and vaccination status of the parents. Statistical significance level was at P< 0.05. Conclusion: Majority of parents considered existing vaccines as safe for children and almost everyone thought of vaccination as social responsibility. Most parents wanted the vaccines to be given from immunisation clinics or through schools. They also had a clear preference for government facilities.

Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.

Rationale: Mesenteric cysts are rare abdominal tumours that can originate from any part of the mesentery of the bowel but have been found mostly in the mesentery of the small bowel. Patient Concerns: Because they lack specific clinical signs, mesenteric cysts can be difficult to diagnose. Diagnosis: Especially when there are concomitant abdominal conditions. In some circumstances, these cysts can grow to considerable sizes making resection almost impossible as different structures can be compromised. Intervention: Surgery is the treatment of choice as complete resection is the only curative treatment. Outcome: We present the case of a 27-year-old pregnant female patient who presented with recurrent abdominal pain and was discovered to have calcular cholecystitis along with a huge mesenteric cyst. She underwent laparoscopic cholecystectomy with complete excision of the mesenteric cyst without the need for bowel resection and anastomosis.

Rationale: Primary mesenteric leiomyosarcoma is a very rare finding. It is seen predominantly in the seventh decade and is very rare in the young. Fine needle aspiration cytology is the initial diagnostic procedure in soft tissue lesions, followed by excision biopsy. Patient Concerns: Herein, we present a rare case of primary multiple mesenteric leiomyosarcoma in a 19 year old female, who presented with abdominal lump and pain since the last 4 months. Diagnosis: CT scan of abdomen showed multiple large multiloculated masses in the sub-hepatic space and sub-diaphragmatic region, which seemed to be arising from the mesentery. The uterus and cervix were normal. Fine needle aspiration cytology of the mass revealed fascicles of spindled cells with elongated, blunt ended fusiform nuclei admixed with dispersed cells or stripped nuclei. Some cells showed pleomorphism with occasional intranuclear vacuoles. Grossly the resected specimen was multiple nodular, brown, soft to firm, with the largest measuring 8.5x8x2.5 cm and the smallest 2.2x2.2x1 cm in size. On microscopic examination, sections showed fascicular pattern of atypical spindle cells having cigar shaped nuclei showing pleomorphism and eosinophilic fibrillary cytoplasm with 1-2 mitotic figures/10HPF. Immunohistochemistry with SMA showed strong diffuse cytoplasmic positivity and desmin showed mild focal cytoplasmic positivity in the tumor cells. A diagnosis consistent with primary multiple mesenteric leiomyosarcoma was given. Interventions: Wide surgical excision of the mass lesion was performed. The patient was subsequently administered 6 cycles of 5- Fluorouracil based chemotherapy. Outcomes: She is recovering well after 2 month of follow up period. Lessons: Our case will widen the vision of both physicians and pathologists to consider the possibility of primary mesenteric leiomyosarcoma in young females, presenting without any involvement of female genital tract, thus guide in the proper diagnosis and management of such lesions.