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This case report highlights complexities in an intellectually disabled adult who ingested a chicken bone, resulting in a rare complication—superior thyroid artery injury. Presentation, diagnostic challenges, and a multidisciplinary approach are detailed. Initial attempts at esophagoscopy under general anesthesia were hindered by blood coughing, leading to a change of plan. Subsequent findings revealed mucosal edema and continuous bleeding from the site. Challenges in anesthetizing intellectually disabled individuals are emphasized, stressing tailored induction methods. The case concluded with successful embolization but developed neurological complication which was successfully managed showcasing the significance of a collaborative and adaptable approach.

Abstract Chronic Limb Threatening Ischemia (CLTI) is a challenging clinical problem associated with high morbidity and mortality. Endovascular interventions have been the cornerstone of treatment whenever possible. It is estimated that CLTI represents

Abstract Background Youth engagement refers to the collaboration between researchers and youth to produce research. Youth engagement in health research has been shown to inform effective interventions aimed at improving health outcomes. However, limited evidence has identified promising practices to meaningfully engage youth. This synthesis aims to describe youth engagement approaches, frameworks, and barriers, as well as provide both evidence-based and youth-generated recommendations for meaningful engagement. Main body This review occurred in two stages: 1) a narrative review of existing literature on youth engagement and 2) a Youth Advisory Council (YAC) to review and supplement findings with their perspectives, experiences, and recommendations. The terms ‘youth engagement’ and ‘health research’ were searched in Google Scholar, PubMed, Web of Science, Scopus, and PsycINFO. Articles and non-peer reviewed research works related to youth engagement in health research were included, reviewed, and summarized. The YAC met with research team members and in separate youth-only forums to complement the narrative review with their perspectives. Types of youth engagement include participation as research participants, advisors, partners, and co-investigators. Barriers to youth engagement were organized into youth- (e.g., time commitments), researcher- (e.g., attitudes towards youth engagement), organizational- (e.g., inadequate infrastructure to support youth engagement), and system-level (e.g., systemic discrimination and exclusion from research). To enhance youth engagement, recommendations focus on preparing and supporting youth by offering flexible communication approaches, mentorship opportunities, diverse and inclusive recruitment, and ensuring youth understand the commitment and benefits involved. Conclusions To harness the potential of youth engagement, researchers need to establish an inclusive and enabling environment that fosters collaboration, trust, and valuable contributions from youth. Future research endeavors should prioritize investigating the dynamics of power-sharing between researchers and youth, assessing the impact of youth engagement on young participants, and youth-specific evaluation frameworks.

Carcinoid crisis is a potentially fatal condition with severe hemodynamic instability. A 25-year-old female with metastatic pancreatic neuroendocrine tumor with recurrent carcinoid crises was posted for surgical debulking. Intraoperatively, the patient was on crisis during manipulation of the lesion by the surgeon, which was unresponsive to octreotide, infusions of phenylephrine, and norepinephrine agents. The patient was then effectively managed with adrenaline blouses at 10 µg along with infusion of adrenaline. Use of inotropes and vasopressors is not encouraged in carcinoid due to release of inflammatory mediators which can precipitate the hemodynamic instability. Here, we managed her with adrenaline boluses and infusion.

The main of the study is to comprehend how the mean variance efficient frontier method may be used in conjunction with Markowitz portfolio theory to produce an optimal portfolio. The study uses daily observations 8 pharma companies closing price namely Auropharma, Granules, Glaxo, Lauruslabs, Pfizer, Sanofi and Torntpharma. Further, Nifty pharma index is considered as benchmark index to check the performance of the chosen companies. The study chosen the reference period from 2020 to 2023 and required data has been extracted from the National Stock Exchange (NSE). This research is based on implementing a stochastic method for efficient portfolio optimisation employing a blended Monte Carlo and Markowitz model. In order to forecast the price of these indices in the future and to determine the likelihood of profit or loss while investing in a portfolio of stocks representing the aforementioned indices, the study also uses Monte Carlo simulation. The study involves two algorithms, namely the deterministic optimisation algorithm, which uses Markowitz Portfolio Theory, and the probabilistic optimisation algorithm, which uses Monte Carlo simulation. The study employed correlation matrix to find the exist relationship between the chosen companies and benchmark index. Also, expected return and volatility has been identified with the help of standard deviation using Python. The study found that the NIFTY Pharma index offers a higher return of 14.35. In addition to this, NIFTY Pharma portfolio’s volatility is considerably higher. The study concludes that the NIFTY pharma portfolio is more suitable for those investors who have an appetite for risk.

BackgroundThe transition from pediatric to adult care poses a significant health system–level challenge impeding the delivery of quality health services for youth with chronic health conditions. In Canada and globally, the transition to adult care is regarded as a top priority in adolescent health in need of readily applicable, adaptable, and relevant national metrics to evaluate and benchmark transition success across disease populations and clinical care settings. Unfortunately, existing literature fails to account for the lack of engagement from youth and caregivers in developing indicators, and its applicability across chronic conditions, primary care involvement, and health equity considerations. ObjectiveOur proposed study aims to establish a consensus-driven set of quality indicators for the transition to adult care that are universally applicable across physical, developmental, and mental health conditions, clinical care settings, and health jurisdictions. MethodsUsing an integrated knowledge translation (iKT) approach, a panel comprising youth, caregivers, interdisciplinary health care providers, and health system leaders will be established to collaborate with our research team to ensure that the study methodology, materials, and knowledge dissemination are suitable and reflect the perspectives of youth and their families. We will then conduct an iterative 3-round Online Modified Delphi (OMD) study (n=160) to (1) compare and contrast the perspectives of youth, caregivers, health care providers, and health system leaders on quality indicators for transition; and (2) prioritize a key set of quality indicators for transition applicable across disease populations that are the most important, useful, and feasible in the Canadian context. Using the RAND/UCLA Appropriateness Method (RAM) multistage analytic approach, data from each panel and stakeholder group will be examined separately and compared to establish a key set of indicators endorsed by both panels. ResultsThe study is funded by the Canadian Institutes of Health Research and Physicians Services Incorporated. ConclusionsThis study will produce quality indicators to evaluate and inform action equitably to improve transition from pediatric to adult care for youth and their families in Canada. International Registered Report Identifier (IRRID)PRR1-10.2196/60860

Background: The present study was conducted to estimate the prevalence of oral carcinoma and precancerous lesion, oral healthcare seeking behaviour and identify accessible areas of tobacco cessation centres and oral healthcare facilities among Irular adult tribes residing in Pondicherry. Objectives: 1. To estimate the prevalence of oral carcinomas and precancerous lesion by using toluidine blue solution. 2. To determine their oral healthcare seeking behaviour in terms of utilizing oral healthcare facilities. 3. To identify accessible tobacco cessation centres and oral healthcare centres for prevention of oral cancer. Materials and Methods: A cross-sectional study is designed to identify oral carcinomas, oral health-care seeking behaviour among Irular tribes of Pondicherry. 1% toluidine blue solution prepared for detection of oral precancerous lesion. Data was collected using a questionnaire and clinical examination. The collected data was subjected to statistical analysis. Results: Out of 587 study population, oral mucosal lesion among the study population was 46 (7.8%) leukoplakia and 18 (3.1%) candidiasis. Positive health seeking behaviour 24 (41.7%) was observed. Conclusion: The study concluded that low prevalence of oral precancerous lesion and oral healthcare seeking behaviour is poor.

Introduction: The objective of this study is to evaluate the role of minimally invasive surgery for the management of necrotising pancreatitis in acute settings and to propose tailor-made approaches to deal with various locations of pancreatic necrosis. Patients and Methods: Three hundred and thirteen patients underwent laparoscopic management of necrotising pancreatitis in this study period from January 2010 to June 2021, out of which 122 patients underwent minimally invasive necrosectomy for acute necrotising pancreatitis. The remaining 191 patients underwent laparoscopic internal drainage in the form of cystogastrostomy/cystojejunostomy for walled-off pancreatic necrosis. Results: Mean body mass index was 26.45 ± 3.78 kg/sqm. Mean operating time was 56.40 ± 20.48 min and mean blood loss was 120 ± 31.45 mL. Ten patients required reoperation (6 underwent open procedure and 4 underwent laparoscopic redo necrosectomy). Six patients died of multi-organ failure. The mean duration of return of bowel function was 5 ± 1.8 days. The mean length of hospital stay after surgery was 10.19 ± 7.09 days. There were no major wound-related complications. Conclusion: A minimally invasive approach to pancreatic necrosectomy is safe and feasible with good outcomes in centres with advanced laparoscopic expertise. It requires not only careful case selection but also proper timing and the ideal route of access to achieve optimal outcomes.