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Among the greatest threats is the ongoing human-mediated spread of invasive iguanas from Central and South America, which are destroying the endemic insular lineages through multiple diachronic introgression events.Because of their ability for aerial dispersal using silk and preference for open habitats, many wolf spiders are formidable colonisers. Pioneering arachnologists were already aware of the large and colourful wolf spiders in the Madeira archipelago, currently included in the genus Hogna Simon, 1885. The origins were investigated and species boundaries of Madeiran Hogna examined by integrating target-gene and morphological information. A multi-locus phylogenetic analysis of a thorough sampling across wolf-spider diversity suggested a single origin of Madeiran endemics, albeit with low support. Divergence time estimation traced back their origin to the late Miocene, a time of major global cooling that drove the expansion of grasslands and the associated fauna. Morphological examination of types and newly collected material revealed a new species, hereby described as H.isambertoi Crespo, sp. nov. Additionally, H.blackwalli is revalidated and three new synonymies are proposed, namely H.biscoitoi Wunderlich, 1992, junior synonym of H.insularum Kulczynski, 1899, H.schmitzi Wunderlich, 1992, junior synonym of H.maderiana (Walckenaer, 1837), and Arctosamaderana Roewer, 1960 junior synonym of H.ferox (Lucas, 1838). Species delimitation analyses of mitochondrial and nuclear markers provided additional support for morphological delineations. The species pair H.insularum and H.maderiana, however, constituted an exception the lack of exclusive haplotypes in the examined markers, along with the discovery of intermediate forms, pointed to hybridisation between these two species as reported in other congeneric species on islands. Finally, the conservation status of the species is discussed and candidates for immediate conservation efforts are identified.This commentary article highlights the status of clinical pharmacy education in Nepal, explores the challenges and solutions in sustainably reintroducing Post-Baccalaureate Doctor of Pharmacy (PharmD, Post-Bac) in Nepal, as was previously launched by Kathmandu University (KU) Department of Pharmacy in 2010, and suggests a few prospects forward. Clinical pharmacy practice has remained on the sidelines and subordinate to physicians in Nepal. KU launched the PharmD (Post-Bac.) as a postgraduate program to establish the professional identity of clinical pharmacists in the country. However, despite unremitting efforts, the program did not thrive long and held since 2014. This paper aimed to explore challenges that remained at the forefront of the program and provide possible solutions for its reintroduction. The KU produced three batches of PharmD Post-Bac. graduates and now the revival of the program is crucial. Undoubtedly, a well-trained clinical preceptor can bring significant changes in the quality and competency of the PharmD graduates. Advocacy programs to foster the role of clinical pharmacists in the patient care services and revisiting of Bachelor of Pharmacy (BPharm) curriculum to complement the necessity of the PharmD program are needed. The non-sustenance of the PharmD program is emblematic of the dire mosaic that the clinical pharmacists are facing while delivering patient-oriented services in the country. Hence, strategies need to be formulated for the revival and sustainability of the program.

The 2020 COVID-19 crisis affected all sectors, including education. This study explored the experiences and challenges faced by tertiary students in the United Arab Emirates when they were suddenly required to transition from traditional classroom learning to E-learning following the outbreak of COVID-19.

This cross-sectional study used mixed methods to collect and analyse qualitative and quantitative data. The participants were Nursing students involved in clinical training.

Most students (87%) reported inexperience with studying via E-learning. Challenges encountered included the lack of privacy, Internet connection issues, problems with the teaching platform and communication difficulties. Some students also reported that instructors were slow at responding to their needs. The lack of robust internet coverage was a major overarching issue that affected communication, students' engagement, preparedness for E-learning, and other challenges.

This study is significant because it highlights the challenges experienced by Nursing Students during the rapid transition from traditional education to e-learning. It enables the faculty to understand and support students during the time of crisis. Communication with students needs to be streamlined for successful E-learning. Authorities should provide more essential infrastructure such as reliable and stable Internet connectivity to strengthen the E-learning approach.

This study is significant because it highlights the challenges experienced by Nursing Students during the rapid transition from traditional education to e-learning. It enables the faculty to understand and support students during the time of crisis. selleck chemical Communication with students needs to be streamlined for successful E-learning. Authorities should provide more essential infrastructure such as reliable and stable Internet connectivity to strengthen the E-learning approach.

Motivation to pursue health professions education may stem from external incentives such as wealth, fame, and popularity. For others it is for internal reasons like the desire to serve society. In this study, we aimed to identify what influences students' choice for an undergraduate health professions program at Makerere University College of Health Sciences (MakCHS).

A cross-sectional qualitative study was conducted among first-year undergraduate students pursuing bachelor degrees in medicine and surgery (MBChB), nursing (BNur), pharmacy (BPharm), medical radiology (BMR), and dental surgery (BDS). A self-administered questionnaire with open-ended questions was distributed to the students during a tutorial session in the second week of the first semester (academic year 2010/2011). Completed questionnaires were entered into a Microsoft Access database. Median (Interquartile range-IQR) and frequencies of respondents were used to describe the study sample. Content analysis with emergent coding was used to analyze the qualitative data.

Overall, 145 students (response rate = 72%, N = 201) with a median age of 20 (IQR 19-20) years responded to the study. The majority of the participants were male (75.2%, n = 109), and were pursuing MBChB (65.5%, n = 91). Two themes identified showed that students appeared to be motivated by internal motivation and external motivation factors. Personal desire, and a calling to serve, were the significant internal motivating factors, while nature of the education system and the need to upgrade were prominent external motivating factor.

Multiple factors that are both extrinsic and intrinsic influence the choice for medical education among health professions student at this African institution.

Multiple factors that are both extrinsic and intrinsic influence the choice for medical education among health professions student at this African institution.Jenunoileal atresia is a congenital defect that causes small bowel obstruction in newborns. They are classified into 5 types and simple abdominal x-ray can aid in the diagnosis and with prompt resuscitation and surgery provides positive outcome. We present a 5-day-old newborn male baby was presented with features of intestinal obstruction since birth. Diagnosis of atresia of the small bowel was made through plain abdominal x-ray and was successfully operated. During the recovery, the baby developed surgical site infection which was managed promptly.Dyspnea is reported in a minority of patients affected by coronavirus disease 2019 (COVID-19). Even patients with pneumonia can present hypoxemia without any respiratory distress, a phenomenon known as "silent" or "happy hypoxemia". During the current pandemic there were only a few studies conducted on this subject and these were quite heterogeneous. Therefore, the prevalence of "silent hypoxemia" varied substantially. While studies did not show a clear tendency of "silent hypoxemia" to poorer outcomes compared to hypoxemia presenting with dyspnea, several showed that patients with "silent hypoxemia" are not protected from poor outcomes either. There is a need for a uniform definition of "silent hypoxemia", in order to better guide clinicians and investigators. More studies are needed to shed light on the mechanisms of "silent hypoxemia", as well as its presentation and influence in the disease's progression and outcomes, so as to better assist physicians in the care of COVID-19 patients.Hemodialysis catheter fracture with distal embolization is a rare complication. The natural process of retained asymptomatic hemodialysis is unclear. This is a report of an iatrogenic fracture of the tip of the hemodialysis catheter in an adult patient who was successfully retrieved using an image-guided endovascular technique. In the event of catheter fracture with distal embolization, percutaneous retrieval is the treatment of choice.A 70-year-old man was referred to our department for evaluation of nephrotic syndrome. Renal biopsy revealed membranous nephropathy (MN). Immunohistochemical analysis demonstrated IgG4-positive staining in the glomeruli and interstitial cells. The presence of serum anti-phospholipase A2 receptor (PLA2R) antibody and enhanced staining of PLA2R in the glomeruli was noted. Computed tomography unidentified the extrarenal lesions of IgG4-related disease. He was diagnosed with PLA2R-associated MN possibly complicated with IgG4 related kidney disease (IgG4-RKD). Storiform fibrosis, a typical manifestation of IgG4-RKD, was not apparent. We herein describe a case of serologically and histologically confirmed PLA2R-associated MN with IgG4+ cell infiltration into the interstitium without any signs of IgG4-RD.

Total knee arthroplasty is associated with considerable perioperative hemorrhage. The decrease in hemoglobin concentration and the need for allogenic blood transfusion are related to increased morbidity and mortality. Strategies for minimizing perioperative bleeding are used, such as tranexamic acid and cell salvage. The study aimed to compare intravenous, intra-articular tranexamic acid and cell salvage protocols regarding perioperative hemoglobin variation. Secondary outcomes included blood loss; allogenic transfusions; complications and in-hospital stay.

Patients submitted to unilateral total knee arthroplasty between January and December 2018 were retrospectively evaluated. After excluding 62 patients, 204 were subdivided into 3 groups according to the protocol used. Statistical analysis was performed with SPSS version 26.0. One-way ANOVA and Kruskal-Wallis tests were used. Considered a p-value of <0.05 for statistical significance.

Variation of hemoglobin in the intra-articular tranexamic acid group was significantly lower than that of intravenous (p < 0.001) and cell salvage (p = 0.001) groups. Blood loss, variation of hematocrit, need for blood transfusion and in-hospital stay were also statistically significantly lower in the intra-articular tranexamic acid group. The only related complications were in the intravenous tranexamic acid group. No thromboembolic complications were identified which further solidifies the safety of tranexamic acid administration.

This data shows superiority of the intra-articular administration of tranexamic acid over the other techniques in total knee arthroplasty. We propose this protocol as an efficient, low-risk blood-sparing strategy.

This data shows superiority of the intra-articular administration of tranexamic acid over the other techniques in total knee arthroplasty. We propose this protocol as an efficient, low-risk blood-sparing strategy.