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Stokes-Adams syndrome is defined as a transient loss of consciousness with spontaneous recovery after a decrease in cardiac output that leads to a state of cerebral hypoxia and may cause seizures. It is a rare and poorly documented condition. High-degree atrioventricular block, paroxysmal ventricular arrest, and pulseless ventricular tachycardia have been described as causes, and depending on the case, temporary or permanent pacemaker implantation or cardiac defibrillation may be necessary. We present the case of a 78-year-old male patient with Stokes-Adams syndrome secondary to 2:1 atrioventricular block requiring definitive pacemaker implantation without recurrence of syncopal or convulsive episodes. It is important to consider Stokes-Adams syndrome as a possible cause of syncope or seizures and that the recognition of this disease through an adequate clinical history and interpretation of paraclinical tests can save lives due to the risk of sudden death. There is not much information about this syndrome, since there are few cases reported in the literature.

Brown tumors, though rare, are significant manifestations of hyperparathyroidism, often presenting with multifocal osteolytic lesions and occasionally leading to pathological fractures. This case report details the presentation and management of a 38-year-old male with multifocal brown tumors, including a right tibial fracture, and provides a comprehensive literature review. The patient exhibited multiple osteolytic lesions in the legs, thighs, and forearms, alongside elevated serum calcium and parathyroid hormone (PTH) levels. Management included conservative fracture treatment, surgical resection of the parathyroid adenoma, and postoperative rehabilitation. Follow-up revealed significant tibial fracture healing and reduction in the size of osteolytic lesions. This report underscores the importance of timely diagnosis and comprehensive management to prevent complications and improve outcomes in patients with multifocal brown tumors.

Introduction: Persistent racial and gender disparities are prevalent within the higher education and medical training system, notably seen in the underrepresentation of Hispanic or Latinos, Black Americans, and female surgeons compared to their respective population proportions. This study aims to quantify publications addressing ethnic or gender diversity across various surgical specialties, analyze publication trends, and explore specific topics within medical literature.

Database: The Database includes PubMed, Google Scholar, and Scopus.

Methods: Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we conducted a systematic literature review utilizing the PubMed, Google Scholar, and Scopus databases. A broad inclusion criterion for both ethnic and gender diversity of plastic surgery, neurosurgery, otolaryngology, dermatology, orthopedic surgery, and gender surgery was utilized. The literature was selected between 2014 and 2024. In the content of our study, diversity in articles was defined as any article that focused on addressing gender or racial/ethnicity in the subspecialty.

Results: Of 1529 initially screened articles, 346 were included. Orthopedic surgery had the most diversity publications (n = 86), followed by general surgery (n = 67) and plastic surgery (n = 51). Significant increases in diversity publications were observed across all specialties. Orthopedic surgery showed the highest growth (+0.17 publications/year, p < 0.001), followed by plastic surgery (+0.12, p = 0.002) and general surgery (+0.11, p = 0.003). Race/ethnicity was the primary focus (51.4%), with fewer articles on gender (19.7%) or both (28.9%). Diversity topics included demographics, pipeline/recruitment, application process, training experience, leadership, and workplace treatment.

Conclusion: These insights underscore the importance of continued efforts to promote diversity within surgical specialties to enhance patient care and outcomes. Further research and initiatives are needed to ensure equitable representation in surgical fields. Addressing diversity issues in surgical specialties is essential for improving healthcare outcomes and reducing disparities.

Background: Achieving universal health coverage is one of the prominent targets of the United Nations' sustainable development goals. Reducing out-of-pocket expenditure (OOPE) is essential because high OOPE can deter the use of healthcare services, which can lead to poor health outcomes and medical impoverishment.

Objectives: The study sought to determine the effects of various factors such as Domestic General Government Health Expenditure, Gross Domestic Product, Government schemes and compulsory contributory healthcare financing schemes, and Voluntary health insurance schemes on OOPE per Capita in emerging economies.

Design: Econometric methods using panel data.

Data sources and methods: The study analyzed the publicly available panel data from the World Health Organization using fixed, random, and dynamic models.

Results: Domestic General Government Health Expenditure and Gross Domestic Product are associated with an increase in OOPE. Government schemes, compulsory contributory healthcare financing schemes, and voluntary health insurance programs are linked to a reduction in OOPE.

Conclusion: In conclusion, this study, conducted through econometric methods on panel data, sheds light on the critical importance of reducing OOPE to achieve universal health coverage, aligning with the United Nations' sustainable development goals. Countries shall implement a holistic approach focusing on preventive healthcare and health promotion, providing comprehensive health insurance, strengthening public health systems, and regulating medicine prices.

Background: There is growing concern in sub-Saharan Africa that poor-quality antimicrobial medicines may negate management of infectious diseases of public health importance should they fail to meet the set criteria of quality, safety and efficacy.

Objectives: The objective was to ascertain the quality of antiretroviral, antimalarial and antituberculosis medicines supplied and available in the public health sector in Zambia.

Design: A descriptive cross-sectional study was conducted involving the analysis of data from the continuous routine in-country post-marketing surveillance programme in Zambia that assessed the quality of antiretroviral, antimalarial and antituberculosis medicines supplied to public healthcare facilities between January 2018 and June 2023.

Methods: Data were extracted from laboratory quality analysis results from samples collected as part of routine post-marketing surveillance by the Zambia Medicines Regulatory Authority between January 2018 and June 2023. The samples were collected from various levels of the pharmaceutical supply chain across Zambia. Samples were analysed according to their respective pharmacopoeia standards at the Medicines Control Authority of Zimbabwe Quality Control Laboratory, a World Health Organization prequalified laboratory. Data were extracted using a structured Excel database and analysed using Microsoft Excel, and GraphPad Prism Software was used for visualizations.

Results: Of the 198 samples, 86 (43.43%) were antiretrovirals, 54 (27.27%) antimalarials and 58 (29.29%) antituberculosis medicines. Of these 198 samples, 171 (86.36%) originated from Asia, 19 (9.60%) Africa and 8 (4.04%) Europe. All sampled medicines met their respective quality specifications with respect to tests, which included appearance, identification, assay, uniformity of mass, weight variation, disintegration, dissolution, pH and specific gravity, giving a compliance rate of 100%.

Conclusion: Antiretrovirals, antimalarials and antituberculosis medicines obtained from public healthcare facilities in Zambia through routine post-marketing surveillance met their quality standards. This might positively impact treatment outcomes for HIV/AIDS, malaria and tuberculosis. There is a need for large-scale continuous monitoring of the quality of medicines in order to ensure quality is maintained and substandard products removed from the pharmaceutical supply chain.

Objectives: This study aimed to assess healthcare professionals' awareness and acceptance of telemedicine residing in Pakistan.

Materials and methods: A cross-sectional study was conducted across Pakistan from November 2021 to March 2022. Data entry was done through a self-administered questionnaire. In this survey, the non-probability purposive sampling method was adopted. Medical doctors from all specialties that fall into the age category of 20-60 years were included in this study. Statistical Package for Social Sciences (SPSS) version 22.0 was used for univariate data analysis.

Results: Among the 860 healthcare professionals who received the survey, 198 responded (23.0% response rate). The mean ± SD age of the participants was 31.16 ± 8.56. The results were found to be statistically significant for knowledge about telemedicine among healthcare professionals workplace, that is, healthcare professionals working in the private sector indicated a high level of awareness regarding telemedicine as compared to those in the public sector (p = 0.03). A significant difference (p-value ⩽ 0.05) in knowledge was seen among doctors working in the public sector and those working in a private setup. Results indicate significant positive associations between telemedicine utilization and perceived benefits over disadvantages (β = 1.03, p = 0.017), reliance among healthcare professionals (β = 1.22, p = 0.008), and enhancement in healthcare quality (β = 1.42, p = 0.001). Moreover, familiarity with telemedicine correlates strongly with its usage (β = 2.56, p < 0.000).

Conclusion: Overall, healthcare professionals exhibited satisfactory knowledge regarding telemedicine and showed an accepting attitude toward telemedicine. Our study recommends enhancing the importance of Telemedicine training at the Healthcare professionals' level to produce quality service delivery in healthcare organizations.

Background: Community pharmacies play a vital role in promoting the rational use of medicines by providing medication counseling to their clients to ensure the safe and appropriate use of medicines. Thus, this study aimed to assess awareness of the rational use of medicines and the medication counseling practice in community pharmacies.

Methods: A descriptive cross-sectional study was conducted from June to July 2021. The study was carried out in community pharmacies in Nyamagana district, Mwanza, Tanzania. Data were collected using a self-administered, semi-structured questionnaire. The data for descriptive statistics were entered in Microsoft Excel and analyzed using STATA version 15.

Results: A total of 68 pharmaceutical personnel participated in this study. Thirty-eight participants, that is, 55.9%, were aware of the rational use of medicines. The awareness was significantly influenced by the participant's age and profession. The majority of the dispensers practiced rational use of medicines by telling their clients the dose of the medicine (n = 63, 92.6%), frequency of administration (n = 61, 89.7%), and route of administration (n = 60, 88.2%). However, only 21 (30.9%) told clients about the need to comply with their medications. The information that was not regularly provided by dispensers to clients was the side effects of medicines (n = 6, 8.8%). Less than a quarter of participants frequently told their clients information regarding why the medicine is prescribed, drug interactions, storage conditions, and contraindications.

Conclusion: This study has shown that almost half of the participants were aware of the rational use of medicines. There was a low frequency at which information was given regarding medication compliance, side effects, storage conditions, drug interactions, and contraindications. These findings underscore the need for targeted interventions to enhance pharmaceutical personnel's understanding of rational use of medicine principles and improve their practice of patient medication counseling.

Background: Diarrhea is a significant global health concern, particularly among children, and its impact is particularly pronounced in countries with limited resources and ongoing conflicts, such as Yemen. Diarrheal diseases remain one of the leading causes of morbidity and mortality in children under the age of 5 years worldwide.

Objectives: The aim of our study is to assess the treatment patterns and counseling of community pharmacists regarding the management of acute diarrhea in children in Yemen.

Design: A simulation-based cross-sectional study was carried out targeting community pharmacy professionals in Sana'a city.

Methods: A questionnaire and simulated client methods were used to assess the pharmacists' evaluation of a case based on five indicators including the child's age, diarrhea frequency, presence of fever, and blood or mucus. In addition, the pharmacists' recommendations and counseling were also evaluated.

Results: During the study, a total of 100 pharmacists were visited and evaluated using both a questionnaire and simulation. The results demonstrated that 43.0% of the pharmacists utilized all five indicators in the questionnaire, with a mere 3.0% using all five indicators in the simulation. Oral rehydration solution (ORS) alone was recommended by 42.0% of the pharmacists and in combination with other drugs by 47.0% in the questionnaire, and the rest (11.0%) recommended only other drugs; while in the simulation, 7.0% of the pharmacists referred the patients to clinic, only 6.0% recommended ORS alone, 47.0% gave ORS plus other drugs including antibiotics, and 40.0% dispensed only antibiotics. In regards to counseling, 89.0% of pharmacists reported that they would explain to the patient regarding the recommended medicine during the questionnaire, and only 36.0% gave any sort of explanation to the simulated client.

Conclusion: In the current study, community pharmacists did not ask enough questions to accurately evaluate a child with acute diarrhea during the simulation. This finding has apparently differed from their responses in the questionnaire. Furthermore, the pharmacists failed to provide sufficient dietary advice, and their recommendation of ORS was inadequate.

Objectives: This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe.

Methods: A systematic literature review of quantitative evidence in English and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool.

Results: Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare.

Conclusion: Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.