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Neuroendocrine tumors (NETs) have varied pathophysiological characteristics, location, clinical presentation, management & outcome. Unfortunately, most NETs are non-functional and therefore, either remain asymptomatic until incidentally detected or present very late with pressure symptoms, adding up to the associated morbidity and mortality. Here we presented a case of a 43-year gentleman, who presented to gastroenterology OPD with chief complaints of heartburn and pain in the upper abdomen for one year. He had an equivocal clinical examination and laboratory parameters. Upper GI endoscopy and computed tomography revealed multiple nodular growths in the D1 segment and pylorus of the stomach. He was successfully managed by wide local excision of D1 and distal stomach (pylorus) followed by Polya gastrojejunostomy reconstruction. Histopathology confirmed well-differentiated NETs, low Ki67, and positive for chromogranin and synaptophysin. This case draws attention to the early age of presentation of multifocal NETs with vague symptoms and equivocal clinical examination. Coexisting gastric NETs with duodenal NETs in itself is very rare, never the less non-functional status and pre-operative diagnostic dilemma. Here, we have also drawn attention to the pros and cons of various diagnostic tools and how their utility can sometimes limit the approach of clinicians, apart from a high index of suspicion.
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Background: Visual impairment presents a significant public health concern globally, with a notable impact on individuals' quality of life. Despite efforts to address this issue, unmet eye health needs persist, particularly in vulnerable populations such as truck drivers in low and middle-income countries like India. The RAAHI (National truckers eye health programme) initiative aims to fill this gap by providing essential eye care services in India. Methods: This research manuscript delves into the journey of the RAAHI programme from 2017 to 2022, assessing its achievements, challenges, and lessons learned. A mixed-methods approach involving a secondary review of literature, programme records, and stakeholder interactions was employed. Quantitative analysis of beneficiary demographics and service utilization trends was complemented by qualitative insights from beneficiary feedback and stakeholder interviews. Results: RAAHI demonstrated a significant presence across 54 locations, screening over 540,000 beneficiaries between 2018 and June 2022. The programme primarily targeted truck drivers, addressing their unmet eye health needs and raising awareness about prevalent health conditions. Beneficiary feedback highlighted overall satisfaction with RAAHI services, emphasizing the programme's structured approach and immediate access to quality spectacles. Furthermore, qualitative analysis suggests RAAHI's success enriching the programme's effectiveness and client-centric approach. Conclusions: These findings offer valuable insights into addressing visual impairment among vulnerable populations and advocating for the integration of eye care into public health initiatives. Additionally, the study highlights the importance of sustained efforts and collaborative partnerships in ensuring the success and scalability of programmes like RAAHI.
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Background: Benign Prostate Hyperplasia (BPH) is a prevalent condition among older males, characterized by an enlarged prostate gland leading to lower urinary tract symptoms and impacting quality of life. Transient receptor potential melastatin (TRPM) genes regulate various physiological processes. Methods: We studied 194 BPH patients and 194 healthy controls, genotyping six selected TRPM gene SNPs. PSA levels were measured using the Cobas® e411 analyzer. Results: Prostate-specific antigen (PSA) levels were significantly higher in BPH patients (135.76±578.03 ng/mL) than in controls (2.01±1.09 ng/mL). TRPM2 (rs168355) and TRPM7 (rs2362295) genotypes were significantly associated with elevated PSA levels. The TRPM2 GG genotype was associated with decrease in the likelihood of severe PSA levels (OR=0.34, 95% CI: 0.12-0.96, P=0.034), while the TRPM7 CC genotype showed increased odds for severe PSA levels (OR=1.48, 95% CI: 1.08-3.56, P=0.041). Conclusions: Our findings suggest a potential link between TRPM gene variants and the severity of prostatic changes reflected in PSA secretions, indicating the need for further research to understand the underlying mechanisms and clinical implications.
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A validated liquid chromatography with tandem mass spectrometry (LC-MS-MS) technology was developed for the quantification of infigratinib, using a simple and specific approach. This method utilizes a liquid-liquid extraction (LLE) strategy to achieve high sensitivity. The analytical approach that was developed underwent validation in terms of many characteristics including specificity, sensitivity, carry-over, recovery, precision, matrix effect, accuracy, and stability. The elution of the drug and IS occurred in a time frame of 6.5 minutes using a PhenomenexSB-C18 column (250 × 4.6 mm x 5 ?m). The mobile phase consisted of a mixture of acetonitrile and 0.1% v/v formic acid in water, with a ratio of 80:20. The infusion flow rate was set at 0.9 mL/min. The retention times (RT) of infigratinib and IS were determined to be 5.12 and 3.31 minutes, respectively. The elution time required for complete separation of infigratinib was 6.5 minutes. The equation of the linear regression line was determined to be y = 0.994x + 2.662, and the coefficient of determination (r2) was calculated to be 0.999. The coefficient of variation (%CV) obtained for the calibration graph of infigratinib was determined to be less than or equal to 3.73. The matrix effect was assessed by calculating the coefficient of variation (%CV) for the High and low quality control (QC) samples, yielding values of 1.64 and 0.70% respectively.
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Juvenile ossifying fibroma (JOF) is a cancerous bone condition that mainly affects the facial bones, particularly the jaw and upper jaw. This review article provides an overview of JOF, covering its signs, difficulties in diagnosis, radiographic characteristics, histopathological features, and current treatment strategies. The exact cause of JOF is still uncertain, leading to debates about whether it originates from a tumor growth, abnormal development, or reactive response. The way JOF presents clinically can vary greatly, emphasizing the importance of an approach when evaluating patients with facial swellings. Radiographically, JOF appears as a defined area of bone with varying degrees of mineralization. Clinical and histopathological findings must be combined with the results to diagnose this condition accurately. Histopathologically, JOF is characterized by increased tissue and mineralized components that create a two-phase pattern. Surgical treatment options range from removing the affected area to complete resection; however, achieving surgical margins can be challenging and may lead to recurrence due to its ability to infiltrate surrounding tissues. Reconstruction using either bone grafts or artificial materials is necessary for lesions caused by JOF. Long-term follow-up that includes imaging techniques is crucial due to the likelihood of recurrence in JOF cases. Various factors, such as the extent of removal and the aggressiveness of the lesion, influence recurrence rates. Highlight the complexity involved in managing JOF—emerging developments in procedures and understanding at the level offer promising possibilities for focused treatments. A comprehensive approach to managing JOF includes collaboration between healthcare experts, educating patients, and providing support. It is essential to continue research endeavors and promote data sharing to unravel the complexities surrounding JOF, improve precision and treatment approaches, and enhance well-being.
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In the field of endodontic therapies, the use of antibiotics, especially in the form of root canal medications, plays a pivotal role in ensuring successful treatment outcomes. This review examines the role of triple antibiotic paste (TAP) in such therapies, delving into its composition, application, and effects on endodontic infections. TAP, a combination of metronidazole, ciprofloxacin, and minocycline, targets the diverse microbial flora in odontogenic infections. Its local application within the root canal space proves more effective than systemic administration, significantly reducing microbial count and aiding in tissue regeneration and disinfection. However, the use of TAP is not without challenges, as it can cause tooth discoloration, particularly due to minocycline, and raise concerns about antibiotic resistance and long-term biocompatibility. This study, conducted through a comprehensive literature search, evaluates the efficacy of TAP, its impact on tooth structure, and its role in maintaining the vitality of diseased pulp. The findings highlight TAP’s significant role in endodontic treatments, emphasizing its benefits in achieving therapeutic goals while acknowledging the need for careful consideration of its drawbacks.
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Background: Technology continues to impact various spheres of life, including learning. Over the years, eLearning has experienced a steady rise in popularity. At Kenya Medical Training College (KMTC), the influence of technology on education became more noticeable due in part to a policy directive. This directive, prompted partly by the COVID-19 pandemic, emphasized adopting online teaching to address the loss of instructional hours. This study addressed a specific gap in KMTC's internal quality assurance efforts by accumulating evidence related to the extent of E-learning and user satisfaction. Methods: The study employed a descriptive cross-sectional design, utilizing qualitative and quantitative techniques. It involved KMTC campuses conveniently selected from the Coast and Nairobi regions, with 1139 students selected through simple random, stratified, and proportionate sampling methods. A mixed questionnaire (both open and closed-ended questions) was used to collect data. Specifically, the study aimed to assess the level of eLearning utilization among students in selected KMTC campuses and identify the determinants of this utilization. Results: Most of the respondents (89.2%) participated in online classes; 11.8% of those who did not participate cited reasons such as lack of gadgets, bundles, and poor internet connectivity, among others. Despite widespread e-learning utilization, 76.8% of learners strongly preferred face-to-face classes. Conclusions: Key factors linked to e-learning utilization included effective instructional strategies, quality technical support, and well-conducted online classes. The choice of communication channels, particularly platforms like WhatsApp, was strongly linked to e-learning utilization. Therefore, this study recommends that KMTC should acknowledge the strong preference for face-to-face classes and offer hybrid learning options. Further, the KMTC should address accessibility challenges and competing responsibilities at home by supporting data connectivity, ensuring user-friendly online platforms, and providing flexible scheduling options for diverse learner needs.
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Background: The untoward events of COVID-19 led to the enforcement of work from home (WFH) for nearly every wage earner across the globe. One of the several fields that saw its implications was the IT sector. We conducted the following study to understand how the IT techies have been affected by the shift in their workspace- from their cubicles at work to the tables at home and the implications of this shift on their general and mental health. Methods: A cross sectional study was conducted in January 2021. A Google form was circulated among IT professionals. Sample size was calculated by universal sampling technique. Data collected was entered in MS Excel and analysed using SPSS version 26. Results: Among the 47 received responses, the mean age group of the study sample was 20-30 years. 73.9% felt that personal obligations interrupted their work which led to increased frustration. There is also a rise in the incidences of backpain and eyestrain. The mean stress score of the study sample was 17.85±5.729 and though 80.9% felt they had a comfortable place at home to work, 62.52% of them wished to return to their workplace. Conclusions: Better innovative strategies need to be thought of and implemented to help employees have an efficient work-life balance.
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Background: Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease of the airways and lung parenchyma and the risk factors include both genetic and environmental factors. Tobacco smoking has remained the most important risk factor associated with it. The occurrence of COPD in non-smokers is not widely appreciated, even though its relative burden is higher in developing countries than developed countries. There is limited information on the risk factors associated with spirometrically confirmed COPD in non-smokers in the general population and more data from population-based studies are needed. Hence, the objective of this study was to determine the prevalence of COPD and associated risk factors among non-smokers in rural areas of Lucknow district, Uttar Pradesh, India. Methods: This cross-sectional study with multi-stage random sampling was conducted among 552 non-smoking participants aged 18 years and above in rural areas of Lucknow. It was conducted using pre-designed questionnaire for data collection. COPD assessments were done using a combination of clinical history and portable spirometry. Data collected was analysed using SPSS 23.0 version. Results: FEV1/FVC <0.7 was used to define COPD which yielded a prevalence of 8.5 percent among non-smoking participants. Gender, occupation, type of family, presence of ex-smoker, presence of dampness and livestock in the house were the risk factors that showed statistically significant association with COPD. Conclusions: The higher prevalence noted in this study highlights the need for enhanced community-based screening programme for secondary prevention of COPD among adults.
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Background: Intimate partner violence includes all forms of aggression by former or current intimate partner. It accounts to 1.3 million deaths annually. Women of reproductive age, 18% globally have experienced physical and sexual forms of IPV. IPV cases ranges from 55% and 46% respectively in Africa and South Asia.COVID-19 has seen increase of IPV by 5% among WRA. IPV among WRA increases incidence of suicide, abortion and depression. Methods: Descriptive cross-sectional study design was used. Stratified 2 stage random sampling and simple random sampling techniques were used. Sample size was 229 WRA. Primary data was collected using a self-administered questionnaire, KIIS and FGDS. Data analysis was carried out through both descriptive statistics and inferential analysis findings were presented in percentages and pie charts. Results: Age category of 26 -33 years, participants who are casual workers, alcohol consumption by partner, length of relationship, level of education and culture were significantly associated with physical, psychological, sexual and economic violence.66.80%of the participants did not know about the policies on IPV and the available community level services to combat IPV was majorly reconciliation of couples by the local chiefs. Conclusions: The health system factors that facilitates support of IPV was not in line with SDGs Goal 5: Gender equality and SDGs Goal 16: Peace, justice and strong institutions. A large number of respondents (79.5%) reported unavailability of health facilities linked to social, health and legal services to support victims of IPV.
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Background: Benign prostate hyperplasia (BPH) results in the enlargement of the gland and ultimately obstructs the bladder and the kidney. The effect on the kidney results in the dysregulation of the electrolyte causing electrolyte imbalance. Methods: An analytical cross-sectional study conducted at a tertiary teaching hospital aimed at assessing the levels and severity of electrolyte imbalance among BPH patients. The blood samples were analyzed for electrolytes and PSA levels for both patients and control group. An Independent t-test was used to compare the means of the BPH patients and healthy control subjects. Chi-square was used to determine the association between the electrolyte imbalance and the PSA levels of the BPH patients. Results: The mean age of the BPH patients and the healthy individuals was 65.47�.55 and 64.52�.19 years respectively. Hyponatremia, and hypernatremia were observed in 26.08% (n=104) and 4.22% (n=8) of the BPH patients respectively. There was a statistical significance positive correlation between potassium (K) and sodium (Na) concentrations (r=0.350, p<0.01), as well as a notable positive association between chloride (Cl) and magnesium (Mg) levels (r=0.288, p<0.01). PSA biomarker levels varied among the patients. There was a statistical significance (<0.0001*) difference in PSA levels between the BPH patients and the control group. Conclusions: With high prevalence of electrolyte imbalance among BPH patients there is a need to monitor the electrolytes and PSA levels in the management of BPH aiming at restoration of kidney function.
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Background: Changes in the liver function test may serve as an early marker for timely diagnosis and identification of patients who may develop severe dengue. The purpose of this study was to examine the link between dengue fever severity and liver function test. Methods: This prospective observational study was conducted in the Department of General Medicine, Madhesh Institute of health sciences, provincial hospital, Janakpurdham in which we included dengue positive patients (aged 18 years or more) based on NS1 antigen or high titer on IgM/IgG testing from July 2023 till August 2023. We excluded patients with diseases like malaria, cirrhosis of liver, enteric fever, viral hepatitis or any other disease or taking any medication which can derange LFT. Results: We included 96 patients fulfilling the study criteria. Of these, 71% had DF, 22% had DHF and 7% had DSS. Among liver enzymes, mean AST of the patients was significantly higher in DSS group of patients (775.19�.65 U/l), as compared to those in the DF and DHF group of patients, p value <0.01. Similarly, mean ALT of the patients was significantly higher in DSS group of patients (387.8�.6 U/l), as compared to those in the DF and DHF group of patients, p value<0.01. On the contrary, mean alkaline phosphatase levels were similar between the three patient groups. Conclusions: Based on the results our study, we conclude that raised AST and ALT levels were significantly associated with severity of DSS and DHF. Patients with dengue infection should have a baseline liver function test and subsequent LFT monitoring to detect early hepatic impairment.
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Individuals with special needs may have conditions that are either present from birth, arise from environmental factors, or are acquired later in life. These conditions can significantly restrict their ability to engage in everyday activities, such as self-care tasks and essential life activities. Special needs encompass a wide range of conditions, including physical, developmental, mental, sensory, behavioral, and emotional impairments. These individuals may face challenges in communication and cooperation during dental treatment. Various medical conditions, such as cardiovascular diseases, hypertension, diabetes, bleeding disorders, and pregnancy, also impact endodontic care. Management strategies include careful evaluation, the use of general anesthesia, and minimizing technical compromises. Dental professionals deal with individuals in their everyday routines who suffer from a variety of medical conditions and special circumstances The review further discusses considerations for patients with bleeding disorders, diabetes, lung disorders, HIV, and those undergoing cancer treatment. Finally, it highlights the unique challenges of providing endodontic care to elderly patients and COVID-19-positive individuals, emphasizing the importance of safety protocols during the pandemic.
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While cervical swellings usually are located in anterior midline like thyroglossal cyst, thyroid swellings, or in antero-lateral aspect of neck like cold abscess, branchial cyst, lymphangioma, cervical lymphadenopathy etc. Nape of the neck swelling is even less common with differentials including lipoma, sebaceous cyst, lymphangioma, etc. Hydatid cyst (HC) is often missed as a differential resulting in intraoperative surprises. This case report might change the mind of the readers to keep HC in back of their minds while approaching a case of swelling of the neck. Here we report a case of 15 years’ female who presented with swelling of nape of neck which on evaluation was inclining towards lipoma/epidermal cyst. With an intention for surgical exploration and excision, the patient was taken for operation, where we discovered it to be HC and the same was later confirmed by histopathology as well. Because of its rare presentation the primary diagnosis of HC is often missed out in spite of having sensitive cytology and imaging modalities. Hence, by reporting this case we intend to emphasize six facts a clinician, a radiologist and also a pathologist must consider while keeping primary HC at an unusual site as a differential diagnosis.
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Aims/ Objectives: Effect of soil propagation media and bio-fertilizers on seedling germination and seedling vigour in Aonla.Study Design: Completely Randomized Block Design.Place and Duration of Study: Research Field, Department of Fruit Science, College of Horticulture, Mandsaur, Madhya Pradesh during 20th February 2021 to 05th April 2021.Methodology: The experiment was laid out using Completely Randomized Block Design with 18 different combinations of growing media. In the preparation of media and filling of polybags the soil was sieved and mixed FYM, Vermicompost and Neemcake in the ratio of 1:1:1:1 then added the bio-fertilizers.Results: In this study we found that treatment GM18- Soil + Neemcake + Vermicompost + FYM + Rhizobium + Trichoderma spp. @ 2.5 g found minimum days taken to seed germination (10.00 days), maximum number of seedlings sprouted (13.32), maximum survival percent (81.03%), maximum germination percentage (94.54%), maximum seedling height (8.94 cm), maximum number of leaves per plant (7.27), maximum leaf area (17.80 cm2),maximum fresh weight of shoot (4.34 g), maximum dry weight of shoot (2.21 g), maximum length of roots (7.21 cm), maximum diameter of roots (1.05 mm), maximum fresh weight of roots (1.04 g), maximum dry weight of root (0.44 g), maximum speed of germination (7.56), maximum mean daily germination (3.53), maximum peak value (1.33), maximum germination value (4.68).Conclusion: On the basis of results obtained in present investigation it is concluded that treatment GM18 (Soil + Neemcake + Vermicompost + FYM + Rhizobium + Trichoderma spp. @ 2.5 g) was found to be the best for seed germination characters and seedling vigour characters.Directions of Further Use: The experiment should be done with different concentrations of growth regulator to find the best combination.
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Pain management in neonates, infants, and children is a complex and challenging aspect of healthcare, with a high prevalence of undertreatment. Efforts have been made to improve pain assessment and implement effective interventions. Pharmacological approaches include non-opioid analgesics, opioids, and adjuvant analgesics, while non-pharmacological interventions involve physical techniques and cognitive behavioral strategies. Pediatric pain management requires considering developmental stages, individual variability, and emotional factors. Accurate pain assessment, weight-based dosing, and involving parents are crucial. Minimizing procedural pain and addressing psychosocial aspects contribute to better outcomes. Comprehensive pain management is necessary to prevent long-term consequences and enhance recovery. However, there is a persistent gap between evidence-based guidelines and clinical practice, indicating the need for further education and training. Implementation of pain management protocols and multidisciplinary approaches involving healthcare providers, psychologists, physical therapists, and educators are essential. By adopting these strategies, healthcare providers can improve the quality of life for pediatric patients, reduce the burden on the healthcare system, and mitigate the long-term impact of untreated pain.
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Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood neurodevelopmental disorder. There are various genetic and social factors implicated in the development of ADHD. One of the factors is parenting style. Thus, the present study was undertaken to assess the various parenting styles present in the population and the statistical association between parenting style and ADHD prevalence. Methods: A cross- sectional study among 470 primary school students was undertaken in Mysuru district. Oral assent from students and written consent from parents was obtained for collection of data. Data was entered in MS Excel and analysed using Chi- square/Fisher's Exact test. p<0.05 was considered to be statistically significant. Results: The present study found that majority of mothers and fathers were supportive towards their children, 260 (56.4%) and 246 (53.02%) respectively. It was found that majority of the parents 324 (68.93%) preferred to sit down and reason with their children. ADHD scores for inattention showed a statistical significance with father’s parenting style (p= 0.044). However, mother’s parenting style did not show any association with ADHD scores. Conclusions: The development of regular, structured parent management programmes would be helpful in improving parents' knowledge about ADHD children and changing their attitudes towards them.
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Background: Cervical cancer is the second most common cancer among women in India even though it is a vaccine preventable disease. Women ever undergone a screening for cervical cancer in India is only 1.7% in rural (NFHS-5). The focus of this study was to identify the factors affecting cervical cancer screening among rural women of Chengalpattu district. Methods: It is a community based cross sectional study conducted in 12 villages coming under field practicing areas of rural health training centre of Chettinad Hospital and Research Institute in Chengalpattu district. Sampling was done by using Simple random sampling method and our sample size was 220. A pre-tested, semi-structured questionnaire was used for data collection. The collected data was entered in Microsoft Office Excel and analysis was done using SPSS software version 21. Results: The Mean (SD) age of the study participants was 45±10.17 years. Among all the participants, 181 (82.3%) were unaware about any method of cervical cancer screening. Factors that are barriers to cervical cancer screening includes feeling of being healthy (79.6%), fear of finding out cancer (71.9%), anticipation of pain (68.1%). Conclusions: Present study found out that most study participants were unaware about the methods of cervical cancer screening. It is important to educate women about cervical cancer screening methods to overcome barriers.
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A field experiment was conducted at Potato Research Station, S. D. Agricultural University, Deesa during 2018-19 and 2019-20 for evaluation of efficacy of insecticides against whitefly in potato. The seven different treatments viz. T1: Control, T2: Seed treatment with imidacloprid (200 SL) @ 0.04% followed by foliar sprays of imidacloprid @60 gm a.i./ha at 85% emergence + second spray with thiamethoxam 25WG @100g a.i./ha, T3: Foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence, T4: Foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence followed by second spray of diafenthiuron after 10 days, T5: Foliar spray of castor oil @0.05% at 85% emergence, T6: Foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence mixed with castor oil @0.05%, T7: Foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence mixed with castor oil @0.05% by second spray with diafenthiuron after 10 days. Based on pooled data of two years, the significantly highest per cent reduction (i.e. 68.57 %) after 2nd spray was recorded in T7 i.e. foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence mixed with castor oil @0.05% by second spray with diafenthiuron after 10 days which was at par with T4 (Foliar spray of diafenthiuron 50WP 350 g a.i. at 85% emergence followed by second spray of diafenthiuron after 10 days). The tuber highest yield and benefit cost ratio were also recorded with T7.
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In early January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the agent responsible for coronavirus disease 2019 (COVID-19). Recently, a high percentage of patients show a high interest in natural medicines. This is mainly due to the general feeling that natural medicines are safer than synthetic drugs. This study is designed to measure the prevalence of medical and edible plants during the (COVID-19) pandemic in Taif-Saudi Arabia. A cross-sectional study was conducted. Data was collected online using a Google forms survey. The online questionnaire was distributed to participants aged 18 years or older, living in Taif city. The data were analyzed by using IBM- SPSS version 25. In this study, we collected data from 325 participants where 76.9% of the participants were females. Considering the use of plants, 25.7% of the participants reported using Cinnamon while 20% of the participants reported using Star anise. Among the users of plants, family and friends were the main advisors of using these plants at 44.62% followed by social media at 23.69%. Moreover, 62.4 % of the participants reported using plants to protect against COVID-19 while 37.5 % reported using plants in relieving the symptoms of COVID-19. There is a significant increase in the trend of using herbs and natural products among Saudi populations, due to the COVID-19 pandemic. Cinnamon, Star Anise, and pomegranate were the main reported plants to be used by the participants.