altered level of consciousness is defined as a condition of being less responsive to and aware of environmental stimuli. • LOC is gauged on a continuum with a normal state of alertness and full cognition(consciousness) on one end and coma on the other end.

Tumors of the heart are rare; most (75% to 88%) are benign (Braunwald et al., 2001; Kamiya et al., 2001). • Primary tumors occur in less than 1% of the population; metastatic tumors have been • reported in 1.5% to 35% of oncology patients (Braunwald et al., 2001; Reynan, 1996; Shapiro, 2001). • Tumors may be sites for thrombus formation and therefore create a risk of embolism. • Dysrhythmias may occur as the myocardium or conduction system is affected. PRIMARY CARDIAC TUMOURS BENIGN 1. Myxoma 2. Papillary fibroelastoma 3. Fibroma 4. Lipoma 5. Rhabdomyomas 1. MYXOMA • Myxoma is a noncancerous tumor that arises from connective tissue, which is tissue that connects and supports other tissues all over the body. • Show familial pattern of tumor development based on autosomal dominant inheritance. • Mostly occur after trauma or even surgery i.e atrial septal defects, valve repairs. • Present with signs of right ventricle failure

The Digestive System Consists of ; a) Long hollow muscular tube or canal or tract called gastrointestinal tract or (GIT): • it is about 5 meters long b) Accessory glands: include: • Salivary glands • Liver and gall bladder • Pancreas

Disorders of the digestive system have serious consequences for the activity of the organism as a whole congenital malformations traumatic processes inflammatory processes neoplastic processes infectious processes Digestive system communicates with the external environment through the intake of fluids and food. Common git disorders • Motor dysfunction of smooth muscle of the individual parts of the digestive system • Indigestion of food and absorption of nutrients - malabsorption syndrome • Bleeding into the individual parts of the digestive tract • Perforation of the wall of the digestive system with subsequent leakage of the contents to the peritoneal cavity • Obstruction in moving of the contents of one part of the digestive system to the next section • Circulation disorders in the wall of the individual parts of the digestive system

Gastric or stomach cancer is a disease in which malignant (cancer) cells form in the lining of the stomach. Gastric cancer is the fifth most frequently diagnosed cancer and the third leading cause of cancer deaths worldwide. (Globocan 2018,Babiker,2021)

Definition: This describes the Impaction of the anterior shoulder against the symphysis pubis after delivery of the fetal head. Shoulder dystocia is said to have occurred when there is: • Failure of the shoulders to rotate spontaneously into anterior, posterior diameter of the pelvis outlet after delivery of the head • The anterior shoulder becomes trapped behind or on the symphysis pubis while the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory

Domiciliary Care It’s the care given to a pregnant woman by a midwife at her home environment, embracing prenatal, Intranatal and postpartum management.

INTEGRATED MANAGEMENT OF NEWBORN AND CHILDHOOD ILLNESS INTRODUCTION(IMNCI ) • A systematic approach with interventions that focuses on the health, growth and development of children under five years of àge • Indicates strategies that were developed by UNICEF, WHO, and MOH to reduce preventable disability, mortality and morbidity rates in children under five years of age. • Strategies include preventable measures on the part of families and communities as well as curative actions to be taken by health workers and health facilities

Rational use of medications in neonates depends on an appreciation of the physiologic immaturity and developmental maturation that influence neonatal drug disposition. Have altered body composition, weight, size and physiologic parameters.

Inflammation is mediated by prostaglandins • The treatment of inflammation involves two primary goals: First, the relief of symptoms and the maintenance of function; and second, the slowing or arrest of the tissue-damaging process. • Salicylates and other similar agents share the capacity to suppress the signs and symptoms of inflammation. • They also exert antipyretic and analgesic effects.