This paper presents a co-designed solution aimed at improving community healthcare assistance management. To enhance patients’ self-awareness of their health status, encouraging active participation in care process, and to support nurses in delivering patient-centered care, we have developed an innovative platform with a highly customized app. This platform was designed using a multi-disciplinary bottom-up approach. Patient data collection and processing facilitate the automation of care timeline planning, based on real time patients’ needs and the available resources. To achieve this goal different components have been considered: real-time health data collection and processing, patient care planning, decision support for nurses, secure communication for data transmission, and user-friendly interfaces to ensure easy access to platform functionalities.

The study, conducted at the Department of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, aimed to investigate the prevalence of iron deficiency anaemia among anaemic overweight and obese individuals. Fifty participants were included after screening and consent, undergoing socio-demographic assessment, clinical evaluation, and laboratory investigations. Middle to old-aged individuals predominated (Mean ± SD: 54.54 ± 11.32 years), with females comprising 62%. All subjects were obese (mean BMI: 37.27 ± 5.71 kg/m²), with common comorbidities including hypertension (68%), diabetes (36%), and obstructive sleep apnea-hypopnea syndrome (32%). Nutritional deficiencies, particularly iron deficiency, were prevalent, affecting 62% of subjects, with 48% having iron deficiency alone. Anemia of chronic illness was observed in 38%. Laboratory parameters showed low hemoglobin (8.53 ± 1.23 g/dL), MCV (78.75 ± 10.13 fL), and elevated ESR (20.56 ± 21.47 mm/hour) and CRP levels (4.71 ± 3.32 mg/dL), indicating inflammation. Correlation analyses revealed negative associations between BMI and serum iron/ferritin and positive associations with serum hepcidin. The study underscores the significance of addressing nutritional deficiencies and monitoring iron status in obese populations, suggesting potential associations between obesity and iron metabolism. Further research is needed to explore these relationships for clinical management implications.

The aim of this study was to evaluate patients' knowledge and perception of the use of systemic antibiotics in the treatment of endodontic infections and to determine the possible contribution of patients to the development of bacterial resistance. Five hundred and fifty patients were asked to respond to a survey on the perception of systemic antibiotic use in the treatment of endodontic infections and antibiotic resistance during January 2022 and March 2023. Data were analyzed using descriptive statistics and Pearson's Chi-square test. 514 patients were included in the study, 65.9% of whom were women. While 34.6% of the population studied thought that it was always necessary to take antibiotics prior to endodontics, 49.4% considered that they were necessary after endodontics, regardless of the clinical symptoms (p>0.05). The prevalence of self-medication was 17.3% and women self-medicate more than men, with significant differences (p<0.05), although they have greater knowledge of antibiotic resistance than men (p>0.05). Forty-four percent of the population expect to take antibiotics when faced with dental pain, mainly women (p<0.05). The general population is contributing to the serious problem of bacterial resistance. It is necessary to promote educational strategies focused on the correct use of antibiotics in the community.

This is a survey study that dialysis patients were randomly sampled from a medical center in northern Taiwan, and those who gave their consent to participate were included in this study. The purpose of this study was to explore the correlation between depression, hope, and quality of life of dialysis patients. All subjects agreed to take "Beck’s Depression Inventory", " The Chinese version of Herth Hope Index" and " The Chinese version of Kidney Disease Quality of Life" (KDQOL-SFTM). Data were processed using SPSS for descriptive and inferential statistics. The results showed that patients were 12.45±SD 9.03, which was mild depression, the mean score of hope was 34.25, which was equivalent to 72.60%, and was at the middle level. In KDQOL-SFTM, the score in mental composite (M=42.65, SD=8.81) was higher than in physical composite (M=37.38, SD=9.28), and the score was at the intermediate quality of life, and hope and depression were significantly and negatively correlated. This study suggests that dialysis case managers provide nursing guidance to help dialysis patients learn comfortable care methods and support the resilience they need.

The adoption of eHealth has not made great strides in Uganda especially among patients despite its potential in improving patient outcomes through access to care, patient engagement and its ability to reduce unnecessary hospital visits. Previous studies have focused on barriers and facilitators of eHealth in general. None has examined the adoption of eHealth among patients. Therefore, this study set out to investigate the barriers and facilitators of eHealth adoption among patients in Uganda. A cross-sectional survey was conducted in four districts across the country. A total of 292 patients of 18 years and above participated in the study and their selection was through simple random sampling. The bivariate analysis results revealed that education level (χ2 = 14.9, ρ<0.05), gender (χ2 = 4.95, ρ<0.05) and location (χ2 = 85.9, ρ<0.05) have a statistical significant relationship with eHealth adoption. The logistic regression model further revealed that male patients (OR=2.662), those with master’s degree and above (OR=2.2797) and those residing in Kampala (OR=.012) were more likely to use eHealth systems than their counterparts. The success of eHealth requires players in the health sector to ardently focus on the socio-demographic factors of the users, technological and hospital conditions if eHealth adoption is to ensue.

In this work the seismic resilience of the Emergency Department of a real Hospital complex, located in Tuscany (Italy), has been quantified, with special reference to its nonstructural components and organizational features. Special attention has been paid to the ceilings, whose importance stood out in past earthquakes. A comprehensive meta-model has been set, able to relate all the considered parameters to the assumed response quantity, i.e. the waiting time of the red-code patients arriving to the Emergency Department in the hours immediately after the seismic event. The seismic resilience of the Emergency Department has been measured with reference to earthquakes compatible to the seismic hazard of the area.

We present a modified version of the Szilard Engine, demonstrating that an explicit measurement procedure is entirely unnecessary for its operation. By considering our modified engine, we are able to provide a new interpretation of Landauer’s original argument for the cost of erasure. From this view, we demonstrate that a reset operation is strictly impossible in a dynamical system with only conservative forces. Then, we prove that to approach a reset yields an unavoidable instability at the reset point. Finally, we present an original proof of Landauer’s principle that is completely independent from the Second Law of Thermodynamics.

Pathogenesis of the connection of HIV-infection and cancer is a nowadays problem for research. More important is also to take into consideration a complexity of abordasions, such as prevention, diagnosis, monitoring, treatment, including control measures. These should be supported by statistical studies that report on restricted or extended geographical areas, to the level of social class and age. In our written text we try to describe from our opinion, strategies in HIV, infection a social and a healthcare problem.

The accurate identification of bacterial infections is critical for effective treatment in intensive care units (ICUs), yet current diagnostic methods face limitations in sensitivity and specificity, along-side cost and accessibility issues. Consequently, there's a pressing need for a marker that is economically feasible, rapid, and reliable. Presepsin (PSP), also known as soluble CD14 subtype (sCD14-ST), has emerged as a promising biomarker for early sepsis diagnosis. PSP, derived from soluble CD14, reflects the activation of monocytes/macrophages in response to bacterial infec-tions. It has shown potential as a marker of cellular immune response activation against patho-gens, with plasma concentrations increasing during bacterial infections and decreasing post-antibiotic treatment. Unlike traditional markers such as procalcitonin (PCT) and C-reactive protein (CRP), PSP specifically indicates monocyte/macrophage activation in bacterial infections. While limited studies in critical illness have explored PSP's role in sepsis, its diagnostic accuracy varies with threshold values, impacting sensitivity and specificity. Recent meta-analyses suggest PSP's diagnostic potential for sepsis, yet its standalone effectiveness in ICU infection management remains uncertain. This review provides a comprehensive overview of PSP's utility in ICU set-tings, including its diagnostic accuracy, prognostic value, therapeutic implications, challenges, and future directions.

This study aimed to investigate the knowledge of patients with hypertension about their condition, adherence to antihypertensive medication, and the factors influencing it. A cross-sectional study was conducted in two cardiology outpatient clinics of two tertiary hospitals, in Greece. The study included 188 patients diagnosed with hypertension. The patient’s knowledge about their disease and adherence to medication were assessed by using the HK-LS and A-14 scales, respectively. Patients had sufficient knowledge levels about their disease, but significantly low levels of adherence to medication. Patients with higher knowledge levels were more adherent to medications [r(188) = 0.885, p < 0.001]. By using multivariate analysis, higher age (p = 0.018), residence in a more populous area (p = 0.041), more years with the disease (p = 0.012), and a lower number of medications (p = 0.03) were associated with higher levels of knowledge. Conversely, younger age (p = 0.036), lower educational levels (p = 0.048), fewer years with the disease (p = 0.001), and a higher number of medications (p = 0.003) were associated with lower adherence to medication. The Greek patients' hypertension knowledge was sufficient, however, adherence to medication was significantly low. Healthcare managers could utilize our findings to design targeted interventions for improving adherence to medication for these patients.

Today, the various abilities that nurses require to meet patients’ healthcare needs adequately are all affected by AI-enabled systems. This research used an experimental study design in which 60 subjects were randomly assigned to either an experimental (AI image e-book guidance) group or a control (text paper guidance) group after meeting the admission conditions and agreeing to participate in the study. It was proven that providing AI image e-book guidance before surgery significantly changed the behavior of patients and promoted relief of urinary catheter discomfort through self-efficacy to reduce urinary catheter pain after surgery(p=0.000). It was found that providing AI image e-book guidance can shorten the time for health education and provide patients with repeated medical education and familiarity with health guidance, which can help to address the important clinical service demand issue and the shortage of nursing staff.

Aim: The majority of medicines used in Poland are generic drugs – substitutions of the original. Objective of the study was to obtain information on the current knowledge about generic medicines among Polish patients with epilepsy. Material and Methods: The study was conducted based on a self-developed questionnaire. The questionnaire consisted of 25 questions, including questions regarding their knowledge about generics, their previous experience and the factors behind these choices. Results: Overall, 1220 questionnaires were analyzed. Among all patients, 66.39% reportedly heard about generics. Of these 61.48% of patients had used the generic drugs in past. A significant proportion of participants had never been recommended to switch to a generic medicine by their health care professional (22.95% physician and 13.93% pharmacist). Statistically relevant differences were observed regarding the respondents’ kind and level of education, place of residence, and net income per household. Conclusions: Significant gaps were identified in the knowledge and perceptions among patients regarding generic medicines especially in relation to efficacy and safety of generic medicines. Efforts must be directed towards increasing public awareness of generic medicines and should also focus on educating patients about generic medicines.

This study was to determine the prevalence of hepatitis C virus (HCV) among febrile patients attending a General Hospital in Emohua LGA, Rivers State, Nigeria. Eighty-nine patients, including 31 males and 58 females, aged 2 to 60 years, were recruited for this study. Blood samples were screened for antibodies to hepatitis C virus (HCV) using a commercially available anti-HCV-Ab enzyme-linked immunosorbent assay (ELISA) based kits following the manufacturer's description. The results showed an overall prevalence of 5.6%. Higher prevalence of HCV was observed among females (6.9%), age groups >41 years (11.1%), singles (7.9%) and patients with primary education (33.3%). Among all the variables evaluated, only education (p = 0.007) was significantly associated with the prevalence of HCV. Age (p = 0.21), sex (p = 0.47) and marital status (p = 0.42) were not associated with the prevalence of HCV among the studied population. This study showed a prevalence rate (5.6%) that is slightly alarmingly well above several other studies done in the past in Nigeria. The seropositivity of HCV among febrile patients remains a great danger to public health. Therefore, HCV screening by ELISA methods in all patients is recommended. Planned prevention, screening and treatment are needed to reduce further transmission.

Neurological disorders are the leading cause of cognitive and physical disability worldwide, affecting 15% of the global population. Due to the demographics of aging, the prevalence of neurological disorders, including neurodegenerative diseases, will double over the next two decades. Unfortunately, while available therapies provide symptomatic relief for cognitive and motor impairment, there is an urgent unmet need to develop disease-modifying therapies that slow the rate of pathological progression. In that context, biomarkers could identify at-risk and prodromal patients, monitor disease progression, track response to therapy, and parse causality of molecular events to identify novel targets for further clinical investigation. Thus, identifying biomarkers that discriminate between diseases and reflect specific stages of pathology would catalyze the discovery and development of therapeutic targets. This review will describe the prevalence, known mechanisms, ongoing or recently concluded therapeutic clinical trials, and biomarkers of three of the most prevalent neurodegenerative diseases, including Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), and Parkinson’s disease (PD).

This study aimed at investigating the quality statuses of graduates’ sustainable core competences development and the causes behind the identified competence statuses by applying the core competencies’ model. The study employed case study design with thematic analysis involving seven interviewees. This study used tracer study findings and national exit exam results as exhibits. The study revealed “very good” and “excellent” quality statuses for the graduates’ core competence development of College of medicine and Health Sciences (CMHS). Similarly, this study identified “Good +” statuses for the quality of graduates’ core competence development in College of Agriculture and Environmental Sciences ( CAES) and College of Science (CS). Furthermore, the study identified "good" - and +” statuses for the quality of graduates’ competence development at the Faculty of Social Sciences (FSS) and Faculty of Humanities (FH). Improved instruction with a balance of theory and practice, task-oriented deans’ leadership behavior with fairness and shared vision- mission identity, handling internal conflicts, and external ethnic-based war influences were the major reasons for the identified higher competence quality statuses in CMHS, CAES, and CS, whereas the opposite direction decline of these factors were the causes for the low statuses of FSS and FH. Sustainable graduates’ core competence development leads to sustainable employability, labor force, and individual to nation-wide holistic sustainable development

The purpose of the study is to analyse and to identify specific structural characteristics of melanocytic nevi. Using the optical microscope, could be possible a proper describtion related melanocytic nevi, reffering to youth pacients. In this study direction play a significant role, different factors, such as genetic, epigenetic, microbiomic, and proteomic factors. Future directions refers to preventive and prophylactic methods. Disease diagnostic and management directions are also important.

The purpose of this study is to provide an accurate formula for calculating entropy for short DNA sequences and to demonstrate how to use it to examine leukemia patient surviving. We used IDIBAPS leukemia patient’s data base with 117 anonymized records. The generalized form of the Robust Entropy Estimator (EnRE) for short DNA sequences was proposed and key EnRE futures was showed. The Survival Analysis has been done using statistical package IBM SPSS. Entropy EnRE were calculated for leukemia patients for two samples: A. 2 groups divided by median EnRE and B. 2 groups of patients were formed according to their belonging to 1st and 4th quartiles of EnRE. The result of survival analysis are statistically significant: A. p < 0.05; B. p < 0.005. The death hazard for a patient with EnRE below median is 1.556 times that of a patient with EnRE over median and that the death hazard for a patient of 1st quartile (lowest EnRE) is 2.143 times that of a patient of 4th quartile (highest EnRE). The transition from median to quartile patients’ groups with more EnRE differentiation confirmed the unique significance of the entropy of DNA sequences for leukemia patients surviving.

There are complex ethical dilemmas inherent in medicine teaching, particularly in clinical prac-tice involving actual patients. Questions must be raised on fulfilling medical students' training needs while still respecting patients' fundamental rights to autonomy and privacy. We aimed to assess patients' perspectives regarding medical students' involvement in their medical care. An observational, cross-sectional study was developed, and an interview-like questionnaire was ap-plied randomly to patients waiting for a consult/admitted to three distinct departments: General Surgery, Obstetrics/Gynaecology, and Infectious Diseases. Of the 77% interviewed patients who reported previous experiences with medical students, only 59% stated that they were asked for consent for their participation and 28% that students had adequately introduced themselves. Pa-tients from Gynaecology/Obstetrics were the ones who reported lower rates of these practices and were also the ones who were most bothered by students' presence, stating that they would refuse students' participation in the future. Male patients received more explanations than female pa-tients regarding the same matters. 35% of patients stated they would feel more comfortable without the medical students' presence. The study shows a need to pay closer attention to ful-filling patients' fundamental rights.

Ongoing concerns regarding the morbidity and mortality from cancer-associated thrombosis led the European Cancer Patient Coalition (ECPC), the voice of cancer patients across Europe, to create a pan-European cancer-associated awareness patient survey to assess CAT knowledge among a large population of patients with cancer. The ECPC survey represents the largest of its kind amongst patients/caregivers with CAT and identified significant gaps in patient awareness and knowledge of CAT. It also identified a need for educational CAT-related discussions and interventions between healthcare professionals and patients with cancer and their caregivers. The aim of this paper is to highlight these gaps and to provide healthcare professionals with awareness of what information should be shared with patients/caregivers as well as how and when that information should be provided. Notably, the importance of providing information on CAT risk and risk factors, how to reduce their risk of CAT, the role of anticoagulant prophylaxis and treatment (short- and long-term) including possible side-effects, and finally how to early identify CAT symptoms. Here we outline what type of information should be provided, as well as when and how to best discuss CAT with our oncology patients and their caregivers along the cancer care continuum, to reduce the risk of CAT and associated complications with a goal of improving patient outcomes.

Most malignant ovarian germ cell tumors (MOGTCs) have a very good prognosis and can be cured by chemotherapy, with yolk sac tumors (OYSTs) having the worse prognosis among MOGCTs. These tumors are rare and can benefit in the next future from specific therapeutic strategies after failure of platinum-based first-line and salvage regimens. In collaboration with EORTC SPECTA, we have developed a project to explore the molecular characteristics of OYST. The pilot part of the project was performed using retrospective samples and ten OYST patients including relapsed and disease free patients. The molecular analysis was performed using FoundationOne CDx. For each patient, the following variables are described in the molecular report provided by FMI (Fondation Medicine Incorporation): alteration type (SNV, deletion), actionable gene alteration, therapies approved in EU (patient's tumor type and other tumor types), tumor mutational burden (TMB) and microsatellite instability (MSI) status. A total of 10 patients with OYST diagnosed between 2007 and 2017 were analyzed. Four patients (40%) had a molecular alteration, according to the FMI test. A subset of three patients (33.3% of all patient) harbored targetable (KRAS, KIT, ARID1A) oncogenic mutations. Two patients at relapse harbored a targetable mutation. In this retrospective study, we were able to identify clinically relevant molecular alterations for all relapsed patients with molecular analysis. Dedicated studies are needed to demonstrate if they could benefit from specific therapeutic strategies after failure of platinum-based first-line and salvage regimens and if the presence of a molecular alteration could be linked to patients’ outcome.

Herein, we describe a highly efficient, non-complicated, and non-organic procedure to overcome the negative effect of chemotherapeutic drugs on the quality of the extracted DNA by applying several modulations in cell washing, suspension, and lysis of cells treated with these drugs. In this protocol, 500µl were extracted from patients who received systemic sessions of chemotherapy. The validity of this protocol for digestion with restriction endonucleases and both conventional and real-time polymerase chain reaction were tested. This protocol proved obvious purity (1.8±0.02 and 2.1±1.2, for A_260/280 and A_260/230, respectively) and adequate yields (10±2.24) µg/100 ml. The positive results of validation experiments proved the validity of the extracted DNA for downstream applications of molecular biology. In addition to the proven efficiency of this protocol to extract DNA from normal samples, its validity was also confirmed from patients who were exposed to chemotherapy. This entails a novel approach to extract a molecular biology grade DNA without having inhibitors against enzymes used in digestion, amplification, and subsequent sequencing even after the systemic sessions with several doses of chemotherapy.

Background The acknowledgment of computed tomography (CT) defined diagnosis in high prevalence northern Italy may identify more patients with Coronavirus Disease-2019 (COVID 19) infection, than RT-PCR alone. Methods We retrospectively reviewed 148 chest CT scans of oncological patients who were referred to the Radiological Unit of Policlinico S. Marco from 1st of February 2020 to 30th of April 2020, during the Covid-19 outbreak in Bergamo area. Therefore, we analyzed RT-PCR tests of these 148 patients. Results Among 32 patients with diagnosis of COVID-19 infection: 17 patients were asymptomatic or had mild symptoms (53.1%), while 15 developed severe disease (46.8%). The incidence of COVID-19 infection is 22.9%, the mortality rate is 18.8%. Severe COVID-19 disease is associated with higher median age. We did not find any correlation between disease severity and sex, smoke or cardiovascular comorbidities. Remarkably, patients who were on treatment developed milder disease than cancer patients who were not on treatment. Conclusions The acceptance of CT-defined diagnosis in high prevalence area like Bergamo highlighted a larger number of COVID-19 oncological population than RT-PCR alone, in particular asymptomatic and mild symptomatic patients. We observed that actively treated patients had milder disease, according to previous studies that suggested a protective role of immunosuppression.

Urban tourism has witnessed significant growth in recent years, driven by various factors that foster the transformation of urban areas into tourist hotspots. These factors include a rising interest in culture and heritage, ongoing urban redevelopment and conversion processes, and the introduction of new experiences and activities. Two particularly influential factors contributing to this growth are low-cost travel, which facilitates more accessible access to urban destinations, and the emergence of new types of accommodation, such as short-term rental (also known as local accommodation or Airbnb-type accommodation). This sudden and continuous growth of this type of tourist accommodation brings new challenges to cities and local communities. On the positive side, it contributes to job opportunities, the dynamism of the local economy, and urban revitalization. On the other hand, it also represents more difficulty in retaining the local population in city centers, as more and more buildings are converted into hostels and tourist apartments. In this context, it becomes essential to conduct studies evaluating the impacts of these dynamics in urban areas and how they influence residents' and visitors' perspectives. Therefore, this study aims to identify the main transformations resulting from short-term rental (STR) development, focusing on the impacts felt by tourists and residents in Porto. A questionnaire was distributed to tourists and residents in Porto's city center in June 2023. The results reveal differences in opinions between tourists and residents, particularly concerning historical heritage preservation, local population relocation, and reduced housing availability for residents. Nevertheless, there is a similarity in their opinions regarding the stimulus that local accommodation brings to the economy and the rehabilitation of buildings and urban areas. This study reinforces the need to pay more attention to the future development of tourist accommodation in city centers, especially regarding local policies and territorial planning, to balance better tourism development and local communities' quality of life.

Although the empirical Kepler’s laws can be proven by applying Newton’s laws to the dynamics of two particles attracted due to the gravitational interaction, there is no explicit formula for the motion as a function of time. In this paper, a quasi-analytical solution for this problem is proposed. It approximates the real behavior of celestial bodies with an acceptable degree of accuracy. All calculations involved require a low computational cost. This problem is closely related to Kepler’s equation, since, the solution for the equations of motion as a function of time gives us the solution to Kepler’s equation as well. The results are presented for each planet of the solar system (including Pluto), and the solution is compared against the real orbits.

The conformity assessment of products or a measured value with the given standards is carried out based on the global risk of producers and consumers calculation. A product may conform to specifications but be falsely rejected as non-conforming. This is about the producer's risk. If a product doesn't meet the requirements but is falsely accepted as conforming, that poses a risk to the consumer. The conventional approach to risk assessment, which yields only a single numerical value for the global risk of producers and consumers, is naturally extended, and utilized for assessing risk in measurement models with linear regression. The outcomes of the two-dimensional extension, along a moderate scale, are the parabolas with an opening upwards. Risk surfaces were obtained through three-dimensional extension over the area limited by the moderate scale and guard band axes. Four models with different ranges of tolerance intervals were used to test this innovative method of risk assessment in linear regression. The corresponding standard measurement uncertainties are determined by applying a simplified measurement model with the use of comprehensive data on the measurement performance and by determining measurement uncertainty derived from consideration of the functional relationship obtained by linear regression analysis. Models that utilize information from linear regression analysis to determine measurement uncertainty are biased towards risks at the edges of the moderate scale. Testing the model's performances with metrics related to the confusion matrix, such as the F1 score, further substantiated this assertion. The diagnostic odds ratio has been proven to be extremely effective in identifying the curve along the guard band axis, along which the global risks of producers and consumers are at their lowest.

Critically ill patients treated in the intensive care unit (ICU) can present many abdominal conditions that need a prompt diagnosis and timely treatment because of their general frailty. Clinical evaluation and diagnostic tools like ultrasound or CT scan are not reliable or feasible in these patients. Bedside laparoscopy (BSL) is a minimally invasive procedure that allows surgeons to assess the abdominal cavity directly in the ICU, thus avoiding unnecessary exploratory laparotomy or incidence related to intra-hospital transfer. We conducted a review of the literature to summarize the state-of-the-art of BSL. Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases were utilized to identify all relevant publications. Indications, contraindications, technical aspects, and outcomes are discussed. The procedure is safe, feasible, and effective. When other diagnostic tools fail to diagnose or exclude an intra-abdominal condition in ICU patients, BSL should be preferred over exploratory laparotomy.

Living with a chronic disease involves a variety of daily life limitations that severely affect people in their daily life. Identifying and promoting self-management strategies may improve health outcomes and increase patients’ autonomy. The purpose of the present study was to explore the perceived limitations and self-management strategies of elder patients suffering from chronic diseases. An inductive content analysis was applied, with a purposive sampling of 21 patients living with chronic conditions. Data was collected through semi-structured interviews. Two main-categories were emerged from content analysis, namely “Limitations of daily life” and “Disease Management”. Physical restrictions and negative feelings were referred to as daily burdens, while scheduling and self-care, supporting environment and technology were related to disease management. Information, training and provision of digital literacy may increase patients' self-efficacy in managing their chronic condition.

Background and Objectives: HIV infection is a global public health problem that can lead to the progression of AIDS. Nutritional status and biochemical markers can significantly contribute to the progression of AIDS in HIV/AIDS patients. The main objective of this study is to examine the association between the nutritional and biochemical markers as well as BMI in HIV/AIDS patients in the kingdom of Bahrain. Methods: A retrospective cohort study, including 300 patients (248 males and 52 females) with HIV/AIDS in Bahrain. Various biochemical markers were collected from patients’ medical records including CD4^+ T cells counts, albumin, Hb, HCT, MCV, WBC, and creatinine. A semi-structured questionnaire using of a standardized food frequency questionnaire (FFQ) was used from which total energy and total macronutrients were calculate. Results: the mean BMI of participants was 27.20 kg/m2 with none of the participants had a BMI lower than 18.5 kg/m2 (underweight). The majority of patients’ dietary intake of macronutrients and total calories intake were either within or above the recommended RDA levels. The results also showed that all mean values of the nutritional and biochemical markers (CD4^+ T cells counts, albumin, Hb, HCT, MCV, WBC, and creatinine) are within the referenced normal ranges. A significant positive correlation of CD4^+ T cells counts, Hb, HCT and albumin at <0.05 level was found. There was no significant correlation between CD4^+ T cells counts and MCV, WBC and creatinine. A positive significant correlation was found between BMI, CD4^+ T cells counts, and WBC at <0.01 level. Conclusion: BMI values significantly correlated to biochemical markers of AIDS progression. Dietary pattern of participants was undiversified among participants, with high prevalence of obesity and overweight. Malnutrition among this study population was not present.

Simulation-Based Medical Education that uses Virtual Patients has become increasingly important during the COVID-19 pandemic. With the need for social distancing and minimizing contact, medical simulation technology has provided a valuable tool for healthcare professionals to practice and improve their skills without the need for face-to-face interactions. MedSIM is a medically accurate simulation platform with Virtual Patients designed for undergraduate medical education. Our study involved two groups of students. The PreCOVID group, before the pandemic, underwent conventional teaching methods. The COVID group, during the pandemic, had students exposed to conventions skills taught earlier and were taught again with MedSIM. Students indicated high satisfaction with the clinical skills demonstrated by the Virtual Patients. More than half agreed that MedSIM had enabled them to perform all kinds of procedures on patients (PreCOVID group 68.8%, COVID group 71.3%), showed cues and consequences much like those in natural clinical environments (PreCOVID 68.4%, COVID 71.3%). Also, MedSIM allowed them to have a repetitive practice that helps in critical skills transfer to actual patients (PreCOVID 72.7%, COVID 74.7%). MedSIM met the expectations of most of the students. Students from both groups rated the online performance of the MedSIM simulator as "Very good." Analysis from a customized word cloud indicated that most students found MedSIM to be good and of educational value. MedSIM platform enhances healthcare professionals' skills and knowledge, leading to better patient outcomes and increased access to healthcare, supporting SDG 3 (Good Health and Well-being). It also provides a safe and controlled environment for healthcare professionals to learn and practice essential skills, supporting SDG 4 (Quality Education).

The global burden of stroke is still high, particularly in developing countries, with hypertension serves as the main risk factor. Knowledge related to stroke is essential to establish better prevention strategies. This study aimed to identify factors associated with stroke awareness among hypertensive patients in Indonesia. This was a cross-sectional study conducted in five Community Health Centers in Indonesia. We used a standardized questionnaire to asses stroke awareness and the influencing factors. The knowledge on hypertension was assessed using Hypertension Knowledge Level Scale (HK-LS). Multivariate logistic regression analysis was performed to measure factors associated with stroke awareness. A total of 457 hypertensive patients were included. Majority of patients (77.46%) had low stroke awareness. Having higher knowledge on hypertension, higher income, and a history of previous stroke were associated with higher level of stroke awareness (odds ratio [OR] 1.878, 95%CI 1.176-2.999, p 0.008; OR 1.887, 95%CI 1.170-3.045, p 0.009; OR 5.276, 95%CI 2.210-12.594, p<0.001, respectively). This study suggests that knowledge on hypertension, income, and history of previous stroke are factors which may influence the level of stroke awareness. This emphasizes the need to provide better campaign and education program to raise stroke awareness in a community setting.

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19, and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio [HR], 95% Confidence Interval). Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to non-frail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs 20.8%, p<0.001) and were more likely to die (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24). Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission and diagnosis should prompt early advanced care planning.

We report an unusual case of Terson's syndrome that resulted in the di-agnosis of a right posterior communicating artery aneurysm. Interest-ingly Terson's syndrome presented with Roth spot resembling features accompanied by third nerve palsy in a patient without any disturbance of consciousness. To our knowledge, the association of Terson's syndrome with third nerve palsy has not been described before in the absence of radiologically diagnosed subarachnoid haemorrhage. We present the case of a 48-year old woman who presented in the De-partment of Emergencies of the University Hospital of Patras with right-sided complete pupil-involving third nerve palsy combined with bilateral Terson's syndrome. More precisely, fundoscopy revealed multi-ple scattered intra- and pre-retinal haemorrhages in both eyes while some retinal haemorrhages had a white-centered pattern resembling Roth spots. Neurological examination revealed no nuchal rigidity or any other neurological signs. The Glasgow coma scale was 15/15. A cerebral computed tomography angiography revealed a 5mm aneurysm of the right posterior communicating artery and the patient underwent a mi-crovascular clipping operation after craniotomy. The significant contribution of the ophthalmological consultation to the appropriate and timely diagnosis and management of a life-threatening condition is highlighted.

Neurodegenerative diseases (NDs) are a set of progressive, chronic, and incurable diseases characterized by the gradual loss of neurons, culminating in the decline of cognitive and/or motor functions. Alzheimer’s disease (AD) and Parkinson’s disease (PD) are the most common NDs and represent an enormous burden both in terms of human suffering and economic cost. The available therapies for AD and PD only provide symptomatic and palliative relief for a limited period and are unable to modify the diseases’ progression. Over the last decades, research efforts have been focused on developing new pharmacological treatments for these NDs. However, to date, no breakthrough treatment has been discovered. Hence, the development of disease-modifying drugs able to halt or reverse the progression of NDs remains an unmet clinical need. This review summarizes the major hallmarks of AD and PD and the drugs available for pharmacological treatment. It also sheds light on potential directions that can be pursued to develop of new, disease-modifying drugs to treat AD and PD, thereby decreasing the social and economic burdens linked to these NDs.

Conclusion: The study highlights the high prevalence of depression among caregivers of geriatric patients in Jeddah and underscores the significant impact of caregiving burden on mental health. These findings emphasize the need for targeted interventions, such as mental health support, respite care programs, and culturally sensitive educational training, to mitigate caregiver burden and enhance the well-being of caregivers.

Background Praziquantel is the commonly used conventional treatment recommended for schistosomiasis in the mainstream healthcare system. Although Praziquantel may be free in healthcare facilities, many individuals may resort to the use of traditional medicine. This study aimed to assess perceptions of participants on the availability of Praziquantel and to ascertain whether individuals infected with schistosomiasis used concurrently African traditional medicines with this treatment. Methods A cross–sectional descriptive study, using face-to-face interviews, was conducted from January to April 2023 among healthcare workers (HCWs) and patients. A review of medical chart records of patients was further carried out to triangulate the information from interviews. Ddescriptive statistics including frequency and percentage were used; categorical data were represented as tables. Chi-squared tests were performed for the association between continuous variables. A p value ≤ 0.05 was estimated as statistically significant. Results Most of HCWs (114/124; 91.9%) reported that Praziquantel was available in healthcare facilities. Majority of HCWs (76/124; 61.3%) did not know whether patients seen by them used concurrently traditional medicine and Praziquantel for schistosomiasis. There was no significant relationship between the availability of Praziquantel and the concurrent use of TM by patients for schistosomiasis (X2 = 3.042, p = 0.551). Patients seen by THPs (8/20, 40%) did not use Praziquantel for schistosomiasis. Those patients (8/15, 53.3%) who crossed from TM to the mainstream healthcare system did not disclose their use of TM to HCWs. Their main reason was that concurrent use of TM and Praziquantel could destroy organs or make Praziquantel not to work properly. None of the medical chart records analysed documented the concurrent use of TM and Praziquantel. Conclusion Most of HCWs were not aware of the concurrent use of TM and Praziquantel by patients for the treatment of schistosomiasis. Patients seen by THPs relied solely on TM for schistosomiasis. Although patients indicated crossing from TM to the mainstream healthcare system, there was no evidence of documented use of TM in medical chart records of patients. Further studies are needed to contribute to the knowledge of medicinal plants used by THPs for schistosomiasis.

Purpose: To identify factors linked with nutritional risk via the Malnutrition Universal Screening Tool scale assessment among critically ill patients from a hospital in Cali (Colombia). Materials and methods: A retrospective, analytical observational study was conducted with patients admitted to an intensive care unit (ICU). Sociodemographic, clinical, hematological, and biochemical parameters were analyzed, as well as their association with nutritional risk and patient mortality. Binary logistic regression was applied to outline nutritional risk. Results: Overall, 28.4% prevalence of elevated nutritional risk was observed. An association was found between nutritional risk and hemoglobin and hematocrit values, primary diseases accounting for ICU admission, gastrointestinal symptoms, and nutritional support route (p < 0.05). Mortality was 11.6% and it was correlated with nutritional risk, hemoglobin, and blood urea nitrogen. Conclusions: Gastrointestinal symptoms and the type of nutritional support received during hospitalization may increase nutritional risk, whereas polycythemia was a protective factor. We found an associative model to determine nutritional risk with high specificity and an adequate diagnostic validity index.

ACE2 impact on the severity of COVID-19 is widely discussed but still controversial. To estimate its role in aspects of the main risk factors and comorbidities, we involved post-COVID-19 patients in Ternopil region (Ukraine). Recruitment period was July 2020 to December 2021. Medical records, treatment modalities and outcomes were recorded and analyzed. Serum human ACE2 protein was measured with Cusabio ELISA kits (Houston, TX, USA). Statistical analysis was performed with SPSS21.0 software (SPSS Inc., Chicago, IL, USA). The level of ACE2 serum protein was significantly higher (p < 0.001) in patients with mild symptoms compared to more severe course of disease, and inversely had changed from 1 to 90 days after recovery. In patients with mild COVID-19, ACE2 level significantly decreased over time, while among critical patients, it increased by 34.1percent. Such results could be explained by ACE2 shedding from tissues into circulation. Loss of the membrane-bound form of the enzyme decreases the virus entry into cells. Our studies did not identify any sex-related ACE2 serum levels correlation. The most common comorbidities were hypertension, cardiovascular diseases, respiratory diseases and diabetes mellitus. All comorbidities except respiratory diseases contribute to the severity of disease and correlate with ACE2 blood serum level.

The early detection of cutaneous melanoma, a potentially lethal cancer with rising incidence, is key to increase survival and therapeutic adjustment. Especially in stages II-IV biomarkers are urgently needed for adjuvant therapy purposes after resection and for treatment of metastatic patients. We here investigated if fatty acid (FA) and protein composition of small extracellular vesicles (sEV) deriving from plasma of 0-I, II, and III-IV stage melanoma patients (n=38) could reflect disease stage and thus function as biomarker. The subpopulation of sEV expressing CD81 (CD81sEV) was isolated by an ad hoc immune affinity technique from microvesicle-depleted plasma. Biological macromolecules were investigated by gas chromatography and mass spectrometry in CD81sEV. A higher content of FA and a decrease in Saturation Index (C18:0/C18:1), already detectable in early stages, distinguished patients’ from healthy donor CD81sEV. Proteomics (identifier PXD024434) detected an exclusive and significant increase of CD14, PON1, PON3 and APOA5 in stage II and a significant decrease of Rap1b in stage III-IV CD81sEV. The FA and proteomic stage dependent CD81sEV signature strengthens the potential of circulating sEV studies in providing discriminatory information for early diagnosis, prediction of metastatic behavior and follow up of melanoma patients.

Objectives: To demonstrate the efficacy of Gemtuzumab ozogamicin in refractory AML patients with organ dysfunctions and poor performance status. Three refractory AML patients with are described. One of them was pretreated by intensive chemotherapy, two other patients progressed during Azacitidine treatment. WHO performance status III . Two patients had respiratory failure grade 2, the other one suffered from acute kidney insufficiency. Two patients were highly febrile with elevated CRP level. Gemtuzumab ozogamicin administration was performed in three patients followed by further switch to Gemtuzumab ozogamicin + Azacitidine or “7+3” treatment. Results: Gemtuzumab ozogamicin administration resulted in abrupt fever cessation in two febrile patients simultaneously with CRP level decrease and fast gradual resolution of respiratory failure. Recovery of kidney function was noticed in patient with renal insufficiency. WHO performance status have elevated in all three patients. No adverse effects grade II-III were noticed. Further treatment made two patients eligible for intensive chemotherapy, one patient was transplanted, patient with kidney failure obtained complete remission. Conclusions: Gemtuzumab ozogamicin therapy appeared to be safe and highly efficacious in relapsed/refractory AML patients with organ dysfunctions and poor performance status.

Background: The present study analyzes the evaluation of communication skills by standardized patients (SPs) and medical evaluators (Es) in an OSCE setting. Methods: The OSCE involved 189 sixth-year medical students, as well as 34 SPs and 63 Es. Communications skills were evaluated in 8 stations, simultaneously by SPs and Es. The SPs were actors who had been trained in the clinical case and who acted in accordance with a standardized script in a simulated clinical situation. The evaluators, also standardized, were Resident Doctors or staff Doctors from the Hospital Services involved. Results: The global scores awarded to students for communication skills were very similar in both groups, although the score awarded by Es was significantly higher, and a direct relationship was also observed between the mean scores awarded by both groups. Evaluators awarded significantly higher scores than SPs in 7 out of the 10 items on the checklist. Female medical students also scored significantly higher than their male counterparts in many items, including external appearance, listening, cordiality, optimism, interest, expression and empathy. Conclusions: Our data indicate that SPs and Es evaluated communication skills in a similar manner in an OSCE setting, a finding which suggests that health-related professionals can be used as an alternative to SPs, thus helping to lower economic costs. Our study also confirms a gender difference (in favor of women) in the evaluation of communications skills by both groups.Our data indicate that SPs and Es evaluated communication skills in a similar manner in an OSCE setting, a finding which suggests that health-related professionals can be used as an alternative to SPs, thus helping to lower economic costs. Our study also confirms a gender difference (in favor of women) in the evaluation of communications skills by both groups.

Background: Exposure to chronic low levels of aflatoxin B1 (AFB1) contamination can lead to immune suppression and nutritional consequences that might greatly contributed in the increase of hepatocellular carcinoma (HCC). The toxicity of AFB1 is greatly vary between different population, affected by age, gender, and environmental factors. Material and subjects: Aflatoxin B1 (AFB1) was measured in 50 blood samples collected from non B, C hepatitis viruses and non CMV-Ab liver disease patients from different general hospitals and polyclinic in KSA during period 01-2013 to 06-2014. All Patients demonstrate elevation of ALT and AST with unknown etiology. Serum samples were obtained and kept at −20 °C for AFB1detection. Results: Out of the 50 blood samples, 38 demonstrate a detectable serum level of AFB1 while the remaining 12 patients were AFB1 negative and used as control participants. While AST was non-significantly different in AFB1 exposed patients, ALT was significantly higher in AFB1 positive samples compared to control AFB1-negative. AFB1 was positively correlated with AST and ALT as liver function enzymes and with age as a risk factor of long duration of AFB1 chronic exposure. Multiple linear regression analysis ascertained the association between AFB1 chronic exposure and ALT increase in liver dysfunction Saudi patients. Conclusion: Measurement of elevated ALT as marker of liver injury in AFB1 chronically exposed Saudi patients can help to avoid the future development of HCC. Moreover, early detection of AFB1 exposure, together with early vaccination against HBV and HCV can remove the synergistic effects of these two etiological factors and thus decrease the risk of developing liver cancer.

Background and objective: Symptoms of most neurodegenerative diseases, including Parkinson’s disease (PD), usually do not occur until substantial neuronal loss occurs. This makes the process of early diagnosis very challenging. Hence, this research used variant call format (VCF) analysis to detect variants and novel genes that could be used as prognostic indicators in the early diagnosis of prodromal PD. Materials and Methods: Data were obtained from the Parkinson’s Progression Markers Initiative (PPMI), and we analyzed prodromal patients with gVCF data collected in the 2021 cohort. A total of 304 participants were included, including 100 healthy controls, 146 prodromal genetic individuals, 21 prodromal hyposmia individuals, and 37 prodromal RBDs. A pipeline was developed to process the samples from gVCF to reach variant annotation and pathway and disease association analysis. Results: Novel variant percentages were detected in the analyzed prodromal subgroups. The prodromal subgroup analysis revealed novel variations of 1.0%, 1.2%, 0.6%, 0.3%, 0.5%, and 0.4% for the genetic male, genetic female, hyposmia male, hyposmia female, RBD male, and RBD female, respectively. Interestingly, 12 potentially novel loci (MTF2, PIK3CA, ADD1, SYBU, IRS2, USP8, PIGL, FASN, MYLK2, USP25, EP300 and PPP6R2) that were recently detected in PD patients were detected in the prodromal stage of PD. Conclusion: Genetic biomarkers are crucial for the early detection of Parkinson’s disease and its prodromal stage. The novel PD genes detected in prodromal patients could aid in the use of gene biomarkers for early diagnosis of the prodromal stage without relying only on phenotypic traits.

The article proposes asymptotic methods for calculating Sommerfeld integrals, which enable us to calculate the integral using the expansion of a function into an infinite power series at the saddle point, where the role of a rapidly oscillating function under the integral can be fulfilled either by an exponential or by its product by the Hankel function. The proposed types of Sommerfeld integrals are generalized on the basis of integral representations of the Hertz radiator fields in the form of the inverse Hankel transform with the subsequent replacement of the Bessel function by the Hankel function. It is shown that the numerical values of the saddle point are complex. During integration, auxiliary or so-called standard integrals, which contain the main features of the integrand function, were used. As a demonstration of the accuracy of the technique, a previously known asymptotic formula for the Hankel functions was obtained in the form of an infinite series. The proposed method for calculating Sommerfeld integrals can be useful in solving the half-space Sommerfeld problem. An example is the expression in the form of an infinite series for the magnetic field of reflected waves, obtained directly through the Sommerfeld integral (SI).

Additive manufacturing (AM) techniques are widely investigated for the cost-effective use of titanium (Ti) alloys in various aerospace applications. One of the AM techniques developed for such applications is plasma transferred arc solid free-form fabrication (PTA-SFFF). Materials manufactured through AM techniques often exhibit anisotropies in mechanical properties due to the layer-by-layer material build. In this regard, the present study investigates the isothermal directional fatigue of Ti-TiB metal matrix composite (MMC) manufactured by PTA-SFFF. This investigation includes rotating beam fatigue test, electron microscopy, and fatigue calculations. The fatigue experiments were performed at 350 ºC using specimen with the test axis oriented diagonally (45º) and parallel (90º) to the AM builds directions. The fatigue values from the current experiments along with literature data find that Ti MMC manufactured via PTA-SFFF exhibit fatigue anisotropy reporting highest strength in 90º and lowest in perpendicular (0º) AM build directions. Further, the electron microscopy investigations on 0º, 45º, and 90º AM build specimens reveal frequent TiB clusters in all three AM build directions and suggest that the spread of these TiB clusters play a role in fatigue anisotropy. Moreover, the fatigue calculations were performed using both the Paris’ and recently reported modified Paris’ equations. Comparison of R^2 values for these calculations show that modified Paris’ equation predicts the fatigue life of AM Ti-TiB MMC more accurately than the Paris’ equation.

In this paper, I introduce a new concept of representing numbers in base ; in other words, I have found new series for any number similar to series that could be written according to the collatz sequence which is called zi(n) in this article. These series need to end with 1. Then, we use two sets of rules to make a diagram which then proves the existence of such series for any number.In this diagram, by branching numbers into different branches in accordance to the modularity of 4 and continuing branching to the point that their numbers have enough common terms in their collatz series, we could reduce zi(n) to zi(k) so that k<n in any branch by Rule Number One. This diagram shows that zi(n) exists for every number, in other words, this proves the theorem (A) or zi-existence theorem. The proof of zi-existence theorem leads to a proof of the collatz conjecture because the collatz series could be written as a linear combination of such series that all of them end with 1, so the collatz series for any number ends with 1.

Background This study aimed to determine the association between immune checkpoint inhibitors (ICIs) and the risk of herpes zoster (HZ) incidence in patients with lung cancer. Method We obtained national claims data of 51,021 patients from South Korea with lung cancer between August 2017 and December 2021. The study population was classified into ICIs and non-ICIs groups based on prescription of ICIs at least once during the study period. To estimate the effects of ICIs treatment compared with those without ICIs treatment on HZ incidence, we used the Cox proportional hazards model adjusted for sex, age, comorbidities, and concomitant use of immunosuppressive drugs. Stratified analyses based on sex, age, and comorbidities were conducted to identify corresponding risk factors. Results Of the 51,021 study participants, 897 (1.8%) were prescribed ICIs, and 2,262 (4.4%) were diagnosed with HZ. Approximately 75.6% of the patients were male, and the prevalence of diabetes, cardiovascular disease, and chronic lung disease in the ICIs group was significantly lower than that in the non-ICIs group. The Kaplan–Meier plot showed that the probability of incidence of HZ in the ICIs group was lower than that in the non-ICIs group. Additionally, treatment with ICIs was associated with a 31% lower risk of developing HZ when compared to that seen without ICIs treatment (95% confidence interval [CI], 0.48–1.00). This association was stronger in females (hazard ratio [HR], 0.42; 95% CI, 0.19–0.94) and those less than 68 years of age (HR, 0.58; 95% CI, 0.34–0.99). Conclusion In these real-world data from an Asian population with lung cancer, ICIs treatment might be associated with a reduced risk of HZ compared to that without ICIs treatment.

The treatment of cancer and associated healthcare procedures often impose a detrimental effect on patients’ quality of life. Symptoms stemming from treatment often hinder patients’ social interactions, emphasizing the crucial role of social support in preserving quality of life and alleviating stress. Moreover, patient resilience serves as a valuable asset in mitigating stress levels and upholding an optimal quality of life amidst the challenges posed by the illness. This study aims to explore the correlation between diverse sources and forms of social support, resilience, and their impact on the quality of life and stress levels among patients undergoing cancer immunotherapy. This study involved thirty patients undergoing immunotherapy at Costa del Sol Hospital in Marbella. Resilience correlated with improved cognitive functioning and diminished symptoms. Informational support from healthcare providers and emotional support from friends were linked to symptom alleviation, such as reduced appetite and insomnia. Moreover, emotional support from friends emerged as a predictor for decreased perceived stress. Interventions targeting the improvement of quality of life and reduction of stress among cancer patients should prioritize assessing support needs and involving the patient's social network, especially during the treatment phase.

Diabetes self-management education helps to improve health outcomes, quality of life and to reduce expenses for diabetic patients. This systematic review aimed to examine the effectiveness of diabetes self-management education used for newly diagnosed patients with type 2 diabetes (T2DM). A review of studies that have researched the use and the impact of health education in newly diabetic patients with T2DM was implemented. A literature search was conducted using the electronic database of Pub MED, Walters Kluwer, Cochrane Library, Elsevier, JSTORE between January 2017 – November 2022. The data on participants and intervention characteristics were extracted by two reviewers independently. We found 789 studies and after selection of PRISMA flow chart we selected 19 studies, including 2512 newly diagnosed adult T2DM. Biomedical results presented the pooled effect of HbA1c -0.64%, FBG -0.32. The evaluation of emotional and social results and behavioral effects has been evaluated respectively in 10 and 9 studies. The education and support of recently diabetic patients help to improve biomedical, psychosocial, and behavioral results. This intervention must be ongoing to maintain healthy behaviors

Alternaria alternata is a saprophyte and is also known to cause many opportunistic infections in humans. Alternaria infections are important factors of morbidity and mortality in im-mune-compromised and solid organ transplant (SOT). Sensitivity to the airborne fungus Alter-naria alternata is also believed to be a common cause of allergic asthma. Therapies are limited by the lack of knowledge about the role of individual fungal gene products and symptoms in im-mune-compromised and transplant patients. This review summarizes the published case studies on Alternaria alternata infections in transplant patients.

Despite advancements in antiretroviral therapy (ART) that reduces the viral load to undetectable levels, viral eradication has not been achieved due to HIV-1 persistence in resting CD4+ T-cells. We, therefore, characterized the tat gene, which is essential for HIV-1 replication, from 20 viro-logically controlled HIV-infected (HIV+) older patients on long-term ART with improved CD4+ T-cell counts. PBMC genomic DNA from HIV+ patients were used to amplify tat gene by PCR fol-lowed by nucleotide sequencing and analysis. Phylogenetic analysis showed that each patient’s tat sequences were confined to their own subtrees and well discriminated from other patients’ sequences. Moreover, there was a low degree of viral heterogeneity and lower estimates of genetic diversity within these patients’ tat sequences. Most patients’ Tat deduced amino acid sequences showed intact open reading frames and maintained the important functional domains for Tat functions, including transactivation, TAR binding and nuclear localization. Furthermore, Tat deduced amino acid sequences showed variation in previously characterized cytotoxic T lym-phocytes (CTL) epitopes, suggesting escape mutants. In conclusion, a low degree of genetic varia-bility and conservation of functional domains and variations in CTL epitopes were the features of tat sequences from 20 HIV+ older patients with undetectable viral load on long-term ART.

Human displacement is on the rise globally, and the increase in the burden of tuberculosis (TB) is also attributed to migrations worldwide. A significant number of such displacement occur in regions with considerably higher areas of TB burden. Displacements may delay in TB diagnosis and treatment, which possibly will lead to TB transmission among healthy individuals. In this study, we assessed the association of existing determinants after a protracted internal displacement of people with the delay in TB diagnosis and treatment outcomes. A cross-sectional study was conducted on internally displaced TB patients registered at selected health facilities in three urban districts of Pakistan from March 2019 to February 2020. The univariate and multivariate logistic regression model was used to assess the delay in diagnosis and treatment outcomes. IDPs with delay in initiation of treatment beyond 30 days were at high possibility of unsuccessful TB treatment outcomes (adjusted odds ratio AOR,2.60; 95% CI 1.06-6.40). Analysis of factors that affect health seeker behavior and timely treatment showed a significant association (p<0.05) in-between age group 55-65 years (AOR, 2.66; 95% CI 1.00-7.07), female patients (AOR, 2.42; 95% CI 1.21-4.81), visited non-formal health provider (AOR, 8.81; 95% CI 3.99-19.46), self-medication (AOR, 2.72; 95 % CI 1.37-5.37), poor knowledge of TB (AOR, 11.39; 95% CI 3.31-39.1), and perceived stigma (AOR, 8.81; 95% CI 3.99-19.4). Prolong delay in treatment was associated with unfavorable treatment outcomes among IDPs, more specifically. As migrants and IDPs are more likely to experience an interruption in care due to overall exclusion from social and health care services. Therefore, it is imperative to understand the barriers in providing public health care services, particularly in preventing and treating TB.

Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients’ experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients’ satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients’ satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients.

We have shown that Newton’s third law does not strictly hold in a system with remote elements, due the finite speed of signal propagation and thus force imbalance occurs at the system’s center of mass. As the said system is affected by a total force for a finite duration, mechanical energy and momentums are gained by the system. In early works we assumed that the bodies were macroscopically charge neutral. Later we removed this restriction, thus analyzing the consequences on a possible electric charged relativistic motor. On the first published paper on this subject we studied this phenomena in general but gave only an example of a system reaching a stationary state, in this paper we shall analyze a charged retarded electromagnetic motor in a more general time dependent setting giving specific examples in which the system never reaches a stationary state yet produces steady linear momentum non the less.

Hamman’s syndrome is a rare condition that mostly affects young males, often with a predisposition of asthma. It includes the presence of free air in the mediastinum and subcutaneous emfysema with no other underlying cause such as trauma or infection. It occurs spontanously and often in association with prolonged valsalva manouvre. This might explain why there are some cases of Hamman syndrome among young females giving birth. Here we present a case report of a 24-year- old primigravida with Hamman’s syndrome. She presented with symptoms a few hours after an uncomplicated vaginal delivery at 40+1 pregnancy week. The symptoms resolved spontanously after a few days of observation. We also give a systemic review of reported cases since 2000 to provide overview on pathomechanism, symptoms, diagnostics, treatment and management of this condition. Hamman’s syndrome is a rare, usually benign, but potentially serious complication that can occur during the second stage of labour. Diagnostics include inquiring about typical symptoms, clinical examination and chest x-ray or CT scan. Treatment is usually conservative with oxygen, bronchodilators and pain relief. The reccurence rate is low and there is no contraindication to vaginal delivery in future pregnancies. However, it is suggested that physicians and midwives be cautious and consider low threshold for instrumental delivery or caesarean section to avoid excessive valsalva manoeuvre.

Malocclusions have a continuously increasing prevalence from a generation to another as a result of climate changes, soil, atmosphere and water pollution. All of these aspects have unfavorable consequences on the nutritional scheme. Thus, nutrition together with other etiopathogenic factors contribute to complex alterations in the somatic development of the entire organism and, implicitly, of the cephalic extremity. The study group included 4147 children from randomly selected schools from Vâlcea County, Romania. The aim of this study is to determine the prevalence of malocclusions in schoolchildren from Vâlcea County, Romania, according to the three main classes of malocclusions (according to Angle’s classification), age groups (from 6 to 10 years old and from 11 to 14 years old), gender (male and female) and place of origin (rural and urban). For Angle class I malocclusions we recorded the highest prevalence (48,78% from the total number of schoolchildren with malocclusions), followed by Angle class II malocclusions (45,85% from the total number of schoolchildren with malocclusions) and for Angle class III malocclusions we found the lowest prevalence (5,37% from the total number of schoolchildren with malocclusions).According to gender, we found the highest prevalence in female gender (29,90% from the total number of female subjects), while in male gender we recorded a prevalence of 27,70% from the total number of male subjects. Regarding the place of origin, there is a higher prevalence of malocclusions in the urban areas (29,16%). The study subgroup included 140 children randomly selected from the total number of subjects from the study group. They were included in a more advanced study. The aim is to find potential associations between the presence of malocclusions and various oral variables. Categorical variables were expressed as numerical values and percentages, and their association was evaluated with either the Chi-square test of association or homogeneity, or the Fisher Exact test. The acquired data were incorporated into a binomial logistic regression model to assess the likelihood of developing malocclusions in relation to the following variables: defective phonation, bruxism, frequency of teeth brushing, onychophagia, oral respiration, infantile deglutition, placing objects between the maxillaries, thumb sucking and salivary aspects. It is also aimed to compare the results obtained with similar ones from the specialized literature.

Driver’s distractions are more prone to occur with automated driving vehicles, which might turn into cancelling some of their advantages. Traffic reports, naturalistic observations and in-lab tests are carried out to determine the influence of driver’s distractions in car crashes and to develop technology to detect and prevent them from happening. One of the best strategies to cope with this problem is education. In this work we propose a simulation environment to design laboratory experiments to study driver’s distractions as well as simple games to train drivers to take over the control of the vehicle when required. The result framework enables drivers to experience driving highly automated cars in their neighborhoods or in places of their choice with different levels of events to check their ability in taking over the control when required.

Many neurodegenerative diseases are directly related to the formation of toxic protein aggregates, such as Parkinson’s and Alzheimer’s diseases, which are associated with the aggregation of alpha-synuclein (α-syn) and beta-amyloid (Aβ ), respectively. In this context, protein fibrils are the hallmark of these neurodegenerative diseases. In this sense, planning or designing compounds that are capable of preventing or reducing the formation of protein aggregation in the brain can be of fundamental importance for the curative treatment of these diseases. This work presents an in silico and experimental study to investigate the inhibitory potential of the ligands Octovespin (bioinspired by the wasp venom Polybia Occidentalis) and Fraternine-10 (bioinspired by the wasp venom Parachartergus fraternus wasp) against the aggregation of fibrils of the peptides Aβ(17-42) and α-syn, respectively. Using molecular docking and molecular dynamics simulations with 100 ns, the disaggregation capacity of these ligands was studied. The results obtained indicate that Octovespin and Fraternine-10 interact with the Aβ and α-syn protein fibrils throughout the simulation time. The RMSD values and the interactions with amino acids responsible for fibril aggregation demonstrate that both Octovespin and Fraternine-10 have a significant disaggregation potential, which corroborates the observations in vitro and in vivo. Furthermore, experimental results of Fraternine-10 demonstrate an anti-aggregation effect, indicating that it can promote the disaggregation of fibrils and prevent them from aggregating again to form oligomers. These discoveries qualify these molecules as potential candidates to become medicines against Parkinson’s and Alzheimer’s diseases.

Background:Caregiving for individuals with neurological disease involves providing physical, emotional, and social support, which can be a challenging and stressful experience. This study aims to compare the caregivers' burden, including the impact on mental and physical health, social support, and quality of life, in different neurodegenerative disorders. Methods:Fifty-five primary caregivers (F=41;mean age=53.07±12.29) of patients with Parkinson's Disease (PD=26), Multiple System Atrophy (MSA=16), and Amyotrophic Lateral Sclerosis (ALS=13), took part in the study. Standardized screening scales for the quality of life (EQ-5D/EQ-VAS and PQoL), levels of the caregiving burden (CBI and FSQ), and the assessment of the anxiety-depressive axis (HADS) were administered. Results: The mean CBI score was higher for caregivers of MSA patients (28.81±21.90) and ALS (25.15±16.23) than for caregivers of PD patients (16.08±10.34; p=0.036). Critical burden (cut-off>36) was present in the caregivers of MSA (31.3%), ALS (23.1%), and PD (19.2%) patients. Caregivers of patients with ALS had a worse perception of quality of life (EQ-5D total score) than caregivers of patients with MSA and PD (p

In this paper, we propose an extension of the Planck distribution function derived from the Boltzmann principle. That is, we consider extending Planck's law with new distribution functions. In addition, using ideas applied to the expansion of the Planck distribution function, Von Koch's inequality is derived without using the Riemann hypothesis, showing that the abc conjecture is negated. We also describe some challenges for the future. Namely, we will discuss that Entropy is related to dynamical systems described by logistic function models, such as the bacterial and the population growth.

This study explores the intricate relationship between the angle of vehicle-to-vehicle (V2V) conflicts and the severity of conflicts at signalized intersections during traffic signal failures, leveraging the advanced capabilities of LiDAR sensor technology. The research delves into the impact of conflict angles on collision outcomes and introduces LiDAR as a novel and precise tool for capturing spatial dynamics during unregulated traffic movements. Findings reveal that as the angle of V2V conflicts increases, indicating a wider approach between vehicles, the severity of conflicts tends to decrease. This reduction in severity is attributed to the detailed spatial data provided by LiDAR, enabling the identification of glancing impacts rather than direct head-on collisions. The mitigation of forces involved in collisions at increased angles contributes to a decreased likelihood of severe consequences, such as extensive vehicle damage and serious injuries to occupants.Conversely, as the angle of V2V conflicts decreases, signifying a narrower approach between vehicles, the potential for severe collisions tends to increase. LiDAR technology facilitates precise measurements of spatial coordinates and temporal dynamics, revealing that collisions occurring at smaller angles involve more direct and concentrated impact forces. This heightened risk of extensive damage to vehicles and increased injury severity is crucially captured by LiDAR, providing valuable insights into the relationship between conflict angles and collision outcomes during traffic signal failures. This study underscores the efficacy of LiDAR sensor technology in understanding the nuanced dynamics of V2V conflicts and highlights its role in developing targeted safety interventions. The integration of LiDAR data into traffic safety analyses offers a sophisticated approach to mitigating the impact of conflicts and enhancing overall safety at signalized intersections during signal failures. The research also highlighted that as the angle of V2P conflicts widens, PET experiences a proportional increase. A larger conflict angle signifies a more complex interaction between vehicles and pedestrians, leading to prolonged PET values. Conversely, a decrease in the angle of V2P conflicts is associated with a reduction in PET during traffic signal failures.The study commences with an examination of traffic characteristics at the E Cold Spring Ln – Hillen Rd intersection in Baltimore City, MD, utilizing a deployed LiDAR sensor. When the signal at this intersection experienced a temporary malfunction on a regular working day in September 2023, the LiDAR captured data related to vehicle and pedestrian volumes, as well as V2V and V2P conflicts. The primary objective of the research is to evaluate the repercussions of traffic signal failures on both traffic flow and safety, specifically V2V and V2P conflicts, occurring during periods of improper signal functionality. Additionally, this investigation delves into various factors that impact traffic signal performance, encompassing traffic demand, geometric layout, pedestrian interactions, and the incorporation of emerging technologies.

Alzheimer's Disease (AD) and Parkinson's Disease (PD) are two neurodegenerative diseases posing a significant disease burden due to their increasing prevalence and socio-economic cost. Traditional therapeutic approaches for these diseases exist but provide limited symptomatic relief without addressing the underlying pathologies. This review examines the potential of immunotherapy, specifically monoclonal antibodies (mAbs), as disease-modifying treatments for AD and PD. We analyze the pathological mechanisms of AD and PD, focusing on the roles of amyloid-beta (Aβ), tau (τ), and alpha-synuclein (α-syn) proteins. We discuss the latest advancements in mAbs therapies targeting these proteins, evaluating their efficacy in clinical trials and preclinical studies. We also explore the challenges faced in translating these therapies from bench to bedside, including issues related to safety, specificity, and clinical trial design. Additionally, we highlight future directions for research, emphasizing the need for combination therapies, improved biomarkers, and personalized treatment strategies. This review aims to provide insights into the current state and future potential of antibody-based immunotherapy in modifying the course of AD and PD, ultimately improving patient outcomes and quality of life.

In this work we looked for a stable and accurate procedure to perform feature selection in datasets with a much higher number of predictors than individuals, as in Genome-Wide Association Studies. Due to the instability in feature selection when many potential predictors are measured, a variable selection procedure is proposed that combines several replications of shrinkage regression models. A weighted formulation is used to define the final predictors. The procedure is applied to investigate Single Nucleotide Polymorphisms (SNPs) predictors associated to Alzheimer’s disease in the Alzheimer’s disease Neuroimaging Initiative (ADNI) dataset. Two data scenarios are investigated: one considering only the set of SNPs and another with the covariates age, sex, educational level and APOE4 genotype. The SNP rs2075650 and the APOE4 genotype are given as risk factors for AD, which is in line with the literature, and other four new SNPs are pointed, opening new hypotheses for in vivo analyses. These experiments demonstrate the potential of the new method for stable feature selection.

Background: There are limited evidence-based data to guide treatment recommendations for breast cancer (BC) patients ≥ 80 years (P80+). Identifying and addressing unmet needs are critical. Aims: Advocate-BREAST80+ compared the needs of P80+ vs. patients < 80 years (P80-). Methods: In 12/2021, a REDCap survey was circulated electronically to 6,918 persons enrolled in the Mayo Clinic Breast Disease Registry. The survey asked about concerns and satisfaction with multiple aspects of BC care. Results: 2,437 participants responded (35 % response rate); 202 (8.3%) were P80+. P80+ were less likely to undergo local regional and systemic therapies vs. P80- (p

Previously, pseudomyogenic hemangioendothelioma (PMHE) is regarded as epithelioid sarcoma-like hemangioendothelioma due to significant histologic overlapping and diffuse cytokeratin expression since the first description in 1992. After considerable controversy and long-term debating, it is currently defined as a distinct intermediate malignant, rarely metastasizing neoplasm with vascular/endothelial differentiation in nature. PMHE is characterized by young age (typically < 40 years old) and extremity location (approximately ~80%) with t(7:19) SERPINE1-FOSB fusion as the most common molecular alteration. Here we reported a 59-year-old male presenting with multifocal lesions, including right temporalis muscle, right frontoparietal calvarium, right pterygoid muscles, and right mandibular condyle. Histologic examination of the lesion from right temporal mass revealed a multinodular biphasic lesion composed of sheets and fascicles of elongated spindle cells, and epithelioid small round to ovoid cells infiltrating into the adjacent skeletal muscle admixed with abundant neutrophilic infiltration. No rhabdomyoblast-like cells, prominent nuclear pleomorphism and mitosis were identified. IHC staining showed that the tumor cells were diffusely and strongly positive for FOSB, pan-cytokerain (AE1/AE3), CD31, ERG, and molecular testing further demonstrated a t(9:19) EGFL7::FOSB fusion mRNA. This constellation of morphological, IHC and molecular findings was consistent with the diagnosis of PMHE. This is the first reported case of multiple PMHEs with EGFL7::FOSB fusion in a patient aged more than 50 years old in the head and neck area. Since the vast majority of the differential diagnoses of PMHE are high-grade malignancies with aggressive clinical behavior and PMHE is rarely reported in the head and neck region, awareness of this tumor will avoid misdiagnosis and over-treatments of this entity.

Extracellular vesicles (EVs) are lipid bilayer envelopes that encapsulate cell-specific cargo, rendering them promising biomarkers for diverse diseases. Chagas disease, caused by the parasite Trypanosoma cruzi, poses a significant global health burden, transcending its initial epicenter in Latin America to affect individuals in Europe, Asia, and North America. In this study, we aimed to characterize circulating EVs derived from patients with chronic Chagas disease (CCD) experiencing reactivation of acute symptoms. Blood samples collected in EDTA were processed to isolate plasma and subsequently subjected to ultracentrifugation for particle isolation and purification. The EVs were characterized using nanoparticle tracking analysis and enzyme-linked immunosorbent assay (ELISA). Our findings revealed distinctive differences in size, concentration, and composition of EVs between immunosuppressed patients and those with CCD. Importantly, these EVs play a critical role in the pathophysiology of Chagas disease and demonstrate significant potential as biomarkers in the chronic phase of the disease. Overall, our findings support the potential utility of the CL-ELISA assay as a specific sensitive tool for detecting circulating EVs in chronic chagasic patients, particularly those with recurrent infection following immunosuppressive treatment or with concurrent HIV and Chagas disease. Further investigations are warranted to identify and validate the specific antigens or biomarkers responsible for the observed reactivity in these patient groups, which may have implications for diagnosis, monitoring of treatment and prognosis.

The COVID-19 pandemic has disrupted healthcare worldwide, potentially impacting disease management. This cross-sectional study assessed the influence of COVID-19 on diabetes self-management in 341 Saudis with type 2 diabetes using the Diabetes Self-Management Questionnaire (DSMQ). The DSMQ contains 16 items across 4 domains assessing glucose management, dietary control, physical activity, and healthcare use. Three additional items measured the perceived overall impact of COVID-19. Total DSMQ scores were significantly higher in patients aged &gt;60 years versus younger groups. Scores were significantly lower in patients diagnosed for 1-5 years versus longer durations. Patients on insulin had higher glucose management subscores than oral medication users. Overall, DSMQ scores were higher than the pre-pandemic Saudi population and Turkish post-pandemic findings. DSMQ results suggest that while COVID-19 negatively impacted some self-management domains, Saudi patients upheld relatively good diabetes control during the pandemic. Further research is warranted on specific barriers to optimize diabetes care during public health crises.

Introduction. This retrospective study aimed to compare the risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with calcification biomarkers. Methods. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF23, fetuinA, sclerostin, and VC scores (Adragao method). Multivariable linear regression identified VC predictors. Results: The prevalence of VC was similar in both groups, but HD patients had more pronounced VC scores ≥6. Pre-HD patients were older, with higher prevalence of Balkan endemic nephropathy, hypertension, and less frequent use of calcium phosphate binders. Both groups exhibited similar patterns of hyperphosphatemia, low vitamin D, and iPTH levels. In HD group normal phosphate was significantly common in patients with VC, whereas hyperphosphatemia was significantly common in patients without VC. Fetuin-A levels were higher in pre-HD patients, while FGF23 was elevated in HD patients. In pre-HD patients, male gender was associated with reduced VC risk, while in HD patients, malignancies and serum phosphate levels were negative VC predictors. Conclusion: Effective monitoring and tailored treatment of VC in CKD are still focused on phosphate regulation. Besides, mineral disturbances, hormones and biomarkers regulation, and patient-specific variables need to be considered.

Historically, admission of hematological patients in the ICU shortly after the start of a critical illness is associated with better survival rates. Early intensive interventions administered by MET could have a role in the management of hematological critically ill patients, eventually reducing ICU admission rate. In this retrospective and monocentric study, we evaluate the safety and effectiveness of intensive treatments administered by the MET in a medical ward frame. The administered interventions were mainly helmet CPAP and pharmacological cardiovascular support. Frequent reassessment by the MET at least every 8 to 12 hours was guaranteed. We analyze data from 133 hematological patients that required MET intervention. In hospital mortality was 38%; mortality doesn’t increase in patients not immediately transferred to the ICU. Only 3 patients died without a former admission in ICU; in these cases, mortality was not related to the acute illness. Moreover, 37% of patients overcame the critical episode in the hematological ward. Higher SOFA and MEWS scores were associated with a worst survival rate, while neutropenia and pharmacological immunosuppression were not. The MET approach seems to be safe and effective. SOFA and MEWS confirmed to be effective tools for prognostication.

In recent years, there has been a notable rise in the incidence of breast cancer among young patients, who exhibit worse survival outcomes and distinct characteristics compared to the intermediate and elder patients. Therefore, it’s imperative to identify identify the specific features unique to young patients, which could offer insights into potential therapeutic strategies and improving survival outcomes. In our study, we performed an integrative analysis of bulk transcriptional and genomic data from extensive clinical cohorts to identify prognostic factors. Additionally, we analyzed the single-cell transcriptional data and conducted in vitro experiments. Our work confirmed that young patients exhibited higher grading, worse disease-free survival (DFS), a higher frequency of mutations in TP53 and BRCA1, a lower frequency of mutations in PIK3CA, and upregulation of eight metabolic pathways. Notably, galactose metabolism pathway showed upregulation in young patients and was associated with worse DFS. Further analysis and experiments indicated that galactose metabolism pathway may regulate the stemness of cancer cells and ultimately contribute to worse survival outcomes. In summary, our finding identified distinct clinicopathological, transcriptional, and genomics features and revealed a correlation between galactose metabolism pathway, stemness, and poor disease-free survival of breast cancer in young patients.

Background: Studying anxiety, stress and the selection of coping strategies in the COVID-19 pandemic is necessary to minimize the adverse changes associated with the risk of infection and the consequences of the disease. Objective: To investigate the level of anxiety, stress perception and coping strategies in relation to the presence of illness. Material and Methods: The anonymous cross-sectional online survey was conducted among 3950 university students of northeastern Poland (1822), Lithuania (232) and the Russian exclave of Kaliningrad (1896). Due to the almost identically applied anti-epidemic measures, the respondents were treated as a unified group. The State-Trait Anxiety Inventory, Perceived Stress Scale-10 and Coping Orientations to Problems Experienced questionnaires were used. Results: Among 1212 men and 2738 women, COVID-19 was diagnosed in 348 (28.7%) and 1020 (37.3%) individuals, respectively, according to the clinical protocol. The prolonged nature of the process and the longer consequences of the disease were indicated by an increase in anxiety levels. Conclusions: The risk of possible infection and coping with illness required the adoption of active anti-stress strategies, which was observed regardless of going through the disease. Convalescents differed from non-diseased individuals in having higher levels of concern about their own emotions and their more frequent turn to religion, notably among the females. The repertoire of strategies among women was broader, with elevated levels of helplessness and avoidance seen as integral strategies.

Background: Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. The study was conducted to identify the frequency of cryptosporidium cases and other parasitic agents. Methods: A Cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. A particular staining procedure was performed to identify oocysts of Cryptosporidium spp. And PCR was conducted to determine the SSU rRNA and gp60 gene of Cryptosporidium. Results: Cyst of Giardia, ova of Ascaris lumbricoides (AL), Trichuris trichiura (TT), AL, and TT were identified in 2.3%, 1.4%, 0.5%, and 0.9% samples by wet mount preparation. The distribution of Cryptosporidium spp. was 1.4% and 4.1%, which was detected by the staining method and nested PCR. Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. Conclusions: This is the first report to detect the frequency of Cryptosporidium and other intestinal parasites and associated factors in Chattogram city of Bangladesh.

Omicron variant is more invasive against immunity, but it's not more invasive in any change in degree against masks, and indoor air; than previous variants. With its arrival, dentistry is facing another challenge. With a mission to protect both patients and healthcare workers, we are adapting to the current epidemiologic situation and anticipate the incoming change. This article presents an unpublished prospective setting for dental care in the new chapter of pandemics after Omicron variant. Introduced biosafety protocol has been clinically tested for 18 months in the field. Three fundamental pillars of this sustainable biosafety protocol are: (1) UVC air disinfection; (2) air saturation with certified virucidal oils through nebulizing diffusers; (3) telehealth solutions. As a method of evaluation pseudonymous on-line smart form was used. This biosafety protocol is not relying on persons` identification as uninfected; it is designed for environments where healthcare workers or patients are hypothetical asymptomatic carriers. Results from 115 patient feedbacks suggest that with this protocol in place, there was no observed or reported translation of infection from patient to another patient or from patient to doctor or nurse and vice versa, albeit nine of the patients have retrospectively admitted being probably infectious during their dental appointment. The key of this protocol is its clinical sustainability, as full-body protective suits don’t represent sustainable dental care as well as there is no acceptable risk of patients getting infected during dental procedures.

BACKGROUND: Endoscopic placement of Self Expandable Metal Stents to relieve malignant colorectal obstruction has become a common therapeutic advancement in clinical practice. MATERIAL: In a 16 year period 167 patients had endoscopic placement of a Self Expandable Metal Stent in a center where gastroenterologists and surgeons cooperate in a daily basis, discussing indications. RESULTS: There was no operative mortality and no major complication in placement of the stent. Technical and clinical success was respectively 95.1% and 92.9%. Consultation among specialists changed the preoperative indication in 60 patients, during the same time period. CONCLUSIONS: Self expandable metal stents placement represents an important tool to treat patients with obstructing colorectal cancer and complications after colorectal resection . A proper training is required, and this training in operative endoscopy is not always available and possible. In this scenario, a close collaboration among specialists in selecting the most appropriate operative procedure is essential and brings to better results.

Hospitalized patients frequently have disordered and poor-quality sleep due to a variety of both intrinsic and extrinsic factors. These include frequent nighttime intrusions, insomnia related to pain and unfamiliar environments, dark conditions during the day with loss of natural light, and disruption of natural sleep cycle due to illness. Sleep wake disturbances can result in deleterious consequence on physical, emotional and cognitive status, which may impact patient satisfaction, clinical recovery, and hospital length of stay. Despite this, clinicians frequently fail to document sleep disturbances and are generally unaware of best practices to improve sleep quality in the hospital. The purpose of this review is to discuss sleep disturbances in hospitalized patients with a focus on causes of sleep disturbance, effect of poor quality sleep, high risk populations, considerations for surveillance and prevention, as well as pharmacologic and non-pharmacologic options for treatment.

A 64-year-old woman with primary Sjogren’s syndrome which was not treated, was admitted to our hospital for nasal bleeding, oral bleeding, and purpura on her entire body. On this admission, laboratory findings were as follows: WBC counts, 8,910 /μL; hemoglobin, 9.9 g/dL; and platelet counts, 0.1×10⁴/μL. Although the anti-PLT antibody was positive, other autoimmune antibodies such as anti-DNA were negative. Moreover, cytomegalovirus IgM, Parbovirus B19 IgM, and Helicobacter pyroli IgG antibodies were not detected. No abnormal findings suggestive of infection were identified in the systemic examination. A bone marrow aspiration smear revealed normal bone marrow. Based on these findings, the patient was diagnosed with primary Sjogren’s syndrome-related immune thrombocytopenia. The patient initially received intravenous immunoglobulin, methyl prednisolone pulse therapy, and subsequent high dose prednisolone without significant improvement. Therefore, eltrombopag, a thrombopoietin-receptor agonist, was added. Subsequently, erythromycin was also added, considering its immunomodulatory effects. After initiating the erythromycin treatment, the platelet counts increased. Therefore, add-on eltrombopag and erythromycin treatment was effective; however, the platelet counts gradually decreased with reducing the prednisolone dosage. Instead of increasing the prednisolone dosage again, tacrolimus, a calcineurin inhibitor, was successfully added. Consequently, the prednisolone dosage could be reduced. This case shows that treatment with erythromycin and tacrolimus may be efficacious when conventional immunosuppressants show limited effectiveness in primary Sjogren’s syndrome-related immune thrombocytopenia.

Crohn’s disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the endoscopic and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. Our study included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies performed in these 8 years were matched and compared. We found a statistically significant decrease in stool changes, weight loss, and abdominal pain as presenting symptoms, and in the fecal calprotectin levels. On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. Non-caseating granulomas were found on 9% of oesophageal, 18% of gas-tric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum and descending colon between the first and second biopsies. Our study showed that more than a third of patients had specific endoscopic (36.59%) and histopathologic (32%) findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular endoscopic and histopathological assessments of pediatric CD patients.

Introduction and Purpose: Nurses are expected to be competent in practice based on the domain of standards and interpersonal soft skills (ISS). Nurses are faced with inadequate physical assessment 28%, formulating diagnoses 56%, plans 34%, implementation 31%, evaluation 37,5%, and communication skills 41%. Aims to develop an ISS learning model based on transformative learning theory and digitalization (TLTD) to improve nurses’ competencies. Method: Used Explanatory cross-sectional involved 190 practitioner nurses. Variables of individual characters (X1), facilities (X2), Social environment support/SES (X3), TLTD (X4), ISS (X5), and nursing competencies (Y) were measured. Data was collected using a checklist questionnaire, conducted on 6 June to 10 August 2022 at Dili, Baucau, and Maliana hospitals. Used descriptive and inferential analysis with SEM-PLS. Result: Five of the 11 hypotheses of statistical p-value < 0,05 and T-Test > 1,96, including X2>X4, X3>X5, X4>X5, and X5>y, to form ISS learning model. The characteristic of respondents were 81,8% young adults, 67,9% women, 57,8% undergraduates, judging the previous training 35% was unsuccessful, and 45,8% did not meet expectations. Learning facilities that are still lacking include policies 23,7%, curriculum 23,4%, guideline 22,7%, modules 27,9%, infrastructure 20,3%, social environment support 24,2% low, organizational support, 30,0% low peer support and 26,3% low family support. The average TLTD is 25,3% to 34,2%, ISS 22,1% to 30,5%, and nurse competence 25,3% to 30,5%.Suggestion: Result of the study become base to improve nurse’s competencies. Conclusion: Learning model was formed by facilities, SES, TLTD, ISS, and nurses’ competencies.

Background: Takayasu’s arteritis is a rare type of vasculitis, with severe complications like stroke, ischemic heart disease, pulmonary hypertension, secondary hypertension, aneurysms. Diagnosis is conducted by clinical and angiographic criteria. Treatment is medical and surgical, but unfortunately, the outcome is reserved. Case presentation: A 34- year- old Caucasian women had an ischemic stroke (2009). She was diagnosed with Takayasu’s arteritis and she received treatment with methotrexate, prednisolone, antiplatelet agents, with a mild improvement of clinical state. After 5 years (2014) she associated ascending aorta aneurysm, pulmonary hypertension, mild aortic regurgitation. The surgical treatment solved both ascending aorta aneurysm and left carotid artery stenosis (ultrasound in 2009 and computed tomography angiogram in 2014). Morphopathology revealed typical appearance for Takayasu’s arteritis. Tumor necrosis factor inhibitors (TNF-inhibitors) were associated to methotrexate. At 48 years (2023) she developed coronary heart disease (angina, electrocardiogram); echocardiography revealed severe pulmonary hypertension; angiography described normal coronary arteries, abdominal aorta pseudoaneurysm and arterial-venous fistula, with origin in right coronary artery and drainage on medium pulmonary artery. The patient refused surgical/ interventional treatment; she received again TNF- inhibitors, methotrexate, antiplatelet agents, statins. Conclusions: This case report presents us a severe form of Takayasu’s arteritis. We consider that morphopathology had a great importance in revealing to clinicians the typical appearance and the stadialization of inflammatory arterial process: acute or chronic. The verdict of morphopathologist was chronic phase, with acute relapses, so we decided that immunosuppressive treatment was still necessary.

his quantitative study investigates teachers' perceptions of self-efficacy during the COVID-19 pandemic and explores the correlation between these perceptions and the preservice training they received. The research addresses the cognitive connection between teachers' current self-efficacy, particularly their satisfaction with and appreciation of preservice lecturers. Utilizing a retrospective lens, the study reveals a significant correlation between teachers' evaluation of their preservice training, especially their appreciation of lecturers, and their present self-efficacy. The findings highlight that teachers, amidst the challenges of the pandemic, evaluated their self-efficacy at a remarkably high level. This underscores their resilience during a period of unprecedented uncertainty, demanding substantial personal and professional adaptability. The nuanced interplay observed suggests that teachers' sense of self-efficacy serves as a predictive variable of their mental and professional resilience when confronting uncertainty and navigating rapid and profound changes, as exemplified by the exigencies of the COVID-19 pandemic.

Keywords: Parkinson’s disease; sleep disorders; GBA; Parkin

Variable-Angle Tow (VAT) laminates can improve straight fiber composites mechanical properties thanks to the application of curvilinear fibers. This characteristic allows to achieve ambitious objectives for design and performance purposes. Nevertheless, the wider design space and the higher number of parameters result in a more complex structural problem. Among the various approaches that have been used for VATs study, Carrera’s Unified Formulation (CUF) allows to obtain multiple theories within the same framework, guaranteeing a good compromise between the results accuracy and the computational cost. In this article, the linear buckling behavior of VAT laminates is analyzed through the extension of CUF 2D plate models within the Reissner’s Mixed Variational Theorem (RMVT). Results show that RMVT can better approximate the prebuckling non-uniform stress field of the plate when compared to standard approaches, thus improving the prediction of the linear buckling loads of VAT composites.

The editorial explores the realm of emerging translational research in neurology and psychiatry, providing insights into various subjects, including neurodegenerative disorders and innovative therapeutic methods. The main objective is to study neurological and psychiatric disorders, such as Alzheimer's disease, with a particular emphasis on techniques for neural regeneration and repair. The editorial highlights the importance of taking a comprehensive approach to studying and treating complex neurological and psychiatric conditions. This involves thoroughly reviewing research papers on the causes, development, biomarkers, and treatment options for these conditions. The editorial emphasizes the necessity of using multidisciplinary and integrative methods to gain a deeper understanding and improve the treatment of these conditions. The development of an animal model for recurrent primary dysmenorrhea showcases the innovative techniques employed in the investigation of gynecological disorders, illustrating the capacity of translational research to connect fundamental scientific knowledge with practical medical applications. The cooperative endeavors of researchers and clinicians emphasized in this editorial lay the foundation for revolutionary advancements that hold the potential to enhance outcomes for individuals afflicted with neurological and psychiatric disorders globally.

Recent research has implicated the gut microbiota in the development of lymphoma. Dysbiosis of the gut microbial community can disrupt the production of gut microbial metabolites, thereby impacting host physiology and potentially contributing to lymphoma. Dysbiosis-driven release of gut microbial metabolites such as lipopolysaccharides can promote chronic inflammation, potentially elevating the risk of lymphoma. In contrast, gut microbial metabolites, such as short-chain fatty acids, have shown promise in preclinical studies by promoting regulatory T-cell function, suppressing inflammation, and preventing lymphoma. Another metabolite, urolithin A, exhibited immunomodulatory and antiproliferative properties against lymphoma cell lines in vitro. While research on the role of gut microbial metabolites in lymphoma is limited, this article emphasizes the need to comprehend their significance, including therapeutic applications, molecular mechanisms of action, and interactions with standard chemotherapies. The article also suggests promising directions for future research in this emerging lymphoma and gut microbiome investigation field.

Systemic lupus erythematosus (SLE) is a prevalent autoimmune condition, yet its alignment with a specific host immunological pathway remains unclear. The THαβ host immunological pathway, recognized for its defense against viruses and prions, has recently emerged as a response to DNA, RNA, and protein pathogens. SLE patients often produce anti-double strand DNA antibodies and anti-nuclear antibodies, suggesting a potential association with the THαβ host immune reaction. Throughout the course of SLE, elevated levels of type 1 interferons, type 3 interferons, interleukin-10, IgG1, and IgA1 are commonly observed. These cytokines and antibody isotypes are indicative of the THαβ host immunological pathway. Similarly, Myasthenia gravis, Grave’s disease, Graft versus host disease, autoimmune hemolytic anemia, immune thrombocytopenia, dermatomyositis, and Sjogren’s syndrome are also linked to THαβ-related type 2 hypersensitivities. Considering the potential association of these diseases with dysregulated THαβ immune responses, therapeutic strategies such as anti-interleukin-10 or anti-interferons α/β could be explored to manage these disorders effectively.

Abstract: The COVID-19 pandemic has brought about significant psychological challenges, particularly depressive and anxiety-related behaviors in those who have recovered from the virus. This study focuses on individuals aged 30-75+ to understand the prevalence, severity, and impact of these symptoms. By exploring their lasting consequences and potential risk factors, we aim to provide valuable insights for healthcare and mental health professionals, guiding the development of effective support systems to address the psychological aftermath of COVID-19. In this study, a quantitative research design was used to investigate the effects of depressive and anxiety behaviors in patients aged 30-75+ who had experienced COVID-19. The research employed a cross-sectional approach, collecting data at a specific time to assess the prevalence and severity of depressive and anxiety symptoms in the target population. A total of 422 patients were recruited through convenience sampling from various sources, including healthcare facilities, community organizations, and online platforms. Inclusion criteria encompassed individuals aged 30-75+ who had tested positive for COVID-19 and had recovered from the infection. Those with pre-existing mental health conditions significantly affecting depressive and anxiety symptoms were excluded. The sample was diverse in terms of age, gender, employment status, education level, marital status, and past chronic problems. Data collection involved administering standardized questionnaires, such as the Patient Health Questionnaire (PHQ-9) for depressive behaviors and the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety behaviors. These questionnaires assessed symptom severity, while demographic variables were collected separately. The collected data underwent analysis using the Statistical Package for the Social Sciences (SPSS) software, encompassing descriptive statistics, reliability assessments, normality tests, non-parametric tests for demographic comparisons, correlation analyses, and linear regression. Ethical approval and informed consent were obtained, ensuring participant confidentiality and data privacy. Several limitations were acknowledged, including the cross-sectional design's inability to establish causal relationships, potential selection bias due to convenience sampling, susceptibility to response biases with self-report measures, and assumptions and limitations inherent in statistical tests. Overall, the study aimed to provide insights into the effects of depressive and anxiety behaviors in COVID-19 survivors aged 30-75+ and contribute to the development of targeted interventions and support services for this population. This study explored the impact of depressive and anxiety behaviors in COVID-19 survivors aged 30-75+. It involved data collection through validated questionnaires and rigorous statistical analysis. The findings underscore the importance of tailored interventions and support systems to address the long-term psychological effects of the pandemic. Healthcare professionals, researchers, and policymakers must collaborate to prioritize mental well-being and allocate resources accordingly, ultimately improving the quality of life for survivors.

Research indicates that painful experiences can significantly affect the fear of cancer recurrence among cancer survivors, which is a distressing concern that influences both physiological and psychological recovery. Yet, the role of potential factors and mechanisms in these relationships is not fully known. This cross-sectional study aimed to advance our comprehension of the associa-tions between total pain and the fear of recurrence in post-treatment cancer patients by examining two potential mediators: psychological flexibility and mentalization. Three hundred and thirty-five participants (aged 22 to 88, 49.1% female) who had finished their cancer treatment completed self-report assessments of total pain, fear of recurrence, psychological flexibility, and mentalization. The serial mediation analysis showed that all dimensions of total pain were positively related to the fear of recurrence indirectly through psychological flexibility and mentalization, in serial. Additionally, gender moderated these serial mediational effects. In line with the psychological flexibility model, personal capacities to face difficult internal/external problems and interpret one’s behaviour in motivational terms can counterbalance patients’ negative emotions and feelings related to the illness.

The late diagnosis of Type 2 Diabetes Mellitus can occur due to lack of access to the primary health care system and the non-manifestation of symptoms. Faced with this problem, this work presents the creation of a mobile application, called DiabetesCheck, for predicting the risk of Type 2 Diabetes Mellitus. A mathematical model is used, which classifies the risk of Type 2 Diabetes Mellitus for a group of patients with intervention and for a comparative group, using Fuzzy Classification and Decision Trees. The proposed application allows the health professional to monitor patients through the history stored in a database, allowing a representation of the evolution of patients and indication of medications. Therefore, this proposal aims to carry out the diagnosis in the initial phase of the disease and help in the prescription of more effective treatments and in the proposition of public policy strategies in epidemiology and screening.

Thromboprophylaxis of hospitalized patients at risk of venous thromboembolism (VTE) presents challenges owing to patient heterogeneity and lack of adoption of evidence-based methods. Intuitive practices for thromboprophylaxis have resulted in many patients being inappropriately prophylaxed. Multiple interventions for thromboprophylaxis have been tested, including use of multifaceted approaches such as national VTE prevention programs with audits, use of passive alerts (either human or electronic), and more recently use of active clinical decision support (CDS) tools incorporated into electronic health records (EHRs). Multifaceted health-system interventions have shown mixed results in their ability to increase appropriate thromboprophylaxis and reduce VTE, unless mandated through a national VTE prevention program, though the latter approach is potentially costly, effort- and time-dependent. Studies utilizing passive human or electronic alerts have also shown mixed results in increasing appropriate thromboprophylaxis and reducing VTE. The use of active CDS tools holds the greatest promise, especially with further refinement and widespread implementation within various EHRs and clinical workflows. Recent-ly a universal cloud-based and EHR-agnostic CDS VTE tool revealed high adoption and effectiveness in increasing appropriate thromboprophylaxis and reducing major thromboembolism. This narrative review summarizes the literature on system-wide thromboprophylaxis interventions in hospitalized patients, with a focus on CDS tools.

We conducted this systematic review with the objective to understand the efficacy and safety of proton pump inhibitors [PPIs] in the pediatric population. We have used PubMed to identify randomized controlled trials [RCTs] published between 1st June 2010 and 30th June 2023, in patients from birth to 18 years old, with gastroesophageal reflux disease [GERD], who received treatment with any PPI. The literature yielded 76 articles and 13 met inclusion criteria. For infants, PPIs were equal to placebo in reducing GERD symptoms in 4 articles. In 1, the number of GER episodes and esophageal acid exposure were lower in infants who received PPIs and left lateral position, but there was no significant improvement in symptoms. In another publication, the combination of PPIs and feeding modifications [FM] was not more effective than PPIs alone. For children and adolescents, PPIs were effective in improving symptoms and achieving mucosal and histological healing, which was subsequently maintained. To conclude, PPIs are not effective to reduce symptoms related to GERD in infants, but are effective in older children, along with histological remission. Generally, PPIs are well tolerated, but it is important to not forget the possible adverse events [AE], especially if they are used for a long time.

The characteristics of response to stressful situations depend on a complex of factors such as personality traits, emotional regulation, health state, features of the nervous system, motor functions and proprioception. In cases of disruption of the brain's dopamine system due to disease or chemotherapy, hormone discharge due to stress, changes in emotions and proprioception may occur. The aim of our study was to find the relationship of stress resilence in verbal test and individual differences performed in proprioceptive test in onco-patients, sportsmen and group of control; as well as to observe the differences between these groups in the verbal stress resistance and individual differences proprioceptive tests. The results showed that onco-patients were less resistant as per verbal stress resistance outcomes for a major part of variables compared to other groups. The sportsmen were superior in verbal Risk and Control dimensions compared to other groups; but less in Positive Affectiveness. The proprioceptive test perfomance revealed the only statistically significant difference in performance in the dimension related to Mood, showing more Pessimism in the sportsmen group, but more Optimism in the oncopatients at temperamental (or intrisinc) level. The obtained results can be used by psychologists, therapists, coach and healthcare when needed to attend the specific needs of public, being pateints or sportsmen, etc.

Background: COVID-19 pneumonia caused by SARS-Cov-2 virus induces alveolar collapse and hypoxia that may become severe. The aim of the study is to analyze the effects of chest physiotherapy using a threshold valve in patients with acute respiratory failure due to COVID-19 pneumonia. Methods; Retrospective observational study, in hospitalized patients from March to May 2020. Breathing exercises were performed with a threshold valve of 10 cmH2O. Fraction of inspired oxygen, oxygen saturation, heart rate, respiratory rate and dyspnea were collected before and after the first session and at the end of the 5th day of chest physiotherapy treatment. Results: The final sample included 125 patients. Significant differences (p&lt;0.01) were found in the pre-post intervention SpO2/FiO2 ratio (250±88.4 vs 275.6±97.5, p&lt;0.001), reaching 354.4±110.2 after 5 days of therapy (p&lt;0.001 with respect to baseline). Mean baseline respiratory, heart rate and level of dyspnea measure by the Borg scale did not change during the technique performance. In patient maneuvers with FiO2&gt;0.4, the SaO2/FiO2 ratio increase was higher than in patients with milder severity (46.85 ± 77.69, p&lt;0.01). Conclusions: Chest physiotherapy with a 10 cmH2O threshold valve is a safe and tolerated intervention with short-term improvement in oxygenation in patients with COVID-19 pneumonia.

Background/Objectives: It is known that balance disorders involve occupational hazards. However, the inverse relationship (between certain occupations and an increased incidence of vertigo or dizziness) has been scarcely studied. The objective of this work was to analyze the occupation of a group of patients with vertigo, compared to economically active general population, and to evaluate the prevalence of occupational noise and/or vibration-exposure in both groups. Methods: A cross-sectional, observational, case-control study was carried out including 461 patients (220: Meniere’s disease; 73: vestibular migraine; 28: vestibular neuritis; 140: BPPV) (310 women and 151 men). These patients were compared to a control group from the general population, obtained from 6th EWCS-Spain (2015). Possible differences regarding sex, age, occupation, exposure to noise, and exposure to mechanical vibrations were analyzed. Results: Differences in distribution of occupations between patients with vertigo and general population were observed (Chi-square, p=6.142 e-30). Patients with vertigo were significantly more exposed to noise (p=8.19 e-12; OR=2,127, CI95% (1.720;2.630)) and vibrations (p=1.11 e-12; OR=2.288, CI95% (1.835;2.853)) than the control group. These differences were observed both between men and women. Conclusions: A relationship between occupational exposure to noise and/or vibrations and the presence of vertigo was observed. Protective and preventive measures could help prevent the occurrence of some diseases involving vertigo.

Neurosteroids are pleiotropic molecules involved in various neurodegenerative diseases with neuroinflammation. We assessed neurosteroids serum levels in a cohort of Parkinson’s Disease (PD) patients with heterozygous glucocerebrosidase (GBA) mutations (GBA-PD) compared with matched cohorts of consecutive non-mutated PD (NM-PD) patients, and healthy subjects with (GBA-C) and without (NM-HC) GBA mutations. A consecutive cohort of GBA-PD was paired for age, sex, disease duration, Hoehn &amp; Yahr stage, and comorbidities with a cohort of consecutive NM-PD. Two cohorts of GBA-C and HC were also considered. Clinical assessment included the MDS-UPDRS and the Montreal Cognitive Assessment (MoCA). Serum samples were processed and analyzed by liquid chromatography coupled with triple quadrupole mass spectrometry. Twenty-two GBA-PD (males: 11, age: 63.68), 22 NM-PD (males: 11, age: 63.05), 14 GBA-C (males: 8; age: 49.36), and 15 HC (males: 4; age: 60.60) were studied. Compared to NM-PD, GBA-PD showed more hallucinations and psychosis (p&lt;0.05, Fisher’s exact test) and higher MDS-UPDRS part-II (p&lt;0.05). Most of the serum neurosteroids were reduced in both GBA-PD and NM-PD compared to the respective control cohorts, except for 5α-DHP. Allopregnanolone was the only neurosteroid significantly lower (p&lt;0.01, Dunn’s test) in NM-PD compared to GBA-PD patients. Only in GBA-PD, allopregnanolone, and pregnanolone levels correlated (Spearman) with a more severe MDS-UPDRS part-III. Allopregnanolone levels also negatively correlated with MoCA scores, and pregnanolone levels correlated with more pronounced bradykinesia. This pilot study provides the first observation of changes in neurosteroid peripheral levels in GBA-PD. The involvement of the observed changes in the development of neuropsychological and motor symptoms of GBA-PD deserves further attention.

Falls are a frequent and serious problem for older adults and especially those living with Parkinson’s. The relationship between falls and physical activity is complex and people often restrict activity following a fall. Exercise is an important aspect of re-ducing further risk of a fall and a key component of the management of Parkinson’s. The aim of this study was to understand the types of activity that are engaged in, the environments in which they take place and the experience of people with and without Parkinson’s who have fallen. 17 people with Parkinson’s and 13 older adults, who had experienced at least one fall in the previous year, were recruited to this mixed methods study. Activity levels were captured over one week using accelerometers and body worn cameras, allowing the type and location of activity to be recorded and analysed. This information informed an interview. Findings showed that although both groups often achieved up to 10,000 steps per day, this was in very short bouts of activity. Sedentary activity such as watching television dominated the findings. Participants were aware of the benefits of being active but described many barriers to achieving the level of activity they would like to.

The field of epigenetics, which explores how heritable traits or stable alterations of cell functions occur without changes to the DNA sequence and how environmental factors affect gene expression, is rapidly advancing. Epigenetics plays a critical role in memory formation, learning, and cognitive functioning, effectively bridging genetics with environmental influence. Maternal behavior in rats, for instance, can modify the stress response of their offspring through epigenetic mechanisms such as histone acetylation and DNA methylation. Understanding neurodegenerative diseases like Parkinson's disease (PD) depends on comprehending the mechanisms of epigenetic regulation. Epigenetic modifications, which alter proteins and DNA structure without changing the DNA sequence, can activate or suppress gene expression, assisting organisms in adapting to environmental changes. These modifications may influence genes involved in inflammation, synaptic plasticity, and neuroprotection, potentially contributing to cognitive deficits in PD patients. MicroRNAs (miRNAs), histone modifications, and DNA methylation are the epigenetic mechanisms that significantly influence cell differentiation and maintain normal cellular activity. Understanding the intricate molecular processes of epigenetics could lead to more targeted and effective therapies. Despite numerous findings on how epigenetics affects cognitive alterations in PD patients, only some studies coordinate and integrate these results. Here, we summarize recent findings on how epigenetic changes impact gene expression linked to cognitive impairments in PD.

There has been significant increase of studies investigating plasma biomarkers of Alzheimer’s and their relationship to cognitive functioning. The impact of ethnicity on this relationship has not been extensively studied. The current research investigated the relationship between the plasma biomarkers of total tau, Aβ40, Aβ42 and NfL and neuropsychological test performance in a bi-ethnic sample of cognitively unimpaired, older community dwelling adults. The 1326 cognitively unimpaired participants drawn from The Health & Aging Brain Study – Health Disparities (HABS-HD) study included 765 Mexican American participants and 860 non-Hispanic White participants with complete plasma biomarkers and neuropsychological testing. Plasma samples were assayed using Simoa technology. Significant differences in concentrations were found for all of the plasma biomarkers. NHWs had significantly higher levels of each of the biomarkers with a lower Aβ42/ Aβ40. With none of the biomarkers related to performance on any of the neuropsychological tests. For MAs, Aβ40 was the only biomarker that was significantly related to neuropsychological test performance. Aβ40 levels were negatively related to performance on Trails A, Trails B and Digit Symbol Substitution. Results suggest that the relationship of these biomarkers to cognitive functioning is impacted by ethnicity and may be domain specific.

Introduction: While preparing for dive exams, divers are trained to perform rescue exercises. Currently, divers think they will manage and control their body at any time.Methods: At the bottom of the water, the student takes the instructor who simulates a sickness, up to the surface, by controlling the going up. Then, if the exercise is wrong, both divers go down and exercise again. If the exercise is successful, both divers go down to perform another exercise until they are tired or until they have no more air. Results: I discovered that there was a mistake in the preparation of divers for rescue training due to Descartes’ error, “I think, thus I am”, which is part of our collective memory. Going up and going down after a sickness simulation is a repetitive action of the body and going down is therefore part of the automatisms of rescue, which is very dangerous. Conclusions: The body is not necessarily controlled by the present thinking, and if divers forget sickness while going up in a real rescue situation, they will go down automatically because their bodies were trained like this. In addition, it is very easy to forget sickness. Divers should not go down after rescue, they should be on the dive boat or on the land. Descartes’ error has to be reversed: “I am, thus I think” is right. The divers’ rescue exercises must be simplified and divers should never go down after the simulation of a sickness.

Background: Crohn’s disease (CD) and ulcerative colitis (UC) are well defined phenotypes of chronic inflammatory bowel diseases (IBD). A mechanism of inflammation in these diseases is partially controlled by intestinal dendritic cell (DC). In this study we observed a mature CD83+DC in colonic bioptic samples, and its correlation with disease phenotype and activity. Methods: There were 219 subjects included in the study: 100 with UC, 44 with CD and 75 healthy subjects. Colonic biopsy specimens were incubated with primary antibody Anti-CD83. Intraepithelial CD83+DC were counted per 100 enterocytes. Presence of CD83+DC was analysed according type of IBD, histopathologic inflammation activity and treatment outcome. Results: The presence of mature CD83+DCs (0, ≥1) significantly differed among disease types of IBD (p=0.001), histologic inflammation activity (p=0.049) and applied therapy (p=0.001). The odds for CD83+DC presence was 5.2 times higher in CD group than in control/UC group. The odds for CD83+DC presence was 2.6 times higher in subjects without inflammation or chronic inflammation than in acute inflammation. It was also 3.7 times higher in subjects without therapy. The cut-off value 0.5 CD83+DC (Rock analysis area=0.699; SE 0,046;p<0.001;95%CI:0.609-0.788) had been assessed as a differentiation marker between UC and CD. Conclusion: Presence of CD83+DC could be used as a possible parameter in distinction between UC and CD, as well as predictor of inflammation activity and treatment outcome.

Cassava mosaic disease (CMD) and cassava brown streak disease (CBSD) are endemic threats to cassava production. To fill the existing gaps in the understanding of the epidemiology of these diseases in Côte d’Ivoire, nationwide field surveys were conducted in 2016, 2017 and 2020. The leaf samples collected were analysed by PCR. CBSD was not detected in all fields visited. However, an increase of CMD incidence was observed from 45.95% in 2016 to 51.37% in 2020 while CMD severity remained moderate over the years with a mean value of 2.29. Low whiteflies number was observed in field and decreasing over the years. Molecular analysis allowed detection of East African cassava mosaic Cameroon virus (EACMCMV) in single as well as in mixed infection with African cassava mosaic virus (ACMV). Single EACMCMV infection, which was detected only in three agroecological zones of the eastern Côte d’Ivoire in 2016, spread throughout the country in 2017 and became more widespread in 2020 with a preponderance in the central and southern zones, whereas the ACMV+EACMCMV coinfection has spread to the entire zones studied. Knowing the dynamics of the evolution of these viruses across the country, better disease management strategies could be adopted to control the disease.

Coupling the Maxwell tensor to the Riemann-Christoffel curvature tensor is shown to lead to a geometricized theory of electrodynamics. While this geometricized theory leads directly to the classical Maxwell equations, it also extends their physical interpretation by giving charge density, mass density and the four-velocity that describes their motions geometric definitions. Assuming the existence of a conserved energy-momentum tensor, all solutions to the geometricized theory of electrodynamics developed here are shown to be consistent with the emergence of gravity obeying the General Relativity field equation augmented by a term that mimics the properties of dark matter and/or dark energy. Finally, due to the symmetries of the theory, the properties and phenomenology of antimatter emerge in solutions.