Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality education and fewer occupational opportunities, faced by ethnic minorities. Objective: This study examined the protective effect of years of schooling—used as a proxy for educational attainment—on diabetes mellitus (DM), overall and by ethnicity. Based on the MDRs framework, we hypothesized that the protective effect of education would be weaker for Latino individuals compared to non-Latinos. Methods: Data were drawn from the 2012 wave of the Understanding America Study (UAS), a nationally representative, internet-based panel. The outcome of interest was self-reported doctor diagnosis of DM. Logistic regression models were used to assess the association between educational attainment and DM, with an interaction term to explore differences between Latino and non-Latino individuals. Models were adjusted for age, sex, employment, immigration status, and marital status. Findings were presented as adjusted odds ratios (OR), p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower odds of DM in both Latino and non-Latino individuals (p < 0.001). An interaction between education and ethnicity (p < 0.05) indicated that the protective effect of education was weaker for Latino individuals compared to non-Latinos. Conclusion: The findings align with the MDRs framework, which suggests that the health benefits of education are not equally distributed across ethnic groups. For Latino individuals, structural barriers such as lower educational quality and labor market discrimination may limit the protective effect of education against DM. While education is a key determinant of health, its unequal returns contribute to ethnic health disparities. Policymakers must address structural inequalities in education and employment that disproportionately affect ethnic minorities. Tackling these disparities through multi-sector policy interventions will require bipartisan political support.

Rabies is a virus present in more than 150 nations and territories worldwide, but it can be prevented through vaccination. Each year, tens of thousands of people die from rabies, primarily in Asia and Africa, with children under the age of 15 representing 40% of these fatalities. Up to 99% of rabies transmissions to humans occur through dog bites, making dogs the leading cause of rabies-related deaths in humans. We present a fatal case of rabies after a 5-month exposure incident. The patient, a 55-year-old Nigerian missionary from Enugu state, Nigeria presented with restlessness, hydrophobia, occasional barking gestures, abdominal discomfort and agitation. His condition was said to have progressively worsened as patients was unable to eat and drink fluids for days. His wife reported that the patient had experienced a bite from a stray dog on his right arm 5 months before presentation, for which no antirabies prophylaxis was given. The patient died on the second day of admission to the hospital (within 7 days of symptom onset).

Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. Objectives: This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. Results: Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. Conclusion: AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.

Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in patients with a high pre-test probability of OSA. In terms of diagnosis, advancements in wearable technology and mobile health applications have enabled continuous monitoring of sleep patterns and respiratory parameters. These tools provide valuable data that can be used to identify OSA more accurately and promptly. Additionally, machine learning algorithms are being integrated into diagnostic processes to enhance the accuracy of OSA detection by analyzing large datasets and identifying patterns indicative of the condition. Management of OSA has also seen significant progress. Continuous positive airway pressure (CPAP) therapy remains the gold standard, but new developments include auto-adjusting CPAP devices that optimize pressure settings based on real-time feedback. Mandibular advancement devices and hypoglossal nerve stimulation are emerging as effective alternatives for patients who are CPAP-intolerant. Furthermore, lifestyle interventions such as weight management, positional therapy, and exercise have been shown to complement medical treatments, leading to better overall outcomes. This review article highlights these advancements that collectively contribute to improved patient adherence, reduced symptoms, and enhanced quality of life for individuals with OSA.

Introduction: Meigs’ Syndrome, characterized by a benign ovarian tumor that leads to ascites and occasionally pleural effusion, is a rare condition that often presents significant diagnostic challenges, particularly in young female patients. This case report highlights an 18-year-old-female with persistent gross ascites and pleural effusion unresponsive to diuretics, paracentesis, and thoracentesis. Despite extensive diagnostics evaluations including negative results from several tumor makers, histology and pathology reports, Liver and renal function tests, abdominal CT scans, ECHO, Ecg, Chest X-rays and HBV screening PCR test, the underlying causes of the ascites and pleural effusion remained elusive. The diagnosis was only made following an exploratory laparotomy, which revealed the presence of bilateral benign ovarian tumors. Subsequent bilateral Oophorectomy and Salpingectomy resulted in the complete resolution of the ascites. This case underscores not only the importance of considering ovarian pathology in young females with unexplained ascites but also highlights the critical role of exploratory laparotomy when non-invasive diagnostics fails to provide answers. Conclusion: This case emphasizes the need for a high index of suspicious for Meigs’ Syndrome in young females presenting with persistent ascites and pleural effusion, even when standard diagnostic tests yield negative results. It highlights the potential necessity of surgical intervention when other diagnostic approaches fail to identify the underlying causes. Clinicians should be aware of this condition and consider it in their differential diagnosis to ensure appropriate and effective management

Myeloproliferative neoplasms (MPNs) are hematological disorders affecting myeloid stem cells. They are classified as Philadelphia (Ph) chromosome positive-chronic myeloid leukemia, and Ph-negative polycythemia vera, essential thrombocythemia, primary myelofibrosis, chronic neutrophilic leukemia, chronic eosinophilic leukemia, juvenile myelomonocytic leukemia, and MPN unclassifiable. This review is mainly focused on the Ph-negative MPNs namely, PV, ET, and PMF. These affect both males and females with a slight male predominance, with patients mainly presenting in the seventh decade. Patients often present with thrombotic events resulting in complications that lower survival rates. The major driver mutations that have been identified in MPNs are JAK2 Exon 14, JAK2 Exon 12, MPL Exon 10, and CALR Exon 9. The importance of these driver mutations gives due recognition to their inclusion into the 2022 diagnostic criteria of the MPN WHO Classification. However, other non-driver mutations have also been reported, especially in triple-negative cases. These mutations lead to downstream constitutive activation of the JAK/STAT signaling pathway, as well as the MAPK, and PI3K/Akt pathways. Insights into the molecular pathogenesis of MPN and its association with JAK2, CALR, and MPL mutations have identified JAK2 as a rational therapeutic target. Thus, as an approach to MPN therapy, JAK2 inhibitors, such as ruxolitinib, have been shown to effectively inhibit JAK2, and are currently in clinical trials in combination with other drug classes. This review comprehensively examines the molecular markers of the main Ph-negative MPNs, as well as diagnosis and treatment options.

Delirium is a major complication most commonly observed in patients with advanced cancer. However, despite its prevalence, the early diagnosis, management, and prevention of this condition have not seen significant progress. Aim of this research is to provide insights into the prevalence of delirium, the optimization of interventions for managing delirium symptoms, their effectiveness and the impact of underlying factors on the reversibility of delirium in advanced cancer patients receiving palliative care. The review involved systematic searches of relevant databases including MEDLINE, CINAHL, ProQuest Nursing and Allied Health, and PsychInfo using refined search terms. Eight publications out of 614 studies originally searched were selected and critically reviewed. Their quality was assessed using Joanna Briggs Institute's Critical Appraisal Tool for Case Series. Data abstraction and content analysis were performed to synthesize the findings. Delirium is prevalent among advanced cancer patients in palliative care, with rates ranging from 10.3% to 24.1%. Pharmacotherapy and non-pharmacological interventions showed effectiveness in reducing delirium symptoms. Delirium was found to be reversible through palliative care interventions, antipsychotic medications, and exercise therapy. Effective delirium management is crucial in improving the quality of life of cancer patients. This review emphasizes the importance of subtype-specific treatments, standardized guidelines, and long-term follow-up studies. Implementing evidence-based individualized approaches to delirium management can optimize treatment efficacy and clinical outcomes in patients as well as improve the quality of care. Tailored interventions, standardized protocols, and further research are hereby recommended.

Cancer is the second cause of death worldwide, affecting one in six people, with breast cancer being the most prevalent in females. Adapting to an oncological disease entails many physical and psychological changes that affect the patient and their families. This work aims to present existing scientific research on adaptation to oncological disease and the end of life of women with metastatic cancer aged between 45 and 65, framing with Acceptance and Commitment Therapy. (TAC). Fifty documents with publication dates between 2002 and 2022 were included in this study. It was found that there is much information on the topic in question, as it is a problem that affects not only women but also all the systems they are in. When faced with a terminal diagnosis, a woman faces many doubts and uncertainties, in addition to all the physical effects of the disease. Therefore, she should be accompanied by a team specialized in Palliative Care, which can provide her and her family with all the support needed in this challenging phase.

Authors describe autoptic findings of two cases whose COVID-19 diagnosis was supported by laboratory data. Both patients were Caucasian individuals of middle age (one male, 47 years old; the other a female aging 36 years) that were considered as previously healthy. Clinically they died from cardiorespiratory insufficiency while being treated in intensive care units. None of them was intubated and blood oxygen levels (SpO2) decreased below 90% only during the agonal phase. Myopericardial changes were visible from a macroscopic point of view, with hemorrhagic and necrotic areas involving pericardium. Fresh hemorrhage and severe hyperemia were both signs of vascular damage and extravasation leading to acute myocardial injuries. Lymphocytic presence was disparate and not constant.

Background: Sexuality is considered to be one of the most significant markers of quality of life. This is due to the fact that sexuality is linked to ideas, feelings, behaviors, social integration, and therefore, a person's physical and mental health and well-being but with patients who have gynecologic cancers, there are significant challenges when it comes to matters of sexuality and intimacy. Aim: To find out how gynecological cancer affects women's sexual experiences and how they express sexuality in the context of their sickness Design: A qualitative synthesis, thematic approach Result: Nineteen (19) eligible studies centered with gynecologic cancers on sexual functioning were included with two (2) main themes emerged: (1) Issues with Sexual Experiences and (2) Physical and Emotional Burden. Many individuals were found to have one or more sexual dysfunctions, which commonly caused distress. Conclusion: Changes in the women’s quality of life in the sexual aspect due to their disease takes a toll not just on the physical but in other facets as well. Better knowledge and patient-centered approaches would improve gynecologic cancer patients' capacity to cope in terms of sexual functioning. Implications: Healthcare professionals such as oncology nurses and doctors should better understand ways to address the sexual problems of their patients following the myriad of events following their diagnosis and treatment of their gynecologic cancers.

Retinal detachments comprised of serious ocular conditions and can lead to permanent vision loss. When the retina, the neurosensory layer, detaches from the back of the eye, it loses its oxygen and nutrient supply leading to the death of the tissue. Immediate diagnosis and treatment are essential to avoid significant morbidity associated with this condition. In this mini review, we outline the evaluation and management of retinal detachments and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

Background: There are currently numerous risk instruments available to aid in predicting the present or future chance of getting a cancer diagnosis. It aids in determining a person's likelihood of developing certain cancers by looking at various risk factors, including environmental, behavioral, and genetic. Aim: To analyze the effectiveness of cancer risk assessment techniques utilized in primary care settings. Methods: An integrative review of literature Results: Five (5) studies were met the criteria based on the inclusion and exclusion criteria. These tools demonstrated effectiveness in improving patient outcomes and serving as useful therapeutic tools in the primary care setting. Conclusion: Advantages that may aid clinicians in the primary care setting in validating the diagnosis and assisting patients in determining the early signs and symptoms in the diagnosis of cancer. The role of assessment tools can enhance the reliability and caliber of clinical judgment, which can enhance patient outcomes. Implications: The role of healthcare professionals, such as oncologists, nurses, and the healthcare team, on cancer risk assessment in the primary care setting across the lifespan is crucial to ensure a care plan tailored to each patient’s needs.

Background: Neck pain is one of the most common reasons patients seek treatment in the hospital. The causes of neck pain vary widely, trigger misdiagnosis, and often result in mistreatment. Misdiagnoses and mistreatment-related neck pain diagnoses are often associated with a diagnosis of cervical herniated disc. The implication of the misdiagnosis is the use of excessive investigations and inappropriate therapy. This review aims to determine the causes of neck pain often obtained in daily practice and how to diagnose and treat it. Method: Search relevant articles on clinical diagnosis of neck pain with the keywords neck pain diagnostic therapy using Medline and PubMed databases. Results: Neck pain can be in the form of axial pain, which is mostly related to disorders of the joints and muscles of the neck, or in the form of pain in the roots and spinal cord. Investigations and therapy must be related to the clinical diagnosis of neck pain experienced by patients with a history of neck pain. Conclusion: Neck pain is one of the most common complaints encountered in outpatient department settings, associated with reduced quality of life. Patients may come with differing degrees of pain, various symptoms, and aetiologies making it quite challenging to treat them into complete remission. Despite being frequently encountered, some patients with neck pain are underdiagnosed and undertreated due to failure to understand the clinical symptoms before deciding possible aetiologies.

Background: Oral health plays an important role in maintaining life functions and quality of life. Periodontal disease can vary with respect to bacterial etiology, host response, and clinical disease progression. A key role of genetic effects has suggested distribution of lesions and severity of destruction in each individual. Many diseases, particularly digestive disorders, cancer, and infection, show preferences among the ABO blood types. Knowledge of blood groups and their association with oral diseases is very important, as it may help in early diagnosis and treatment strategies‏. Objectives: The study aimed to investigate the distribution of patients with oral and dental health problems according to age, regions, Socio-demographic Variables, and blood groups in the Tripoli region. Material and Methods: The present study was conducted on 200 patients with oral and dental health problems attending six medical centers in Tripoli region from the 01^st March 2022 to the 01^st June 2022. Also, 100 healthy individuals without any oral and dental health problems or any other diseases were recruited as a control group. This study was approved by the Research and Ethical Committee of the medical centers and Libyan Academy of graduate studies. One ml of venous blood was withdrawn from each participant in the study for determination of blood groups. The data were compared using Chi-Square using SPSS Statistics for Windows, Version 25. Results: The results showed that the mean age of the patients was 43.03±13.82 years. The higher distribution of patients was 58 patients (29%) in the age group (26-35) years while the lower distribution was 10 patients (5%) in the age group (66-75) years. The distribution of patients according to the region were 81.5%, 13%, 4%, and 1.5% in Tripoli, South Tripoli, West Tripoli, and East Tripoli, respectively. The Distribution of patients according to occupation were 4.5% Students, 30% Housewives, 10.5% Employers, 12.5% Teachers, 14% Nurses, 7.5% Doctors, 12.5% Laboratory Technicians and 8.5% Freelance workers. The distribution of patients according to levels of education were 23.5% Pre-Secondary, 19% Secondary, 46% Bachelor's or equivalent, and 11.5% Master's or equivalent. The distribution of patients according to marital status were 26% single and 74% married. The distribution of patients according to oral and dental problems were 5% with bridge, 8% with missing teeth, 86% with dental caries, 63.5% with bleeding of gum, and 25.5% with swelling of gum. The degrees of gingival erythema among patients were 36.5% mild, 38% moderate, and 25.5% severe. The degrees of gingival inflammation among patients were 36% mild, 38.5% moderate, and 25.5% severe. The distribution of A, B, AB, and O blood groups showed a significant (P=0.000) difference between healthy individuals and oral and dental health problems among patients that, were 54%, 12%, 4%& 30%, and 21.5%, 9%, 3.5% & 66%, respectively. Also, the distribution of A⁺, A^-, B⁺, B^-, AB⁺, O⁺, and O^- blood groups showed a significant (P=0.000) difference between healthy individuals and patients with oral and dental health problems that, were 49%, 5%, 10%, 2%, 4%, 25%, & 5%, and 18%, 3.5%, 8%, 1%, 3.5%, 60%& 6%, respectively. But, the distribution of Rh⁺ and Rh^- blood groups showed a non-significant (P=0.695) difference between healthy individuals and patients that, were 88% & 12%, and 89.5%& 10.5%, respectively. Conclusion: It can be concluded that the mean age of the patients with oral and dental health problems was 43.03 years and the higher distribution of patients was in the age group (26-35) years. The higher distribution of ABO blood groups was O blood group among patients especially O⁺ blood groups. The distribution of Rh+ and Rh- blood groups were showed a non-significant difference between healthy individuals and patients with oral and dental health problems. Further studies are needed to confirm these results.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that includes a wide range of functional impairments, such as social and communication deficiencies, as well as limited and selective interest and behavioral patterns that are repetitive. Children with ASD often show developmental delay, which is noticeable at an early age, and show a wide range of symptoms that interfere with daily functioning, so early diagnosis includes early interventions. A complex set of genetic and environmental factors is associated with the development of ASD, which makes ASD a complex disorder, so there is a clear distinction between neurodivergent and neurotypical individuals. Since ASD is caused by a combination of certain genetic mutations and the prenatal/postnatal environment, we focused on the etiology of ASD in viral infections, i.e., Cytomegalovirus (CMV) as a possible cause of ASD. CMV is a neurotropic herpesvirus, which can be transmitted from mother to child during pregnancy. Cytomegalovirus (CMV) infection, which is often asymptomatic and can remain latent throughout life, can pose a danger to immune insufficiency individuals during pregnancy. CMV is the most common pathogen that causes intrauterine infections, is the most common cause of nongenetic sensorineural hearing loss in children, and the main cause of neurodevelopmental delay, so research suggests an association between congenital CMV infection with ASD and maternal seropositivity for CMV in pregnancy. spectrum in children. In the research, we used various online databases as sources for our study. The result of our research and processing of the given information indicates that maternal CMV infection in pregnancy is related to the development of autism spectrum disorders in children.

The deleterious health effects of ethanol abuse are widely known and a diversity of medical conditions appear with excessive consumption. Acute and chronic abuse have different clinical characteristics, although severe intoxications are rare among alcoholics of a long career, where the systemic complications will dominate the symptomatology. While the medical focus acutely will mostly stay on the nervous and circulatory effects, gastrointestinal complications that will come up chronically (liver, pancreas, bowel dysfunction) need proper consideration. Ethanol will affect gastrointestinal functionality through a triple action, directly on the epithelial cell and the secretory activity, by altering the motility and in the long-term scope, through promoting carcinogenesis. Medical teams dealing with acute and chronic ethanol intoxication or abuse must be aware of the multiple effects it shows, and perform a prompt diagnosis as well as appropriate intervention.

An unhealthy dietary habit leads to excess calorie consumption (overnutrition) or inadequate supply of one or more essential micronutrients (undernutrition).This nutritional imbalance is assessed by Anthropometric measurements, Biochemical estimations, Clinical examination and assessment of Dietary intakes. Anthropometry is an inexpensive, rapid and non-invasive method that provides details on different components of body structure and is highly sensitive to the broad spectrum of nutritional status. Hence, it has always been an important tool for screening and early diagnosis of malnutrition. Undernutrition in below 5 year children is life-threatening epidemic contributing to about 45% of under 5 child deaths. Children with Severe Acute Malnutrition (SAM) are nine times more likely to die, compared to their healthy counterparts. Therefore, early and accurate diagnosis of children with SAM is crucial for its management and prevention of morbidity and mortality from the same. SAM is defined as weight-for-height Z scores (WHZ) below -3SD of the median or a mid upper arm circumference (MUAC) of <115mm in children of 6-59 months age. The cut-offs for MUAC and WHZ are scientifically approximated to each other and both are used to diagnose children with SAM (Severe Wasting). However, the research findings from various countries revealed that the agreement between WHZ and MUAC is poor as both indices classify the children with SAM differently, with a small overlap, which varies greatly among countries. These discrepancies have an implication when using either one alone for measuring the prevalence of acute malnutrition. Therefore, it is pertinent to adopt both WHZ and MUAC indices to assess the burden of severe acute malnutrition (SAM) in the community.

The International Association for the Study of Pain has classified pain into nociceptive pain, neuropathic pain, and nociplastic pain based on the cause of the pain. At present, nociplastic pain is pain that is not nociceptive pain and has the following characteristics: no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. If there is tissue damage, disease or lesion, it is neuropathic pain; if there is none, it is nociplastic pain. In other words, the difference in diagnosis is whether or not tissue damage, disease, or lesion can be found at the current medical level (testing equipment). The treatment of nociplastic pain is almost the same as the treatment of neuropathic pain. Fibromyalgia is included in nociplastic pain. To my knowledge, of the nociplastic pain and neuropathic pain, fibromyalgia is the disease with the highest number of pharmacological and non-pharmacological treatments with evidence of efficacy. Effective treatments for fibromyalgia are often given to neuropathic pain. This expands treatment options. I presume that tissue damage, disease or lesion will be found in fibromyalgia through advances in the medical science by the time humans emigrate to Mars. The distinction between nociplastic pain and neuropathic pain complicates the diagnosis of chronic pain. However, the distinction does not improve the treatment outcomes. Medical science is the discipline to find a treatment method that can produce better outcomes. In the event of a medical controversy, the medical theory with better treatment outcomes should be adopted. It is desirable to combine nociplastic pain and neuropathic pain into one pain. This will simplify diagnosis and increase treatment options (improve treatment outcomes) in nociplastic pain and neuropathic pain.

Although rarely, echinococcosis might present cardiac involvement, with cysts growing inside myocardial structures of arising adjacent to heart. A careful differential diagnosis with other mass formations and rare cardiac tumours is necessary, whenever there is a clinical and radiological suspicion. Imaging studies and serology will establish diagnosis. A multidisciplinary approach is warranted in all cases, with surgical intervention being unavoidable in most settings. Patients generally present with chest pain and dyspnoea. Cases need a close follow up of their postoperative course, while being treated appropriately with albendazole (or mebendazole) for prevention of recurrences.

This study is a literature review with a qualitative approach. It is justified by the significant increase in diseases acquired through lifestyle habits that generate health risks, which impair and are responsible for decreasing longevity and decreasing quality of life, such as hypertension, depression, obesity and respiratory tract diseases. Physical activity is recognized as a protective factor for health, and its benefits are associated with the reduction of chronic diseases and a decrease in the risk of premature death from diseases related to a sedentary lifestyle. The objective of this research is to search and identify, within the scientific literature, if there are in fact contributions from the practice of physical activity in subjects diagnosed with depression. For the categorization of studies and selection of materials, the following keywords were determined: physical exercise and depression and physical activity and depression. As inclusion criteria for data analysis and interpretation, the following were considered: articles in Portuguese, full texts, published in health journals, between the years 2005 to 2015. As exclusion criteria, we considered articles found by descriptors that did not contain one or more of the inclusion criteria. In this study, articles were selected by searching the Scientific Electronic Library Online (SciELO) and Lilacs. The choice of these databases was prioritized due to the quality and reliability of the materials available, and their easy access. 77 articles were found, of which 4 were selected to be part of this research. It can be noted that physical activity showed positive aspects and possible contributions and can be considered as a bias in an adjunct to conventional pharmacological treatments. The need for further clarification about the disease in relation to psychological, social and physiological issues is also evident, thus opening the possibility for further studies and research on the subject, so that in this way they can guide possible interventions that help in the treatment of the depression.

A 75-year-old female is referred for evaluation of a progressive leg swelling. Angiological and MRI evaluation show the presence of inflammatory tissue surrounding the aorta and the left iliac vessels, causing significant stenosis. Upon suspicion of retroperitoneal fibrosis, we actively seek for secondary causes such as malignancies, autoimmune diseases and infections, as well as IgG4-related disease. All investigations result negative and we make the diagnosis of idiopathic retroperitoneal fibrosis. Steroid therapy was started and we observed a rapid amelioration of symptoms and radiological disappearance of the inflammatory tissue around the aorta.

Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. co-infection presents additional challenges in COVID-19 patients because of its rarity, similar clinical presentation to SARS-CoV-2, and poorer outcomes without prompt treatment. Cases Presentation: Case 1. A 62-year-old female presented with a 3-day history of subjective fever and worsening shortness of breath. Room air saturation (saO2) was 70% and improved to 100% on noninvasive positive- pressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR and urine legionella antigen tests were positive. The diagnosis of hypoxic respiratory failure secondary to COVID-19 and Legionella pneumonia was made. Patient was admitted to intensive care unit (ICU) and managed with decadron, remdesivir, one unit of convalescent plasma for COVID-19 and Azithromycin for Legionella. Patient subsequently developed acute respiratory distress syndrome (ARDS). ARDS protocol was initiated. 13 days after, the patient was compassionately extubated. Case 2. A 41-year-old male presented with 5-day history of fever, worsening shortness of breath, cough and diarrhea. Patient admitted history of ethanol abuse. SaO2 was 88% and improved on oxygen canula. Lung auscultation revealed rhonchi BL. CXR showed extensive left lung consolidation. Urine test for legionella antigen was positive. COVID-19 PCR was negative, but SARS-CoV-2 IgG was reactive. The diagnosis of Legionnaire disease was made. Despite initial treatment with Azithromycin, patient's hypoxia continued to worsen requiring NIPPV, and subsequently mechanical ventilation in the ICU. The adjunction of empiric treatment for COVID-19 with convalescent plasma, remdesivir and steroids improved both clinicals and laboratory findings. Discussion: The cases illustrated the practical challenges of managing COVID-19 and legionella co- infection. Legionella spp and SARS-CoV-2 overlapping incubation periods and similar clinical presentations and complications. In the absence of diagnosis and treatment, legionella pneumonia has an intrinsic mortality rate of up to 80%. As some COVID-19 mitigation strategies, such as the closure of businesses, have enhanced the conditions for Legionella spp proliferation, the incidence of Co-infection with COVID-19 may increase. We recommend clinicians to have high-indexed suspicion of COVID-19 and Legionella co-infection in order to obtain complete work up at patient’s initial presentation.

Background: Cerebral palsy is not only a serious neurodevelopmental disease causing significant morbidity in children, but also a traumatic experience leading to psychosocial trauma to the parents/caregivers of the affected children. It is usually caused by prenatal or early post-natal insults to the newborn brain which may be associated with some congenital syndromes like congenital heart disease with transposition of the viscera but rarely a heterotaxy syndrome, a condition characterized with congenitally abnormal arrangement of the thoracic and abdominal viscera. Method: We present a case report of a 12-month-old boy with neurodevelopmental delay, recurrent episodes of non-mucoid and non-bloody diarhoea, occasional constipation, bilious vomiting, abdominal distension and fever with associated cough and difficulty in breathing. Results: We discuss an unusual presentation of cerebral palsy and heterotaxy syndrome diagnosed clinically with supporting evidence from both laboratory and radiological tests. Cerebral palsy was diagnosed from the history of birth asphyxia, delayed developmental milestone, limb spasticity and low values for all sub-scores of Bayley-III scale. Heterotaxy syndrome was diagnosed from the radiologic evidence of dextrocardia, left-sided stomach, centrally located liver and malrotation of gut with volvulus. We also provide a brief literature review of the incidence and prevalence, causes and risk factors, classification, clinical presentation and associated co-morbidities of heterotaxy syndrome. Conclusion: Diagnosis of heterotaxy syndrome in a child with background cerebral palsy is a great challenge to both physicians and radiologists. This is more so in developing countries due to poor availability of good diagnostic apparatus, therefore, a high index of suspicion is needed. A clear understanding of the clinical features, comprehensive history taking and thorough physical examination are important in making prompt diagnosis. Timely and appropriate imaging is necessary to prevent delays in diagnosis and treatment which lead to poor outcomes.

Alterations in the cardiac electrical system are the cause of morbidity and a wide variety of symptoms – from mild to those requiring urgent intervention – because of the risk of sudden cardiac death. The most prevalent of these types of electrical disturbances is atrial fibrillation, the incidence of which is growing as the average age of the human being increases. Among many other electrical heart alterations is one I describe in this document: "The presence of short PR and QTc intervals together in the same ECG tracing”. Methods: A cardiac calibrator was used by four different cardiologists in blinded fashion to document a distinct ECG pattern, that of a short PR and QTc intervals together in the same ECG tracing from more than 2.500 cases assessed for this condition (more than two thousand five hundred cases evaluated since 2.007 to date). Results: Here we describe the clinical features of 330 patients with a documented short PR and QTc intervals together in the same ECG tracing along with descriptions of their symptoms and ancillary investigations. Conclusions: ECG tracing must be studied carefully in patients with suggestive symptoms before declaring normal an ECG tracing with certain defined characteristics.

We here report a case of an acute cephalic vein thrombophlebitis in a 34-year-old female patient with no known thromboembolic risk factors and no medical history or ongoing treatment. We present the images of her diagnosis, which was made in the presence of a painful and indurated hyperchromic cord of the arm and confirmed by Doppler ultrasound. In the absence of deep extension of the thrombus, his management was limited to a symptomatic treatment without anticoagulation and the symptomatology was amended without complication or recurrence.

The first visualizations of the structures of the sheep's reproductive system, whether of the uterus or ovaries, were performed through exploratory laparotomies, laparoscopies or through materials obtained in slaughterhouse, being possible to evaluate only what was happening at that moment in the estrous cycle. With the emergence of ultrasound from the 90s, it became possible to dynamically monitor what happened at each moment of the estrous cycle at different times of the year, without having to slaughter the females. Because it is a non-invasive technique and the stress caused by its use is very low, it is increasingly necessary to use ultrasound in sheep, either for pregnancy diagnosis or for multiplying herds using biotechnologies, which the ultrasound examination becomes indispensable to obtain the best results. This review aims to describe the main advances in the study of the estrous cycle of sheep with the help of ultrasonography and its influence on the productive efficiency of the herd.

Cell division that is not controlled leads to cancer, an incurable condition. An early diagnosis has the potential to lower death rates from breast cancer, the most frequent disease in women worldwide. Imaging studies of the breast may help doctors find the disease and diagnose it. This study explores an effectiveness of DL and ML models in a classification of mammography images for breast cancer detection, utilizing the publicly available CBIS-DDSM dataset, which comprises 5,000 images evenly divided between benign and malignant cases. To improve diagnostic accuracy, models such as Gaussian Naïve Bayes (GNB), CNNs, KNN, and MobileNetV2 were assessed employing performance measures including F1-score, recall, accuracy, and precision. The methodology involved data preprocessing techniques, including transfer learning and feature extraction, followed by data splitting for robust model training and evaluation. Findings indicate that MobileNetV2 achieved a highest accuracy99.4%, significantly outperforming GNB (87.2%), CNN (96.7%), and KNN (91.2%). The outstanding capacity of MobileNetV2 to identify between benign and malignant instances was shown by the investigation, which also made use of confusion matrices and ROC curves to evaluate model performance.

Neural networks are bringing a transformation in wearable healthcare technology analytics. These networks are able to analyze a vast amount of data to help in making decisions concerning patient care. Advancements in deep learning have brought neural networks to the forefront, making data analytics a straightforward process. This study will help in unveiling the use of ICT and AI in medical healthcare technology, crawling through some industry giants. Wearable Healthcare Technologies are becoming more popular every day. These technologies facilitate collecting, monitoring, and sharing every vital aspect of the human body necessary for diagnosing and treating an ailment. At the advent of global digitization, health data storage and systematic analysis are taking shape to ensure better diagnostics, preventive, and predictive healthcare. Healthcare analytics powered by neural networks can significantly improve health outcomes, maximizing individuals' potential and quality of life. The breadth and possibilities of connected devices are getting wider. From personal activity monitoring to quantifying every bit of health statistics, connected devices are making an impact in measurement, management, and manipulation. In healthcare, early diagnosis could be a lifesaver. Data analytics can help in a big way to make moves and predictions to save lives. We are in another phase of the digitization era, "Neural Network and Wearable Healthcare Technology Analytics." A neural network could be conceived as an adaptive system made up of a large number of neurons connected in multiple layers. A neural network processes data in a similar way as the human brain does. Using a collection of algorithms, for many neural networks, objects are composed of 'input' and 'output' layers along with the layers of the neural network.

Advances of wearables, sensors, smart devices, and electronic health records have generated patient-oriented longitudinal data sources that are analyzed with advanced analytical tools to generate enormous opportunities to understand patient health conditions and needs, transforming healthcare significantly from conventional paradigms to more patient-specific and preventive approaches. Artificial intelligence (AI) with a machine learning methodology is prominently considered as it is uniquely suitable to derive predictions and recommendations from complex patient datasets. Recent studies have shown that precise data aggregation methods exhibit an important role in the precision and reliability of clinical outcome distribution models. There is an essential need to develop an effective and powerful multifunctional machine learning platform to enable healthcare professionals to comprehend challenging biomedical multifactorial datasets to understand patient-specific scenarios and to make better clinical decisions, potentially leading to the optimist patient outcomes. There is a substantial drive to develop the networking and interoperability of clinical systems, the laboratory, and public health. These steps are delivered in concert with efforts at enabling usefully analytic tools and technologies for making sense of the eruption of overall patient’s information from various sources. However, the full efficiency of this technology can only be eliminated when ethical, legal, and social challenges related to reducing the privacy of healthcare information are successfully absorbed. Public and media are to be informed about the capabilities and limitations of the technologies and the paramount to be balanced is juvenile public healthcare data privacy debate. While this is ongoing, the measures have been progressed from patient data protection abuses for progress to realize the full potential of AI technology for hosting the health system, with benefits for all stakeholders. Any protection program should be based on fairness, transparency, and a full commitment to data privacy. On-going innovative systems that use AI to manage clinical data and analyzes are proposed. These tools can be used by healthcare providers, especially in defining specific scenarios related to biomedical data management and analysis. These platforms ensure that the significant and potentially predictive parameters associated with the diagnosis, treatment, and progression of the disease have been recognized. With the systematic use of these solutions, this work can contribute to the realization of noticeable improvements in the provision of real-time, personalized, and efficient medicine at a reduced cost [1].

Emerging smart medical instruments combined with advanced smart industrial equipment facilitate the collection of vast volumes of critical data. This data not only enables significantly more accurate and cost-effective diagnosis and maintenance but also enriches the datasets available for AI algorithms, leading to improved insights and outcomes. The integration of high-speed and ultra-reliable telecommunications infrastructure is crucial, as it supports the cloud model. This model allows for off-device aggregation in the cloud, which effectively offloads infrastructure demands and provides an extended runway for future technological improvements before the deployment of the next generation of devices. However, in certain scenarios, latency and bandwidth limitations present significant challenges. These limitations require that a substantial amount of AI and machine learning processing is conducted directly on the transmitted data, which places rigorous demands on both the processing subsystems and the communications links themselves. The current project directly addresses the accelerator side of this multifaceted issue. It will carry out comprehensive end-to-end demonstrations leveraging pilot 5G networks and telemedicine facilities, collaborating closely with major industry participants to showcase the capabilities and potential of this innovative technology. This collaborative effort is essential to pushing the boundaries of what is possible in smart medical instruments and industrial applications [1].

The effects on the elderly are disproportionately Alzheimer’s disease (AD) is one of the most prevalent and chronic types of dementia. Alzheimer's disease (AD), a fatal illness that can harm brain structures and cells long before symptoms appear, is currently incurable and incurable. Using brain MRI pictures from a publicly accessible Kaggle dataset, this study suggests a prediction model based on Convolutional Neural Networks (CNNs) to help with the early detection of Alzheimer's disease. Four levels of dementia have been applied to the 6,400 photos in the collection: not demented, slightly demented, moderately demented, and considerably mildly demented. Pixel normalization, class balancing utilizing data augmentation techniques, and picture scaling to 128×128 pixels were all part of a thorough workflow for data preparation. To improve the gathering of spatial dependence in volumetric MRI data, a 3D convolutional neural network (CNN) architecture was used. We used important performance measures including F1-score, recall, accuracy, precision, and log loss to gauge the model's effectiveness. A review of the available data indicates that the total F1-score, accuracy, recall, and precision were 99.0%, 99.0%, and 99.38%, respectively. The findings demonstrate the model's potential for practical use in early AD diagnosis and establish its robustness with the help of confusion matrix analysis and performance curves.

Predictive modeling, supported by machine learning technology, aims to analyze data in order to guide decision-making towards actions generating desired values in the future. It encompasses the set of techniques used to build models that estimate the value of a certain variable predicting a forthcoming event from the past or current values of relevant attributes. In predictive healthcare modeling, the built models represent the relationship among the data concerning customer, provider, production, and other aspects of the healthcare environment in order to assist the decision processes in the prevention of diseases and in the planning of preventive actions by detection of high-risk patients. Contrary to trend analysis, whose goal is to describe past events, predictive models aim to provide useful indications regarding future events and changes. Predictive healthcare modeling supports actions that try to prevent the manifestation of diseases in healthy individuals or try to diagnose as early as possible the incidence of a disease in patients at risk. A sound predictive analysis encompasses not only the model-training task, but also the aspects of data quality, preprocessing, and fusion during its entire implementation lifecycle to ensure appropriate input data preparation. The robustness of the predictive model and its results depends highly on data quality. Due to the variety of data sources in healthcare environments, it becomes essential to use preprocessing in order to remove noise and inconsistencies. The increasing number of endorsable data exchange standards makes each data exchange achievable, but it demands the implementation of a data-governance program. In addition, the influence of the hospital-database architect on the architecture of an early-diagnosis model is important to guarantee appropriate input-formatting modularity.