Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×10⁹/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p < 0.0001). Subgroup analyses showed the protective effect of higher ALC was consistent across age, sex, BMI, PEG use, and comorbidity strata, with no significant interactions. Conclusions: ALC is an independent, non-linear predictor of mortality in older dysphagic patients and may aid clinical risk stratification across diverse patient subgroups.

Legionnaires' disease became widely known following an outbreak of pneumonia in the United States in 1976. It is often caused by infection from artificial water sources such as cooling towers, water supply and heating systems, and recirculating hot tubs. To effectively implement infection prevention measures for Legionnaires' disease, collaboration among healthcare workers, water supply and heating system managers, building hygiene personnel, and other relevant parties is essential. It is important to note that outbreaks of Legionnaires' disease continue to occur frequently both domestically and internationally. While the number of reported cases of Legionnaires' disease in Japan has increased, the mortality rate has decreased but has stabilized at a lower level. Caution is also required as reports have been made in association with disasters and travel, in addition to artificial environmental water.

COVID-19 vaccines have demonstrated efficacy in reducing the prevalence of serious illnesses. The relative risk of hospitalization and mortality for patients who get breakthrough infections after immunization versus those who develop reinfections after a prior spontaneous infection is examined in this correspondence. Based on a study on U.S. Veterans who were not vaccinated and experienced reinfections had a much higher risk of experiencing severe illness outcomes compared to those who had received immunizations and experienced breakthrough infections, even if the rates of reinfection and breakthrough infection were similar. Our findings highlight the value of immunization in reducing severe COVID-19 outcomes, even in the presence of reinfections.

Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.

Introduction: Cerebral venous thrombosis is a rare type of stroke caused by partial or complete occlusion of cerebral venous sinuses. Current guidelines recommend the administration of Low Molecular Weight Heparin (LMWH) during the acute phase and oral Vitamin K antagonists (VKAs) such as warfarin for 3-12 months. Direct Oral Anticoagulants (DOACs) are an attractive alternative to VKAs as therapy for CVT, for its safety and efficacy as anticoagulation therapy for deep venous thrombosis or pulmonary embolism. Method: This systematic review is written based on PRISMA guidelines with electronic search performed on various databases for journals published from June 1, 2018 to June 1, 2023. Results: We found four studies fulfilling the inclusion criteria, with four randomized controlled studies presenting 179 CVT patients treated with DOAC and 150 patients treated with standard therapy. DOACs used in reviewed studies are Dabigatran and Rivaroxaban. Discussion: Administration of DOACs as anticoagulation therapy in patients with CVT presents better recanalization rate with no significant differences in efficacy compared with VKAs, along with a better safety profile through similar mortality rate across two groups. Conclusion: DOACs as long-term anticoagulation therapy in patients with CVT has better efficacy along with a similar safety profile compared to VKA.

Background: Coronavirus disease 2019 (COVID-19) is a newly emerging human disease caused by a novel coronavirus, causing a global pandemic crisis. Probiotics and/or colchicine may be considered as options for treatment since they have anti-viral, anti-inflammatory, and immunomodulatory effects. The aim of the current review was to assess the effectiveness of probiotic supplements and colchicine on symptoms, duration, and progression of mild and moderate cases of COVID-19 infection. Review: A randomized, double-blind, placebo-controlled trial in the United States with 182 participants who were randomly assigned to receive daily oral probiotic (Lactobacillus rhamnosus) LGG or placebo for 28 days. The study indicated that LGG is well-tolerated and is associated with a delay in the onset of COVID-19 infection, a reduction in the incidence of symptoms, and alterations in the structure of the gut microbiome when administered as post-exposure prophylaxis within seven days of exposure. Colchicine may lessen mortality and the need for mechanical ventilation in mild-to-moderate COVID-19 patients, according to a systematic review and meta-analysis. Conclusion: Probiotics and/or colchicine may be viable treatment options for COVID-19 patients. To examine the efficacy of probiotics and colchicine in the treatment of COVID-19, it is necessary to conduct additional clinical trials and provide clinicians with evidence, as there are currently insufficient studies to support this conclusion.

Anaphylaxis can be associated with hemodynamic shock, which requires the early initiation of adrenaline as part of its management. Cardiogenic pulmonary edema is a frequent entity in emergency services with increased mortality in patients with acute coronary syndrome. The case report presents the case of a 55-year-old male patient who entered the emergency department with a non-ST-segment elevation myocardial infarction (NSTEMI) associated to pulmonary edema and anaphylaxis. During his stay in the emergency room, he had an anaphylactic reaction to dipyrone (metamizole) used for pain control. The patient presented signs of acute pulmonary edema, a hypertensive urgency after the use of adrenaline for the management of anaphylaxis.  There was doubt as to whether the dyspnea was of anaphylactic or cardiogenic origin, so an emergency ultrasound was performed, which suggested a bilateral pattern B.  This allowed timely management of ventilatory failure with systemic nitrates, diuretics, and oxygen therapy, which controlled blood pressure and resolved ventilatory failure. Subsequently, he was transferred to an institution with a hemodynamic service for the management of NSTEMI. We highlight the utility of emergency ultrasonography for immediate decision-making and the low prevalence of anaphylactic reaction in a patient with NSTEMI leading to acute pulmonary edema.

Background: Shiga toxin producing Escherichia coli (STEC) inducing hemolytic uremic syndrome (HUS) with multiple organ involvement is associated with significant morbidity and mortality. The treatment has mostly been focused on kidney, respiratory and cardiovascular supports and not against the bacteria that cause STEC-HUS. The use of bactericidal therapy has been shown to be antibiotic dependent and certain antibiotics inhibit the production and release of Shiga toxin, eradicate STEC without harmful effects, and improve outcome. Methods: A previously healthy 18-months-old girl with STEC causing severe colitis, kidney failure and multi-organ dysfunction was treated with antibiotics that were known to inhibit the release of Shiga toxin as a supplement to supportive care. Results: The antibiotic regime stopped the pathophysiological process with prompt clinical improvement in association with the disappearance of the Shiga toxins. Conclusions: The present case report fortifies and recommends appropriate antibiotic treatment during STEC-HUS, suggesting clinicians to consider the use of these in severe STEC-HUS as early as possible.

Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X²) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.

Hypertension remains a leading cause of cardiovascular morbidity and mortality. Although effective antihypertensive therapies are available, sustained blood pressure control remains suboptimal due to inconsistent medication use. Most adherence research is quantitative and offers limited understanding of how individuals interpret lifelong treatment within daily life, particularly in culturally grounded contexts. To explore the lived experiences of Filipino adults taking antihypertensive medication. A qualitative study grounded in Heideggerian interpretive phenomenology was conducted. Ten Filipino adults diagnosed with hypertension were purposively recruited from outpatient clinics in Manila, Philippines. In-depth semi-structured interviews were transcribed verbatim and analyzed using the six-step IPA framework. Analysis revealed six interconnected themes describing how participants interpreted and sustained medication use: (1) Diagnosis as Disruption; (2) Medication as Protection and Responsibility; (3) The Paradox of the Silent Illness; (4) Everyday Barriers to Sustained Treatment; (5) Constructing Routine and Adaptive Self-Management; and (6) Family as Anchor within Cultural Contexts. These themes reflected emotional adjustment, symptom-driven adherence, financial and work-related barriers, adaptive coping strategies, and strong family-centered motivation. Medication-taking was experienced as an ongoing negotiation shaped by bodily cues, daily demands, and relational obligations. Conclusion: Antihypertensive medication use is shaped by relational, cultural, and socioeconomic contexts, underscoring the need for family-inclusive and culturally responsive hypertension care.

Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. Clinical Description: A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. Conclusion: This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.

VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the healthcare team works to prevent further deterioration of the patient. VAP is associated with a notably high mortality rate, particularly in individuals with weakened immune systems, as well as in younger and older populations. Extended intubation and prolonged sedation can contribute to the onset of VAP. The previous study had found that incidence of VAP accounts for 9 % to 27 % endotracheal intubated patients, whereas VAP has a mortality rate ranging from 25 % to 50 % [1-3]. VAP increased ICU and hospital length of stay, antibiotic consumption, and healthcare cost (Zhi Mao et al, 2016) [4]. While using the subglottic suctioning could prevent and help the intubated patient to decreased the development of VAP. The study shown by Smith et al (2021) [5] SSD is a technique employed to reduce micro aspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. Another study by Rahul Gujadhur et al (2005) [6], subglottic suction has also been shown to delay the onset of VAP but no benefits in terms of ventilation time, hospital stay or mortality benefit have ever been shown. This investigation into subglottic suctioning may assist the healthcare team, particularly in the intensive care unit, in preventing the development of VAP and shortening the duration of ventilation for patients. The advantages of subglottic suctioning are often debated, particularly regarding its impact on the duration of intubation. However, recent research indicates that implementing subglottic suctioning within a time frame of fewer than three days could help reduce intubation duration and lead to improved patient recovery.

Smoking is a well-documented risk factor of cardiovascular diseases (CVD) and premature death. Previous studies have focused on smoking duration and total cigarette consumption, but a 2024 paper by Li et al. highlights the time between waking up and smoking the first cigarette as a risk factor of mortality, noting that smoking ≤5 minutes after waking is strongly linked to a higher risk of mortality and a higher chance of incident myocardial infarction or stroke, and may be a sign of nicotine dependence. Another study by Hu et al. (2024) states that early-morning smoking more strongly correlates with incident type 2 diabetes than total cigarette consumption, adding to preceding evidence that early-morning smoking is linked to type 2 diabetes and chronic obstructive pulmonary disease (COPD). The demonstrated association with adverse health outcomes and early-morning smoking suggests delayed time to first cigarette can be a useful target as part of smoking interventions. These findings indicate the necessity of public health policies targeting smoking behaviour in addition to cessation as a way to decrease the associated disease burden.

Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study aimed to examine whether college students who use tobacco exhibit lower support for tobacco control policies compared to their non-user counterparts. Methods: We conducted a multi-center, cross-sectional study involving 2403 college students from various provinces in Iran. Tobacco use was ascertained based on self-reported consumption of cigarettes, electronic cigarettes, and hookah. Attitudes toward tobacco control policies were evaluated using a structured survey instrument, and comparative analyses were performed to assess differences in policy support between tobacco users and non-users. Results: The analysis revealed that tobacco users demonstrated significantly lower support for tobacco control policies compared to non-users. This association was consistently observed across users of cigarettes, electronic cigarettes, and hookah, suggesting a systematic pattern irrespective of the type of tobacco product used. Conclusion: These findings indicated a clear association between tobacco use and reduced endorsement of tobacco control policies among Iranian college students. These results have potential implications for public health policy, emphasizing the importance of addressing individual tobacco use behaviors in the development and implementation of tobacco control strategies. Further research is needed to elucidate the underlying mechanisms of this relationship.

Digital therapeutics (DTx) are emerging as a pivotal tool in promoting longevity by addressing non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and mental health disorders. These software-driven interventions offer personalized, evidence-based treatments that can be accessed via digital devices, making healthcare more accessible and scalable. One of the key advancements in DTx is the integration of artificial intelligence (AI) and machine learning (ML) to tailor interventions based on individual health data. This personalization enhances the effectiveness of treatments and supports preventive care by identifying risk factors early. The need for digital therapeutics is underscored by the rising prevalence of NCDs, which are responsible for a significant portion of global mortality and healthcare costs. Traditional healthcare systems often struggle to provide timely and personalized care, especially in low-resource settings. DTx can bridge this gap by offering cost-effective solutions that are easily scalable. Moreover, digital therapeutics can address health inequities by providing low-cost interventions to underserved populations, thereby reducing the burden of NCDs and improving overall health outcomes. As technology continues to evolve, the potential for DTx to enhance longevity and quality of life becomes increasingly promising. Recent advancements in longevity medicine and technology have focused on extending both lifespan and healthspan, ensuring that people not only live longer but also maintain good health throughout their extended years. This review article highlights these advancements that are contributing to this compelling subject of Longevity.

Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.

Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing complications, limited availability of active pharmaceutical ingredients (APIs), market dynamics that discourage the production of less profitable medications, and regulatory challenges that slow down the approval process for new manufacturing capacities. The consequences of these shortages are far-reaching. Patients often face treatment delays, which can lead to adverse health outcomes, increased hospitalization rates, and even mortality. Healthcare providers experience heightened operational costs as they seek alternative therapies and manage complications resulting from inadequate treatment. Furthermore, the frequent occurrence of drug shortages erodes public trust in both the healthcare system and the pharmaceutical industry, leading to decreased patient adherence to prescribed therapies. To mitigate the impacts of drug shortages, this manuscript proposes several strategic solutions, including enhanced communication among stakeholders, diversification of supply sources, increased regulatory flexibility, and collaborative approaches between public and private sectors. Additionally, raising awareness among healthcare providers and patients regarding the causes and potential alternatives can empower stakeholders to navigate shortages effectively. Ultimately, addressing drug shortages necessitates a proactive and coordinated effort from all participants in the pharmaceutical supply chain. By implementing these strategies, stakeholders can enhance the resilience of the supply chain, ensuring that essential medications remain accessible and that patient care is not compromised. The findings of this manuscript underscore the urgent need for ongoing vigilance and collaborative action to tackle the challenges posed by drug shortages, safeguarding public health and improving healthcare outcomes globally.

Background: Smoking cessation is a crucial public health goal due to its substantial impact on reducing the morbidity and mortality associated with tobacco use. However, significant disparities in smoking cessation success persist across socioeconomic groups in the United States. Objectives: This study aimed to examine differences in smoking cessation rates among daily smokers based on race, ethnicity, and socioeconomic status (SES) using data from the Population Assessment of Tobacco and Health (PATH) study, spanning waves 1 to 6 (eight years). Methods: Longitudinal data from PATH were analyzed, focusing on baseline daily cigarette smokers followed over an eight-year period to assess cessation outcomes. SES was measured by education and poverty status. Successful smoking cessation was defined as sustained abstinence from cigarettes for 12 months or more at the final wave. Logistic regression models identified predictors of successful cessation, adjusting for potential confounders, including age, nicotine dependence, and access to cessation resources. Results: The analysis revealed significant disparities in cessation success across racial, ethnic, and SES groups. Smokers living in poverty and those with lower educational attainment were less likely to achieve cessation success than their counterparts. Race (Black) and ethnicity (Latino) were also significantly associated with lower cessation success. Conclusions: This study highlights the social determinants of smoking cessation success among U.S. adult smokers, with lower success rates observed among those in poverty and with less educational attainment. These findings emphasize the need for targeted interventions that address the unique barriers to cessation faced by low-SES groups. Public health strategies should prioritize equitable access to cessation resources and culturally tailored interventions to reduce these disparities and improve cessation outcomes among all smokers.

Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections that are related to increased mortality in cardiac intensive care units (CICUs). To determine the risk factors for CLABSIs, a case-control study was conducted in the CICU of our hospital. Emergency surgery (odds ratio: 9.6, 95% confidence interval: 1.633-56.926) was the strongest risk factor comparing the case group (n=11) to the control group (n=22). In addition, the indwelling period was significantly longer in the case group than in the control group (median 9 days versus 7 days, p=0.004). An intervention for the insertion of central lines was then started, with 1) thorough use of chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) in the insertion of central lines before emergency surgery, and 2) exchange of the central line 7 days after emergency surgery. After the intervention, the CLABSI incidence rate decreased from 6.8 to 0.8/1,000 device-days. These data suggest the usefulness of CHG patches and the importance of the early exchange of central lines in the CICU in patients following emergency surgery.

Background: On the first of October 2018, the Egyptian Ministry of Health and Population (MOHP) launched an initiative; named “100 Million Healthy Lives”, for nationwide screening of hepatitis c virus (HCV) and non-communicable diseases (NCDs). Egypt has the highest prevalence of HCV infection in the world where about 10% of the Egyptian population is affected by the disease. NCDs are the leading cause of mortality in Egypt and account for about 84% of all deaths. This study was conducted to a) Estimate the prevalence of participation in the national campaign on viral hepatitis C and non-communicable diseases among administrative workers in Ain shams University (ASU), b) Estimate the self-reported satisfaction of these participants with the campaign. Subjects and Methods: A cross-sectional study was conducted on 400 administrative workers of ASU faculties between March and August 2019 in Cairo, Egypt. A multistage random sample was done. Results: The study showed that 96% of the study group participated in the campaign. “Evaluating health status” was considered the main reason for participation at 92%, followed by "desire to obtain follow-up card", at 36%. Non-participation rate was about 4% and the main cause of non-participation was “fear of needle prick". About 91% of the participants were satisfied with the provided services. Mass media played a major role in awareness about the campaign for 91% of participants. Conclusions: The majority of the study group participated and was satisfied with the campaign. Mass media played a major role in participant awareness of the campaign.

The SARS-COV-2 rapid spread caused an international public health emergency with unprecedented rates of morbidity and mortality. Post COVID-19 condition occurs as a spectrum of symptoms that present four or more weeks after acute infection with SARS-CoV-2. Most published data to date state 50-70% of hospitalized patients experienced at least one post-acute COVID-19 symptom up to 3 months after discharge. Commonly reported symptoms include; neurocognitive post COVID-19 (fatigue, dizziness, inattention, and brain fog), respiratory post-COVID (dyspnea, chest pain, and cough), and mental health related symptoms (insomnia, depression, and post-traumatic stress disorder). Additionally, gastro-intestinal post COVID-19 (diarrhea, vomiting, and abdominal pain) along with decline in quality of life and decreased ability to perform activities of daily living were reported. The response to post COVID-19 symptoms is still in its infancy despite being an emerging crisis as scientific evidence and robust data are nonetheless required for clear definition, identification of time frame, classification and management of the condition. New studies are needed to identify total and individual incidence/prevalence rates of different clinical presentations of post COVID-19 symptoms. These future studies will help us to o improve early recognition of long term symptoms after acute infection of COVID-19.

Streptococcus pneumoniae is an important pathogenic bacteria causing pneumonia and invasive pneumococcal diseases, and the vaccination for pneumococcal vaccination is recommended in patients with RA and other autoimmune disorders. Compared with the immunocompetent individuals, frequency and the mortality rate were higher in the RA patients. The effect of pneumococcal vaccination may not be weakened in people using corticosteroid and biological disease-modifying anti-rheumatic drug (DMARD) currently being used, but mild to relatively inhibition of immunogenicity was suggested in patients using either methotrexate or rituximab. Administration of 13-valent pneumococcal conjugate vaccine (PCV13), rather than 23-valent Pneumococcal polysaccharide vaccine (PPSV23) may be desirable in preventing pneumonia in people with autoimmune disease and sequential administration of PCV13 in people aged ≤64 years and PPSV23 from age ≥65 years may be useful for preventing pneumonia in people with autoimmune disease according to the insurance system. In addition, PCV15 and PCV 20 will be available soon and expected for more clinical efficiency rather than current PCV13 and PPSV23.

Introduction: Stroke is associated with high mortality. It is the main neurological cause of mortality and the most important cause of disability worldwide. In the year 2007, Stroke was the third cause of admission at the Korle-Bu Teaching Hospital, and the number one cause of death. Objective: To determine the probability of survival (case-fatality rates) of stroke patients admitted at the Korle- Bu Teaching Hospital during the period 2007. Method: A Retrospective descriptive study of Surgical/Medical Emergency, SME and the Medical wards admissions and discharges from 1st January 2007 to 31st December, 2007. Results: A total of 250 hospitalized stroke patients were identified, of which 68(27%) were from the SME and 182(72%) from the medical wards. The mean age (SD) was 57.6(14.7) and 52% were males. Case fatality rate was 52% at the SME versus 35% at the Medical wards) whilst the risk of death in males expressed as risk ratio (RR) was 2.1, (95% CI 0.70-5.6) vs. RR=1.3, (95% CI 0.73-2.5) in females and the median survival time was 2days (95% CI 1.5-2.4) versus 7 days (95% CI 6.3-7.6) at the SME and Medical respectively. The type of admission and stroke outcome was significant P=0.01 (95%CI 0.02-0.14). Conclusion: Stroke was associated with high mortality. The risk of dying from stroke was higher at the SME Findings were independent of stroke subtype, stroke onset and any associated co-morbidities.

Background: Vascular thrombotic events such as pulmonary embolisms have been frequently reported in the course of SARS-Cov-2 infection. However, sagittal sinus thrombus is extremely rare, and patients may lack other appealing Covid-19 infection symptoms. Case report: 46-year-old female with past medical history of Hyperlipidemia, Hypertension presented to Emergency room with headache, chest pain, vomiting. SARS-CoV-2 IgG Antibodies were reactive. Except for elevated PTT-Lupus Anticoagulant at 50 Sec, Hypercoagulable workup was negative. The MRI venogram findings were consistent with the Dural thrombus of superior sagittal sinus. Patient subsequently developed chest pain, and Computed tomography angiography found pulmonary emboli within segmental branches of the right lower lobe pulmonary artery. Patient was managed in the ICU with Heparin and switched to Coumadin for discharged. Conclusion: The incidence of Cerebral Venous Sinus thrombus (CVST) among Covid-19 patients is inferior to 0.02%. And most of the patients lack typical Covid-19 presentations such as pneumonia. The lack of symptoms may promote the insidious course of pre-thrombotic events that lead to CVST. However more Retrospective studies are necessary to established consistent odd ratios. Due to the higher mortality associated with CVST and the ongoing of Covid-19 pandemic, we recommend a higher level of clinical suspicion.

Background: Onchocerciasis is a vector-borne neglected tropical disease (NTD) caused by the filarial worm Onchocerca volvulus. Given the high morbidity and mortality, onchocerciasis control gained great attention from many stakeholders both nationally and internationally. However, there are still the need for further solidified commitments and compelling initiatives across concerned stakeholders including regional bodies in the fight toward controlling its burden and risks. Thus, this review briefly appraised the current understanding and dynamics in the control and eradication efforts of Onchocerciasis in Africa. Methods: A rapid scoping review was used for this paper. Key databases used for this study include Web of Science, Scopus, Science Direct, PubMed and Google Scholar to identify a series of relevant peer-reviewed publications. The search contained just English-language articles. In addition, African government websites and specialized organizations such as WHO, UNAIDS, CDC, etc. were accessed and reviewed to gather important data on national and international control programs, related documentation and consultative expert reports. Results: In Africa, long-standing strides toward the control and elimination measures for onchocerciasis were conducted for several decades. Between 1974 to 2002, OCP had actively led the control and containment efforts for onchocerciasis in the context of 11 West Africa. However, endemic regions and states have switched their policies from controlling to eradication, with the ultimate objective of preventing their territories from parasite spread. Some key challenges are the insufficient identification of all endemic areas, high prevalence of both onchocerciasis and loiasis, potential development of resistance to ivermectin, inconsistent initiatives to address cross-border problems, disagreements and social disturbance. Various challenges, however, impede current efforts to eradicate African onchocerciasis. Conclusion: In the last decades, extensive measures have been taken with specialized state programs, largely efficient in high endemic nations, to manage and control onchocerciasis in African regions. The implications of these and other difficulties at country level control programs must therefore be identified and country-specific contextual remedies used to expedite the elimination of onchocerciasis.

The pandemic corona virus disease 19 (COVID-19), caused by (SARS-CoV-2) a single stranded-RNA virus, has been spread rapidly worldwide with high rate of morbidity and mortality. Few months after the spread of the pandemic, few medications have proven to be efficient in human clinical trials. Several antiviral drugs have been used outside the scope of their initial medical use, such as lopinavir, hydroxychloroquine or azithromycin. Recent researches were done to show the efficacy of ivermectin in reducing SARS-CoV-2 viral RNA within 2 days. The use of ivermectin in in vitro studies has proven its efficacy against Corona virus. Based on the potency of ivermectin in in vitro studies, various clinical trials including patients infected with COVID-19 have been started; most of them have not been completed yet. Since the way how the virus infects the cells in vitro and in vivo is different, a decisive comment about how the ivermectin could exactly be beneficial to the patients has not been proven yet. Nevertheless, if ivermectin is compared to the other therapeutic treatments available for COVID-19 management, ivermectin has proved to have leverage over them. New randomized controlled clinical trials to assess the effectiveness of ivermectin the management of COVID-19 are strongly and urgently needed.

Background: Everywhere in the world, Pregnancy and birth possess a risk to the life and health of women and newborns, regardless of whether a pregnancy was intended or unintended. The level of risk depends on a woman’s health before she is pregnant, her living conditions and the care she receives during delivery which is aggravated by lack of access to maternal health care services, leading to increase in the magnitude of death from preventable health problems. This paper therefore diagnostically assessed health promotion strategies for increasing access to maternal healthcare services in some remote districts in Anambra state. Methods: The study is a cross-sectional study and utilized a structured instrument which was validated by three experts in measurement and evaluation and health education and pilot tested on 20 pregnant women using test-retest in Ugwunagbor Abia state. The reliability yielded 0.84. Percentage, mean and standard deviation were used to answer the research questions. The population was 620 confirmed pregnant women from 4 to 9 months in the area of study in health centers in the state. A sample of 60 participants was selected using simple random sampling technique. Results: Findings show that antepartum, Intra-natal care, puerperium and family planning cares were prevalent in the local governments under study and that access to skilled delivery was associated with age, educational background, number of children and income level of the mother among other findings. Recommendations and conclusion: The researchers therefore recommended that there is urgent need to build healthy public policy, create supportive environments amongst others which can add to the effective measures of reducing maternal mortality in the longer term.

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.

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: Annual influenza outbreaks constitute a major public health concern in the United States. But this health burden appears dwarfed by the impact of COVID-19. Our aim is to quantify the excess mortality attributable to COVID-19, compared to previous influenza seasons. Methods: We retrospectively compare weekly mortality figures attributable to influenza and pneumonia in the United States from 2013 to 2019 with corresponding figures attributable to influenza, pneumonia, and COVID-19 from 2019 to 2021. We utilize a difference in differences regression methodology to estimate excess mortality observed in 2019-21 compared to 2013-2019. Results: Mortality patterns attributable to influenza, pneumonia, and COVID-19 differ significantly from the 2013-19 experience. Notably, distinct, aperiodic mortality waves occur in the 2019-2021 window, and mortality is well in excess of what is observed in typical influenza seasons. Conclusions: The COVID-19 pandemic has led to considerable excess mortality in the United States, and has strained public health resources. One might expect that the mortality waves observed during the pandemic will be damped by increasing levels of vaccination, and prior infections.

Air pollution is currently considered a global problem in both developing and developed countries. Substances that invade our spaces are components of air pollution that cause a strong negative impact on health for those who are exposed, not only in the cardiovascular and respiratory systems but are being related to the etiology of pathologies throughout the body, with a decrease in life expectancy and even an increase in mortality and alterations of the genetic material. This literature review aims to collect employing a search the implications that the components of air pollution have on the health of those exposed, from a clinical and molecular point of view. For the search, the DeCS descriptors created by BIREME were used: air pollution, cardiovascular system, respiratory diseases. The following databases were consulted: PubMed, ScienceDirect, and Scopus. The search criteria considered the year of publication and whether the original language was English or Spanish. It was concluded that the study of the different particles and the consequences that exposure to them entails is of vital importance for the development of control, prevention, and treatment mechanisms; since they can generate pathologies that range from something as tangible as lung diseases and occlusive heart disease to epigenetic changes that affect health.

Since the first outbreak of SARS-CoV2, Severe Acute Respiratory Syndrome Coronavirus-2 in Wuhan, China in the December 2019, the world continues to be in state of fear, uncertainty, tension and anxiety till date and this state might continue because of emerging mutants. The vaccination drive all over the world is continuing, still the new variants are cause of concern, with the aim to prevent the spread of the virus, focus should be on techniques and processes which helps in strengthening our defense mechanism, the immune system. It has becoming clear from several studies that the immune system is greatly impacted by the COVID-19 infection through several inflammatory reactions. The role of balanced diet full of nutrients cannot be overlooked in controlling infectious diseases. A balanced diet which should include plant foods, vitamins and micronutrients and this review wants to emphasize on the preventive role played by the plant foods, vitamins and minerals in COVID-19 infections, to reduce the mortality rate as well as the morbidity in patients who are infected.

We can’t stop breathing, but we can do something about the quality of air that we breathe. Clean fresh air is indispensable ingredient for a good life quality. Individuals poses the right towards expecting that the breathed air will not harm people. Thus, fighting air pollution will not only improve health outcomes, productivity, and well-being, it’s also essential toward reducing the emissions of greenhouse gas as well as fighting climate change. For examples, a third of the global population is at risk from unhealthy of ambient air pollutants concentrations, with the loss of approximately 6.4 million healthy-life-years attributed specifically to chronic exposure to ambient particulate matter. Expert panels have consistently rated air pollution as a greater health hazard than water pollution. Pollution of air is the leading source of unexplained and undiagnosed diseases, besides have remained associated with a variety of serious human health risks, and in fact, a threshold has not been established under which these pollutants exert no adverse effects. This study evaluates ambient air quality at major sawmill sites in Ilorin Metropolis, Kwara State, Nigeria. “Measurements of Air pollution were accurately carried out using direct reading, automatic in situ gas monitors; Hand held mobile multi-gas monitor with model AS8900 [Combustible (LEL), and Oxygen (O₂)], BLATN with model BR – Smart Series air quality monitor (PM₁₀, Formaldehyde) and air quality multimeter with model B SIDE EET100 (Dust (PM_2.5), VOC, Temperature and Relative Humidity)”. The outcomes disclosed among others, the average concentrations of CO, O₂ as well as other measured parameters for instance formaldehyde (HcHo) etc., they are also consistently low as well as within acceptable range in terms of National as well as Global monitoring standards for air quality indices. However, there are few exceptions for instance the average volatile organic compounds (VOCs) concentrations, PM_2.5, PM₁₀ as well as Combustible (LEL) respectively, which are higher when compared to National and Global standards. This high figure is due to pollutant amount existing in the sawmills air environment resulting from input of influents from activities of the sawmill. However, as a result, air pollution in the city of Ilorin is found to be increasingly polluted and are of major health concern because of their synergistic action. Due to the high evidences and values, it can lead to a remarkable rise in over-all figure of hospital visits/ patients’ admissions with acute respiratory illnesses as soon as air pollutants level remained high. Hence, there is the need for an aggressive control of ambient air pollution.

Over the past few decades, cardiovascular disease and related complications have surpassed all others as the important causes of death on a universal scale. At the moment, they are the important cause of mortality universal, including in India. It is important to know how to find cardiovascular problems early so that patients get better care and prices go down. This project utilizes the UCI Heart Disease Dataset to develop ML and DL models capable of detecting cardiac diseases. Heart illness was categorized using Convolutional Neural Network (CNN) models, which are able to detect intricate patterns in supplied data. A confusion matrix rating, an F1-score, a ROC curve, accuracy, precision, and recall were some of the measures used to grade the model. It did much better than the Neural Network, Deep Neural Network (DNN), and Gradient Boosted Trees (GBT) models, with 91.71% accuracy, 88.88% precision, 82.75% memory, and 85.70% F1-score. Comparative study showed that CNN was the most accurate model. Other models had different balances between accuracy and recall. The experiment results show that the optional CNN model is a decent way to identify cardiovascular disease. This means that it could be used in healthcare systems to find diseases earlier and treat patients better.