Background: Mechanical low back pain (MLBP) is a leading cause of disability worldwide, with well-established risk factors such as obesity, occupational ergonomics, and core muscle strength. However, the role of pes planus (flat foot) as a contributing factor remains underrecognized. This study aims to investigate the association between flat foot and MLBP using Clarke’s angle as an objective measure of foot posture. Methods: A case-control study was conducted in South Timor Tengah Regency, East Nusa Tenggara, Indonesia, from December 2024 to February 2025. Fifty patients diagnosed with MLBP and 50 healthy controls were enrolled. Foot type assessment was performed using Clarke’s angle, with a cutoff of ≤30° indicating flat foot. Pain severity in the LBP group was recorded using the Numerical Rating Scale (NRS). Statistical analysis was conducted using chi-square and independent t-tests, with significance set at p < 0.05. Results: Flat foot was significantly more prevalent in the LBP group (58%) than in the control group (18%) (p = 0.000; OR: 6.29, 95% CI: 2.52-15.69), indicating that individuals with flat feet are over six times more likely to experience MLBP. No significant differences were observed between the groups regarding BMI, age, or gender. Conclusion: These findings suggest that flat foot is an independent risk factor for MLBP, likely due to altered spinal biomechanics and compensatory postural changes. Clinicians should consider foot posture assessments in MLBP patients and explore targeted interventions, such as orthotic support, to mitigate symptoms.

Background: Vitamin D plays an important role in the development of bone health and possibly non-communicable diseases. Arab countries had made their own national studies to assess serum vitamin D level among women, yet in Egypt there is no national survey done. The aim of the current study was to identify risk factors affecting vitamin D level among Egyptian females during the child-bearing period. Subjects and methods: A total of 100 healthy adult females in their childbearing period who were attending a Family Medicine Center were included in our study. The age of the included women ranged from 19 to 49 years old with a mean age of 34 (SD 8.47) years. The majority of participants had deficiency (43%) and insufficiency (13%) of vitamin D level. Results: Unemployed women were more likely to have vitamin D deficiency than employed women (P<0.05). Participants who were exposed to sun ˃30 minutes/day were more likely to have sufficient vitamin D level (P<0.05). All participants who consume fish ≥3 times/week had sufficient vitamin D level. Therefore, there was a statistically significance association between a number of consuming fish/week and vitamin D3 level groups. Also, there was statistically significant association between number of consumed milk cups/day and vitamin D3 level groups. All participants who drink 2 cups of milk have sufficient vitamin D level. No statistically significance association was found between using multivitamins and vitamin D3 level groups. Conclusion: Unemployment, low fish consumption and infrequent sun exposure were significant risk factors for vitamin D deficiency. Future research on the role of multivitamins supplements in improving vitamin D nutrition is warranted.

Women must be aware of the risk factors of pregnancy complications and the negative maternal and fetal health consequences to take preventative measures and management strategies that will result in a successful pregnancy. This study aimed to assess the Level of Knowledge about obstetric warning signs and the associated factors among pregnant Saudi women attending antenatal care in a tertiary care maternity set-up in Riyadh City. Data for this cross-sectional study were obtained using a structured questionnaire from eligible pregnant women admitted to King Saud Medical City (KSMC) between August 2020 and March 2021. Data were analyzed using descriptive and inferential statistics. Out of a minimum estimated sample size of 170, researchers recruited 362 participants. As observed, only 92 people, or 25.4%, had enough knowledge about various educational levels. The majority (91.2%) lived in villages, had no history of chronic disease (74.0%), and said that it took them at least 30 minutes to commute from their home to the hospital (69.3%). Two hundred two (55.7%) lacked appropriate knowledge, although most women (76.2%) had one to four pregnancies. Poor psychological health resulted from 37 people's (10.2%) inadequate Awareness. Even though 139 (38.4%) had spent more than 15 minutes receiving education from medical staff and 200 (61.5%) had attended the prenatal care clinic more than four times, most lacked adequate knowledge. The variables education level (P=0.000), working status (P=0.022), and place of residence (P=0.044) showed a statistically significant association with the knowledge level, also only education level statistically significantly affected the likelihood of knowledge gaps. In conclusion, early identification of obstetric warning signs and associated risk factors of pregnancy complications is integral to prevention.

Risks in Public Private Procurement mass housing project (PPP-MHP) initiatives are emerging and this requires early risk identification and allocation to achieve the goal and sustenance of the scheme. The study, being a follow-up of a Delphi survey, elicits the opinion of respondents on the probability of occurrence and severity of identified risks in PPP-MHPs in Nigeria. The study adopts a quantitative research design approach by administering structure questionnaire survey on identified PPP-MHPs partners in Abuja, Nigeria. Data analysis was performed using descriptive and inferential statistical tools such as Mean item score (MIS), standard deviation, and Kruskal Wallis analytical techniques with the aid of SPSS software packages. The findings show that all the listed risk factors were found to be extremely high, very high, high, or moderate in terms of occurrence while all the listed risk factors recorded a very high level of severity on the delivery of PPP-MHPs. The top ten (10) risk factors frequently associated with PPP-MHPs are non-availability of finance, high finance cost, non-involvement of the host community, poor execution of housing policies, corruption and lack of respect for law, wrong perception of housing need by low-income earners, Illegal title to land, land acquisition and site availability, level of demand for the mass housing projects and unstable value of local currency. The respondents differs significantly on 29 risk factors in terms of occurrence and 40 risk factors in term of severity. The study, therefore, recommends that risk management culture should be highly encouraged among the PPP Partners in the sector. The study intends to enumerate the rate of occurrence of some itemized risk factors and their severities on the delivery of PPP – procured mass housing projects in Nigeria and the need to bookmark these risk factors in ensuring the sustainability of the PPP mass housing scheme.

The study accessed the critical risk factors in public-private partnership (PPP)-procured mass housing project (MHP) delivery in Nigeria. The research design adopts a quantitative approach, using well-structured questionnaires distributed to stakeholders involved in PPP-MHPs i.e. consultants, in-house professionals, contractors, and the organized private sector (OPS) registered with PPP departments in the Federal Capital Territory Development Authority (FCDA) Abuja, Nigeria. The instrument relates to the background information of respondents and the risk peculiar to PPP-MHP. Sixty-three (63) risk factors were submitted for the respondents to rank using Mean Item score (MIS) for risk occurrence and its severity, while risk significance index (RI) was used to determine the risk impact. Fuzzy Synthetic Evaluation (FSE) method was subsequently applied to determine the risk criticality groups and the overall risk level in the sector. The fuzzy set theory deals with ambiguous, subjective and imprecise judgments peculiar to decision making in construction project risk assessment. It aims to provide a synthetic evaluation of an object relative to a fuzzy decision environment with multiple criteria that requires qualitative linguistic terms. The findings show that thirty-one (31) risk factors were critical in the sector while financial and micro-economic risk group is contributing most significantly to the overall risk level in PPP-MHPs in Nigeria. The top 10 risk factors in the sector include availability of finance, high finance cost, the unstable value of the local currency, lack of creditworthiness, influential economic events (boom/recession), high bidding cost, poor financial market, financial attraction to project investors, interest rate volatility, inflation rate volatility, corruption and lack of respect for the law, non-involvement of the host community and poor execution of housing policies. The implication for practice is that having known the risk group contributing most significantly to the overall risk level in PPP-MHPs, adequate financial and budgetary allocation should be made available before embarking on such venture so as to sustain the scheme in the country. The study is one of the recent researches conducted on housing, since the procurement option is novel in the sector. The study is of immense value to PPP actors in providing necessary information required to formulate risk response methods in minimize the identified risk impact sector.

To report a case of a major branch retinal vein occlusion (BRVO) in the superotemporal region with superior macular involvement and a review of its natural history. This is a retrospective case presentation of a 49-year-old African Caribbean female patient presented to Accident and Emergency with unilateral persistent acute history of reduced central vision of left eye for 10 days with no other associated symptoms. Treatment options included using scatter (pan-retinal) laser photocoagulation followed by intravitreal injections as the area of non-perfusion is >5-disc area. It is warranted to understand the risk factors associated with BRVO and to develop appropriate treatment and follow-up plans.

Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.

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.

Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. Results: A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. Conclusions: The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.

Background: Early initiation of tobacco use among adolescents is a significant public health concern. While there is extensive research on overall tobacco use, much of it focuses on initiation in late adolescence, uses cross-sectional designs, and lacks specific exploration of electronic versus conventional cigarette use. This study aims to investigate social determinants influencing the early initiation of electronic and conventional cigarette use among U.S. adolescents. Methods: We utilized data from the Adolescent Brain Cognitive Development (ABCD) study, which follows a cohort of tobacco-naïve children from age nine through age 16. The social determinants examined included household income, parental education, financial difficulties, racial/ethnic minority status, family structure, neighborhood income, and gender minority status. Structural equation models were employed to assess associations between these determinants and early initiation of electronic and conventional cigarette use. Results: Male gender was associated with a higher likelihood of conventional cigarette use, while the risk of early initiation of electronic cigarette use was similar across genders. White adolescents were at a higher risk of conventional cigarette use; however, the risk for electronic cigarette use was comparable across White and non-White groups. Financial difficulties were linked to an increased likelihood of early initiation of conventional cigarette use but not electronic cigarette use. Higher household income was associated with a reduced risk of initiating conventional cigarettes but did not significantly impact electronic cigarette use. Adolescents from married families were less likely to initiate electronic cigarette use. No significant effects were found for parental education or neighborhood income on the initiation of either type of cigarette use. Age did not significantly affect the initiation of either cigarette type, and gender minority status was marginally associated with early initiation of conventional cigarette use. Conclusions: The social patterning of electronic cigarette use differs from that of conventional cigarette use, suggesting that distinct tobacco products do not pose a uniform risk across all adolescents. This study underscores the importance of tailored prevention efforts that address the unique challenges associated with early initiation of electronic and conventional cigarette use among adolescents. The differential risk factors identified suggest targeted prevention strategies for conventional cigarette use, focusing on financial difficulties, household income, and gender-specific interventions. In contrast, prevention efforts for electronic cigarette use may require broader, more inclusive approaches that address all adolescents, regardless of their background. Comprehensive universal screening for electronic cigarette use and targeted screening for conventional cigarette use among adolescents are recommended.

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.

The study is a follow-up of the study "Coronavirus in pregnant patients and their clinical outcomes – results of a case-control study" conducted by R.Kadriu et al (2023) in which,in addition to the pregnant patients whose outcome is now being investigated,a control group of patients who were not pregnant,conducted with pregnant patients and a control group that were non-pregnant patients.This study was conducted 6 months after the discharge of the patients and their newborns,and highlights the impact of COVID-19 on their health as well as the health of the newborns. The aim of the study is to follow up the patients after 6 months of their hospitalization as COVID-19 patients and after their delivery.In the COVID study, none of the health indicators showed statistically significant differences between the population before and after hospitalization.Patient data were collected at the case level summarized in their respective groups.For secondary objectives, several comparative analyzes were performed regarding comorbidity-related parameters and available risk factors.A significance level (α) of 0.05 was used for statistical significance. While these results may be reassuring regarding the stability of health status, one should be aware of the limitations of the study, including sample size and specific population characteristics.

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.

We reviewed the influence of coronavirus disease 2019 (COVID-19) on the central nervous system reported in the literature since its prevalence. Common neurological symptoms of COVID-19 include altered or impaired consciousness, headache, dizziness, cerebrovascular accidents, and seizures, etc. Encephalopathy caused by or related to COVID-19 includes stroke, acute encephalitis, and Guillain-Barre syndrome. Concomitant COVID-19 in patients with vascular risk factors increased the risk of stroke; the hypercoagulable state and vascular dysfunction caused by COVID-19 also led to stroke. Acute encephalitis was usually accompanied by a history of headache, fever, and altered mental status, and shown hemorrhagic lesions or high signal on MRI. In Guillain-Barre syndrome, there was a time lag between infection with the primary pathogen and the onset of neurological symptoms, which generally manifest as limb paralysis and various sensory abnormalities. The review illustrated that COVID-19 lead to serious consequences of brain and brought difficulties to the treatment. Exploring the neural mechanisms of COVID-19 to better understand the activity of the virus in the brain and to prevent further viral damage to the brain is an urgent issue.

Caesarean section is the most common surgical procedure in obstetrics, but also in pregnant women with dystocia. The purpose of this study is to identify factors that contribute to post-caesarean complications in emergency of gynecology-obstetrics service of Saint Joseph Hospital in Kinshasa. This is a descriptive cross-sectional study and was conducted at Saint Joseph Hospital in Kinshasa city for a month (1^st and 30^th July 2021). A questionnaire was used to collect different data namely socio-demographic characteristics and different variables important for the study. Independent variables were factors related to the parturient and the current pregnancy, the surgical procedure and the operational room. While the dependent variable was post-caesarean complications in gynecology-obstetrics service. Descriptive statistical analyses namely frequency and percentage were done to describe the sample profile. To measure the strength of association between different variables were estimated using Pearson's Chi-Square (X²) test and the p-value was 0.05. Data analysis was performed using SPSS version 20 software. The majority of participants are over 33 years of age, have secondary school skills, married and have 3 to 4 children. It was observed that 88.2% of participants have acute respiratory distress prior to caesarean section, 76.6% have a personal history of thromboembolic disease prior to caesarean section. All the participants who underwent caesarean section were victims of external ventilation through the windows of the operating room, which remained open before, during and after the surgery and benefited from antibiotic treatment without any para-clinical analysis before the caesarean section. Furthermore, 82.4% of participants had benefited from the caesarean section with sterilized care materials 48 hours before and after the intervention. While 47.1% of participants had caesarean sections with defective equipment for the operation (use of dry heat sterilization etc.). A better identification of these risk factors can reduce significantly rate of complications and can consequently improve the maternal-infantile prognosis. The obstacles to effective management are related to the provision of quality services.

Stroke while driving is an uncommon occurrence, but which might have serious medical and legal implications. While still reported casually and with very few systematized studies, sources underscore mainly the neurological picture and risk factors that will lead herein. Car crashes follow as a rule the event of the stroke. We describe the case of a middle-aged patient that had an incomplete loss of the car control, with a crash of minor severity and with no external signs of trauma. In spite that the patient underwent successfully a thrombectomy intervention, he presented continuously with refractory hypotension. The clinical picture raised suspicions of an internal blood loss and whole body angiography detected the rupture of the mesenteric artery. This sequence of events (stroke while driving – crash – seatbelt injury – mesenteric rupture) is probably not reported before, but mechanistically an unlucky combination to be kept in mind while dealing with such cases.

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.

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.

Background: Cancer surveillance data provide information on the incidence and trends of cancer in the population level. Analyzing cancer trends according to these characteristics plays an important role in cancer surveillance. Knowledge of the causes of cancer allow better prevent the appearance of it. A large number of epidemiological evidence supporting the effect of smoking on the causes of cancer there is strong evidence supporting a role for smoking in the etiology of cancers. Alcohol appears to interact with the tobacco significantly and can be considered a risk factor in the development of cancers. Obesity which is now well recognized as a public health problem increases the risk of developing cancers. All these factors are characterized by uncertainty, complexity and imprecision. Methods: In this study, we propose an analysis of these factors based on the principles of fuzzy logic inference system. The data were collected from WHO data. As this technique addresses the uncertain, its application in this area is perfectly adequate. Results: A database is established, after the analysis system is done, it will be possible to read the prevalence of cancer by introducing randomly the values in inputs variables. Conclusion: like cancer has become a national scourge, this application allows predicting the impact of it just from the introduction inputs variables such as BMI, degree of physical activity, tobacco and sex.