London Journal of Medical and Health Research
London Journal of Medical and Health Research London Journal of Medical and Health Research is focused on publishing groundbreaking ideas on theoretical and experimental research in all domains relating to medicine, diseases, advances in pharma and instruments. As a flagship scholarly journal, It is a peer-reviewed, international, indexed journal. The journal publishes high-quality research papers that are double-blind refereed. The journal has a dedicated team for reviewing articles of COVID-19 to make sure the research is valid and published first. It provides practical, theoretical, and managerial implications useful for further research development. The journal publishes high-quality research papers that are double-blind refereed. Authors and readers include academic researchers and educators, as well as scientists. SUBMIT MANUSCRIPT
The Paradox of Airway Closure: From Protection to Pathology
Airway closure, first recognized by Laennec and later quantified in studies by Dollfuss, Hedenstierna and Hughes, represents a physiological phenomenon with far-reaching clinical consequences. While often overlooked in critical care, its role in promoting atelectasis, impaired gas exchange, and ventilator-induced lung injury is well established. The present narrative review revisits the fundamental physiology of airway closure, its exacerbation in anaesthesia and obesity, and its near-universality in mechanically ventilated ARDS patients. A reinterpretation of pleural pressure data from landmark studies, suggests that airway closure may be far more prevalent than currently appreciated. Strategies such as optimal PEEP and avoidance of high oxygen fractions are discussed, with emphasis on the urgent need for better integration of airway closure physiology into clinical practice. This article re-examines how positive airway pressure in combination with elevated intrathoracic pressure — the inevitable companion of positive pressure ventilation — underlies many of the adverse effects attributed to modern mechanical ventilation. By contrast, negative pressure ventilation, long abandoned, may offer physiological advantages worth reconsidering. The question we must now ask is: could a return to negative extra-thoracic pressure — or a hybrid model — prevent the very complications we have come to accept as inevitable?
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Evaluating Midwives’ Knowledge and Attitudes Regarding Pre-Eclampsia Management at Presbyterian Hospital
Background: Pre-eclampsia is a major contributor to maternal and perinatal morbidity and mortality globally and in Ghana. Midwives play a critical role in the early detection and management; however, their knowledge, attitudes, and the challenges they encounter influence the quality of care. Methodology/Principal Findings: A descriptive cross-sectional study was conducted among 50 midwives using a structured self-administered questionnaire. Data were analyzed using SPSS version 26. Descriptive statistics summarized demographic characteristics, knowledge, attitudes, barriers, and recommendations. Chi-square tests and logistic regression examined associations between demographic variables and knowledge/attitude levels. The majority of respondents were aged 20–39 years (70.0%), with 54.0% having 1–3 years of experience, and 86.0% had received prior training in pre-eclampsia management. Knowledge was generally high, with 88.0% recognizing hallmark symptoms and 84.0% identifying magnesium sulfate as the first-line anticonvulsant. Attitudes were positive; 68.0% strongly agreed that pre-eclampsia training should be mandatory. Key barriers included limited patient awareness (86.0%), understaffing (70.0%), and inadequate diagnostic tools (58.0%). Years of experience were significantly associated with knowledge level (chi-square = 19.470, p=0.003), while logistic regression showed work unit as a significant predictor of knowledge level (p = 0.037). Conclusion: Midwives exhibited good knowledge and positive attitudes toward pre-eclampsia management, though systemic barriers constrain effective care. Strengthening in-service training, improving diagnostic and therapeutic resources, and enhancing patient education are recommended to optimize outcomes.
Calcium Hydroxide Induced Apexification in an Immature, Non-Vital Permanent Tooth – A Case Report
The purpose of the present manuscript is to show case successful formation of apical barrier in an immature young permanent tooth following dental trauma using calcium hydroxide as an intra-canal medicament. Following 9 month follow-up, apical barrier formation and absence of periapical radiolucency was evident on intraoral periapical radiographic examination with clinical absence of signs and symptoms. This case report strongly confirms that calcium hydroxide still remains as age old, gold standard medicament in inducing apical barrier formation thereby facilitating a dental practitioner to perform smooth root canal treatment.
Diabetic Foot: A Multidisciplinary Approach to Limb Preservation
Diabetic foot is a major chronic complication of diabetes mellitus and represents a leading cause of hospitalisation, infection and non- traumatic lower limb amputation worldwide. The pathogenesis is multifactorial primarily involving peripheral neuropathy, peripheral arterial disease, impaired immunity and poor glycemic control which together predispose patients to ulceration and delayed wound healing. This review of literature aims to summarise current evidence regarding epidemiology, risk factors clinical evaluation and treatment strategies for diabetic foot disease. The literature consistently demonstrates that early identification of at-risk patients through routine screening and structured risk stratification significantly reduces ulcer occurrence. Management of established diabetic foot ulcers requires a multi-disciplinary approach combining glycemic control, infection management using culture guided antimicrobial therapy, regular wound debridement, appropriate wound dressings and appropriate offloading techniques.In patients with associated ischaemia, timely vascular assessment followed by endovascular or surgical revascularisation is critical for limb salvage. Advanced adjunctive therapies including negative pressure wound therapy, bioengineered skin substitutes and growth factor- based treatments have shown beneficial outcomes in selected cases. Overall, comprehensive preventive programs and standardised multidisciplinary treatment protocols remain essential for reducing amputation rates and improving functional outcomes in patients with diabetic foot disease.
Effectiveness of Recombinant Enzymes in Cellulite Treatment: A Case Report
Cellulite is a common aesthetic concern that may significantly impact on individuals’ self-image and quality of life. Despite being a non-threatening condition, it may have a negative effect on the psychological well-being of affected individuals. This condition is multifactorial and involves several physiopathology pathways. The role of enzymes in the management of cellulite is a novel approach, particularly lipase and collagenase, which play key roles in adipocyte size reduction and collagen degradation, respectively. The potential of high-molecular-weight hyaluronic acid to promote tissue repair and regeneration is also highlighted. Our case report describes the effectiveness of an association of recombinant enzymes and high-molecular-weight hyaluronic acid by reducing cellulite manifestations in a patient, with a history of multiple unsuccessful treatments, showing visible improvements from the initial treatment session. The importance of understanding the complex physiopathology of cellulite and choosing a targeted approach is emphasized.
The Effect of Dietary Fiber on Glycemic Control in Patients with Type 2 Diabetes Mellitus Receiving Oral Hypoglycemic Therapy
Introduction: Nutritional recommendations for patients with T2DM from various global communities agree on the need to increase dietary fiber (DF) intake; however, there are currently no specific and unified recommendations regarding the recommended amount and type of DF. Studying the effect of DF on glycemic control in patients with T2DM may play an important role in refining intake recommendations and motivating patients to comply these recommendations. Objective of the Study: Evaluation of the effect of Nestlé OptiFibre DF on glycemic control parameters in patients with T2DM treated with combination hypoglycemic therapy with metformin plus dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) or with metformin plus sodium-glucose cotransporter type 2 inhibitors (SGLT2 inhibitors). Materials and Methods: The study included 80 patients with T2DM, with duration not more than 5 years, with HbA1c of not more than 7.5%, and BMI of 27–35 kg/m2, without severe comorbidity. All patients were treated with a combination of metformin and a DPP-4 inhibitor or metformin and an SGLT2 inhibitor. Forty patients comprised the Main Group, where patients received Nestlé OptiFibre DF, a partially hydrolyzed guar gum (PHGG), for 3 months according to the instructions for use. The other patients, who comprised the Control Group, underwent the same examinations as the patients in the Main Group as part of routine clinical practice over a period of 3 months. Changes over time in HbA1c, fasting plasma glucose, blood glucose self-monitoring data, and ambulatory blood glucose profile based on flash glucose monitoring (FGM, FreeStyle Libre, Abbott) were evaluated. Laboratory parameters were evaluated at baseline (2–3 days from the start of the study) and at the completion of the study (84 ± 3 days from the start of the study). A FGM sensor was also applied at Days 2–3 from the start of the study; the readings were obtained and evaluated after 14 days. Repeated FGM application was performed at Day 72 ± 3, and the readings were obtained at Day 84 ± 3. Results: In the group of patients who received DF, there was a statistically significant decrease in the HbA1c level from 6.35 [5.9–7.07]% to 5.95 [5.7–6.3]%, p = 0.01, while in the Control Group almost no changes were found: at baseline, the HbA1c level was 5.85 [5.5–6.7]%, and at study completion it was 6.15 [5.5–6.78]%, p = 0.99. Fasting plasma glucose in the Main Group decreased from 7.0 [6.33–7.78] mmol/L to 6.65 [5.72–7.75] mmol/L, p = 0.18, while in the Control Group, on the contrary, an increase this parameter increased from 6.30 [5.7–7.0] mmol/L to 6.9 [5.6–7.78] mmol/L, p = 0.05. The evaluation of the ambulatory glucose profile (AGP) data showed that the Time in Range (TIR) was significantly higher by the end of the study in the Main Group vs the Control Group by 2.5%: 94.5 [92.0–97.0]% vs 92.0 [77.25–96.0]% (p = 0.01). Time Below Range (TBR) in the Main Group decreased by 0.5% while no changes were observed over time in the Control Group, and the increase in Time Above Range (TAR) in the Main Group was 0.5% lower than in the Control Group. In addition, a decrease in the mean duration of hypoglycemia was found in patients who received DF, from 144.39 ± 76.49 (95% CI 115.87; 172.91) to 118.32 ± 54.49 (95% CI 96.81; 139.84), p = 0.15, as well as a decrease in the frequency of hypoglycemic events from 6.0 [3.0–16.0] to 5.0 [3.0–9.75], p = 0.47. Conclusions:The study obtained data on the positive effect of daily intake of PHGG for 3 months on the HbA1c, fasting plasma glucose and AGP parameters, which is important not only from the point of view of managing T2DM, but also from the standpoint of the prevention of micro- and macrovascular complications and correction of risk factors. Further research is needed on the effects of DF, taking into account the duration of use, doses, and various DF types and forms.
Is Primary Hypothyroidism Truly Primary? A Systems-based Reframing of Thyroid Dysfunction
Primary hypothyroidism is traditionally defined as intrinsic failure of the thyroid gland, most commonly attributed to autoimmune destruction or idiopathic atrophy. While this framework has guided diagnosis and treatment for decades, it may oversimplify the complex neuroendocrine, immune, and metabolic interactions that precede overt thyroid dysfunction. Emerging evidence suggests that immune dysregulation, chronic inflammation, hypothalamic–pituitary–adrenal (HPA) axis activation, nutrient insufficiency, mitochondrial dysfunction, and altered thyroid hormone signaling frequently predate biochemical thyroid failure. In this context, thyroid hypofunction may represent a downstream adaptive response rather than a primary isolated glandular disorder. This narrative review reexamines the concept of “primary” hypothyroidism through an integrative systems-based lens, highlighting mechanisms of functional hypothyroidism, impaired peripheral hormone conversion, thyroid hormone resistance, and immune- mediated loss of tolerance. Clinical implications include recognition of patients who remain symptomatic despite normalization of thyroid-stimulating hormone levels and the limitations of levothyroxine monotherapy in select populations. Reframing hypothyroidism as a secondary manifestation of upstream physiologic stressors may improve diagnostic precision and support more personalized therapeutic strategies.
Cross-Scale Analogies between Astrophysics and Human Biology: Conceptual and Technological Parallels in the Study of Complex Systems
Over the last few decades, our uderstanding of both the universe and the microscopic world has progressed remarkably. The rise of modern science, bolstered by the evolution of observational instruments, such as the Hubble and James Webb telescopes for cosmic exploration, and next-generation microscopes for the study of living organisms, has led to significant discoveries. Since the invention of the telescope, astronomers have progressively unveiled the structure and dynamics of the universe, establishing the foundations of astrophysics. In parallel, advances in microscopy have enabled the exploration of the infinitely small, revealing the fundamental mechanisms of the human body and laying the groundwork for physiology and molecular biology. Nanotechnology has further refined telescopes and revolutionized medical care, particularly in targeted therapy and regenerative medicine. At first glance, the scales of magnitude inherent to the biological world and those governing the observable universe appear fundamentally disjointed. On one hand, molecular biology explores a microscopic universe: cells, proteins, and subcellular structures, where distances are measured in nanometers or even smaller fractions, expressed in negative powers. On the other, astrophysics deals with objects and structures whose dimensions span light-years, parsecs, and megaparsecs, corresponding to extreme positive orders of magnitude. The systemic complexity of the human organism, much like cosmological structures, simultaneously engages the cognitive, metaphysical, and rational dimensions of the observer. Iconographic data from microscopy and astronomy transcend their purely heuristic function to reveal an intrinsic aesthetic capable of catalyzing intellectual inquiry. These representations facilitate the identification of structural correlations that go beyond simple formal analogy. The emergence of these morphological convergences between radically distinct scales raises a fundamental question: the universality of the laws governing the organization of matter. Drawing on literature data and a comparative analysis of visual patterns, this article proposes to study the convergences between the universe and the human body, the two most complex natural systems identified to date. The central objective is to identify and characterize the multidimensional analogies that unite these two seemingly disparate disciplines. This comparative approach, which remains marginal in conventional scientific literature, moves beyond mere aesthetic observation to address fundamental questions regarding the universality of laws governing complex structures. By exploring intracorporeal architectures as reflections of cosmological dynamics, this work suggests that probing the living organism is, by extension, a means of deciphering the organizational principles that govern the very architecture of the universe.
Innovative Wound Dressings and Emerging Technologies for Wound Treatment: Trends and Perspectives – A Review
Background/Objectives: Wound treatment has undergone significant advances with the development of dressings and therapies that provide not only simple protective coverage but also actively promote tissue regeneration. This work addresses the classification of dressings, ranging from primary and secondary types to cutting-edge technologies, including bioactive, innovative, 3D-printed, and nanotechnological dressings. Methods: A structured narrative literature review was conducted by searching major health, nursing, and wound care databases major health, nursing, and wound care databases, complemented by specialized sources. Results: The review indicates that auxiliary therapies, such as stem cells, growth factors, and cold plasma, are predominantly explored as adjunctive approaches alongside advanced wound dressings, with the literature reporting potential benefits in accelerating healing, especially in complex and chronic wound settings. It also highlights the primary challenges to implementing these approaches, including high production costs, a shortage of trained professionals, limited robust, long-term clinical studies, and regulatory hurdles. Additionally, the environmental impacts of dressing production and disposal were addressed, highlighting the role of biopolymers and nanotechnology as sustainable and ef icient alternatives to traditional methods. Conclusions: Despite current limitations, future prospects remain promising, with an emphasis on personalized medicine, intelligent monitoring systems, and bioengineering, underscoring the need for more in-depth research and clinical validation to consolidate these innovations in wound care practice.
Pharmacotherapy of Heart Failure in Infants with Congenital Heart Disease
Every second patient who dies from congenital heart disease is an infant with heart failure. However, infants were de facto excluded from the US Carvedilol trial and PANORAMA HF trial (Sacubitril/Valsartan), probably due to their high mortality risk. Despite the negative results of the US Enalapril trial in infants with univentricular hearts, ACE inhibitors are further recommended in the guidelines. Propranolol is the only drug that has been successful in two prospective randomized trials but was not recommended in the guidelines. This review discusses the dif erences between myocardial heart failure and congestive circulatory failure in infants with congenital heart disease that do not benefit from vasodilators but from beta-blockers that significantly improve clinical symptoms, neurohormonal activation and heart rate variability. The case of a non-invasive monitoring of heart rate variability, blood pressure and oxygen saturation of an infant with Down syndrome and complete atrioventricular septal defect visualize cardiac decompensation after enalapril and the benefits of beta-blocker treatment.
Effectiveness and Safety of Treatment of Double Chin with Combined Enzymatic Therapy
Introduction: Excess fat in the submental area (FSA) is associated with a negative impact on facial harmony and self-perception, often leading to decreased patient satisfaction with appearance and increased demand for aesthetic interventions Methods: in this prospective, multicentric, cohort study Pbserum HA 1.5 Medium, a combined enzymatic therapy (collagenases G/H PB220, lyase PB72K, lipase PB500), together with non cross-linked high molecular weight hyaluronic acid (HMW-HA)), was used for treating FSA in healthy adults according to a recommended protocol. Primary efficacy outcome was the variation of FSA in every visit, quantified by a scale ranging from 0 (no localized FSA) to 4 (extreme submental convexity). Patient-reported outcomes were also considered. Results: 33 patients (median age: 44; range 21-72; 79% females) were evaluated at visit 1; 87.8% completed the study. At baseline, excess FSA scored ≤ 2 was present in 53.3% of patients. After two treatment sessions, proportion increased to 75.8%. Proportion of patients with an FSA score of 4 was reduced from 26.67% to 6.9%. FSA scale was significantly reduced from baseline to final visit (p
Evolution of EU Legislation Governing the Presence of Undesirable Substances in Animal Feeds
The legislative framework for undesirable substances in EU territory is explained at first with parallel commenting on the political dimension involved in this issue as regards the sector of animal feeding. Then, a brief account on developments of Community legislation in this field is given, with paying particular emphasis on the delicate subject of “dilution principle”. In turn, reference is made to methods available for the analysis of undesirable substances in feeds. Furthermore, the article focuses on two groups of undesirable substances, i.e. firstly mycotoxins, where reference is made to legislative developments in this issue as well as prevention measures, and secondly, dioxins where a look is thrown to the historical background in this subject, while focusing on the dioxin episode in Belgium but also on subsequent findings. The legislative tools to confront problems of undesirable substances presence in the sector of animal nutrition is discussed, concluding with the importance of environmental dimension. Finally, reference is made to developments in Community Legislation for dioxins and mycotoxins during the last decade
The use of medications in conventional dosages guarantees their mechanism of action and provides the expected biological effects. Clinical trials and research on substances approved by the national health agency justify their clinical efficacy and demonstrate the risk-benefit of the medication, but they also contain some information on the toxic effects on the body when used in doses above the recommended. A bibliographic review was conducted targeting some classes of medications, such as antipsychotics, SSRI antidepressants (serotonin reuptake inhibitors), tricyclic and tetracyclic antidepressants, lithium, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), anticholinergics, digitalis, opiates, opioids and thyroid hormone, to update knowledge on drug poisoning protocols established by other institutions that are references in the subject, making it possible to identify symptoms and define treatments for these cases. Thus, in drug poisoning, irreversible effects can be observed in the short and long term, and even death if not treated appropriately. The available protocols used in reference centers and units for this type of care describe the identification of possible associated toxic syndromes, symptom management, symptomatic treatment and the antidote that can be used. Therefore, clinical research and pharmacovigilance contribute to the elucidation and understanding of toxicological effects, being an updated source based on the availability of information that occurs in hospital practice.
Expression of Glioblastoma Molecular Markers and Sensitivity to Innate Immune Peptides LL-37 and Protegrin-1 as Predictors of Chemotherapy Response
Glioblastoma (GBM) is one of the most aggressive and difficult-to-treat tumors in humans. The low efficacy of treatment is due to the molecular and cellular heterogeneity of the tumor, as well as disruption of biochemical mechanisms of the innate immune system, including peptides such as cathelicidin LL-37 and protegrin-1 (PG-1). The objective: to establish the effect of the combined use of LL-37, PG-1 and chemotherapy drugs on the expression of p53, GFAP, ATRX, Ki-67, TF, PDPN and EGFR proteins in GBM patient cell cultures, as well as their relationship to overall survival (OS) and life expectancy (LE) of patients. Materials and Methods: Cells were isolated from GBM biopsies obtained from patients (n = 30) and grown under standard conditions for 2 days. The cells were treated with different doses of the following chemotherapy drugs: temozolomide (TMZ), doxorubicin (DOX), carboplatin (CARB), cisplatin (CIS), etoposide (ETO) as well as peptides LL-37, PG-1, to determine the 50% inhibitory concentration (IC50) using the MTT assay. The expression of p53, isocitrate dehydrogenase-1 (IDH1), glial fibrillary acidic protein (GFAP), ATP helicase chromatin (ATRX), proliferation antigen (Ki-67), transferrin (TF), podoplanin (PDPN), and epidermal growth factor receptor (EGFR) proteins in GBM cells analyzed using immunohistochemical (ICH) staining with specific antibodies. Associations between these proteins and OS were analyzed using GraphPad Prism 8.0 software. Results: Statistically significant correlations were found between the expression of TF (r= -0.556, p=0.04), EGFR (r=0.799, p=0.03) and Ki-67 (r= 0.651 p=0.002) and TF (r=-0.899, p=0.004) in GBM cells and the IC50 values of LL-37, PG-1 respectively. The low IC50 value of LL-37 (less than 7 μM) and the high expression of p53 protein (20%, 12 vs 6.5 months, p=0.0037), GFAP (40%, 12 vs 9 months, p=0.0019) were associated with a longer life expectancy for the patients. In contrast, low sensitivity of GBM cells to LL-37 (higher 7 μM) and high expression of Ki-67 (15% or higher) were associated with a shorter life expectancy for the patients (10 vs 14 months, p=0.0452). Conversely, low EGFR expression (below 40%) and a low IC50 for LL-37 were associated with a longer life expectancy (12 vs 6.5 months, p=0.0031). High sensitivity of GBM cells to PG-1 (less than 8 µM) and high expression of proteins p53 (20%, 12 vs 8 months, p=0.0126), GFAP (40%, 24 vs 10 months, p=0.0042), ATRX (higher 15%, 8 vs 14 months, p=0.0346), as well as low expression of Ki-67 (below 15%, 8 vs 14 months, p=0.0346) and EGFR (below 40%, 8 vs 12 months, p=0.0124) were associated with an increase life expectancy. Low EGFR expression (below 40%) and low sensitivity to PG-1 were associated with longer life expectancy (12 vs 8 months, p=0.0124). Conclusions: The observed associations between the expression of p53, GFAP, Ki-67, and EGFR proteins in GBM cells, as well as ATRX expression and IC50 of LL-37 and PG-1 with OS of the patients may potentially be used to develop a chemoimmunotherapeutic scheme for evaluating the efficacy of treatment in GBM patients.
Cervical Encirclage-A Boon for Mid- Trimester Pregnancy with Cervical Insufficiency
The human cervix is a complex structure that undergoes extensive changes throughout pregnancy and parturition to support the fetus and facilitate its expulsion. Cervical insufficiency is defined as the inability of the cervix to retain fetus, in the absence of uterine contractions owing to a functional or structural defect1. The term “Cervical insufficiency” is now replaced by “cervical incompetence”. Epidemiologic studies suggest an approximate incidence of 0.5% in the general obstetric population and 8% in women with a history of previous mid-trimester miscarriages.
Between Vocation and Burnout: Working Conditions, Training, and Career Prospects for Cardiologists in Argentina
Introduction: The practice of cardiology in fragmented healthcare systems faces increasing structural pressures related to heavy workloads, inadequate compensation, and limited professional recognition. These factors negatively affect physician well-being, contribute to burnout, and pose challenges to workforce sustainability. In parallel, demographic changes characterized by the aging specialist population and the reduced influx of young physicians are generating concern regarding the future availability of qualified cardiovascular professionals. Objective: The aim of this study was to evaluate cardiologists’ perceptions of working conditions, income satisfaction, professional recognition, training pathways, and future career expectations, as well as to explore their association with demographic and occupational characteristics. Methods: An observational, analytical, cross-sectional study was conducted using an anonymous, self-administered survey distributed nationwide between June and September 2023. The questionnaire, validated by an institutional ethics committee, consisted of 16 items grouped into three domains: relationship with scientific societies, professional recognition, working conditions, and continuing medical education. Demographic and occupational variables were also collected. Data analysis was performed with descriptive statistics and Pearson or Spearman correlation coefficient analysis, as appropriate, using Python 3.1. Results: A total of 404 responses were analyzed, predominantly from more experienced cardiologists, reflecting an aging workforce. Younger professionals reported a heavier weekly workload, with a significant inverse correlation observed between age and hours worked (r = −0.41). Economic dissatisfaction was highly prevalent: over 70% of respondents expressed dissatisfaction with their income, and 95% felt that their remuneration did not adequately reflect their workload. Nearly half anticipated a worse economic situation within the next five years. Satisfaction with current income showed a positive correlation with future economic expectations (r = 0.23). Medical residency remained the preferred training pathway, while support for professional recertification was moderate and positively associated with greater economic satisfaction. Conclusions: The practice of cardiology in fragmented healthcare systems is characterized by excessive workload, widespread economic dissatisfaction, and unfavorable future prospects, particularly among younger professionals. These conditions contribute to professional burnout and threaten workforce retention and generational renewal. It is essential to implement comprehensive health policies that address remuneration models, professional recognition, training structures, and physician well-being to ensure long-term sustainability of cardiovascular care in diverse healthcare settings.
Optimal Surgical Treatment of Hiatal Hernias of Types II-IV
Hiatal hernias of types II-IV have anatomical features that cause a displacement of the abdominal organs into the mediastinum through the hiatal opening of the diaphragm parallel to the esophagus without or together with it (paraesophageal component), which is an absolute indication for surgical treatment, since it is the cause of life-threatening conditions (acute intestinal or gastric, esophageal obstruction, strangulation and further necrosis of the organs located in the hernial sac). The recurrence rate of hiatal hernias of types II-IV reaches 20-40% and even 60%, underscoring the need for analysis and search for new solutions to this problem. The article analyzes the long-term results of treatment of 150 patients with hiatal hernias of types II-IV hernias, operated in the thoracic surgery department of the P.A. Bayandin Murmansk Regional Clinical Hospital in the period from 2013 to 2017, which made up a retrospective group (standard surgical treatments). Based on the assessment of the treatment results, changes were made to the surgical intervention tactics used. From 2018 to 2024, 180 patients with hiatal hernias of types II-IV underwent surgery in the same unit, forming a prospective study group (optimal surgical treatments). A comparison of these groups was carried out. The research evaluates the perception of certain factors, primarily shortening of the esophagus, as objective conditions with the transformation of surgical tactics allowing for achieving significantly better results. Good or satisfactory treatment outcomes were achieved in 73.7% of cases in patients of the retrospective group, and poor outcomes were achieved in 26.7%. In patients of the prospective group, these results were 88.6% and 11.4%, respectively. The research confirms that with shortening of the esophagus in type III hernias, its high mobilization does not allow to reliably prevent repeated displacement of the stomach into the chest; the use of prostheses to correct the esophageal hiatus in case of shortening of the esophagus is an ineffective method of preventing relapse of the disease; the formation of a fundoplication cuff in the mediastinum in case of shortening of the esophagus should be considered an effective method of preventing relapse; in case of hernias of types II-IV and normal length of the esophagus, the use of prosthetic materials to correct the size of the hiatal opening is justified and allows to reduce the frequency of unsatisfactory treatment results.
Comparison of Transdermal Optical Imaging and Conventional Handcuff Methods for Blood Pressure Screening: A Cross-Sectional Study
Introduction: Non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), contribute significantly to global mortality, accounting for over 70% of deaths worldwide. Recent advancements in Transdermal Optical Imaging (TOI) technologies, such as the Lifesten app, offer innovative approaches to blood pressure measurement. This study compares the accuracy of the Lifesten app to traditional cuff-based methods for measuring blood pressure. Methods: A cross-sectional study was conducted in Kigali, Rwanda, targeting adults aged 18–45, including high-risk individuals that were identified through social media, community outreach, and targeted advertising. Participants underwent blood pressure measurements using both the Lifesten app and a traditional hand-cuff device. Data were analyzed using SPSS software to compare the two methods. Results: Among the 384 participants, 59.63% were male (n=229) and 40.37% were female (n=155), with the majority aged 18–27 years. The mean scores measured using the Lifesten app for systolic and diastolic pressures were 111.45 mmHg and 74.75 mmHg, respectively, compared to 116.78 mmHg and 75.71 mmHg using the traditional device, showing differences of 4.56% and 1.27%. In a subgroup of 12 hypertensive individuals, the app recorded lower systolic (114.17 mmHg) and diastolic (75.67 mmHg) readings than the traditional device (140.17 mmHg and 80.00 mmHg).The app’s systolic MAE was 11.68 mmHg (MAPE: 9.63%), while diastolic MAE was 8.66 mmHg (MAPE: 11.63%). Conclusion: The Lifesten app demonstrated potential for hypertension screening in resource-limited settings. However, algorithm improvements are necessary to enhance its accuracy and ensure reliable clinical use.
Diagnostic Challenges of Eosinophilic Granulomatosis with Polyangiitis: A Case Report
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis that predominantly affects small blood vessels and occurs in patients with asthma and tissue eosinophilia. The form associated with anti-neutrophil cytoplasmic antibodies (ANCA) is rarer. This case report presents a patient with late-onset asthma who initially presented with skin lesions (purpura), progressing to acute kidney injury, and subsequently diagnosed with glomerulonephritis. The difficulty and complexity of the clinical diagnosis and the importance of initiating appropriate and early therapy to minimize damage to target organs, improve prognosis, and avoid adverse effects motivated the presentation of this case and its literature review.
eosinophilic granulomatosis with polyangiitis
Bilateral Mastoiditis Complicated by Unilateral Zygomaticitis – Rare form, Challenging Diagnosis
Introduction: Bilateral mastoiditis complicated by unilateral zygomaticitis is an exceptional clinical entity, rarely described in the literature. Although the incidence of complications of acute otitis media has decreased significantly with the introduction of modern antibiotic therapy, atypical forms of bone extension remain a diagnostic challenge. The association of bilateral mastoid involvement with zygomatic bone involvement can cause a non-specific clinical picture, delaying diagnosis and the establishment of appropriate treatment. Materials and Methods: In this case study we present a 41-year-old male patient who suffered bilateral mastoiditis complicated by unilateral zygomaticitis following a chronic rhinosinusal pathology in exacerbation. He presented with accusations of: pronounced headache, bilateral otodynia, suppurative otorhea, swelling in the projection of the zygomatic bone on the left, bilateral hearing loss. The patient underwent bilateral petromastoid clearance surgery with incision and drainage of the zygomatic collection on the left. Results: Epidemiological data from the literature indicate that acute mastoiditis in adults accounts for approximately 10–15% of all mastoiditis cases. The overall incidence is estimated at less than 0.5 cases per 100,000 adults annually in countries with access to modern health services. Although antibiotic therapy has dramatically reduced mortality associated with mastoiditis (from 20–30% in the pre-antibiotic era to less than 1% today), it remains a pathology with a significant risk of extracranial complications (subperiosteal abscess, apical-cervical mastoiditis, petrositis) and endocranial complications (meningitis, lateral sinus thrombosis, brain abscess). Although less common, acute mastoiditis remains a pathology of current interest, with a significant impact on public health, requiring a multidisciplinary and updated approach to the new infectious challenges. We present a rare case of such an otic pathology in a 41-year-old male patient who suffered bilateral mastoiditis complicated by unilateral zygomaticitis as a result of enduring a chronic acute rhinosinusal pathology. Conclusions: Acute mastoiditis, although rare in the age of antibiotics, continues to be an otological emergency, with significant potential for endocranial and extracranial complications, especially in cases not properly treated.
A Systems-based Approach to Longevity: Integrating Mitochondria, Hormones, and Inflammation through Case-based Precision Endocrinology
Aging is a multifactorial biological process driven by progressive declines in cellular energy production, hormonal signaling, and immune regulation. While advances in geroscience have identified key molecular hallmarks of aging, translation into practical, clinician-friendly frameworks remains limited. Current medical approaches often address metabolic, endocrine, and inflammatory dysfunction in isolation, which may fail to capture the interconnected biology underlying accelerated aging and chronic disease. The Longevity Triadis presented as a systems-based clinical framework integrating three interdependent pillars—mitochondrial resilience, hormonal orchestration, and inflammation modulation—to guide precision longevity care. Mitochondria regulate cellular energy availability, redox balance, and stress adaptation; hormonal networks coordinate metabolism, reproduction, and tissue repair; and chronic low-grade inflammation acts as a central accelerator of biological aging. Dysregulation in any one pillar can destabilize the others, creating self-reinforcing feedback loops that promote metabolic decline, immune dysfunction, and reduced physiologic reserve. This manuscript synthesizes emerging mechanistic and clinical evidence linking the Longevity Triadto established hallmarks of aging and demonstrates its application through case-based clinical examples. Diagnostic strategies including functional metabolic testing, comprehensive endocrine assessment, inflammatory and immune biomarkers, and lifestyle-related exposure evaluation are discussed. Targeted interventions—encompassing lifestyle modification, nutritional and micronutrient support, exercise prescription, and individualized hormonal optimization—are illustrated to show how coordinated, multi-pillar treatment can restore physiologic balance and improve patient-centered outcomes. The Longevity Triad offers a practical, integrative roadmap for clinicians seeking to move beyond symptom-based management toward systems-level, personalized strategies that support healthy aging, metabolic flexibility, and long-term resilience.
Aging biology; Mitochondrial dysfunction
A Rare Benign Multilobulated Floor of Mouth Lesion
Rhabdomyomas are a rare and benign, slow growing tumour of the skeletal muscles. They are even further classified into cardiac and extracardiac types according to their location. Extracardiac rhabdomyomas can be further divided based on cellular differentiation, such as; fetal, genital, and adult subtype [1] . Adult Type Rhabdomyomas shown to have clinical predominance towards adult males and more commonly reported in the head and neck region as compared to other parts of the body. This type of benign tumour also has a high recurrence rate. In this case review we discuss a rare case of floor of mouth rhabdomyoma.
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In dieser Arbeit werden verschiedene Konzepte, die sich als psychoanalytisch verstehen, beschrieben und es wird der Frage nachgegangen, wie es sein kann, dass solche sich gegenseitig ausschließenden Vorstellungen dennoch unter dem Dach der “Psychoanalytik” Zuflucht gefunden haben. Unter Rückgriff auf empirische Studien zum mikroaffektiven Verhalten wird gezeigt, dass etwas, das man als Wiederholungszwang bezeichnen kann, der Kern des Krankheitsprozesses ist, und dass der Erfolg der Psychoanalytiker damit einhergeht, dass Psychoanalytiker sich diesem Zwang entgegenstellen können. Wohlgemerkt, auf der Ebene des Verhaltens, nicht der Erfahrung. Es wird argumentiert, dass Theorien, die ein gleiches Geschehen beim Patienten und Behandler postulieren, keine Krankenbehandlungen sind und nicht psychoanalytisch sein können. Sie haben jedoch einen signifikanten Einfluss auf die Persönlichkeitsentwicklung und können z.B. in Lehranalysen eingesetzt werden.
Antibiotic Stewardship in Nursing – A Comprehensive Review
Antibiotic​‍​‌‍​‍‌​‍​‌‍​‍‌ stewardship is at the center of the healthcare system of the future, in a world where antimicrobial resistance (AMR) is a rapidly growing threat. The primary causes of resistance have been the abuse and overuse of antibiotics in clinical, community, and agricultural settings. As a result, patient outcomes have been negatively impacted, leading to longer illness durations, higher death rates, and higher healthcare expenses. Antibiotic stewardship programs (ASPs) employ evidence-based guidelines, diagnostics, surveillance, and interdisciplinary collaboration to prevent needless antibiotic use. Antibiotic use during direct patient care, surveillance, infection prevention, and health education can be greatly influenced by nurses, who make up the majority of the healthcare workforce It also discusses how to strengthen nursing leadership and stewardship capacity in the future.
Unmasking Olfactory Neuroblastoma: A Case of Rare Pediatric Tumour and the Diagnostic and Therapeutic Challenges
Olfactory Neuroblastoma (ON) A rare malignant tumor originating from the olfactory epithelium of the sinonasal tract, first described by Berger and Richard in 1924. Common symptoms patients typically present with unilateral nasal obstruction (70%), epistaxis (50%) and may also experience headaches, pain, excessive tearing, rhinorrhea, anosmia, and visual symptoms. Incidence Occurs at a rate of 0.1 per 100,000 in the pediatric population, making it particularly rare in toddlers. Imaging is crucial for staging the disease; both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are used for diagnosis and assessment. Treatment Multimodal approach often recommended, including surgical resection, chemotherapy, and sometimes radiotherapy. The role of neoadjuvant chemotherapy in facilitating complete surgical resection requires further study. Prognosis Depends on the stage of the disease, including locoregional extension and presence of distant metastasis.
Epidemiological Profile of Suspected Suicide Victims in the Metropolitan Region of Belém – Pa (2019-2023): A Documental Analysis at the Forensic Medical Institute
Suicide is figured as a public health problem, complex and multicausal in nature, with a significant individual and collective impact. This study aimed to outline the epidemiological profile of suspected suicide victims in the Metropolitan Region of Belém, between 2019 and 2023, based on data from the Renato Chaves Forensic Medical Institute. This is a documentary, quantitative, and retrospective study that analyzed 480 autopsy cases performed during the period. The results indicated a higher prevalence among male individuals (76.66%), with a focus on the 18 to 30 age group (30.83%). Single individuals were the most affected group in terms of marital status (65.83%). A concentration of cases in certain geographical areas and the influence of socioeconomic factors were also observed. The findings reinforce the need for targeted public policies and prevention strategies focusing on the identified vulnerable groups.
Consumption of Iron and Vitamin C in from a Coastal Community in Northern Peru
Background: Iron deficiency anemia is the most frequent cause in the world and derives from the negative balance of iron, due to an inadequate contribution or absorption in the diet, as well as physiological periods such as pregnancy. Methods: Correlational descriptive research, 42 pregnant women who attended their obstetric consultation and nutritional consultation between the ages of 18 and 40 years were interviewed. The 24-hour food consumption recall and the food frequency assessment were used. A descriptive and inferential analysis was carried out with the SPSS program. Results: Iron consumption was deficient by 76.19% in the study group. 64.29% of the pregnant women did not have anemia; Only 19.05% had mild anemia, 7.14% moderate and 9.52% severe anemia. In relation to the consumption of vitamin C, it was deficient by 40.48%. Conclusions: 35.71% of the pregnant women studied presented anemia. The percentage of adequacy of vitamin C iron consumption were deficient by 76.19% and 40.48%, respectively.The main source of heme iron consumption was the liver (Rho= 0.54); of non-heme iron, broccoli (Rho = 0.600) and of vitamin C, orange (Rho = 0.42)
Efficacy of Vacuum Dressing Versus Traditional Dressing in Healing Soft Tissue Injuries in Patients with Post-Traumatic Fractures: A Systematic Review
Introduction: Soft tissue injuries in post-traumatic fractures are a clinical challenge, associated with high complication rates. Negative Pressure Wound Therapy (NPWT) has emerged as a promising alternative to traditional dressings. Objective: To evaluate, through a systematic review, the efficacy of Negative Pressure Wound Therapy (NPWT) compared to traditional dressings in the treatment of soft tissue injuries in patients with fractures. Methods: A systematic literature review was conducted in the PubMed, SciELO, and LILACS databases, including articles published between 2010 and 2025. Six studies were included in the final qualitative synthesis. Results: The evidence indicates that NPWT is superior to traditional dressings in reducing healing time and decreasing infection rates, particularly in lower limb fractures. However, the benefits regarding the reduction of hospitalization time and the need for surgical reinterventions are inconsistent in the literature. The cost-effectiveness of NPWT proved to be controversial and dependent on the healthcare system context, and data on long-term functional outcomes are scarce. Conclusion: NPWT is an effective and preferential therapeutic tool for managing complex wounds associated with fractures, primarily for accelerating healing and reducing infection risk. The decision for its use, however, must be carefully considered, taking into account the controversies regarding its cost-effectiveness, the heterogeneity of the evidence, and the patient’s clinical profile.
Phrenic Nerve Paralysis: Effects on Diaphragm Mobility
Phrenic nerve paralysis is a severe clinical condition with significant repercussions on respiratory mechanics and patient quality of life. It results from the interruption of diaphragmatic innervation, compromising the physiology of the muscle, reducing pulmonary expansion, and leading to alveolar hypoventilation. The phrenic nerve originates from the cervical roots C3 to C5, following a complex anatomical pathway that makes it vulnerable to iatrogenic injury during cervical or thoracic surgeries or anesthetic blocks. This study reviewed scientific evidence from the past decade, without language restrictions, using databases such as PubMed and SciELO and search terms including "phrenic nerve paralysis," "iatrogenesis," and "neurotization." The analysis integrated data from prospective studies and systematic reviews, highlighting diagnostic techniques such as dynamic ultrasonography and electroneuromyography. Therapeutic strategies ranged from conservative approaches to surgical interventions, including neurotization with autologous grafts and diaphragmatic plication. The findings conclude that preventing iatrogenic injuries requires standardized protocols, intraoperative monitoring, and equitable access to therapies. These measures are essential to reduce morbidity and mortality and improve clinical outcomes, particularly in vulnerable populations such as the elderly and patients with neuromuscular comorbidities.
Newborn Survival Analysis: between 2019 and 2021 in Burundi
Progress towards the fourth Millennium Development Goal - to reduce child mortality under the age of 5, to which all countries are committed - has been slow in several countries in the Central African region in recent years. This study includes 2,886 observations from Burundi between 2019 and 2022. Early neonatal mortality (0 - 6 days) accounts for 50% of neonatal deaths in the country. Through survival analysis, I identified several key risk factors�Caesarean section, malaria, and fetal distress�as the primary causes of early neonatal mortality. Contrary to conventional wisdom, most of these health problems can be managed with cost-effective, evidence-based interventions that do not require sophisticated skills or technologies in countries with high infant mortality. By improving the health of the mother, through adequate nutrition during pregnancy, correct management of childbirth and appropriate care of the newborn, 32.9% of infant deaths can be avoided. These results further argue in favor of an appropriate prevention policy focused on the mother-child pair: better monitoring of pregnancies among mothers, ensuring good vaccination coverage and improving health infrastructure.