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
Stress Level in Parents with Premature Children Hospitalized in the Neonatal Intensive Care Unit in Hospital del Niño Dr. José Renán Esquivel During the Month of July 2022
A premature birth is an unexpected event for the parents, generating fear, anxiety and guilt, due to the culmination of the pregnancy and the condition of the baby. mothers with a premature child are three times more likely to have postpartum depression. Advances in technology have increased the chances of survival in premature infants, but they are prone to complications in the medium and long term. Materials and methods: An observational, descriptive study was carried out, applying a survey to 52 parents with premature infants less than or equal to 36 weeks of gestational age (SEG), who remained 7 or more days hospitalized in the Neonatal Intensive Care Unit (NICU). in the Neonatology Unit of the Dr. José Renán Esquivel Children’s Hospital, during the month of July 2022, transferred from the Santo Tomás Hospital. Results: According to the results of our studies, 69.2% of parents perceived themselves as not at all to slightly stressed, but when subdividing the scale into extra and intrapersonal stress levels, in the latter they had a moderate to extremely stressful level of stress. in 75%, therefore, 94.2% want to have a support group. Conclusion: It is essential for parents to have a support group.
Copyright (c) 2023 Authors and Global Journals Private Limited http://creativecommons.org/licenses/by/4.0/
Virtual Autism and the Influence of Screens on Children’s Development
The growing abusive use of screens, such as smartphones, tablets and computers, has increased during and after the pandemic, raising concerns about its impact on children’s healthy development. This scenario is a concern in contemporary society, especially when evaluating its potential impact on children. This article addresses the implications of excessive screen use on child development, including its relationship with Autism Spectrum Disorder (ASD). Excessive time spent on electronic devices has been linked to negative effects on social skills. Additionally, intensive screen use can delay language development, negatively affecting communication skills in children aged 6 to 24 months. Furthermore, excessive use of screens can impair cognitive abilities, such as attention, memory and executive function, and also presents problems related to sleep, due to exposure to blue light that affects the production of melatonin, a sleep-regulating hormone. The findings suggest that excessive screen use can lead to changes in the development of the prefrontal cortex, an area crucial for executive functions. In the context of ASD, excessive screen use can worsen symptoms, including sensory sensitivity, sensory overload, stereotypical behaviors, and attention disorders. To promote healthy screen use, it is essential that parents establish appropriate limits, monitor the content accessed and encourage physical, social and educational activities outside the digital environment, in addition to seeking professional guidance with individualized assessment and the development of balanced strategies to the use of screens, ensuring the general well-being of children in their cognitive and social development. Considering that, although screens offer educational opportunities, their use must be balanced with face-to-face social interactions, which are fundamental for the healthy development of children.
screens. human development. autism. social skills
Medical Women’s Mental Health Factors During the COVID-19 Pandemic
The article is devoted to the study of the fear level of death in young nurses and senior students of medical school, and the role of tolerance to uncertainty in the development of fear of death. A study of 150 respondents was carried out: 73 people are nurses and paramedics, 72 are medical school students, senior courses. Students underwent practical training in hospitals, but were not directly involved in work with patients with COVID-19. The following methods were chosen: & quot; Fear of Death Scale & quot; by J. Boyar, Templer’s Death Anxiety Scale, method & quot; Inclination to suicidal behavior" by T. N. Razuvaev. also the questionnaire & quot; the Multiple Stimulus Types Ambiguity Tolerance Scale-II (MSTAT-II) by McLain in the adaptation of Osin. Women physicians who work directly in hospitals have a higher level of fear of death, but lower suicidal risks than students of medical specialties. Intolerance to uncertainty enhances individual manifestations of fear of death and suicidal risk.
Breast Cancer in Argentina. Surrogate Parameters, Instead of the Genetic Profile, for Recurrence Risk Evaluation Inearly Stages,Estrogenreceptor-Positive, Her2-Neu Negative, Lymph Node-Negative” Cases in A Middle – Income Country.
Background. BreastCancer (BC)is the main cause of death and disability among women in low- and middle-income (MIC) countries like Argentina. In BCthe study of genic profile of cancer has been encouraged. Implementation of the multigene panels assay has led to a change in the manner in which chemotherapy is utilized mainly in patients with, early stage, estrogen receptor (ER)-positive, Her2-neu negative, lymph node-negativeBC. Unfortunately, all these tests are expensive. Given the potential savings in cost, algorithms have been proposed to predict Oncotype DX recurrence score (ODX RS) using commonly acquired clinical and histopathologic variables designated as subrogateparameters (SP).Materials and Methods. We evaluate the possibility, in a MIC country, of having the necessary data from the normally required report of the BC, in order to apply some of the ten (10) selected published algorithms offered as alternatives to ODXRS. From 1832 (stage I to IV) BC cases reported, between 2012 and 2015, a subset of 706 (38,5%) early stages “ER (+) / HER2 (-) / lymph node-negative” BC, was identified and analyzed. An online search and selection of published scientific research on same thematic, from 2010 onwards, was carried out.
A Comparison of Logistic Regression, Modified Logistic Regression and Naïve Bayes Models for Classifying HIV Viral load Suppression: The Case of Zombo District in Uganda
Purpose:To enhance the performance of the logistic regression by integrating step-wise procedures and henceforth compare and evaluate its performance with the Logistic regression and Naïve Bayes in classifying HIV viral load suppression (VLS). Methods:Models for classifying VLS were built using Logistic regression, modified logistic regression and Naïve Bayes classifiers. Accuracy, balanced accuracy and the area under the receiver operating characteristics curve (AUC) were the key performance metrics used to evaluate the generalizability of the various classifiers. Results:The modified logistic regression model trained on fewer predictor attributes achieved an accuracy of 84.9%, a balanced accuracy of 83.8% and an AUC of 92.6%. The traditional logistic regression model trained on a full set of predictor attributes achieved an accuracy of 84.9%, a balanced accuracy of 83.6% and an AUC of 92.5% whereas the naïve Bayes model achieved an accuracy of 81.6%, a balanced accuracy of 80.5% and AUC of 89.4%. Conclusion:The modified logistic regression model outperformed the traditional logistic regression and naïve Bayes models on account of recording higher balanced accuracy and AUC values of 83.8% and 92.6% respectively albeit with fewer predictor attributes. Hence integrating step-wise regression procedures in the traditional logistic regression model can enhance its classification performance leading to better predictions.
Motivation and Awareness Campaign: Institutional Evaluation of Facultade São Francisco De Assis
The quality of higher education is a topic of great relevance, as it is directly linked to the formation of qualified professionals for the exercise of their roles. To assess the quality of higher education, the Ministry of Education established parameters and implemented various evaluation instruments. The publication of Law 10.861/2004 systematized these assessments, highlighting the need for an in-depth study of the system and the active participation of the academic community in this process. The specific objective was to apply new evaluation instruments following a motivation and awareness campaign, assessing the new participation rates. The research was qualitative and quantitative, using a case study with document analysis. In the data discussion analysis, a comparative method was used to address the specific objective. The legislation from INEP and MEC provided the theoretical foundation for this investigation. In the final considerations, it was found that continuous mobilization and awareness efforts, through effective campaigns, enhance the understanding of the topic and contribute to improving the teaching and learning process, as well as promoting improvements in institutional infrastructure.
Copyright (c) 2024 Authors and Global Journals Private Limited http://creativecommons.org/licenses/by/4.0/
Impact of the Transplant Acceleration Program (PAT-MA) Phase I on Transplant Indicators in Maranhão, Brazil: A Retrospective Study
Introduction: In the context of public health, the efficiency of transplant programs is crucial to improving outcomes for patients on waiting lists. This study evaluated the impact of implementing the Transplant Acceleration Program (PAT-MA) at the Transplant Center of Maranhão, Brazil. Objectives: The aim of this study was to assess the impact of PAT-MA implementation on key performance indicators of the Maranhão Transplant Center, with a focus on improving the organization and effectiveness of the regional transplant system through structured management methodology. Methods: We conducted a retrospective observational study analyzing data from the Maranhão Transplant Center before and after the first phase of PAT-MA as a quality improvement initiative, comparing the years 2022 and 2023. The indicators collected included: number of transplants performed, waiting list size, notifications per million population, effective donors per million, organ transplants per million, corneal transplants per million, and number of active CIHDOTTs and OPOs. Results: Following PAT-MA implementation, there was a reduction in the family refusal rate (from 67% to 63%), a decrease in the rate of cardiac arrests before procurement completion (from 28% to 26%), an increase in notifications per million (from 172 [24/million] to 327 [46/million]), effective donors per million (from 12 [1.7/million] to 28 [3.9/million]), organ transplants per million (from 27 [3.9/million] to 62 [8.7/million]), corneal transplants per million (from 133 [18.6/million] to 255 [35/million]), and number of active CIHDOTTs and OPOs (from 3/0 to 10/1). These findings demonstrate marked growth and improvement in the regional transplant system. Conclusion: This study demonstrates that the implementation of the Transplant Acceleration Program (PAT-MA) had a positive impact on key performance indicators at the Maranhão Transplant Center. The results underscore the importance of strategic management approaches to optimize transplant program outcomes.
Copyright (c) 2025 Authors and Global Journals Private Limited http://creativecommons.org/licenses/by/4.0/
Neurological Manifestation of Chikungunya Virus and its Implication in the Pathogenesis of Guillain-Barré Syndrome: A Systematic Review of Clinical and Mechanistic Evidence
Chikungunya virus (CHIKV) infection has been linked to severe neurological outcomes, notably Guillain-Barré Syndrome (GBS). This systematic review highlights clinical and mechanistic evidence associating CHIKV with autoimmune polyradiculoneuropathies. Findings reveal the virus’s neurotropism and support its role as a triggering factor for GBS. Despite methodological heterogeneity among studies, the evidence underscores important implications for diagnosis, clinical surveillance, and patient management. Deeper understanding of this relationship is essential to improve preventive and therapeutic health strategies.
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.
Copyright (c) 2026 Authors and Global Journals Private Limited http://creativecommons.org/licenses/by/4.0/
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.
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.
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 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?
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.
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.
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.
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.
Effectiveness and Safety of Treatment of Double Chin with Combined Enzymatic Therapy
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.