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
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
Copyright (c) 2026 Authors and Global Journals Private Limited http://creativecommons.org/licenses/by/4.0/
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
Unhealthy Diets and Menarche: Association between Ultra-Processed Food Consumption, BMI, and Menstrual Health in Adolescent Girls
Background: The increasing reliance on ultra-processed foods (UPFs) among adolescents has emerged as a global nutritional concern. UPFs are typically energy-dense, rich in unhealthy fats, sugars, and additives, while being poor in micronutrients. Excessive intake of such foods has been linked to obesity, metabolic dysfunction, and early pubertal onset. Menarche, a critical milestone in female reproductive development, is influenced by nutritional and environmental factors. However, evidence from Indian contexts, particularly rural and semi-urban regions, remains limited. Objective: This study aimed to examine the relationship between dietary fat intake from UPFs, body mass index (BMI), and menstrual health indicators�specifically age at menarche and the occurrence of early menarche�among school-going adolescent girls in the Midnapore district of West Bengal, India. Methods: A cross-sectional survey was conducted among adolescent girls (N = 232) using a structured questionnaire covering socio-demographic characteristics, dietary habits, anthropometric measurements, and menstrual history. Nutrient intake, with a focus on fat consumption from UPFs was estimated and BMI was computed using WHO criteria. Descriptive statistics, linear regression, and binary logistic regression analyses were employed to assess associations. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for early menarche (< 12 years). Results: The mean age at menarche in the study population was 12.45 � 0.98 years. Nearly one in five participants (?22%) experienced early menarche. High dietary fat intake (? 75th percentile, proxy for UPF consumption) was significantly associated with early menarche (OR = 1.64, 95% CI: 1.10�2.46). Linear regression analyses indicated that dietary fat intake was inversely related to monarchical age (? = -0.003, p < 0.05), independent of BMI. Furthermore, BMI exhibited a significant negative association with age at menarche (? = -0.020, p < 0.01), suggesting that overweight girls tended to attain menarche earlier. Conclusion: The findings highlight a strong association between ultra-processed food consumption, elevated BMI, and earlier onset of menarche in adolescent girls. Given the potential long-term implications�such as increased risk of menstrual irregularities, metabolic disorders, and reproductive health challenges�public health interventions promoting nutritional literacy, healthier dietary alternatives, and lifestyle modifications are urgently warranted in school and community settings.
The Differences of Night Eating Syndrome, Sleeping Pattern, and Sugar-Sweetened Beverage Consumption Habit based on Metholic Type in Obese Students
Background: The prevalence of obesity in students is currently increasing and it can lead to� metabolic syndrome at such a young age. The habit of students who have bad sleeping pattern, night� eating syndrome, and excessive SSB consumption can increase the risk of metabolic syndrome in� obese students.� Purpose: The purpose of this research was to analyze the differences of night eating syndrome,� sleeping pattern, and consumption habit of sugar-sweetened beverage based on metabolic types in� obese students.� Method: The research was conducted in July-September 2020 with female students in Semarang� City as subjects. This research used a case-control design, as many as 52 subjects aged 19-24 years� were selected by consecutive sampling method. The collected data included: body weight using� digital scales, height using a microtoise, waist size using a medline, blood pressure using a� tensimeter, and a laboratory tests was conducted to check triglyceride levels, HDL cholesterol,� fasting blood glucose, as well as insulin. The used instruments were The Night Eating Questioner� (NEQ) to assess the night eating syndrome, Pittsburg Sleep Quality (PSQI) to assess sleeping� pattern, and Semi-Quantitative Food Frequency Questionnaire (SQFFQ) to see the subject's� consumption of sugar-sweetened beverage during the last one month. The data were analyzed using� Chi-Square test.� Result: The research showed that majority of the subjects who experienced night eating syndrome� (46,2%) and bad sleeping pattern (61,5%) were subjects with Metabolically Unhealthy Obesity� (MUO). Meanwhile, for sugar-sweetened beverage consumption in Metabolically Healthy Obesity� (MHO) and Metabolically Unhealthy Obesity (MUO) were still within the normal range (86,4%). A� difference between night eating syndrome (p=0,006) and sleeping pattern (p=0,012) on� Metabolically Healthy Obesity (MHO) and Metabolically Unhealthy Obesity (MUO) was also� observed.� Conclusion: Students with Metabolically Unhealthy Obesity (MUO) type were experiencing more� night eating syndrome and bad sleeping pattern compared to the students with Metabolically Healthy� Obesity (MHO) type.�
Arthroscopic Fixation and Ligament Reconstruction in Tibial Plateau Fracture: A Case Report
Introduction: Tibial plateau fractures account for approximately 1% of all fractures; however, they are associated with high morbidity due to a wide spectrum of soft tissue injuries and a significant incidence of concomitant ligamentous and meniscal lesions. Among these, anterior cruciate ligament (ACL) injuries are particularly relevant, as delayed diagnosis or inadequate management of these injuries can compromise joint stability and long-term functional outcomes. Case presentation: We present the case of a 33-year-old male patient with a lateral tibial plateau fracture (Schatzker type I) associated with a complete anterior cruciate ligament tear and a fibular head fracture in the right knee following a traffic accident. The patient underwent ACL reconstruction using hamstring tendon autograft, along with open reduction and internal fixation of the tibial plateau and fibular head fractures. Postoperative evolution has been satisfactory, with full recovery of range of motion, a stable, pain-free knee, and favorable functional outcomes. Discussion: Tibial plateau fractures are complex articular injuries with a high incidence of associated ligamentous damage, particularly involving the anterior cruciate ligament. Treatment should be individualized based on the fracture pattern and associated injuries. Arthroscopy-assisted techniques represent a viable option for reduction, fixation, and simultaneous management of intra articular lesions, contributing to joint function preservation and showing satisfactory functional outcomes. Conclusion: This case highlights the importance of maintaining a high index of suspicion for associated ligament injuries in tibial plateau fractures, regardless of the fracture pattern. Additionally, the arthroscopy-assisted approach is emphasized as a valuable tool for achieving precise anatomic reduction and simultaneous anterior cruciate ligament (ACL) reconstruction in a single surgical procedure. The case presented, along with the available evidence, supports the combined approach as a safe, effective, and minimally invasive strategy that promotes early functional recovery and favorable clinical outcomes.
Neurological Manifestation of Chikungunya Virus and its Implication in the Pathogenesis of Guillain-Barr頓yndrome: A Systematic Review of Clinical and Mechanistic Evidence
Chikungunya virus (CHIKV) infection has been linked to severe neurological outcomes, notably Guillain-Barr� 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 Serotonin Hypothesis for Depression: A Comprehensive Study
It has been observed a sharp growth in the number of diagnoses of depression (under the MDD [Major Depressive Disorder] spectrum) in the last decades, accompanied by a similarly increase in sales of antidepressants in several societies, leading to depression being currently considered an epidemic (WHO). The predominant understanding of the cause for depression, the serotonin hypothesis, conveyed by 80% of the population, dates back to the 1960s, when the first antidepressants were being developed. This article sought to verify this state of affairs from the main literature available, starting from the original pharmacological development of antidepressants and their implication in the body�s physiology. Most of the literature gathered for this study did not validate the hypothesis as the most plausible main cause for depression, while nonetheless, this continues to be widespread by pharmaceutical industries and most medical practitioners as such.
Optimizing Patient Flow and Resource Utilization: Transfer Centers as Strategic Command Hubs in Multi-Hospital Healthcare Systems
Healthcare systems face unprecedented operational challenges including capacity constraints and financial pressures, exacerbated by workforce shortages and shifting care delivery models. Optimized transfer centers emerge as a strategic solution, functioning as centralized hubs that coordinate inter- and intra-facility patient transfers while integrating clinical decision-making with logistics and bed management. This article explores how such centers serve as catalysts for enhancing access, efficiency, and cost control across a ten-hospital health system in the DMV region. Through a performance transformation framework, the article examines the structural and technological components contributing to effective transfer center operations, including centralized communication platforms, real-time data integration systems, standardized triage protocols, bed management visualization technologies, and interdisciplinary staffing models. Key outcomes demonstrate significant improvements in transfer times, emergency department boarding, resource utilization, and financial performance. The implementation framework focuses on improving performance and lowering costs for outbound BLS ambulance and wheelchair van services for acute patient transport, while simultaneously reducing administrative burden on clinicians who were previously arranging outbound transportation and decreasing overall length of stay. Optimized transfer centers represent a high-impact intervention for healthcare systems seeking to improve resource allocation while enhancing quality and equity of care across distributed networks.
Effect of using a Composition of 4 Essential Oils on Self-Esteem, Training Quality and Pain Score in Athletes from the Moroccan National Poomsae Team
During training and competitions, athletes face physical factors, including pain, fatigue and exhaustion, added to psychological factors, including negative vibes and mental pressure. Recovery is a key function; it is a step aimed at restoring athletes' physical condition to its normal pre-competition state. Essential oils have shown their positive effect in improving sports performance by modulating psychological states, improving alertness and reducing pain, physical and mental fatigue. This study aims to determine the effect of using a mixture of 4 essential oils on training quality, self-confidence, fatigue and pain in athletes of the Moroccan national poomsae team. Other factors were studied: self-esteem, depression, insomnia and back pain. The results showed a significant effect of using Essential oils on all factors studied.
A Vascular Benign Lesion in a Perilous Location
Background: Hemangioblastomas arehighly vascular grade 1 tumors arising sporadically or, more rarely, in the context of Von Hippel-Lindau disease.Cystic brainstem hemangioblastomas are rare with only few cases reported in literature. Even though they are benign, their surgery is challenging in view of their eloquent location and vascularity.Thorough perioperativemanagement is required. Case presentation: We report the case of a 47-year-old female patient with progressive weakness, difficulty in swallowing and ataxic gait.The brain MRI showed a cystic lesion occupying the caudal part of the fourth ventricle and the dorsal medulla oblangata. We performed a subtotalexcision of the tumor that was challenging due to its adherence to the floor of the 4th ventricle and its high vascularity. The pathology exam concluded to a hemangioblastoma. The patient presented a good evolution with no tumor progression in 6 months follow-up. Clinical discussion: The cystic brainstem hemangioblastoma is a rare seemingly innocuous lesion but highly challenging to neurosurgeons. MRI is the investigation of choice, regularly sufficient for preoperative evaluation. Still, some authors recommend the performance of a cerebral angiography or a CTA preoperatively. In literature, manystrategies, such as the use of preoperative embolizationor radiosurgery were described, aiming for a better-quality surgery and prognosis. Conclusion: Cystic brainstem hemangioblastoma is a scarce histologically benign but challenging lesion with surgical difficulties.Through our case and literature review, we concluded that surgery is the mainstay treatment for brainstem hemangioblastomas mainly cystic ones and that a thorough study of its vascularization via angiography or CTA with a preoperative tumor embolization can help achieve a total tumor resection with good functional outcome andlow mortality.
From Algorithms to Outcomes: Transforming Modern Healthcare through Artificial Intelligence
Artificial Intelligence (AI) refers to the utilisation of computers and advanced technologies to simulate intelligent behaviour and critical thinking comparable to that of humans. The term was first described by John McCarthy in 1956 as the science and engineering of creating intelligent machines. [1,2]. Previously considered a concept of science fiction, AI is now a tangible reality and is widely represented within academic discussion and mainstream applications. Machine Learning (ML), which is a subset of AI, enables machines to learn from patient data and generate predictions by pattern recognition, thereby empowering healthcare providers in delivering better care through accurate diagnosis and treatments. Although current technologies and AI models have not yet advanced to a stage where they may replace a doctor, they hold considerable promise as valuable diagnostic tools in healthcare. [1,3] While the likelihood of AI assuming a significant role in healthcare seems imminent, its evolution is currently tempered by concerns regarding ethical challenges and patient safety. This literature review aims to examine the contemporary applications of AI in healthcare, its potential advantages for both patients and healthcare professionals, and the existing challenges and limitations that may hinder its continued progression. [1,2]
Renal Leiomyoma as a Bosniak IV Lesion: A Case Report
Leiomyoma is a benign neoplasm originating from mesenchymal cells, affecting the smooth muscle of the genitourinary tract. These tumors can occur in various places throughout the urinary tract, mainly in the bladder, but renal involvement is less frequent and is usually in the renal capsule. They are generally asymptomatic, and diagnosis is frequently incidental through imaging studies. When symptomatic, flank pain, palpable abdominal mass or hematuria can be present. This report describes a patient with lower back pain whose computed tomography(CT) revealed a complex Bosniak IV renal lesion. Later, the patient was submitted to a partial robotic nephrectomy and diagnosed with leiomyoma through immunohistochemistry.