All Articles in october, 2025

Introduction: Cervical cancer remains one of the most common malignancies affecting women worldwide, with over 600,000 patients globally every year, and is a leading cause of cancer-related mortality in women. Although there have been advancements in both screening and prevention, radiation therapy, with or without chemotherapy, is the standard of care for treating locally advanced cervical cancer. Radiation typically consists of two methods, external beam radiation therapy (EBRT) and brachytherapy, which have both evolved in their own respective ways technologically and for patient accessibility. This article aims to review the different cervical cancer brachytherapy techniques, such as intracavitary and interstitial approaches, including their advantages and drawbacks.Methods: Resources on PubMed between the years 2000 and 2024 were reviewed based on their relevance to the approaches of brachytherapy. Articles were found through the use of key terms and Boolean operators such as ("cervical cancer,” AND “brachytherapy," OR “high dose rate brachytherapy,”) OR (“intracavitary,” OR “interstitial brachytherapy,” OR “hybrid brachytherapy,”). Discussion: Three techniques of brachytherapy are de: intracavitary brachytherapy (ICBT), interstitial brachytherapy (ISBT), and hybrid intracavitary/interstitial brachytherapy (HBT).Conclusion: Brachytherapy is a vital part of definitive cervical cancer treatment. While ICBT remains the standard of care for most cervical cancers, ISBT and HBT approaches remain important treatment options. HBT has been shown to address variances in patient anatomy and tumor geometry, resulting in better tumor dose coverage and improved outcomes through minimizing toxicity.

Purpose: To determine trends in breast imaging services utilization among privately and government-insured patients at a national radiology practice.Method: Monthly breast imaging volume data from January 2019 to September 2022 were analyzed across five insurance types: three commercial carriers (Com1-Com3), Medicaid, and Medicare. Primary analysis involved calculating quarterly volumes and standard errors of the mean, followed by a joinpoint regression to identify trend inflection points and quarterly percentage changes (QPC). In the secondary analysis, the entire period trend was obtained and measured as the average quarterly percentage change (AQPC).Results: Between 2019 Q1 and 2022 Q3, a total of 4,640,619 breast imaging services were accessed, including 2,034,833 2D screening mammograms, 1,640,689 screening digital breast tomosynthesis, 497,592 diagnostic mammograms, 452,549 breast ultrasounds, and 14,956 breast MRIs. AQPC values for imaging modalities varied across insurance types. Medicare and Medicaid patients showed the highest rates of utilization increases, particularly for modalities other than screening breast tomosynthesis, where private insurers dominated. Variations were observed between different commercial payors.Conclusion: Breast imaging utilization increased among patients insured by Medicare and Medicaid from 2019 to 2022, outpacing that of those with private insurance. These findings contrast previous research suggesting better access and utilization among privately insured individuals, highlighting increased access for government-insured patients in this study.

Background: We report a case of Peri-Partum Cardiomyopathy in a 28-year-old Primigravida, who came in labor and underwent a Caesarean Section in view of meconium-stained liquor, fetal distress. On day 4 post-partum, she complained of a sudden onset of shortness of breath, cough, and restlessness in the morning. The patient had no prior history of heart disease or respiratory disease. Patient developed sudden onset tachypnoea and tachycardia with bilateral crepitus. On further evaluation, she was diagnosed with Peripartum Cardiomyopathy. Results: The case was successfully managed by a multi-disciplinary team using dobutamine, diuretics, and Angiotensin receptor blockers. Conclusion: The case report aims to present a case of Peripartum cardiomyopathy with early diagnosis and successful management in a secondary care level hospital. Peripartum (postpartum) cardiomyopathy is the most common cardiomyopathy in pregnancy, defined as an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or after delivery, in the absence of any other cause of heart failure.  It is a diagnosis of exclusion, and the majority are diagnosed postpartum. Although the LV may not be dilated, the ejection fraction is nearly always reduced below 45%. Incidence of PPCM is 1:3000 to 1:15000 pregnancies. It is a major cause of morbidity and mortality if diagnosis gets delayed; therefore, early diagnosis and timely management can affect patients’ long-term prognosis. This case report aims to raise awareness in health professionals about the possibilities of PPCM and its symptoms, as in our case.

Acute osteomyelitis (AOM) is defined as an inflammation of the bone secondary to infection. Among the most common complications of AOM is the development of a periosteal abscess and the extension of the focus locally to muscle (pyomyositis) and/or joint (osteoarthritis). However, complications with much lower incidence have been described, including deep vein thrombosis (DVT) and septic pulmonary embolisms (SPE), mainly associated with S. aureus infections. The AOM + DVT + ESP triad is a fairly uncommon entity in the pediatric population; however, if it is not diagnosed and treated in time, it implies a high morbidity and mortality. Treatment, which must be early and aggressive, includes targeted antibiotic therapy, anticoagulation, and focused control surgery. In this article, we describe the case of a 14-year-old boy with disseminated staphylococcal infection associated with the triad AOM+ DVT + SPE.

Suicide has become a major cause of human death during the last few decades. It is important to understand the dynamics of suicide and identify effective prevention strategies. In this work, bifurcation analysis and multi objective nonlinear model predictive control are performed on a suicide dynamics model. Bifurcation analysis is a powerful mathematical tool used to deal with the nonlinear dynamics of any process. Several factors must be considered, and multiple objectives must be met simultaneously. The MATLAB program MATCONT was used to perform the bifurcation analysis. The MNLMPC calculations were performed using the optimization language PYOMO in conjunction with the state-of-the-art global optimization solvers IPOPT and  BARON. The bifurcation analysis revealed the existence of limit and branch points. The MNLMC converged on the Utopia solution (best possible). The limit and branch points (which cause multiple steady-state solutions from a singular point) are very beneficial because they enable the Multi objective nonlinear model predictive control calculations to converge to the Utopia point (the best possible solution) in the model. It is proved (with computational validation) that the branch points were caused because of the existence of two distinct separable functions in one of the equations in the dynamic model. A theorem was developed to demonstrate this fact for any dynamic model.

Background: Employee performance appraisal is essential for improving healthcare service delivery through systematic staff evaluation. In the health sector, effective appraisals support decision-making and professional development.Objective: This study aims to map and categorize existing employee performance appraisal methods in the health system using a scoping review approach.Methods: This scoping review was conducted using the JBI 2024 protocol. Articles published up to December 2024 were identified through four databases: PubMed, Scopus, Web of Science, and Google Scholar. The keywords used were “Personnel appraisal,” “Health workers,” and “Health workforce.” The inclusion criteria focused on studies assessing employee appraisal methods in health systems.Results: Of the 1,245 articles initially identified, 18 met the inclusion criteria. Appraisal methods were classified into traditional and modern categories. Traditional methods included ranking, critical incidents, and graphic rating scales. Modern approaches involved 360-degree feedback, Management by Objectives (MBO), and Behaviorally Anchored Rating Scales (BARS).Conclusion: No single appraisal method suits all healthcare environments. A hybrid approach tailored to organizational context and job roles is recommended. Emphasis should be placed on objective evaluation, customization, and the degree of scientific connection between the evaluator and the evaluated person to improve performance outcomes.

Depression, trauma, and anxiety disorders continue to be predominant causes of global disability, with typical therapies proving to be only marginally successful. Heart Rate Variability Biofeedback (HRVB) offers patients a self-regulation method that improves the flexibility of the autonomic nerve system via resonance breathing. Clinical research shows that training can significantly lower symptoms of sadness and PTSD, with improvements shown after 4 to 8 weeks. HRVB is inexpensive, non-invasive, and scalable, making it a promising supplementary therapy in psychiatry. Subsequent study ought to inform its incorporation into clinical protocols.

Sagittal split osteotomy (SSO) of the mandible is still an important part of orthognathic surgery, but “bad split” fractures that happen during the surgery are still a big problem. This report describes a rare case of bilateral bad split associated with highly compact mandibular bone (D1–D2 type) in a 53-year-old male undergoing mandibular advancement. The bone was too hard for the piezoelectric and rotary tools to work, and there was very little bleeding. This caused fractures in the cortex and lingual. Postoperative computed tomography confirmed the presence of highly dense bone, correlated with delayed healing and recurrence. Consistent pre-surgical CT scanning for an assessment of the density of the mandibular bone can provide essential information about the potential risk of the osteotomy procedure in the patient. Performing a careful bone quality and density examination pre-operatively will allow the surgeons to select the most appropriate instruments and surgical techniques that will fit the patient’s individual anatomy. Such a point escalates to being very significant when dealing with the geriatric population, as bone density increase can not only alter the fracture behavior but also the recovery process during and after surgery. The inclusion of regular CT-based bone density evaluations into the preoperative routine not only facilitates the anticipation of surgical difficulties but also results in safer and more efficient osteotomies.

Aims: The study was conducted from January to June 2023 to observe the prevalence of repeat breeding syndrome in cows, to isolate and identify the bacteria with their molecular confirmation, and antibiotic sensitivity in Bangladesh. Study design & Place and duration of study: The study was conducted under the supervision of the Department of Medicine, Surgery, and Obstetrics, Hajee Mohammad Danesh Science and Technology University, Dinajpur-5200. Some laboratory work was performed at the Microbiology Department of Pathology and Parasitology laboratory, HSTU, from January to June 2023.Methodology: A questionnaire was used to identify repeat breeding syndrome. Bacteria were isolated and identified from the cervical mucus of affected cows. For confirmation of the detected bacteria, PCR was used. The agar disc diffusion method was utilized to investigate the antibiotic sensitivity of the detected isolates against widely used antibiotics in vitro. Results: The prevalence of Repeat Breeding (RB) was 41.33%. The prevalence of E. coli was 40%, Staphylococcus aureus 40% and Klebsiella spp. 10%. Molecular detection of E. coli and Staphylococcus aureus was confirmed by using Eco 223 (F), Eco 455 (R), Sau 234(F), and Sau 1501(R) primers. The target genes were 16S and 23S rRNA, and the size of the product amplified at 232 bp and 1267 bp, respectively. According to the antibiogram profile, E. coli was resistant to ciprofloxacin, penicillin, tetracycline, amoxicillin, and erythromycin, but sensitive to ceftriaxone and gentamicin. While Staphylococcus aureus was resistant to ampicillin and erythromycin, it was sensitive to ciprofloxacin, ceftriaxone, and levofloxacin. It was also intermediately resistant to vancomycin and amoxicillin. Klebsiella spp. Showed resistance to ceftriaxone, penicillin, and amoxicillin, while remaining sensitive to ciprofloxacin, tetracycline, and intermediate resistance to erythromycin and gentamicin. Conclusion: This study concluded that E. coli, Staphylococcus aureus, and Klebsiella spp. are the most common bacteria causing repeat breeding syndrome in cows.

With the rapid shift to telemedicine during the COVID-19 pandemic, clinicians have faced unprecedented demands in adapting to prolonged virtual consultations. This has given rise to “Zoom fatigue,” a form of mental and emotional exhaustion associated with extended video-based interactions. While the Zoom Exhaustion and Fatigue Scale (ZEFS) has been widely applied in studies involving students and office workers, there is limited research on its relevance to clinicians. Physicians, in particular, often conduct hours of uninterrupted virtual patient care, which can potentially lead to significant neurocognitive strain. This study explores the impact of prolonged virtual consultations on clinician well-being, employing ZEFS alongside the Depression, Anxiety, and Stress Scale (DASS-21) and Satisfaction with Life Scale (SWLS) to assess emotional and cognitive outcomes. Findings suggest that the increased cognitive load, reduced non-verbal communication, and digital interface stress contribute to higher levels of fatigue, anxiety, and dissatisfaction, highlighting the urgent need for systemic support and ergonomic telehealth practices.

Background: Atrophic scars following acne vulgaris are considered an aesthetic, psychological, and social problem for patients, and despite the existence of many treatment options, finding modern treatments is a necessity to reduce side effects associated with current therapies and reduce the financial burden on patients.Objectives: to evaluate the efficacy of punch elevation combined with dermapen in treating atrophic scars following acne vulgaris on the cheeks, and to evaluate patients' satisfaction with this procedure.Methods: This clinical trial involved 19 patients to evaluate the efficacy of punch elevation combined with dermapen in treating post-acne scars.Results: According to the Goodman and Baroon scale for acne scars, and after 6 months, the percentage of grade 4 decreased from 26.3% to 10.5%, grade 3 decreased from 73.7% to 31.6%, grade 2 increased from 0% to 52.6%, and grade 1 increased from 0% to 5.3%. p - value was less than 0.005, indicating a relationship between the degrees of atrophic scars on the Goodman-Baron qualitative scale after 6 months of treatment. According to the improvement scale, good improvement was 10.5%, acceptable improvement was 57.9% and no improvement was 31.6%. Patients were satisfied with the procedure after 3-6 months according to the modified Global Aesthetic Improvement Scale for Patient Evaluation.

Excipients are fundamental components of galenic formulations, critically influencing the safety and efficacy of the final medicinal product. This is of paramount importance in neonatal and pediatric populations, where physiological immaturity results in significant differences in pharmacokinetics and pharmacodynamics compared to adults. This work provides a comprehensive overview of excipients and vehicles used in galenic preparations for these vulnerable groups. It highlights specific excipients known to be dangerous, detailing their mechanisms of toxicity, and suggests safer alternatives. The discussion covers formulations for oral solutions, suspensions, and topical dermatological use, including ready-to-use vehicles. The role of the prescribing physician and the verifying pharmacist is emphasized, underscoring the necessity of checking for efficacy, safety, incompatibilities, and microbiological compatibility. The results of a practical five-year local experience with an observational analysis are provided.Furthermore, innovative technologies such as 3D printing for pediatric dosage forms are discussed. The conclusion asserts that a rigorous, risk-based assessment of excipients is essential in neonatal and pediatric galenic practice to ensure patient safety.

Fungus is a gathering of eukaryotic life forms that include microorganisms. As of late, the fungus has assumed a part in criminological science and has been utilized in criminal examination as a source of information. As organisms show both sexual and agamic reproduction in their life cycle, they are utilized as a scattering specialist. The investigation of growths is called mycology. Legal mycology is the part of science that portrays the types of growth. Utilizing the limit of the study of fungus distinguishing proof, which step by step opens its place as a device to recognizing tests and investigations in mycology, showed that certain chemoecological gatherings of organisms can go about as over the ground grave markers, in contrast to plants. Organisms can likewise develop on, for instance, stone, block, tiles, wood, and so on. The principal agent tracked down the primary key of contagious gathering in determining the time of body passing. The scientific mycology structures the contagious local area, they give the date after death and post entombment spans. The microbial clock has been created utilizing society-free high-throughput sequencing in a model framework. The extension to issues worried about common examination where there are clinical ramifications. Organisms were cultured from the mucosal swabs, skin scratching, hair, and lung biopsies. The organisms exist in numerous climates. The parasitic spores are created in huge amounts and spread without any problem. Which can frequently track down the person in question. (Garments, hair, or skin). As a follow-up, proof is searched for, and shape spores are tracked down in paleontological readiness. Spores are utilized for ordered qualities and the identification of species-level. The environmental and palynological data showed proof of a connection between the suspect and where the body was kept. During the examination of the parasite, we can recognize the reason for death, the season of death, find a covered carcass, and so on. As per the going timeframe, specific growth shows specific qualities at specific climate.