Elbow hemiarthroplasty (EHA) is a highly effective procedure for treating various elbow joint disorders such as rheumatoid arthritis, osteoarthritis, and fractures involving the articular surface of the distal humerus. It involves replacing the entire distal humerus with a prosthesis and reattaching the supporting soft tissues. The EHA provides significant pain relief, improves joint function, and increases patient satisfaction, with minimal complications that can be easily managed. This case study demonstrates the value of EHA as a viable treatment option for distal humerus fractures in older adults with moderate activity levels, as a superior alternative to osteosynthesis.

Although intussusception occurs in children and adults with celiac disease, it is a relatively uncommon symptom. Even more rare is the occurrence of intussusception as the presenting symptom of the disease. In the two cases we report here, transient intussusception, occurring at three years of age, was the first and only physical sign of celiac disease, and lead to a timely diagnosis by immunoserology and histology, followed by implementation of a gluten-free diet before sequelae such as significant anemia or Failure to Thrive (FTT) developed. In both cases, neither immunoserological nor physical signs of disease were present at the follow-up examination after 6 months on a gluten-free diet. In addition, genetic screening of the patients’ families revealed HLA-DQ2 positivity in two cases, leading to the additional diagnosis of celiac disease in the pregnant mother of one of the patients.

Objective: Assessment of heart rate variability (HRV) is a non-invasive and reliable method to evaluate autonomic disorders after cerebral ischemia. The present study was conducted to investigate the therapeutic potential of IC87201 in reducing post-stroke cardiac dysfunction. Materials and methods: Cerebral ischemia was induced by the middle cerebral artery occlusion (MCAO) method in 15 anesthetized adult male rats in three MCAO, MCAO+ DXM, and MCAO+ IC87201 groups, for one hour. Electrocardiogram was recorded before, and 48 hours after ischemia and drug administration, and HRV parameters were calculated from R-R intervals. In the treatment groups, IC87201 and Dextromethorphan hydrobromide monohydrate (DXM) were injected after an ischemic period. Results: After brain ischemia, the R-R interval decreased and consequently heart rate increased. The R-R intervals were used to extract the HRV frequency and time domains, including normalized low frequency (LF), high frequency (HF), LF/HF ratio, and standard deviation of R-R interval (SDRR). Normalized LF and LF/HF ratio enhanced 48 hours after ischemia, while normalized HF and SDRR significantly reduced compared to the pre-ischemic state. All HRV parameters had returned to their pre-ischemic level 48 hours after IC87201 and DXM administration, except SDRR, which recovered only in the IC87201 administered group. Conclusion: Based on our findings, it can be concluded that cerebral ischemia significantly worsens HRV parameters as a result of sympathetic overactivity. These changes were reversed by administering DXM and IC87201, but IC87201 has generally been more effective in lowering lesions. As a result, IC87201 can be introduced as an effective substance for the treatment of post-ischemic cardiac side effects.

To evaluate the safety and efficacy of weight-based mycophenolate mofetil (MMF) dosing in adult kidney transplant recipients (KTR), this single-center retrospective study of adult KTR compared biopsy-proven acute rejection (BPAR), infections, hospitalizations, granulocyte colony-stimulating factor (G-CSF) use, and MMF dose changes within one year of transplant pre-and post-implementation of a weight-based MMF dosing protocol. Adult patients who received a kidney transplant at University Health Transplant Institute were reviewed for inclusion. Patients in the weight-based MMF group received 1000 mg twice daily by the first clinic visit if ≥ 80 kg, 750 mg twice daily if 50-79 kg, and 500 mg twice daily if < 50 kg. Patients in the fixed-dose MMF group received MMF 1000 mg twice daily. A total of 170 KTR (50.0% ≥ 80 kg, 44.1% 50-79 kg, 5.9% < 50 kg) were included. Baseline characteristics were similar between groups. The majority of patients were middle-aged Hispanic males and received lymphocyte-depleting induction therapy. Incidences of BPAR, infection, and hospitalization were similar between both groups at one-year post-transplant. Weight-based MMF dosing is safe and effective in adult KTR.

Introduction: Minimal change disease (MCD) is a common subtype of primary nephrotic syndrome in adults. The pathogenesis of MCD is still not well understood, but some studies suggest that MCD is a T cell-mediated disease related to podocyte dysfunction. Previous research has also indicated the crucial role of B cells in the pathogenesis of MCD. Rituximab (RTX) is a recombinant chimeric mouse/human antibody targeting CD20 antigen. In recent years, RTX has been increasingly used in adult MCD patients.Methodology: We searched the PubMed database using the keywords “Minimal change disease”, “Nephrotic syndrome”, and “Rituximab” and obtained a total of 140 articles. We will now provide a literature review based on these 140 articles, according to our research topic.Discussion: This article provides an overview of the mechanisms and clinical research progress of RTX in the treatment of adult MCD. We have also discussed the current treatment methods for MCD, exploring the potential of using RTX as a first-line therapy for refractory adult MCD.Conclusion: MCD is a common pathological type of nephrotic syndrome, and the exact mechanisms are still not fully understood. Although RTX as a treatment of adult MCD has shown promising clinical results in patients with refractory adult MCD, the safety and efficacy of RTX still lack high-quality clinical evidence. Further research is needed to explore the pathogenesis of MCD and the RTX treatment for MCD.

The present study focuses on students and teachers in Swedish Municipal Adult Education, in a project aimed at helping students with diagnoses within the neuropsychiatric spectrum. The project aimed to support students to complete their studies for further higher education. As this is an overlooked group of students research results provide insights into students’ views on the project and conclusions regarding the sustainability of school development. In this qualitative study, five teachers and four teachers were observed and in-depth interviewed. Data were analyzed through inductive content analysis. Authentic relations between students and teachers, signified by mutual trust, proved important. As the teachers themselves had originated the ideas guiding the project, the development work had good prior conditions for further sustainable development.  We conclude that autonomous teachers, who set up joint goals and provide individualized support for these students, enable academic success when flexibility, relations, and self-esteem characterize the work.

COVID vaccination has been associated with serious disorders including thrombosis with thrombocytopenia syndrome (TTS), Guillain-Barré syndrome (GBS), and myocarditis. GBS has been reported in adults following COVID-19 infection and rarely following the COVID-19 vaccination. Post COVID vaccination GBS has been associated with prominent and early facial diplegia and quadriplegia. Extension of the COVID vaccination program to the pediatric age group of 5 to 17 years has exposed this population to the adverse effects of the vaccination. Only a few case reports of post-vaccination GBS have been reported in the pediatric age group without any data on the true prevalence. We report a case of a male in his early adolescence with GBS presenting as facial diplegia and rapid quadriplegia following the BECOV2D, (Corbevax) vaccination. Our case is the first case of GBS reported following BECOV2D, (Corbevax) vaccination and highlights the presentation with prominent and early diplegia, which is similar to the presentation in adults.

A 46-year-old lady was diagnosed clinically with X-linked hypophosphatemia (XLH) with a rare pathogenic variant detected using exome sequencing. Phosphate-regulating endopeptidase homologous X linked (PHEX) is normally expressed in osteoblasts and osteocytes, and senses phosphate regulation. More than 1000 PHEX variants have been detected to date, which are caused by missense, nonsense, and frameshift mutations in addition to splice variants and copy number changes. The aberration in the PHEX gene leads to the upregulation of fibroblastic growth factor 23 (FGF23), which leads to defects in phosphate metabolism. This results in impaired bone growth and mineralization, short and disproportionate stature, leg bowing, musculoskeletal pain, spontaneous dental abscesses, rickets, and osteomalacia in XLH patients. The spectrum of manifestations differs between pediatric and adult patients. In our case study, two of the patient’s children started showing symptoms at a younger age, unlike their mother. Timely diagnosis and the start of treatment would help in their better management and improved quality of life.

Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control.Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p ≤ 0.05.Results: The mean age of the respondents was 61.1 ± 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p < 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality. Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients’ holistic care with the aim of achieving better blood pressure control among hypertensive patients.

Background and objectives: A stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post-stroke patients are associated with a high risk of falls among stroke patients. The perturbation-based balance training is mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize computer-generated environments with a full field of view through Head-mounted displays (HMD-VR). This study was conducted to assess and investigate the effect of balance exercises with smartphone-based virtual reality programs on balance in stroke patients.Methods: This was a randomized single-group pre and post-test study design. 30 subjects met the inclusion criteria and were enrolled, assigned, and received intervention. Subjects were given perturbation-based balance exercises and smartphone-based virtual reality along with conventional physiotherapy. The intervention protocol was for 6 days/week for 4 weeks period. Results: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, and SIS 3.0. Paired t-test was used to differentiate the mean significance. The mean pre to post-intervention difference is 12.6 with a p - value < 0.05. TUG score improved from pre to post-intervention difference is 1.443 with a p - value < 0.05. VR BESS score improved from pre to post-intervention difference is 10.266 with a p value < 0.05. The mean BESTest pre to post-intervention difference is 11.467 with a p - value < 0.05. SIS 3.0 score improved from a pre to post-intervention difference is 20.33 with p - value < 0.05. The result of this study showed a highly significant difference in pre and post-treatment.Conclusion: The study concludes that perturbation-based balance exercises with smartphone-based virtual reality programs are a useful adjunct to improving balance in stroke patients along with conventional physiotherapy. 

Hypertrophy of the adenoid is a rare condition in adults, often suspicious of malignancy. We present a case of a 31-year-old female with a clinical presentation of a giant nasopharyngeal mass, clinically suspicious for malignancy, given the size and greyish discoloration. She presented with left-side otalgia, hearing loss, and nasal obstruction. After broad investigations on adenoid tissue following adenectomy, a reassuring diagnosis of adenovirus-related adenoiditis could be made. This case demonstrates the importance of broad microbiological testing in ruling out malignancies. The patient recovered completely. 

Graft Versus Host Disease (GVHD) is a major limitation to the success of allogeneic Hematopoietic Stem Cell Transplantation (HSCT) as Steroid-Refractory (SR) acute GVHD carries poor prognosis due to the absence of an efficacious second-line therapy. Mesenchymal Stem Cells (MSCs) which have immunosuppressive, immunomodulatory, and regenerative properties may become a highly effective therapeutic modality for SR-GVHD in the near future. MSCs have already been approved to treat childhood SR-GVHD in Japan, and they have been conditionally licensed in New Zealand and Canada. It is expected that MSCs will be approved for the treatment of SR-GVHD in adults in Europe, North America, and other parts of the world within a few years. Utilization of the recently introduced techniques including the use of MSC products such as exosomes and Extracellular Vesicles (ECVs) instead of the parent MSCs, robotic manufacturing technology, and genetic engineering of MSCs will ultimately overcome the remaining obstacles facing the widespread utilization of MSCs and their products as therapeutics not only in HSCT but also in other medical fields. The aim of this review is to provide an update on the remarkable progress achieved in the use of MSCs and their products in the field of HSCT.

Introduction: Adolescents and young adults often engage in oral sex. However, the factors affecting the development of agreeing with oral sex are not clear enough.Objective: We aimed to assess the degree of agreement with oral sex among high school students and to search for background factors affecting this.Material and method: We conducted a quantitative cross-sectional study among 157 females and 38 male high school students over the age of eighteen by using an anonymous, paper-based, multiple-choice, self-administered questionnaire. For statistical analysis, we used descriptive statistics, two-sample t-tests, and Spearman rank correlation. Results: Of the respondents 67.9% were sexually active and 31.6% of them had more than one sexual partner. Of males 97.1% and of females 84.9% agreed with accepting oral sex. Degree of agreement with oral sex was higher in those who had had partnered sexual experience, and in those females who more frequently met close friends outside of school. Most participants were not in a current relationship with a partner, and for those who were, its duration did not affect the degree of accepting oral sex. The degree of agreement with the proficiency in male sexuality, and the degree of agreement with those dimensions of sexuality that most expressed the sexual drive and the desire to gratify it with the partner showed the strongest positive correlation with the degree of agreement with oral sex. In addition, the degree of agreement with the items of expressing sexual openness showed correlations with the degree of accepting oral sex. Conclusion: The degree of agreement with oral sex is high among high school students. Among the factors influencing this, the intensity of meeting friends seems to be important. We therefore recommend that the schools improve sex education in groups, highlighting the risks of oral sex, to reach the target individuals and their friends as well as their potential partners.

The need to provide Long-Term Care (LTC) for growing elderly populations is a public policy issue in all industrialized countries. Unlike other OECD countries, the U.S. lacks a foundation for universal LTC benefits. Much can be learned by examining other industrialized countries. LTC systems. In this paper, we will examine how other countries' provide LTC services for their glowing elderly populations, finance the costs of LTC services, determine eligibility for services, and encourage and support informal caregivers.

Mesenchymal stem cells are heterogenous adult multipotent stromal cells that can be isolated from various sources including bone marrow, peripheral blood, umbilical cord blood, dental pulp, and adipose tissue. They have certain regenerative, anti-inflammatory, immunomodulatory, immunosuppressive, antimicrobial, and other properties that enable them to have several therapeutic and clinical applications including treatment of various autoimmune disorders; role in hematopoietic stem cell transplantation and regenerative medicine; treatment of skin, pulmonary and cardiovascular disorders; treatment of neurological and eye diseases; as well as treatment of various infections and their complications. Different factors including donor age, biological source, route of administration, and signaling pathways have an impact on the functions and consequently the clinical applications of mesenchymal stromal cells. The products of mesenchymal stem cells such as extracellular vesicles and exosomes reproduce the biological effects and most of the therapeutic actions of the parent stem cells. Genetic engineering and the use of specific mesenchymal stromal cell products have improved their clinical efficacy and decreased their adverse effects. However, despite the recent progress in the use of mesenchymal stem cells, the clinical application of these cells in the treatment of several diseases still faces real challenges that need to be resolved. The current status of mesenchymal stem cells and the controversies related to their clinical utilization in various disease conditions will be thoroughly discussed in this review.

Background: Liver cancer is a global health concern, with overweight and obese individuals exhibiting an increased risk of its development. Understanding the interplay between obesity-related factors and liver cancer incidence is crucial for early prediction and intervention.Aim: The aim of this investigation was to construct and validate an extreme gradient boosting (XGBoost) based machine learning model for the purpose of establishing a one-year liver cancer risk prediction system specifically tailored to overweight and obese patients. In addition, this study sought to compare the predictive performance of the XGBoost model with those of a random forest model and a logistic regression model, while also identifying the most influential predictive features for liver cancer incidence.Methods: A comprehensive retrospective analysis was conducted on MIMIC III data comprising 2,354 patients. To predict the risk of liver cancer development, three machine learning models were developed: XGBoost, random forest, and logistic regression. Feature selection was executed using a stepwise regression procedure encompassing both forward selection and backward elimination.Results: The stepwise regression technique unveiled 14 predictive factors for liver cancer incidence. Among the patient cohort, 132 individuals developed liver cancer within a year of follow-up, while 2,222 did not. Notably, most liver cancer cases occurred in male patients (60%). Statistically significant differences were observed between patients with liver cancer and those without, in terms of age, gender, total bilirubin, platelet, albumin, chloride, potassium, sodium, prothrombin time (PT) and alanine aminotransferase (ALT). The XGBoost model exhibited an impressive area under the receiver operating characteristic curve (AUROC) of 99%, Random Forest (RF) of 99%, and Logistic Regression (LR) of 90%. In a multivariate analysis, total bilirubin, creatinine levels, age, gender, ALT, alkaline phosphate (ALP), PT, calcium, and chloride emerged as independent predictors for liver cancer incidence.Conclusion: The XGBoost model demonstrated superior predictive performance when compared to the RF and LR models. If corroborated through prospective studies, the XGBoost model may prove to be a valuable tool for the early prediction of liver cancer risk in overweight or obese individuals. Such predictive capabilities could, in turn, facilitate the implementation of timely preventive interventions against liver cancer.

Introduction: Residency training is built on a tripod of research, training, and services. This is well achieved through academic seminar presentations which are held two to three times weekly. This survey aims to examine the presentations of Resident Doctors for Medical Education.Methods: The presentations from 2017 to 2022 were requested and pooled through a submission point. They were assembled and sorted out based on the presenter’s name, specialties, and year of presentation. Results: The presentations covered all the 12 major subspecialties, with General Adult psychiatry having the highest of 41 (20.5%), while Social psychiatry had the lowest of 5 (2.5%). Only 40% followed presentation guidelines, and 30% were well formatted. Conclusion: Compendium 1.0 is a comprehensive encyclopedia of academic presentations that will aid easy accessibility when needed. It is recommended that sessions on academic writing are regular, including plagiarism, referencing, and using writing software applications.

Background: The age-dependent sporadic form of PD is characterized by the degeneration of dopaminergic (DA) neurons in the Substantia Nigra (SN), gliosis, and vascular changes. Vascular changes may contribute to the onset of the disease and exacerbate the neurodegenerative process, as some vascular changes occur before the onset of neuronal loss. To demonstrate the anti-neuroinflammatory efficacy of a new compound, a water-soluble form of dihydroquercetin (DHQ-WF), we studied the structural changes of microcirculatory vasculature, astroglial GFAP, and vascular endothelial growth factor –A (VEGF-A) mRNA expression in the SN of young and old rats after unilateral nigral treatment by lipopolysaccharide (LPS) and oral administration of DHQ-WF.Materials and methods: The experiments were performed on 18 young (8 weeks - 10 weeks old; 250 g - 320 g) and 18 old (18 months - 19 months old; 390 g - 450 g) male Vistar rats. Young and adult rats from the experimental groups were stereotactically injected with 2 μL LPS solution (LPS from Escherichia coli; 0,01 μL/mL) into one side of the SN. Control young and old rats were similarly injected with 2 μL sterile saline. Half of the animals in both the control and experimental groups (6 animals in each group) received a 2 ml solution containing DHQ-WF at a concentration of 3 mg/ml orally every day. After 8 weeks, brains were harvested and serial cryostat sections were prepared for histochemical (FITC-labeled tomato lectin), immunohistochemical (anti-GFAP Antibody, Cy3 Conjugate) staining, and real-time PCR (mRNA VEGF-A).Results: Eight weeks after LPS injection into the SN, a significant excess of areas occupied by cell bodies and processes of astroglial cells, the density of microcirculatory vessels, and mRNA VEGF-A expression was observed in old animals compared to control old animals and young LPS-treated rats.  Oral administration of DHQ-WF to LPS-treated rats resulted in a significant reduction of these parameters in old animals.Conclusion: Injection of LPS into rat SN induces neuroinflammation and vascular angiogenesis, maximally expressed in old animals.  Administration of DHQ-WF for 8 weeks significantly reduces these LPS-induced changes. DHQ-WF may be an effective treatment for reducing the effects of neuroinflammation in the aging brain.

Animals are companions that have continued to hold importance in the average American household. Traditional animals like dogs and cats are often treated as family members due to the human-animal bond. Although it seems as if there are many benefits to having animals in the home, it comes at a price—pet-borne illnesses. Compared to adults, the pediatric population is at a greater risk for these types of illnesses. Animals are natural reservoirs for many bacteria that may be passed to children, especially those who are immunocompromised. The goal of this article is to educate parents on the risks and symptoms of common pet-borne illnesses that are difficult to prevent from coming into the home.

Science is the art of systematic and reproducible measurements, ultimately leading to knowledge supported by a holistic logic. Besides serendipity, there are 6 ways in general to obtain knowledge: authoritarianism; mysticism; rationalism, empiricism; pragmatism; and scepticism. Over the last 100 years, a canonical mythology – cortical spreading depression (CSD) – has prevailed in migraine pathophysiology. Conversely, a well-defined adaptive/protective role has evolved for CSD in locusts, Drosophila, and mammals. Additionally, an elaborate but entirely symptomatic nosologic system has arbitrarily evolved in migraine / primary headache. While the so-called systematic but symptomatic classification system of migraine / primary headache keeps on advancing the data-bank exponentially, the cause-effect nexus continues to obscure the most important systematic and insightful components of the knowledge of primary headache. The first step in advancing the cause-effect mystery of migraine / primary headache is to create a conceptual, consistent, and important adaptive-pathogenetic divide in the massive and disparate data-linked pathophysiology of the disorder. Once certain definitive principles (not laboratory/neuroimaging / genetic/epidemiologic data) emerge in the science of migraine / primary headache, we become empowered to understand the complex but key phenotypic blueprint as well as the neuro-pathophysiology / neuropsychiatry of the entity, including the visual (nasal visual-field sparing digitally-displaceable and eyeball-movement-synchronous scintillating scotomata), the lateralizing fronto-temporal-nuchal headache exclusively involving the ophthalmic division of the trigeminal nerve, and the associated features such as ‘stress’, ‘post-stress’, ‘autonomic storm’, ‘protean’ and ‘spontaneous’ onset and offset, and headache-aborting nausea-vomiting. In this manner, we have also evolved principles to begin to understand the most complex female predominance of migraine patients in adults [F:M=3:1] as well as the decline of prevalence in migraine attacks following menopause and advancing age. The Laws of the Pathophysiology of Migraine encompass the invaluable neurological / neuro-ophthalmological shift in pathophysiology from the brain to the eye.