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Scoliosis is a condition of abnormal lateral curvature of the spinal column greater than 10 degrees as measured by Cobb’s angle. The two main groups of scoliosis are idiopathic scoliosis and non-idiopathic scoliosis. The diagnosis of an idiopathic scoliosis is made if a non-idiopathic one has been excluded. Idiopathic adolescent scoliosis is a more common form. Neuromuscular scoliosis, which is a type of non-idiopathic scoliosis, is characterized by diverse muscular and neurological impairments. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic cases.

The integration of artificial intelligence (AI) technology into various fields, particularly healthcare, has demonstrated considerable potential in improving efficiency and accuracy. However, the potential risks associated with unprofessional or inappropriate use of AI cannot be overlooked. The current landscape of healthcare demonstrates a growing reliance on AI tools, which is expected to expand in the future. The existing literature highlights the effectiveness  of various AI applications, including chatbots, in specific medical domains. This study aims to review relevant literature in the pharmaceutical and galenic fields while evaluating a prominent AI chatbot provider. Based on the findings, this article presents critical considerations for researchers and practitioners. A thorough assessment of the benefits and risks associated with AI technologies is essential as these tools become increasingly prevalent in pharmaceutical practices.

Self-talk is a pivotal psychological technique within sports psychology that significantly influences an athlete’s performance and mental resilience. It involves the process of athletes engaging in internal dialogue to achieve specific psychological objectives such as enhancing motivation, improving focus, and managing stress. This technique encompasses various forms of self-directed communication including positive affirmations, instructional reminders, and motivational statements. Understanding the different types of self-talk and their effects is essential for athletes, coaches, and sports psychologists who aim to develop effective mental strategies for athletic success.

The action of modern emergency care for patients with AP, on the one hand, requires a wait-and-see period, which is unacceptable in cases of rapidly progressing inflammation. On the other hand, it uses methods that do not take into account the features of the disease mechanisms. All this creates conditions for an excess of complications and treatment failures. The accumulated facts on this problem indicate the need to revise the principles of treatment. Consequently, the most important initial step in this direction seems to be the correction of professional views in accordance with the classical provisions of medical science.

Background: Methemoglobinemia is an uncommon hematological condition in which hemoglobin contains iron in an oxidized (Fe³+) state with limited oxygen-carrying ability. It can be congenital or acquired. Anesthetic management of methemoglobinemia poses a great challenge, as there is a risk of refractory hypoxemic crisis in the perioperative period. Case: Here, we present a case of a 24-year-old female with congenital methemoglobinemia who presented with gallstone disease for laparoscopic cholecystectomy under general anesthesia. She had a deficiency of cytochrome B5 reductase, which contributed to 26% of methemoglobin levels on co-oximetry. Despite taking considerable precautions to avoid hypoxemic episodes and metabolic acidosis, an episode of desaturation happened at the end of the procedure, which was managed with intravenous methylene blue. The patient recovered without any hypoxemic insult. Conclusion: Anesthetic management of patients with moderate (20% - 30%) methemoglobinemia can be successful with extreme precautions to avoid events that can increase the methemoglobin levels and adequate preparation and availability of intravenous methylene blue.

Magnusiomyces capitatus is a rare cause of invasive fungal infection in immuno-compromised patients. We report the case of magnusiomyces infection of the central nervous system, the lungs and sinus with a palatal lesion, in a patient treated for acute myeloid leukemia. While Magnusiomyces infections pose diagnostic and therapeutic challenges, a comprehensive understanding of their epidemiology, clinical manifestations, and microbiological aspects is essential to guide effective management. The patient improved under antifungal treatments despite a reduced sensitivity of the different antifungals to the antifungogram. The important delays between chemotherapy cycles and its reduced intensity due to the Magnusiomyces infection has made managing the anticancer treatment more challenging.

Pachydermoperiostosis, also known as Primary Hypertrophic Osteoarthropathy (PHO), is a rare genetic disorder. The three main features are: enlarged fingertips (clubbing), thickened facial skin (pachydermia), and excessive sweating (hyperhidrosis). PHO is characterized by problems with skin and bone growth. Patients with PHO usually have coarse facial features with oily, thick, grooved skin on the face, joint pain, enlarged fingertips and toes, and hyperhidrosis of the hands and feet. Symptoms vary individually; however, men generally present with more severe manifestations. X-rays can help check for features that are not noticeable to the naked eye. There are two genes that are associated with PHO: the HPGD gene, located on the long arm of chromosome 4 at 4q34.1, and the SLCO2A1 gene, located on the long arm of chromosome 3 at 3q22.1 - q22.2. Mutations in the HPGD gene are inherited in an autosomal recessive manner, and the condition is sometimes abbreviated as PHOAR1 or Touraine-Solente-Gole syndrome.

Malignant neoplasms of the external auditory canal, middle and inner ear are rare. This anatomically complex region generates complicated three-dimensional specimens that can be a challenge for macroscopic and microscopic assessment [1]. The most common cause of malignancy involving the EAC and temporal bone is extension of cutaneous malignancy of pinna. Rare occurrences have been described in association with CSOM and sporadic cases arising in previously irradiated fields for the treatment of other head and neck cancers. The tissue diagnosis is relatively straightforward; however staging is a complex task that is best approached with consideration of clinical, radiological, and pathological findings [2].

Polymer Electrolyte Membrane Fuel Cells (PEMFCs) operating in Dead-Ended Anode (DEA) mode present a promising alternative to traditional flow-through systems by simplifying design and reducing costs. However, their efficiency and durability are challenged by transient phenomena such as water accumulation, nitrogen buildup, and carbon corrosion throughout operation. This review investigates the dynamic behavior of DEA PEMFCs under dynamic operating states, aiming to improve their efficiency. By analyzing purge cycle optimization and transient response characteristics, we identify strategies to mitigate hydrogen loss, maintain voltage stability, and extend stack lifetime. The key findings indicate that precise purge scheduling and effective water management are critical for optimizing performance, with dynamic models providing insights into time-dependent processes. This study underscores the potential of DEA PEMFCs for high-efficiency applications provided transient effects are effectively managed.

Touch DNA, the minute quantities of DNA deposited through skin contact, has become a valuable tool in forensic investigations. However, the recovery of touch DNA from non-porous surfaces remains a challenging task, requiring optimized collection and extraction techniques to maximize DNA yield, because non-porous surfaces have smooth, non-absorbing material properties. This review explores various non-porous surfaces such as glass, plastic, and metal, analyzing their impact on DNA recovery efficiency. Different collection methods, including swabbing, tape lifting, scrubbing, and vacuum collection methods, are evaluated to determine their effectiveness in retrieving minute amounts of DNA from these surfaces. Through a comparative analysis of existing studies, this paper identifies which collection methods work best for different non-porous surfaces and why choosing the right technique matters. Factors such as surface type, environmental conditions, and collection technique performed, time duration, and so on can affect DNA recovery, making it crucial to use the most effective approach. This review also emphasizes the need for standardized protocols to ensure consistent and reliable results in forensic investigations. Having clear guidelines can reduce errors, improve DNA analysis, and make touch DNA analysis more reliable in forensic investigations. By focusing on these aspects, this study aims to contribute to the ongoing efforts in refining touch DNA recovery strategies.

Introduction: Bronchoscopy could lead to local spread of pre-existing infection, spread of infection from one patient to another if the bronchoscope is disinfected inadequately, or, isolation of microorganisms from bronchoscopic specimens in a patient who is clinically not infected, i.e., pseudo-infection. This study is one such investigation of an outbreak of bronchoscopic pseudo-infections in a tertiary care hospital.Materials and methods: Bronchoalveolar lavage (BAL) samples were inoculated onto MacConkey Agar and 5% Sheep Blood Agar and incubated at 37 °C overnight. The growths obtained on culture media were processed for identification and antimicrobial susceptibility on Vitek 2 Compact as per manufacturer’s instructions. To investigate the outbreak, 5 mL - 10 mL of sterile water was flushed through the channels of disinfected bronchoscope and collected in a sterile container. The samples were centrifuged and inoculated onto MacConkey Agar and 5% Sheep Blood Agar. The growths obtained were further processed similarly as the BAL samples were processed. Environmental swabs collected from the bronchoscopy unit were also processed as the procedure mentioned above.Results: Bronchoalveolar lavage of 3 patients in a period of 1 week were contaminated with multidrug resistant Klebsiella pneumoniae. Two out of five bronchoscope fluid samples were also contaminated with Klebsiella pneumoniae. Among the swabs collected from bronchoscope unit, Klebsiella pneumoniae was isolated from the detergent box of the endowasher. Conclusion: The risk of propagation of infection via a bronchoscope can be evaded by proper reprocessing and improving the sterilization practices. 

Post-COVID pulmonary fibrosis has emerged as a significant long-term complication among survivors of severe SARS-CoV-2 infection. This review highlights the underlying pathophysiology, diagnostic modalities, and recent advances in the diagnosis and management of post-COVID pulmonary fibrosis. As global cases of COVID-19 continue to evolve, understanding and addressing this emerging chronic respiratory condition is critical for long-term patient care.

Rationale: Pulmonary Arterial Hypertension (PAH) is a progressive vascular remodeling disease with elevated pulmonary vascular resistance that is lethal. While therapeutic progress was recently made with endothelin, nitric oxide, and prostacyclin pathway-based therapy for the treatment of PAH, the disease is currently incurable with a high cost of morbidity and mortality. Sotatercept, a new activin receptor IIA-Fc fusion protein, may prove to be a game-changer as a therapeutic agent for the treatment of PAH by regulating the growth factor signaling aberration of PAH.Methods: It is a narrative review of evidence for the drug Sotatercept for Group 1 PAH from a systematic literature search for clinical trials, mechanism studies, and regulatory data up to 2024. Pivotal clinical trials such as PULSAR, SPECTRA, STELLAR, and ZENITH were evaluated for efficacy, safety, and comparative results.Results: Sotatercept is a TGF-β family member ligand trap that rebalances activin/BMP signaling to target vascular remodeling. Clinically, striking effects were shown with exercise (40.8 m improvement in STELLAR 6MWD), pulmonary hemodynamics (PVR reduction of 146-240 dyn·s·cm-5 in PULSAR), as well as clinical measures (76% reduction of composite morbidity/mortality through ZENITH). On the background with an acceptable drug safety profile of predominantly hematologic effects, as well as injection site reaction, benefits were achieved. Comparison with analyses implies at least similar, if superior in some dimensions, efficacy of current PAH therapies.Conclusion: Sotatercept is a new therapeutic option for PAH as the first drug to act on the activin/BMP pathway. With its strong effect on several clinically relevant end points, it is a “fourth pillar” of PAH therapy. Clinical trials will determine its place in the algorithm, ascertain other combinations, and potentially identify its utility for other types of pulmonary hypertension.

Objectives: Hospitalization following a head injury is associated with high rates of disability that have a strong correlation with depression, anxiety, and low self-esteem. Well-being is related to life satisfaction, quality of life, happiness, personal growth and flourishing, competence, self-acceptance, positive relationships, and autonomy. The well-being of patients and their primary caregivers is important when a patient is left with impaired mobility after neurosurgery. The aim of this study is to examine whether the well-being of patients and their primary caregivers will differ before and after neurosurgery, and whether well-being differs between patients with motor disability (WMD group) and those without, compared to those who are not - NMD group (non-motor disability).Methodology: 123 patients and their main caregivers were recruited. Of these, 62 were in the before neurosurgical group, 31 Patients and 31 caregivers. 61 in the after neurosurgical group, 30 Patients and 31 caregivers, of which there are 16 from WMD group and 15 from NMD. Main outcome measures: Two analyses of Variance (ANOVA) were conducted: for WMD and NMD separately. The results reveal a significant decrease in wellbeing for both, patient and main caregivers, but a stronger decline in well-being was observed among WMD, as indicated by a larger effect size (η² = 0.74) compared to the NMD (η² = 0.38). In addition, no significant effect between group and time of measurement was found, indicating that the decrease in wellbeing was not different among patients compared to their main caregivers. Conclusion: The findings highlight the multifaceted impact of neurosurgery on well-being, particularly for patients who remain with motor disabilities and their primary caregivers.The decline in well-being after neurosurgery highlights the need for improved social support and the importance of developing treatment programs that can help ease the process of coping with these phenomena and provide appropriate support for both patients and their primary caregivers.

Objective: Comparison of visual field progression in patients with Primary Open-angle Glaucoma (POAG) and Pseudo Exfoliative Glaucoma (PEXG).Methods and materials: This is a 2-year longitudinal prospective study including 60 glaucomatous eyes with VA CF ≥ 3 m, IOP ≥ 20 mmHg, CDR ≥ 0.6 and those with Shaffer’s grade 3 or above were categorized as POAG along with signs of Pseudo exfoliative material as PEXG.Patients on anti-glaucoma medications and those who have undergone cataract and glaucoma surgeries are also included in this study. 24-2 visual field test was performed using Humphrey Field Analyzer & the progression was assessed based on 3 parameters- Mean Deviation (MD), Visual Field Index (VFI) & Guided Progression Analysis (GPA).Results: The difference in MD & VFI was higher in PEXG (-5.77 dB) (10.88%) than in POAG (-1.56 dB) (7.17%) respectively & was significant statistically (t - test, p = < 0.001). The GPA showed fast progression in 53.30% of cases in PEXG, 13.30% in POAG (Chi-square, p = < 0.001) about 63.30% of POAG & 46.70% of PEXG showed slow- moderate progression, but 23.30% of POAG subjects had no progression.Conclusion: Compared to POAG, the study showed that PEXG had frequent & faster visual field worsening. Therefore, PEXG patients require more stringent management & treatment than those with POAG.

Aim: This study aims to determine the current status for estimation of radiation dose to blood vessels and components from medical imaging procedures.Methodology: A database search on internet via PubMed and Google Scholar was performed to find published papers in estimation of radiation dose to blood vessels and components from medical imaging procedures. Results: Few published papers were found; namely two published papers. Radiation dose to blood vessels and components were assumed to be included in total radiation dose estimation for organ or tissue, without considering different in radiosensitivity. Conclusion: It seems that effect of radiation on blood vessels and components is underestimated, in ICRP 60 and 103 recommendations reports. Recommendation: It is recommended to conduct more studies to estimate radiation dose for blood vessels and components from medical imaging procedures and revise the value of tissue weighting factor for bone marrow.

Traditional Chinese medicine (TCM) has been used to serve people since antiquity in China, and still has an important role in today’s healthcare. As the outbreak of coronavirus disease 2019 (COVID-19) globally, TCM has played an important role in the fight against COVID-19 in China and other countries. However, scientists outside China doubted TCM. The philosophy of TCM in the description of diseases and the use of herbal medicines is difficult to understand for Western scientists. This article explains the philosophy of TCM using chromatic analogies to make it easily understandable and visually intuitive.

Introduction: Menarche, the onset of a girl's first menstrual cycle, often introduces menstrual taboos in certain eastern cultures. These taboos may manifest as social isolation, dietary restrictions, and exclusion from religious spaces, which can adversely affect health and promote gender inequality.Case history: A 10-year-old girl developed gastroenteritis while in cultural confinement after reaching menarche. Her parents strictly adhered to traditional customs that limited her interactions with the outside world and deprived her of healthy foods. They believed that her fatigue was a result of hormonal changes associated with menarche. Although her condition worsened over four days, they did not seek medical treatment. The child succumbed upon admission. The autopsy revealed extensive cyanosis in the left hand due to multiple thrombotic occlusions of the brachial vein. Microscopic examination confirmed the presence of brachial venous thrombi. The cause of death was determined to be Multiple Organ Dysfunction Syndrome (MODS) as a consequence of hypovolemic shock.Discussion: Key medico-legal issues in this case include parental negligence and failure to provide medical care under Section 308A of the Penal Code, potentially leading to criminal liability for negligence-related death under Section 298. Violations of the child's rights, protected by the Children and Young Persons Ordinance (CYPO) and the Protection of Children's Rights Act, form the legal framework for child protection in Sri Lanka. The ISD has interviewed family members and collected witness statements from neighbors and teachers, referring the case to the police for further investigation and notifying the National Child Protection Authority for an additional inquiry. Additionally, Sri Lanka is a signatory to the United Nations Convention on the Rights of the Child (UNCRC), which guarantees children's fundamental rights.

Background & objectives: Mitochondrial DNA (mtDNA) contains valuable genetic information and plays a crucial role in missing person investigations, mass disasters, and forensic cases involving limited or degraded biological material. mtDNA is maternally inherited, with a highly variable control region divided into three hypervariable regions are generally used for forensic investigation. This study aimed to evaluate maternal inheritance patterns of mtDNA using PCR-RFLP techniques to confirm maternal relatedness. Method: The study was designed after prior permission from the institute’s ethical committee in which subjects were enrolled. This pilot study analyzed 50 voluntary participants (mother-child pairs). DNA was extracted from blood or saliva, and the mtDNA hypervariable region (HV region) was amplified by PCR using specific primers for the HV1 region. The amplified fragments (1024 bp) were subjected to RFLP analysis using seven restriction endonucleases (Alu I, BsuR I (Hae III), Hinf I, HsYF31 (Dde I), Mbo I, Rsa I, and SsPI) to reveal morphotypes. Results: The study identified five morphotypes for Alu I, three for BsuR I (Hae III) and Rsa I, two for Hinf I, and one each for HsYF31 (Dde I), Mbo I, and SsPI. There was minimal genetic polymorphism in the hypervariable region among unrelated individuals, but consistent restriction patterns were observed between mothers and their children in same pair. Conclusion: The findings demonstrate the low genetic polymorphism in the hypervariable region among unrelated individuals and consistent restriction patterns within maternal pairs, underscoring mtDNA's utility in forensic and genealogical applications. 

Introduction: Flow analysis in the apical view of transthoracic echocardiography is validated to assess fluid responsiveness at the bedside. Still, it is not always reachable, especially in mechanically ventilated patients and during surgery. We compared it to supra-sternal and sub-xiphoid views to evaluate their validity in assessing fluid responsiveness in critically ill patients.Method: A cross-sectional prospective monocentric pilot study of three months duration has been led in the critical care unit for surgical emergencies of Ibn Sina University Hospital of Rabat (Morocco). We used the time-velocity index (VTI) and peak velocity variation (∆Vpeak) values correlation between the three acoustic windows as the main judgment criteria. Measurement of data was made in the Left Ventricle Outflow Tract (LVOT) in the 5-chamber apical view, Descending Thoracic Aorta (DTA) in the supra-sternal view, and Right Ventricle Outflow Tract (RVOT) in the sub-xiphoid view.Results: There were 14 adult patients involved in the study, and the data presented are preliminary results. There was no significant difference in VTI and ∆Vpeak values between the three acoustic windows at each time of the study protocol, with a very high correlation for initial VTI value between 5-chamber apical view and supra-sternal view (r = 0.96, p < 0.001), and sub-xiphoid view (r = 0.86, p < 0.001). A very high correlation of initial ∆Vpeak value was also observed between the 5-chamber apical view and supra-sternal view (rho = 0.89, p < 0.001) and sub-xiphoid view (rho = 0.79, p < 0.001).Discussion: Supra-sternal and sub-xiphoid views showed high potential to predict fluid responsiveness, but further data are needed to validate their use for this purpose in ICU and in operating room.