impact

Chronic infection with the hepatitis C virus (HCV) is estimated to affect 58 million people worldwide and around 700,000 individuals in Brazil. Various non-invasive markers of hepatic fibrosis have been proposed, such as transient hepatic elastography (THE) using FibroScan®. However, the reliability of the performance, by operators in the training phase is undetermined, which hinders its applicability in clinical practice. Objectives: The present study aimed to evaluate the impact of training an inexperienced operator to perform the examinations using FibroScan® in patients with chronic hepatitis C. Specifically, the frequency of unreliable results throughout the training was assessed. Methods: This is a cross-sectional study with retrospective data collection including compensated chronic hepatitis C patients who underwent the examinations using FibroScan® between March 2014 and December 2016, performed by two researchers. Included patients were divided into two groups based on the operator's experience in the examination: the Experienced Examiner (EE) group and the Examiner in Training (ET) group, with the latter divided into two phases: phase 1, consisting of the first 100 examinations, and phase 2, comprising subsequent examinations. For the reliability analysis, parameters such as success rate (SR), interquartile range (IQR) to median (Md) ratio (IQR/Md), and reliability criteria of Castéra, et al. and Boursier, et al. were used. Results: Between March 2014 and December 2016, 771 adult HCV-infected individuals were evaluated and divided into EE group (n = 161), ET phase 1 (n = 100), and ET phase 2 (n = 158), showing similar demographic, clinical, and laboratory characteristics. SR and IQR/Md ratios were similar among EE, ET phase 1, and ET phase 2 groups. The proportion of reliable results was comparable in all three groups, using Castéra, et al. reliability criteria (92.5%, 92.0%, and 97.5%, respectively) and Boursier, et al. criteria (96.9%, 95.0%, and 98.1%, respectively). Conclusion: A short training period (up to 100 examinations) seems to be sufficient for them to have good clinical applicability in the hands of an operator with initial experience in the method

Evening and weekend imaging services at outpatient radiology centers offer extended access to diagnostic imaging, potentially increasing patient satisfaction and accessibility, especially for underserved populations. This review explores the benefits and challenges associated with these after-hours operations, focusing on health equity, patient satisfaction, economic considerations, energy and cost savings, and the impact on healthcare professionals. Findings indicate that while after-hours operations can enhance patient satisfaction and access, they also pose challenges such as increased operational costs and staff fatigue. Strategies for improvement include optimizing shift schedules, leveraging technology for better scheduling and communication, and enhancing patient-centered care. Collaborative efforts among imaging centers can further improve service delivery and efficiency.

Bloodstain Pattern Analysis (BPA) is a crucial forensic technique in crime scene investigation, employing the interpretation of blood spatter patterns to reconstruct event sequences and determine spatial relationships between victims and surfaces. This study explores BPA’s application in forensic science, emphasizing its role in establishing links between crimes and culprits, as posited by Edmond Locard’s exchange principle. The research examines how bloodstain shape, size, and distribution reveal critical information about impact angles, areas of convergence, and points of origin, while also providing insights into blood flow direction, force applied, suspect positioning, and weapons used. The investigation delves into various bloodstain types, including void patterns, spikes, and satellite stains, and their formation on different surfaces. To enhance understanding of blood behaviour from various sources, the study compares blood samples from three species: human (Homo sapiens), obtained from a professional doctor from discarded piles with precaution from a government hospital in Laxmangarh, Rajasthan and goat (Capra aegagrus hircus), and chicken (Gallus gallus domesticus), obtained from butcher shops in Laxmangarh, Rajasthan. The experimental setup involves dropping blood from a height of 50 centimetre’s and measuring the resulting stain dimensions. This comprehensive approach to BPA research aims to refine crime scene analysis techniques, ultimately contributing to more accurate event reconstructions and enhanced forensic investigations. The study underscores the importance of BPA in modern forensic science while acknowledging the need for its integration with other investigative methods to ensure robust and reliable crime scene interpretations.

Cholangiocarcinoma (CCA), a rare malignancy originating from bile duct epithelial cells, often presents a challenging prognosis due to its rarity, delayed diagnosis, and early recurrence post-curative-intent treatments. Additional complexities include difficulties in achieving R0 resection during surgical intervention and the lack of effective second-line treatments following the failure of first-line regimens, particularly in unresectable advanced cases.In this case study, we demonstrate a durable response to a combination regimen of pembrolizumab and lenvatinib in a patient with distal CCA. Despite the regimen’s interim median Progression-Free Survival (PFS) of 6.1 months (95% CI, 2.1-6.4), our patient achieved a clinical and radiological PFS of approximately two years. The underlying mechanisms, potentially involving the upregulation of immune response pathways through undisclosed means or influenced by lenvatinib’s activation of T cells, might augment the sensitivity to PD-1 antibodies like pembrolizumab, contributing to the patient’s sustained response over two years.This case also highlights the significance of the patient’s initial good health condition, multidisciplinary care, and the potential impact of molecular subtyping on treatment selection in a patient with distal CCA who underwent numerous diagnostic procedures, intricate surgical interventions, and subsequent treatment regimens over seven years. Additionally, we underscore significant landmark trials and emerging combination therapies, including chemotherapies, immunotherapy, and targeted treatments in this report.

The presence of heavy metals (HMs) on Earth is essential to all forms of life. These metals are essential for plant and animal development but can have numerous negative effects on the living environment. In this review, we looked at where HMs come from, why they are harmful, and how they affect plants. Articles indexed in Google Scholar, PubMed, Research Gate, Science Direct, and a few books on heavy metals were consulted for this study. Heavy metals are essential for plant development and growth. According to this analysis, the hazardous effects of HMs are on the rise all throughout the globe, and this trend may be attributed mostly to human activity. Because of its impact on agricultural productivity and environmental changes, soil pollution caused by HMs is among the most crucial elements. Plants have evolved very sophisticated defense systems to deal with these environmental challenges. The threat that HM stress poses to plants has attracted a lot of attention worldwide because it could stunt agriculture’s long-term expansion. In spite of their importance for plants, this study found that HMs pose a significant threat to plant life. The novelty of this review lies in its detailed examination of both the beneficial and detrimental roles of HMs, providing a balanced perspective often overlooked in current literature. The significance of this work is underscored by its potential to inform sustainable agricultural practices and environmental management strategies, as it highlights the delicate balance required to harness the benefits of HMs while mitigating their risks. Despite their necessity for plant development, this review underscores the significant risks HMs pose to plant health and ecosystems.Less than 10 cases have been reported in the literature of the association of germline BRCA1 and Squamous cell Carcinoma – the esophagus. The article focuses on the probable pathogenesis of BRCA1 mutation with non-classic malignancies and the response of Poly adenosine diphosphate ribose polymerase inhibitors (PARP) inhibitors in such a scenario. We report an unusual manifestation of the BRCA1 gene with second primary oesophageal squamous cell cancer occurring five years later to triple-negative breast cancer.

Purpose of the study:  To evaluate the performance of Best Practice Recommendation (BPR) compliance in reporting abdominal aortic aneurysm findings on imaging, comparing the results before and after its deployment.Methods: Best Practice Recommendations for AAA were deployed in 2020 at a large radiology practice site. Reports between January 2018 through October 2022 were reviewed, representing studies read prior to and subsequent to the implementation of the reporting standards. Cases of abdominal aortic aneurysms ≥ 2.6 cm were counted by year. Adherence to the BPR for each year was calculated as [total number of confirmed cases of ≥ 2.6 cm AAAs with compliant reports] * 100 / [the total number of confirmed ≥ 2.6 cm AAAs]. A secondary analysis was performed to determine whether there was a statistically significant difference in the proportion of BPR-compliant reports for AAA cases before (from 2018 to 2019) and after (from 2020 to 2022) BPR deployment using a chi-square test. Results: From January 2018 to December 2022, there were 8,693 reports referencing AAA. After excluding cases of suspected AAA (N = 2,131), confirmed AAAs with indeterminate sizes (N = 103), and confirmed AAAs with sizes < 2.6 cm (N = 85), the number of AAA cases ≥ 2.6 cm in size was 6,374. Concordance with the BPR standards for the remaining cases with sizes ≥ 2.6 cm were 1.6% and 4.1% in 2018 and 2019, respectively. Post-implementation of BPRs, there was a substantial improvement in guideline adherence to 32.1%, 84.3%, and 83.6% in 2020, 2021, and 2022, respectively. In general, the proportion of BPR-compliant reports of AAA cases in the pre-deployment (3.6%) period statistically differs (p - value < 0.0001) from those in the post-deployment period (73.9%)Conclusion: Adherence to reporting standards increased after the BPR deployment in 2020. The inclusion of management recommendations in the radiology report when AAA is identified is a simple and cost-effective way of improving outcomes for patients with AAAs through appropriate follow-up treatment.

Dentistry is a challenging and demanding physical profession, and this impacts not only the quality of the task outcomes but also the professional’s quality of life. The nature of dentistry demands prolonged static and awkward seated postures, frequent motions, positioning struggles, and working distances to the oral cavity for strategic procedure management, which become cumulative challenges over the working days, prone to discomfort, pain, or injuries, and musculoskeletal disorders for the operator.The limitations of the naked eye in dentistry, particularly in terms of visual information and resolution, underscore the need for visual aids. These aids are crucial for achieving the precision required for accurate procedures. Also, visual aids, such as magnifying loupes and the operative microscope, have been in the market for a while, and their proper use has shown ergonomic benefits that promote a neutral working posture and changes in work practice-oriented to control unbalanced awkward posture and motions.In this study, the Rapid Upper Limb Assessment RULA compares the posture between naked-eye dentistry, conventional loupes, and operative microscope, and with the observational assessment, determine the risk of developing musculoskeletal disorders and the need for priority of change. The Rodgers muscle fatigue analysis RMFA is used to predict fatigue in the muscular regions of the body during specific dental tasks.

Background: The impact of COVID-19 and long-term COVID-19 on gastrointestinal neoplasms remains underexplored. The current review investigates the potential link between these conditions and the role of gut microbiota in mediating oncogenic processes. Dysbiosis, characterized by alterations in gut microbial composition, may exacerbate inflammation and immune dysregulation, contributing to cancer development.Methods: A comprehensive literature review was conducted using databases including PubMed, Scopus, Embase, SciELO, and Web of Science. Inclusion criteria encompassed studies published between 2020 and 2024 that explored the intersection of COVID-19, long-term COVID-19, and gastrointestinal cancers. The articles were critically appraised for quality and relevance, and data were synthesized to elucidate common mechanisms and outcomes.Results: The review identifies several mechanisms by which gut microbiota may influence cancer risk in COVID-19 patients. Persistent inflammation, oxidative stress, and immune dysfunction observed in Long COVID were associated with dysbiosis. Specific microbial metabolites, such as secondary bile and short-chain fatty acids, were implicated in promoting tumorigenesis. Comparative analysis of studies suggests that SARS-CoV-2-induced dysbiosis may heighten susceptibility to gastrointestinal cancers, particularly in patients with prolonged post-infection symptoms.Conclusion: The findings underscore the need for further research to clarify the role of gut microbiota in cancer development among COVID-19 patients. These mechanisms could inform preventative strategies and therapeutic interventions, particularly for those experiencing COVID. The review highlights gaps in current knowledge and advocates for longitudinal studies to assess the long-term effects of COVID-19 on gastrointestinal health.

Mental illness is an international health crisis that puts the lives of over three hundred million people (Four percent of the world’s population) at risk. The study was conducted at the Erigavo Mental Hospital in Somaliland and its main focus was the bond between substance abuse and mental illness. The research was to check the influence of the different drugs, screen mental health problems, and draw a link between drugs and mental illness. The sources of the quantitative data were a total of 27 employees and managers. This study is cross-sectional. We employed the measure of the magnitude and direction of a linear relationship between two variables with the Pearson correlation coefficient. The outcomes that were acquired show that there was use and particularly abuse of khat, substance smoking, and alcohol consumption, the score means of which were quite high. The investigation results, however, imply that through drug use and other forms of alcohol drug abuse, one of them counter various mental health problems. Furthermore, the addicted people demonstrated the tendency to use force in their attempt to solve the conflicts and to experience the highest degree of tension, with the mean score of the former giving 4.11 while the standard deviation of the latter giving 1.086, thus this shows the mental impact of drug use on the inhabitants of Erigavo. The main result of the study was the strong, positive relationship between drug addiction and mental illness, which became evident through an r - value of 0.509 and a p - value of 0.559. It means that those people who are involved in drug misuse are the ones who are likely to have mental health disorders. Based on the findings of the study, we suggest a combination of measures to recover drug addiction and mental illness. This consists in strengthening prevention. The study that lays the groundwork for suggestions, involves an approach that is holistic in nature. The main ideas of preventing drug usage, psychological health care, enhancing mental health services, and working towards certified professionals are key integrated activities of the whole concept. The hospital, thus, will be in a better position to eliminate the two major disease components namely; drug abuse and mental ailment. Thus, in this way, with the help of the new treatment approaches, a hospital provides and their patients who are quite likely to recover and lead healthy.

Objectives: This study aims to introduce and differentiate between traditional craze lines and a newly identified type of line in enamel, termed an “internal craze line.” This novel classification enhances diagnostic precision and carries significant clinical implications for treatment strategies. The goal is to provide a clear description of these two types of lines, discuss their unique clinical implications, and highlight their differing appearances and staining characteristics, contributing to improved understanding and management of enamel anomalies.Method and materials: Four extracted teeth exhibiting visible and internal craze lines were selected and examined using a stereo microscope to observe the structural characteristics of the lines. Cross-sections of the coronal parts of the teeth were prepared to document the differences between traditional craze lines (extending from the dentin-enamel junction [DEJ] to the enamel surface) and internal craze lines (originating at the DEJ but terminating midway through the enamel). Additionally, intraoral observations were conducted under high magnification to identify the visual differences between the two types of lines, noting that traditional craze lines can be stained while internal craze lines cannot.Results: Microscopic examination revealed two distinct types of lines: traditional craze lines extending from the DEJ to the enamel surface and internal craze lines terminating within the enamel. Intraoral observations confirmed that these lines could be distinguished under high magnification. Traditional craze lines appear as continuous lines reaching the enamel surface and can be stained, whereas internal craze lines are shorter, do not extend to the surface, and cannot be stained.Conclusion: The identification of internal craze lines presents significant clinical implications. Differentiating between traditional and internal craze lines can enhance diagnostic accuracy and inform treatment decisions. Recognizing internal craze lines might indicate different etiologies or risk profiles compared to traditional craze lines, influencing preventive and therapeutic strategies in dental practice. Further research is needed to explore the prevalence, causes, and long-term impacts of internal craze lines.

The gut microbiome is a complex network of interactions between the brain and the gastrointestinal tract, playing a pivotal role in human health and disease. The microbiota-gut-brain axis (GBA) serves as a crucial connector between the brain’s emotional and cognitive centers and the peripheral intestinal functions, emphasizing the profound impact of gut health on overall well-being. The GBA is characterized by a symbiotic relationship between the gut and the brain, regulating the expression of inflammatory cytokines and neurotransmitters. The MGBA is also regulated by microbial metabolites, such as short-chain fatty acids (SCFAs) and fatty acid derivatives. This paper focuses on the importance of the GBA in regulating gut health and the potential for targeted therapeutic interventions to improve health outcomes. The implications of this research are vast, suggesting that future strategies aimed at modulating the gut biome may offer promising avenues for the development of personalized medicine and dietary interventions.

According to a 2022 systematic review on the prevalence of psychiatric disorders in general hospitals, it was estimated that approximately one-third of medical inpatients present with a coinciding psychiatric condition. However, other studies have reported that a low rate of patients actually obtain an inpatient psychiatric consult; and even fewer patients receive a consultation when it would not be traditionally indicated. Therefore, we have seen an emergence of the use of Proactive Consultation-Liaison (C-L) Psychiatry across many hospital settings. This model of care utilizes systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based delivery, and care integration with primary services to provide psychiatric consultation earlier. This study conducted a focused PubMed search to review the research to date on proactive C-L psychiatry and its impact on hospital length of stay (LOS) in patients over 18 years old. Results show a consequential reduction in average hospital LOS when proactive C-L psychiatry services are used compared to reactive, on-request consultation services. A shortened LOS is seen with this practice when there is a quicker time for consultation or referral. Thus, there is evidence of proactive C-L psychiatry’s success in decreasing average hospital LOS and improving patient care. Additional studies are necessary to determine its significance, as little research to date has been completed on the topic. It is recommended to expand the scope of investigation to different patient populations, including but not limited to pediatrics and patients without an underlying mental health illness.

The aim of this work is to verify the pharmaceutical form in the galenic field of oral Budesonide compounded used in Crohn’s disease: capsules delay release or oral suspension. In particular ways the kinds of excipients or bases-vehicle used in the galenic pharmacy practice. The therapeutic need for Crohn’s disease requires a release of the API in delayed-release DR. The Budesonide molecule shows low systemic impacts due to its hepatic metabolism vs. a topical effect useful in this pathology. In this work, the oral pharmaceutical forms are analyzed: modified-release capsules and oral suspension with specific advantages for each one. Some formulations provided by various pharmacies are reported in this work as well as new technology like the 3D-PRINTING systems for colonic targeting tablets.

Background: The frequency of latex allergy is increasing, posing a major health problem. This increase is related to the widespread use of latex materials and cross-reactions between latex proteins and certain foods. This cross-reactivity makes latex avoidance difficult, and latex sensitization is likely to worsen atopic conditions. Objective: The authors evaluated the role of latex sensitization in the poor control of asthma and rhinitis. Methodology: An analytical cross-sectional study was conducted on 1860 patients of all ages and genders, followed up for allergic asthma and rhinitis since March 2012 in the Immuno-Allergology Unit of the Cocody University Hospital in Abidjan. Prick tests with native extracts and the European standard battery were performed to identify allergenic sensitization. The impact of latex sensitization on asthma and rhinitis control was assessed by calculating odds ratios. Results: A high frequency of latex sensitization was associated with asthma and rhinitis. The risks of poor control were related to monosensitization to latex and were even higher in the context of polysensitization. Conclusion: The impact of latex sensitization on the progression of asthma and rhinitis has been well demonstrated. It is recommended to integrate the latex sensitization status into the therapeutic management strategy of these two pathologies.

Flooding is a significant natural hazard impacting societies worldwide, with increasing severity in urbanized regions. This paper presents a case study of Lagos, Nigeria, examining flood risk management efforts in the city. The purpose is to evaluate the effectiveness of current strategies and suggest improvements for reducing the impacts of flooding. Findings highlight the roles of government and private stakeholders, as well as policy challenges. Recommendations for sustainable flood management practices are provided, with implications for other high-risk areas. 

The Enterprise Radiation Forest (ERF) study was initially introduced as a topic of discussion at the Institute of Forest Genetics, USDA, USFS, in the late 1960s. During that period, a program was endorsed for investigating the impacts of radiation on the forest ecosystem. The rationale for this was to facilitate the prediction of potential outcomes in the occurrence of a nuclear disaster. The research location was situated within the forested lands in Enterprise of Oneida County, Wisconsin, United States. The radiation source in question was a 10,000 curie source of Cesium-137, characterized by a halflife of 33 years. Furthermore, a study concerning lichens was also carried out, the data, photographs, and micrographs were meticulously gathered to illustrate the pre-irradiation activity of the species. This subject holds significant value for dissemination among peers in the scientific community, particularly considering the resilience exhibited by natural ecosystems in response to varying levels of radiation. The information is reviewed with the objective of the entire program to ascertain the potential consequences for a northern forest ecosystem in the event of a nuclear disaster, in addition to the two publications from the Atomic Energy Commission.

Children who experience Adverse Childhood Experiences (ACEs)—including trauma, family instability, or significant loss—are at increased risk for enduring mental, emotional, and physical challenges, including conditions such as depression, anxiety, and chronic health issues. Without effective support, these adverse experiences can have lasting effects on a child’s well-being, often persisting into adulthood and impacting mental, emotional, and physical health outcomes over the long term. Storytelling is a powerful method to support resilience in these children by enabling them to process emotions, make sense of complex experiences, and view themselves as active agents in their lives. By framing their experiences within personal narratives, children can create coherent stories that aid emotional regulation and support mental well-being. Through storytelling, children can frame their struggles as part of a larger, purposeful journey, fostering a sense of agency and self-worth. Techniques such as narrative therapy, story circles, and resilience-themed books-exemplified by The Adventures of Gabriel—help children explore their experiences, visualise positive outcomes, and strengthen social bonds. Moreover, storytelling is an accessible tool that aids in perspective—taking, allowing children to relate their challenges to those of characters, which reinforces their ability to overcome adversity and navigate life’s complexities with strength and optimism.

Introduction: Busulfan (Bu)-based regimens are crucial for myeloablative conditioning in pediatric allogeneic stem cell transplantation. Despite its efficacy, Intravenous Bu has a narrow therapeutic index and variable pharmacodynamics especially in children, heightening the risk of adverse events. This study explores Bu dosing and related organ toxicities in pediatric patients at a tertiary center in Saudi Arabia.Methodology: This retrospective study at King Fahad Specialist Hospital in Dammam (KFSH-D), Saudi Arabia, included pediatric patients (≤16 years) treated with intravenous Bu before bone marrow transplantation from 2010 to 2022. Pharmacokinetic dose adjustments were based on AUC targets of 900-1350 µMol-min. Descriptive measures included mean, Standard Deviation (SD), median, minimum-maximum values, counts, and percentages. Statistical analyses used Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Ethical approval was obtained from KFSH-D.Results: We identified 44 pediatric patients who underwent Bu prior to HSCT. Mean age was 4.95 ± 2.49 years, with a female majority (56.8%). Primary diseases included Beta Thalassemia (34.09%), Neuroblastoma (29.55%) among others. There was no significant difference in the cohort’s demographic and clinical features of the cohort. Nonetheless, higher infections were found in the Low-AUC group (66.7%) compared to the Target-AUC (40.0%) and Higher-AUC groups (0.0%) (p = 0.015).Conclusion: This study emphasizes the need for therapeutic drug monitoring and individualized Bu dosing in pediatric HSCT to minimize toxicity and improve outcomes. Larger multicenter studies are recommended to refine dosing strategies and enhance the safety and efficacy of Bu-based regimens.

Background: High blood pressure and dyslipidemia are risk factors that begin silently and share many pathophysiological mechanisms of tissue damage.Aim: Draw attention to this binomial (Hypertension and dyslipidemia) that is highly prevalent in Mexico and is mainly responsible for the leading atherothrombotic process as a cause of death in Mexico and the world.Methods: Reflective analysis of the evidence accumulated in the last 20 years. We launch key messages and support why every hypertensive patient should be treated with a statin.Results: We call for awareness to measure lipid levels and blood pressure twice a year from the age of 20 and to detect these devastating nosological entities as soon as possible. We remove the myth that PCSK9 inhibitors as well as the small interfering RNA of its synthesis are only for familial dyslipidemia. Measurement of serum Lp(a) should be routine, especially if you have a history of your own and family cardiovascular events.Conclusion: We should be aware of the little impact that health strategies have had to stop the main cause of death in Mexico. Every hypertensive patient should receive a statin, even if their serum LDLc levels are apparently normal. The great challenge of optimal control of the population with hypertension and/or dyslipidemia continues. The small interfering RNA synthesis PCSK9 should also be considered when conventional therapies are not sufficient and this situation is not infrequent.

The psychophysical impact of a high-complexity environment such as the dental office is not a novelty. This article outlines the organizational and human factors that impact the overall health of dentists, assistants, hygienists, and administrative staff. A careless organizational and human factors approach cannot only function as a stress and error trigger but also affect the highly precise requirements of dentistry and task performance in the daily demands of the office. Ergonomics and human factors principles guidelines should be structured and taught from the basics in dental schools and supported by prevention programs and interventions in the dental professional field, as in other industries, to promote safety, health, and efficiency within the integration of humans, systems, and environments.Usually, the main focus of dentistry research is the physical aspect of the job; the high rates of musculoskeletal disorders are a real problem, but the cognitive-organizational element of the job is not a minimal issue, which highly contributes to physical-emotional exhaustion in the work environment.A fatigued mind impacts the physical aspect of the job, and physical fatigue impacts the mental aspect of the job. This dual effect in a job that requires dealing with anxiety and fear patients, administrative situations in the office, financial aspects, and technical and skill aspects from the dentist, among other requirements, makes dentistry a unique profession.This article addresses the components of the factors that promote cognitive depletion in our field and provides simple tips on controlling them to avoid burnout among dentists. It highlights the importance of awareness of how we manage the organization in the office and the effect on human behavior and performance. It wants to bring to light a common problem for dental practitioners and the workforce to prevent health and performance decrease.