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Introduction: Extracellular Traps (ETs) are fibers composed of chromatin and cytoplasmic proteins, which can trap and kill pathogens by the phenomenon called ETosis. They are released by neutrophils, macrophages, and monocytes, and can be found in semen. The aim of this presentation is to evidence of the indirect effect of SARS-CoV-2 in semen by ETs.Patients and methods: Experimental design: retrospective descriptive observational study.Semen samples from two groups were studied following WHO guidelines: 1) SARS-CoV-2 infected donors (n: 5; at 7, 15, 30, 60, and 90 days after PCR diagnosis); 2) COVID-19 positive patients assisted in our laboratory between 2021 and 2022 (n: 70). They were observed in fresh and in Papanicolaou-stained smears by CASA and light microscopy; the presence of macrophages, spermiophages, ETs and hyperviscosity were recorded while neutrophilic concentration was calculated. Two control groups were designed: a) Patients belonging to group 2, studied before de pandemia (n: 13); b) Culture-negative semen samples (n: 28).Results: In the first group, ETs were observed in all the samples, while only 18% had leucospermia. Macrophages, spermiophages, and hyperviscosity were recorded in 68%, 27%, and 36% of the studied cases respectively.In the second group, ETs were present 100% in the acute phase (< 90 days after diagnosis) and decreased to 71% in the later stage (90 to 270 days). The trapped sperm were non-progressive motile or immotile alive or dead.No traps were found in either control group.Conclusion: In our study ETs were the most sensitive seminal marker of SARS-CoV-2 infection.

A 61-year-old patient with autosomal dominant polycystic kidney disease (Irazabal class 1E) in whom renal function had decreased and kidney size had increased over the past 3 years (change in serum creatinine, 1.3 mg/dL to 1.5 mg/dL; change in total kidney volume, 5632 cm3 to 7301 cm3) was treated with tolvaptan 60 mg/day. After 8 years of tolvaptan treatment, serum creatinine remained at 1.51 mg/dL, and total kidney volume was at 6812 cm3. Adequate salt intake and good weight control may have resulted in good outcomes, even in patients with treatment-resistant giant cystic kidney disease.

More than 60 million persons all over the world are living with the diagnosis of “Autism”, in accordance with the UNO. According to the WHO, almost every hundredth child is a sufferer of ASD. Such figures emphasize globalization of the problem, and its impact not only on the child’s family but also on the economies of entire countries.Autism diagnosis is difficult and based on the general symptoms in kids. Today, the neuroimaging techniques (methods of functional Magnetic Resonance Imaging (MRI) and MRI tractography), Electroencephalography (EEG), evoked cognitive potentials and dynamic monitoring of the results help with an objective evaluation of stem cell therapy.Treatment options in modern pharmacology and rehabilitation psychotherapy for ASD kids are limited. Therapy methods do not ensure a full integration into social life and personality awareness. To alleviate likely problems in society, different therapeutic approaches exist that might reduce the manifestation of the various autism symptoms. FSC therapy is one such innovative method that has recently become enough popular.We inform about the clinical case of successful treatment using fetal stem cells for a child with autism followed by the period of 1-year follow-up showing significant clinical results. Over one year, the positive changes that had been proved by the ATEC questionnaire, the EEG results, and MRI-tractography were noted by the patient’s family. As emphasized in the clinical case report, fetal stem cell  therapy is a promising and efficient treatment for children with autism. All that was sufficiently confirmed by the results acquired because we saw an overall improvement in this patient.

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.

Spin-depending internal magnetic interactions in oxygen are crucial for the chemistry and photobiology of this molecule. Photosynthesis, respiration, and many other life-supporting oxygen reactions are governed by enzymes that use fine magnetic forces to overcome the spin-forbidden character of all aerobic metabolism. Life on Earth occurs on the border between combustion and oxidative phosphorylation, and this balance is largely dependent on reactive oxygen species. ROS can cause apoptosis or cell necrosis, and ROS also controls homeostasis through numerous signaling functions. Until recently, biochemists had not paid attention to internal magnetic interactions that influence the chemical activity of such ROS as superoxide ion, singlet oxygen, peroxynitrite, and many others. The role of superoxide dismutase, the oldest enzyme on the Earth, which provides superoxide concentration control, stresses the importance of the O2-• species as the precursor of many other ROS. Spin-orbit coupling in O2-• and O2 species are the main internal magnetic interactions that could influence cancer growth and be connected with cancer therapy.

Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS).Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies.Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.

Urine typically has an amber-yellow color due to the amorphous pigment urochrome, a distinct scent, and an average pH of 6.0, which is somewhat acidic. Green urine can result from drug intake, dyes, infections, adverse drug reactions, and other causes. Less than 1% of propofol users experience green urine, a rare and benign side effect. The green tint in urine is caused by the phenolic metabolites of propofol. In this case, a 33-year-old man diagnosed with organophosphorus poisoning and aspiration pneumonia had been given a modest dose of propofol sedation for six hours and began to exhibit green urine. After five hours of halting the propofol infusion, the urine returned to its usual color. Healthcare practitioners should be aware of this unusual but safe side effect of propofol.

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.

Chronic bacterial prostatitis is a commonly diagnosed genitourinary infection that presents significant challenges both in diagnosis and treatment. In an upcoming era of antibiotic resistance, and limited therapeutic options it becomes imperative to revise current guidelines and to provide more effective treatment strategies. At the Eliava Phage Therapy Center (Tbilisi, Georgia) we utilize bacteriophage therapy as an alternative approach against chronic bacterial infections. Bacteriophages, viruses that target and lyse specific bacterial cells, can be used as a stand-alone treatment or in conjunction with antibiotics. We present a case report of a patient with prostatitis caused by Escherichia coli infection, who prior to addressing our clinic, has been receiving antibiotic therapy without any positive effect. Our approach of combined use of antibiotics and phages was successful not only in complete clinical improvement but also in total bacterial eradication. This outcome shows the potential of bacteriophage therapy as a valuable adjunct to conventional antibacterials in the management of prostatitis.

Coronary artery aneurysm is an uncommon condition defined as abnormal dilatation of the coronary artery.We report the case of a man admitted to the Emergency Department for suspected intestinal obstruction. At abdominal/thoracic Computed Tomography (CT) it was reported a suspected pericardial cyst. Contrast echocardiography showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region where it was also possible to sample an ECG-synchronized system-diastolic Pulse-Wave (PW)-Doppler pattern, typical for a coronary artery flow. Our suspicion of a giant coronary artery aneurysm was then confirmed by coronary CT and coronary angiography. The patient was transferred to a Cardiac Surgery center where he underwent surgical treatment for the aneurysm.Most coronary aneurysms are clinically silent and are often incidentally detected. Coronary angiography is the ‘‘gold standard’’ for diagnosis and evaluation of coronary artery aneurysms. Among non-invasive diagnostic techniques, Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. However, echocardiography with the use of a contrast agent, a cost-effective non-radiation nature, and a widespread use method, maybe a reliable method to detect and characterize the masses, allowing a differential diagnosis.Learning objective1.    Recognition and evaluation of cardiac masses require first-line imaging methods such as echocardiography.2.    The use of additional non-invasive (cardiac CT or MRI) and/or invasive imaging methods are often required. 3.    Contrast echocardiography may be helpful, as second-line imaging methods, to better characterize the mass and approach the correct diagnosis.

Xanthogranulomatosis is an uncommon disease affecting non-Langerhans histiocytes. Laryngeal involvement is very rare.We describe the clinical case of an adult patient with disseminated xanthogranulomas affecting the supraglottic region of the larynx, leading to thickening and immobility of the epiglottis. The patient experienced inspiratory dyspnea on exertion. A transoral supraglottic epiglottectomy was performed, and a tracheostomy was subsequently required.

This study presents a comprehensive simulation and analysis of photonic band gaps in one-dimensional (1D) photonic crystals using the open-source software MEEP. Photonic crystals, with their periodic structures, exhibit photonic bandgaps that prevent the propagation of specific wavelengths of light, making them crucial for various optical applications. Unlike previous studies that primarily focused on theoretical and experimental methods, this research introduces a novel computational approach that enhances the accuracy and flexibility of modeling these bandgaps. Through detailed simulations, we explore the impact of different structural parameters on the photonic bandgap properties, providing valuable insights into optimizing these crystals for practical use. Our findings demonstrate significant improvements in the design and understanding of 1D photonic crystals, particularly in tailoring bandgaps for specific applications in optical devices. This work contributes to the advancement of photonic crystal technology by offering a robust framework for their analysis and application.

Social insects have eradicated the instincts inherited from their solitary ancestors that were harmful to communities. The elimination of these instincts was accomplished by natural selection, the units of which were communities. Man has not yet eradicated the instincts inherited from their solitary animal ancestors that were harmful to communities. But their eradication is underway. And it is also being accomplished by natural selection, the units of which are societies. Completion of evolution in this direction will probably lead to the disappearance of human instincts harmful to society, as they have disappeared in social insects. This will happen after a period of time measured not by historical standards, but by geological.

Introduction: Cognitive impairment is defined as a new deficit in at least two areas of cognitive functioning. These may include disturbances in memory, executive functioning, attention or speed of information processing, perceptual motor abilities, or language. It has been shown that cognitive impairment is associated with the severity of kidney disease. Methods: The study was a descriptive research design, with participants purposively sampled from the general chronic kidney disease population which included haemodialysis and peritoneal dialysis patients at Steve Biko Academic Hospital in Pretoria, Gauteng Province, South Africa. Hundred and fifty-one participants (76 hemodialysis & 75 peritoneal dialysis patients), 58% were males, and 42% were females aged 19-61 years. To establish the prevalence of cognitive impairment by testing the level of cognition the Mini-Mental State Examination was utilized to provide a brief screening test to quantitatively assess the cognitive abilities and cognitive changes of patients while on dialysis. Results: Ninety-nine percent (99%) of the recruited population reported no cognitive impairment, irrespective of dialysis modality, demographic characteristics, and socio-economic status. Conclusion: Despite the findings highlighting that the majority of the chronic kidney disease population at Steve Biko Academic Hospital reported no cognitive impairment, it is crucial to increase awareness of the potential effects of cognitive impairment on daily activities, quality of life, and treatment adherence. Early detection and management of cognitive impairment can significantly impact the quality of life and adherence to treatment among these patients. Further research is needed to understand the prevalence and impact of cognitive impairment in different populations and to develop effective interventions for its prevention and management.

Familial hypocalciuric hypercalcemia (FHH) is one of the rare reasons for hypercalcemia. FHH is an autosomal dominant disease that is inheritable. The most common calcium sensitive receptors (CaSR) develop because of the inactivation of. In addition, they also develop due to the function loss of AP2S1 and GNA11. The FHH sickness is characterized by hypercalcemia, hypocalciuria, the regular or increased level of the parathyroid hormone, and normal renal function. The symptoms of hypercalcemia are usually not observed. It is often diagnosed by calculating the calcium/creatine clearance ratio of a 24-hour urine sample, and then genetically looking at it. FHH is usually a benign disorder, and when symptomatic and rarely complications develop, calcimimetics are used or parathyroidectomy can be performed. In conclusion, FHH is a benign and genetically transmitted, moderate cause of hypercalcemia. It is rare and usually asymptomatic.

An autoimmune condition known as Systemic Lupus Erythematosus (SLE) affects several systems and manifests itself in a variety of ways. It is far more common among young women who are fertile.It has been demonstrated that a mix of environmental and genetic variables may trigger immunological responses, triggering T and B cells, and leading the B cells to overproduce pathogenic autoantibodies and dysregulate cytokines, which ultimately result in harm to many organs and tissues. One feature of SLE is the presence of antibodies against cytoplasmic and nuclear antigens. An autoimmune illness is also type 1 diabetes. β-cell antibodies (Ab) and other antibodies that cause the autoimmune death of the pancreatic β-cells, which make insulin, are part of the multifactorial pathophysiology of type 1 diabetes mellitus (T1DM).Immunosuppression is the therapy for systemic lupus erythematosus (SLE), and diabetes itself compromises immunity, making infections more opportunistic. We came across an unusual instance of a patient with SLE, T1DM, hypothyroidism on immunosuppression who subsequently acquired pulmonary TB.Key phrase: Autoimmune diseases such as type 1 diabetes mellitus (T1DM) and Systemic Lupus Erythematosus (SLE).

Primary adrenocortical insufficiency or Addison’s disease (AD) is a rare, life-threatening condition with different aetiologies, but the most common cause is autoimmune destruction of the adrenal cortex. Autoimmune Addison’s disease (AAD) can present as an isolated condition or associated with others, as part of an autoimmune polyglandular syndrome (APS). The aim of this work is to investigate and emphasise the roles of autoantibodies in adrenocortical insufficiency, through the description of three clinical cases.

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.

Myocardial infarction is the leading cause of morbidity and mortality worldwide. The overall aim of the study was to evaluate community awareness about myocardial infarction.It was a community-based cross-sectional study conducted during one month including both male and female participants aged 18 years and over in Nangarhar province of Afghanistan. The percentage of awareness for risk factors was as follows: Diabetes (56.4%), Hypertension (43.4%), Elderly (42.1%), Obesity (39.8%), Physical inactivity (38.5%), Hyperlipidemia (37.6%), and Family history (33.8%). Furthermore, knowledge about symptoms and signs was as the following: chest pain (67.4%), pain in neck and jaw (57.8%), Dyspnea (50.7%), pain in arms (46.1%), weakness/fainting (40.1%), cold sweats (38.2%), nausea and vomiting (34.5%), anxiety (29.6%), fever (22.7%), hypotension/shock (20.1%), and silent myocardial infarction (11.3%). Moreover, 24% of participants did not know about the prevention strategies for myocardial infarction. Regarding treatment, 80.3% of participants exactly knew to go to the emergency room, 11.9% of participants would intend to go to a general practitioner (GP), 5.6% of participants would ask others for advice on what to do, and 2.2% of participants would wait to see if the symptoms go away spontaneously or if the symptoms were due to other diseases. The current awareness level about myocardial infarction especially atypical symptoms, risk factors, prevention, and treatment strategies in Nangarhar residents was insufficient, especially in females and healthy individuals, and warrants designing and implementing immediate awareness programs in order to avoid delay of treatment-seeking, misbeliefs about the disease and subsequent morbidity and mortality.

Purpose: Loop Diuretics (LD) are the first-line pharmacotherapy to address Heart Failure (HF)-associated edema and dyspnea. However, LD causes frequent urinary, resulting in inconvenience and possibly undermining the quality of life. While prescription adjustment is an essential part of Palliative Care Consultation (PCC), it remains unclear how PCC affects the deprescribing of diuretics for adults with HF. Methods: We conducted a pre-post analysis of the percentage of HF patients who were prescribed LD in a national Electronic Health Record (EHR) database 12 months before and after the first PCC. The difference in prescription rates between the periods was determined. Adjusted associations of post-PCC LD prescription with pre-PCC LD prescription and patient’s characteristics, insurance, provider type, and clinical factors were quantified.Results: From 2010 to 2018, 5,969 patients with newly diagnosed HF received at least one PCC, among whom 2,539 (42.5%) were prescribed LD before and 1,552 (26.0%) after their first PCC. Despite a decrease in LD prescription rate encompassing the date of PCC, post-PCC LD prescribing was strongly associated with pre-PCC prescribing (aOR[95%CI] 3.2[2.8,3.7]) and varied by age at first PCC, year of HF diagnosis (aOR[95%CI] 2.1[1.9,2.4]) and months from HF diagnosis to first PCC. While our finding demonstrates reduced polypharmacy associated with PCC, the strong association between pre- and post-PCC indicates reverse therapeutic inertia. Future research should investigate the benefits and costs of polypharmacy among specific patient groups to help develop personalized treatment for HF.