TitleA case of intracranial dural arteriovenous fistula presenting as transient right-sided weakness following new-onset seizures

¿p#1 Background: Sexually transmitted infections (STIs) pose a significant global health challenge, necessitating an accurate assessment of their global impact. Methods: Hierarchical clustering analysis was performed based on estimated annual percentage change (EAPC) values to evaluate trends in STIs across Global Burden of Disease (GBD) regions and identify areas with similar temporal changes in disease burden. Decomposition analysis identified the drivers of STIs burden variations, while the Inequality Slope Index (SII) and Concentration Index (CI) evaluated regional and national health disparities. Frontier analysis visualized the burden reduction potential at the developmental level. The Bayesian age-period-cohort model with integrated nested Laplace approximation (INLA) projected future incidence rates by examining multiplicative age, period, and cohort effects. Results: In 2021, global reported approximately 723 million STIs cases, trichomoniasis accounted for the highest proportion of new STI cases globally (47.3%), followed by chlamydial infection (32.6%), gonococcal infection (11.9%), genital herpes (5.6%), and syphilis (2.6%). From 1990 to 2021, the EAPC of the age-standardized incidence rate (ASIR) is –0.02 (95% CI –0.07 to 0.03), which was not statistically significant. Unsafe sex was a key risk factor for STIs; among all age groups, individuals aged 35-39 (36.38%) and 40-44 (36.7%) showed the highest attribution to high-risk sexual behavior. Despite the high Socio-Demographic Index (SDI) rankings, South Africa exhibits a high prevalence of STIs, necessitating attention. Projections indicate a decline in ASIR for all STIs from to 2022-2035, the most significant decrease in incidence occurs in the 20-24 age group, whereas the 40-44 age group experienced the largest increase. Conclusion: The results of our analysis can help policymakers to develop more effective STIs prevention strategies.

Case report: a 21-year-old Asian male with Crohn’s Disease misdiagnosed as postoperative intra-abdominal abscesses

Cavernous Sinus Thrombosis Following the Use of Oral Contraceptive Pills in a Young Woman: A Case Report

The National Health Service (NHS) receives thousands of complaints weekly, yet existing systems remain largely manual, inconsistent, and unable to generate strategic insights. This paper examines the potential of Artificial Intelligence (AI) and digital technologies to transform complaint and feedback management within the NHS. Using a pilot initiative at Oxford University Hospitals (OUH) as a case study, the article explores the design, implementation, and impact of an AI-enabled Complaint Management System (AI-CMS). The system leverages Natural Language Processing (NLP) to streamline complaint triage, detect emergent themes, and offer real-time analytics. We discuss the operational, financial, and ethical implications of AI-CMS deployment and highlight the need to expand its remit to cover broader patient feedback mechanisms. The findings underscore AI’s potential not only to enhance efficiency but to catalyse a shift towards learning, responsiveness, and patient-centred service redesign.

We perform a thorough test of the “| Δµ| big is good” principle (DMB) using double-exchange reactions between diatomic molecules. We conclude that DMB is “not bad” at predicting whether or not a reaction will be favorable, but its performance is inferior to alternatives like the maximum hardness principle.

IntroductionAnomalous aortic origin of the coronary arteries (AAOCA), a rare congenital malformation, is reported with a prevalence of less than 1% in angiographic series in average (1, 2). Among these, anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp is particularly uncommon and is associated with variable clinical consequences depending on its course (1).Clinically, many cases are asymptomatic and considered benign. But some of the AAOCA variants like when the left coronary artery arises from the right sinus and courses between the aorta and pulmonary artery (inter-arterial course), are considered high risk. They are potentially associated with myocardial ischemia, angina, syncope, and sudden cardiac death (SCD), particularly in young athletes and active individuals (3, 4).Patients with anomalous LMCA may present with a wide spectrum of symptoms, ranging from exertional chest pain to acute coronary syndromes, or the anomaly may be discovered incidentally during imaging (1, 3). Multimodal imaging, particularly coronary angiography combined with computed tomography angiography (CTA), is often required to define the course of the anomalous vessel and to guide therapeutic decision-making.We present the case of a 56-year-old woman with unstable angina and ST-segment elevation who was found to have an anomalous origin of the LMCA from the right coronary cusp with a prepulmonic trajectory, in the setting of significant multivessel coronary artery disease.

A document by ali asilian. Click on the document to view its contents.

case report

A document by Animaw Dagnaw. Click on the document to view its contents.

IntroductionBelly Dancer’s Dyskinesia (BDD), also known as diaphragmatic myoclonus or diaphragmatic flutter, is named for the hallmark clinical finding of repetitive, involuntary, rhythmic twitching of the upper abdomen and diaphragm. The pathophysiology of this disease is not well understood as few cases have been documented. Hypothesized mechanisms include spinal cord lesions, dysfunction of inhibitory spinal interneurons, local structural neuron dysfunction, phrenic nerve irritation, lesions of the basal ganglia, or idiopathic etiologies.1 Given the unspecified pathophysiology and scant diagnostic tools available, treating this disease remains difficult. Case reports describe successful treatment with anti-convulsant medications, benzodiazepines, and first-generation antipsychotics, though research is limited.2The focus of this report was a 57-year-old female who presented with a history of constant, repetitive muscle spasms of her right upper abdomen present since undergoing an open cholecystectomy eight years prior. She failed multiple treatment regimens including pharmacologic, procedural, and physical therapy interventions. The patient’s disease left her in a state of extreme, daily discomfort and caused difficulty with eating more than one meal per day. Our combined anesthetic and surgical teams attempted a novel treatment with a combination of anesthetic agents and surgical re-incision and closure of the cholecystectomy site.The aim of this case study is to document this approach to treatment and its outcomes. The combined efforts of our anesthetic and surgical teams allowed our patient to be observed in real time while receiving a series of multi-modal treatments, culminating with re-incision and closure of the prior surgical site. Through this, we seek to provide new information to existing literature and improve the ability of other clinicians to effectively treat this disease.This study was exempted by the Colorado Multiple Institutional Review Board and written, signed consent was obtained from the patient. The following manuscript adheres to the applicable EQUATOR guidelines.

Introduction. CCHS is a rare disorder caused by PHOX2B gene variants. While CCHS hallmarks are hypoventilation and respiratory control dysfunction necessitating lifelong artificial ventilatory support, affected individuals also experience widespread, but less studied, autonomic nervous system (ANS) dysregulation. PHOX2B variants may be divided into moderate and severe groups based upon molecular and in-silico data. The International CCHS Registry is a secure repository for longitudinal data from individuals with a PHOX2B variant-confirmed diagnosis, including information on seven systems served by the ANS (cardiovascular, gastrointestinal, neurological, ophthalmologic, renal/urinary, respiratory, sudomotor). Our objective was to analyze patient-reported symptoms (PRS) across all ANS-served systems and determine their relationship with PHOX2B variant severity. We hypothesized an increase in PRS in all organ systems in individuals with severe variants. Methods. This study focused on completed initial surveys. Descriptive statistics were generated for all PRS, and by variant groups, with statistical comparison using the Wilcoxon Rank-Sum and Fisher’s exact tests. Results. Analysis of 148 surveys confirmed broad, multi-system ANS dysfunction in CCHS. Those with severe PHOX2B variants were more likely to report cardiovascular, gastrointestinal, neurological, and ophthalmological system dysfunction compared to individuals with moderate variants. Individuals with severe PHOX2B variants reported significantly more symptoms in 6/7 organ systems than those with moderate variants. Conclusions. The individual-reported impact of CCHS varies by both PHOX2B variant severity and the ANS organ system/symptom manifestations. Beyond the traditional clinical focus on cardiorespiratory dysfunction, these results highlight other ANS-related systems that are critical for comprehensive clinical management and future therapeutic trial design.

Background: While fast embryo development has been associated with improved ICSI outcomes, the effects of slow embryo development (D9-11 post ICSI) and of vitrification vs. fresh IVP transfer on foaling rates and the foal’s sex are less explored. Objectives: To determine: 1) the effect of day of embryo development (D7-11) and 2) of vitrification and warming assessing two methods: direct warming in isotonic commercial embryo holding medium (one step) or serial dilution warming (three step) vs. fresh IVP embryos, on pregnancy, early pregnancy loss, foaling rates and the foal’s sex Study design: Retrospective clinical study Methods: Blastocysts (n=201) were collected on D7-11 after ICSI of in vitro matured (IVM) oocytes from Warmblood mares (n=22) and transferred either fresh or vitrified-warmed into recipient mares on D4 post-ovulation. Pregnancy, early pregnancy loss, foaling rates and the foal’s sex were compared by RStudio statistics. Results: The day of blastocyst development did not affect initial pregnancy rates, but transfer of D11 IVP embryos resulted in significantly higher early pregnancy loss (D7,-8,-9,-10 and -11; 0%, 5.7%, 11.1%, 20.0% and 83.3%, resp., p < 0.001) and lower foaling rates (D7,-8,-9,-10 and 11; 88.2%, 64%, 60.8%, 50% and 10%, resp., p < 0.0001). The foal’s sex showed a skewed sex ratio towards female in D10 (78.9%:21.1%) vs. D7 (35.7%:64.3%; P = 0.02), D8 (50%:50%; P = 0.05) and D9 (48.4%:51.6%) IVP embryos. Transfer of fresh vs. vitrified-warmed (one-and three step protocol) embryos did not significantly affect pregnancy nor foaling rates. Main limitations: Small sample size per day of blastocyst development Conclusions: Slow in vitro embryo development negatively affects foaling rates after transfer of D11 IVP embryos. Transfer of D10 IVP embryos yields acceptable foaling rates and favors female offspring. Vitrification provides a safe method to preserve equine embryos with the flexibility to use a one-step warming protocol.

IntroductionRhinophyma represents a severe, disfiguring manifestation of phymatous rosacea, characterized by progressive glandular hypertrophy and fibroplasia of the nasal soft tissues [1]. Pathologically, it is defined by marked sebaceous hyperplasia, which can precipitate significant aesthetic distortion and, in advanced stages, functional airway obstruction [1, 2]. While primarily localized to the nose, phymatous changes can occasionally involve adjacent facial structures [3]. The clinical presentation varies in severity, a spectrum which often guides the therapeutic strategy [4].Although surgical excision is the definitive treatment for advanced rhinophyma, recurrence remains a formidable therapeutic challenge. Relapse is frequently attributed to the incomplete extirpation of deep-seated sebaceous follicular units that serve as a nidus for regrowth. The literature, however, offers limited guidance on optimal strategies for managing patients after multiple surgical failures. In this case, we present a rare case of triple-recurrent rhinophyma to illustrate the profound therapeutic challenges involved and to delineate the meticulous surgical principles essential for achieving a durable aesthetic and functional outcome in such recalcitrant scenarios.

Background While the role of genetic predisposition in asthma and other allergic conditions is well established, the contribution of nutritional patterns is heterogeneous and has been demonstrated in cross-sectional studies but not in prospective cohorts. We examined the association between ultra-processed food (UPF) consumption and asthma and allergic diseases in a prospective cohort of Spanish children. Methods We analyzed data from 1,546 participants who were enrolled in the SENDO cohort between January 2015 and June 2024. Children aged 4–5 years were prospectively recruited. UPF consumption was assessed at baseline and updated at the 3-year follow-up. Information on asthma and allergic diseases was collected at baseline and updated annually during the follow-up. A final sample of 691 participants were classified into tertiles (T1, T2, T3) according to UPF consumption. Prevalent cases of asthma, allergic asthma (AA), atopic dermatitis (AD), food allergy (FA), aeroallergen sensitization (AS), and atopy cases were excluded from the analysis of the corresponding outcome in order to ensure that incident cases were included during the follow-up. The adjusted risk (and 95% Confidence Interval [CI]) of each outcome by tertile of UPF consumption was estimated using hierarchical regression modeling. In the main analyses, we calculated the adjusted hazard ratios (HRs) and 95% CI with survival analyses displayed using Nelson-Aalen plots. Results Our final sample included 691 children with a mean age of 4.86 years at baseline; 52.5% female. After a mean follow-up of 3.4 years, the adjusted risk for asthma in each tertile (T1, T2, T3) of UPF consumption was 2.6%, 9.9%, and 7.6% respectively (p for trend: 0.03). In the fully adjusted model of the survival analysis, children with greater UPF consumption (T2+T3) showed a significantly higher risk of asthma (HR 3.76; 95% CI 1.15-11.51, p=0.02) but not of AA (HR 2.14; 95% IC (0.55-8.31), p=0.27), nor other allergic outcomes compared with their peers in the lowest tertile (T1) of UPF consumption. Conclusion Higher UPF consumption maybe associated with an increased risk of developing asthma in school-age children.

ArticleWidth Identification and Spatiotemporal Change in the Landscape Ecotones in the Poyang Lake Sandy Land Based on an Advanced Remote Sensing Ecological IndexWangyang Wu 1,2, Junwen Tian 2, Lihui Tian 1,*, Dengshan Zhang 1, Peng Fan 2 and Shuyu Yang 21 State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining 810016, China ;2 School of Earth and Planetary Sciences, East China University of Technology, Nanchang 330013, China;* Correspondence: lhtian@qhu.edu.cn; Tel.: +86-155-2830-2040

Neurogenic Arrhythmias following Insular Stroke: Case Reports and Monitoring ImplicationsFarah Hakim1,3, Nadia Bouattour1,3, Mariem Jabeur2,3, Amine Bahloul2,3, Khadija Sonda Moalla 1,3, Mariem Damak1,31: Department of Neurology and Research Laboratory LR12SP19, Habib Bourguiba University Hospital, Sfax, Tunisia2: Department of cardiology, Hedi Chaker University Hospital, Sfax, Tunisia3: University of Sfax, Tunisia- Corresponding author: Farah Hakim; MD, specialist in neurologyORCID: https://orcid.org/0009-0005-3821-640XEmail address: hakimfarah1996@gmail.comFull address: Neurology’s department, Habib Bourguiba Hospital, Ferdaous Street, Sfax, Tunisia, 3029.Telephone number: + 216 52911822

Soil salinization is a major cause of land degradation and ecological deterioration. Traditional monitoring methods are spatially limited and inefficient. This study explores the use of multi-source remote sensing to improve the accuracy and timeliness of soil salinity inversion, providing support for precise management of saline-alkali land.The research was conducted in Lihe Township, Ningxia, China. We integrated Sentinel-1 SAR, Sentinel-2 multispectral data (including reflectance and derived salinity, vegetation, and texture indices), and SRTM DEM data. Feature selection was performed using Recursive Feature Elimination (RFE), Partial Least Squares (PLS), and Out-of-Bag (OOB) estimation methods. Soil salinity inversion models were developed for three maize growth stages (D1–D3) and a bare soil period (D4) using Random Forest (RF), Support Vector Regression (SVR), and Back-Propagation Neural Network (BPNN) algorithms.The RF model achieved the best and most stable performance across all periods, with an average coefficient of determination (R 2) > 0.77 on the test set. RFE yielded the most robust feature subsets. Sensitive features evolved with crop phenology: from vegetation and salinity indices in early stages, to topographic and texture features in middle stage, and finally to original bands and specific salinity indices in late and bare soil periods. Spatially, salinity was highest in the eastern and northern regions, with the west remaining stable. Temporally, soil salinity exhibited “summer-autumn leaching and winter-spring accumulation”.The multi-period, multi-model inversion framework developed in this study offers a reliable approach for stage-specific monitoring and management of regional soil salinization.