Background andAim: Hypertension remains a major global health challenge affecting over 1.28 billion adults worldwide. Conventional hypertension management often involves multiple medications with adverse effects and economic burden, while natural alternatives such as ginger and garlic have demonstrated promising cardiovascular benefits. This randomized controlled trial evaluated and compared the antihypertensive effects of ginger and garlic supplementation, individually and in combination, among male hypertensive patients. Materials and methods: A total of 120 hypertensive male participants were randomly allocated to four groups (n = 30 each): control, ginger (2 g twice daily), garlic (2 g twice daily), and ginger + garlic (2 g each twice daily). Participants mixed crushed herbs with yogurt and consumed it for 90 days. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline and after 90 days. Results: All intervention groups demonstrated statistically significant reductions in both SBP and DBP compared to controls (p < 0.05).The ginger group showed a mean SBP reduction from 180 +/- 1.40 to 130 +/- 1.26 mmHg and a DBP reduction from 130 +/- 2.35 to 90 +/- 2.45 mmHg. The garlic group exhibited similar results, with an SBP of 129 +/- 1.27 mmHg and a DBP of 89 +/- 2.48 mmHg. The combination group demonstrated the greatest reduction, with an SBP of 120 +/- 1.20 mmHg and a DBP of 85 +/- 0.27 mmHg. When comparing the ginger and garlic groups, no statistically significant difference was observed (p > 0.05), indicating comparable efficacy. Conclusions: Ginger and garlic supplementation effectively reduced blood pressure in hypertensive patients, with their combination showing enhanced benefits. These herbs may serve as cost-effective, well-tolerated adjuvant therapies in hypertension management, reducing dependence on multiple pharmacological agents and their associated adverse effects.
Objectives: To investigate whether patients with a positive tap-test (TT) result for iNPH exhibit improved auditory event-related potential (ERP) responses following lumbar puncture. Design: Alongside gait and neuropsychological assessment, auditory ERPs were recorded using the oddball paradigm before and after lumbar puncture, with subsequent comparison of responses between the groups. Study sample: Forty elderly individuals suspected of iNPH were enrolled, with 20 showing a negative TT result and 20 with a positive TT result. Results: Participants with a positive TT result demonstrated a significant decrease in P2 latency in the left ear, of approximately 5.15 ms, and a tendency toward statistical significance for P3 latency in the right ear, of approximately 27.65 ms, after lumbar puncture, compared to those with a negative TT result. However, an increase in amplitude was not observed in subjects with a positive TT result. Conclusions: The reduction of the P2 and P3 latencies following lumbar puncture was associated with a positive TT result. Thus, latency analysis of these components holds promise in supporting TT results in individuals suspected of iNPH. Therefore, auditory ERP results could be useful as an auxiliary tool alongside the TT in the investigation of iNPH.
Plaque grinding is an interventional procedure for removing arterial obstructions using a high-speed rotational device on a flexible driveshaft. Complications have been reported in plaque grinding to limit population of the process. In order to reveal the calcified plaque grinding mechanism inside the artery, a series of experiments were conducted. The wheel motion was identified through high-speed camera observation and grinding marks identification. The effects of rotation speed, wheel diameter, and lumen size on the grinding force and debris size distribution were discussed. The findings demonstrated that the grinding wheel rotates along the guidewire and orbits around the lumen, exhibiting intermittent contact to remove plaque discretely. The complex wheel motion generates an irregular grinding force, which was identified through the implementation of statistical methods based on probability theory. It has been demonstrated that a decrease in wheel diameter and rotation speed and an increase in lumen size can result in a reduction in force. The debris size distribution was found to be primarily influenced by the wheel speed. The elevated wheel speed can result in smaller debris, owing to the reinforced impaction effect. This study provides a comprehensive understanding of the plaque grinding, which inform future clinical applications.
The diagnosis of early-onset bipolar disorder (EOBD) remains a major clinical challenge due to overlapping symptoms with other childhood psychiatric conditions and its divergence from adult presentations. There has been significant controversy over the phenomenology of EOBD due to the "Pediatric Bipolar Disorder" (PBD) proposed phenotypes, which, unlike adult mania, are often characterized by chronic irritability, affective instability, and mixed mood states rather than episodic euphoria. This case report presents B., a 12-year-old boy admitted for suicidal ideation and severe mood dysregulation. His history revealed early hyperactivity, oppositionality, progressive social withdrawal, somatic complaints, and persecutory ideation. Clinical assessment identified a major depressive episode with mixed features, supported by psychometric evidence of affective, anxiety, and somatic symptoms, as well as a cyclothymic-hypersensitive temperament. Treatment with lithium salts and aripiprazole led to significant clinical improvement, confirming the bipolar spectrum nature of his disorder. This case underscores the complexity of diagnosing "hidden bipolarity" in children, where irritability, anxiety, and subthreshold manic symptoms may obscure bipolar pathology. Although bipolar disorder was significantly overdiagnosed in prepubertal children in the past, B.'s case illustrates that rare peripubertal presentations can indeed manifest the phenomenological features described in the pediatric bipolar disorder literature.
This study aimed to evaluate the knowledge of the interdependence and mutual influence among components of the morphofunctional basic capability profile of follicular cells. In a 1-month experiment, 4 groups of male albino rats were involved: Group 1 (control)-in conditions of a standard vivarium diet; Group 2-in conditions of an iodine deficiency; Group 3-in conditions of a potentiated iodine deficiency; and Group 4-in conditions of hyperthyroidism. The shape of the cells, the contour and condition of their lateral membranes, the shape of the nuclei, the contour of the karyolemmata, and the condition of the central and marginal chromatin were analyzed using electron micrographs. The author's methods were applied. Additionally, a Pearson correlation analysis and the process of creating graphic correlation portraits were employed. The main significance of the normal functioning of follicular cells is played by associations of unaltered lateral membranes, oval nuclei, and fine-grained central and narrow, unfragmented, highly dense marginal chromatin with other components of the profile. The following associations support the functioning of follicular cells under unfavorable conditions: (1) in the case of iodine deficiency-cuboidal and prismatic cells, fine-grained and sparse central chromatin, and narrow and wide marginal chromatin with other components of the profile; (2) in potentiated iodine deficiency-highly wavy karyolemmata, fine-grained and sparse central chromatin, and narrow marginal chromatin with other components of the profile; and (3) in hyperthyroidism-cylindrical nuclei and dense central chromatin with other components of the profile. An analysis of the correlation portraits of the morphofunctional basic capability deepens our understanding of the characteristics of interrelationships and interdependencies between follicular cell components under euthyroidism, hypothyroidism, and hyperthyroidism. When thyroid homeostasis is disturbed, the functioning of follicular cells occurs, taking changes in the primary functional balance, the formation of compensatory and adaptive mechanisms, and the attainment of a new state of functional balance into account.
This study aimed to investigate the association between adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and d-dimer (D-D) levels in pleural fluid, as well as to assess the diagnostic value of their combined detection in tuberculous pleurisy. A total of 255 patients admitted between July 2022 and July 2024 were included in the study and categorized into two groups: tuberculous pleural (TBP) group (148 cases, 57.6%) and nontuberculous pleural (non-TBP) group (107 cases, 42.4%). Correlation analysis was conducted on adenosine deaminase (ADA), Mycobacterium tuberculosis immunoglobulin G (MTB-IgG), and D-dimer (D-D) in tuberculosis patients. The diagnostic outcomes of these three biological indicators alone as well as in combination were compared by setting the lowest threshold of different biomarkers. The levels of ADA (60.78 +/- 27.58 U/L vs. 38 +/- 4.96 U/L) and D-D (6.18 +/- 5.38 mg/L vs. 1.29 +/- 0.69 mg/L) in TBP patients were found to be significantly elevated compared to non-TBP patients (P < 0.001). When the MTB-IgG test was positive, the diagnostic accuracy was as high as 77.4% in TBP patients, while non-TBP patients showed a low immune characteristic, and the MTB-IgG negative rate was as high as 80.4%. When combined with ADA + MTB-IgG (-), D-D + MTB-IgG (-), and ADA + D-D + MTB-IgG (-), the diagnostic accuracy of non-TBP patients can be significantly improved. The combined detection of pleural effusion ADA, D-D, and MTB-IgG can enhance the diagnostic accuracy of tuberculous pleurisy.
The aim of the present study was to analyze the reliability and evidence of convergent validity of self-rated single items for specific health assessments among adolescents. A crosssectional study was performed involving 650 Brazilian adolescents who answered a questionnaire containing 12 self-rated single items for specific health assessments. In addition, the respective measures of health were estimated using validated questionnaires or multi-item scales. The health measures were diet, physical activity, sedentary behavior, musculoskeletal symptoms, alcohol consumption, tobacco use, daytime sleepiness, duration of sleep, and mental health. The reliability of the single items was analyzed using a seven-day test-retest. The Kappa coefficient of agreement (k) and prevalence ratios (PR) obtained by Poisson regression were adopted. Self-report single items presented acceptable reliability (k = 0.50-0.78) and absolute agreement values varying from 80.6 to 88.9%. Self-rated diet was associated with consumption of salads, vegetables and greens (PR = 1.53 and 1.77) and any vegetable intake (PR = 1.30) (P < 0.05). Self-rated sedentary behavior was associated with TV and internet use on weekdays (PR = 1.17-1.73) and TV use (PR = 1.36-1.59) on the weekend, but the associations were dependent on the volume analyzed. Poor self-rated physical activity (PR = 1.44-4.16), alcohol consumption (PR = 2.04-2.45), tobacco use (PR = 1.54-1.56), sleep-related variables (PR = 1.28-1.81), musculoskeletal health (PR = 1.28-1.73), and mental health (PR = 1.51-3.43) were significantly and consistently associated with their respective health measure (P < 0.05), even when multiple outcomes were tested. The self-rated single items analyzed presented acceptable reliability and evidence of convergent validity. Although these single items do not substitute complete questionnaires, multi-item scales, or objective measures of health, they can be used as an additional tool for adolescent self-rated health assessments in different contexts.
Stage IV pelvic endometriosis poses significant surgical challenges. When umbilical access is deemed high-risk, alternative non-umbilical laparoscopic entry points may be considered. Currently, there is no consensus on the safest or most ideal alternative non-umbilical access site. We report a case of Stage IV pelvic endometriosis accompanied by severe pelvic pain, in which a novel right-sided, alternative non-umbilical laparoscopic entry was successfully employed. This approach was selected due to the presence of retro-umbilical adhesions, a large left-sided ovarian endometrioma, a tubo-ovarian mass, and left-sided hydrosalpinx. The surgical technique and postoperative recovery are detailed, demonstrating favorable outcomes. In selected cases of Stage IV pelvic endometriosis, particularly those with left-sided adnexal pathology, the right-sided "Darwish point" may offer a relatively safe and effective non-umbilical alternative for laparoscopic access. Further studies are needed to validate its safety and efficacy before this entry site can be recommended.
Chronic illnesses, such as diabetes and chronic kidney disease (CKD), impose a substantial global burden, affecting hundreds of millions of people and straining healthcare systems. Managing these conditions involves not only physical challenges but also considerable psychosocial distress. Patients with complex treatment regimens-frequent medical appointments, dietary restrictions, and potential complications-often experience depression, anxiety, and reduced quality of life, all of which can impede treatment adherence and worsen clinical outcomes. Research, including meta-analyses in dialysis and diabetes populations, indicates that psychosocial interventions and integrated mental health support can improve quality of life, glycaemic control, and emotional well-being. Despite the clear value of mental health integration, current in-person care models face significant limitations. Scarcity of trained mental-health professionals, geographical barriers, financial constraints, and social stigma frequently preclude timely psychosocial support. Consequently, many patients with chronic conditions receive inadequate mental-health care, compromising overall treatment success. This perspective outlines how a digital mental-health triage solution-supported by platforms like My-E-Health-could leverage artificial intelligence (AI). By embedding routine assessments, such as the Empowerment for Participation (EFP) mini, into chronic-disease management, patients can be screened more frequently for emotional distress. AI algorithms would then stratify patients into low-, moderate-, or high-risk categories and deliver tailored interventions. Moderate-risk patients could receive AI-guided coaching and self-management tools, while high-risk patients would be promptly linked to clinicians for intensive therapy. This approach optimises resource allocation, directing professional attention to the most vulnerable patients. Integrating AI-driven digital platforms- including telehealth portals and culturally sensitive, multilingual interfaces-may enable real-time monitoring, early intervention, and sustained patient engagement. Recent studies suggest that expanding telehealth options can reduce access barriers and stigma, encouraging patients to seek help. Further investigations-particularly longitudinal studies-are warranted to confirm sustained clinical benefits, cost-effectiveness, and scalability across diverse healthcare contexts. With continued improvements in AI-driven screening tools and patient-centred design, a well-implemented digital mental-health triage solution could make chronic disease care more holistic, sustainable, and effective.
Objectives: To determine the validity of the non-invasive, novel procedure of partial urethral obstruction in adult male rats to induce bladder outlet obstruction (BOO), this study investigated the reproducibility of non-surgical induction of partial urethral obstruction to induce BOO. Effects in the rat model were compared to those of an overactive bladder (OAB) in real-world adult human males. Previous reports of BOO induction in male rats applied an invasive technique through abdominal incision and dissection of the pelvic urethra, which deviates from real-world events of BOO in men. Method: Sixteen adult male Sprague-Dawley rats (16 weeks old, 340 +/- 10 g) were randomly divided into three groups: Bladder outlet obstruction group (n = 8), sham group (n = 4), and control group (n = 4). Eight rats underwent induction of BOO with the novel technique. At 8 weeks, the bladders of BOO, sham, and control groups were taken and examined histopathologically. The human study included tissue samples from three patients who had OAB secondary to neurogenic bladder dysfunction and had undergone surgical closure of vesicostomy with excision of the vesicostomy tract; tissue samples were examined histopathologically. Induction of BOO in adult male rats used a non-invasive technique that induces partial urethral occlusion via approaching the urethra at the root of the penis. The subsequent morphological and histological patterns of the male rat BOO were compared to patterns of human OAB. Results: All rats survived, were active, and had no complications. Histological examination of tissue samples of the bladder wall with hematoxylin & eosin and Masson's trichrome stains showed thinner urothelium and condensation of collagen between muscle bundles. Human tissue samples showed similar cytoskeleton events. Conclusions: The non-invasive technique to induce BOO in male rats proved to be safe, reproducible, and led to no complications. An increased collagen/smooth muscle ratio in the rat model was similar to that in humans. The results showed that the non-invasive procedure of BOO induction in male rats leads to identical cytoskeleton changes as in human OAB. The results indicate that this model could aid in understanding human male BOO and could be used for experimental studies of BOO in adult men.
Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder caused by pathogenic or likely pathogenic variants in genes encoding the transforming growth factor beta (TGF-(R)) pathway components. The disease was originally characterized by a typical symptomatologic triad: Bifid uvula or cleft palate, hypertelorism and aortic aneurysm with tortuosity. However, the clinical manifestations are very varied, including vascular findings (cerebral, thoracic, and abdominal arterial aneurysms and/or dissections), skeletal manifestations (pectus excavatum or pectus carinatum, scoliosis, joint laxity, arachnodactyly, talipes equinovarus, and cervical spine malformation and/or instability), craniofacial features (hypertelorism, strabismus, bifid uvula/cleft palate, and craniosynostosis that can involve any sutures), and cutaneous findings (velvety and translucent skin, easy bruising, and dystrophic scars). Neurological involvement is very uncommon in LDS, although it has been reported that serial cases with 1q41 deletion encompassing TGF-(R) 2 ligand (TGFB2) are linked to neurodevelopment abnormalities. The association between LDS or 1q41 deletion and paroxysmal tonic downward gaze (PDT) has never been described in the literature. Here, we describe the case of a 4-month-old male with LDS type 4 caused by 1q41 deletion involving TGFB2 who has neurodevelopment abnormalities and paroxysmal ocular motor events (OPEs). Thanks to polygraphic video-EEG monitoring, such ocular paroxysms are classified as "paroxysmal tonic downward gaze" (PTD), a type of nonepileptic OPE. PTD has been described in most newborns as a benign phenomenon related to an immaturity of the extrageniculocalcarine visual pathway, so more often it concerns healthy and neurologically negative newborns, although associations with central nervous system pathology have been described. This is the first report of LDS with PDT as a novel clinical finding of the compatible syndrome.
Vaccine co-administration is safe and convenient, and it is recommended for ensuring timely age-appropriate vaccinations and offering the best protection against vaccine-preventable infectious diseases both to the pediatric and to the adult population. The purpose of this study is to assess the compliance of the vaccination services of a 500000-inhabitant local health agency of the Northeast of Italy with such a recommendation and the value of co-administrations. This was a population-based analysis of an anonymous vaccination database containing complete information on all the vaccines administered in 2023 to the population of the study area. The frequency and types of vaccine coadministration were assessed and the advantage in terms of healthcare-time spare was estimated. Coadministration regarded 18% of the 27922 persons vaccinated in 2023. Co-administration was routine in the pediatric age, where it showed 3 peaks at 0-2, 5-6, and 12-14 years. It was less common among adults, with a peak at age 65. Frequent patterns of vaccine co-administration were identified. In one year, co-administration resulted in a spare of 450 working days for both physicians and vaccination nurses and a time spare double than that could be obtained if co-administration was practiced whenever possible. Co-administration is an efficient strategy to provide timely protection to population groups at risk for infectious diseases and to reduce the use of healthcare resources.
Introduction and Objectives: Fluorine-18 fluorodeoxyglucose (18F-FDG) is used to stage various malignancies, with approximately 30% of non-metabolized 18F-FDG being excreted through urine. Patients are advised to drink 500 mL-1 L of water to increase urine production so that they can empty their bladder whilst still at the facility to reduce the radiation dose to the bladder wall; this makes their urine radioactive. This study aims to assess the radiation dose rates from a toilet at a positron emission tomography/computed tomography (PET/CT) center. Methods: Radiation dose measurements were conducted using a portable digital rate meter (6150AD-6 Automess) with a measuring range of 1 mu Sv/h to 10 mSv/h (energy range 60 keV to 1.2 MeV). The measurements were carried out over a 5-day period. The background radiation was recorded between 8:00-8:30 am. Dose rate measurements were taken daily at 9 am at several places in the toilet: on the seat, on the cistern lid, and approximately 1 m to the left and right of the chamber. Additional daily measurements carried out at 10 am, 11 am, and 12 pm. The annual cumulative dose was estimated based on a five-day working week for 42 working weeks, 8 hours per day. Results: The measured weekly dose rate from the toilet was 14.40 +/- 0.020 mu Sv/h. The approximate annual dose over 42 working weeks was 0.63 +/- 0.001 mSv/year. Conclusions: The estimated annual radiation dose from the toilet (0.63 mSv/year) is well below the recommended dose limits for members of the public (1 mSv/year) and radiation workers (20 mSv/year) by the International Commission on Radiological Protection (ICRP). Therefore, there is no significant concern regarding an exposure from patient urine in this setting.
Objective To investigate the clinical characteristics and risk factors for coronary artery lesion (CAL) in Kawasaki disease (KD) through a comprehensive analysis of 418 pediatric cases, thereby enhancing the diagnostic and therapeutic approaches for this condition. Methods We conducted a retrospective analysis of 418 children diagnosed with KD and hospitalized between January 2017 and January 2024. Data on clinical manifestations, laboratory findings, echocardiography results, and treatment outcomes were systematically reviewed. Results Among the 418 KD patients, the male-to-female ratio was 2.07:1 (276 males, 66.03%; 142 females, 33.97%), with 84.92% (355/418) under 5 years of age. The cohort included 292 cases (69.86%) of typical KD and 126 cases (30.14%) of incomplete KD. Coronary artery lesions were identified in 11.72% (49/418) of patients, with significantly higher incidence in the incomplete KD group [23.02% (29/126)] compared to the typical KD group [6.85% (20/292); chi(2) = 16.00, P < 0.001]. Subgroup analysis revealed that infants < 1 year old had a higher CAL rate [24.72% (22/89)] than 1-5-year-olds [9.40% (25/266); chi(2) = 11.95, P < 0.001]. Regarding treatment timing, the CAL incidence was significantly lower in patients receiving intravenous IVIG within 7 days of fever onset [6.74% (18/267)] compared to those treated at 7-10 days [20.53% (31/151); chi(2) = 16.53, P < 0.001]. Conclusions Kawasaki disease primarily affects infants, with children under 1 year at higher risk for coronary artery lesions. Incomplete cases often present with atypical symptoms, requiring prompt diagnosis through imaging and lab tests. Early Intravenous immunoglobulin (IVIG) (2 g/kg) combined with aspirin within 7 days of onset significantly reduces coronary complications (6.74% vs. 20.53% with delayed treatment). Glucocorticoids are reserved for severe or IVIG-resistant cases. Immediate treatment initiation, regular echocardiography monitoring (using Z-score), and anticoagulation for high-risk patients are essential. Long-term follow-up is mandatory, with lifetime management for coronary abnormalities. The key strategy involves early recognition, standardized treatment within 10 days (optimally 7 days), and systematic follow-up to improve outcomes.
