Correct Management Research Articles

Intramedullary sclerosing meningioma: operative video.

Sclerosing meningiomas (SMs) represent a rare histological variant of meningiomas, first described in 1989 as invasive bulking masses of whorling collagen bundles with a minimum percentage of meningothelia-resembling cells, and they are often misdiagnosed. The literature reports only 30 cases of SMs, with only two of them being intramedullary. The authors present the case of a patient with a cervical intramedullary SM who presented with gait disturbances, sensory deficits, weakness in four extremities, and hyperreflexia. The surgery was performed under neurophysiological monitoring and after administration of sodium fluorescein, which allowed us to discriminate the exact myelotomy point. Intramedullary SMs are very rare entities whose correct management may result in a good outcome.

Overview of the Genetic Aspects of Lynch Syndrome

"Lynch syndrome (LS) is one of the most common inherited cancer predisposition syndromes and the most important cause of hereditary colorectal and endometrial cancers. It is inherited in an autosomal dominant pattern, caused by a pathogenic germline variant in one of the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, or PMS2), which encode proteins responsible for maintaining genome stability. A defective MMR system confers an elevated risk of developing certain types of cancer, at a younger age than in the general population and at a high rate of multiple primary neoplasia. Lynch syndrome is not just one disease, but a collection of different subtypes of underlying molecular aspects with specific clinical implications. A better understanding of these subgroup profiles could offer better care for each patient, leading to more personalized risk-reduction and surveillance strategies. Lynch syndrome is a frequent but yet underdiagnosed condition that needs multidisciplinary increased awareness for correct diagnosis and management. The aim of this review is to provide a summary of available literature data on the genetic aspects of Lynch syndrome together with geno-type-phenotype correlations and its clinical implications in the detection, genetic counseling, genetic testing, risk stratification, and management of this condition."

Hemostasis disorders in intensive care unit in Assiut University Hospital: a prospective study

Abstracts Hemostasis disorders either bleeding or thrombosis that occur in intensive care unit (ICU) are common multifactorial problems that affect morbidity and mortality. Prompt identification and correct management improve ICU patient’s outcome. The aim of this study is to assess the incidence of hemostasis disorders among ICU patients and to establish a relationship between hemostasis disorders and outcome of ICU patients. A total of 350 patients were admitted to ICU during the study period. Hundred were excluded secondary to having one or more exclusion criterion; liver diseases (n=33), receiving anticoagulant agents (n=23), bleeding or coagulation disorders at time of admission (n=17), atrial fibrillation (n=12), nephrotic syndrome (n=8), inherited coagulation defects (n=7) and 10 patients were excluded due to incomplete data. A total of 240 patients were recruited in the study analysis. Eighty (33.3%) patients developed different form of hemostatic disorders during their hospital stay within ICU while 160 (66.7%) patients did not develop hemostatic disorders. On admission patients with hemostasis disorder had significantly longer INR (1.10 ± 0.19 vs. 1.05 ± 0.09, P=0.03) and D-dimer (2.32 ± 0.97 vs. 0.55 ± 0.28, P<0.001) with lower fibrinogen level (77.56 ± 9.89 vs. 134.56 ± 10.98, P<0.001). The most frequent form of hemostasis was thrombocytopenia (55%) with mean platelets count (90.87 ± 10.19 × 109/l) followed by pulmonary embolism (16.2%) and DIC (13.7%) with mean D-dimer (2.87 ± 1.11). There were another three patients were found to had thrombasthenia. Four patients developed DVT, three patients were diagnosed as Churg-Strauss syndrome, and two patients had acute limb ischemia. Causes of thrombocytopenia were HIT (4.5%), sepsis (70.5%) and drug-induced (25%). Patients with hemostasis disorders had significantly longer hospital stay (13.12 ± 5.76 vs. 7.01 ± 1.43 (days); P<0.001) while patients without hemostasis disorders had significantly higher overall survival (19.25 (16.69–21.82) vs. 8.55 (8.11–8.98) days; P<0.001) in comparison to those with hemostasis disorders.,In Conclusion, critically ill patients are vulnerable to develop different forms of hemostatic disorders that may seriously affect the outcome. ClinicalTrials.gov Identifier: NCT04179357

High-levels of toxic elements and radioactivity in an abandoned sulphur mine: Insights on the origin and associated environmental concerns

Natural fibrous epsomite crystals containing high amounts of toxic and radioactive elements have recently been discovered in the abandoned sulphur mine of Perticara (Italy). In the present study, all the different matrices that characterize the Perticara mine (air, water, host-rock, minerals, and bitumen) were sampled and investigated employing a multi-analytical approach to define the distribution and origin of these hazardous elements. Water samples showed high Al, Fe, Pb, Mg, and Mn content but not radioactive elements. The bitumen sample showed a higher amount of 210Po and 210Pb (0.12 Bq/g and 0.11 Bq/g, respectively), compared to the host-rock and fibrous sericolite samples, but lower than fibrous epsomite crystals (210Po 5.59 Bq/g; 210Pb 5.93 Bq/g). A high 222Rn concentration was also detected in the tunnels and it is likely the source of both 210Po and 210Pb, which are in radioactive equilibrium, especially in epsomite. This latter mineral, being capable of capturing 210Po and 210Pb, can be used as a helpful mineral indicator for the presence of radioactive elements in similar environmental conditions. Moreover, our results also highlight a slight anomaly in the 40K and 226Ra content of the host-rock, probably derived from the evaporitic sediments of the rock succession. The current risk for humans linked to the mine environment is minor since the activity of the mine ended several decades ago. However, the results of this study must be taken into serious consideration for any future development of this area (e.g., industrial archaeology, farming, educational, scientific and touristic purposes), and represent the basis for the calculation of radiotoxicity and dose assessment, which is fundamental for the correct and safe management of the mining environment and neighbouring areas.

A broad-based probe-free qPCR assay for detection and discrimination of three human herpes viruses

Primary infection or reactivation of latent human cytomegalovirus (HCMV) or herpes simplex viruses (HSV) 1 or 2 during pregnancy can transmit the virus in utero or during natural childbirth to the fetus. The majority of these infections are asymptomatic at birth but may present later with potentially lethal disseminated infection or meningitis (HSV), or long-term neurodevelopmental sequelae including sensorineural hearing loss or neurodevelopmental impairments (HCMV). Unfortunately, early signs and symptoms of disseminated viral infections may be misdiagnosed as bacterial sepsis. Therefore, immediate testing for viral etiologies may not be ordered or even considered by skilled clinicians. In asymptomatic HCMV infections, early detection is necessary to monitor for and treat future neurologic sequelae. In acutely ill-appearing infants, specific detection of viruses against other disease-causing agents is vital to inform correct patient management, including early administration of the correct antimicrobial(s). An ideal test should be rapid, inexpensive, require low sample volumes, and demonstrate efficacy in multiple tissue matrices to aid in timely clinical decision-making for neonatal infections. This work discusses the development of a rapid probe-free qPCR assay for HSV and HCMV that enables early and specific detection of these viruses in neonates. The assay’s probe free chemistry would allow easier extension to a broad-based multiplexed pathogenic panel as compared to assays utilizing sequence-specific probes or nested PCR.

Pengaruh Smartphone Addiction Terhadap Bedtime Procrastination Taruna Poltekip Angkatan 56 Prodi Manajemen Pemasyarakatan

The general public must continually be informed of technological developments, such as the use of smartphones, also referred to as "smarphones," in order to be able to complete this role. Large-scale touchscreen cellphones have already been adopted by several countries throughout the world. Additionally, this phenomena was noticed by Cadets from the Polytechnic for Criminal Justice, notably Class 56 for the Correctional Management Study Program. However, there may be certain drawbacks to utilizing a smartphone. The taruna's most obvious practical effect, which resulted in time-wasting tiredness, was a brilliant addiction phone, The researcher did research to comprehend the relationship between the smartphone's kecanduan and the prokrastination of sleep time in the 56th program study of management of the POLTEKIP. This study employs quantitative methods to assess the effects of the independent and dependent variables. The study sample consists of 31 cadets from batch 56 of the POLTEKIP Correctional Management Study Program. The distribution of surveys through Google Forms was done using the random sample data collection technique. Because of the strong association between the variables X and Y revealed by the study's findings, the alternate hypothesis (Ha) was accepted and the null hypothesis was rejected. The study also reveals a weak relationship between procrastinating before bed and smartphone addiction.

Comparison of humans versus mobile phone-powered artificial intelligence for the diagnosis and management of pigmented skin cancer in secondary care: a multicentre, prospective, diagnostic, clinical trial

Diagnosis of skin cancer requires medical expertise, which is scarce. Mobile phone-powered artificial intelligence (AI) could aid diagnosis, but it is unclear how this technology performs in a clinical scenario. Our primary aim was to test in the clinic whether there was equivalence between AI algorithms and clinicians for the diagnosis and management of pigmented skin lesions. In this multicentre, prospective, diagnostic, clinical trial, we included specialist and novice clinicians and patients from two tertiary referral centres in Australia and Austria. Specialists had a specialist medical qualification related to diagnosing and managing pigmented skin lesions, whereas novices were dermatology junior doctors or registrars in trainee positions who had experience in examining and managing these lesions. Eligible patients were aged 18-99 years and had a modified Fitzpatrick I-III skin type; those in the diagnostic trial were undergoing routine excision or biopsy of one or more suspicious pigmented skin lesions bigger than 3 mm in the longest diameter, and those in the management trial had baseline total-body photographs taken within 1-4 years. We used two mobile phone-powered AI instruments incorporating a simple optical attachment: a new 7-class AI algorithm and the International Skin Imaging Collaboration (ISIC) AI algorithm, which was previously tested in a large online reader study. The reference standard for excised lesions in the diagnostic trial was histopathological examination; in the management trial, the reference standard was a descending hierarchy based on histopathological examination, comparison of baseline total-body photographs, digital monitoring, and telediagnosis. The main outcome of this study was to compare the accuracy of expert and novice diagnostic and management decisions with the two AI instruments. Possible decisions in the management trial were dismissal, biopsy, or 3-month monitoring. Decisions to monitor were considered equivalent to dismissal (scenario A) or biopsy of malignant lesions (scenario B). The trial was registered at the Australian New Zealand Clinical Trials Registry ACTRN12620000695909 (Universal trial number U1111-1251-8995). The diagnostic study included 172 suspicious pigmented lesions (84 malignant) from 124 patients and the management study included 5696 pigmented lesions (18 malignant) from the whole body of 66 high-risk patients. The diagnoses of the 7-class AI algorithm were equivalent to the specialists' diagnoses (absolute accuracy difference 1·2% [95% CI -6·9 to 9·2]) and significantly superior to the novices' ones (21·5% [13·1 to 30·0]). The diagnoses of the ISIC AI algorithm were significantly inferior to the specialists' diagnoses (-11·6% [-20·3 to -3·0]) but significantly superior to the novices' ones (8·7% [-0·5 to 18·0]). The best 7-class management AI was significantly inferior to specialists' management (absolute accuracy difference in correct management decision -0·5% [95% CI -0·7 to -0·2] in scenario A and -0·4% [-0·8 to -0·05] in scenario B). Compared with the novices' management, the 7-class management AI was significantly inferior (-0·4% [-0·6 to -0·2]) in scenario A but significantly superior (0·4% [0·0 to 0·9]) in scenario B. The mobile phone-powered AI technology is simple, practical, and accurate for the diagnosis of suspicious pigmented skin cancer in patients presenting to a specialist setting, although its usage for management decisions requires more careful execution. An AI algorithm that was superior in experimental studies was significantly inferior to specialists in a real-world scenario, suggesting that caution is needed when extrapolating results of experimental studies to clinical practice. MetaOptima Technology.

Does ownership impact perception of reptile cognitive abilities and welfare needs?

An increase in reptile-ownership has resulted in a parallel rise in welfare-related problems. Reptiles have been considered suitable pets for beginners due to the misconception that they are low-maintenance and behaviourally simple animals. However, there is increasing recognition that reptiles are cognitively complex, and due to their ectothermic nature, have diverse species-specific requirements that must be met in captivity. Therefore, it is possible that the welfare problems experienced by many reptiles are associated with how their cognitive abilities and welfare needs are perceived by their owners. Equally, the experience of pet ownership can itself alter perception of a species. This study therefore investigated what the general public understands about reptile cognitive abilities (e.g. learning, memory retention) and their welfare needs (e.g. environmental requirements), and to identify any differences between the opinions of reptile owners and non-owners. Data were collected using an online questionnaire; we obtained the opinion of 734 participants, of these 334 were reptile owners and 400 non-owners. Results showed that, compared to non-owners, reptile owners assigned higher scores to reptile cognitive abilities and were also more informed about the welfare needs of captive reptiles. Our findings suggest that pet reptiles are considered to be cognitively complex and sentient creatures, particularly by reptile owners; therefore, the poor conditions experienced by some pet reptiles in captivity may be due to a lack of knowledge of the correct management practices necessary in order to meet their needs, rather than a low perception of their capabilities.

2 x 6 appliance a versatile option for treatment of malocclusion in early permanent dentition

Children in growing age develop dental malocclusion due to transition and exchange of dentition, oral habits or discrepancy in tooth size and arch size. If timely treatment is not performed it may progress to full fledged malocclusion that may require much time-consuming treatment and also correlation of trauma prone profile like class II div I or class II div II can even be beneficial in prevention of trauma. Early correction also reduces the psychological trauma associated with malocclusion. This Versatile 2x6 fixed appliance appliance offers many advantages over alternative techniques as it provides complete control of anterior tooth position, is extremely well tolerated, ease the space closure by precise tooth movement with shorter duration of correction, reduces the patient compliance, and less laboratory work makes it a acceptable treatment option in growing child. In the case report mentioned here a successful management of correction of class I malocclusion with maxillary anterior proclination was done during early permanent dentition using 2 x 6 appliance.

RENURE – PROCESSED NATURAL FERTILIZERS. SELECTED ENVIRONMENTAL, PRODUCTION-ECONOMIC ISSUES

The aim of the paper is to present the essence of natural fertilizers in the form of RENURE, taking into account environmental and production-economic issues. For several decades, international programs and strategies for sustainable development have been implemented. The need to achieve various objectives in business activity is also underlined by the European Green Deal strategy, introduced at the end of 2019. An important element of it is the correct management of natural fertilizers, both for environmental and production and economic reasons. The case of the Netherlands was presented, where pilot studies on the conversion of manure into RENURE were introduced. The study used literature sources and selected, recent statistics from Eurostat resources (2019, 2020). Agriculture in EU countries in the context of production and possibilities of using natural fertilizers is illustrated. Analysis of statistical data has shown that agriculture in the EU is highly diversified in terms of manure management. The case of the Netherlands, which has implemented the RENURE pilot program, results from the specificity of their agriculture – a small area of the country, a very high population and a high stocking density of livestock. Countries that face similar agricultural challenges as the Netherlands can seek similar solutions. In the case of Polish, which differs significantly in terms of the organisation of agriculture and its natural management conditions, the economic and environmental justification for the introduction of RENURE is not justified on a sector-wide scale.

Traumatic Pseudoaneurysm Thoracic Aorta Artery

Thoracic aortic trauma is a frequent injury in patients with closed chest trauma and polytrauma in general; its association with injuries in other territories adds an important morbimortality. A multislice axial tomography with intravenous contrast should be performed in patients suspected of this lesion. The correct management and treatment of this lesion constitutes an emergency. Endovascular treatment is considered a valid option in these cases. Some lesions may be susceptible to medicalconservative treatment.

Edaphosphere: A Perspective of Soil Inside the Biosphere

The integration of soil into ecology in the current climate crisis is essential for correct environmental management. Soil is a part of ecosystems; above all, it is a component of the biosphere. It is necessary to establish a definition of soil that integrates biota and biodiversity without losing sight of the historical development of edaphology, the science that studies soil. In this opinion article, we proposes a definition for all soils grouped together in the edaphosphere, which is, in fact, a subsystem of the biosphere. In addition, we highlight the importance of the definition of soil provided by Vasily Dokuchaev, the founder of edaphology, with respect to the integration of soil into the biosphere and the differences between the concepts of pedosphere and edaphosphere.

Geophysical Constraints to Reconstructing the Geometry of a Shallow Groundwater Body in Caronia (Sicily)

The characterization of a groundwater body involves the construction of a conceptual model that constitutes the base knowledge for monitoring programs, hydrogeological risk assessment, and correct management of water resources. In particular, a detailed geological and geophysical approach was applied to define the alluvial Caronia Groundwater Body (CGWB) and to reconstruct a hydrogeological flow model. The analysis of the CGWB, located in north-eastern Sicily, was initially approached through a reanalysis of previous stratigraphic (boreholes) and geophysical (vertical electrical soundings and seismic refraction profiles) data, subsequently integrated by new seismic acquisitions, such as Multichannel Analysis of Surface Waves (MASW) and horizontal-to-vertical seismic ratio (HVSR). The analysis and reinterpretation of geoelectrical data allowed the construction of a preliminary 3D resistivity model. This initial modeling was subsequently integrated by a geophysical data campaign in order to define the depth of the bottom of the shallow CGWB and the thickness of alluvial deposits. Finally, a preliminary mathematical model flow was generated in order to reconstruct the dynamics of underground water. The results show that integration of multidisciplinary data represent an indispensable tool for the characterization of complex physical systems.

A case of hemorrhagic shock due to massive upper gastrointestinal bleeding: from the differential diagnosis to the correct management

Upper Gastro-Intestinal Bleeding (UGIB) spans from minor bleeding to life-threatening events. Identification of early signs of shock, proper management of hemodynamically unstable patients, and correct risk stratification are essential for an appropriate diagnostic workup and therapy. This case reports a young man admitted to the emergency department with haematemesis. His medical history was unremarkable, without any risk factors for gastrointestinal bleeding. A few hours after admission, further episodes of haematemesis occurred, and the patient's condition rapidly deteriorated to irreversible shock. A contrast-enhanced computed tomography (CECT) revealed morphological features of chronic liver disease and oesophagal varices. The patient underwent upper gastrointestinal endoscopy, confirming oesophagal varices with massive bleeding. Although promptly applied, endoscopic hemostasis was ineffective, and the patient died twenty-four hours after admission. Based on this case, we reviewed the diagnostic and therapeutic approaches for patients with massive UGIB and provided a practical approach to this life-threatening emergency.

THE SOIL AT SITE LARANJEIRAS/QUIPAPÁ - PE, EXTREMELY DEGRADED

Sítio Laranjeiras, is part of the municipality of Quipapá PE, in this place, many years ago farmers explored the region, devastated the local forests, destroyed most of the native vegetation, today what remains of vegetation in this place is just a small forest, the farmers in that region were mostly people, people who didn’t even have elementary school, some knew how to write only their name, others not even that. Currently the correct management of the soil is studied by numerous scientists and scholars in the area of sustainability, these scholars and the like see every day more acting for a correct use of the soil. Looking for ways to plant and not cause so much erosion. Due to lack of important knowledge, the farmers in the studied area practically destroyed the soil, currently there are no more cassava crops and others that before were quite common in the place.

Knowledge About Medical Waste Management: How do Healthcare Professionals Learn and Practice?

The management and disposal of medical waste follow scientific protocols to ensure safety. However, the effective implementation of the medical waste management system depended on correct handling and segregation by the healthcare workers, during their daily activities. These professionals need to know about health waste management, since incorrect handling and disposal pose a potential risk to the environment and human health. This study aimed to analyze the knowledge regarding the management of medical waste of the healthcare teams working in the Family Health Strategy (FHS). Designed to provide preventive and basic healthcare using multidisciplinary professional teams, the FHS reflects many best practices. The research was carried out in a city that is the 3rd economy in southern Brazil. This was a cross-sectional descriptive study with a quantitative approach, and data were assessed by using self-administered and pretested questionnaire. The study sample consisted of 74 participants, including doctors, nurses, and nursing technicians. Descriptive statistics were carried out to express participants’ demographic information, mean knowledge score, and the teaching strategies used with the team. The main research results show that the healthcare teams working in the Family Health Strategy have, in part, knowledge about the correct management of waste. Besides, they are sensitive, in general, to its impact on the environment. Nevertheless, the results highlighted that more practical training would be needed, to help healthcare workers with everyday doubts. Furthermore, the results show that it requires attention to rethinking the strategies used to train and develop knowledge and skills in health services.

Selective IgM Deficiency: Evidence, Controversies, and Gaps.

Selective Immunoglobulin M deficiency (SIgMD) has been recently included in the inborn errors of immunity (IEI) classification by the International Union of Immunological Societies Expert Committee. The understanding of SIgMD is still extremely limited, especially so in cases of SIgMD in the pediatric population. The epidemiology of SIgMD in the pediatric population is still unknown. The pathogenesis of SIgMD remains elusive, and thus far no genetic nor molecular basis has been clearly established as a definitive cause of this primary immunodeficiency. Recurrent respiratory infections represent the main clinical manifestations in children, followed by allergic and autoimmune diseases. No conclusive data on the correct therapeutic management of SIgMD are available. Although, for most SIgMD patients, Ig replacement therapy is not required, it may be recommended for patients with significantly associated antibody deficiency and recurrent or severe infections. Prophylactic antibiotics and the prompt treatment of febrile illness are crucial. There is insufficient evidence on the prognosis of this condition. Therefore, further studies are required to define the disease trajectories and to increase our understanding of the molecular mechanisms underlying SIgMD in order to facilitate a better clinical, immunological, and prognostic characterization of the condition and develop tailored therapeutic management strategies.

Animals’ Logistics and Protection with a Focus on Slaughter Animals During Transport in Accordance with the Rules

Abstract This paper is devoted to the transport of slaughter animals. There are obstacles that needs to be pointed out, removed, and resolved. General requirements for the movement of slaughter animals within the Union have proven to be an unjustified administrative burden and costly. It also presents how important is to keep and follow all the rules provided by European Union to prevent any issues and keep the animals in good conditions and welfare during the transport. Bad conditions and not keeping the rules during animal transport can cause the stress of the animals and have a huge effect on their health. The stress can cause injuries and even a death of the animals that were healthy and had no signs of any sickness before the transfer. The main goal of the paper is to present the circumstances under which safe transport depends on choosing the correct logistical management, starting with the proper vehicles. Specific rules apply depending on the type and quantity of animals transported. The paper explains and summarizes the special establishment for road transport, including all mandatory actions, documents, and data centralisation (COMEX, TRACES, IMSOC).

INTRAHEPATIC BILIARY PROLIFERATIONS: HISTOPATHOLOGY AND POTENTIAL IMMUNOHISTOCHEMICAL MARKERS.

•Intrahepatic biliary proliferations represent a spectrum varying from reactive to malignant entities. •Clinical and imaging patterns may be similar, requiring histopathological and immunohistochemistry for precise diagnosis. Intrahepatic biliary proliferations represent a spectrum from reactive (ductular reaction, some with atypical architecture), hamartomatous (von Meyenburg complex), benign (bile duct adenoma) and precursor/borderline entities (biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct) to fully malignant (cholangiocarcinoma) neoplasms. Clinical pictures and even imaging patterns may be similar, requiring refined studies aiming at histopathological and immunohistochemistry for more precise diagnosis, essential for correct patient management. This article discusses updated concepts and definitions of most relevant entities aiming more specifically at the differential diagnosis in practice, focusing on morphology and immunohistochemistry, with a discussion of potential markers to help distinguishing between benign and malignant lesions.

Pseudohalitosis – More than a Complicated Multidisciplinary Case

Abstract Introduction Halitophobia is also known as false halitosis or psychosomatic halitosis. This pseudo-pathology originates from the somatization of the compulsive idea that the patient has bad breath in the absence of oral pathology. Case Presentation A patient addressed dental surgery complaining of a self-diagnosed halitosis. The dental consultation did not find any dental problem that could cause bad breath. She was referred to a general practitioner for further investigations to rule out a general condition. The investigations revealed a perfectly healthy person, without any chronic ailment that could cause bad breath. The patient refused to consult a psychologist or psychiatrist, considering that she does not have a mental health problem. Conclusions Patients with a suspicion of psychogenic halitosis require psychiatric counseling, and dentists have to be prepared with an efficient strategy for the correct management of these patients.