Case History Research Articles

Vibro stone column ground improvement practice in the United Kingdom

Vibro stone-column (VSC) techniques have been applied in the United Kingdom (UK) since the late 1950s–early 1960s, where they are one of the most commonly adopted ground improvement techniques. While there have been significant advances in VSC equipment development and also in the monitoring of the installation process for the VSC technique over the past 50 years, the design of VSC remains largely empirical and has changed very little since the 1970s. Publication of well-documented case histories and of instrumented field trials has also been limited over the past 25 years in the UK, in a VSC ground improvement market, which is predominantly commerce driven, based on the cheapest price. This has inherent implications for further advancement of design and innovation through funded full-scale field-based research. Current state-of-the-art of VSC in UK ground improvement is reviewed in the above context, together with comments on future challenges.

Comparison of Perinatal Outcome of Delta and Omicron Variant of COVID-19 Infection-A Retrospective Observational Study.

Background and Objectives: The aim of the present work was to compare the characteristics of delta and omicron variants of COVID-19 infection in pregnant women, the association of infection with comorbidity, clinical manifestation of the disease, type of delivery, and pregnancy outcome. Material and Methods: The study was designed as an observational, retrospective study of a single center. The analysis included the cohort of women who had SARS-CoV-2 infection during pregnancy and/or childbirth in the period from 1 March 2020 to 30 June 2023. Results: Out of a total of 675 pregnant women with SARS-CoV-2 infection, 130 gave birth with the delta and 253 with the omicron variant. In our retrospective analysis, pregnant women with both SARS-CoV-2 variants had a mild clinical history in most cases. In the omicron period, a significantly lower incidence of pregnancy loss (p < 0.01) and premature birth (p = 0.62) admission of mothers and newborns to the intensive care unit (p < 0.05) was recorded. Conclusions: In our retrospective analysis, pregnant women with COVID-19 infection generally exhibited a milder clinical manifestation with both variants (delta and omicron) of the viral infection. During the delta-dominant period, ten percent of affected pregnant women experienced a severe clinical history. However, during the omicron-dominant period infection, a significantly lower incidence of complications, pregnancy loss, preterm delivery, and admission of mothers and neonates to the intensive care unit was recorded. This can be partly explained by the greater presence of pregnant women with natural or induced vaccine immunity.

Hematologic malignancies in Li-Fraumeni syndrome.

10613 Background: Li-Fraumeni Syndrome (LFS) is a hereditary cancer predisposition syndrome caused by mutations in the tumor suppressor gene TP53. Since its discovery, a growing list of cancers have been described in association with LFS, predominantly solid tumors. However, hematologic malignancies (HMs) cumulatively account for 4-10% of cancer diagnoses in LFS. In this study, we present the largest series of HMs in families with LFS with detailed clinical courses. Methods: This was a two-center retrospective observational cohort study conducted at the University of Utah and the University of Wisconsin-Madison with IRB approval. Cancer genetics clinic registries were reviewed to identify all families with LFS who also had a confirmed diagnosis of a HM. To meet criteria for LFS, the patient had to have a confirmed germline pathologic or likely pathologic TP53 variant. Patients with a TP53 variant of unknown significance (VUS) were also included if they met classical LFS testing criteria. Data was gathered by manual chart review of both the families’ histories and electronic health records. Results: Among the 121 families identified with LFS, 35 (29%) families had one or more HM. Of these, 17 individuals from 16 families (13%) had confirmed germline TP53 mutations. The most frequent HMs found were acute lymphoblastic leukemia (ALL) (n=6), non-Hodgkin lymphoma (NHL) (n=5), myelodysplastic syndromes (MDS) (n=3), and chronic lymphocytic leukemia (CLL) (n=2). Acute myeloid leukemia (AML), Langerhans cell histiocytosis (LCH), and chronic myeloid leukemia (CML) were each diagnosed once. Most cases were identified in adulthood (n=12, 71%). Of the 19 total HMs, the minority (n=5, 26%) were diagnosed post-cytotoxic therapy and only six (35%) individuals had received a diagnosis of LFS prior to HM diagnosis. The MDS/AML cohort (n=4) all exhibited bi-allelic inactivation of TP53. Two of these four patients achieved long term survival after matched-unrelated donor (MUD) hematopoietic stem cell transplant (HSCT). All three patients who underwent MUD donor HSCT had immune-mediated adverse events. Conclusions: In this study we found a significantly higher incidence of HMs in LFS than previously described, with a predominance of lymphoid over myeloid malignancies. The majority of patients had excellent outcomes after standard of care therapy pointing towards more favorable outcomes for patients with LFS and HMs than previously reported. We also report several unusual immune-mediated adverse events in our patients indicating possible immunogenicity of some TP53 variants. Most patients did not have prior exposure to cytotoxic treatments and were diagnosed with the HM prior to their LFS diagnosis. We also show that 38% of individuals with an HM have multiple family members with an HM, consistent with a familial HM pattern. This underscores the importance of detailed family and personal histories in HM patients found to carry a somatic TP53 variant.

Is there a relationship between low back pain and ligamentum flavum hypertrophy?

A condition known as ligamentum flavum (LF) hypertrophy occurs when the ligamentum flavum (LF) swells as a result of pressures applied to the spine. Among the elderly population, lumbar spinal stenosis is a major cause of pain and disabilities. Numerous studies indicate that lumbar spinal stenosis etiology involves the ligamentum flavum in a major way. This study looks into the relationship between low back pain and ligamentum flavum thickening. The imaging tests and case histories of all patients with low back pain who had consecutive magnetic resonance imaging exams performed at the Prince Sattam University and King Khalid hospitals in Al Kharj City will serve as the basis for this retrospective observational study. A radiologist utilized the Pfirrmann grading system, which is based on spinal levels starting from the first lumbar to the first sacral vertebrae, to measure the thickness of the ligamentum flavum in all cases who underwent magnetic resonance imaging (MRI). A correlation between age, hypertrophy of LF, and low back pain was investigated. There were 79 participants in the study, ages ranging from 21 to 82, 49 of which were men. The patients' average age was 54 years, and 62% of them were men. We found no appreciable variations in LF thickness according to gender. At the L4-L5 and L5-S1 levels, the left LF was noticeably thicker than the right. Moreover, there was a significant difference (p < 0.05) in the bilateral LF thicknesses at L5-S1 compared to the comparable sides at L4-L5. By evaluating the thickness of LF on magnetic resonance images, we discovered that it may be closely associated with the etiology of pain processes in the spine.

Hipotiroidismo

Hypothyroidism is one of the most prevalent endocrine diseases in routine clinical practice. The most common etiology worldwide is iodine deficiency. In countries with sufficient iodine intake, it is Hashimoto's thyroiditis. In this sense, it is important to take an adequate case history and physical examination for a diagnosis, although confirmation is determined by biochemical analysis. The universal screening protocol consists of the initial TSH measurement and, in case of abnormal values, FT4 measurement. The normal limits for TSH are controversial and continue to be the subject of debate today. They have associated conditioning factors such as pregnancy or the normal limit in the older adult population. Replacement therapy is not always indicated, but when it is, oral levothyroxine is the treatment of choice.

"Anything of Note": Recovering "Lost Life" in the Psychoanalytic Archive

Abstract: This essay engages with the hitherto embargoed letters, drawings and case notes of Stella Coomber ("Susan"), the subject of Marion Milner's case history The Hands of the Living God . Using these documents as a starting point, I decode the identities of medical staff, institutions, and contacts whose names are disguised in Milner's book, and reconstruct some of Stella's life behind the scenes of, and after, Hands . The letters disclose her project of writing an autobiographical companion volume to Milner's, a project which was never realized. In later letters Stella is increasingly despondent about her failure to write this book, feeling that her life has been wasted, for she has not produced "anything of note." The essay suggests that there is a way of reading her "notes" as themselves both autobiography and counter case-history. I approach Stella's correspondence as a piece of life writing: not a traditional narrative, but one whose fragmentary form gives expression to her complex and exemplary experience.

Evaluation of a technology enhanced breast multidisciplinary cancer conference (MCC).

e23202 Background: Tumor board meetings have been a standard approach for managing complex cases. In 2020, a digital platform, navify® Tumor Board Solution (NTBS), was implemented at a comprehensive academic cancer center. The objectives of this study were to assess the impact of NTBS (1) on quality of patient information and case deliberation, (2) rate of change in care plans by the MCC, (3) compliance of care plans with national guidelines, and (4) concordance of treatment received with MCC recommendations. Methods: We conducted a prospective study from September 2020 to February 2022, before and after implementation of NTBS. We used a validated tool, “Metric for the Observation of Decision-Making", to assess the impact of the platform on the quality of breast MCC case presentation and discussion. We reviewed medical records to compare the rate of change in care plans, compliance with national guidelines, and concordance of treatment received with MCC recommendations. Results: There were 39 and 47 patient cases in the pre- and post-NTBS groups, respectively. We found that implementation of technology led to an improvement in the overall quality of the MCCs (mean composite scores: 56.4 vs 67.5; p &lt; .001). Specific components that were significantly improved include case history, reason for presentation, radiology and pathology presentations, and medical oncology contribution to case discussions (mean scores: 3.4 vs 3.9; p &lt; .001, 3.3 vs 3.9; p &lt; .001, 2.7 vs 4.1; p &lt; .001, 3.1 vs 4.2; p &lt; .001 &amp; 3.7 vs 4.1; p = .05). Pre- vs post-NTBS, rate of change in care plans decreased from 57.1% to 51.1%, compliance of MCC care plans with NCCN guidelines increased from 80.0% to 81.4%, and concordance of treatment received with MCC recommendations increased from 83.9% to 86.5%, though they were not statistically significant. Conclusions: Technology increases the quality of patient information presentation and case discussion at Breast MCCs, but in this small study we did not demonstrate an impact on MCC decision making. Areas for further development include assessment of improved efficiency of MCCs, opportunities for asynchronous MCC evaluation using this platform, establishment of automated case summaries, and technology-driven matching of detailed patient characteristics to established national guidelines.

A Case Report: Combination between Millard Technique and Paranasal Flap in Unilateral Cleft Lip and Palate

Background: Cleft lip and palate, are spaces or gaps in the alveolus, palate, or upper lip. They are the most common congenital anomaly of the orofacial region with etiologies rooted in genetic and environmental factors. As the result of these structural abnormalities, patients with cleft lip and palate have speech difficulties, feeding problems, reduced nasal airflow, and aesthetic issues. Patient with cleft lip and palate need to be treated at the appropriate time and age to achieve functional and aesthetic well-being. Case History: A 4-month-old male, born with cleft lip up the nostrils, upper gum and palate on left side, experienced feeding difficulties, came to DR. H. Moch Ansari Saleh Hospital Banjarmasin. The patient then underwent a modified Millard technique with paranasal flap. Conclusion: The modified Millard technique and paranasal flap can be considered a viable option for treating unilateral cleft lip as it provides good aesthetic results by minimizing lip scarring. Although primary nasoplasty remains controversial, primary nasoplasty during cleft lip repair gives good results with limited or no effect on nasal growth. When the patient reach 9-months old, another surgery to restore the palate was scheduled.

Resistance and Prevention: Rural local government and the fight against tuberculosis.

With Wales considered 'the blackest spot on the tuberculosis map' of Britain, the Welsh National Memorial Association (WNMA) was founded in 1910 with the aim to rid Wales of the disease within a generation. Although the Association's vision of a national health service was lauded by contemporaries as providing a model for England, as the WNMA took over the running of tuberculosis services from local authorities, it met with resistance from county and rural district councils. This essay explores this resistance. In placing the views and work of county and rural district councils at the centre of analysis this essay uses Wales and opposition to the WNMA as a case study to rethink the marginalization of county councils and rural district councils in histories of local government, public health, and housing policy in a pivotal period of central-location relations. As this essay shows, the opposition county and rural district councils expressed to the WNMA was not a straightforward rejection of centralization by authorities on the margins of 'the modern'. Rather, they put forward a competing vision of health and social welfare that championed local autonomy and a strategy of prevention focused on the material and domestic environment and housing reform. As the essay shows, opponents of the WNMA were not backwoodsmen. They were part of a wider national and progressive social reform movement.

Beyond the buzz: the fatal consequences of caffeine overconsumption.

Caffeine is a naturally occurring stimulant present in dozens of plant species including Coffea arabica and Camellia sinensis, from which we obtain coffee and tea, respectively. It is one of the world's most widely consumed psychoactive substances frequently used to increase alertness, elevate mood, and ward off fatigue. In traditional preparations, caffeine is generally well-tolerated by the consumer. However, complications can arise with the addition of caffeine to products like energy drinks, medications, and supplements. Furthermore, with pure caffeine accessible online, a consumer may unknowingly or inadvertently consume caffeine in dangerous amounts. Symptoms of caffeine toxicity include classic central nervous system stimulation side effects, such as agitation, insomnia, gastrointestinal distress, tachycardia, seizures, and death in extreme cases. To evaluate concentrations of toxicological significance, caffeine cases were assessed at a large reference laboratory (NMS Labs). From 2019 to 2023, 406 blood cases underwent confirmation testing via LC-MS-MS; the mean and median caffeine concentrations were 35 and 4.8 µg/mL, respectively. While most caffeine-containing cases indicate traditional use in the general population with concentrations <25 µg/mL (62%, N = 254), 10% (N = 42) of the cases were >100 µg/mL, indicating levels which may contribute to a fatal outcome. To gain insight into the significance of caffeine in determining the cause and manner of death, cases with various manners of death are presented. Despite being one of the most common toxicological findings in medicolegal death investigations, caffeine is often overlooked. Screening results should undergo scrutiny, and confirmation testing should be considered in cases where caffeine intoxication is prominently featured in the case history or scene investigation.

Management of compound odontoma associated with unerupted maxillary permanent incisors: A case report

Introduction: Odontomas, the most common odontogenic tumors, result from developmental abnormalities where epithelial and mesenchymal cells grow, forming functional ameloblasts and odontoblasts. Typically asymptomatic, they are often associated with unerupted or impacted teeth. Odontomas are categorized as complex or compound, based on their tissue composition and structure. The preferred treatment is conservative surgical excision, followed by histopathological analysis for confirmation. Case History: A 13-year-old female patient came to the Pedodontic Clinic at RSGM Airlangga University with the chief complaint of unerupted upper front teeth. Intraoral eximination revealed no facial asymmetry. Intraoral examination revealed the absence of maxillary right central and lateral incisors with an asymptomatic swelling and no inflammation of the overlying mucosa. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. Discussion: Odontomas are generally asymptomatic and associated with unerupted or impacted teeth or retention of primary teeth. Removal of obstructions like odontome results in a spontaneous eruption of the impacted tooth. Another method currently being undertaken involves surgically exposing unerupted teeth and placing bonded attachment along with ligatures/e-chains for orthodontic traction so that it will speedup eruption process. Conclusion: The odontoma must be removed so that it will not disrupt dental growth and development, especially tooth eruption.

Cautery excision of oral mucocele in pediatric children: A case report

Introduction: Oral mucocele is a common, oral lesions that mostly present as painless, clear, or bluish cysts on the lower lip of children and young adults. These are harmless, mucus-filled growths usually resulting from a little salivary gland or duct injury. Mucus can leak into surrounding subepithelial tissue when the salivary glands are injured by lip biting, sucking, or trauma. This is known as a mucus extravasation cyst, and it is the most frequent variety of mucoceles. This report presents two cases of mucocele. Case History: Two case studies of oral mucoceles reported that almost all included lip mucoceles were clinically bullous lesions, it was soft, fluctuant, and palpable, which corroborates the hypothesis that lip mucoceles are commonly incited by traumatic injury such as tooth impingement and lip-biting habit. All cases were treated with a simple excision using an electrocautery. Two lesion diagnosis was confirmed by Histopathology anatomy (HPA). Discussion: Mucoceles are common oral lesions often seen in children and adolescents, typically caused by lip biting due to psychological stress. Diagnosis is based on clinical features such as rapid appearance, size variations, and bluish color. Treatments include scalpel excision and electrocautery, with electrocautery providing minimal bleeding and painless wounds. Conclusion: One of the typical salivary gland lesions in the oral cavity is mucocele. The use of electrocautery is known to be beneficial for wound healing. Awareness education for children and parents is necessary to eliminate a lip-biting habit.

Frenectomy management for Ankyloglossia in a 1-Year-old patient under general anesthesia: A case report

Introduction: Ankyloglossia is defined as a congenital disorder that alters tongue mobility and function. It is listed as one of the possible reasons behind breastfeeding issues. The WHO currently recommends mothers to breastfeed exclusively up to 6 months of age, emphasizing the importance of promptly identifying any breastfeeding obstacles and determining the root cause of the problems as the primary focus. The purpose of writing this article is to describe a frenectomy as a surgical procedure that addresses ankyloglossia by excising the lingual frenulum with general anesthesia. Case History: A 1-year-old male patient presented at Dr. Saiful Anwar Regional General Hospital with complaints of difficulty in breastfeeding and consuming complementary foods, as well as prolonged pain experienced by the mother during breastfeeding. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. The patient was uncooperative (Frankl scale number 1). After analyzing the ankyloglossia, the choice of frenectomy with general anesthesia was chosen to treat this case. Discussion: Dental examinations and treatments for uncooperative 1-year-old children can be challenging in regular dental offices. Effective behavioral management, such as general anesthesia (GA), is required for safe and efficient treatment. GA involves a multidisciplinary team to oversee the procedure stages, allowing for one-visit treatment, reduced anxiety, and a safer, less painful dental experience. Conclusion: Frenectomy procedure under GA has been performed as an option to facilitate restorative therapy, improve nutritional intake, and quality of life.

Management of Avulsion tooth within golden period in young permanent tooth

Introduction: Tooth avulsion is described as a displacement of the tooth from its socket. It may occurs due to trauma and most often involves the maxillary teeth. Numerous studies have shown that this injury is one of the most serious dental injuries, so prompt and correct emergency management is essential for attaining the best outcome after this injury. Factors that determine healing after replantation are media storage, periodontal tissue damage, extra-alveolar period and intact alveolar socket. Case History: A 11-years-old male patient was referred from Puskesmas Perak to the Department of Paediatrics Dentistry at RSKGM-P Airlangga Surabaya with complaints that his upper tooth was off from its socket. The incident occurs after his head hit the table around 30 minutes ago. The patient had no history of systemic disease and didn’t have any allergic to food and medicine. The tooth was soaked on normal saline. Discussion: The optimal treatment option following an avulsion injury is to replant avulsed tooth at the earliest. Appropriate emergency management, significant treatment plans, and prompt action influence good prognosis in the management of an avulsion injury. In the past, it was advised to perform root canal therapy extra-orally before replantation. However, the current guidelines recommend root canal therapy be performed intra-orally to minimizes the extra-oral time. After the replantation, we continue to observe the tooth every month to see the vitality, mobility, ankylosis and resorption. Conclusion: Replantation is the treatment of choice following avulsion to facilitates restorative therapy and quality of life.

Mucormycosis: A sweet enemy, case series

Mucormycosis is a rare fungal infection caused by fungi of the Mucorales order that occurs in immunocompromised individuals or with loss of skin or mucosa barrier integrity. This report presents four cases of rhinocerebral mucormycosis attended at a third-level hospital in Cali (Colombia) during a period of three years. All patients had different case histories and times of evolution. All four had a previous or de novo diagnosis of type 2 diabetes mellitus, with glycated hemoglobin higher than 10% on admission. We ruled out other possible pathologies that could explain their immunocompromised condition. Mucormycosis diagnosis was made with direct visualization of hyaline coenocytic hyphae on biopsies. The basis of treatment was liposomal amphotericin B and surgical debridement. Two patients presented bacterial coinfection. One asked for voluntary discharge without having completed the treatment, and another one died. The remaining two have attended controls and had an adequate evolution.

A Knowledge, attitude and practice (KAP) study on sheep owners regarding fasciolosis in northwest of Tunisia

Fasciolosis is a worldwide zoonotic snail-borne infection that affects ruminants, it causes high economic losses among livestock. A participatory epidemiological survey was conducted on 204 sheep owners of Sejnane region (District of Bizerte, Northwest Tunisia) to assess their knowledge, attitude and practice regarding fasciolosis. All interviewed sheep owners are aware of this parasitic infection (100%, 204/204), among them, 81% (165/204) reported history of clinical cases in their sheep flocks. According to 33.73% (113/335) of them, sheep get infected by fasciolosis mainly by grazing in wet areas, 79.9% (163/204) of these farmers think that wet climate is the most favourable for the infection. Weight loss (28.40%, 121/426) and submandibular oedema (20.42%, 87/426) are the main clinical signs of fasciolosis cited by interviewed sheep owners and the majority of them (98.53%; 201/204) confirmed that fasciolosis causes significant economic losses. Fasciolosis infection persists in Sejnane region despite the use of antiparasitic drugs, this is due mainly to the fact that animals graze in moist grass (39.88%, 132/331). Treat animals (51.47%, 193/375), prohibit grazing on moist grass (15.20%, 57/357), prohibit grazing on wet soils (14.33%, 53/357) and avoid pastures (10.93%, 41/357) are the main prevention measures cited by interviewed sheep owners. Only 18,14% (37/204) of responders knew that fascioliasis is a zoonotic disease. These results could be considered by animal health decision makers and field veterinarians when implementing control programmes in order to increase breeders' knowledge of fasciolosis.

Severe Avian Influenza A H5N1 Clade 2.3.4.4b Virus Infection in a Human with Continuation of SARS-CoV-2 Viral RNAs

Background. Since 2020, global attention has heightened towards epidemics caused by avian influenza A H5N1 virus of clade 2.3.4.4b in birds and mammals. This study presents the epidemiological history, clinical manifestations, and prognosis of a unique case infected with avian influenza A H5N1 clade 2.3.4.4b, along with the continuation of SARS-CoV-2 viral RNAs, in Eastern China. Methods. We collected and analysed the patient’s clinical, epidemiological, and virological data. Both sputum and bronchoalveolar lavage fluid (BALF) samples were subjected to real-time RT-PCR to test for respiratory pathogens of interests, including SARS-CoV-2 and influenza virus. Influenza virus isolation and propagation were performed on embryonated eggs. Serological tests were used to determine the presence of SARS-CoV-2 antibodies. Phylogenetic analysis was constructed to explore viral evolution and origin of A/H5N1 virus. Results. A 53-year-old female farmer with chronic bronchiectasis was hospitalized with severe pneumonia. Real-time RT-PCR revealed the presence of avian influenza A H5N1 and SARS-CoV-2 in BALF and sputum samples. Sequence analyses classified the human isolate as clade 2.3.4.4b of avian influenza A H5N1. The amino acid motif GlnSerGly at residues 226–228 of the haemagglutinin protein indicated avian-like receptor binding preference. Epidemiological investigation established that the patient had exposure to sick or dead poultry 3 days before illness onset, while no cases of human-to-human H5N1 virus transmission were identified in 31 close contacts. Conclusion. We presented that the clade 2.3.4.4b H5N1 avian influenza virus has the potential to cross-infect humans with serious symptoms, especially in individuals already affected by COVID-19. It is indeed crucial to closely monitor the virus’s evolution in both avian populations and humans. Continued research and surveillance efforts are vital to monitor any potential changes in the virus, as well as to inform public health policies and interventions.

Medullary Thyroid Carcinoma

Medullary thyroid carcinoma is a rare malignant tumor of the thyroid. An early diagnosis is associated with a better prognosis. Calcitonin is the cornerstone of diagnosis. In this study, we will discuss the clinical and evolutionary characteristics of this condition through a retrospective study of thirty-three patients over a period of seven years between January 2013 and December 2019. Our study includes 33 patients, comprising 12 men and 21 women with a sex ratio of 0.57. The average age of our patients is 45 years. A family history of similar cases was present in six patients (18%). As for the circumstances of discovery in our study, all our patients consulted for a cervical swelling (100%). Seven patients (20%) presented with signs suggestive of malignancy (dysphonia), and fourteen patients (40%) had lymphadenopathy at the time of diagnosis. Calcitonin levels were measured preoperatively in eighteen patients with a very high recurrence rate (60%). Cervical lymph node metastases were present in 40% of cases (fourteen patients). Total thyroidectomy was performed in all patients in our series. It was performed initially in 70% of cases. For patients who initially underwent partial thyroidectomy, we performed totalization regarding the other thyroid lobe. Lymph node dissection was performed in 60% of cases. Radiotherapy was indicated for all patients in our series except for the two patients with normal postoperative calcitonin levels. Close surveillance was the therapeutic choice for these patients. MTC remains a relatively rare tumor. It mainly affects young adults and mainly manifests as an isolated thyroid nodule. It is a lymphophilic tumor, and lymph node involvement is very early. Calcitonin is the basis of preoperative diagnosis. It guides the stage of the disease, helps to guide surgery, constitutes a key element of follow-up, and is considered an important prognostic factor for survival. Despite advances in targeted therapy, complete surgical resection rem

Peran Hukum Internasional Dalam Etnis Rohingya

The failure to prosecute the perpetrators of the Rohingya ethnic genocide crime is the beginning of the blunting of international law. The Rohingya ethnic group must get their Human Rights (HAM) back, as we know that Human Rights are basic rights that are inherent from birth by the grace of God and everyone must protect and respect them. Myanmar has a long history of human rights violations, according to Amnesty International. Suppression of freedom of expression and violations of human rights against underrepresented ethnic groups continue. The research used in this study uses normative juridical research methods with a case and legal history approach. In fact, institutional dogmatism is the result of the failure to protect human rights against ethnic groups. Rohingya, this study concludes that international law is blunt and only applies if there is a large benefit to the UN Security Council, the people of a country like Rohingya only suffer from injustice.

Reproductive sex ending in failure affects sexual health – A qualitative study of men and women attending a fertility clinic

ObjectiveTo explore men’s and women’s experiences regarding their history of sexual health when attending a fertility clinic. MethodsA qualitative study with semi-structured individual interviews was conducted among heterosexual males and females seeking infertility care at a public fertility clinic in Sweden in 2022–2023. The interviews were audio-recorded, transcribed verbatim and analyzed using qualitative content analysis. ResultsEight males and ten females were included. The analysis resulted in an overarching theme: A change from spontaneous to scheduled intercourse affects various aspects of sexual health. In the beginning of the relationship sex had been spontaneous, joyful and satisfying. However, sex was not always unproblematic, and there had been sexual changes. Sex with a reproductive purpose was scheduled according to ovulation, leading to changes in sexual behavior. Increased erectile problems in men and decreased frequency of orgasms in women, and a lack of sexual desire in both, were experienced. Men and women felt pressured to have sex when it became a requirement. Men’s sexual and women’s reproductive failures led to negative emotional reactions, including stress, frustration, disappointment, anxiety and guilt. Sexual and reproductive problems affected the relational well-being, leading to feelings of sharing the burden but also conflicts and sexual avoidance. ConclusionsExperiencing reproductive failures, sexual problems and negative emotional reactions can affect men’s and women’s sexual health. Therefore, an implication for clinical practice among healthcare professionals during evaluation of infertility, is a need to be aware of and ask questions about sexual health after reproductive failures.