Main Signs Research Articles

Abstract 4138603: Adult-onset Kawasaki Disease: An Updated Review of the English-Language Literature from 1980 Through 2023

Introduction: Kawasaki disease (KD) is a pan-vasculitis that primarily affects children and rarely adults. Available data on adult-onset KD are based on case reports and case series, both of which are limited by small sizes. We aimed to characterize the epidemiology, presentation, hospital course, and outcomes of adult-onset KD published in the English literature from 1980 through 2023. Methods: We retrospectively reviewed and included published articles with a diagnosis of KD in patients age ≥18 years. We searched PubMed and Google scholar for case reports/series published in English using the keywords “adult”, “Kawasaki disease”, and “mucocutaneous lymph node syndrome”. We extracted data from individual articles onto an Excel spreadsheet for analysis. Outcomes of interest were the demographic characteristics of patients, clinical presentation and hospital course, management, and complications. Descriptive statistics were used to analyze the data. Results: A total of 137 patients from 29 countries were included in this study. The majority were male (90/137, 64.9%; M:F ratio 1.8) and the median age was 25 years (range, 18-68). The median time to clinical presentation was 5 days (range, 4-60). The main signs and symptoms were fever (95.7%), skin rash (92.9%), conjunctivitis (89.3%), extremity changes (84.3%), oral changes (85.7%), and cervical lymphadenopathy (73.7%). The majority of the patients had no co-morbidities (125/137, 91.2%). EKG changes were not reported in 48 patients (35%). In the remaining 89, 26 (29.2%) had normal EKG or sinus tachycardia, 9 (10.1%) had ST segment elevation, and 9 (10.1%) had arrythmias or abnormal EKGs. Pharmacotherapy included IVIG (80/137, 58.4%), Aspirin (105/137, 76.6%), steroids (31/137, 22.6%) and antibiotics (68/137, 49.6%). For complications, 18.2% (25/137) had aneurysms, 8% (11/137) had myocardial infarction, 10.9% (15/137) had myocarditis, 10% had pericarditis/pericardial effusion, and 10.9% (15/137) had KD shock syndrome. The median length of stay was 14 days (range, 1-60 days). Three patients (2%) died from KD. Conclusion: Adult-onset KD is rare and is associated with significant cardiovascular complications. Clinicians should have high index of suspicion for prompt diagnoses and initiate appropriate treatment to improve outcomes.

Epidemiological profile of severe malaria and sickle cell disease in children at the mother and child university hospital center Jeanne Ebori foundation of libreville from 2020 to 2021

Background: Hemoglobinopathies represent the most common genetic diseases worldwide. In Gabon, the clinico-biological profile of patients with homozygous hemoglobin S or those with AS sickle cell traits, faced with this prevalence of serious malaria, remains unknown today. The objective was to evaluate the complications of severe malaria in SS homozygous sickle cell patients and those carrying AS sickle cell traits. Methods: This is an observational, retrospective study, with descriptive and analytical aims which took place from January 2020 to October 2021. The parameters studied were socio-demographic, clinical and paraclinical data, the diagnosis chosen, therapeutic data and evolution. Results: severe neurological form of malaria was the most common criterion with a frequency of 41.7%, followed by parasitic forms 35.8% and anemic forms 21.8%. Among AS heterozygotes, the most widespread severe form was the neurological form with a frequency of 63.2%, the anemic form 26.3% and parasitic at 10.5%. In homozygous SS subjects, the most widespread severe form was the anemic form with a frequency of 68.1% followed by neurological forms 27.7% and parasitic forms 4.2%. Abdominal pain, prostration, respiratory distress were the main signs in SS homozygotes. In heterozygotes, prostration, convulsion and clinical jaundice were the main signs. A total of 99.8% of our patients were cured. Conclusions: All the electrophoretic profiles identified were subject to this infection which mainly affects heterozygous AS subjects and subjects with the AA electrophoretic profile in its severe neurological form and homozygous SS subjects in its anemic form.

Chest Wall Hydatid Disease: Surgical management and risk Factors for Recurrence and Mortality

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

The umblicus says it all

Abstract Introduction/Objective Umbilical nodules can be divided into benign and malignant. Malignant lesions of the umbilicus are very rare. They can arise from primary tumors or secondary to abdominal and pelvic malignancies. Literature review suggests that these umbilical lesions can present as primary tumor in 38% of the cases, endometriosis in 32%, and metastatic lesions in 30%. Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is known as Sister Mary Joseph’s nodule (SMJN). It is a very rare finding and the incidence of SMJN is 1- 3% in people diagnosed with intra-abdominal or pelvic malignancies. Methods/Case Report A 31-year-old male with no past medical history presented to the emergency room with 3 months history of umbilical nodule and 60 pounds weight loss. He experienced early satiety, abdominal pain, nausea and generalized fatigue. CT abdomen showed hepatomegaly with numerous hypoattenuating lesions throughout the liver with peripheral enhancement, and hypoattenuating mass within the pancreatic tail and body measuring approximately 2.1 x 5.8 cm that appears contiguous with hilar splenic lesion. CT chest showed multiple pulmonary metastases with prominent precarinal and subcarinal lymph nodes. Serologic tests revealed elevated Alpha fetoprotein, ALP, ALT, and CA19-9. Patient underwent umbilical nodule core biopsy and right liver core biopsy. Microscopic evaluation of the specimens revealed pancreatic acinic cell carcinoma with two different morphological variants. Umbilical nodule with glandular pattern and liver lesion with trabecular pattern. Immunohistochemical stains were performed with tumor cells positive for CK 7, Trypsin and BCL-10 and negative for Glypican 3, CK 20, AFP and CD56. The prognosis is poor, with an average survival time of about 19 months. After the diagnosis patient underwent chemotherapy. Results (if a Case Study enter NA) NA Conclusion Umbilical nodules can be diagnosed with careful clinical and histopathological evaluation. The prognosis of patients presenting with SMJN is generally poor as it is a sign of advanced malignancy. Sometimes it may be the first and only sign of an internal neoplasm. Therefore, this is an important differential diagnosis to consider.

Current approaches to prenatal imaging of lung malformations: a review

INTRODUCTION: Congenital lung malformations are result of developmental disorders at any stage of organ formation. Manifestations of these changes vary significantly: from minimal in size to large space-occupying lesion of the lung, which can cause fetal death or severe postnatal respiratory disorders. In proper time and accurate prenatal diagnosis of lung development abnormalities is one of the fundamental factors determining management of pregnancy and prognosis.OBJECTIVE: To demonstrate the most typical features of a wide range of congenital lung anomalies by ultrasound and MRI.MATERIALS AND METHODS: The literature search was performed in open Russian and English databases Medline, PubMed, Web of Science, RSCI, eLIBRARY using keywords and phrases: «prenatal diagnosis», «fetal MRI», «ultrasound diagnostics», «сongenital lung malformations».RESULTS: Based on literature data and our own experience in the use of ultrasound and MRI in diagnosis of сongenital lung malformations, the main signs of normal development and the most specific types of lung anomalies are described. Algorithm for diagnostic search for congenital lung malformations is presented.CONCLUSION: Ultrasound is the main method for diagnosing congenital lung anomalies. Fetal MRI is used to clarify the nature and extent of changes, a more detailed assessment of adjacent organs, also to determine Multiple congenital anomalies. Understanding the characteristics of semiotics of lung malformations and the main signs of these anomalies is a fundamental criterion for prenatal counseling, as well as peri- and postnatal management of this category of patients.

Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed-Methods Study.

To explore orthodontists' (OTs) and paediatric dentists' (PDs) practices and perceptions regarding the screening and management of paediatric obstructive sleep apnea (OSA). This explanatory sequential mixed methods design included OTs and PDs with active clinical practice in Brazil and encompassed a quantitative phase followed by a qualitative phase. In the quantitative phase, a survey assessing OSA screening and management practices was administered to OTs and PDs practicing in Brazil. Information-rich OTs and PDs were interviewed in the qualitative phase. Descriptive statistics and the chi-square test were used to analyse the survey data, while inductive content analysis was applied to the interview data. The results from both phases were integrated and reported narratively. Three hundred eighty-one OTs and PDs completed the survey, and ten of them were interviewed. Nearly half of OTs and PDs administered sleep questionnaires and demonstrated some knowledge about paediatric OSA signs and symptoms. PDs and OTs primarily offered rapid maxillary expansion and functional mandibular advancement for managing selected children with OSA, with OTs being more frequently involved in this task than PDs. OTs and PDs identified several barriers and expressed the need for support regarding access to reliable screening tools and interprofessional care. Brazilian OTs and PDs were aware of the main signs and symptoms of paediatric OSA and were somewhat involved in offering oral appliance management options. To further define the role of these professionals, increasing support for dental professionals in OSA management and updating existing clinical guidelines is warranted.

Proposed Methods for Preventing Overfitting in Machine Learning and Deep Learning

The article discusses various approaches and methods to combat overfitting, which is a key problem in the field of artificial intelligence. Overfitting occurs when the model over-adapts to the training dataset, losing the ability to generalize to new data. The main causes and signs of overfitting are also discussed, including excessive complexity of models and limited data. The focus is on methods such as regularization, dropout, and the use of ensemble methods that can significantly reduce the risk of overfitting. These approaches are evaluated using examples from various fields of neural network applications, providing the reader with a comprehensive understanding of the problem and its solution methods.

Phenotypes of 126 Moroccan HIES patients according to NIH Score.

Hyper-IgE syndrome is a group of inborn errors of immunity, some of which are syndromic, characterized clinically by the classic triad of chronic eczema, cutaneous and/or pulmonary staphylococcal infections and high serum IgE concentrations (> 2000 IU/ml or > 10 x normal for age). We report here the clinical and immunological aspects of Moroccan patients presenting probable or possible HIES according to NIH-HIES score. This retrospective study covers the period from 1998 to 2023 and includes Moroccan patients with a clinical presentation suggestive of HIES (skin and/or pulmonary infections, eczema, high IgE levels) and an NIH score ≥ 20. We attempted to classify the patients phenotypically according to the 2022 IUIS IEI Expert Committee classification. Median age at symptom onset was 0.5 years and median age at diagnosis was 5.5 years. The main clinical signs were eczema (66%), skin abscesses (32.5%), pneumonia (32.5%), otitis (20%), mucocutaneous candidiasis (19%), diarrhea (12%), facial dysmorphism (10.3%), lymphadenopathy (9.5%), bronchial dilation (8%), pneumatoceles (8%), conjunctivitis (7.1%), rhinitis (6.3%), psychomotor delay (5.6%), pathological fractures (4%), retention of deciduous teeth (4%), cognitive delay (3.2%). This is the first clinical description of a cohort of Moroccan patients presenting HIES according to NIH criteria. Phenotype can sometimes orient towards identification of the mutated gene, but the overlapping clinical signs make molecular analysis necessary for genetic counseling and appropriate treatment.

Intramuscular vascular malformations in pediatric patients: a retrospective study in a vascular anomalies clinic.

Intramuscular vascular malformations (IVMs) are rare developmental congenital structural abnormalities. Their clinical diagnosis is difficult, and imaging studies are essential to determine the type and extent of vessels involved. Treatment can be challenging and must be managed by a multidisciplinary team. A descriptive, observational, retrospective, longitudinal study of clinical records of patients diagnosed with IVMs who were evaluated at the vascular anomalies clinic from January 2011 to December 2021 was performed. Demographic, clinical, imaging, diagnosis, treatment, and response data were collected. Seven patients (five females and two males) with a mean age of 13.66 years (standard deviation 5.82 years) were included in the study. In all cases, the clinical diagnosis was venous and lymphatic malformation. The radiological findings were dilated and tortuous vascular structures or multilobulated lesions with septa inside, with or without vascular flow; these findings allowed diagnosis in all cases. Treatment modalities included sclerotherapy in five patients, surgical resection in two, medical treatment with sirolimus in three, and surveillance in one. Subsequent clinical evolution was favorable in all patients, with decreased pain in six (partial in four and total in two) and size reduction in one patient. IVMs in our pediatric population most frequently affect the lower extremities. The main symptoms and signs were pain on exertion and volume increase. Treatment can be challenging given the extension and depth of the malformations, so a combination of therapeutic modalities may be necessary to obtain the best outcome.

Проблемы противодействия хищению бюджетных средств, выделенных на строительство автомобильных дорог

The article touches upon the problems of the field of road construction in terms of embezzlement of public funds allocated for both construction and major repairs of roads and road infrastructure.. The article considers the main signs, types of violations and crimes in this area, which are often committed during the construction of highways. The issue of criminal liability and consequences for committing crimes related to embezzlement of budget funds has been raised. The article suggests ways to solve this problem, including improving control over the use of budget funds, improving the system of state and municipal procurement, tougher penalties for crimes and other measures.

Forming Readiness of Students to Implement Research Activities in Pedagogical Practice

The article discusses ways to increase the effectiveness of research competence during practice from the whole set of problems of developing students' research abilities. The process of developing the readiness of physics students to conduct research work during internships in schools in the city of Pavlodar is described. A step-by-step plan for preparing students for teaching practice in a modern educational environment is proposed. The relevance of this article lies in the need to prepare students of pedagogical universities to organize and conduct research study with schoolchildren. The purpose of the study is to prepare students to conduct research activities at school during teaching practice. The main signs of the development of research skills in future teachers should be, in our opinion, the ability to structure lessons with elements of research activity; skills in drawing up a research plan; preparation of creative lesson and home research assignments; increasing the level of knowledge of students in physics and developing research skills. The article also discusses the stages of preparation for the implementation of research skills that reveal the teaching abilities and professionally important personal qualities of students.

The association of systemic condition and medications on alveolar bone loss and tooth attrition.

Periodontal disease is caused by subgingival bacteria that adversely affect the host immune system and create and maintain unmitigated inflammation in gingival and periodontal tissues. The condition is also linked to systemic conditions including cardiovascular disease, diabetes, and arthritis. Periodontitis elevates the bacterial load and spreads systemic inflammation through infection and inflammation. The main radiographic sign of periodontitis is marginal bone loss. Risk factors, including medications, smoking, age, and sex, are known to influence periodontal health. However, there is little information about the impact of systemic conditions and medications on tooth wear. The aim of the present study was to assess the association between systemic conditions and medications and radiographic signs of tooth wear and marginal bone loss. This retrospective analysis was conducted on a group of 2,223 consecutive patients who came for dental treatment in the clinics of a large Health Maintenance Organization in Israel. Data available for the study included details of concomitant systemic diseases and medication and full-mouth radiographic surveys. Odds ratio and logistic regression analysis were used to detect associations between systemic conditions and medication, and marginal bone loss and tooth wear. The results indicated an elevated odds ratio for tooth wear associated with age, sex, and smoking across all age groups. Among young patients, those using proton pump inhibitors and psychiatric medications had an elevated risk of tooth wear. Age, smoking, and diabetes conditions were associated with an increased odds ratio for marginal bone loss in all age groups. Psychiatric medications and sex elevated the odds ratio for marginal bone loss only among older patients. The results highlight the significant impact of age, sex, and smoking on tooth wear, and extend these risks to alveolar bone loss when combined with diabetes and psychiatric conditions.

Redefining the phenotype of alpha-methylacyl-CoA racemase (AMACR) deficiency

BackgroundAlpha-methylacyl-CoA racemase (AMACR) deficiency is a rare peroxisomal enzyme deficiency caused by biallelic variants in the AMACR gene. This deficiency leads to the accumulation of toxic bile acid intermediates (R)-trihydroxycholestenoic acid (THCA) and (R)-dihydroxycholestenoic acid (DHCA) and pristanic acid. With less than 20 patients described in literature, the phenotype of AMACR deficiency is poorly defined and no data on the natural history are available.ResultsHere we describe a cohort of 12 patients (9 adults and 3 children) with genetically confirmed AMACR deficiency (median age at diagnosis 56 years, range 3–69), followed for an average of 6 years (between 2015 and 2023). Five novel pathogenic variants are described. In 5/9 adult patients, retinitis pigmentosa was detected at a median age of 45 years (range 30–61). The median delay to diagnosis of AMACR deficiency after the diagnosis of retinitis pigmentosa was 24 years (range 0–33). All adult patients subsequently developed neurological signs and symptoms after the age of 40 years; most frequently neuropathy, ataxia and cognitive decline with prior normal cognitive functioning. One patient presented with a stroke-like episode. All adult patients showed a typical MRI pattern involving the thalami and gray matter structures of the pons and midbrain. One patient had a hepatocellular carcinoma at the time of the AMACR deficiency diagnosis and two patients suffered from gallstones. All three included children had elevated liver transaminases as single presenting sign and showed no brain MRI abnormalities.ConclusionAMACR deficiency can be considered as an adult slowly progressive disease with a predominant neurological phenotype. The main signs comprise retinitis pigmentosa, neuropathy, ataxia and cognitive decline; stroke-like episodes may occur. Recognition of typical MRI abnormalities may facilitate prompt diagnosis. In addition, there is a risk of liver fibrosis/cirrhosis and hepatocellular carcinoma in these patients, requiring active monitoring.

ОСНОВНІ ОЗНАКИ ТА ВИДИ МАСКУВАННЯ РОЗПРАВИ У СИЛОВОМУ КОНФЛІКТІ

Проаналізовано важливу проблему маскування розправи в силових конфліктах, освітлено його основні ознаки. Маскування розправи в контексті представленого дослідження визначається як використання провокаційних дій, спрямованих на початок активної фази силового конфлікту з метою розправи, що передбачає надмірне застосування фізичного насильства, незважаючи на реальну небезпеку нападу. Це явище призводить до ускладнень у проведенні досудових розслідувань і має негативні наслідки для жертв. Крім того, розглянуто маскування розправи за допомогою законного процесу, коли насильство намагаються легалізувати, використовуючи законні інструменти, за допомогою соціального тиску, що передбачає психологічний вплив на потенційних жертв, за допомогою технологій та кіберпростору, що використовуються для дезінформації і відволікання від справжніх подій. Представлена тематика актуальна, оскільки маскування розправи залишається серйозною проблемою в сучасному світі. Знання про основні ознаки та види маскування розправи може значною мірою сприяти його виявленню та запобіганню, а це, в свою чергу, допоможе зберегти безпеку та захистити права громадян.

Rare Complication of Cardiopulmonary Resuscitation-Liver Injury.

Background and Objectives: Liver injury is a rare complication of cardiopulmonary resuscitation. Correct and early diagnosis and treatment are essential. The clinical signs of injury may be masked by the cardiac arrest. We present a single-centre retrospective observational study of traumatic liver injury after cardiopulmonary resuscitation. Materials and Methods: A retrospective analysis of the patients treated for liver injury after cardiopulmonary resuscitation was conducted. Demographic data, the cause of resuscitation, the duration of restoration of spontaneous circulation (ROSC), and the surgical approach were analysed. Results: We have treated nine patients with severe liver injury after cardiopulmonary resuscitation. The diagnosis was made on the basis of cardiopulmonary instability, a fall in the erythrocyte count in eight cases, and was confirmed by CT or ultrasound examination. The last one was diagnosed accidentally on MR. Surgery, in cases of unstable patients, was followed immediately after a diagnosis. We combined liver sutures and intra-abdominal packing with a planned second-look surgery. Five of the nine patients survived. Conclusions: Liver injury after cardiopulmonary resuscitation is rare and is associated with high mortality. The recurrence of cardiopulmonary instability and/or a low or falling red blood cell count are the main signs of this injury. Bedside ultrasound and CT scans are the most important methods to confirm the diagnosis. The rule of surgical repair is the same as in all liver injuries, regardless of aetiology. The key factors for survival include early diagnosis, together with the length of restoration of spontaneous circulation (ROSC).

Effectiveness of demographic policy measures in addressing population decline in contemporary Russia

Demographic policy is one of the key tasks of almost any state at the present time. It correlates with the solution of pressing problems in the economic and social spheres, directly depends on the state of healthcare, education, migration policy and other factors and directly affects the socio-economic development of both individual regions and the country as a whole. Many Russian and foreign researchers believe that demographic indicators very accurately reflect the socio-economic and political situation of the state. The relevance of the study is due to the fact that for the progressive socio-economic development of any country, positive demographic dynamics are necessary. The main sign of the negative demographic situation that has developed in modern Russia and a number of countries, primarily European, is the growing scale of depopulation (population extinction). The purpose of this work was to analyze the existing demographic policy of Russia and compare demographic trends in Russia and other countries. The work uses methods of statistical data analysis, comparison of statistical indicators of fertility, mortality, natural population decline, migration, marriage rates in Russia and the Republic of Srpska, methods of retrospective analysis, research of the institutional environment created by the action of state and national programs “Demography”, “Providing accessible and comfortable housing and public services for citizens of the Russian Federation”, “Strategy of socio-economic development for the period until 2024”, Presidential decrees, etc. Research has shown that despite measures taken to overcome the demographic crisis, Russia’s population continues to decline. According to the Federal State Statistics Service of the Russian Federation (Rosstat), as of 1 January 2023, 146.45 million people lived in Russia. By 1 January 2046, according to a Rosstat forecast published in October 2023 the country’s population will decrease to 138.77 million people. To solve demographic problems in the Russian Federation, a national project “Demography” was developed and approved. The government has allocated more than 3 trillion rubles for its implementation. However, it is not possible to completely overcome the negative trend. The authors proposed a number of economic and ideological measures within the framework of agglomeration, migration, and family support policies that can be used within the framework of socio-economic development strategies and national programs aimed at overcoming the demographic crisis.

Manipulation Strategies in Interpersonal Relationships and Their Psychological Impact

Manipulation is a purposeful, conscious, organized psychological influence with the aim of using the personality of another person as a means of achieving one's own goals. The purpose of the article is to characterize the main strategies of manipulation in interpersonal relationships. A set of theoretical research methods was used: the conceptual and terminological analysis was used to determine the essence of the main concepts of the study, comparative and contrastive, which made it possible to analyze the periodicals and scientific-methodical publications on psychology, classification. The results identify the major components of the process of manipulative interaction and the main signs of manipulation in interpersonal relationships. The results showed that manipulators control their victims through positive reinforcement (praise, excessive apologies, gifts, attention), negative reinforcement (getting rid of the problem), unstable or partial reinforcement (fear, doubt), punishment (reproaches, shouting). The conclusions indicate that the psychological mechanisms of manipulative action ensure the effectiveness of the manipulator's psychological influence on the object of manipulation. The conclusions also summarize that the main manipulative techniques are organizational and procedural, logical and psychological, and personal. The prospect of further scientific research is an empirical study of the features of manipulative tendencies in interpersonal relations.

Otomycosis, Review

The word "otomycosis" refers to a specific type of fungal infection affecting the external auditory canal. It appears to be a highly prevalent clinical condition seen in otorhinolaryngology outpatient departments worldwide. Most Aspergillus and Candida species are the etiological microorganisms that form biofilm inside the ear canal. The development of otomycosis can be caused by improper self-cleaning, self-medication, and the insertion of needless instruments into the ear canal. Ear pain, discharge from the ears, and hearing loss are the main signs of otomycosis. Therefore, in order to take a percussive action during the primary stage of infection, the correct diagnosis is imperative. However, special medical attention is required, particularly in patients with low immunity, when infection spreads to a mastoid area with a suppurative condition. The purpose of this thorough review is to raise awareness of the importance of good health education and self-hygiene in order to maintain a healthy lifestyle. The majority of cases of otomycosis affect one ear, and immunocompromised patients are more likely to experience bilateral involvement. The most often mentioned risk factors include swimming, applying mustard oil to ears, overusing antibiotic ear drops, using Q-tips, wooden sticks, metal pickers, and self-cleaning of ears with these items. Staphylococcus aureus is the most frequently implicated bacterium in cases of concurrent otomycosis. In order to lower the incidence of otomycosis, this literature review emphasizes the necessity of education in order to eliminate the previously mentioned predisposing risk factors.

Epitranscriptome: A Novel Regulatory Layer during Atherosclerosis Progression.

RNA modifications have recently gained great attention due to their extensive regulatory effects in a wide range of cellular networks and signaling pathways. In cardiovascular diseases (CVDs), several RNA changes, called "epitranscriptome" alterations, are found in all RNA molecules (tRNA, rRNA, mRNA, and ncRNAs). Unlike the epigenetic process, which influences the progression of atherosclerosis (AS), its transcriptional and post-transcriptional regulatory mechanisms are still unknown. Here, we described the main epitranscriptome signs to provide new insights into AS, including m6A, m5C, m1A, m7G, Ψ, and A-to-I editing. Moreover, we also included all current known RNA-- modifier-targeting, including small molecular inhibitors or activators, mainly designed against m6A- and m5A-related enzymes, such as METTL3, FTO, and ALKBH5. Finally, since only a few drugs, such as azacitidine and tazemetostat, targeting the DNA epigenome, have been approved by the FDA, the next challenge would be to identify molecules for targeting the RNA epitranscriptome. To date, total Panax notoginseng total saponin could reduce vascular hyperplasia via Wilms' tumor-associated protein-1 m6A-dependent. Indeed, a virtual screening allowed us to individuate a phytomolecule, the rhein, which acts as an FTO inhibitor by increasing mRNA m6A levels. In this review, we highlighted the RNA epitranscriptome pathways implicated in AS, describing their biological functions and their connections to the disease. The identification of epitranscriptome- sensitive pathways could provide novel opportunities to find predictive, diagnostic, and prognostic biomarkers for precision medicine.

Preeclampsia and timing of delivery: Disease severity, maternal and perinatal outcomes

ObjectivesThis study aimed to elucidate clinical characteristics, disease severity, and obstetric outcomes in women with pregnancy complicated with preeclampsia stratified by gestational age at delivery. Study designThis retrospective study was conducted at a tertiary care facility from January 2011 to December 2020. Main outcome measuresMaternal characteristics, risk factors, clinical signs and symptoms, laboratory test results, and maternal and perinatal outcomes were compared between early (<34 weeks) versus late (≥34 weeks) and preterm (<37 weeks) versus term (≥37 weeks) preeclampsia. ResultsMore than half of the women (56 %, 612/1094) had preterm preeclampsia. Overall, 30 % (329/1094) delivered before 34 weeks of gestation. Pregnancies with early preeclampsia had the worst maternal signs and symptoms, the highest median blood pressure level, and more abnormal laboratory abnormalities compared to those with late preeclampsia. Additionally, women with co-morbid diseases (chronic hypertension, chronic kidney disease, and systemic lupus erythematosus) were more likely to develop early than late preeclampsia. Of note, although adverse maternal and perinatal events occurred more commonly in early rather than late preeclampsia, 18 % (7/39) of eclampsia and 16 % (8/50) of hemolysis, elevated liver enzymes, and low platelet count syndrome cases occurred after 37 weeks of gestation. ConclusionsEarly preeclampsia posed the highest risk to the mother and infant(s); however, adverse maternal and perinatal events were still present even in cases of preeclampsia at term. Therefore, it is crucial for healthcare practitioners to remain vigilant and manage all cases with great care to prevent adverse outcomes.