Medical Examination Research Articles

Cost-Effectiveness of Influenza Vaccination in Healthy Children: A 10-Year Population-Based Study

Background/Objectives: Seasonal influenza annually puts a significant burden on the pediatric population, especially the youngest, causing severe illness and death. Additionally, associated healthcare costs cause a significant financial strain on healthcare systems. While vaccination is the most effective prevention method, its cost-effectiveness for healthy children remains unassessed. Methods: Using the Pedianet database spanning from 2009 to 2019, we analyzed influenza cases among 6-month-olds to 14-year-olds in Italy. Data included influenza-related medical visits, prescriptions, exams, emergency visits, hospitalizations, and costs. Adverse events and quality-adjusted life years (QALYs) were considered from the existing literature. A static decision-tree model compared annual vaccination strategies, assessing probabilities for influenza or influenza-like illnesses by vaccination status. Incremental cost-effectiveness ratios (ICERs) were calculated, along with sensitivity analyses and cost-effectiveness acceptability curve generation. Results: Mean total influenza costs for vaccinated children averaged EUR 18.6 (range 0–3175.9, including EUR 15.79 for the influenza vaccination), whereas costs for unvaccinated children were consistently lower at around EUR 4.6 (range 0–3250.1). The average ICER for years where vaccine and virus strains are matched was EUR 29,831 per QALY, which is below the EUR 40,000 threshold set by the Italian National Health Services. The ICER values range from EUR 13,736 (2017/2018) to EUR 72,153 (2013/2014). Averted influenza costs averaged EUR 23 per case, with fluctuations over the years. In most observed years, influenza vaccination was cost-effective from the healthcare providers’ standpoint. The exception was 2009–2010, due to a mismatch between vaccine and virus strains. Conclusions: This study highlights the economic viability of influenza vaccination, especially when virus and vaccine strains align. It demonstrates the potential of vaccination programs in preserving children’s health and well-being while managing healthcare costs.

Demographic, epidemiological and clinical characteristics of Ukrainian war refugees with HIV infection in the Slovak Republic

BackgroundThe Slovak Republic, an Eastern European country, borders Ukraine, which has one of the highest rates of HIV/AIDS in Europe. This study aims to inform readers about the demographic characteristics of Ukrainian war refugees with HIV/AIDS seeking temporary protection status in Slovakia due to the Russian invasion of February 24, 2022. It focuses on their epidemiology, immunological profiles, co-infections, and treatment. DesignMulticenter, retrospective study between March 1, 2022, and March 31, 2023. MethodsData were collected from all Ukrainian patients with refugee status living with HIV or newly diagnosed, who presented to any of the five HIV/AIDS centers in Slovakia. Information was obtained through medical interviews, physical examinations, laboratory tests and medical reports from the Ukrainian Ministry of Health. ResultsFrom March 1, 2022, to March 31, 2023, 141 Ukrainian refugees were included, mostly women (56.7 %, n = 80), with a median age of 41 years. The median CD4+ count was 680 cells/mL; 69.2 % (n = 97) had a viral load below 40 copies/mL. On arrival, 87.8 % (n = 123) were on ART, 90.2 % (n = 111) on dolutegravir. Coinfections included hepatitis C (31 %, n = 41), hepatitis B (12.5 %, n = 17), and tuberculosis (11.3 %, n = 16). Three died from AIDS complications. ConclusionThe study provides a detailed overview of the epidemiological, demographic, immunological, co-infection, and treatment characteristics of Ukrainian PLWHA displaced by the war to the Slovak republic. With the conflict ongoing, it is necessary to be prepared for more refugees in the coming months.

Analysis of Echocardiography Indicators Depending on the Type of Surgical Correction of the Mitral Valve in Patients with Ischemic Heart Disease

The aim. To study the influence of echocardiography indicators on the choice of surgical intervention on the mitral valve in patients with mitral insufficiency and coronary heart disease. Materials and methods. The study included patients with mitral insufficiency who underwent myocardial revascularization and mitral valve reconstruction (plasty or replacement). The mean age of the study participants was 65.9 ± 4.0 years. The material for analysis was data from the primary medical records: medical history, clinical and instrumental examination data and protocols of operations. The division into study groups was performed retrospectively, according to the mitral valve operation performed: plasty (experimental group) or replacement (control group). Results. We identified the features of the main echocardiographic data that guide the cardiologist when choosing the tactics of surgical correction of the mitral valve. It was established that in patients of the research group, the following was reliably significant: moderate degree of mitral insufficiency (p = 0.02; χ2 = 9.38), decrease in the systolic function of the left ventricle (p = 0.001; χ2 = 10.75); it was found that calcium deposits on the fibrous ring of the mitral valve were insignificant. When analyzing the morphological changes in patients of the experimental group, we found a significantly lower frequency of anterior leaflet prolapse (p = 0.04; χ2 = 4.21) and in general the frequency of all prolapses of any type, while in the control group the frequency of all prolapses was significantly higher (p = 0.04; χ2 = 4.0). In patients of the control group, a significantly higher frequency of akinesis (p = 0.04; χ2 = 4.21) and hypokinesis zones of the posterior-inferior-lateral wall (p = 0.001; χ2 = 19.76) was established, which is an additional sign of involvement of the chordal-muscular apparatus of the mitral valve in pathological process. Conclusions. As a result of the study, echocardiographic differences in the structure of the mitral valve were established, which influenced the selection of the intervention volume. It was found that in patients of the experimental group, the early postoperative mortality and the duration of inpatient treatment were significantly higher than in patients of the control group, which indicates the imperfection of the criteria used by cardiac surgeons when choosing the tactics of surgical correction of the mitral valve in an attempt to perform organ-preserving surgery.

A case of alternating hemiplegia in 2-month-old children with nystagmus as the first symptom: A case report.

This case report delves into the rare neurological condition known as alternating hemiplegia of childhood (AHC), focusing on its clinical manifestations, diagnostic approaches, and treatment options. AHC typically presents in infants under the age of 18 months with intermittent episodes of hemiplegia, often triggered by stressors such as environmental changes, bathing, or emotional stress. Recognizing the clinical features of AHC is crucial for early identification and intervention. The paper presents a case of a 2-month-old child with nystagmus as the initial symptom, followed by limb movement disorder in the left upper limb and weakness in the right limbs. The child's condition did not improve with treatment at an external hospital, highlighting the complexity of the disease and the need for specialized care. After a comprehensive review of the patient's medical history, physical examination, and imaging studies, the child was diagnosed with AHC. The diagnosis was confirmed through video electroencephalogram and whole-exome gene detection, which revealed a de novo mutation in the ATP1A3 gene, identified as pathogenic according to the American College of Medical Genetics and Genomics guidelines. The child was admitted to Peking University First Hospital and treated with levetiracetam and flunarizine oral administration. These medications were chosen for their efficacy in managing the symptoms of AHC, particularly the hemiplegic episodes. Post-treatment, the child experienced a reduction in the frequency and intensity of hemiplegic attacks compared to the initial stage. However, the child still exhibited paroxysmal symptoms and abnormal eye movements, and developmental milestones were delayed, indicating the need for ongoing care and monitoring. This case underscores the importance of early recognition and prompt intervention in managing children with AHC. The varied clinical presentations of AHC necessitate vigilance for early differential diagnosis. Although AHC is currently incurable, appropriate treatment can mitigate the impact of complications and improve the long-term quality of life for affected children, facilitating better societal integration.

Factors associated with uterine fibroids in women of reproductive age: A cross-sectional study

Background. Uterine fibroids is a benign monoclonal tumor originating from the smooth muscle layer of the uterus. Non-modifiable risk factors for the development of uterine fibroids, such as age, ethnicity, age at menarche, etc, have been studied quite extensively, while the role of many controllable factors remains debatable.The aim of the study. To identify the main modifiable factors associated with uterine fibroids in women of reproductive age living in the Baikal region, including certain ethnic groups.Materials and methods. We carried out a multicenter cross-sectional study in 2016–2019 in institutions of Irkutsk and Bokhan (Irkutsk region) and Ulan-Ude (Republic of Buryatia). The subjects of the study were women to have annual workplace medical examination. The study included 1,347 participants of reproductive age (34.33 ± 6.37 years) who met the inclusion criteria. Among all women included in the study, there were 867 (64.37 %) Caucasians, 361 (26.80 %) Asians, and 119 (8.83%) women of mixed (Caucasian-Asian), ethnicity. The research methods included a questionnaire, general clinical and gynecological examination, and pelvic ultrasound examination.Results. According to our study, the main non-modifiable factors associated with the presence of uterine fibroids were: Asian ethnicity; age at menarche 12–13 years; age of the study participant 40–44 years; menopausal symptoms; adenomyosis. The “controllable” factors included: city residency; body mass index over 40 kg/m2; history of abortions and miscarriages; metabolic syndrome; using combined oral contraceptives; lack of sexual activity; smoking; presence of anumber of occupational hazards.Conclusion. Our study identified the main controllable factors associated with the presence of uterine fibroids in a multiethnic population of women of reproductive age.

"This Time It Was Different:" Creating a Multidisciplinary, Trauma-Informed, Victim-Centered Approach to Sexual Assault Cold Case Investigations and Prosecutions.

Police and prosecutors recommend that sexual assault survivors have a medical forensic exam and the collection of a sexual assault kit (SAK; also known as a "rape kit") to preserve biological evidence (e.g., semen, blood, saliva, hair) if they want to pursue criminal prosecution. However, law enforcement personnel do not routinely submit SAKs to crime laboratories for forensic DNA testing. Instead, they often place untested kits in storage and close many of these reported cases after minimal investigation. Current estimates indicate there are 300,000 to 400,000 untested SAKs in law enforcement agencies throughout the United States. In response to this national problem, the U.S. Department of Justice created the Sexual Assault Kit Initiative (SAKI) Project to support kit testing, re-investigation, and prosecution of these "cold case" sexual assaults. The SAKI program also provides training and technical assistance to police, prosecutors, and victim advocates on how to use a multidisciplinary, trauma-informed, and victim-centered approach in cold case prosecutions. This study examined the extent to which one SAKI-funded site implemented these three guiding principles in their interactions with victims while prosecuting cold case sexual assaults. We conducted semistructured qualitative interviews with N = 32 sexual assault survivors from the first cohort of cold cases that were re-opened and prosecuted in this jurisdiction. Nearly all cases (n = 31) ended in a guilty plea or trial conviction, and the vast majority of survivors indicated that they had positive experiences with the SAKI team. Survivors noted that they were listened to, believed, supported, and well-prepared by a multidisciplinary team of practitioners who were personally invested in their cases and in their well-being. Implications for creating multidisciplinary, trauma-informed, and victim-centered approaches with other communities are discussed.

Raman fiber-optic probe for rapid diagnosis of gastric and esophageal tumors with machine learning analysis or similarity assessments: a comparative study.

Gastric and esophageal cancers, the predominant forms of upper gastrointestinal malignancies, contribute significantly to global cancer mortality. Routine detection methods, including medical imaging, endoscopic examination, and pathological biopsy, often suffer from drawbacks such as low sensitivity and laborious and complex procedures. Raman spectroscopy is a non-invasive and label-free optical technique that provides highly sensitive biomolecular information to facilitate effective tumor identification. In this work, we report the use of fiber-optic Raman spectroscopy for the accurate and rapid diagnosis of gastric and esophageal cancers. Using a database of 14,000 spectra from 140 ex vivo tissue pieces of both tumor and normal tissue samples, we compare the random forest (RF) and our established Euclidean distance Raman spectroscopy (EDRS) model. The RF analysis achieves a sensitivity of 85.23% and an accuracy of 83.05% in diagnosing gastric tumors. The EDRS algorithm with improved diagnostic transparency further increases the sensitivity to 92.86% and accuracy to 89.29%. When these diagnostic protocols are extended to esophageal tumors, the RF and EDRS models achieve accuracies of 71.27% and 93.18%, respectively. Finally, we demonstrate that fewer than 20 spectra are sufficient to achieve good Raman diagnostic accuracy for both tumor tissues. This optimizes the balance between acquisition time and diagnostic performance. Our work, although conducted on ex vivo tissue models, offers valuable insights for in vivo in situ endoscopic Raman diagnosis of gastric and esophageal cancer lesions in the future. Our study provides a robust, rapid, and convenient method as a new paradigm in in vivo endoscopic medical diagnostics that integrates spectroscopic techniques and aRaman probe for detecting upper gastrointestinal malignancies.

Review of Local Homeless Mortality Efforts: A Call for Standardized Data and Reporting.

There are currently no national estimates of how many people die while unhoused in the US. Local jurisdictions have developed their own approaches for estimating homeless mortality. We aimed to examine these local approaches, document what is known about homeless mortality, and summarize local methodologies. We reviewed 17 publicly available homeless mortality reports (ie, gray literature). Reports were sought from government, Health Care for the Homeless, coalition to end homelessness, and other advocacy and social service websites. From each report, we extracted the number of homeless deaths, dates of observation, data source(s) used, determination of homeless status, manners and causes of death, and decedent demographics. Data collection and reporting on homeless mortality varied greatly across reports. This variation limits aggregation across reports. Medical examiner data was the most used data source. Manner of death was the most consistently collected field, with accidental deaths reported as the most prevalent manner of homeless deaths. Not all reports listed specific causes of death, but those that did reported toxicity (eg, overdose) and cardiovascular causes as most prevalent. The most granular age category of most homeless decedents was 40 to 60years. On average, 80% of decedents were of male sex. While over half of reports included race and ethnicity information, disparities could not be estimated without suitable denominators. Standardized data collection and reporting guidance is needed for homeless mortality. Health departments can work with local Health Care for the Homeless programs and Continuums of Care to establish data sharing processes. Matching vital statistics with homeless service utilization records may be one opportunity to improve these efforts. Until there is federal or national guidance on these standards, localities can consider adding housing or homelessness variables as optional or mandatory fields in electronic death reporting systems.

Who is a minor? Age assessments of refugees in Germany and the classificatory multiplicity of the state

The categories that states use to classify and govern migrants often diverge from how migrants themselves perceive and experience their conditions, biographies, and identities. Building on this insight, I argue in this article that state categories not only clash with migrants’ varied notions of categories: state categorization itself often relies on multiple definitions of categories and methods of categorization. Age assessments of young refugees in Germany demonstrate this multiplicity. These assessments are carried out by forensic medical examiners and social workers, respectively, who work with very different understandings of what constitutes age. While forensic scientists view age as countable, particular, and objective, social workers think of it as lived, assembled, and constructed. What I term the classificatory multiplicity of the state complements current scholarly endeavors aimed at critically examining state categories, particularly in the context of migration governance.

A Study of the Clinical Profile of Iron Deficiency Anemia in Children With Sickle Cell Disease in a Tertiary Care Center.

Background Sickle cell disease (SCD) and iron deficiency anemia (IDA) are significant global health concerns, particularly in pediatric populations. This study investigates the prevalence, clinical impact, and management challenges of IDA in children with SCD. Methods A prospective observational study was conducted at the Department of Pediatrics, Jawaharlal Nehru Medical College(JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, from June 2022 to May 2024. The study included 60 children diagnosed with SCD. Comprehensive assessments were performed, including medical histories, physical examinations, and hematological investigations. Diagnosis of IDA was based on hemoglobin levels, mean corpuscular volume (MCV), red cell distribution width (RDW), peripheral blood smears, serum iron levels,and serum ferritin concentrations. Results Of the 60 participants, 15% exhibited iron deficiency. No significant gender differences were found in iron deficiency status. A significant association was observed between SCD type and the presence of pallor (p = 0.025) and sickle cell crises (p = 0.023). The study also found no significant association between SCD type and the presence of organomegaly (p = 0.079) or iron deficiency status (p = 0.675). The mean hemoglobin levels varied across SCD types, with sickle cell anemia patients showing lower levels than those with sickle cell trait or disease. Conclusion Diagnosing and managing IDA in children with SCD is complex due to overlapping hematological features and the risk of iron overload from frequent transfusions. Tailored diagnostic and therapeutic approaches are essential to improving hemoglobin levels, reducing complications, and enhancing the quality of life for affected children. This study provides valuable insights for refining clinical practices and emphasizes the need for a multidisciplinary approach to managing these intertwined conditions.

Study on risk factors of impaired fasting glucose and development of a prediction model based on Extreme Gradient Boosting algorithm.

The aim of this study was to develop and validate a machine learning-based model to predict the development of impaired fasting glucose (IFG) in middle-aged and older elderly people over a 5-year period using data from a cohort study. This study was a retrospective cohort study. The study population was 1855 participants who underwent consecutive physical examinations at the First Affiliated Hospital of Soochow University between 2018 and 2022.The dataset included medical history, physical examination, and biochemical index test results. The cohort was randomly divided into a training dataset and a validation dataset in a ratio of 8:2. The machine learning algorithms used in this study include Extreme Gradient Boosting (XGBoost), Support Vector Machines (SVM), Naive Bayes, Decision Trees (DT), and traditional Logistic Regression (LR). Feature selection, parameter optimization, and model construction were performed in the training set, while the validation set was used to evaluate the predictive performance of the models. The performance of these models is evaluated by an area under the receiver operating characteristic (ROC) curves (AUC), calibration curves and decision curve analysis (DCA). To interpret the best-performing model, the Shapley Additive exPlanation (SHAP) Plots was used in this study. The training/validation dataset consists of 1,855 individuals from the First Affiliated Hospital of Soochow University, yielded significant variables following selection by the Boruta algorithm and logistic multivariate regression analysis. These significant variables included systolic blood pressure (SBP), fatty liver, waist circumference (WC) and serum creatinine (Scr). The XGBoost model outperformed the other models, demonstrating an AUC of 0.7391 in the validation set. The XGBoost model was composed of SBP, fatty liver, WC and Scr may assist doctors with the early identification of IFG in middle-aged and elderly people.

Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success. Step 1 completion before clerkships promotes learning outcomes (e.g., integration and mastery of foundational material), may encourage students to focus on the curriculum, and may better prepare students for clinical science exams (CSEs). However, delaying the exam ensures that students maintain foundational knowledge and may encourage clinical educators to demonstrate basic science illustrations. An early Step 1 may affect learner behavior by allowing clerkship students to focus on clinical learning. The associated National Board of Medical Examiners performance report may also be used for Step 2 and CSE preparation. However, delaying Step 1 allows greater scheduling flexibility based on developmental milestones. Administration of Step 1 before clerkships removes a significant stressor from the clinical year and decompresses the residency application period. However, a delayed Step 1 reduces the pressure on students to engage in numerous extracurricular and research activities to distinguish themselves due to the pass/fail change. An early Step 1 exam may also lead to improved CSE performance, which is often linked to clerkship honors criteria, an increasingly valuable distinction for residency match success after the change to pass/fail. In contrast, delaying Step 1 is associated with higher first-time pass rates, which may be especially important for students at risk for failure. Medical educators and students should collaboratively approach the question of Step 1 timing, considering these factors within the context of the medical school program, curricular constraints and priorities, and students' individual needs and goals.

Comparing Confirmed Sodium Nitrite Suicide Deaths With Poison Center Surveillance Estimates

Sodium nitrite is a curing agent increasingly used for self-harm and suicide, and multiple locales have reported increasing cases. However, approaches to forensic investigation of these cases are not standardized, and current modes of surveillance in the United States may be inadequate. To define a potential standard approach for identifying sodium nitrite deaths based on forensic confirmation, and compare findings based on this standard to poison center surveillance. This retrospective case series of sodium nitrite exposures and deaths was conducted in 2 urban medical examiner jurisdictions in New York State from 2000 to 2022. The population-based sample included individuals from (1) medical examiner reports of decedents where the cause of death was sodium nitrite and (2) poison center reports of intentional exposures to sodium nitrite. Sodium nitrite as either cause of death (medical examiner reports) or intentional exposure (poison center reports). Medical examiner determination of sodium nitrite deaths was considered the criterion standard and relied largely on confirmatory blood nitrite testing. Poison center records were assessed for intentional exposures to sodium nitrite. In this case series of 36 decendents, median (range) age was 28 (20-57) years; 23 (63.8%) were male; 6 (16.7%) were African-American, 5 (13.9%) were Chinese, 13 (36.1%) were White, and 4 (11.1%) had unknown race; and 6 (16.7%) were Hispanic. No deaths were found from 2000 to 2018, and yearly increases in deaths from 2019 to 2022; these deaths were largely missed by local poison center surveillance. Most cases (83.3% [n = 30]) had postmortem blood nitrite concentrations available, and multiple decedents had evidence of suicide kit recommendations from internet sources. In this case series of decedents in 2 New York medical examiner jurisdictions, sodium nitrite deaths increased yearly, and the medical examiners were able to obtain confirmatory nitrite concentrations in most cases. These findings suggest that poison center surveillance underestimates confirmed deaths from sodium nitrite; public health authorities should rely on multiple data sources when analyzing this problem, and forensic analyses should be standardized.

Опыт внедрения информационной системы с технологиями искусственного интеллекта в работу поликлиники для оптимизации организации периодических медицинских осмотров.

Organizing medical examinations for patients with minimal time losses is the most difficult task for an outpatient clinic when creating a New model of a medical organization providing primary health care. Since during medical examinations it is necessary to perform a whole range of works associated with certain sets of actions, the authors developed an information system with technologies of artificial intelligence, which was tested during periodic medical examinations. The purpose of the study is to develop and test an information system with technologies of artificial intelligence that allows balancing the capabilities of a medical organization and the needs of the patient when undergoing periodic medical examinations. Materials and methods. The tool for solving this problem was an artificial intelligence platform based on the principle of decision making by controlling the positions of attractors in the state space of the Hopfield neural network, which was built into the medical information system using HL7 FHIR. Results. The result of the work was the “Smart Clinic” project, which provides for the creation of an information system with technologies of artificial intelligence for routing patients during periodic medical examinations. The information system provided dynamic routing of patients in real time with the construction of the shortest trajectory and minimal movement across the floors of the building, based on current information about the workload of specialists and the duration of each stage of the examination. Conclusions. The use of an artificial intelligence information system in the outpatient clinic made it possible to reduce the average duration of a patient’s trajectory during a periodic medical examination by 45%, the average waiting time for an appointment – from 7 minutes to 3 minutes, and the total time for undergoing a preventive examination – from 200 to 150 minutes. This made it possible to increase the number of periodic medical examinations per year by 1.5 times, and the level of patient satisfaction reached 95%.

Nonlinear relationship between triglyceride-glucose index and the risk of prediabetes and diabetes: a secondary retrospective cohort study.

The triglyceride-glucose (TyG) index, recognized for its cost-efficiency and simplicity, serves as an accessible indicator of insulin resistance. Yet, its correlation with the risk of prediabetes and diabetes (Pre-DM/DM) in the Chinese demographic remains uncertain. Consequently, our study explored the association between the TyG index and the development of Pre-DM/DM within the Chinese population. The retrospective cohort study was carried out utilizing data from a health screening initiative. The study included 179541 adults over 20 who underwent medical examinations at the Rich Healthcare Group over a period spanning from 2010 to 2016. The correlation between the TyG index and Pre-DM/DM risk was investigated using Cox regression analysis. Furthermore, Cox proportional hazards regression with cubic spline functions and smooth curve fitting was incorporated to explore their non-linear connection. The mean age of study participants was 41.18 ± 12.20 years old, and 95255 (53.05%) were male. During a median follow-up of 3.01 years, 21281 (11.85%) participants were diagnosed with Pre-DM/DM. After adjusting the potential confounding factors, the results showed that the TyG index was positively correlated with incident Pre-DM/DM (HR: 1.67, 95%CI: 1.62-1.71, P< 0.001). Additionally, a non-linear association was observed between the TyG index and the onset of Pre-DM/DM, with an inflection point identified at 8.73. Hazard ratios (HR) to the left and right of this inflection point were 1.95 (95%CI: 1.86-2.04) and 1.34 (95%CI: 1.27-1.42), respectively. Furthermore, sensitivity analyses confirmed the stability of these findings. The TyG index exhibited a non-linear positive relationship with the risk of Pre-DM/DM. These findings imply that maintaining the TyG index at a lower, specified threshold may be beneficial in mitigating the onset of Pre-DM/DM.

The Management of Congenital Idiopathic Clubfoot Deformity: An Observational Study

Background: Club feet are a frequent birth defect, and congenital club foot is one of the most prevalent. Patients with this condition are often treated with surgery. A congenital club foot is a complicated joint malformation that may take many different forms. Objective: To observe the management of congenital idiopathic clubfoot deformity. Methodology: This research was conducted between January 2007 and December 2008 at the orthopaedic department of Bangabanghu Sheikh Mujib Medical University in Shahbag, Dhaka. Group-I included 13 patients with 19 feet who had surgery using Mckay's process, and Group-II included 12 patients with 17 feet who underwent surgery using Turco's technique, for a total of 25 patients with 36 feet. There was complete observance of all ethical norms. Medical history, physical exams, and specific tests all pointed to a positive diagnosis. Two groups then had surgery, one through the Turco incision and the other via the Cincinnati one. SPSS (Statistical Package for the Social Science) was used for the statistical analysis. Results: The next most common age range was between 12 and 17 years old. McKay's method had a success rate of 23.07%, whereas Turco's method achieved a success rate of 25.0%. There were around 75% males and 25% females in the Turco group. There were more men than women in McKay's group (61.53% vs. 38.46%). Four patients included their right foot (21.05%), three their left foot (15.80%), and six their both feet (63.15%) during McKay surgery. Of McKay's patients who had the treatment, just 10.54 percent had negative results, while the remaining 89.46 percent performed well. Conclusion: Everyone agrees that a congenital clubfoot abnormality should be surgically corrected. Bias was not a possibility. It may be advantageous for our people if this prospective research evaluating the results of the Turco and McKay surgical procedures for treating congenital clubfoot is completed.

Right to information: legal positions of the Constitutional Court of Ukraine

The article reveals the legal positions of the Constitutional Court of Ukraine regarding everyone’s right to information. Attention is focused on information that is collected by state authorities, local self-government bodies, institutions and organizations, and which is not a state or other secret protected by the Law of Ukraine «On Information» and which every person has the right to familiarize himself with. Separate attention is focused on confidential information (information with limited access). One of the types of confidential information is medical information, which, on the one hand, in special cases provided for by the Fundamentals of the Health Care Legislation of Ukraine, can be disclosed to family members or a legal representative of the patient, and on the other hand, in accordance with the decision of the European Court of Human Rights person in the case of «M.K. against Ukraine» confirmation by a doctor of a patient’s illness to a member of his family, even if he learned about it from the patient himself, is an interference by the state in a person’s right to private life, and in the case of infectious diseases, it is qualified as not carried out «in accordance with the law». Attention is focused on the fact that such situations arise more and more when military personnel undergo medical examinations and that there are prohibitive norms of a special law that forbid the disclosure of medical information regarding a certain list of diseases of a military personnel to his employer (military unit), commander, family members of the military personnel. Regarding the confidentiality of information and about a person who holds a position related to the performance of the functions of the state, local self-government bodies, and about members of his family, the legal positions of the Constitutional Court of Ukraine are established: absolutely in each specific case it is determined whether information about a person belongs to confidential; there are guarantees of protection of the rights of the above-mentioned persons, and additional legal burdens, and therefore the state is called upon to ensure a balance of public and private interest. The article also draws attention to the fact that even under martial law conditions, control (direct; indirect) by institutions of public power is prohibited both in terms of content and dissemination of information, even if the state pursues such a goal as protecting the information space from what is considered harmful by the state information that is not necessary for society. The practice of the Constitutional Court of Ukraine on this issue is established. Attention is focused on the fact that censorship cannot be used in Ukraine to protect the information field of the state even in war conditions - it is prohibited in part 3 of Art. 15 of the Constitution of Ukraine.

Constitutional Factors and Irradiation as Risk Factors for Thymoma: A European Case-Control Study.

Little is known about the aetiology of thymoma. This study aims to identify medical risk factors for thymoma as a systematic approach to new hypotheses on the aetiology of this disease. A European multi-centre case-control study was conducted from 1995 to 1997, including incident cases aged 35-69 years with thymoma. Altogether, we accepted 85 cases and 3350 controls, of which we interviewed 77 cases and 2071 population controls about constitutional factors, medical examinations, and former diseases. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Medical examinations with X-ray or radiotherapy performed >20 times at least one year before the thymoma diagnosis indicated a possible risk factor for thymoma (OR 1.58, 95% CI 0.93-2.69). Having the first radiotherapy treatment at least one year before the thymoma diagnosis yielded an OR for thymoma of 2.39; 95% CI (0.96-5.99), and if it was at least five years before, the OR for thymoma was 2.81; 95% CI (1.03-7.72). Having a red/auburn hair colour was associated with thymoma, (OR 3.6, 95% CI 1.4-9.5) whereas having pigmented skin was slightly associated with thymoma (OR 1.8, 95% CI 0.8-3.8). Over twenty instances of X-ray examinations or radiotherapy were identified as potential risk factors for thymoma, along with certain constitutional factors. The observed correlations between benign tumours and thymoma could stem from an inherent predisposition to tumour development or result from detection bias. Given that this is the initial analytical study examining medical risk factors for thymoma, all of the results should be approached with caution, acknowledging the possibility that some findings might be incidental.

Pathological correlation between eosinophils and thyroid nodules based on medical image testing

Thyroid nodule is a common thyroid disease, but the study of its pathology and pathogenesis is still limited. As a non-invasive diagnostic method, medical image examination is of great value to study the pathological correlation of thyroid nodules. The purpose of this study was to investigate the expression of eosinophils in medical image examination and the pathological correlation between eosinophils and thyroid nodules. The study analyzed the pathological reports of a group of patients with thyroid nodules examined by medical images and performed corresponding imaging scans or examinations. The imaging data is processed, including image reconstruction, data transmission and other steps, to generate images that can be diagnosed by doctors. Thyroid function and parameters of leukocyte were collected and compared.The serum levels of TT4 and fT4 were observed lower in G2 group, while thyroid stimulating hormone (TSH) was higher compared to G1 group before surgery. Compared to G2 group, eosinophils count and percentage were lower in G1group (p < 0.05) post-surgery and lower ratio of eosinophils count with lymphocyte count (ELR) were observed in G1 group patients (p < 0.05).Elevated TSH is closely related to malignant TN per surgery, while lower ELR suggesting that TN removed thoroughly. Relevant cut-off values required further study to guide the diagnosis, treatment and follow-up of TN.

Natural Product Interventions in Peripheral Diabetic Neuropathy: A Multi-Target Approach

Peripheral diabetic neuropathy (PDN) is a well-known impediment of diabetes mellitus. That is one of the common kinds of neuropathy, categorized by reduced neuronal function in the minor limbs including excruciating neurological pain. A medical examination is used to subclassify asymmetric and symmetric neuropathy. Diabetes is associated with several pathways, one of which is the activation of the polyol route, the production of oxidative stress, poly ADP-ribose polymerase, the formation of advanced glycation outputs, and the pathways of hexosamine. Although there are a few symptomatic and supportive treatments in use, like antiarrhythmics, tricyclic medications, aldose reductase, opioid analgesics, protein kinase C inhibitors, and incretin the results are unimpressive. To bridge this space, herbal product-based treatment can be a very successful replacement. This narrative review tries to understand the research currently accessible on the function of different biological entities in the treatment of PDN. These chemicals are essential for lowering aldose reductase activity, oxidative-nitrosative stress, and neuronal death. They improve axonal regeneration, nerve transmission velocity, as well as antioxidant molecules while controlling glucose and HbA1c%. (Malondialdehyde, catalase, superoxide dismutase). They are renowned for their ability to reduce heat and mechanical hyperalgesia as well as tactile allodynia. Thus, these substances need to have their animal study and clinical efficiency assessed. Natural compounds may be auspicious participants in the fight against PDN that provide a glimpse of optimism to those in need.