Epidemiological evidence implicates Epstein-Barr virus (EBV) as the cause of multiple sclerosis (MS). However, its biological role in the pathogenesis of MS is uncertain. The article provides an overview of the role of EBV in the pathogenesis of MS and makes a case for targeting EBV as a treatment strategy for MS. EBV potentially triggers autoimmunity via molecular mimicry or immune dysregulation. Another hypothesis, supported by immunological and virological data, indicates that active EBV infection via latent-lytic infection cycling within the central nervous system or periphery drives MS disease activity. This supports testing small molecule anti-EBV agents targeting both latent and lytic infection, central nervous system-penetrant B-cell therapies and EBV-targeted immunotherapies in MS. Immunotherapies may include EBV-specific cytotoxic or chimeric antigen receptors T-cells, therapeutic EBV vaccines and immune reconstitution therapies to boost endogenous EBV-targeted cytotoxic T-cell responses. EBV is the probable cause of MS and is likely to be driving MS disease activity via latent-lytic infection cycling. There is evidence that all licensed MS disease-modifying therapies target EBV, and there is a compelling case for testing other anti-EBV strategies as potential treatments for MS.

This study reviewed the survey of malformed frogs and the probable causes of their deformities. It analysed the checklist and pattern of malformations in frogs and examined different malformations in frogs of selected articles. It also reviewed the causes of malformation in frogs of different articles. The reviewed showed that limb malformations with 22.41% was the most recorded malformations in frogs with pattern of publications revealed that there was varying trend in article publication which peaked in 2000 and 2023. Different malformations in frogs are abnormal skin, albinism, extra hindlimb, eye malformation. Others are lack of palms, appendages and appendicular, limb malformation, ectrodactyly, brachydactyly and ectrodactyly. The causes of malformations in frogs reviewed includes mutation, parasites, heavy metals, environmental stressors and ultraviolet light. The study concluded that human factors or anthropogenic activities played an important role in malformations in frogs reviewed.

Pulmonary artery aneurysm (PAA) is a rare abnormality of pulmonary vasculature. It can be idiopathic or secondary to various pathologies, frequently with multiple factors leading to its formation. We report the case of a man with concomitant sarcoidosis and PAA. A 75-year-old male with a diagnosis of pulmonary sarcoidosis was referred to the Cardiology department due to heart failure with reduced left ventricular ejection fraction (LVEF). The transthoracic echocardiogram revealed mildly reduced LVEF, aortic root and pulmonary artery (PA) dilatation, and no signs of pulmonary hypertension (PH). Cardiac magnetic resonance imaging was performed, revealing mild left ventricular dilation, LVEF of 40%, main PA dilation (43 mm) and a pattern of late gadolinium enhancement suggestive of cardiac sarcoidosis. At follow-up, a thoracic computed tomography (CT) angiography scan revealed ascending aorta ectasia and giant main PA aneurysm (60 mm). A right heart catheterisation was performed, and a mean PA pressure of 34 mmHg was obtained. Given the clinical context, the patient was considered to have PH due to lung disease and left heart disease, and PAA was possible due to vascular granulomatous involvement by sarcoidosis. PAA is a rare finding and mostly occurs in the setting of PH. Sarcoidosis is a granulomatous disease that mostly affects the lungs, but the sarcoid involvement of great vessels has been described. In this clinical case, the probable cause for the PA fragility leading to aneurysm formation remains sarcoid vascular infiltration, regarding the discrepancy between the PA dimensions and mildly elevated PA pressure. Pulmonary artery aneurysm is a rare abnormality of pulmonary vasculature that can be idiopathic or a consequence of pulmonary hypertension, congenital heart disease, infection, vasculitis or collagenopathies.Due to the low incidence of this disease, there are no guidelines for its diagnosis, management or follow-up, and treatment is based on the underlying aetiology, aneurysm dimensions and occurrence of symptoms.Sarcoidosis is a multisystem disorder of unknown aetiology characterised by non-caseating granulomas that mostly involve the lungs, but can also affect skin, eyes, and lymph nodes. Sarcoid involvement of great vessels has been rarely described.

Acute right lower quadrant (RLQ) abdominal pain typically raises the suspicion of appendicitis and must be ruled out, as the treatment is primarily surgical. Other differentials, many of which are medically treated, ought to also be considered. Right sided diverticulitis, although uncommon, often mimics appendicitis due to its inflammatory nature and its location of pain. A 37-year-old woman with a history of recurrent right-sided diverticulitis presented with rapidly escalating RLQ pain. While appendicitis was a prime suspect, additional imaging was refused due to radiation concerns, hence clinical judgement had to be aptly applied. Facing diagnostic ambiguity, Hickam's dictum (seeking the most probable cause) pointed towards appendicitis, while Ockham's razor (favouring the simplest explanation) supported recurrent right sided diverticulitis. This uncertainty necessitated a definitive approach, weighing up the risks and benefits of medical vs surgical treatment for an unconfirmed pathology. To resolve the uncertainty, a diagnostic laparoscopy was performed. Contrary to expectations, it revealed a perforated diverticulum of the appendix with a mucinous tip and free-floating mucin, making both leading differentials, that is, right sided diverticulitis and appendicitis, correct. We explore the diagnostic reasoning used in the case, including the anticipated management strategies and outcomes, if other differentials were encountered. This case aims to support clinicians in pursuing further investigations, or need be, a diagnostic laparoscopy, in order to prioritise patient safety, if clinical concern is present.

Abstract Concurrent thrombus formation in both the arterial and venous systems is rare and present as a diagnostic challenge in these cases; therefore, we must explore various possible etiologies and mechanisms. Herein, we report a case of concurrent chronic limb threatening ischemia (CLTI) and deep vein thrombosis (DVT) of a limb in a patient with systemic lupus erythematosus (SLE) and chronic heart failure who underwent laboratory examinations and multimodality imaging. A 37-year-old male presented with a complaint of pain and swelling of the lower left extremity since 21 days before admission. Echocardiography showed dilated all chambers with ejection fraction, moderate-to-severe pericardial effusion, and no intracardiac shunt. Doppler ultrasound of the lower extremities showed DVT at the left mid-femoral and popliteal vein, severe stenosis at the left dorsalis pedis artery, moderate stenosis of the left popliteal, anterior, and posterior tibial arteries, and soft tissue swelling in the tibial region. Computed tomography angiography showed significant stenosis of the left popliteal, anterior, and posterior tibial arteries. The patient was diagnosed with CLTI and DVT of the left inferior extremity, heart failure, SLE, and tuberculous meningitis on antituberculosis medication. Primary amputation was performed, and the patient was discharged uneventfully.Concurrent CLTI and DVT in the same limb caused by SLE and heart failure is a rare condition. In this case, the probable causes were hypercoagulable state and vasculitis. Despite exhaustive attempts, the exact mechanism was not fully elucidated in this patient. However, we excluded other possible causes that require specific intervention, such as intracardiac shunt or phlegmasia cerulea dolens.

Unraveling the conjunctivitis crisis: understanding the spiking incidence in Karachi and Lahore-Pakistan

This case report describes the death of a 52-year-old male who was bitten by a venomous snake, Vipera berus (common European adder), on his left wrist. Despite experiencing symptoms, the patient refused medical care and self-medicated with alcohol instead. He was later found dead in his residence. Autopsy and histological examination revealed evidence of an anaphylactic reaction in response to the snake bite, with additional findings of alcohol intoxication and other underlying medical conditions.

The regularities of distribution, migration, and accumulation of natural gamma-active nuclides 40K, uranium 238U (214Pb, 214Bi), and thorium 232Th (212Pb, 212Bi, 228Ac, 208Tl) series, as well as man-made 137Cs in the sediments of the tributary of the Tysa River (Bila Tysa), have been established. It is shown that the total content of the studied radionuclides in the bottom sediments along the entire length of the Tysa River differs slightly and is proportional to the level of its siltation. And this largely depends on many factors, in particular - the intensity of radionuclide exchange processes between soil and water, the water content in the soil, organic substances, and the morphological features of the river. Fluctuations of the total specific activity of natural gamma-active radionuclides (excluding 40K) in sediments within the range of 195.5-293.9 Bq/kg were established. The highest content of these isotopes was determined at the confluence of the White and Black Tisza. Mapping of the studied territories according to the content of 40K and 137Cs has show that the area of accumulation of gamma-active nuclides is concentrated in the lower part of the river (the point of confluence of the White and Black Tisza), and the probable causes of this phenomenon were substantiated. The analysis of the degree of connection between the content of radionuclides (238U and 232Th, 40K and 137Cs series) and the territorial factor showed that for the majority of GAN there is a zonal distribution - in the bottom sediments of the river source. Keywords: radionuclides; gamma-active nuclides; radioecological monitoring; bottom deposits; migration; accumulation; Cs/K content; Tysa river.

Structural and optical properties of silicon oxycarbide thin films using silane based precursors via sol-gel process

BackgroundRib fracture nonunion is a probable cause of chronic pain following chest trauma, although its prevalence remains unknown. The aims of this study were to determine rib fracture nonunion prevalence following nonoperative management and to determine if presence of nonunion was associated with the number of rib fractures, or the rib fracture classification of anatomical location, type, and displacement. MethodsThis multicenter prospective cohort study included trauma patients with three or more fractured ribs but without a flail segment, who participated in the nonoperative management group of the FixCon trial between January 2019 and June 2022. The number and classification of rib fractures were assessed on trauma chest CT. Chest CTs conducted six months post-trauma were evaluated for the presence of nonunion. Radiological characteristics of nonunions were compared with normally healed rib fractures using the Mann-Whitney U, χ2 test, and Fisher's exact test as appropriate. A generalized linear model adjusted for multiple observations per patient when assessing the associations between nonunion and fracture characteristics. ResultsA total of 68 patients were included with 561 post-traumatic fractures in 429 ribs. Chest CT after six months revealed nonunions in 67 (12 %) rib fractures in 29 (43 %) patients with a median of 2 (P25-P75 1–3) nonunions per patient. Nonunion was most commonly observed in ribs seven to 10 (20–23 %, p < 0.001, adjusted p = 0.006). Nonunion occurred in 14 (5 %) undisplaced, 22 (19 %) offset, and 20 (23 %) displaced rib fractures (p < 0.001). No statistically significant association between rib fracture type and nonunion was found. ConclusionsForty-three percent of patients with multiple rib fractures had radiographic nonunion six months after trauma. Fractures in ribs seven to 10 and dislocated fractures had an increased risk of rib fracture nonunion.

Introduction: The term “suspected poisoning” describes the potential exposure of a human or animal to a poisonous chemical, which might result in a variety of symptoms ranging from minor symptoms to severe consequences. The kind and quantity of the poison implicated may affect the symptoms. If poisoning is suspected, it’s crucial to get help right away so that the correct toxin can be identified and the proper management can be given.Aim: To monitor the epidemiological traits and clinical trends of poisoning cases at the emergency department of Dr. RMLIMS Lucknow.Methods: All 295 instances of acute poisoning were reported to the emergency department between April 2022 to March 2023. It is retrospective observational research of 12 months duration carried out in a tertiary care hospital. Data on the patient’s age, gender, kind of poisoning, length of hospital stay, and result were gathered from hospital medical records and examined.Result: The majority of victims have married housewives with poor socioeconomic and educational standingwho were between the ages of 31 and 40. Agriculture poisons and domestic poisons were the two most often used toxins. Most of the time, the general health at the time of presentation was unstable.Conclusion: Suspected poisoning is a serious medical emergency that might have life-altering effects on thevictims. Knowledge of the probable causes and symptoms of poisoning is crucial to ensure prompt diagnosis and treatment. Those who have been exposed to harmful chemicals can recover and prevent long-term harm with the proper measures.

The frequency of achieving control as a result of taking antihypertensive drugs in women in the age group 55-64 years reaches 78.9%, the frequency of gastrointestinal symptoms occurring during treatment of hypertension is up to 62%. The aim: to analyze the probable causes of the development of symptoms of diseases of the gastrointestinal tract in postmenopausal patients receiving antihypertensive therapy. Material and methods. A comprehensive clinical examination of out-patient and in-patient patients of health care institutions of the Smolensk region with hypertension aged 50 to 84 years, (group AG, n=160) mean age 67.4 ± 17.4 years. Results. Complex examination and observation on the basis of standard methods with high probability shows the formation of gastroesophageal reflux disease, gastritis, simple erosions of the gastric mucosa, biliary dysfunction, chronic pancreatitis steatohepatosis in the observed patients. Conclusions: In postmenopausal women receiving antihypertensive therapy, there are major gastrointestinal symptoms of varying severity, arising in conditions of irrational nutrition, psycho-emotional and physical stress on the background of irregular medication. Based on the analysis of modern scientific sources, it can be argued that complex rational antihypertensive, antiplatelet, hypolipidemic, antisecretory and eradication therapy and the correction of modifiable risk factors ensures the achievement of remission of gastrointestinal and cardiovascular disease in the optimal time, improves the quality, life expectancy of patients and improves disease prognosis.

Integrated building fault detection and diagnosis using data modeling and Bayesian networks

Introduction: Psychiatric patients have a higher rate of falls even in the hospital setting compared to other patients; falls are a safety concern because of the negative consequences for health and quality of life. Methods: descriptive, retrospective study. A total of 162 clinical records of patients who fell during hospitalization were analyzed. Factors for falls were classified as intrinsic and extrinsic. Frequency and percentages of qualitative variables were calculated and the U-Mann Whitney test was used to compare means of qualitative variables. A logistic regression model was constructed. All analyses were performed using SPSS version 26 statistical software. Results: The frequency of falls was higher in women (n=110) with a rate of 5.4 falls per 1000 hospital days. 27.2% had more than two falls and 67.3% of patients were injured when falling (6.2% serious). In 30.9%, the adverse effect of psychotropic drugs was identified as the probable cause of the fall. Some of the predictors of falls that showed a significant difference were: cognitive impairment (ExpB=2.59), female sex (ExpB=6.41) and night shift (ExpB=1.16). Conclusions: We identified that the variables female sex, cognitive impairment (intrinsic factors) and night shift (extrinsic factor) explain the higher probability of falling during hospitalization. We consider that cognitive assessment should be included to identify the risk of falling and reduce the staffing deficit in the night shift.

Evaluation of welded joints of austenitic stainless steels at high temperatures in the presence of SO2, SO3, and O2

Stillbirth is an important health problem, and in Mexico, only half of the stillbirths have an explainable cause. The aim of this study was to implement a multidisciplinary workup to identify the etiology and potential risk factors for stillbirth at the Hospital Universitario "Dr. José Eleuterio González". This is a prospective, descriptive, observational study that included stillbirths from the Obstetrics Service from October 1st, 2019 to May 25, 2020. Evaluation strategies included a complete maternal medical history, physical examination of the fetus, and a photographic medical record. For every stillbirth either a prenatal ultrasound, a postnatal x-ray, or a fetal autopsy, were needed. Multiplex Ligation Probe Amplification (MLPA) was performed with an umbilical cord sample. Thirty-three stillbirths were reported; 21 were included in the analysis. Eleven women (52.3%) had known risk factors for stillbirth, mainly elevated body mass index and diabetes. On physical examination, external birth defects were found in 8 fetuses (38%). X-ray was performed in 14 cases (66%), alterations were detected as a probable etiologic cause just in one. All cases underwent MLPA, which were reported negative. Three cases had criteria for autopsy. Findings were inconclusive to determine etiology. The best tools for evaluation of stillbirth were the elaboration of clinical history, physical examination, and prenatal ultrasound. Diabetes and obesity were the most frequent risk factors found in our population. These factors are preventable by implementing strategies that lead to better prenatal care.

ABSTRACT Lampreys were considered a delicacy among most royal families and the nobility in medieval Britain. The tradition was for the people to present the monarch with a lamprey pie once a year. King Henry I (1068–1135) of England was known for his lust for eating lampreys and is reported to have died from a “surfeit of lampreys,” as the chronicle said. The information concerning this event is scarce, confined to only two sources, the chronicle of Henry of Huntingdon and the history of Roger of Wendover. Both write about Henry’s death, but only the former mentions its cause, albeit without many details. It remains a mystery then whether the king died from gluttony, or maybe from food poisoning or some other reason. The author of the article describes the circumstances of Henry’s death and presents the arguments to justify the probable cause of it. Medieval dietetics has been used as a springboard to writing about the importance of fish in the diet despite its unfavorable opinion in the light of the theory of humors. Fish were believed to predominate in cold and moist humors, which, in terms of humoral theory, is particularly dangerous to anyone in cold and moist seasons.

The Decline of the Norwegian National Travel Survey Empire

Neurodegenerative diseases are defined by progressive nervous system dysfunction and death of neurons. The abnormal conformation and assembly of proteins is suggested to be the most probable cause for many of these neurodegenerative disorders, leading to the accumulation of abnormally aggregated proteins, for example, amyloid β (Aβ) (Alzheimer's disease and vascular dementia), tau protein (Alzheimer's disease and frontotemporal lobar degeneration), α-synuclein (Parkinson's disease and Lewy body dementia), polyglutamine expansion diseases (Huntington disease), or prion proteins (Creutzfeldt-Jakob disease). An aberrant gain-of-function mechanism toward excessive intraparenchymal accumulation thus represents a common pathogenic denominator in all these proteinopathies. Moreover, depending upon the predominant brain area involvement, these different neurodegenerative diseases lead to either movement disorders or dementia syndromes, although the underlying mechanism(s) can sometimes be very similar, and on other occasions, clinically similar syndromes can have quite distinct pathologies. Non-Euclidean image analysis approaches such as fractal dimension (FD) analysis have been applied extensively in quantifying highly variable morphopathological patterns, as well as many other connected biological processes; however, their application to understand and link abnormal proteinaceous depositions to other clinical and pathological features composing these syndromes is yet to be clarified. Thus, this short review aims to present the most important applications of FD in investigating the clinical-pathological spectrum of neurodegenerative diseases.

To analyse the daily measured Dosimetric Quality Assurance (QA) parameters of linear accelerator (linac) using Unsupervised Machine Learning (ML) Algorithm thereby evaluating the current machine status and to highlight the probable cause of the 'out-of-range' measured parameter. Five Parameters measured using PTW QuickCheckwebline device in a linac is subjected to KMeans clustering technique. The measured parameters comprise of Central Axis Dose (CAX), Beam Flatness, SymmetryLR, SymmetryGT and Beam Quality (BQF). Data from Varian with 55- and 107-day's measurements and from Elekta with 75 days measurements from 2 beam matched linacs were used in this clustering technique. This evaluation is used to review the current linac status and obtain 1) Upper and lower limits of each parameter (CAX, Flatness, Symmetry, Beam Quality), 2) Frequency of the days when the linac parameters are closer to the target value and when they deviate from the target value. 3) The date when these parameters deviate from the estimated limits. 4) The probable reason for the deviation and 5) Finally if the machine requires maintenance. This methodology ensures that the machine is always closest to the target value, thus providing quality radiation treatment for the cancer patients. Moreover, the performance of the linac is studied meticulously and the need for maintenance is alerted before the linac beam shows marked deviation from the base value. KMeans clustering is a very simple and easy to use ML tool. With quick computation time and with lesser data it can arrive at the actual limits of the linac parameters and help to determine if the linac needs maintenance well in advance.