Loiasis is a vector-borne filarial infection endemic to parts of sub-Saharan Africa. It disproportionally affects economically disadvantaged communities in rural, forested regions. To better understand the economic burden of loiasis, we conducted a comprehensive cost-of-illness study in an endemic region of Gabon, with the aim of quantifying the financial costs incurred by individuals infected with the disease from a societal perspective. We conducted a cross-sectional survey in 2023 in rural Gabon. Study participants took part in diagnostic testing for loiasis and were interviewed based on a standardized questionnaire covering a wide range of medical and non-medical costs. Participants reporting eye worm migration or harboring loiasis microfilariae were defined as loiasis positive. Various cost estimates were derived by creating a synthetic control group by means of entropy-balancing and then applying generalized linear models (GLM) for the study region. We show that the average annual costs directly attributable to loiasis amount to 39.94 USD per individual per year. Average cost estimates are primarily driven by indirect costs and direct non-medical costs. We further show that in the rarer cases that individuals seek treatment at formal or informal healthcare providers for loiasis-specific symptoms, costs from the patient's perspective can be excessively high and amount to about 43 percent of the average monthly per capita income in the study region.

The challenges associated with achieving a clear diagnosis in patients with a suspected bleeding disorder are evident in those who end up categorized as bleeding disorder of unknown cause (BDUC), which can contribute to uncertainty in management and suboptimal care. BDUC is a diagnosis of exclusion, with nondiagnostic first-line hemostatic laboratory testing not meeting the criteria of an inherited mild bleeding disorder, despite the patient having a positive bleeding phenotype and/or positive family history. An abnormal bleeding phenotype, an important diagnostic criterion for BDUC, should be assessed through the use of standardized bleeding assessment tools, allowing for the quantification of bleeding symptoms as well as through clinical gestalt and judgment. The first-line laboratory workup must include a minimum set of hemostasis assays with normal results, including complete blood count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, von Willebrand disease testing, factor VIII, platelet aggregation testing, and, if available, platelet-dense granule assessment. Following normal results of initial laboratory testing, specialized tests may be ordered based on examination in addition to the patient's clinical history, including measurement of individual clotting factor assays to identify other rare bleeding causes, and in rarer cases, additional platelet assays and fibrinolysis assays may be performed. Genetic testing involving targeted genomic sequencing of known genes associated with bleeding and platelet dysfunction is not currently part of the standard line of care, primarily due to the cost and low diagnostic yield.

Guillain–Barré syndrome (GBS) is an acute, immune-mediated inflammatory polyradiculoneuropathy. Its most common symptom is limb muscle weakness, which usually occurs symmetrically, typically involving the lower limbs. There is a weakening or abolition of deep reflexes, and radicular pain, most often in the lumbar or intercostal regions. In half of patients, facial muscle weakness can be observed. In most cases, especially at the onset of symptoms, there is paraesthesia involving the distal parts of the lower extremities and, in rarer cases, also the distal parts of the upper extremities. The uncharacteristic and varied symptoms mean that the diagnosis can present some difficulties. This review discusses the latest updates on the diagnosis and treatment of Guillain–Barré syndrome based on the 2023 European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria. The guidelines emphasise a systematic approach to clinical evaluation, diagnostic testing, and therapeutic strategies, using robust evidence and best-practice recommendations. Key points include the role of preceding infections, particularly Campylobacter jejuni, in the pathogenesis of the syndrome, and the identification of diagnostic subtypes, such as acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, and Miller Fisher syndrome. Electrodiagnostic tests have been recognised by the EAN/PNS as essential tools for diagnosing Guillain–Barré syndrome, while plasmapheresis and intravenous immunoglobulin remain the pillars of treatment. The article highlights the importance of early intervention and differentiation of Guillain–Barré syndrome from chronic neuropathies for optimal outcomes.

The objective: to analyze the frequency of respiratory pathologies associated with rheumatoid arthritis (RA), their structure and diagnostic approaches. Materials and methods. In order to achieve the task, a detailed analysis of scientific articles on the topic of respiratory system pathologies in patients with RA was conducted in journals indexed in the SCOPUS, Web of Science, MEDLINE, Google Scholar, UpToDate, ResearchGate databases. The search in scientometric databases was conducted using the following keywords: “Rheumatoid arthritis”, “Shared epitope”, “Interstitial lung disease”, “Bronchiectasis”, “Bronchiolitis”, “Cricoarytenoid arthritis”, “Common interstitial pneumonia”, “Nonspecific interstitial pneumonia”, “Pleurisy”, “Pleural effusion”, “Follicular bronchiolitis”, “Constrictive bronchiolitis”, “Rheumatoid lung nodules”, “Pulmonary vasculitis”. Results. RA is an autoimmune pathology that primarily affects the musculoskeletal system, but the presence of extra-articular manifestations often indicates a more severe course and requires a balanced approach to the treatment of this category of patients. The incidence of RA in Europe is 0.5–1%, with the involvement of the respiratory system in the pathological process, which occurs in 30–40% of cases, contributing to a significant increase in mortality. Clinical manifestations of respiratory damage in RA may be mild or even absent, so the issue of managing these pathologies in the context of patients with RA currently remains open. This literature review highlights current information on the involvement of the respiratory system in patients with RA. The most common pathologies of the respiratory system are interstitial lung disease (ILD), which is associated with RA (RA-ILD) – 19–66%, cricoarytenoiditis – 54–72% and pleural effusion / pleurisy – up to 70%. Less common pathologies are bronchiolitis and bronchiectasis – up to 30% both, and the frequency of pulmonary rheumatoid nodules, pulmonary vasculitis and drug toxicity varies within 1%. Firstly, the patterns of ILD and their frequency have been described: usual interstitial pneumonia (6–66%), nonspecific interstitial pneumonia (14–57%), organizing pneumonia (0–11%), and diffuse alveolar damage, acute interstitial pneumonia and bronchiolitis obliterate are much rarer cases. RAILD has been actively studied in recent years and is associated with damage to the airways, pulmonary vascular system and pleura in the patients with RA. High-resolution computed tomography (HRCT) and functional respiratory tests (FRT) are the preferred methods for RA-ILD diagnosis, and ultrasound-guided thoracocentesis with subsequent pleural fluid analysis is the first-line method for determining pleural involvement. It is important to note that smoking, older age, male gender, high antibody levels and high RA activity, as well as drug toxicity to the lungs in combination with genetic factors are leading risk factors for developing ILD, which makes it possible to influence these modifiable factors through non-drug and drug therapy. In addition to RA-associated pathologies, chronic obstructive pulmonary disease (COPD) can be detected in half of patients, the course of which is complicated by RA, which makes the process of differential diagnosis quite difficult. Conclusions. RA can be characterized not only as pathology of the musculoskeletal system, but also a disease that simultaneously affects other body systems. Although the damage to the respiratory system in RA can be 30–40%, its impact on the quality of life of patients and the prognosis is quite significant. Analysis of modern scientific publications provides an idea not only of the frequency of respiratory system lesions in RA, but also determines the structure of these pathologies: the most frequently diagnosed are 2 patterns of RA-ILD (common and nonspecific interstitial pneumonia), cricoarytenoiditis and pleural effusion/pleurisy associated with RA, as well as COPD; less frequent are lesions of the large and small caliber respiratory tracts, and the rarest conditions are rheumatoid pulmonary nodules, rheumatoid pulmonary vasculitis and iatrogenic effects of drugs. HRCT and FRT allow us to diagnose most pathologies of the respiratory system in RA, however, in the case of pleural effusion/pleurisy, thoracocentesis with pleural fluid analysis is the first choice. Understanding the features of lesions of the respiratory system in patients with RA will allow us to outline an approach to diagnosing these conditions in order to create an individual treatment plan for this category of patients.

Jacobsen syndrome (JS) is a rare combined immunodeficiency caused by partial deletion of the long arm of chromosome 11. Clinical features include physical growth retardation, psychomotor retardation, characteristic facial dysmorphism (skull deformities, hypertelorism, ptosis, coloboma, epicanthal folds, broad nasal bridge, short nose, v-shaped mouth, small low set ears). Patients commonly have malformations of the heart, kidney, gastrointestinal tract, genitalia, central nervous system and skeleton. Abnormal platelet function and immunological problems are usually present. Here we describe a patient with deletion of 11(q) chromosome resulting in clinical phenotype of the facial dysmorphisms, congenital malformations, neurological symptoms, as well as clinical and laboratory features of immunodeficiency. Features of immune dysregulation in a patient with JS are clearly characterized. Patient's parents agreed to use personal dats and photos in research and publications.

This article discusses the impact of building and planning codes on the improvement of affordable housing settlements. It is part of a larger research project that proposes a framework for the planning of affordable housing, based on the model of a type of informal Brazilian settlement, the favela. The purpose of this article is to contribute to the literature that reveals how planning and building codes relate to opportunities for the improvement of affordable housing settlements. The article also demonstrates how alternative assessment tools can provide a more holistic evaluation for a housing settlement, offering suggestions for the general improvement of the neighbourhood. This article considers affordable housing that is produced specifically for low-income families. Its production is subsidised by the Brazilian government and the monthly payment of the loan (or rent, in some rarer cases) cannot be more than 30 per cent of the family’s income. Despite the government’s efforts, the estimated housing shortage in Brazil in 2024 totals 6 million residences. Throughout the twentieth century in Brazil there were numerous efforts by the federal and local governments to address the problem of housing shortage. There were also many attempts to eradicate favelas, which were always seen by the public as places of poverty, misery and criminality. This article analyses how a case study, the Santa Marta favela in Rio de Janeiro, complies with local and building codes. It also uses a qualitative tool for assessing housing quality to evaluate the same case.

Цель. Продемонстрировать широкий спектр патологий и мультисистемность поражения у новорожденного ребенка с синдромом Гольденхара. Основные положения. Синдром Гольденхара (окуло-аурикуло-вертебральный спектр) – врожденное заболевание, развитие которого связано с патологией производных 1–2-й жаберных дуг. Характерными проявлениями болезни являются пороки развития глаз, ушных раковин, позвоночника, челюстных структур. В более редких случаях возможны аномалии и других органов. В приведенном клиническом случае у новорожденного ребенка с гемифациальной формой синдрома выявлены нижняя атрезия ануса с перинеальным свищом, гидронефроз, мегауретер. Заключение. Синдром Гольденхара может проявляться не только классическим окуло-аурикуло-вертебральным спектром, но и поражением других органов, что требует междисциплинарного комплексного подхода к диагностике заболевания. Purpose. To demonstrate the broad spectrum of pathologies and multisystemic involvement in a newborn child with Goldenhar syndrome. Main points. Goldenhar syndrome (oculo-auriculo-vertebral spectrum) is a congenital disease, the development of which is associated with pathology of the derivatives of 1–2 branchial arches. Characteristic manifestations of the disease are malformations of the eyes, ears, spine, jaw structures. In rarer cases, anomalies of other organs are possible. In the given clinical case, a newborn child with a hemifacial form of the syndrome was found to have lower anal atresia with a perineal fistula, hydronephrosis, and megaureter. Conclusion. Goldenhar syndrome can manifest itself not only in the classical oculoauriculovertebral spectrum, but also in damage to other organs, requiring an interdisciplinary integrated approach to the diagnosis of the disease.

Perforation of the hypopharynx is an extremely rare condition of various etiologies. In even rarer cases, it can lead to mediastinitis, a serious complication with a high mortality rate of up to 35%. We present a case of a 52-year-old male patient with a purulent descending mediastinitis caused by a rare condition of rupture of the hypopharynx after the ingestion of solid food. Mediastinal gas and fluid as well as pleural empyema were observed on CT scan. The case is unique because of the cervical surgical approach used to treat it, as well as a number of techniques that appear to control the infection and treat the source of mediastinitis. The patient recovered completely 20 days postoperatively and was followed up clinically and by computed tomography without persistent symptoms or late complications.

Infantile exotropia is a relatively rare strabismus disorder characterized by outward deviation of one or both eyes. Because of its rarity, there are few population-based studies to identify its true incidence. Here is a 12years old child presented with abnormal outward eye deviation since birth. Ocular examination revealed infantile exotropia with lambda pattern which is among the rarest case ever found of which squint surgery was done and the alignment was brought back to normal. Definitive treatment is surgery before age of two years to have best binocular single vision outcome, wherein this patient lost his binocular single vision due to the delay.

The global rollout of COVID-19 vaccines has been a significant step in controlling the SARS-CoV-2 pandemic. While the vaccines have proven to be generally safe, adverse reactions, including both local and systemic effects, have been observed. Cutaneous manifestations, though rare, have been reported in some instances. We report the case of a 67-year-old male who developed pruritic erythematous-to-violaceous papules and plaques three days after receiving the second dose of a COVID-19 vaccine. The lesions were found on the right inner thigh, forearms, trunk, and neck. Histopathological examination revealed findings consistent with a lichenoid drug eruption (LDE), a condition typically linked to medications or, in rarer cases, vaccines. Lichenoid drug eruptions are often seen in association with certain medications, and less commonly with Hepatitis B vaccination. However, this case presents an uncommon presentation of LDE following COVID-19 vaccination, with an atypical distribution of lesions, involvement of uncommon sites, and no history of prior drug or vaccine hypersensitivity. This case underscores the importance of recognizing rare or atypical skin manifestations, such as lichenoid drug eruptions, as potential vaccine-related adverse effects. Identifying these conditions allows clinicians to ensure accurate diagnosis and appropriate management.

Introduction: Bordeline Brenner tumors of the ovary are rare tumors accounting for 2% of all ovarian tumors and are characterized by the presence of papillary structures covered with transitional epithelium without or minimal stromal invasion. Case Presentation: In the present case report a 60-year-old postmenopausal woman presented with complaints of lower abdominal pain and a right ovarian mass of 4x5cm, which was diagnosed on histopathological examination as borderline Brenner tumor of the ovary. There were coexisting nonatypical endometrial hyperplasia and endocervical polyps of 1.2x0.9x0.6cm, indicating endometrial hyperstimulation as a result of estrogen secreted by the tumor. The patient was managed successfully with staging laparotomy and was diagnosed with stage I borderline Brenner tumor with non-atypical endometrial hyperplasia and benign endocervical polyp. Conclusion: Borderline Brenner tumors are rare tumors of ovaries with uncertain malignant potential. They have no precise predictive markers but are known to produce estrogen. Surgery remains the mainstay of treatment for these tumors.

Breast cancer is characterized by abnormal cell growth, which leads to tumor formation. Autonomous breast cancer detection has seen good progress. However, there are still several challenges to robust detection. This survey article explores the complexities inherent in multiclass classification for breast cancer diagnosis, aiming to improve patient care, efficiency, and timeliness. In our study, we focus on using histopathology slide images and assess the current state of breast cancer classification, particularly with artificial intelligence, specifically deep learning and convolutional neural networks. The histopathology images are key tools in the diagnosis process, allowing pathologists to visually assess tissue samples for signs of cancer. Our analysis reveals several challenges that hinder the effectiveness of current diagnostic methods. One significant issue is the need for more diversity in the existing datasets, which often fail to represent a wide range of patient populations. This limitation reduces the accuracy of diagnostic results, mainly when applied to different clinical environments. Furthermore, class imbalances within these datasets, where certain cancer types or stages are underrepresented, lead to biased diagnoses, with more common cases being easily identified while rarer cases are frequently missed. Another challenge is the limited generalizability of current diagnostic techniques, which perform well in controlled environments but often need to improve when applied to new, unseen data from different institutions or imaging systems. Additionally, the complexity of histopathological analysis means that it can be difficult for clinicians to interpret certain findings, leading to uncertainty in the diagnostic process. Our study reveals that addressing these issues requires collaborative efforts to improve the quality of datasets, reduce class imbalances, and develop optimal standardized diagnostic methods. By overcoming these challenges, we can enhance the accuracy, efficiency, and accessibility of breast cancer diagnosis, ultimately leading to better patient outcomes and global healthcare. We believe that by examining several factors and variables and conducting an in‐depth analysis of the state of the art, this study will contribute to the state of the art and benefit researchers in both computing and medical domains.

The article represents the analysis of one of the fifteen military journals that were published in Serbia, or the Serbian-speaking region, between 1864 and the beginning of World War I. The journal, under the editorship of Colonel Ljubomir Popović and Vasa Božidarević, was focused primarily on a military-technical issues, mainly those concerning the artillery and engineering branches of the army. In addition to these topics, the journal also covered other content, such as news on aviation, the railway networks of certain countries, and, in rarer cases, covered experiences from the military history. The journal's "news" section included information related to various European and non-European armies, often making comparisons. The high cost of this monthly publication, along with the likely small number of subscribers and contributors, quickly led to its discontinuation. As a result, only 17 monthly issues were printed between mid-1905 and the end of 1906.

ABSTRACT Background New York State (NYS) reported a polio case (June 2022) and outbreak of imported type 2 circulating vaccine-derived poliovirus (cVDPV2) (last positive wastewater detection in February 2023), for which uncertainty remains about potential ongoing undetected transmission. Research Design and Methods Extending a prior deterministic model, we apply an established stochastic modeling approach to characterize the confidence about no circulation (CNC) of cVDPV2 as a function of time since the last detected signal of transmission (i.e. poliovirus positive acute flaccid myelitis case or wastewater sample). Results With the surveillance coverage for the NYS population majority and its focus on outbreak counties, modeling suggests a high CNC (95%) within 3–10 months of the last positive surveillance signal, depending on surveillance sensitivity and population mixing patterns. Uncertainty about surveillance sensitivity implies longer durations required to achieve higher CNC. Conclusions In populations that maintain high overall immunization coverage with inactivated poliovirus vaccine (IPV), rare polio cases may occur in un(der)-vaccinated individuals. Modeling demonstrates the unlikeliness of type 2 outbreaks reestablishing endemic transmission or resulting in large absolute numbers of paralytic cases. Achieving and maintaining high immunization coverage with IPV remains the most effective measure to prevent outbreaks and shorten the duration of imported poliovirus transmission.

Acute vestibular vertigo (AVV) is manifested by the illusion of movement of surrounding objects in front of the eyes or the sensation of movement of one's own body in space. The cause of AVV is in most cases a pathology of the peripheral vestibular analyser, in rarer cases – involvement of the brain stem. Headaches, neck pain, anxiety-depressive disorders, unsteadiness when walking, reduced cognitive abilities and general weakness often complicate AVV, significantly impair quality of life and slow down recovery. Treatment of patients with AVV should include rapid relief of an acute attack to prevent the development of these symptoms, increase patient compliance with vestibular rehabilitation and reduce the risk of developing anxiety-depressive syndrome. As a drug therapy for AVV, a fixed combination of dimenhydrinate and cinnarizine (Arlevert) is effective; it has a minimal sedative effect compared to other vestibular blockers and helps to rapidly reduce the intensity of dizziness and vegetative symptoms. Vestibular gymnastics promotes the processes of natural habituation, reduces the severity of instability and the risk of falling and increases motor activity. All patients with dizziness should have their mental state assessed and existing disorders corrected in collaboration with psychiatrists and cognitive behavioural therapists.

Maternal uniparental disomy of chromosome 14, upd(14)mat, leads to Temple syndrome (TS), an imprinting disorder characterized by pre- and postnatal growth retardation, hypotonia, motor delay, joint laxity, and precocious puberty. The occurrence of upd(14)mat is rare, and it may, in even rarer cases, co-occur with trisomy 14 mosaicism. To date, only 11 live-born cases have been reported in the literature. We present a newborn girl with severe hypotonia, global developmental delay, feeding difficulties, dysmorphic features, and cardiac malformations. Using trio whole genome sequencing (WGS) no causative sequence or structural variants were detected. As a chromosomal disorder was suspected the data was further analyzed with a pipeline including analysis of UPD and low-level mosaicism, which revealed upd(14)mat and low level trisomy 14 mosaicism. This study underscores the significance of advanced genetic testing techniques, thorough data interpretation, and expert clinical evaluation in diagnosing rare disorders with complex molecular mechanisms.

Background: Micrognathia is usually associated with genetic syndromes, characterized by mandibular hypoplasia causing a receding chin. The overall incidence of micrognathia was 1 per 1600 births, makes it a rare case. Severe micrognathia can be a neonatal emergency due to airway obstruction by the tongue in the small oral cavity. One method for correcting micrognathia is distraction osteogenesis. Lack of experience due to rare incidence of case, expensive cost of distraction device and technical complexity of the operation can be obstacles to this management. Patient and Method: We report two cases of micrognathia corrected with distraction osteogenesis conducted in Cipto Mangunkusumo Hospital from 2011-2012. The method consists of implantation of bilateral distraction device to the inferior border of the mandibular body. The patients then followed postoperatively. Result: Mandibular lengthening by gradual distraction is a proper method for young patients with micrognathia. Despite our minimal experience and intricate kind of method, we are trying to improve our skill in the future. Summary: Distraction osteogenesis is one method for correcting congenital mandibular hypoplasia.

Background: Clinical and radiological examinations are used to predict the location of the bullet in bullet penetration injury. The maxillofacial region had a variety of structure which could make the bullet deviate from its normal trajectories. Patient and Methods: A rare case of bullet penetration in the face caused by accidental gunshot is described. A 32 year-old male was hit by a bullet in the face with entrance wound on the left temporal region. Radiologic examination showed a bullet in the left inferior orbita. Treatment was exploration and extraction of the bullet. In this case we observe the difference between the clinical examination, radiological diagnosis and intraoperative findings Result: The patient underwent an explorative operation based on the prediction of location of the bullet from the clinical and radiological examination. The bullet was found in the inferior rectus muscle which the location is out of the prediction of clinical examination and radiologic findings. Summary: Clinical and radiological examination do not always give the accurate prediction regarding the location of bullet in penetrating bullet injury of the face because the face has a variety of bone, muscle and soft tissue structure.

Backgrounds: The main objective of Frontoethmoidal encephalomeningocele (FE) treatment are neural morbidities defect correction and aesthetically pleasing looks. Staged procedures are used to be performed in Indonesia. This article aimed to reveal the result of FE correction through the single-stage modified Chula technique (ST-MCT) procedure in collaboration with the neurosurgery team. Case Reports: A rare case of 5 years old girl diagnosed with FE was reported in this study. The FE was slowly increased in size, causing apparent facial deformity and the appearance of telecanthus. An ST-MCT procedure in collaboration with the neurosurgery team was conducted to correct the defects. The IOD values, IPD values, postoperative complications, and anesthetic improvements were evaluated in this study. Result: The patient was well after the surgery, with no complications and short length of stay. There were noted improvement of ICD, IOD and IPD postoperative follow up. At three years after the surgery ICD= 29mm; IOD= 26mm; IPD= 52 mm (normal range). Summary: ST-MCT procedure conducted in collaboration with neurosurgery team had shown excellent correction of ICD, IOD, and IPD values, no complication, shorter length of stay, and minimal scars. It considers as the most proper technique to reach a good result of correction and aesthetically pleasing looks in FE cases.

To date, the complex picture of atopic dermatitis (AD) has not yet been fully clarified, despite the important prevalence of this disease in the pediatric population (20%) and the possibility of persistence into adulthood, with important implications for the quality of life of those affected, as well as significant social and financial costs. The most recent scientific evidence suggests a new interpretation of AD, highlighting the important role of the environment, particularly that of nutrition in the early stages of development. In fact, the new indications seem to point out the harmful effect of elimination diets, except in rare cases, the uselessness of chrono-insertions during complementary feeding and some benefits, albeit weak, of breastfeeding in those at greater risk. In this context, metabolomics and lipidomics can be necessary for a more in-depth knowledge of the complex metabolic network underlying this pathology. In fact, an alteration of the metabolic contents in children with AD has been highlighted, especially in correlation to the intestinal microbiota. While preliminary lipidomic studies showed the usefulness of a more in-depth knowledge of the alterations of the skin barrier to improve the development of baby skin care products. Therefore, investigating the response of different allergic phenotypes could be useful for better patient management and understanding, thus providing an early intervention on dysbiosis necessary to regulate the immune response from the earliest stages of development.