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Background: Although there is minimal information on the role of stress in PCOS, it is well-known that it may trigger the exacerbation and maintenance of the disease. Despite there being only a few studies in the literature, many researchers highlighted situations of autonomic hyperactivation characterizing PCOS. In light of these assumptions, the purpose of this study is to report on a patient who underwent psychological intervention to enhance stress management skills.Case: A 30-year-old woman was referred by the endocrinologist. From a clinical-psychological point of view, the condition of the patient was characterized by a modest psychophysiological activation. Interpersonal difficulties did not allow the patient to benefit from the social support of her loved ones, further favoring the maintenance of the excessive arousal generated by stressful life events. The patient was treated with HRV-Biofeedback integrated within cognitive-behavioral psychotherapy.Discussion: The multidimensional intervention brought benefits to the patient, teaching her better stress management strategies (i.e., reduction of psychological symptoms and improvement of hormonal tests). Keeping in mind the interplay between physiological, psychological, and interpersonal factors is fundamental in all psycho-somatic and somato-psychic disorders and is crucial to enhance the use of specific treatments to restore psychophysical well-being.

Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control.Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p ≤ 0.05.Results: The mean age of the respondents was 61.1 ± 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p < 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality. Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients’ holistic care with the aim of achieving better blood pressure control among hypertensive patients.

Introduction: Sports injuries can affect athletes across all ages, sexes, and levels of competition. The mental aspect of acute sports injury is often overlooked by coaches, trainers, and medical professionals. This study investigated if and how an acute traumatic sports injury affects an athlete’s psychological well-being, adherence to sport, and athletic identity. Methods: The study consisted of surveys sent to former or current athletes over 18 with one or more athletic injuries. The Qualtrics surveys were anonymous, and participants consented to the study within the survey. Results: There were 101 total participants (20.2% response rate) with an average age of 36. All reported one or more acute athletic injuries throughout their athletic careers. Specific survey sets were compared against each other using a variable correlation analysis (p - value < 0.05) and via Pearson’s Correlation.Conclusion: The results indicated that injury impacts the lives of athletes most significantly on the field and can harm their performance based on their perception of the severity of the injury. However, this decline in performance and decrease in confidence does not correlate to an athlete’s desire to leave their sport or how they identify as being an athlete. 

Introduction: Factor VII (FVII) deficiency, a rare bleeding disorder, can manifest as an autosomal recessive congenital or an acquired coagulopathy. Acquired FVII deficiency, although infrequently reported, presents unique challenges in understanding its mechanisms and identifying underlying causes. Case presentation: We present a case of acquired FVII deficiency discovered in a 23-year-old female patient with no apparent underlying disease. The patient exhibited spontaneous ecchymosis and gingival hemorrhage, along with low FVII activity and isolated prolongation of prothrombin time. Extensive laboratory investigations excluded liver dysfunction, familial deficiency, vitamin K deficiency, and inhibitory antibodies. Prompt treatment with Fresh Frozen Plasma (FFP) and bypassing agents resulted in a favorable response and resolution of hematomas. Conclusion: Acquired FVII deficiency was identified with bleeding symptoms in association with prolonged prothrombin time and a low level of FVII activity. In literature, this deficiency has been associated with various conditions such as sepsis, aplastic anemia, stem cell transplantation, and neoplasms, although approximately 14% of cases remain idiopathic. Clinical outcomes remain generally poor, with limited complete remissions reported.

Non-contact injuries with playing surfaces occurring from applied player impact and frictional forces are a major source of lower extremity injuries in competitive sports. Artificial playing surfaces are a common alternative to natural grass surfaces; however, these surfaces are associated with player injury as well. The purpose of this manuscript is to explore the existing literature on the relationship between cleat surface interface and lower extremity injuries in athletes and the importance of proper playing surface conditions alongside proper cleat selection to optimize injury prevention and athletic performance. As artificial turf has become more advanced, studies have shown the rates of lower extremity injuries of the knee, ankle, and foot have decreased to be more similar to the rate of injury on natural grass. However, foot and ankle injury rates remain significantly higher on artificial turf. Furthermore, certain studies continue to demonstrate an increased rate of knee injuries in football players, suggesting that significant performance differences still exist between artificial turf and natural grass. Future studies warrant focusing on ways to improve the cleat-surface interface of new-generation turf, emphasizing proper cleat selection, and playing surface conditions for injury prevention thus optimizing athletic performance.

Bone marrow and the central nervous system are both protected by bone. The two systems are interconnected not only structurally but also functionally. In both systems specialized cells communicate through synapses. There exists a tridirectional communication within the neuroimmune network, including the hormonal system, the immune system, and the nervous system. Bone marrow is a priming site for T cell responses to blood-borne antigens including those from the central nervous system. In cases of auto (self) antigens, the responses lead to immune tolerance while in cases of neo (non-self) antigens, the responses lead to neoantigen-specific T cell activation, immune control, and finally to the generation of neoantigen-specific immunological memory. Bone marrow has an important function in the storage and maintenance of immunological memory. It is a multifunctional and very active cell-generating organ, constantly providing hematopoiesis and osteogenesis in finely-tuned homeostasis. Clinical perspectives include mesenchymal stem cell transplantation for tissue repair within the central nervous system.

Objectives: The study’s goals are to evaluate the management of Stroke Mimics (SMs), conditions with stroke-like symptoms but non-vascular origins. It seeks to avoid the unnecessary intravenous thrombolysis, the target therapy delays and determine the best SMs diagnosis approach.Materials and methods: A review was conducted of all patients admitted to the Emergency Department under a “stroke code” from January 1, 2018, to January 31, 2019. Anamnestic and clinical data, along with information on neuroimaging protocols and findings, were collected. Advanced MRI sequences, such as Arterial Spin Labeling (ASL) MR perfusion and MR spectroscopy, were revised to confirm the diagnoses.Results: 513 stroke codes were found; a neurovascular disease was diagnosed in 414 cases: 282 ischemic strokes and 73 intracranial hemorrages and 59 TIAs. The 99 SMs included, 13 infections, 12 syncopes, 11 epileptic seizures, 11 hemodinamic conditions, 10 tumors, 9 metabolic disorders, 9 diziness, 7 migraines, 4 drug/alcohol intoxication, 3 functional disorders, 3 acute hydrocefalus, 2 multiple sclerosis, 2 arteriovenous malformations, 1 spinal cord compression and 2 unexplained conditions. Specific neuroimaging findings were evaluated for all cases. Positive and negative predictive values of clinical diagnosis of SM were respectively 0.23 and 0.35. 125 SM patients underwent MRI examination, 40 of which within 3 hours from the activation of stroke code. Advanced MRI sequences as ASL, MR perfusion, MR spectroscopy were used to reach the correct diagnosis.Conclusions: Advanced multimodal MRI can be a valuable tool in the assessment of, particularly in cases where conventional imaging techniques such as DWI-FLAIR mismatch are inconclusive. The novelty of this retrospective study is to demonstrate that the consistent use of arterial spin labeling perfusion in cases with stroke code leads to a rapid and accurate diagnosis of SMs. The implementation of an MRI-based pathway can expedite the diagnosis and treatment of underlying non-vascular causes such as SMs.

Background and objectives: A stroke is a neurological deficit, caused due to vascular changes. Impaired postural control and balance impairments in post-stroke patients are associated with a high risk of falls among stroke patients. The perturbation-based balance training is mainly used in older adults and balance impairment. Virtual reality (VR) as a novel technology is rapidly becoming a popular intervention for improving balance. VR can visualize computer-generated environments with a full field of view through Head-mounted displays (HMD-VR). This study was conducted to assess and investigate the effect of balance exercises with smartphone-based virtual reality programs on balance in stroke patients.Methods: This was a randomized single-group pre and post-test study design. 30 subjects met the inclusion criteria and were enrolled, assigned, and received intervention. Subjects were given perturbation-based balance exercises and smartphone-based virtual reality along with conventional physiotherapy. The intervention protocol was for 6 days/week for 4 weeks period. Results: Following 4 weeks of intervention showed improvement in postural control and balance which was assessed using BBS, TUG, VR BESS, BESTest, and SIS 3.0. Paired t-test was used to differentiate the mean significance. The mean pre to post-intervention difference is 12.6 with a p - value < 0.05. TUG score improved from pre to post-intervention difference is 1.443 with a p - value < 0.05. VR BESS score improved from pre to post-intervention difference is 10.266 with a p value < 0.05. The mean BESTest pre to post-intervention difference is 11.467 with a p - value < 0.05. SIS 3.0 score improved from a pre to post-intervention difference is 20.33 with p - value < 0.05. The result of this study showed a highly significant difference in pre and post-treatment.Conclusion: The study concludes that perturbation-based balance exercises with smartphone-based virtual reality programs are a useful adjunct to improving balance in stroke patients along with conventional physiotherapy. 

The majority of people view color therapy as an alternative therapy. It is a rather young field of study. There are a tonne of various elements in life that might affect your mood and mental health. It is proposed that colors and colored lighting can improve one’s physical or mental health. If you want to create a calm and clear workplace, it’s critical to understand how color influences your mood. The interaction between the human body and colors has been thoroughly explored in a variety of research. Despite the fact that color therapy has been used for thousands of years, people’s interest in it has grown more recently. Different body parts are related to different colors. These are the various energy centers’ inherent healing abilities. In today’s age of globalization, color therapy is one of the most well-liked complementary treatments used to affect people’s conduct and brains. In forensic psychology, color is a crucial element that helps to build our surroundings. Without color, our world would be lifeless and sad. It is essential to our built environment, especially for teenagers, people who are partially blind, adolescents, and those who, for one reason or another, feel confined and dissatisfied with their way of life. Our brains are programmed to focus on things that stand out from our surroundings in terms of color. Which qualities and traits we associate with a person are influenced by the color of her clothing. Depending on the context, it may be culturally prejudiced due to political movements or historical occurrences. This review clarified the significance of this therapy and its advancement in the field of psychology, raised awareness among today’s youth, and added a fresh perspective to this investigation.

This report illustrates and provides a novel explanation for post-trabeculectomy improvements in the visual field, cup disc contours, and apparent deepening of an arcuate nerve fiber layer (NFL) defect after trabeculectomy for open-angle glaucoma. These changes are all plausible manifestations of recovered axonal transport and thickening retina, previously thinned by elevated intraocular pressure (IOP). Serial pre-and post-operative clinical fundus photos in case 1(A,B) demonstrate increased prominence of an inferior temporal arcuate nerve fiber layer defect, improved cup disc ratio, and visual field following eye pressure lowering by + 50% after trabeculectomy. Case 2 (C,D) also demonstrates obvious cup disc improvement in post-operative photos with associated improvement in visual field after trabeculectomy and lowering IOP by + 30%. We suggest that elevated IOP suppresses primarily orthograde axonal transport resulting in nerve fiber layer (NFL) thinning that can recover back to normal thickness when IOP is surgically lowered by the magnitude achieved in these two examples.

“A 40-year-old woman with melanoma, under treatment with Dabrafenib and Trametinib, was evaluated in our hospital for rapidly progressive deterioration of renal function”. 8 months before the current admission, the patient had been diagnosed with melanoma, and underwent radical surgery and subsequent therapy with Dabrafenib and Trametinib.After 5 months of therapy, the patient was brought to this hospital for precordial pain, with a diagnosis of myopericarditis, therapy was started for heart failure with a good response. However, the patient developed a progressive impairment of renal function, associated with hemolytic anemia and thrombocytopenia. The peripheral smear showed the presence of schistocytes.The suspicion of atypical Hemolytic Uremic Syndrome (aHUS) was confirmed by the assay of C5B-9 induced by serum on endothelial cells, which showed a deposition of 331%, treatment with Eculizumab was initiated.After 3 administrations the patient did not improve, with further worsening of the hemolytic condition, and progression of renal damage.Due to the failure of Eculizumab, we considered the use of Ravulizumab. However, in Italy only can be administered to patients in Eculizumab stable treatment for at least three months. Nevertheless, faced with the catastrophic condition, it was decided to shift the therapy and use off-label Ravulizumab. After 10 days of the first administration, the laboratory tests showed a continuous rise in the values of haptoglobin, platelets, and hemoglobin, and a decrease in LDH. The renal function failed to return to normal values but after 20 days of therapy with Ravulizumab, there was complete resolution of the hemolytic condition.

Cardiac revascularization surgery has a long history. Its results and safety are well known. Nonetheless, the long-term patency rate of certain grafts used in cardiac revascularization is non-optimal, and CABG is associated with a risk of cerebrovascular stroke due to aortic manipulation. We have developed a simple control quality protocol of the anastomosis performed in CABG, aiming to improve the long-term patency of certain grafts used in cardiac revascularization surgery and reduce the risk of cerebrovascular stroke in those patients. 

Background: Ectopic pregnancy (EP) is a common and serious early pregnancy problem with a significant morbidity rate and the potential for maternal death. Women commonly present with minimal vaginal bleeding and abdominal pain.Objective: The main objective of the study was to evaluate the risk factors, clinical presentation, sites, and management outcomes of ectopic pregnancies. Methodology: It was a prospective descriptive, cross-sectional hospital-based study conducted at Bashair Teaching Hospital during the period January 2021–June 2021.An interview questionnaire was used, and eighty-two (82) women were included after informed consent. Demographic and clinical data concerning personal history, symptoms of presentation, risk, site, and type of management were recorded.Results: Ectopic pregnancy incidence was 2% and most risk factors were infection 29.3%, surgery 15.9%, miscarriage 13.4%, infertility 12.2%, tubal surgery 4.9%, previous ectopic pregnancy 4.9%, intrauterine contraceptive device (IUCD) 3.6%, and tubal ligation 2.4%. Women presented with bleeding and abdominal pain at 47.5%, bleeding at 18.3%, abdominal pain at 9.7%, and shock at 8.5%.The sites are ampullary (57.3%), fimbria (9.7%), interstitial (8.5%), isthmus (8.5%), ovarian (7.3%), cervical (4.8%), and abdominal (3.6%).Surgical management was 93.9%, medical and surgical management was 3.6% and medical management was 2.4%. A blood transfusion was received at 37.8%.Conclusion: The study concluded that women of reproductive age are at risk of ectopic pregnancy, so healthcare providers and doctors should have a high index of suspicion, prompt diagnosis, and intervention for ectopic pregnancy. Assessment of women at risk factors and modifications will reduce incidence. 

Objective: To explore the pathologic response rate to primary progesterone treatment in patients with Endometrial Intraepithelial Neoplasia (EIN) and early-stage endometrioid-type Endometrial Adenocarcinoma (EAC).Methods: Retrospective chart data were collected for patients with either EIN or EAC receiving primary progesterone treatment between 2015 and 2022. The presence of complete or partial response, time to response, and other demographic and treatment factors were recorded to determine independent predictors of response to progestin treatment.Results: In total, 112 women who were diagnosed with EIN or EAC were treated with upfront progestin therapy, of whom 79 had sufficient follow-up to assess response. Fifty patients (63%) responded, of whom 10 (20%) ultimately relapsed. Response was more robust among patients with EIN (79%, n = 33) compared with patients who had cancer (46%, n = 17). The median time to respond was 5.8 months overall. Diagnosis of EIN, younger age at diagnosis, and any pathologic evidence of progesterone effect were all predictors of treatment response. Younger patients had a significantly shorter time to partial or complete response with a median time to response of 5.9 months in patients ≤ 45 and 13.8 months in patients > 45. Conclusion: Our study demonstrated a lower overall response rate (63%) than reported in previous studies, especially for patients with cancer (46%). Younger patients had a significantly shorter time to respond than older patients. Pathologic progesterone effect observed at any time during treatment was a significant predictor of treatment response regardless of diagnosis and could serve as an early predictor of response to therapy.

Excitation functions (EF) for four reactions of the type 93Nb (α, xn); x = 1-4 were studied. This study provides current evidences about the dominance of pre-equilibrium processes at high energies followed by compound nucleus equilibration at low energies. The main objective of the work is to look pre-equilibrium emission induced by alpha particle energies up to 100 MeV on Niobium through describing, analyzing and interpreting the theoretical results of cross sections obtained from computer code COMPLET by comparing with experimental data obtained from EXFOR library. COMPLET code has been used for the analysis using the initial exciton number n0 = 4(4p+oh) and level density parameter ACN/10. A general agreement was found for all reactions.

Hypertrophy of the adenoid is a rare condition in adults, often suspicious of malignancy. We present a case of a 31-year-old female with a clinical presentation of a giant nasopharyngeal mass, clinically suspicious for malignancy, given the size and greyish discoloration. She presented with left-side otalgia, hearing loss, and nasal obstruction. After broad investigations on adenoid tissue following adenectomy, a reassuring diagnosis of adenovirus-related adenoiditis could be made. This case demonstrates the importance of broad microbiological testing in ruling out malignancies. The patient recovered completely. 

Scientific interest in low-molecular-weight pectins is not accidental. Despite the experimental material widely presented in the literature on the pharmacological effects of pectins, the clinical application of the developments has not yet been fully implemented. On the one hand, antitumor potential is registered in polymers with a mass of hundreds of kilodaltons, on the other hand, practically nothing is known about such in pectin derivatives weighing less than 20 kDa. In addition, the issues of assessing the nature of the pharmacological interaction of nanoscale pectin and conventional cytostatics are not covered. The aim of this work is an experimental study of the antitumor potential of low-molecular, low-esterified pectin in combination with a cytostatic agent on a model of Walker’s carcinosarcoma. Pectin therapy of Walker’s transplanted tumor in several series of experiments consistently caused inhibition of its growth from 60% to 80%. The combined use of pectin and cyclophosphane caused inhibition of tumor growth up to 72.4%. The increase in life expectancy in the “pectin + cyclophosphane” group versus the “cyclophosphane” group was 200%. It can be concluded that nanoscale pectin is a promising drug for in-depth study since it meets the criteria of primary screening (increase in animal life expectancy, inhibition of tumor growth, survival without tumor growth).

Purpose: To compare between the two commonly used methods to deliver the fetus in emergency cesarean section with fully dilated cervix and impacted fetal head; vaginal push up of the fetal head and reverse breech extraction regarding safety and efficacy.Methods: A retrospective observational study was conducted 152 women underwent emergency CS with fully dilated cervix and impacted fetal head were divided into two groups; Group 1, vaginal push (n = 96) and Group2, reverse breech delivery (n = 56). Data variables were collected and analyzed to evaluate whether either method is more safe regarding maternal and fetal outcomes.Results: There was a significant higher percentage of extension of uterine incision in group 1 (p = 0.002). Also, there were significant higher mean values of operative time and operative blood loss in group 1 (p = 0.008 and 0.015; respectively). On the other hand, there was a significantly shorter uterotomy to delivery time in group 1 (p < 0.001). There was a significantly higher mean value of APGAR score at one minute in group 1 (p = 0.043) but no significant difference between the two groups regarding APGAR score at five minutes, atonic PPH, postoperative blood transfusion and hospital stay.Conclusion: Vaginal push technique was associated with significantly higher intraoperative maternal morbidity but postoperative maternal morbidity and fetal outcomes were comparable between both groups. Push method (after uterine incision) is still the preferable method and larger studies are required to assess the fetal safety with reverse breech extraction.

Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses.Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018.An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded.Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%).Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and > 7 in 86.9%.Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week.Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection.

Purpose: Acute kidney injury (AKI) is a real public health problem due to its severity and gravity. In a 2013 meta-analysis, Susantitaphong, et al. estimated the incidence of AKI worldwide at between 10% and 20%. In the latter study, no African studies were included, given the lack of data in the literature. Our objective was to identify the clinical and paraclinical epidemiological characteristics of patients with AKI.Patients and methods: We conducted a retrospective study including patients who had AKI with recovery of normal renal function hospitalized in a nephrology service between 2002 and 2015.Results: Our population consisted of 107 men and 107 women with a median age of 61 years (IQR 43-73.25) of which 42.1% were multitargeted. Functional AKI represented the predominant mechanism of AKI retained in our study with a rate of 53.2% with dehydration as the main etiology for 108 patients (50.46%). Organic cause was retained in 38.8% of patients, with acute tubular necrosis (ATN) as the most frequent etiology (37.35%). Kidney disease improving global outcomes (KDIGO) stage 3 was the stage retained for 115 patients included in our series, 31 of whom required extra renal purification. During their hospitalization, 78.5% of the patients presented a persistent AKI (duration of the episode > 7 days). A glomerular filtration rate (GFR) lower than 60 ml/min/1.73 m² at discharge was found in 119 patients and 10 patients had a GFR higher than 90 ml/min/1.73 m². After 3 months from discharge, 77.5% of patients had a GFR between 60 and 90 ml/min/1.73 m².Conclusion: Our results give us an idea of the epidemiological and clinical characteristics of patients who have had acute renal failure with recovery of normal renal function and enable us to better recognize patients at risk in order to avoid such complications. AKI remains a major issue and knowing its epidemiological and clinical characteristics will allow its prevention.