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Ceftriaxone is having many uses and useful “third-generation” cephalosporin that necessitates being given every day. Ceftriaxone acts as binds to one or many of the penicillin-binding proteins which inhibit the final transpeptidoglycan step of peptidoglycan synthesis in the bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.Ceftriaxone-associated biliary adverse events in children less than eighteen years cause biliary pseudolithiasis and scarcely nephrolithiasis often happen in children less than eighteen years after receiving overdoses of ceftriaxone. Ceftriaxone perhaps binds with calcium and figure insoluble chelation leading to biliary pseudolithiasis. Cholelithiasis, increased biliary thickness, and pseudolithiasis rarely happen in a period of being a child, but there are two modes of distribu¬tion described by two peaks, the first being at an early stage of development and the second is a period of life when a child develops into an adult. Hyperbilirubinemia is significantly contraindicated for neonates administrated ceftriaxone, particularly premature neonates, because of the displacement of bilirubin from albumin-binding sites and increase in blood concentrations of free bilirubin. A child than one month old and a child less than twelve-month old in special are at great risk of poor results because of bilirubin encephalopathy. Coincident administrations of ceftriaxone with aminoglycosides such as gentamycin and loop diuretics (furosemide) perhaps increase the risk of nephrotoxicity (rapid degeneration in the kidney function to the toxic outcome of double or triple medications). Coincident administrations of ceftriaxone with anticoagulant medications such as warfarin are associated with bleeding due to increased prothrombin times, which is reversible with vitamin K.

Background: Leiomyoma itself is not a rare disease, but it is rarely found intravascularly. Case presentation: A 54-year old female sought medical help after noticing her leg being swelling. A diagnosis of deep vein thrombosis (DVT) was made and antithrombotic treatment was given after her initial imaging exam. Several days later, a contrast CT and sequential pathology revealed the real diagnosis was intravascular leiomyoma. The patient was discharged after a successful surgery. Conclusion: Intravascular leiomyoma should not be confused with DVT.

Introduction: Fatigue is a common non-motor symptom of Idiopathic Parkinson’s Disease (IPD). The aim is to research the relationship between fatigue of IPD patients and the clinical findings, of mood disorders.Material and methods: A total of 39 patients with IPD were included in the study. The relationship between fatigue severity and demographic characteristics and the treatment was evaluated in IPD. The severity of fatigue was evaluated by Fatigue Severity Scale (FSS). Motor impairment was scored by the modified Hoehn and Yahr scale. The patients were assessed for the presence of depression and anxiety with the Hospital Anxiety and Depression Scale (HADS). Results: The mean age of the patients was 70.62 ± 8.35 years. 23 were men and 16 were women. The mean disease duration was 6.18 ± 3.35 years. The patients were assigned into two groups according to the presence of fatigue measured by FSS with less than 5 (Group I) and 5 or more (Group II). There were no statistically significant differences between the two groups with respect to mean age, mean age of onset, and mean disease duration of the patients (p > 0.05). There were no significant differences between the two groups for HADS depression, anxiety values, and terms of antiparkinsonian therapies (p > 0.05). The severity of fatigue was correlated with the HADS anxiety levels (p < 0.05).Discussion: Fatigue is an important non-motor symptom that is underestimated in clinical follow-up. We didn’t find any correlation between fatigue and age, duration of disease onset, or drug use. There was no significant correlation between the fatigue score and depression, and pain. However, the fatigue scores were higher in patients with high anxiety scores and females.

A mass arising from the pituitary gland commonly damages cells of the anterior pituitary gland and affects the secretion of gonadotropins and growth hormone. However, central hypothyroidism and secondary adrenal insufficiency from such damage is a rare phenomenon. Acute urinary retention as the main symptom of central hypothyroidism is also an unusual initial presentation. We report a male patient who comes with frequent urinary retention and hyponatremia at our hospital.

Objectives: This novel study explores the leadership traits held by people with substance use disorder. The purpose of this study is to help advance understanding of the positive qualities people with substance use disorder possess which can produce positive societal and organizational benefits once that person enters recovery. Additionally, this understanding can provide insight into effective treatment approaches that incorporate personal attributes that are present within active addiction. Methods: A qualitative methodology was used which included semi-structured interviews, observations, and a focus group which allowed the researcher to conduct a thematic coding analysis. The participants came from diverse backgrounds and included participants from multiple regions across the United States. Leadership was defined as having various dimensions of effective leadership that are found in both Transformational and Authentic Leadership Theories. Results: The findings revealed that people in addiction possess numerous leadership traits which position them for effective leadership and are further enhanced during their recovery journey. The top three traits which emerged from the data indicate that people in recovery from addiction are authentic, tenacious, and empathetic. Additionally, those in recovery have strong abilities to empower and inspire others and demonstrate posttraumatic growth which helps establish significant bonds of trust and commitment among followers. Conclusion: The impact of this study will change how people view addiction. Identifying the hidden treasures of leadership which are present in those struggling with addiction could illuminate recovery pathways that help identify purpose and value. This would not only advance treatment opportunities but greatly assist organizations that need strong leadership. People with substance use disorder have all the right tools to become effective leaders, and this understanding can help mitigate the stigma associated with addiction and paint it in a more positive light. 

Asthma is a chronic respiratory disease characterized by chronic airway inflammation. Common manifestations of asthma include wheezing, chest tightness, cough, shortness of breath. Diagnosis of asthma requires clinical documentation of respiratory symptoms, exacerbation of symptoms following exposure to triggers, as well as demonstration of expiratory airflow obstruction. Wheeze is a continuous sound, lasting longer than 0.25 s that is produced by oscillation of opposing airway walls [1,2]. Wheezing, although a typical symptom of asthma, can also be caused by other diseases. Apart from asthma, wheezing can be due to extra-thoracic upper airway obstruction, intrathoracic upper airway obstruction, lower airway obstruction. Benign multimodal goiter is a common disease, that rarely causes upper airway obstruction. Retrosternal goiter should be taken into account the differential diagnosis of upper airway obstruction [3]. The respiratory symptoms of a retrosternal goiter may be masked for years due to the slow growth of the goiter. Patients commonly complain of respiratory symptoms if tracheal diameter is narrowed more than 50% from the normal size. Respiratory symptoms may be suddenly precipitated by spontaneous or traumatically induced bleeding into the substernal goiter, as well as by tracheal infections [4]. Clinical management of this condition is really challenging. Diagnosis is also not straightforward, as clinical suspicion is needed. There are cases of retrosternal goiter mimicking asthma that remain undiagnosed for many years. Retrosternal goiter should be taken into account in the differential diagnosis of patients diagnosed as suffering from asthma, and presenting no improvement despite medical therapy. In addition, it should be taken into account that sudden gland enlargement due to hormonal changes might lead to life threatening upper airway obstruction with clinical picture similar to bronchial asthma attack [5]. In a recent very interesting case report, the authors present a case of a pregnant woman in the second trimester who presented with an acute airway obstruction due to the enlargement of a retrosternal goiter [3]. Goiters are the more common masses of the superior mediastinum [6,7]. Commonly, retrosternal goiter is due to the extension in the thorax of a cervical goiter. However, rarely, it may represent primary disease due to the growth of ectopic thyroid tissue. In addition, retrosternal goiter may develop in patient submitted to thyroidectomy due to cervical multinodular goiter [8]. Although retrosternal goiters are commonly asymptomatic, symptoms may include dyspnea, stridor, hoarseness, dysphagia, superior vena cava syndrome, transient ischemic attacks, cerebral edema, Horner’s syndrome, and thyrotoxicosis [4]. Diagnosis could be verified by neck and chest radiography, thorax CT and MRI. Chest radiography commonly shows a widened mediastinum with a superior mediastinal mass causing compression of the trachea as well as deviation of the trachea to the right. Mediastinal computed tomography reveals a mass that is extension of the thyroid gland. The presence of respiratory symptoms in a patient with retrosternal goiter is an indication for surgery. The majority of retrosternal goiters can be approached through a cervical approach [9,10].

Background: Vascular closure devices (VCD) are routinely used to achieve haemostasis following percutaneous arterial procedures. The extravascular polyethylene-glycol based MynxGrip® device (Cardinal Health) received FDA approval for use in the closure of femoral veins, but so far limited data is available on its use, especially with concomitant use of anticoagulants. Method: This is a retrospective analysis of data from a single-centre on the effectiveness and complication rates following the use of the MynxGrip® device for femoral venous closure in patients undergoing diagnostic/interventional (temporary pacing during balloon aortic valvuloplasty, or electrophysiology) procedures utilising 5-7F sheaths. Results: 85 patients (mean age 74 years) underwent femoral venous closure with the MynxGrip® device. 51.8% were male. The rate of concomitant anticoagulant or antiplatelet use was 52.9%. Device deployment was 100% successful with full haemostasis in all cases. There were no major vascular complications (bleeding, thrombosis, or infections). There was one case of a minor small venous hematoma which did not require treatment. The mean length of stay was less than 1 day (67.1% patients discharged the same day) and overnight stay only indicated by interventional procedure. Conclusion: These data support safety and efficacy of the MynxGrip® device for femoral venous closure with same-day discharge, even with concomitant aggressive antiplatelet and anticoagulant use. It has the potential for use in other large bore venous access sites. 

The radial artery shows great anatomical variability with respect to its origin [1]. Generally, its origin is located in the cubital fossa at the level of the neck of the radius [2]. However, the artery may have a high origin from the brachial artery or even the axillary artery [1].

Aim of this work is to analyze the coronavirus viral surface properties related the pattern of electrical features. This chemical physical property is relevant and crucial to set profile of diffusion, severity of disease, efficacy of therapeutic strategy and in order to search new way to fight COVID-19 and the NEW VARIANT. The phenomena of immune evasion and the different pattern of efficacy towards variants of some vaccine or some antibodies combination produce the need to verify if considering the electrical feature of viral surface can be a right tool or not. As result of this research it is possible to submit to the scientist that the viral surface properties and electrical feature can be an element to be considered in various preventive or treatment measure. The specificity of action of some vaccine or antibodies seem to tell us that also the aspecific methods are useful. A specific chemico physical factors can influence the electrical charges viral surface behavior. Hpertonic saline solution, humidity, electrical charge barrier in mask are simply example of the effect. That can be obtained action on viral surface chemico -physical properties.

Non-alcoholic fatty liver disease (NAFLD) is a condition that is associated with cirrhosis and hepatocellular carcinoma, and is increasing in prevalence worldwide. Sleep disruptions are commonly seen in NAFLD, and the disease process is associated with sleep disorders, including obstructive sleep apnea, circadian rhythm disorders, and insufficient sleep. The intermittent hypoxia seen in obstructive sleep apnea may contribute to fibrotic changes in the liver.A major component of this linkage may be related to gut microbiome changes. One notable change is increase in Bacteroidetes/Firmicutes ratio, and decrease in flora that ferment fiber into anti-inflammatory short-chain fatty acids. Several therapeutic options exist for NAFLD that target both sleep and NAFLD, including non-pharmacological factors, such as lifestyle modification (mainly diet and exercise). Pharmacological options include melatonin, Vitamin E, thiazolidinediones, and fecal microbiota transplantation.Core tipThe pathogenesis of non-alcoholic fatty liver disease is closely tied to sleep and circadian rhythm abnormalities, through shared inflammatory pathways and altered metabolism. This review explores the pathogenesis of NAFLD in the context of sleep and circadian abnormalities. The associated inflammatory response is linked to changes in gut-microbiome interactions that contribute to the disease process. Understanding of this linkage has implications for various therapies for disease mitigation.