Search Results (32,540)

Background: Tuberculosis (TB) remains a major public health concern globally, despite sustained declines in incidence in many countries. Kazakhstan has implemented long-term national TB control strategies; however, comprehensive nationwide analyses integrating temporal trends, demographic patterns, and treatment outcomes over the past decade remain limited. Methods: A nationwide retrospective registry-based analysis of programmatic TB treatment episodes was conducted using anonymized data from the national tuberculosis registry of the Ministry of Health of Kazakhstan. All registered TB cases from 1 January 2014 to 31 December 2023 were included. Treatment outcome was analyzed as the final end-of-episode programmatic status (favorable vs. unfavorable). Because the anonymized extract did not contain complete patient-level dates required to derive person-time (treatment initiation and event dates), time-to-event models were not applied; instead, factors associated with unfavorable end-of-treatment outcomes were assessed using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs. Unfavorable treatment outcomes were defined as death, treatment failure, loss to follow-up, and not evaluated or not recorded outcome, according to the national TB program outcome definitions. Results: A total of 93,985 TB cases were analyzed. The number of registered cases declined from 16,391 in 2014 to 6548 in 2023, corresponding to a cumulative reduction of 60.1% and an AAPC of −9.7% per year. TB incidence decreased in both sexes, although rates remained consistently higher among men. Over time, the peak incidence shifted toward older age groups, particularly among men. The proportion of new cases increased to 80.1% by 2023, while relapses and treatment failures declined. In multivariable analysis, unfavorable treatment outcomes were independently associated with male sex (aOR 1.25), older age, relapse, treatment after interruption, prior treatment failure, smear-positive disease (aOR 1.60), combined pulmonary and extrapulmonary involvement, and disseminated TB (ICD-10 A19). The risk of unfavorable outcomes increased during 2020–2021 and declined in 2022–2023. Conclusions: Kazakhstan has achieved a substantial and sustained reduction in TB incidence over the past decade. Nevertheless, marked demographic and clinical disparities persist, particularly among men, older patients, smear-positive cases, and individuals with prior or interrupted treatment. Targeted interventions focused on these high-risk groups may further improve treatment outcomes and support continued progress toward TB control. Full article

Background and Clinical Significance: Myolipoma is a rare benign tumor, typically found in the retroperitoneum and characterized by a combination of mature adipocytes and well-differentiated smooth muscle cells. Myoplipomas usually present a delay in diagnosis due to the painless and slow-growing clinical behavior; therefore, the lesion can reach a large dimension with challenging treatment. Case Presentation: We present the case of a retroperitoneal myolipoma infiltrating the left hip of an 11-year-old male. It was suspected based on magnetic resonance imaging. The patient has been successfully treated with surgical excision without complications. Histological examination revealed mature adipose tissue infiltrating smooth muscle cells. The muscle fibers appeared normal, while the dense connective tissue was infiltrated by clusters of mature lymphocytes. Conclusions: Although myolipoma is extremely rare in male children and has never been reported to infiltrate the hip, it should be considered in the differential diagnosis of fat-containing retroperitoneal masses. Full article

Introduction: Isolated pelvic nodal metastasis from carcinoma of unknown primary origin (CUP) is rare. Evaluation should prioritize gynecological and anorectal sites based on pelvic lymphatic drainage. Although spontaneous regression of these primary lesions is exceptional, regressed lesions can present as CUP, necessitating diagnostic caution. Case presentation: Here, we report the case of a 40-year-old woman with a solitary, intensely fluorodeoxyglucose F-18 avid left obturator lymph node and a subtle endocervical abnormality on pelvic magnetic resonance imaging. Loop electrosurgical excision revealed a Nabothian cyst only. Excisional nodal biopsy by polymerase chain reaction revealed metastatic squamous cell carcinoma with diffuse block-type p16 and human papillomavirus (HPV) 16. Considering the potential for a primary cervical tumor along the obturator drainage pathway, the patient underwent hysterectomy with pelvic lymph node dissection. No residual invasive carcinoma was found; however, HPV16 was detected in the cervix with a low-grade squamous intraepithelial lesion, supporting a regressed cervical focus. She received adjuvant cisplatin-based chemoradiotherapy and has remained disease-free for 56 months. Conclusions: This case highlights the diagnostic value of integrating lymphatic anatomy with the molecular profile of HPV. Cervical squamous cell carcinoma rarely regresses and presents solely as an isolated nodal disease. Full article

Introduction: Functional pituitary tumors (FPT) are hormone-producing adenomas that present distinct surgical difficulties, primarily because they are often microadenomas and require total removal to restore normal hormone levels. Distinguishing these tumors from healthy pituitary tissue during endoscopic transsphenoidal surgery can be challenging. Indocyanine green (ICG) fluorescence has shown promise as a technique to enhance visualization during surgery; however, its use in FPTs remains poorly defined. This literature review aims to evaluate the use of ICG in endoscopic transsphenoidal surgery for adult functional pituitary tumors. The primary focus is on assessing complete tumor resection, biochemical remission, and tumor differentiation from normal tissue after ICG use. Secondary goals include reviewing different ICG administration methods. Methods: We developed a search strategy to perform a systematic literature search across multiple databases with a set of MeSH terms and keywords on the OVID platform. In addition, we conducted a manual literature search by reviewing the reference lists of the studies included. After this, the relevant search results were uploaded to COVIDENCE for systematic management of the screening process by two reviewers. Articles that met our inclusion criteria were then selected for data extraction. Results: The initial search results gave 319 studies, of which 10 met the inclusion criteria after going through various screening phases. These were then included in the final analysis, consisting of 55 adult FPT cases. The majority of studies reported successful differentiation between tumor and normal pituitary tissue, with ICG fluorescence facilitating complete tumor resection and subsequent biochemical remission. Our review also identified two primary ICG administration techniques: low-dose intraoperative injection and high-dose preoperative administration. Conclusion: Findings from our study indicate that ICG fluorescence is a clinically effective tool for enhancing tumor visualization during endoscopic transsphenoidal surgery in adult FPT patients. Both low-dose intraoperative and high-dose preoperative ICG administration techniques showed promising outcomes in improving surgical precision. Having said that, further research, with larger comparative studies and the development of a standardized protocol, is required to optimize ICG use in FPTs as well as to address the variability in fluorescence intensity observed among different FPT subtypes. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a safe and effective modality for treating severely calcified coronary lesions. While the Shockwave™ system is well-established, clinical data on newer IVL platforms such as the Shunmei ShockFast™ system remain limited. Objectives: To evaluate the safety, feasibility, and procedural outcomes of the ShockFast IVL device in patients with heavily calcified de novo coronary artery disease. Methods: We conducted a prospective, single-center case series of 16 patients undergoing percutaneous coronary intervention (PCI) with the ShockFast IVL system between June and December 2025. Inclusion required angiographic or optical coherence tomography (OCT) evidence of severe coronary calcification. The primary efficacy endpoint was acute procedural success and absence of in-hospital MACE. Secondary endpoints included, among others, device deliverability, presence of calcium fracture and post-stent expansion metrics. Results: All patients underwent successful lithotripsy delivery with the ShockFast IVL system. Acute procedural success was 100%, with no intraprocedural complications, abrupt closure, or in-hospital MACE. OCT was performed in 50% of cases and demonstrated calcium fractures in all imaged lesions, with ≥2 fractures in 63% of cases. Median stent expansion was 90% [IQR 9], with no major malapposition or edge dissections. Quantitative coronary analysis showed a median acute lumen gain of 1.86 mm [0.62]. Conclusions: The ShockFast IVL system showed excellent safety and procedural performance in this first-in-center experience. Outcomes were encouraging and consistent with those reported in early-stage studies of other IVL platforms. These findings support the clinical feasibility of ShockFast as a novel tool for calcium modification in complex PCI. Full article

Dengue is a mosquito-borne viral disease which is predominantly endemic in tropical and subtropical countries. In Bangladesh, 321,179 dengue cases were reported in 2023, followed by 101,214 cases in 2024, which highlights a severe and ongoing public health challenge. Dengue transmission risks are shaped by climatic variability, rapid urbanization, socio-economic vulnerability, and healthcare strain. But existing dengue surveillance models remain limited in their ability to capture district-level disparities in Bangladesh. This study aimed to develop a district-level dengue early warning system that integrates climatic, socio-demographic, economic, healthcare, and environmental determinants to generate accurate and interpretable predictions. We examined dengue cases across all 64 districts in Bangladesh from 2017 to 2024, integrating Directorate General of Health Services (DGHS) case records with climate, socio-demographic, economic, and healthcare indicators. Machine learning and deep learning approaches, including Multi-Layer Perceptron (MLP) and Convolutional Long Short-Term Memory (ConvLSTM), were combined with SHAP (Shapley Additive Explanations)-based explainable artificial intelligence. We also used Bayesian spatio-temporal models to capture spatial clustering, temporal dependence, and the lagged transmission effects of dengue. Dengue outbreaks peaked in September 2023, with Dhaka recording 113,233 cases. DENV-4 (Dengue Virus type 4) emerged in 2022, accounting for 27% of infections in 2023. Climate was the strongest predictor of dengue transmission (humidity SHAP = 0.314; minimum temperature SHAP = 0.146; rainfall RR = 1.303). Poverty (SHAP = 0.193) and healthcare capacity (nursing/midwifery density SHAP = 0.073) mostly contributed to dengue prediction. The MLP model achieved the best yearly performance (accuracy = 0.93; ROC-AUC = 0.99), ConvLSTM was the best model in monthly prediction (recall = 0.88; ROC-AUC = 0.81), and Bayesian BYM2_RW2 with lagged effects improved predictive fit (DIC = 3671.055). Our integrated framework delivers transparent, interpretable predictions and district-level early warnings, supporting adaptive dengue outbreak preparedness and resource allocation in Bangladesh. Full article

Space weather monitoring depends critically on passive sensor systems that detect and measure natural solar and geospace emissions without transmitting radio frequency energy. These include riometers, solar radio monitors, interplanetary scintillation detectors, GNSS-based ionospheric sensors, and broadband solar spectrographs that enable the provision of critical data required to forecast geomagnetic storms, protect critical infrastructures, and support aviation services, satellite operations, and defense services. However, with the increasing proliferation of radiocommunication technologies such as 5G/6G networks, dense HF/VHF/UHF deployments, and large constellations of low-Earth-orbit (LEO) satellites, the interference threat to these exceptionally sensitive receivers has grown. Most of these operate near the thermal noise floor and thus require strict protection criteria to ensure continuity of data. This review and perspective article provides a cross-disciplinary synthesis of scientific requirements, documented RFI case studies, and ongoing regulatory developments related to spectrum protection for passive space weather sensors. It systematically integrates perspectives on physical, technical, and regulatory aspects that are typically addressed separately in the literature. The article reviews the operating principles of major sensor classes and analyzes documented RFI cases affecting GNSS, riometers, CALLISTO, BINGO, and systems impacted by LEO satellite emissions, drawing from existing reports and regulatory submissions. Building on this evidence base, the work comparatively evaluates regulatory methods under consideration for WRC-27 shows that hybrid approaches combining primary allocations in core observation bands with secondary status and coordination procedures in adjacent bands offer the most viable path forward. This synthesis contextualizes and analyzes how technical protection criteria can be integrated with existing and evolving regulatory instruments to inform spectrum governance. The study concludes that without coordinated international spectrum management incorporating explicit protection thresholds and registration procedures, the long-term viability of space weather monitoring infrastructure faces significant risk in an increasingly congested radio frequency environment. Full article

Background. Chondrosarcomas of the manubrium are exceedingly rare, accounting for approximately 20% of all primary bone malignancies, and present unique challenges in surgical management and reconstruction. Reliable reconstructive strategies for medial clavicular stabilization remain limited. Case Presentation. We report the first documented use of STRATOS bars for unilateral clavicular stabilization following manubrial chondrosarcoma resection. A 19-year-old woman with a poorly differentiated (G3) chondrosarcoma of the manubrium underwent neoadjuvant chemotherapy followed by en bloc resection of the manubrium, medial clavicle, and first rib. Reconstruction and clavicular stabilization were achieved using STRATOS, which is traditionally employed for chest-wall reconstruction. This represents a novel use of the device for medial clavicular stabilization after SCJ resection. At the 6-month follow-up, the patient remained disease-free, with preserved shoulder function and stable reconstruction. STRATOS provided stable fixation, preserved shoulder function, and an excellent cosmetic outcome. A brief review of the literature on sternal chondrosarcoma and reconstruction techniques is also presented. Conclusion. This unique application expands the reconstructive possibilities of modular titanium systems. It may offer a more reliable biomechanical alternative to traditional fixation methods in cases requiring stability of the shoulder girdle after SCJ resection. Further validation through biomechanical studies and larger case series is warranted. Full article

Background/Objectives: Inflammatory bowel disease (IBD), mainly encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is strongly linked to psychological comorbidities such as depression, anxiety, and stress. These mental health factors negatively impact disease progression, healthcare utilization, and quality of life (QoL). Methods: Participants completed the Depression–Anxiety–Stress Scale 21 (DASS-21) and EuroQol (EQ-5D-5L) questionnaires. Statistical analyses included multivariate linear regressions to identify predictors of psychological distress. Results: We conducted a cross-sectional case–control study involving 355 participants: 55 with CD, 90 with UC, and 210 healthy controls. Patients with IBD reported significantly higher levels of stress (p < 0.01), anxiety (p = 0.016), and depression (p < 0.01) compared to controls. Severe or very severe symptoms were more prevalent in those with CD and UC. The relative risk for stress was high (RR = 2.1), and the risk for depression was significantly elevated (RR = 1.54) in the IBD population. Quality-of-life analysis revealed lower EQ visual analog scale scores and increased difficulties across all domains, particularly in emotional well-being and pain. Multivariate analysis showed UC diagnosis, female sex, and corticosteroid use as predictors of higher stress and depression scores, while self-reported rest was consistently protective. Conclusions: This study confirms the psychological burden of IBD and underscores the importance of regular screening for stress, anxiety, and depression in clinical care. Self-reported rest emerged as a key protective factor, suggesting potential benefits from interventions targeting sleep quality and emotional support. Future research should explore longitudinal outcomes and personalized psychological interventions in IBD populations. Full article

Background: Neonatal sepsis is a bloodstream infection and constitutes a major cause of morbidity and mortality among newborns. The diagnosis is primarily based on a positive blood culture result. An additional diagnostic and therapeutic challenge may be congenital infection, particularly in preterm infants. This is associated with the lack of routine screening of the maternal genital tract, except for testing for group B streptococci during earlier stages of an uncomplicated pregnancy. Case presentation: This paper presents a case of a neonate with early-onset sepsis (EONS) caused by Escherichia coli. Methods: We carried out analysis of documents combined with the case report method. Results: Preterm birth associated with PPROM constitutes a significant risk factor for early-onset neonatal sepsis (EONS). Conclusions: The case illustrates the dynamic course of congenital infection and the resulting need for immediate, life-saving interventions. It also demonstrates abnormalities identified in ancillary investigations involving both the visual system and the central nervous system (CNS), confirming the intrauterine onset of the infectious process. Full article

Objective: To analyze multiple aspects of advanced bladder endometriosis surgery, based on the experience of an endometriosis reference center. Methods: This retrospective/prospective study included 80 consecutive patients with deep bladder endometriosis treated with laparoscopic surgery. Results: In 96.3% of cases, bladder endometriosis coexisted with other organ involvement: bowel (87.5%), uterus (61.3%), and ureters (37.5%); isolated bladder lesions occurred in 3.7%. Full-thickness bladder infiltration occurred in 36.4% of patients, and 71.8% had a history of surgery. The most frequent preoperative symptoms related to multiorgan involvement were dysmenorrhea (88.7%), dyschezia (75.0%), and dyspareunia (55.7%). Dysuria (55.7%), pollakiuria (17.9%), and urinary urgency (9.0%) were also reported. Shaving was performed in 45.0% of cases, resection in 40.0%, skinning in 15.0%, with two rare cases requiring bladder augmentation with bowel insert. Of all multiorgan surgeries (96.3% of cases), the most complex 30% were performed by a bi-disciplinary team of gynecologists and urologists. Postoperative complications occurred in 8 patients (10%) and were significantly associated with larger lesions, full-thickness infiltration, trigonum involvement, multiple organs opened, and prior surgery. Conclusions: Laparoscopic management of bladder endometriosis is feasible and effective, even in complex cases. Postoperative complications were linked to disease complexity but remained low, likely due to protective techniques used by the reference team. Optimal outcomes for the most difficult cases are more likely when procedures are performed by a bi-disciplinary team involving both oncological gynecologists specialized in deep endometriosis surgery and urologists. Given the heterogeneous clinical profiles of bladder endometriosis, treatment should be carried out in specialized centers where individualized surgical strategies can be implemented. Full article

To enhance the accuracy of wind shear identification by coherent Doppler wind lidar (CDWL), it is necessary to clarify the variation characteristics of CDWL detection results under typical airflow disturbance conditions. This study first numerically simulated typical wind shear fields and generated the Plane Position Indication (PPI) results of CDWL through coordinate projection. Then, it compared the performance of the double-slope algorithm and the least squares algorithm on wind shear identification from the PPI data. The results showed that for wind fields with significant peak characteristics, the double-slope algorithm can more sensitively identify wind shear near the peak, compared with the least square algorithm. In contrast, for wind fields with stable, continuous and linear gradient characteristics, the least squares algorithm can better suppress noise and fit the wind speed gradient changes. Finally, a self-developed long-range CDWL was used to conduct wind shear detection experiments at a plateau airport. After the CDWL beam position was calibrated, its data were compared with those from the anemometer. The “least square + double-slope” scheme was adopted to analyze the typical wind shear case, and the effectiveness and reliability of the identification scheme were verified in combination with an aircraft crew report. Full article

In clinical practice, the coexistence of Superior Mesenteric Artery (SMA) syndrome (also known as Wilkie’s syndrome) and Celiac Artery Compression Syndrome (also referred to as Dunbar’s syndrome) is extremely rare. This combined pathology is characterized by simultaneous impairment of blood flow in the celiac trunk and compression of the duodenum, which complicates both diagnosis and treatment strategy selection. Traditional open surgical correction is associated with significant invasiveness due to the complexity of the anatomical relationships involved. Minimally invasive approaches, including robot-assisted surgery, allow precise dissection within confined anatomical spaces. This article presents a clinical case of simultaneous robot-assisted decompression of the celiac trunk and duodenum using the da Vinci Xi system. The case demonstrates the technical feasibility of a combined minimally invasive approach for the management of concurrent vascular and duodenal compression. Full article

Background/Objectives: Familial Mediterranean fever (FMF) is the most common periodic fever syndrome worldwide, and persistent subclinical inflammation has been reported in 10–20% of cases during attack-free periods. Although the immunomodulatory effects of vitamin D, vitamin B12 and folate have been investigated in various conditions, data on their relationship with subclinical inflammation in FMF patients remain limited. This study aimed to evaluate the association between micronutrient levels and subclinical inflammation in pediatric FMF. Methods: Children aged 2–18 years with an FMF diagnosis of more than two years, receiving regular colchicine therapy, and attack-free for at least two months were included. Patients with other autoinflammatory diseases, colchicine resistance, concomitant renal disease, active infection, or inadequate follow-up were excluded. Demographic, clinical, genetic, and biochemical data were analyzed. Results: A total of 253 patients were included, with a median age of 14 years (range, 3–18), and 133 (52.6%) were female. Persistent subclinical inflammation was observed in 31 patients (12.3%). Genetic analysis revealed homozygous M694V mutations in 71 patients (28%). Median vitamin levels were as follows: vitamin D 17.3 ng/mL (IQR 10.6–27.1), vitamin B12 288 pg/mL (IQR 214–367), and folate 6.4 ng/mL (IQR 4.8–7.6). Comparison between patients with and without subclinical inflammation showed no significant differences in micronutrient levels. Conclusions: Although micronutrients have been reported to play immunomodulatory roles, we did not observe significant association between vitamin levels and subclinical inflammation in pediatric FMF patients in our study. Full article

Background/Objectives: Viper envenomation in Italy is uncommon but carries significant clinical and forensic implications: an average of 257 bites per year are estimated, with only one fatality. This epidemiological context necessitates careful consideration of the standard of care and professional liability The article aims to outline the clinical and medico-legal dimensions of viper bites within both national and international contexts. Methods: We report the case of a 40-year-old woman bitten by a viper in an urban environment. At the initial emergency department visit the presentation was classified as Grade 0 (“dry bite”) according to Boels and, after 21 h, was discharged in good condition. Three days later, she returned with worsening symptoms and CT imaging revealed intrafascial and subcutaneous edema. The subsequent onset of complications prompted a criminal malpractice investigation. Therefore, we performed a PubMed search which yielded 125 records; after applying eligibility criteria, 33 articles were included, supplemented by manual reference checking for a total of 60 sources reviewed. Results: Comparison with the Australian model suggests the need for more standardized care pathways in Italy, while accounting for local toxicological and epidemiological specificities. Conclusions: This case and the accompanying literature analysis highlight that, even in low-incidence settings, structured patient communication, multidisciplinary management, collaboration with Poison Control Centers, and adherence to good clinical practice are crucial for patient safety and for mitigating medico-legal risk. Full article