Search Results (1,024)

Background: Angling-related injuries include acute trauma and chronic overuse conditions, but detailed clinical descriptions of different injury mechanisms remain limited. This retrospective case series presents four clinically distinct injuries associated with recreational and sport angling. Methods: Four purposively selected patients were recruited between 6 November 2025 and 30 April 2026 through questionnaires, angling forums, events, and regional angling associations. All provided written informed consent and sufficient medical documentation. Clinical data were obtained from participant-provided medical documentation, imaging reports, and interviews, with follow-up varying according to the clinical course. Results: Cases included high-velocity open-globe ocular trauma, a penetrating palmar injury caused by a baiting needle, a penetrating finger injury caused by a large barbed double hook, and rotator-cuff tendinopathy with lateral epicondylitis in the context of high angling exposure. Management included surgery, antimicrobial treatment, rehabilitation, and load modification. Outcomes ranged from substantial visual recovery to persistent scar-related hand limitation and improvement in overuse symptoms. Conclusions: These cases illustrate projectile, penetrating, and repetitive-load injury mechanisms associated with angling and support clinical awareness, careful assessment of equipment-related trauma, and activity modification and rehabilitation in overuse conditions. Preventive measures discussed should be regarded as clinical considerations and hypotheses for further study rather than interventions of established effectiveness. Full article

Cervical cancer is one of the most preventable malignancies, yet disparities in survival remain a significant public health burden across Eastern Europe and the Balkans. Bulgaria illustrates this paradox: HPV vaccination coverage is very low, and prevention continues to rely substantially on opportunistic screening, although recent national initiatives have introduced HPV-based testing and self-sampling. This article argues that the primary barrier to cervical cancer control in Bulgaria is not the lack of medical technology, but the absence of a structured, organized screening system. A modern national cervical cancer screening program should be recognized as a structured clinical and organizational pathway rather than a single diagnostic test. Such a programme requires population identification, active invitation and recall, reg-istry-based tracking, standardized referral and follow-up pathways, and continuous quality assurance. Primary high-risk HPV (hrHPV) testing provides high sensitivity and excellent negative predictive value, supporting longer screening intervals; however, screening for HPV positivity alone is insufficient as a sole referral criterion because many infections are transient and clinically insignificant. We propose a rational framework for cervical cancer screening in Bulgaria and comparable health systems: invitation-based screening for women aged 25–65 years built on primary hrHPV testing with genotyping, reflex cytology, and selective use of p16/Ki-67 dual staining. Drawing on a regional comparison of HPV vaccination and screening programs and on Bulgarian cost-of-illness data, we argue that transitioning from opportunistic testing to an integrated, registry-based screening cascade is essential for effective and equitable cervical cancer prevention in the region. Full article

Eating disorders are associated with substantial morbidity and mortality yet remain underidentified in general mental health practice, delaying intervention and worsening outcomes. Counselor preparation often provides limited eating disorder content within broader psychopathology coursework, leaving trainees underprepared to recognize subtle, culturally diverse, and nonstereotypical presentations. This conceptual paper draws on scholarship in counselor education, body image, embodied self-awareness, and eating disorder training to propose a four-domain framework intended to strengthen counselor preparation for eating disorder recognition and clinical response. The framework includes foundational knowledge of eating disorder diagnosis, medical and nutritional risk, levels of care, and multidisciplinary treatment; reflective body-related self-awareness concerning clinicians’ beliefs about food, weight, health, exercise, appearance, and culture; embodied and creative practices that strengthen awareness of bodily and relational responses; and clinical translation through direct assessment, supervision, consultation, and referral. A seven-session graduate course illustrates how the framework can be implemented while protecting students from coerced personal disclosure. Within the U.S. counselor education and mental health training context, policy recommendations address curriculum infusion, weight stigma, countertransference, competency assessment, and basic detection and referral preparations. Integrating body-related reflection with diagnostic knowledge may offer a promising approach for helping clinicians recognize when eating disorder and body image concerns warrant further inquiry, reduce stereotype-based omissions, and respond more deliberately across diverse clinical settings; however, whether embodied training improves detection outcomes remains an empirical question. Full article

Endometriosis is a chronic and often debilitating condition whose symptoms extend beyond pelvic pain to include fatigue, gastrointestinal and urinary complaints, menstrual irregularities, and reduced work capacity. These symptoms are typically framed within medical or occupational health discourse, yet little attention has been paid to how they are socially interpreted within workplace relationships. Drawing on the workplace bullying literature alongside qualitative research on the lived experience of endometriosis, this conceptual review proposes that endometriosis-related symptoms are minimized through two interconnected mechanisms: symptom fragmentation, in which the disease’s varied and cyclical presentations are perceived as unrelated complaints rather than expressions of one chronic illness, and identity pathologization, in which the resulting pattern of absence and reduced capacity is reattributed to the worker’s character rather than her condition. The review further situates these mechanisms within the broader literature on women-to-women workplace bullying and examines how humor may function as a socially deniable vehicle for mistreatment. Three anonymized vignettes drawn from clinical practice illustrate each mechanism in isolation and in combination, tracing the self-reinforcing loop through which fragmentation and pathologization sustain one another over time. Practical implications are offered for occupational health practice, managerial training, anti-bullying policy, and clinical care. The aim is not to psychologize endometriosis, but to contextualize suffering that currently falls between medical, organizational, and psychological frameworks—and to prevent the gradual transformation of illness into stigma and of symptoms into moral judgment. Full article

Background: Managing urinary calculi during a multiple gestation pregnancy presents significant clinical challenges, which require rigorous care to prevent adverse maternal and fetal outcomes. This report aims to offer clinical nursing references by summarizing the management of a complex pregnancy complicated by ureteral calculi and thyrotoxicosis. Case Presentation: A patient with a twin gestation complicated by a ureteral calculus and thyrotoxicosis was managed with nurse-led continuous care within a physician-directed multidisciplinary framework. During hospitalization, interdisciplinary medical and nursing teams continuously monitored maternal and fetal vital signs to establish individualized surgical and nursing regimens. Post-discharge integrated care was delivered via online and offline follow-up, incorporating collaborative assessments from the obstetrics, endocrinology, and psychology departments, alongside multidimensional physical care and targeted psychological counseling. Conclusions: With standardized treatment and continuous nursing intervention, the patient delivered healthy boy-girl twins by caesarean section at 37 weeks of gestation, followed by successful ureteroscopic lithotripsy and uncomplicated hospital discharge. This case illustrates a feasible approach to nurse-led continuous care within a physician-directed multidisciplinary framework for complex, high-risk pregnancies. As this is a single case, the findings should be interpreted cautiously and require further validation. Full article

Japan’s universal health coverage is often discussed in terms of broad access and regulated prices, but its national fee schedule also shapes how services are organized, governed, and delivered. Pediatric procedural sedation illustrates this governance function in short-horizon, safety-critical care, where quality depends not only on technical expertise but also on staffing, monitoring, recovery capacity, rescue readiness, and coordination across departments. In this setting, reimbursement policy, specialist capacity, patient safety, and short-term economic consequences intersect in routine practice. Japanese studies of pediatric magnetic resonance imaging suggest that comparative economic results are sensitive to sedation failure pathways and payment design, while the FY2026 medical fee revision signals a shift toward recognizing deep sedation as a managed clinical service rather than a simple act of drug administration. These issues extend beyond Japan, because many health systems face growing demand for procedural sedation under constrained specialist capacity. Value in this setting should therefore be considered more broadly than price or adverse events alone. It should also include implementation, family and system consequences, and the design of reliable service models. Reappraising value in this way may help move discussion beyond fee revision toward better alignment of payment, governance, measurable outcomes, and feasible service design. Full article

Calcaneal stress fracture is an uncommon osseous cause of heel and hindfoot pain. A 33-year-old woman with chronic underweight status (body mass index, 16.59 kg/m²) presented with a 2- to 3-week history of right lateral hindfoot pain that reportedly began during treadmill walking in association with a perceived twisting event. The medical record documented tenderness in the region of the calcaneofibular ligament and a negative talar tilt test, but heel-specific examination was incompletely documented. Magnetic resonance imaging (MRI) obtained at the initial evaluation was formally interpreted as showing a calcaneal tuberosity stress fracture and quadratus plantae strain, with no abnormality reported in the ankle ligament complexes. On retrospective MRI review, an incomplete, vertically oriented fracture line extending to the cortex without articular extension or osseous displacement was identified, with surrounding marrow signal abnormality meeting the imaging criteria for Nattiv grade 4. Weight-bearing radiographs obtained 4 days later showed a corresponding sclerotic band. This case illustrates MRI–radiographic correlation in a calcaneal tuberosity stress fracture presenting with lateral hindfoot pain and supports inclusion of osseous injury in the differential diagnosis. Full article

Public health emergencies often unfold over extended periods and place sustained pressure on community-level governance, particularly when demands for supplies, information, medical access, and daily support exceed routine service capacity. This study examines how community response organizations develop adaptive capacity under such conditions, drawing on a Shanghai community during the 2022 COVID-19 lockdown. Grounded theory was used to analyze semi-structured interviews, field observations, archival documents, and online community records and to identify the process through which fragmented resident mutual aid developed into organized collaboration. The grounded analysis identifies four linked stages of organizational evolution: capacity building, structural emergence, institutional consolidation, and experience accumulation. Building on these findings, a system dynamics model formalizes selected causal relationships and explores the feedback interactions among demand pressure, material reserves, information gaps, panic, volunteer mobilization, organizational division of labor, institutional support, and trust. The analysis illustrates how, within the proposed mechanism, resident participation may be activated through social capital, stabilized through institutional coordination and rule support, and sustained through feedback linking service performance, information reliability, trust, and continued participation. The study provides a feedback-based explanation of how community response capacity develops under prolonged emergency pressure and clarifies how informal resident action and formal governance arrangements can become mutually reinforcing. These findings contribute to research on community emergency adaptation and offer implications for grassroots preparedness, volunteer coordination, and collaborative governance. Full article

Background: Adverse perinatal outcomes impose a substantial burden on maternal health services, particularly in regions with a high prevalence of maternal medical conditions and marked health inequities. Population-specific evidence on how common maternal conditions relate to delivery outcomes remains limited for high-burden Southeast Louisiana. Methods: We conducted a retrospective cohort study of 7161 delivery encounters at an urban New Orleans hospital between 2020 and 2024, using electronic health record data from the LSU Health Clinical Data Warehouse. Multivariable logistic regression estimated adjusted associations of three non-overlapping exposure groups—gestational hypertension/preeclampsia (O13/O14), diabetes in pregnancy (predominantly gestational), and coded obesity—with cesarean delivery, ascertained from the recorded delivery-mode code and adjusted for age, race, ethnicity, and marital status; a composite of cesarean or preterm-labor coding was examined only as an exploratory secondary outcome. Because each encounter carried a single defined-condition code, the exposures were mutually exclusive, and their estimates describe separate exposure groups rather than the relative contributions of co-occurring conditions. Results: The cesarean rate ascertained from the delivery-mode code (11.9%) was well below the national benchmark (approximately 32%), indicating substantial administrative under-capture; such non-differential misclassification of the primary outcome would be expected to bias associations toward the null and limit the reliability of the effect estimates. Gestational hypertension/preeclampsia (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.53–2.19), diabetes (aOR 1.94, 95% CI 1.51–2.49), and coded obesity (aOR 1.41, 95% CI 1.05–1.88) were each associated with higher odds of cesarean delivery after adjustment for the available covariates. Conclusions: Because important clinical confounders (e.g., parity, prior cesarean delivery, multiple pregnancy, gestational age) were unavailable and the outcomes were not validated against clinical records, these associations should be interpreted as adjusted rather than independent. They are hypothesis-generating observations from administrative data rather than evidence for a risk-stratification tool, and they illustrate both the potential and the limits of routinely collected delivery data for monitoring maternal health services in high-burden settings. Full article

In this paper, we propose a new flexible modification of the Lomax distribution within the Bilal-G family generated through the T-X framework, referred to as the Lomax–Bilal distribution. The proposed model offers greater flexibility for modeling-skewed and heavy-tailed phenomena that frequently arise in survival and reliability studies. A comprehensive set of statistical properties is derived, as moments, order statistics, reliability measures, the quantile function, stochastic ordering, and maximum likelihood estimation. Furthermore, several information measures are obtained to characterize the uncertainty structure of the distribution, namely Shannon entropy, Rényi entropy, extropy, cumulative residual extropy, and generalized weighted extropy. Also, the Lorenz, Bonferroni, Zenga curves and Gini index are presented. The practical applicability and effectiveness of the proposed distribution are illustrated through analyses of two real datasets: survival times of patients with head and neck cancer treated with chemotherapy and radiation therapy, and repair times of an airborne communication transceiver. The empirical results showed that the Lomax–Bilal distribution consistently provides a better fit than several well-established lifetime distributions according to goodness-of-fit statistics and information criteria, particularly in modeling tail behavior. These findings suggest that the Lomax–Bilal distribution constitutes a flexible and competitive alternative for analyzing complex lifetime data in reliability engineering and medical survival studies. Full article

Background/Objectives: Molecular autopsy increasingly identifies rare variants in heritable aortopathy and Loeys–Dietz spectrum genes among sudden-death decedents, yet classification and causal attribution remain challenging when a syndromic diagnosis was never established during life. We reviewed eight unrelated Florida medical examiner decedents ascertained by sudden or unexpected death under medical examiner jurisdiction, including laboratory-reported heterozygous missense variants spanning the Loeys–Dietz syndrome (LDS)/familial thoracic aortic aneurysm and dissection (FTAAD) gene spectrum (TGFBR1, TGFBR2, TGFB2, and SMAD3). None had a premortem clinical diagnosis of LDS; ascertainment was therefore a variant-positive molecular autopsy series, not clinically diagnosed LDS. This illustrative series of eight cases cannot estimate prevalence, diagnostic yield, penetrance, or incidental-finding frequency. Methods: Autopsy (±premortem) phenotype–variant concordance was graded as strong, limited, discordant, or not assessable without treating death as evidence of pathogenicity or equating laboratory detection with clinical LDS diagnosis. Grades were assigned by the authors using predefined rules, were not blinded to laboratory class, and were reconciled by consensus discussion; inter-rater reliability was not quantified. Population, computational, and ClinVar annotations, together with multi-axis molecular triangulation, were retained as supplementary context only. Results: Laboratory classifications were pathogenic in one case (TGFBR1 p.Arg487Gln, Case 1), likely pathogenic in another (TGFBR2 p.Glu428Asp, Case 3), and variants of uncertain significance (VUS) in the remaining cases. Strong phenotype–variant concordance mapped to two aortic-catastrophe decedents (Cases 1 and 3), limited concordance to two cases (Cases 4 and 5), and discordant presentations to four (Cases 2, 6, 7, and 8), including pulmonary thromboembolism without aortopathy, infant sudden death with competing cardiomyopathy-gene context, and ethanol-related death with a normal aorta (SMAD3 Case 8). Conclusions: In this illustrative variant-positive series, 2/8 cases had strong autopsy-led concordance, 2/8 limited, and 4/8 discordant. Autopsy-led concordance grading distinguished two LDS-spectrum variants with strong phenotype–variant concordance for fatal ascending aortic catastrophe from six variants with limited or discordant support. Rare variants in TGFBR1, TGFBR2, TGFB2, or SMAD3 should not be conflated with an LDS diagnosis or with the cause of death without concordant autopsy evidence. Full article

This study presents a closed-loop digital–physical workflow for manufacturing patient-specific anatomical models and surgical guides for maxillofacial reconstruction. The workflow combines medical-image segmentation, additive manufacturing of anatomical models, surgeon-led physical simulation, re-digitization of the modified models, landmark-based and surface-based alignment with the original CT-derived anatomy, with FFD used as a limited supporting approach for localized geometry updating, CAD design, and fabrication of sterilizable guides. Technical feasibility was examined in two detailed mandibular reconstruction cases involving temporomandibular joint prosthesis implantation. The workflow was subsequently used in adapted forms in eight clinically heterogeneous mandibular reconstruction cases related to oncological treatment. These cases are reported as supplementary clinical implementations and were neither treated as direct replications of the complete closed-loop methodology nor pooled for quantitative comparison. In the two detailed cases, the guides were verified on the anatomical models, used intraoperatively, and followed by postoperative imaging providing qualitative clinical confirmation of implant positioning. The study did not include a direct CT-based control workflow or standardized geometric deviation analysis. Therefore, operating-time and cost effects are reported as case-specific observations and an illustrative scenario rather than comparative evidence. The main contribution is the physical-to-digital feedback step, which allows surgeon-introduced modifications of a printed model to be transferred back to the digital geometry before final guide design. The results support the technical feasibility and adaptability of the workflow, while prospective quantitative validation remains necessary. Full article

Sex differences in intensive care unit (ICU) admission and treatment are reflected in the underrepresentation of women, poorer outcomes, and higher mortality risk. Historical exclusion from clinical trials has limited evidence for providing sex-specific care. This study aims to examine demographic and admission data from MIMIC-IV electronic health records to understand sex differences in ICU admissions, treatments, and outcomes, addressing critical gaps in care. Using the MIMIC-IV database of de-identified electronic health records, multiple correspondence analysis (MCA) was applied as an exploratory method to identify patterns and associations across categorical variables, including ICU type and demographic factors, for both heart failure (HF) and myocardial infarction (MI) patients. The study aimed to determine whether demographic or socioeconomic factors influenced assignment to specialty cardiac ICUs, and to evaluate differences in critical care delivery among patients with HF and MI. We observed that women were associated with admission to non-specialty ICUs, whereas men were admitted to specialty cardiac ICUs. MCA uncovered subgroup patterns showing that admission to cardiac ICUs is not uniform across sex, race, insurance, age, or marital status. There were also racial discrepancies noted in assignments to specialty ICUs, with minority groups being underrepresented in specialty ICUs. Marital status was a factor in admissions: widowed and single people were more frequently admitted to non-specialty ICUs. Length of stay (LOS) was comparable between HF and MI patients; however, chi-square analysis showed LOS being significantly associated with sex, age and marital status in HF, and with insurance status in the MI cohort. This data exploration illustrates systemic inequities in ICU allocation based on sex, race, and socioeconomic factors. Evidence of sex-based bias in the medical community highlights the need to address these inequalities in treatments and critical care to achieve better outcomes in the future. Full article

Decisions about vector-borne zoonotic disease control often have to be made before the evidence is complete. Human surveillance, entomological observations, animal reservoir or sentinel data, environmental indicators, and modelling outputs may provide warning before human disease patterns are clear. In some settings, early action can prevent harm, yet it can also impose social, economic, ecological, animal-welfare, liberty-related, and trust-related burdens. Technical risk assessment remains necessary, although it may need to be complemented by ethical analysis. In this conceptual manuscript, we propose a seven-step One Health ethical decision-making framework that links integrated evidence and transmission plausibility to precaution, proportionality, equity, One Health trade-offs, legitimacy, feedback, impact evaluation, and adaptation. Its contribution lies not in introducing new ethical principles, but in integrating them into an iterative governance sequence and proposing medical bioethics mediation for persistent value conflict. Illustrative domains include West Nile virus, dengue, Zika, Crimean–Congo haemorrhagic fever, and other mosquito-, tick-, and sand fly-borne zoonotic threats. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article