Enhancing fraud detection in auto insurance and credit card transactions: a novel approach integrating CNNs and machine learning algorithms.

Fraudulent activities especially in auto insurance and credit card transactions impose significant financial losses on businesses and individuals. To overcome this issue, we propose a novel approach for fraud detection, combining convolutional neural networks (CNNs) with support vector machine (SVM), k nearest neighbor (KNN), naive Bayes (NB), and decision tree (DT) algorithms. The core of this methodology lies in utilizing the deep features extracted from the CNNs as inputs to various machine learning models, thus significantly contributing to the enhancement of fraud detection accuracy and efficiency. Our results demonstrate superior performance compared to previous studies, highlighting our model's potential for widespread adoption in combating fraudulent activities.

Analysis of rotational grazing management for sheep in mixed grassland.

Sown mixed grassland is rarely used for livestock raising and grazing; however, different forages can provide various nutrients for livestock, which may be beneficial to animal health and welfare. We established a sown mixed grassland and adopted a rotational grazing system, monitored the changes in aboveground biomass and sheep weights during the summer grazing period, measured the nutrients of forage by near-infrared spectroscopy, tested the contents of medium- and long-chain fatty acids by gas chromatography, and explored an efficient sheep fattening system that is suitable for agro-pastoral interlacing areas. The results showed that the maximum forage supply in a single grazing paddock was 4.6 kg DM/d, the highest dry matter intake (DMI) was 1.80 kg DM/ewe/d, the average daily weight gain (ADG) was 193.3 g, the DMI and ADG were significantly correlated (P < 0.05), and the average feed weight gain ratio (F/G) reached 8.02. The average crude protein and metabolizable energy intake by sheep were 286 g/ewe/d and 18.5 MJ/ewe/d respectively, and the n-6/n-3 ratio of polyunsaturated fatty acids in mutton was 2.84. The results indicated that the sheep fattening system had high feed conversion efficiency, could improve the yield and quality of sheep, and could be promoted in suitable regions.

Non-communicable diseases and their risk factors in Ukraine: analysis of the global burden of disease 2019 study.

OBJECTIVE: Aim: To analyse the burden and risk factors of Non-Communicable diseases (NCDs) in Ukraine to determine the ways to prevent them. PATIENTS AND METHODS: Materials and Methods: Using a statistical method, NCDs DALYs (Disability-Adjusted Life Years) in Ukraine were analyzed in dynamics for 1990-2019 and in comparison, with European and EU countries based on the data from "Global Burden of Disease, 2019" research. RESULTS: Results: The burden of NCDs in Ukraine is 1.5 time higher than in European and EU countries. The most negative dynamic trends and significant differences between indicators in Ukraine and EU countries (with an excess of 2 or more times) were identified for DALYs due to cardiovascular diseases, digestive diseases and substance use disorders. In Ukraine the burden of NCDs can be reduced on 25.9% by normalization of systolic blood pressure, on 21.2% by optimizing diet, on18.5% by quitting smoking, on 17.6% by lowering LDL cholesterol, on 16.5% by normalizing body weight and on 9.2% by quitting alcohol abuse. CONCLUSION: Conclusions: Ukraine should develop and implement a modern system for monitoring and assessing the NCDs burden and their risk factors; strengthen the capacity of public health institutions and their ability to attract communities to implement interventions to control NCDs modified risk factors, increase awarnes and the population's responsible attitude towards their health; strengthen the ability and motivate primary health care to provide quality primary prevention, screening and timely diagnosis and treatment of chronic NCDs.

[Low back pain and referral to the spine specialist: situation and resources in Buenos Aires]. / Lumbalgia y derivación al especialista de columna: situación y recursos en hospitales públicos de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: 90% of cases of acute low back pain have no specific underlying cause. International guidelines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first consultation with a specialist physician. METHODS: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. RESULTS: A total of 44 patients were included, with an average age of 53 years; 50% sought medical attention for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency department visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. CONCLUSION: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median waiting time for the consultation was 24 days.

Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada principalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con recolección prospectiva de los datos a través de un cuestionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consultas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación informal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

Progressive supranuclear palsy: Neuropathology, clinical presentation, diagnostic challenges, management, and emerging therapies.

Progressive supranuclear palsy (PSP) is a neurodegenerative disease characterized by the accumulation of 4R-tau protein aggregates in various brain regions. PSP leads to neuronal loss, gliosis, and tau-positive inclusions, such as neurofibrillary tangles, tufted astrocytes, and coiled bodies. These pathological changes mainly affect the brainstem and the basal ganglia, resulting in distinctive MRI features, such as the hummingbird and morning glory signs. PSP shows clinical heterogeneity and presents as different phenotypes, the most classical of which is Richardson's syndrome (PSP-RS). The region of involvement and the mode of atrophy spread can further distinguish subtypes of PSP. PSP patients can experience various signs and symptoms, such as postural instability, supranuclear ophthalmoplegia, low amplitude fast finger tapping, and irregular sleep patterns. The most common symptoms of PSP are postural instability, falls, vertical gaze palsy, bradykinesia, and cognitive impairment. These features often overlap with those of Parkinson's disease (PD) and other Parkinsonian syndromes, making the diagnosis challenging. PSP is an essential clinical topic to research because it is a devastating and incurable disease. However, there are still many gaps in knowledge about its pathophysiology, diagnosis, and treatment. Several clinical trials are underway to test noveltherapies that target tau in various ways, such as modulating its post-translational modifications, stabilizing its interaction with microtubules, or enhancing its clearance by immunotherapy. These approaches may offer new hope for slowing down the progression of PSP. In this review, we aim to provide an overview of the current knowledge on PSP, from its pathogenesis to its management. We also discuss the latest advances and future directions in PSP research.

Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol.

Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes' effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).

Development and impact of a tailored eHealth resource on fibromyalgia patient's self-management and self-efficacy: A mixed methods approach.

Aim: To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Background: Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. Design: A 3-phase mixed methods exploratory sequential design. Methods: Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Results: Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. Conclusions: The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients' self-efficacy to cope with this debilitating condition. Impact: This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.

Management of COVID-19-Associated Acute Respiratory Distress Syndrome (ARDS) During Pregnancy Following In Vitro Fertilization (IVF).

Coronavirus disease 2019 (COVID-19), the disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is recognized for its heterogeneous clinical presentation, complex pathophysiology, and broad spectrum of manifestations. Obstetric patients have been a subject of considerable interest due to their potential vulnerability to more severe infection and adverse pregnancy outcomes, exemplified by this report of a 43-year-old pregnant female with severe COVID-19 infection and respiratory complications. This case report aims to contribute to the existing scientific knowledge by presenting a detailed clinical profile of a patient with COVID-19 who achieved pregnancy through in vitro fertilization (IVF) and discussing the management and outcomes of the infection. The neonate's negative COVID-19 tests suggest no intrauterine transmission; prompt medical interventions, including mechanical ventilation and targeted antibiotic therapy, were implemented to stabilize her condition. Close collaboration among the multidisciplinary team and careful monitoring of vital functions and laboratory parameters were crucial in managing the patient's complex condition. Thus, this case highlights the importance of a comprehensive and multidisciplinary approach in managing severe COVID-19 cases in pregnancy, emphasizing the need for prompt recognition of complications and timely intervention.

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications (perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97, p = 0.252; 9.81 vs. 9.87, p = 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4; p = 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%, p = 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p = 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

Awareness and Management of Knee Pain and Osteoarthritis in Saudi Arabia: A Cross-Sectional Analysis.

OBJECTIVE:  The study sought to assess the level of awareness regarding osteoarthritis and its management. METHODS:  This study was cross-sectional, using data from a sample of 389 individuals from the central region of Saudi Arabia. The participants completed an online questionnaire and ensured anonymity.  Results: A total of 389 participants made up the sample for this study, which had a predominance of females (56.6%, n=220), a majority aged <50 years (66.6%, n=259), and most of them (51.7%, n=201) weighing 60-80 kg, substantial proportion lived in the Riyadh region (27.5%, n=107), with more than half (59.4%, n=231) having a university education and working in offices (28.3%, n=110). The majority (73.3%, n=285) of participants were married, and a vast majority (87.9%, n=342) were not smokers. The findings revealed that only 32.9% (n=128) of the participants had good knowledge about osteoarthritis. The study found that stiffness (80.2%, n=312) and swelling (97.9%, n = 381) are the most common signs and symptoms of osteoarthritis; the risk factors for osteoarthritis were genetic factors (79.7%, n=310) and age (91.3%, n=355). The treatment of osteoarthritis identified in the study included exercises such as swimming (85.1%, n=331), physical therapy (86.6%, n=337), and joint replacement surgery (92.0%, n=358). The study established a statistically significant association between age, education level, previous diagnosis of osteoarthritis, family history of osteoarthritis (p = 0.004, 0.001, 0.002, and 0.001, respectively), and level of knowledge about osteoarthritis. However, there was no statistically significant association between gender, marital status, smoking status, previous knee injuries, physical activity level, and the level of knowledge about osteoarthritis (p > 0.05).  Conclusion: Overall, the study revealed that 32.9% (n=128) of the participants had good knowledge about osteoarthritis. Participants aged 50-60 years, those with a university and post-graduate level of education, as well as those who had a previous diagnosis of osteoarthritis and those with a family history of osteoarthritis, had greater and better knowledge and awareness about osteoarthritis. Joint stiffness and swelling were identified, as the most common signs and symptoms of osteoarthritis. The risk factors identified in the study were genetic factors and age, while the treatment options noted by the study were exercise, such as swimming, physical therapy, and joint replacement surgery. The study notes the need for enhanced public awareness of the problems associated with osteoarthritis among the Saudi Arabian population.

Referenciación competitiva para la mejora de la calidad de la atención de Enfermería / Competitive Benchmarking for Improving Quality of Nursing Care

Introducción: La búsqueda continua de la mejora de la atención de enfermería conlleva la aplicación de instrumentos contemporáneos. Objetivo: Identificar buenas prácticas para la mejora de procesos relacionados con la calidad de la atención de enfermería en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Métodos: Se realizó un proyecto de desarrollo tecnológico, descriptivo, que empleó las tecnologías gerenciales de referenciación competitiva y gestión por procesos entre el 2018-2021. La institución de referencia fue la Clínica Central "Cira García". El grupo de estudio quedó conformado por personal vinculado a los procesos. Para la recolección de la información se diseñaron 10 instrumentos que se validaron con expertos por el método de Barraza. El estudio de los procesos de urgencias, esterilización y hospitalización se realizó en dos momentos: en el "Ramón Pando Ferrer" con el empleo de la metodología Lean y en la institución de referencia para conocer las buenas prácticas. Para el procesamiento de la información se utilizó la metodología planteada por Rodríguez y de Souza, para ello se tuvo en cuenta el referencial teórico del enfoque Lean y el de la referenciación competitiva. Resultados: Se identificaron mudas como espera, movimiento, sobreprocesamiento y defecto, se confeccionaron los diagramas de flujo y se identificaron indicadores de calidad. Conclusión: El procedimiento utilizado mostró resultados satisfactorios que evidencian la aplicabilidad de la integración de tecnologías en la identificación e incorporación de buenas prácticas(AU)

Introduction: The continuous search for the improvement of nursing care leads to the application of contemporary instruments. Objective: To identify good practices for the improvement of processes related to the quality of nursing care at Instituto Cubano de Oftalmología Ramón Pando Ferrer. Methods: A descriptive technological development project was carried out between 2018-2021, using the managerial technologies of competitive benchmarking and process management. The reference institution was Clínica Central Cira García. The study group was made up of personnel involved in the processes. For the collection of information, 10 instruments were designed and validated with experts by the Barraza method. The study of the emergency, sterilization and hospitalization processes was carried out in two stages: at the Ramón Pando Ferrer institution, with the use of the Lean methodology; and at the reference institution, to learn about good practices. The methodology proposed by Rodriguez and de Souza was used to process the information; also taking into account the theoretical referential of the Lean approach and that of competitive benchmarking. Results: Shortfalls were identified, such as waiting, movement, overprocessing and defect. Flow charts were drawn up and quality indicators were identified. Conclusion: The used procedure showed satisfactory results that demonstrate the applicability of integrating technologies in the identification and incorporation of good practices(AU)

Segundas víctimas en enfermería y su desafío para Latinoamérica / Second Victims in Nursing and its Challenge in Latina America

Introducción: El paciente y su familia son las primeras víctimas de un evento adverso. Los profesionales de la salud pueden desarrollar signos y síntomas físicos y psicológicos conocidos como el fenómeno de segundas víctimas. Este fenómeno se puede resolver con aprendizaje, pero también puede llevar al abandono de la profesión o al suicidio. Objetivo: Reflexionar acerca del fenómeno de segundas víctimas y la evidencia que existe acerca del fenómeno en enfermeras. Métodos: Se realizó una revisión de alcance con la pregunta: ¿cuál es la evidencia que existe del fenómeno de segundas víctimas en enfermeras?, en las bases de datos PUBMED, Google Scholar y EBSCO, entre noviembre y diciembre 2022, para artículos sobre el fenómeno de segundas víctimas en enfermería. Se utilizaron palabras clave "gestión de la calidad", "eventos adversos" y "enfermería". Se siguió la guía de PRISMA para seleccionar los artículos relevantes. Se incluyeron 11 estudios en la revisión. La prevalencia global de segundas víctimas oscila entre el 10,40 por ciento y el 43,30 por ciento, las enfermeras son las más afectadas. Los trastornos del sueño y cansancio son los signos y síntomas físicos más comunes, mientras que la vergüenza y la culpa son los síntomas psicológicos predominantes. Hay estrategias personales y organizativas para afrontar el fenómeno de segundas víctimas. En Latinoamérica hay investigación limitada y falta de programas de apoyo. Conclusiones: El fenómeno de segundas víctimas afecta más a las enfermeras que a otras profesionales. En Latinoamérica se debe estudiar este fenómeno de segundas víctimas y crear un foco en planes de soporte adaptados a nuestra cultura(AU)

Introduction: The patient and their family are the first victims of an adverse event. Health professionals can develop physical and psychological signs and symptoms known as the second victim phenomenon. This phenomenon can be resolved with learning, but it can also lead to abandonment of the profession or suicide. Objective: To reflect on the second victim phenomenon and the existing evidence about the phenomenon in nurses. Methods: A scoping review was conducted under the question: What evidence exists on the phenomenon of second victims in nurses in the databases PubMed, Google Scholar and EBSCO, between November and December 2022, for articles about the phenomenon of second victims in nursing? The following keywords were used: gestión de la calidad [quality management], eventos adversos [adverse events] and enfermería [nursing]. PRISMA guidelines were followed to select relevant articles. Eleven studies were included in the review. The overall prevalence of second victims ranged from 10.40 percent to 43.30 percent, nurses being the most affected. Sleep disturbances and fatigue are the most common physical signs and symptoms, while shame and guilt are the predominant psychological symptoms. There are personal and organizational strategies to cope with the second victim phenomenon. In Latin America, there is limited research and lack of support programs. Conclusions: The second victim phenomenon affects nurses more than other professionals. In Latin America, the second victim phenomenon should be studied and a focus on support plans adapted to our culture should be created(AU)

Self-Monitoring and Self-Efficacy in Patients with Chronic Kidney Disease During Low-Sodium Diet Self-Management Interventions: Secondary Analysis of the ESMO and SUBLIME Trials.

BACKGROUND: Patients with chronic kidney disease are often requested to engage in self-monitoring sodium (i.e. salt) intake, but it is currently unknown how self-monitoring would empower them. This study aims to assess: (1) how frequent self-monitoring tools are being used during low-sodium diet self-management interventions; (2) whether self-efficacy (i.e. trust in own capability to manage the chronic disease) is associated with self-monitoring frequency; and (3) whether higher self-monitoring frequency is associated with an improvement in self-efficacy over time. METHOD: Data from two multicenter randomized controlled trials (ESMO [n = 151] and SUBLIME [n = 99]) among adult Dutch patients with chronic kidney disease (eGFR ≥ 20-25 mL/min/1.73 m2) were used. In both studies, routine care was compared to a 3-month low-sodium diet self-management intervention with several self-monitoring tools (online food diary, home blood pressure monitor, and urinary sodium measurement device [only ESMO]). Data was collected on usage frequency of self-monitoring tools. Frequencies during the interventions were compared between low and high baseline self-efficacy groups using the Mann-Whitney U test and T-test and associated with changes in self-efficacy during the interventions using Spearman correlation coefficients. RESULTS: Large variations in self-monitoring frequency were observed. In both interventions, usage of self-monitoring tools was highest during the first month with sharp drops thereafter. The online food diary was the most frequently used tool. In the ESMO intervention, low baseline self-efficacy was associated with a higher usage frequency of self-monitoring tools. This finding was not confirmed in the SUBLIME intervention. No significant associations were found between usage frequency of self-monitoring tools and changes in self-efficacy over time. CONCLUSION: Patients with low self-efficacy might benefit most from frequent usage of self-monitoring tools when sufficient guidance and support is provided.

Müllerian Cyst: An Uncommon Etiology of Chronic Pelvic Pain Syndrome in Men.

Chronic pelvic pain syndrome (CPPS) in men is a complex pathological entity with a delicate nosological diagnosis and multiple etiological hypotheses dominated by urological causes. The Müllerian cyst has an embryological origin and is part of an organic anomaly of the male urogenital tract, incidentally detected during an initial infertility examination or in the presence of non-specific urinary symptoms. By its mass effect, it puts tension on the pelvic floor muscles and induces a stimulation of nerves which could explain its implication in the CPPS. Through this case report and literature review, we will clarify the etiopathogenesis and the diagnosis of CPPS as well as the approach to follow for better therapeutic management.

Assessment of the Relation Between Asthma Severity and Serum Vitamin D Levels: A Cross-Sectional Study.

Introduction Vitamin D3's importance for bone health in children and its potential role beyond musculocutaneous health is an ongoing area of research. This study assesses vitamin D3 deficiency prevalence in asthmatic children and its correlation with asthma cases and healthy controls.  Methods This cross-sectional study was conducted in a tertiary care hospital in Punjab, India among children between 5 and 15 years of age. Fifty children diagnosed with "bronchial asthma" who were under follow-up in the asthma clinic in outpatient and inpatient patients were enrolled as cases. Age-matched 50 healthy controls who presented for routine check-ups were enrolled in the control group. Demographic details were noted and clinical examination was done in all the cases. 25-(OH) vitamin D levels were estimated and compared in all cases and controls. The study also analyzed the relationship between 25-(OH) vitamin D levels with asthma control and severity. Results The study showed that serum vitamin D3 level was significantly decreased in asthmatic children (24.62 ± 14.95 ng/ml) as compared with the healthy control group (32.08 ± 12.22 ng/ml). Also, serum vitamin D3 level was significantly decreased in children with uncontrolled asthma (12.06 ± 4.68 ng/ml) as compared to children with well-controlled asthma (44.82 ± 10.48 ng/ml).  Conclusion The findings showed that low serum levels were observed more in asthmatic children as compared to healthy children. A correlation was also found between vitamin D3 levels and asthma severity, its control, and the number of acute exacerbations in the last year.

Aplasia Cutis Congenita of the Scalp with Bone Defect and Exposed Sagittal Sinus in Trisomy 13 Newborn - a Case Report.

Background: Aplasia cutis congenita is a heterogeneous disorders group with a rare reported incident of 0.5 to 1 in 10,000 births. ACC can be associated with physical defects or syndrome that may help in diagnosis, prognosis and further evaluation of the patient. Trisomy 13 is one of the most common fetal life limiting diagnosis which is associated with ACC of membranous type scalp. Objective: In this article, we report cases of aplasia cutis congenita of the scalp with dura and bone defect and exposed sagittal sinus in newborn diagnosed to have trisomy 13. It emphasizes the importance of ACC associated syndrome which is having high mortality prior to surgical intervention. Case presentation: The patient was born at 35 weeks of gestation. Her physical examination revealed a newborn girl with dysmorphic facial features including widely separated eyes, downward slanting of the palpebral fissure, microphthalmia, retrognathia, and low seat ears. She had area of loss of scalp skin and skull bone with seen brain tissue and sagittal sinus were exposed that was measure 6 by 5 cm in size. Additionally, she had a clenched fist and overlapping fingers and rocker bottom feet. Laboratory investigations include basic labs and the TORCH screen was negative. On the 9th day of life, a chromosomal analysis showed a female karyotype with three copies of chromosome number 13 in all 20 metaphase cells counts. Conclusion: The patient was managed conservatively. However, a multidisciplinary team agreed on do not resuscitate with no further surgical intervention as survival rate of trisomy 13 is poor.

Surgical Management of Swan Neck Deformity Following Mallet Finger Injury: A Review of 25 Patients Over 20 Years.

INTRODUCTION: Swan neck deformity develops as a sequela of chronic mallet finger. Surgical management can include soft tissue reconstruction or distal interphalangeal joint (DIPJ) fusion. Studies examining the incidence and management of posttraumatic swan neck deformity following mallet fracture are limited. METHODS: A retrospective, single-institution review of patients undergoing surgical management of swan neck deformity following a traumatic mallet finger from 2000 to 2021 was performed. Patients with preexisting rheumatoid arthritis were excluded. Injury, preoperative clinical, and surgical characteristics were recorded along with postoperative outcomes and complications. RESULTS: Twenty-five patients were identified who had surgical intervention for swan neck deformity. Sixty-four percent of mallet fingers were chronic. Median time to development of mallet finger was 2 months. Twelve (48%) mallet fingers were Doyle class I, 6 (24%) were class III, and 7 (28%) were class IVB. Forty percent of injuries failed nonoperative splinting trials. Sixteen (64%) underwent primary DIPJ arthrodesis, 8 (32%) underwent DIPJ pinning, and 1 underwent open reduction and internal fixation of mallet fracture. The complication rate was 50% overall, and 33% of surgeries experienced major complications. The overall reoperation rate was 33%. Proximal interphalangeal joint hyperextension improved by 11° on average. Median follow-up was 61.2 months. CONCLUSIONS: The development of symptomatic swan neck deformity following traumatic mallet finger injury is rare. All patients warrant an attempt at nonsurgical management. Attempts at surgical correction had a high rate of complications, and DIPJ fusion appeared to provide the most reliable solution.

Dengue Infection Triggering Concurrent Thrombotic Thrombocytopenic Purpura in a Case of Chronic Idiopathic Thrombocytopenic Purpura.

We present a case report detailing the medical history of a 53-year-old female who had a well-established 10-year history of idiopathic thrombocytopenic purpura (ITP). The patient presented with fever and gum bleeding, prompting a series of laboratory investigations. These examinations revealed concurrent thrombocytopenia and hemolytic anemia, alongside a positive test result for serum dengue IgM antibodies. Initial treatment for the patient involved intravenous administration of glucocorticoids and intravenous immunoglobulin. Regrettably, this therapeutic intervention did not yield a favorable response. Subsequent clinical developments, including the onset of generalized tonic-clonic seizures, raised suspicions of thrombotic thrombocytopenic purpura (TTP). A notable diagnostic indicator was the elevated PLASMIC score (platelet count; combined hemolysis variable; absence of active cancer; absence of stem-cell or solid-organ transplant; mean corpuscular volume; international normalized ratio; creatinine), reinforcing the consideration of TTP. To confirm the diagnosis, ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) enzyme levels were assessed and found to be low. Consequently, the patient was diagnosed with TTP. Plasmapheresis was administered, resulting in a positive clinical response after two cycles. Notably, the patient experienced a resolution of thrombocytopenia and hemolytic anemia. Following successful treatment, the patient was discharged with a prescription for immunosuppressants. This case underscores the critical importance of including TTP as a potential differential diagnosis when encountering patients with chronic ITP. TTP is characterized by its acute and life-threatening nature, often deviating from the typical clinical presentation. The application of the PLASMIC score serves as a valuable tool in guiding decision-making processes when TTP is suspected.