Type A interrupted aortic arch is a rare congenital heart disease characterized by a complete loss of continuity between the ascending and descending portions of the aorta; presentation in adults is exceptional due to its high mortality. This article presents the case of a 57-year-old woman with resistant arterial hypertension since the age of 15, treated with multiple therapeutic regimens, presenting long-standing nonspecific symptoms. CT angiography and aortography were performed, confirming the diagnosis of type A interrupted aortic arch. She was referred to a tertiary care center where a left subclavian artery–descending aorta bypass was performed with an extra-anatomic graft, with good clinical evolution; she is currently asymptomatic under follow-up. Interrupted aortic arch is a rare congenital heart disease with low prevalence in adults due to its high mortality, of which type A is the most frequent and is associated with greater survival due to the formation of collateral arteries. Multiple studies have compared imaging methods to evaluate sensitivity, with modalities such as computed tomography and magnetic resonance imaging being superior to echocardiography.

Background: Anticholinergic medications are among the most widely prescribed drug classes in older adults, yet their cumulative burden poses substantial risks for cognitive decline, falls, and functional impairment. The Anticholinergic Cognitive Burden (ACB) scale provides a validated framework for quantifying this risk, with scores ≥3 indicating clinically significant burden. Objective: This quality improvement project (QIP) aimed to identify patients aged ≥65 years with an ACB score ≥3 in a primary care setting and to implement structured medication review interventions, including de-prescribing, switching, or dose adjustment, to reduce anticholinergic burden. Methods: A cross-sectional quality improvement design was employed over a six-month period (January–June 2024) in a GP practice in the United Kingdom. All registered patients aged ≥65 years were systematically screened using the ACB scale. Patients with a total ACB score ≥3 underwent structured medication reviews. Interventions included de-prescribing, therapeutic switching to alternatives with lower anticholinergic activity, and dose reduction. Pre- and post-intervention ACB scores were compared. Results: Of 120 patients screened, 98 were aged ≥65 years and 62 (63.3%) had an ACB score ≥3. The most prevalent anticholinergic agents were amitriptyline (29.0%), oxybutynin (22.6%), and tolterodine (19.4%). Following intervention, the mean ACB score decreased from 4.7 ± 1.1 to 2.9 ± 1.0 (p<0.001), the proportion of patients with ACB ≥3 reduced from 63.3% to 42.9%, and Mini-Mental State Examination scores showed modest improvement. Conclusion: Structured, ACB-guided medication reviews in older primary care patients are feasible and effective in reducing anticholinergic burden. Embedding systematic pharmacological review within routine geriatric care can meaningfully protect cognitive function and reduce fall risk in this vulnerable population.

Background: Tinea capitis is a common pediatric dermatophytosis involving the scalp, hair shafts, and follicles, most frequently caused by Trichophyton, Microsporum, and Nannizzia species. Although most cases are non-inflammatory, a subset progresses to kerion celsi. While appropriate antifungal therapy typically leads to resolution, persistent inflammation may occur despite microbiological clearance, suggesting additional pathogenic mechanisms. We report a 7-year-old male presenting with a chronic pseudoalopecic plaque on the scalp following inflammatory tinea capitis, with negative mycological studies but histopathological evidence of granulomatous dermatitis. Dermoscopic-guided removal of keratin plugs and ingrown hairs resulted in clinical improvement. This case highlights a novel mechanism of persistent inflammation in kerion celsi associated with hair shaft fragmentation, aberrant follicular penetration, and retention of keratinous debris acting as endogenous foreign bodies, triggering a chronic granulomatous response.

The vertebral column begins at the occipital bone and concludes with the coccyx, collectively forming the structure referred to as the Ṣulb, or spine. The vertebrae are relatively small in size and extend from the cervical region down to the coccyx, with the spinal cord being distinct from the brain. The cervical vertebrae are essential for facilitating a range of movements while maintaining stability, and their cavities are designed to be spacious, allowing the spinal cord to reside within them comfortably. The vertebrae have a distinctive thorn-like form, with each featuring two foramina located on its right and left sides. From each foramen, two processes extend; one connects to the upper vertebral foramen, while the other connects to the lower vertebral foramen. The closure of these foramina has enhanced stability and strength within the vertebral structure. Each vertebra is characterized by three analogous processes: one that extends upward and two that project laterally. A vertebra typically features four processes, with two located on the right and two on the left of the foramen. The processes serve the essential function of establishing articular connection between adjacent vertebrae, utilizing the cavities of some processes and the condyloid projections of others. They also provide protection, support, and resistance to impact, as well as facilitate the attachment of ligaments. The structures located at the posterior aspect of the vertebrae are referred to as spinous processes, while those situated laterally on the right and left are known as transverse processes. These processes serve to safeguard the nerves, blood vessels, and muscles that are situated deeper within the body along its length. The spinal cord's gradual reduction in thickness from top to bottom mirrors natural patterns found in rivers and trees, allowing for the emergence of nerve pairs from the intervertebral foramen. The cervical region comprises five cervical vertebrae, each characterized by four processes that extend both upward and downward. The twelve vertebrae of the spine are arranged such that each joint produces two upwardly extending processes, while two additional processes descend into corresponding pits that interlock with adjacent vertebrae. The research aims to conduct a comprehensive analysis of the complex anatomical framework of the vertebral column, as described by various esteemed scholars and notable philosophers from both Greek and Arab civilizations.

Background: The vaginal microbiota consists primarily of Lactobacillus species, which help maintain microbial balance through acid production and antimicrobial activity. The disruption of balance causes vaginal dysbiosis and infection. Objective: The aim of this study was to analyze the association of vaginal infection with the distribution of Lactobacillus species, vaginal pH, and antimicrobial activity. Methods: The study was designed as a case-control study. A total of 100 subjects, including 50 healthy subjects and 50 infected subjects, were included. Vaginal swabs were collected to assess pH, microbial isolation, and identification using the standard microbiology technique. The antimicrobial activity of Lactobacillus isolates was assessed using the agar well diffusion technique and peroxide production was assessed qualitatively. Chi-square test and independent t-test were used for the statistical analysis of the results. Results: The isolation of Lactobacillus was 90% in healthy women and 40% in infected women, with a statistically significant difference (p < 0.001). Infected women had increased vaginal pH (5.6 ± 0.5) as compared to healthy women (4.3 ± 0.3) (p < 0.001). Lactobacillus crispatus was the most frequent in healthy women and Lactobacillus iners was the most frequent in infected women. Pathogenic organisms, especially Gardnerella vaginalis, were statistically significantly more common in the infected group. The isolates taken from healthy women had the highest hydrogen peroxide production and antimicrobial activity. Conclusions: An increase in vaginal pH, a decrease in antimicrobial defenses, and overgrowth of pathogens are associated with the loss of functionally active Lactobacillus species. Composition and functional capacity are critical factors in determining vaginal health.

The purpose of the study was to examine the impact of a low-intensity aerobic fitness program on the chosen physiological and biochemical markers of kidney activity, the parameters of physical fitness in physically active elderly men of 55 60 years. A one-group pretest- posttest design was used as the experimental method. The sample was chosen as 12 physically active elderly men, who were carefully chosen out of elderly population of Misan Governorate in Iraq. The training had a duration of 12 weeks and it had four sessions in a week. It was composed of walking workouts, stationary bicycle, and bodyweight trainings whereby intensity and duration were increased gradually. Physiological measurements were done in heart rate and systolic and diastolic blood pressure. Measures of physical fitness included cardiorespiratory endurance, muscular endurance and body mass index (BMI). The findings showed statistically significant differences in the post-test measures in favor of most variables, which means that the training program is effective in improving the functioning of kidney and blood pressure regulation as well as physical fitness in general. The research suggests the implementation of such low-intensity aerobic exercises programs as one of the safe and effective preventive measures aimed at maintaining physiological health among older adults.

Background: Ruxolitinib is a JAK1/JAK2 inhibitor with demonstrated success in treating MF intermediate to high-risk patients, although the implications for low-risk disease classes are not yet established. Objective: To evaluate the effect of ruxolitinib on spleen size reduction and symptom burden in patients with low- and intermediate-1 risk primary myelofibrosis, and to analysis the relationship between baseline hematologic parameters and treatment response. Methods: A cross-sectional study was carried out on 30 patients diagnosed with primary myelofibrosis who were treated at the Hematology consultant/Merjan teaching hospital between January and August 2025. Patients were classified according International Prognostic Scoring System (IPSS). Ruxolitinib treatment was initiated at doses of 15–20 mg twice per day and therapeutic response was assessed after a minimum of six months. The main outcomes studied were reduction in spleen size (%) (estimated by ultrasound measuring the longest axis) and alterations in the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS). Statistical evaluations were performed using Jamovi version 2.6.44, establishing significance at p < 0.05. Results: Among the 30 patients, 14 (46.7%) were classified as low-risk, while 16 (53.3%) were considered in the intermediate-1 risk category. The median baseline spleen sizes recorded were 20 cm for the low-risk group and 18.5 cm for the intermediate-1 group. After treatment, the median reduction in spleen size was 17.9% in low-risk compared to 15.4% in intermediate-1 group (p = 0.16). Moreover, an average decrease in the MPN-SAF TSS was 71.7% in the low-risk group as well as 66.4% in the intermediate-1 group (p = 0.52). There were no significant correlations in these data between initial hematologic parameters and treatment outcomes. Conclusion: Ruxolitinib therapy resulted in reduction of splenic size and symptom severity for patients with lower-risk myelofibrosis (MF). However, the variations observed between different International Prognostic Scoring System (IPSS) categories were not statistically significant. These results underscore the possible advantages of initiating ruxolitinib therapy earlier for symptomatic low-risk MF patients and point to the necessity for larger prospective studies to confirm these findings.