Dengue-Associated Hemophagocytic Lymphohistiocytosis: A Diagnostic and Therapeutic Challenge

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Dengue fever, a widespread arboviral infection, ranges in severity from mild febrile illness to life-threatening conditions such as dengue hemorrhagic fever and dengue shock syndrome. Rarely, dengue can precipitate hemophagocytic lymphohistiocytosis (HLH), a severe hyperinflammatory syndrome characterized by dysregulated macrophage and T-cell activation. We report a case of a 45-year-old female presenting with fever, hepatosplenomegaly, cytopenias, and hyperferritinemia, who was diagnosed with dengue-associated HLH. The diagnosis was established using clinical findings, elevated ferritin, cytopenias, splenomegaly, and hemophagocytosis in the bone marrow, fulfilling the HLH-2004 criteria. Early initiation of dexamethasone, along with supportive therapy, improved the patient’s clinical status. This case underscores the importance of increased clinical vigilance for HLH in dengue patients with rapid clinical deterioration. Early diagnosis and prompt immunomodulatory therapy can significantly improve outcomes. Further research is needed to better understand the pathophysiology, diagnostic challenges, and optimal treatment strategies for dengue-associated HLH.

Generation and Distribution of Protons in the Nucleus According to New Axioms and Laws

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The Theory of new Axioms and Laws  contains 2 new Axioms and 8 new Laws and is created by the same author. This Theory  claims that elementary particles are constructed simultaneously from 2 different vortices: open transverse vortex and open longitudinal vortex. They are mutual orthogonal in space S and in time T. These vortices can be accelerating or decelerating.

The transverse   vortex   is   open  ,  transversely coiled in 2D .Pulsating in time T  it  forms  pulsating  transverse vortex that  spread  in space  as  transverse wave  .Every points on this  transverse wave move with a constant time T= const.   This is the real time-space of light waves and Electromagnetic waves.

The longitudinal  vortex is also open, but is wound longitudinally in 3D .Pulsating  in time T it forms  longitudinal waves . If it has  positive  acceleration   the accelerating  longitudinal vortices   suck in free vortices  from outside to inward. They   attract and pack  such  that they insert  each inside other and  form an accelerating longitudinal Funnel. In  Funnel the   longitudinal  and angular speed of spirals  are changing so that  the length all   spirals is one and the same: S=.const. The acceleratng longitudinal Funnels generate   the  Gravitational  time-space of attraction.

Transverse and longitudinal vortices transform each other: when the transverse vortex  expands in radius R , the longitudinal vortex shrinks  in length L and vice versa.

The proton is generated by a longitudinal decelerating vortex  with length L in 3D that comes from outside space .It   winds up a transverse acceleration vortex in a 2D  from in to outward  direction  in form of sphere  with radius R( Law 2).

It is known   that the nucleus of atom is formed  by  many shells of protons inserted one into another .Because the protons repell each other  ,that is why it is neccessary are tightened and laced up each other.This take place   by (software approach)   the accelerating longitudinal Funnels coming from  all directions of 3D  from out-inward  and  by   (hardware approach)  implemented  by the  of the neutrons .

The central spirals of  accelerating longitudinal Funnel  have maximal longitudinal velocity (in direction of  the moving) and minimal angular speed (along the radius) (Law6).That is why  the generated in  center protons have maximal  length L max  of longitudinal vortex and  minimal transverse radius  R min (Law2).Thus  the central protons look like to invisible points.

The peripheral spirals have minimal  longitudinal velocity (in direction of moving ) and maximal angular speed (along radius)( Law6). That is why the peripheral protons have minimal  length  L min of longitudinal vortex and  maximal transverse radius R max(Law2). Thus the peripheral protons   look like of well visible spheres.

The Influence of Service Quality on Loyalty Mediated by Customer Satisfaction at Hospital X

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The development of the business world is increasing, competition is very tight, so the thing that companies need to pay attention to is service quality. Service quality plays a very important role in hospital services because it will influence the loyalty and satisfaction of customers or patients who come to the hospital. Factors that influence service quality, namely Tangibility, Assurance, Reliability, Responsiveness, and Emphaty. Meanwhile, the definition of satisfaction is a person’s assessment of the product’s perceived performance or results in relation to expectations. And the definition of loyalty is a classic word used to describe loyalty and very enthusiastic devotion to an individual. What can be done to prepare ourselves for market demands is to improve service quality. The aim is to increase customer satisfaction and loyalty. This research aims to find out how much influence service quality has on customer satisfaction and loyalty at Hospital X. The number of samples in this research was 100 respondents. The data used is a type of quantitative data obtained from filling out questionnaires by selected respondents using a simple random sampling method. The analytical method used is processed using Smart PLS (Partial Least Square) software. The results of this research show that there is a significant influence of service quality on customer satisfaction and customer loyalty, customer satisfaction has a significant influence on customer loyalty, but customer satisfaction does not mediate the influence of service quality on customer satisfaction and loyalty.

The Degrowth of Tourism Industry in the Island of Crete, Greece. Is it Desirable and Feasible?

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The concept of degrowth has been developed recently as an alternative paradigm to continuous and unlimited growth which prevails nowadays. The degrowth of tourism industry has been proposed in overcrowded tourism destinations balancing the satisfaction of tourists and local residents with the sustainability of the natural ecosystems. The island of Crete, Greece is located in eastern Mediterranean basin hosting an increasing number of visitors every year. The tourism industry in the island is well developed having a high economic impact. The prosperous tourism industry in Crete has surpassed the carrying capacity of the island threatening its fragile ecosystems causing phenomena of overtourism with undesired and harmful impacts in the local societies. The degrowth of the local tourism industry can be conceived as an alternative paradigm of the current growth model of tourism which threatens its long-term sustainability. It rejects the current model of continuous and unlimited growth of tourism promoting the values of locality, development of small-scale enterprises, quality of life, environmental sustainability, reduction of carbon emissions, decommodification of tourism activities and smaller production and consumption. The adoption of tourism degrowth in Crete requires the mobilization and the active participation of the multiple stakeholders of the tourism industry in the island while it promotes their long-term interests which are currently threatened by overtourism, climate crisis and overconsumption of the limited natural resources.

Dietary Educational Program and Its Effect on the Knowledge of Patients with Diabetes Mellitus in Rivers State Nigeria

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Background: Diet is one of the key risk factors of T2DM because many nations have experienced dietary changes favoring increased calorie consumption due of urbanization and economic expansion. However, many diabetic patients still suffer the complications of diabetes mellitus because of their poor knowledge of the dietary management of diabetes mellitus. The purpose of this study was to ascertain the effects of a dietary educational program on the knowledge of diabetic patients. This study was carried out among patients with Type 2 diabetes mellitus in Rivers State University Teaching Hospital (RSUTH) and University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. This study used a quasi-experimental design. Multistage sampling techniques was used to enroll a total of 162 participants,  with 81 in the Control Group (CG) and 81 in the Experimental Group (EG), while Rivers State University Teaching Hospital (RSUTH) and University of Port Harcourt Teaching Hospital (UPTH) served as EG and CG respectively. Both groups received equal intervention of personalized meal timetables and 2 weekly phone call follow-ups. Additionally,   EG received Dietary education, using cooked and raw food demonstrations. Data was collected using a Semi-structured interviewer-administered questionnaire was used to collect data while the statistics analysis was conducted using SPSS version 22 statistical software with a p-value of <0.05 regarded as significant. Patients’ QoL, knowledge were assessed at baseline and six months (P1 & P3). The knowledge was classified into “good” fair and “poor,” At P1, EG had poor knowledge (EG: 17.3%) while CG had 18.5%. Knowledge at P3, 0% of patients in EG had poor knowledge while 17.3 % was seen in CG there was an improvement in both groups with p=0.001. Because of the educational program, the patients’ knowledge was affected positively at the end of the program. However, EG had better knowledge because of the demonstration of food. Thus, dietary intervention programs improved the knowledge of the patients.

Senior High School Science Teachers’ Attitudes, Knowledge and Skills in Alternative Assessment

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This study investigated senior high school science teachers’ attitudes, knowledge, and skills in alternative assessment within the Philippine context. A descriptive-quantitative research design was employed to gather data from 60 senior high school science teachers. The findings reveal that the teachers generally possess a high level of knowledge and skills in using alternative assessment methods. They hold positive attitudes towards alternative assessment, recognizing its benefits in improving student learning and assessment effectiveness. Some reservations exist, such as time consumption and difficulty in grading. The study also found no significant differences in teachers’ knowledge and attitudes based on current location in teaching, age, highest degree, and years of teaching experience. In contrast, teachers who received in-service training on alternative assessment demonstrated a significantly higher level of knowledge compared to those who did not. These findings highlight the potential of alternative assessment in senior high school science education. The need for ongoing professional development and support to enhance teachers’ knowledge and skills in effectively implementing these methods is crucial. To strengthen the positive attitudes and knowledge base identified in this study, it is recommended that senior high school science teachers be provided with professional development opportunities focused on alternative assessment methods. Additionally, resources and materials should be developed to support them in designing, implementing, and evaluating these assessments. By integrating alternative assessment practices into the curriculum and teacher training programs, we can ensure these effective methods become a mainstay in senior high school science education. Further research into the effectiveness of various alternative assessment methods would provide valuable insights for continual improvement.

Functions of Suffix -an in Javanese

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This article aims at describing functions of suffix –an in Javanese. Suffix -an is the most utilised suffix in Javanese, this suffix is used to create nouns, verbs and adjectives in word formation by maintaining or changing classes of the base. This suffix also functions as marker of reciprocal construction. Data in this article are gathered from novel and magazine which were analysed by using descriptive qualitative method. In the affixation process, suffix -an is used solely or together with prefixes and infixes as circumfixes. In several circumfixes, suffix -an is attached to reduplicated bases. The analysis also shows that the word formation process that uses suffix -na causes vowel shift.

Brain and Neuronal Changes Associated With Over Weight and Obesity

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Considerable brain and neural alterations associated with obesity affect behavior, thought, and emotional control. Changes in brain shape and function are revealed by neuroimaging research, especially in reward-processing regions like the striatum and prefrontal cortex. These alterations could result in a rise in the desire for foods rich in calories and a decline in judgment. Furthermore, neuroinflammation and changes in neurotransmitter systems are linked to obesity and can impact mood and cognitive function. To effectively treat obesity and the health problems it causes, it is essential to comprehend these brain alterations. Obesity is a complex medical problem that has significant effects on brain structure and function in addition to physical health. With an emphasis on changes in brain regions related to reward, food management, and cognitive function, this study examines the most recent research on the neuronal modifications linked to overweight and obesity.

Generative AI in the Categorisation of Paediatric Pneumonia on Chest Radiographs

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Paediatric pneumonia is a leading cause of morbidity and mortality worldwide, necessitating accurate and timely diagnosis. This study explores the application of Generative AI for categorising paediatric pneumonia using chest radiographs. Leveraging deep learning techniques, including Generative Adversarial Networks (GANs) and Variational Autoencoders (VAEs), we enhance image quality, generate synthetic training data, and improve model generalizability. The proposed framework integrates AI-driven feature extraction, convolutional neural networks (CNNs), and attention mechanisms to improve diagnostic accuracy. The results demonstrate significant improvements in classification performance compared to traditional methods, with a focus on interpretability and clinical usability.

Urinary Tract Infections as a Trigger for Dementia Progression

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Urinary tract infections (UTIs) are one of the infections that occur most frequently among the elderly and are now increasingly recognized as a significant factor in the causation of cognitive decline, particularly among those who had previously experienced dementia. This broad review focuses on epidemiological evidence, underlying pathophysiological mechanisms, and clinical consequences for examining the complex interrelationship between UTIs and dementia. Frequent UTIs have been shown to worsen the symptoms of dementia and accelerate cognitive deterioration due to the induction of systemic inflammation, neuro-inflammation, and disturbances of the blood-brain barrier. Delayed treatment due to diagnostic difficulties in the elderly further exacerbates cognitive effects. Preventive measures associated with alleviation of UTI-related cognitive burden include early detection, efficient management of UTI, and techniques reducing inflammation. It thus emphasizes on integrating multidisciplinary approaches as an improvement pathway towards better results in this highly vulnerable population.