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Mycoplasma penumoniae (MP) is a common etiological agent of community-acquired pneumonia. However, there has been an increasing incidence of macrolide-unresponsive Mycoplasma penumoniae pneumonia (MUMPP) in recent years. The treatment of MUMPP requires further investigation. In this report, we describe a case of MUMPP complicated by secondary spontaneous pneumothorax. The patient was unresponsive to initial macrolide treatment and his pneumonia worsened with increasing hypoxemic respiratory failure. However, after receiving a novel tetracycline and a carbapenem antibiotic as anti-infective agents, glucocorticoid for anti-inflammatory and bronchoscopic interventions to clear the bronchial casts, his fever and hypoxia resolved, and his lung lesions had significantly improved. Symptomatic supportive measures, including supplemental oxygen, was provided for the management of spontaneous pneumothorax developed twenty days after discharge. At follow-up, he did not experience any more initial symptoms. All indexes remained normal for half a year. This study represents the initial investigation into the utilization of tigecycline in conjunction with bronchoscopic interventions including bronchoalveolar lavage (BAL) and bronchoscopic cryotherapy (BC) in the treatment of MUMPP, glucocorticoid can be considered for anti-inflammatory purposes, especially for patients with severe pneumonia. The findings from this case offer valuable insights into a potential therapeutic approach for individuals afflicted with MUMPP.

Introduction: With advancements in detection equipment and an increase in the frequency of examinations, thyroid nodules and goiter in children have garnered attention.

Objective: This study aims to determine the effects of high iodine and fluoride exposure on thyroid nodules and goiter in school-aged children.

Methods: We recruited children aged 8 to 12 from rural Jiangsu, China, based on the concentrations of iodine and fluoride in local drinking water and urine. Participants were divided into four groups: a group with high fluoride and iodine (HFHI), a group with high fluoride (HF), a group with high iodine (HI), and a control group (CONTROL). Fluoride levels in both drinking water and urine samples were measured using the ion-selective electrode method. Urinary iodine (UI) was assessed using inductively coupled plasma mass spectrometry, and children's thyroids were examined with portable ultrasound equipment equipped with a linear 7.5-MHz probe.

Results: The detection rates of thyroid nodules in the HFHI, HF, HI, and CONTROL groups were 10.4 %, 6.5 %, 7.7 %, and 2.8 %, respectively. The goiter detection rates were 3.8 %, 2.9 %, 3.8 %, and 1.1 %, respectively. In the HFHI group, statistically significant correlations were found between urinary fluoride (UF) and thyroid nodules (P = 0.011, adjusted OR and 95 % CIs were 2.29 [1.21, 4.32]), as well as between UI and thyroid nodules (P = 0.038, adjusted OR and 95 % CIs were 1.58 [1.04, 2.40]), and between UI and goiter (P = 0.014, adjusted OR and 95 % CI were 2.31 [1.19, 4.48]). In the HI group, there was a statistically significant link between UI and goiter (P = 0.005, adjusted OR and 95 % CI were 2.45 [1.31, 4.58]).

Conclusions: Combined high iodine and fluoride exposure may have an adverse effect on thyroid nodules in school-age children.

Introduction: Nursing care for people living with HIV/AIDS (PLWHA) can be challenging and is dependent on the context. However, there is a lack of information about nurses' experiences in caring for PLWHA in the western region of Iran. Therefore, this study aimed to describe the experiences of nurses in caring for PLWHA in Kermanshah, Iran.

Methods: In this qualitative descriptive phenomenological study, data were gathered via semi-structured, in-depth interviews. The sample comprised 15 nurses employed at hospitals affiliated with Kermanshah University of Medical Sciences, selected through purposive sampling. Colaizzi's seven-step method was employed to analyze the data, and MAXQDA 10 software was used for data management.

Results: In this study, we obtained 579 codes and four main themes of "caring with fear", "Care ethics", "protective precautions" and "duality of feeling ".

Conclusion: According to the results, nurses confront numerous difficulties, challenges, fears, and stress when dealing with PLWHA. Participants' perceptions and practical experiences of AIDS patients enable patients to receive appropriate and high-quality care and provide valuable insights for nursing managers to enhance the preparedness of HIV ward nurses. To gain a comprehensive understanding of HIV nursing care, nurses require further education and awareness on this subject.

Despite insurance contributions to economic growth, the intervening role of structural transformation on the insurance-growth nexus remains scarce, leaving a gap in the literature. Motivated by the 2030 Sustainable Development Agenda, which envisages higher structural transformation, financial development and economic progress, this study examines the threshold effects and the joint impact of insurance and structural transformation on economic growth in Africa. The study employed the generalised method of moments and dynamic panel threshold estimations on 38 countries covering 2008 to 2020. The following findings emerge: First, insurance and structural transformation promote economic growth. Second, the results indicate that structural transformation enhances the impact of insurance on economic growth. This suggests that structural transformation matters in driving insurance market development, ultimately promoting economic growth. Third, the empirical evidence further reveals nonlinearities in the relationship and presents that a high level of insurance penetration stimulates growth and vice versa. More so, the synergistic effect of insurance and structural transformation on economic growth is more substantial at higher threshold levels. This implies that though insurance spurs economic growth, its impact is more effective through the intervening role of a strong structural transformation. Therefore, this study calls for government intervention and policies to improve structural transformations and form insurance synergies to promote growth.

Raw milk and processed dairy products are among the primary important sources of nutrients and have significant roles in the world's dietary practices. However, the safety and quality of both milk and dairy products are critical issues that should be given more attention, especially from the nutritional and health perspectives. Comprehensive evidence on milk and commonly produced dairy products general quality characteristics in Ethiopia is limited. So, this review was meant to present an overview of the most vital quality measures for milk and dairy products. Previous research revealed that the microbiological characteristics of milk and milk products in different parts of Ethiopia are below accepted standards with high counts of microbial load. The physical quality indicators also did not meet the acceptable standards. Studies supported that the production and handling of milk and various dairy products take place under unsanitary conditions, which in turn attributed to higher microbial counts. This comprehensive review also revealed that the lack of hygienic preparation approaches, uncontrolled fermentation, and the lack of knowledge and awareness of small-holder dairy producers and dairy value chain actors are the main reasons for the inconsistent quality and safety challenges. Thus, designing relevant trainings and the introduction of strategies on hygiene practices are essential to being efficient in reducing the microbiological loads or contamination of raw milk and processed products. Generally, dairy producers must maintain milk quality throughout the whole production process in order to achieve the requisite raw milk input and high-quality processed products.

White-Sutton Syndrome (WHSUS) is a rare neurodevelopmental genetic disorder with an autosomal dominant mode of inheritance. Truncating mutations in pogo transposable element with zinc finger domain (POGZ) gene have been reported in cases of WHSUS. In this article, we present the first diagnosed case of WHSUS in Lebanon. The 10-month-old infant presented with failure to thrive, chronic diarrhea, vomiting and recurrent upper respiratory tract infections. Molecular testing was performed showing a novel nonsense variant in the POGZ gene: c.1135C > T p.(Arg379∗). With a relatively mild form of the disease, our findings suggest that WHSUS patients may present heterogenous clinical features.

The development of health services of hospitals in developing countries has led to a significant increase in the production of infectious waste, which has important economic and environmental consequences. Therefore, reducing pollutant leakage caused by disinfection and reducing infectious waste management costs are important in achieving sustainable development goals in hospital management. In this study, the centralized and decentralized patterns of infectious waste management were studied in three hospitals in Behbahan, Iran. Economic analysis was done based on the financial model. Phthalate emission from disinfection equipment was measured for investigating the level of exposure to the pollutant in the studied patterns. The results showed that the cost of waste transportation for studied hospitals in the centralized patterns increased by 12.1 %. However, reductions in disinfection and transfer costs up to 32.4 % were available by increasing the segregation ratio of infectious waste. The average emission of phthalates from disinfection equipment in the studied hospitals was 0.260 ng/kg. But emission of phthalate types was not the same, so that the emission of BEHP, IBP, and DBP was 35.97, 4.90, and 1.55 μg/m³, respectively. Considering the hospital waste reduction plan and increasing the segregation ratio to reduce the costs of the hospital led to economic justification of the centralized pattern of infectious waste management as a safe option.

The application of the amidohydrolase enzyme, L-asparaginase (ASNase), as a biocatalyst in the food and pharmaceutical industries has garnered significant interest. However, challenges such as hypersensitivity reactions, limited stability, and reusability under various operational conditions have hindered its cost-effective utilization. This paper introduces a novel nano-support for ASNase immobilization, namely the nanocomposite of iron oxide magnetic nanoparticles and amino acid-decorated graphene oxide (GO-Asp-Fe₃O₄). Characterization using FTIR spectroscopy, FE-SEM, and TEM microscopy revealed the homogeneous distribution of iron oxide nanoparticles on the surface of GO sheets. The effects of carrier functionalization and carrier-to-protein ratio on the immobilization of ASNase were studied to optimize the immobilization conditions. The magnetized nanocomposite of ASNase exhibited a 4.4-fold lower Michaelis-Menten constant (Km), suggesting an enhanced affinity for the substrate. The immobilized ASNase demonstrated two to eight times higher thermostability compared to the free enzyme and showed an extremely extended pH stability range. Furthermore, the immobilized enzyme retained over 80 % of its initial bioactivity after eight repeated reaction cycles. These findings suggest that the immobilization of ASNase on GO-Asp- Fe₃O₄ nanocomposite could be a viable option for industrial applications.

Background: Cardiac implantable electronic devices (CIEDs), including pacemakers, have undeniably revolutionized the treatment of cardiac conditions. However, just like any other treatment or intervention some significant challenges can be encountered in CIEDs, mainly, CIED infections. With reported incidence rates ranging from 1 % to 15 % these infections can pose lead to dangerous complications. Our case report presents an occurrence of late-onset pacemaker endocarditis, which despite proper antibiotic therapy required an open-heart surgery as the only curative option.

Case presentation: Our patient is a 50-year-old female known to have a pacemaker implanted twenty years ago, she presented with fever and purulent discharge from her pacemaker site. After thorough investigations, diagnostic tests confirmed a Serratia marcescens infection and despite antibiotic treatment, the patient's symptoms persisted, an echocardiography revealed tricuspid valve involvement with vegetations. Surgical intervention, by complete removal of the old and new pacemaker leads, tricuspid valvuloplasty, and installation of an epicardial pacemaker, was performed.

Conclusion: Our case highlights the rarity and complexity of Serratia marcescens-related pacemaker endocarditis and all CIEDs in general, while emphasizing the importance of interdisciplinary management to optimize patient outcomes. Early diagnosis, prompt treatment, and comprehensive surgical approaches are essential in managing CIED infections and achieving successful outcomes.

In the context of the fourth industrial revolution, this study examines the digital transformation of the luxury industry through a bibliometric analysis of 236 articles (1991-2022) and a bibliographic coupling of research from 2022 to 2024. The analysis identifies key trends, including the use of digital tools to enhance customer engagement, the growing role of review-based feedback in the tourism sector, value creation through innovative products and promotional strategies, and the advances in sustainability via digitalization. Despite these hot trends, many firms in the luxury sector have not yet involved in a real digital transformation, as they have only digitalized specific aspects of their operations. The findings suggest that while luxury firms are embracing digital tools to meet the expectations of digitally native consumers, they face the challenge of balancing innovation with the preservation of their core values. The study concludes that digital transformation is not merely an operational shift but a strategic imperative for the future competitiveness and profitability of the luxury sector.