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 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: 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.

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.

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.