Background: Hiccups are benign and self-limited condition, but attention should be paid to the underlying conditions when persist. There are various causes of persistent hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease. Case Summary: We report a case of intractable hiccups in a 67 y/o male as the initial symptom of coronary heart disease. He presented with a few-week history of hiccups and no other complaints. Echocardiography demonstrated wall motion abnormalities in the left ventricle with severe impairment of systolic function. He was He was admnistered chlorpromazine and anti-ischemic treatment, and a thallium viability study was advised before cardiac catheterization to confirm viable or nonviable myocardium. He refused further evaluation and was discharged with appropriate care. The gentleman was readmitted for heart failure two weeks after discharge due to poor medication adherence. The delay in treatment had affected his chances of survival, and his hiccuping symptoms had recurred and persisted. Finally, he died after two months from the time of diagnosis. Discussion: This case makes highlights the importance of having a high index of suspicion, especially in elderly diabetic patients where benign self-limiting conditions like hiccups can only present symptoms of severe cardiac disease. Cardiac disease should be considered even when the symptoms are only gastrointestinal; simple investigations in the form of changes in electrocardiogram with cardiac enzyme elevation may disclose the cardiac findings, as they did in our case!

A detailed description of the model for calculating epidemic spread under conditions of lockdown and mass vaccination of the population is given (ASILV model). The proposed analytical model adequately describes the development of the epidemic in New York City. The estimates of the total number of infected persons and the seven-day incident rate made using the proposed model correlate well with the observed data in all the stages of epidemic growth. Model calculations of the spread of the epidemic under different vaccination rates allowed an assessment of the effect of vaccination on the growth of the epidemic. Analysis of seven-day incidence curves at different vaccination intensities led to the preliminary conclusion that at vaccination rates above a minimum value, the emergence of new strains did not lead to a growing epidemic.

Background: Dispite of postural analysis is a fundamental tool for evaluating the neuromusculoskeletal structure of a subject a unique formal analysis process has not yet been determined. The aim of this work is to propose a postural analysis protocol t promote discussion with other practitioners so as to make continuous improvements in the proposed protocol to provide a tool that can serve the needs of specialists even more efficiently. Materials and Methods: The proposed system consists of four subsystems: medical history data, photographic references, overall observations, and tests. Results: Even though the initial results are encouraging, additional use of the described analysis system is considered essential to improve the technique and the skills of the operator. In this light, specific requests and observations from other professionals are essential, and obtaining these requests and observations is one of the purposes of the present article, as initially declared. Conclusions: The proposed postural analysis system represents a good balance of various, often opposing needs, being easily completed and reasonably fast and repeatable, making it possible to compare time series data.

60%-70% Several drugs can be administered orally as liquids, capsules, tablets, or chewable tablets because the oral route is the most convenient, safest and less expensive. The important challenge in the oral drug delivery is the growth of novel approaches to approve absorption of poorly permeable drugs across the intestinal permeability. The Biopharmaceutics Classification System (BCS) categorized based on their solubility and permeability. The BCS Class III, Class IV with low permeability across the biological membranes with low bioavailability. While these drugs are pharmacologically effective, poor absorption due to low permeability becomes the rate-limiting step to improve oral bioavailability. Various approaches for improving the permeability include physical, chemical, colloidal carriers and other methods such as prodrugs, permeation enhancers, ion-pairing, nanoencapsulation and combination/hybridization of one or more traditional approaches to improve drug permeability for better absorption. Among many advantages over other routes of administration 3 crucial ones are avoiding metabolism in liver, minimal negative effects and increased bioavailability. This article discusses the commonly various strategies and various approaches for improving the permeability of BCS Class III and Class IV drugs to enhance bioavailability.

Objectives: Bronchiolitis obliterans organizing pneumonia occurs with prevalence rate 1–3% after breast conservative treatment in series. In response to radiation of a lung or surrounding tissues, an inflammatory reaction can affect both lungs and is located within the radiation field. Characteristic imaging features include multiple alveolar opacities and diffuse ground-glass shadows. Letrozole may induce iatrogenic organizing pneumonia. Materials and methods: we report the case of a 76-year-old female who underwent conservative treatment for an invasive ductal carcinoma of the left breast. Hypofractionated radiotherapy was delivered with a total dose of 42.5 Gy in 16 sessions of 2.65 Gy using a three-dimensional technique. After the radiotherapy ended letrozole was indicated. Results: Several weeks after the radiotherapy ended and letrozole was introduced, she described a flu-like syndrome. Samples were negative, and there was no improvement after four courses of antibiotics. Imaging suggested bronchiolitis obliterans organizing pneumonia. Her symptomatology lessened after the letrozole was discontinued, and 11 months after radiotherapy finished, her imaging results were clear. Conclusion: Physicians must consider bronchiolitis obliterans organizing pneumonia. Cases may increase with hypofractionated radiation treatment and new drugs. Letrozole may potentiate the risk. Dosimetry may be adapted to the lung and subpleural areas for patients with risk factors and taking adjuvant or concurrent drugs with potential pneumotoxicity.