Breast milk analysis provides useful information about acute newborn exposure to harmful substances, such as psychoactive drugs abused by a nursing mother. Since breast milk represents a complex matrix with large amounts of interfering compounds, a comprehensive sample pre-treatment is necessary. This work focuses on determination of amphetamines and synthetic cathinones in human breast milk by microextraction techniques (liquid-phase microextraction and electromembrane extraction), and their comparison to more conventional treatment methods (protein precipitation, liquid-liquid extraction, and salting-out assisted liquid-liquid extraction). The aim of this work was to optimize and validate all the extraction procedures and thoroughly assess their advantages and disadvantages with special regard to their routine clinical use. The applicability of the extractions was further verified by the analysis of six real samples collected from breastfeeding mothers suspected of amphetamine abuse. The membrane microextraction techniques turned out to be the most advantageous as they required low amounts of organic solvents but still provided efficient sample clean-up, excellent quantification limit (0.5 ng mL-1), and good recovery (81-91% and 40-89% for electromembrane extraction and liquid-phase microextraction, respectively). The traditional liquid-liquid extraction as well as the salting-out assisted liquid-liquid extraction showed comparable recoveries (41-85% and 63-88%, respectively), but higher quantification limits (2.5 ng mL-1 and 5 ng mL-1, respectively). Moreover, these methods required multiple operating steps and were time consuming. Protein precipitation was fast and simple, but it demonstrated poor sample clean-up, low recovery (56-58%) and high quantification limit (5 ng mL-1). Based on the overall results, microextraction methods can be considered promising candidates, even for routine laboratory use.

• MeSH
• Amphetamines MeSH
• Liquid-Liquid Extraction MeSH
• Humans MeSH
• Limit of Detection MeSH
• Milk, Human * MeSH
• Liquid Phase Microextraction * MeSH
• Infant, Newborn MeSH
• Solvents MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Karcinom ledviny (RCC) je nejmalignějším urologickým nádorem a Česká republika patří mezi země s jeho nejčastějším výskytem na světě. Významná část nemocných je stále ještě primárně diagnostikována až ve stádiu pokročilého onemocnění nebo k progresi dochází v průběhu dalšího sledování. Druhá část článku se věnuje významu a integraci chirurgické léčby, případně dalších alternativních miniinvazivních technik, léčbě lokálně pokročilého či metastazujícího karcinomu ledviny (mRCC) při v součastnosti používaných režimech cílené biologické léčby. Pozornost je věnována prognostickým kritériím a výběru nemocných k jednotlivým způsobům cílené biologické léčby. Základem je komplexní léčba, integrující především chirurgické či nové miniinvazivní ablační techniky s léčbou systémovou. Mezi největší pokroky patří v posledním období biologická léčba generalizovaného onemocnění s použitím preparátů sunitinib (Sutent®) a sorafenib (Nexavar®), která statisticky významně prodlužuje přežívání nemocných (ty jsou považovány za léky první volby v I. a II. linii léčby generalizovaného RCC). Kromě tradičních preparátů pro systémovou imunoterapii, kterými jsou interferon-? (INF-?) a interleukin-2 (IL-2) se stále více uplatňují také další, například bevacizumab (Avastin®), temsirolimus či everolimus. V prevenci a léčbě skeletálních komplikací (SREs) se používá zoledronát (Zometa®), způsobující signifikantní snížení rizika jejich výskytu. Přehledný článek upozorňuje na současné trendy terapie a péče o nemocné s pokročilým a generalizovaným karcinomem ledviny.

Renal cell carcinoma (RCC) is the most malignant urological tumour and the incidence of RCC in the Czech Republic is currently highest in the world. The overview has 2 parts. In part 1. the authors present some current facts about epidemiology, molecular pathophysilogy of RCC, general mechanism of new molecularly targeted biological therapies with antiangiogenic drugs, importance of cytoreductive nephrectomy in cytokines era and about of current regimes of systemic antiangiogenic therapies. In part 2. the surgical therapy or new alternative methods of minimally invasive procedures incorporated in current complex treatmet strategies of advanced or metastatic RCC together with biological systemic therapy are discussed. The authors focus attention also on prognostic factors and individual profiles of patients (histological subtypes of RCC, performance status etc.) which can be used to predict outcomes in complex algotithm to facilitate treatment decision-making in everyday clinical practice with new targeted treatment regimes. Basic treatment modality for localized disease is surgical therapy. But significant number of patients are still primarily diagnosed in advanced or metastatic stage of disease. Complex care and interdisciplinary approach with integration of surgery and systemic medication with best supportive care on individual basis is optimal method of treatment for a patients with advanced or metastatic RCC. In recent years also minimally invasive methods for treatment of metastases has become an established and important equivalent to conevtional surgical procedures in some cases. Especially for high-risk and polymorbid patients we used for example radiofrequency ablation. Systemic therapy for metastatic RCC with new two antiangiogenics drugs: an oral oxindol tyrosine kinase inhibitor – sunitinib (Sutent®) and with an oral multikinase inhibitor – sorafenib (Nexavar®) is more effective than previous immunotherapy with cytokines (interleukin-2 and interferon-alpha). Another medicaments such as bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus are currently also successfully used for a treatment of metastatis disease. Bone metastases of RCC can lead to debilitating skeletal complicatinons. Zoledronic acid (Zometa®) significantly delays the onset and reduces the incidence of skeletal-related events and demonstrated trends for longer overall survival in these patient populations. This review article summarize new knowledge and current trends for a treatment of advanced or metastatic RCC.

• MeSH
• Survival Analysis MeSH
• Biological Therapy trends   utilization   MeSH
• Interferon-alpha therapeutic use   MeSH
• Interleukin-2 therapeutic use   MeSH
• Carcinoma, Renal Cell therapy   MeSH
• Humans MeSH
• Neoplasm Metastasis therapy   MeSH
• Antibodies, Monoclonal therapeutic use   MeSH
• raf Kinases antagonists & inhibitors   MeSH
• Receptors, Platelet-Derived Growth Factor antagonists & inhibitors   MeSH
• Receptors, Vascular Endothelial Growth Factor antagonists & inhibitors   MeSH
• Receptor Protein-Tyrosine Kinases antagonists & inhibitors   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Electrophoresis MeSH
• Chemistry, Clinical methods   MeSH
• Publication type
• Periodical MeSH

• Conspectus
• Chemie. Mineralogické vědy
• NML Fields
• chemie, klinická chemie
• chemie, klinická chemie

Karcinom ledviny (RCC) je nejmalignějším urologickým nádorem a Česká republika patří mezi země s největším výskytem karcinomu ledviny na světě. Významná část nemocných je stále ještě primárně diagnostikována až ve stadiu pokročilého onemocnění nebo k progresi dochází v průběhu dalšího sledování. První část článku je zaměřena na epidemiologická data, na současný pohled na molekulární patofyziologii rozvoje RCC, na obecné principy cílené biologické léčby, na význam cytoredukční nefrektomie při použití imunoterapie a na jednotlivé možnosti biologické léčby. Druhá část se věnuje postavení a integraci chirurgické léčby, případně dalších alternativních miniinvazivních technik léčby lokálně pokročilého či metastazujícího karcinomu ledviny (mRCC) při v současnosti používaných režimech cílené biologické léčby. Pozornost je věnována prognostickým kritériím a stratifikaci nemocných k jednotlivým režimům cílené biologické léčby. Základem léčby pokročilého onemocnění je komplexní léčba, integrující především chirurgické či nové miniinvazivní ablační techniky s léčbou systémovou. Mezi největší pokroky léčby u generalizovaného onemocnění patří v posledním období biologická léčba s použitím preparátů sunitinib (Sutent®) a sorafenib (Nexavar®), které jsou považovány za léky první volby v I. a II. linii léčby generalizovaného RCC a statisticky významně prodlužují přežití nemocných. Kromě tradičních preparátů pro systémovou imunoterapii, kterými jsou interferon-? (INF?) a interleukin 2 (IL-2) se stále více uplatňují i další preparáty pro cílenou systémovou léčbu. Jedná se například o bevacizumab (Avastin®), temsirolimus či everolimus. V minulosti prakticky neléčitelné kostní metastázy jsou v posledních letech rovněž příznivě ovlivnitelné. Jako nový zlatý standard se v prevenci a léčbě skeletálních komplikací (SREs) používá zoledronát (Zometa®), který signifikantně snížuje riziko kostních komplikací. Článek upozorňuje na současné trendy léčby a péče o nemocné s pokročilým a generalizovaným karcinomem ledviny.

Renal cell carcinoma (RCC) is the most malignant urological tumour and the incidence of RCC in the Czech Republic is currently highest in the world. The overview has 2 parts. In part 1. the authors present some current facts about epidemiology, molecular pathophysilogy of RCC, general mechanism of new molecularly targeted biological therapies with antiangiogenic drugs, importance of cytoreductive nephrectomy in cytokines era and about of current regimes of systemic antiangiogenic therapies. In part 2. the surgical therapy or new alternative methods of minimally invasive procedures incorporated in current complex treatmet strategies of advanced or metastatic RCC together with biological systemic therapy are discussed. The authors focus attention also on prognostic factors and individual profiles of patients (histological subtypes of RCC, performance status etc.) which can be used to predict outcomes in complex algotithm to facilitate treatment decision-making in everyday clinical practice with new targeted treatment regimes. Basic treatment modality for localized disease is surgical therapy. But significant number of patients are still primarily diagnosed in advanced or metastatic stage of disease. Complex care and interdisciplinary approach with integration of surgery and systemic medication with best supportive care on individual basis is optimal method of treatment for a patients with advanced or metastatic RCC. In recent years also minimally invasive methods for treatment of metastases has become an established and important equivalent to conevtional surgical procedures in some cases. Especially for high-risk and polymorbid patients we used for example radiofrequency ablation. Systemic therapy for metastatic RCC with new two antiangiogenics drugs: an oral oxindol tyrosine kinase inhibitor – sunitinib (Sutent®) and with an oral multikinase inhibitor – sorafenib (Nexavar®) is more effective than previous immunotherapy with cytokines (interleukin-2 and interferon-alpha). Another medicaments such as bevacizumab (Avastin®), temsirolimus (Torisel®), everolimus are currently also successfully used for a treatment of metastatis disease. Bone metastases of RCC can lead to debilitating skeletal complicatinons. Zoledronic acid (Zometa®) significantly delays the onset and reduces the incidence of skeletal-related events and demonstrated trends for longer overall survival in these patient populations. This review article summarize new knowledge and current trends for a treatment of advanced or metastatic RCC.

• MeSH
• Biological Therapy trends   MeSH
• Humans MeSH
• Antibodies, Monoclonal therapeutic use   MeSH
• Bone Marrow Neoplasms drug therapy   complications   secondary   MeSH
• Kidney Neoplasms drug therapy   surgery   physiopathology   MeSH
• Nephrectomy mortality   rehabilitation   MeSH
• Sirolimus pharmacokinetics   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Pro primární diagnostiku kolorektálního karcinomu je zlatým standardem kolonoskopie spojená s biopsií. Přesný staging a předoperační vyšetření jsou pro stanovení optimální léčby kolorektálního karcinomu klíčové, jsou důležitým faktorem při rozhodování o neoadjuvantní léčbě a také determinují prognózu. Nejpřesnější metodou pro hodnocení invaze do rektální stěny je zejména u nižších stadií onemocnění endoskopická ultrasonografie, která se používá především pro T staging. Přesnost endoskopické ultrasonografie při T stagingu závisí na stadiu lokální invaze tumoru, v průměru se pohybuje okolo 85 %. Přesnost nodálního stagingu je okolo 70-75 %. Vyšetření výpočetní tomografií je široce dostupné a rychlé, nicméně není metodou volby pro hodnocení vrstev stěny střeva, proto ho nelze dobře použít pro lokální staging tumoru a špatně lze na něm hodnotit superficiální nádory. Vyšetření hrudníku, břicha a pánve touto zobrazovací metodou se používá především k hodnocení vzdálených metastáz. Magnetická rezonance je v rukou zkušeného radiologa metodou první volby pro staging a měla by být povinná při plánování léčby a typu operačního výkonu i při hodnocení léčebné odpovědi. Magnetická rezonance je v současnosti jediná zobrazovací a reprodukovatelná metoda s vysokou specificitou (92 %) pro předpověď negativního cirkumferenčního resekčního okraje a pro určení hloubky invaze mimo muscularis proprii. U tumorů distálního rekta je stěžejní pro rozhodnutí chirurga, zda je realizovatelný sfinktery šetřící zákrok či nikoli. U vyšších stadií může magnetická rezonance zobrazit extramurální vaskulární invazi tumoru, která je nezávislým prognostickým faktorem lokální i vzdálené rekurence a horšího celkového přežití. Umožňuje selektovat pacienty, kteří budou mít profit z neoadjuvantní terapie. Magnetická rezonance dokáže odlišit pacienty s dobrou odpovědí na neoadjuvantní léčbu od tzv. non-respondérů. Stanovení stupně regrese tumoru pomocí této metody je nezávislým předpovědním faktorem celkového přežití a celkového bezpříznakového přežití pacientů s karcinomem rekta. V neposlední řadě má významnou roli také u pacientů s lokální rekurencí. U pacientů, kteří podstoupili neoadjuvantní chemoradioterapii, mají všechny tyto metody nižší přesnost, a to vzhledem k problematickému odlišení fibrózy, desmoplastické reakce, edému, zánětu a viabilních nádorových okrsků v jizevnaté tkáni.

The golden standard for primary diagnosis of colorectal cancer is colonoscopy together with biopsy. Exact staging and the preoperative assessment are crucial for optimal management of colorectal carcinoma, influencing decision making in case of neoadjuvant treatment and also determining the prognosis. EUS depicts the anatomic layers of the rectal wall with a high degree of accuracy and thus enables precise determination of the tumor extent in relation to the different wall layers (T staging). EUS accuracy is about 85% for T staging and 70-75% for nodal staging. Compared with the other commonly used techniques, CT scan is more largely accessible, faster, inexpensive and less operator-dependent, however CT is not the first choice method for local staging, because the definition of the bowel wall layers is not possible, but is one of the preferred tools to evaluate mainly distant spread, because of its high reproducibility and availability. High-resolution MRI in hands of experienced radiologist plays a pivotal role and has become almost mandatory in the pretreatment assessment of primary rectal cancer. MRI is currently the only imaging modality that is highly accurate (with specificity 92%) in predicting whether or not it is likely that a tumor-free margin can be achieved and in determination of the local invasion depth. Especially in distal tumors MRI provides important information for surgeon's decision whether sphincter-sparing surgery is possible. In patients with advanced rectal cancer extramural vascular invasion of the tumor can be depicted, used as an independent negative prognostic factor for local and distant recurrence rate and shorter overall survival rate. MRI can determine which patients can be treated with surgery alone and which will require radiation therapy to promote tumor regression. MRI can differentiate patients with good therapy response from non-responders. Tumor regression grade assessment is an independent predictor of overall survival and overall symptom-free survival rates and also plays substantial role in patients with the local recurrence. In patients with rectal cancer who have received concurrent chemotherapy and radiation therapy before surgery, all methods have lower accuracy in prediction of the pathologic stage owing to overstaging or understaging. The factors related to this problem include fibrosis, desmoplastic reaction, oedema, inflammation, and viable tumor nets at a fibrotic scar from a previous tumor.

• MeSH
• Diagnostic Imaging * methods   MeSH
• Endoscopy methods   MeSH
• Colorectal Neoplasms * diagnostic imaging   MeSH
• Response Evaluation Criteria in Solid Tumors MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Tomography, X-Ray Computed methods   MeSH
• Neoplasm Staging methods   MeSH
• Ultrasonography methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Background and Objectives: Iron deficiency (ID) is a common comorbidity in patients with heart failure. It is associated with reduced physical performance, frequent hospitalisations for heart failure decompensation, and high cardiovascular and overall mortality. The aim was to determine the prevalence of ID in patients with advanced heart failure on the waiting list for heart transplantation. Methods and Materials: We included 52 patients placed on the waiting list for heart transplantation in 2021 at our centre. The cohort included seven patients with LVAD (left ventricle assist device) as a bridge to transplantation implanted before the time of results collection. In addition to standard tests, the parameters of iron metabolism were monitored. ID was defined as a ferritin value <100 μg/L, or 100-299 μg/L if transferrin saturation (T-sat) is <20%. Results: ID was present in 79% of all subjects, but only in 35% of these patients anaemia was expressed. In the group without LVAD, ID was present in 82%, a median (lower-upper quartile) of ferritin level was 95.4 (62.2-152.1) μg/mL and mean T-sat was 0.18 ± 0.09. In LVAD group, ID was present in 57%, ferritin level was 268 (106-368) μg/mL and mean T-sat was 0.14 ± 0.04. Haemoglobin concentration was the same in patients with or without ID (133 ± 16) vs. (133 ± 23). ID was not associated with anaemia defined with regard to patient's gender. In 40.5% of cases, iron deficiency was accompanied by chronic renal insufficiency, compared to 12.5% of the patients without ID. In the patients with LVAD, ID was present in four out of seven patients, but the group was too small for reliable statistical testing due to low statistical power. Conclusions: ID was present in the majority of patients with advanced heart failure and was not always accompanied by anaemia and renal insufficiency. Research on optimal markers for the diagnosis of iron deficiency, especially for specific groups of patients with heart failure, is still ongoing.

• MeSH
• Anemia, Iron-Deficiency * complications   epidemiology   MeSH
• Anemia * complications   MeSH
• Iron Deficiencies * MeSH
• Ferritins MeSH
• Humans MeSH
• Heart Failure * complications   epidemiology   diagnosis   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

PURPOSE OF THE STUDY This study investigated whether there was an optimal interval between two operations for total knee arthroplasties in patients with advanced bilateral gonarthrosis scheduled to undergo staged total knee arthroplasty (TKA). MATERIAL AND METHODS A prospective cohort of 219 patients (136 females, 83 males) undergoing staged total knee arthroplasty for the treatment of advanced bilateral gonarthrosis were followed for up to 12 months. The mean was 69.51±5.02 (56-80) years. Patients were categorized into five groups based on the time between the first and second operations; Group I (21-90 days), Group II (91-180 days), Group III (181-270 days), Group IV (271-360 days), and Group V (more than 360 days). Patients were evaluated based on time from surgery and were assigned to corresponding groups. The data recorded included age, body mass index (BMI), side of operated knee, complications, and radiological and clinical findings. Visual analog scale (VAS) for non-operated knees was applied. Activities of Daily Living Score (ADLS) was applied to the patients at last follow-up. RESULTS No statistically significant difference was noted in BMI values (p=0.634), range of joint motion (RJM) (p=0.940) and age (p=0.785) distribution between the five groups. In Group I, the mean VAS score increased by 7.83 to 7.98, 7.86 to 8.53 in Group II, by 7.85 to 8.54 in Group III, 7.85 to 8.59 in Group IV, and 7.88 to 8.64 in Group V. There was no statistically significant difference in preoperative ADLS between the groups (p=0.064), but there was a statistically significant difference in postoperative ADLS (p=0.001). Group I patients had significantly lower postoperative ADLS compared to the other groups (p=0.001). The mean increase in postoperative ADLS versus preoperative scores of all groups were statistically significant The most significant improvements occurred in Groups II and III. Similarly, preexisting pain in the non-operated knee started to increase in Group II and continued in all groups. DISCUSSION Given all these findings, we believe that it is reasonable to advise patients to receive their second TKA, 3-6 months after their initial TKA, as this interval will allow for the greatest improvements in functional and daily living activities, and pain in the non-operated knee simultaneously becomes more severe. This recommended interval would minimize both the functional problems with the operated extremity due to pain, and deformity and dysfunction in the non-operated knee and the subsequent overloading. CONCLUSIONS Even though a number of factors influence the optimal interval for staged TKAs in bilateral gonarthrosis, an interval of 91-270 days appears to be the optimal interval between surgeries in terms of minimizing pain and maximizing ADL s and knee scores. Key words: bilateral total knee arthroplasty, optimal interval, knee society scores, activities of daily living.

• MeSH
• Osteoarthritis, Knee * surgery   MeSH
• Activities of Daily Living MeSH
• Knee Joint surgery   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Range of Motion, Articular MeSH
• Arthroplasty, Replacement, Knee * adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

CONTEXT: Advance care planning (ACP) is relevant yet challenging with cognitive decline. OBJECTIVE: To provide evidence and consensus-based clinical recommendations for how to conduct ACP in dementia. METHODS: International Delphi study conducted by the European Association for Palliative Care 'ACP in dementia' taskforce with four online surveys (September 2021-June 2022). A panel of 107 experts from 33 countries and seven individuals with dementia contributed. The recommendations specific for dementia were initially based on two earlier Delphi studies and literature searches addressing guidance including the right timing and how to personalize ACP. We used conservative preregistered criteria for consensus. RESULTS: Thirty constitutive elements of ACP were identified (e.g., 'assess understanding of ACP'). Only five were deemed 'optional.' The panel estimated a median of four conversations could address elements to be addressed at least once. Recommendations included to assume capacity as a principle, conscious of the need to explore its fluctuation, to encourage engaging and playing active roles, and to establish connection and inform and prepare family. There was a consensus to offer ACP around dementia diagnosis, to raise end-of-life issues later, and to personalize ACP with flexibility, providing of information and exploring understanding. The advice of the persons with dementia pointed to a wish for a well-coordinated holistic approach. CONCLUSION: Consensus was reached, including in areas of ambiguity, to guide ACP in dementia. ACP should be embedded in a nonprescriptive, individualized approach that involves both the person with dementia and their families. Future studies may evaluate trade-offs between optimal ACP and feasible implementation.

• MeSH
• Delphi Technique MeSH
• Dementia * therapy   MeSH
• Consensus MeSH
• Humans MeSH
• Palliative Care MeSH
• Terminal Care MeSH
• Advance Care Planning * MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH

Direct matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) bacterial cell or lysate analysis appears to meet all the criteria required for a rapid and reliable analytical microorganism identification and taxonomical classification tool. Few-minute analytical procedure providing information extending up to sub-species level underlines the potential of the MALDI-MS profiling in comparison with other methods employed in the field. However, the quality of MALDI-MS profiles and consequently the performance of the method are influenced by numerous factors, which involve particular steps of the sample preparation procedure. This review is aimed at advances in development and optimization of the MALDI-MS profiling methodology. Approaches improving the quality of the MALDI-MS profiles and universal feasibility of the method are discussed.

• MeSH
• Bacteria chemistry   isolation & purification   MeSH
• Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization methods   MeSH
• Bacterial Typing Techniques methods   MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

INTRODUCTION: This work focuses on the Dengue-viremia ABC (Atangana-Baleanu Caputo) fractional-order differential equations, accounting for both symptomatic and asymptomatic infected cases. Symptomatic cases are characterized by higher viremia levels, whereas asymptomatic cases exhibit lower viremia levels. The fractional-order model highlights memory effects and other advantages over traditional models, offering a more comprehensive representation of dengue dynamics. METHODS: The total population is divided into four compartments: susceptible, asymptomatic infected, symptomatic infected, and recovered. The model incorporates an immune-boosting factor for asymptomatic infected individuals and clinical treatment for symptomatic cases. Positivity and boundedness of the model are validated, and both local and global stability analyses are performed. The novel Adams-Bash numerical scheme is utilized for simulations to rigorously assess the impact of optimal control interventions. RESULTS: The results demonstrate the effectiveness of the proposed control strategies. The reproduction numbers must be reduced based on specific optimal control conditions to effectively mitigate disease outbreaks. Numerical simulations confirm that the optimal control measures can significantly reduce the spread of the disease. DISCUSSION: This research advances the understanding of Dengue-viremia dynamics and provides valuable insights into the application of ABC fractional-order analysis. By incorporating immune-boosting and clinical treatment into the model, the study offers practical guidelines for implementing successful disease control strategies. The findings highlight the potential of using optimal control techniques in public health interventions to manage disease outbreaks more effectively.

• MeSH
• Dengue * MeSH
• Disease Outbreaks MeSH
• Humans MeSH
• Viremia * MeSH
• Dengue Virus immunology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH