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Background: Existing research has suggested that self-reported empathy in medical students is moderated by personality traits and diverse demographic and educational factors including age, gender, nationality, career aspirations, as well as year of curriculum. It is unclear how empathy, personality, and background factors might impact on students' attitudes towards professionalism in medicine., Methods: A cross-sectional questionnaire-based study was conducted in first and final year medical students at an Irish medical school. The following instruments were administered: (a) Jefferson Scale of Empathy; (b) NEO Five-Factor Inventory (NEO-FFI-3); (c) Attitudes towards Professionalism Scale. Demographic and educational variables were also measured. Descriptive and correlational analysis was conducted to examine the association between empathy, personality, professionalism-related attitudes and additional measures. Regression analysis was used to examine determinants of attitudes towards professional behaviour., Results: Both selected NEO-FFI personality traits and empathy were independently associated with distinct categories of professional behaviour. Specifically, Openness to Experience was associated with higher empathy scores, and higher 'Social responsibility'. Extraversion was linked with higher scores on the "Personal characteristics" and "Interactions with team" categories, while Conscientiousness was also positively associated with "Personal characteristics". In agreement with previous studies, the personality traits most associated empathy were Agreeableness and Openness to Experience. Empathy did not vary according to programme year or career specialty preference., Conclusions: This study is the first to show that empathy and personality factors may act as determinants of students' attitudes towards medical professionalism in a manner which is dependent upon category of professional behaviour., Competing Interests: The authors have declared that no competing interests exist.

Background: The lack of standardised studies remains an obstacle to developing a consistent approach to integrating virtual dental simulation (VDS) into dental education. The aim of this study was to develop consensus among experienced educators and dental practitioners on the optimal integration of VDS at various stages of dental curricula. The goal was to propose clear yet flexible recommendations that could be implemented by most educational institutions. Methods: Focus groups were established, consisting of experienced academic educators involved in VDS, experienced academic staff who had not previously been involved in VDS, and experienced dental practitioners. These groups exchanged ideas about the best ways to integrate VDS into dental curricula. The Simodont® Dental Trainer system was used to design a curriculum for VDS. Results: The expert group agreed that VDS for manual dexterity exercises should be introduced in the first year of dental curricula. This should be followed by cariology exercises in the second year and crown preparation exercises in the third year, alongside traditional manikin-based simulation exercises. Additionally, VDS was recommended for senior students on an ad hoc basis for academic recovery purposes. However, VDS endodontic exercises were excluded from the proposed integrative dental curriculum. Other ways of utilising VDS were identified, such as student recruitment activities and intensive refreshment programs at the start of each academic year. Conclusions: This study proposes a flexible approach to including VDS in dental curricula. This proposed approach can be customised to meet the specific needs of each educational institution, providing a tailored learning experience for students.

Abstract Concrete has been widely utilized as a radiation shielding material due to its properties and structural integrity. This study aims to evaluate the efficiency of ordinary concrete versus barite concrete as radiation shielding materials, focusing on the physical aspects and changes in crystal size lattice parameters after neutron irradiation. Specifically, the research investigates the shielding effectiveness of these materials across different grades (M15, M25, M35, and M45) against gamma-ray sources Cobalt-60 and Caesium-137. The methodology involves measuring the linear attenuation coefficient (μ), half value layer (HVL), tenth value layer (TVL), and mean free path (MFP). Additionally, X-ray diffraction (XRD) was employed to assess crystallite size and lattice parameter changes post-irradiation for neutron irradiation. Results indicate that incorporating barite as an aggregate significantly enhances the density and crystallite macroscopic properties of the concrete. Irradiation with Cobalt-60 and Cesium 137 revealed that ordinary concrete has a lower linear attenuation (μ) ranging from 0.172 to 0.195 cm−1, with consistent mass attenuation across all grades at 0.81 cm2/g. XRD analysis demonstrated a rightward shift in the SiO₂ and BaSO₄ peaks post-irradiation, signifying crystalline expansion. In terms of lattice parameters, the d-value showed a notable decrease of 0.10 after 48 h of irradiation in grade 25, while the most significant increase of 0.02 occurred after 24 h of irradiation in grades 15 and 45. In conclusion, barite concrete proves to be more effective for radiation shielding in nuclear facilities, whereas ordinary concrete is suitable for medical shielding, or facilities exposed to lower radiation doses.

Abstract Introduction Restorative sleep is essential for the maintenance of overall health and for the prevention of chronic diseases, including hypertension. The aim of this study was to determine the effect of motivational interviewing (MI) on sleep quality in patients with hypertension. Methods The study was a randomised controlled trial (PACTR202301917477205) of 250 adult patients aged 18 to 65 years (125 in each group) with hypertension presenting to the Family Medicine Clinics of Irrua Specialist Teaching Hospital, Irrua, Nigeria from April to December 2023. Patients were selected through systematic random sampling and randomised into intervention and control group with the intervention group having monthly sessions of motivational interviewing in addition to standard care for hypertension and the control group having standard care only. Data were analysed with Stata with level of significance set at p

Abstract Ensuring power system safety involves effective arc fault detection and localization. Existing devices struggle to differentiate between normal and abnormal conditions, especially in confined spaces, posing precision challenges. Strategically placing antennas around the arc helps detect electromagnetic radiation, even in limited areas, enabling valuable data collection for real-time monitoring. To address these challenges, this paper proposes integrating experimental work using a compact multi-square microstrip antenna and signal processing techniques. The study compares the effectiveness of two signal processing approaches: Discrete Wavelet Transform (DWT), and Continuous Wavelet Transform (CWT). These techniques separate genuine arc signals from background noise by identifying unique characteristics and isolating the dominant frequency. The Time of Arrival (ToA) is measured and used in Least Square and Gauss-Jordan Elimination methods to calculate the arc source location. The outcomes illustrate the precision of the proposed model in detecting and pinpointing arc source signals, with error margins ranging from 0.0615 to 0.0713 m for the CWT technique, 0.0688 to 0.0789 m for the DWT technique, and 0.0799 to 0.0844 m from the actual signal captured. These results hold promise for enhancing the integration of experimental approaches in assessing arcing conditions, thereby addressing challenges in insulation systems.

Abstract Background: Understanding the factors that influence academic achievement among university students is crucial for educational institutions. This study aims to clarify the possible relationship between students' academic achievement, emotional intelligence, and self-esteem. The findings from this research may provide valuable insights for educators and policymakers in developing strategies to enhance students' academic performance and well-being. Methods: A descriptive-correlational study design was used. Participants were a total of 412 university students belonging to the selected 13 medical, scientific, and literary faculties of Jouf University, Saudi Arabia. The sample was determined randomly from different faculties. A multipart assessment tool was used to focus on assessing demographic information in terms of college, years of education, gender, parents' educational level, marital status, and birth order. Students' academic performance was based on their self-reported responses, as the grade point average is measured out of five. In contrast, emotional intelligence was measured using the Trait Emotional Intelligence Questionnaire-Short Form and the Rosenberg Self-Esteem Scale used to calculate students' self-esteem. Results: The study found a strong positive correlation between grade point average, emotional intelligence, and self-esteem with parental educational level and academic year. Emotional intelligence and self-esteem were significantly influencing grade point average. Gender and academic year also had slight positive effects. Conclusion: There is a significant positive correlation between academic achievement, emotional intelligence, and self-esteem. Variables like fathers, mothers, academic year, gender, and self-esteem positively impacted grade point average.

Context: The mucociliary clearance system is an important component in the prevention of chronic inflammation of the nasal and paranasal sinus. Aim: The study aims to establish the normal values of mucociliary clearance in our region and to study the variation in mucociliary activity in patients with chronic rhinosinusitis in Ilorin, North-central Nigeria. Settings and Design: This was a prospective, cross-sectional study using consecutive consenting participants in both the control and study groups carried out at both family medicine and otorhinolaryngology clinics among patients attending the clinics. Subjects and Methods: After ethical approval was sought, informed consent was obtained from patients, a modified version of the validated health questionnaire was filled, semi-structured questionnaires were also filled after which patient undergo anterior rhinoscopy, nasal patency test and spirometry was done. The saccharine test has been used to measure nasal-mucociliary clearance time in the past. Statistical Analysis: All information were entered into SPSS version 20 and analysed descriptively, and results were presented in tables and figures. Results: Consecutive consenting 125 patients with rhinosinusitis (study group) and those without rhinosinusitis (control group) underwent naso-mucociliary clearance test. There were 34 males and 91 females with a male:female ratio of 1:2.6 among the study group and 55 males and 70 females with a male:female ratio of 1:1.3 for the control group. The age range was from 18 to 68 years with 18–40 years constituting the modal age group. The mean age for the studied group was 35.7 years while that of the control group was 33.1 years. The mean naso-mucociliary clearance time among the study group was 35.1 min standard deviation (SD = 12.32 ± 1.63), while among the control group, it was 14.8 min (SD = 5.59 ± 0.43). Conclusion: Compared to the control group, there was a roughly 200% prolonged increase in the duration of naso-mucociliary clearance time among patients with rhinosinusitis. There was also a positive correlation with increasing age. Future studies comparing the pre-operative and post-operative treatment of rhinosinusitis will contribute to knowledge.

Background: Sickle cell disease (SCD) is an autosomal recessive haemoglobin disorder, affecting about 7.74 million individuals worldwide, but it is more prevalent among Africans and Asians. SCD is characterised by many complications, and it is a major health issue in Nigeria, the country with the largest burden of the disease globally. This work aims to present the design and implementation of electronic registries (ER) for SCD in a tertiary hospital in Nigeria. Methods: Registry design was initiated during a staff exchange programme within the ARISE initiative (EU grant agreement no. 824021). Ethical approval was obtained, and paper records were retrieved and transferred into one adult and one paediatric database, developed with Microsoft Access. Results: Data from 2659 SCD patients were entered in the ERs, including 698 (26.3%) adults and 1961 (73.7%) children. There were 287 (41%) male adults, 404 (58%) female and 7 (1%) patients whose gender was missing. There were 1041 (53.1%) male children, 906 (46.2%) female and 14 (0.7%) whose gender was missing. Information on phenotype was available for 2385 subjects, and most of them (2082, 87.3%) were SS. The most prevalent SCD-related complication was painful events (26.6% in adults and 68.7% in children, considering valid cases). Conclusions: About 60% of SCD patients in the centre were included in the ERs providing useful, hands-on recommendations for future ER design in SCD. These ERs might be an appropriate tool for collecting and analysing SCD patients’ data.

Objectives: Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder.Methods: Seven databases were systematically searched: PubMed/MEDLINE, Clinicaltrials. gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking).Results: Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = –0.79 [–3.55-1.98]).Conclusion: Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO: CRD42024514509).

Abstract This research study is performed on the self-compacting geopolymer concrete (SCGC) combining coal bottom ash (CBA) and metakaolin (MK) as a substitution for GGBFS alone and combined for analysing the fresh properties (slump flow, V-Funnel, and T50 flow), mechanical characteristics (compressive, splitting tensile and flexural strengths) and durability tests (permeability and sulfate attack test). Though, total 195 SCGC samples were made and tested for 28 days. It has been revealed that the consumption of CBA and MK as a substitution for GGBFS alone and combine in the production of SCGC is decreased the workability of SCGC while mechanical characteristics of SCGC are enhanced by utilizing CBA and MK as a substitution for GGBFS alone and combine up to 10%. In addition, the compressive, splitting tensile and flexural strengths were calculated by 59.40 MPa, 5.68 MPa, and 6.12 MPa while using the 5CBA5MK as a substitution for GGBFS in the production of SCGC after 28 days correspondingly. Furthermore, the permeability is decreased by growing the quantity of CBA and MK by the weight of GGBFS alone and jointly in the production of SCGC after 28 days. Besides, the minimum change in length of the SCGC specimen is recorded by 0.062 mm at 7.5MK7.5CBA while the maximum change in length is calculated by 0.11 mm at 10CBA10MK as a substitution for GGBFS at 180 days correspondingly. In addition, the embodied carbon is recorded reduce as the addition of CBA while it is getting higher when the accumulation of MK alone or combined with CBA in SCGC. Besides, response models for prediction were constructed and confirmed using ANOVA at an accuracy rate of 95%. The models' R2 fluctuated from 88 to 99%. It has been observed that the utilization of CBA and MK alone and together up to 10% as substitution for GGBFS in geopolymer concrete provides the best results therefore it is suggested for structural applications.

Abstract Background Neuroblastoma (NB) is a complex disease, and the current understanding of NB biology is limited. Deregulation in genomic imprinting is a common event in malignancy. Since imprinted genes play crucial roles in early fetal growth and development, their role in NB pathogenesis could be suggested. Methods We examined alterations in DNA methylation patterns of 369 NB tumours at 49 imprinted differentially methylated regions (DMRs) and assessed its association with overall survival probabilities and selected clinical and genomic features of the tumours. In addition, an integrated analysis of DNA methylation and allele-specific copy number alterations (CNAs) was performed, to understand the correlation between the two molecular events. Results Several imprinted regions with aberrant methylation patterns in NB were identified. Regions that underwent loss of methylation in > 30% of NB samples were DMRs annotated to the genes NDN, SNRPN, IGF2, MAGEL2 and HTR5A and regions with gain of methylation were NNAT, RB1 and GPR1. Methylation alterations at six of the 49 imprinted DMRs were statistically significantly associated with reduced overall survival: MIR886, RB1, NNAT/BLCAP, MAGEL2, MKRN3 and INPP5F. RB1, NNAT/BLCAP and MKRN3 were further able to stratify low-risk NB tumours i.e. tumours that lacked MYCN amplification and 11q deletion into risk groups. Methylation alterations at NNAT/BLCAP, MAGEL2 and MIR886 predicted risk independently of MYCN amplification or 11q deletion and age at diagnosis. Investigation of the allele-specific CNAs demonstrated that the imprinted regions that displayed most alterations in NB tumours harbor true epigenetic changes and are not result of the underlying CNAs. Conclusions Aberrant methylation in imprinted regions is frequently occurring in NB tumours and several of these regions have independent prognostic value. Thus, these could serve as potentially important clinical epigenetic markers to identify individuals with adverse prognosis. Incorporation of methylation status of these regions together with the established risk predictors may further refine the prognostication of NB patients.

Abstract Background In medical education, the learning environment (LE) significantly impacts students' professionalism and academic performance. Positive LE perceptions are linked to better academic outcomes. Our study, which was conducted 15 years after curriculum reform at King Saud University's College of Medicine, aimed to explore students' perspectives on their LE and identify areas for improvement. By understanding their experiences, we strive to enhance LE and promote academic success. Methods This mixed-method study employed an explanatory sequential approach in which a cross-sectional analytical survey phase was collected first using the Johns Hopkins Learning Environment Scale (JHLES), followed by qualitative focus groups. Findings from quantitative and qualitative methods were integrated using joint display. Results A total of 653 medical students completed the JHLES. The total average score was 81 out of 140 (16.8), and the average subscale scores ranged from 2.27 (0.95) for inclusion and safety to 3.37 (0.91) for community of peers. The qualitative approach encompasses both inductive and deductive analyses, identifying overarching themes comprising proudness, high expectations and competition, and views about the curriculum. The integration of results emphasizes the need for continued efforts to create a supportive and inclusive LE that positively influences students' experiences and academic success. Conclusion This research offers valuable insights for educational institutions seeking to enhance medical education quality and support systems. Recommendations include faculty development, the cultivation of supportive environments, curriculum revision, improved mentorship programs, and initiatives to promote inclusivity and gender equity. Future research should explore longitudinal and comparative studies, innovative mixed methods approaches, and interventions to further optimize medical education experiences. Overall, this study contributes to the ongoing dialog on medical education, offering a nuanced understanding of the complex factors influencing students' perceptions and suggesting actionable strategies for improvement.

Abstract Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is considered a growing health concern. The majority of NTM-PD cases in Europe are caused by slow-growing mycobacteria (SGM). However, distinct radiological features of different SGM remain largely uninvestigated. We applied a previously described radiological score to a patient cohort consisting of individuals with isolation of different SGM. Correlations between clinical data, species and computed tomography (CT) features were examined by logistic and linear regression analyses, as well as over the course of time. Overall, 135 pulmonary CT scans from 84 patients were included. The isolated NTM-species were mainly Mycobacterium avium complex (MAC, n = 49), as well as 35 patients with non-MAC-species. Patients with isolation of M. intracellulare had more extensive CT findings compared to all other SGM species (coefficient 3.53, 95% Cl − 0.37 to 7.52, p = 0.075) while patients meeting the ATS criteria and not undergoing therapy exhibited an increase in CT scores over time. This study provides insights into differential radiological features of slow-growing NTM. While M. intracellulare exhibited a tendency towards higher overall CT scores, the radiological features were similar across different SGM. The applied CT score might be a useful instrument for monitoring patients and could help to guide antimycobacterial therapy.

Background Sickle cell disease (SCD) is a prevalent inherited blood disorder. Globally, approximately 515 000 babies are born with SCD annually, with 75% of these births occurring in Africa. Integrating newborn screening (NBS) for SCD into primary healthcare structures, such as immunisation programmes, holds significant promise, with dried blood spots (DBS)-point-of-care technologies (POCT) like HaemoTypeSC offering cost-effective screening solutions. However, scaling up DBS-POCT for NBS of SCD in Africa remains challenging.Objective This study aims to explore individual, organisational and external factors that may influence the reliability, feasibility, acceptability, adoption and sustainability of using DBS-POCT with HaemoTypeSC for NBS of SCD at primary healthcare centres in African countries.Method This qualitative study will be conducted in seven African countries that are part of the SickleInAfrica consortium sites. The study design is informed by the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcome Model. Participants will be mothers whose babies have been diagnosed with SCD, healthcare professionals and policy-makers. In-depth interviews and focus group discussions will be used for data collection. Data analysis will be through thematic analysis.Ethics and dissemination Research ethics approvals have been obtained from the seven countries. Written informed consent will be obtained from all participants. The study results will be disseminated in peer-reviewed scientific journals, scientific conferences, reports to national ministries of public health and webinars.

This study determined the frequency and molecular features of from 206 burn and wound patients (BWPs) as well as 94 healthcare workers (HCWs) at the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria. Nine (4.4%) and five (5.3%) samples from BWPs and HCWs were identified as S positive, respectively. Seven (50%) were -positive (associated with SCC types IVa and V), while 35.7% presented a multidrug resistance (MDR) phenotype. The isolates belonged to 11 diverse types, including three new (t4539, t6043, t11694) and one singleton (t779), which were assigned to four clonal complexes. Two and three carrying strains were identified. All the isolates were moderate biofilm producers with diverse combinations of the biofilm and regulatory genes. The detection of genetically diverse lineages and toxigenic strains highlights the need for improved surveillance of resistant and pathogenic strains in healthcare facilities.

Chatbots are computer programs designed to engage in natural language conversations in an easy and understandable way. Their use has been accelerated recently with the advent of large language models. However, their application in medicine and healthcare has been limited due to concerns over data privacy, ther risk of providing medical diagnoses, and ensuring regulatory and legal compliance. Medicine and healthcare could benefit from chatbots if their scope is carefully defined and if they are used appropriately and monitored long-term. The confIAnce chatbot, developed at the Geneva University Hospitals and the University of Geneva, is an informational tool aimed at providing simplified information to the general public about primary care and chronic diseases. In this paper, we describe the certification and regulatory aspects applicable to chatbots in healthcare, particularly in primary care medicine. We use the confIAnce chatbot as a case study to explore the definition and classification of a medical device and its application to chatbots, considering the applicable Swiss regulations and the European Union AI Act. Chatbots can be classified anywhere from non-medical devices (informational tools that do not handle patient data or provide recommendations for treatment or diagnosis) to Class III medical devices (high-risk tools capable of predicting potentially fatal events and enabling a pre-emptive medical intervention). Key considerations in the definition and certification process include defining the chatbot’s scope, ensuring compliance with regulations, maintaining security and safety, and continuously evaluating performance, risks, and utility. A lexicon of relevant terms related to artificial intelligence in healthcare, medical devices, and regulatory frameworks is also presented in this paper. Chatbots hold potential for both patients and healthcare professionals, provided that their scope of practice is clearly defined, and that they comply with regulatory requirements. This review aims to provide transparency by outlining the steps required for certification and regulatory compliance, making it valuable for healthcare professionals, scientists, developers, and patients.

Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4%) of patients between the ages of (50-69). Females made up 50.9%. (38.2%) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.

Key Clinical Message It is important to recognize and manage gastrointestinal symptoms in patients with BD, as they are linked to high rates of mortality and morbidity. BD can affect any part of the gastrointestinal tract, and prompt diagnosis and appropriate treatment are essential to prevent complications. Additionally, the diagnosis of BD is primarily based on clinical factors due to the lack of pathognomonic laboratory tests. Abstract Behçet's disease (BD) is an idiopathic, chronic, and relapsing multi‐systemic vasculitis characterized by recurrent skin lesions and eye disease. There is no pathognomonic laboratory testing; the diagnosis is made mainly on clinical factors. BD symptoms affecting the gastrointestinal (GI) system are particularly important as they are linked to high rates of mortality and morbidity. Although ileocecal involvement is most frequently mentioned, BD can affect any part of the GI tract. There are techniques for keeping track of disease activity during treatment, but they are not ideal. We present a case of a 38‐year‐old male patient admitted to the ICU with a history of black tarry stools of 1‐month duration, fresh blood per rectum 5 to 7 times a day associated with fever, chills, and back and nonspecific joint pain for five days. The patient also experienced left eye episcleritis while being hospitalized, which was later confirmed to be BD.

Background Plant-derived drugs are often preferred over synthetic drugs because of their superior safety profiles. Phenolic compounds and flavonoids—major plant components—possess antioxidant properties. Limited research has been conducted on the bioactive compounds and biochemical properties of Bellevalia pseudolongipes (Asparagaceae), an important pharmacological species endemic to Turkey. Therefore, the chemical composition and antioxidant properties of B. pseudolongipes were investigated in this study. Methods The chemical composition of B. pseudolongipes was analyzed using liquid chromatography-high-resolution mass spectrometry, and radical scavenging and antioxidant activities were evaluated using DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonic acid)) tests. Results Thirty-eight compounds were identified, including trans-cinnamic acid, caffeic acid, vitexin, schaftoside, orientin, and narirutin. B. pseudolongipes showed high antioxidant activity in antioxidant activity tests. Conclusion These findings provide novel insights into the potential utility of B. pseudolongipes in the pharmaceutical, food, and cosmetics industries, highlighted by its significant antioxidant capacity.

Objective: We assessed trends in socioeconomic inequalities in cardiovascular risk factors prevalence among Swiss adults from 2008 to 2019. Methods: Using data from the Bus Santé study, an annual survey of adults living in Geneva, Switzerland, we calculated the prevalence per period and by demographic and socioeconomic indicators, assessing inequality trends using the relative index of inequality (RII) and the slope index of inequality (SII). Results: Among 10,739 participants, most CVD risk factors decreased over time, while diabetes, obesity, and smoking prevalence remained steady. In 2017–2019, prevalence of most CVD risk factors was higher in socioeconomically disadvantaged groups. Relative and absolute inequalities decreased over time, but mostly remained, for hypertension [in 2017–2019, education-RII (95 % CI) = 1.27 (1.12–1.46), income-RII = 1.27 (1.10–1.47)], hypercholesterolemia [education-RII = 1.15 (1.00–1.32)], and sedentarity [education-RII = 1.95 (1.52–2.51), income-RII = 1.69 (1.28–2.23)], and appeared to have reversed for hazardous alcohol use [income-RII = 0.75 (0.60–0.93)]. Substantial and persistent relative and absolute inequalities in diabetes prevalence were observed [education-RII = 2.39 (1.75–3.27), income-RII = 3.18 (2.25–4.48), and subsidy-RII = 2.77 (1.89–4.05)]. Inequalities were also marked across all socioeconomic indicators for obesity prevalence [education-RII = 3.32 (2.63–4.19), income–RII = 2.37 (1.85–3.04), subsidy-RII = 1.98 (1.48–2.66)] and for smoking [education-RII = 2.42 (2.06–2.84), income-RII = 2.37 (1.99–2.84), subsidy-RII = 1.91 (1.56–2.35)]. Conclusions: Over 12 years in Geneva, Switzerland, socioeconomic inequalities in hypertension, hypercholesterolemia, hazardous alcohol use, and sedentarity decreased but persist, while substantial inequalities in diabetes, obesity, and smoking remained unchanged.

Cushing Syndrome, a rare condition with increased glucocorticoid production can affect renal function directly by its effect on glomerular and tubular functions or indirectly through the cardiovascular system. The aim is to report a case of Cushing Syndrome complicated by End Stage Renal Failure. The authors present symptoms, clinical course and laboratory findings of a 16-year-old girl with a diagnosis of Cushing syndrome complicated by end stage renal failure. She presented with excessive weight gain of 7-years, recurrent abdominal pain of 1-year, vomiting of 3-weeks and headache of a day duration. She had moon face, striae, buffalo hump and hypertension.

Abstract The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7–1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774–5740), respectively. Females have lower mean arterial pressure (− 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.

Abstract To test the hypothesis that genetic and pharmacological modulation of the classical cannabinoid type 1 (CB1) and 2 (CB2) receptors attenuate cancer-induced bone pain, we searched Medline, Web of Science and Scopus for relevant skeletal and non-skeletal cancer studies from inception to July 28, 2022. We identified 29 animal and 35 human studies. In mice, a meta-analysis of pooled studies showed that treatment of osteolysis-bearing males with the endocannabinoids AEA and 2-AG (mean difference [MD] − 24.83, 95% confidence interval [95%CI] − 34.89, − 14.76, p

Highly pathogenic avian influenza A(H5N1) clade 2.3.4.4b viruses were isolated from domestic ducks in South Kalimantan, Indonesia, during April 2022. The viruses were genetically similar to those detected in East Asia during 2021–2022. Molecular surveillance of wild birds is needed to detect potential pandemic threats from avian influenza virus.

ABSTRACT BACKGROUND & OBJECTIVE: This study investigates gender differences in dental anxiety among Pakistani undergraduate students to enhance their oral health awareness and help reduce the avoidance of necessary dental care. To study the gender variations in dental anxiety among Pakistani undergraduate students. METHODOLOGY: Data was collected from 350 students by using cross-sectional study design and the age of the students was 18-24 years. A non-probability convenience sampling technique was utilized. After getting institutional ethical permission, the study was carried out. Every participant provided their consent, and confidentiality was maintained. The significance level was set at 0.05, and a 95% confidence level was determined. RESULTS: 350 students responded to the survey. Dental anxiety was more prevalent in females than males and found to be associated with other risk factors like visits to the dentist (

Objective: To determine the effects of pre-operative Calcium supplements on post-total thyroidectomy hypocalcemia. Study Design: Randomized Control Trial (IRCT Id20231016059739N1). Place and Duration of Study: Combined Military Hospital Bahawalpur Pakistan, from Sep 2022 to Sep 2023. Methodology: All the patients undergoing total thyroidectomy and having normal Calcium levels were included. Baseline demographic data, medical history, and pre-operative Calcium levels were recorded for all participants. A total of 105 patients were enrolled in the study, with 52 patients assigned to the intervention group (Group-A) and 53 patients assigned to the control group (Group-B). Group-A was given a Calcium supplement and Group-B was given a placebo. Post-operative follow-up assessments were conducted at designated time points to evaluate serum Calcium levels and monitor for the occurrence of hypocalcemia. Results: The demographic characteristics, baseline Calcium levels, and surgical procedures were similar between the two groups, ensuring comparability. The mean value of the post-operative Calcium level of the interventional group was 8.904±0.4542 mg/dl and control group was 8.647±0.4964 mg/dl showing statistically significant difference (p-value 0.007). In the Group-A, 8 out of 52 patients (7.6%) developed hypocalcemia, whereas in the Group-B, 20 out of 53 patients (19%) experienced hypocalcemia showing statistically significant difference (p-value 0.009). Conclusion: Preoperative Calcium supplementation may not only decrease the occurrence of hypocalcemia but also promote a faster recovery from this complication following thyroid surgery.

Background: Physicians often focus on possible cardiac causes in patients presenting with chest pain. However, this case highlights a patient who presented with chest pain caused by ingestion of a foreign body after an uneventful meal eaten an hour prior to presentation. The fishbone was discovered after imaging. The article aims to raise awareness regarding the potential origins of chest pain, highlighting that it may stem from non-cardiac conditions. Methods: The methodology employed in this study involved conducting a case study that meticulously examined the repercussions and management strategies associated with foreign body ingestion. Results: The case report delineates the scenario of a 27-year-old male patient who inadvertently ingested a fishbone during a routine meal. It details the swift decline in clinical status, the meticulous diagnostic procedures employed, the subsequent management strategies implemented and the ultimate discharge of the patient in a stable condition. Conclusion: This case highlights the importance of comprehensive history taking and considering a wide range of causes of chest pain when evaluating a patient. The foreign body ingested with the resulting cardiac complications could have been fatal if not promptly diagnosed. Contribution: This study contributed to advancing awareness surrounding foreign body ingestion, shedding light on potential complications and offering valuable insights into effective management strategies.

Introduction Tonsillectomy is one of the most common operations performed by otorhinolaryngology surgeons worldwide; however, the insufficient quality of the postoperative pain management and effective posttonsillectomy pain relief remain a clinical dilemma.

Abstract Whether cardiovascular risk scores geographically aggregate and inform on spatial development of atherosclerotic cardiovascular diseases (ASCVD) remains unknown. Our aim is to determine the spatial distribution of 10-year predicted cardiovascular risk and ASCVD, and to compare the overlap of the resulting spatial distributions. Using prospective data from the CoLaus|PsyCoLaus cohort study (2003–2021) we computed SCORE2 in participants free from ASCVD. Geographical distributions of predicted risk and events were determined using the Gi* Getis-Ord autocorrelation statistic. 6203 individuals (54% women, mean age 52.5 ± SD 10.7, ASCVD incidence rate 5.7%) were included. We identified clusters of high versus low predicted risk (4%, 6%, respectively) and ASCVD (5%, 5% respectively) at baseline. They persisted at follow-up. Overlap of SCORE2 and ASCVD clusters was marginal. Body-mass index and alcohol consumption explained most of the predicted risk distribution. For ASCVD, high clusters persisted or were reinforced after multivariate adjustment, while low incidence clusters were reduced, multifactorial determinants. Incidence rate of ASCVD was 2.5% higher (IC 95%, 1.4–3.7) in clusters of higher incidence of ASCVD. To develop up-to-date, geographically targeted prevention strategies, there is a need to study novel geographically risk factors affecting ASCVD and to update commonly used prediction models for a population approach.

Abstract The enteric nervous system (ENS) is a large and complex part of the peripheral nervous system, and it is vital for gut homeostasis. To study the ENS, different hyper- and hypo-innervated model systems have been developed. The NSE-Noggin mouse model was described as one of the few models with a higher enteric neuronal density in the colon. However, in our hands NSE-Noggin mice did not present with a hyperganglionic phenotype. NSE-Noggin mice were phenotyped based on fur appearance, genotyped and DNA sequenced to demonstrate transgene and intact NSE-Noggin-IRES-EGFP construct presence, and RNA expression of Noggin was shown to be upregulated. Positive EGFP staining in the plexus of NSE-Noggin mice also confirmed Noggin protein expression. Myenteric plexus preparations of the colon were examined to quantify both the overall density of enteric neurons and the proportions of enteric neurons expressing specific subtype markers. The total number of enteric neurons in the colonic myenteric plexus of transgenic mice did not differ significantly from wild types, nor did the proportion of calbindin, calretinin, or serotonin immunoreactive myenteric neurons. Possible reasons as to why the hyperinnervated phenotype could not be observed in contrast with original studies using this mouse model are discussed, including study design, influence of microbiota, and other environmental variables.

Abstract Polymeric based composites have gained considerable attention as potential candidates for advanced radiation shielding applications due to their unique combination of high-density, radiation attenuation properties and improved mechanical strength. This study focuses on the comprehensive characterisation of polymeric based composites for radiation shielding applications. The objective of this study was to evaluate the physical, mechanical and microstructural properties of tungsten carbide-based epoxy resin and tungsten carbide cobalt-based epoxy resin for its efficiency in shielding against gamma-rays ranging from 0.6 up to 1.33 MeV. Polymeric composites with different weight percentages of epoxy resin (40 wt%, 35 wt%, 30 wt%, 25 wt%, 20 wt%, 15 wt% and 10 wt%) were fabricated, investigated and compared to conventional lead shield. The attenuation of the composites was performed using NaI (Tl) gamma-ray spectrometer to investigate the linear and mass attenuation coefficients, half value layer, and mean free path. High filler loadings into epoxy resin matrix (90% filler/10% epoxy) exhibited excellent gamma shielding properties. Mechanical properties, such as hardness were examined to assess the structural integrity and durability of the composites under various conditions. The fabricated composites showed a good resistance, the maximum hardness was attributed to composites with small thickness. The high loading of fillers in the epoxy matrix improved the microhardness of the composites. The distribution of the filler powder within the epoxy matrix was investigated using FESEM/EDX. The results revealed the successful incorporation of tungsten carbide and cobalt particles into the polymer matrix, leading to increased composite density and enhanced radiation attenuation. The unique combination of high-density, radiation attenuation, and improved mechanical properties positions polymeric based composites as promising candidates for radiation protection field.

Abstract Introduction Diabetes mellitus in pregnancies is associated with adverse outcomes both for the mothers and babies. Postponing pregnancy in unoptimized conditions and stabilisation of glucose should be prioritized. This scoping review is aimed to determine the scope and at the same time map the types of evidence available that is related to family planning behaviours among women with diabetes mellitus, with a particular focus on their factors which influence family planning usage and subsequently enable the identification of knowledge gaps in preventing unintended pregnancies among this high-risk population. Methods This scoping review is guided by the methodological framework by Arksey and O’Malley’s and Prisma-ScR checklist. PubMed, EBSCO and OVID were searched for empirical studies between 2000 and February 2022 using the search terms “family planning”, “contraceptive” and “diabetes mellitus”. Data were summarized according to the study characteristics and levels of factors influencing family planning behaviours. Results Thirty-five articles that met the eligibility criteria included 33 quantitative studies, one qualitative study and one mixed-methods study. The prevalence of family planning methods used by women with diabetes mellitus varied ranging from 4.8 to 89.8% among the studied population. Women with diabetes mellitus were reported to be less likely to utilise any family planning methods compared to women without diabetes mellitus. Conclusions Most of the evidence to date on family planning behaviours among women with diabetes mellitus focuses on the role of individual level sociodemographic factors. Few studies focused on exploring determinants at multiple levels. In this review we found that there is limited evidence on disease control and pregnancy intention in relation to their family planning practices. Future studies with more clinical and contextual factors are needed to guide the strengthening of family planning services for high-risk group women specifically for women with diabetes mellitus.

Abstract Background Growing demand for student-centered learning (SCL) has been observed in higher education settings including dentistry. However, application of SCL in dental education is limited. Hence, this study aimed to facilitate SCL application in dentistry utilising a decision tree machine learning (ML) technique to map dental students’ preferred learning styles (LS) with suitable instructional strategies (IS) as a promising approach to develop an IS recommender tool for dental students. Methods A total of 255 dental students in Universiti Malaya completed the modified Index of Learning Styles (m-ILS) questionnaire containing 44 items which classified them into their respective LS. The collected data, referred to as dataset, was used in a decision tree supervised learning to automate the mapping of students' learning styles with the most suitable IS. The accuracy of the ML-empowered IS recommender tool was then evaluated. Results The application of a decision tree model in the automation process of the mapping between LS (input) and IS (target output) was able to instantly generate the list of suitable instructional strategies for each dental student. The IS recommender tool demonstrated perfect precision and recall for overall model accuracy, suggesting a good sensitivity and specificity in mapping LS with IS. Conclusion The decision tree ML empowered IS recommender tool was proven to be accurate at matching dental students’ learning styles with the relevant instructional strategies. This tool provides a workable path to planning student-centered lessons or modules that potentially will enhance the learning experience of the students.

The aim of the present study was to calculate maternal mortality rates by analyzing pregnancy-related death cases in Samsun over the last 20 years, to identify causes of death and preventability, and to examine the change over the years. The Samsun Provincial Health Directorate's pregnancy-related mortality data from 2002 to 2021 were examined retrospectively. Causes of maternal death were classified as direct, indirect, undecided, and incidental. The maternal mortality rate was calculated as the number of maternal deaths per 100,000 live births. Between 2002 and 2021, Samsun experienced a total of 344,324 live births juxtaposed with 79 pregnancy-related deaths. The computed maternal mortality rate is 19.16 per 100,000 live births across the two-decade span. Detailed analysis reveals that 30 deaths (38%) were attributable to direct causes, 31 (39.2%) to indirect causes, 13 (16.5%) were incidental, and 5 (6.3%) remained inconclusive post-autopsy. A breakdown of the direct causes unveils obstetric bleeding as the primary culprit (18.2%), trailed by cardiovascular diseases (13.6%). Moreover, incidental causes, represented by traffic accidents, account for a 7.6% fatality rate. While the observed decline in maternal deaths, particularly from preventable direct causes, over the previous twenty years signifies the efficacy of the instated health policies, the persistent mortality underscores the imperative for ongoing research and strategy recalibration. Identifying fluctuations in causative factors through comparative analyses is pivotal in strategizing future preventive studies on pregnancy-related deaths. The results advocate a pronounced emphasis on continuous professional development to curtail mortalities from avoidable sources, especially postpartum hemorrhage, thereby fortifying existing health policies with reinforced, data-driven interventions. [Med-Science 2023; 12(4.000): 1252-7]

Abstract Background: Attention deficit hyperactivity disorder, which is a prevalent neurodevelopmental condition, commonly manifests during early childhood and has the potential to adversely affect an individual's social, academic, and occupational performance in multiple settings. Students with ADHD may struggle with attention, focus, listening, and completing schoolwork. Additionally, they may exhibit restless or disruptive behavior in class and may have learning disabilities that affect their academic performance. The aim of this study was to explore the perspectives of primary school teachers on ADHD in Alkadrow, Khartoum, Sudan. Methods: A descriptive cross-sectional study was conducted in Alkadrow-Bahri locality, Sudan, over a period of three to six months in 2022. The study population included primary school teachers who had taught for at least one year and encountered at least one student with ADHD. A convenience sampling technique was used to select a minimum of 59 participants, and data were collected using a self-administered questionnaire with closed-ended questions. SPSS version 23 was used to analyze the data, including descriptive statistics and inferential statistics such as chi-square tests and logistic regression analysis. Results: The study had 59 participants, with the majority being female and in the age group of 41–45 years. The participants were mostly married and had obtained psychology courses, with a bachelor's degree being the most common level of education. Many participants had over 20 years of teaching experience. Regarding the attitude toward attention deficit hyperactivity, most participants strongly agreed that they did have a negative/positive attitude toward it, and a majority agreed or were neutral toward ADHD. However, in the case of attention deficit hyperactivity, a significant percentage of participants disagreed or strongly disagreed with the statement. Conclusion: The study found that most participants had a negative attitude toward student referrals for medical care and believed that most symptoms of ADHD can be lowered by aging. Additionally, more than half strongly disagreed that punishment has a positive effect on ADHD.

Medical students are more likely than the general population to experience perceived stress during the pandemic due to many variables. This study aimed to evaluate the stress levels and prevalence of different mental health conditions among graduate medical students in Al Kharj City. An anonymous online survey was conducted among graduate medical students of Prince Sattam bin Abdulaziz University (PSAU). For this investigation, the following scales were used to measure the prevalence of common mental health issues: DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult (CCSM-A); Perceived Stress Scale (PSS-10-C), to measure COVID-19-related student stress; and the COVID-19 Student Stress Questionnaire to get the global stress score (GSS). Two hundred twenty-one students were contacted, and 214(96.8%) consented to participate in the study. According to the CCSM-A scale, anxiety (73%) and depressive symptoms (71%) were the most frequently reported symptoms by the students. After correcting for age and self-perceived COVID-19 risk, there was a significant relationship between anger, suicidal ideation, and substance use, on one hand, and the study year on the other graduate medical students who have mental health issues bear a heavy load. In the post-pandemic recovery period, regular mental health assessments and providing early and adequate mental health assistance to needy people are imperative.

Introduction SARS-CoV-2 mainly infects respiratory endothelial cells, which is facilitated through its spike protein binding to heparan sulphate. Calcium dobesilate (CaD) is a well-established, widely available vasoactive and angioprotective drug interacting with heparan sulphate, with the potential to interfere with the uptake of SARS-CoV-2 by epithelial cells. The CADOVID trial aims to evaluate the efficacy and safety of CaD in reducing the SARS-CoV-2 viral load in non-hospitalised adult patients diagnosed with COVID-19, confirmed by a positive SARS-CoV-2 PCR, including its efficacy to reduce the impact of persistent COVID-19 symptoms.Methods and analysis This is a randomised, placebo-controlled, double-blind, monocentric phase II trial. Enrolment began in July 2022. A total of 74 adult patients will be randomly allocated to the CaD arm or the placebo group with a 1:1 ratio, respectively. Participants in the intervention arm will receive two capsules of CaD 500 mg two times per day and the placebo arm will receive two matching capsules of mannitol 312.5 mg two times per day, with a treatment period of 7 days for both arms, followed by a 77-day observational period without treatment administration. Participants will be asked to complete secured online questionnaires using their personal smartphone or other electronic device. These include a COVID-19 questionnaire (assessing symptoms, temperature measurement, reporting of concomitant medication and adverse events), a COVID-19 persistent symptoms’ questionnaire and the Short Form 12-Item (SF-12) survey. SARS-CoV-2 PCR testing will be performed on nasopharyngeal swabs collected on days 1, 4, 8 and 21. The primary endpoint is the reduction from baseline of SARS-CoV-2 viral load determined by RT-PCR at day 4.Ethics and dissemination This trial has received approval by the Geneva Regional Research Ethics Committee (2022-00613) and Swissmedic (701339). Dissemination of results will be through presentations at scientific conferences and publication in scientific journals.Trial registration number NCT05305508; Clinicaltrials.gov; Swiss National Clinical Portal Registry (SNCTP 000004938).

Aim: Acute kidney injury (AKI) is a clinical syndrome that can cause disturbances in fluid-electrolyte and acid-base balance, resulting in the accumulation of nitrogen and uremic toxins along with the loss of kidney functions within hours or days. In this study, it was aimed to retrospectively examine patients with acute kidney injury to determine whether there is a relationship between infection parameters and urine volume. Materials and Methods: The study included a total of 144 patients with (n=74) and without infection (n=70) out of 294 patients with AKI who received treatment between 1 January 2020 and 31 December 2021 in the nephrology clinic of a tertiary university hospital. Results: The mean age was 66.4±15.7 (range:19-95) in patients with infection and 63.8±15.2 (range:36- 93) in non-infected patients. 51.4% (n=38) of those with infection and 52.9% (n=37) of those without infection were women. There was no difference between the individuals with and without infection in terms of age and gender (p>0.05). Infection was present in 51.4% (n=74) of the patients included in the study. Urinary tract (31.3%) and respiratory tract infections (13.2%) were the most common in those with infection. A moderate negative correlation was observed between admission CRP and discharge creatinine level in patients with infection. There was no correlation between PCT and sedimentation rate, urine volume and admission/discharge creatinine level. Moderate positive correlations were found between admission/discharge PCT and admission/discharge urine volume in patients without infection. In addition, moderate negative correlations were found between admission/discharge sedimentation rate and admission urine volume. Conclusions: No correlation was found between PCT and sediment (incoming/exit) and outflow urine volume in patients with infection.

BACKGROUND AND OBJECTIVES: Pandemic-related life changes may have had a deleterious impact on suicidal behaviours. Early detection of suicidal ideation and identification of subgroups at increased risk could help prevent suicide, one of the leading causes of death among adolescents worldwide. Here, we aimed to investigate the prevalence of and risk factors for suicidal ideation in adolescents using a population-based sample from Switzerland, two years into the pandemic. METHODS: Between December 2021 and June 2022, adolescents aged 14 to 17 years already enrolled in a population-based cohort study (State of Geneva, Switzerland) were asked about suicidal ideation over the previous year. In addition to a regression model, we conducted a network analysis of exposures which identified direct and indirect risk factors for suicidal ideation (i.e. those connected through intermediate risk factors) using mixed graphical models. RESULTS: Among 492 adolescents, 14.4% (95% CI: 11.5–17.8) declared having experienced suicidal ideation over the previous year. Using network analysis, we found that high psychological distress, low self-esteem, identifying as lesbian, gay or bisexual, suffering from bullying, extensive screen time and a severe COVID-19 pandemic impact were major risk factors for suicidal ideation, with parent-adolescent relationship having the highest centrality strength in the network. CONCLUSION: Our results show that a significant proportion of adolescents experience suicidal ideation, yet these rates are comparable with pre-pandemic results. Providing psychological support is fundamental, with a focus on improving parent-adolescent relationships.

Objectives Restorative sleep is critical in preventing hypertension and other chronic diseases. Limited research has explored the relationship between sleep quality and hypertension in Africa. This study investigated the association between sleep quality and blood pressure control among hypertensive patients in Southern Nigeria.Design Cross-sectional study.Setting A rural tertiary hospital in Southern Nigeria, April to June 2023.Participants 250 systematically selected hypertensive adults. Participants completed a validated semistructured interviewer-administered questionnaire to assess their sleep patterns, including sleep duration, self-reported trouble sleeping and a history of clinical diagnosis of sleep disorders. Sleep patterns were categorised as restorative (healthy) or non-restorative (unhealthy). The blood pressure of respondents was checked and categorised as controlled (

This study aims to present the functional outcomes of patients who were treated surgically for childhood femoral neck fractures. In addition, to obtain information about the complications seen after these fractures, especially avascular necrosis of the femoral head (AVN), and to investigate the relationship with the treatment process. Our study is a retrospective study including 22 fractures of 22 patients operated for femoral neck fractures between 2012 and 2021. Thirteen of the patients were boys and 9 were girls The mean age at the time of trauma was 12.6 years (5-17 years). The fractures were classified based on the Delbet/Colonna classification. Fracture type and its effect on functional outcomes and the effect of fracture type on complications were investigated. The relationship between the time and type of treatment and AVN was evaluated. The mean follow-up period of the patients included in the study was 36.9 (12-132 months) months. Orthopedic injury in combination with femoral neck fracture was seen in 4 patients. Femoral neck fractures were classified as type 1 in 1 patient, type 2 in 15 patients, type 3 in 4 patients, and type 4 in 2 patients. In our study, 5 of 8 complications were AVN. The clinical results of the patients were classified with Ratliff score and 14 patients had good, 3 patients had fair and 5 patients had poor results. According to this classification system, 5 patients who developed AVN had a poor outcome, but no significant correlation was found between AVN and the timing of surgery and treatment method. All of the cases with AVN were Type 1 and Type 2 fractures. Pediatric femoral neck fractures are inherently difficult fractures for orthopedists who need long-term follow-up. Although the appropriate time, methods, and materials for surgical management are frequently discussed, the severity of the injury and the anatomical location of the fracture is most important in the development of AVN. [Med-Science 2023; 12(3.000): 689-94]

OBJECTIVES/GOALS: Physicians can request the clinical use of investigational products for their patients through an FDA pathway called Expanded Access (EA). Most evaluations of EA focus on the FDA submission only. We sought to evaluate these requests through the full academic medical center process. METHODS/STUDY POPULATION: Through the Transforming Expanded Access to Maximize Support and Study grant, we reviewed regulatory records for single-patient EA requests at four institutions (Duke University, University of Rochester, University of Michigan, and University of Texas Southwestern) which occurred between June 1, 2021 and February 28, 2023. Key data was collected, including the investigational product requested, submission and approval dates, urgency of request, and indication for treatment. Descriptive statistics were performed with Microsoft Excel. RESULTS/ANTICIPATED RESULTS: A total of 405 EA requests were identified, of which 319 (78.8%) were for drugs, 59 (14.6%) for biologics, and 27 (6.7%) for medical devices. The majority were characterized as non-emergency (60.7%), but the proportion of emergency to non-emergency cases varied considerably when stratified by year, with a peak in emergency cases in 2020. The most common products included therapies for COVID-19 and Mpox. Median time to obtain all approvals for treatment was 7 days for emergency cases and 28 days for non-emergency. The FDA review took the least time, with a median of 1 day in non-emergency cases. Full board approval from an institutional review board in non-emergency cases was 7 days. DISCUSSION/SIGNIFICANCE: These results generally align with previous reports on EA submissions received by the FDA. The timelines for the EA process represent an important benchmark both for treatment planning and institutional improvement.

Background: Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic was a serious healthcare concern not responding to conventional anti-viral therapies between 2012 and 2017 with high fatality rates. Saudi Arabia is still among the best world examples in combating both MERS-CoV and COVID-19 pandemics. Objectives: Investigating the medical and biochemical knowledge of healthcare professionals in Al-Madinah, Saudi Arabia on preventive, diagnostic and therapeutic measures against MERS-CoV epidemic. Subjects and methods: In 2019, this cross-sectional study included 416 healthcare personnel of which 402 participants answered the questions with a response rate of 96.7%. Specialties of participants were medical students (1.4%), physicians (64.4%), nurses (23.6%) and others (10.7%). Results: The vast majority of the investigated healthcare personnel gave the right answers. 96.7% of the participants answered that washing hands using water helps prevent MERS-CoV. 90.8% of the participants answered that wearing a clean non-sterile long-sleeved gown and gloves does helps prevent MERS-CoV infection. 94.7% of participants answered that using alcohol-based hand rub helps prevent MERS-CoV infection. 92.03% of the participants thought that wearing protective equipment does help preventing MERS-CoV infection. 86.1% answered that there is no vaccine available against MERS-CoV infection and 86.1% answered that taking vaccines is suitable for preventing MERS-CoV infection. 90.04% of the participants answered that MERS-CoV patients should be diagnosed using PCR and 84.3% thought that the highest levels of anti-CoV antibodies are in abattoir workers while 87.8% thought that isolation of suspected cases helps preventing MERS-CoV infection. Conclusion: The investigated healthcare workers had a satisfactory knowledge on the preventive and therapeutic measures and biochemical knowledge against MERS-CoV epidemic at mass gatherings as pilgrimage season.

Kurang Energi Kronis (KEK) merupakan masalah gizi pada ibu hamil yang hingga saat ini masih menjadi permasalah gizi di dunia. Upaya yang dilakukan dalam perbaikan gizi ibu hamil KEK adalah dengan pemberian makanan tambahan. Tujuan: untuk mengetahui hubungan program pemberian makanan tambahan dengan ibu hamil kekurangan energi kronik (KEK). Metode: penelitian ini menggunakan literature review dengan cara mengumpulkan artikel yang sesuai topik dan tujuan penulisan yang didapat dari berbagai databased jurnal. Telaah dilakukan dengan menganalisis artikel ilmiah yang didapat dari database elektronik google scholar dan scopus dengan kriteria inklusi, tahun 2013-2023, bahasa indonesia dan bahasa Inggris. Teknik analisis artikel penelitian yaitu dengan format tabel yang berisi penulis, judul, tahun, metode (desain, sampel dan analisis), dan hasil. Hasil: hasil penelitian didapatkan 10 artikel dengan menggunakan perumusan PICO. Berdasarkan 10 artikel penelitian yang diperoleh, menunjukkan bahwa pemberian program pemberian makanan tambahan (PMT) pada ibu hami kekurangan energi kronik (KEK) berpengaruh pada kenaikan asupan energi total, status gizi, berat badan, penambahan lingkar lengan atas (LILA), penurunan kadar malondialdehyde, kekurangan vitamin A dan bayi dengan ibu KEK yang mengonsumsi PMT lahir dengan normal, tidak mengalami BBLR (Bayi Berat Lahir Rendah). Studi literature review ini diharapkan bisa menjadi referensi khususnya dalam bidang kesehatan masyarakat.

Abstract Introduction Adult Intussusception is an uncommon diagnosis, with one to three cases occurring in a population of 1,000,000 per year, primarily due to underlying pathological lead points, of which 70% are malignant. Lipoma is the most common benign tumour, and primary adenocarcinoma is the most common malignant one. Early diagnosis and treatment are essential to reducing poor outcomes, including ischemia, perforation, and sepsis. Computed tomography imaging is a modality of choice for diagnosis. With a diagnostic accuracy of up to 100% and a specificity of up to 71%. Surgical intervention is the definitive treatment, and the decision is taken according to the situation. Case presentation A 61-year-old Black African female presented to our surgical casualty with intermittent colicky abdominal pain for 1 month. After that, she started to experience abdominal swelling in the right iliac fossa. A CT scan confirmed the presence of colo-colic Intussusception, cecum-ascending-transverse colon. Laparotomy was scheduled, and a right hemicolectomy was done accordingly. Diagnosis of adenocarcinoma (Dukes stage B2) was made histologically. Conclusion Intussusception in adults is a challenging diagnosis requiring high clinical suspicion and has a high incidence of fatal complications. Colonic cancer can be worsening by any infection and chronic medical problem. CT imaging is the lifesaving modality of choice for diagnosis. Good patient outcomes depend on timely diagnosis and recruitment of a multi-disciplinary team.

Abstract Experts have warned against the pandemic burden on healthcare workers early on, however little is known about the evolution of this burden with time, in addition to the long-term effects of post-COVID symptoms in healthcare workers. Staff at the Geneva University Hospitals in Switzerland had an online follow-up in July and December 2021, on their physical and mental health, quality of life and functional capacity using validated scales. Descriptive analyses compared the prevalence of symptoms, functional impairment and quality of life in SARS-CoV-2 positive and negative individuals at baseline and at follow-up. Out of the initial n = 3,083 participants that answered at baseline in July 2021, n = 900 (mean age of 46.4 years, 70.1% women) completed the follow-up in December 2021. With time, more individuals reported fatigue (+ 9.4%), headache (+ 9.0%), insomnia (+ 2.3%), cognitive impairment (+ 1.4%), stress/burnout (+ 8.8%), pain (+ 8.3%), digestive symptoms (+ 3.6%), dyspnea (+ 1.0%), and cough (+ 7.7%) compared to baseline, with a differentially larger increase in symptoms in the SARS-CoV-2 negative group. Individuals had more functional impairment (12.7% at baseline and 23.9% at follow-up), with more absenteeism and worsening quality of life. Healthcare workers are potentially suffering from long term consequences of the pandemic burden, calling for urgent action and solutions.

Background There has been a resurgence of measles infection in countries with high vaccination rates, including Malaysia. Understanding the geographical variation in measles resurgence and associated factors is important for measles prevention and control programs, especially where local information is scarce. Objective To determine the incidence of laboratory-confirmed measles infection and associated factors in the state of Melaka, in the southern region of Malaysia. Methods We obtained measles surveillance data for 4 years (January 2015 to December 2018) from the e-Measles national database. A comparative cross-sectional study was carried out on these data involving children who had been selected through convenience sampling. Results A total of 130 laboratory-confirmed measles cases and 213 non-measles cases were included in the study. Among the laboratory-confirmed cases, 56 (43.1%) had not been vaccinated against measles virus. Thirty-eight cases (51.4%) had received at least one dose of measles vaccine, while 36 cases (48.6%) had completed two doses of measles vaccination. There was a higher risk of contracting laboratory-confirmed measles among unvaccinated children (OR 19.39, 95%CI 8.82 to 42.6, P

Abstract Liquid biopsy approaches offer a promising technology for early and minimally invasive cancer detection. Tumor-educated platelets (TEPs) have emerged as a promising liquid biopsy biosource for the detection of various cancer types. In this study, we processed and analyzed the TEPs collected from 466 Non-small Cell Lung Carcinoma (NSCLC) patients and 410 asymptomatic individuals (controls) using the previously established thromboSeq protocol. We developed a novel particle-swarm optimization machine learning algorithm which enabled the selection of an 881 RNA biomarker panel (AUC 0.88). Herein we propose and validate in an independent cohort of samples (n = 558) two approaches for blood samples testing: one with high sensitivity (95% NSCLC detected) and another with high specificity (94% controls detected). Our data explain how TEP-derived spliced RNAs may serve as a biomarker for minimally-invasive clinical blood tests, complement existing imaging tests, and assist the detection and management of lung cancer patients.

Abstract Background Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors’ perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. Method A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors’ perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. Results A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. Conclusion Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Abstract Gestational diabetes mellitus (GDM) is a common complication of pregnancy that has been associated with an increased risk of obesity and diabetes in the offspring. Pregnancy is accompanied by tightly regulated changes in the endocrine, metabolic, immune, and microbial systems, and deviations from these changes can alter the mother’s metabolism resulting in adverse pregnancy outcomes and a negative impact on the health of her infant. Maternal microbiomes are significant drivers of mother and child health outcomes, and many microbial metabolites are likely to influence the host health. This review discusses the current understanding of how the microbiota and microbial metabolites may contribute to the development of GDM and how GDM-associated changes in the maternal microbiome can affect infant’s health. We also describe microbiota-based interventions that aim to improve metabolic health and outline future directions for precision medicine research in this emerging field.