Search

Providing tuberculosis preventive treatment (TPT) to close contacts of persons with TB is a core strategy recommended by WHO for the prevention and control of TB. Nigeria rolled out the 3-month Isoniazid-Rifampicin (3HR) shorter regimen TPT as a pilot for use among eligible adult and child contacts. This study assesses acceptance and completion rates of 3HR TPT among contacts and determines the perspectives of healthcare workers (HCWs) and contacts on acceptance and completion of 3HR TPT in Nigeria. In this cross-sectional descriptive study using mixed methods, records of TPT-eligible clients were retrospectively reviewed, while 18 purposely selected HCWs and 18 contacts on 3HR were interviewed. Of the 30,012 eligible contacts, 12,040 (40.1%) were initiated on TPT. Among these, 8213 (68%) were enrolled on 3HR, and 6972 (84.7%) of them completed treatment. Perceived facilitators include belief in its effectiveness, training among HCWs, and a good understanding of TPT from HCW counseling sessions. Barriers reported were linked to stockouts, misconceptions about side effects, non-disclosures, and disincentive follow-up strategies. The acceptance and completion rate for 3HR TPT was good. Scaling up 3HR TPT will require redesigning policies towards addressing identified barriers and utilizing interventions linked to capabilities, opportunities, and motivations among contacts of TB patients and HCWs.

Resumen: Las variaciones de los vasos que surgen del arco aórtico son numerosas1, reportándose según la literatura consultada entre el 6 al 49% en diversos países. La mayoría de las variantes son descritas como asintomáticas. No obstante, algunas se han asociado con síntomas significativos y problemas quirúrgicos serios, causados por efectos de la compresión o presión que ejercen esas variantes sobre la tráquea o el esófago2. Presentamos el caso de una variante que no encontramos descripción previa en la literatura la cual fue un hallazgo transquirúrgico durante una corrección de un paciente neonato con diagnóstico de coartación aortica. Abstract: The variations of the vessels that arise from the aortic arch are numerous, reported according to the literature consulted between 6 to 49% in various countries. Most variants are described as asymptomatic. However, some have been associated with significant symptoms and serious surgical problems, caused by the effects of compression or pressure that these variants exert on the trachea or esophagus. We present the case of a variant that we found no previous description in the literature, which was a trans surgical finding during a correction of a neonatal patient with a diagnosis of aortic coarctation.

BackgroundThe eco-climatic crisis has been defined by the World Health Organization as the “single biggest health threat facing humanity,” influencing both the emergence of zoonoses and the spread of vector-borne and water-borne diseases. The aim of this survey was to explore knowledge, eco-anxiety and attitudes toward the ecological and climate crisis among young Italian doctors and medical students.MethodsA cross-sectional, multicenter survey was conducted from November 2022 to June 2023, by administering an anonymous questionnaire to Italian doctors and students of medicine. Endpoint of the study was a Knowledge, Attitudes and Practices (KAP) score on ecological and climate crisis (0–20 points). Association between variables and KAP score was assessed by Kruskal-Wallis’ or Spearman’s test, as appropriate, and significant variables were included into ordinal regression model and reported as adjusted odds ratio (aOR) with their 95% confidence intervals (CI).ResultsBoth KAP and eco-anxiety scores showed acceptable levels of consistency with Cronbach’s alpha. A total of 605 medical doctors and students living in 19 Italian regions were included in the study. Median age [Q1-Q3] was 27.6 [24.1–31.3] and females were 352 (58.2%). Despite showing good attitudes toward climate action, knowledge gap were found, with 42.5% (n = 257) of the respondents not knowing the temperature limits set by the Paris Agreements and 45.5% (n = 275) believing that climate change is caused by sunspots. Fears suggestive for eco-anxiety were common. At multivariable ordinal regression, high levels of eco-anxiety (aOR 1.29, p = 0.001) and low trust in government action (aOR 1.96, p = 0.003) were associated with a higher KAP score. Only one Italian medical school offered an educational module on climate change.ConclusionYoung Italian doctors and medical students are concerned about the climate crisis but show poor knowledge of these topics. The Italian academic system should urgently respond to this need.

ABSTRACT Objective: to determine the surgical indications for glenoid bone grafting associated with better postoperative ranges of motion. Methods: This systematic review was conducted according to PRISMA. The included studies were subdivided according to the criteria used to indicate glenoid bone graft surgery: group for radiological indications only (Group R), group for radiological indications associated with clinical indications (Group R + C), and group for arthroscopic indications (Group A). The extracted and evaluated data were the range of motion of the shoulder. Results: in the electronic search conducted in October 2022, 1567 articles were selected. After applying the inclusion criteria, 14 articles were selected for the systematic review. Regarding the ranges of motion, group A had the highest number of statistically positive results together with group R. Group A showed positive results in elevation parameters, loss of lateral rotation in adduction, and medial rotation in abduction. Group R showed positive results in lateral rotation in adduction and loss of lateral rotation in adduction. On the other hand, Group R + C was the one that presented the highest number of statistically negative results, in the following parameters: elevation, lateral rotation in abduction, loss of lateral rotation in adduction, and medial rotation in abduction. Conclusion: the subgroups presented variable results in the evaluated parameters; however, the groups with arthroscopic and radiological indications showed the highest number of positive results, with the latter group showing the best results regarding lateral rotation. Level of Evidence II, Systematic Reviews.

As Vehicle-to-Everything (V2X) communication technologies gain prominence, ensuring human safety from radiofrequency (RF) electromagnetic fields (EMF) becomes paramount. This study critically examines human RF exposure in the context of ITS-5.9 GHz V2X connectivity, employing a combination of numerical dosimetry simulations and targeted experimental measurements. The focus extends across Road-Side Units (RSUs), On-Board Units (OBUs), and, notably, the advanced vehicular technologies within a Tesla Model S, which includes Bluetooth, Long Term Evolution (LTE) modules, and millimeter-wave (mmWave) radar systems. Key findings indicate that RF exposure levels for RSUs and OBUs, as well as from Tesla’s integrated technologies, consistently remain below the International Commission on Non-Ionizing Radiation Protection (ICNIRP) exposure guidelines by a significant margin. Specifically, the maximum exposure level around RSUs was observed to be 10 times lower than ICNIRP reference level, and Tesla’s mmWave radar exposure did not exceed 0.29 W/m2, well below the threshold of 10 W/m2 set for the general public. This comprehensive analysis not only corroborates the effectiveness of numerical dosimetry in accurately predicting RF exposure but also underscores the compliance of current V2X communication technologies with exposure guidelines, thereby facilitating the protective advancement of intelligent transportation systems against potential health risks.

Resumen: Introducción y objetivos: A medida que la supervivencia de los niños con cardiopatía congénita intervenidos de cirugía cardiaca ha aumentado significativamente, la necesidad de seguimiento en términos de calidad de vida relacionada con la salud se ha vuelto cada vez más importante. En este estudio, describimos la calidad de vida relacionada con la salud en niños con cardiopatía congénita con y sin reparación quirúrgica. Métodos: Estudio descriptivo. Aplicamos el cuestionario Pediatric Quality of Life Inventory (PedsQLTM) en 271 pacientes con edades de 2 a 17 años, de los que acudieron a consulta de cardiología tanto en protocolo prequirúrgico como posquirúrgico. La calidad de vida relacionada con la salud se expresó como puntaje total (100 más alto) y se proporcionó como medianas y porcentajes de 10 a 100. Resultados: Incluimos a 271 pacientes de 2 a 17 años, el 94,8% con un corazón biventricular. La cirugía cardiaca se realizó en el 67,8%. Los principales factores que afectaron de forma negativa en la calidad de vida fueron la fisiología univentricular, la presencia de cortocircuito residual, requerir otra cirugía, el manejo con polifármacos y el acceso quirúrgico por esternotomía media. Conclusión: Los pacientes con cardiopatías congénitas no solo presentan su enfermedad principal, sino que también experimentan una calidad de vida que puede afectarse por factores sociales, educativos y emocionales. La evaluación de la calidad de vida de la salud debe ser parte integral en la evaluación de estos pacientes. Abstract: Introduction and objectives: As the survival of children with congenital heart disease who have undergone cardiac surgery has increased significantly, the need for follow-up in terms of health related quality of life has become increasingly important. In this study, we sought to describe the health related quality of life in children with congenital heart disease with and without surgical repair. Methods: We applied the Pediatric Quality of Life Inventory (PedsQLTM) questionary in 271 patients aged 2 to 17 years, of the patients who attended the cardiology clinic both pre surgery and postsurgery. Health related quality of life was expressed as a total score (highest 100) and provided as medians and percentages from 10 to 100. Results: We included 271 patients from 2 to 17 years old, 94.8% had a biventricular heart. Cardiac surgery was performed in 67.8% The main factor that negatively affected quality of life were univentricular physiology, the presence of residual shunt, requiring another surgery, management with polidrugs, and surgical access through median sternotomy. Conclusion: Patients with congenital heart disease nor only suffer from their main disease, but also experience a quality of life that can be affected by social, educational and emotional factors. The assessment of quality of life by health professionals should be an integral part of the evaluation of these patients.

The tectonic evolution of highly oblique continental margins that result from extension above lithospheric subduction–transform edge propagator (STEP) faults is poorly understood. Here, we investigate the case of the Alboran margin in the eastern Betics characterized by crustal thinning of 15–10 km, oblique to the direction of slab retreat. The current deformation patterns indicate that oblique rifting is underway. However, it is unclear whether these conditions are those that prevailed during the formation of the metamorphic domes and intramontane basins. We review the temporal and spatial evolution of Neogene sedimentary basins and brittle deformation in the eastern Betics and exploit offshore seismic reflection lines to propose a crustal-scale section across the oblique margin. The history of sediment infill and rates of subsidence combined with the analyses of fault slip data confirm that brittle extension oriented from north 20∘ E to E–W occurred during an interval spanning from the Serravallian–early Tortonian to the late Tortonian (14–8 Ma). This extension is associated with both normal and strike-slip regimes and the evolution of the strike-slip fault zones flanking the metamorphic domes. The transtensional model forms a coherent scheme linking the ductile deformation associated with metamorphic domes and the formation of E–W- and NW–SE- or NNW–SSE-directed sedimentary basins in the brittle upper crust during the Tortonian. The oblique extension, which is closely associated with STEP faulting, occurred during the regional convergence between Africa and Iberia since the Miocene. Only recently, around 8 Ma, has slab detachment started to migrate westward, leading to tectonic inversion in the eastern Betics. Such a type of narrow oblique-rifted margin associated with transform-like plate boundaries is not unique but is expected to be hardly preserved in the geological record due to the transient nature of retreating subduction systems.

This study aimed to evaluate the impact of using an AI model, specifically ChatGPT-3.5, in remote sensing (RS) applied to archaeological research. It assessed the model’s abilities in several aspects, in accordance with a multi-level analysis of its usefulness: providing answers to both general and specific questions related to archaeological research; identifying and referencing the sources of information it uses; recommending appropriate tools based on the user’s desired outcome; assisting users in performing basic functions and processes in RS for archaeology (RSA); assisting users in carrying out complex processes for advanced RSA; and integrating with the tools and libraries commonly used in RSA. ChatGPT-3.5 was selected due to its availability as a free resource. The research also aimed to analyse the user’s prior skills, competencies, and language proficiency required to effectively utilise the model for achieving their research goals. Additionally, the study involved generating JavaScript code for interacting with the free Google Earth Engine tool as part of its research objectives. Use of these free tools, it was possible to demonstrate the impact that ChatGPT-3.5 can have when embedded in an archaeological RS flowchart on different levels. In particular, it was shown to be useful both for the theoretical part and for the generation of simple and complex processes and elaborations.

Global public goods and the contrast to global public bads require a dramatic change in the international monetary system, enforcement capacity, democratic legitimation, the return to regionalism and multilateralism. Pending the emergence of a more equitable global reserve and payments system, an increased use of the Special Drawing Rights, channeled through Multilateral Development Banks, may help managing the transition towards the provision of such global public goods. This would also provide a guidance for the reduction of Central Banks’ balance sheets, the financialization of the economy and an increase of real investment, thus anchoring the whole international economy to a less vulnerable and volatile monetary structure.

Gravity is a primary physical force that has a profound influence on the stability of the cell cytoskeleton. In our research, we investigated the influence of microgravity on altering the cytoskeletal pathways of glioblastoma cells. The highly infiltrative behavior of glioblastoma is supported by cytoskeletal dynamics and surface proteins that allow glioblastoma cells to avoid stable connections with the tissue environment and other cells. Glioblastoma cell line C6 was exposed to a microgravity environment for 24, 48, and 72 h by 3D-RPM, a laboratory instrument recognized to reproduce the effect of microgravity in cell cultures. The immunofluorescence for GFAP, vinculin, and Connexin-43 was investigated as signals related to cytoskeleton dynamics. The polymerization of GFAP and the expression of focal contact structured by vinculin were found to be altered, especially after 48 and 72 h of microgravity. Connexin-43, involved in several intracellular pathways that critically promote cell motility and invasion of glioma cells, was found to be largely reduced following microgravity exposure. In conclusion, microgravity, by reducing the expression of Connexin-43, alters the architecture of specific cytoskeletal elements such as GFAP and increases the focal contact, which can induce a reduction in glioma cell mobility, thereby inhibiting their aggressive metastatic behavior.