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Abstract Orange (Citrus sinensis L.) is a common fruit crop widely distributed worldwide with the peel of its fruits representing about 50% of fruit mass. In the current study, orange peel was employed to mediate the synthesis of silver nanoparticles (AgNPs) in a low-cost green approach. Aqueous extracts of suitably-processed peel were prepared using different extraction methods; and their phytochemical profile was identified. Based on phytochemical screening, amount of main phytochemicals, free radical-scavenging ability, reducing power and antioxidant activity, the peel extract prepared by boiling seemed to be the most promising. Thus, major compounds of this extract were identified by gas chromatography-mass spectrometry. Potency of the peel extract to mediate the synthesis of AgNPs was then monitored by visual observation, UV-visible spectroscopy, energy dispersive X-ray analysis, transmission electron microscopy and zetametry. Color change of the reaction mixture to brown and absorption peak at 450 nm indicated AgNPs formation. Characterization of AgNPs revealed spherical shape, size of 30–40 nm, zeta potential of -18.2 mV and yield conversion of 82%. The as-synthesized AgNPs had antioxidant capacity (free radical-scavenging ability, reducing power and antioxidant activity) lower than that of the orange peel extract. However, these biogenic AgNPs had antitumor activity (IC50 of 16 ppm against HCT-116 and 1.6 ppm against HepG2 cell lines) much higher than the peel extract that was completely non-toxic to the considered cell lines.

Abstract With the growing resistance of pathogenic microbes to traditional drugs, biogenic silver nanoparticles (SNPs) have recently drawn attention as potent antimicrobial agents. In the present study, SNPs synthesized with the aid of orange (Citrus sinensis) peel were engineered by screening variables affecting their properties via Plackett–Burman design. Among the variables screened (temperature, pH, shaking speed, incubation time, peel extract concentration, AgNO3 concentration and extract/AgNO3 volume ratio), pH was the only variable with significant effect on SNPs synthesis. Therefore, SNPs properties could be enhanced to possess highly regular shape with zeta size of 11.44 nm and zeta potential of − 23.7 mV. SNPs purified, capped and stabilized by cloud point extraction technique were then checked for their antimicrobial activity against Bacillus cereus, Listeria innocua, Listeria monocytogenes, Staphylococcus aureus, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhimurium and Candida albicans. The maximum antimicrobial activity of SNPs was recorded against E. coli, L. monocytogenes and C. albicans with clear zone diameter of 33.2, 31.8 and 31.7 mm, respectively. Based on minimum inhibition concentration and minimum bactericidal concentration of SNPs (300 mg/l) as well as their effect on respiratory chain dehydrogenases, cellular sugar leakage, protein leakage and lipid peroxidation of microbial cells, E. coli was the most affected. Scanning electron microscopy, protein banding and DNA fragmentation proved obvious ultrastructural and molecular alterations of E. coli treated with SNPs. Thus, biogenic SNPs with enhanced properties can be synthesized with the aid of Citrus peel; and such engineered nanoparticles can be used as potent antimicrobial drug against E. coli.

The antidiabetic drugs metformin, glipizide and gliclazide have been used for many years to control blood glucose levels. In recent years, they have gained importance in non-diabetic pharmacological purposes including cancer and hearing loss treatment. Co-administration of these therapeutics represents a challenge to some clinicians seeking an efficient, sensitive and rapid analytical method to use in the pharmacokinetic studies and the therapeutic monitoring of these agents. This research outlines the development and validation of a new precise, robust, sensitive, selective and rapid ion-pairing reversed-phase HPLC method for the simultaneous determination of a ternary mixture of metformin, glipizide and gliclazide in the same isocratic chromatographic run within 5 min. The limits of detection were 59.22 ng/mL for metformin, 169.48 ng/mL for glipizide and 151.29 ng/mL for gliclazide. The method was applied in quantifying metformin uptake by the auditory cell line HEI-OC1, to gain an insight into the kinetics of this biguanide in the organ of Corti. Metformin exhibited a concentration-dependent uptake by HEI-OC1 cells up to 5 mM, after which, saturation of the uptake was noticed. When HEI-OC1 cells were subjected to diabetes-simulated conditions, metformin was able to mitigate the hyperglycaemic stress and revealed a protective role in this cell line.

Abstract Background During the COVID-19 pandemic, health care had to find new ways to care for patients while reducing infection transmission. The role of telemedicine role has grown exponentially. Methods A questionnaire on experiences and satisfaction was sent to the staff of the Head and Neck Center of Helsinki University Hospital and to otorhinolaryngology patients treated remotely between March and June 2020. Additionally, patient safety incident reports were examined for incidents involving virtual visits. Results Staff (response rate 30.6%, (n = 116)) opinions seemed to be quite polarized. In general, staff felt virtual visits were useful for select groups of patients and certain situations, and beneficial in addition to face-to-face visits, not instead of them. Patients (response rate 11.7%, (n = 77)) gave positive feedback on virtual visits, with savings in time (average 89 min), distance travelled (average 31.4 km) and travel expenses (average 13.84€). Conclusions While telemedicine was implemented during the COVID-19 pandemic to ensure patient treatment, its usefulness after the pandemic must be examined. Evaluation of treatment pathways is critical to ensure that quality of care is upheld while new treatment protocols are introduced. Telemedicine offers the opportunity to save environmental, temporal, and monetary resources. Nonetheless, the appropriate use of telemedicine is essential, and clinicians must be offered the option to examine and treat patients face-to-face.

Aims: literature outlining the impact of diabetes on the inner ear environment and the exact etiology of diabetes-induced hearing malfunctioning is scarce. Methods: The Scopus, Pubmed and google scholar databases were used to source relevant epidemiological, clinical, biomedical, histopathological, otolaryngological and pharmacological articles published between 1960 and 2020 using keywords ‘diabetes, hearing loss, inner ear, cellular, cochlea, microangiopathy, neuropathy’. AG and CD preidentified and reviewed selected articles to structure and construct the manuscripts based on relevant inclusion criteria of epidemiological, animal histopathological as well as human temporal bone findings in diabetes setting. Results: several histopathological findings in different animal models of diabetes have highlighted the existence of various abnormalities in their ears, compared with healthy control animals. The prevalence of such associations on the other hand has recently been observed in numerous epidemiological studies across various populations. A plethora of events associated with diabetes and dysglycaemia are linked to biochemical alterations, impaired physiological homeostasis, perturbed blood rheological characteristics and architectural disturbances in the vestibulocochlear system. While various hypotheses have been put forward to explain such associations, microvascular impairment of the inner ear vasculature as well as neuropathic involvement constitute two major ones to date. Conclusions: this review highlights associations between diabetes as a serious endocrinological manifestation and hearing impairment (an overlooked sequalae of diabetes), discusses fundamental etiologies (microangiopathy and neuropathy) of hearing dysfunction in patients with diabetes and sheds light on the otological and audiological impacts of diabetes on the inner ear environment.

Solar-driven water evaporation is crucial for drinkable water production using cost-effective solar energy and has recently gained more interest through the improvement of heat localization strategies. However, the original water sources may contain oil impurities and other organic pollutants that seriously impair the evaporation process and pose environmental hazards. Here, we developed a multifunctional nanocomposite Ag, Cu-rGO for the production of clean water by simultaneous photocatalysis, oil resistance, adsorption, and water evaporation powered by the sun. The phonon-assisted relaxation process under solar irradiation was effectively accelerated by the incorporation of rGO by Ag and CuNPs alloy, which can alter the bandgap and introduce a significant number of intermediate band (IB) states. We demonstrate that by employing the Ag, Cu-rGO evaporator under solar light irradiation, a high-water evaporation rate of 1.89 kg m−2 h−1 with a high solar-to-heat conversion efficiency of 90.2% can be accomplished. Additionally, the membrane can concurrently purify the raw water during solar evaporation by organic dye degradation, heavy metals adsorption, oil resistance, and pathogenic bacteria disinfection. Meanwhile, the heat dissipation to the bulk water can be recovered by the conversion to electricity using a commercial TE-module which simultaneously generates voltage generation of 17.3 mV with a power density of 5.72 W m−2. For solar-driven water evaporation from multiple sources, such an all-in-one multifunctional membrane is an excellent candidate.

Objectives The COVID-19 pandemic has globally affected healthcare workers’ (HCWs) health and wellbeing. Most studies on COVID-19 have focused on tertiary healthcare. The aim of this study was to increase the knowledge on the effects of the pandemic on working conditions in tertiary and primary healthcare. Material and Methods The comparative cross-sectional study consisted of an online questionnaire sent to HCWs of the City of Helsinki (primary healthcare) and Helsinki University Hospital (tertiary healthcare). Altogether 1580 HCWs with direct patient contact participated in the study: 895 from tertiary and 685 from primary healthcare. Statistical analysis used SPSS 25 from IBM. The tests used were the χ 2 test, Fisher’s exact test, and binary logistic regression analysis. Results Primary HCWs were less likely to treat COVID-19 patients (OR = 0.45, 95% CI: 0.37–0.56). However, both groups reported a similar number of COVID-19 infections, primary HCWs 4.9% and tertiary HCWs 5.0%, and workrelated quarantine was significantly more prevalent (OR = 1.96, 95% CI: 1.38–2.79) among primary HCWs. In addition, work-related wellbeing was poorer among primary HCWs than tertiary HCWs in terms of feeling more stressed at work (OR = 3.20, 95% CI: 2.55–4.02), not recovering from work (OR = 0.49, 95% CI: 0.39–0.62), reported mental wellbeing below normal levels (OR: 1.59, 95% CI: 1.26–2.00), and increased working hours (OR = 1.63, 95% CI: 1.25–2.12). Conclusions The study demonstrates how the pandemic has affected the wellbeing and working conditions of not only tertiary but also less studied primary HCWs. The authors’ findings suggest that the challenges identified during the COVID-19 pandemic in the health and wellbeing of healthcare workers are even greater in primary care than in tertiary care. Int J Occup Med Environ Health. 2023;36(1):139–50

The goal of this study to use carotid ultrasonography to detect changes in carotid flow time in comparison to echocardiography in assessment of changes in heart dynamics to assess changes in volume status before &after passive leg raising in septic patients. We arranged patients into two groups ,Group one: fluid responder 18 paients (45.5%), Group two non-fluid responder :22 patients(54,5%) . Increase carotid flow time (CFT) by 7msec is cosidered fluid responsive, 10% increase in stroke volume to be fluid. The PLR test could assess fluid responsiveness with specificity 100% and sensitivity 95% with cut of 10.6% change in CO to predict fluid responsiveness.the study show a statistically significant moderate positive correlation between CCA flow time (CFT) both after PLR and the percent of change in CO measured by echocardiography. An agreement analyses were formed, we concluded that an overall good agreement between carotid artery blood flow measurement and Doppler echocardiography measurement with P value < 0.001, so we can use this parameters to predict fluid responsiveness post PLR perform are promising tool for the evaluation of fluid responsiveness in critically ill septic patients ,The PLR maneuver has demonstrated excellent performance for predicting fluid responsiveness. It is simple to perform, but requires a reliable system of COP monitoring able to quantify the short-term changes.

Abstract Background Vocal-fold augmentation is a continuously developing treatment modality for glottic insufficiency. Patients with glottic insufficiency attend the phoniatrics clinics with increasing frequency. Glottic insufficiency may be due to vocal-fold paralysis, paresis, atrophy, sulcus vocalis, scarring, and vocal-fold deficiency after laryngeal surgery. A variety of materials exist for injection augmentation. This follow-up study aimed to assess the short-term as well as long-term outcomes of vocal-fold injection with calcium hydroxyapatite (CaHA) in patients with glottic gap 1–3 mm. Method This study included 25 patients with glottic insufficiency who underwent injection augmentation with CaHA. All patients were scheduled for voice evaluation using a comprehensive subjective and objective battery of assessments. Assessments were performed before the procedure and after the procedure at 2 months and at 1 year. Results Perceptual voice quality assessed with the GRBAS scale improved and the results were stable after 1 year. Shimmer and HNR improved continuously through the follow-up sessions, while jitter and f0 showed slight improvement after CaHA injection. Conclusion Voice improvement after injection of CaHA requires a minimum of 2 months to develop and may last for a long period.

Objectives The COVID-19 pandemic has caused unseen pressure on healthcare systems in many countries, jeopardizing the mental well-being of healthcare workers. The authors aimed to assess the mental well-being of Finnish healthcare workers from 2 hospital districts (Helsinki University Hospital [HUS] and Social and Health Services in Kymenlaakso [Kymsote]) with differing COVID-19 incidence rates during the first wave of the COVID-19 pandemic in spring 2020. Material and Methods A total number of 996 healthcare workers (HUS N = 862, Kymsote N = 134) participated in this prospectively conducted survey study during summer 2020. Symptom criteria of self-reported mental health symptoms followed ICD-10 classification, excluding duration criteria. Participants were divided into symptom categories “often/sometimes”, and “rarely/never”. These groups were compared to sociodemographic factors and factors related to work, workload, and well-being. Results The degree of mental health symptoms did not differ between the 2 healthcare districts despite differing COVID-19 incidences (p = 1). The authors observed a significant relationship between self-reported diagnostic mental health symptoms and experiences of insufficient instructions for protection against COVID-19 (in HUS cohort p < 0.001), insufficient recovery from work (p < 0.001), and subjective increased workload (p < 0.001). Conclusions The authors’ results show the importance of well-planned and sufficient instructions for protection from SARS-CoV-2 for healthcare workers, indicating their need to feel safe and protected at work. The workload of healthcare workers should be carefully monitored to keep it moderate and ensure sufficient recovery. Sufficient control of the epidemic to keep the burden of the healthcare system low is vital for healthcare workers’ well-being. Int J Occup Med Environ Health. 2022;35(6):708–18

Abstract Objectives Given its rarity and the lack of clear clinical markers, amyotrophic lateral sclerosis (ALS) remains a diagnostic challenge. Because bulbar‐onset ALS (buALS) presents with impaired speech or swallowing, patients are often primarily referred to an otolaryngologist (ORL) or phoniatrician. The objectives of this retrospective cohort study were to analyze the role of ORLs and phoniatricians in ALS diagnostics and treatment and the potential diagnostic delay related to initial visit to aforementioned specialists. Methods We reviewed data for all 327 patients treated for ALS through the Hospital District of Helsinki and Uusimaa (HUS) between 2010 and 2014, focusing specifically on 110 (34%) patients presenting with bulbar nerve onset (buALS). Their presenting symptoms, referral to specialized care, and delay in referral to a neurology clinic were assessed. Indications and findings from swallowing studies were reviewed as well as the incidence of percutaneous endoscopic gastrostomy (PEG) and tracheostomy. Results Among the 110 patients with buALS, 64 (58%) were primarily referred to a neurologist, 28 (25%) to an ORL, and five (5%) to a phoniatrician. The most common presenting symptom was dysarthria in 89 patients, (81%), followed by dysphagia in 26 (24%). In most cases, an ORL or phoniatrician suspected a neuromuscular disease; however, in eight (24%) cases, the neurological etiology of symptoms was missed. Overall, 49 (45%) patients underwent a swallowing study and 86 (78%) patients underwent PEG placement. Conclusions Among buALS patients, 30% initially consulted an ORL or phoniatrician and 45% underwent a swallowing study. Based on our results, swallowing studies rarely lead to immediate PEG placement. An initial visit to other specialists had no impact on diagnostic delays or survival.

Abstract During the COVID-19 pandemic, healthcare workers (HCWs) have faced unprecedented workloads and personal health risks leading to mental disorders and surges in sickness absence. Previous work has shown that interindividual differences in psychological resilience might explain why only some individuals are vulnerable to these consequences. However, no prognostic tools to predict individual HCW resilience during the pandemic have been developed. We deployed machine learning (ML) to predict psychological resilience during the pandemic. The models were trained in HCWs of the largest Finnish hospital, Helsinki University Hospital (HUS, N = 487), with a six-month follow-up, and prognostic generalizability was evaluated in two independent HCW validation samples (Social and Health Services in Kymenlaakso: Kymsote, N = 77 and the City of Helsinki, N = 322) with similar follow-ups never used for training the models. Using the most predictive items to predict future psychological resilience resulted in a balanced accuracy (BAC) of 72.7–74.3% in the HUS sample. Similar performances (BAC = 67–77%) were observed in the two independent validation samples. The models' predictions translated to a high probability of sickness absence during the pandemic. Our results provide the first evidence that ML techniques could be harnessed for the early detection of COVID-19-related distress among HCWs, thereby providing an avenue for potential targeted interventions.

Abstract Background Caring for our patients while taking care of our own safety as well as theirs is a major concern during the current pandemic. Therefore, many societies developed guidance documents to educate clinicians about the required precautions. This study aims to assess personal protective equipment (PPE) usage, hand hygiene practice and infection control training among phoniatricians and otolaryngologists during the pandemic. An online survey was administered during the first wave of the COVID-19 pandemic in June 2020. Data collected included PPE availability, infection control training, adopted infection control precautions, hand hygiene practice, and use of different PPE elements as well as adherence to its use during potential aerosol generating procedures. Results Based on their country of residences, eligible 154 participants were grouped into 4 groups and their responses were compared. Conclusion Following the suggested recommendations, while adequate for some precautions, was still not satisfactory. Certain defects that are specific to particular groups had also been identified.

ObjectivesThe COVID-19 pandemic has posed several risk factors to healthcare workers' (HCWs') emotional distress. The purpose of the study was to enhance understanding of the experiences and feelings of HCWs during the COVID-19 pandemic, with specific reference to infection prevention and control (IPC) practices and guidance, focusing on the quality and availability of personal protective equipment (PPE), guidelines, and management. With a qualitative approach, we aimed to enable a wider narrative; to gain a more detailed understanding related to PPE use and identify experiences that can be overlooked in forced-choice questionnaires.MethodsAn online questionnaire was conducted among HCWs of the City of Helsinki and Helsinki University Hospital between 12.6.2020 and 5.4.2021. Altogether 1,580 HCWs participated in the study, from whom 579 shared 1,666 free-text responses. These responses were analyzed qualitatively, and the results were combined with statistical data on the participants' working conditions and backgrounds.ResultsWe identified problems in PPE availability and changing guidelines as factors causing the most distress in the participants. Regarding availability, running out of masks and respirators emerged as the most worrying issue, and inadequate PPE was associated with the excessive workload (OR 1.51, CI 95% 1.01–2.25). The results also highlight the importance of transparent and clear communication regarding IPC instructions and guidance, and clear IPC guidance was associated with better levels of reported recovery from work (OR 1.51, CI 95% 1.06–2.14).ConclusionsOur study highlights the importance of adequate PPE provision, transparent communication, clear guidance, and supportive supervisory work in this ongoing pandemic and potential new ones. We suggest more rigorous preparation, with crisis communication planning and emergency storage of PPE.

Background:. Velopharyngeal dimensions change as a child with cleft palate (CP) grows. The aim of this study was to assess if the decision for velopharyngeal insufficiency (VPI) surgery can be made by the age of 3 years among CP children with moderate-to-severe VPI. In addition, we sought to clarify if speech therapy before VPI surgery is beneficial for VPI speech characteristics. Methods:. This retrospective study reviewed documentation of children with moderate-to-severe VPI at age 3 years who did not undergo VPI surgery until age 5 years. Based on the national cleft register, 959 patients with syndromic and nonsyndromic CP were treated by the craniofacial team at Helsinki University Hospital, Finland between 2000 and 2014. Eighty-six patients fulfilled the study inclusion criteria. The speech pathologist evaluated velopharyngeal function at age 3, 5, and 8 years. Results:. Of the 86 children presenting with moderate-to-severe VPI at age 3 years, 94% still had moderate-to-severe VPI at age 5 years, even though speech therapy was offered to 77%. Of those whose velopharyngeal function improved by age 5 years, function regressed to incompetent over time. Overall, 93% underwent VPI surgery and 82% underwent VPI surgery between ages 5 and 8 years. Only 23% at age 8 years still had moderate-to-severe VPI. Speech therapy alone did not improve VPI speech characteristics. Conclusions:. Moderate-to-severe VPI did not improve from 3 to 5 years or improved but subsequently relapsed. This suggests that the decision for VPI surgery can be made for children aged 3 years with moderate-to-severe VPI.

When the skin is injured through physical, chemical, mechanical, and/or thermal damage, a spontaneous series of events start to happen, often called the “cascade of healing,” so as to restore the injured tissues, replace the damaged structures and prevent the invasion of pathogens into the damaged tissues. A number of traditional products are available for wound healing such as gels, creams, ointments, dressings and solutions, which depend mainly on moisture intake so as to help tissue repair, yet they do not provide optimal conditions to permit recovery of the wounds. Nanocarriers play a significant role in wound healing, since they are reported to improve drug delivery into the skin through alternation of pharmacokinetics and biodistribution of drugs, hence they increase bioavailability of drugs. Vesicular systems such as liposomes, niosomes, transfersomes, penetration enhancer containing vesicles (PEVs) and ethosomes are among the carriers proven to enhance the therapeutic action of drugs applied for wound healing. In this review, we summarize and discuss different vesicular systems used for wound healing, their composition, their advantages and disadvantages, their methods of preparation and their mechanisms of skin penetration.

Objectives To evaluate the effectiveness of safety guidelines in the workplace, the authors analyzed the work-related exposure to SARS-CoV-2 and the source of COVID‑19 infections among healthcare workers (HCWs), together with the use of personal protective equipment (PPE). Material and Methods A cross-sectional prospective study was conducted in tertiary hospitals in the Uusimaa region, Finland, with 1072 volunteers being enrolled in the study from among the HCWs at the Helsinki University Hospital. Overall, 866 (80.8%) HCWs (including 588 nurses, 170 doctors, and 108 laboratory and medical imaging nurses) completed the questionnaire by July 15, 2020, with 52% of the participants taking care of COVID‑19 patients. The participants answered a structured questionnaire regarding their use of PPE, the ability to follow safety guidelines, exposure to COVID‑19, and the source of potential COVID‑19 infections. The participants with COVID‑19 symptoms were tested with the SARS-CoV-2 realtime polymerase chain reaction method. All infected participants were contacted, and their answers were confirmed regarding COVID‑19 exposure. Results In total, 41 (4.7%) participants tested positive for SARS-CoV-2, with 22 (53.6%) of infections being confirmed or likely occupational, and 12 (29.3%) originating from colleagues. In 14 cases (63.6%), occupational infections occurred while using a surgical mask, and all infections originating from patients occurred while using a surgical mask or no mask at all. No occupational infections were found while using an FFP2/3 respirator and following aerosol precautions. The combined odds ratio for working at an intensive care unit, an emergency department, or a ward was 3.4 (95% CI: 1.2–9.2, p = 0.016). Conclusions A high infection rate was found among HCWs despite safety guidelines. Based on these findings, the authors recommend the use of FFP2/3 respirators in all patient contacts with confirmed or suspected COVID‑19, along with the use of universal masking, also in personnel rooms. Int J Occup Med Environ Health. 2021;34(2):239–49

Endophytic bacteria are those that colonise the internal tissues of plant without negative impact on plant health. This work aims to isolate the endophytic bacteria colonising Triticum vulgare and Phragmites australis and evaluate their compatibility as biostimulants to maize. Three of the six obtained isolates were selected upon their surpassing ability to stimulate the growth of maize seedlings (maximum of 18% increase in germination and 2.4-fold increase in the number of lateral roots). These isolates were molecularly identified as Klebsiella MK2R2, Bacillus B2L2 and Enterobacter E1S2. The response of maize seedlings to the combined effect of these isolates revealed that Bacillus B2L2, containing treatments, surpassed the other treatments in growth vigour parameters and upon this result these treatments were applied in a field experiment either alone or in combination with 100% N fertilisation. Maize plants, inoculated with Klebsiella MK2R2 and Bacillus B2L2 either alone or in combination with Enterobacter E1S2 in the presence of urea, surpassed significantly other treatments as the weight of ear increased almost two times and the number of grains increased 1.8 times compared to the control values. It could be concluded that the obtained strains are compatible biostimulants to maize.

Background: Periodontal diseases are a major public health problem with a 70% prevalence in adults. This retrospective controlled study aimed at studying radiologic periodontal findings in chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (sNP). Methodology: Radiologic and patient record data of CRSsNP (n=66) and CRSwNP (n=78) patients undergoing sinus surgery consultation in 2005-18 were used. Chronic rhinitis/oral disease patients served as a control group (n=52). Radiologic periodontal findings referring to chronic periodontitis of maxillary premolar and molar region and Lund-Mackay (LM) scores were analyzed blinded from sinus computed tomography (CT) scans. Results: The prevalence of ≥1 periapical radiolucency was 4.0 % in controls, 14.5% in CRSsNP and 25.4% in CRSwNP group, however this difference became insignificant when adjusted by age. In multivariable linear regression model, the presence of ≥1 other radiologic periodontal finding than periapical radiolucency, was significantly associated with high Total LM score. About half (47%) of the sinus CT scans did not visualize cemento-enamel-junction because of limiting radiation. Conclusions: Radiologic periodontal findings were significantly associated with an increment of Total LM score. Detection of radiologic periodontal findings in CRS patients seems to be possible, if adding the maxillary bone region in sinus CT scans.

The antidiabetic drugs metformin, gliclazide and glipizide have been widely used and studied in terms of pharmacological and antidiabetic effects, and their individual stability has been studied in the literature. However, the drugs’ combined stability profiling remains poorly understood, and hence the aim of this study was to investigate the collective stability profiling of different combinations at various controlled conditions. Degradation assessments were carried out on metformin, glipizide and gliclazide by applying a stability-indicating HPLC method that was developed and validated in accordance with ICH guidelines. Glipizide, gliclazide, metformin and the binary mixtures (metformin/glipizide and metformin/gliclazide) were subjected to different forced degradation conditions and were detected at 227 nm by an isocratic separation on an Alltima CN column (250 mm × 4.6 mm × 5µ) utilizing a mobile phase that consists of 20 mM ammonium formate buffer (pH 3.5) and acetonitrile at a ratio of (45:55, v/v). The method is linear (R2 = 0.9999) at the concentration range 2.5–150 µg/ml for metformin and 1.25–150 µg/ml for sulfonylureas respectively and offers a specific and sensitive tool for their determination in

A novel gliclazide-loaded elastomeric carbohydrate pharmaceutical vehicle was successfully developed. This new siliconized alginate platform showed pseudoplastic rheology with a zeta potential ranging from (−43.8 mV to −75.5 mV). A Buchi-B390 encapsulator was employed to formulate different types of silicone-grafted alginate microcapsules loaded with gliclazide relying on the vibrational ionic gelation technology. The use of tetraethyl orthosilicate (TEOS) to crosslink the silicone elastomer (hydroxy terminated polydimethylsiloxane) of this new platform had improved the gliclazide encapsulation (>92.13% ± 0.76) of the free-flowing composite microcapsules, which showed good mechanical durability (up to 12 h in PBS pH 6.8) and promising results to sustain the drug release.

Information on phenotypic variation helps to breed better varieties. Forty-nine bread wheat genotypes were evaluated in simple lattice design at Jamma and Geregera to determine the extent of variation and association among 11 traits. Analysis of variance showed significant differences (p < 0.01) among the genotypes for all traits, indicating the presence of adequate variability. Maximum values of genotypic coefficients of variation were recorded for spike length (8.66 %), number of productive tillers (8.4 %), number of grains per spike (6.4 %) and thousand-seed mass (6.15 %); this also shows the presence of substantial variability for these traits. Genetic parameters of the study revealed that days to heading, plant height, spike length, number of grains per spike and thousand-seed mass had moderate to high heritability and genetic advance as percent of the mean. Therefore, direct selection could be practiced to improve bread wheat for these traits. Moreover, selection of early-cycle lines which can escape the negative effects of climate change will be possible. Grain yield had strong and significant positive correlation with thousand-seed mass (rg = 0.395**), biological yield (rgv= 0.617**) and harvest index (rg = 0.731**); selection based on these traits will be most effective in future bread wheat yield improvement programs as they also exerted strong positive direct effects on grain yield.

Background Functional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI. Purpose Our randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs. Patients and methods Our study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential). Conclusion Our study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.

Abstract Background Developmental language disorder (DLD, also called specific language impairment, SLI) is a common developmental disorder comprising the largest disability group in pre-school-aged children. Approximately 7% of the population is expected to have developmental language difficulties. However, the specific etiological factors leading to DLD are not yet known and even the typical linguistic features appear to vary by language. We present here a project that investigates DLD at multiple levels of analysis and aims to make the reliable prediction and early identification of the difficulties possible. Following the multiple deficit model of developmental disorders, we investigate the DLD phenomenon at the etiological, neural, cognitive, behavioral, and psychosocial levels, in a longitudinal study of preschool children. Methods In January 2013, we launched the Helsinki Longitudinal SLI study (HelSLI) at the Helsinki University Hospital (http://tiny.cc/HelSLI). We will study 227 children aged 3–6 years with suspected DLD and their 160 typically developing peers. Five subprojects will determine how the child’s psychological characteristics and environment correlate with DLD and how the child’s well-being relates to DLD, the characteristics of DLD in monolingual versus bilingual children, nonlinguistic cognitive correlates of DLD, electrophysiological underpinnings of DLD, and the role of genetic risk factors. Methods include saliva samples, EEG, computerized cognitive tasks, neuropsychological and speech and language assessments, video-observations, and questionnaires. Discussion The project aims to increase our understanding of the multiple interactive risk and protective factors that affect the developing heterogeneous cognitive and behavioral profile of DLD, including factors affecting literacy development. This accumulated knowledge will form a heuristic basis for the development of new interventions targeting linguistic and non-linguistic aspects of DLD.

Abstract: Central memory T cells (TCM) patrol lymph nodes, providing central immunosurveillance against known pathogens, but have not been described as conducting primary tissue immunosurveillance. We analyzed the expression of tissue-homing addressins in human TCM vs effector memory T cells (TEM) from the same donors. In humans, the majority of human TCM were tropic for either skin or gut, and the overall tissue tropism of TCM was comparable to that of TEM. TCM were present in healthy, noninflamed human skin, lung, colon, and cervix, suggesting a role for TCM in the primary immunosurveillance of peripheral tissues. TCM also had potent effector functions; 80% of CD8+ TCM produced TC1/TC2/TC17/TC22 cytokines. TCM injected into human skin–grafted mice migrated into skin and induced inflammatory eruptions comparable to TEM-injected mice. In summary, human TCM express peripheral tissue-homing receptors at levels similar to their effector memory counterparts, are found in healthy human tissues, have impressive effector functions, and can act alone to induce skin inflammation in human engrafted mice. Our studies support a novel role for human TCM in primary immunosurveillance of peripheral tissues and highlight the important role of this long-lived cell type in tissue-based immune responses.

Abstract Background Tinnitus, which can persist for many years, usually affects the quality of life. Tinnitus is challenging to manage with a variety of options including psychotherapy and pharmacological treatment. Intratympanic (IT) injections of steroids or lidocaine (LD) are two of the pharmacological treatment options used in the treatment of idiopathic tinnitus. Objective The aim of the study was to evaluate the efficacy and safety of IT-methylprednisolone acetate (MPA) versus IT-LD in the treatment of idiopathic subjective unilateral tinnitus of less than 1-year duration. Participants and methods In this randomized, double-blind, clinical study, 46 people who had been diagnosed with idiopathic subjective unilateral tinnitus were randomly divided into two groups and treated with IT-MPA acetate or IT-LD, accordingly. Improvement was evaluated in both groups 3 months after the injections and then again after 1 year. Safety was evaluated by recording the side effects of the injections. Results At 3 months after the injections, the mean improvement rates (using visual analog scale) were 56.5% in the MPA group and 47.8% in the LD group. After 1 year, this declined to 30.4 and 26.1%, respectively. The difference in improvement was not statistically significant. The side effects were all minor, and were primarily reported after LD injection. Conclusion IT injections of MPA and LD result in moderate improvement in tinnitus, but no statistically significant differences between these treatments were found.

Hepatocellular carcinoma (HCC) ranks as the third most prevalent reason for cancer-related death on a global scale. Tyrosine kinase inhibitors (TKIs) continue to be the primary treatment option for advanced hepatocellular carcinoma. A series of fluoro-11H-indeno[1,2-b]quinoxaline derivatives as an HCC drug targeting the VEGFR2/AKT axis was designed and synthesized. The novel compounds were investigated against HepG-2 and HuH-7 liver tumor cell lines. Compound 5 was the most active derivative against HepG-2 and HuH-7 cell lines with IC 50  = 0.75 ± 0.04 and 3.43 ± 0.16 μM, respectively, in contrast to Sorafenib which shows IC 50 values of 5.23 ± 0.31 and 4.58 ± 0.21 μM, respectively. IC 50 values on normal liver cells (THLE-2) show that all tests are more selective than Sorafenib, prompting further research. The most promising cytotoxic compound has virtually equal VEGFR2 inhibition efficacy to Sorafenib. The total VEGFR2 and p-VEGFR2 inhibitory effects were subsequently evaluated, showing 38.32 % and 77.64 % attenuation, respectively. Compound 5 also reduced total and phosphorylated AKT concentrations in HepG-2 cells by 55.29 % and 78.01 %, respectively. Furthermore, Compound 5 upregulated BAX and caspase-3 and downregulated Bcl-2 to promote apoptosis. Hybrid 5 stops HepG-2's cell cycle at the S phase 48.02 % higher than untreated. Docking experiments assessed AKT and VEGFR2 binding patterns., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Overall, stoma-related morbidity affects a reported 20-38% of pediatric patients. However, determining the true incidence of major stoma-related morbidity is challenging due to limited cohort sizes in existing studies. Thus, the aim of this study was to investigate colostomy related morbidity among children both after stoma formation and stoma closure., Methodology: This is a retrospective cohort hospital-based study, conducted in an Abha maternity and children hospital, between August 1, 2018, and August 1, 2023, among 126 pediatric patients (aged 0-12 years) who underwent colostomy formation and subsequent closure during the study period. Data were collected from medical records. Data was analyzed using Statistical Package for Social Sciences (SPSS) v.26., Results: This study included a total of 126 children who underwent colostomy. (N = 37, 29.4%) of cases included in this study were emergency cases, while (N = 89, 70.6%) were elective. A variety of antibiotics were used for surgical prophylaxis, metronidazole (77%) and cefuroxime (62.7%) were the most prevalent. Oral feeding was started after 5-6 days in more than one third of cases (39.7%). Wound infection (N = 15, 11.9%) was the most reported post-operative complication, followed with bowel obstruction (N = 6, 4.8%). Emergency cases had a longer duration of hospital stay than elective cases; this difference was statistically significant (P = .04)., Conclusions: Majority of patients reported no stoma related complications, while among those who reported complications, wound infection was the most reported complication, followed by bowel obstruction., (© 2024. The Author(s).)

Background and Aims: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by social difficulties, speech and nonverbal communication issues, and restricted behaviors. Nutritional issues, such as food allergies and intolerances, can affect children with ASD. This study aimed to evaluate the impact of diet programs on ASD behavior and gastrointestinal symptoms, which would be considered as a starting point to increase the family's knowledge about how to practice healthy and suitable dieting for their children., Materials and Methods: The study was a cross-sectional observational study on 45 children with an autism spectrum disorder in four centers aged 2-18 in Khartoum state. Data was collected through an interview questionnaire, which included sociodemographic, diet, gastrointestinal, and behavioral assessments. The data was analyzed using SPSS to find the correlation between the various variables. Independent t -test, Analysis of Variance, and Mann-Whitney test were used in univariant analysis to assess the association between study variables, while multiple linear regression was used in multivariant analysis for the same purpose., Results: The study involved a large number of children with autism spectrum disorder (ASD), with 80% being male and 73.3% being school-aged. Most had parents as guardians and 71.1% were in intermediate financial status. About 20% were overweight or obese, and 57.8% did not have a specific diet program. Food selectivity was prevalent, with 22.7% having allergies to milk and wheat. ASD children experienced vomiting, gastric reflux, abdominal pain, and changes in stool characteristics. A significant link was found between financial status, behavioral status and gastrointestinal changes. High financial status was significantly different from intermediate and low statuses based on behavioral changes. However, no significant association was found in multivariant analysis., Conclusion: The study found that ASD children generally have good nutritional health, with a higher degree of dietary selection. The financial status of guardians significantly influenced behavioral and gastrointestinal changes in the children. Further interventional studies are recommended to assess the direct impact of diet programs on these symptoms., Competing Interests: The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this articles., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Wastewater from the food industry is considered harmful to human health and aquatic life, as well as polluting water and soil. This research is centered around finding an affordable and easy physicochemical method for dealing with waste generated by the food industry. To accomplish this goal, a new bio-based flocculant called 4-benzyl-4-(2-oleamidoethylamino-2-oxoethyl) morpholin-4-ium chloride was created using sustainable sources, specifically crude olive pomace oil. Its chemical structure was confirmed using various spectroscopic techniques such as FTIR, 1 H-NMR, mass spectra, and 13 C-NMR. This new bio-based cationic flocculant was combined with alum to act as a coagulant in the waste treatment process. Also, a study was conducted to determine the optimal conditions for the coagulation-flocculation process parameters, namely, pH and alum dosage, on COD and removal efficiency. The results showed that the optimal conditions for flocculation were achieved at pH 5.8, with 680 mg/L alum and 10 mg/L of commercial flocculant dose compared to only 5 mg/L of a new bio-based cationic flocculant. A comparison was made between the new bio-cationic flocculant and a commercial CTAB one for treating wastewater in the food industry. The study found that the new bio-based cationic flocculant was more effective in reducing the chemical oxygen demand, achieving a reduction of 61.3% compared to 54.6% for using a commercial cationic flocculant. Furthermore, using a new bio-based cationic flocculant costs only 0.49 $/g, which is less than the present cationic flocculant, which costs 0.93 $/g. The adoption of this new flocculant provides a sustainable alternative to existing industrial wastewater treatment processes., (© 2024. The Author(s).)

Introduction and Importance: Dengue virus (DENV) is an RNA virus transmitted by Aides mosquito causing dengue fever. There is growing recognition of neurological symptoms associated with DENV infection, some of which might be lethal if left untreated. Case reports describing sagittal sinus thrombosis, as a serious neurologic consequence of dengue infection, are rare. It is still unknown how often sagittal sinus thrombosis occurs and what variables increase the risk in dengue patients., Case Presentation: Herein the authors presented an elderly Sudanese patient diagnosed with dengue fever. He was admitted, then 2 days after admission, the condition was complicated by atrial fibrillation, sagittal sinus thrombosis complicated by massive left temporal lobe infarction with haemorrhagic transformation and recurrent episodes of status epilepticus. After receiving the necessary care, his condition remained the same and no progress or deterioration was seen., Clinical Discussion: Sagittal sinus thrombosis can happen due to several underlying causes. DENV can very rarely lead to such condition. The authors' patient developed this condition, which was later complicated by ischaemic stroke with haemorrhagic transformation and status epilepticus. In addition to a familial history of DVT and a history of myocardial infarction, our patient also acquired cardiac mural thrombus and DVT throughout his illness, which increased the suspicion of a protein C, protein S, or antithrombin 3 deficiency., Conclusion: Sagittal sinus thrombosis with haemorrhagic infarction associated with thrombocytopenia is a very rare kind of stroke that occurs in dengue. Dengue as a pathogenic mechanism of ischaemic stroke requires validation with further data., Competing Interests: The authors declares no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Aims: Artificial intelligence (AI) has emerged as a rapidly developing tool within the medical landscape, globally aiding in diagnosis and healthcare management. However, its integration within healthcare systems remains varied across different regions. In Sudan, there exists a burgeoning interest in AI potential applications within medicine. This study aims to evaluate the knowledge, attitudes, and practices of AI applications in medicine among physicians in Sudan., Methods: The authors conducted a web-based survey cross-sectional analytical study using an online questionnaire-based survey regarding demographic details, knowledge, attitudes, and practice of AI distributing through various e-mail listings and social media platforms. A sample of 825 Physicians including doctors in Sudan with different ranks and specialties were selected using the convenient non-probability sampling technique., Result: Out of 825 Physicians, 666 (80.7%) of Physicians have previous knowledge about AI. However, only a small number 123 (14.9%) were taught about AI during their time in medical school, even fewer, just 120 (14.5%) had AI-related lessons in their training program. Regarding attitude, 675 (81.8%) agree that AI is very important in medicine, almost the same number, 681 (82.6%) support the idea of teaching AI in medical schools. Practically, 535 (64.8%) of doctors, think that should get special training in using AI tools in healthcare. Excitingly 651 (78.9%) of physicians are interested in working with AI in future. Based on different ranks of doctors toward AI; Medical Officers exhibited the highest proportion at (32.7%) of knowledge and understanding of AI concepts, followed by House Officers at (16.7%) ( p =0.076); regarding attitude, Medical Officers demonstrated the highest (31.6%) favorable attitude, followed by House Officers at (17.5%) ( p =0.229); In practice also, Medical Officer showed the highest portion (28.0%) among participants ( p =0.129)., Conclusion: While there is a positive attitude and some level of AI practice, there remains a considerable gap in knowledge that needs addressing., Competing Interests: The authors declared no potential conflicts of interest concerning the research, authorship, and /or publication of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Despite the widespread practice of consanguinity in Sudan, there is a lack of exploration into the community's awareness of its health implications on offspring and their overall attitude towards consanguineous unions., Aim: This study aimed to evaluate the community's awareness of the possible health adversities of consanguinity on children and assess the effect of knowledge level on the prevailing attitude towards this practice in Sudan., Methods: From August to December 2018, data were collected from adults aged 18 years and above in five provinces of Sudan regardless of their marital status. The analysis involved both descriptive and multivariate statistical techniques., Results: This study revealed a consanguinity rate of 30.2%. Despite a high awareness level (73.7%) regarding the effects of consanguineous marriage on the health of the offspring, a moderately negative attitude towards this practice (63.9%) was observed., Conclusion: The discordance between the high consanguinity rate in the Sudanese population and the moderately negative attitude suggests a potential persistence of this practice in the future. Without the implementation of educational programs and the provision of genetic counselling services to consanguineous couples, the prevalence of consanguinity is likely to endure., Competing Interests: The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Coumarins are heterocycles of great interest in the development of valuable active structures in chemistry and biological domains. The ability of coumarins to inhibit biofilm formation of Gram positive bacterium (Staphylococcus aureus), Gram negative bacterium (Escherichia coli) as well as the methicillin-resistant S. aureus (MRSA) has been previously described. In the present work, new hybrid coumarin-heterocycles have been synthesized via the reaction of coumarin-6-sulfonyl chloride and 6-aminocoumarin with different small heterocycle moieties. The biological efficacy of the new compounds was evaluated towards their ability to inhibit biofilm formation and their anti-inflammatory properties. The antimicrobial activities of the newly synthesized compounds were tested against Gram positive bacterium (S. aureus ATCC 6538), Gram negative bacterium (E. coli ATCC 25922), yeast (Candida albicans ATCC 10231) and the fungus (Aspergillus niger NRRL-A326). Compounds 4d, 4e, 4f, 6a and 9 showed significant MIC and MBC values against S. aureus, E. coli, C. albicans, and methicillin-resistant S. aureus (MRSA) with especial incidence on compound 9 which surpasses all the other compounds giving MIC and MBC values of (4.88 and 9.76 µg/mL for S. aureus), (78.13 and 312.5 µg/mL for E. coli), (9.77 and 78.13 µg/mL for C. albicans), and (39.06 and 76.7 µg/mL for MRSA), respectively. With reference to the antibiofilm activity, compound 9 exhibited potent antibiofilm activity with IC 50 of 60, 133.32, and 19.67 µg/mL against S. aureus, E. coli, and MRSA, (respectively) considering the reference drug (neomycin). Out of all studied compounds, the anti-inflammatory results indicated that compound 4d effectively inhibited nitric oxide production in lipopolysaccharide-(LPS-) stimulated RAW264.7 macrophage cells, giving NO% inhibition of 70% compared to Sulindac (55.2%)., (© 2024. The Author(s).)

Objectives: This study intends to evaluate the prevalence of active Schistosomiasis in school children, as well as their awareness, attitude, and behavior towards the illness in El-Rahad province., Methods: This facility-based analytical cross-sectional study among 495 primary school children aged seven to 13 in five villages; Structured and pre-tested questionnaires were used to collect the data in face-to-face interviews, in addition, urine samples were collected from each pupil and then assessed microscopically for S. Haematobium eggs Presence. Data was analyzed using SPSS version 25.0., Results: A total of 424 primary school students participated in the study. Almost all the students (96%) had poor knowledge about urinary schistosomiasis. In general, 100% of the students had poor practices. Attitude revealed that females have lower chance of having the infection than their male counterparts. About 27% ( n  = 115) of them had active urinary schistosomiasis infection at the time of the study., Conclusion: The study revealed poor level of awareness and knowledge, positive attitude, and poor practices among primary school students. There was also high level of active infection among participants., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)

Background: Increased COVID-19 transmission among the populace may be caused by healthcare workers (HCWs) who lack knowledge, awareness, and good preventive practices. Additionally, it may cause elevated stress levels, anxiety, poor medical judgement, and situational overestimation., Objectives: The present survey aimed to assess knowledge and risk perception regarding COVID-19 among HCWs in Khyber Pakhtunkhwa (KP), Pakistan., Methodology: A web-based online, pre-tested questionnaire comprising 26 items was circulated via social media in April 2020 amongst HCWs in major tertiary care facilities in KP., Results: The study's results, revealing both the commendable knowledge levels among HCWs about COVID-19 and their heightened risk perception, highlight the critical need for targeted interventions to address the potential impact on self-protective behaviour and mental health within this vital workforce. This insight is important for designing strategies that not only enhance HCWs' well-being but also ensure the continued effectiveness of healthcare delivery during pandemics. The percentage mean score (PMS) of COVID-19 knowledge was 85.14±10.82. Male HCWs and those with an age older than or equal to 32 years demonstrated a higher knowledge score (85.62±11.08; P =0.032 and 87.59±7.33, P =0.021, respectively). About 76% of HCWs feared contracting COVID-19. Nearly 82% of respondents were mentally preoccupied with the pandemic and also terrified of it. 'Of these, 81% were nurses, 87% had a job experience of 6-8 years and 54.45% were frontline workers. Feelings of panic and concern about the pandemic were found to be more in HCWs who were physicians above the age of 32, and who had 3-5 years of work experience. HCWs' overall risk perception was found to be significantly different between males (7.04±2.26) and females (8.01±1.97), job experience of 6-10 years (8.04±177) with 3-5 years and younger than or equal to 2 years job experience (7.18±2.43,6.93±2.22), respectively, and between frontline HCWs (7.50±2.10) and non-frontline HCWs (6.84±2.40)., Conclusion: HCWs demonstrated good knowledge about COVID-19. As the risk perception of COVID-19 among HCWs is high, it can raise concerns about their self-protective behaviour, and mental health. These issues need to be addressed., Competing Interests: The authors declared no potential conflicts of interest concerning the research, authorship, and /or publication of this article.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction and Importance: Sternalis/rectus sterni is a rare muscle found in the anterior chest wall, it occurs in 35% of humans. The early detection of its presence is critical in regular mammogram screening in order to avoid possible differential diagnostic dilemma., Case Presentation: We report here a case of the sternalis muscle observed bilaterally, it was found during routine dissection session of an elderly male cadaver in the dissection room, Faculty of Medicine, University of Khartoum., Clinical Discussion and Conclusion: Sternalis muscle is a familiar entity to anatomists, but can pose a diagnostic and surgical dilemma to some clinicians. Presence of the muscle can be confusing in regular mammogram screening and CT and MRI should be utilized to clear the dilemma, and further evidence needs to be explored and studied., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Sudan is classified among countries with a high hepatitis B surface antigen (HBsAg) endemicity of more than 8%. Cross-sectional studies have showed a marked increase in the prevalence of occult hepatitis B infection (OBI) in patients with cirrhosis or hepatocellular carcinoma. In terms of OBI infectivity by transfusion, it is largely unknown whether residual risk estimates translate into true rates of infection., Aim: The current study aimed to determine the frequency of OBI among blood donors in Sudan., Materials and Methods: This study was carried out during the period between 2011 and 2012. It included 100 HBsAg-negative blood donors who attended the Central Blood Bank in Sudan. Sera collected from all donors were tested for HBsAg, antibodies against hepatitis B core antigen (anti-HBc), antibodies against hepatitis Be antigen (anti-HBe), and antibodies against hepatitis B surface antigen (anti-HBs) by enzyme-linked immunosorbant assay. Anti-HBc-positive patients were tested for hepatitis B virus (HBV)-DNA., Results: The anti-HBc was detected in 42% of the blood donors, among whom 90.5% were positive for HBV-DNA. Two main profiles have been detected, namely, the presence of the three genes (S, C, and X genes) together in 35.7% of the blood donors or the presence of the X gene in addition to the core gene., Conclusion and Recommendations: With the use of HBsAg as the sole detection marker for HBV, there is a danger of HBV transmission through blood transfusion. Anti-HBc testing should be added to the routine blood donor screening test if occult hepatitis B is to be diagnosed.

Jejunal leiomyosarcoma is a rare neoplasm. We report a case of gigantic leiomyosarcoma of the jejunum in a 30-year old man who presented with abdominal distension, pain and constipation. Computerized tomography scan revealed a giant tumor filling the entire abdominal cavity. Fine needle aspiration cytology was suspicious. At laparotomy, a huge jejunal leiomyosarcoma measuring 30 x 25 x 19 cm and weighing 13 kg was completely excised. To the best of our knowledge, this is the first case of a giant jejunal leiomyosarcoma.