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The present study investigated the toxicity of cadmium (Cd) to the freshwater mussel Unio tigridis. Mussels were treated with six doses of cadmium chloride (CdCl2) control (0), 1, 2, 3, 4, and 5 ppm for up to 96 hours. The Cd accumulation and oxidative stress markers, including Acetylcholinesterase (AChE), malondialdehyde (MDA), reduced glutathione (GSH), and catalase (CAT) rather than histological changes were evaluated. Results showed that exposure to CdCl2 induced a significant increase in MDA levels and CAT activity. Notably, a significant decrease was observed in the AChE and GSH levels in the groups exposed to CdCl₂, which was dependent on exposure time. The cadmium (Cd) concentrations in both aquarium water and the mussel’s body have fluctuated, and these changes were influenced by the concentration and duration of the exposure. Histological investigation of the mussel gills showed alternation in gill structure after being exposed to different cadmium concentrations when compared to the control group.

Abstract Introduction Placenta is a vital organ with highly specialized functions. According to the Perinatal Section of the Pediatric Pathology Society, placental histopathological abnormalities are typically categorized into maternal vascular hypoperfusion, fetal thrombotic vasculopathy, and inflammatory lesions. This study aims to assess the placental histopathological abnormality results in relation to adverse obstetric outcomes and to investigate whether specific placental abnormalities are associated with particular adverse outcomes. Methods A retrospective cross-sectional study was conducted between January 2017 and January 2020 including all women who were admitted to Sultan Qaboos University Hospital with an adverse obstetric outcome who met the inclusion criteria, and whose placentas were sent for histopathological examination. Results A total of 191 women were included in the study. The most common adverse obstetric outcomes included preterm labor (25.1%), fetal growth restriction (FGR) (19.4%), preeclampsia and related complications (15%), placental abruption (14.1%), and chorioamnionitis (14%). 74% of women had abnormal placental findings. Among women with preterm labor, inflammatory lesions were present in 56.3% of cases (p = 0.006). Fetal thrombotic vasculopathy lesions were present in 13.5% of FGR cases (p = 0.037). In preeclampsia cases, maternal under perfusion lesions were present in 79% of cases (p = 0.013). Conclusion Placental histopathological examination is an important tool for assessing perinatal outcomes. Correlating placental findings with specific obstetrical conditions and adverse outcomes provides valuable information that can assist obstetricians in developing appropriate management plans for future pregnancies.

Abstract In this study, we analysed the mutation spectrum in subjects with suspected lipodystrophy using a targeted Next-generation sequencing (NGS) approach. Subjects with suspected lipodystrophy were for screened six genes (AGPAT2, BSCL2, LMNA, PPARG, ZMPSTE24, INSR) and the variants identified were confirmed through Sanger sequencing. The clinical and biochemical parameters were compared among the mutation positive and negative subjects. We identified eight individuals with pathogenic or likely pathogenic mutations, including both homozygous and heterozygous variants. Homozygous variants included AGPAT2(NM_006412.4):c.493-2A>G, AGPAT2(NM_006412.4):c.254_258dup, and BSCL2(NM_001122955.4):c.570del, while heterozygous variants encompassed LMNA(NM_170707.4):c.1444C>T, LMNA(NM_170707.4):c.1456A>G, LMNA(NM_170707.4):c.1445G>A, and PPARG(NM_015869.5):c.949T>C mutations. In this cohort, three subjects were diagnosed with congenital generalized lipodystrophy, while the remaining five had familial partial lipodystrophy. Majority (7/8) of the patients with lipodystrophy had hepatic involvement. Notably, more than half of the subjects (5/8) achieved optimal glycemic control through insulin sensitizers (PPARγ agonist and Metformin). Interestingly, even with a limited gene panel test, mutation-positive individuals exhibited a higher prevalence of typical clinical features and biochemical characteristics associated with lipodystrophy compared to their mutation-negative counterparts. In subjects with lipodystrophy, targeted NGS based screening may establish a genetic diagnosis and aid in family screening and genetic counselling. Knowing the clinical and biochemical features typical to lipodystrophy may help in diagnosis especially in resource limited setting.

Objective: Thyrotoxic periodic paralysis is a rare manifestation of thyrotoxicosis. Here, we describe the clinical and biochemical features and treatment outcomes of this disorder. Methods: This retrospective study was conducted at a tertiary care centre in southern India. The clinical and biochemical features, treatment received, and therapeutic outcomes of all patients with thyrotoxicosis and acute flaccid paralysis without any other identifiable causes (cases for the study) were compared with an equal number of consecutively selected patients who presented with thyrotoxicosis but without features of paralysis (controls for the study) during the same period. Results: In total, 41 cases and controls were included in this study. The proportion of males was 92.6% and 43.9% in the cases and controls, respectively. The mean age was 32.8 (±7.6) years (cases) and 39.7 (±11.3) years (controls). In the cases, 20% of patients presented without clinical thyrotoxic features. Graves’ disease was the most common aetiology of thyrotoxicosis in both groups (92.6% of cases and 87.8% of controls). The prevalence of goitre was significantly higher among controls (90.2%) than among cases (53.7%). The mean serum potassium, free T4, total T4 and total T3 levels were significantly lower in the cases than in the controls. In these cases, two patients had an additional aetiology for persistent hypokalaemia, likely Gitelman’s syndrome. Conclusion: This is one of the largest series of thyrotoxic periodic paralysis cases in India. In subjects with thyrotoxicosis, serum potassium, free T4, total T4 and total T3 levels were significantly lower in those with periodic paralysis than in those without.

Abstract An emerging paradigm in modern electronics is that of CMOS+ $${\mathsf{X}}$$ X requiring the integration of standard CMOS technology with novel materials and technologies denoted by $${\mathsf{X}}$$ X . In this context, a crucial challenge is to develop accurate circuit models for $${\mathsf{X}}$$ X that are compatible with standard models for CMOS-based circuits and systems. In this perspective, we present physics-based, experimentally benchmarked modular circuit models that can be used to evaluate a class of CMOS+ $${\mathsf{X}}$$ X systems, where $${\mathsf{X}}$$ X denotes magnetic and spintronic materials and phenomena. This class of materials is particularly challenging because they go beyond conventional charge-based phenomena and involve the spin degree of freedom which involves non-trivial quantum effects. Starting from density matrices—the central quantity in quantum transport—using well-defined approximations, it is possible to obtain spin-circuits that generalize ordinary circuit theory to 4-component currents and voltages (1 for charge and 3 for spin). With step-by-step examples that progressively become more complex, we illustrate how the spin-circuit approach can be used to start from the physics of magnetism and spintronics to enable accurate system-level evaluations. We believe the core approach can be extended to include other quantum degrees of freedom like valley and pseudospins starting from corresponding density matrices.

Abstract Background Defining the protective thresholds against the severe-acute-respiratory-syndrome-related corona virus-2 pandemic is a crucial challenge. To reduce the risks of severe disease, hospitalization, and death, various COVID-19 vaccines have been rapidly developed. Aim of the work This study aimed to assess the impact of three common COVID-19 vaccine types; two mRNA COVID-19 vaccines: (Pfizer/BioNTech’s BNT162b2 and Moderna’s mRNA-1273), one adenoviral vector vaccine: Oxford/AstraZeneca’s ChAdOx1, and one inactivated vaccine (Sinovac Biotech/China’s Sinovac) on the level of neutralizing antibodies, considering factors such as vaccine type, demographic characteristics, and hybrid immunity. We conducted a direct comparative analysis involving 300 healthcare workers, both with and without prior SARS-CoV-2 infection (B.1, C.36.3, and AY.32 (Delta) variants). Neutralizing antibodies levels were measured at baseline (before vaccination), before the second dose, and six months after the second dose. Results The results showed a significant increase in neutralizing antibodies levels after complete vaccination with all vaccine types. Among healthcare workers, those vaccinated with mRNA vaccines (Moderna or Pfizer) exhibited the highest neutralizing antibodies titers, followed by AstraZeneca, and finally Sinovac with the lowest titer. On studying the effect of previous COVID-19 infection after vaccination, no significant difference in neutralizing antibodies levels was observed between healthcare workers vaccinated with mRNA or AstraZeneca vaccines, both with prior COVID-19 infection, following the first and six months after the second dose. Conclusion These findings suggest that individuals with prior COVID-19 may only require a single dose of mRNA or AstraZeneca vaccines to achieve a similar level of immunization as those without prior COVID-19 who completed the vaccination program. Highlights There is a significant increase in neutralizing antibodies levels after complete vaccination against COVID-19 Vaccination with mRNA vaccines exhibits the highest neutralizing antibodies titers. Vaccination with Sinovac exhibits the lowest neutralizing antibodies titers. Graphical abstract

Objective: This study aims to conduct an epidemiological analysis of the country, race, weapon type, and type of attack, along with the medical consequences of terrorist attacks on ambulances. Methods: The population of this retrospective cross-sectional epidemiological study consisted of terrorist attacks on ambulances, as documented in the Global Terrorism Database provided by The National Consortium for the Study of Terrorism and Responses to Terrorism, covering the period from 1970 to July 2021. Incidents, deaths, and injuries from these terrorist attacks were analyzed according to country, attack type, and weapon type. Additionally, incidents, deaths, injuries, and material losses from attacks against ambulances were analyzed by year. Results: In the last 52 years, 80 terrorist incidents occurred, and 444 people were adversely affected medically in 75 of these incidents. In 96.3% of these cases, the terrorist organization achieved its desired goal, and 71.3% resulted in material loss. During this period, terrorist attacks on ambulances were reported in 27 countries. In 17 of these incidents, the nationality of the attacker was different from that of the target person, and 70 people were adversely affected medically. These incidents featured seven different types of attacks and five different types of weapons. The most preferred type of attack was bombing (n=38), while the most commonly used weapon type was explosives (n=39). Conclusion: In the last six years, there has been an increase in terrorist attacks, adversely affecting many people medically. The main reasons for this increase include growing civil unrest in countries, easy access to ambulances, perceived lack of threat, and a rise in individual armament. Due to these issues, it is crucial to train health workers, take precautions, make preparations, and create emergency action plans to mitigate terrorist attacks.

Abstract Background Sickle cell hepatopathy (SCH) is a relatively uncommon complication of sickle cell disease (SCD), yet it does not accommodate variations in presentation, outcome, or severity according to age. Aim To present SCH characteristics and assess the effect of implementation of a high-suspicion systematic diagnostic approach and early intervention plan of management. Methods This case series presented the characteristics of five children with SCD with variable hepatic manifestation and implemented a diagnostic approach that included testing the transaminases and bilirubin in any patient with any suspicion of liver affection. Results The five patients had a complicated SCD history. They all presented with fever, abdominal pain, and deepening of jaundice. The final diagnosis was reached with a more individualized approach; two had significant coagulopathy and were diagnosed with sickle cell intrahepatic cholestasis, while one had normal synthetic functions of the liver with rising transaminases and bilirubin levels, as well as high titer of Epstein–Barr virus diagnosed as acute viral hepatitis complicated with sickle cell hepatic crisis. One other patient had markedly elevated bilirubin with mild elevation of transaminases, and magnetic resonance cholangiopancreatography showed acute extrahepatic biliary dilatation treated by endoscopic removal of the stone. The fifth patient proved to have portal vein thrombosis by portal duplex causing portal hypertension and decompensated liver. The management plan included early exchange transfusion to keep their hemoglobin S (HbS) below 15% which was performed in three of the patients, in addition to aggressive supportive measures for correction of coagulopathy with full recovery and normalization of their liver functions. Conclusion Despite the diagnostic challenges, the lack of standard diagnostic criteria, and the overlapping clinical presentation of SCH, the management and outcomes improved by following a systematic diagnostic approach.

Abstract Background Schizophrenia is a chronic severe mental disorder characterized by impairment in cognition, emotion, perception, and other aspects of behavior. In light of the association of craniofacial dysmorphology with schizophrenia, mandibular morphology may provide clues about the role of neurodevelopment in the pathophysiology of schizophrenia. This retrospective cross-sectional study aimed to compare the mandibular morphology of patients with schizophrenia with controls using digital panoramic radiography (DPR). Methods 302 recorded diagnostic panoramic images obtained from 143 schizophrenia patients (98 males, 45 females), and 159 controls (73 males, 86 females), aged 18–45 years, were evaluated. Seven mandibular measurements consisting of ramus height, condylar height, gonial angle, antegonial angle, antegonial notch depth, ramal notch depth and bigonial width were measured from the DPRs in a double-blinded manner. Bivariate comparisons were carried out using the Independent t-test and Mann–Whitney U test. Logistic regression analysis was used for multivariate comparisons. Results Linear measurements were higher while angular measurements were lower in schizophrenia patients. Regression analyses indicated that female patients had greater ramus height (OR = 1.243; P = 0.001), condylar height (OR = 1.463; P = 0.048) and bigonial width (OR = 1.082; P

Ovarian hyperstimulation syndrome (OHSS) usually occurs in patients undergoing assisted reproduction techniques and ovulation induction. Its variant, spontaneous ovarian hyperstimulation syndrome, a potentially life-threatening disorder, is uncommon and only a few cases have been reported in association with hypothyroidism. This study analysed five patients with untreated chronic hypothyroidism presenting with multicystic ovaries, isosexual precocious puberty, and delayed bone age; subsequently, the follow-up and regression of ovarian pathology was assessed. Two patients had presented to the emergency department with menorrhagia and hypotension, of these, one had ovarian torsion at presentation. Three patients presented to the outpatient department: one for evaluation of short stature, one for premature menarche, and another with polycystic ovaries. They were all diagnosed with long-standing, untreated chronic hypothyroidism. There was regression of the size of the cystic ovaries on subsequent follow-up. In all these patients, long-standing hypothyroidism had resulted in ovarian hyperstimulation syndrome. The potentially life-threatening complications of this syndrome may be prevented by careful screening and a strong index of clinical suspicion at the outset.

Background: Intracranial hemorrhage (ICH) is reportedly rare but has high morbidity and mortality risk in persons with hemophilia. Although the risk factors that facilitate bleeding are known, the factors affecting the sequelae are not well known. Objectives: We planned to investigate the risk factors for neurologic sequelae in children and adolescents with hemophilia suffering from ICH. Methods: An invitation was sent to pediatric hematology centers via email. Clinical and laboratory findings, neurologic sequelae, and recurrence of bleeding in persons with hemophilia who developed ICH were questioned. Results: Eighty-six patients from 21 centers were evaluated. All patients were less than 18 years of age at the time of ICH. Thirteen patients had ICH in the neonatal period, while 40 patients had a known diagnosis of hemophilia before ICH, and 33 patients were undiagnosed before ICH. Five patients died, 2 of whom died in the neonatal period. The rate of neurologic sequelae was 25 of 81 (30%). The most common neurologic sequela was epilepsy (n = 11/25), followed by hemiparesis (n = 5/25). Cerebral shift (odds ratio, 3.48) and development of ICH in the neonatal period (odds ratio, 4.67) were significant for the development of neurologic sequelae in multivariate analysis. On follow-up, recurrence of ICH occurred in 8 of 81 (10%). Conclusion: ICH in the neonatal period and cerebral shift were the two main risk factors for the development of neurologic sequelae. Neonatal departments must be alert to the signs of bleeding. It is important for healthcare professionals to overcome the barriers to primary prophylaxis and to take trauma-related precautions.

Objective: The aim of the study was to evaluate respiratory syncytial virus (RSV) infections in cases followed in the pediatric intensive care unit (PICU). Materials and Methods: The study was designed as a prospective cohort in 6 PICUs. There were 3 groups: only RSV (+), RSV (v+) who were positive for another viral agent(s) in addition to RSV, and RSV (b+) who were positive for a bacterial agent(s) in addition to RSV. Results: A total of 119 cases were included in the study, 67 (56.3%) of whom were male. The RSV (+) group had a lower pH compared to the other groups and a higher rate of acute bronc hiolitis/bronchitis diagnoses compared to the RSV (v+) group. The RSV (v+) group had higher bicarbonate levels, higher creatinine levels, longer hospital stays, and higher Pediatric Risk of Mortality-3 scores (PRISM-3) compared to the RSV (+) group. Cases with RSV (b+) were younger and also had lower body weight compared to the other groups. Furthermore, the RSV (b+) group had higher C-reactive protein and Procalcitonin (PCT) levels and higher rates of High Flow Nasal Cannula-Oxygen Therapy (HFNC-OT) use. Multiple linear regression analysis revealed that PRISM-3 score, PCT levels, Pediatric Acute Respiratory Distress Syndrome diagnoses, inhaled steroid use, chronic illness status, and heart rate on admission were associated with the length of stay in the PICU. Conclusion:High flow nasal cannula-oxygen therapy continues to be the most frequently preferred respiratory support method in RSV infections. Viral infections accompanying RSV can increase the severity of the disease.

Understanding the health culture of tribal community is important as health problems among tribal communities and their care is influenced by sociocultural factors, which will help in the implementation of health services. The conventional way of improving the access for the general populations may not suit the tribal populations owing to their distinct culture and owing to health systems factors as well. A stepwise process was followed for the development of a protocol to study to strengthen the implementation of National Programme for Prevention and Control of Non-Communicable Diseases. The study was planned to be carried out across six tribal districts of India. A detailed protocol was built around Implementation Research Logic Model, primarily as a method for planning, executing, reporting, and synthesizing the implementation.

Abstract Cochlear implant (CI) benefits deaf children's speech perception, language development and speech production. Early fitting of an implant results in improved outcomes. Over a period of more than 3 decades, cochlear implantation (CI) is firmly known as safe and effective treatment for children with bilateral severe to profound sensorineural hearing loss (SNHL) who develop minimal or no benefit from conventional hearing aid use. The primary aim of CI is to improve auditory perception of the child and hence the spoken language. The development of functional spoken language would be the major long-term benefits of CI. Children who received a cochlear implant before a real delay in spoken language development (i.e., between 12–16 months) were more able to achieve age-appropriate spoken language. These results strengthen the idea of doing cochlear implantation before 24 months of age, especially for children with a better ear aided pure tone with average thresholds greater than 65 dB prior to surgery.The main aim is to study the effect of age on CI patients results by applying simple questioners on 31 CI children, that are easy to assess the auditory perception and discrimination as an important prerequisite for language development. Results There was an inverse correlation between; age at CI, categories of auditory performance (CAPS), and meaningful auditory integration scale (MAIS) scores. While; there was direct correlation between MAIS & CAPS scores. Conclusions The auditory perception development after CI in children being 3 years old or younger is much better than the older children which would be reflected on their speech perception and acquiring their 1st word and sentence, but language development did not differ between both groups for this period of follow up. With a need of further detailed full language aspects assessment and follow up to ensure these results.

Abstract Introduction Treatment of an immature permanent tooth required a special disinfection protocol due to the presence of thin radicular walls, which are prone to fracture. Mineral Trioxide Aggregate (MTA) has been proposed as a root repair material for root canal treatment. The aim of this in vitro study was to compare the push-out bond strength of conventional White MTA cements and second generation NeoMTA 2 in imitated immature roots treated with different disinfection protocols, which are 5.25% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA), and NaOCl, followed by 20% etidronic acid (HEBP). Methods The root canals of freshly extracted single-root teeth were manually prepared until 90 K-file to imitate immature roots. Roots were randomly divided into four groups (G) according to the disinfection protocol (n = 15 per group). where G1 (NaOCl + EDTA + White MTA) and G2 (NaOCl + EDTA + NeoMTA 2) While G3 (NaOCl + HEBP + White MTA) and G4 (NaOCl + HEBP + NeoMTA 2) All groups were activated with manual agitation. All specimens were incubated for 48 h. The apical third of each root was perpendicularly sectioned to attain a slice of 3 mm thickness. Push-out bond strength values were assessed using a two-way ANOVA and a Student’s t test. Results G3 and G4 that were treated with HEPB showed higher significant push-out bond strength mean values than G1 and G2 treated with an EDTA chelating agent. Irrespective of the chelating agent used, it was found that both NeoMTA 2 and White MTA had no significant influence on push-out bond strength mean values (p ≤ 0.05). Conclusion The combined use of 5.25% NaOCl and 20% HEBP increased the push-out strength values of both NeoMTA 2 and White MTA, rendering them suitable to be used as an alternative chelating agent to EDTA.

Abstract The newly recorded Phyllymenia gibesii in the Mediterranean Sea at Alexandria coast of Egypt is regarded as a significant source of bioactive substances and is applied as an antioxidant, anti-inflammatory, and antimicrobial agent. According to the HPLC chromatograms, the acetone extract of P. gibesii comprised ten photosynthetic pigments (chlorophyll-a, chlorophyll-d, α-carotene, β-carotene, phycocyanin, allophycocyanin, antheraxanthin, β-cryptoxanthin, lutein, and violaxanthin). Total carotenoids were the dominant class in the pigments’ profile, achieving a concentration of 257 g/g dry weight. The P. gibbesii extract had a total content of phenols (146.67 mg/g) and a total content of flavonoids (104.40 mg/g). The capacity of all the investigated biological activities augmented with the concentration of the algal extract. The maximal DPPH scavenging capacity was 81.44%, with an inhibitory concentration (IC50) of 9.88 μg/mL. Additionally, the highest ABTS scavenging capacity was 89.62%, recording an IC50 of 21.77 μg/mL. The hemolytic activity of P. gibbesii attained a maximum capacity of 49.88% with an IC50 of 100.25 μg/mL. Data also showed the maximum anti-inflammatory effectiveness at 81.25%, with an IC50 of 99.75 μg/mL. Furthermore, the extract exhibited antimicrobial capacity against all reference strains, particularly at high concentrations (0.1 mg/mL), with the greatest effect on C. albicans and E. coli.

Hypertensive disorders of pregnancy are significant contributors to maternal and perinatal morbidity and mortality. The definition, classification, and management of these disorders have evolved over time. Notably, the disease classification enables caretakers to manage the disease as well as safeguard maternal and fetal health. The approach and management for pregnancies with gestational and chronic hypertension or pre-eclampsia with or without severe features should be adequately elucidated to mitigate adverse perinatal outcomes. This review aimed to present the most recent definition and classification of hypertensive disorders of pregnancy to address their management, determine the optimal timing of birth, and establish short- and long-term follow-up protocols following parturition.

INTRODUCTION: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported non-adherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the Coronavirus disease-2019 (COVID-19) pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. METHODS: This was a multicenter survey study that was sent to pediatric endocrinologists during the pandemic period (June-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, missed dose data and the causes in the recent year (after the onset of the pandemic) were questioned. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% non-adherence). RESULTS: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and “others“ (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 μg/kg, the annual growth rate was 1.15 standard deviation score (minimum -2.74, maximum 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for non-adherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Non-adherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as non-adherence rate increased. DISCUSSION AND CONCLUSION: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.

INTRODUCTION: Maturity onset diabetes of the young (MODY) occurs due to mutations in genes involved in pancreatic beta cell function and insulin secretion, has heterogeneous clinical and laboratory features, and account for 1-5% of all diabetes cases. The prevalence and distribution of MODY subtypes vary between countries. The aim of this study was to evaluate the clinical and laboratory characteristics, mutation distribution, and phenotype-genotype relationship in a large case series of pediatric Turkish patients genetically diagnosed with MODY. METHODS: MODY cases from 14 different pediatric endocrinology departments were included. Diagnosis, treatment, follow-up data, and results of genetic analysis were evaluated. RESULTS: A total of 224 patients were included, of whom 101 (45%) were female, and the mean age at diagnosis was 9.4±4.1 years. Gene variant distribution was: 146 (65%) GCK; 43 (19%) HNF1A; 8 (3.6%) HNF4A, 8 (3.6%) KLF11 and 7 (3.1%) HNF1B. The remaining 12 variants were: PDX (n=1), NEUROD1 (n=3), CEL (n=1), INS (n=3), ABCC8 (n= 3) and KJNC11 (n=1). Of the cases, 197 (87.9%) were diagnosed with incidental hyperglycemia, 16 with ketosis (7%) and 7 (3%) with diabetic ketoacidosis (DKA), while 30% presented with classical symptoms of diabetes. Two-hundred (89%) had a family history of diabetes. Anti-GAD antibody was detected in 13 cases, anti-islet antibody in eight and anti-insulin antibody in four. Obesity was present in 16. Distribution of therapy was: 158 (71%) diet only; 23 (11%) intensive insulin treatment; 17 (7.6%) sulfonylureas; 10 (4.5%) metformin; and 6 (2.7%) insulin and oral anti-diabetic treatment. DISCUSSION AND CONCLUSION: This was the largest genetically diagnosed series from Turkey. The most common gene variants were GCK and HNF1A with much lower proportions for other MODY types. Hyperglycemia was the most common presenting symptom while 11% of patients had diabetes-associated autoantibodies and 7% were obese. The majority of patients received dietary management only.

The aim of this study is to determine the experiences of students with high levels of digital addiction in their application of digital detox processes to reduce or overcome their addiction. The Digital Addiction Scale for University Students, developed by Kesici and Tunç (2018), was applied to 152 students participating in the study, and interviews were conducted with 49 students who had high/very high levels of digital addiction. Based on volunteered participation, 10 students were included in the digital detox program. Data were collected using a semi-structured interview form and analyzed using content analysis. It has been observed that students express that overcoming digital addiction with beneficial activities is a challenging yet highly useful experience. Students have stated that the easiest applications for them during the digital detox process are not watching anything while eating, picking up a hobby, and using a wristwatch, while the most challenging applications are turning off notifications for mobile applications and leaving the phone in another room while going to bed. Furthermore, it has been observed that while some students describe reading books as an easy application in the digital detox, others express that they face difficulties in implementing this application.

Introduction: Ultrasonic retrieval is a time-consuming procedure sacrificing considerable amounts of dentin. This study aimed to assess the retrieval capability of katana tip on different alloys under different lubricants regarding dentin thickness and retrieval time. Materials and Methods: Extracted premolars were used to reach 40 samples. The apical 4 mm of X2 ProTaper Next and A1 Neoniti instruments were fractured, and katana tip was utilized for retrieval, using ethylenediaminetetraacetic acid or olive oil as intracanal lubricants. Dentin thickness was assessed using cone-beam computed tomography, and the time of retrieval was recorded. Results: There was no significant difference in the retrieval capability among the groups. Different alloys and lubricants had no significant effect on dentin thickness. However, olive oil significantly reduced the retrieval time. Conclusion: Katana tip proved to be efficient enough to retrieve apically separated instruments in curved canals, with instrument’s metallurgical makeup presenting minimal effect on its capability. Katana tip and high-viscosity lubricants reduced the retrieval time, which might reduce the dentin removal amount.

Bilateral edematous optic disc swelling from papilledema is caused by elevated intracranial pressure (ICP). Idiopathic intracranial hypertension (IIH), a clinical syndrome with elevated ICP of unclear etiology, is a frequent cause of this condition. IIH typically affects obese middle-aged females. Papilledema usually has a fairly symmetrical bilateral pattern. Unilateral papilledema is a rare disorder that must be detected early to avoid optic nerve damage. However, the etiology of unilateral papilledema remains unclear. Based on bilateral optic nerve sheath diameter measurements, we aimed to find an explanation for the unilaterality in this rare case.

Objective: Spinal muscular atrophy (SMA) is a hereditary disorder with progressive muscle weakness and atrophy. Nusinersen is an antisense oligonucleotide directed against SMN2 and has been shown in studies to improve the motor skills of patients. The aim of this study was to evaluate the efficacy of nusinersen treatment in patients with SMA type 2 and type 3 using the Hammersmith Functional Motor Scale Expanded (HFMSE) score. Method: The diagnosis and differentiation of SMA type 2 and type 3 were based on clinical findings and genetic tests. The HFMSE scores of all patients were evaluated in detail before nusinersen doses. Results: Evaluation was made of a total of 15 patients, 12 SMA type 2 and 3 SMA type 3, with a median age of 13 years. None of the patients had regression of acquired abilities after nusinersen treatment. The median HFMSE score of SMA type 2 patients before treatment was 9. After nine doses of nusinersen, the HFMSE score showed a significant increase from 9 to 30 points. Although none of the patients could walk, their motor skills improved significantly. The median HFMSE score of SMA type 3 patients before treatment was 60. After 3 doses of nusinersen treatment, HFMSE scores were found to be 63. Conclusion: Nusinersen is an effective and safe treatment for patients with late-onset SMA. It can be suggested that different motor scales should be applied and developed for SMA type 2 (sitter) and type 3 (walker) patients due to differences in the clinical characteristics of SMA types.

Abstract There is an enormous diversity of life forms present in the extremely intricate marine environment. The growth and development of seaweeds in this particular environment are controlled by the bacteria that settle on their surfaces and generate a diverse range of inorganic and organic chemicals. The purpose of this work was to identify epiphytic and endophytic bacterial populations associated with ten common marine macroalgae from various areas along the Mediterranean Sea coast in Alexandria. This was done to target their distribution and possible functional aspects. Examine the effects of the algal habitat on the counting and phenotypic characterization of bacteria, which involves grouping bacteria based on characteristics such as shape, colour, mucoid nature, type of Gram stain, and their ability to generate spores. Furthermore, studying the physiological traits of the isolates under exploration provides insight into the optimum environmental circumstances for bacteria associated with the formation of algae. The majority of the bacterial isolates exhibited a wide range of enzyme activities, with cellulase, alginase, and caseinase being the most prevalent, according to the data. Nevertheless, 26% of the isolates displayed amylolytic activity, while certain isolates from Miami, Eastern Harbor, and Montaza lacked catalase activity. Geographical variations with the addition of algal extract may impact on the enumeration of the bacterial population, and this might have a relationship with host phylogeny. The most significant observation was that endophytic bacteria associated with green algae increased in all sites, while those associated with red algae increased in Abu Qir and Miami sites and decreased in Eastern Harbor. At the species level, the addition of algal extract led to a ninefold increase in the estimated number of epiphytic bacteria for Cladophora pellucida in Montaza. Notably, after adding algal extract, the number of presented endophytic bacteria associated with Codium sp. increased in Abu Qir while decreasing with the same species in Montaza. In addition to having the most different varieties of algae, Abu Qir has the most different bacterial isolates.

Background and objective: LN19183 is a proprietary, synergistic combination of Citrus aurantifolia fruit rind and Theobroma cacao seed extracts that increased resting energy expenditure (REE) in high-fat diet (HFD)-fed obese rats. The objective of this study was to validate the thermogenic potential of LN19183 in obese Sprague Dawley (SD) rats and to assess its clinical efficacy in a proof-of-concept, randomized, placebo-controlled, cross-over human trial. Methods: In the rat study, HFD-fed obese rats were supplemented with either HFD alone or with 45, 90, or 180 mg LN19183 per kg body weight (BW) for 28 days. In the human study, 60 overweight adults (male and female, aged 20–39 years) were randomized. Subjects took LN19183 (450 mg) or a matched placebo capsule on two consecutive days in phases one and two of the study, separated by a 10-day washout period. In each phase, on day 1, REE at pre-dose, 60-, 120-, and 180-min post-dose, and on day 2, metabolic rates at pre-dose and post-dose during and 20 min after exercise were measured using indirect calorimetry. Results: In rats, LN19183 significantly increased REE, reduced BW gain and fat masses, and increased fat and carbohydrate metabolism marker proteins including beta 3 adrenergic receptor (β3-AR), phospho-AMP-activated protein kinase (AMPK), glucagon-like peptide-1 receptor (GLP-1R) in the liver, and serum adiponectin levels. Furthermore, LN19183-supplemented human volunteers increased (P < 0.05, vs. placebo) the metabolic rates at rest and with exercise; their fat oxidation was increased (P < 0.05, vs. placebo) at rest and 20 min post-exercise. The groups’ systolic and diastolic blood pressure (BP), heart rates (HR), and safety parameters were comparable. Conclusion: These observations suggest that LN19183 is a thermogenic botanical composition with no stimulatory effects on BP and HR.

Abstract Objectives We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection. Methods A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children’s Oncology Group (COG), grading based on the Norris system, management, and outcomes. Results Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively. Conclusions Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.

Abstract Background Systemic sclerosis (SSc) is an autoimmune disease that results in micro-vasculopathy, leading to organ dysfunction. Sirtuins are known for their role in cellular processes such as the cell cycle, aging, and inflammation, Sirtuins also play an important role in regulating fibrotic responses, inhibiting collagen production and myofibroblast differentiation, implying that its dysregulation is involved in the pathogenesis of systemic sclerosis. The aim of this study was to determine the circulating Sirtuin3 and Sirtuin7 levels in patients suffering from systemic sclerosis with a focus on how they might be associated with the different clinical features and subsets of the disease. Methods This prospective cross-sectional case–control study included 56 participants 41 SSc patients and 15 healthy controls. Demographics, clinical, and laboratory data were analyzed. Quantitative determination of human Sirtuin3 and Sirtuin7 concentrations was done. Results Among systemic sclerosis patients, the age of SSc patients was 42.27 ± 10.46 years. The mean serum levels of Sirtuin3 and Sirtuin7 were significantly lower in SSc patients than in healthy controls (p

Selecting the appropriate biomaterials for fabricating a wound dressing is an essential issue for accelerating the process of wound healing. The biopolymer “chitosan” attracted attention owing to its non-toxicity, biocompatibility, and biodegradability. However, chitosan showed poor mechanical, antioxidant and antibacterial properties. These limitations can be encountered by its conjugation with a nanofiller reinforcing and improving the film properties. The proposed nanofiller, derived from zein-methylcellulose loaded curcumin (ZeinMCNPs) was incorporated with different concentrations into a chitosan matrix (Ch) forming Ch/ZeinMCNPs1–3 films. Ch/ZeinMCNPs3 film showed a significant improvement in tensile strength, elongation at break% and Young's modulus over Ch film. Notably, the antibacterial and antioxidant activities of the Ch/ZeinMCNP1–3 films signified enhancement over chitosan. In wound rat model, wound healing contraction reached 96 % and 98 % for Ch/ZeinMCNPs2,3 opposite to 79 % for Ch film. In Ch/ZeinMCNPs2,3 treated wounds, H&E tissues sections revealed a reduction in inflammation, an enhancement in re-epithelization and neovascularization. Furthermore, Ch/ZeinMCNPs2,3 films boosted more collagen deposition as shown in MTC sections. Ch/ZeinMCNPs2,3 significantly increased SOD level (at day 7 and14) with a decrease in MDA level. Overall, the present study declares Ch/ZeinMCNPs nanocomposite film as a multifunctional wound dressing category covering the necessitates required for accelerating wound healing process safely.

Argania spinosa (L.) Skeels, an endemic Moroccan plant species from the Sapotaceae family, holds significant ecological, pharmaceutical, and socioeconomic value in the arid mid-western region. However, it is facing rapid degradation. Therefore, understanding its genetic diversity is critical for preserving this national heritage. We sequenced, assembled, and annotated the mitochondrial genome of A. spinosa and compared it to other plants in the Ericales order. Mitochondrial-like sequences from the A. spinosa genome were assembled using GetOrganelle, resulting in a 707,441 base pair mitochondrial genome with 45.75 % GC content. Annotation identified 32 protein-coding genes, 16 transfer RNAs, and 2 ribosomal RNA genes. Phylogenetic analysis of 15 Ericales species affirms that A. spinosa is closely related to the Theaceae family, which is in accordance with results from the chloroplast genome.

This study examines how price sensitivity parameters affect customer lifetime value in the luxury business. Quality, position, information, time, and customer lifetime were examined as price sensitivity factors followed by a conceptual model and research hypotheses were produced based on previous studies. Secondary analysis and in-depth interviews with industry specialists and customers. A representative sample of 232 A class consumers was included in a survey that was given to A-class customers in Egypt. A new level of price sensitivity known as ‘quality positioning value’ was found through the use of factor analysis. Multiple discriminant analysis was performed to validate the hypotheses and Cronbach’s alpha was utilised to assess the reliability of the data. This analysis sheds light on the effect of price sensitivity on customer lifetime value in the luxury industry.

Background: Recurrent hemarthrosis and resultant hemophilic arthropathy are significant causes of morbidity in persons with hemophilia, despite the marked evolution of hemophilia care. Prevention, timely diagnosis, and treatment of bleeding episodes are key. However, a physical examination or a patient’s assessment of musculoskeletal pain may not accurately identify a joint bleed. This difficulty is compounded as hemophilic arthropathy progresses. Objectives: Our system aims to utilize artificial intelligence and ultrasonography (US; point-of-care and handheld) to enable providers, and ultimately patients, to detect joint bleeds at the bedside and at home. We aimed to develop and assess the reliability of artificial intelligence algorithms in detecting and segmenting synovial recess distension (SRD; an indicator of disease activity) on US images of adult and pediatric knee, elbow, and ankle joints. Methods: A total of 12,145 joint exams, comprising 61,501 US images from 7 international healthcare centers, were collected. The dataset included healthy participants and adult and pediatric persons with hemophilia, with and without SRD. Images were manually labeled by 2 experts and used to train binary convolutional neural network classifiers and segmentation models. Metrics to evaluate performance included accuracy, sensitivity, specificity, and area under the curve. Results: The algorithms exhibited high performance across all joints and all cohorts. Specifically, the knee model showed an accuracy of 97%, sensitivity of 96%, specificity of 97%, and an area under the curve of 0.97 in SRD. High Dice coefficients (80%-85%) were achieved in segmentation tasks across all joints. Conclusion: This technology could assist with the early detection and management of hemarthrosis in hemophilia.

In congenital stationary night blindness, type 2 (CSNB2)—a disorder involving the Cav1.4 (L-type) Ca2+ channel—visual impairment is mild considering that Cav1.4 mediates synaptic release from rod and cone photoreceptors. Here, we addressed this conundrum using a Cav1.4 knockout (KO) mouse and a knock-in (G369i KI) mouse expressing a non-conducting Cav1.4. Surprisingly, Cav3 (T-type) Ca2+ currents were detected in cones of G369i KI mice and Cav1.4 KO mice but not in cones of wild-type mouse, ground squirrels, and macaque retina. Whereas Cav1.4 KO mice are blind, G369i KI mice exhibit normal photopic (i.e. cone-mediated) visual behavior. Cone synapses, which fail to form in Cav1.4 KO mice, are present, albeit enlarged, and with some errors in postsynaptic wiring in G369i KI mice. While Cav1.4 KO mice lack evidence of cone synaptic responses, electrophysiological recordings in G369i KI mice revealed nominal transmission from cones to horizontal cells and bipolar cells. In CSNB2, we propose that Cav3 channels maintain cone synaptic output provided that the nonconducting role of Cav1.4 in cone synaptogenesis remains intact. Our findings reveal an unexpected form of homeostatic plasticity that relies on a non-canonical role of an ion channel.

Solar-thermal biomass conversion using both direct and indirect concentrated solar thermal energy is an emerging approach that combines two renewable energy sources to enhance energy efficiency and enable sustainable processing. This review paper provides a comprehensive examination of various types of solar concentrators and reactors, showcasing the diversity of available technologies and their roles in enhancing conversion efficiency. The paper focuses on the reported studies on biomass solar-thermal conversion through gasification and pyrolysis processes, critically discussing the integrated process operating conditions and the quality of the products (biofuels). These analyses affirm the technical viability, emphasizing the relatively low energy investment required for pyrolysis compared to the total energy output from biomass feedstock. This points to the substantial promise of solar thermal biomass conversion as a sustainable and efficient renewable energy solution. The conclusion highlights the importance of ongoing research, technological advancements, and policy support to fully realize the potential of solar-thermal conversion of biomass.

ABSTRACT Background This study examines the psychophysiological differences between virtual reality (VR) and real archery. It explores whether VR archery induces heart rate (HR), heart rate variability (HRV), and breathing rates similar to those experienced in real archery. Additionally, the study assesses differences in perceived anxiety, difficulty, confidence, rate of perceived exertion (RPE), and shooting performance between the two modalities, providing insights into the efficacy of VR as a training tool for archery. Methods Twenty‐two (women: 8) individuals aged 20–24 participated in the study. We first recorded individuals’ resting HR, HRV, and breathing rates during baseline. Afterward, participants shot 10 real and virtual arrows from 18 m, whereas their HR, HRV, and breathing rate were measured, each lasting 4 min. Performance in VR and real archery was determined separately as the sum of the shots. We performed paired sample t‐tests to compare individuals’ performance, psychological, and psychophysiological responses recorded during VR and real arrow shooting. Afterward, we compared percentage changes between VR and real archery. Results Results showed that HR and root mean square of successive differences (RMMSD) were significantly higher during real archery compared to virtual archery. In addition, VR archery led to a greater percentage change in RMSSD compared to real archery. Participants reported greater RPE and perceived difficulty after real archery. Performance was also higher during VR archery than real archery. Conclusions Consequently, the results of the present study illustrated that VR, and real archery might lead to different autonomic response patterns in terms of vagal activity.

Introduction: Thyroid storm is an uncommon but life-threatening presentation of thyrotoxicosis with a mortality rate of 10%. Our objective was to study the demographics, clinical and biochemical characteristics, and outcomes of inpatients diagnosed with thyroid storm in the Indian context. Methods: This retrospective study was conducted by analysing the institutional electronic medical records (EMR) of all patients admitted with thyroid storm from 2004 to 2020 with a Burch–Wartofsky score (BWS) of ≥45. Results: Thirty-five patients with a BWS ≥45 were included, of whom 71.4% were women, with a mean age of 44.9 ± 10.2 years. 43% did not have any prior history of thyrotoxicosis. Graves’ disease was the most common underlying aetiology (71.4%), followed by toxic multinodular goitre (14.3%). Cardiovascular (94.3%) and gastrointestinal-hepatic dysfunction (88.6%) were the most common clinical manifestations. Features of Central nervous system (CNS) dysfunction were seen in only 42.3% of patients diagnosed with a thyroid storm. The Japanese Thyroid Association (JTA) criteria diagnosed only 26 patients (74.3%) with “definite” thyroid storm. The mortality rate was 8.6%, and all three patients expired within 48 hours of admission. Conclusion: Nearly one in every two patients with thyroid storm had previously undiagnosed thyrotoxicosis. Toxic multinodular goitre is a notable aetiology in Indians. Features of CNS dysfunction, considered relatively specific for thyroid storm, were less prominent in our series. The JTA criteria might alter the classification of some patients diagnosed with a thyroid storm, when compared to the BWS score due to fewer CNS features among Indian patients.

Introduction: High mobility group box (HMGB)-1 protein is a promising prognostic marker for predicting the course of retinopathy and the prognosis in patients with diabetic retinopathy (DR). The aim of this study is to investigate whether serum HMGB-1 protein levels can be used as a biomarker about the severity of the disease in patients with diabetic retinopathy. Material and methods: This study was carried out in the internal medicine and ophthalmology departments of the Gaziantep Medicalpark Hospital. The records of 50 patients diagnosed with type 2 diabetes mellitus with diabetic retinopathy and 47 healthy subjects who applied to our clinic between January 2016 and December 2018 were retrospectively scanned. Five cc of venous blood was taken from the patients, and control groups were included in the study for routine laboratory tests and serum HMGB-1 levels to be studied under appropriate conditions. Human HMGB-1 levels were measured using the ELISA method. Results: There was a significant difference among the groups in terms of HMGB-1 levels (p

Abstract Background Arterial switch operation (ASO) is the standard surgical choice for D-transposition of great arteries (D-TGA). However, the implications of ASO on pulmonaries, coronaries, and aorta have not been adequately investigated. The current study evaluates arterial morphologic changes post-ASO at intermediate-term surveillance. Methods From May 2021 to May 2022, patients with D-TGA who underwent ASO for more than six months were recruited. Preoperative and operative data were collected. Patients were assessed using echocardiography (ECHO) and multislice CT angiography (MSCT) to evaluate pulmonary, coronary, and aortic arterial anatomy. Results Twenty patients were included with median age of 11 (10-23.25) days at ASO and 14 (7.25–32.75) months on last follow-up. Neo-aortic regurgitation was detected in 12(60%) and neo-pulmonary regurgitation in 3 (15%). Using ECHO, complete evaluation of pulmonary arteries (PAs) was not achieved in 35% and incomplete coronaries assessment in 40% of cases. No stenosis was detected in coronaries using MSCT, although coronary anomalies were found in 9/20 (45%). Dilated Aortic annulus was detected in 16/20 (80%), dilated aortic root in 18/20 (90%), and dilated sinotubular junction in 70%. Right PA stenosis was diagnosed in 10/20 (50%) and left PA(LPA) stenosis in 7/20 (35%). Although Z-score of PAs did not correlate with aortic data, LPA bending angle was positively correlated to neo-aortic root diameter and Z-score (rho = 0.65,p = 0.016; rho = 0.69,p = 0.01), respectively. Conclusion Echocardiography alone is not a conclusive surveillance tool for detecting late post-ASO anatomic changes in D-TGA patients. Cardiac MSCT should be considered for comprehensive evaluation on the intermediate-term follow-up post-ASO to accurately track morphologic abnormalities in the aorta, pulmonary, and coronary arteries.

Investigating solutions of differential equations has been an important issue for scientists. Researchers around the world have talked about different methods to solve differential equations. The type and order of the differential equation enable us to decide the method that we can choose to find the solution of the equation. One of these methods is the integral transform, which is the conversion of a real or complex valued function into another function by some algebraic operations. Integral transforms are used to solve many problems in mathematics and engineering, such as differential equations and integral equations. Therefore, new types of integral transforms have been defined, and existing integral transforms have been improved. One of the solution methods of many physical problems as well as initial and boundary value problems are integral transforms. Integral transforms were introduced in the first half of the 19th century. The first historically known integral transforms are Laplace and Fourier transforms. Over the time, other transforms that are used in many fields have emerged. The aim of this article is to describe the Mohand transform and to make applications of linear ordinary differential equations with constant coefficients without any major mathematical calculations This integral transform method is an alternative method to existing transforms such as Laplace transform and Kushare transform. When recent studies in the literature are examined, it can be said that Mohand transform is preferred because it is easy to apply.

Abstract Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients’ echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (−20.6 ± −2.3, −19.7 ± −1.9, p:.13; −21.3 ± −2.7, −21 ± −2.4, p:.68; −21.2 ± −2.2, −21.2 ± −2.3, p:.93; and −20.8 ± −1.5, −20.4 ± −1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p

Objective: This study aims to assess the neurodevelopmental progress of high-risk infants 2 years post implementation of the Neurodevelopmental Follow-Up Unit (NFU) program at our hospital and explore implementation challenges for insights. Materials and Methods: Infants were assessed using the Hammersmith Infant Neurological Examination (HINE), The Alberta Infant Motor Scale (AIMS), and Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). A multidisciplinary team provided comprehensive parent education covering neurologic cues, postural advice, and developmental instructions in accordance with the children’s assessment findings. In addition, a pediatric physical therapist provided motor development training emphasizing age-appropriate milestones and functional independence, while child development specialists addressed delays identified through BSID-III assessments. Results: A total of 121 high-risk babies were enrolled during a 2-year period. Results revealed that 9 infants exhibited suboptimal HINE scores at 3-4 months, with only 2 maintaining suboptimal scores at 12-15 months. Similarly, 2 infants with suboptimal AIMS scores at 3-4 months reached normal values at 12-15 months. Comparable improvements were observed in BSID-III scores. While no correlation between HINE and AIMS scores was found at the 3-4-month mark, a significant correlation emerged between AIMS and HINE scores at 6-9 months (r = 0.643, P < .001) and 12-15 months (r = 0.820, P < .001). Conclusion: Encouraging early family education alongside regular monitoring of high-risk newborns appears to have a positive impact on their motor and cognitive development. Consideration of clinical recommendations, such as tailored interventions and periodic assessments, may contribute to optimizing developmental outcomes.

Phaselis is a harbour city located at the point where the Lykia, Pamphylia and Pisidia regions intersect. During the surveys and excavations carried out between 2019 and 2023, a total of 18 stamped amphora handles were found at different points of the city - the Hellenistic Temple, Main Street and Necropolis. The aim of the research presented in this paper is to classify the stamped amphora handles according to their production centres, date the stamped handles, determine whether the names on the stamps refer to eponyms or fabricants, and improve understanding Phaselis’ maritime trade relationships. As a result, in this study, the amphora stamps found in the city were classified according to their production centre: Rhodes (13), Rhodian Peraea (1), Knidos (1), Pamphylia (2), and Latin DR 2-4. While the earliest example of stamped handles can be dated back to the second quarter of the 3rd century BC, the latest example is dated to the end of the 1st century BC - 1st century AD.

This study aimed to establish the correlation between the nutritional knowledge levels of amateur and professional athletes and their attitudes towards doping. Additionally, it sought to analyze these relationships in relation to relevant variables. The study included a sample group of 141 amateur athletes and 57 professional athletes, resulting in a total of 197 athletes. The average age of the participants was 21.60±6.89 years. The study's data were gathered through online means, utilizing the Athlete Nutrition Knowledge Scale and Attitude Towards Doping Scale. The data that followed a normal distribution was analyzed using the Independent T-Test, One-Way Anova, and Pearson Correlation test. According to the analyzed results, there were no significant differences in attitude levels towards doping based on gender, sport branch, sport history, and age (p>0.05). However, there was a significant difference in attitude levels based on educational status (p0.05), there were significant differences based on educational status, sport history, and age (p0.05). These findings can provide insights into the correlation between athletes' understanding of nutrition and their inclination towards doping, contributing to a deeper understanding of this matter.

Congenital adrenal hyperplasia (CAH) comprises a heterogeneous group of autosomal recessive disorders impairing adrenal steroidogenesis. Most cases are caused by mutations in the CYP21A2 gene resulting in 21-hydroxylase (21-OH) deficiency (21-OHD). The genetics of 21-OH CAH is complexed by a highly homologous pseudogene CYP21A1P imposing several limitations in the molecular analysis. Therefore, genetic testing is still not a part of routine CAH diagnosis and is mainly dependent on 17-hydroxy progesterone (OHP) measurements. There are very few reports of CYP21A2 gene analysis from India and there is no comprehensive review available on genetic testing and the spectrum of CYP21A2 mutations from the country. This review focuses on the molecular aspects of 21-OHD and the genetic studies on CYP21A2 gene reported from India. The results of these studies insist the compelling need for large-scale CYP21A2 genetic testing and newborn screening (NBS) in India. With a high disease prevalence and consanguinity rates, robust and cost-effective genetic testing for 21-OH CAH would enable an accurate diagnosis in routine clinical practice. Whereas establishing affordable genotyping assays even in secondary care or resource-poor settings of the country can identify 90% of the mutations that are pseudogene derived, initiatives on reference laboratories for CAH across the nation with comprehensive genetic testing facilities will be beneficial in those requiring extended analysis of CYP21A2 gene. Further to this, incorporating genetic testing in NBS and carrier screening programmes will enable early diagnosis, better risk assessment and community-based management.

Abstract Background Lymphoma is the most common primary hematological malignancy. FDG PET/CT has recently become the standard imaging modality for clinical management owing to its ability to provide precise, non-invasive anatomical and functional data. The purpose of this study was to highlight the role of 18F FDG-PET/CT in the management of lymphoma by monitoring treatment response, providing a guide for response-adapted therapy, and predicting the final therapeutic outcome. Methods This was a prospective monocentric cohort observational study in which thirty-three patients with histopathologically proved lymphoma of different types performed FDG-PET/CT scanning several times throughout the 24-month duration of the study. Early-stage interim SUVmax of the most active lesion (both nodal and/or extra-nodal) was measured and statistically analyzed together with data of the international prognostic index parameters and score. Results Among the included 33 patients of lymphoma, international prognostic index parameters and score together with the early-stage interim SUVmax of the predominant nodal and extra-nodal sites showed statistical significance in predicting the initial as well as the final treatment response after 24 months. Using ROC analysis, we could obtain cutoff values of SUVmax of the predominant nodal lesion of 2.75 (AUC 72%, 95% CI 0.42–1.0) and SUVmax of the predominant extra-nodal lesion of 3 (AUC 70.8% and 95% CI 0.23–1.0); therefore, SUVmax of higher than these values was related to stable or progressive disease, and lower levels than these values were related to complete or partial metabolic response based on Deauville 5-point scale and Lugano response criteria. Conclusions Early-stage interim PET-CT SUVmax of the predominant nodal and extra-nodal lesion could be a reliable parameter in predicting initial and final therapeutic outcome in lymphoma patients.

Despite advances in diagnosis and treatment, breast cancer is still one of the three most common cancers in the world and a significant cause of morbidity and mortality. Lipids play a role in many basic physiological pathways in cells, from regulating cell homeostasis to energy expenditure. As in many types of cancer, changes in lipid metabolism and their relationship have been reported in breast cancer. The STARD3 gene encodes a member of the subfamily of lipid trafficking proteins. It is a sterol-binding protein that mediates the transport of cholesterol from the endoplasmic reticulum to endosomes. It has been shown that STARD3 is correlated with human epidermal growth factor receptor 2 (HER2) amplification since it has the same localization as HER2 in the chromosome. In this review, we aimed to emphasize that investigating lipid metabolism together with the STARD3 biomarker has great potential not only for subtype-specific strategies but also for patient-specific strategies.

Abstract Aims The widely used dynamic disposition index, derived from oral glucose tolerance testing, is an integrative measure of the homeostatic performance of the insulin‐glucose feedback control. Its collection is, however, time consuming and expensive. We, therefore, pursued the question if such a measure can be calculated at baseline/fasting conditions using plasma concentrations of insulin and glucose. Methods A new fasting‐based disposition index (structure parameter inference approach‐disposition index [SPINA‐DI]) was calculated as the product of the reconstructed insulin receptor gain (SPINA‐GR) times the secretory capacity of pancreatic beta cells (SPINA‐GBeta). The novel index was evaluated in computer simulations and in three independent, multiethnic cohorts. The objectives were distribution in various populations, diagnostic performance, reliability and correlation to established physiological biomarkers of carbohydrate metabolism. Results Mathematical and in‐silico analysis demonstrated SPINA‐DI to mirror the hyperbolic relationship between insulin sensitivity and beta‐cell function and to represent an optimum of the homeostatic control. It significantly correlates to the oral glucose tolerance test based disposition index and other important physiological parameters. Furthermore, it revealed higher discriminatory power for the diagnosis of (pre)diabetes and superior retest reliability than other static and dynamic function tests of glucose homeostasis. Conclusions SPINA‐DI is a novel simple reliable and inexpensive marker of insulin‐glucose homeostasis suitable for screening purposes and a wider clinical application.

Abstract Pharmacogenomic Polygenic Risk Scores (PRS) have emerged as a tool to address the polygenic nature of pharmacogenetic phenotypes, increasing the potential to predict drug response. Most pharmacogenomic PRS have been extrapolated from disease‐associated variants identified by genome wide association studies (GWAS), although some have begun to utilize genetic variants from pharmacogenomic GWAS. As pharmacogenomic PRS hold the promise of enabling precision medicine, including stratified treatment approaches, it is important to assess the opportunities and challenges presented by the current data. This assessment will help determine how pharmacogenomic PRS can be advanced and transitioned into clinical use. In this review, we present a summary of recent evidence, evaluate the current status, and identify several challenges that have impeded the progress of pharmacogenomic PRS. These challenges include the reliance on extrapolations from disease genetics and limitations inherent to pharmacogenomics research such as low sample sizes, phenotyping inconsistencies, among others. We finally propose recommendations to overcome the challenges and facilitate the clinical implementation. These recommendations include standardizing methodologies for phenotyping, enhancing collaborative efforts, developing new statistical methods to capitalize on drug‐specific genetic associations for PRS construction. Additional recommendations include enhancing the infrastructure that can integrate genomic data with clinical predictors, along with implementing user‐friendly clinical decision tools, and patient education. Ethical and regulatory considerations should address issues related to patient privacy, informed consent and safe use of PRS. Despite these challenges, ongoing research and large‐scale collaboration is likely to advance the field and realize the potential of pharmacogenomic PRS.