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Abstract Background The Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity. Methods Data from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM. Results The median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1–3 versus median 0, IQR: 0–2; p 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively. Conclusion The OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.

Objective: This study aimed to evaluate the general characteristics of geriatric cases aged ≥65 years, who presented at the Forensic Medicine Clinic due to trauma, and the severity of injury using trauma scoring systems. Methods: The study included all trauma cases over 65 years with a forensic report prepared in the Forensic Medicine Clinic between 2015 and 2021. Evaluations were made using the chi-square, Mann- Whitney U, and Kruskal-Wallis (post-hoc: Dunn-Bonferroni) tests. A value of p75 years were higher than in those aged ≤75 years (p

This study examines the Green Vision of Saudi Arabia and its efforts towards achieving sustainability in various domains such as energy, economy, tourism, and carbon emissions. The research uses time-series data from 2002 to 2020 to analyze the dynamic impacts of these variables. To achieve this, it employs a co-integration regression test, Granger causality relationships, and one-way and two-way causal effects between carbon emissions, tourism, economic growth, and energy use. The findings of the study provide valuable insights into the challenges and opportunities for sustainability in the kingdom, considering the goals of SDGs 8 and 13. This research contributes to the ongoing discourse on sustainable development in Saudi Arabia and offers significant insights for lawmakers, entrepreneurs, and researchers to influence the country's future direction. The research aims to guide strategic decision-making in line with Saudi Arabia's commitment to achieving a sustainable and resilient future by examining the interconnections between energy, economic growth, tourism, and carbon emissions.

Nanomedicines for drug delivery and imaging-guided cancer therapy is a rapidly growing research area. The unique properties of nanomedicines have a massive potential in solving longstanding challenges of existing cancer drugs, such as poor localization at the tumor site, high drug doses and toxicity, recurrence, and poor immune response. However, inadequate biocompatibility restricts their potential in clinical translation. Therefore, advanced nanomaterials with high biocompatibility and enhanced therapeutic efficiency are highly desired to fast-track the clinical translation of nanomedicines. Intrinsic properties of nanoscale covalent organic frameworks (nCOFs), such as suitable size, modular pore geometry and porosity, and straightforward post-synthetic modification via simple organic transformations, make them incredibly attractive for future nanomedicines. The ability of COFs to disintegrate in a slightly acidic tumor microenvironment also gives them a competitive advantage in targeted delivery. This review summarizes recently published applications of COFs in drug delivery, photo-immuno therapy, sonodynamic therapy, photothermal therapy, chemotherapy, pyroptosis, and combination therapy. Herein we mainly focused on modifications of COFs to enhance their biocompatibility, efficacy and potential clinical translation. This review will provide the fundamental knowledge in designing biocompatible nCOFs-based nanomedicines and will help in the rapid development of cancer drug carriers and theranostics.

Objective:Evaluation of children and adolescents pushed to crime should be different from adult offenders. In this study, it is aimed to analyze the qualities of children and adolescents pushed to crime and to discuss them in the light of the literature.Methods:Children who were evaluated in terms of criminal liability at Bolu Abant İzzet Baysal University Faculty of Medicine Department of Forensic Medicine and Bolu Forensic Medicine Branch Office between January 1, 2016 and December 31, 2018 were included in the study.Results:A total of 237 children and adolescents were included in the study. Of the cases, 76.8% (n=182) were male and 23.2% (n=55) were female. The mean age was 13.38±0.83. Of the cases, 80.6% were living in the nuclear family. Twenty-two cases (9.3%) were working in any job and sixty-four (27%) of the cases had one or more substance use history. Of the cases, 47.7% committed deliberate wounding crimes whereas 20.3% of cases committed burglary crimes. One hundred and fifty two cases (64.1%) committed a crime for the first time. One hundred and ten (46.4%) cases committed the crime together with a group of friends. Forty-seven cases (19.8%) had a psychiatric disorder. In 60.8% of the cases (n=144), it was reported that they had criminal responsibility.Conclusion:It is necessary to increase the number of child support centers and to develop effective intervention methods for juveniles pushed to crime in these centers, and more studies should be conducted on these issues.

Fluorescence imaging of amyloid beta (Aβ) polypeptide using a small‐molecule fluorophore is a practical system for Alzheimer's disease (AD) diagnosis in clinical and research fields. Herein, a molecular designing strategy for a new fluorogenic probe that equips bathochromic emission shift and enhanced binding affinity toward Aβ fibril through structural optimization is suggested. Thioflavin T (ThT)‐derived fluorescent dyes are developed by adjusting the hydrophobicity of electron donor moiety in D–π–A structures with biannulated ring expansion. Indeed, probes are tuned to have redshifted fluorescence emission wavelength and optimized binding affinities for Aβ fibrils in vitro and cortical imaging. Detection of background signal is minimized by maintaining the photophysical properties of twisted intramolecular charge transfer (TICT), resulting in significantly sensitive fluorogenic probes for outstanding bioimaging in AD.

The Dirichlet distribution as a multivariate generalization of the beta distribution is especially important for modeling categorical distributions. Hence, its applications vary within a wide range from modeling cell probabilities of contingency tables to modeling income inequalities. Thus, it is commonly used as the conjugate prior of the multinomial distribution in Bayesian statistics. In this study, the parameters of a bivariate Dirichlet distribution are estimated by entropy formalism. As an alternative to maximum likelihood and the method of moments, two methods based on the principle of maximum entropy are used, namely the ordinary entropy method and the parameter space expansion method. It is shown that in estimating the parameters of the bivariate Dirichlet distribution, the ordinary entropy method and the parameter space expansion method give the same results as the method of maximum likelihood. Thus, we emphasize that these two methods can be used alternatively in modeling bivariate and multinomial Dirichlet distributions.

Pica is the continuous consumption of non-nutritive and non-food items for at least one month. In this study, a 17-year-old boy pica case diagnosed with motor-mental retardation due to cerebral palsy was presented. It was learned that the case was exhibiting object swallowing behaviour. He was found dead in the field by his relatives. At the autopsy, a 3.5x3.0x2.5 cm foreign body (stone) that completely obstructed the upper part of the larynx lumen was removed. In addition, three foreign bodies were removed from the cecum region. The death was caused by mechanical asphyxia due to foreign body aspiration.

Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients. Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery. Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without. Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034). Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.

The nature of dependence between random variables has always been the subject of many statistical problems for over a century. Yet today, there is a great deal of research on this topic, especially focusing on the analysis of nonlinearity. Shannon mutual information has been considered to be the most comprehensive measure of dependence for evaluating total dependence, and several methods have been suggested for discerning the linear and nonlinear components of dependence between two variables. We, in this study, propose employing the Rényi and Tsallis mutual information measures for measuring total dependence because of their parametric nature. We first use a residual analysis in order to remove linear dependence between the variables, and then we compare the Rényi and Tsallis mutual information measures of the original data with that the lacking linear component to determine the degree of nonlinearity. A comparison against the values of the Shannon mutual information measure is also provided. Finally, we apply our method to the environmental Kuznets curve (EKC) and demonstrate the validity of the EKC hypothesis for Eastern Asian and Asia-Pacific countries.

In this study; a case about three brothers exposed to long-lasting severe neglect and abuse up to cachexia and severe depression will be presented and discussed in the light of the literature data. It was learned from the statements of the suspect, mother and child victims that father worked at night shift, that a distant relative who began to live at their home to help with the expenses of the house for the last three years, had sexual and emotional relationship with the mother during the day, that although this person act well in the beginning but in time he left the three children hungry for several days in order to punish, hang them to the ceiling from their hands and feet, used physical violence like punch, beatings, extinguished illuminated cigarettes in their bodies, made skin burns by using a lighter and that father and mother turned a blind eye even knowing all that for a long time. It was reported that one day a second suspect who was brought by this suspect and stayed at home with them for two months, took the children into the bathroom with the purpose to wash them and that he applied anal sexual abuse to the younger child at the age of three years. In the examination it was determined that the four years old youngest brother was highly cachectic, unable to stand, unable to sit, lied constantly, had difficulties in talking, had decreased skin turgor and tone, was cachectic, had bruises, burns, scars in different parts of the body at different ages and an old fracture in the mandible was seen in the radiography. The 9-year-old middle brother testified likewise and strained and swollen appearance of abdomen, growth retardation, extensive bruising also on both cheeks and at the rear of the right thigh were determined in the examination. Ecchymosis and hematoma in both cheeks and left auricula was detected on the 11-year-old oldest brother. After a detailed evaluation it was found that the child was admitted to the hospital due to a fall, four years ago, due to activity and attention disorders six and four months ago. It is remarkable that child abuse and neglect incident was not detected in the examinations done at the hospital before. [Med-Science 2017; 6(4.000): 760-763]

Novel Coronavirus, also known as COVID-19, is a health emergency that is having an ever-growing impact on the global economy. COVID-19 has caused economic disruption at an unprecedented speed and scale. The economic costs it will bring to society can only be measured in times to come. Millions of people across the globe have already become unemployed, and similarly, millions of businesses have either shut down or are on the verge of collapse. It is a great challenge for policymakers to minimize the economic impact of COVID-19 and put the economy on a growth trajectory once again. Unfortunately, there is so far no country in the world that can be viewed as a role model for its economic response to the COVID-19 pandemic. The present study proposes Islamic finance as a potential tool to help affected economies safely pass through the economic crisis resulting from the pandemic. This study identifies a four-stage COVID-19 model and proposes ten innovative Islamic financial services for each stage of the pandemic. In addition, it analyzes how these services can be effectively utilized at different stages to overcome the economic damage caused by the pandemic.

Mycotic aneurysms constitute a small proportion of aortic aneurysms. Endovascular repair of mycotic aneurysms has been applied with good short-term and midterm results. However, the uncommon aortoenteric fistula formation remains a potentially fatal complication when repairing such infective aneurysms. We present the case of an 80-year-old woman with thoracic and abdominal aortic mycotic aneurysms, which were successfully treated with endografting. However, the patient presented 3 months later with upper gastrointestinal bleeding secondary to erosion of the thoracic graft into the oesophagus. The patient was treated conservatively due to the high risk of surgical repair. There is currently little exposure to the management of mycotic aortic aneurysms. If suspected, imaging of the entire vasculature will aid initial diagnosis and highlight the extent of the disease process, allowing for efficient management. Aortic endografting for mycotic thoracic aneurysms is a high-risk procedure yet is still an appropriate intervention. Aortoenteric fistulae pose a rare but severe complication of aortic endografting in this setting.

Bu çalışmada, Konya’da çocukluk çağmda meydana gelen ateşli silah yaralanmalarına bağlı ölümler incelenerek, olguların demografik özellikleri, kullanılan silah türü, orijin, yaralanan bölge, olay yeri, ölüm yeri, atış mesafesi, silahm ait olduğu kişi gibi verilerin değerlendirilmesi amaçlanmıştır. Bu amaçla, Konya Adli Tıp Şube Müdürlüğü ve Konya’ya bağlı ilçelerde adli tıp uzmanı tarafından 1999-2007 yılları arasında otopsisi yapılan olgular retrospektif olarak incelendi. 18 yaş ve altındaki 985 ölüm olgusunun 50’sinin (%5.1) ateşli silah yaralanması neticesinde meydana geldiği tespit edildi. Olguların yaşları 1 ile 18 arasında değişmekte olup, ortalama yaş 14.6+3.9 bulundu. 34(%68) olgu erkek, 16 (%32) olgu kız çocuk idi. Erkek, kız oranı 2.1:1 bulundu. Orijin 20(%40) olguda intihar, 17(%34) olguda kaza, 13(%26) olguda cinayet idi. 33(%66) olguda av tüfeği, 17(%34) olguda tabanca kullanılmıştı. 27(%54) olguda yalnızca kafa bölgesi, 10(%20) olguda yalnızca karın bölgesi yaralanmıştı. Ateşli silah yaralanmalarının 29’u (%58) ev içerisinde meydana gelmişti. 35(%70) olgu olay yerinde, 12(%24) olgu hastanede, 3(%6) olgu ise hastaneye kaldırılırken yolda ölmüştü. 24(%48) olgu bitişik ya da bitişiğe yakın mesafeden; 11 (%22) olgu yakın mesafeden; 15(%30) olgu ise uzak mesafeden yapılan atış nedeniyle kaybedilmişti. Kullanılan silah 24(%48) olguda, olgunun babasına aitti. Sonuç olarak, kullanımı giderek artan ateşli silahların evlerde bulundurulması nedeniyle, bu silahların çocukluk çağı ölümlerine yol açabildiği görülmektedir. Halkımızın; bulunduğu ortamda çocukların ateşli silahlara kolayca ulaşabilmeleri halinde, intihar veya kaza orijinli yaralanma ve ölüm olaylarının meydana gelebileceği, bu nedenle ev gibi yaşam alanlarında mümkün olduğunca ateşli silah bulundurulmaması, mutlaka bulunması gerekiyorsa çocukların ulaşamayacağı, yüksek konumlarda veya sağlam kilit altına alınmış alanlarda emniyetinin sağlanması gerektiği konusunda eğitilmesinin gerekli ve faydalı olduğunu düşünüyoruz. Anahtar kelimeler: Çocuk, ateşli silah, ölüm, adli tıp

Traumatic brain injury (TBI), also known as intracranial injury, is a common condition with the highest incidence rate among neurodegenerative disorders and poses a significant public health burden. Various methods are used in the treatment of TBI, but the effects of cold-induced traumatic brain injury have not been thoroughly studied. In this context, vinpocetine (VPN), derived from Vinca minor, exhibits notable anti-inflammatory and antioxidant properties. VPN is known for its neuroprotective role and is generally utilized for treating various neurodegenerative disorders. However, the function of VPN after cold-induced TBI needs to be studied in more detail. This study aims to investigate the neuroprotective effects of VPN at varying doses (5 mg/kg or 10 mg/kg) after cold-induced TBI. C57BL/6 mice were sacrificed 2 or 28 days after cold-induced TBI. Results indicate that VPN administration significantly reduces brain infarct volume, brain swelling, blood-brain barrier disruption, and DNA fragmentation in a dose-dependent manner. Additionally, VPN enhances neuronal survival in the ipsilesional cortex. In the long term, VPN treatment (5 mg/kg/day or 10 mg/kg/day, initiated 48 h post-TBI) improved locomotor activity, cell proliferation, neurogenesis, and decreased whole brain atrophy, specifically motor cortex atrophy. We performed liquid chromatography-tandem mass spectrometry (LC-MS/MS) to elucidate the underlying mechanisms to profile proteins and signaling pathways influenced by prolonged VPN treatment post-TBI. Notably, we found that 192 different proteins were significantly altered by VPN treatment, which is a matter of further investigation for the development of therapeutic targets. Our study has shown that VPN may have a neuroprotective role in cold-induced TBI., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The metal surface-supported rotation of artificial molecular structures is technologically important for developing molecular-level devices. The key factors leading to the practical applications of these molecular machines on metal surfaces are the atomic-scale control of the rotation and the counterbalance of the temperature-driven instability of the molecules. In this work, we present a means by which triptycene-based molecular wheels can roll repetitively on a metal surface. Our results show that regularly stepped surfaces are the perfect candidate not only for stabilizing the molecule on the metal surface but also for providing the pivot points needed for repetitive vertical rotation of the molecule at higher temperatures. In addition to the geometrical compatibility of the substrate and the molecule, intermittent application of the external electric field is needed for rolling the molecule on a metal-stepped surface in a controllable manner.

Purpose : Strabismus is an ocular condition characterized by misalignment of the visual axis. The global prevalence of strabismus is about 2-3%, which varies between different countries and ethnicities. The aim of this study was to conduct a meta-analysis of studies, which had previously reported the prevalence of strabismus in Pakistan, in order to obtain the overall prevalence of strabismus in the country. Methods : All community-based studies reporting the prevalence of strabismus from Pakistan were searched using international databases and local ophthalmology journals. Information about sample size, number of individuals with strabismus, and location and duration of the study was recorded. Statistical analysis including heterogeneity testing, pooled prevalence calculation and regression analysis were done using the R software. Results : Heterogeneity tests, P heterogeneity  < .01, suggested high heterogeneity between the different studies. The pooled prevalence of strabismus was 0.7% [95% confidence interval (CI): 0.39%-1.23%] according to the random effects model, with a decreasing trend in prevalence from 1995 to 2020. Esotropia was more frequent than exotropia in both population-based and clinic-based studies. Conclusion : The prevalence of strabismus in Pakistan is comparatively lower than the worldwide prevalence, and it appears to be decreasing over the last three decades, consistent with global trends.

Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings., (© 2024. The Author(s).)

Advanced incurable diseases are often accompanied by numerous losses and burdens as the disease progresses, leading to a loss of autonomy, self-determination, and dignity for those affected, all of which can subsequently promote feelings of loneliness at the end of life. Declining health, increasing symptom burden, loss of social roles, and the fear of death and dying are among the key risk factors for loneliness towards the end of life. In this article, we provide an overview of the different dimensions of loneliness experienced at the end of life. We discuss existential loneliness alongside emotional and social loneliness, explore causes and health implications of loneliness at the end of life, suggest diagnostic tools for assessing loneliness, and finally provide recommendations for addressing emotional, social, and existential loneliness at the end of life. The loneliness of caregivers is also discussed. We suggest that addressing social and emotional loneliness early in the course of a terminal illness is crucial. Palliative, psychological, and spiritual support can strengthen interpersonal relationships, foster a sense of meaning and purpose, and alleviate the adverse effects of loneliness on mental and physical health as well as quality of life. In contrast, existential loneliness is considered an expression of profound emotional maturity and can offer opportunities for inner growth, contributing to a more refined sense of self while reinforcing identity, dignity, and transcendence at the end of life., (© 2024. The Author(s).)

Purpose of Review: This review delves into the intricate landscape of airway complications post lung transplantation. With the rising prevalence of end-stage lung disease and the increasing number of lung transplantation worldwide, understanding and effectively managing airway complications are crucial. Given the nuanced nature of these complications and the array of treatment options available, this review aims to provide a comprehensive overview of how to identify, classify, mitigate risk factors for, and manage these complications., Recent Findings: Several donor, recipient, and surgical risk factors are associated with the increased risk of airway complications. In managing these complications, bronchoscopic interventions, notably balloon dilation and stenting, are pivotal. Although self-expanding metallic stents offer versatility, silicone stents are preferred in certain scenarios for their durability. Emerging techniques such as biodegradable stents and advancing imaging modalities show promise in mitigating complications and improving outcomes., Summary: These findings underscore the significance of a multidisciplinary approach and personalized treatment algorithms in managing airway complications post lung transplantation. By elucidating specific indications and complications of treatment modalities, this review serves as a valuable resource for optimally managing airway complications. Ongoing research into novel interventions holds promise for further enhancing outcomes in this challenging clinical setting., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Semen traces are considered important pieces of evidence in forensic investigations, especially those involving sexsual offenses. Recently, our research group developed a fluorescence-based technique to accurately determine the age of semen traces. However, the specific compounds resonsible for the fluoresescent behaviour of ageing semens remain unknown. As such, in this exploratory study, the aim is to identify the components associated with the fluorescent behavior of ageing semen traces. In this investigation semen stains and various biofluorophores commonly found in body fluids were left to aged for 0, 2, 4, 7, 14 and 21 days. Subsequently, thin-layer chromatography (TLC) and ultra-performance liquid chromatography (UPLC) mass spectrometry were performed to identify the biofluorophores present in semen. Several contributors to the autofluorescence could be identified in semen stain, these include tryptophan, kynurenine, kynurenic acid, and norharman. The study sheds light on the., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

This retrospective study assessed the mortality trends related to Parkinson's Disease (PD) between 1999 and 2020. We assessed individuals aged 65 years and older and a total of 831,793 deaths were identified. Of these total number of deaths, place of death was accessible for 830,176 cases. Majority of the deaths occurred in nursing homes of long-term care facilities (367,633), followed by at home (212,886), medical facilities (165,450), other locations (44,506), and hospice (39,701). Analysis of age-adjusted mortality rates (AAMR) revealed an overall rise from 1999 to 2020, 88.9 to 119.6 per 100,000 population. AAMR showed an initial decline between 1999 and 2013, followed by a slight increase between 2013 and 2018 and then a significant rise from 2018 to 2020. Gender-based analysis showed a constantly higher AAMR for older men compared to older women. Variations in AAMR based on race and ethnicity revealed that Non-Hispanic White population had the highest AAMRs. Geographic disparities among states showed that Nebraska, Vermont, Minnesota, Utah, and Idaho had a significantly higher AAMR than Hawaii, Florida, Nevada. New York, and District of Columbia. Midwest region had a consistently higher AAMR followed by West, South, and Northeast. Additionally, nonmetropolitan areas had a higher AAMR than metropolitan areas. These findings offer valuable insights into mortality patterns related to PD among the elderly, highlighting the significance of incorporating demographic and geographic variables into public health planning and interventions., 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 Ltd. All rights reserved.)

Nanomaterials with piezoelectric properties can significantly improve the applicability of polymers used in tissue engineering applications. In this study, we report the one-step synthesis of a novel hybrid piezoelectric composite comprising barium titanates and boron nitride nanotubes. This composite is distinguished by its unique microstructures, including nanoflakes, triangular boron nitride structures, and fiber-like boron nitride nanotube configurations, which contribute to its enhanced piezoelectric properties. The composite was incorporated into a chitosan-based tissue scaffold and evaluated in vitro. Electric-responsive Human Osteoblast cells cultured on the scaffolds are exposed to low-frequency ultrasound stimulation during cell growth. The biocompatibility, cell adhesion, alkaline phosphatase activities, and mineralization of osteoblast cells on the piezo-composite scaffolds were evaluated. The results show that the hybrid piezoelectric composite significantly enhances the properties of chitosan-based scaffold., 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. Published by Elsevier Ltd.)

The current study offers the nanomolar quantification of gallic acid (GAL) based on gold nanoparticles (AuNps) and kaolinite minerals (KNT) modified on a screen-printed electrode (SPE). The electrochemical behavior of GAL was performed using differential pulse voltammetry (DPV) in Britton Robinson (BR) buffer solution at pH 2.0 as a supporting electrolyte. Under the optimized DPV mode parameters, the oxidation peak current of GAL (at 0.72 V vs Ag/AgCl) increased linearly in the range between 0.002 μmolL -1 and 40.0 μmolL -1 with a detection limit of 0.50 nmolL -1 . The effect of common interfering agents was also investigated. Finally, the applicability of the proposed method was verified by quantification analysis of GAL in black tea and pomegranate juice samples., 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 Ltd. All rights reserved.)

Background: Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras., Methods: This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group., Results: Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K + , and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%., Conclusion: Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols., (© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Rationale, Aims, and Objective: Breastfeeding provides optimal nutrition for infants, and health literacy significantly influences breastfeeding rates. This study aimed to develop a tool to assess the breastfeeding health literacy levels of pregnant women., Methods: This methodologically structured study was conducted with 590 pregnant women who visited the pregnancy follow-up clinic between January and April 2024 and met the sampling criteria. Data were collected using a participant form and the Health Literacy Scale for Breastfeeding for Pregnant Women (BFHLS). To assess the BFHLS validity, the content validity index (CVI) and factor analysis were used, while the reliability was evaluated using the test-retest method, item-total score correlation, and Cronbach's alpha reliability coefficient., Results: The BFHLS for pregnant women is structured into four dimensions, comprising 25 items. To assess the scale's stability, test-retest measurements were conducted with a minimum interval of 2 weeks, revealing no significant difference in mean scores (p > 0.05). The CVI for each item was 99%. The corrected item-total correlations ranged from 0.48 to 0.92, and Cronbach's alpha value was determined to be 0.96., Conclusion: The BFHLS developed for pregnant women is a valid and reliable tool. Higher scores on the scale indicate a greater level of breastfeeding health literacy in pregnant women. This scale can effectively be used to assess the breastfeeding health literacy levels of pregnant women., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Encapsulating antiepileptic drugs (AEDs), including ethosuximide (Etho), into nanoparticles shows promise in treating epilepsy. Nanomedicine may be the most significant contributor to addressing this issue. It presents several advantages compared to traditional drug delivery methods and is currently a prominent area of focus in cancer research. Incorporating Etho into bismuth ferrite (BFO) nanoparticles within diverse controlled drug delivery systems is explored to enhance drug efficacy. This approach is primarily desired to aid in targeted drug delivery to the brain's deepest regions while limiting transplacental permeability, reducing fetal exposure, and mitigating associated adverse effects. In this investigation, we explored Etho, an antiepileptic drug commonly employed for treating absence seizures, as the active ingredient in BFO nanoparticles at varying concentrations (10 and 15 mg). Characterization of the drug-containing BFO nanoparticles involved scanning electron microscopy (SEM) and elemental analysis. The thermal properties of the drug-containing BFO nanoparticles were evaluated via differential scanning calorimetry (DSC) analysis. Cytotoxicity evaluations using the MTT assay were conducted on all nanoparticles, and human neuroblastoma cell line cultures (SH-SY5Y) were treated with each particle over multiple time intervals. Cell viability remained at 135% after 7 days when exposed to 15 mg of Etho in BFO nanoparticles. Additionally, in vitro drug release kinetics for Etho revealed sustained release lasting up to 5 hours with a drug concentration of 15 mg., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Guldorum et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this study, two novel tetra-substituted manganese (III) phthalocyanines bearing 9H-Carbazol-2-yloxy groups on peripheral or non-peripheral positions were prepared and used for modification of reduced graphene oxide by applying a simple one-step electrodeposition technique for the first time. The manganese (III) phthalocyanines (1 and 2) were electropolymerized and graphene oxide was electrochemically converted into reduced graphene oxide simultaneously. Subsequently, an rGO-MnPc hybrid structure was formed directly on the NiF electrode (substrate) via layer-by-layer assembly. Additionally, the effect of substituent position on the charge storage capacity of the prepared hybrid capacitive candidates was investigated. The fabricated hybrid electrodes exhibited remarkable electrochemical performance due to the combination of manganese (III) phthalocyanines and reduced graphene oxide. The NiF/rGO2-2 electrode exhibited the highest specific capacitance (512.4 F g-1) at 0.5 A g-1 and the remained specific capacitance was obtained 88.1% after 5000 consecutive charge-discharge cycles. An asymmetric supercapacitor (ASC) was constructed from rGO2-2 as the positive electrode and rGO as the negative electrode with a working potential of 1.5 V. The as-prepared device delivered a specific energy of 17.4 Wh kg-1 at 350 W kg-1. Hence, manganese (III) phthalocyanine-reduced graphene oxide electrodes can be considered outstanding materials for energy storage applications in the future., (© 2024 Wiley‐VCH GmbH.)

Childhood obesity is a growing global public health problem. Studies suggest that environmental cues contribute to developing and maintaining obesity. We aimed to evaluate pupillary changes to auditory food words vs. nonfood words and to conduct a dynamic temporal analysis of pupil size changes in adolescents with obesity without binge eating disorder by comparing healthy-weight adolescents. In this study, a total of 63 adolescents aged 12-18 years (n = 32, obesity group (OG); n = 31, control group (CG)) were included. In an auditory paradigm, participants were presented with a series of high and low-calorie food and nonfood words. A binocular remote eye-tracking device was used to measure pupil diameter. Generalized additive mixed models (GAMMs) were used for dynamic temporal analysis of pupillometry data. The results of GAMM analysis indicated that CG had larger pupil dilation than the OG while listening to auditory food words. CG had larger pupil dilation in food words than in nonfood words. However, the OG had a similar pupillary response in food and nonfood words. Pupil dilation response to higher-calorie foods was extended over the later stages of the time period (after 2000 ms) in the OG. In summary, our findings indicated that individuals with obesity had lower pupil dilation to auditory food words compared to normal-weight peers. Adolescents with obesity had prolonged pupillary dilation in higher calories of food words. The individual psychological factors affecting the dynamic changes of pupil responses to food cues in adolescents with obesity should be examined in further studies., 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 B.V. All rights reserved.)

We report a pediatric patient with prolidase deficiency, caused by a mutation in the PEPD gene, which encodes the enzyme prolidase D, with a lupus-like clinic and marked dysmorphic features along with pulmonary, neurological, skeletal, and immune system involvement. In addition to being the first known case in the literature where Friedrich's ataxia and prolidase deficiency were observed together, we aimed to highlight that this diagnosis should be considered in patients with autoimmunity and additional systemic findings such as treatment-resistant skin lesions, intellectual disability, and pulmonary manifestations. Furthermore, we sought to compare this case with others documented in the literature., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction:  We aimed to investigate the accuracy of clinical staging without the routine use of positron emission tomography/computed tomography (PET/CT) in patients with cIA1 and cIA2 non-small-cell lung cancer (NSCLC) scheduled for segmentectomy., Methods:  A total of 305 consecutive segmentectomies were retrospectively analyzed. Overall survival was calculated using the Kaplan-Meier method. Logistic regression was performed to investigate factors independently associated with pathologic upstaging., Results:  The Union for International Cancer Control (UICC) upstaging was found in 86 patients (28%). Upstaged patients had longer operative times (146 ± 46 vs. 131 ± 44 minutes, p  = 0.009), a higher number of lymph node resection (17 ± 10 vs. 13 ± 8, p  = 0.001), and a higher rate of L1 involvement (34 vs. 16%, p  < 0.001) than nonupstaged patients. N1 was found in 10 patients (3%) and N2 in 13 patients (4%). Nodal positive patients had longer operation times (154 ± 50 vs. 133 ± 44 minutes, p  = 0.031) and higher rates of R1 (9 vs. 1%, p  = 0.006) and L1 (39 vs. 20%, p  < 0.026) than patients without nodal involvement. The 3- and 5-year overall survival rates for nonupstaged and upstaged patients were 85 and 67% and 67 and 54%, respectively ( p  = 0.040). In logistic regression, L1 involvement (odds ratio [OR]: 2.394, p  = 0.005) and the number of dissected lymph nodes (OR: 1.037, p  = 0.016) were independently associated with upstaging. Patients who received PET as part of clinical staging did not have a significantly lower nodal upstaging., Conclusion:  Selective use of PET/CT based on the results of CT may be a viable option for patients with proven or suspected NSCLC up to 2 cm in size., Competing Interests: None declared., (Thieme. All rights reserved.)

Background and Objectives : Defining the exercise habits of individuals with Alzheimer's Disease (AD) may help to determine optimal rehabilitation programs. This study aimed to investigate the physical and psychological parameters associated with exercise barriers in older individuals with AD, with the goal of informing more effective rehabilitation programs. Materials and Methods : A cross-sectional prospective study was conducted with 50 individuals with AD. The individuals were evaluated with the Exercise Benefit/Barriers Scale (EBBS), the Mini-Mental State Examination (MMSE), the Five Times Sit to Stand Test (FTSTS), the Barthel Index (BI), the Tampa Scale for Kinesiophobia (TSK), and the Hospital Anxiety and Depression Scale (HADS). Results : There was a significant positive correlation between age with EBBS-Exercise Barriers (r = 0.308; p = 0.029) and EBBS-Total Score (r = 0.295; p = 0.038). There were significant negative correlations between the time of diagnosis with EBBS-Exercise Benefits (r = -0.569; p = 0.000), EBBS-Exercise Barriers (r = -0.324; p = 0.022), and EBBS-Total Score (r = -0.508; p = 0.000). There was a positive correlation between MMSE and EBBS-Exercise Benefits (r = 0.465; p = 0.001), EBBS-Exercise Barriers (r = 0.471; p = 0.001) and EBBS-Total Score (r = 0.519; p = 0.000). There were significant positive correlations between FTSTS and EBBS-Exercise Barriers (r = 0.340; p = 0.016), and EBBS-Total Score (r = 0.280; p = 0.049). There were positive correlations between BI and EBBS-Exercise Benefits (r = 0.362; p = 0.010), EBBS-Exercise Barriers (r = 0.377; p = 0.007), and EBBS-Total Score (r = 0.405; p = 0.004). Conclusions : Exercise barriers/benefits were associated with cognition and post-diagnosis duration in individuals with AD. Individuals with lower physical function had lower exercise perception. In addition, living with relatives or caregivers led to better exercise benefit scores.

In the high-stakes arena of drug discovery, the journey from bench to bedside is hindered by a daunting 92% failure rate, primarily due to unpredicted toxicities and inadequate therapeutic efficacy in clinical trials. The FDA Modernization Act 2.0 heralds a transformative approach, advocating for the integration of alternative methods to conventional animal testing, including cell-based assays that employ human induced pluripotent stem cell (iPSC)-derived organoids, and organ-on-a-chip technologies, in conjunction with sophisticated artificial intelligence (AI) methodologies. Our review explores the innovative capacity of iPSC-derived clinical trial in a dish models designed for cardiovascular disease research. We also highlight how integrating iPSC technology with AI can accelerate the identification of viable therapeutic candidates, streamline drug screening, and pave the way toward more personalized medicine. Through this, we provide a comprehensive overview of the current landscape and future implications of iPSC and AI applications being navigated by the research community and pharmaceutical industry.

Cardiovascular diseases persist as a global health challenge that requires methodological innovation for effective drug development. Conventional pipelines relying on animal models suffer from high failure rates due to significant interspecies variation between humans and animal models. In response, the recently enacted Food and Drug Administration Modernization Act 2.0 encourages alternative approaches including induced pluripotent stem cells (iPSCs). Human iPSCs provide a patient-specific, precise, and screenable platform for drug testing, paving the way for cardiovascular precision medicine. This review discusses milestones in iPSC differentiation and their applications from disease modelling to drug discovery in cardiovascular medicine. It then explores challenges and emerging opportunities for the implementation of 'clinical trials in-a-dish'. Concluding, this review proposes a framework for future clinical trial design with strategic incorporations of iPSC technology, microphysiological systems, clinical pan-omics, and artificial intelligence to improve success rates and advance cardiovascular healthcare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objective: Loading is invariably an important factor of consideration for understanding the causality flow and parallel existence of articular cartilage and subchondral bone changes. The goal of this study was to investigate the patterns of subregional 18 NaF-SUV vs. T 1p -T 2 associations and vertical ground reaction force loading rates; in isolated patellofemoral-joint-osteoarthritis (PFJ-OA) patients., Method: Thirty-five isolated PFJ-OA patients, with no tibiofemoral involvement, underwent simultaneous scans in a 3.0T whole-body hybrid positron emission tomography-magnetic resonance imaging scanner. MRI Whole-Organ Magnetic Resonance Imaging Scoring assessments were performed to identify/confirm isolated PFJ-OA knees from bilateral scans. T 1p -T 2 relaxation and SUV values were automatically computed for both trochlear and patellar cartilage and subchondral bone subregions (deep, superficial, lateral, and medial). Maximum vertical impact loading rates (Loading-Rate Norm ) were calculated from walking trials. Relationships were explored between SUV uptake, T 1p -T 2 values, and Loading-Rate Norm via linear mixed-effects modeling., Results: Significant and complex association patterns were noted between medial and lateral bone 18 NaF-SUV uptakes vs. medial and lateral cartilage sub-regional T 1p and T 2 . SUV Mean and SUV Max were positively associated with deep cartilage subregional T 1p and T 2 values; and negatively associated with superficial cartilage subregional T 1p -T 2 values in both medial and lateral regions. Both medial and lateral bone 18 NaF-SUV Mean and SUV Max uptakes remained positively associated with the individual gait characteristics, i.e., peak vertical impact loading rates (Loading-Rate Norm )., Conclusion: Evidence of simultaneous, complementary, cross-sectional associations between T 1p -T 2 values and peak vertical loading rates with 18 NaF-SUV, have been rare in the isolated PFJ-OA cohort. The clinical implications of such novel associations remain of utmost importance from a gait retraining perspective., Competing Interests: Conflict of interest The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Myometrial changes in polycystic ovary syndrome (PCOS) are poorly investigated. Thus, we aimed to investigate endoplasmic reticulum (ER) stress in myometrial smooth muscle cells and changes in spontaneous uterine contraction in PCOS. Twenty-one female Sprague-Dawley rats (21 days old) were divided into control (n = 7), vehicle (n = 7) and PCOS (n = 7) groups. While the control group was not injected subcutaneously, the vehicle group was injected subcutaneously with sesame oil (0.2 ml/day) for 20 consecutive days. The PCOS group was injected subcutaneously with dehydroepiandrosterone (6 mg/100 g/day dissolved in 0.2 ml sesame oil) for 20 consecutive days. Blood samples were collected for the measurement of follicle stimulating-hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2) and glucose-regulated protein 78 (GRP78). The mRNA expression of GRP78 in the uterine tissue samples was analysed by quantitative real-time polymerase chain reaction. GRP78 protein expression was assessed by immunohistochemistry. Myometrial smooth muscle cells were examined by transmission electron microscopy. Uterine contractions were evaluated with isolated organ bath experiments. In the PCOS group, T and LH levels increased significantly, although FSH and E2 levels decreased, but this decrease was not statistically significant. Additionally, GRP78 levels increased significantly in the PCOS group. In the PCOS group, the mRNA level, immunostaining intensity of GRP78, and ER damage grade increased, but the uterine tissue calcium levels, and the frequency and amplitude of spontaneous uterine contractions decreased. The results indicated that increased ER stress in myometrial smooth muscle cells may play a causative role in the decreased spontaneous uterine contractions in PCOS., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Scholars have asserted and provided evidence on the developmental benefits of prosocial behaviors on later academic performance and well-being. However, research directly examining these links in US Latine early adolescents and work that explains the positive link between prosocial behaviors and academic outcomes is scarce. The present study investigated whether social skills and self-efficacy mediate the positive relations between prosocial behaviors and US Latine early adolescents' educational performance., Method: Participants were 543 low-income, US Latine middle school students (M age  = 11.7, SD = 0.73; 275 girls) attending after-school programs. Measures of prosocial behaviors, social skills, self-efficacy, and academic performance were administered at three-time points., Results: Findings showed that prosocial behaviors were significantly and positively linked to later self-efficacy, which in turn, was subsequently positively linked to academic performance. In contrast, the paths among prosocial behaviors, social skills, and academic performance were not significant., Conclusion: The discussion focuses on the central role of self-efficacy in understanding the relations between prosocial behaviors and educational performance in US Latine early adolescents., (© 2024 Foundation for Professionals in Services to Adolescents.)

Objective: Craniopharyngiomas (CPG) have complex treatment challenges due to their proximity to vital structures, surgical and radiotherapeutic complexities, and the tendency for recurrence. The aim of this study was to identify the prevalence of endocrine and metabolic comorbidities observed during initial diagnosis and long-term follow-up in a nationwide cohort of pediatric CPG patients. A further aim was to highlight the difficulties associated with CPG management., Methods: Sixteen centers entered CPG patients into the ÇEDD NET data system. The clinical and laboratory characteristics at presentation, administered treatments, accompanying endocrine, metabolic, and other system involvements, and the patient’s follow-up features were evaluated., Results: Of the 152 evaluated patients, 64 (42.1%) were female. At presentation, the mean age was 9.1±3.67, ranging from 1.46 to 16.92, years. The most common complaints at presentation were headache (68.4%), vision problems (42%), short stature (15%), and nausea and vomiting (7%). The surgical procedures were gross total resection (GTR) in 97 (63.8%) and subtotal resection in 55 (36.2%). Radiotherapy (RT) was initiated in 11.8% of the patients. Histopathological examination reported 92% were adamantinamatous type and 8% were papillary type. Postoperatively, hormone abnormalities consisted of thyroid-stimulating hormone (92.1%), adrenocorticotropic hormone (81%), antidiuretic hormone (79%), growth hormone (65.1%), and gonadotropin (43.4%) deficiencies. Recombinant growth hormone treatment (rhGH) was initiated in 27 (17.8%). The study showed hesitancy among physicians regarding rhGH. The median survival without relapse was 2.2 years. Median (range) time of relapse was 1.82 (0.13-10.35) years. Relapse was related to longer followups and reduced GTR rates. The median follow-up time was 3.13 years. Among the last follow-up visits, the prevalence of obesity was 38%, but of these, 46.5% were already obese at diagnosis. However, 20% who were not obese at baseline became obese on follow-up. Permanent visual impairment was observed in 26 (17.1%), neurological deficits in 13 (8.5%) and diabetes mellitus in 5 (3.3%) patients., Conclusion: Recurrence was predominantly due to incomplete resection and the low rate of postoperative RT. Challenges emerged for multidisciplinary regular follow ups. It is suggested that early interventions, such as dietary restrictions and increased exercise to prevent obesity, be implemented., Competing Interests: Conflict of Interest: Three authors of this article, Damla Gökşen, Korcan Demir, Samim Özen, are member of the Editorial Board of the Journal of Clinical Research in Pediatric Endocrinology. However, they did not take part in any stage of the editorial decision of the manuscript. The editors who evaluated this manuscript are from different institutions. The other authors declared no conflict of interest., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

Objective: 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., 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., Competing Interests: Conflict of interest: None declared., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

Dyshormonogenesis (DG) is the failure of thyroid hormone production due to a defect in thyroid hormonogenesis. Loss-of-function mutations in the thyroglobulin ( TG ) gene are a cause of DG, leading to gland stimulation by thyroid-stimulating hormone (TSH), resulting in goiter. We report a mitotically active follicular nodule in an 11-year-old female with a novel mutation in the TG gene. The patient had been under follow-up for congenital hypothyroidism (CH) since the neonatal period, and she had normal TSH levels on replacement therapy. Genetic test revealed a novel compound heterogeneous mutation [c.2149C>T (p.R717*) (P.Arg717Ter) / c.5361&#95;5362delCCinsG (p.H1787Qfs*3) (p.His1787GlnfsTer3)] in the TG gene. She underwent total thyroidectomy for a thyroid nodule that was reported as Bethesda IV on fine needle aspiration biopsy (FNAB) and noted as suspicious for noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Pathological examination revealed a 16 mm, well-demarcated follicular nodule with a solid/insular pattern. Mitotic activity and Ki67 proliferation index were unusually high (10 mitoses/mm2 and 10%, respectively). Marked cellular pleomorphism and nuclear atypia are well-known diagnostic pitfalls in patients with dyshormonogenetic goiter. However, high mitotic activity is a feature that is less commonly reported in dyshormonogenetic goiter and may raise suspicion of poorly differentiated carcinoma when observed together with a solid pattern. The absence of signs of invasion, history of CH, and awareness of the presence of mutations compatible with dyshormonogenetic goiter can prevent the overinterpretation of such lesions. The risk of cancer development in the dyshormonogenetic thyroid gland is possible in childhood. The close follow-up is life-saving and prevents morbidities and possible mortality., Competing Interests: Conflict of interest: None declared., (©Copyright 2024 by Turkish Society for Pediatric Endocrinology and Diabetes / The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.)

Aim: The research aimed to determine the attitudes of students studying in health-related departments toward sexual myths and the factors affecting them., Methods: The study is descriptive research involving 287 students enrolled in health-related departments. The data were collected using a "Descriptive Information Form" and the "Sexual Myths Scale (SMS)" and analyzed using the SPSS 22.0 software package. The SPSS 22.0 package program was used to evaluate the data. In statistical analysis, Spearman correlation analysis was employed to determine the relationship between continuous variables and the SMS score, and the statistical significance level was accepted as p<0.05., Results: The total score was found to be 53.57±17.54 (min: 28.00 to max: 140.00), reflecting a moderate level. There was a statistically significant difference between the total score of SMS according to gender, family type, maternal employment status, and paternal education level (p<0.05). It was also determined that male students, students whose mothers were unemployed, who lived in extended families, and whose fathers had low education had lower SMS scores., Conclusion: Despite students studying in health-related departments and receiving relevant courses, their level of sexual myths remains at a moderate level, indicating the presence of knowledge gaps and misconceptions in the subject matter. Therefore, it is crucial to implement comprehensive education and counseling services on reproductive and sexual health for all university students.

Background and Aim: Chronic myeloid leukemia (CML) incidence has recently increased in younger individuals. With time, given the nature of the disease and available therapies, as well as the existing paucity and inconsistency of advice, worries about fertility have surfaced. With all these clear unknowns, we designed this study to raise awareness among both physicians and CML patients about whether male and female patients of childbearing age were using contraception at the time of diagnosis, and if so, which methods they were using. In this context, this study aimed to evaluate the contraception methods in patients with CML., Materials and Methods: Eighteen centres from Turkey participated in the study. Male and female patients of childbearing age diagnosed with chronic and accelerated phase CML between the years 2000 and 2024 were evaluated retrospectively., Results: Of the two hundred and thirty-two patients included, one hundred and twenty-five (53.9%) of these patients were female and 107 (46.1%) were male. At diagnosis, all female patients were in the childbearing age, and male patients were sexually active. The median age at diagnosis of the patients was 38 (range, 18-77) years. Eighty-six (68.8%) female patients were using any contraception method, while this was 53.2% (n = 57) among male patients., Conclusion: In conclusion, since CML patients are diagnosed at an earlier age and the desire of these patients to have children, adequate information and evaluation should be provided regarding fertility and contraception issues, especially in female patients, from the moment of diagnosis., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Environmental enteric dysfunction (EED) is characterized by reduced absorptive capacity and barrier function of the small intestine, leading to poor ponderal and linear childhood growth., Objectives: To further define gene expression patterns that are associated with EED to uncover new pathophysiology of this disorder., Methods: Duodenal biopsies from cohorts of children with EED from Bangladesh, Pakistan and Zambia were analyzed by immunohistochemistry (IHC) to interrogate gene products that distinguished differentiation and various biochemical pathways in immune and epithelial cells, some identified by prior bulk RNA sequence analyses. Immunohistochemical staining was digitally quantified from scanned images and compared to cohorts of North American children with celiac disease (gluten-sensitive enteropathy) or with no known enteric disease and no pathologic abnormality (NPA) detected in their clinical biopsies., Results: After multivariable statistical analysis, we identified statistically significant (P < 0.05, 2-tailed t-test) elevated signals representing cluster of differentiation 45 (80%; 95% confidence interval [CI]: 24%, 127%), lipocalin 2 (659%; 95% CI: 198%, 1838%), and regenerating family 1 beta (221%; 95% CI: 47%, 600%) and lower signals corresponding to granzyme B (-74%; 95% CI: -82%, -62%), and sucrase isomaltase (-58%; 95% CI: -75%, -29%) in EED biopsies compared with NPA biopsies. Computerized algorithms also detected statistically significant elevation in intraepithelial lymphocytes (49%; 95% CI: 9%, 105%) and proliferation of leukocytes (267%; 95% CI: 92%, 601%) in EED biopsies compared with NPA biopsies., Conclusions: Our results support a model of chronic epithelial stress that decreases epithelial differentiation and absorptive function. The close association of several IHC parameters with manual histologic scoring suggests that automated digital quantification of IHC panels complements traditional histomorphologic assessment in EED., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Environmental enteric dysfunction (EED) is a precursor of growth faltering in children living in impoverished conditions who are frequently exposed to environmental toxins and enteropathogens, leading to small bowel inflammatory, malabsorptive, and permeability derangements and low-grade chronic systemic inflammation., Objectives: We explored the association between anthropometrics and duodenal histologic features of EED among children from 3 lower middle-income country centers., Methods: In this cross-sectional study, Pakistani children (n = 63) with wasting, Bangladesh children (n = 116) with stunting or at risk for stunting (height-for-age Z score [HAZ] <-1 but ≥-2), and Zambian children (n = 108) with wasting or stunting received nutritional intervention. Children with anthropometric status refractory to intervention underwent endoscopy. Linear regression models included anthropometric around endoscopy, scores of histology parameters, and a global index score of EED-the total score percent-5 (TSP-5). Multivariable models were adjusted for center, age, sex, and histology slide quality., Results: Intersite variation was observed while exploring the association between anthropometrics and the TSP-5; for example, Pakistani children had the worst HAZ, yet their median TSP-5 score was lower than that of the other 2 centers. Even within each site, no overall pattern of higher TSP-5 score was observed with worsening HAZ. During univariate analysis, TSP-5 (coefficient: 0.01; 95% confidence interval [CI]: 0, 0.02), goblet cell depletion (coefficient: 0.22; 95% CI: 0.06, 0.37), and Paneth cell depletion (coefficient: 0.14; 95% CI: 0.01, 0.27) were associated with HAZ scores; however, they lost statistical significance in the multivariable models, with study center most strongly confounding the relationships seen in univariate models between anthropometry and histology., Conclusions: This study contributes a crucial negative finding that duodenal morphological features did not associate with anthropometric phenotypes; hence, anthropometric measurements may not be a suitable outcome measure for use in EED trials. Trial outcomes may need to be defined by combining the functional and structural elements of the gut to monitor EED., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Environmental enteric dysfunction (EED) is an asymptomatic intestinal disorder associated with growth impairment, delayed neurocognitive development, and impaired oral vaccine responses., Objectives: We set out to develop and validate a histopathologic scoring system on duodenal biopsies from a cohort study of children with growth failure in Bangladesh, Pakistan, and Zambia ("EED") with reference to biopsies from United States children with no clinically reported histologic pathology (referred to hereafter as "normal") or celiac disease., Methods: Five gastrointestinal pathologists evaluated 745 hematoxylin and eosin slide images from 291 children with EED (mean age: 1.6 y) and 66 United States children (mean age: 6.8 y). Histomorphologic features (i.e., villus/crypt architecture, goblet cells, epithelial and lamina propria acute/chronic inflammation, Brunner's glands, Paneth cells, epithelial detachment, enterocyte injury, and foveolar metaplasia) were used to score each histopathologic slide. Generalized estimating equations were used to determine differences between EED, normal, and celiac disease, and receiver operating characteristic curves were used to assess predictive value., Results: Biopsies from the duodenal bulb showed higher intramucosal Brunner's gland scores and lower intraepithelial lymphocyte scores than from the second or third parts of the duodenum (D2/3), so only D2/3 were included in the final analysis. Although 7 parameters differed significantly between EED and normal biopsies in regression models, only 5 (blunted villus architecture, increased intraepithelial lymphocytosis, goblet cell depletion, Paneth cell depletion, and reduced intramucosal Brunner's glands) were required to create a total score percentage (TSP-5) that correctly identified EED against normal biopsies (AUC: 0.992; 95% CI: 0.983, 0.998). Geographic comparisons showed more severe goblet cell depletion in Bangladesh and more marked intraepithelial lymphocytosis in Pakistan., Conclusions: This scoring system involving 5 histologic parameters demonstrates very high discrimination between EED and normal biopsies, indicating that this scoring system can be applied with confidence to studies of intestinal biopsies in EED., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Endotracheal intubation is a frequently performed procedure in anesthesia practice, and ensuring the correct inflation of the cuff is essential for maintaining the airway seal. Overinflation of endotracheal tube (ETT) cuffs can lead to complications, such as postoperative sore throat. This study aimed to compare the incidence of elevated ETT cuff pressure between saline and air inflation in elective laparoscopic abdominal surgery., Methods: The study involved 60 participants ranging in age from 18 to 65, with American Society of Anesthesiologists physical status levels 1-2, who underwent laparoscopic abdominal surgery. We randomly assigned patients to two groups: Group A (air-filled ETT cuffs, N.=30) and Group S (saline-filled ETT cuffs, N.=30). Intra-cuff pressure was recorded before and after CO2 insufflation, as well as during changes in patient position. The number of interventions to restore intra-cuff pressure to 18 mmHg was documented. Peak airway pressure, plateau pressure, and positive end-expiratory pressure (PEEP) were measured at 15-minute intervals., Results: The number of interventions needed to maintain intra-cuff pressure was significantly lower in the saline group compared to the air group. All patients started with initial cuff pressures above 20 mmHg. After insufflation, the first-minute cuff pressures were higher in the air group (P=0.001). Both groups experienced a significant increase in intra-cuff pressure with the Trendelenburg position, and after moving to the reverse Trendelenburg position (saline and air groups, P=0.001 and 0.012, respectively), the air group had higher intra-cuff pressure than the saline group (P=0.002). There were no significant differences between groups in peak airway pressure, plateau pressure, and PEEP., Conclusions: Inflating ETT cuffs with saline instead of air during laparoscopic abdominal surgeries led to a reduced requirement for interventions in maintaining pressure. This indicates that the use of saline inflation may significantly lower the risk of high cuff pressure and related complications.

Recently, interest in tooth-colored fluoride-releasing dental materials has increased. Although physical and mechanical properties such as surface hardness, elastic modulus and surface roughness of the restorative materials have been investigated, the effect of different immersion media on these properties is still controversial. The aim of this study was to evaluate the nanohardness, elastic modulus and surface roughness of the fluoride release of tooth-colored restorative materials after immersion in acidic beverages. Prepared samples of three restorative materials (a highly viscous glass ionomer (EQUIA Forte; GC, Tokyo, Japan), a compomer (Dyract XP; Dentsply, Weybridge, UK), and a bioactive restorative material (Activa BioACTIVE; Pulpdent, MA, USA)) were randomly divided and immersed in distilled water, a cola and an orange juice for one week. The HYSITRON T1 950 TriboIndenter device (Hysitron, USA) with the Berkovich diamond indenter tip was used for all measurements. The nanohardness and elastic modulus of the samples were measured by applying a force of 6000 μN to five different points on the sample surface. Surface roughness measurements were evaluated on random samples by scanning five random 40 × 40 μm areas. The properties were measured at the initial and one week after immersion. The values of nanohardness, elastic modulus and surface roughness were tested for significant differences using a two-way analysis of variance (ANOVA) with repeated measures ( p < 0.05). Tukey's honest significant difference (HSD) test was used for multiple comparisons. AB (Activa BioACTIVE) had the highest initial mean values for nanohardness. After post-immersion, the highest mean value for elastic modulus was the initial AB value. The lowest mean value for roughness of 100.36 nm was obtained for the initial DX (Dyract XP) measurement. Acidic beverages had a negative effect on the nanohardness, elastic modulus and surface roughness of the restorative materials., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

To accurately evaluate dietary intake, multiple resources are necessary, including serving-size modules, pictures, and questionnaires that are used to gather information during surveys. One critical component is the accessibility of food composition data at the national or regional level, which is required to determine dietary intake. Food Agriculture Organization/International Network of Food Data Systems (FAO/INFOODs) tools are useful for developing high-quality food composition data. We used these tools to create a nutrient dataset for a nutritional survey in Matiari, Sindh, and to collect dietary information through a 24-hour food recall questionnaire. The survey results indicated 540 distinct types of foods, including 291 ready-to-eat items, 84 foods used as ingredients in recipes, and 164 various composite and mixed recipes. Most food items corresponded to the national and regional Food Composition Tables (FCTs) and the Food and Nutrient Database for Dietary Studies (FNDDS) of the USDA, with the exception of recipe food data. We utilized Eurofir-recipe calculation methods to compute the recipe data. The data were homogenized and standardized utilizing EFSA and Langual™. Because of the obsolescence and inadequacy of Pakistan's food composition table in assessing essential nutrients, we had to source data from various other sources. Consequently, to establish the nutrient dataset, we incorporated approximately 25 % of user data from national sources, with recipe data comprising 46 % and less than 20 % extracted from regional, U.S database, and diverse online sources. This study is the first effort in which we gathered data from reliable sources representing local eating patterns, with some exceptions. Future studies will hugely benefit from this database, especially as we face a high prevalence of undernutrition in our part of the world., Competing Interests: 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., (© 2024 The Authors.)

Bigeminy is a cardiac arrhythmia in which there is a single ectopic beat, or irregular heartbeat, following each regular heartbeat. This case demonstrates the diagnostic challenges that can be encountered while interpreting ECGs of patients with "apparent ventricular bigeminy'., Competing Interests: Declaration of competing interest There is no conflict of interest among the authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)