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Abstract Background Gastrojejunostomy junction perforation is a rare yet critical complication associated with enteral tube placement, presenting unique challenges in patients with a history of Roux-en-Y gastric bypass surgery. Case presentation A 63-year-old white female with a complex medical history, including heart failure, atrial fibrillation, stage 4 chronic kidney disease, and prior Roux-en-Y gastric bypass surgery in 2015, experienced a significant decline in her health. She was discharged to a skilled nursing facility after a fall but deteriorated rapidly in the 2 weeks before admission. She presented with symptoms of failure to thrive, abdominal/back pain, inability to eat or drink, constipation, and stool incontinence. Lab tests showed anemia, electrolyte imbalances, and acute kidney injury. Imaging confirmed Roux-en-Y gastric bypass anatomy and a small hiatal hernia. Despite treatment attempts, her condition worsened. Nutrition discussions led to a temporary Dobhoff tube placement, considering her Roux-en-Y gastric bypass history, with plans for a gastrostomy tube. However, Dobhoff tube placement posed challenges, and imaging later revealed perforation near the gastrojejunostomy junction. After consulting with the family, the decision was made to transition the patient to comfort care due to her overall condition. Yearly education of staff about Roux-en-Y gastric bypass anatomy and updated Dobhoff placement protocol was implemented with physician oversight. Further imaging protocol in a patient who had had a Roux-en-Y gastric bypass was updated to include fluoroscopic guidance when endoscopic placement was unavailable. Conclusions This case highlights the intricacies of managing patients with Roux-en-Y gastric bypass history and underscores the need for meticulous planning and consideration of anatomical variations when performing procedures involving the gastrointestinal tract and the importance of involving multiple healthcare disciplines in complex decision-making and preventive measures to enhance patient safety in similar cases.

Let $K = \mathbb{Q} (\alpha) $ be a pure number field generated by a complex root $\alpha$ of a monic irreducible polynomial $ F(x) = x^{2^r\cdot3^k\cdot7^s} -m \in\bb{Z}[x]$, where $r$, $k$, $s$ are three positive natural integers. The purpose of this paper is to study the monogenity of $K$. Our results are illustrated by some examples.

Introduction: From the beginning of suicide research by Durkheim (1897); the relationship between religiosity and suicidal risk has been seen as a crucial issue. During the last decade, studies on this question have given variable results. However, such studies became a gateway to multiple questions, not only on the relationship between religion and suicide risk but more specifically among patients with depressive disorders, in particular. This study’s main objective is to assess the influence of religiosity on suicidal ideation; suicidal intentionality and on the severity of depressive symptoms in patients with depressive disorders diagnoses or bipolar depression episodes. We carried out an observational, descriptive, and analytical study of 324 patients with a current diagnosis of a major depressive disorder or a bipolar depressive episode. Patients were all Muslims and were interviewed using the Beck Depression Inventory; Suicide Intent Scale and Mini International neuropsychiatric interview Suicide Risk. The religiosity was assessed using the BIAC (Belief Into Action) adapted to Muslims in Morocco. We found that higher religiosity scores were associated with older age (>50 years), marriage, no negative impact of depression on work, presence of bipolar depression, and regularity of medical follow-up. Similarly, higher scores of religiosity were associated with lower scores of depression, suicidal intentionality, or suicidal risk. It will be useful to compare our results with other published results to appraise the positive impact of religiosity on reducing suicidal ideation and behavior among different populations, regardless of their religious affiliations.

Immune check-point inhibitors (ICPi) are immunomodulating agents, which have revolutionized the management of advanced metastatic cancers. Being immunomodulating agents, they are predisposed to causing colitis. This descriptive review article emphasized on the management of ICPi-associated colitis in advanced metastatic cancers. We used PubMed, Google Scholar, Scopus, and Embase databases for literature review, and terminologies commonly searched were “management,” “immune check-point inhibitors,” “colitis,” “metastatic,” “cancers,” “literature,” and “review.” We reviewed a total of 11 articles done in the last 15 years relevant to ICPi colitis and its management; all the articles showed that diarrhea and colitis are the most common adverse effects observed in patients on ICPi, but prior to establishing the diagnosis of ICPi-causing colitis, possibility of Clostridium difficle or cytomegalovirus infections should be ruled out. Once the diagnosis of ICPi colitis is established, treatment should be started depending upon the severity of colitis. In mild severity, discontinuation of ICPi can resolve the symptoms but, in most of the patients with moderate to high severity of colitis, corticosteroids are considered a cornerstone treatment. Patients unresponsive to steroid treatment should be re-evaluated for infections after which anti-TNF therapy—infliximab or vedolizumab, cyclosporine, mycophenolate mofetil—can be considered.

This research study delves into the complex relationship between parental educational background and student participation in lesson activities in the context of secondary school education in Sri Lanka. This study explores whether student participation in lesson activities differs based on parent education. The stratified sampling method selected the sample from Grade 10 secondary school children in Sri Lanka. A carefully selected sample of 1,350 secondary school students was surveyed using a questionnaire instrument to assess their self-perceived levels of engagement in lesson activities and their parents' educational backgrounds. The study employs rigorous statistical analysis, including Two-Way Multivariate Analysis of Variance (MANOVA) tests and post hoc analyses, to explore the impact of parental Education on student participation. The findings reveal that, based on the highest educational level of the mother, significant differences exist in student participation in lesson activities. Students whose mothers hold tertiary education degrees exhibit the highest mean scores, demonstrating that maternal educational attainment positively influences student engagement. However, no significant disparities were observed based on the father's educational level, emphasizing the unique role of the Education of mothers in shaping student participation. The study also underscores the absence of a significant interaction effect between the educational levels of fathers and mothers concerning student participation. This implies that the impact of parental Education on student engagement operates primarily through the mother’s educational background. Overall, this research provides critical insights into the influence of parental educational experience on student participation in lesson activities. The results demonstrate that parents with higher academic qualifications contribute significantly to their children's active involvement in the learning process, ultimately enhancing their educational experiences. These findings have implications for educators, policymakers, and parents, as they underscore the importance of fostering an inclusive and supportive learning environment to promote equitable student participation in lesson activities. Furthermore, the study recommends parental involvement through workshops, media, and educational resources for parents with lower academic levels to bridge the educational gap and enhance student engagement.

AimInternet addiction is a mental health issue that can have detrimental effects on an individual’s life. This study aims to estimate the prevalence of Internet Addiction and identify the risk factors associated with this behavioral addiction.MethodsThis cross-sectional study was conducted in 6 universities in southern Morocco, involving 1,690 students who completed a self-administered questionnaire. The questionnaire collected socio-demographic data, and information on substance use, and included validated tools to assess Internet addiction (Young’s IADQ), depressive symptoms (Patient Health Questionnaire. PHQ-9), and social phobia (Mini Neuropsychiatric International Interview. M.I.N.I).ResultsThe findings of our study indicate that the prevalence of Internet addiction was 30.60% (95% CI), depressive symptoms were present in 44.10% of participants, and the prevalence of social Phobia was 30.20%. A significant correlation was identified between early initiation of tobacco and Internet addiction (p = 0.05). The multivariate regression model revealed a possible association between cocaine use and Internet Addiction (OR = 5.67, IC 95%: 0.45 to 10.80) (p = 0.03), as well as a significant association between social phobia and a higher internet addiction score (OR = 3.45, IC 95%: 1.70–5.02) (p

Introduction: Menopause is the beginning of a new era in a woman's life. This period, like all other stages of life, has positive and negative aspects. The present study aimed to investigate the effectiveness of Pilates exercises on serum BDNF level, balance, and quality of life in menopausal and non-menopausal women.Methods: The current study was a quasi-experimental research with a pre-test and post-test design that included two experimental and two control groups. The sample consisted of 60 menopausal and non-menopausal women (age 45.77±1.77 years) who were voluntarily selected and randomly assigned into four groups of 15 people. Fasting blood was drawn from all the participants 48 hours before the start of training and after the end of the training period. Then both experimental groups performed Pilates exercises for 12 weeks, three sessions per week and each session lasted 60 minutes. Also, the participants similarly performed the Y dynamic balance test and completed the World Health Organization Quality of Life (WHOQOL) questionnaire in pre-test and post-test.Results: The results of Mixed ANOVA showed a significant difference between the pre-test and the post-test of menopausal and non-menopausal women in relevant variables, so it can be said that probably 91%, 76%, and 94% of the changes in serum BDNF levels, balance and quality of life of menopausal and non-menopausal women are influenced by Pilates exercises. However, no significant effect was observed in the relevant variables of control groups (P≤0.05).Conclusion: Pilates exercises can be an effective strategy to improve serum BDNF levels, balance, and quality of life in menopausal and non-menopausal women.

Background: Outcomes of device-detected AF remain unclear in individuals without a prior history of AF. Methods: A meta-analysis was conducted to evaluate outcomes in individuals with no prior history of AF who experienced device-detected AF. Outcomes assessed were clinical AF, thromboembolism and all-cause mortality. A fixed-effects model was used to calculate RRs with 95% CI. Results: Compared to individuals who did not experience device-detected AF, those who did had increased risks of clinical AF (RR 3.33, 95% CI [1.99–5.57]; p

Let $K$ be a pure number field with $\alpha$ a complex root of a monic irreducible polynomial $F(x) = x^{120}-m \in \mathbb{Z}[x]$ with $ m \neq \pm 1 $. In this paper, we study the monogenity of $K$. More precisely, we prove that if $m$ is square-free, $m \not \equiv 1\md{4}$, $m \not \equiv \pm 1 \md{9} $, and $\ol{m}\not \in \{ \mp 1, 7, 18 \} \md {25}$, then $K$ is monogenic. On the other hand, if $m \equiv 1\md{4}$, $m \equiv 1 \md{9} $, or $m \equiv 1 \md{25}$, then $K$ is not monogenic. Our results are illustrated by some computational examples.

Wilms tumor, the most common pediatric kidney cancer, accounts for 5% of childhood cancers and is classified by stage and histological subtype. Despite high survival rates (80-85%), approximately 15% of patients experience relapse, reducing survival to around 50%. Epigenetic changes, particularly DNA methylation, play a critical role in Wilms tumor pathogenesis. This study investigates the prognostic potential of DNA methylation in stage I and II patients with favorable histology, aiming to identify early relapse biomarkers. Genome-wide methylation was assessed using methylation microarrays in tumor tissues from relapsed patients (n = 9) and those with complete responses (n = 9), alongside normal tissues (n = 3 each). Differentially methylated probes and regions were analyzed, with additional ROC and survival analyses. Real-time PCR was used to measure IGF2 and INS-IGF2 gene expression. The analysis revealed hypomethylation in intergenic regions in remission patients, identifying 14 differentially methylated positions as potential biomarkers. Increased INS-IGF2 expression was associated with relapse, suggesting its role in disease progression. While the study concentrated on stages I and II patients, where relapse rates are lower, this focus inherently led to a smaller sample size. Despite this, the findings provide valuable insights into the potential role of DNA methylation markers for monitoring disease progression and guiding personalized treatment in Wilms tumor patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Wilms tumor (WT) is a pediatric kidney cancer associated with poor outcomes in patients with unfavorable histological features such as anaplasia. Small non-coding RNAs, such as miRNAs, are known to be involved in WT pathogenesis. However, research on the clinical potential of blood-based miRNAs is limited. This study aimed to profile aberrantly expressed miRNAs in WT serum samples, evaluate their potential to differentiate standard-risk patients with favorable histology from those with anaplastic WTs, and assess their clinical value as minimally invasive biomarkers for WT detection. The study used next-generation sequencing (NGS) to analyze miRNA expressions in serum samples from 37 Egyptian children, including 10 healthy individuals, 14 with non-anaplastic WTs (favorable histology FH-WTs), and 13 with anaplastic WTs (unfavorable histology UnFH-WTs). Functional enrichment analysis was conducted to identify critical pathways and biological processes affected by dysregulated miRNAs, and a network was created for the most promising miRNA-target interactions linked to WT. The study identified a distinct miRNA expression signature of 45 miRNAs (3 upregulated and 42 downregulated) in WT serum samples compared to healthy controls, with 29 miRNAs exclusively dysregulated in FH-WTs and 6 miRNAs dysregulated solely in UnFH-WTs. These dysregulated miRNAs displayed significant enrichment in cancer-related pathways, such as PI3K/AKT, FOXO, and MAPK signaling. In relation to WT clinicopathological features, decreased levels of hsa-miR-2355-3p showed a significant positive correlation with clinical stage ( r = 0.6597, p = 0.0006) and WT metastasis ( r = 0.439, p = 0.021). The ROC curve analysis revealed that multiple dysregulated miRNAs in WT, specifically hsa-miR-7-5p, hsa-miR-146a-5p, hsa-miR-378a-3p, and hsa-miR-483-5p, exhibited high diagnostic potential for WT, with AUC values exceeding 0.86. Among WT histopathology types, the hsa-miR-1180-3p showed a 2.3 log2fold difference in expression between UnFH-WTs and FH-WTs, indicating its potential as a biomarker with 92% sensitivity and 85% specificity for identifying UnFH-WTs. Its target genes were enriched in pathways related to cell division and cell cycle regulation. In conclusion, hsa-miR-1180-3p could be a reliable blood-based biomarker for distinguishing WT histopathological types, and further research is needed to validate its clinical value., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mohamed, Jalal, Fadel, El-Mashtoly, Khaled, Sayed and Ghazy.)

Chronic kidney disease (CKD) increases the risk of cardiovascular disease and cognitive impairment. Curcumin is a polyphenol that improves vascular and cognitive function in older adults; however, its effects on vascular and cognitive function in patients with CKD are unknown. We hypothesized that curcumin supplementation would improve vascular and cognitive function in patients with CKD. Eighty-eight adults diagnosed with stage 3b or 4 CKD (aged 66 ± 8 years, 75% male) participated in a 12-month, randomized, double-blind, placebo-controlled study to test the effects of curcumin (Longvida ® , 2000 mg/day) on vascular and cognitive function. Our primary outcome was brachial artery flow-mediated dilation (FMD). Our secondary outcomes were nitroglycerin-mediated dilation, carotid-femoral pulse wave velocity (cfPWV), and cognitive function assessed via the NIH Toolbox Cognition Battery. At baseline, the mean estimated glomerular filtration rate was 34.7 ± 10.8, and the median albumin/creatinine ratio was 81.9 (9.7, 417.3). A total of 44% of participants had diabetes. Compared with placebo, 12 months of curcumin did not improve FMD (median change from baseline was -0.7 (-2.1, 1.1) and -0.1 (-1.5, 1.5) for curcumin and placebo, respectively, with p = 0.69). Similarly, there were no changes in nitroglycerin-mediated dilation, cfPWV, or cognitive outcomes. These results do not support chronic curcumin supplementation to improve vascular and cognitive function in patients with CKD.

Background: There is little robust data about the cardiovascular safety of hydroxychloroquine in patients with rheumatoid arthritis (RA), who often have cardiovascular comorbidities. We examined the association between use of hydroxychloroquine (HCQ) in patients with RA and major adverse cardiovascular events (MACE)., Methods: In a retrospective cohort of Medicare beneficiaries aged ≥ 65 years with RA, we identified patients who initiated HCQ (users) and who did not initiate HCQ (non-users) between January 2015-June 2017. Each HCQ user was matched to 2 non-users of HCQ using propensity score derived from patient baseline characteristics. The primary outcome was the occurrence of MACE, defined as acute admissions for stroke, myocardial infarction, or heart failure. Secondary outcomes included all-cause mortality and the composite of MACE and all-cause mortality. Cox proportional hazards model was used to compare outcomes between HCQ users to non-users., Results: The study included 2380 RA patients with incident HCQ use and matched 4633 HCQ non-users over the study period. The mean follow-up duration was 1.67 and 1.63 years in HCQ non-users and users, respectively. In multivariable models, use of HCQ was not associated with the risk of MACE (hazard ratio 1.1; 95% CI: 0.832-1.33). However, use of HCQ was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.45-0.64) and the composite of all-cause mortality and MACE (HR 0.67; 95% CI: 0.58-0.78)., Conclusion: HCQ use was independently associated with a lower risk of mortality in older adults with RA but not with incidence of MACE events. Key Points • Using an incident user design (to avoid the biases of a prevalent user design) and a population-based approach, we examined the effect of hydroxychloroquine (HCQ) on the risk of major cardiovascular events (MACE) in older patients with RA. • We did not find an association between HCQ use and incident MACE. We did, however, find a significant association with the composite outcome (MACE and all-cause mortality) driven by a significant reduction in all-cause mortality with HCQ use., (© 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR).)