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Comprehending English medical terms represents a major obstacle for medical students, especially the none-native English speaking learners that might lead some of them to failure sometimes. This study was intended to examine the usefulness of a "pre-lecture medical terminology guide" in improving those students' academic achievement and class participation during their study of a physiotherapy course. A two-cycle approach of intervention was followed implementing a written pre-lecture guide in the first cycle, and a written pre-lecture guide with a 5-minute explanatory lecture in the second cycle. The obtained results showed a slight improvement in students' scoring in the first cycle, but a significant one during the second cycle. In addition, the findings revealed students' preference of pre-lecture medical terminology guide with a 5-minute explanatory lecture as an effective teaching method for them to understand the medical terms in English. The students also showed a positive feedback towards the pre-lecture guide and felt it helped them understand and memorize difficult medical vocabulary more easily. They also believed that the same technique should be used with other physiotherapy classes.

Abstract The most cost-effective data collection method is electroencephalography (EEG), which obtains meaningful information about the brain. Therefore, EEG signal processing is crucial for neuroscience and machine learning (ML). Therefore, a new EEG stress dataset has been collected, and an explainable feature engineering (XFE) model has been proposed using the Directed Lobish (DLob) symbolic language. The first phase of this research is the data collection phase, and an EEG stress dataset was gathered from 310 participants. This collected stress dataset contains two classes: (i) stress and (ii) control. An XFE model has been presented to detect stress automatically. The presented XFE model has four main phases, and these are (i) channel transformer and quadruple transition pattern (QuadTPat)-based feature generation, (ii) feature selection deploying cumulative weighted neighborhood component analysis (CWNCA), (iii) explainable results creation with DLob and (iv) classification with t algorithm-based k-nearest neighbors (tkNN) classifier. The proposed XFE model generates a DLob string, and the explainable results were obtained using this string. Moreover, the presented XFE model attained 92.95% and 73.63% classification accuracy, deploying 10-fold and leave-one subject-out (LOSO) cross-validations (CV). According to the classification performances, the recommended QuadTPat-based XFE is a good model for EEG signal classification. Also, the presented QuadTPat-based XFE model is a good model for explainable artificial intelligence (XAI) since TTPat-based XFE is cooperating with the DLob.

Abstract Background Migrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients. Methods We carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility. Results Ninety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation. Conclusions Clinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

Abstract Background Headache disorders, including migraine, pose a significant burden globally, with varying prevalence rates across different regions. However, research on migraine in Nigeria and other low-income countries is limited. Understanding the prevalence, characteristics, and treatment outcomes of migraine in Nigeria is essential for informing healthcare policies and improving patient care. Methods This systematic review and meta-analysis aimed to synthesize existing literature on migraine prevalence, characteristics, and treatment outcomes in Nigeria. Eligible studies were identified through comprehensive searches of multiple electronic databases and grey literature sources. Studies reporting migraine prevalence, diagnostic criteria, treatment modalities, and outcomes were included. Data extraction and quality assessment were performed following established guidelines. Results Ten studies involving 7,768 participants met the inclusion criteria and were included in the meta-analysis. The pooled prevalence of migraine headache in Nigeria was calculated to be 16% (95% CI = 7–28), with significant heterogeneity observed among studies (I² = 99.35%, P

Abstract Background Preeclampsia and eclampsia (PE/E) are hypertensive disorders of pregnancy with significant morbidity and mortality for both mothers and fetuses. This study aimed to investigate the prevalence of PE/E, associated complications, and mortality rates in pregnant women in Nigeria using a systematic review and meta-analysis approach. Methods A search strategy was employed to identify relevant studies published in English from electronic databases like PubMed, Google Scholar, Science Direct, AJOL, DOAJ and Cochrane Library. Studies investigating the prevalence of PE/E, associated complications, and mortality rates in pregnant women in Nigeria were included. Data extraction and quality assessment were conducted using standardized tools. Pooled prevalence estimates were calculated using random-effects models. Statistical heterogeneity was assessed using the I 2 statistic. Publication bias was evaluated using the Egger test. Results The analysis revealed a pooled prevalence of 4.51% (95% CI 3.82–5.29) for preeclampsia and 1.39% (95% CI 1.02–1.84) for eclampsia in Nigerian pregnant women. Significant heterogeneity was observed for both PE (I 2 = 99.20%, P

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria. Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak. Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5–8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases

Abstract Polylactic acid modified with graphene oxide (PLA/GO) is proposed to interact with ZnO through 6 different schemes. Density functional theory at B3LYP/LANL2DZ level was utilized to calculate total dipole moment (TDM), HOMO/LUMO energy gap (ΔE) and to map the molecular electrostatic potential (MESP). Results indicated that PLA/GO interacted with ZnO through O-atom forming PLA/GO/OZn composite. This composite interacts with methane, hydrogen sulfide, humidity (H2O), carbon dioxide and ethanol. The same gases were supposed to interact further with PLA/GO/Cu2O. Adsorption energy for the interaction between each composite and the proposed gases were calculated. Both PLA/GO/OZn and PLA/GO/Cu2O composites interacted favorably with H2O. Adsorption energy for interaction of other gases with studied structures are generally low compared to H2O. PLA/GO/OZn have adsorption energy slightly higher than that of PLA/GO/Cu2O. PLA/GO/OZn has higher TDM values than those of PLA/GO/Cu2O, indicating a more polar material. Conversely, PLA/GO/Cu2O exhibited larger ΔE values than those of PLA/GO/OZn. TDM and energy gap results for both studied structures indicated good sensing capabilities. Further insights come from analyzing the calculated density of states (DOS) and partial density of states (PDOS). PLA/GO/Cu2O exhibited high peak for copper in its DOS and PDOS spectra compared to zinc and oxygen in case of PLA/GO/OZn. This means a higher density of available electronic states associated with Cu.

Abstract The human microbiome is a complex and dynamic system that plays important roles in human health and disease. However, there remain limitations and theoretical gaps in our current understanding of the intricate relationship between microbes and humans. In this narrative review, we integrate the knowledge and insights from various fields, including anatomy, physiology, immunology, histology, genetics, and evolution, to propose a systematic framework. It introduces key concepts such as the ‘innate and adaptive genomes’, which enhance genetic and evolutionary comprehension of the human genome. The ‘germ-free syndrome’ challenges the traditional ‘microbes as pathogens’ view, advocating for the necessity of microbes for health. The ‘slave tissue’ concept underscores the symbiotic intricacies between human tissues and their microbial counterparts, highlighting the dynamic health implications of microbial interactions. ‘Acquired microbial immunity’ positions the microbiome as an adjunct to human immune systems, providing a rationale for probiotic therapies and prudent antibiotic use. The ‘homeostatic reprogramming hypothesis’ integrates the microbiome into the internal environment theory, potentially explaining the change in homeostatic indicators post-industrialization. The ‘cell-microbe co-ecology model’ elucidates the symbiotic regulation affecting cellular balance, while the ‘meta-host model’ broadens the host definition to include symbiotic microbes. The ‘health-illness conversion model’ encapsulates the innate and adaptive genomes’ interplay and dysbiosis patterns. The aim here is to provide a more focused and coherent understanding of microbiome and highlight future research avenues that could lead to a more effective and efficient healthcare system.

Abstract This retrospective cohort study conducted in Turkey between December 2020 and June 2022 aimed to assess antibiotic use, bacterial co-infections, and the associated factors on mortality in hospitalized patients with mild-to-severe COVID-19. Among the 445 patients, 80% received antibiotics, with fluoroquinolones being the most common choice, followed by beta-lactams and combinations. Various clinical and laboratory parameters, including symptoms, comorbidities, CCI, oxygen requirements, and CRP levels were observed to be elevated in the antibiotic group. Non-survivors had more ICU admissions and longer hospital stays compared to survivors. We conducted a multivariate Cox regression analysis to evaluate factors related to mortality. However, we did not find an association between antibiotic use and mortality [HR 2.7 (95% CI 0.4–20)]. The study identified significant factors associated with an antibiotic prescription, such as CCI (OR 1.6), CRP (OR 2.3), and ICU admission (OR 8.8), (p

Abstract This study investigated the impact of two extraction methods, traditional hydrodistillation (TDH) and microwave-assisted hydrodistillation (MAH), on the essential oil yield and chemical profile of Lavandula angustifolia L., as well as the bioactive potential of the resulting wastewater. Essential oil composition was analyzed via GC–MS, revealing similar qualitative and quantitative profiles for both methods, with α-terpinolene and (–)borneol as major constituents. Wastewater analysis via LC–MS/MS and spectrophotometric assays demonstrated the presence of significant total phenolic content (3.29–1.78 mg GAE/g) and 32 individual phenolics (463.1 µg/kg for TDH; 479.33 µg/kg for MAH). These findings suggest that both essential oil and wastewater obtained by either method possess considerable bioactive potential, with the MAH method potentially offering advantages over TDH for essential oil extraction. Further exploration of wastewater applications in various industrial sectors is warranted.

Tuberculosis remains a pressing public health concern in Indonesia, ranking second globally after India. Factors contributing to Indonesia’s high TB incidence include lengthy treatment, rising HIV/AIDS cases, and multi-drug resistant TB. Effective TB control focuses on targeted screening, avoiding costly mass screening. This study explores early lung TB detection using WHO systematic screening at Tamalate District, Makassar, Indonesia, addressing screening challenges and program management concerns.

Abstract Background This case report presents an exceptionally rare and atypical presentation of diphtheria in a 17-year-old female of Hausa ethnicity residing in an area with an elevated incidence within Kano State, Nigeria. By the end of 39th epidemiological week of 2023, only two cases of cutaneous diphtheria have been reported among 5,811 cases managed at MMSH diphtheria treatment center (DTC), representing approximately 0.035% of all diphtheria cases during that time period. Case presentation A 17-year-old Hausa female presented with a 3-day history of throat discomfort, malaise, and muffled speech. Physical examination revealed a pseudomembrane covering the tonsillar pillars, grade 3 tonsillar enlargement, and an unusual genital manifestation characterized by extensive vulval edema, severe pain, and a large, greyish patch extending into the vaginal introitus. Her medical history was significant for recent exposure to diphtheria and the emotional impact of her sibling's death from the same disease. Diagnostic tests, including throat swab culture and histocytology, confirmed diphtheria in the throat and vulvovaginal regions. The patient was promptly initiated on diphtheria antitoxin, Azithromycin, and innovative sitz baths with hydrogen peroxide. After 4 days of Sitz bath therapy, complete pseudomembrane clearance was observed, and the patient's symptoms resolved. Conclusion This case underscores the complexity of diphtheria presentations, particularly with rare pseudomembranes in both throat and vaginal regions. The successful management, combining traditional and innovative therapies, highlights the importance of recognizing and addressing unusual manifestations promptly. The potential role of auto-inoculation and the efficacy of interventions like hydrogen peroxide sitz baths warrant further investigation. Overall, this case contributes to the understanding of diverse diphtheria presentations, guiding future clinical strategies for management of diphtheria cases and emphasizing the imperative of comprehensive vaccination efforts.

Abstract This paper aims to study the natural convective magneto-hydrodynamic flow of fluid through vertical concentric annuli with iso-flux heating under the conditions of constant internal heat absorption and an induced magnetic field. By solving the set of dimensionless coupled governing equations, we were able to obtain exact expressions for the temperature field, velocity field, and induced magnetic field. We also managed to derive the formulas for skin friction, mass flux, and induced current density. We also examined the effects of non-dimensional parameters on skin friction and mass flux. For easy comprehension and interpretation, the results are provided graphically and in tabular form. The heat absorption parameter, the induced current density, the induced magnetic field, and velocity exhibit a negative trend as the Hartmann number (Ha) value increases. The induced magnetic field has the effect of raising both the induced current density and velocity profile. It is found that, when a fluid absorbs heat, the heat absorption parameter experiences reverse flow. For the heat-absorbing fluids, the radii ratio has the effect of increasing velocity, induced magnetic field, and induced current density. The numerical values of skin friction and mass flux at cylindrical walls increase (decrease) with increasing heat absorption parameter and generally it has decreasing tendency with increasing Hartmann number

Introduction: : Families of schizophrenia patients need to obtain information from health services about how to care for them. Limited information and understanding of responsibilities in caring are still obstacles to becoming an empowered family in caring for patients with schizophrenia. The study aimed to explore family needs regarding information from health services and family responsibilities when caring for patients with schizophrenia. Methods: This study used a descriptive qualitative design. The study involved families who cared for patients with schizophrenia in Surabaya, Indonesia. Twenty participants were obtained using purposive sampling techniques and the sample size was determined by data saturation. Data were collected using in-depth interviews, field notes and interview question guides. The data were processed with content analysis. Results: The results showed eight themes. Families need information about patient conditions, medication, routine control, and counseling for patient conditions as well as for families. The family describes the responsibilities carried out for the patient as providing support for patient treatment, fulfilling daily needs, helping with social skills, and providing activities in spare time. Conclusions: Adequate information from health services regarding both the patient's condition and family counseling can help to meet the demands of care, which stimulates families to be more empowered to carry out care responsibilities and has an impact on the ability to care better Keywords: counseling, empowerment, family, mental disorder, responsibility, schizophrenia

Abstract The diverse applications of magnetorheological elastomer (MRE) drive efforts to understand consistent performance and resistance to failure. Stress relaxation can lead to molecular chain deterioration, degradation in stiffness and rheological properties, and ultimately affect the life cycle of MRE. However, quantifying the energy and molecular dynamics during stress relaxation is challenging due to the difficulty of obtaining atomic-level insights experimentally. This study employs molecular dynamics (MD) simulation to elucidate the stress relaxation in MRE during constant strain. Magnetorheological elastomer models incorporating silicone rubber filled with varying magnetic iron particles (50–80 wt%) were constructed. Experimental results from an oscillatory shear rheometer showed the linear viscoelastic region of MRE to be within 0.001–0.01% strain. The simulation results indicated that stress relaxation has occurred, with stored energies decreased by 8.63–52.7% in all MRE models. Monitoring changes in energy components, the highest final stored energy (12,045 kJ) of the MRE model with 80 wt% Fe particles was primarily attributed to stronger intramolecular and intermolecular interactions, revealed by higher potential energy (3262 kJ) and van der Waals energy (− 2717.29 kJ). Stress relaxation also altered the molecular dynamics of this MRE model as evidenced by a decrease in kinetic energy (9362 kJ) and mean square displacement value (20,318 Å2). The MD simulation provides a promising quantitative tool for elucidating stress relaxation, preventing material failure and offering insights for the design of MRE in the nanotechnology industry.

Latar belakang. Kelahiran bayi dengan risiko tinggi mendapat pelayanan dan perawatan di Neonatal Intensive Care Unit. Berbagai faktor risiko dapat memengaruhi kematian neonatus, dan berbagai upaya telah dilakukan untuk mengetahui dan mengenali secara dini masalah yang dihadapi. Salah satunya dengan sistem skoring Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) yang merupakan sistem penilaian untuk memprediksi mortalitas dan morbiditas di unit perawatan intensif neonatal pada 12 jam pertama setelah lahir. Tujuan. Mengetahui faktor risiko mortalitas pada neonatus kurang bulan yang sakit kritis menggunakan skoring SNAPPE-II Metode. Penelitian ini merupakan studi observasional analitik dengan desain cross sectional retrospektif. Data penelitian diambil dari data rekam medis berupa bayi dengan penyakit kritis, yang dinilai menggunakan skoring SNAPPE-II dimulai sejak Oktober 2023- Desember 2023. Hasil. Terdapat 37 sampel yang memenuhi kriteria inklusi dan eksklusi penelitian. Hasil analisis faktor risiko mortalitas neonatus pada penyakit kritis menggunakan SNAPPE III didapatkan bahwa pH serum darah, rasio PO2/FiO2 dan Berat Badan Lahir (BBL) berhubungan dengan mortalitas neonatus dengan p-value

Abstract Ischaemic stroke, a leading cause of global morbidity and mortality, necessitates effective biomarkers for enhanced diagnostic and prognostic stratification. MicroRNAs (miRNAs), particularly miR-210, have emerged as promising candidates due to their intricate regulatory roles in cellular responses to hypoxia and neuroprotective effects. This study explores the potential of miR-210 as a biomarker for ischaemic stroke, considering its expression patterns, regulatory functions and diagnostic/prognostic implications. A literature search was conducted on PubMed, Scopus, Google Scholar and Web of Science to identify studies focusing on miR-210 in ischaemic stroke. Inclusion criteria comprised reports on miR-210 expression in ischaemic stroke patients, excluding non-English studies, reviews, commentaries and conference abstracts lacking primary data. Studies investigating miR-210 levels in ischaemic stroke patients revealed significant alterations in expression patterns compared to healthy controls. Diagnostic potential was explored, indicating miR-210’s sensitivity and specificity in distinguishing ischaemic stroke from other neurological conditions. Prognostic value was evident through associations with infarct size, functional outcomes and long-term survival. Challenges included variability in miR-210 levels, limited diagnostic specificity, absence of standardised assays and concerns regarding cost-effectiveness and accessibility. While miR-210 holds promise as an ischaemic stroke biomarker, challenges must be addressed for its successful integration into clinical practice. Standardised reference ranges, validation studies in diverse populations and collaborative efforts for assay standardisation are crucial. Despite challenges, miR-210’s diagnostic and prognostic potential, particularly in predicting therapeutic responses, suggests a significant role in advancing ischaemic stroke management.

Interest in naturally occurring phytochemicals has been on the increase, they are believed to reduce the risk of brain disorders. Hispidulin (HN) is a phenolic flavonoid compound with various pharmacological and biological effects on the central nervous system. It belongs to the flavone class of flavonoids. It can be found in different plant materials, especially fruits and vegetables. The literature used in this review was collected from credible scientific databases including ScienceDirect, Scopus, PubMed, Google Scholar, and Hindawi without time restriction, using relevant keywords, such as HN, brain, central nervous system, flavonoids, and flavones. HN was discovered to possess pro-apoptotic properties, act as an antioxidant, inhibit cytokine production and toll-like receptor 4 expression, as well as impede nuclear factor kappa beta and mitogen-activated protein kinase B. HN was also found to inhibit lipid peroxidation in vitro and reduce brain edema in mice. These pharmacological potentials suggest that HN is a promising candidate for neuroprotection in CNS disorders like depression and epilepsy. This review provides an update on the scientific literature concerning how these activities could help provide various forms of neuroprotection in the CNS. Additional experimental data on the effects of HN in models of neurological disorders and neuroprotection should be explored further. Based on the current study, HN is a promising candidate for neuroprotection of the CNS.

Abstract We previously identified a unique genetic feature of Autism Spectrum Disorder (ASD) in human patients and established mouse models, a low to very low level of six microRNAs, miR-19a-3p, miR-361-5p, miR-3613-3p, miR-150-5p, miR-126-3p and miR-499a-5p. We attempted to interfere experimentally in mice with two of them, miR19a-3p and miR499a-5p by microinjecting into zygote pronuclei either the complementary sequence or an excess of the microRNA. Both resulted in low levels in the tissues and sperm of the targeted microRNAs and their pri and pre precursors. This method stably modify predetermined levels of miRNAs and identify miRNA alterations that cause changes in autistic behavior and predispose the individual to an inherited disease. Excess miRNA results in single-stranded miRNA variations in both free and DNA-bound RNA (R-loop) fractions in mouse models thus appearing to affect their own transcription. Analysis of miRNAs fractions in human patients blood samples confirm low level of six microRNAs also in R-loop fractions.

Introduction: Endovascular aortic repair (EVAR) is commonly used for abdominal aortic aneurysms, but its mortality rate remains high. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, which measures hemoglobin, albumin, lymphocyte, and platelet levels, provides prognostic value by reflecting the nutritional status and systemic inflammation. This study aimed to explore the relationship between the HALP score upon admission and long-term mortality in patients with EVAR. Methods: Consecutive patients with EVAR at our tertiary center from October 2010 to August 2021 were retrospectively analyzed. HALP scores were calculated using the following formula: hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L)/platelet count (/L). In-hospital and long-term mortality data were extracted. Receiver operating characteristic curve analysis identified predictors of in-hospital mortality. Multivariate Cox regression analysis was performed to examine determinants of long-term mortality. Results: Among the 162 participants (mean age: 69.4±8.2 years, 90.1% male), the HALP score was the most significant predictor of in-hospital mortality (area under the curve: 0.752, 95% confidence interval: 0.674-0.830; p

Abstract The objective of this study was to investigate the change in mineral composition depending on tea variety, tea concentration, and steeping time. Four different tea varieties, black Ceylon (BC), black Turkish (BT), green Ceylon (GC), and green Turkish (GT), were used to produce teas at concentrations of 1, 2, and 3%, respectively. These teas were produced using 7 different steeping times: 2, 5, 10, 20, 30, 45, and 60 min. It was also aimed to optimize the regression equations utilizing these factors to identify parameters conducive to maximizing Zn, K, Cu, Mg, Ca, Na, and Fe levels; minimizing Al content, and maintaining Mn level at 5.3 mg/L. The optimal conditions for achieving a Mn content of 5.3 mg/L in black Turkish tea entailed steeping at a concentration of 1.94% for 11.4 min. Variations in K and Mg levels across teas were inconsistent with those observed for other minerals, whereas variations in Al, Cu, Fe, Mn, Na, and Zn levels exhibited a close relationship. Overall, mineral levels in tea can be predicted through regression analysis, and by mathematically optimizing the resultant equations, the requisite conditions for tea production can be determined to achieve maximum, minimum, or target mineral values.

Abstract Importance Cataract is one of the leading causes of childhood blindness in Africa. The management of this condition requires timely surgical extraction of the cataractous lens with immediate optical correction and long-term follow-up to monitor visual improvement and manage complications that may arise. This review provides an opportunity to benchmark outcomes and to shed light on the reasons for those outcomes. Objectives To review the published literature and report on the outcomes of paediatric cataract surgery with intraocular lens insertion in sub-Saharan Africa. Data source The EMBASE, PubMed, Scopus, and Web of Science were searched for relevant articles. Study selection We included all published primary studies from sub-Saharan Africa on cataract surgery outcomes in children aged 0–16 years with primary intraocular lens implantation conducted between 1990 and 2020. Eligible studies were those published in English or for which an English translation was available. In addition, reviewers screened the reference lists of all studies included in the full-text review for eligible studies. During the review, studies fitting the inclusion criteria above except for having been conducted in middle and high-income countries were tagged and placed in a comparison arm. Data extraction and synthesis Study eligibility was determined by two independent reviewers, and data extraction was conducted by one reviewer with entries checked for accuracy by another reviewer. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data synthesis were followed. The Joanna Briggs Institute (JBI) critical appraisal checklist was used for quality appraisal of the studies. The statistical software R was used in the analysis, and data were pooled using a random-effects model. Forest plots were generated using the R package ‘metafor’. Main outcomes and measures The primary outcome was visual acuity (VA) after cataract surgery and the proportions of eyes that achieved good, borderline, or poor visual outcome according to the World Health Organisation (WHO) categorisation of post-operative visual acuity. The secondary outcome measures reported included lag time to surgery, rates of follow-up, and rate of complications. Results Eight out of 4763 studies were eligible for inclusion in this review, and seven were included in the quantitative analysis. There was a male preponderance in the study population, and the mean age at the time of cataract surgery ranged from 3.4 to 8.4 years. Visual outcomes were available for short-term visual outcomes (1 to 6 months) as the studies had a significant loss to follow-up. The pooled proportion of eyes that achieved a good visual acuity (i.e. equal to or greater than 6/18) in the short-term period was 31% (CI, 20–42). The comparative studies from middle and high-income countries reported proportions ranging from 41 to 91%, with higher thresholds for good visual acuity of 6/12 and 6/15. Conclusion and relevance This review reports that there is a lower proportion of eyes with good outcomes after undergoing paediatric cataract surgery in sub-Saharan Africa than in middle- and high-income countries. Furthermore, this review states that there is a high proportion of patients lost to follow-up and suboptimal refractive correction and amblyopia treatment after paediatric cataract surgery.

Background: The global increasing prevalence of obsessive-compulsive disorders and symptoms among various age groups and nationalities is considered a great clinical challenge. However, limited data are available on this topic in the Middle East and Gulf Council Countries. This study aimed to raise awareness of obsessive-compulsive symptoms among adults in Bahrain by determining its prevalence and risk factors among patients attending primary healthcare centers Materials and Methods: A cross-sectional study was conducted among adult patients attending primary healthcare centers in Bahrain. A self-administered online questionnaire using Google form, a free online survey-creating website, was distributed through WhatsApp messages. A snowball sampling technique was used. The questionnaire consisted of three parts: the socio-demographic data of participants, the Maudsley Obsessional-Compulsive Inventory, and the Yale-Brown Obsessive-Compulsive Scale. Descriptive and inferential analyses were conducted. Results: A total of 614 participants were included with a mean age of 30.04 ± 13.04 years. Most participants were females (82.5%) and single (n = 347, 56.5%). The estimated prevalence of obsessive-compulsive symptoms among the participants was 15%; most of them reported mild symptoms (85%). Significantly higher obsession and compulsion symptoms were found among non-Bahraini (P < 0.001 and P < 0.002), single (P < 0.001 and P < 0.033), and student participants (P < 0.001 and P = 0.002) compared to their counterparts, respectively. In addition, undergraduates reported higher obsessions compared to other participants (P = 0.005). Conclusions: Approximately, one in every eight people in Bahrain were found to suffer from obsessive-compulsive symptoms, especially single, students, and non-Bahraini participants. These findings highlight the need for raising awareness of obsessive-compulsive disorder and its symptoms as well as the importance of early detection and management of obsessive-compulsive disorder.

Background: Varicella Zoster infection occurs exclusively in man and commonly affects children with predilection for school age children. Following infection the course of the disease in immunocompetent children is often mild and self limited but in older age groups infection may be severe with poor outcomes ranging from complicating bacterial morbidities to death. In Kaduna State, Northern Nigeria the seroprevalence ofVaricella - zoster virus (VZV) infection is unknown The current cross - sectional study was conducted to assess the seroprevalence of VZV infection among nursery and primary school pupils in Kaduna State. Methods: Nursery and primary school pupils between the ages 4 and 15 years were randomly selected from the three geopolitical z o n e s o f Ka d u n a S t a t e . Demographic data on each subject were obtained by administration of a questionnaire and blood samples were collected for serum analysis of Varicella - zoster virus immunoglobulin G (IgG) using the Automat ion ELISA IgGKi t manufactured by Automation INC. USA. Data obtained were summarized using percentages and frequency tables. Results were analyzed using Epi- info version 3.0. Results: Three hundred and fifty three pupils were recruited for the study. The overall prevalence rate for VZV infection was 66.3% with the value in males being 68.5% and in females 63.9%. The prevalence of VZVinfection increased with age in both sexes. A high percentage of children (60%) were seropositive at 4-6 years. Conclusion:The study shows a 66.3% prevalence of VZV infection among children in Kaduna State. This high prevalence rate necessitates further studies to establish the burden of the problem in Nigeria and rationalize the institution of preventive measures against the infection, particularly immunocompromi sed young children.

Background & Aims: Malaria disease imposes a substantial global health burden, urging the search for effective treatments amid escalating drug resistance. This study investigates the antiplasmodial potential of Azanza garckeana root bark extract in Plasmodium berghei-infected mice and evaluates its impact on hematological indices. Materials & Methods: In this experimental research, we studied on six groups of 30 mice (Groups A to F) comprising of five mice per group. Group A was only given food and water with no inoculation and treatment, B was inoculated with Plasmodium berghei but no treatment was given, C was infected and treated with artemether while D E F were infected and treated with 100mg/kg, 200mg/kg and 300mg/kg of Azanza garckeana root-bark extract respectively for 4 days. Parasitemia levels, chemo-suppressive effect and hematological parameters were assessed on four different days following the start of the treatment. The findings were expressed as mean ± SEM. One-way analysis of variance was used to find the differences between the four groups, and p < 0.05 was considered statistically significant. Results: Phytochemical analysis revealed diverse bioactive compounds in the extract. The 4-day suppressive test demonstrated substantial antiplasmodial activity, with the 300 mg/kg dose achieving an 88.17% chemo-suppressive effect, comparable to Artemether's efficacy. Significant (p < 0.05) increases in hemoglobin, packed cell volume, red blood cells, white blood cells, and platelets were seen in hematological examinations in intervention groups, especially with the 300 mg/kg dosage. Conclusions: Azanza garckeana root-bark extract exhibited potent antiplasmodial effects, possibly mediated by identified phytochemicals. The dose-dependent chemosuppression and modulation of hematological parameters underscore its potential as an alternative antimalarial therapy in mammals.

Background: Adolescents with tuberculosis (TB) form a significant proportion of childhood TB cases presenting with specifics clinical patterns. Objective: To describe the clinical presentation of tuberculosis in adolescent at National Hospital Abuja (NHA), Nigeria. Subjects and method: This is a descriptive and retrospective study of adolescents aged 10- 15 years seen at the department of Paediatrics NHA Nigeria from August 2009 to July 2013. Result: Thirty- six a dolescents diagnosed with tuberculosis were reviewed. Adolescent TB accounted for 18.8%(36/192) of total cases of children aged 0- 15years seen at the Department of Paediatrics Respiratory Clinic during the study period. The mean (SD) age was 12.3(1.76) years.Twenty seven patients (75.0%) were females and 9(25.0%) were males. Thirty (83.3%) were of ower socioeconomic class. History of contact with a case of TB was obtained in 17(47.2%). Thecommonest symptoms identified in these adolescents were; cough 27(75.0%), weight loss 22 (61.1%), fever18(50.0%), sputum 14(38.9%), body swelling 7(19.4%), hemoptysis 2(5.6%); while signs were underweight, pyrexia and chest findings. Nine (25.0%) had associated retroviral disease. Thirty four (94.4%) presented at time of diagnosis with clinical symptoms while 2(5.6%) were asymptomatic; identified during contact tracing as latent TB infection (LTBI). Abnormal chest radiograph findings were; widespread lung infiltrate in 10(27.8%), hilar opacities 7(19.4%), cavitatory lesions 4(11.1%), pleural Effusion 3(8.3%) and military opacities 1(2.7%). AFB was isolated in 5(13.9%), while 23(63.9%) had a raised ESR above 30mm/hr. Twenty seven (75.0%) of the adolescents completed treatment for tuberculosis, 7(19.4%) were lost to follow up and 2(5.6%) died while 4(11.1%) had re-treatment for TB from relapse.Clinical presentations were pulmonary TB (PTB) 22(61.1%), and extrapulmonary TB 12(33.3%); distributed as TB adenitis 4(11.1%), TBM 3(8.3%), Pericardial TB 3(8.3%), Miliary TB 1(2.8%) and Spinal TB 1(2.8). Of the nine with HIV- TB coinfection, the clinical resentation were; PTB 5(55.6%), and extrapulmonary 4(44.4%). Conclusion: The patterns of TB in adolescents are admixture as seen in younger children and adult from clinical and radiological characteristic findings. TB remains a preventable disease condition and is curable with early appropriate treatment

Background: Proteinenergy malnutrition is a prevalent public health problem in the developing countries. It affects body systems including cell-mediated immunity. Objectives: To determine the effect of PEM on CD4+ Tlymphocyte counts among under - 5 children. Methods: This was a prospective cross-sectional study conducted among HIV-negative children aged 6 - 59 months with PEM and the HIV-negative well-nourished children between November 1st, 2010 and July 31st, 2011. The socio-demographic characteristics, weight and some haematological indices of the both groups were documented. The CD4+ Tlymphocyte count was determined using Partec cytoflow machine. Result: One-hundred children were recruited for each group over a 9 month period. The two study groups were comparable in age (p= 0.53) and sex (p= 0.65). The mean CD4+ T-lymphocyte count in chilren with PEM was 1705.5±605.6 cells/μL as compared to 2314.3±491.1 cells/μL among the controls (p= 0.0001). A statistically significant difference was observed in the mean CD4+ T-lymphocyte count of the different types of PEM with the highest value observed among chi ldren wi th kwashiorkor (2097.7±712.9 cells/μL) and lowest value observed among those with marasmus (1449.3±368.2 cells/μL). There were significant differences in the mean CD4+ Tlymphocyte count of the control (2314.3±491 cells/μL) when compared to those of marasmus (1449±368 cells/μL) (p= 0.001), marasmic-kwashiorkor (1888±762 cells/μL) (p= 0.002), underweight (1559±452 cells/μL) (p= 0.001) and underweight- washiorkor (1534±402 cells/μL) (p= 0.001), but it was comparable with that of kwashiorkor group (2098±713 cells/μL) (p= 0.21). A statistically significant difference was observed in the mean CD4+ Tlymphocyte count of the different types of PEM with the highest value observed among children with kwashiorkor (2097.7±712.9 cells/μL) and lowest value observed among those with marasmus (1449.3±368.2 cells/μL). Conclusion: The PEM has deleterious effects on the CD4+ Tlymphocyte counts among under-5 children with PEM with the lowest count observed among those presenting with marasmus.

INTRODUCTION: Pelvic organ prolapse (POP) can be the source of discomfort for women, leading to issues such as urinary incontinence, discomfort from herniated organs, and sexual dysfunction. In this study, our aim is to share our experiences with abdominal sacrocolpopexy and colpocleisis. METHODS: In the study, 28 patients who underwent POP surgery between January 1, 2011 and November 1, 2022 were included. All patients had POP-Q stage 3 and above. Age, comorbidities, previous gynecological operations, history of prolapse and urinary incontinence surgery, and quality of life were recorded. In the postoperative period, the patients were followed up in terms of complications, incontinence and recurrence. RESULTS: A total of 28 patients underwent surgical treatment for POP, with 22 undergoing abdominal sacrocolpopexy and 6 undergoing Le Fort colpocleisis.Since 17 of the patients undergoing sacrocolpopexy had stress urinary incontinence, additional Burch colposuspension was applied. Two patients who underwent sacrocolpopexy developed de novo urge incontinence. These patients benefited from medical treatment. No cases of incontinence developed in the colpocleisis group. There were no recurrences observed in any of the cases. DISCUSSION AND CONCLUSION: Abdominal sacrocolpopexy and colpocleisis are methods with high success and satisfaction rates. Colpocleisis surgery stands out with shorter hospital stay. These patients should be well informed in terms of sexual life, and if there is concomitant stress urinary incontinence, it is recommended to perform the necessary surgery before colpocleisis. For sacrocolpopexy, the patient should be well informed about mesh and related complications beforehand.

Tuberous sclerosis (TS) is inherited as an autosomal dominant trait with variable penetrance characterised by glial cell tumor which arises from the cerebral and the retina. Blindness in association with Tuberous sclerosis (TS) is rare. When visual loss occurs it may be associated with hamartomas from retinal or optic nerve involvement or from intracranial (brain) tumours that affect either the part of the brain that processes visual information or from optic nerve damage following raised intracranial pressure. Very few cases of TS with blindness have been reported globally. Deterioration in academic performance might be the first pointer to the visual impairment. We report a case of a 13 year old girl who presented with increasing number of facial rash over an 11years period, recurrent headache and deteriorating academic performance of 1year and loss of vision of 6months with a recent episode of convulsion. Similar skin rashes without other associated symptoms were noticed on the mother and one of the younger siblings. She was a Tanner stage one in development. She had facialangiofibromas, shagreen patches over the left hypochondria, back regions and face. Ophthalmic evaluation showed a visual acuity of being able to count fingers at not more than one meter from the face and only perception of light in the right and left eye respectively, both eyes had brisk pupillary activities, good mydriasis and clear media. The retinal and optic nerve head appeared normal in the right eye whereas in the left eye was a huge tuberous hamartoma of the optic disc and macular as well as generalised vascular occlusion and subretinal fluid. The Computerized tomography (CT) scan showed an Intraventricular tumour, with calcification within the tumours and subependymal. There was associated obstructive hydrocephalus. Patient was managed by a multidisciplinaryteam of ophthalmologists, neurosurgeons and radiologists, co- ordinated by a paediatrician. Conclusion: The diagnosis of tuberous sclerosis complex (TSC) was based on the lesions found on clinical examination, imaging, and pathologic studies. The blindness was multi-factorial in cause including intracranial, retinal and optic nerve tumours. Comprehensive medical history, detailed physical examinations and neuroimaging study are essential in making a diagnosis of TSC. Our patient was mis-diagnosed at various health facilities for many years. This delay in making appropriate diagnosis and instituting treatment could have contributed to the eventual outcome.

Background: Childhood Acute Lower Respiratory Tract Infection (ALRTI) remains an important public health problem in the developing world, with significant morbidity and mortality a challenge. An understanding of risk factors in the development of childhood ALRTI may offer clues to prevention of the disease; identify conditions that lead to progression to severe disease, complications and even death in a child receiving treatment. Aim: to determine risk factors for ALRTI among Under five children hospitalized. Methods: A prospective study of children aged 2-60 months admitted into hospital with diagnosis of pneumonia and bronchiolitis from November 2011 to September 2012 at the National Hospital, Abuja, Nigeria. With a questionnaire data on socio- demographic and potential risk factors for ALRTI were obtained. Results: A total of 50 children aged 2-60 months were enrolled, 92.0 % had pneumonia while 8.0% had bronchiolitis. 86.0% of pneumonia subjects were 24months and below, while all those with bronchiolitis were infants. 43(86.0%) of subjects were hospitalized in the rainy season. The weights for height z score was less than minus 2 in 12 (24.0 %) of the subjects. Significant risk factor for ALRTI was the use of kerosene and solid fuel for domestic cooking, 33 (66.0%), p value 0.0001; Mortality was four percent among the infants. We conclude that younger ageunder 24 months and exposure to hydrocarbon and biomass from indoor pollution was contributing risk factors for ALRTI in Under five children.

Introduction: Sickle cell anaemia (SCA) is a non- communicable disease of public health significance. SCA is characterized by chronic red blood cell haemolysis and vaso- occlusion which further complicated by nitric oxide deficiency, causes oxidative damage to the body organs especially the kidneys. Objectives: To document the prevalence of renal function and structural abnormalities in children with SCA in a teaching hospital in north western Nigeria. Materials and Methods: One hundred and ten subjects with SCA in steady state without known renal or cardiac abnormalities were enrolled and matched for age and sex with controls (haemoglobin AA). Interviewer-administered questionnaires, clinical examination and renal ultrasound scans were carried out. Urinalysis, spot urine albumin creatinine ratio and serum creatinine were carried out using standardized laboratory methods. Results: Eleven (10.3%) children with SCA had haematuria while 6.5% had overt proteinuria. Children with SCA who had proteinuria were five times more likely, to develop haematuria than the controls with proteinuria (p = 0.03). Microalbuminuria was found in 24.3% of children with SCA. The mean estimated glomerular filtration rate was normal for both subjects and controls. Only three (2.8%) of the SCA subjects had increased renal echogenicity all of whom had microalbuminuria and were older than nine years. Conclusion and recommendations: Renal abnormalities were found in children with SCA occurring as early as 4 years of age. Regular screening for renal disease in children with SCA is recommended to ensure management modalities are instituted early.

Background: Complementary feeding is the corner stone of child’s nutrition. Most malnourished children had their predicament originating from the period of transition from breast-feeding to family diet. Objectives: To determine the complementary feeding practices and nutritional status of young children in Gwiwa community. Materials and Methods: This cross-sectional study was carried out in Gwiwa community, Wam- makko LGA, Sokoto State between January and June, 2018. Three hundred and ten mothers with their children aged 6 – 36 months were interviewed using structured interviewer administered questionnaire and the children’s nutritional status was assessed using WHO classification of malnutrition. Data was analysed using SPSS version 22.0.A pvalue ≤0.05 was taken as significant Results: One hundred and forty (45.2%) respondents were aged 15 – 24years and 168(54.2%) were of low socio- economic class. There were 190 males and 120 females with 66 (21.3%) children exclusively breast fed for 6months. The mean age of cessation of breast feeding was 17.8 ±3.6 months. One hundred and sixty-nine (54.5%) children commenced complementary feeding at 6 - 8month of age with the mean age of 5.7(±2.6) months. One hundred and eighty- four (59.4%) used plain pap with 41.2% fed more than 3 times per day. Eighty – two (26.5%), 56(18.1%) and 76 (24.5%) children were under weight, wasted and stunted respectively. Conclusion: The complementary feeding practices were suboptimal in this community and might explain the poor nutritional status of their under fives. Efforts should be geared towards optimal complementary feeding practices in this community.

Approximately 15 million babies are born preterm each year.1 Preterm infants commonly experience postnatal growth failure due to insufficient intake of micronutrients. We aim to determine the outcome of preterm neonates thatreceived micronutrients. Methods: The study subjects comprised of 210 preterm neonates admitted to (SCBU) of Federal Medical Centre, Brinin kebbi, Kebbi State from 1st June 2020 to 30st May, 2022. The subjects were randomized into two groups; 100 preterm neonates (Study group) received micronutrients (Reload; Reload Brands, LLC, Salt Lake City, Utah, USA) while, 110 preterm neonates (Control group) did not receive micronutrients. Biodata and other important information were obtained. All the babies (210) received the usual treatment protocol of preterm admitted to our SCBU. Ethical approval was obtained from the Research and Ethics Committee. Results: Birth weights of the 210 neonates ranged from 800grams to the highest 2500grams with mean CC –BY 4.0 birth weight of 1.54kg ±0.95. Average daily weight gains in 71% of the study subjects ranged from 25grams to a maximum of 29 grams per day while, in the non- micronutrients group, 54% had daily weight gain range of 10- 14grams per day (p = 0.001). Twelve (12%) of the Micronutrient group (MG) and 30% 0f the Non-Micronutrient group (NMG) had need for blood transfusion respectively (p = 0.002). The average ho sp ital stay was 22.95±9.68; hospital stay for the MG was 8 to 21 days while that of the NMG was 22 to 42 days (p =0.001). C o n c l u s i o n s : M i c r o n u t r i -ents intake were in consistent with optimal weight gain, shorter hospital stay and lower need for blood transfusion in preterm newborns.

Abstract Cytochrome P450 2D6 (CYP2D6) plays a crucial role in metabolizing approximately 20% of medications prescribed clinically. This enzyme is encoded by the CYP2D6 gene, known for its extensive polymorphism with over 170 catalogued haplotypes or star alleles, which can have a profound impact on drug efficacy and safety. Despite its importance, a gap exists in the global genomic databases, which are predominantly representative of European ancestries, thereby limiting comprehensive knowledge of CYP2D6 variation in ethnically diverse populations. In an effort to bridge this knowledge gap, we focused on elucidating the CYP2D6 variation landscape within a multi-ethnic Asian cohort, encompassing individuals of Chinese, Malay, and Indian descent. Our study comprised data analysis of 1850 whole genomes from the SG10K_Health dataset using an in-house consensus algorithm, which integrates the capabilities of Cyrius, Aldy, and StellarPGx. This analysis unveiled distinct population-specific star-allele distribution trends, highlighting the unique genetic makeup of the Singaporean population. Significantly, 46% of our cohort harbored actionable CYP2D6 variants—those with direct implications for drug dosing and treatment strategies. Furthermore, we identified 14 potential novel CYP2D6 star-alleles, of which 7 were observed in multiple individuals, suggesting their broader relevance. Overall, our study contributes novel data on CYP2D6 genetic variations specific to the Southeast Asian context. The findings are instrumental for the advancement of pharmacogenomics and personalized medicine, not only in Southeast Asia but also in other regions with comparable genetic diversity.

Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayıs University’s Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

Background: Although several surgical landmarks have been proposed to localize the recurrent laryngeal nerve (RLN), there is still no reliable landmark. Aims: To validate the reliability of a novel reference point at the intersection of the inferior border of the cricopharyngeal muscle and the inferior cornu of thyroid cartilage for locating the RLN. Study Design: Cadaver dissection study in the academic department of otolaryngology-head and neck surgery. Methods: Sixty-four RLNs in cadavers were assessed, and measurements of different surgical landmarks in conjunction with the proposed surgical landmark were obtained. Descriptive statistics, Pearson’s chi-squared test, and Student’s t-test were performed to analyze the data using GraphPad Prism (version 9.4.1; Dotmatics, Boston, Massachusetts, USA). Results: The average distance from the proposed landmark to the RLN was 2.3 ± 0.85 mm. The RLN was located just posterior to the reference point in 95.31% of the cadavers. The RLN passed under the inferior constrictor muscle in 90.63% of the cadavers. There was no statistically significant difference between right- and left-sided RLNs in terms of their relation with the reference point. Conclusion: The proposed reference point can be used as a reliable landmark to locate the RLN. This reference point may help surgeons during difficult thyroidectomy surgeries by providing an additional anatomical landmark.

Objective: Breast cancer (BC) is the most frequent cancer among women. Many BC patients suffer from sleep problems, which have a negative impact on their quality of life (QoL). Our study aims to investigate sleep problems in BC patients treated with active chemotherapy or in remission in comparison with a healthy control group (HCG), given the importance of sleep disorders and QoL. Materials and Methods: A multicenter, cross-sectional study was conducted. Four different surveys including sociodemographic characteristics questionnaire, Pittsburgh sleep quality index (PSQI), hospital anxiety and depression scale and The European Organisation for Research and Treatment of Cancer core quality of life questionnaire (QLQ-C30) were used to collect study parameters. Results: Of 164 participants, the mean age was 42.0±11.7 years. Overall PSQI median score for all participants was 6 points (range, 3-9 points). PSQI median value was higher in cancer patients compared to the control group, which were 6 points (range, 4-9 points), and 4 points (range, 3-7 points), respectively (p=0.004). The mean depression score was 5 points (range, 3-8 points) in BC patients, and 4 points (range, 2-6 points) in HCGs, respectively (p=0.025). Having BC diagnosis was an independent factor increasing the risk of bad sleep quality in compared to healthy controls (odds ratio: 2.568, 95% confidence interval: 1.169-5.645; p=0.019). Conclusion: There was a close association between poor sleep quality, depression and QoL scores in patients with BC. In patients with breast cancer, appropriate management of associated comorbidities will aid a better quality of life in these patients.

Objective: This study aims to assess the effect of bone graft materials derived from pearl oyster shells on the tumor necrosis factor-alpha (TNF-α) level.

Latar belakang. Respiratory Distress Syndrome merupakan penyebab gangguan pernapasan, sering terjadi pada bayi baru lahir dan juga menjadi penyebab paling umum terjadinya morbiditas dan mortalitas pada neonatus. Salah satu komplikasi yang sering terjadi adalah Acute Kidney Injury. Tujuan. Penelitian ini bertujuan untuk menganalisis hubungan antara Respiratory Distress Syndrome dengan kejadian Acute kidney injury pada neonatus di Rumah Sakit dr. Zainoel Abidin Banda Aceh. Metode. Penelitian ini menggunakan pendekatan analitik obervasional dengan desain cross-sectional. Data dikumpulkan dari pasien yang dirawat dalam periode Januari 2021-Desember 2021. Sampel penelitian adalah populasi terjangkau yang memenuhi kriteria inklusi dan eksklusi. Besar sampel penelitian adalah total populasi. Penelitian bersifat retrospektif dengan variabel dependen dan independen yang diamati secara sekaligus. Hasil. Selama penelitian berlangsung didapatkan 50 sampel yang memenuhi kriteria inklusi dan eksklusi penelitian, jumlah neonatus berjenis kelamin laki-laki (50%) sebanding dengan perempuan (50%). Usia neonatus terbanyak pada kelompok 3 hari yakni 36 subjek (72%). Mayoritas jenis persalinan dijumpai pada kelompok sectio caesarea yakni 45 subjek (90%). Kelompok usia gestasi 34-36 minggu (preterm) terbanyak yakni 32 subjek (64%). Subjek kelompok Berat badan lahir 1000-7 berhubungan dengan kejadian Acute Kidney Injury. Mayoritas subjek penelitian dengan Respiratory Distress Syndrom tidak dijumpai Acute Kidney Injury, sebanyak 39 subjek (78%) dengan hasil normal. Kesimpulan. Pada penelitian ini didapatkan terdapat hubungan antara Respiratory Distress Syndrom dengan kejadian Acute Kidney Injury (p

Abstract Climate change (CC) will likely significantly impact the world’s infrastructure significantly. Rising temperatures, increased precipitation, and rising sea levels are all likely to stress critical infrastructures (CI). Rising temperatures can lead to infrastructure damage from extreme heat events. This can cause roads and bridges to buckle or crack, leading to costly repairs and potential traffic disruptions. In addition, heat waves can damage vital electrical infrastructure, leading to widespread power outages. In light of this context, this article reports on a study which examined the connections and impacts of CC on infrastructure. The study employed a mixed-method approach, combining bibliometric analysis for the period 1997–2022 with a series of relevant case studies from the five continents to offer insight into the impact of CC on infrastructure. The article fills a research gap in respect of assessments of the extent to which climate change (CC) negative influences the infrastructure, with a special focus on developing countries. It also showcases CI projects and adaptation measures being currently deployed, to address CC. The results show that the current infrastructure is vulnerable to CC. The selected case studies on CI adaptation show that in developing and industrialised countries, there is a perceived need to understand better the connections and potential impacts of CC on critical areas such as transport, settlements, and coastal infrastructure. In order to protect infrastructure from CC impacts, governments need to invest in measures such as flood control, early warning systems, and improved building codes. Additionally, they need to work to reduce greenhouse gas emissions more actively, which are the primary cause of CC.

Abstract Intensification of staple crops through conventional agricultural practices with chemical synthetic inputs has yielded positive outcomes in food security but with negative environmental impacts. Ecological intensification using cropping systems such as maize edible-legume intercropping (MLI) systems has the potential to enhance soil health, agrobiodiversity and significantly influence crop productivity. However, mechanisms underlying enhancement of biological soil health have not been well studied. This study investigated the shifts in rhizospheric soil and maize-root microbiomes and associated soil physico-chemical parameters in MLI systems of smallholder farms in comparison to maize-monoculture cropping systems (MMC). Maize-root and rhizospheric soil samples were collected from twenty-five farms each conditioned by MLI and MMC systems in eastern Kenya. Soil characteristics were assessed using Black oxidation and Walkley methods. High-throughput amplicon sequencing was employed to analyze fungal and bacterial communities, predicting their functional roles and diversity. The different MLI systems significantly impacted soil and maize-root microbial communities, resulting in distinct microbe sets. Specific fungal and bacterial genera and species were mainly influenced and enriched in the MLI systems (e.g., Bionectria solani, Sarocladium zeae, Fusarium algeriense, and Acremonium persicinum for fungi, and Bradyrhizobium elkanii, Enterobacter roggenkampii, Pantoea dispersa and Mitsuaria chitosanitabida for bacteria), which contribute to nutrient solubilization, decomposition, carbon utilization, plant protection, bio-insecticides/fertilizer production, and nitrogen fixation. Conversely, the MMC systems enriched phytopathogenic microbial species like Sphingomonas leidyi and Alternaria argroxiphii. Each MLI system exhibited a unique composition of fungal and bacterial communities that shape belowground biodiversity, notably affecting soil attributes, plant well-being, disease control, and agroecological services. Indeed, soil physico-chemical properties, including pH, nitrogen, organic carbon, phosphorus, and potassium were enriched in MLI compared to MMC cropping systems. Thus, diversification of agroecosystems with MLI systems enhances soil properties and shifts rhizosphere and maize-root microbiome in favor of ecologically important microbial communities.

Abstract Background The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery. Methods and analysis The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta‐Analysis (CINEMA). Discussion This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing. Systematic review registration PROSPERO CRD42023429618.

Abstract Among the factors affecting the effectiveness of malaria control is poor knowledge of the entomologic drivers of the disease. We investigated anopheline populations as part of a baseline study to implement house screening of windows and doors as a supplementary malaria control tool towards elimination in Jabi Tehnan district, Amhara Regional State of Ethiopia. The samples were surveyed monthly using CDC light traps between June 2020 and May 2021. Mosquito trap density ( 80% of total anopheline captures and contributed ~ 42% of Plasmodium-infected mosquitoes. On the other hand, morphologically scored Anopheles funestus s.l., constituting about 6% of anopheline collections, accounted for 50% of sporozoite-infected mosquitoes. Most of the infected An. funestus s.l. specimens (86.7%) were grouped with previously unknown or undescribed Anopheles species previously implicated as a cryptic malaria vector in the western Kenyan highlands, confirming its wider geographic distribution in eastern Africa. Other species with Plasmodium infection included An. longipalpis C, An. theileri, An. demillioni, and An. nili. Cumulatively, 77.8% of the infected mosquitoes occurred outdoors. These results suggest efficient malaria parasite transmission despite the low vector densities, which has implications for effective endpoint indicators to monitor malaria control progress. Additionally, the largely outdoor infection and discovery of previously unknown and cryptic vectors suggest an increased risk of residual malaria transmission and, thus, a constraint on effective malaria prevention and control.

Abstract Blast and gunshot-induced penetrating traumatic vascular injuries represent a significant portion of patients with vascular trauma in countries where there are higher rates of war-related violence. These injuries are especially challenging in resource-limited countries due to early diagnosis and transfer delays. This report aimed to present our experience regarding the surgical management and outcome of such injuries at a major referral vascular surgery centre in the country. A retrospective descriptive review of 326 patients with blast and gunshot-induced penetrating traumatic vascular injuries managed during a five-year period between April 2018 and April 2023. The demographics, mechanism of injury, type of vascular injury, Anatomical location, time to the operation, length of hospital stay, amount of blood products given, concomitant neuroskeletal injuries, development of Vascular injury associated acute kidney injury, surgical procedures performed and patient outcome were reviewed. In this study, 326 patients with 445 vascular injuries fulfilled the inclusion criteria. Most of the patients were male 92.3%, and the mean age was 28.3 ± 9.9 years. The gunshot mechanism of vascular injury was implicated in 76.1% of the injuries, and explosive-induced injury was 78 (23.9%). 193 (59.2%) of the patients had isolated arterial injuries, 117 (35.9%) patients had combined arterial and venous injuries while 18 (4.9%) patients had isolated venous injuries. The most commonly injured arteries were the femoral artery, followed by Brachial and popliteal artery injuries (26.1%, 23.5% and 19.4%, respectively). The median time to revascularization was 8.8 ± 8.7 h. 46.8% of the patients had Concomitant fractures, while 26.5% had Concomitant nerve injuries. Only three patients had temporary non-heparin-bound shunts during their arrival. The most common surgical intervention in arterial injuries was reversed saphenous vein graft 46.1%. The mortality was 5.8% and 7.7% of the patients needed secondary amputation. The majority of wartime arterial injuries are a result of Blast and gunshot vascular injuries. Frequent need for autologous vein grafts should be considered to manage such injuries. Results are encouraging despite delays in intervention; therefore, all viable limbs should be revascularized, keeping in mind the long-term functionality of the limb.

Abstract The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03–2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29–2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08–2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19–3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.

Kahramanmaraş earthquakes occurred on 6 February 2023, and many people died and were trapped under the rubble. The objective of this research was to investigate child victims of the quake, who were most dramatically affected, required intensive care and were trapped under debris/rubble/wreckage in terms of psychiatric status and the disaster-related or personal determinants of psychopathologies. Pediatric patients (n=77) who were hospitalized in intensive care units and inpatient wards within the first month after the earthquake and were consulted to the Child Psychiatry, were examined in terms of psychiatric symptoms, use of psychotropics, duration under debris, loss of relatives, loss of limbs, and intensive care requirement. Anhedonia, loss of appetite, psychosomatic and dissociative symptoms, as well as psychotropic need/use were significantly higher in patients who required intensive care. Dissociative and psychosomatic symptoms were linked with longer durations under debris. The current findings highlight prominent and predominated psychiatric symptoms in child victims of quakes, hospitalized in intensive care units and being prolonged trapped under debris. Prolonged entrapment correlated with increased dissociative and psychosomatic symptoms, emphasizing the need for targeted psychiatric support for vulnerable earthquake survivors. [Med-Science 2024; 13(3.000): 590-7]

Objective The study aims to evaluate anxiety and depression levels and access to mental health services among internally displaced persons (IDPs) in Mogadishu, Somalia.Design A community-based, cross-sectional survey was carried out in IDP camps. Face-to-face interviews were conducted using a modified Hospital Anxiety and Depression Scale. Data were analysed using SPSS V.25.0, incorporating univariate and logistic regression analyses.Setting The study was conducted in 10 IDP camps located in the districts of Daynile and Kahda in the Banadir region of Somalia between November and December 2023.Participants The study included 522 randomly sampled individuals aged 18–70 years living in the selected IDP camps.Results The study revealed high prevalence rates of anxiety (43.7%) and depression (35.8%) among IDPs in the selected districts. Of those with anxiety, 54% were categorised as borderline cases and 46% as severe cases. Similarly for depression, 72.7% were classified as borderline cases and 27.3% as severe cases. Significant associations were found between anxiety symptoms and variables such as camp residence (OR: 3.872, 95% CI 2.333 to 6.424), female gender (OR: 2.387, 95% CI 1.604 to 3.552), young age (OR: 6.319, 95% CI 4.309 to 9.267), marriage contract (OR: 4.569, 95% CI 2.850 to 7.325), lack of education (OR: 1.92, 95% CI 1.349 to 2.737) and past experiences of trauma (OR: 5.207, 95% CI 3.274 to 8.281). Depressive symptoms were significantly associated with younger age (OR: 1.536, 95% CI 1.069 to 2.208), lack of formal education (OR: 1.661, 95% CI 1.153 to 2.395) and history of trauma (OR: 3.695, 95% CI 2.529 to 5.400). Additionally, the study highlighted a grave shortage of mental health and psychosocial support (MHPSS) services. User evaluations of MHPSS services varied, indicating room for improvement.Conclusion The study revealed elevated levels of anxiety and depression among IDPs in the districts of Kahda and Daynile in the Banadir region of Somalia, underscored by a critical shortage of MHPSS services, emphasising the need for tailored mental health interventions.

Background Acute coronary syndrome (ACS) remains one of the leading causes of death worldwide. Smoking may also increase the risk of developing ACS. The most advantageous therapy is percutaneous coronary intervention. However, this therapy may fail because of the no-reflow phenomenon. This case report describes a young male patient admitted to the emergency department due to ST-segment elevation of myocardial infarction (STEMI), with smoking as the only risk factor. Case description A 37-year-old male presented to our hospital with a typical chest pain. He was a heavy smoker. Electrocardiography (ECG) revealed extensive anterior STEMI. Coronary angiography revealed total occlusion of the proximal left anterior descending artery (LAD) with a high-burden thrombus. The no-reflow phenomenon occurs during Percutaneous Coronary intervention (PCI). After two days of hospitalization, the patient developed cardiogenic shock and acute decompensated heart failure. The patient was administered ticagrelor, acetylsalicylic acid, enoxaparin for three days, high-dose statins, and optimized heart failure treatment. The patient was discharged on the 7th day after admission. Discussion Cigarette smoke chemicals may induce atherosclerosis and thickened blood in the arteries. Lipid oxidation leads to plaque formation. If plaque ruptures, it will cause thrombus occlusion. A high-burden thrombus can induce a no-reflow phenomenon, leading to heart failure and cardiogenic shock. Conclusion Smoking may induce STEMI and tends to result in a high-burden thrombus. The no-reflow phenomenon is an evidence of miscarriage during PCI, which may increase because of smoking.