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Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.

Background The development of autism spectrum disorder (ASD) may stem from exposure to environmental pollutants such as heavy metals. The primary objective of this study is to determine the role of heavy metals of concern such as manganese (Mn), cadmium (Cd), lead (Pb), arsenic (As), and essential trace element selenium (Se) among ASD children in Kuala Lumpur, Malaysia. Method A total of 155 preschoolers in Kuala Lumpur between the ages 3 to 6 participated in an unmatched case-control study, comprising ASD children (n = 81) recruited from an early intervention program for autism, and 74 children without autism who were recruited from public preschools. Urine samples were collected at home, delivered to the study site, and transported to the environmental lab within 24 hours. Inductively coupled plasma mass spectrometry (ICP-MS) was applied to measure the concentration of heavy metals in the samples. Data were analysed using bivariate statistical tests (Chi-square and T-test) and logistic regression models. Result This study demonstrated that Cd, Pb, and As urine levels were significantly greater in children without autism relative to those affected with ASD (p 1, p

BackgroundMelioidosis, a tropical infectious disease caused by Burkholderia pseudomallei, is epidemic in most region in Southeast Asia with high case fatality. However, there is scanty information regarding the disease's epidemiological pattern, demographics, and underlying risk factors.MethodThis 5-year retrospective study of 185 confirmed cases which were taken from the Negeri Sembilan Melioidosis Registry between 2018 and 2022. We aim to describe the incidence, mortality rate, case fatality, relationship with meteorology, and factors that influence mortality in this central region of Peninsular Malaysia.ResultsIncidence rate (IR) of melioidosis in Negeri Sembilan is varied at 1.9 to 5.1 with mean of 3.1 in 100,000 population per year. IR varied between districts in the state from zero to 22.01 in 100,000 population per year. Mortality rate were ranged from 0.17 to 0.74 cases with mean of 0.44 cases in 100,000 population per year. The case fatality rate of this state scattered from 8.70% to 16.67%. There were no significant linear associations between cases and deaths with monthly rainfall and humidity. The mean age of patients was 52.8 years, predominated with age around 41-60 years old. Males (77.8%) predominated, and the majority of cases were Malays (88.9%) and had exposed to soil related activities (74.6%). Mortality from melioidosis was more likely in Bumiputera and non-Malaysians (pConclusionThe epidemiological patterns of cases reported from Negeri Sembilan are consistent for the most part from previous studies in other states in Malaysia and global with regard to its incidence, case fatality, demographic and predisposing chronic diseases. Diabetes mellitus and hypertension were significantly linked to increased mortality among all determinants.

One of the most important tasks of educationists from preschool centers in Malaysia is to prepare the young child for global readiness. This study involved (N=529) preschool children in Malaysia. The main objective was to gauge the level of global readiness of children aged (5-6 years old) according to several dimensions of global readiness namely (a) diversity and multiculturalism (b) use of ICT (c) communication and multiple language ability (d) problem solving and (e) environmental awareness. Responses to the Global Readiness Scales were recorded and analyzed using One Way ANOVA. The main findings indicated that (a) a generally high level of global readiness in diversity dimension (b) high level of global readiness was found in usage of ICT and problem solving dimension (c) moderate level of global readiness were found on communication and environmental awareness (d) all types of preschool scored high level of global readiness except in Islamic based preschool which scored moderate (e) significance differences were found according to the types of preschools in all dimensions except cause and effect. The findings suggest that (a) there is need to conduct qualitative study on the implementation of global readiness in the preschool centers (b) there is the need to develop global readiness curriculum modules to be integrated effectively in teacher training (c) a cross-cultural comparative study should be conducted across preschools at the regional and international level to gain wider perspective on the implementation of global readiness.

Background:. Diabetic peripheral neuropathy (DPN) is a leading cause of morbidity. This systematic review and meta-analysis evaluate the efficacy of lower extremity nerve decompression in reducing DPN symptoms and complications. Methods:. A database search was performed using Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials. Articles addressing surgical decompression of lower limb peripheral nerves in patients with diabetes were screened for inclusion. Two independent reviewers undertook the assessment. Methodological quality measures were the Cochrane risk of bias and Newcastle-Ottawa scale. Results:. The pooled sample size from 21 studies was 2169 patients. Meta-analysis of 16 observational studies showed significant improvement in the visual analog scale (VAS) (P < 0.00001) and two-point discrimination (P = 0.003), with strong reliability. Decompression of the tarsal tunnel region had the highest improvement in VAS [MD, 6.50 (95% CI, 3.56–9.44)]. A significant low-risk ratio (RR) of ulcer development and lower limb amputation was detected (P < 0.00001). Lowest RR of ulcer development was detected with tarsal tunnel release [RR, 0.04 (95% CI, 0.00–0.48)]. Improvements in VAS, two-point discrimination, and nerve conduction velocity were nonsignificant in the meta-analysis of five randomized controlled trials (RCTs). The RCT analysis was limited to only two studies for each outcome. Conclusions:. Meta-analysis of observational studies highlights the efficacy of lower extremity nerve decompression in reducing DPN symptoms, ulcerations, and amputations. Releasing the tibial nerve in the tarsal tunnel region was the most effective observed procedure. Nevertheless, high-quality RCTs are required to support the utility of this intervention in DPN.

Background: Healthcare is currently struggling to provide access and coverage for an increasingly diverse aging population who frequently have multiple co-morbid conditions complicating their care and medical management. Methods: This retrospective study analyzed the prevalence and distribution of common co-morbid conditions (hypertension, dyslipidemia, dementia, and diabetes mellitus) in 316 elderly heart failure patients (age range 80–103; mean 87 ±4.9). Results: Chart review analysis showed a racial distribution of 65 African American versus 251 Caucasian patients (21 vs. 79%). Hypertension was comparable in both groups (98.5% African American vs. 92.4% Caucasian). Dyslipidemia, diabetes and dementia diagnoses were all approximately 20% higher in African American versus Caucasian patients. The concurrent presence of all four conditions was approximately three times more prevalent in African Americans (18.5%) versus Caucasians (7.2%). Conclusion: Our study is unique for studying disparity in octogenarian and nonagenarians residing in a rural setting. Our results also highlight the importance of making a special effort to engage older African American patients in seeking healthcare. In addition, strategies must be designed to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.

The association between large pericardial effusion and restrictive cardiomyopathy (RCM) is uncommon and has seldom been described. We describe an uncommon case of a 31-year-old male with RCM who presented with large, recurrent pericardial effusion, heart failure, and echocardiographic findings showing progressive worsening of diastolic function even after total pericardiectomy who was eventually transferred for cardiac transplant evaluation.

Introduction Public health achievements throughout the last century have resulted in a steady increase in life expectancy. An emergent subset has distinguished themselves, living well beyond the ninth decade by avoiding or delaying the onset of most age-related diseases, including bone diseases and fractures. In this study, we evaluated the bone health of the oldest community-dwelling individuals living in rural Arkansas. Methods 299 patients aged ≥90 years were retrospectively reviewed for recorded fractures within 12 years prior to the investigation period. Records were also examined for medications and test results pertinent to bone health, including thyroid stimulating hormone, vitamin D levels, hematocrit, hemoglobin, body mass index, and bone densitometric values. Results 68 patients (23%) had at least one fracture documented, and 15 had >1 fracture. 40% of patients with fractures had osteoporosis and 28% had osteopenia, respectively. 232 patients (78%) had no documented fractures, and of these, only 18% had osteoporosis and 16% had osteopenia. No significant clinical markers were found among the very old to explain the relatively low occurrence of fractures. Conclusions Patients over 90 years of age had an overall low prevalence of fractures and relative preservation of bone health, suggesting a preserved bone molecular profile in these individuals. Epigenetic factors and activity levels might also have favorably affected bone health. The low percentage of osteoporosis and fractures likely reduced the morbidity and mortality in this population, potentially contributing to their overall longevity.

Millions of Americans live with dementia. Caregivers of this population provide countless hours of multifaceted, complex care that frequently cause unrelenting stress which can result in immense burden. However, it is not fully understood what efforts can be made to reduce the stress among caregivers of persons with dementia (PWD). Therefore, the aim of this pretest–posttest designed study was to evaluate changes in caregiver burden after providing an educational intervention to those caring for PWD in Arkansas. Forty-one participants completed the Zarit Caregiver Burden Scale before and after attending a 4-hour dementia-focused caregiving workshop. The analysis of the means, standard deviations, and paired t tests showed that there was an increase in the confidence and competence in caring for PWD 30 to 45 days after attending the workshop. Health care providers need to understand both the vital role caregivers provide in managing a PWD and the importance of the caregiver receiving education about their role as a caregiver. Utilizing caregiver educational programs is a first step.

A356 alloy based composites are extensively used in different component industries like components of automobile parts owing to pronounced strength to weight ratio. In the current paper, A356/Si3N4 nanocomposites are fabricated by means of stir casting by varying Si3N4 reinforcement nanoparticles. Silicon Nitride (Si3N4) nanoparticle is intermixed to Al powder mechanically to develop their wettability among the particles of A356/Si3N4 nanocomposites. The Si3N4 nanoparticle is integrated by altering weight percentage. The electomechanical stirring process to produce the vortex is taken up to spread Si3N4 nanoparticles in the liquefied matrix dispensed into a permanent mould. Morphological investigation of the composite specimen is accomplished by TEM. Based on the study, it can be acquired that the strengthening by Si3N4 nanoparticles promotes the strength and hardness of the fabricated nanocomposites. The maximum tensile strength is depicted to be 319 MPa for A356/5%Si3N4 nanocomposites whereas hardness is increased from 43 HBN to 86 HBN. The physical properties such as density and porosity are also increased due to the presence of Si3N4 nanoparticles. The maximum porosity of 1.12% was predicted at 5 wt. % of Si3N4. The TEM examination discloses the presence of Si3N4 nanoparticles in the fabricated composites. Additionally, the current research guidance has ability to afford a monitor to the industrialized preparation of A356/Si3N4 nanocomposites. [ABSTRACT FROM AUTHOR]

Background: The most prevalent mental or emotional problem associated with childbirth is post-partum depression (PPD). This study was designed to determine the psychological responses of Iranian women to difficult childbirth. Methods: In this prospective cohort design, incidence rate and associated obstetric predictors of PPD over twelve week’s post-partum were investigated among 1801 non depressed pregnant women attending primary health centers (PHCs) of Mazandaran province from January to June 2009 using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS > 12). Using logistic regression analyses, odds ratios (ORs) for the significant obstetric risk factors that were significantly associated with PPD from chi-square tests were calculated. The associations were controlled for possible socio-demographic confounding factors. Results: The incidence proportions of depression occurring over a 12 weeks period of post-partum were 12.30%. The regression model showed that the risk of PPD was increased by experienced recurrent urinary infection [OR=2.25, (95% CI: 1.15-4.38), unwanted pregnancy [OR=1.97, (95% CI: 1.15-3.35)] and gestational diabetes [OR=3.41, (95% CI=1.46-5.88)] during pregnancy. Conclusions: Although the mode of delivery was not predictive of PPD, other difficulties during pregnancy were associated with higher levels of depressive symptoms over 12 weekchr('39')s post-partum that needs on-time interventions.