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The global burden of skin diseases affects over 3 billion individuals, posing important public health challenges worldwide, with profound impacts in both high-income and low-income and middle-income countries. These challenges are exacerbated by widespread disparities in access to dermatologic care and the prevalence of misinformation. This article, derived from the Skin and Digital Summit at the International Master Course on Aging Science critically evaluates how digital technologies such as artificial intelligence, teledermatology, and large language models can bridge these access gaps. It explores practical applications and case studies demonstrating the impact of these technologies in various settings, with a particular focus on adapting solutions to meet the diverse needs of low-income and middle-income countries. In addition, the narrative highlights the ongoing conversation within the dermatologic community about the role of digital advances in health care, emphasizing that this discussion is dynamic and the one that is continuously evolving. Dermatologists play an essential role in this transition, integrating digital tools into mainstream care to complement a patient-centered, culturally sensitive approach. The article advocates for a globally coordinated digital response that not only addresses current disparities in skin health care but also promotes equitable access to digital health resources, making dermatologic care more representative of all skin types and accessible worldwide.

Abstract Senescent cells within tumors and their stroma exert complex pro- and anti-tumorigenic functions. However, the identities and traits of these cells, and the potential for improving cancer therapy through their targeting, remain poorly characterized. Here, we identify a senescent subset within previously-defined cancer-associated fibroblasts (CAFs) in pancreatic ductal adenocarcinomas (PDAC) and in premalignant lesions in mice and humans. Senescent CAFs isolated from mouse and humans expressed elevated levels of immune-regulatory genes. Depletion of senescent CAFs, either genetically or using the Bcl-2 inhibitor ABT-199 (venetoclax), increased the proportion of activated CD8+ T cells in mouse pancreatic carcinomas, whereas induction of CAF senescence had the opposite effect. Combining ABT-199 with an immune checkpoint therapy regimen significantly reduced mouse tumor burden. These results indicate that senescent CAFs in PDAC stroma limit the numbers of activated cytotoxic CD8+ T cells, and suggest that their targeted elimination through senolytic treatment may enhance immunotherapy.

Study’s Excerpt: • The ameliorative effects of mango kernel, coconut, and cottonseed oils on hydrogen peroxide-induced renal toxicity is investigated. • Physicochemical properties of the oils such as peroxide, acid, saponification and iodine values, among others were analyzed. • Coconut oil showed the lowest peroxide value, highest antioxidant potential and hence superior histopathological recovery in the rats. • Therefore, coconut oil is the most suitable therapeutic agent for nephrotoxicity compared to mango kernel and cottonseed oils. Full Abstract: Nephrotoxicity is the rapid deterioration in kidney function due to the toxic effect of medications and chemicals. Mango, coconut and cotton seed oils are natural plant oils with various beneficial and therapeutic effect. This study was designed to investigate the potential ameliorating effect of mango kernel, coconut, and cottonseed oils on hydrogen peroxide-induced renal toxicity. The physicochemical properties of the oils were determined, and kidney markers of the blood serum, such as urea and creatine, were analysed, followed by histopathology of the kidney. The physicochemical properties showed that the oil yield was 12.06 %, 65.29 %, and 35.18 % for mango, coconut, and cottonseed oils, respectively. Mango kernel oil had a higher melting point (29.25). The specific gravity of mango kernel oil, coconut oil, and cotton seed oils was 0.89, 0.91, and 0.88, respectively. The highest flash point was recorded in cottonseed oil (302.45). Cotton seed oil had the highest moisture content (0.35). The pH of Mango kernel oil was 4.88, coconut oil 6.97 and cotton seed oil 6.15. Mango kernel oil had the highest smoke point (250.73). The lowest peroxide value was observed in coconut oil (0.52), while the highest was in cottonseed oil (3.43). Cotton seed oil had the highest acid value (6.82) and iodine value (42.16). The saponification values of mango kernel, coconut, and cottonseed oils were 142.39, 258.98, and 180.31, respectively. The unsaponifiable matter was 1.46 in mango oil, 0.42 in coconut oil, and 1.50 in cottonseed oil. The percentage of free fatty acids in mango kernel oil, coconut oil, and cottonseed oil was 2.14, 0.21, and 3.40, respectively. The levels of creatinine and urea were significantly reduced in the serum of rats that received the oils, as compared to the positive control group. The histopathological examination showed significant recovery in the group treated with coconut oil. The results of this study, however, established that coconut oil had a better ameliorating effect on kidney toxicity compared to the other oils under study, which may be due to its antioxidant properties.

Deep learning (DL) algorithms require massive amounts of data in diverse variations to attain close to human recognition accuracy. This enables them to perform well on unseen in-distribution viewpoints. However, critical areas such as health face a challenge in generating large data. This is mainly attributed to regulatory policies surrounding the collection of such data. Hence, the domain of health is known to have smaller datasets. This limitation, therefore, requires algorithms that can derive maximum benefit from the small-size dataset. An example of such an algorithm is Capsule Network (CapsNet). Though Capsule Networks perform well on smaller datasets, they attain low performance on datasets consisting of complex real-life images. This challenge is attributed to their weak encoders. This paper, therefore, proposes a feature enhancement technique termed patch-and-amplify to improve the feature extraction task and enhance extracted features in the encoder layer. A model-specific squash function is proposed to enhance the coupling of capsules between the higher and lower capsule layers and reduce the impact of polarization. To evaluate the network's robustness and generalizability, the proposed model was evaluated on CIFAR-10, Fashion-MNIST, and Kvasir-V2 datasets achieving recognition accuracies of 85.50 %, 98.40 %, and 93.40 %. Extensive visualizations were explored to assist in understanding the predictions and internal structure of the network. The proposed model performs well compared with the state-of-the-art in the literature and can serve as a helpful tool in assisting medical practitioners in diagnosing gastrointestinal diseases.

Hardware impairments (HWI) are imperfections in hardware components that diminish wireless communication performance. Unlike Geometric-based Stochastic Models (GBSMs), existing works on the impact of HWI on cooperative-relay (CR) Non-Orthogonal Multiple Access (NOMA) systems employ the Correlated-based Stochastic Model (CBSM), which does not capture realistic propagation mechanisms. Moreover, studies on CR-NOMA with large antenna transmitters (LATs) using CBSM and GBSM have attracted little attention in academia. We consider this as a computational issue. Although considerable work has been done, there is still a significant knowledge gap about how HWI and imperfect successive interference cancellation affect far-users in CR-NOMA with the LAT system. In this study, the LAT is considered a cylindrical array, and parameters such as delay spread, angle of arrival, and departure are incorporated to achieve a CR-NOMA-GBSM system with amplify-and-forward (AF) or decode-and-forward (DF) relaying schemes. To reduce computing demands, we offer a novel concept of using the physical dimensions of the array to derive the location vector of the antenna element. Using Monte Carlo simulation, near and far users' BER performances deteriorate for AF and DF at 15 dB and 5 dB or below, respectively. As far-users can receive comparable performances as near-users for both AF and DF in terms of achievable rates, this demonstrates the potential rewards of CR-NOMA with LAT.

Abstract Cerebrospinal meningitis (CSM) is a public health burden in Ghana that causes up to 10% mortality in confirmed cases annually. About 20% of those who survive the infection suffer permanent sequelae. The study sought to understand the predictive signs and symptoms of bacterial meningitis implicated in its outcomes. Retrospective data from the Public Health Division, Ghana Health Service on bacterial meningitis from 2015 to 2019 was used for this study. A pre-tested data extraction form was used to collect patients’ information from case-based forms kept at the Disease Control Unit from 2015 to 2019. Data were transcribed from the case-based forms into a pre-designed Microsoft Excel template. The data was cleaned and imported into SPSS version 26 for analysis. Between 2015 and 2019, a total of 2446 suspected bacterial meningitis cases were included in the study. Out of these, 842 (34.4%) were confirmed. Among the confirmed cases, males constituted majority with 55.3% of the cases. Children below 14 years of age were most affected (51.4%). The pathogens commonly responsible for bacterial meningitis were Neisseria meningitidis (43.7%) and Streptococcus pneumoniae (53.0%) with their respective strains Nm W135 (36.7%), Nm X (5.1%), Spn St. 1 (26.2%), and Spn St. 12F/12A/12B/44/4 (5.3%) accounting for more than 70.0% of the confirmed cases. The presence of neck stiffness (AOR = 1.244; C.I 1.026–1.508), convulsion (AOR = 1.338; C.I 1.083–1.652), altered consciousness (AOR = 1.516; C.I 1.225–1.876), and abdominal pains (AOR = 1.404; C.I 1.011–1.949) or any of these signs and symptoms poses a higher risk for testing positive for bacterial meningitis adjusting for age. Patients presenting one and/or more of these signs and symptoms (neck stiffness, convulsion, altered consciousness, and abdominal pain) have a higher risk of testing positive for bacterial meningitis after statistically adjusting for age.

Students in STEM know well the stress, challenge, and effort that accompany college exams. As a widely recognizable feature of the STEM classroom experience, high-stakes assessments serve as crucial cultural gateways in shaping both preparation and motivation for careers. In this essay, we identify and discuss issues of power around STEM exams to further the understanding of exam practices that can unjustly hold students back. Through theory and practical examples, we consider the numerous ways in which power manifests both on and off the pages of the exams themselves, as well as ways in which power is consolidated away from students through logistical norms and tradeoffs. Centering the "rules of the culture of power" as delineated by Dr. Lisa Delpit, we reflect on exam practices that prioritize faculty voice and faculty convenience above student learning and student identity. We share some of what we have learned from our students as part of a call to improve STEM education by relinquishing some of our exam-related power over students, redistributing it to students so that they have more power to shape their own education.

Abstract This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2023 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .

Abstract We introduce a class of 3d theories consisting of strongly-coupled N $$ \mathcal{N} $$ = 4 systems coupled to N $$ \mathcal{N} $$ = 3 Chern-Simons gauge multiplets, which exhibit N $$ \mathcal{N} $$ = 4 enhancements when a peculiar condition on the Chern-Simons levels is met. An example is the SU(N)3 Chern-Simons theory coupled to the 3d T N theory, which enhances to N $$ \mathcal{N} $$ = 4 when 1/k 1 + 1/k 2 + 1/k 3 = 0. We also show that some but not all of these N $$ \mathcal{N} $$ = 4 enhancements can be understood by considering M5-branes on a special class of Seifert manifolds. Our construction provides a large class of N $$ \mathcal{N} $$ = 4 theories which have not been studied previously.

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an established rescue therapy in the management of refractory acute respiratory distress syndrome (ARDS). Although ECMO played an important role in previous respiratory viral epidemics, concerns about the benefits and usefulness of this technique were raised during the coronavirus disease 2019 (COVID-19) pandemic. Indeed, the mortality rate initially reported in small case series from China was concerning and exceeded 90%. A few months later, the critical care community published the findings from several observational cohorts on the use of extracorporeal membrane oxygenation (ECMO) in COVID-19-related ARDS. Contrary to the preliminary results, data from the first surge supported the use of ECMO in experienced centers because the mortality rate was comparable to those from the ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial or other large prospective studies. However, the mortality rate of the population with severe disease evolved during the pandemic, in conjunction with changes in the management of the disease and the occurrence of new variants. The results from subsequent studies confirmed that the outcomes mainly depend on strict patient selection and center expertise. In comparison with non-COVID-related ARDS, the duration of ECMO for COVID-related ARDS was longer and increased over time. Clinicians and decision-makers must integrate this finding in the ECMO decision-making process to plan their ICU capacity and resource allocation. This narrative review summarizes the current evidence and specific considerations for ECMO use in COVID-19-associated ARDS.

Abstract Background Although rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother’s and child’s conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation. Methods We included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed. Results Among 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21–29) gestational weeks, and 13 after an emergency delivery performed at 32 (17–39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26–98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported. Conclusion Continuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers.

BackgroundSimple Congenital Heart Defects such as septal defects constitute a large proportion of Congenital Heart Defects. New research has demonstrated more co-morbidities than previously thought. In particular, co-morbidities involving neurocognitive, psychiatric, and social difficulties have been described. Neurocognitive and psychiatric morbidities affect social interaction. Social interaction is important in everyday social life (education, work life, family life). In this study, we investigated social interaction through self- and proxy-answered Social Responsiveness Scale 2 (SRS-2) in young adults with simple Congenital Heart Defects and compared their social interaction profile to healthy matched controls.MethodsWe included a total of 80 patients with either atrial or ventricular septal defect (age 26.6 years) and 38 heart-healthy, age, sex, and ISCED educational matched controls (age: 25.3 years). A close relative proxy from each participant took part in the study as well. All participants answered the Social Responsiveness Scale 2 (SRS-2) (n = 225). Our primary and secondary outcomes were the SRS-2 Total score and the SRS-2 sub-scores.ResultsIn the Congenital Heart Defects group, 31.3% had a Total score above 60 compared to 7.9% in the control group (p = 0.005, RR = 3.96). The participants with a septal defect had a higher Total score (52.5 vs. 45.5, p = 0.004), a higher Social Cognition sub-score (55.0 vs. 47.0, p = 0.0004), and a higher Social Motivation sub-score (50.0 vs. 45.0, p = 0.003) than the heart-healthy participants. We found no difference between the two groups regarding the sub-scores of Social Awareness and Social Communication. A multiple linear regression model showed that the variable that explained most of the variation in Total Score was having a previously diagnosed psychiatric disorder.ConclusionWe found that young adults with atrial or ventricular septal defects have a fourfold increased risk of social interaction difficulties compared to heart-healthy peers. They have a social interaction profile, with difficulties in social cognition and social motivation, and preserved social awareness and social communication. Psychiatric morbidity explained most of the variation in social interaction problems. As social difficulties and psychiatric morbidities are intertwined, social interaction difficulties could be an indication of already underlying psychiatric morbidities or a risk factor for future psychiatric morbidity.

ObjectiveSeptic shock is one of the most common reasons for admission to the Intensive Care Unit (ICU) and is associated with high mortality. Fundamentally, its management rests on antibiotics, fluid therapy and vasopressor use while many adjunctive therapies have shown disappointing results. Thiamine has recently gained interest as a metabolic resuscitator, though recent trials have tempered this enthusiasm, more specifically when thiamine is associated with ascorbic acid. However, thiamine use alone has been poorly investigated.DesignWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in septic shock patients to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.SettingPubMed, Embase and the Cochrane library databases were searched from inception to April of 2023. Data were extracted independently by two authors. The main outcome was mortality.SubjectsWe included RCTs comparing standard care using thiamine alone, to standard care or placebo, in patients admitted to the ICU with sepsis or septic shock.Main resultsWe included 5 RCTs (n = 293 patients). In this analysis, use of thiamine alone did not significantly change mortality, RR 0.87 (95%CI 0.65; 1.16, I2 = 21%) p = 0.34.ConclusionCurrent RCTs did not show an improvement in mortality when using thiamine in septic shock patients as an adjunctive therapy. However, these trials are largely underpowered for a definitive conclusion to be drawn. Further studies are therefore needed to assess the effects of thiamine without ascorbic acid as an adjunctive therapy.

Summary: Background: Obesity is recognized by the World Health Organization as a chronic disease. As such, it should be referred to using the language of chronic diseases, with correct and established terminology and definitions. This study was designed to map the current language used to discuss obesity and to compare this with the standard language used for chronic disease. Methods: We performed a modified Delphi study to identify the language of chronic disease that is being used in the context of obesity, and to identify discrepancies and potential use of inadequate language with respect to the standard language used for chronic diseases. Participants (n = 24) were identified from relevant stakeholder groups and desk research, and included patients, healthcare professionals, policymakers, researchers, industry, and payers (social insurers) of 18 nationalities/regions in Europe, North/South America, and South Africa. Participants were enrolled between 20.10.2020 and 30.10.2020. The study comprised two rounds of qualitative surveys. In Round 1, participants responded to six open-ended questions. Round 2 comprised 38 statements based on key terms/themes identified in Round 1 and covered the definition, causes, progression, treatment, management, and complications of obesity. Consensus was defined as ≥70% participant agreement on a statement. Findings: All participants completed Round 1 and 23 participants completed Round 2. In Round 2, consensus was reached for 28 of the 38 statements. Participants reached a consensus regarding the use of statements that acknowledge the heterogeneous nature of obesity, but not on the use of statements that: defined obesity based on body mass index; regarded psychological, physical, or physiological factors among the main causes of obesity; or implied that weight loss should be the aim of obesity treatment. Interpretation: This study uses expert consensus to provide insight into the language used to describe obesity as a chronic disease, and forms the basis for a unified language of obesity. Funding: Innovative Medicines Initiative, Novo Nordisk A/S.

Introduction Delirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known. We hypothesise that automated pupillometry could predict the occurrence of delirium in critically ill patients without primary brain injury, requiring more than 48 hours of invasive mechanical ventilation in the ICU.Methods and analysis The PupillOmetry for preDIction of DeliriUM in ICU (PODIUM) study is a prospective cohort study, which will be conducted in eight French ICUs in the Paris area. We aim to recruit 213 adult patients requiring invasive mechanical ventilation for more than 48 hours. Automated pupillometry (Neurological Pupil Index; NPi-200, Neuroptics) will be assessed two times per day for 7 days. Delirium will be assessed using the Confusion Assessment Method in ICU two times per day over 14 days in non-comatose patients (Richmond Agitation and Sedation Scale ≥−3).The predictive performances of the seven automated pupillometry parameters (ie, pupillary diameter, variation of the pupillary diameter, pupillary constriction speed, pupillary dilatation speed, photomotor reflex latency, NPi and symmetry of pupillary responses) measured to detect the delirium occurrence within 14 days will be the main outcomes. Secondary outcomes will be the predictive performances of the seven automated pupillometry parameters to detect complications related to delirium, ICU length of stay, mortality, functional and cognitive outcomes at 90 days.Ethics and dissemination The PODIUM study has been approved by an independent ethics committee, the Comité de Protection des Personnes (CPP) OUEST IV—NANTES (CPP21.02.15.45239 32/21_3) on 06 April 2021). Participant recruitment started on 15 April 2022. Results will be published in international peer-reviewed medical journals and presented at conferences.Trial registration number NCT05248035; clinicaltrials.gov.

Population growth and urbanisation are contributing to the growth of the use of pesticides in Africa. However, poor understanding of the health and environmental effects of these chemicals represents a significant risk to both human health and ecosystems. Knowledge of health effects of pesticide use and endocrine disrupting chemicals (EDCs) was assessed using 300 respondents in three communities of Ghana. The data were fitted to bivariate and multivariate ordinary least squares regression models. About 76 per cent of the respondents used pesticides while 82 per cent had no knowledge of human diseases associated with pesticide use and EDCs. At the bivariate level, individuals who used pesticides had less knowledge of health effects of EDCs and pesticide use compared to their counterparts who did not use pesticides. Urban residents had more knowledge compared to rural dwellers and this robust relationship persisted at the multivariate level. Females of all ages had more knowledge of pesticides and EDCs’ effects than their male conterparts. Formal and informal education is required to improve knowledge on appropriate chemical use.

It is well known that the Gilbert relaxation time of a magnetic moment scales inversely with the magnitude of the externally applied field, H, and the Gilbert damping, α. Therefore, in ultrashort optical pulses, where H can temporarily reach high amplitudes, the Gilbert relaxation time can momentarily be extremely short, reaching even picosecond timescales. Here we show that for strong enough ultrashort pulses, the magnetization can respond within the optical cycle such that the optical control of the magnetization emerges by merely considering the optical magnetic field in the Landau-Lifshitz-Gilbert (LLG) equation. Surprisingly, when circularly polarized optical pulses are introduced, an optically induced helicity-dependent torque results. We find that the strength of the interaction is determined by η=αγH/f_{opt}, where f_{opt} and γ are the optical frequency and gyromagnetic ratio, respectively. Our results illustrate the generality of the LLG equation to the optical limit and the pivotal role of the Gilbert damping in the general interaction between optical magnetic fields and spins in solids.

Capsule Networks (CapsNets) were proposed to mitigate the shortcomings of Convolutional Neural Networks (CNNs) such as invariance. Even though they have achieved equivariance, they fail to perform on the recognition of complex images and images with varied backgrounds such as CIFAR-10. Real-life images such as those found in plant disease datasets (aside from being complex with varied backgrounds) pose additional challenges such as class imbalance and the availability of a smaller number of annotated datasets. The original CapsNet uses CNNs as feature extractors, SoftMax for normalization, and dynamic routing (DR) to enable active capsules to make predictions resulting in the activation of higher-level capsules. However, CNNs do not serve as superior texture extractors and SoftMax restrains capsules from forming optimal coupling during routing. In this paper, we propose the use of an efficient texture descriptor (Local Binary Pattern -LBP), sigmoid function, and k-means routing respectively in place of CNN, SoftMax, and dynamic routing. We evaluate our model on six publicly available datasets; MNIST, fashion-MNIST, CIFAR-10, tomato, maize, and citrus datasets. Experimental results show that the proposed model generates fewer parameters and performs comparably well with the state-of-the-art multi-lane capsule networks on complex images.

The excessive use of weedicide and fertilizer by farmers, indiscriminate waste disposal as well as unregulated and pervasive chemical use for mining and industry has huge impacts on the sustainability of soil resource. However, land use-specific characterization of soil has not been extensively studied. The soil quality of 4 different land use classes-cultivated soils, industry, decommissioned waste dump and forest reserve that depict different anthropogenic effect in urban and rural settings were assessed. Twelve composite samples were taken per site at a depth of 30cm with an auger, air dried and sieved with 2mm mesh and portions used for analysis. Soil mineral parameters analyzed include bulk density, reaction pH, organic carbon, total nitrogen, phosphorus, exchangeable cations: sodium (Na), potassium (K), magnesium (Mg), calcium (Ca), and extractable trace elements: manganese (Mn), nickel (Ni), iron (Fe), cadmium (Cd), copper (Cu), zinc (Zn) and lead (Pb). The mean %SQIs for soil samples collected from cultivated soils, decommissioned dump, industrial and forest reserved sites are 54.9%, 57.6%, 60.6% and 61.4% respectively. Mean concentrations of Cd, Pb and Ni are 0.020 mg/kg, 1.301 mg/kg and 0.213 mg/kg, respectively. There were significant variations pairwise between cultivated soil and forest reserve soil and then cultivated and industrial soil (p< 0.05). Assessing soil quality (SQ) through evaluation of changes in soil properties across different land use classes is an essential tool for proper management to promote sustainable use to sustain life.

Abstract Background Caesarean delivery (CD) is the commonest obstetric surgery and surgical intervention to save lives of the mother and/or the new-borns. Despite been accepted as safe procedure, caesarean delivery has an increased risk of adverse maternal and fetal outcomes. The rising rate of caesarean delivery has been a major public health concern worldwide and the consequences that come along with it urgently need to be assessed, especially in resource limited settings. We aimed to examine the relationship between first birth caesarean delivery and adverse maternal and perinatal outcomes in the second pregnancy among women who delivered at a tertiary hospital in Northern Tanzania. Methods A retrospective cohort study was conducted using maternally-linked data from Kilimanjaro Christian Medical Centre. All women who had singleton second delivery between the years 2011 to 2015 were studied. A total of 5,984 women with singleton second delivery were analysed. Multivariable log-binomial regression was used to determine the association between first caesarean delivery and maternal-perinatal outcomes in the second pregnancy. Results Caesarean delivery in the first birth was associated with an increased risk of adverse maternal and perinatal outcomes in the second pregnancy. These included repeated CD (ARR 1.19; 95% CI: 1.05–1.34), pre/eclampsia (ARR 1.38; 95% CI: 1.06–1.78), gestational diabetes mellitus (ARR 2.80; 95% CI: 1.07–7.36), uterine rupture (ARR 1.56; CI: 1.05–2.32), peri-partum hysterectomy (ARR 2.28; CI: 1.04–5.02) and preterm birth (ARR 1.21; CI: 1.05–1.38). Conclusion Caesarean delivery in their first pregnancy had an increased risk of repeated caesarean delivery and other adverse maternal-perinatal outcomes in the following pregnancy. Findings from this study highlight the importance of devising regional specific measures to mitigate unnecessary primary caesarean delivery. Additionally, these findings may help both clinicians and women in deciding against or for trial of labor after previous caesarean delivery in an event of absent direct obstetric indication.

Abstract When it comes to tracking goods from manufacturers to consumers, barcodes are useful instruments for monitoring and certifying their legitimacy. Because of its capacity to self‐validate all generated codes, the EAN‐13 is the most extensively used barcode for processed consumable products. Further investigations into the construction of the EAN‐13 barcode revealed that several additional components were required to make the EAN‐13 more credible for consumer use. Country code, production code, product code, and check digit make up the present EAN‐13 format. Meanwhile, the type of product and the number of times it has been manufactured are key components that must be included in the EAN‐13 barcode structure for barcode analysts to interpret. The study presented the GHBS‐13, an upgraded barcode structure that captured the two new components, namely, the product type and production count. The paper proposed a universal method called Tabiri Check Digit as a mathematical means of easily computing the check digit of the two barcodes. The formula was validated using EAN‐13 and GHBS‐13 barcodes, and the results were correct. The study also established a central point platform for customers to use to validate processed consumable products they buy in Ghana.

Abstract BackgroundWound healing is a process that involves multiple physiological steps, and despite the availability of various wound treatment methods, their effectiveness is still limited due to several factors, including cost, efficiency, patient-specific requirements, and side effects. In recent years, nanovesicles called exosomes have gained increasing attention as a potential wound care solution due to their unique cargo components which enable cell-to-cell communication and regulate various biological processes. Umbilical cord blood plasma (UCBP) exosomes have shown promise in triggering beneficial signaling pathways that aid in cell proliferation and wound healing. However, there is still very limited information about the wound-healing effect of UCBP exosomes in the literature. ObjectivesThe primary objective of this study was to investigate the “hybrosome” technology generated with calf UCBP-derived exosome–liposome combination. MethodsThe authors developed hybrosome technology by fusing cord blood exosome membranes with liposomes. Nanovesicle characterization, cell proliferation assay, wound-healing scratch assay, immunohistochemistry analysis, anti-inflammation assay, real-time polymerase chain reaction (RT-PCR), enzyme-linked immunosorbent assay, and cellular uptake studies were performed using the novel hybrid exosomes. ResultsExperimental results showed that hybrosome increases cell proliferation and migration by 40% to 50%, depending on the dose, and induces an anti-inflammatory effect on different cell lines as well as increased wound healing–related gene expression levels in dermal cells in vitro. All in all, this research widens the scope of wound-healing therapeutics to the novel hybrosome technology. ConclusionsUCBP-based applications have the potential for wound treatments and are promising in the development of novel therapies. This study shows that hybrosomes have outstanding abilities in wound healing using in vitro approaches. Level of Evidence: 3

Selected endocrine disrupting chemicals (EDCs) were measured in adult female menstrual blood for the first time in Ghana, Africa, taking into account the importance of non-invasive means of matrices sampling in vulnerable groups, such as pregnant women, the elderly or chronically ill people. The menstrual blood samples of twenty (20) female adults between the ages of 25–45 years were sampled. The Quick, Easy, Cheap, Effective, Rugged and Safe (QuEChERS) method was applied for the extraction and clean up, while gas chromatography-mass spectrometry (GC-MS) was used to measure the selected EDCs in adult female menstrual blood, taking into account the composition of menstrual discharge. Diethyl phthalate (DEP), Dibutyl phthalate (DBP) and Bis (2-ethylhexyl) phthalate (DEHP) were detected in all samples, whereas bisphenol A (BPA) was found in 13 participants. Dimethyl phthalate (DMP) was detected in 7 participants, Di-n-octyl phthalate (DNOP) was detected in 3 participants, Bis (2-ethylhexyl) adipate (DEHA) and pyrimidine were detected in 2 participants, while benzyl butyl phthalate (BBP) was detected in only 1 participant. The maximum concentration of DEP measured was 115.6 µg.L-1and the minimum was 439 µg.L-1. DEHP was the next most abundant phthalate with a maximum measured concentration of 982 µg.L-1 and minimum of 95 µg.L-1. The presence of parent phthalates (rather than metabolites) in menstrual blood of all participants studied suggests that bioaccumulation of selected phthalate compounds such as DEHP, DEP and DBP may be occurring with appreciable human toxicity though the carcinogenic exposure risks of DEHP via various routes were much lower than 1 × 10−6 considered to be very low.

Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three timepoints among birth cohorts (ages 3-28 months) in a cluster-randomized trial. Over 50% of children used antibiotics at least once in the 90 days preceding data collection. In Bangladesh, the prevalence of antibiotic use was 10-14% lower in groups receiving WSH (prevalence ratio [PR] = 0.90 (0.82-0.99)), nutrition (PR = 0.86 (0.78-0.94)), and nutrition+WSH (PR = 0.86 (0.79-0.93)) interventions. The prevalence of using antibiotics multiple times was 26-35% lower in intervention arms. Reductions were largest when the birth cohort was younger. In Kenya, interventions did not affect antibiotic use. In this work, we show that improving WSH and nutrition can reduce antibiotic use. Studies should assess whether such reductions translate to reduced antimicrobial resistance.