Background: Myelomeningocele (MMC) is the most common open spinal dysraphism (OSD) and is typically associated with other clinical and/or radiological abnormalities. Chiari type 2 malformation (CM-II) is observed in 80% to 96.7% of patients, and approximately 80% of cases involve posterior fossa abnormalities leading to hydrocephalus. MMC patients can present with syringomyelia, which usually improves by treating hydrocephalus. However, a minority of patients develop a progressive form of syringomyelia requiring more invasive treatments. Through this retrospective observational study, our objective is to elucidate the incidence of syringomyelia, its symptomatic manifestations, and the associated radiological and clinical characteristics in pediatric patients diagnosed with myelomeningocele Methods: A retrospective analysis was conducted on the medical records of 39 pediatric patients diagnosed with myelomeningocele at a tertiary referral institute. The study encompassed individuals born between 1997 and 2022. Descriptive statistics were employed to explore epidemiological aspects and clinical features. Additionally, incidence rates of syringomyelia and its progressive variants were calculated, with a focus on their correlation with diagnoses of hydrocephalus, Chiari type 2 malformation (CM-II), and spinal cord tethering. Results: Over the last twenty-five years, the incidence of syringomyelia in pediatric patients affected by MMC was 46.2%. The incidence of its progressive forms was 16.7%. Two patients improved after the management of hydrocephalus with secondary Endoscopic Third Ventriculostomy (ETV), and only one patient required syrinx-shunting. Conclusions: The occurrence of syringomyelia among patients with myelomeningocele (MMC) in our center aligns with reported rates in existing literature. Our findings indicate that active hydrocephalus, leading to a deterioration of hindbrain herniation, appears to be a significant factor in the development of progressive symptomatic syringomyelia within this population.

Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of the adult population in many developed and developing countries. This spectrum of liver disease ranges from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis. The incidence of NASH is projected to increase by up to 56% over the next 10 years. There is growing epidemiological evidence that NAFLD has become the fastest growing cause of hepatocellular carcinoma (HCC) in industrialized countries. The annual incidence of HCC varies between patients with NASH cirrhosis and patients with noncirrhotic NAFLD. In this review, NAFLD/NASH-associated HCC will be described, including its epidemiology, risk factors promoting hepatocarcinogenesis, and management of HCC in patients with obesity and associated metabolic comorbidities, including preventive strategies and therapeutic approaches to address this growing problem.

Parents play an important role in shaping the eating habits of their children through: appropriate selection of food products, snacking between meals and appropriate exposure to information from television advertisements, the press or the Internet. The level of parents' knowledge about proper nutrition and substances added to food is therefore crucial in promoting appropriate dietary choices in children and adolescents in order to prevent diet-related diseases. Objectives: Assessment of the consumption of snack foods by children and adolescents according to the surveyed parents and analysis of parents' knowledge about additional substances in food. Methods: The study was conducted among 129 parents of students from selected primary schools. The research tool was an original survey questionnaire consisting of 24 questions. Survey interviews were conducted with parents during meetings at schools. Statistical analysis was performed using the Pearson ch2 test, the significance level was set to p<0.05. Results: Parents most often indicated sweets, confectionery products and sweetened drinks (25%) and vegetables or fruit (21%) as the form of snack for their children. 46% of children and adolescents drank sweetened drinks at least once a day. Parents had an average level of knowledge about food additives. Significant correlations were found between the level of knowledge of parents of school-age children about food additives and their level of education. Parents' knowledge and education did not significantly influence the level of snack consumption by their children. Children's eating behavior should be considered unsatisfactory. Conclusions: Research has shown the need for parents to be educated about food additives and to pay more attention to reading food labels so that they can reliably prepare their children to make the right food choices. Measures should be implemented to improve the eating habits of children and adolescents.

Cutaneous melanoma (CM) is a candidate for screening programs, since its prognosis is excellent when diagnosed in an early disease stage. Targeted screening of those at high risk for developing CM, a cost-effective alternative to population-wide screening, requires valid procedures to identify the high-risk group. Self-assessment of the number of nevi has been suggested as a component of such procedures, but its validity has not yet been established. We analyzed the level of agreement between self-assessments and expert assessments of the number of melanocytic nevi in the area between the wrist and the shoulder of both arms based on 4548 study subjects in whom mutually blinded double counting of nevi was performed. Nevus counting followed the IARC protocol. Study subjects received written instructions, photographs, a mirror, and a “nevometer” to support self-assessment of nevi larger than 2 mm. Nevus counts were categorized based on the quintiles of the distribution into five levels defining a nevus score. Cohen’s weighted kappa-coefficient was estimated to measure the level of agreement. In the total sample, agreement between self-assessments and expert-assessments was moderate (raw agreement: 50.29%, weighted κ=0.596). Self-assessed nevus counts were higher than those determined by experts (mean differ-ence: 3.33 nevi). The level of agreement was independent of sociodemographic and cutaneous factors; however, participants’ eye color had a significant impact on the level of agreement. Our findings show that even with comprehensive guidance, only a moderate level of agreement between self-assessed and expert-assessed nevus counts can be achieved. Self-assessed nevus information does not appear to be reliable enough to be used in individual risk assessment to target screening activities.

There are few longitudinal studies on the association between dietary vitamin C and sleep disorders. The aim of this study was to investigate the association between dietary vitamin C intake and various types of sleep disorders, including sleep apnea and insomnia, as well as recommended dietary intakes. A total of 68,221 participants from the UK Biobank were enrolled in the study. Dietary vitamin C intake was calculated by a 24-hour dietary recall questionnaire. We used Cox regression model to assess the association between dietary vitamin C and sleep disorders and restricted cubic spline models to explore potential nonlinear relationships. Stratified analyses and sensitivity analyses were also performed to further test the results. The results showed that vitamin C intake at the Q4 level (132.88-191.51 mg/d) was significantly protective against sleep disorders with an HR (95% CI) of 0.78 (0.65-0.94), and against sleep apnea with an HR (95% CI) of 0.75 (0.62-0.92). The protective effect remained significant in stratified analyses of men and age ≤60 years, and the results were robust in sensitivity analyses. Adequate dietary vitamin C intake may have a protective effect in preventing sleep disorders.

Background: Osteoporosis and bone fractures affect health and quality of life. Since bone disease is multifactorial, identifying risk factors is key in prevention. There are multiple reports on how viral hepatitis especially chronic hepatitis B (CHB) and chronic hepatitis C (CHC) are affecting bone disease, but results vary. Here, we analyzed the potential association between CHB/CHC and osteoporosis or bone fractures in a large outpatient cohort in Germany. Methods: We included 3,136 outpatients with CHB and 15,608 matched non-hepatitis individuals as well as 2,867 outpatients with CHC and 14,335 matched non-hepatitis individuals from the Disease Analyzer Database between 2005 and 2022. The main outcome was the 5-year cumulative incidence of osteoporosis and bone fractures as a function of either CHB or CHC. Results: Within 5 years of the index date, 2.9% vs. 1.6% of patients with and without CHB were diagnosed with osteoporosis (p=0.001) and 1.0% vs. 0.4% were diagnosed with bone fractures (p<0.001). Moreover, 3.3% of CHC patients and 2.2% of individuals without hepatitis were diagnosed with osteoporosis (p=0.002). In Cox-regression analyses, CHB was significantly associated with an increased risk for osteoporosis (HR: 1.76) and fractures (HR:2.43) and CHC with osteoporosis (HR: 1.54). For both CHB and CHC, the association with osteoporosis was restricted to the female subgroup. Conclusion: CHB and CHC are associated with osteoporosis in women. CHB in male patients is associated with a higher risk of fractures. More research is are needed to understand the underlying pathophysiological mechanisms.

Syringomyelia can be associated with multiple etiologies. The treatment of the underlying causes is the first-line therapy, however, a direct approach to the syrinx is accepted as rescue treatment. Any direct intervention on the syrinx requires a myelotomy, posing a significant risk of iatrogenic spinal cord (SC) injury. Intraoperative neurophysiological monitoring (IONM) is crucial to detect and prevent surgically induced damage in neural SC pathways. We retrospectively reviewed the perioperative and intraoperative neurophysiological data and perioperative neurological examinations in ten cases of syringomyelia surgery. All monitored modalities remained stable throughout the surgery in six cases, correlating with no new postoperative neurological deficits. In two patients, significant transitory attenuation, or loss of motor evoked potentials (MEPs), were observed and recovered after a corrective surgical maneuver, with no new postoperative deficit. In two cases, a significant MEP decrement was noted, which lasted until the end of the surgery and was associated with postoperative weakness. A transitory train of neurotonic electromyography (EMG) discharges was reported in one case, the surgical plan was adjusted and the patient showed no postoperative deficit. The dorsal nerve roots were stimulated and identified in the seven cases where the myelotomy was performed via the dorsal root entry zone. Dorsal column mapping guided the myelotomy entry zone in four cases. In conclusion, multimodal IONM is feasible and reliable and may help prevent iatrogenic SC injury during syringomyelia surgery.

Few studies have examined the dietary protein intake and sources in combination with the longitudinal changes in brain structure markers. Our study aimed to examine the association between dietary protein intake and different sources of dietary protein with the longitudinal rate of change in brain structural markers. A total of 2723 and 2679 participants from the UK Biobank were included in the analysis. The relative and absolute amounts of dietary protein intake were calculated through a 24-hour dietary recall questionnaire. The longitudinal change rates of brain structural biomarkers were computed using two waves of brain imaging data. We utilized multiple linear regression to examine the association between dietary protein and different sources and the longitudinal changes in brain structural biomarkers. Restrictive cubic splines were used to explore nonlinear relationships, and stratified and sensitivity analyses were conducted. Increasing the proportion of animal protein in dietary protein intake is associated with a slower reduction in the total hippocampus volume (THV, β: -0.02524, P&lt;0.05), left hippocampus volume (LHV, β: -0.02435, P&lt;0.01) and right hippocampus volume (RHV, β: -0.02544, P&lt;0.05).Higher intake of animal protein relative to plant protein is linked to a lower atrophy rate in THV (β: -0.01249, P&lt;0.05) and LHV (β: -0.01173, P&lt;0.05) and RHV (β: -0.01193, P&lt;0.05). Individuals with higher intake of seafood exhibit lower longitudinal rate of change in HV compared to those with no consume (THV, β: -0.004514; P&lt;0.05; RHV, β: -0.005527, P&lt;0.05). In subgroup and sensitivity analyses, there was not a significantly alteration. A moderate increase in the intake and proportion of animal protein in the diet, especially from seafood, is associated with a lower longitudinal change rate in hippocampus volume.

More than 20 years after the discovery of the first anelloviruses (AVs), they still remain a mysterious group of viruses. To date, there is no clear understanding of their impact on the host organism, although information is emerging about their participation in various pathologies. However, it is well known that AVs are an important component of the human virome. In the current study we assessed the abundance of AVs in viromes from four nasal and pharyngeal samples from children with respiratory symptoms using a metagenomic approach. It is worth noting that three patients had known respiratory viruses and one did not have any. Regarding AVs, they were detected in all samples, namely Torque teno mini virus (TTMV). The greatest abundance and diversity of AVs (Torque teno virus (TTV), TTMV and Torque teno midi virus (TTMDV)) were shown in a diseased patient with an absence of respiratory viruses, which may indicate the potential involvement of AVs in the maintenance of respiratory symptoms. An activated immune system to combat the main pathogens, against the background of which the number of AVs decreases, is discussed as a possible reason for the reduced diversity of anellome in other patients. We also compared the results of the metagenomic approach and qPCR for major respiratory viruses, which were in agreement. In addition, metagenomic sequencing made it possible to obtain additional data on viral genomes in order to establish their taxonomic identification and characterize individual viral profiles in patients from the Siberian part of Russia.

Innovation is a crucial issue in healthcare services since it can affect job-related variables such as productivity, satisfaction and burnout. The aim of our study was to examine the impact of innovation support on quiet quitting, innovative behavior and innovation outputs among nurses. We conducted a cross-sectional study in Greece during April 2024. We employed a convenience sample of nurses. We used the following instruments: (a) the Innovation Support Inventory (ISI) to measure innovation support, (b) the Quiet Quitting Scale (QQS) to measure quiet quitting, (c) the Innovative Behavior Inventory (IBI) to measure innovative behavior, and (d) the Innovation Outputs (IO) scale to measure innovation outputs. Our multivariable analysis identified a negative relationship between innovation support and quiet quitting. Moreover, we found that managerial support and cultural support improved several aspects of innovative behavior, such as idea generation, idea search, idea communication, implementation starting activities, involving others, and overcoming obstacles. Additionally, managerial support improved innovation outputs. Our findings suggested the positive impact of innovation support on quiet quitting, innovative behavior and innovation outputs among nurses. Organizations and nurses’ managers should establish an innovative working environment to improve nurses’ passion, motives and productivity.

Early childhood may be a stressful period for families with a significant impact on parents’ mental health and the child’s healthy development. The goal of the SKKIPPI cohort study was to assess the occurrence and determinants of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions. Based on random samples from three residents' registration offices, parents with infants up to 12 months of age at the time of sampling, were invited to participate in the study. A screening online questionnaire was newly developed, available in four languages, to assess common psy-chosocial stressors and mental health problems of parents with small children. The study enrolled 4,984 mothers and 962 fathers. The most common potential psychosocial stressors at baseline were professional problems (mothers 22%, fathers 33%), lack of social sup-port (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obses-sive-compulsive thoughts (21%, 16%), depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory prob-lems of the child were reported by between 1.5% and 5.1% of parents. The SKKIPPI study showed that a substantial proportion of parents are burdened by psychoso-cial problems and suffer from mental health problems in the first years after birth. Early pre-ventive and low-threshold support measures should be available in the health and social care system. The newly developed questionnaire can be used to screen in the relevant populations in order to avoid disturbances in the mother-child attachment.

In 2011-2012, Northern Vietnam suffered its first large scale hand foot and mouth disease (HFMD) epidemic. Two sets of official guidelines were issued during the outbreak to handle the HFMD crisis. The city of Hai Phong was therefore used as a model to analyze the impact of the guidelines release. 9621 HFMD cases were reported in Hai Phong city from April 2011 to December 2012. Three distinct waves of HFMD occurred. Enterovirus A71 and Coxackievirus A16 were successively associated to the epidemics. Two periods, before and after guidelines realease, could be distinguished which were characterized by different patient patterns Time to admission and severity changed notably. Guideline publication help the health system refocusing on the 0.5-3 years age group with highest incidence of the disease. The three waves showed different special distribution but main routes of infection were rivers and local secondary roads most likely through local trade and occupational movements of people.

National heatwave plans are aimed at reducing the avoidable human health consequences due to heatwaves, by providing warnings to and improving communication between relevant stakeholders. The aim of this study was to assess the perceptions of key stakeholders within plans in Belgium and the Netherlands on their responsibilities, the partnerships, and the effectiveness of the local implementation in Brussels and Amsterdam. Key informant interviews were held with stakeholders that had an important role in development of the heatwave plan in these countries, or its implementation in Brussels or Amsterdam. Care organisations, including hospitals and elderly care organisations, had a lack of familiarity with the national heatwave plan in both cities, and prioritised heat the lowest. Some groups of individuals, specifically socially isolated individuals, are not sufficiently addressed by the current national heatwave plans and most local plans. Stakeholders reported that responsibilities were not clearly described and that the national plan does not describe tasks on a local level. We recommend to urgently increase awareness on the impact of heat on health among care organisations. More emphasis needs to be given to the variety of heat risk groups. Stakeholders should be involved in the development of updates of the plans.

This study is aimed to assess the prevalence of Coxiella burnetii infection among veterinary medicine students from two Bulgarian Universities, located in Sofia and Stara Zagora. A total of 185 veterinary students blood samples were collected and tested for the detection of C. burnetii phase II antibodies and presence of DNA using an enzyme-linked immunosorbent assay (ELISA) and end-point PCR test, respectively. Out of all samples, 29.7% were positive for at least one C. burnetii phase II antibody marker or by PCR test. Veterinary students from Stara Zagora showed significantly seropositive status of Q fever (33.6%), then those who studied in Sofia (23%). The evidence for recent exposition with detection of anti-C. burnetii IgM (+) antibodies had 14.6%. Seroprevalence among students in Stara Zagora was higher (15.3%). Anti-C. burnetii phase II IgG antibodies were detected in 21.6% examined samples. Our study revealed a higher seropositivity among male students (32.8%) as compared to the female ones (16.0%). End-point PCR assay detected as positive 5.9% blood samples. The relative risk (RR) of Q fever exposure for male students was 40.7%, whereas for female (24.6%). Findings from this study indicated that the C. burnetii infection is widely distributed amongst veterinary students from Bulgaria. The study emphasizes the need for improved safety protocols and infection control measures in veterinary training programs.

Emotional intelligence may help nurses to cope with demanding work environments. Although it is well known that emotional intelligence is positively related to work performance literature on nurses is limited. The aim of our study was to examine the impact of emotional intelligence on work performance in a sample of nurses in Greece. We conducted a cross-sectional study in Greece. We collected data from a convenience sample of nurses during January 2024. We measured emotional intelligence with the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and work performance with the Individual Work Performance Questionnaire (IWPQ). We created multivariable linear regression models adjusted for sex, age, educational level, and work experience. We found that the four streams of emotional intelligence (i.e. well-being, self-control, emotionality, sociability) increases nurses’ work performance. In particular, we found a positive relationship between well-being and task performance and contextual performance. Similarly, there was a positive relationship between self-control and task performance. Additionally, sociability increased task performance and contextual performance. Moreover, emotionality and sociability reduced counterproductive work behavior. Our multivariable models identified a positive impact of emotional intelligence on nurses’ work performance. Nurses managers and healthcare organizations should adopt appropriate interventions to improve nurses’ emotional intelligence.

ABSTRACT Background: To date, the COVID-19 pandemic has been the foremost health concern for humankind in the new millennia. This paper aims to describe the related hospitalizations in Italy during the first two years of the health emergency. Design and methods: This is a retrospective, population-based study of Italian hospitalizations for patients diagnosed with COVID-19 during the 2020-2021 period, extracted from the National Hospital Discharge Registry. The outcome variables considered include hospital admissions, costs, and length of stay, among other hospitalization-level variables. Costs were estimated through the charges associated with the Diagnosis-Related Group and Major Diagnostic Categories coding system, plus an additional cost attributed to COVID-19 admissions. To these charges was added an extra cost defined by the ministry of health. Results: In Italy, there were 357,354 hospitalizations for COVID-19 attributed to 298,856 patients in 2020 and 399,043 hospitalizations for COVID-19 attributed to 333,447 patients in 2021. COVID-19 patients faced a transfer rate thrice that of other patients. Hospitalizations were concentrated predominantly in the northern regions, particularly in the first year. Hospitalization rates varied by age in a sine wave pattern, peaking in the youngest and oldest age groups, with mortality rates escalating with age— tending to remain below 3% for those under 44 but surging to 40% in individuals over 75. The financial impact of COVID-19 hospitalizations was substantial, with total costs reaching €3.97 billion in 2020 and €4.99 billion in 2021. Costs per admission and per day also rose, from €11,112 and €807 in 2020 to €12,503 and €844 in 2021, respectively. Excluding the added financial burden of COVID-19, costs would have been notably lower. Hospitalizations involving continuous invasive mechanical ventilation were particularly costly (about 24.000 euros x admission), reflecting the significant resources required for these treatments. Conclusion: Implementing a protective pad around the entire health system that leverages networks of family doctors and nurses, connected in real time to the entire health system, can be crucial. Such a network, tasked with monitoring the local epidemiological situation, protecting vulnerable individuals also through telehealth visits, and establishing a triage system for infections in the initial phase, may effectively help in managing virus spread and protecting hospitals from unpredictable waves of admission demand. Strengthening primary health care could be a decisive factor for the future and enhance the system's resilience in facing new challenges.

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of vaccination declines experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on impacts to routine childhood vaccinations in low-income countries from January 1, 2020 to February 8, 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations.

Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic including pandemic burnout and job burnout. The aim of the study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. Study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 burnout scale, and single item burnout measure respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support (adjusted beta = -0.075, 95% CI = -0.125 to -0.024) and increased resilience (adjusted beta = -0.399, 95% CI = -0.491 to -0.308) were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout (adjusted beta = -0.263, 95% CI = -0.405 to -0.121). A similar negative relationship was found between resilience and job burnout (adjusted beta = -0.529, 95% CI = -0.785 to -0.272). Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses’ social support and resilience since they are the backbone of healthcare systems worldwide.

Estimating parameters for multiple datasets can be time consuming, especially when the number of datasets is large. One solution is to sample from multiple datasets simultaneously using Bayesian methods such as adaptive multiple importance sampling (AMIS). Here we use the AMIS approach to fit a von Misses distribution to multiple datasets for wind trajectories derived from a Lagrangian Particle Dispersion Model driven from a 3D meteorological data. The primary objective is to characterise the uncertainties in wind trajectories in a form that can be used as inputs for predictive models of wind-dispersed insect pests and pathogens of agricultural crops for use in evaluating risk and in planning mitigation actions. Our results show that AMIS can significantly improve the efficiency of parameter inference for multiple datasets.

Workplace bullying is common among nurses affecting negatively several work-related variables, such as job burnout and job satisfaction. However, no study until now has examined the impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data during February 2024. We used the Negative Acts Questionnaire-Revised, the Quiet Quitting Scale and the Brief COPE to measure workplace bullying, quiet quitting and coping strategies, respectively. We found that workplace bullying and negative coping strategies were positive predictors of quiet quitting, while positive coping strategies was a negative predictor of quiet quitting. Our mediation analysis showed that positive and negative coping strategies partially mediated the relationship between workplace bullying and quiet quitting. In particular, positive coping strategies caused competitive mediation, while negative coping strategies caused complimentary mediation. Nurses’ managers and policy makers should improve working conditions by reducing workplace bullying and strengthening positive coping strategies among nurses.

Background: Rabies, a zoonotic disease caused by the lyssavirus genus, is widely distributed and a significant cause of human death in Africa and Asia. This study aimed to investigate human rabies exposure and associated risk factors in Northwest Ethiopia. Methods: The study encompassed four zones, seven districts, and four kebeles from each district. The research team developed a questionnaire for data collection. Results: A total of 642 households were interviewed. The current study rabies exposure was revealed 10.47%. Over 98% of respondents displayed a strong understanding of rabies, with 99.69% correctly identifying rabies as a zoonotic disease. However, 80% of the interviewees were trusted traditional medicine could treat rabies. Only 21.93% of victims were took post exposure prophylaxis. Dogs were the primary affected animals (87.73%), of this 48.70% was bites by own dogs. Metema district had higher risk (p < 0.001) compared to others six districts. Dog ownership (p<0.05) and a higher number of households (p<0.01) were also identified as risk factors for rabies exposure. Conclusion: Residence, low education levels, high household density, free-roaming dogs, and dog ownership as key risk factors for rabies exposure. Public health awareness campaigns are crucial to emphasise the risks associated with animal bites.

Although the influence of climate on the fire regime is unanimously recognized, most publications are studies on this influence are at the global scale. Therefore, this study aims to demonstrate the role of climate in the incidence of wildfires at the country and regional scale using statistical analysis and machine learning methods. Mainland Portugal was chosen as a case study due to its climate and because it is the European region most affected by wildfires. Results demonstrate the climate signature in the spatial and temporal distribution of the wildfire incidence. The conclusions of the study include (i) the existence of two pyro-regions, with different types of climate (Csb and Csa) composed of NUTS II regions: the northern region composed of the Norte and Centro regions and the southern region composed of Alentejo and Algarve; (ii) the intra-annual variability in the incidence of wildfires, characterized by two peaks, one in spring and the other in summer, are a consequence of the country's type of climate; and, (iii) how the annual cycle of wildfire incidence varies over the years depends on the weather conditions throughout each year. These results are of fundamental importance for wildfire managers, especially in the context of climate change.

Due to the significant price difference, expensive oils like olive oil are often blended with cheaper edible oils. This practice of adulteration in edible oils, aimed at increasing profits for producers, poses a major concern for consumers. Furthermore, adulteration in edible oils can lead to various health issues impacting consumer well-being. In order to meet the requirements of fast, non-destructive, universal, accurate and reliable quality testing for edible oil, the oblique-incidence reflectivity difference (OIRD) method combined with machine learning algorithms was introduced to detect a variety of edible oils. The prediction accuracy of Gradient Boosting, K-Nearest Neighbor, and Random Forest models exceeded 95%. Experimental results indicate that the OIRD method can serve as a powerful tool for detecting edible oils.

The present study aimed to undertake a detailed investigation of pathological epidemiology and molecular confirmation of Ehrlichia canis among pet dogs in smart city Bhubaneswar, Odisha, a state in eastern India. A total of 178 dogs were screened for Ehrlichiosis on the basis of history, clinical signs, blood, and buffy coat smear examination, resulting in only 56 dogs (31.46%) screening positive. The epidemiological study recorded an increase in incidences among dogs less than one year of age (41%), males (68%), German Shepherds (25%), dogs more than 20 kg body weight (75%), summer months (55%) and dogs housed on pukka houses with exposure to the outside (59%). The majority of the infected dogs had a history of tick infestation (79%) at some point in their life. Clinical signs showed non-typical manifestations like fever, lethargy, diarrhoea, epistaxis, hind limb edema, and corneal opacity. Haematological studies revealed anaemia and thrombocytopenia along with neutrophilia with relative lymphopenia and monocytosis. A decreasing trend was observed in the levels of total protein and albumin with an increase in the levels of globulin, AST, ALT, BUN, and creatinine. The ultrasonography studies revealed hepatosplenomegaly along with hyper-echogenicity in various organs. Pro-teinuria and haematuria were consistent, along with the presence of bile salts in the urine of affected dogs. Molecular confirmation from n-type PCR data using Ehrlichia-specific primers targeting p28 gene (843 bp) was done, and the identified gene sequences submitted to NCBI databases have accession numbers OQ383671-OQ383674 and OP886674-OP886677. Ticks collected from dogs were identified morphologically through microscopy and scanning electron microscopy as Rhipicephalus sanguineus.

Some medical professional organizations have advocated for including the menstrual cycle as a vital sign in adolescence, but not in adulthood. However, documenting menstrual cycle patterns is not routine clinical or research practice. Vital signs are used to predict health outcomes, indicate needed treatment, and monitor a clinical course. They can help identify pathologies, affirm wellness, and are responsive to exposures. Here we review the scientific evidence showing how the menstrual cycle meets these criteria and should therefore be treated as a vital sign. Using key words and controlled vocabulary terms, we carried out multiple literature searches, prioritizing the inclusion of systematic reviews, meta-analyses, and clinical practice guidelines. This review describes how the menstrual cycle is a health indicator, can cyclically impact health conditions, and its associations with long-term post-menopausal health outcomes. We review exposures influencing the menstrual cycle, evidence underlying its use to optimize wellness, and available tools for documenting cycles. Supplementary materials include patient handouts on menstrual cycle tracking, and an index of related clinical practice guidelines and reviews by subject. The menstrual cycle is a vital sign from menarche through menopause, an underutilized but powerful tool for understanding gynecological and general health.

Brucellosis is a zoonoses caused by bacteria of the genus Brucella, which causes economic losses in livestock and threatens public health. A cross-sectional study was conducted to determine the prevalence of Brucella species and risk factors in smallholder dairy cattle in six regions of Tanzania from July 2019 to October 2020. Dairy cattle (n=2048) were sampled from 1371 farms. DNA ex-tracted from blood and vaginal swabs was tested for Brucella using qPCR targeting the IS711 gene and positives were tested for the alkB marker for B. abortus and BMEI1172 marker for B. melitensis. The molecular prevalence was 3.5% (95% CI: 2.8-4.4) with the highest prevalence 8.1% (95%CI: 4.6-13.0) in Njombe region. B. melitensis was the predominant species detected (66.2%). Logistic regression revealed PCR positivity in dairy cattle was higher in the animals with a history of abortion (OR: 3.17, 95%CI: 1.05-9.62) and farms without dogs around (OR: 2.68, 95%CI: 1.12-5.90). Further studies are recommended to understand the source of B. melitensis and the implications to veterinary public health. Livestock keepers should be informed of the risks and biosecurity practices to reduce introduction and control Brucella. Cattle and small ruminant vaccination pro-grams could be implemented to control brucellosis in high-risk populations in the country.

Background and Objectives: Wilson disease (WD) is a disorder of copper metabolism caused by genetic muta-tions in the ATP7B gene which lead to the accumulation of copper in the body. The aim of the present study is to investigate the severity of WD in patients in Romania. Materials and Methods: This study was conducted us-ing an online questionnaire consisting of 32 questions in a group of patients suffering from Wilson disease. Results: The study included 67 people aged 7 to 56 with WD. The most common symptoms of the participants were hepatic and neurological in 22 cases (32.8%). The most common neurological symptom in the assessed cases was muscle stiffness (49.5%), followed by tremor (45%), and speech disorders (40.5%). The Kay-ser-Fleischer ring was present in 50.7% of the participants. The most commonly used drug treatment in the participants was D-penicillamine (77.61%). Conclusions: The severity of WD is based on many aspects, the most important being early diagnosis and access to treatment throughout the year. The prognosis is favorable with early diagnosis and treatment, but it is crucial to diagnose individuals before they develop major symp-toms. Therefore, advances in WD screening can lead to an earlier diagnosis and better results.

Abstract: This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses still reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950–1969 and 1970-1794 as well as cancer incidence rates for the period 1998–2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, and diabetes and obesity prevalence near the 2016–2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin’s lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in overweight and obesity, which lowers 25-hydroxyvitamin D concentrations and generates systemic inflammation, a risk factor for cancer. The dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore cancer, would be one based mostly on whole-plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce risk of cancer.Keywords: alcohol consumption; cancer incidence;

Wastewater-Based Epidemiology (WBE) is currently used to monitor not only the spread of the pandemic virus SARS-CoV-2 but also for other viruses in endemic conditions, particularly in the absence of syndromic surveillance. Continuous monitoring of sewage requires high costs and significant time investment, highlighting the need for standardized methods and structured monitoring strategies. In this context, we conducted weekly wastewater monitoring in northwestern Italy, targeting Human Adenovirus (HAdV), Norovirus Genogroup II (NoVggII), Enterovirus (EV), and SARS-CoV-2. Samples collected at the entrance of treatment plants were concentrated using PEG/NaCl precipitation and viral nucleic acids were extracted and detected by real-time (RT-)qPCR. NoVggII resulted the most identified target (84.4%), followed by HAdV, SARS-CoV-2, and EV. Only HAdV and EV exhibited seasonal peaks in spring and summer. SARS-CoV-2 results compared with data previously collected in the same study area (February 2021 to September 2021) revealed a shift from an epidemic to a pandemic status, likely due to the evolution of variants. In conclusion, WBE, using standardized methods and an efficient monitoring strategy, proves valuable for virus surveillance in pandemic and epidemic scenarios, enabling the identification of temporal-local distribution patterns that are useful for making informed public health decision.

Since the 20th century, numerous studies have detected or isolated parasites from the Trypanosomatidae family in various tick species. However, the status of ticks as vectors of medically or veterinary important Trypanosoma and Leishmania remains unclear. We conducted a systematic review and meta-analysis to pro-vide new insights into the potential vector status of Leishmania and Trypanosoma, which have medical and veterinary significance. We searched three databases (PubMed, Google Scholar, and Web of Science) from 1912 to June 30, 2023, resulting in 94 and 86 papers included in the qualitative and quantitative analyses, respectively. All identified field studies were conducted in endemic areas and investigated the presence of Trypanosoma and Leishmania parasite, DNA, or antigen in ticks. We recorded a pooled prevalence of Trypa-nosomatidae detection in ticks at 15.48% [7.99-24.61%], with significant variations depending on the year, detection method, and geographical area. Most of positive tick species belonged to the genera Amblyomma, Hyalomma, Ixodes, and Rhipicephalus. Experimental laboratory work on transmission routes proved potential vector competence in both the Argasidae and Ixodidae tick families. Although our systematic review and meta-analysis provide unambiguous evidence of the natural infection of ticks by Trypanosomatidae para-sites with some evidence of non-traditional transmission routes, it does not provide conclusive evidence on the role of ticks as biological or mechanical vectors for veterinary and medically interest protozoan Trypa-nosomatidae species. All these unambiguously demonstrates the need of additional investigations to address this point.

Purpose: The aim of this article is to analyze the incidence of undiagnosed obstructive sleep apnea OSA in patients affected by dento-skeletal malformation. We also evaluated the patterns most affected by the condition and calculated the post surgical changes. Methods: We conducted a retrospective cohort study on 71 patients including 35 men and 36 women. Patients were evaluated with Polysomnography before surgery and at least 6 months after surgery to assess any improvement or worsening of the apnea hypopnea index AHI index. Regarding AHI evaluation criteria an AHI > 5 was considered indicative of OSA, 4 5, com-pared to 20.5% described in the Italian population. Conclusion: In patients who receive orthognathic surgery the presence of Obstructive Sleep Apnea is significantly higher than in the general population. When planning the surgical correction of a dentoskeletal malformation, the surgeon must aim not only to the aesthetics results, but also to a proper stomatognathic and respiratory function, this cannot be done without taking poly-somnography information into account.

This study delves into the dynamic field of medical education research, emphasizing the integration of research training within medical curricula. It seeks to understand the impact of such integration on the competencies of future medical professionals. The primary aim is to systematically categorize and analyze the current trends and future directions in medical education research. This involves assessing the influence of research training on medical students' skills and the methodologies used in such research. Methods: The research employs an extensive bibliographic literature review across multiple databases. It classifies studies into categories like experiential or case studies, editorials, and original research articles. This classification is based on criteria such as geographical location, research objectives, theoretical frameworks, and methodologies. Results: Findings reveal a diverse landscape in medical education research, with a significant emphasis on research training. The research showcases varying methodologies and approaches used globally, highlighting the thematic focus and geographical distribution of these studies. Conclusion: Medical education research is a globally expansive and evolving field. It underscores the importance of continuous investigation, particularly focusing on integrating research elements at curricular levels and exploring innovative educational strategies. The study also points out potential gaps in research, especially in underrepresented regions, indicating directions for future research efforts.

Dearth of information on extent of genetic variability in cassava limits the genetic improvement of cassava in Sierra Leone. This study aimed at assessing the genetic variability and relationships within 103 cassava genotypes using agro-morphological and culinary markers. A field trial was conducted in the School of Agriculture and Food Sciences research site. The experiment was laid in an augmented randomized block design. Morphological classification based on qualitative and quantitative traits categorized the germplasm into three different groups. A total of ten principal components (PCs) in the qualitative and six PCs in the quantitative trait sets accounted for 66.74% and 67.27% of the total genetic variation, respectively. Traits with significantly strong and positive correlations included presence of fruit (PFRT) and presence of seed (PSE)(r = 0.86***),root yield per plant (RYPP) and number of storage root (NSR) (r = 0.76***), RYPP and number of commercial root (NCR) (r = 0.68***), length of leaf lobe (LLL) and width of leaf lobe (WLL) (r = 0.66***),and between NSR and NCR (0.84***). Cooking time, cooking percentage, texture, mealiness, taste and aroma varied widely among the accessions. Findings established that the cassava germplasm possess useful genetic variability that could be exploited through selection for short term release programme, genetic conservation of valuable germplasm and genetic improvement of the crop.

This is a single tertiary center in southwest Romania, population-based, study. We retrospectively compared data obtained in two periods: January 2008 - December 2013 and January 2018 - De-cember 2023, respectively. The global incidence of transposition of great arteries (TGA) - the ter-minated cases added to the ones resulting in live-born pregnancies, remained almost constant. The live-born incidence of TGA decreased (0.34% to 0.013%). The prenatal detection rate increased slightly (71.42% to 87.5%). The median gestational age at the diagnosis decreased, from 29.3 ges-tational weeks (mean 25.4) to 13.4 weeks (mean 17.2). The proportion of terminated pregnancies significantly increased (14.28% to 75%, p = 0.019).

The study investigated the application of Wastewater-Based Epidemiology (WBE) as a tool for monitoring SARS-CoV-2 prevalence in a city in Northern Italy from October 2021 to May 2023. Starting from a widely applied deterministic model, this study proposed a variation to take into account population characteristics and virus biodegradation in the sewer network. The model calculated virus loads and corresponding COVID-19 cases over time in different areas of the city and was validated with healthcare data while considering viral mutations, vaccinations, and testing variability. The correlation between the predicted and reported cases was high across the three waves that occurred in the considered period, demonstrating the model’s capacity to predict relevant fluctuations in the number of cases. Population characteristics did not substantially influence the predicted and reported infection rates. Conversely, biodegradation significantly reduced the virus load reaching the wastewater treatment plant, resulting in a 30% reduction in the total virus load produced in the study area. This approach can be applied for comparing virus load values across cities with varying population demographics and sewer network structures, enhancing the comparability of WBE data for effective surveillance and intervention strategies.

An HFMD outbreak spread over the city of Hải Phòng from Summer 2011 to Autumn 2012. This epidemic was chosen because it was the very first HFMD epidemic in North Vietnam, eliminating thus interferences with previous outbreaks. This epidemic displayed 3 separate waves. A complete dataset was collected for more than 9500 patients during this period, which enabled us to analyze this epidemic at different scales. Access to the healthcare system was crucial during this period, with a reorganization of the system in February-March 2012. An analysis at commune level enables us to track the epidemic along certain communication routes. The three-waves structure reveals a wide disparity at district level. We develop a mathematical model showing high accuracy at the adjustment of data for both the total number of cases and for the number of cases per week. As a consequence, the model was able to accurately determine the dates of beginning and end of each wave and to show that they overlapped. Using mathematical functions associated with this model, it was possible to calculate the probability for a patient to belong to a specific wave.

Despite significant prevention efforts, the numbers of physically inactive individuals, chronic illnesses, exhaustion syndromes and sick leaves are increasing. A still unresolved problem with exercise promotion is the low participation of sedentary persons. This collective term covers heterogeneous subgroups. Their engagement with movement campaigns and resistance to change are influenced by numerous factors. Our aim was to analyse survey data on health, performance, lifestyle habits and the approachability to physical activity campaigns obtained from the Germany-wide ActIv survey. From 2,888 study participants aged 50-60 years, 668 persons were categorised into the subgroups "never-athletes", "sports-dropouts", "always-athletes" and "sports-beginners". Large and significant group differences were found for BMI, assessment of quality of life, health and fitness, risk factors and health problems. 42.5% of "never-athletes" and 32.5% of "sports-dropouts" did not state any barriers to sport. There are substantial disparities between the non-athlete groups in terms of their motivation to exercise. In contrast, there are comparatively minor differences in motivation between "sports-dropouts" and "sports-beginners", whose health and fitness are the primary motivators for sport. Our analyses suggest that (i) negative health and performance trends cannot be compensated by appeals for voluntary participation in exercise programmes and (ii) powerful incentive systems are required.

Developmental, clinical, and epidemiological research have demonstrated the salience of perceived racial discrimination (PRD) as a contributor to negative mental health outcomes in adolescence. This article summarizes secondary analyses of cross-sectional data from a large-scale youth survey within a predominantly rural state to estimate the prevalence and strength of association between PRD and serious psychological distress, suicidal ideation, and prior suicidal attempts. Data from 93,812 students enrolled in Grades 6, 8, 10, and 12 within 129 school districts across Kentucky were examined to determine prevalence rates for subgroups within the cohort. Logistic regression analyses assessed differences and established comparative strength of association among these variables for racial/ethnic subgroups. PRD was self-reported at high rates across several demographic subgroups and was most evident among Black (24.5%) and Asian (22.1%) students. Multiracial students experienced the highest rates of both SPD and suicidality. Both for the entire cohort and for each racial/ethnic subgroup, PRD was significantly associated with increased likelihood of negative mental health outcomes, although the strength of these associations varied across subgroups and developmental levels. Implications for early intervention and prevention are discussed.

Background The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from the demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. Materials and methods The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. Sixty-eight percent of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptom of the disease. Result The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. Conclusion The incidence of CC was estimated to be 26.44 per 100,000 new-born births. The number of patients with CC has tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.

We provide a summary of various epidemiological parameters related to COVID-19 such as incubation period, serial interval and other parameters. Understanding these parameters is important for developing prevention strategies. SARS-CoV-2 can be transmitted by droplets and close contact, but there is evidence of airborne transmission. Aerosol-generating procedures have been identified as one of the specific risk factors for healthcare workers. Super-spreading events refer to situations where a small number of individuals cause the majority of infections. The basic reproductive number (R0) and the spread parameter (k) are used to characterise the transmissibility of the disease. Estimated values for R0 range from 2 to 3 and the estimated value for k is 0.1.The duration of infectiousness depends on viral load and shedding. Viral load varies according to factors such as clinical spectrum, type of variant and vaccination status. The relationship between viral load and infectivity is not fully understood.With regard to the frequency of symptoms and signs of COVID-19, fever, cough, fatigue and dyspnoea are common. The prevalence of olfactory and gustatory dysfunction (OGD) varies between studies and countries. Age and comorbidities are factors associated with olfactory dysfunction.Estimates of the proportion of asymptomatic patients range from 6% to 96%. Asymptomatic transmission is considered likely and is important for control measures.We reviewed the quantitative semiology of COVID-19 is reported on sensitivity, specificity and likelihood ratios of signs.Finally, we also review risk factors for COVID-19 (including health care workers), co-infections, and epidemiology of variants..

Mozambique is endemic to aflatoxigenic Aspergillus but the country has to heavily rely on foreign research to deduct what is happening locally. There is some information produced by local scholars and institutions but it needs to be “tied” together. This review briefly synthetizes the country’s major findings in relation to the toxin’s etiology, epidemiology, detection and control, discussing and meta-analyzing them as far as they allow. The causes and foods affected are the same as in most tropical countries, the toxin is widespread and the level of exposure is high. Regarding the control, it is still marginal but some institutions have driven efforts in this direction. Learning from other countries is still the best approach to take, as the solutions are probably the same for most places.

Despite global efforts to improve vaccination coverage, the number of zero dose and under immunized children has increased in the African continent, particularly in Nigeria where more than 2.3 million unvaccinated children currently reside, making it the country with highest number of unvaccinated children on the African continent. It is thus imperative to identity barriers and facilitators of immunization in Nigeria with a view to formulate and design targeted interventions that can effectively bridge the immunization gap in Nigeria. In this review, we systematically mapped and summarized existing literature and data on key barriers to vaccine uptake, and facilitators influencing immunization practices in Nigeria. The electronic databases were systematically searched and articles that reported determinants of routine immunization uptake in Nigeria from inception of the databases up till October 2023 were included. The eligible articles were evaluated using a set of pre-defined criteria and the extracted data were analysed and visualized. This scoping review identified barriers spanning logistical, socio-economic, cultural, and healthcare system-related aspects, highlighting the need for a multi-pronged approach to address these challenges. While considerable progress has been made over the years, persistent barriers like distance between area of residence of caregivers and immunization centers, vaccine shortages, poor interpersonal relationship between healthcare workers and caregivers and cultural/religious influences persist. Lastly, collaborative efforts among stakeholders and communities remain paramount in ensuring improved routine immunization coverage across the Nigeria’s diverse socio-cultural landscape.

Background and Objectives: Recent studies have focused on the association between the risk of diabetic retinopathy (DR) and rs1501299 and rs2241766 polymorphisms of the ADIPOQ gene, whereas their results remain inconclusive. Thus, a systematic review and meta-analysis was car-ried out to clarify the role of these polymorphisms in the development of DR. Materials and Methods: A systematic research of electronic databases (PubMed, Scopus, and Cochrane Library) was conducted until June 16, 2023, and a reference list of relevant articles was collected, which explored the association between rs1501299 and rs2241766 polymorphisms of the ADIPOQ gene and the risk of DR. The pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated via random-effects model and the meta-analysis was implemented by using Review Manager 5.4. Results: In total, 6 out of 178 studies, with 1,888 cases (DR) and 2,285 controls (without DR), were included in the meta-analysis. A statistically significant association between rs1501299 poly-morphism and DR risk was recorded in G vs. T in the overall analysis (OR=0.84, 95% CI=0.72-0.99, p=

The EASY-NET network program (NET-2016-02364191 - Effectiveness of Audit and Feedback (A&F) strategies to improve health practice and equity in various clinical and organizational set-tings), piloted a new and more structured A&F strategy. This study compared the effectiveness of the new strategy versus the periodic publication of indicators alone in improving the appropri-ateness and timeliness of emergency health interventions in patients with Acute Miocardial In-farction (AMI) and ischemic stroke in the Lazio Region. Efficacy was evaluated according to a prospective quasi-experimental design of pre-post (2021-2022) intervention type with control group. The exposed are hospitals in the Lazio Region where professional teams voluntarily par-ticipated in the intervention. The control group is involved only in the usual reporting activities. Effectiveness analysis was conducted at the patient level. Regional health information systems were used to calculate process and outcome indicators. The effectiveness of the intervention was assessed with Difference In Difference models, comparing pre-post intervention periods between exposures and controls. Estimates were calculated in terms of the difference in percentage points (pp) between absolute risks. Sixteen facilities for the IMA pathway and 13 for the stroke pathway joined the intervention. The intervention reduced the proportion of 30-days readmissions after a hospitalization for ischemic stroke by 0.54 pp in the exposed patients with a significant difference of -3.80 pp (IC95% -6.57; -1.03; 5453 patients, 63.7% cases) in the exposed compared to controls. There were no statistically significant differences attributable to the implemented A&F interven-tion in the other indicators considered. The results show, for the first time in Italy, the impact of A&F interventions in an emergency setting using aggregated data from hospitals involved in the Lazio Region emergency network.

Introduction: Management of hypoxic-ischemic encephalopathy (HIE) has been the subject of international recommendations. However, some aspects remain within the realm of service practices and appear to vary greatly from one center to another. Objectives: To achieve a multidisciplinary consensus in France regarding management of HIE newborns that are not covered by international and national guidelines. Methods: This is a prospective, multicenter study using the Delphi method from April 21, 2021, to July 15, 2021. Perinatal professionals were contacted through professional societies. Participants received a questionnaire in three successive rounds. Each proposal was rated using a Likert scale from 1 (completely disagree) to 8 (completely agree). An item was considered consensual if at least 70% of responses were in agreement or disagreement. Results: 58 french neonatal professionals participated. A consensus was reached in the first round concerning the use of passive hypothermia in maternity ward, with 84% agreement and to define the target temperature between 35.0°C and 35.5°C at the third round. Regarding hypoglycemia in the delivery room, 79.2% agreed in the first round to correct blood glucose levels below a threshold of <2.2 mmol/l. Parenteral route was the preferred correction method for 91.4% of respondents, while enteral route via nasogastric tube did not reach consensus. Conclusion: This study highlights the variability in definitions and practices among professionals in the management of HIE. Consensus was found regarding certain care practices performed without formal guidelines. The work to harmonize definitions and practices for the management of HIE likely needs to continue.

The growing population in Yucatan has led to the expansion of construction in the Mayan jungle for tourist spaces, residential areas, and agriculture. Recently, rabies cases in cats (Felis catus) have increased. This study aimed to perform the antigenic and genetic characterization of the RABV and to try to identify factors contributing to the increased transmission of rabies virus from wildlife to cats in the State of Yucatan. The ArcGIS software was employed to generate maps depicting the geographic locations of rabies outbreaks in cats. A mixed-effects Poisson regression model was applied to investigate the association between cat rabies cases and sociodemographic and ecological variables. A total of nine feline rabies cases occurred, three antigenic variants were detected: RVV1 (n=1); (RVV3) (n=1), and the canine-originated atypical variant (n=7). Rabies cases were spatially distributed at the urban-jungle interface, which may favor contact between cats and wildlife. No statistically significant associations with sociodemographic/ecological variables were observed. Urban areas with low (0-2%) to moderate (2-4%) changes in land cover showed a substantial increase in the probability of feline rabies cases. This study highlights the concerning resurgence of rabies infections in cats, emphasizing the looming threat of its reintroduction in dogs should vaccination rates diminish. The genetic affinity between the atypical variant and the canine virus underscores the urgent need for vigilance in maintaining high vaccination coverage across all susceptible species.

Traumatic Brain Injury (TBI) is one of the leading causes of death and disability worldwide. Patient treatment and management pose a challenge for healthcare systems. The prognosis of these patients may be influenced by factors such as sex. This study aims to describe the clinical parameters of patients hospitalized in the Intensive Care Unit (ICU) of a Spanish hospital due to Trauma Brain Injury and to establish differences based on sex. Methodology: An observational, cross-sectional, and analytical study was conducted from March 2015 to December 2019. All patients admitted to the ICU during this period who presented isolated significant Traumatic Brain Injury, defined as an abbreviated injury scale (AIS) ≥ 3, were included. Data on baseline characteristics, mechanism of injury, substance use, and acute management in the prehospital and hospital stages (including the need for hospitalization) were recorded. A descriptive and in-ferential analysis was conducted using the chi-square test. Results: A total of 950 patients were ultimately included. The majority of the patients were men (723) with a mean age of 45.16 (± 17.55). There were statistically significant differences in terms of the mechanism of injury (p

In Brazil, Brazilian borreliosis (BB), characterized molecularly, exhibits symptoms akin to Lyme disease (LD) but presents unique epidemiological, clinical, and morphological features. This study explores the incidence, diagnostic challenges, and awareness initiatives regarding this disease in Brazil. Employing a narrative review methodology, data were sourced from Pubmed, Ebsco, Google Scholar, and Web of Science without temporal constraints. Results reveal diagnostic complexities in Brazil due to the low sensitivity of conventional tests and the use of North American B. burgdorferi antigens. Despite challenges, epidemiological studies indicate an upswing in cases in humans and animals. Therefore, there is an urgent need to define new biomarkers, molecular strategies, or new antigenic targets to advance the development of vaccines and diagnostics. Early and accurate pathogen identification is crucial for active surveillance to comprehend and manage this zoonosis.

The global issues of overweight and sedentary lifestyles demand comprehensive responses from health systems, yet health education still needs to be more cohesive and less sporadic. This study focuses on primary school children as a specific target for instilling healthy habits, employing ac-tive learning strategies to address healthy diet and physical activity. Through Problem-Based Learning projects, the study engaged fourth-grade primary students in acquiring healthy habits. The study was carried out over four consecutive years at a school with two lines, allowing the employment of an opportunity sample and evaluating intervention and control groups by com-paring their corresponding scores. Control groups integrated a total of 54 students, while the in-tervention group included a total of 159 students. A pre-test and post-test questionnaire were used for data collection. Evaluation differential scores revealed statistically significant higher scores in the intervention groups: 3.62 points in control groups and 6,94 in intervention groups, particu-larly in attitudinal competences. These strategies not only facilitated the development of crucial skills such as information search, synthesis, representation, analysis, decision-making, teamwork, and intrapersonal awareness but also significantly broadened the knowledge acquired in aspects related to healthy habits. This approach proved effective in helping children comprehend the im-portance of healthy choices and encouraged integrating such habits into their daily lives.

Pneumonic plague outbreaks are relatively infrequent in modern times but in the early part of the 20th century, they were commonplace including several well-documented epidemics responsible for the deaths of thousands. The transmissibility of this disease seems to be discontinuous since in some outbreaks few transmissions occur, while in others, the progression of the epidemic is explosive. Modern epidemiological studies explain that transmissibility within populations is heterogenous with relatively few subjects likely to be responsible for most transmissions and that ‘super spreading events’, particularly at the start of an outbreak, can lead to a rapid expansion of cases. These findings concur with outbreaks observed in real-world situations. It is often reported that pneumonic plague is rare and not easily transmitted but this view could lead to unnecessary complacency since future risks such as the spontaneous incidence of anti-microbial strains, climate change leading to a disruption of natural cycles within plague foci and use of plague as a bioweapon cannot be discounted. Carers and first responders are vulnerable, particularly in poorer countries where access to medicines may be limited, out-breaks occur in inaccessible areas or where there is a lack of surveillance due to a paucity of funds.

Background: Whilst lack of concentration is a known symptom of anaemia, its association with post-stroke dementia is unclear. Methods: We used data from a UK regional stroke register. To be eligible, patient must have survived to discharge and had anaemia by WHO criteria. Dementia status and other prevalent co-morbidities were assessed using ICD-10 codes. Patients were followed till May 2015 (mean follow-up 3.7 years, total person years = 27,769). Hazard Ratio for incident dementia was calculated using Cox-proportional hazards model controlling for potential confounders. Fine and Gray model was additionally constructed using mortality as the competing risk. Results: A total of 7,454 stroke patients were included with mean age (SD) of 75.9(12.3) years (50.2% men). Those with anaemia were older, has higher disability and co-morbidity burden prior to stroke. We observed a large amount of variation in the dementia incidence rates over time and that the hazard ratio increased every year. The significant association between anaemia and dementia incidence was lost after controlling for pre-stroke Modified Rankin score (HR1.17(0.97,1.40)). With every 20g/dL increase in Hb was associated with a significant reduction in the risk of dementia after adjustment for age, sex, stroke factors and disability but lost significance after adjustment for vascular risk factors. Competing risk analyses showed similar results. Conclusion: Whilst we found no evidence of anaemia as a risk factor for post-stroke dementia, the findings may be limited by potential under recognition of post stroke dementia.

Background: Whilst lack of concentration is a known symptom of anaemia, its association with post-stroke dementia is unclear. Methods: We used data from a UK regional stroke register. To be eligible, patient must have survived to discharge and had anaemia by WHO criteria. Dementia status and other prevalent co-morbidities were assessed using ICD-10 codes. Patients were followed till May 2015 (mean follow-up 3.7 years, total person years = 27,769). Hazard Ratio for incident dementia was calculated using Cox-proportional hazards model controlling for potential confounders. Fine and Gray model was additionally constructed using mortality as the competing risk. Results: A total of 7,454 stroke patients were included with mean age (SD) of 75.9(12.3) years (50.2% men). Those with anaemia were older, has higher disability and co-morbidity burden prior to stroke. We observed a large amount of variation in the dementia incidence rates over time and that the hazard ratio increased every year. The significant association between anaemia and dementia incidence was lost after controlling for pre-stroke Modified Rankin score (HR1.17(0.97,1.40)). With every 20g/dL increase in Hb was associated with a significant reduction in the risk of dementia after adjustment for age, sex, stroke factors and disability but lost significance after adjustment for vascular risk factors. Competing risk analyses showed similar results. Conclusion: Whilst we found no evidence of anaemia as a risk factor for post-stroke dementia, the findings may be limited by potential under recognition of post stroke dementia.

(1)Background: Fascioliasis is considered a neglected tropical disease affecting an estimated 17 million people in more than 70 countries worldwide. The highest prevalence of human fascioliasis is found in regions where livestock farming and consumption of raw or undercooked freshwater plants are common, such as parts of Africa, Asia, Europe, and Latin America. It is responsible for over 90,000 disability-adjusted years of life due to associated abdominal complications. We conducted a study to investigate the prevalence of human fascioliasis through a systematic review and meta-analysis of all available literature in Sun-Saharan Africa.(2). Methods: We screened a total of 126 publications using pubmed online search engine databases; Web of Science and CAB for articles published within a 20-year period between 2000 and 2022. We used a comprehensive search method using a combination of terms, parasite and disease names. The initial search resulted in a screening of articles by title, abstracts and full texts. The relevant information on the prevalence of human fascioliasis in Africa was extracted. Of the 126 publications, 33 articles were selected for meta-analysis. The essential information required was extracted from these documents and determined through statistical analysis in Microsoft Excel for calculating the prevalence of human fascioliasis in sub-Saharan Africa. The variance of each study was assessed using a bimodal distribution and heterogeneity assessment using a I2 index. Analysis was performed using random effects models.(3)Results: A total of 271 articles were searched through the database search and 33 articles were eligible studies that provided qualitative information on the prevalence of human fascioliasis in Africa. These make up 12.17% (n=33). The pooled prevalence estimates for human fascioliasis are 0.032% (IVhet PPE: 0.032% (95%CI 1.4-6.53). The highest prevalence rate was observed in Egypt with a prevalence of 100%. The prevalence of human fascioliasis is very high in some sub-Saharan countries, partly due to neglect of diagnostics, demonstrating the bias of available information for decision-making in human fascioliasis across Africa, given the spatial presence, scarcity and incompleteness are region.(4)Conclusions: The prevalence of Human fascioliasis is very high in some Sub-Saharan Countries partly due to neglect in diagnostics. This presents how highly focal with spatial occurrences, scarcity and patchy the available information for decision making is on Human fascioliasis across the Sub-Saharan African region.

This study aimed to determine the impact of a novel formulation of a supplement composed of the natural ingredients: bromelain, quercetin, and Lentinula edodes, on the gut microbiota of healthy adult dogs. Adult healthy female dogs were administered either a placebo (CTR, n = 15) or the supplement (TRT, n=15) over 28 days. Stool samples were collected for 16S rRNA sequencing before supplement administration (T0), at completion of supplement administration (T28), and one week after the end of supplement administration (T35) to characterize changes in the gut microbial communities. QIIME was used to determine both alpha- and beta-diversity and ANCOM-BC was used to identify differences in taxonomic abundances before and after supplementation. We found a significant decrease in overall diversity in CTR group, but no significant differences in overall diversity in the TRT group over time. Furthermore, we found differences in the abundance of several taxa in both CTR and TRT groups but differences in abundance of beneficial bacteria were more pronounced in TRT group. Specifically, we found increases in the abundance of sequences belonging to the genera Bifidobacterium, Lactobacillus, and Pediococcus at T28 in the TRT group with significant increases in Bifidobacterium and Lactobacillus persisting at T35 when compared to T0. Importantly, members of these genera are known to be pro anti-inflammatory and associated with a healthy gut microbiota in dogs. The results of our study show the potential of our supplement to selectively enhance specific beneficial bacterial taxa, offering a targeted approach to modulating the gut microbiome without causing disruptions to the overall equilibrium.

Patients with predominantly antibody deficiencies (PAD) display hypogammaglobulinemia with a high prevalence of infections, along with autoimmune manifestations, benign and malignant lymphoproliferation and granulomatous disease. It is noteworthy that PAD patients, even those with defects in the same causative genes display a variable clinical phenotype, suggesting that additional genetic polymorphisms, located in either immune-related or non-immune-related genes, may affect their clinical and laboratory phenotype. In this context, we analyzed 80 PAD patients, including 70 with common variable immunodeficiency (CVID) for SERPINA1 defects, in order to investigate their possible contribution to PAD clinical phenotype. Eight CVID patients carried heterozygous pathogenic SERPINA1 defects with normal alpha-1 antitrypsin levels. Interestingly, the presence of the Z allele (rs28929474) which was found in three patients, was significantly associated with liver disease; hepatic complications were also observed in patients carrying the p.Leu23Gln (rs1379209512) and the p.Phe76del (rs775982338) alleles. Conversely, no correlation of SERPINA1 defective variants with respiratory complications was observed, although patients with pathogenic variants exhibit a reduced probability of developing autoimmune diseases. Therefore, we recommend SERPINA1 genetic analysis in PAD, in order to identify patients with a higher risk for liver disease.

Background: Endometriosis is a female chronic inflammatory disease in which endometrial tissue develops outside the uterine cavity. It is a complex pathology, that significantly contributes to morbidity in premenopausal women, leading to chronic pain, infertility, and subfertility negatively impacting the physical, and emotional well-being and overall quality of life. The public health burden of endometriosis remains elusive and challenging to determine, and this uncertainty can lead to inadequate healthcare services and treatments. Objective: To estimate the incidence and prevalence of endometriosis in Italy using the hospital discharge records database. Population-based retrospective study. Nationwide between 2011 and 2020. Methods: From the National Hospital Discharge Database were selected all admissions with a diagnosis of endometriosis (ICD-9-CM, codes 617.x), supported by the presence of a procedure code of laparoscopy or any other surgical procedure allowing direct visualisation of the lesions. Main outcomes measures Incidence and prevalence of endometriosis were estimated for the entire 2010-2020 period and by individual year, analysing the time trend and variability in different geographical areas of Italy. Results: A total of 134,667,646 women aged 15–50 years with one or more hospitalisations for endometriosis in all Italian hospitals. The incidence of endometriosis in Italy during this period was 0.839 per 1000 women (CI95% 0.834-0.844), exhibiting a statistically significant decreasing trend over the years. A discernible north-south gradient was observed, with higher rates documented in the northern regions. The prevalence rate stood at 14.0 per 1000 during the same period, and a similar north-south geographical gradient was identifiable in the prevalence rates as well. Conclusions: The utilization of national-level hospital data enables the generation of incidence and prevalence data for endometriosis without variations in methods and definitions, facilitating the evaluation of temporal trends and regional comparisons. Understanding and quantifying this phenomenon is essential for appropriate healthcare planning in various Italian regions.

Acanthamoeba keratitis (AK) is a severe, rare protozoal infection of the cornea. Acanthamoeba can survive in diverse habitats and at extreme temperatures. AK is mostly seen in contact lens wearers, whose lenses have become contaminated, or a history of water exposure, and in those without contact lens wear, who have experienced recent eye trauma involving contaminated soil or water. Infection usually results in severe eye pain, photophobia, inflammation, and corneal epithelial defects. The pathophysiology of this infection is multifactorial, including the production of cytotoxic proteases by Acanthamoeba that degrades the corneal epithelial basement membrane and induce the death of ocular surface cells, resulting in degradation of the collagen-rich corneal stroma. AK can be prevented by avoiding the risk factors, which include avoiding water contact such as swimming or showering in contact lenses, and wearing protective goggles when working on the land. AK is mostly treated with an antimicrobial therapy of biguanides alone or in combination with diaminidines, although the commercial availability of these medicines is variable. Other than anti-amoeba therapies, targeting host immune pathways in Acanthamoeba disease may lead to the development of vaccines or antibody therapeutics which could transform the management of AK.

Scrub typhus (ST) is one of the most neglected tropical diseases, a leading cause of acute undifferentiated febrile illness in areas of the ‘tsutsugamushi triangle’, diagnosed frequently in South Asian countries. The bacteria Orientia tsutsugamushi is the causative agent of the disease, which enters to human body through the bite of trombiculid mite (Chigger) of the genus Leptotrombidium deliense.The diagnosis of the disease becomes challenging as its early symptoms mimic other febrile illnesses like dengue, influenza, and corona viruses. Lack of rapid, reliable, and cost-effective diagnostic methods further complicates the identification process. Northeast India, a mountainous region with a predominantly rural tribal population, has witnessed a resurgence of scrub typhus cases in recent years. Various ecological factors, including rodent population, habitat characteristics, and climatic conditions, influence its prevalence. Entomological investigations have confirmed the abundance of vector mites, highlighting the importance of understanding their distribution and the probability of transmission of scrub typhus in the region. Proper diagnosis, awareness campaigns, and behavioral interventions are essential for controlling scrub typhus outbreaks and reducing its impact on public health in Northeast India. Further research and community-based studies are necessary to accurately assess the disease burden and implement effective prevention strategies.

Lower cutoff levels in screening programs have led to an increase in the proportion of detected cases with transient hypothyroidism, leading to increase of the overall incidence of primary congenital hypothyroidism (CH) in several countries. We have performed retrospective evaluation on the data from 251,008 (96.72%) neonates screened for thyroid-stimulating hormone (TSH) level in dried blood spot specimens taken 48 hours after birth, between 2002 and 2015, using DELFIA method. A TSH value of 15 mIU/L was used as the cutoff point until 2010 and 10 mIU/L thereafter. Primary CH was detected in 127 newborns (1/1976) of which 81.1% had permanent and 18.9% had transient CH. The incidence of primary CH was increased from 1/2489 until to 2010 to 1/1585 thereafter (p=0.131). However, the incidence of permanent CH was slightly increased (p=0.922), while the transient CH incidence had 8-fold increasing after lowering the TSH cutoff level (p<0.001). In cases with permanent CH, we observed lower frequency for thyroid dysgenesis (82.7 vs. 66.7%) and higher frequency for normal in-situ thyroid gland (17.3 vs. 33.3%), for the period with reduced TSH cutoff value. Our findings support the impact of lower TSH cutoff on the increasing incidence of congenital hypothyroidism.

The aim of the present study was to investigate the incidence of breast (females), prostate, testicular and thyroid cancer in the Italian National Priority Contaminated Sites (NPCSs), served by cancer registries, where the presence of endocrine disruptors (EDs), reported to be linked to these tumors, was documented. Evidence of carcinogenicity of EDs present in NPCs was assessed based on evaluation by international scientific institutions/committees. Standardized Incidence Ratios (SIRs) were computed for each NPCS and cancer site with reference to the time window 1996-2005. Excess incidence of one or more cancer site at study was found in twelve out of fourteen NPCSs. Significantly increased SIRs were found for breast cancer in eight NPCSs, for prostate cancer in six, for thyroid cancer (both gender) in four and for testicular cancer in two. Non significantly increased SIRs were found in five NPCSs for testicular cancer and in two for thyroid cancer (males). Even if increased incidence of one or more cancer sites at study were found in several NPCSs, the ecological study design and the multifactorial etiology of the considered tumors do not allow reaching conclusions in terms of causal links with environmental contamination. In light of the observation of some excesses in SIRs, continuing epidemiological surveillance is warranted.

This review article focuses on the role of Artificial Intelligence (AI) in transforming healthcare in Africa, specifically in combatting infectious diseases, neglected tropical diseases (NTDs), and antimicrobial resistance. We provide a comprehensive overview of the significance of AI in the healthcare industry, highlighting its urgency and importance in addressing these specific health challenges in Africa. We begin by discussing the role of AI in infectious disease surveillance and outbreak detection. We explore how AI technology can be employed for real-time tracking and prediction of outbreaks, providing examples of successful AI applications in infectious disease surveillance within the African context.Next, we examine the potential of AI-enabled diagnosis and treatment for faster and more accurate diagnoses of infectious diseases and NTDs. We highlight specific examples of AI applications in diagnosing and treating these diseases in Africa, showcasing the potential of AI to improve clinical outcomes and save lives.Furthermore, we focus on how AI-driven drug discovery and development can expedite the search for new treatments for infectious diseases and combat antimicrobial resistance. We present examples of AI applications in drug discovery within the African context, illustrating the potential for AI to revolutionize the development of effective therapeutics.In addition, we delve into how AI-powered public health interventions can enhance the design and implementation of targeted interventions. We explore how AI can optimize resource allocation and facilitate data-driven decision-making processes, providing examples of AI applications in public health in Africa.Finally, we address the challenges and limitations of implementing AI in combatting infectious diseases, NTDs, and antimicrobial resistance in Africa. We discuss potential barriers and ethical concerns surrounding AI applications in healthcare, aiming to encourage informed and responsible utilization of AI technologies.Overall, this review emphasizes the importance and potential of AI in combatting infectious diseases, NTDs, and antimicrobial resistance in Africa. It positions AI as a catalyst for revolutionizing healthcare in the region, leading to more effective disease surveillance, diagnosis, treatment, drug discovery, and public health interventions.

Herein, we examined the effects of weather parameters and individual clinicodemographic risk factors on hemorrhagic stroke (HS) incidence, severity on admission, and disability at discharge in a harsh desert climate. In a retrospective design we studied patients admitted to a stroke unit in Arab Emirates in 2016-2019. With a distributed lag nonlinear model we explored immediate and delayed effects of weather on stroke incidence. Supervised machine learning was used to build models predictive of scores in NIHSS and mRS scales. We assessed model performance by calculating ROC AUC, F1 scores, specificity, and sensitivity. HS risk increased after a significant change in any weather parameter. The risk was reduced below baseline after 1-week adjustment to environmental changes. Climate input from the previous 3 days yielded reliable classification models. Humidex was a better predictor of severity than air temperature, whereas body mass index, age, and time of day at stroke onset were the strongest clinical predictors. Weather parameters before admission were stronger predictors of disease severity than individual clinical factors. We addressed limitations of previous studies by analyzing a full set of climate parameters: ambient temperature, relative humidity, humidex, atmospheric pressure, and wind speed. Predictive models may help to optimize patient management and develop preventative strategies.

Background: It has shown that meal timing, poor sleep quality and chronotype could play a relevant role in the development of type 2 diabetes mellitus (T2DM). However, the relationship with macronutrients by eating occasions has not been explored deeply. Objective: Our aim was to estimate the association between chrono-nutrition, sleep quality, chronotype and the prevalence of T2DM. Methods: This cross-sectional study included a subset of 3465 middle-aged adults (2068 women) from the European Prospective Investigation into Cancer and Nutrition (EPIC) Spain cohort study. In the 2017-18 follow-up, we assessed chronotype, sleep quality, diet, and sociodemographic data by validated questionnaires. Further, we used blood samples to determinate serum levels of glucose. We defined a case of T2DM when serum glucose concentration was ≥126 mg/dl or when participants self-reported diabetes. Results: Higher prevalence of T2DM was associated with poor sleep quality (ORpoorvsgood=2.90, 95%CI=1.30, 6.28). Carbohydrate intake at breakfast was inversely associated with the prevalence of T2DM (OR=0.75, 95%CI=0.66, 0.85). Finally, lipid intake at breakfast were associated with a 13% higher the prevalence of T2DM (OR=1.13, 95%CI=1.01, 1.26) for each 1 standard deviation (1-SD) increase. We observed no associations between macronutrient intake at lunch or dinner and T2DM. Conclusions: The study concludes that a breakfast with higher content in carbohydrate at breakfast is correlated with a reduced prevalence of T2DM. While higher lipids intake at breakfast was associated with higher prevalence of T2DM. Furthermore, poor sleep quality is as a potential factor associated with an elevated prevalence of T2DM. Our results emphasize the need for prospective studies to validate and strengthen these observed associations.

The platelet count, a component of the full blood count, has been identified as a useful diagnostic marker for cancer in primary care. The reference range for the platelet count is 150 to 400 or 450 × 109/l; this range does not account for natural variation in platelet count by age and sex. This study used three primary care cohorts from England Canada, and Australia. Patients aged 40 years and over with a full blood count were included and stratified by age (in 10-year bands), sex, (male/female), and platelet count group. Cancer incidence within one year of test date was estimated from linked registry data. In all three countries there was a clear upwards trend in cancer incidence with increasing platelet count, for both sexes and at all age groups. Lung and colorectal were the most common sites. These results have important implications for the international application of this work; analysis of local health datasets will be crucial to determine appropriate thresholds. Appropriate upper thresholds will depend on local populations, healthcare needs, and priorities. Further research is needed to assess the likely impact of new recommendations on the healthcare system, on cancer outcomes, and patient benefit.

Cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests are associated with infectivity and viral load, and they could be an aid to forecast the evolution of SARS-CoV-2 outbreaks. The objective was to know the Ct values related to the incidence and reinfection of SARS-CoV-2 in successive outbreaks, which took place in nursing homes in Castellon (Spain) during 2020-2022, and to test its usefulness as an instrument of epidemic surveillance in nursing homes. Poisson regression and multinomial logistic regression were used in the analysis. We studied four nursing home SARS-CoV-2 outbreaks, and the average infection rate, reinfection rate, and case fatality were 72.7%, 19.9%, and 5.5%, respectively; 98.9% of residents were vaccinated with three doses of a mRNA SARS-CoV-2 vaccine. Ct values for first infections and reinfections were 27.1±6.6 and 31.9±5.4 (p = 0.000). Considering Ct values ≥30 versus

Novel genetic risk markers have helped to advance the field of cardiovascular epidemiology and refine our current understanding and risk stratification paradigms. Discovery and analysis of variants can help to tailor prognostication and management. However, populations underrepresented in cardiovascular epidemiology and cardiogenetics research may experience inequities in care if prediction tools are not applicable to them clinically. Therefore, the purpose of this article is to outline the barriers that underrepresented populations can face in participating in genetics research, describe current efforts to diversify cardiogenetics research, and outline strategies that researchers in cardiovascular epidemiology can implement to include underrepresented populations. Mistrust, a lack of diverse research teams, improper use of sensitive biodata, and constraints of genetic analyses are all barriers for including diverse populations in genetics studies. Current work is beginning to address the paucity of ethnically diverse genetics research and has already begun to shed light on the potential benefits of including underrepresented and diverse populations. Reducing barriers for individuals, utilizing community-driven research processes, adopting novel recruitment strategies, and pushing for organizational support for diverse genetics research are key steps that clinicians and researchers can take to develop equitable risk stratification tools and improve patient care.

With enhanced life expectancy and ageing global populations, the prevalence of multimorbidity continues to increase. However, there is a dearth of evidence linked to multimorbidity diagnoses, treatments and health outcomes which remains a concern for future proofing optimal healthcare services. Generating evidence is critical to managing multimorbidity, promoting public health and minimizing health inequalities via effective healthcare policies that improve quality of life for vulnerable populations. This study assessed meta-epidemiology of multimorbidity to report the gaps in scientific knowledge and clinical practice. A systematic methodology was designed and published in PROSPERO (CRD42022347308) to report meta-epidemiology analyses using databases including PubMed, Web of Science, ScienceDirect, EMBASE, The Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials and MEDLINE for studies published between the 1^st of January 1980 - 31^st December 2022. A random-effects model was used to estimate the pooled proportion of multimorbidity in adults. Forest plots, pooled odds ratios and statistical heterogeneity metrics were used to assess the association between multimorbidity and investigated factors. Funnel plots and Egger’s regression were used to detect and correct for publication bias. Our findings identified women to be 0.32 times more likely to have multimorbidity in comparison to males. In regard to ethnicity, white people were 0.47 times less likely to develop comorbidities than black people. People who identified as a drinker or unmarried were more likely to develop comorbidities than those who are non-drinkers or married, respectively. Regardless of smoking status, people were equally likely to have comorbidity. In terms of environmental influences, people in rural areas were found to be 0.2 times less likely to have comorbidity in comparison to those living in urban areas. Interestingly, people with a higher education level were 0.57 times more likely to develop comorbidities than those with only a high school education. It is evident that multimorbidity has a significant burden globally and impacts the provision of care necessitated across populations given its association with several social determinants of health. Robust research and healthcare policies are required to better manage multimorbidity in patients. An example of such intervention includes employing prevention programs to reduce risk and incidence of multimorbidity within at-risk populations.

A brain tumor is an abnormal mass of tissue found inside the brain that consists of cells that grow and multiply without any control and unchecked by the mechanisms that regulate normal cell growth. It is one of the leading causes of death in many different regions worldwide, affecting various ages, sex, race, or ethnicities. Besides being a life-threatening condition, it can also disrupt normal brain function leading to severe cognitive morbidity. Additionally, the cost associated with active treatment and palliative care of the brain tumor most often proves to be out of reach for many people. Over the past decades, even though we have several published literature showing the epidemiology and characteristics of brain tumors, up-to-date epidemiological data is yet to be published. This review will provide comparable recent statistics regarding the incidence of brain tumors in 3 different regions; - the USA, the UK, and Australia. Also, a focus will be given to brain tumor’s key characteristics, classifications, and treatment protocol.

Background/Objectives: Vitamin D’s effect on risk health outcomes is often evaluated using prospective cohort studies. Risk ratios (RRs; e.g., hazard ratios or odds ratios) are determined for incidence for participants with baseline serum 25-hydroxyvitamin D [25(OH)D] concentrations below or above specified values. Serum 25(OH)D concentrations vary over time, thereby diluting the effect of 25(OH)D for long follow-up periods. Inverse relationships between RR and follow-up period have been reported for all-cause mortality rate and cancer incidence rates. Here I evaluate the effect for neurological outcomes. Methods: I analyzed how follow-up period affected results from 10 cohort studies of all-cause dementia, 6 studies of Alzheimer’s disease, and 9 for cognitive impairment with respect to vitamin D deficiency. Results: For all-cause dementia, Alzheimer’s disease, and cognitive impairment, respectively, the linear regression fits are RR = 2.9 – 0.14 × years, r = 0.73, p = 0.02; RR = 2.9 – 0.14 × years, r = 0.69, p = 0.13; and RR = 1.8 – 0.066 × years, r = 0.72, p = 0.03. The regression fit to RR for the shortest follow-up period for each outcome is considered the best estimate of vitamin D deficiency’s effect on risk. Those values are approximately twice that found by averaging all RRs without considering the effect of follow-up period. Conclusions: Vitamin D’s effect on risk of neurological conditions should be determined with relatively short follow-up periods after repeated 25(OH)D measurements as warranted during follow-up.

The COVID-19 pandemic has significantly impacted human health and daily life. Meteorological factors play a crucial role in virus transmission. Understanding these factors is critical for pandemic control, yet debates continue due to variations in research methods and data. This study uses a global dataset and focuses on administrative units smaller than 10,000 km². The relationship between daily COVID-19 incidence rates and meteorological factors—including temperature, relative humidity (RH), ultraviolet radiation (UVR), and diurnal temperature range (DTR)—was analyzed across 173 units in 62 countries. The results revealed significant nonlinear responses and lag effects between incidence rates and the meteorological factors. Key inflection points were observed at 0°C and 24°C for temperature, 63% for RH, 102 KJ/m² for UVR, and 15°C for DTR. Below 0°C, infection risk increased with rising temperatures; from 0°C to 24°C, risk decreased; and above 24°C, risk escalated rapidly. RH below 63% correlated inversely with infection risk, while above 63%, the correlation was positive. Infection risk decreased with UVR below 102 KJ/m² but increased beyond this threshold. These nonlinear responses are primarily driven by the differential effects of these factors on virus survival, transmission, and human immunity. Conditions around 24°C, 63% RH, 102 KJ/m² UVR, and DTR below 15°C appear optimal for human immunity, correlating with lower infection risk. High temperature and low UVR prompted immediate infection responses, while low temperatures, high UVR, and larger DTR showed delayed effects. These findings provide new, more reliable evidence for understanding the mechanisms driving COVID-19 pandemic dynamics and for preventing the future normalization of the epidemic.

Background: Autism spectrum disorder (ASD) is a persistent neurodevelopment disorder frequently co-occurring with Attention-Deficit/Hyperactivity Disorder (ADHD) and behavior-related disorders. While behavioral therapy is the first-line option to manage ASD core symptoms, pharmacological therapy is sometimes needed to treat acute problems, such as agitation and aggressive behaviors. Recent guidelines recommend neuroleptics to reduce psychomotor agitation in people with ASD. However, since children with ASD are often drug-resistant, alternative treatments are often justified. Reports from literature showed that intra-venous valproate (IV-VPA) can be effective in reducing agitation in psychiatric patients, with lower frequency of adverse events compared to convention-al treatments. However, since findings are occasionally inconsistent, IV-VPA is not an approved option in clinical psychiatry. We aim at improving the knowledge on the IV-VPA treatment option in emergency psychiatry in the pediatric age. Methods: We report the case of a 11-year-old boy suffering from a complex neurodevelopmental condition, who experienced a psychotic episode with severe aggressive and disruptive behaviors, successfully treated with IV-VPA. Besides, we conducted an up-dated literature review on this topic. Conclusion: In our case, first-line therapies proved to be ineffective. On the contrary, IV-VPA led to a safe and prompt clinical success, in line with other reports. Based on our literature review, IV-VPA can be highly effective and can reduce the risk of adverse events that frequently occur with the use of high-dose standard medications in emergency psychiatry.

Mycotoxins are fungal secondary metabolites, which can cause acute and chronic toxic effects in animals and humans. The present study aimed to determine multi-mycotoxin levels in Algerian workers using urine as target. A method based on a QuEChERS (quick, easy, cheap, effective, rugged, and safe) extraction procedure followed by LC-MS/MS (liquid-chromatography tandem mass spectrometry) was optimized and validated for determination of 11 mycotoxins in 96 urine samples. Different sorbents were tested to be used in the dispersive solid-phase extraction (d-SPE) cleanup step of QuEChERS. The final method was fit-for-purpose and showed good analytical performance in terms of specificity, linearity and precision. All samples contained at least 2 mycotoxins, being toxin-2 (T-2) the most common, which was found in 92.7% of the samples, followed by zearalenone (ZEN) with 90.6% of positive samples, and ochratoxin A (OTA) with 86.4%. T-2 levels ranged from 0.3 μg/L to 36.3 μg/L, while OTA ranged from 0.3 μg/L to 3.5 μg/L and ZEN ranged from 7.6 μg/L to 126.8 μg/L. This was the first mycotoxin biomonitoring study carried out in the Algerian population. The findings highlight the need of accurate data for better risk assessment and the development of better regulation to manage mycotoxin contamination in this country.

The relativistic effects of the dynamical properties of light at angular incidence were analyzed from the perspectives of Bohr indeterminacy and Heisenberg uncertainties and statistical dispersion. It was found that these effects report minimal uncertainties that agree with one or the other according to the angular range of incidence and that decrease with increasing refringence of the medium, constituting a specific relativistic uncertainty at angular incidence. An anomaly is indicated for the uncertainty principle in the Quantum Theory (QT) setting for small angles of incidence, where the accuracy of the angular position does not imply an increase in the uncertainty of the linear momentum. The anomalies arise because TQ does not predict the alternation between the classical and relativistic regimes of photon inertia at angular incidence. Specific relativistic uncertainty particularizes the uncertainty principle in the transmission of light between media pairs at angular incidence for the relativistic scenario, considering an observer that registers the relativistic effects of measurements that interfere with the observed system, in another inertial referential.

The aim of study was to investigate epidemiology aspects of magnetic resonance imaging (MRI) during COVID-19 pandemic. The study comprised depersonalized residents of Tomsk and Tomsk Region (n = 1714). Invitations to take online survey were sent to 50,000 residents by target SMS with response rate of 1.2% (n = 727, Cohort 1). Cohort 2 comprised retrospective patients (n = 987) who underwent contrast-enhanced cardiac MRI (CMR) in 2019-2022. Referrals, clinical characteristics, diagnosis, gender, age, past COVID-19, MRI study protocols, and MRI data were analyzed. 29% of respondents in cohort 1 received MRI examination within past two years; 26% of respondents considered MRI the most informative imaging modality for detecting COVID-19 pneumonia; 12% of respondents reported MRI unavailable. Proportion of CMR among MRI studies increased during COVID-19 pandemic, and maximum incidence of cardiac diseases detected by MRI was in 2021. Incidence of myocardial fibrosis increased from ~67% in 2019 to ~84% in 2022. The rate of outpatient MRI studies significantly increased in 2020, but returned to pre-pandemic level in 2021. COVID-19 pandemic increased the need for MRI and CMR. Patients with history of COVID-19 had persistent and newly occurring symptoms of myocardial damage suggesting chronic cardiac involvement requiring continuous follow-up.

Back-care knowledge and behaviour may play a vital role in preventing musculoskeletal current and future discomfort and injuries. The aim of the current survey was to explore the level of knowledge regarding ergonomics and posture together with postural behaviour and the incidence of musculoskeletal pain (MSP) in university students in the northeast of England. A mixed methods survey was conducted on a convenience sample of 55 university students. The 32-item valid and reliable questionnaire contains questions on socio-demographics, MSP, knowledge regarding ergonomics and posture (8 closed ended and 8 open-ended items) as well as postural behaviour. Nearly 1.8%, 20% and 78.2% of the university students had poor, fair and good knowledge of ergonomics and posture respectively. Among the 37 students who carried a backpack, 51.4% were found to have poor postural behaviour, 37.8% had fair behaviour and 10.8% had good postural behaviour. Of the 18 students who did not carry a backpack, 55.6% were found to have poor postural behaviour, 27.8% had fair behaviour and 16.6% had good postural behaviour. 70.9% of the students experienced MSP with the most prevalent site of pain being the lower back region. The key themes that emerged from qualitative data (8 open-ended questions) were: “Comfortable posture”, “Correct spinal alignment”, “Spine support”, “less pain and injuries”, “Use knees not the back”, “Keep the object close to body”, “Hands on desk”, “Feet flat on floor” as well as “eyes at screen level”. The findings of this study can be used to develop targeted interventions aimed at educating university students about ergonomics and posture in order to prevent the incidence of MSP. Future research in this field with a large and more representative sample of the university students’ population is strongly recommended to fully understand their knowledge of ergonomics and posture, postural behaviour as well as incidence of MSP.

The study investigated farmers’ perception on pests and diseases management strategies, agricultural practices, production constraints and selection criteria of elite varieties using a survey research design. A total of 700 questionnaires were administered to smallholder farmers who were farming for household consumption, those producing for sale and household consumption and those who were mainly producing for sale because their primary goal was to produce for the market. Findings revealed that the most prevalent pests identified were whiteflies (Bemisia tabaci), grasshoppers (Zonocerus variegatus), aphids (Aphis gossypii), mealybugs (Phenacoccus manihoti), termites (Isoptera), and grasscutters (Thryonomys swinderianus). The three most common diseases of cassava limiting growth and yield with mixed infection include viral, bacterial, and fungal. The study also revealed that only 12.5% of farmers cultivated improved cassava varieties. The management practices implemented encompassed field sanitation and the application of pesticides. Lack of capital and no availability of market were the most important production and marketing constraints faced by farmers in the study area, whereas poundability and high storage root yield are the most preferred traits farmers consider in selecting a new variety. Results suggest that smallholder farmers should endeavor to undergo various developmental programs to develop themselves to increase their competitive advantage in their locality and in the local and global agricultural sectors. In addition, governments and other policy makers should strategize plans and programs that would contribute to smallholder farmers’ agriculture, community and national development.

This research delves into the epidemiology, clinical manifestations, and management of hyperprolactinemia, particularly focusing on prolactin-secreting pituitary adenomas, or prolactinomas, in Dolj County, a region historically underrepresented in medical literature. Hyperprolactinemia, a prevalent endocrine disorder, arises from excessive prolactin secretion by the pituitary gland's lactotrope cells and presents a diverse clinical picture. The most significant etiological contributors identified are prolactinomas, accounting for approximately 39% of all secretory pituitary tumors. In light of hyperprolactinemia's substantial morbidity and prevalence, this study underscores the necessity of comprehensive understanding of its regional epidemiology and clinical presentations. Our methodology incorporated collecting retrospective data across various medical facilities in Dolj, ensuing a meticulous analysis of clinical features, paraclinical investigation outcomes, and therapeutic responses among patients with prolactinomas. Emphasis was placed on discerning risk factors, demographic characteristics, and associated comorbidities to encapsulate the full spectrum of these tumors' impact within the community. Preliminary results suggest a nuanced incidence rate of prolactinomas within Dolj, with specific demographic and clinical trends potentially distinct from those reported in wider literature. These findings stress the critical role of localized studies in enhancing screening, diagnostic, and therapeutic protocols. Ultimately, this investigation offers critical insights into the epidemiology and symptomatology of prolactinomas in Dolj, significantly augmenting existing literature and informing regional medical practices.

Animal trypanosomiasis (AT) is a complex of veterinary diseases known under various names such as nagana, surra, dourine and mal de caderas, depending on the country, the infecting trypanosome species and the host. AT is caused by parasites of the genus Trypanosoma, and the main species infecting domesticated animals are T. brucei brucei, T. b. rhodesiense, T. congolense, T. vivax, T. evansi and T. equiperdum. AT transmission, again depending on species, is through tsetse flies or common Stomoxys and tabanid flies or through copulation. Therefore, the geographical spread of all forms of AT together is not restricted to the habitat of a single vector like the tsetse fly and currently includes almost all of Africa, and most of South America and Asia. The disease is a threat to millions of companion and farm animals in these regions, creating a financial burden in the billions of dollars to developing economies as well as serious impacts on livestock rearing and food production. Despite the scale of these impacts, control of AT is neglected and under-resourced, with diagnosis and treatments being woefully inadequate and not improving for decades. As a result, neither the incidence of the disease, nor the effectiveness of treatment is documented in most endemic countries, although it is clear that there are serious issues of resistance to the few old drugs that are available. In this review we particularly look at the drugs, their application to the various forms of AT, and their mechanisms of action and resistance. We also discuss the spread of veterinary trypanocide resistance and its drivers, and highlight current and future strategies to combat it.

Viral Encephalitis is a significant public health concern globally, especially west Africa. There are more than 500 known arboviruses with over 100 of them identified to cause encephalitic diseases in humans and animals, giving rise to a tremendous burden of the diseases, and socioeconomic strains in tropical and subtropical regions worldwide. Despite their importance, few effective preventive and control measures in form of vaccines and therapeutics are available and where they are, usage is limited. These limitations are largely hinged on the paucity of information about the molecular epidemiology and transmission patterns of VE in west Africa. Here, we reviewed the transmission dynamics, ecological drivers, and molecular epidemiology of VE in the region. Collectively, timely and accurate interventions are essential for encephalitic viral disease control. Moreover, the integrated health system approach, combining surveillance, vaccination, vector control, and community engagement could be effective in preventing viral encephalitis globally.

Hepatitis C virus (HCV) causes both acute and chronic disease of the liver that can lead to liver cirrhosis, cancer and liver failure. HCV is characterized by high genetic diversity and substantial variations in prevalence of specific HCV genotypes in different countries of the world. Many effective regimens of direct-acting antivirals (DAAs), including pan-genotypic, can successfully treat HCV infection. However, genotype-specific treatments for HCV are being actively employed in the national plans for elimination of HCV infection around the world. Evaluation of HCV genotype prevalence in a country is mandatory for successful implementation of the national plans for elimination of HCV infection and allocation of financial resources to DAAs most effecting for specific HCV genotypes prevalent in a country. Here, we analyzed HCV genotypes, subgenotypes and recombinants in 10,107 serum samples from patients with chronic HCV infection from all Federal districts of Russia collected in 2015-2017. This is the first, largest evaluation of HCV genotypes performed on samples from all territories of Russia, from its Central Federal district to the Far East. Moreover, we have updated retrospective epidemiological analysis of chronic and acute HCV infection in Russia in 2001-2021. We demonstrate that the incidence of acute HCV infection in Russia reduced from 16.7 cases per 100,000 population in 2001 to 0.6 cases per 100,000 population in 2021. The number of cases of chronic HCV infection decreased from 29.5 to 16.4 per 100,000 population during this period. HCV genotype analysis indicated that HCV genotype 1 dominates in Russia (53.6%). Genotypes 3 and 2 were detected in 35.4% and 7.8% of patients respectively. These proportions are virtually identical in all regions of Russia except for Far East, where HCV genotype 2 amounts only to 1%. HCV genotypes 1 and 2 are more widespread in women, while HCV genotype 3 in men. The highest frequency of identification of genotype 3 was found in the age group of 31-40 years old (44.9%, respectively), and genotype 1 was more prevalent in a group of over 70 years old (72.2%). The proportion of HCV genotype 2 is predominant among HCV-infected persons older than 40 years. Discriminating HCV genotype 2 and recombinant RF1_2k/1b, which are frequently misclassified, is important for successful antiviral treatment of such patients. For the first time, we demonstrate the countrywide prevalence of HCV RF1_2k/1b in different regions of Russia. HCV RF1_2k/1b amounts to 3.2% in the structure of HCV genotypes, reaching 30% among samples classified as genotype 2 by some commercial genotyping tests. The highest proportion of HCV RF1_2k/1b was detected in the north-west (60%), southern (41.6%) and central (31.6%) federal district. Its frequency in Far Eastern and North Caucasus Districts was ~ 14.3%. HCV RF1_2k/1b was not detected in the Volga, Ural and Siberian districts. To conclude, this is the first and most complete evaluation of HCV epidemiology and genotype/subgenotype distribution in Russia.

In this work, we analysed human isolates of nontyphoidal Salmonella enterica subsp. enterica (NTS), which were collected from salmonellosis cases in Armenia from 1996 to 2019. This disease became a leading food-borne bacterial infection in the region, with the younger age groups especially affected. The isolates were characterised by serotyping, Enterobacterial Repetitive Intergenic Consensus (ERIC-PCR) typing, and whole genome sequencing (WGS). The main serotypes were S. Typhimurium, S. Enteritidis, and S. Arizonae. ERIC-PCR indicated a high degree of clonality among S. Typhimurium strains, which were also multidrug-resistant and produced extended spectrum beta-lactamases. During the study period, the frequency of S. Typhimurium and S. Arizonae isolations were decreasing, but with the increase of S. Enteritidis and other NTS. A total of 42 NTS isolates were subjected to WGS and explored for virulence-related traits and the corresponding genetic elements. Some virulence and genetic factors were shared by all NTS serotypes, while the main differences were attributed to the serotype-specific diversity of virulence genes, SPIs, virulence plasmids, and phages. The results indicated the variability and dynamics in the epidemiology of salmonellosis and a high virulence potential of human NTS isolates circulating in the region.

The ciguatera is a food poisoning caused by the consumption of primarily coral fish; these species exist in large numbers in the seas that bathe the Colombian territory. The underreported diagnosis of this clinical entity has been widely highlighted due to multiple factors, as are among others, ignorance by the primary care practitioner consulted for this condition, clinical similarity with secondary gastroenteric symptoms, to common food poisonings of bacterial, parasitic or viral etiology. Eventually people affected by ciguatotoxin are related to trips to coastal areas hours before the onset of symptoms. Thanks to multiple studies over the years it has been possible to identify the relation of the dinoflagellates in the assembly of said toxin and its introduction into the food chain, starting by fish primarily inhabiting reef ecosystems and culminating in the intake of these by humans. Identifying the epidemiological link, its cardinal symptoms and affected systems such as gastrointestinal, peripheral nervous system and fortunately with a low frequency, the cardiovascular system, leads to a purely clinical diagnostic impression without further complementary studies, performing an adequate treatment primarily symptomatic without underestimating or overlooking any associated complications.

Endemic in over 45 countries globally, recent reports of locally acquired melioidosis in novel geographical areas, such as Southern US, have highlighted the expanding geographical range of Burkholderia pseudomallei. Climate change and severe weather events have been linked to an increase in cases of melioidosis, which follows environmental exposure to the bacterium. Healthcare professionals should be aware of the possibility of the disease, with its diverse and often delayed presentations, even in areas not previously known to have risk. Over 200 cases of travel-associated melioidosis have been reported in the literature, highlighting the need to consider this disease in non-endemic areas, as diagnostic delays of up to 18 months have been identified. The review updates the global epidemiology of melioidosis focusing on new geographical areas where cases have been diagnosed and imported cases, unusual clinical presentations and co-infections, and less frequent modes of transmission (laboratory exposures and the risk of acquisition due to imported infected animals and contaminated products).

The increase in incidence of superficial fungal infections combined with the emergence of antifungal resistance represents both a global health challenge and a considerable economic burden. Recently, dermatophytes, the main culprit causing superficial fungal infections, have started to exhibit antifungal resistance. This can be observed in some of the most common species such as Trichophyton rubrum and Trichophyton mentagrophytes. Importantly, the new subspecies, known as Trichophyton indotineae, has been reported to show high resistance to terbinafine, a first-line treatment for dermatophyte infections. Compounding these issues is the realization that diagnosing the causative infectious agents requires using molecular analysis that goes beyond the conventional macroscopic and microscopic methods. These findings emphasize the importance of conducting antifungal susceptibility testing to select the appropriate antifungal necessary for successful treatment. Implementing these changes may improve clinical practices that combat resistant dermatophyte infections.

Background: Metformin is a drug used to treat patients with type 2 diabetes, especially those who suffer from obesity. It is also used in the treatment of women with polycystic ovary syndrome (PCOS). This disease has been shown to be related to insulin resistance and multiplied blood sugar ranges. Further, it has been found that the use of metformin improves the menstrual cycles and ovulation rates of these women. Methods: A structured questionnaire will be conducted to determine the prevalence of breast cancer among women using metformin in the Ha’il region. Result: Incidence of breast cancer among women using metformin in the Ha’il region is very low. Conclusions: According to previous findings, metformin has been linked to lower breast cancer risk in women with type 2 diabetes. Furthermore, the findings of this study have corroborated the literature for the same by indicating that there is a substantial connection between metformin use and a lower risk of breast cancer in women with type 2 diabetes

Cardiovascular diseases, which are the leading cause of death in Croatia, are linked to the high prevalence of hypertension. Both are associated with high salt intake which was determined almost two decades ago when Croatian Action on Salt and Health (CRASH) was launched. The main objective of the present study was to evaluate salt, potassium, and iodine intake using 24-hour urine samples in a random sample of adult Croatian population, and to analyse trends in salt consumption after the CRASH has intensively started. Methods: In this national population-based EH-UH 2 study performed in 2018-2021 (participation rate 72 %) in which we analysed a single 24-hour urine sample, 1067 adult participants (mean age 57.12 (SD 13.9), men 35%) were included. Results: Mean salt and potassium intakes were 8.6 g/day (IQR 6.2-11.2) and 2.8 g/day (IQR 2.1-3.5), respectively, with sodium-to-potassium ratio of 2.6 (IQR 1.8-3.3). We detected a decrease of 17.6% (2 g/day less) in salt consumption compared to our previous salt-mapping study. However, only 13.7%, and 8.9 % met the WHO salt and potassium recommended target of 5 g/day, and 3.5 g/day, respectively. Salt intake was higher, and potassium ingestion was lower in rural vs. urban regions, and in continental vs. Mediterranean parts of Croatia. Moderate to severe iodine insufficiency was determined in only 3% adult participants. Conclusion: In the last fifteen years, salt consumption has been significantly reduced in Croatian adult population because of intensive and broad CRASH program led by the Croatian Society of Hypertension and the Croatian Hypertension League. However, salt intake is still too high, and potassium ingestion is too low. With expected more active engagement and help of the government, obtained results could be significantly improved. Salt reduction programs are most cost-effective methods of cardiovascular disease prevention and should be considered more seriously by the government and health policy makers.

Background: Many risk-modifying factors affect cancer incidence and mortality rates. Solar UVB reduces cancer risk by producing vitamin D, which has many mechanisms to reduce risk of cancer incidence, progression, and metastasis. Obesity increases cancer risk through several mechanisms, including increased inflammation. Method and Materials. We present an ecological study (a type of observational study) of incidence and/or mortality rates for cancers during 2007–2016 of 17 anatomical sites with respect to solar ultraviolet-B (UVB) doses and obesity prevalence. Data were averaged for 12 geographical regions. Results: Solar UVB doses were significantly inversely correlated with incidence rates for three types of cancer for males. They were inversely correlated with mortality rates for five cancers for males and four for females. Obesity prevalence was directly correlated with mortality rates for three cancers for males and seven for females. Discussion: The ecological approach has certain limitations, such as its sensitivity only to regional variations in relation to specific risk-modifying factors. In this study, these limitations include numerous factors influencing cancer risk and the fact that the data are averaged across entire regional populations, which may not reflect individual risks. Despite this, the study reveals important correlations. Specifically, it found that solar UVB exposure is linked to a lower risk of certain cancers, while obesity is associated with an increased risk of some cancers in France. These findings are consistent with results from a similar study in the United States on cancer rates between 2016 and 2020. The association between obesity and cancer risk aligns with other observational studies. However, it is uncertain to what extent higher solar UVB exposure or elevated serum 25-hydroxyvitamin D levels might mitigate the impact of obesity on cancer risk. Reducing cancer mortality in France may be achievable through vitamin D supplementation and efforts to lower obesity prevalence.

Introduction: Frostbite is a condition that mostly affects skin, but also the underlying tissues, resulting from prolonged exposure to temperatures below freezing point (-0.55°C). Although frostbite has been a known phenomenon for several millennia, the exact incidence of frostbite is not known. This is partly due to variable internal and external etiological factors. One of the many consequences of climate change are extreme cold events, which increase the risk of frostbite in the general population, particularly among individuals who are involuntarily exposed to cold for prolonged periods of time. Severe cold injury can lead to deep frostbite with irreversible sequalae such as amputations. Objectives: The reviews objective is to compare data collection and incidence rates of frostbite in different studies and populations. Methods: Out of a total of 61 studies using the keywords "frostbite" and "incidence", 7 were selected that dealt with frostbite causes and incidence over 20 years. The studies results were briefly summarized and their conditions were compared. Results: Frostbite can damage tissue superficially or deeply, depending on its degree. The results of the seven studies show a great variation of frostbite incidence depending on population, its size, and method of data collection. Studies that include the entirety of the civilian population show significantly lower frostbite incidence rates than studies focusing individuals who are exposed to temperatures below -0.55°C for long periods of time, such as mountaineers, military personnel, or homeless people. Although cold injuries are rare, they are becoming increasingly problematic for individuals who are exposed to a cold environment for prolonged periods of time due to climate change. This includes homeless individuals, outdoor workers in cold regions, alpinists and persons with inadequate equipment. The results underline different incidence rates for different populations and show that retrospectively collected data are insufficiently comparable. Enhanced frostbite susceptibility in some individuals should also be considered in the future in order to estimate the frostbite incidence more accurately. Moreover, defining frostbite susceptibility in advance could prevent frostbite incidence in the future to some degree, especially in military operations in the cold and certain leisure activities (e.g. mountaineering). Conclusions: Frostbite poses a significant risk in cold regions and can lead to severe complications without adequate protection. To enhance our ability to predict frostbite occurrences within the general population, it is crucial to understand its incidence in relation to climatic factors. Establishing an international or national frostbite registry in high-risk countries could effectively guide preventive measures and safeguard individuals. This registry should encompass frostbite occurrences alongside contextual elements, such as freezing temperatures and cold exposure duration. Moreover, comprehensive weather conditions like wind chill, precipitation, humidity, and cloud cover must also be considered. When similar external conditions result in frostbite, investigating protective measures becomes pivotal. Furthermore, researching individual susceptibility to cold is essential to discern variations in frostbite vulnerability, especially for activities in cold environments.

Background/Objectives: Infectious Endocarditis often requires surgical intervention, with postoperative acute kidney injury (AKI) posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with endocarditis scheduled for valve surgery. Methods: This single center study enrolled 130 consecutive endocarditis patients from 2013 to 2021 undergoing valve surgery. Creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence, the relevance of creatinine levels for AKI detection, and the association of AKI with 30-, 60- and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the 2nd postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dl on the 2nd day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the 2nd day were robust predictors for short-term mortality at 30, 60 and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 hours postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical endocarditis patients. A specific threshold (1.35 mg/dl) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population.

Background & Aims: Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. Methods: This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990-2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged 0.05). With reference to the 1990-1999 era, overall survival improved in subsequent eras in SA (2000-2009: HR 0.53 [0.38-0.73]; 2010-2017: 0.44 [0.28-0.68]); however, remained unchanged in the NT (2000-2009: 0.78 [0.40-1.51]; 2010-2017: 0.50 [0.24-1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92-6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p0.05). Conclusions: The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children.

Pancreatic cancer is one of the most fatal common cancers affecting both men and women, representing about 3 percent of all new cancer cases in the United States. In this study, we aimed to investigate the association of pancreatic cancer risk with alcohol consumption as well as folate intake. We performed a case-control study of 384 patients diagnosed with pancreatic cancer from May 2004 to December 2009 and 983 primary care healthy controls. Our findings showed no significant association between risk of pancreatic cancer and either overall alcohol consumption or type of alcohol consumed (drinks/day). Our study showed dietary folate intake was modestly but significantly inversely associated with pancreatic cancer (OR=0.99, P <.0001). The current study supports the hypothesis that pancreatic cancer risk is reduced with higher food-based folate intake.

The study delves into the multifaceted landscape of human-macaque conflict within temple ecosystems, with a specific focus on Bonnet Macaques. In the context of intertwined religious, cultural, and social values, understanding public attitudes towards these commensal species becomes pivotal. The research aims to decipher the socio-economic factors that shape perceptions of human-monkey conflict within temples and to explore public attitudes within sacred groves. To achieve these objectives, a comprehensive questionnaire was administered through household interviews to 100 residents living within both a 1 sq. km and a 2 sq. km radius of the study area, ensuring direct participant interaction. The survey, taking approximately 40 minutes per participant, examined six variables, including occupation, religion, and annual income. The data collected was analysed using SPSS ver. 24 software, employing the chi-square test of independence to explore associations between categorical variables. The findings revealed that occupation and religion emerged as influential factors in shaping perceptions of Bonnet Macaques as problematic. While annual income hinted at significance, age, education, and knowledge of Kysannur Forest Disease (KFD) did not significantly impact Bonnet Macaque perception. Interestingly, age emerged as a significant factor influencing the perception of the monkeys' religious significance, whereas only education and religious affiliation impacted feeding practices towards the monkeys. Surprisingly, other demographic variables such as age, gender, occupation, and income showed no significant influence on monkey feeding practices. These results underscore the intricate interplay of socioeconomic, cultural, and religious factors in shaping public attitudes and behaviours towards Bonnet Macaques. The study further sheds light on the impact of education and religious affiliation on feeding practices, emphasizing the need for nuanced conservation strategies. Recognizing these complexities is crucial for developing culturally sensitive conservation efforts. By acknowledging the influential factors identified in this research, conservation strategies can be tailored to specific communities, fostering harmonious coexistence between humans and Bonnet Macaques in temple ecosystems. This nuanced approach ensures that conservation efforts are not only effective but also respectful of the diverse socio-cultural contexts within which they are implemented.

Malignant lymphomas, encompassing Hodgkin lymphomas (HL) and non-Hodgkin lymphomas (NHL), represent a significant category of hematological malignancies with diverse presentations and prognoses. This review synthesizes current understanding of malignant lymphomas, focusing on their classification, incidence, epidemiology, staging, histopathology, and evolving treatment strategies. Malignant lymphomas are broadly classified into HL and NHL, with NHL further subdivided into B-cell, T-cell, and NK-cell neoplasms. The emergence of grey zone lymphomas, which exhibit overlapping features and heightened aggressiveness, underscores the complexity of diagnosis and treatment. Epidemiologically, HL predominantly affects younger individuals, while NHL incidence increases with age, reflecting a global rise in both incidence and mortality rates. Advances in diagnostic techniques and treatments have led to improved outcomes, yet challenges persist, particularly in distinguishing between overlapping lymphoma types and managing increasing incidence rates. The management of HL and NHL involves a variety of treatment options tailored to the disease stage and individual patient characteristics. After diagnosis and staging, treatment regimens may include radiotherapy, chemotherapy (either alone or in combination), and immunotherapy. Monitoring patient response is crucial, with adjustments made in cases of therapeutic failure. Achieving remission—either partial or complete—depends on the normalization of biomarkers and imaging results, reduction of lymphoid organ size, and resolution of symptoms. Despite therapeutic advances, treatment complications, including short-term effects like myelosuppression and long-term issues such as cardiomyopathy and secondary cancers, remain significant. The future of HL and NHL treatment lies in refining these approaches, minimizing adverse effects, and enhancing efficacy through innovative therapies and personalized medicine strategies.

Urinary infections are very prevalent in pregnant women and are a cause for great concern con-sidering the negative impacts they can have on both, the mother and the baby. The objectives were characterize urinary infections associated with pregnant women, study the most prevalent strains in urinary infections in pregnant women and analyze the antibiogram of the most prevalent strains in infections in pregnant women. A retrospective observational study was carried out on all posi-tive urine cultures from pregnant women between January 2018 and December 2022 at a Hospital Center in the Center of Portugal, totaling 201 samples. Data were collected with computer support, including age, origin, previous antibiotic therapy, catheterization, isolated bacteria and tested an-tibiotic therapy. The majority of pregnant women were in the third trimester of pregnancy and came from the External Consultation. The most identified bacteria was Escherichia coli, followed by Streptococcus agalactiae. Regarding the interaction with antibiotics, Escherichia coli showed total sensitivity to one antibiotic, while Streptococcus agalactiae showed sensitivity to four anti-biotics in 2022. This work contributes to the knowledge of urinary infections in pregnant women in the center of the country, being a contribution to the continued improvement of the care provided

Introduction: Nephrotic syndrome (NS) remains the most frequent mode of presentation of glo-merular diseases in children; in addition, the NS is primitive, i.e., idiopathic in 90% of cases with an average age of onset between 2 and 10 years. The objective of our study was to describe the char-acteristics and outcome of NS in children from 3 major hospitals from one of the poorest countries worldwide (Chad). Patients and Methods: Observational, cross-sectional, descriptive and multicenter study which took place over a period of 36 months (January 1,2019-December 31,2021) carried out in 3 hospitals in N’Djamena (Chad). All children aged 1-15 years presenting with NS were included. Results: Out of 16,776 children hospitalized or followed-up in outpatient clinics, 24 cases of NS were identified, giving a prevalence of 0.14%. The median age at presentation was 6.16(1-10) years. Nineteen children were male (sex ratio 3.8). There were 8 impure NS (33.3%). Edema was present in all patients, oliguria in 29.16%(n=7), and arterial hypertension in 20.83%(n=5) of cases. Mean proteinuria, albuminemia and total proteins were 2.86g/L, 19.13g/L and 30.41g/L respectively. Median serum creatinine was 87.3 µmol/L(75-1375µmol/L); three patients had acute renal failure on admission. Four patients had secondary NS. All patients (n=20) with idiopathic NS had received corticosteroid therapy; steroid-sensitivity was found in 90% of patients. Those who were not ster-oid-sensitive or relapsed underwent kidney biopsy (n=7); the most represented histological lesion was focal segmental glomerulosclerosis (FSGS; n=4), followed by minimal change disease (n=2), and membranoproliferative glomerulonephritis (n=1). The median length of hospitalization stay was 10.67 (5-27) days. None of the patients with idiopathic NS died. At last follow-up sixteen patients (80%) achieved long-term complete remission with normal renal function; however, 4 had subse-quent relapses. 16 patients. One patient with secondary NS died. Conclusion: In Chad childhood idiopathic nephrotic syndrome involves mostly young male; steroid sensitivity is as high as 95% and in the long-term 80% of the patients are in remission with normal renal function.

Background and aim: Human Papillomavirus (HPV) is sexually transmitted, one of the three most common sexually transmitted infections (STIs) in both males and females, and the most common viral STI. A crucial public health strategy to protect people against HPV is through vaccination, which has shown its effectiveness in preventing HPV related diseases. Presently three types of vaccines are available (bivalent, quadrivalent, and nonavalent) and they all target at least the two most oncogenic virus genotypes (HPV 16, 18). In the past few years, the need to implement vaccination programmes that include all genders has been discussed in order to achieve herd immunity against HPV. To date, only a few countries have included young males in their vaccination programmes, so we aim through this review to provide an overview of the epidemiology of HPV and prevention strategies to prevent it, reporting the latest findings from the scientific literature.

A descriptive epidemiological study has been conducted using hospital database of Teaching Veterinary Hospital (TVH) at Jhenaidah Government Veterinary College (JGVC) from July 2018 to June 2019. The study aimed to estimate the proportionate prevalence of different livestock and poultry diseases along with their spatiotemporal distribution and drug prescribing pattern. A total of 960 clinical cases were recorded during the study period. Ectoparasitic cases were proportionately higher in cattle (25.2%), whereas Peste des Petits Ruminants (PPR) cases were more frequent in goat (53.4%). The proportionate prevalence of other cases in cattle was Fascioliasis (14.3%), Myiasis (11.2%) and Foot and Mouth Disease (FMD) (7.2%). The proportionate prevalence of other cases in goats were vitamin and mineral deficiency (12.3%), bloat (5.2%), abscess (4.7%), and dog bite (1.2%). Again, the proportionate prevalence of poultry diseases was Infectious Bursal Disease (41.2%), salmonellosis (33.4%), fowl cholera (13.7%) and pox (7.8%). Most of the cattle cases were highly prevalent during the summer season except fascioliasis. In goat, PPR was predominated in the rainy season whereas myiasis was in the winter. Around 92% of disease cases were spatially located within the 2.5 km radius of the TVH of JGVC where only 0.9% of disease cases came from >10km away from TVH of JGVC. Simple linear regression identified a significant relation (p=0.01) with the distance and number of diseased animals came to the hospital. Antimicrobials belonging to b-Lactam group were most frequently prescribed for both poultry (48.6%), cattle (32.5%) followed by goat (9.2%), however sulfar drugs (34.8%) were commonly prescribed for goat cases. This type of study is very novel in Jhenaidah region of Bangladesh that might contribute to the researchers for further investigation.

Background. Our knowledge regarding the epidemiology of pediatric cardiomyopathy is based on large national population studies reporting an annual incidence of 1 case per 100 000 children with a higher incidence observed in infancy and among selected populations. The aim is to document the epidemiology of pediatric cardiomyopathy in a Mediterranean population. Methods. Children younger than 18 years of age, living on the Mediterranean island of Crete, Greece and evaluated during 20 years since the establishment of tertiary pediatric cardiology services (2002-2022) were included in this retrospective study. Results. A total of 40 children were included, corresponding to an average annual incidence of pediatric cardiomyopathy of 1.59 cases (95% CI: 1.4-2,3) and a prevalence of 26 cases per 100.000 children. In decreasing order of frequency most cases corresponded to dilated cardiomyopathy (50%) followed by hypertrophic (42.5%), arrhythmogenic (5%) and restrictive (2.5%). An etiology was identified in 40%, including a genetic diagnosis in 22.5%. Conclusion. The incidence of pediatric cardiomyopathy in the Mediterranean island of Crete is higher compared with that reported previously for other Caucasian populations. Further study is needed to investigate the exact prevalence and specific genetic factors associated with the epidemiology of pediatric cardiomyopathy in Mediterranean populations.

Compartmental models that dynamically divide the host population in categories such as susceptible, infected and immune constitute the mainstream of epidemiological modelling. Effectively such models treat infection and immunity as binary variables. We constructed an individual based stochastic model that considers immunity as a continuous variable and incorporates factors that bring about small changes in immunity. The small immunity effects (SIE) comprise cross immunity by other infections, small increments in immunity by sub clinical exposures and slow decay in the absence of repeated exposure. The model makes qualitatively different epidemiological predictions including repeated waves without the need for new variants, dwarf peaks (peak and decline of a wave much before reaching herd immunity threshold), symmetry in the upward and downward slopes of a wave, endemic state, new surges after variable and unpredictable gaps, new surge after vaccinating majority of population. In effect the SIE model raises alternative possible causes of the universally observed dwarf and symmetric peaks and repeated surges, observed particularly well during the Covid-19 pandemic. We also suggest testable predictions to differentiate between the alternative causes for repeated waves. The model further shows complex interactions of different interventions that can be synergistic as well as antagonistic. The model suggests that interventions that are beneficial in the short run can also be hazardous in the long run.

The effective management of Fusarium wilt of bananas (FW) depends on the knowledge of the disease dynamics in time and space. The objectives of this work were: To estimate disease intensity and impact, and to investigate the spatial and temporal dynamic of FW. Fields planted with Silk (n = 10), Pome (n = 17) or Cavendish (n = 3) banana subgroups were surveyed in Brazil, totaling 95 ha. In each field, all plants were visually assessed and diseased plants were georeferenced. The incidence of FW and the impact of the disease on yield on a regional scale were estimated. Spatial patterns were analyzed using quadrat- and distance-based methods. FW incidence ranged from 0.09 to 41.42%, being higher in Silk fields (median = 14.26%). Impacts of epidemics on yield ranged from 18.4 to 8,192.5 kg.ha-1.year-1, with a median of 935.2 kg.ha-1.year-1. The higher economic impact of the disease was observed on Silk cultivar with a median loss of US$ 910.5 ha-1.year-1. Overall, estimated losses increased on average by US$ 109.8 ha-1.year-1 at each 1% of incidence. Aggregation of FW was detected by all analytical methods in 13 fields (1 of Cavendish, 11 of Pome and 1 of Silk). In the other 17 fields, at least one analytical method did not reject the null hypothesis of randomness. One field (5 ha), composed of six plots, was selected for spatial and temporal studies during two years with bi-monthly assessments. A sigmoidal curve represented the FW progress and the Gompertz model best fitted disease progress. The level of aggregation varied over time, and evidence of secondary infection to neighboring and distant plants were detected. FW is a widespread problem in Brazil and yield losses can be of high magnitude. Epidemiology-based management strategies can now be better established.