Introduction: Transforming growth factor beta receptor 2 (Tgfbr2) signaling regulates odontoblast differentiation, dentin mineralization, and the paracrine signaling that guides sensory innervation in developing mouse molars. We hypothesized that Tgfbr2 also regulates the neuro-pulpal responses to injury to activate axon sprouting and tertiary dentin secretion. Methods: We per-formed a timed deletion of Tgfbr2 using tetracycline-responsive Osterix-Cre;Tgfbr2f/f (Tgfbr2^cko) mice, which allowed them to develop normally. At 3 months, we drilled a shallow hole on the mesial side of the first mandibular molar (M1) in both control and Tgfbr2^cko mice. Hemi-mandibles were collected 4, 8, 21, and 56 days post-injury (dpi). In situ hybridization (ISH) for Sp7 was performed to confirm Osterix-Cre transcription. Microcomputed tomography (micro-CT) imaging and histology were used to examine the tertiary dentin, and immunofluorescence was used to visualize CGRP+ axons following the injury. Results: Tgfbr2 deletion was inferred by Sp7 ISH. Micro-CT and histology indicated a lower dentin volume in 21 dpi Tgfbr2^cko M1s compared to WT M1s, but the volume was comparable by 56 dpi. The duration of axon sprouting was longer in injured Tgfbr2^cko M1s compared to WT M1s. Conclusions: These results suggest that sensory afferents may support dentin repair in Tgfbr2-deficient odontoblasts.

Several types of guided bone regeneration materials are available with various properties and clinical indications. Among them, dentin-derived matrix from extracted teeth is an excellent alternative to traditional graft materials, such as allografts and xenografts. Different clinical preparation protocols exist: block form versus powder form, demineralized versus non-demineralized form. Out of these methods, demineralization protocols for dentin-derived matrix from extracted teeth have been noted for a wide range of successful clinical outcomes. The purpose of this animal study was to find out the most effective method of demineralizing dentin-derived matrix to result in the highest regenerative ability in the bone graft material in rabbit calvaria. The study conducted a comparative histomorphometric analysis of four groups in distinguished matrix conditions: a control group without graft placement, a non-demineralized dentin-derived matrix graft placement group, a 15-minute demineralized dentin-derived matrix graft placement group, and a 30-minute demineralized dentin-derived matrix graft placement group. Regenerative processes were evaluated three times at 2, 4, and 8 weeks post-graft placement. These groups of rabbits were evaluated randomly in a blinded setting to prevent bias. Among the four groups compared, the group with a 15-minute demineralized dentin-derived matrix graft showed the most efficient bone regeneration in the histomorphometric analysis. Based on this animal study, it was apparent that a 15-minute demineralization of dentin-derived matrix is the preferred preparation protocol to maximize the regenerative potential in the matrix.

Background/Objectives: Peritoneal dialysis as a form of renal function sub-stitution is not as widespread as hemodialysis. However, it has recognized advantages such as preservation of the residual renal func-tion, no need for vascular access , can be performed at home, but requires a proper in-sertion of a peritoneal dialysis (PD) catheter and maintaining its patency. Methods: We presented a 10-year retrospective study on a group of 133 patients hos-pitalized for peritoneal dialysis catheter insertion/replacement. We routinely implant the catheter laparoscopically, but there were cases in which the insertion was performed open route. We analyzed the patient group by age and gender criteria, number of complications and time when they appeared, duration of surgical intervention and the surgical technique used (126 were performed laparoscopically and 7 were inserted via open route). The open technique was performed mainly in patients with contraindications of general anesthesia. Results: We encountered a number of 23 complications in 18 patients, in only 1 case the patient was switched to permanent hemodialysis (at his own wish). We highlighted in the study the indisputable advantages of laparoscopy, supported by the results obtained: correct placement of the catheter, the possibility of adhesiolysis, preservation of the peritoneal surface through minor op-erative trauma, low number of complications(bleeding, migration, hernia 0,8%, leakage 4%, lower than those found in the literature). Even if infection was the most frequent complication (peritonitis 35%, catheter exit site infection 30.4%), only 1 case appered in the pretraining period. All complications were managed by medical treatment or by temporary cessation of peritoneal lavage, except of two cases that required reimplantation of the catheter. Conclusions: Laparoscopic catheter insertion for PD is a safe method, with reduced post-procedural complications, thus ensuring a long duration of the functionality of the catheter.

Tertiary lymphoid structures (TLSs) have become the focus of antitumor immunity. However, the prognostic significance of TLSs in epithelial ovarian cancer (EOC) treated with primary debulking surgery (PDS) or interval debulking surgery (IDS) remains unelucidated. This retrospective study examined the prognostic value of TLSs in tumor tissues obtained during PDS and IDS. Pathological specimens were collected from patients with EOC who underwent PDS or IDS between 2017 and 2020 at the National Cancer Center Hospital East. The correlation of tumor-infiltrating lymphocyte frequency, TLS presence, and PD-L1 expression with progression-free survival (PFS) and overall survival (OS) and the correlation between TLS and PD-L1 expression were analyzed. Overall, 25 specimens (15 from PDS and 10 from IDS) were analyzed. The presence of TLS was associated with a significantly longer OS in patients who underwent PDS but not in patients who underwent IDS. No correlation was identified between TLS and PFS in patients with PDS or with IDS. However, TLS was positively correlated with PD-L1 positivity. The prognostic impact of TLS, specifically in pre-chemotherapy specimens, and a positive correlation between TLS and PD-L1 indicate the potential of TLS as a meaningful biomarker for understanding antitumor immunity and developing immunotherapy for EOC.

Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era. Antimicrobial stewardship (AMS) programs are recognized as a key intervention to improve antimicrobial use and combat AMR. However, implementation of AMS programs remains limited in Africa, particularly in Rwanda. This qualitative study, conducted at King Faisal Hospital (KFH) in Rwanda, aimed at assessing current prescription practices to identify areas for improvement and promote adherence to AMS principles. The interviews were recorded, transcribed, and thematically analyzed, revealing four emerging themes. First, emerged on AMS activities that were working well which includes availability of microbiology laboratory results, and prescription guidelines as factors influencing antibiotic prescription adjustments. Second, Implementations challenges to AMS which identified the prescription of broad-spectrum antibiotics, limited local data on AMR patterns, stock-outs of essential antibiotics, Thirdly, the importance of adhering to AMR management guidelines at KFH was underscored. Lastly, participant recommendations centered on regular training for healthcare workers, widespread dissemination of AMR findings across departments, and the enforcement of antibiotic restriction policies. These actions can improve prescription behaviors, upholding the highest standards of patient care, and strengthening the nascent AMS program.

This study set out to determine the effect of Tertiary Education Tax Fund (TETFUND) on management in Nigerian tertiary education. Specifically, the study sought to determine whether ETF fund allocations to Nigerian Tertiary Institutions significantly affect the enrollment ratio to Nigerian Tertiary Institutions in Nigeria. The hypothesis was formulated in line with the objectives of the study. Survey and Time series research design were adopted. Data were obtained from National Bureau of Statistics by use of financial ratios and tested using regression analysis with aid of SPSS statistical package version 20.0. Based on the analysis, the study found that ETF fund allocations to Nigerian Tertiary Institutions have no correlation with the enrollment ratio of Nigerian Tertiary Institutions. Based on the findings, the study recommends that to the intervention agency to achieve meaningful on its constituents fund allocations should commensurate with enrolment ratio of tertiary institutions in Nigeria.

: This study was aimed at assessing adaptation and bonding of discontinuous (short) glass fiber-reinforced composite to intraradicular dentin EverX Flow (GC Corporation, Tokyo, Japan), when used as intracanal composite filling and anchorage instead of traditional fiber posts. (2) Methods: Seventy intact extracted human teeth were endodontically treated and randomly divided into 6 groups (n=10), depending on the materials used in the post space. In Group 1, a 2-bottle universal adhesive G2 Bond Universal + EverX Flow were tested. In group 2, a single-component universal adhesive G-Premio Bond + EverX Flow were used. In groups 3 and 4 the same materials are tested, but after cleaning of the canal walls with 17% EDTA and final irrigation with 5.25% NaOCl Ultrasound Activated. In the last three Groups (5-7) traditional prefabricated GC Fiber Posts 1.6 mm silanized with G-Multi Primer for 1 minute are cemented with a dual-cured composite resin cement (GradiaCore), after ultrasonic irrigation in the groups 6 and 7. In each group, 1 mm-thick slices from each sample (n=10) were cut for light microscope and SEM inspection for study materials adaption to the dentin and for measuring push-out strength of post / cemement material to the dentin / prefabricated post. These results were statistically analyzed: as the data distribution was not normal, the Kruskal-Wallis Analysis of Variance by Ranks had to be applied. The level of significance was set at p<0.05. Results: Push-out forces varied between 6.66-8.37 MPa. No statistically significant differences were recorded among the groups. Microscopic examination showed that ultrasonic irri-gation increased adaptation of the materials to the dentin surface. There was a trend of higher bond strength among the tested groups when EverX Flow was used. Also, the type of failure was more often cohesive when ultrasonic irrigation and two-step adhesive system were used. Conclusions: Within the limitations of this in vitro study, it may be concluded that when EverX Flow was used for intracanal anchorage in the post-endodontic recon-struction, similar push-out retentive forces and strength to those of traditional fiber posts cemented with particulate filler resin composite cements were achieved. Although further studies are necessary, EverX Flow represents an effective alternative to traditional fiber post adhesion in particular when used in combination with the two-step adhesive system and ultrasonic activation.

This study compares the action of different handpieces (turbine, high-speed electric handpiece and piezoelectric device) on surface roughness of enamel and dentin when using diamond-coated working tips and burs of the same grit size. Experiment was conducted on 15 extracted first molars from patients aged 45 to 60 years. The occlusal portion was removed using a diamond-coated water wheel and then refined with a 120-130 μm grit bur in order to obtain a flat surface with an adequate exposition of the dentin core. Each surface was divided into three portions and every portion was finished with one of the three tested instruments. Rotary burs and piezoelectric tips had the same grit size (60 μm) and load on handpiece during preparation never exceeded 150 g. Surface roughness parameters (Ra, Rsk, Rku) were recorded with an optical profilometer and SEM analysis of treated surfaces and working tips was conducted. Ra and Rsk differed significantly between enamel and dentin only after using turbine (p=0.004 and p=0.007, respectively). No significant differences were observed in Ra, Rsk, and Rku between enamel and dentin when using high-speed electric handpiece or piezoelectric device. Turbine produced higher Ra and Rsk values on dentin than the other devices, while no significant differences were found between piezoelectric handpiece and high-speed electric contra-angle on both substrates. Summarizing, the findings of the present study demonstrated that turbine generated rougher surfaces on dentin compared to the other handpieces. Moreover, the turbine produced more asymmetrical surface profiles on both enamel and dentin. However, it should be considered that these differences in roughness (Ra) were within the range of 0.25-0.30 μm: it is still unclear if these variations, although statistically significant, will influence final clinical outcomes.

The formation of hydrogen sulfide (H₂S) in petroleum reservoirs by anaerobic microbial activity is called biogenic souring of reservoirs and is a risk in the oil and gas industry as the compound is extremely toxic, flammable and corrosive. In this paper, we present a workflow and the tools to assess biogenic souring from a pragmatic engineering perspective. The retention of H₂S in the reservoir due to the reactions with iron-bearing rock minerals (e.g. siderite) is shown in a theoretical approach here and supported with literature data. Cases are given for two fields under secondary (waterflooding) and tertiary flooding with microbial enhanced oil recovery (MEOR). The use of the Monte Carlo method as a numerical modelling tool to incorporate uncertainties in the measured physical/chemical/ biochemical data is demonstrated as well. A list of studies conducted with different chemicals alone or in combination with various biocides to mitigate biogenic souring provides an overview of potential inhibitors as well as possible applications. Furthermore, the results of static and dynamic inhibition tests using molybdate are presented in more detail due to its promising mitigation ability. Finally, a three-step workflow for the risk assessment of biogenic souring and its possible mitigation is presented and discussed.

(1) Background: Bacterial reinfection and root fracture are the main culprits related to root canal treatment failure. This study aimed to assess the utility of quercetin solution as an adjunctive endodontic irrigant that strengthen root canal dentin with commitment anti-biofilm activity and bio-safety. (2) Methods: Based on a noninvasive dentin infection model, dentin tubules infected with Enterococcus faecalis (E. faecalis) were irrigated with sterile water (control group), and 0, 1, 2, 4 wt% quercetin-containing ethanol solutions. The live and dead bacteria proportions within E. fae-calis biofilms were analyzed using confocal laser scanning microscopy (CLSM). Elastic modulus and hydroxyproline release and X-ray photoelectron spectroscopy (XPS) characterization was tested on irrigant-treated demineralized dentin to evaluate irrigants’ biostability. The cytotoxicity of irrigants was tested by CCK-8 assay. (3) Results: Quercetin increased the proportion of dead bacteria volumes within E. faecalis, and improved the flexural strength of dentin collagen com-pared to control group. The XPS characterization revealed an increase in C-O peak area under both C1s and O1s narrow-scan spectra. The CCK-8 assay confirmed no cytotoxicity of quercetin solutions. (4) Conclusions: Quercetin exhibited anti-biofilm activity, collagen-stabilizing effect as well as cytocompatibility, supporting quercetin as a potential candidate for endodontic irrigant.

Background. During the COVID-19 pandemic, there was an increased number of the hospitalized COVID-19 positive patients suffering from type 2 diabetes mellitus (T2DM). The objective of this research was to explore factors associated with the length of hospitalization of patients with T2DM and mild form of COVID-19. Material and Methods. This retrospective cohort study involved all patients who tested positive for COVID-19 and were treated in the dedicated COVID department of the University Clinical Center (UCC) in Nis between September 10, 2021, and December 31, 2021. Upon admission, patients underwent blood tests for biochemical analysis, including blood count, kidney and liver function parameters (C-reactive protein-CRP, creatinine kinase, D-dimer), as well as glycemia and HbA1c assessments. Additionally, all patients underwent lung radiography. Univariate and multivariate regression analyses were employed to assess the impact of specific factors on the length of hospitalization among patients with T2DM. Results. Out of the total 549 COVID-19 positive patients treated, 124 (21.0%) had T2DM, while 470 (79.0%) did not have diabetes. Among patients with T2DM, men were significantly younger than women (60.6±16.8 vs. 64.2±15.3, p

Autogenous demineralized dentin matrix (ADDM), derived from human extracted tooth, is commonly used as a bone-graft substitute to reconstruct alveolar defects when placing dental implants. The purpose of this retrospective study is to examine efficacy of ADDM in terms of surgical complications and marginal bone resorption by analyzing the medical records and radiographs of patients who received ADDM graft from 2008 to 2011 in our institute. Occurrence of complications, marginal bone loss around implants were investigated with regard to the type of defect, location of bone grafting, and types of bone graft techniques. ADDM-based bone grafting was performed on 221 sites in 82 patients and 208 implants were placed afterwards: The percentage of complications after bone grafting was 15.84%, and the implant survival rate was 95.19%. All complications were resolved with conventional treatment except for the 10 cases of osseointegration failure. The average marginal bone loss was 0.31 mm at the last examination after the average follow-up period of 7.2 years. Within the limitation of this study, the results of long-term follow-up are consistent with the short-term results of relevant studies. ADDM can produce promising clinical outcomes when used for alveolar ridge augmentation around implants.

Eliminating anxiety in higher education is essential to creating a positive learning atmosphere and improving students' general well-being. University students frequently struggle with anxiety, which is frequently made worse by social expectations, academic demands, and the adjustment to living on one's own. This article review aims to give collective ideas from relevant research articles to solidify such solutions in eradicating anxiety among students at the tertiary level. Eliminating anxiety in higher education necessitates a multifaceted strategy that includes identifying the problem, offering extensive support networks, encouraging a balanced lifestyle, fostering inclusivity, reducing financial stress, fostering a sense of community, fostering open communication, routinely evaluating tactics, and working with outside organizations. By implementing these measures, universities and colleges may foster a more positive, healthy environment where students can succeed academically and personally.

Antimicrobial photodynamic therapy (aPDT) used to sterilize carious dentin may irritate the pulp tissues because of tissue-penetrating laser and singlet oxygen generation. This study aimed to assess the effects of aPDT on rat pulp tissues. A cavity formed in a rat maxillary first molar was treated with aPDT. The combined photosensitizer and laser irradiation conditions in the aPDT groups were as follows: methylene blue and 100 mW for 60 s, brilliant blue (BB) and 100 mW for 60 s, BB and 50 mW for 120 s, and BB and 200 mW for 30 s. Each cavity was treated with an all-in-one adhesive and filled with flowable resin. aPDT was not applied for the control. In each group, the rats were sacrificed on postoperative days 1 and 14, and thin sections of the treated teeth were prepared. Pulp tissue disorganization (PTD), inflammatory cell infiltration (ICI), and tertiary dentin formation (TDF) were evaluated. At 1 day evaluation, there were significant differences between the aPDT group and controls with respect to PTD and ICI. 14 days later, almost all specimens showed tertiary dentin formation. aPDT caused temporarily reversible injury to the rat dental pulp, which healed with tertiary dentin formation.

We are in the era where various processes need to be online. However, data from digital learning platforms are still underutilised in higher education, yet, they contain student learning patterns, whose awareness would contribute to educational development. This limits development of adaptive teaching and learning mechanisms. In this paper, a model for data exploitation to dynamically study students progress is proposed. Variables to determine current students progress are defined and are used to group students into different clusters. K-means clustering is performed on real data consisting of students from a South African tertiary institution. Cluster migration is analysed and the corresponding learning patterns are revealed.

Objective: The causes of vertigo and dizziness in children are diverse and require attention from various specialists. Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood - BPV). We aimed to check whether this could be applied to our group of patients. Materials and methods: A retrospective case series of 257 consecutive pediatric vertigo and diz-ziness patients referred to the tertiary pediatric ENT clinic from 2015 to 2020. Patients received a complete audiovestibular workup and were referred to pediatric neurologists and other special-ists depending on the signs and symptoms. Results: Of 257 children aged 1-17 years, almost one fifth of them, 49/257 (19.1 %) had a central type of vertigo, 20/257 of them (7.8%) had benign paroxysmal vertigo of childhood and 4/257 (1.6%) had a migrainous type of vertigo. Most of the children, 112/257 (43.6%), remained unclas-sified, without a final diagnosis. Conclusion: Due to the numerous possible causes, a child presenting with dizziness and vertigo requires a multidisciplinary approach. In the majority of cases, vertigo spells are self-limiting. They stop spontaneously and sometimes remain clinically undiagnosed. The most prevalent reasons for pediatric vertigo may be temporary hemodynamic (vaso-vagal) and psychological imbalance.

The aim of the study was to examine the influence of different irrigation protocols on the shear bond strength (SBS) of self-adhesive resin composite cement (SARC) to primed radicular dentin. Radicular dentin slabs (N=58) were sectioned from extracted intact third molars, embedded in acrylate, polished, and randomly assigned to five experimental groups (N=8-12) and one control group, CG (N=8). Irrigation solutions used were sodium hypochlorite (H), ethylene-diamine-tetra acetic acid (EDTA), etidronic acid with hypochlorite (HEDP), saline solution (SS), and chlorhexi-dine (CHX). Each experimental group underwent different irrigation protocol for two minutes: 1) H/EDTA/H, 2) HEDP, 3) H/EDTA/CHX, 4)H/EDTA/SS, and 5) HEDP/SS. The CG samples were not treated with any irrigation solution. After drying, adhesive enhancing primer (AEP) and du-al-curing SARC were applied to the radicular dentin using molds corresponding to the Ultra Tester. Specimens were stored at 37°C in distilled water and fractured in shear mode after 10 days. The results were analyzed using the ANOVA statistical test and Post-hoc Games-Howell test, α=0.05. CG exhibited the highest SBS. Except for HEDP and HEDP/SS, all experimental groups showed significantly lower SBS compared to the control group (p< 0.05). HEDP seems to be ad-equate solution for root canal cleaning before dentin priming and fiber post cementation with self-adhesive resin cement. Cleaning protocols with H, EDTA and CHX cause a significant de-crease in bond strength.

We aimed to reveal the disease burden of aphasia after acute ischemic stroke (AIS) at the national level and investigate the impact of aphasia on tertiary care resources and patient outcomes. The local database from the Cluj-Napoca Emergency County Hospital (CNECH), the second largest stroke center in Romania was used to export demographics, baseline clinical and laboratory data, inpatient length of stay (LOS), NIH Stroke Scale (NIHSS), and discharge modified Rankin Scale (mRS) score data for all AIS patients admitted during March 2019. Of 92 patients included in the study, 30 (32.6 %) had aphasia on admission. In a marginally significant unadjusted hierarchical multiple regression model, individuals with aphasia had a LOS of 1.86 days longer than stroke survivors without aphasia. In an adjusted version of the model, the NIHSS score at baseline was a significant predictor for LOS. In addition, the presence of aphasia was associated with a 1.49 increase in the mean mRS score. Aphasia was a marginally significant predictor for increased LOS. Presence of aphasia was more likely to produce a poor functional outcome. Considering an estimated impact of approximately EUR 3 million on direct medical expenditure annually, future policymaking efforts should improve prevention of stroke and improved access to post-stroke aphasia care in Romania.

The practice of collecting, treating and management of solid waste prior to disposal has become a necessity in developing and modern societies. Over the years, it is known that most wastes that are disposed have a second hand value. However, the construction cost for conventional Material Recovery Facility(s) (MRFs) has been a major barrier for implementation. These technologies require considerable technical expertise, which is often not available in developing nations to successfully operate the MRFs. Covenant University; a private mission institution through her waste to wealth scheme is focused on managing and processing used materials to reusable products. These include Pet bottles, Paper wastes, Food wastes from cafeteria, plastic food packs, nylon, tin cans and others. Specific areas chosen for the Survey include the residential areas for staff and students and the two cafeterias. The waste generated was characterized based on the waste stream so as to quantify the amount of recyclable waste generated and most occurring. The survey involved the use of structured questionnaires, on-site observations and measurements. The study reveals an average amount of recyclable waste generated per day in the institution as 13.46% pet bottles, 4.03% paper, 55.56% food waste, 12.64% plastic, 9.63% nylon and 4.68% tin cans. The study established that adequate waste characterization is a requirement for effective integrated solid waste management which would boost resource recovery, reuse and recycling.

The purpose of this study was to analyze the influence of Chitosan 0.2% in various final cleaning methods on the bond strength of fiberglass post (FP) to intrarradicular dentin. Ninety bovine incisors were sectioned to obtain root remnants measuring 18 mm in length. The roots were divided: G1: EDTA 17%; G2: EDTA 17% + PUI; G3: EDTA 17% + EA; G4: EDTA 17% + XPF; G5: Chitosan 2%; G6: Chitosan 2% + PUI; G7: Chitosan 2% + EA; G8: Chitosan 2% +XPF. After carrying out the cleaning methods, the posts were installed, and the root cleaved to to generate two disks from each root third. Bond strength values (MPa) obtained from the micro push-out test data were assessed by Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner tests for multiple comparisons (α = 5%). Differences were observed in the cervical third between G1 and G8 (p=0.038), G4 and G8 (p=0.003), G6 and G8 (p=0.049), and Control and G8 (p=0.019). The final cleaning method influenced the adhesion strength of cemented FP to intrarradicular dentin. Chitosan 0.2% + XPF positively influenced adhesion strength, with the highest values in the cervical third.

From the existing millions of fungal species only a few cause disease. In this study, we investigated invasive fungal infections in the head and neck over a 19-year period (2005 to 2024) at a large academic healthcare system. Among 413 cases, 336 were noninvasive, and 77 were invasive. The highest incidence of invasive infections occurred in the sinonasal cavities, with a 15-fold difference compared to other sites. Most infections affected adults over 40 years old. The most common organisms were Mucorales (51%), hyaline molds (29%), and Candida (11%). Risk factors included malignancy, transplant, diabetes, and illicit drug use. Mortality was high in patients with malignancy and/or transplant. Infections affecting the mandible were usually a complication of osteoradionecrosis and were associated with coinfection of Candida and Actinomyces. At other sites, infections were rare and were usually the result of penetrating injuries or immunosuppression. Treatment typically involved a combination of antifungals and surgical procedures.

The operating theatre represents a key contributor to healthcare-derived emissions. Here, we outline the carbon footprint of a lumbar microdiscectomy at our regional unit in Greater Manchester, with the use of AI technology. In doing so, we aim to define the extent of the environmental impact and identify carbon hotspots for sustainable change. Our unit of analysis covered the start of the patient journey into hospital through to the final outpatient appointment. Publicly available and locally sourced data was used. An inventory analysis of two lumbar microdiscectomies was conducted. Each item was categorised reconciled against our AI-powered ‘CO2 analysis’ database. Kilograms of carbon dioxide equivalent (kg CO2e) was chosen as the primary measure of impact. An average lumbar microdiscectomy at our trust generates 477.73kg CO2e. The operation (173.89kg CO2e, 36.40%) and the inpatient stay (144.67kg CO2e, 30.28%) constituted the biggest contributors. Single-use intraoperative equipment contributed to over three-quarters of the total emissions from the operation. By defining the environmental burden of elective spinal surgery, we have identified carbon hotspots to target for sustainable change. Substituting polluting elements for carbon-friendly alternatives and challenging the single-use culture, modern healthcare systems can help pave the way to a ‘net zero’ healthcare system.

I Introduction: Pneumothorax is a pathological condition characterized by the presence of air between the visceral and parietal pleura. Objectives: To investigate incidence, clinical characteristics, risk factors, management and perinatal outcome among newborns with pneumothorax in a tertiary care center. Materials and Methods: A prospective observational study was conducted in Maternity hospital with tertiary NICU from 2015-2019. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, concurrent diseases, clinical course and method of chest drainage between full term (≥37 GW) and preterm (<37GW) newborns. Results: Mong 30.378 neonates, 74 developed pneumothorax (2, 4/1000 newborns). The incidence of neonatal pneumothorax (NP) was higher in preterm group (59, 5%), with a mean age 34,62 GW in whole group. The mode of delivery was c. section in 68.9%. NP occurred mostly on the right side (47,3%), on the second day of life , in males (67,6%). Chest drainage was performed in 64,9% of cases. Of 74 NP cases, 64 (85.1%) recovered, 6 (8,1%) died. Conclusion: Pneumothorax is a pathological condition of the newborn, which, if not diagnosed in time and treated adequately, leads to a fatal outcome.ads to a

Good child protection systems and processes require reliable and accurate data. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken to determine whether routinely collected data on a child’s journey through the child protection system, together with a study of related multidimensional factors, can be used to develop an enhanced dataset to protect children in the UK and in other countries. Child maltreatment was substantiated in 65% of referred cases, with the vast majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse, and the child’s previous involvement with statutory bodies was associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites, and burns. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse, and to self-harm. The strengths and weaknesses for single centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.

Background: Radiotherapy is an important part of the medical therapy concept treating tumors in the head and neck region; however, the impact on the field of dentistry could be im-mense. The objective of this study was to evaluate the microtensile bond strength (µTBS) of uni-versal adhesives and to compare the results of different application modes (etch-and-rinse and self-etch) on irradiated and sound human dentin. Methods: Dentin specimen of 180 extracted human wisdom teeth were divided in two superordinate groups. Ninety teeth received either no irradiation (control group) or the high-level therapeutic dose of 60 Gy (test group) applied frac-tionally (2 Gy/day, 5 days/week, 6 weeks). Samples from each group were randomly divided in-to six subgroups assigned to three established universal adhesives (Futurabond® U, VOCO; AdheSE® Universal, Ivoclar Vivadent; Xeno® Select, Dentsply) in both conceivable application modes: etch-and-rinse and self-etch (n = 15). Bond strength was assessed with a universal testing machine immediately after application and light curing of the adhesive materials. Statistical analysis was performed using two-way ANOVA (p<0.01) and Tukey's test (p<0.05). Results: The effect of dentin irradiation and application mode for the adhesive restoration was found to be significant (p<0.01, ANOVA). In all groups, a decrease of µTBS could be observed when used on irradiated dentin. However, no significant influence of high level radiation on the bond strength of Futurabond® U and AdheSE® Universal in both modes could be evaluated (p>0.05, Tukey´s test). Solely in the case of the adhesive system Xeno® Select, significantly reduced bond strength could be determined in self-etch mode after irradiation (group 60 Xse) compared to the control group (0 Xse) (p<0.05, Tukey´s test). Conclusions: Within the limitations of an in vitro study, some effects of high-level tumor irradiation on the bond strength of universal adhesives can be detected. However, these effects were strongly depending on the used material and application mode.

The accurate prediction of heat load profiles with a daily resolution is required for a broad range of applications such as potential studies, design, or predictive operation of heating systems. If the heat demand of a consumer is mainly caused by (production) processes independent of the ambient temperature, existing load profile prediction methods fail. To close this gap, this study develops two ex post machine learning models for the prediction of the heat demand with a daily resolution. The selected input features are commonly available to each consumer connected to public natural gas and electricity grids or operating an energy monitoring system: Ambient temperature, weekday, electricity consumption, and heat consumption of the last seven days directly before the predicted day. The study’s database covers electricity and natural gas consumption load profiles from 82 German consumers over a period of two years. Electricity and heat consumption correlate strongly with individual patterns for many consumers. Both, shallow and deep learning algorithms are evaluated. The highest accuracy is achieved by a Long Short Term Memory (LSTM) model with a median of R² of 0.94. The ex post model architecture makes the model suitable for automated anomaly detection in energy monitoring systems.

Candida species are one of the most important causes of human infections, especially in hospitals and among immunocompromised patients. The correct and rapid etiological identification of yeast infections is important to provide adequate therapy, reduce mortality and control outbreaks. In this study, Candida species were identified in patients with suspected fungal infection, and phenotypic and genotypic identification methods were compared. A total of 167 axenic fungal cultures and 46 clinical samples were analyzed by HardyCHROM®, MicroScan®, and PCR-RFLP. The species of the C. albicans complex were the most frequent, followed by C. tropicalis and C. glabrata. Less common but clinically relevant species of Candida were also isolated. The comparison between the three methods was concordant, especially for the most common Candida species. Fungal DNA amplification was successful in all clinical samples.

Tandem mass spectrometry (MS/MS) for diagnosing inborn errors of metabolism (IEM) is recognized as an ethical, safe, simple, and reliable screening test. Presented bibliometric analysis aims to describe the network structure of the scientific community in the study area at the level of countries, institutions, authors, papers, keywords, and sources; scientific productivity, directions, and collaboration efforts in a considered period (1991–2023.) Using the PRISMA method, we conducted a systematic search for articles reporting using MS/MS to screen for inherited metabolic disorders and inborn errors of metabolism collected from the Web of Science Core Collection (WOSCC.) A total of 451 articles out of 546, by 2,682 authors, published in 190 journals, with 15,440 citations in 8,181 citing articles, with an average citation of 34.24 per article, and an H-index of 64 were retrieved from the WOSCC. The research status of MS/MS in IEM screening was identified. The most relevant current research directions and future areas of interest were revealed: "selective screening for IEM," "new treatments for IEM," "new disorders considered for MS/MS testing," "ethical issues associated with newborn screening," "new technologies that may be used for newborn screening," "use of a combination of MS/MS and gene sequencing," etc.

Variations in geochemical signatures of fossil brachiopod shells may be due to diagenesis and/or biological processes (i.e. ‘vital effects’). Characterize them is crucial to identify reliable areas into the shell suitable to paleoclimatological studies. This investigation contributes to an in-depth understanding of geochemical variations of Gigantoproductus sp. shells (SW Spain, Serpukhovian age), which could affect to the Late Paleozoic Ice Age interpretation. Microstructural, crystallographic, cathodoluminescence and geochemical (minor and trace elements, δ18O, δ13C, and strontium isotopes) characterisation have been performed on the tertiary layer of the ventral valve, to assess the preservation state. Poorly-preserved areas exhibit microstructural and geochemical changes such as recrystallisation, fracturing and higher Mn and Fe enrichment. Moreover, these areas have higher dispersion of ⁸⁶Sr, ⁸⁷Sr, δ18O and δ13C than well-preserved areas. Three structural regions have been identified in well-preserved areas of ventral valve by differences in valve curvature and thickness, such as the umbonal, thick and thin regions. These regions have different proportions of Mg, S, Na, δ18O, and δ13C, whom are interpreted as ‘vital effects’ and probably are related with growth rate differences during shell growth. Gigantoproductus tertiary layer seems the best suitable to paleoclimatological studies because it retains the original microstructure and geochemistry.

The prevalence and case fatality rates of Pediatric Lassa fever disease (LFD) are not well documented. This study was aimed at determining the prevalence, pattern and outcome of Pediatric LFD. It was a prospective observational study. A total of 183 subjects that met the criteria for LFD suspects were recruited consecutively and subjected to Lassa virus PCR test. Structured questionnaire was used to collect information. Of the 183 children recruited, 24 tested positive to Lassa virus PCR, giving a positivity rate of 13.1%. Mean duration of illness at presentation was 8.54 ± 3.83 days. Fever, abdominal pain and vomiting were the three highest presenting complaints. Seven out of 24 children died giving a case fatality rate (CFR) of 29.2%. Subjects with bleeding, poor urine output, convulsions and unconsciousness were more likely to die of LFD. Positivity and CFR of LFD are high. Improved case finding and prompt treatment is advocated.

The aim of this study was to determine the most common maternal and neonatal complications related to cesarean section at Sultan Qaboos University Hospital (SQUH) and to compare the outcomes between emergency and elective cesarean sections. A retrospective cohort study was conducted in the department of Obstetrics and Gynecology at SQUH from 1st January 2016 to 31st December 2016. This comparative study involved 300 women who underwent cesarean section, 150 in elective cesarean section group and 150 in emergency cesarean section group. Data was collected from the delivery ward maternity registry and Electronic Patient Records. SPSS software version 23 was used to analyze the data.The mean maternal age was 29.66 (± 4.96) and 33.22 (± 4.63) years in the elective and emergency cesarean section groups respectively (p=001). The main risk factor for both the groups was maternal diabetes and the most common indication for both was previous cesarean section. Hypotension related anesthetic complication was noted more in elective cesarean section (15.3%) than in emergency cesarean section group (4.0%) with p value=0.002. The most common major intraoperative complication in both groups was postpartum hemorrhage, 66.9% women in emergency group and 63.0% women in elective group. Post-partum fever was seen in 12.0% of women in emergency group as compared to 4% in elective group (p=0.019). Anemia was observed in 79.2% and 65.3% in emergency and elective groups respectively (p=0.011). Respiratory distress syndrome and transient tachypnea of the newborn were the main neonatal complications in both groups. There was no significant difference between emergency and elective cesarean section related maternal and neonatal complications except for transient intraoperative hypotension, maternal postoperative febrile morbidity and anemia. Future prospective studies including larger sample size and multiple centers is recommended.

This narrative review aims to clarify the role of tertiary lymphoid structures in breast cancer. We examine their development, composition, prognostic value and current ways of recognising them. A comprehensive literature review was performed using PubMed/Medline, Scopus and EMBASE databases. A significant area of interest in breast cancer research involves targeting immune checkpoint molecules, particularly in the triple-negative subtype, where treatment options remain limited. However, existing biomarkers have limitations in accurately predicting treatment response.  In this context, tertiary lymphoid structures (TLS) emerge as a prognostic biomarker and also as a promising predictive marker for response. TLS are ectopic lymphoid formations or neo-organogenesis that can develop after prolonged exposure to inflammatory signals mediated by chemokines and cytokines. Their presence is inversely correlated with estrogen receptor (ER) and/or progesterone receptor (PR) expression, but positively associated with a higher pathologic complete response rate and improved overall  survival. In certain scenarios, TLS-positive tumors were associated with improved outcomes regardless of the presence of PDL-1 (programmed cell death ligand 1) expression or and TILs (tumor-infiltrating lymphocytes).

Background: Abdominal wall hernias are a common condition that is seen in daily general surgery patients. However, still more researches are needed to be conducted regarding hernias. The aim of this study is to see the prevalence of hernias among patients admitted to the Department of Surgery of a tertiary care center. Methods: A descriptive cross-sectional study was performed among patients who admitted to the department of surgery in a tertiary care center between 1 August 2023 and 20 September 2023. All patients data were extracted to an excel sheet. Results: We had 760 patients who visited in this period. Only 272 patients (27.9 %) were diagnosed with hernias. We found 52.6 % of patients were male and 47.4 % of patients were female. The age between 46- 60 years old was the most to have hernias (97 patients). Inguinal hernias were the common among other types. Diabetes mellitus, hypertension, COPD, and hydrocele were found in 10.7 % of all patients. Conclusion: The prevalence of hernias in this study was nearly to other studies that conducted in the same conditions. Early diagnosis and patient’s education are the corner stone to prevent morbidities and mortalities.

BACKGROUND: Retinoblastoma is a malignant tumour that develops from the immature cells of the retina. It is the most frequent type of paediatric intraocular cancer and is curable. Clinical and histological findings after enucleation of the affected eye dictate not only the patient's secondary care but also their prognosis. We assessed the clinical and histopathologic predictors of survival among children with retinoblastoma from two tertiary health facilities in Uganda. METHODS: This retrospective research utilized archived formalin fixed & paraffin embedded blocks of eye specimens enucleated between 2014 to 2016 at Mbarara University, pathology department and Ruharo Eye Centre. The specimens were then processed and stained with haematoxylin and eosin. The confirmation of retinoblastoma was made to include histologic stage and features of the tumor. Biographic data of the patients and the clinical features such as leukocoria, proptosis, phthisis, staphyloma, buphthalmos were retrieved from the records.RESULTS: Males (55.1%) dominated the study population (N=78). The median age was 31 months. The commonest clinical sign was leukocoria (69.2%) and the most abundant histopathological stage was stage 1 (41%). Optic nerve invasion 39.5%, choroidal invasion 29.5%, scleral invasion 7.7% and orbital extension 16.7% were seen. Flexner-Wintersteiner rosettes were seen in 24.6%. Necrosis was a prominent feature (71.2%). The two-year survival was estimated to be 62%. Leukocoria (RR 1.1), female gender (RR 1.4), intralaminar optic nerve invasion (RR 7.6) and a lack of orbital extension (RR- 7) were significant predictors of survival.CONCLUSION: Leukocoria and proptosis are noticeable clinical signs of retinoblastoma. Most patients present while in stage one although stage four presentation is also common. Leukocoria, optic nerve invasion, orbital extension, and gender are significant factors predictive of survival in patients with retinoblastoma.

(1) Background: Breast cancer is the leading malignancy worldwide and in Ghana it has a poor overall survival. However, approximately 50% of cases are early stage disease and with advances in breast cancer treatment and improvement in survival, quality of life (QOL) becomes as im-portant as treatment of the disease. (2) Methodology: This was a cross-sectional study of survivors who had breast conserving surgery (BCS), mastectomy only (M) and mastectomy with breast re-construction (BRS) from 2016 to 2020 at a tertiary hospital in Ghana, comparatively assessing their QOL using EORTC QLQ C-30 and EORTC QLQ BR-23. (3) Results: The study participants had an overall Global Health Status (GHS) median score of 83.3 [IQR: 66.7-91.7] with no significant differences between the surgery types. The BRS group had a statistically significant lower median scores for the Functional scale (82.8 and 51.0) and the highest scores for the Symptomatic scale (15.7 and 16.5). Body image was significantly lowest for the BRS group 83.3 [68.8-91.7] and highest 100 [91.7-100] for the BCS group (p < 0.001). (4) Conclusion: There is a need to develop support systems tailored at improving the QOL of breast cancer survivors taking into consideration the type of surgery performed.

Academic integrity faces persistent challenges in Anambra State's tertiary institutions due to fraudulent behaviors among undergraduate students. This study addresses gaps in the literature by investigating lecturers' attitudes toward these fraudsters, recognizing the need for localized insights and informed interventions. Employing a survey research design, the study focuses on 20 lecturers. A validated questionnaire, utilizing a 4-point Likert scale, captures lecturers' perspectives. The study examines attitudes, motivations, and potential variations based on academic discipline, teaching experience, and institutional context. Preliminary findings indicate a nuanced spectrum of attitudes among lecturers, with male lecturers exhibiting slightly more positive attitudes than their female counterparts. Variability in attitudes is influenced by factors such as academic discipline and teaching experience. The study identifies inadequacies in existing interventions and highlights the role of lecturers in preventive strategies

Introduction: Intrauterine fetal death (IFD) is death of fetus after the 20th week of gestation. Despite regular monitoring, the incidence of IFD remains high. This study aims to assess the incidence and risk factors for IFD in term pregnancies for better prevention and reduction of neonatal morbidity and mortality. Materials and Methods: A retrospective cohort study was conducted with term pregnant women diagnosed with IFD. The analysis included the number of deliveries, live births, and stillbirths. Statistical analysis involves descriptive and analytical statistical methods. Results: Average age was 30 years. Most patients had intermediate and high education, and one-third of patients had regular pregnancy monitoring. 53.33% were primiparous, and pregnancies occurred spontaneously. IFD mainly occurred in the 39th week of gestation. The average birth weight was approximately 3000g. 38.3% had one to two associated diseases, 5% more than three, and 56.7% were healthy. Recurrence of IFD was reported by 10% of patients, while 8.33% had a history of spontaneous abortion. Over 80% of placental histopathological findings indicated some pathology (infarction, infections, abruptio placenta). Conclusion: The most significant risk factors were pregnancy-induced hypertensive disorders, obesity, and diabetes, followed by hypothyroidism, maternal tachycardia, and anemia.

Introduction Urolithiasis, a prevalent urological condition (8-13% globally) exhibits regional variations, influenced by water quality, climate, health factors and diet. Sri Lanka with its tropical climate and dietary patterns is part of the "Stone Belt" of Asia. This study in Northern Sri Lanka examines urinary stone compositions and assesses the prevalence of metabolic disorders among urolithiasis patients. Methods This prospective cross-sectional study, conducted at tertiary urology centre from July 2022 to June 2023, focused on surgically treated urolithiasis patients. Institutional ethical clearance was obtained. Patient details and investigational findings were collected through questionnaires and data extraction forms. Stone analysis utilized Fourier transform infrared spectroscopy and detailed metabolic evaluation of 24 hour urine collection sample is carried out. Results This study followed 153 surgically treated urolithiasis patients, primarily male (64.3%), mean age 48.64. Ureteric colic (48.4%) was common, with kidney stones (45.8%) prevalent; 57.52% had recurrent stones. Diabetes mellitus (DM=23.5%) was the top comorbidity. Calcium oxalate monohydrate (COM) stones (78.4%) were most frequent, followed by uric acid (12.4%). COM predominated in 40-59 age group. No significant gender-stone type association. 86.9% had metabolic abnormalities, notably hypocitraturia (60.1%). 23% had both hypocitraturia and hypomagnesuria. Some metabolic disorders showed gender differences, with a marginal age-metabolic disorders association (p < 0.061). Urine oxalate levels were normal with higher variability in males. Conclusion Middle-aged males with urolithiasis commonly presented with ureteric colic and predominantly had calcium oxalate monohydrate stones. Recurrent stones were common, often accompanied by metabolic abnormalities such as hypocitraturia and hypomagnesuria, with diabetes mellitus as the primary comorbidity.

Objective: To evaluate the variables influencing the length of stay (LoS) for COVID-19 ICU patients at Tygerberg Hospital (Cape Town) and to identify the covariates that significantly influenced it and any potential risk factors associated with LoS. Methods and Results: Poisson, negative binomial (NB), Hurdle–Poisson, and Hurdle–NB regression models were used to model the LoS in this prospective cohort study. The fitted models were compared using the Akaike information criterion (AIC), Vuong’s test criteria, and Rootograms. Based on the chosen performance criteria, the NB model provided the best fit outperforming other candidate models. The baseline LoS count was 8 days. On average, antibiotics reduced LoS by 0.74-fold (95% CI 0.62-0.89) compared to not taking antibiotics. The second wave had a significant effect on the average LoS, which decreased by 0.36-fold (95% CI 0.14-0.93) compared to the first wave. Average LoS increased by 1.01-fold (95% CI 1.01-1.02) for every one-year increase in the age of the patient and by 1.02-fold (95% CI 1.01-1.03) for every 1 unit increase in neutrophils. A 1 ng/L increase in log (TropT) levels decreased the average LoS by 0.87-fold (95% CI 0.81-0.93) similarly, a unit increase in the PF ratio decreased the average LoS by 0.998-fold (95% CI 0.997-0.999) respectively. Conclusion: The study identified common clinical characteristics associated with length of stay in ICU for COVID-19 patients, including age at admission, PF ratio, neutrophils, TropT, Wave, and antibiotic use. These results can aid in identifying risk factors for increased length of stay, assist in healthcare systems planning, and aid in evaluating different models for analysing this type of data.

A The aim of this study is to analyze the effect of different endodontic irrigants and adhesive systems on resin bond strength of fiber post cementation. 144 single-rooted, unrestored human teeth were endodontically treated and randomly divided into 12 groups according to 4 endodontic irrigants (distilled water as control; EDTA 17%; NaOCl 5%; clorhexidine 2%) and 3 different adhesive/resin cement systems (etch-and-rinse: ortofosforic acid, Parabond® A+B/Paracore®; self-etch: ParaBond® Non-Rinse Conditioner, Parabond® A+B /Paracore®; Universal: ClearfilTM Universal Bond/ ClearfilTM DC Core Plus). 48 h after post cementation ten teeth from each group were cross sectioned into 3 discs (cervical, middle and apical regions). 30 specimens of each group (n=30) were submitted to push-out test at a crosshead speed of 1 mm/min. The remaining 2 teeth of each group were sectioned in the same manner and the resin-dentin interface was evaluated using scanning electron microscopy (SEM). The results were statistically analyzed with the ANOVA and Tukey’s test (< 0,01). The adhesive protocols and post space region showed no significant effect on bond strength (> 0.01). The combination of NaOCl 5% and ClearfilTM Universal Bond reduced the adhesive strength (< 0.01). The NaOCl 5%, in relation with other irrigants, significantly decreased the push-out bond strength.

In the context of the French tertiary decree, it is crucial to reduce the energy consumption of buildings by first addressing the design of the electrical architecture. Implementing Direct Current (DC) nanogrids in buildings could offers a promising advantage for energy efficiency, significantly impacting overall energy consumption and sustainability goals. For an insulated area with a subtropical climate, such as La Réunion island, DC nanogrids could also facilitate the insertion of local renewable energy sources, especially solar energy. This article presents the deployment and efficiency evaluation of an end-to-end Low Voltage Direct Current (LVDC) nanogrid, from conception to real-world installation within a company. The nanogrid consists of a photovoltaic power plant, a Lithium-Iron-Phosphate (LFP) battery, and DC end-use equipment such as LED lighting and DC fans for two individual offices. An innovation is provided for the power supply and energy management of terminal equipment using the Power Over Ethernet (PoE) standard IEEE 802.3bt. The efficiency of the nanogrid is measured to be 40% higher than the efficiency of an installation powered by PV and distributed at 230 VAC. These results are obtained under certain deployment conditions, which are discussed in this article, in order to enhance the energy efficiency of buildings by using 48VDC. The nanogrid hardware and software infrastructure, the methodology employed for efficiency quantification and the measurement results are described in the paper.

Background Candida auris is an emerging multidrug-resistant fungal pathogen that represents a serious threat to healthcare settings currently. Objective: Its objective was to determine the prevalence of C. auris in the hospital since its initial detection in late 2019. Methods: Using an adapted risk assessment tool, we reviewed the charts. and medical files of all suspected? and confirmed cases of C. auris cases reported at King Khalid University Hospital, Riyadh between November 2019 and December 2022. Anonymized data were retrieved in a pre-established datasheet and analyzed to determine the epidemiological characteristics of C. auris infection in our facility. We established our initial prevalence by age, gender, risk factors, and according to sampling source. Results: Of the 53 confirmed cases positive for C. auris during the study period, 33 (62%) were males. Their ages ranged between 15 and 98; most positive cases occurred in 50 and above. Only one of the confirmed cases was hospital-acquired. All patients had at least one risk factor, and Urine samples yielded the greatest number of positive cases while admission to healthcare facilities constituted the highest risk in our study. Conclusion: Establishing a local prevalence could serve as our baseline/benchmark to compare with regional and international benchmarks.

Aims: Multidisciplinary diabetic foot clinics have been shown to be an effective therapeutic model for reducing major amputations and mortality rates. The aim of this article is to assess the economic impact of the implementation of a multidisciplinary diabetic foot clinic in a hospital in Barcelona, Spain. Methods: Observational cost-benefit study of all subjects with diabetes admitted with the diagnosis of a major amputation due to diabetic foot from 2010 to 2020. Direct and indirect costs were compared before and after the introduction of the multidisciplinary diabetic foot clinic. Results: The individual cost per patient with diabetic foot was €14,768 before the implementation of the unit. After the implementation of the clinic, the expected cost was reduced to €5,985 due to a 40% reduction in the probability of hospitalization. Overall, the implementation of the clinic resulted in cost savings per patient valued at €8,783, of which, €7,165 are related to hospital benefits. Conclusion: The results of this analysis contributes to the evidence suggesting that multidisciplinary diabetic foot clinics are cost-effective, by demonstrating that they have a positive impact on patient health while also reducing the utilization of healthcare resources.

Task-Based Instruction (TBI) is a dynamic approach in tertiary language education that emphasizes the integration of authentic and meaningful tasks to enhance language learning outcomes. This study aims to explore the implementation of TBI in the Philippines, investigate its cognitive benefits and transformative nature, identify pedagogical considerations, and provide recommendations for optimization. The study employed a qualitative research design, with data collected from five private schools in Iligan City. A purposive sampling procedure was used to select 20 participants who engaged in interviews, focus group discussions, and thematic analysis. The results revealed that TBI positively influenced language proficiency, cognitive development, learner autonomy, intercultural competence, and pedagogical considerations. Participants reported enhanced language skills and increased confidence in real-life language use. They also highlighted the development of critical thinking, problem-solving, and decision-making skills through engaging in challenging tasks. TBI was found to empower learners by promoting autonomy, ownership, and self-directed learning. Additionally, it cultivated intercultural communicative competence and fostered appreciation for diverse perspectives. Pedagogical considerations included task design, clear instructions, scaffolding, and feedback, while recommendations focused on optimizing TBI, integrating technology-enhanced learning, and supporting professional development for educators. This research contributes to the growing body of literature on TBI in tertiary language education and underscores its potential for creating transformative learning experiences. The findings provide valuable insights for educators, curriculum designers, and policymakers in enhancing language education practices in the Philippines and beyond.

Background: The use of peripherally inserted central catheters and midline catheters is growing due to their potential benefits. These devices can increase patient safety and satisfaction while reducing the use of resources. As a result, many hospitals are establishing vascular access specialist teams staffed by nurses who are trained in the insertion and maintenance of these catheters. Objective: Evaluate ex-ante whether the benefits of replacing peripheral venous catheters, peripherally inserted central catheters and midline catheters with ultrasound-guided peripherally inserted central catheters and midline catheters by a vascular access specialist team outweigh their costs. Methods: Cost-benefit analysis from the perspective of the healthcare provider based on administrative data. The study estimates the reduction in resources used when replacing peripherally inserted central catheters, midline catheters and peripheral venous catheters with ultrasound-guided peripherally inserted central catheters and midlines, as well as the additional resources required for their use. Results: Each ultrasound-guided peripherally inserted central catheter replacing a peripherally inserted central catheter, results in a measurable resource reduction of approximately €31. When 3 peripheral venous catheters are replaced by an ultrasound-guided peripherally inserted central catheter, the saving is €63. Similarly, each ultrasound-guided midline catheter replacing a midline, results in a reduction of €16, while each ultrasound-guided midline catheter replacing 3 peripheral venous catheters results in a reduction of €96. Conclusion: The benefits of replacing peripheral venous catheters, peripherally inserted central catheters and midline catheters by introducing a vascular access specialist team trained in the implantation of ultrasound-guided peripherally inserted central catheters and midline catheters, outweigh its cost mainly because of the decrease in hospital stay due to the lowered risk of healthcare-associated infections. These results motivate the implementation of the service, adding to previous experience suggesting that it is also preferable from the point of view of patient safety and satisfaction.

The COVID-19 pandemic has had a major impact on health systems around the globe and Romania is no exception. The impact on healthcare expense for pregnant women has been considerable, especially in COVID-only tertiary centers, where specialized care is being provided .The aim of this study is to analyze the impact of SARS-CoV-2 infection on healthcare costs, in particular by managing cases in COVID-only maternity. Material and Methods: The objective of the study was to analyze if the model adopted by the health system consisting in complete separation of delivering obstetrical care for covid and non-covid patients was efficient. We conducted an observational study in which we compared a group of pregnant women infected with SARS-CoV-2 (study group) with a control group in which we included uninfected pregnant women. The patients were recruited from Bucur Maternity Hospital, declared a COVID-only center in march 2020. We compared the two groups in terms of expenses over the entire period of hospitalization, i.e. expense on hospitalization, medicines, medical supplies, and medical investigations.

The new need to move to an online mode of administration has necessitated the adoption of Software-as-a-Service (SaaS) and Platform-as-a-Service (PaaS). The conventional paper-based administrative memorandum is relatively costly, requires manpower, insecure and non-confidential, prone to unauthorized access and has a relatively slow cycle time; among others. An electronic memo (e-memo) can save cost, offer high speed of processing, reliability and security. The aim of this work was to conceptualize, design and develop a novel semantic web-based memo platform that allows for handling memos within an organization. The tools used include HTML, CSS, PHP, JavaScript, jQuery and AJAX, MySQL. The developed system was tested in three stages. Testing was done in the Department of Computer Science of the institution of case study, then in the Faculty of Science and finally in the entire Lagos State University. Agile development method was used in the development process. The designed system was hosted on a cloud-server and a total of 43 test cases were considered and an average of four minutes was recorded for a complete memo cycle. eMemo allows users to generate, sign, treat and memo electronically. It is such a useful tool that will enhance information processing in a faster, standardized and more secure manner.

Antimicrobial resistance (AMR), a serious global public health challenge, may have accelerated development during the COVID-19 pandemic because antibiotics were prescribed for COVID-19. This study aimed to assess antibiotics use before and during the pandemic and correlate the results with the rate of resistant microorganisms detected in hospitalized patients during the study period. This single centre study looked retrospectively at four years of data (2018–2021) from Royal Hospital, Muscat, Oman. The consumption rate was presented as the antibiotic consumption index, the ratio of defined daily dose (DDD) per 100 bed-days. Analyses were performed using the nonparametric test for trend across the study period. Correlation between antibiotic consumption indexes and the isolated microorganisms in the four-year study period was performed using Spearman’s rank correlation coefficient. We compared data from the pre-COVID-19 to the COVID-19 period. Though more patients were admitted pre-COVID-19 (132,828 versus 119,191 during COVID-19) more antibiotics were consumed during the pandemic; vancomycin and ceftriaxone had higher consumption during than before the pandemic (p-values 0.001 and 0.036, respectively). Vancomycin-resistant Enterococcus (VRE) and Candida. auris were detected more during the COVID-19 period with p-values of 0.026 and 0.004, respectively. Carbapenem-resistant Enterobacterales (CRE), vancomycin resistant Enterococcus spp., and C. auris were detected more often during the pandemic with p-values of 0.011, 0.002, and 0.03, respectively. Significant positive correlations between antibiotic consumption and drug resistant isolates were noted. This study confirms that the overuse of antibiotics triggers the development of bacterial resistance; our results emphasize the importance of antibiotic control.

Hospital-based adverse drug reaction (ADR) monitoring and reporting programs intend to identify and quantify the risks associated with the use of drugs. To examine the causality, preventability and severity of ADR in a hospital setting; a prospective cohort study on spontaneous ADR reporting was conducted from December 2015 to May 2016. Incidence of ADRs, causality, type, severity and preventability were assessed using necessary assessment scales. The study included 3157 hospitalized individuals, in whom 51 ADRs were detected among 49 patients. The overall incidence of suspected ADRs was found to be 1.6%. According to the causality assessment, most of the ADRs reported were probable (n = 26, 51.0%), and type A (augmented/pharmacological) reactions (n = 39, 76%) were the most common type of ADR found. The majority of ADRs were moderate to severe (n = 35, 68.6%), of which 37.3% were found to be potentially preventable. Predictability was observed in 28 (54.9%) reported ADRs. The drugs most frequently associated with ADRs were antibiotics, antiepileptics and antihypertensives. This feasibility study was able to highlight the clinical pharmacist’s role in ADR monitoring service and create awareness about the way it could be done to promote safer drug use. Similar ADR reporting programs are necessary to educate and to improve awareness among the healthcare professionals in developing countries.

2-Pyridone ligand-facilitated palladium-catalyzed direct C–H bond functionalization via the transient directing group strategy has become an attractive topic. Here we report a Pd-catalyzed direct β-C(sp3) –H arylation reaction of tertiary aliphatic aldehydes by using an α-amino acid as a transient directing group in combination with a 2-pyridone ligand.

Heme proteins serve diverse and pivotal biological functions. Therefore, clarifying the mechanisms of these diverse functions of heme is a crucial scientific topic. Distortion of heme porphyrin is one of the key factors regulating the chemical properties of heme. Here, we constructed convolutional neural network models for predicting heme distortion from the tertiary structure of the heme-binding pocket to examine their correlation. For saddling, ruffling, doming, and waving distortions, the experimental structure and predicted values were closely correlated. Furthermore, we assessed the correlation between the cavity shape and molecular structure of heme and demonstrated that hemes in protein pockets with similar structures exhibit near-identical structures, indicating the regulation of heme distortion through the protein environment. These findings indicate that the tertiary structure of the heme-binding pocket regulates the distortion of heme porphyrin, thereby controlling the chemical properties of heme relevant to the protein function; this implies a structure–function correlation in heme proteins.

Alcohol and substance addiction is a type of brain disease that damages many areas of life of the individual and has psychological components. Since questioning alcohol use alone is not sufficient in the diagnostic evaluation process, self-awareness and the individual's long-term psychological well-being are important in the rehabilitation process. Since investigating alcohol use alone is not sufficient in the diagnostic evaluation process, self-awareness and the individual’s long-term psychological well-being are important in the rehabilitation process. Primary prevention is used to prevent disease in healthy people, and secondary prevention is used for early diagnosis to people at risk. Tertiary prevention is important to prevent recurrence of the disease in the treated person. In addiction, which is a chronic problem, a need has emerged for tertiary prevention, that is, rehabilitation standards. If people are uncertain about the harm perception and the natural result of their behavior, they easily slip into the substance. Therefore, as a positive psychotherapy technique, harm perception and result awareness levels should be clarified. For this reason, scales were developed. The inclusion of new psychology perspectives and therapy techniques, such as positive psychology, in the treatment process requires setting new standards. In this study, it was aimed to develop result awareness and harm perception scales to determine the awareness levels and rehabilitation standards of alcohol and substance addicted individuals, and to compare awareness in normal and addicted groups. The study group consisted of 1134 participants, 41 of whom were addicts. Among the two scales developed in the study, the Uskudar Result Awareness Scale (USRAS) consisting of 25 items and 6 factor, explained 58.4% of the total variance. The Uskudar Harm Perception Scale (USHPS), consisting of 36 items and 10 factors, explained 56.3% of the total variance. Confirmatory factor analysis of the two scales resulted in acceptable goodness-of-fit values. (X2/df<3; RMSEA<.08; NFI>.90; NNFI>.95; CFI>.95; GFI>.90; AGFI>.85). In the comparisons made, the result awareness of the normal group was moderate (X=3,81); whereas the addicted group had a low result awareness (X=3,20); The effect size of the difference between the two groups was found to be high (d=1,45; >0,8). In the other measure, the harm perception of the normal group was found in the low-risk group (X=3,78); the harm perception of the addicted group was found in the moderate-risk group (X=3,43). According to Cohen d calculations, the effect size of the difference between the two groups is high (d=1,43; >0,8). It has been concluded that the two scales that emerged in the research are valid and safe, can be included in the rehabilitation studies and the creation of self-awareness, and their effectiveness should be tested.

This study employed e-Vol DX cone beam computed tomography (CBCT) software to assess dentin remnants in the furcation area of mesial canals in mandibular molars during root canal retreatment (RCR). Four groups (Reciproc®, ProTaper Next®, Race Evo®, Protaper Gold®) were subjected to RCR, and CBCT images were captured before (T1) and after (T2) treatment. Measurements of remaining dentin thickness at 1 mm and 3 mm below the furcation were scrutinized. Results revealed no significant differences in mean thicknesses of mesiobuccal (MB) and mesiolingual (ML) canals at 1 mm and 3 mm from the furcation pre-treatment (T1). Post-treatment (T2) showed analogous findings, with no significant differences in mean thicknesses. However, disparities surfaced between MB and ML canals at both distances, both before and after retreatment. In essence, the evaluated instruments exhibited safety in RCR, implying their appropriateness for use in critical areas of mandibular molars without inducing excessive wear. This study underscores the instruments' reliability in navigating danger zones during RCR, contributing valuable insights for dental practitioners handling complex root canal scenarios in mandibular molars.

This study aimed to assess the impact of different modes of laser irradiation on the bactericidal efficacy of aPDT. Dentin plates were prepared by sectioning the crown dentin of bovine teeth infected with Streptococcus sobrinus. Nine aPDTs involving the combinations of three photosensitizers (brilliant blue, BB; acid red, AR; and methylene blue, MB) and three laser irradiation modes (50 mW for 120 s, 100 mW for 60 s, and 200 mW for 30 s) were performed for each infected dentin plate, and the control group consisted of the specimens not applied with aPDT. The bactericidal effects in 10 experimental groups were evaluated (n=11) using both assays of the colony-count and adenosine triphosphate (ATP). The data obtained were analyzed using the Kruskal-Wallis test. The aPDT performed with semiconductor laser in combination with BB, AR, and MB exerted a remarkable bactericidal effect. aPDT with MB exerted a more significant bactericidal effect in the colony-count assay. The results of aPDT performed with varying irradiation times and powers but with constant irradiation energy showed no difference with AR and MB between the modes, whereas BB showed a more significant bactericidal effect when irradiated for a shorter time at a higher irradiation power.

BACKGROUND: Cervical cancer is the second most frequent cancer among women worldwide between 14 and 49 years of age including Nigeria. Figures have greatly reduced in developed countries after the introduction and implementation of effective screening and vaccination programs which is greatly undeveloped and inefficient in Nigeria and other developing countries at large. OBJECTIVES: The study assessed the knowledge and attitude of reproductive age women towards cervical cancer prevention in selected tertiary institutions in Osun State. METHODOLOGY: The study was a descriptive cross-sectional study carried out among reproductive age women in selected tertiary institutions in Osun State, Nigeria. A probability based multistage sampling technique was adopted as the sampling technique for the study. Data was collected using a semi-structured, self-administered and interviewer guided questionnaire. RESULTS: Age of respondents was 25.305±8.195. 313(79.0%) of the total respondents were Christians, and 83(21.0%) of the respondents were Muslims. For the overall knowledge score, only 52.0% of the respondents had good knowledge while 48.0% of the respondents had poor knowledge. 52.0% exhibited negative attitude towards cervical cancer prevention while 48% exhibited positive attitude towards cervical cancer prevention. Only 23% of the respondents had taken part in screening and vaccination towards cervical cancer prevention while 77% of the respondents had not. CONCLUSION: The knowledge of reproductive age women towards cervical cancer prevention was above average while their attitude towards cervical cancer prevention was low. This issue could be addressed by increasing the awareness of the effects of cervical cancer among reproductive age women in the country.

The Covid-19 pandemic has produced a change in the way of living, socializing and a modification in Health Systems around the world. A multicentre retrospective study was carried out to study orofacial trauma in one of the regions most affected during the first wave of the pandemic, with the participation of the five main tertiary hospitals in Madrid. The aim of this study is to evaluate the epidemiology of orofacial surgical trauma during the 1 year of COVID pandemic and compared to de prior year. Age, sex, mechanism, localization, and treatment were studied. P-value <0.05 was considered statically significative. Reduction of 39.36% (<0.001) in maxillofacial fractures was observed, without significance change in sex, localization or treatment. Significant increase in age (35,92 vs. 40,26) (p = 0.006) was observed. Significant decline in mechanism was noted (p = 0.025), decreasing personal violence (41% vs 35%) and sports (14% vs 8%); increasing in falls (27% vs 35%), precipitation (2 vs 5%), and traffic accidents (12% vs 13%). The mandible was the most frequent fractured bone. The COVID pandemic has produced epidemiological variations in orofacial trauma, making it necessary to monitor social and legal changes that may require reorganization to adjust to population needs.

This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail 2-2.5 years since their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the ankle/foot (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. New-onset chronic pain may occur for up to 2-2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.

AIM: Aim of our study was to evaluate incidence and causative factors for acute kidney injury in gastrointestinal and hepatobiliary surgeries. Material and methods: All the gastrointestinal surgeries performed between April 2018 to March 2020, in our institution have been analysed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi square test and continuous variables by Mann Whitney U test. Statistical analysis was done using SPSS version 23. P< 0.05 was considered significant Results: We performed 331 gastrointestinal and hepatobiliary surgery from April 2018 to March 2020. After exclusion 317 patients were included in study population.14 patients (4.4%) were defined as having acute kidney injury according to acute kidney injury network classifications. On univariate analysis acute kidney injury was associated with open surgery (p= 0.002, Intra operative hypotension (p=0.006), CDC grade of surgery (p<0.001), increased used to blood products (p=0.004), higher ASA grade (p<0.0001), increased operative time(p<0.0001). On multivariate logistic regression analysis higher ASA grade (p=0.001) and increased operative time (0.015) independently predicted acute kidney injury. Acute kidney injury was also significantly associated with 90 days mortality. ( p= <0.0001) Conclusion:Post-operative acute kidney injury was associated with significant mortality in gastrointestinal and hepatobiliary surgery. Open surgery, higher CDC grade surgery, more blood products, higher ASA grades, increase operative time predicted acute kidney injury in post operative periods. Higher ASA grades and increased operative time predicted acute kidney injury.

Introduction: On March 11, 2020, the World Health Organization (WHO) declared Coronavirus disease 2019 (COVID-19) as a pandemic. The spread of the Delta variant of coronavirus started in June 2021 and accounted for the fifth peak of COVID-19 in Iran in July 2021. According to reports from other countries, vaccination protects against severe diseases caused by COVID-19, including the Delta variant. Studies have also shown that vaccination provides strong protection against SARS-CoV-2 infection, COVID-19-related hospitalization, and mortality. This retrospective cohort study was designed based on the medical care monitoring center (MCMC) database of Sayyad Shirazi Hospital.Methods: The following patient data were extracted for this study: demographic characteristics, signs and symptoms, ICU admission, need for aggressive oxygen therapy, including intubation, mortality, and vaccination status. Results: Being vaccinated was associated with a 4.14-fold increase in survival (adjusted OR=4.14; 95% CI: 2.22 to 7.69; P<0.01), and individuals in a younger age group demonstrated a 5.58-fold higher likelihood of surviving (adjusted OR=5.58; 95% CI: 4.25 to 8.14; P<0.01). The risk of severe COVID-19 was significantly lower in vaccinated individuals, showing a 3.12-fold decrease in risk (adjusted OR=3.12; 95% CI: 2.06 to 4.72; P<0.01), and in younger age groups, the risk exhibited a 3.28-fold decrease (adjusted OR=3.28; 95% CI: 2.66 to 4.04; P<0.01).Conclusion: The present results suggest that receiving at least one dose of COVID-19 vaccine had a significant relationship with decreased COVID-19 severity and mortality in vaccinated patients compared to unvaccinated patients.

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious public health issue. Aim of the study was to identify the antimicrobial resistance and accessory genes, the clonal relatedness and the evolution dynamics of selected CRKP isolates recovered in an adult and a pediatric intensive care unit of a tertiary hospital in Greece. Methods: Twenty-four CRKP isolates recovered during 2018-2022 were included in the study. Next-generation sequencing was performed using the Ion Torrent PGM Platform. The identification of the plasmid content, MLST and antimicrobial resistance genes, as well as the comparison of multiple genome alignments and the identification of core genome single-nucleotide polymorphism sites, were performed applying various bioinformatics software. Results: The isolates belonged to eight sequence types 11, 15, 30, 35, 39, 307, 323, and 512. A variety of carbapenemases (KPC, VIM, NDM and OXA-48) and resistance genes were detected. CRKP strains shared visually common genomic regions with the reference strain (NTUH-K2044). ST15, ST323, ST39, and ST11 CRKP isolates presented on average 17, 6, 16 and 866 recombined SNPs, respectively. All isolates belonging to ST15, ST323 and ST39 were classified in distinct phylogenetic branches, while ST11 isolates were assigned to a two-subclade branch. For large CRKP sets, the phylogeny seems to change approximately every seven SNPs. Conclusion: The current study provides insight into the genetic characterization of CRKP isolates in the ICUs of a tertiary hospital. Our results indicate clonal dispersion of ST15, ST323, and ST39 and highly diverged ST11 isolates.

Klebsiella pneumoniae is a leading cause of healthcare acquired infections. The severity of the infections is multifactorial including virulence and antimicrobial resistance properties. The objective of the study was to investigate the virulence determinants of K. pneumoniae strains colonizing patients hospitalized in the intensive care units (ICU) of a tertiary hospital in Uganda. A hospital based cross-sectional study involving 103 patients admitted in the ICU of Mulago National Referral hospital was conducted from January 2022 to April 2022. A total of 31 identified clinical strains of K. pneumoniae isolated from rectal swabs of the same number of patients were characterized. Susceptibility testing of colistin was performed by broth microdilution method, thereafter, 5 colistin resistant K. pneumoniae were purposefully selected for whole genome sequencing. Bioinformatics analysis was performed using established web-based tools to detect virulence genes, sequence type and other genomic features. Numerous virulence factor genes related to pathogenicity of K. pneumoniae were identified. They ranged from those related to colonization to those of persistence and dissemination including capsule genes (wzi), siderophore systems; yersiniabactin (ybt15), aerobactin (iutA), enterobactin (entC, entD, entF, entS, fepB, fepD, fepG, fes), and salmochelin (iroN), secretion systems; type II (T2SS) and type VI (T6SS-1). Furthermore, the isolates harbored outer membrane protein (ompA) gene, biofilm synthesis gene (fimH) and several adhesion genes. The results demonstrate the dual-risk of K. pneumoniae strains combining high level of virulence and colistin resistance which is a great concern as it leads to unmanageable infection outbreaks with high morbidity and mortality.

Invasive fungal infections, notably candidemia, have been associated with COVID-19. The epidemiology of candidemia has significantly changed during the COVID-19 pandemic. We aim to identify the microbiological profile, resistance rates, and outcomes of COVID-19 associated candidemia (CAC) compared to patients with candidemia not associated with COVID-19. We retrospectively collected data on patients with candidemia admitted to the American University of Beirut Medical Center between 2004 and 2022. We compared the epidemiology of candidemia during and prior to the COVID-19 pandemic. Additionally, we compared the outcomes of critically ill patients with CAC to those with candidemia without COVID-19 from March 2020 till March 2022. Among 245 candidemia episodes, 156 occurred prior to the pandemic and 89 during the pandemic. Of the latter, 39 (43.8%) were CAC, most of which (82%) were reported from intensive care units (ICU). Non-albicans Candida (NAC) spp. were predominant throughout the study period (67.7%). Candida auris infection was the most common cause of NAC spp. in CAC. C. glabrata had decreased susceptibility rates to fluconazole and caspofungin during the pandemic period (46.1% and 38.4% respectively). Mortality rate in the overall ICU population during the pandemic was 76.6%, much higher than the previously reported mortality of candidemia from previous studies at our center. There was no significant difference in 30-day mortality between CAC and non-CAC (75.0% vs 78.1%; P =0.76). Performing ophthalmic examination (P = 0.002), CVC removal during the 48 hours following the candidemia (P = 0.008) and identifying the Candida spp. (P = 0.028) were significantly associated with a lower case-fatality rate. The epidemiology of candidemia has been significantly affected by the COVID-19 pandemic at our center. Rigorous infection control measures and proper antifungal stewardship are essential to combat highly resistant species like C. auris.

The 30-day postoperative outcome after elective endovascular aneurysm repair (EVAR) was evaluated and the possible predictors were identified. Demographics, medical history, laboratory values, length of hospitalization (LOH), intensive care unit (ICU) admission and 30-day complications, classified as major [major adverse cardiovascular events (MACE), acute kidney injury (AKI) and death of any cause] and minor [post-implantation syndrome (PIS), postoperative delirium (POD), urinary tract infection (UTI) and technical graft failure] were documented, respectively. We included 322 patients (median LOH 4 days). One-hundred and twenty one (37.5%) complications, mostly minor (n=103, 31.9%), were recorded. Eleven patients (3.4%) evolved MACE, 5 (1.6%) AKI and 2 patients (0.6%) died in ICU. Seventy-seven patients (23.9%) suffered from PIS, eleven from POD, 11 from UTI and 4 from technical graft failure. Multivariate logistic regression analysis revealed that aneurysm diameter (p=0.01) and past smoking (p=0.003) were predictors for postoperative complications. PAD was an independent predictor of MACE (p=0.003), preoperative neutrophil to lymphocyte ratio (NLR) value of AKI (p=0.003) and past smoking of PIS (p=0.008), respectively. Our study showed that 30-day morbidity after EVAR exceeded 35%. However, the majority of complications were classified as minor and the associated mortality was low. Aneurysm diameter and past smoking were independent predictors for postoperative outcome.

This work presents patient radiation dose data for pediatric interventional cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient dose data distributions for kerma area-product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically in all weight and age bands, except the group between 1-5 years. The local DRLs were 69 Gy/cm2 (< 5 kg), 3.44 Gy/cm2 (5-<15 kg), 8.87 Gy/cm2 (15-<30 kg), 10.51 Gy/cm2 (30-<50 kg) y 22.61 Gy/cm2 (50-<80 kg), respectively. In conclusion, from comparing our results with other existing DRL values, we are similar to other centers and scope to continue optimizing the radiation dose values. This will contribute to setting national diagnostic reference levels (DRLs) for Colombia in the near future.

The main aim of this study was to determine the prevalence of plasmid-mediated colistin resistance mcr-1 to mcr-5 genes among colistin and multi-drug resistant Enterobacterales, Pseudomonas aeruginosa and Acinetobacter sp strains isolated from patients in a tertiary hospital in the city of Toluca, Mexico. 241 strains were included in the study. The presence of mcr genes among these strains was assessed by PCR and sequencing. In the case of mcr-carrying E. coli, further PCR tests were performed to determine the presence of blaCTX-M and whether the strains belonged to the O25b-ST131 clone. Conjugation experiments were carried to assess plasmid-mediated colistin resistance horizontal transmission. 12 strains (5.0%), of which four were E. coli; four, P. aeruginosa; three, K. pneumoniae and one, E. cloacae, were found to be resistant to colistin. Of these strains, two E. coli isolates were found to carry mcr-1. Both mcr-1-carrying E. coli strains were found to co-express blaCTX-M, belong to the O25b-ST131 clone and horizontally transmit their colistin resistance. The results of this study confirm the presence of plasmid-mediated colistin resistance in hospitalized patients in Mexico and demonstrated that the multidrug-resistant O25b-ST131 E. coli clone can acquire mcr genes and transmit such resistance trait to other bacteria.

Structure–function relationships in proteins have been one of the crucial scientific topics. Heme proteins have diverse and pivotal biological functions. Therefore, clarifying their structure–function correlation is significant to understand their functional mechanism and is informative for various fields of science. In this study, we constructed convolutional neural network models for predicting protein functions from the tertiary structures of heme-binding sites (active sites) of heme proteins to examine the structure–function correlation. As a result, we succeeded in the classification of oxygen-binding protein (OB), oxidoreductase (OR), proteins with both functions (OB–OR), and electron transport protein (ET) with high accuracy. Although the misclassification rate for OR and ET was high, the rates between OB and ET and between OB and OR were almost zero, indicating that the prediction model works well between protein groups with very different functions. However, predicting the function of proteins modified with amino acid mutation(s) remains a challenge. Our findings indicate a structure–function correlation in the active site of heme proteins. This study is expected to be applied to the prediction of more detailed protein functions such as catalytic reactions.

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring Programme, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related hepatitis but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild hepatitis. Mean age for the cases was 45.7 years, 4(26.7%) were women and 5(33.34%) were children under 18 years, of them 3(20%) were fatal. Polytherapy with other antiepileptic drugs (p=0.047) and alcohol consumption (p<0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p<0.001). The cases developed hepatocellular hepatitis (p<0.001), while the mild hepatitis controls had a higher rate of cholestatic hepatitis (p<0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p= 0.033 and p=0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

Pythium insidiosum(PI) can cause sight threatening keratitis which is managed commonly by performing penetrating keratoplasty. This article is a retrospective review to assess outcomes of keratoplasty performed in patients diagnosed with PI keratitis. (2) Methods: Pre-operative, intra operative and post-operative data of patients diagnosed with PI keratitis and who underwent keratoplasty for their condition from January 2020 to December 2021 were col-lected from the central patient database of a tertiary eye care hospital in India. The data were an-alyzed for anatomic success, elimination of infection, graft survival, incidence of repeat kerato-plasty, final visual acuity and varied complications. (3) Results: In total, 16 eyes underwent pene-trating keratoplasty for PI keratitis during the study period. Mean time to keratoplasty from on-set of symptoms was 31.3 days and mean graft size was 10.4 mm. Nine out of the 16 cases had recurrence of infection following surgery, six of which required a repeat keratoplasty for elimina-tion of infection. Out of these 6 patients, one patient underwent 2 repeat keratoplasties. Mean graft size for repeat keratoplasty performed in recurrent cases was 11.7 mm. Globe was successfully salvaged in 14 out of 16 patients (87.5 %). Endo-exudates, graft infiltration, graft dehiscence, secondary glaucoma and retinal detachment were the various complications noted after kerato-plasty. (4) Conclusion: Keratoplasty remains the choice of treatment in PI keratitis, however re-currence of disease and graft failure are common. Large sized grafts, meticulous per-operative removal of infection, adjuvant cryotherapy, and intraoperative and post-operative use of antibi-otics can help in improving outcome of keratoplasty in these patients.

Institutional support and quality education are linked in a significant way. During Covid-19, institutional support is critical to closing the huge academic gap that has emerged as physical academic practices have been moved to a virtual education system using technology. This research aims to assess institutional support for online education in Bangladesh during the Covid-19 pandemic. This analysis is focused on the three main elements of the Adapted Model of Institutional Support (AMIS) of Bond et al, 2007, and the Institutional Support Model (ISM) of Valverde and Rodriguez, 2002, namely Financial Support (FS), Technical Support (TS), and Mentoring Support (MS). According to the findings, a few universities in Bangladesh have provided average support for continuing online education, while others have just started taking online classes. Several problems have been discovered, such as the lack of dedicated software for conducting online academic activities, lack of training and grooming, lack of mentoring, poor internet access, lack of smartphones, high internet package rates, and so on. This study concludes with some policy recommendations for a smooth online education system in Bangladesh.

Introduction: Tuberculosis (TB) is one of the most prevalent respiratory diseases in the world. In 2020 there were at least 9.9 million new infections, with 1.5 million deaths. Approximately 10% of people infected with Mycobacterium tuberculosis (LTBI) develop the disease during the first 2 to 5 years after infection. Currently in South America, the diagnosis of LTBI continues to be per-formed through the Mantoux tuberculin skin test (TST). Objective: The objective of our study was to compare the sensitivity of a new immunofluorescence IGRA test against a widely available IGRA kit on the market. Material and method: Close contact to infectious patients with TB, or HIV patients or immunocompromised for another cause were recruited. Two interferon gamma release assay (IGRA) diagnostic kits were used and compared with TST. Results: 76 patients were recruited. 93.42% were Chilean nationality, 98.68% of the patients did not have immunosuppres-sion. The sensitivity of the new technique was 88.89% and specificity 92.50% in the study popula-tion compared to the IGRA previously used. In the subgroup older than 36 years, the sensitivity was 95.65% and the specificity 89.47%. Conclusion: IGRA techniques are a new resource in clini-cal laboratories to be able to make an accurate diagnosis in LTBI in the region of the Americas. In our population, the greatest benefit of this new IGRA would be observed in people over 36 years of age, where the sensitivity of the technique was like that of the currently available test.

Background: Gram-negative bacteremia, especially from Klebsiella spp., Escherichia coli, and Pseudomonas aeruginosa, poses a significant public health threat due to multidrug resistance and high mortality rates. Cost-effective treatments are essential in low-middle income countries as Colombia. Methods: This descriptive, phase IV study was conducted in a tertiary care hospital in Colombia. Adult patients with Gram-negative bacteremia treated with generic piperacillin/tazobactam (Penibactam®) were evaluated. Clinical and microbiological responses were assessed over 12 months. Results: The study included 30 critically ill patients with an average APACHE II score of 22.12. The clinical response at day 7 was 66% (n = 20), and the microbiological response was 56.7% (n = 17). By the end of follow-up, clinical improvement was observed in 63.3% (n = 19), with a mortality rate of 23% (n = 7). The cardiovascular system was the most common infection site. Conclusions: Generic piperacillin/tazobactam demonstrated effectiveness and safety comparable to existing literature in treating Gram-negative bacteremia, offering a viable, cost-effective alternative for critically ill patients in real-world settings.

Background: As the world tends to recover from the crisis created by the COVID-19 pandemic, vaccines have served as one of the most valuable tools of combat and large-scale immunization has helped to tide over the catastrophe. However, several reports of post -vaccination neurological complications around the globe have surfaced up in recent literature. This study was conducted with an aim to describe the spectrum of neurological ailments requiring hospitalization following COVID-19 vaccination.Methods: An ambispective observational study was carried out from March 2021 to February 2022 at a tertiary care institute with 25 patients who satisfied the inclusion criteria of a new onset neurological illness requiring hospitalization within 4 days to 42 days of vaccination. The patients were duly followed upto months after discharge.Results: The median age of the sample was 36 years and the median latency of onset of neurological events was 14 days. Guillain-Barré syndrome was documented in 11 patients; majority were acute motor axonal neuropathy (45.45%) followed by acute inflammatory demyelinating polyradiculoneuropathy (36.36%) and acute motor sensory axonal neuropathy (18.18%). Central nervous system demyelination was reported in 9 patients; two patients had acute disseminated encephalomyelitis, 2 patients were diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease, one patient with aquaporin-4 positive neuromyelitis optica spectrum disorder , and the rest were labelled as seronegative central nervous system demyelination. Vascular events were noted in 5 patients comprising of 2 cases each of cerebral venous sinus thrombosis and intracerebral hemorrhage and a case of Moyamoya angiopathy. All patients were conservatively managed and had a complete to partial recovery suggestive of a favorable outcome after 3 months. Conclusion: The pathomechanisms of post -vaccination neurological complications is yet to be elucidatedand any causal association attributable to vaccination warrants further research. Compared to the enormity of the vaccinated population, the adverse effects are miniscule to hinder and discourage vaccination.

In 2021, an operational research study in two tertiary hospitals, Freetown, showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February-April 2023, a cross-sectional study was conducted in the same two hospitals using the WHO Hand Hygiene tool to assess hand hygiene practices and compare hand hygiene compliance with that observed between June-August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (P&lt;0.001), and this applied to both handwash actions with soap and water and alcohol-based-hand-rub: significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (P&lt;0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were attributed to more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments compared with 34MH where interventions were less well applied, possibly due to extensive hospital reconstruction at the time. In conclusion, improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments are effective, and need to be strengthened, scaled-up and combined with other innovative ways to promote good hand hygiene practices.

Catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections (HAIs). Prolonged hospitalization, invasive devices such as catheters, and irrational use of antimicrobial agents are believed to be the major causes of high rates of HAIs. Infections such as pyelonephritis, urethritis, cystitis, and prostatitis are the main concern in catheterized ICU patients. In these cases, Gram-negative bacteria are the most common. The present study is undertaken to determine the frequency, antibiograms, disease pattern, and risk factors involved in providing an advocacy recommendation to prevent CAUTI. A total of 1078 patients were admitted to the hospital ICU, out of which healthcare-associated infection was reported in 316 patients. CAUTI was reported only in 70 patients. Klebsiella pneumoniae (20%) was the predominant isolate, with Serratia (3%) and Providencia (3%) species as the least common in this study. The present study provides CAUTI incidence rates in a tertiary care hospital in Hail, Saudi Arabia. Furthermore, information on risk factors of CAUTI common causative organism associated, and their antibiogram patterns are also presented. This study provides vital information that can be used to formulate an effective antibiotic stewardship program that can be implemented throughout the kingdom.

Breast self-Examination (BSE) is the cheapest most recommended Breast Cancer (BC) preventive tool for resource deprived settings. There is paucity in the Attitude research domain of the BSE literature. The purpose of this study is to assess the combined and exclusive gender BSE attitude of undergraduate health trainees and to determine significant difference between scores of both genders. Online cross-sectional method was used to assess BSE attitude of 336 mixed gender purposively sampled KNUST College of Health Sciences (CoHS) students. Compared to the constructors’ average BSE attitude score of 101.17 (SD = 9.55), our Study Participants’ BSE attitude is lower (92.51; SD = 11.80). However, using popular attitude mid-point and 3 part scoring methods, our Study Participants (SPs) attitude scores are comparable to sub-regional and national findings. Also contrary to the authors’ expectation, the male participants scored generally high BSE attitude but significantly lower compared to their female compatriots (p < 0.5). Implication, contextual challenges and recommendations for future research have been discussed. BSE KAP research and education must involve more males as important BSE stake holders and there is the need to adjust the curicullum of all health trainee students in developing nations to reflect relevant BC preventive measures.

A 1-year prospective study was carried out on patients in the ICU unit at a tertiary care hospital, Hail, Kingdom of Saudi Arabia. A total of 163 bacterial isolates were obtained from different clinical specimens with a high proportion of bacteria found associated with ventilator-associated pneumoniae (70, 43%), followed by catheter-associated urinary tract infection (39, 24%), central line-associated bloodstream infection (25, 15%), and surgical site infection (14, 8.6%). Klebsiella pneumoniae was the most common isolate (39, 24%), followed by Acinetobacter baumannii (35, 21.47%), Pseudomonas aeruginosa (25, 15%), and Proteus spp (23, 14%). Among the highly prevalent bacterial isolates, extended-spectrum beta-lactamase was predominant (42, 42.4%). Proper use of antibiotics, continuous monitoring of drug sensitivity patterns, and taking all precautionary measures to prevent beta-lactamases-producing organisms in the clinical settings are crucial and significant factors to fend off life-threatening infections and for a better outcome.

Background Successful treatment for patients with metastatic colorectal cancer who failed to response to first-line treatment has been a challenge due to their low response rate for later-line treatment and poor progression free survival and overall survival. The application of dendritic cell-cytokine-induced killer cells (DC-CIK) immunotherapy combined with conventional treat-ment, either surgical resection or chemotherapy, showed improvement in survivals in first-line treatment for metastatic colorectal cancer. In this retrospective study, we aimed to evaluate the benefit of dendritic cell-cytokine-induced killer cells (DC-CIK) immunotherapy for patient with refractory metastatic colorectal cancer. Methods A total of 20 patients with refractory metastatic colorectal cancer receiving cell-cytokine-induced killer cells (DC-CIK) immunotherapy were enrolled to this study. Among these patients, 11 patients responded to the treatment and the remaining 9 patients did not. All patients were followed for at least one years and the determination of treatment response was mainly based on image study at 6 months after the completion of treatment. Data were analyzed with Kaplan-Meier method and log-rank test. Results The treatment response rate of the study group is 55% (11/20). The median progression free sur-vival (PFS) and median overall survival (OS) of responsive patients was 7 months and 12 months, respectively. The median overall survival of irresponsive patients was 9.5 months. Four responsive patients received subsequent metastectomy or cytoreduction plus hyperthermic in-traperitoneal chemotherapy surgery (CRS + HIPEC). Conclusion DC-CIK cell-based immunotherapy may provide benefits for patients with refractory mCRC with improved response rate and progression free survival.

The mechanistic pathway of TEMPO/I₂-mediated oxidative cyclization of N,N-diaryl amino alcohols 1 is investigated in this study. Based on our direct empirical experiments, three key intermediates (the aminium radical cation 3, the α-aminoalkyl radical 4, and the iminium 5), four kind reactive species (radical TEMPO, cationic TEMPO, TEMPO-I and iodo radical) and three kind pathways (1. SET/PCET mechanism, 2. HAT/1,6-H transfer mechanism, 3. Ionic mechanism) were assumed. Under the assumption, nine free energy diagrams are acquired through DFT calculation. From the comparison of the solution phase free energy, some possibility can be excluded and then the chosen plausible mechanisms are concretized with the more stable intermediate 7.

Free-of-charge HCV screening in some key populations and in 1969–1989 birth cohorts have been funded in Italy as the first step to diagnosing individuals unaware of their infection. The aim of this study is to use available in-hospital routine screening data to understand the inpatients HCV screening in a region of North Italy. A retrospective search of in-hospital patients tested for HCV-antibody (HCV-Ab) from January 2017 to the end of December 2022, was conducted according to age categories (older than 76 years, birth group 1947-1968; birth group1969-1989 and two other categories with patients younger than 33 years) using the TriNetX network. Of 42,805 in-hospital patients tested, 1,297 (3.03%) resulted HCV-Ab positive. The proportion decreased from 2017 to 2022 (from 2.03% to 0.36%) years). The higher prevalence of HCV-Ab was in patients older than 76 years (5.3%) while, the lowest was in the younger birth cohort (2000-2022, 0.16%). Of 1,297 patients found HCV-Ab positive, only 198 (15.3%) were tested for the presence of HCV RNA. Although the birth cohort 1969-1989 had a lower seroprevalence (1.5%), they represented the most affected age group with 44.4% of HCV RNA positivity. The in-hospital HCV screening including birth cohort 1947-1989 could be a valuable option respect to the screening for birth group 1969-1989 in the general population. Since a high proportion of patients were not tested for HCV RNA during hospitalization, reflex testing promptly ascertaining an active infection could facilitate linkage to care to stop the burden of HCV.

There is a lack of information on vaccination for pregnant women in the Brazilian literature. Our aim was to evaluate the data on vaccines recorded on the pregnancy card and knowledge about the importance of vaccination for women admitted for labor in a reference public tertiary maternity unit in Presidente Prudente, São Paulo, Brazil. Vaccine data as prescribed by the National Immunization Program of Brazil (NIP) in prenatal cards for patients in labor from the 45 municipalities of the western region of São Paulo state were obtained. A questionnaire relating to knowledge about the types and importance of vaccination in pregnancy was applied. All vaccines indicated by the NIP were registered in only 12.0% of the prenatal cards, and 33.0% of cards registered any vaccines. In this group, 16.6% were aged between 14 and 21 years, and tetanus and COVID-19 were the most prevalent vaccines that they had heard of during prenatal care. Data on vaccines was poorly recorded in the cards, suggesting a lack of attention and unpreparedness of professionals working in primary care. Our study has countrywide and global relevance, and may be applied mainly in Latin American countries facing similar difficulties and limitations with low rates of vaccination during pregnancy.

Objective: To assess the spectrum of PET-CT-related large vessel vasculitis (LVV) in a Spanish tertiary center and to determine whether FDG uptake by PET-CT differs between giant cell arteritis (GCA) with predominant cranial or extracranial phenotypes. Methods: The spectrum of patients diagnosed with LVV by PET-CT in a tertiary referral hospital that cares for 450,000 people over a period of two years was reviewed. Moreover, differences in FDG uptake between LVV-GCA with predominantly cranial and extracranial phenotype were analyzed. Results: Eighty patients were diagnosed with LVV by PET-CT. Most were due to systemic vasculitis (n=64; 80%), especially GCA (n=54; 67.5%). Other conditions included the presence of rheumatic diseases (n=4; 3.2%), tumors (n=9; 7.2%), and infections (n=3; 2.4%). LVV-GCA patients with predominant extracranial GCA phenotype were younger (mean ± SD: 68.07 ± 9.91 versus 75.46 ± 7.64 years; p= 0.017) and had a longer delay to the diagnosis (median [interquartile range] 12 [4-18] versus 4 [3-8]; p=0.006), but had PMR symptoms more frequently than those with predominantly cranial GCA phenotype (46.3% versus 15.4%, p= 0.057). When FDG uptake was compared according to the two different disease patterns, no statistically significant differences were observed. However, patients with extracranial LVV-GCA showed a non-significantly higher frequency of vasculitic involvement of lower extremity arteries. Conclusion: Regardless of the predominant phenotype, LVV identified by PET-CT is more commonly due to GCA in the Spanish population. In these GCA patients, younger age, PMR and a higher frequency of lower extremity artery vasculitis suggest the presence of LVV.

Aim of the study: To draw inferences from a retrospective evaluation of PSMA PET CT scans performed for the evaluation of biochemical recurrence. Material and Methods: Retrospective analysis of 295 PSMA PET CT scans spanning 3 years between 2020 and 2022 was undertaken. Results: Of 295 PET CT scans, 179 were positive, 66 negative and 50 had indeterminate findings. In positive group, 67 had radical prostatectomy and PSMA avid lesions were seen most commonly in pelvic lymph nodes. Remaining 112 positive scans, in non-radical prostatectomy group; 25 had recurrence only in prostate, 17 had recurrence involving prostate bed; 28 had no recurrence in prostate gland, while 42 had recurrence in prostate as well as extra prostatic sites. Overall, in non-prostatectomy group, 75 % population was harbouring a PSMA avid lesion in prostate gland while in remaining 25% population recurrence did not involve prostate gland. Majority of indeterminate findings were seen in small pelvic or retroperitoneal lymph nodes or skeletal regions (ribs/others) and in 9 patients indeterminate focus was seen in the prostate bed only. Follow up PSMA PET CT was helpful in prior indeterminate findings and unexplained PSA rise. Conclusion: A higher recurrence in prostate bed while evaluating biochemical recurrence prompts us to think; whether prostatectomy should be offered more proactively? Follow up PSMA PET CT is helpful for indeterminate findings; a PSA rise of 0.7 ng/ml in 6 months can result in positive PSMA PET CT while negative scan can be seen upto 2ng/ml PSA rise in 6 months.

A retrospective study including 49 women with ovarian clear cell carcinoma between January 2009 and December 2021 at Oxford cancer centre was done. The mean age was 63 years, with 78% post-menopausal. All women underwent cytoreductive surgery with no residual disease (R0) in 39 women. The follow-up time ranged between 12-144 months, with mean of 105.5 months. The 3-year OS was 73.4%, and 3-year PFS was 81.3%, with a mean of 101.7months (95%CI, 84.63-118.93). As expected, women with stage 1 disease had the best outcome. In comparing OS in respect to absence or presence of residual disease, the 3-year OS was 88.6% (95% CI 108.6-141.8), compared to 12.5% (95% CI 4.48-32.11) respectively (P<0.001). In multivariant analysis the variables included were CA 125 (< or >200 IU/ml), Hb (< or >115 g/L), albumin (< or >40 g/L), associated endometriosis, ascites, residual disease, and FIGO staging. FIGO stage was the only independent prognostic indicator of OS with (p<0.05). Surgery to achieve no residual tumour is necessary to improve the prognosis in advanced OCCC. At present, the true challenge is to predict which patients with early-stage disease are at higher risk of recurrence and would most benefit from adjuvant treatments.

Abstract Background COVID-19 vaccination program among Adults in India is one of the highly successful vaccination drives globally. Indian children aged 15–18 years old became eligible for COVID-19 vaccination on 3rd January, 2022 followed by 12-14 years old children on 16th March, 2022. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination for children in India. Aim To assess parental perceptions and intention to get COVID-19 vaccination for their children (aged<18 years), Materials and Methods A cross-sectional anonymous web-based survey was designed. Healthcare workers of a tertiary care institute in Eastern U.P. having any children aged <18 years were the study population. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with socio-demographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior routine childhood immunization. Bi-variate analysis was performed to find out the predictors of child vaccination intention among the parents. Results A total of 388 healthcare workers parents (HCWPs) having A child < 18 years of age completed the survey. Mean age of the parents were 40.28 ±11.34 years with majority(97.0%) completing recommended 2 doses of COVIID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for child’s health whereas about 89% agreed to the statement that COVID-19 vaccines are effective. A total 356 (91.7%) participants were willing to vaccinate their child against COVID-19, 91.3% of them liked to do so as soon as possible. The factors significantly associated with the stated likelihood of child vaccination among the participants were younger age, female gender, urban residence, absence of any chronic illness, lower monthly income, history of COVID-19 in child and the child/children completed with routine childhood vaccines. Parental concerns mainly centered around vaccine need, safety and side effects. Conclusion The healthcare worker parents(HCWPs) have good knowledge and positive attitude towards COVID-19 vaccination for children. Around 92% of them were willing to vaccinate their children with COVID vaccine currently, which implies very low vaccine hesitancy among the HCWPs . Further longitudinal studies are required to be conducted to assess the trend of parental acceptance of COVID vaccine.

During the COVID-19 pandemic, the high prevalence of comorbidities in Mexico, as well as the disparities between public and private health subsystems, substantially contributed to the severe impact it had in the country. The objective of this study was to evaluate and compare risk factors present at admission for mortality of hospitalized patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 was conducted at a private tertiary care center. The study population consisted of 1,258 patients with a median age of 56 ± 16.5 years, of whom 1,093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p &lt;0.001), comorbidities such as hypertension (p &lt;0.001) and diabetes (p &lt;0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p &lt;0.001), the presence of cyanosis (p 0.005) and previous myocardial infarction (p 0.032) were independent predictors for mortality. In the studied cohort, risk factors present at admission associated with an increased risk of death were older age, cyanosis and a previous myocardial infarction, which can be used as valuable predictors for patients’ outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended on a private tertiary hospital in Mexico.

Despite the efforts to deliver the best evidence-based care, in-hospital death is an inevitable event among some patients hospitalized in cardiology departments. We retrospectively evaluated mortality events from inpatient admissions to Cardiology Department between 2010-2019. Data were collected from morbidity &amp; mortality meeting presentations which evaluated comorbidities, medical history, treatments, and causes of death for the overall cohort and according to age group and sex. There were 1,182 registered deaths. The most common causes of death among patients were acute myocardial infarction (AMI) (53.0%), heart failure (HF, 11.7%), cardiac arrest (CA, 6.6%), HF with complication/defined cardiomyopathy (6.3%) and sepsis (4.4%). We observed a decline in deaths from AMI from 61.9% in 2010 to 46.7% in 2019 while there was an apparent increase in deaths from HF (11.1% in 2010 to 25.9% in 2019). Compared to patients ≥65 years, younger patients were more likely to have died from CA (15.7% vs. 4.3%, p&lt;0.001) and other cardiac reasons (3.0% vs. 0.4%, p&lt;0.001). The majority of deaths were due to AMI, HF, and CA. We observed a significant decline in the proportion of deaths due to AMI in recent years with an increase in deaths due to HF.

: (1) Background: Healthcare workers (HCWs) are a well-known risk group for coronavirus infections with increased working hours in a potentially infectious environment. We evaluated both IgG and Neutralizing antibody levels, with IgG avidity index and persistence among health workers. (2) Methods: 1001 HCWs were tested for both IgG and Neutralizing antibodies. IgG avidity testing and one-year follow-up testing were done on selected HCWSs. (3) Results: COVID-19 IgG antibody levels were high among 299 (94.62%) HCWs with a history of COVID-19 infection (p &lt;0.0001) compared with 479 (69.92%) HCWs who were not infected with COVID-19 during the first and second wave. A total of 899 (89.81%) HCWs had more than 50% neutralizing antibodies while the remaining 102 (10.19%) HCWs had less than 50% of Neutralizing antibodies. The avidity index was maintained at almost 40% (Gray zone). Both antibody levels were found markedly increased after one year when compared to initial results. (4) Conclusions: Healthcare workers are at a 2.29-fold higher risk of infection; Two folds higher IgG levels in HCWs involved in COVID-19 duty and their persistence for a longer time than in other groups signifies IgG antibody role in the prevention of severe disease in HCWs involved in Covid-19 patient care.

Background: Although triptorelin acetate (TA) is generally considered a safe medication, severe adverse drug reactions (ADRs) to triptorelin have occurred. In this study, we present the largest retrospective analysis of ADRs related to TA during the treatment of pediatric central precocious puberty. Methods: We describe a total of 38 suspected cases of TA-induced ADRs reported to the pharma-covigilance center of Shenzhen Children’s Hospital from September 2015 to December 2022. Causality assessment was carried out using the validated Kramer’s algorithm. The severity of ADRs was evaluated using the Modified Hartwig and Siegel Scale. Results: The most common ADRs attributed to TA were damage to the cutaneous tissues (29.3%) and reactions affecting the systemic and digestive systems (20.7%). The majority (61.1%) of ADRs occurred within 2 hours of administration. Among the 12 patients with severe ADRs, the three most frequent symptoms were anaphylactic reactions, hip synovitis, and arthralgia. Additional-ly, six patients experienced ADRs due to a change in the manufacturing process. Conclusion: The majority of ADRs observed in pediatric cases were type I anaphylactic reactions, which are rare but life-threatening. It is advisable to perform skin prick tests and intradermal tests when switching pharmaceutical manufacturers.

Multidrug resistance (MDR) among gram-negative bacteria is a global public health threat because it has exhausted all standard therapeutic options. This has necessitated clinicians to reconsider colistin, an “old sort” antibiotic which was deemed toxic for clinical use. Unfortunately, swift resistance towards colistin by K. pneumoniae has been reported in different parts of the world. The study aimed at investigating the genetic determinants of colistin resistance in K. pneumoniae isolated from patients admitted in a tertiary care hospital in Kampala, Uganda. 31 archived multidrug resistant K. pneumoniae isolates obtained from rectal swabs of patients admitted to the Mulago Hospital ICU were retrieved. From this collection, we selected 7 colistin resistant K. pneumoniae isolates for whole genome sequencing and molecular profile analysis. In silico sequence data analyses were performed using established web-based bioinformatics tools. The sequence analysis of the genes involved in colistin resistance revealed several non-synonymous mutations in nucleotide sequences of pmrA, pmrB, phoP, phoQ and mgrB genes. Insertion transposase genes for the insertion sequences IS1 and IS5 which are highly implicated in colistin resistance via modification or inactivation of mgrB gene were identified in all isolates and were located in the chromosomal DNA at different genomic positions. No plasmid-borne mcr genes were detected. More so, the strains harbored numerous multidrug resistant genes. This study underscores the need of genomic surveillance of K. pneumoniae strains to limit further spread of colistin resistance genes to avert the potential risk of pandrug resistance. And high throughput sequencing is imperative.

Milk serves as a crucial source of natural bioactive compounds essential for human nutrition and health. The gastrointestinal digestion of milk proteins releases various biologically active peptides that positively impact human health and enhance physiological performance. With the growing production of cheese, Greek yogurt, and other dairy products, the volume of unutilized acid whey is significantly increasing. Acid whey, containing almost all whey proteins and approximately one-quarter of casein, presents a valuable raw material for generating peptides with potential health benefits. These peptides exhibit properties such as antioxidant, antimicrobial, anti-inflammatory, anticarcinogenic, antihypertensive, antithrombotic, opioid, mineral-binding, and growth-stimulating activities, contributing to improved human immunity and the treatment of chronic diseases. Enzymatic hydrolysis of milk proteins has been developed as a method to produce these peptides, facilitating their use in food fortification. To incorporate whey into functional beverages, it undergoes fermentation by lactic acid bacteria with proteolytic activity. To specifically enrich these beverages with peptides exhibiting targeted bioactivities, it is essential to select lactic acid bacteria strains possessing the requisite protease profiles. Additionally, the sensory properties of the final product can be enhanced using starter cultures with diverse metabolic capabilities, even in the absence of added flavoring agents. Given the imperative to develop waste-free technologies and enhance the profitability of the dairy industry, there is a growing need to efficiently utilize and transform acid whey into a broad spectrum of valuable products and food additives. This approach is justified not only by the nutritional benefits of the bioactive components in whey but also by the commercial potential of safe and health-enhancing products.

The paper focuses on the application of a multilevel, integrative and territorial approach to the protection of cultural heritage through planning instruments in Serbia. It points out the problems of the sectoral approach and discusses international recommendations that can be integrated into the planning methodology. The case study is the area of Djerdap National Park, which has an already established international and national importance. The research suggests that the cultural heritage in the area, with the exception of the Roman limes, is still recognized at the level of individual localities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The interna-tional and national importance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the inte-gration of local values and local communities into development programs and projects.

In order to shorten the detection time and improve the average precision on embedded devices, A lightweight and high accuracy model is proposed for passion fruit in complex environments (backlight, occlusion, overlap, sunny, cloudy, rainy). Firstly, replacing the backbone network of YOLOv5 with a lightweight GhostNet model reduces the number of parameters and computation while improving detection speed. Secondly, a new feature branch is added to the GhostNet network, and the feature fusion layer in the neck network is reconstructed to effectively combine the lower-level and higher-level features, which not only improves the accuracy of the model but also maintains its lightweight. Finally, the knowledge distillation methods are used to transfer the knowledge from the more capable teacher model to the less capable student model, which significantly improving the detection accuracy. The improved model is denoted as G-YOLO-NK. The average accuracy of the G-YOLO-NK network is 96.00%, which is 1.00% higher than the original YOLOv5s model. Furthermore, the improved model size is 7.14MB, reduced to half of the original model, and the real-time detection frame rate is 11.25 FPS on the Jetson Nano. Compared to the state-of-the-art model, the proposed model outperforms them in terms of average precision and detection performance. The present work provides an effective model for real-time detection of passion fruits in complex orchard scenes, which can provide valuable technical support for the development of orchard picking robots and greatly improve the intelligence level of orchards.

The impact of interaction SS with MJO on rainfall along Java Island to East Nusa Tenggara has been studied using daily rainfall observation data from 2140 weather observation stations, which are also equipped with GSMaP, OLR, and ERA5 data. There were 61 SS events found, 17 during active MJO and 44 in inactive MJO. Rainfall increases more in the western study area when the active MJO and more in the eastern study area when the inactive MJO is due to SS. SS reduces rainfall in the Jakarta region, regardless of the activity or inactivity of the MJO. SS causes extreme rainfall to only occur in a small part of certain areas, so it tends to significantly reduce the possibility of extreme rainfall. In the southern part of the IMC, SS predominates over MJO in supporting increased water vapor transport. Large-scale synoptic circulations like the monsoon, SS, and MJO can interact with local land-sea wind circulation to produce spatiotemporal variability in rainfall on Java Island. Rainfall mostly increases in the afternoon and decreases in the morning when SS occurs, whether there is MJO or not. Convective instability analysis indicates that SS increases precipitation, most likely by lowering CIN and raising VIMFC.

The Simultaneous Localization And Mapping (SLAM) scanner is an easy and portable Light Detection And Ranging (LiDAR) data acquisition device. Its main output is a 3D point cloud covering the scanned scene. Regarding the importance of accuracy in the survey domain, this paper aims to assess the accuracy of two SLAM scanners: the NavVis VLX and the BLK2GO Scanner. This assessment is conducted for both outdoor and indoor environments. In this context, two types of reference data are used: the Total Station (TS) and the static scanner Z+F Imager 5016. To carry out the assessment, four comparisons are tested: cloud to cloud, cloud to mesh, mesh to mesh, and edge detection board assessment. However, the results of the assessments confirm that the accuracy of indoor SLAM scanner measurements (5 mm) is greater than that of outdoor ones (between 10 mm and 60 mm). Moreover, the comparison of cloud to cloud provides the best accuracy regarding direct accuracy measurement without manipulations. Finally, based on the high accuracy, scanning speed, flexibility, and the accuracy differences between tested cases, it is confirmed that SLAM scanners are effective tools for data acquisition.

Glycosidic linkage analysis was conducted on the unfractionated polysaccharides in the alcohol-insoluble residues (AIRs) prepared from six red seaweeds (Gracilariopsis sp., Prionitis sp., Mastocarpus papillatus, Callophyllis sp., Mazzaella splendens, and Palmaria palmata) using GC-MS/FID analysis of partially methylated alditol acetates (PMAAs). The cell walls of P. palmata primarily contained mixed-linkage xylans and small amounts of sulfated galactans and cellulose. In contrast, the unfractionated polysaccharides of the other five species were rich in galactans displaying diverse 3,6-anhydro-galactose and galactose linkages with varied sulfation patterns. Different levels of cellulose were also observed. This glycosidic linkage method offers advantages for cellulose analysis over traditional monosaccharide analysis that is known for underrepresenting glucose in crystalline cellulose. Relative linkage compositions calculated from GC-MS and GC-FID measurements showed that anhydro sugar linkages generated more response in the latter detection method. This improved linkage workflow presents a useful tool for studying polysaccharide structural variations across red seaweed species. Furthermore, for the first time, relative linkage compositions from GC-MS and GC-FID measurements, along with normalized FID and total ion current (TIC) chromatograms without peak assignments, were analyzed using principal component analysis (PCA) as a proof-of-concept demonstration of the technique's potential to differentiate various red seaweed species.

Background: Educating college students about the importance of good sleep habits could lead to the adoption of healthier sleep routines, including sufficient sleep duration and sleep quality. The current pre-post study examines the impact of completing a sleep education program called “Sleep 101” on (1) sleep hygiene practices, (2) sleep quality, and (3) weekday and weekend sleep behaviors among college students. “Sleep 101” is an interactive online course developed to educate college students about the importance of sleep by addressing basic sleep physiology, the impact of sleep on mood, academic and physical performance, the interactions between sleep and various substances, and common sleep disorders. Methods: 338 college students were recruited from a midsized public university in the US and invited to participate in “Sleep 101”, of which 25 participants completed the baseline and post-intervention questionnaire. The Sleep Hygiene Index (SHI) was utilized to evaluate sleep hygiene practices, while standard questions were employed to assess weekday and weekend sleep behaviors and overall sleep quality. Results: Those who completed the study demonstrated a significant increase in weekday sleep duration and were less likely to engage in negative prior bedtime activities. In addition, 40% of those who completed baseline and post-intervention assessments noticed improvements in their sleep quality. Conclusion: These findings suggest that a brief online program is beneficial in improving sleep behaviors among college and could be a scalable approach to addressing current sleep issues and preventing future sleep problems in college students.

The profile of secondary metabolites occurring in apple cuticular layer is not only characteristic for particular apple cultivar, but also dynamically reflects various external factors in growing environment. In this study, the possibility to authenticate apple samples based on analysis of their cuticular layer extracts was investigated. Ultra-high-performance liquid chromatography coupled to high resolution tandem mass spectrometry (UHPLC-HRMS/MS) was employed for obtaining metabolomic fingerprints. In total, 274 authentic apple samples, four cultivars harvested within the seasons 2020 to 2022 in the Czech Republic and Poland were analysed. The generated complex data processed by univariate and multivariate statistical methods enabled to build classification models for discrimination of apple cultivars as well as their geographical origin. The models showed very good performance in differentiation of Czech and Polish samples for three of four cultivars: ‘Gala’, ‘Golden Delicious’ and ‘Idared’, moreover, the validity of the models was verified over harvest seasons. The diagnostic markers, besides metabolites of triterpene biosynthetic pathway, mainly represented wax esters. ‘Jonagold’, which is known to be susceptible to mutations, was the only cultivar for which the unambiguous classification of geographical origin was not possible.

Superior fiber quality is one of the most important objectives in cotton breeding. To detect the genetic basis underlying fiber quality, an F2 population containing 413 plants was constructed by crossing Jifeng 914 and Jifeng 173, both of which have superior fiber quality, with Jifeng 173 being better. Five fiber quality traits were investigated in the F2, F2:3, F2:4, and F2:5 populations. Quantitative trait loci (QTL) mapping was conducted based on a high-density genetic map containing 11,488 single nucleotide polymorphisms (SNPs) and spanning 4,202.12 cM in length. Transgressive segregation patterns and complex correlations in the five tested traits were observed. A total of 108 QTLs were found, including 27 for fiber length (FL), 16 for fiber strength (FS), 24 for micronaire (MC), 17 for fiber uniformity (FU), and 24 for fiber elongation rate (FE). Chromosome A7 contained 12 QTL, ranking the first. No QTL was found on chromosome D1 and D11. Each QTL contributed 1.98%–21.45% to the phenotypic variation (PV), including 13 major effect QTLs that contributed more than 10% toward PV. Two QTLs could be repeatedly detected in three populations, including qFL-D3-2 in F2, F2:4, and F2:5 with 9.18%–21.45% of PV, qFS-A11-1 in F2:3, F2:4 and F2:5 with 6.05%–10.41% of PV. Another seven stable QTLs could be detected in two populations, including four major effect QTLs: qFL-A12-3, qFS-D10-2, qMC-D6-2, and qMC-D8-1. Fourteen QTL-overlapping regions were found, which might explain the complex correlations among the five phenotypic traits. Four regions on chromosome A11, D3, D6, and D10 covered by both stable and major effect QTLs are promising for further fine mapping. The genomic regions of the two QTLs detected in three populations and the four major effect QTLs contain 810 genes. Gene functional analysis revealed that the annotated genes are mainly involved in protein binding and metabolic pathways. Fifteen candidate genes in the qFL-D3-2 region are highly expressed in fiber or ovules during fiber initiation, elongation, secondary cell wall thickening, or maturation stages. qRT-PCR revealed that Ghir_D03G005440.1 and Ghir_D03G011310.1 may play a role in promoting fiber initiation, Ghir_D03G006470.1 may be beneficial for promoting fiber elongation. This study provides more information for revealing the molecular genetic basis underlying cotton fiber quality.

Currently there are fewer depth models applied to pepper picking detection, while the existing generalized neural networks have problems such as large model parameters, long training time, and low model accuracy.In order to solve the above problems, this paper proposes a Yolo-chili target detection algorithm for chili pepper detection. First, the classical target detection algorithm yolov5 is used as a benchmark model, and an adaptive spatial feature pyramid structure combining the attention mechanism and the idea of multi-scale prediction is introduced to improve the model's detection effect on occluded peppers and small target peppers. Secondly, a three-channel attention mechanism module is introduced to improve the algorithm's long-distance recognition ability and reduce the interference of redundant testers. Finally, the quantized pruning method is used to reduce the model parameters and realize the lightweight processing of the model. Applying the method to the homemade chili pepper dataset, the AP value of chili pepper reaches 93.11%; the accuracy rate is 93.51% and the recall rate is 92.55%.The experimental results show that yolo-chili is able to achieve accurate and real-time pepper detection under complex orchards.

The temporary immersion system bioreactor named GreenTray®[2], [3]presents advantages over the existing ones. Firstly, there is no need to use forceps to move the shoots or plantlets in or out of the recipient, neither the use of scalpel to divide them. Secondly, the basis of the shoot can remain in the GreenTray® and can sprout again in several cycles of growth. These two characteristics reduce the costs in the process of micropropagation. Besides, shoots or plantlets development is enhanced by the aeration of the recipient, thus enriching with CO2 the recipient atmosphere. The chapter describes and provides images and values of interest in (1) the micropropagation process of some commercial Prunus or Pyrus rootstocks; (2) the plantlet growth under autotrophic conditions; and (2) the inoculation of plants with pathogens that reproduce in vitro the symptoms observed in vivo, using the GreenTray® bioreactor.