Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region.

Peripheral neuropathy (PN) significantly impacts the quality of life, causing substantial morbidity and increased mortality, as well as escalating healthcare costs. While PN can have various causes, the most common form, diabetic peripheral neuropathy, poses considerable risks for potential complications. Diabetic peripheral neuropathy (DPN) affects over 50% of people with prediabetes and diabetes. Despite its prevalence, a global gap in diagnosis and management exists, exacerbated by the COVID-19 pandemic. This expert consensus was formulated through a comprehensive evaluation by a panel of experts, informed by a focused literature review, aiming to establish a clinically robust approach to diagnosing and managing pre- and diabetic PN with the early utilization of neurotropic B vitamins. This document offers a consensus perspective on the existing challenges in diagnosing and managing PN, focusing on DPN. The expert panel proposes measures to address this underdiagnosed burden, highlighting the importance of early intervention through innovative screening methods, integrated care approaches, and therapeutic strategies. The document advocates for increased awareness, targeted campaigns, and proactive care strategies to bridge gaps in the patient care of individuals with diabetes, emphasizing the importance of early detection and timely management to improve overall health outcomes. Specific recommendations include incorporating simplified questionnaires and innovative screening methods into routine care, prioritizing neurotropic B vitamin supplementation, optimizing glucagon-like peptide 1 (GLP-1) receptor agonist treatments, and adopting a holistic approach to neuropathy management. The consensus underscores the urgent need to address the underdiagnosis and undertreatment of PN, offering practical measures to enhance early detection and improve health outcomes for individuals with DPN.

Response surface optimization of a single-step castor oil-based biodiesel production process using a stator-rotor hydrodynamic cavitation reactor.

In order to combat environmental pollution and the depletion of non-renewable fuels, feasible, eco-friendly, and sustainable biodiesel production from non-edible oil crops must be augmented. This study is the first to intensify biodiesel production from castor oil using a self-manufactured cylindrical stator-rotor hydrodynamic cavitation reactor. In order to model and optimize the biodiesel yield, a response surface methodology based on a 1/2 fraction-three-level face center composite design of three levels and five experimental factors was used. The predicted ideal operating parameters were found to be 52.51°C, 1164.8 rpm rotor speed, 27.43 min, 8.4:1 methanol-to-oil molar ratio, and 0.89% KOH concentration. That yielded 95.51% biodiesel with a 99% fatty acid methyl ester content. It recorded a relatively low energy consumption and high cavitation yield of 6.09 × 105 J and 12 × 10-3 g/J, respectively. The generated biodiesel and bio-/petro-diesel blends had good fuel qualities that were on par with global norms and commercially available Egyptian petro-diesel. The preliminary cost analysis assured the feasibility of the applied process.

Multi-View Soft Attention-Based Model for the Classification of Lung Cancer-Associated Disabilities.

Background: The detection of lung nodules at their early stages may significantly enhance the survival rate and prevent progression to severe disability caused by advanced lung cancer, but it often requires manual and laborious efforts for radiologists, with limited success. To alleviate it, we propose a Multi-View Soft Attention-Based Convolutional Neural Network (MVSA-CNN) model for multi-class lung nodular classifications in three stages (benign, primary, and metastatic). Methods: Initially, patches from each nodule are extracted into three different views, each fed to our model to classify the malignancy. A dataset, namely the Lung Image Database Consortium Image Database Resource Initiative (LIDC-IDRI), is used for training and testing. The 10-fold cross-validation approach was used on the database to assess the model's performance. Results: The experimental results suggest that MVSA-CNN outperforms other competing methods with 97.10% accuracy, 96.31% sensitivity, and 97.45% specificity. Conclusions: We hope the highly predictive performance of MVSA-CNN in lung nodule classification from lung Computed Tomography (CT) scans may facilitate more reliable diagnosis, thereby improving outcomes for individuals with disabilities who may experience disparities in healthcare access and quality.

Using an Active Screwed Nasoalveolar Molding Device for Defect Rehabilitation in Patients With Bilateral Cleft Lip and Palate.

The present case series aimed to assess non-surgical elongation of the columella and reduction of cleft gaps in patients with bilateral cleft lip and palate using the active nasoalveolar molding (ANAM) device and tissue expansion principles. The study included six complete bilateral cleft patients aged one month: three males and three females. A nasoalveolar molding technique was applied using an active device (ANAM) with a 3D screw, worn by infants for two months. The activation protocol for screw closure is approximately 0.25 mm (quarter turn) on alternating days, resulting in almost 1 mm per week and 4 mm per month and reaching 8 mm after eight weeks. Evaluation involved measuring lip defect sizes and the nostril gap, columellar length and rotation of premaxilla before and two months after the ANAM period before surgical repair. The results show that the anterior rotation of the premaxilla and the lip and nostril gaps were significantly reduced (p < 0.05), with maximum reduction in the anterior rotation of the premaxilla (mean difference ± SD was 4.22 ± 0.4). Simultaneously, the columellar height was significantly increased with a mean difference ± SD of 2.0 ± 0.4 (p < 0.001). The current case series demonstrated that the ANAM device is a safe and effective technique for decreasing the lip and nostril gaps, repositioning the protruded premaxilla, and elevating the depressed columella. No side effects were recorded in current cases.

Epidemiological modeling of COVID-19 data with Advanced statistical inference based on Type-II progressive censoring.

This research proposes the Kavya-Manoharan Unit Exponentiated Half Logistic (KM-UEHL) distribution as a novel tool for epidemiological modeling of COVID-19 data. Specifically designed to analyze data constrained to the unit interval, the KM-UEHL distribution builds upon the unit exponentiated half logistic model, making it suitable for various data from COVID-19. The paper emphasizes the KM-UEHL distribution's adaptability by examining its density and hazard rate functions. Its effectiveness is demonstrated in handling the diverse nature of COVID-19 data through these functions. Key characteristics like moments, quantile functions, stress-strength reliability, and entropy measures are also comprehensively investigated. Furthermore, the KM-UEHL distribution is employed for forecasting future COVID-19 data under a progressive Type-II censoring scheme, which acknowledges the time-dependent nature of data collection during outbreaks. The paper presents various methods for constructing prediction intervals for future-order statistics, including maximum likelihood estimation, Bayesian inference (both point and interval estimates), and upper-order statistics approaches. The Metropolis-Hastings and Gibbs sampling procedures are combined to create the Markov chain Monte Carlo simulations because it is mathematically difficult to acquire closed-form solutions for the posterior density function in the Bayesian framework. The theoretical developments are validated with numerical simulations, and the practical applicability of the KM-UEHL distribution is showcased using real-world COVID-19 datasets.

Post-surgical complications of supernumerary teeth in the mandibular premolar area: A systematic review.

In the mandibular premolar area, supernumerary teeth are a rare disorder that are rarely documented in the literature. The purpose of this study was to evaluate the post-surgical problems associated with the buccal and lingual techniques used to treat the extra teeth in this area. Using PubMed, PubMed Central, Science Direct, Cochrane, Wiley, and manual search, a thorough search was done to locate and identify cases and case series with extra teeth in the mandibular premolar region. For every study that was included, data on the surgical technique and postoperative problems were documented. Seven studies involving 90 patients were included. Supernumerary teeth in the mandibular premolar region were predominantly found in male patients (65.55 %), with most cases occurring in the right mandibular region (77.16 %). Postoperative complications after removing supernumerary teeth using buccal and lingual approaches were similar, with only one complication reported among the 90 cases reviewed. Although the findings suggest that surgical management of supernumerary teeth in the mandibular premolar region is relatively safe, caution is advised due to the limited sample size. Detailed pre-operative evaluation, a comprehensive treatment plan, and regular follow-up can minimize postoperative complications.

Simultaneous implementation of unrelated tumour sites on the MR Linac: A review of the commissioning process from a radiographer perspective and lessons learned.

INTRODUCTION: This work reports on a systematic approach to select MRI sequences, quantify inter-observer image registration variation and determine patient positioning for the clinical implementation of MR-guided adaptive radiotherapy (MRgRT) in patients with oropharyngeal (H&N) and lung cancer. METHODS: A total of 30 participants (N=10 H&N and N=10 lung cancer patients and N=10 healthy participants) were scanned on the Elekta Unity Magnetic Resonance Linear Accelerator (MRL). Participant experience questionnaires were used to determine the most appropriate positioning device for lung treatments and tolerability of H&N immobilization devices within the confined MR Linac environment. Visual guided assessments (VGAs) completed by three observers (one oncologist and two radiographers) were used to determine the most suitable tissue weighting (using vendor-provided 3D T1w and T2w sequences) for online image registration. Offline MRI to CT and MRI to MRI rigid registrations were undertaken by nine radiographers using bony and soft tissue matching. Single-factor ANOVA and paired t-tests were utilized to determine the interobserver variation. RESULTS: Based on oncologist and patient feedback, lung cancer patients would be treated in a vac-bag with their arms by their sides, while H&N cancer patients would be immobilized using a 5-point fixation device and 5-point personalized thermoplastic shell. There was no clear preference for T1w or T2w images in the H&N cohort. However, observers preferred T2w sequences for tumour and organ at risk (OAR) visualization in the lung images. When a bony match was conducted, single-factor ANOVA tests showed no statistically significant differences between all H&N image registration types (p=0.09). For the soft-tissue registrations, T1w-CT and T1w-T1w registrations showed a statistically significant (p=0.01) reduction in inter-observer variability over T2w-CT registrations. Paired t-tests showed no statistically significant differences for bony or soft tissue matches using T1w or T2w sequences to the planning CT in the lung cohorts (p=0.63 and p=0.52, respectively). CONCLUSION: We describe the systematic approach to the selection of strategies for imaging, immobilization, and online image registration we used for H&N and lung cancer treatments on the MRL. This has facilitated the selection of the most appropriate adaptive MRgRT strategies for treating these sites at our institution.

Awareness of Antibiotic Misuse in Upper Respiratory Tract Infections Among Adults in the Bisha Governorate in 2024.

INTRODUCTION: Antibiotics are targeted to kill or inhibit the growth of bacteria and have no effect on viral agents. Unfortunately, viruses cause about 80% of respiratory tract infections, and up to 75% of antibiotics are prescribed for URTIs. Overuse of antibiotics is linked to a number of issues, including the emergence of antibacterial resistance, an increase in the prevalence of chronic illnesses, a rise in the expense of healthcare services, and the emergence of side effects. This study aimed to assess the awareness of antibiotic misuse for URTIs among adults in the Bisha governorate in 2024. METHODS AND MATERIALS: A community-based, cross-sectional study was conducted in the Bisha governorate among the adult population. Data was collected using an online standardized self-administered adapted questionnaire. The questions vary from multiple choice to Likert scale questions, and each question has 2 points. Data was analyzed using SPSS version 26 (IBM SPSS Statistics, Armonk, NY). RESULTS: The response rate was about 85.3% (721/845). The ages of the participants ranged between 18 and 75 years. There were 360 (49.9%) male respondents and 361 (50.1%) female respondents. The study revealed that 83.1% (599) of the participants have poor awareness of antibiotic misuse in URTIs. Knowledge of antibiotic misuse consequences was poor at 66.7% (481). There was a significant difference observed between the residents of Bisha city compared to the residents of Bisha villages in total knowledge level about antibiotic misuse in URTIs (p = 0.030). CONCLUSION AND RECOMMENDATIONS: The population of the Bisha governorate has a poor knowledge of antibiotic misuse in URTIs. Therefore, efforts should be made to increase the knowledge and awareness of the general public about the problem.

Utilizing Bayesian inference in accelerated testing models under constant stress via ordered ranked set sampling and hybrid censoring with practical validation.

This research investigates the application of the ordered ranked set sampling (ORSSA) procedure in constant-stress partially accelerated life-testing (CSPALTE). The study adopts the assumption that the lifespan of a specific item under operational stress follows a half-logistic probability distribution. Through Bayesian estimation methods, it concentrates on estimating the parameters, utilizing both asymmetric loss function and symmetric loss function. Estimations are conducted using ORSSAs and simple random samples, incorporating hybrid censoring of type-I. Real-world data sets are utilized to offer practical context and validate the theoretical discoveries, providing concrete insights into the research findings. Furthermore, a rigorous simulation study, supported by precise numerical calculations, is meticulously conducted to gauge the Bayesian estimation performance across the two distinct sampling methodologies. This research ultimately sheds light on the efficacy of Bayesian estimation techniques under varying sampling strategies, contributing to the broader understanding of reliability analysis in CSPALTE scenarios.

Knowledge, Awareness, and Attitude of Physicians Toward Child Abuse: A Cross-Sectional Study.

INTRODUCTION: Child abuse refers to any type of mistreatment of a child, perpetrated by a parent, caregiver, or another individual in a custodial capacity, which may lead to instances of physical, sexual, or emotional abuse. Physicians play a crucial role in identifying and managing this phenomenon in the healthcare setting, as the number of unreported cases increases globally. METHODS: A questionnaire-based cross-sectional study was conducted between 2022 and 2023 among physicians practicing in Saudi Arabia to assess their knowledge, awareness, and attitude toward child abuse. The data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). RESULTS: A total of 153 physicians were involved in this study, in which 65 participants (42.5%) indicated poor awareness of child abuse, while 79 participants (51.6%) indicated moderate knowledge of child abuse. Additionally, lack of knowledge was the most common barrier to reporting child abuse in 87 participants (56.9%). A positive significant correlation was identified between awareness and knowledge and between knowledge and attitude. Also, it was found that a higher attitude score was more associated with being male, having less experience, practicing in the emergency medicine department, and working in a governmental hospital. CONCLUSION: These results highlight the significance of implementing specialized training programs and workshops focused on identifying and reporting child abuse, as well as providing guidelines for recognizing signs of abuse and taking appropriate intervention measures.

Expanding Global Radiotherapy Access via Telemedicine.

AIMS: Cancer is a leading cause of death globally. Over 70% of the 10 million cancer deaths worldwide in 2020 occurred in low- and middle-income countries. Radiotherapy is an important cancer treatment, used in half of cancer patients. Significant global disparities in radiotherapy access exist, with low access in low- and middle-income countries. The benefits of tele-radiotherapy in low- and middle-income countries for expanding global radiotherapy access are yet to be fully realized. In this paper, we highlight potential applications of tele-radiotherapy in expanding access to high-quality radiotherapy in developing countries. MATERIALS AND METHODS: We performed a literature search to retrieve studies involving telemedicine applications in radiotherapy to provide a comprehensive overview of the topic. PubMed database served as the main source for retrieving studies, using the following search terms: ("telemedicine", "radiotherapy", "telehealth", "remote monitoring", "oncology", and "remote training"). Additional selected papers were obtained from Web of Science, and Google Scholar using the same search terms. RESULTS: Telemedicine in radiotherapy has many applications. Virtual training could upgrade radiotherapy skills in low- and middle-income countries, enabling safe adoption of new radiotherapy techniques and quality assurance. Tele-radiotherapy consultations and patient follow-up could improve the efficiency of clinics while tele-radiotherapy planning and peer-review could enable equitable global access to radiotherapy expertise. Telemedicine could also facilitate wider global access to radiotherapy trials. While telemedicine in radiotherapy holds significant promise in improving global radiotherapy access, several barriers to its adoption exist. These include a lack of infrastructure, data security concerns, regulatory challenges, resistance from providers and patients, financial constraints, miscommunication during remote consultations, and lack of training. CONCLUSION: Tele-radiotherapy applications hold promise in providing solutions to overcome global radiotherapy access inequity but the benefits of tele-radiotherapy in low- and middle-income countries are yet to be fully realized.

A simple technical innovation to prevent needle stick injuries among dental professionals.

OBJECTIVE: Dental healthcare personnel face the potential danger of being exposed to infectious patients while administering local anesthesia injections during dental operations. This could lead to unintentional transfer of infectious diseases from patients to physicians. Although safety measures such as the One-hand-scoop technique and the use of safety syringes, plastic needle cap holders, and needles with safety caps are in place, there have been instances of needle stick injuries reported in clinics. This might be due to the lack of adherence to conventional safety measures or the impracticality of safety techniques and safety syringes. This article aims to demonstrate the utilization of dental tweezers, specifically London College tweezers or dental forceps, for the secure recapping of needles, eliminating the requirement for extra equipment or devices. SUBJECTS AND METHODS: After obtaining ethical approval (Approval No.: 024-01-2024) from the College of Dentistry, Dar Al Uloom University, 67 dental professionals, with consent for participation in the study, were included. They were requested to use dental tweezers/London College tweezers and dental extraction forceps such as maxillary anterior, mandibular anterior, and maxillary bayonet root forceps individually to recap the local anesthetic needles. The efficacy of these techniques was evaluated against the one-hand scoop technique for its ease, convenience, and reliability in preventing needle stick injuries. RESULTS: The evaluation of dental professionals regarding the ease of using dental tweezers to recap needles, compared to the one-hand scoop technique (p=0.592), maxillary bayonet root forceps (p=0.746), mandibular anterior forceps (p=0.380), and maxillary anterior forceps (p=0.808), did not yield statistically significant results. The assessment of the procedural simplicity of the one-hand scoop technique showed a satisfaction rate of over 40%, whereas the application of dental tweezers resulted in a satisfaction rate of 30%. However, the use of dental tweezers for needle recapping resulted in a satisfaction rate of over 50%, compared to a satisfaction rate of 30% for the one-handed scoop technique. CONCLUSIONS: There is no statistically significant difference in the assessment of the efficacy of dental tweezers and the one-hand scoop technique, bayonet root forceps, mandibular anterior forceps, maxillary anterior forceps, and dental tweezers for the needle capping technique. Therefore, dental forceps can be used instead of the one-handed scoop approach. The needle recapping procedure outlined in our study, aimed at preventing needle stick injuries, is simple to implement, and all dental specialties have convenient access to the required instruments.

Retraction: Ruptured Isolated Common Iliac Artery Aneurysm Masquerading as Renal Colic.

[This retracts the article DOI: 10.7759/cureus.19752.].

Adsorptive removal of organic pollutants from aqueous solutions using novel GO/bentonite/MgFeAl-LTH nanocomposite.

The contamination of water with organic pollutants such as dyes and phenols is a serious environmental problem, requiring effective treatment methods. In the present study, a novel nanocomposite was synthesized by intercalating graphene oxide and bentonite clay into MgFeAl-layered triple hydroxide (GO/BENT/LTH), which was characterized using different techniques. The adsorption efficacy of the GO/BENT/LTH nanocomposite was assessed via the removal of two harmful organic water pollutants, namely methyl orange (MO) and 2-nitrophenol (2NP). The obtained results revealed that the maximum adsorption capacities (qmax) of MO and 2NP reached 3106.3 and 2063.5 mg/g, respectively, demonstrating the excellent adsorption performance of the nanocomposite. Furthermore, this study examined the effects of contact time, initial MO and 2NP concentrations, pH, and temperature of the wastewater samples on the adsorptive removal of MO and 2NP by the GO/BENT/LTH nanocomposite. The pH, zeta potential, and FTIR investigations suggested the presence of more than one adsorption mechanism. Thermodynamic investigations elucidated the exothermic nature of the adsorption of MO and 2NP onto the GO/BENT/LTH nanocomposite, with MO adsorption being more sensitive to temperature change. Additionally, regeneration studies revealed a marginal loss in the MO and 2NP removal with the repetitive use of the GO/BENT/LTH nanocomposite, demonstrating its reusability. Overall, the findings of this study reveal the promise of the GO/BENT/LTH nanocomposite for effective water decontamination.

Impact of maternal topiramate ingestion on ossification of skull and appendicular bones in rat fetuses.

The skull and appendicular bones are derived from different embryological sources during their development. The impact of prenatal exposure of topiramate on ossification of these bones is not adequately studied. The goal of this study was to assess the ossification patterns of the craniofacial bones and bones of the forelimbs and hindlimbs in 20-day-old rat fetuses after maternal exposure to topiramate at doses equivalent to human therapeutic doses. Three groups of Sprague-Dawley pregnant rats were used: control, topiramate 50mg/kg/day (T50) and topiramate 100mg/kg/day (T100). Topiramate was given by oral gavage from day 6 to day19 of gestation. Ossification was evaluated in the bones of 20 days fetuses after staining with Alizarin red. Results showed a significant reduction in complete ossified centers of the metacarpal, metatarsal and craniofacial bones in topiramate-exposed fetuses at both doses when compared to the control group. Also, a significant decrease in the length of ossified part of the long bones of the forelimbs and hindlimbs in topiramate-exposed fetuses at both doses was noted when compared to the control group. Crown-rump length and fetal weight were significantly decreased in topiramate treated groups compared to the control group. In all examined groups, there was a positive correlation between the crown-rump length and the lengths of humerus and femur. No abnormalities in the ossified bones and no significant changes in their ossification pattern were observed between the treated groups. In conclusion, prenatal administration of topiramate in doses equivalent to human therapeutic doses delayed ossification and development of craniofacial and appendicular bones in rat fetuses and their effects are not dose dependent at doses investigated. The implications of these findings in women who require topiramate therapy in pregnancy merit further evaluation.

Ensemble meta machine learning for predicting the adsorption of anionic and cationic dyes from aqueous solutions using Polymer/graphene/clay/MgFeAl-LTH nanocomposite.

Adsorption is one of the most promising wastewater treatment methods due to its simplicity and efficacy at ambient temperature and pressure. However, the technical and economic feasibility of this process largely depends on the performance of the utilized adsorbents. In this study, a promising adsorbent made of polyethyleneimine, graphene oxide (GO), bentonite, and MgFeAl-layered triple hydroxide (MgFeAl-LTH) has been synthesized and characterized. The results revealed that the synthesized nanocomposite (abbreviated as PGB-LTH) possesses good porosity and crystallinity. The adsorption performance of the PGB-LTH nanocomposite towards two harmful water pollutants (i.e., methyl orange (MO) and crystal violet (CV)) was investigated, and the results revealed that the nanocomposite outperforms its parental materials (i.e., GO, bentonite, and MgFeAl-LTH). The maximum adsorption capacity (qmax) of MO and CV onto the nanocomposite could reach 1666.7 and 1250.0 mg/g, respectively, as predicted using the Langmuir adsorption isotherm. Additionally, the PGB-LTH nanocomposite is highly reusable with an insignificant decline in performance upon repetitive use. In terms of thermodynamics, MO adsorption onto the nanocomposite is exothermic while CV adsorption is endothermic despite that both dyes adsorb spontaneously as revealed by the negative values of the Gibbs free energy change at all the examined temperatures. The generated adsorption data were utilized for constructing and assessing ensemble meta-machine learning techniques aimed at cost-effective simulation and prediction of the proposed adsorption method. Bagging and boosting methods were developed and evaluated intensively using the obtained adsorption data. The Extra Trees model achieved promising results as evidenced by the high correlation coefficient of 99% as well as low computed RMSE and MAE errors of 11.42 and 5.11, respectively, during the testing phase. These results demonstrate the model strong capability to effectively simulate and predict the adsorption process in question.

Multi-Disease Detection Using a Prism-Based Surface Plasmon Resonance Sensor: A TMM and FEM Approach.

This research introduces a surface plasmon resonance (SPR)-based biosensor with multilayered structures for telecommunication wavelength in order to detect multiple diseases. The malaria and the chikungunya viruses are taken into account and the presence of these viruses are determined by examining several blood components in healthy and affected phases. Here, two distinct configurations (Al-BTO-Al-MoS2 and Cu-BTO-Cu-MoS2) are proposed and contrasted for the detection of numerous viruses. The performance characteristics of this work have been analyzed using Transfer Matrix Method (TMM) method and Finite Element Method (FEM) method under angle interrogation technique. From the TMM and FEM solutions, it is evident that the Al-BTO-Al-MoS2 structure provides the highest sensitivities of ~270 deg./RIU for malaria and ~262 deg./RIU for chikungunya viruses, with satisfactory detection accuracy of ~1.10 for malaria, ~1.64 for chikungunya, and quality factor of ~204.40 for malaria, ~208.20 for chikungunya. In addition, the Cu-BTO-Cu MoS2 structure offers the highest sensitivities of ~310 deg./RIU for malaria and ~298 deg./RIU for chikungunya, with satisfactory detection accuracy of ~0.40 for malaria, ~0.58 for chikungunya, and quality factor of ~89.85 for malaria, ~86.38 for chikungunya viruses. Therefore, the performance of the proposed sensors is analyzed using two distinct methods and gives around similar results. In a sum, this research could be utilized as a theoretical foundation and first step in the development of a real sensor.

The Cross Talk Between Psoriasis, Obesity, and Dyslipidemia: A Meta-Analysis.

Although psoriasis is a multi-organ disease, it is usually managed as a skin disease, ignoring its associated serious comorbidities. This meta-analysis aimed to investigate the relationship between psoriasis, dyslipidemia, and obesity. Two authors independently searched three databases (PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), The Cochrane Library, and Google Scholar). The search was set for articles published in the English language during the period from January 2013 to August 2023. The keywords "psoriasis", "hypercholesterolemia", "dyslipidemia", "low-density lipoproteins", "high body mass index", and "obesity", were used. Out of the 145 full texts reviewed, only seven studies fulfilled the inclusion and exclusion criteria (773,761 participants and 196,593 events). Psoriasis was associated with dyslipidemia and obesity (odds ratio (OR)=1.63, 95% CI: 1.42-1.88 and OR=1.70, 95% CI: 1.43-2.02), respectively, with significant heterogeneity (98% and 97%, respectively). Dyslipidemia and obesity were significant psoriasis comorbidities; a broader approach, viewing psoriasis as a multi-organ disease, is recommended for optimal treatment and outcomes.

Solitary Osteochondroma at Unusual Sites: A Case Report and Literature Review.

Osteochondromas (OCs) are bone lesions composed of cartilaginous and medullary bone capped with hyaline cartilage. OCs result from the separation of epiphyseal growth plate cartilage, pushing through the periosteal bone cuff. They commonly appear as pedunculated or sessile masses in the metaphysis of long bones and are the most common benign bone tumors. While rare in the scapula, OCs can occur there. Symptoms may arise from fractures, osseous abnormalities, or potential malignant transformation, especially in the presence of hereditary multiple exostoses (HME). The estimated rate of malignant transformation in solitary lesions is 1%, whereas in hereditary multiple OCs, it can reach up to 3-5%. We report a case of a 10-year-old female who presented with a gradually progressive swelling on the back of her right scapula. This progressive growth has been observed over the course of the past two years accompanied by mild pain. The pain was intermittent and did not affect her daily activities. On examination, a hard, tender, non-mobile swelling of approximately 2 × 2 cm was found over the right scapula. The patient had a normal range of motion in the shoulder and scapulothoracic regions. In conclusion, since solitary scapular OCs are extremely rare, they are quite common when associated with HME. This study aimed to increase awareness of the unusual site of OCs. Furthermore, we have included a full account of the surgical therapy we administered to this patient in order to assist future surgeons who may come across similar conditions.