Complex Variations in Branches of the Axillary Artery / Variaciones Complejas en Ramas de la Arteria Axilar

SUMMARY: The axillary artery is a continuation of the subclavian artery and transitions into the brachial artery. Variations in the axillary artery are not uncommon. During the upper-limb dissection of a 95-year-old Korean female cadaver, assorted anatomical variations of the axillary artery branches were identified. On the right side, no branches emerged from the first part of the axillary artery. The thoracoacromial artery (excluding the pectoral branch) and the common subscapular trunk arose from the second part, with the common subscapular trunk giving origins to the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, and accessory posterior circumflex humeral artery. Additionally, the superior thoracic artery arose from the lateral thoracic artery. The third part of the axillary artery gave rise to the anterior and posterior circumflex humeral arteries, accessory acromial branch, and accessory thoracodorsal artery. On the left side, the thoracoacromial artery (excluding the pectoral branch) and the superior thoracic artery arose from the first part. The common subscapular trunk arose from the second part, which included the pectoral branch, lateral thoracic artery, and subscapular artery. The subscapular artery is divided into the thoracodorsal artery, circumflex scapular artery, accessory posterior circumflex humeral artery, and accessory lateral thoracic artery. The third part gave rise to the anterior and posterior circumflex humeral arteries and the accessory acromial branch. This study presents variations of the axillary artery, emphasizing their rarity, considering their embryologic basis, and highlighting their importance not only for educational purposes but also surgical and radiological applications.

La arteria axilar es una continuación de la arteria subclavia y luego esta continua como arteria braquial. Las variaciones en la arteria axilar no son infrecuentes. Durante la disección de los miembros superiores de un cadáver de una mujer coreana de 95 años, se identificaron diversas variaciones anatómicas de las ramas de la arteria axilar. En el lado derecho no se originaban ramas de la primera parte de la arteria axilar. La arteria toracoacromial (excluyendo la rama pectoral) y el tronco subescapular común surgieron de la segunda parte, y el tronco subescapular común dio origen a la rama pectoral, la arteria torácica lateral y la arteria subescapular. La arteria subescapular se dividía en arteria toracodorsal, arteria circunfleja escapular y arteria humeral circunfleja posterior accesoria. Además, la arteria torácica superior se originaba de la arteria torácica lateral. La tercera parte de la arteria axilar dio origen a las arterias circunflejas humerales anterior y posterior, la rama acromial accesoria y la arteria toracodorsal accesoria. En el lado izquierdo, de la primera parte surgían la arteria toracoacromial (excluyendo la rama pectoral) y la arteria torácica superior. De la segunda parte se originaba el tronco subescapular común, que incluía la rama pectoral, la arteria torácica lateral y la arteria subescapular. La arteria subescapular se dividía en arteria toracodorsal, arteria circunfleja escapular, arteria circunfleja humeral posterior accesoria y arteria torácica lateral accesoria. La tercera parte daba origen a las arterias circunflejas humerales anterior y posterior y a la rama acromial accesoria. Este estudio presenta variaciones de la arteria axilar, enfatizando su rareza, considerando su base embriológica y destacando su importancia no sólo para fines educativos sino también para aplicaciones quirúrgicas y radiológicas.

A nomogram to predict the absence of clinically significant prostate cancer in males with negative MRI

ABSTRACT Purpose: To create a nomogram to predict the absence of clinically significant prostate cancer (CSPCa) in males with non-suspicion multiparametric magnetic resonance imaging (mpMRI) undergoing prostate biopsy (PBx). Materials and Methods: We identified consecutive patients who underwent 3T mpMRI followed by PBx for suspicion of PCa or surveillance follow-up. All patients had Prostate Imaging Reporting and Data System score 1-2 (negative mpMRI). CSPCa was defined as Grade Group ≥2. Multivariate logistic regression analysis was performed via backward elimination. Discrimination was evaluated with area under the receiver operating characteristic (AUROC). Internal validation with 1,000x bootstrapping for estimating the optimism corrected AUROC. Results: Total 327 patients met inclusion criteria. The median (IQR) age and PSA density (PSAD) were 64 years (58-70) and 0.10 ng/mL2 (0.07-0.15), respectively. Biopsy history was as follows: 117 (36%) males were PBx-naive, 130 (40%) had previous negative PBx and 80 (24%) had previous positive PBx. The majority were White (65%); 6% of males self-reported Black. Overall, 44 (13%) patients were diagnosed with CSPCa on PBx. Black race, history of previous negative PBx and PSAD ≥0.15ng/mL2 were independent predictors for CSPCa on PBx and were included in the nomogram. The AUROC of the nomogram was 0.78 and the optimism corrected AUROC was 0.75. Conclusions: Our nomogram facilitates evaluating individual probability of CSPCa on PBx in males with PIRADS 1-2 mpMRI and may be used to identify those in whom PBx may be safely avoided. Black males have increased risk of CSPCa on PBx, even in the setting of PIRADS 1-2 mpMRI

The physiology of orgasmic headache

Orgasmic headache is a headache caused by sexual activity that emerges as sexual excitement increases (progressive at onset) or as an immediate and powerful headache following orgasm (thunderclap at onset) or combines these two characteristics. The idea that orgasmic headache (OGH) is caused by physiologically inappropriate responses is extremely simplistic. As a result, a complete analysis of the physiological mechanisms is provided here in order to comprehend the complex situation of OGH. The physiology of OGH was studied in humans utilizing peer-reviewed papers from Pubmed, Science direct, EBSCO, Scopus, Cochrane library, Sage Journals, and Google Scholar. Author, year of publication published between 2003 and 2020. OGH can regulate psychophysiological reactions, but it can also cause a rise in blood pressure, persistent pain, intracranial hemorrhage, and cerebral infarction. This review explains two physiological systems: the release of calcitonin gene-related peptide (CGRP), which induces the creation of less serotonin, resulting in an inflammatory response and discomfort. The release of epinephrine and nor-epinephrine can cause cerebral ischemia, which can lead to headaches in headache-prone patients. Fear of an orgasmic headache can lead to lower libido, leading to lower sex pleasure. As a result, the condition may deprive sex of its pleasure and turn it into a ‘headache’. We conduct a literature review to study the physiological processes of OGH in connection to its physiological maladaptive responses. A greater understanding of the physiological mechanisms underlying Orgasmic headache will allow practitioners to properly identify and counsel patients without attributing physiological maladaptive reactions to OGH.

Proficiency testing program for screening drug testing laboratories in the Philippines, 2009-2019: Experience of the National Reference Laboratory of the East Avenue Medical Center

Background@#According to the guidelines of the Department of Health (DOH)’s Health Facilities and Services Regulatory Bureau (HFSRB), accreditation of drug testing laboratories (DTLs) requires annual participation in a proficiency testing (PT) program. Since 2009, the National Reference Laboratory for Environmental and Occupational Health, Toxicology and Micronutrient Assay of the East Avenue Medical Center (NRL-EAMC) has conducted the PT program for DTLs.@*Objectives@#This article aims to provide a general overview of the PT program conducted for screening drug testing laboratories (SDTLs) and to examine data on laboratories’ participation and performance in the PT program.@*Methodology@#Laboratories registered for the PT program were given ten 3-mL synthetic urine specimens which may or may not contain drugs of abuse such as methamphetamine and tetrahydrocannabinol at or above the cut-off level. Laboratories analyzed the PT specimens using immunoassay test kits. The results of the analysis were reported back to NRL-EAMC. The performance of the laboratories in the PT depends on the number of incorrect responses.@*Results@#For ten years (2009-2019), 1102 ± 188 laboratories annually participated in the program. The mean passing rate was 96.6 ± 4.8%. The number of laboratories which initially failed the PT program significantly decreased from 2009 (15.1%) to 2012 (1.5%). From 2013 to 2019, only below 2.5% of the participating laboratories initially failed the PT. On average, 48.4 ± 18.4% of the laboratories achieved an excellent performance, 34.0 ± 13.6% had a highly satisfactory performance, and 14.3 ± 5.4% got an acceptable performance.@*Conclusion@#The continued decreasing number of laboratories which failed the PT signifies the improvement of laboratories in urine drug testing. In general, some laboratories participating in the PT for the first time are the ones which initially fail the PT which could be due to a lack of experience in handling PT test items. The PT program highlights the effectiveness of quality control procedures being implemented in a drug testing laboratory.

Validation of the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) among Filipino patients in a Tertiary Medical Center / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#Gestational diabetes mellitus (GDM) is a common pregnancy complication with adverse fetal and maternal outcomes. Currently, there are only a few validated tools available that address knowledge in GDM. Recognition of the inconsistencies will provide for an effective learning program to achieve optimal results. This study aimed at validating the “Gestational Diabetes Mellitus Knowledge Questionnaire” (GDMKQ).@*Methodology@#A cross-sectional validation study on GDMKQ among 51 GDM patients aged at least 18 years was conducted in the outpatient clinics of a tertiary hospital. Excluded were those with pre-existing diabetes. The questionnaire was submitted for peer review for translation to Filipino and back-translation. Concurrent validity, internal consistency and test-retest reliability of the questionnaire were undertaken as part of the validation process. Descriptive analysis was used for data elaboration by using SPSS v23.@*Results@#The Filipino version of GDMKQ demonstrated sensible content and face validity. As measured, respondents obtained higher total and domain scores with better knowledge levels of GDM compared to its English version. An overall adequate knowledge was observed among those married and college subgroup as compared to single women and those with secondary level of education. The reliability of the questionnaire was calculated at 0.632 using the Kuder-Richardson 20. The test-retest scores using the Filipino-translated questionnaire has a Pearson correlation coefficient of 0.853 with moderate to good level of agreement with each other, and Cohen’s kappa of 0.564 with an intra-class correlation coefficient of 0.828.@*Conclusion@#The Filipino-translated version of GDMKQ is a valid screening tool that assesses a patient’s knowledge of gestational diabetes. Identifying the level of their understanding will enable clinicians to develop an individualized, effective learning program to improve pregnancy outcomes.

Determination of the relationship between olfactory function threshold and quality of life among adult Filipinos with perceived olfactory dysfunction

Objective@#To determine the relationship between olfactory function threshold and quality of life (QOL) among adult Filipinos with perceived olfactory dysfunction (OD).@*Methods@#Design:Cross - Sectional Study. Setting:Tertiary Government Training Hospital. Participants: 98 adults who had self-perceived olfactory dysfunction described as “poor” or “no sense” of smell@*Results@#We analyzed data from 98 participants, with a mean age of 35.91 + 12.58 years old, composed of 46 men (47%) and 52 women (53%), with 82 normosmic, six hyposmic and ten anosmic as categorized by their BTT scores. Twenty-seven percent (27%) identified themselves as having poor QOL based on Fil 17 QODNS. Differences were exhibited between sexes’ BTT scores - [t(96) = -2.32; p = .022; females, M: 9.25; SD: 2.33 vs. males, M: 7.76; SD : 3.91], civil status - Fil17QODNS scores [t(96)= 3.05, p < .003; married M: 11.72, SD: 13.74 vs. single, M: 4.71; SD: 8.66), and the presence of ENT symptoms BTT [t(96) = -7.15; p < .0001; symptomatic, M: 5.62; SD: 4.54, vs. asymptomatic, M: 9.78; SD: 1.14] and Fil 17 QODNS scores [t(96)= 3.94; P < .00001; symptomatic, M: 14.86; SD: 13.97] vs. asymptomatic, M: 5.217; SD: 9.60]. Significant risk factors were the presence of ENT symptoms [OR= 0.15; 95% CI: 0.02-0.97; P = .046] for poor smell threshold, and comorbidities [OR= 3.36; 95% CI: 1.04-10.85; P = .043] for poor QOL. A negative correlation was observed between Fil-QOD-NS scores and BTT scores [r = -0.477, p < .001; rs = -0.292, p = .004], signifying that the presence of olfactory dysfunction has an inverse relationship with the quality of life.@*Conclusion@#Individuals with olfactory dysfunction in this study population had poor quality of life as determined by the translated Filipino 17-item QOD-NS which has an inverse relationship with their smell threshold as represented by the BTT results. Among the factors studied, significant differences were found between sexes, civil status and presence of ENT symptoms in the BTT and Fil 17 QODNS scores. However, only presence of comorbidities and ENT symptoms are significant risk factors for quality of life and smell threshold, respectively, in this population.

Surveys on Suspected Adverse Effects Related to Coronavirus Disease 2019 Vaccination and the Impact of Early Publication of Results / 医薬品情報学

Objective: The coronavirus disease 2019 (COVID-19) vaccine was a specially approved pharmaceutical in Japan in February 2021. However, several people were concerned about its safety. Therefore, we conducted a survey on our hospital staff with suspected adverse effects related to COVID-19 vaccines and promptly published the results on our website. Methods: The current study included hospital staff who received the COVID-19 vaccine. A questionnaire survey on suspected adverse effects was conducted after each vaccination from the first to the fifth dose. Data on the survey results were promptly posted on the hospital’s website. The number of hits and time spent on the site were also evaluated. Then, we examined. the media (newspapers and television) that reported our findings and the content of their coverage. Results: There were no new findings regarding suspected adverse effects of the COVID-19 vaccines. An article published on our website on June 18, 2021, received more than 9,000 page views with an average time spent of > 3 min. Four media outlets reported on our hospital’s articles from June to July 2021, when public interest in the first and second doses of the vaccine was high. Conclusion: The early release of the survey results has provided a source of information for people who want to obtain safety information regarding the adverse effects of the COVID-19 vaccine.

Genomic aspects in reproductive medicine / 대한생식의학회지

Infertility is a complex disease characterized by extreme genetic heterogeneity, compounded by various environmental factors. While there are exceptions, individual genetic and genomic variations related to infertility are typically rare, often family-specific, and may serve as susceptibility factors rather than direct causes of the disease. Consequently, identifying the cause of infertility and developing prevention and treatment strategies based on these factors remain challenging tasks, even in the modern genomic era. In this review, we first examine the genetic and genomic variations associated with infertility, and subsequently summarize the concepts and methods of preimplantation genetic testing in light of advances in genome analysis technology.

Late-onset drug resistant epilepsy in an adolescent with Allan-Herndon-Dudley syndrome

Allan-Herndon-Dudley syndrome (AHDS) is a rare X-linked neurodevelopmental disorder with abnormal thyroid function caused by mutation in the solute carrier family 16 member 2 (SLC16A2) gene. Clinical manifestations of AHDS are global or axial hypotonia, a variety of movement disorders, severe intellectual disability, quadriplegia or spastic diplegia, growth failure, and seizures. A 10-year-old boy visited our hospital with the chief complaint of newly onset generalized tonic seizures with vocalization of weekly to daily frequency. He showed early infantile hypotonia, severe intellectual disability, and frequent respiratory infections. He could not walk independently and was non-verbal. Electroencephalogram revealed generalized slow spike and waves with multifocal spikes and slow background rhythms. His tonic seizures were controlled with more than two anti-seizure medications (ASMs). At 11 years of age, he was evaluated for thyroid function as part of regular screening for ASM maintenance and was found to have abnormal thyroid function. We performed whole exome sequencing for severe global developmental delay, drug-resistant epilepsy, and abnormal thyroid function. The hemizygous c.940C>T (p.Arg314Ter) variant in the SLC16A2 gene (NM_006517.5) was identified and confirmed based on Sanger sequencing. Herein, we describe a case of an AHDS patient with late-onset drug-resistant epilepsy combined with congenital hypotonia, global developmental delay, and abnormal thyroid function results. To the best of our knowledge, this is the oldest adolescent among AHDS cases reported in Korea. In this report, clinical characteristics of a mid-adolescence patient with AHDS were presented.

Association between oral health behaviors and dental scaling frequency: linked datasets from the National Health Insurance Service and the Korea National Health and Nutrition Examination Survey / 대한구강보건학회지

Objectives@#This study aimed to investigate the association between oral health behaviors and dental scaling to suggest effective preventive oral health behaviors. @*Methods@#This cross-sectional survey examined linked datasets derived from the Korean National Health Insurance Service and Korean National Health and Nutrition Examination Survey, 2014-2017. The data of 4,258 adults aged ≥19 years were included. A multivariate regression analysis was performed to evaluate the effect of oral health behaviors on willingness to undergo dental scaling. @*Results@#The multivariate regression analysis revealed that the participants whose oral hygiene habits included a thrice-daily tooth brushing frequency were 1.5% more likely to undergo dental scaling (95% confidence interval [CI], 1.167-1.881) than the others. Furthermore, those whose oral hygiene habits included a thrice-daily tooth brushing frequency and the daily use of dental floss or an interdental brush were 1.6% more likely to undergo dental scaling (95% CI, 1.194-2.032) than their counterparts. @*Conclusions@#The group with the most favorable oral health behaviors underwent dental scaling more frequently. Better personal oral health habits may lead to willingness to undergo dental scaling, and incremental dental hygiene improvements can be achieved through further oral health education. Educational programs are needed to raise awareness of and promote improvements in individual oral health behaviors.

Relationship between Nurse Staffing and Critical Nursing Activities in Intensive Care Units : Analysis of National Health Insurance Claims Data from 2009 to 2020 / 중환자간호학회지

Purpose@#: This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. @*Methods@#: A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. @*Results@#: The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend＜.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend＜.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p ＜.05). @*Conclusion@#: The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

Social Inequities in the Survival of Liver Cancer: A Nationwide Cohort Study in Korea, 2007–2017

Background@#To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. @*Methods@#A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient’s insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. @*Results@#The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27–1.47) for all patients, 1.44 (1.32–1.57) for men, and 1.16 (1.01–1.34) for women) compared to the highest income group (1–6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. @*Conclusion@#Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.

Significance of C4d expression in peritubular capillaries concurrent with microvascular inflammation in for-cause biopsies of ABO-incompatible renal allografts

Pathologic diagnosis of antibody-mediated rejection (ABMR) in ABO-incompatible (ABOi) transplantation patients is often challenging because patients without ABMR are frequently immunopositive for C4d. The aim of this study was to determine whether C4d positivity with microvascular inflammation (MVI), in the absence of any detectable donor-specific antibodies (DSAs) in ABOi patients, could be considered as ABMR. Methods: A retrospective study of 214 for-cause biopsies from 126 ABOi kidney transplantation patients was performed. Patients with MVI score of ≥2 and glomerulitis score of ≥1 (n = 62) were divided into three groups: the absolute ABMR group (DSA-positive, C4d-positive or C4d-negative; n = 36), the C4d-positive group (DSA-negative, C4d-positive; n = 22), and the C4d-negative group (DSA-negative, C4d-negative; n = 4). The Banff scores, estimated glomerular filtration rates (eGFRs), and graft failure rates were compared among groups. Results: C4d-positive biopsies showed higher glomerulitis, peritubular capillaritis, and MVI scores compared with C4d-negative specimens. The C4d-positive group did not show significant differences in eGFRs and graft survival compared with the absolute ABMR group. Conclusion: The results indicate that C4d positivity, MVI score of ≥2, and glomerulitis score of ≥1 in ABOi allograft biopsies may be categorized and treated as ABMR cases.

Gender differences in hepatitis A seropositivity rates according to the Republic of Korea’s vaccination policy

Objectives@#This study aimed to investigate differences in the anti-hepatitis A (HAV) antibody seropositivity rate by age and gender. @*Methods@#We collected information on anti-HAV immunoglobulin G and immunoglobulin M status from samples submitted for HAV antibody testing in 2012–2022. A total of 1,333,615 cases were included in the analysis. @*Results@#By age, the seropositivity rate was represented by a U-shaped curve, such that the rate was low for the group aged 20 to 39 years and higher in those who were younger or older. Over time, the curve shifted rightward, and the seropositivity rate declined gradually in the group aged 35 to 39 years and older. A gender-based difference in antibody seropositivity rate was especially noticeable in the group aged 20 to 29 years. This difference between genders widened in the participants’ early 20s—when men in the Republic of Korea enlist in the military—and the divergence continued subsequently for older individuals. @*Conclusion@#These results indicate a higher risk of severe infection among older individuals and a gender-based difference in seroprevalence. Therefore, it is necessary to implement policies to promote vaccination in adults.

Implications of the diagnosis of locomotive syndrome stage 3 for long-term care

Objectives@#Locomotive syndrome stage 3 (LS3), which has been established recently, may imply a greater need for care than LS stage 0 (LS0), LS stage 1 (LS1), and LS stage 2 (LS2). The relationship between LS3 and long-term care in Japan is unclear. Therefore, this study aimed to examine this relationship. @*Methods@#A total of 531 patients (314 women and 217 men; mean age, 75 years) who were not classified as requiring long-term care and underwent musculoskeletal examinations in 2012 were grouped according to their LS stage. Group L comprised patients with LS3 and Group N comprised those with LS0, LS1, and LS2. We compared these groups according to their epidemiology results and long-term care requirements from 2013 to 2018. @*Results@#Fifty-nine patients (11.1%) were diagnosed with LS3. Group L comprised more patients (50.8%) who required long-term care than Group N (17.8%) (P < 0.001). Group L also comprised more patients with vertebral fractures and knee osteoarthritis than Group N (33.9% vs 19.5% [P = 0.011] and 78% vs 56.4% [P < 0.001], respectively). A Cox proportional hazards model and Kaplan–Meier analysis revealed a significant difference in the need for nursing care between Groups L and N (log-rank test, P < 0.001; hazard ratio, 2.236; 95% confidence interval, 1.451–3.447). @*Conclusions@#Between 2012 and 2018, 50% of patients with LS3 required nursing care. Therefore, LS3 is a highrisk condition that necessitates interventions. Approaches to vertebral fractures and osteoarthritis of the knee could be key.

Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014–2018

Purpose@#Missing teeth is one of the most important indicators of oral health behavior and the result of dental caries, periodontal disease, and injuries. This study examined a trend in the incidence of severe partial edentulism (SPE) using the Korean National Health Insurance Service (KNHIS) data. @*Materials and Methods@#Data of adults aged ≥20 years were obtained from the KNHIS for the 2014–2018 period. SPE was defined in dental information within a population with a treatment history of dental scaling as having 1 to 8 natural teeth. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence interval were calculated per 100000 persons. The Cochran Armitage trend (CAT) test and average annual percentage change were used to analyze SPE trends. @*Results@#The CIRs among Korean adults were from 346.29 to 391.11 in 2014–2016 and from 391.11 to 354.09 in 2016–2018. The AIRs trend statistically increased by 4.31% from 346.29 to 376.80 and decreased by 4.72% from 376.80 to 342.10. The AIRs in men increased by 4.00% and decreased by 3.01%. The AIRs in women decreased by 2.18% and increased by 2.11% (CAT; p<0.01). The AIRs by region and income also showed trends of increase and decrease. @*Conclusion@#The study showed that the incidence trend of SPE increased and decreased from 2014 to 2018. This result would be able to aid in the planning of public oral health, and may also serve as fundamental data for verifying the impact of the public oral health policies implemented.

Enhancing gestational diabetes management in Filipino patients: Evaluating the impact of education on knowledge, attitude, and pregnancy outcomes at a Tertiary Medical Center

Introduction@#Patient education is integral in the management of gestational diabetes mellitus (GDM), a common pregnancy complication that may cause adverse perinatal outcomes. This study evaluated the effect of diabetes education on the knowledge and attitude among patients with GDM, comparing pre- vs post-diabetes session scores and determining pregnancy outcomes.@*Methodology@#A one-group pre-test and post-test experimental design study was conducted on 75 patients after one- session diabetes counseling using the Gestational Diabetes Mellitus Knowledge Questionnaire (GDMKQ) and the third version of the Diabetes Attitude Scale (DAS-3).@*Results@#Of the 75 subjects, 84% exhibited adequate knowledge of diabetes. Post-education, a significant increase in the total scores was seen among those less than 35 years of age (p-value: 0.003), both employed and unemployed (p-value: 0.0.026, 0.047, respectively), with a secondary level of education (p-value: 0.014) and multigravid (p-value: 0.015). An overall median positive attitude score of 3.6 was documented. For neonatal outcomes, no adverse events existed. For maternal outcomes, 17.9% had elevated fasting blood glucose while 7.1% had elevated 2-hour post-glucose tolerance test.@*Conclusion@#Diabetes education improves patient’s knowledge but not their attitude. Hence, improvement in attitude interventions should be incorporated into the current diabetes education program.

Mental health and substance use services in schools and workplaces

Background@#In 2021, the World Health Organization (WHO) reported that about 3.6 million Filipinos suffer from mental health (MH) or substance use (SU) conditions [1]. However, there is a dearth of literature on the delivery of MH and SU services in Philippine schools and workplaces.@*Objectives@#This study aimed to describe the prevalence of MH and SU services in Philippine schools and workplaces. It also examined the level of institutional support, barriers, and stigma and discrimination for MH and SU.@*Methodology@#Data was gathered in October 2022 using an online survey. The survey generated 262 respondents from all regions of the country. Schools represented 55% of respondents whereas 45% were from government and private workplaces. @*Results@#Schools and workplaces report providing more services for MH compared to SU. They also have more budget for mental health compared to substance use. The most commonly provided services are prevention programs on stress with a greater percentage of schools providing this compared to workplaces. Majority of schools and workplaces do not have any screening or treatment programs for MH and SU. Barriers to service delivery include the lack of budget, personnel, and knowledge of what services to provide. Results showed moderate levels of stigma and discrimination, with attitudes towards substance users being more negative compared to those with MH issues.@*Conclusion@#Despite national policies requiring MH and SU services in schools and workplaces, gaps in service delivery and institutional support hinder implementation. To improve service delivery, there is a need to strengthen resources, policy, leadership support and address stigma and discrimination.

Protocolo Clínico e Diretrizes Terapêuticas (PCDT) complementares de dermatite atópica no Estado de Goiás - versão setembro de 2023 / Clinical Protocol and Therapeutic Guidelines (CPTG) complementary for atopic dermatitis in the State of Goiás - version September 2023

A dermatite atópica é uma doença cutânea inflamatória, crônica, recidivante e de alta prevalência. Esse Protocolo estadual complementar ao PCDT do Ministério da Saúde, deve ser considerado como referência diagnóstica e terapêutica pelos profissional de saúde, em Goiás, no atendimento de pessoas com dermatite atópica

Atopic dermatitis is an inflammatory, chronic, recurrent and highly prevalent skin disease. This State Protocol, complementary to the Ministry of Health's PCDT, should be considered as a diagnostic and therapeutic reference by health professionals in Goiás when caring for people with atopic dermatitis

Vitisin B inhibits influenza A virus replication by multi-targeting neuraminidase and virus-induced oxidative stress

The development of drug-resistant influenza and new pathogenic virus strains underscores the need for antiviral therapeutics. Currently, neuraminidase (NA) inhibitors are commonly used antiviral drugs approved by the US Food and Drug Administration (FDA) for the prevention and treatment of influenza. Here, we show that vitisin B (VB) inhibits NA activity and suppresses H1N1 viral replication in MDCK and A549 cells. Reactive oxygen species (ROS), which frequently occur during viral infection, increase virus replication by activating the NF-κB signaling pathway, downmodulating glucose-6-phosphate dehydrogenase (G6PD) expression, and decreasing the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant response activity. VB decreased virus-induced ROS generation by increasing G6PD expression and Nrf2 activity, and inhibiting NF-κB translocation to the nucleus through IKK dephosphorylation. In addition, VB reduced body weight loss, increased survival, decreased viral replication and the inflammatory response in the lungs of influenza A virus (IAV)-infected mice. Taken together, our results indicate that VB is a promising therapeutic candidate against IAV infection, complements existing drug limitations targeting viral NA. It modulated the intracellular ROS by G6PD, Nrf2 antioxidant response pathway, and NF-κB signaling pathway. These results demonstrate the feasibility of a multi-targeting drug strategy, providing new approaches for drug discovery against IAV infection.