High Incidence of Esophageal Cancer in Women in Eritrea and Its Potential Link to Low Age at Menopause: Evidence from a 10-Year Retrospective Data Analysis.

Background: Detecting a group of esophageal cancer (EC) cases in endemic regions is essential in identifying high-risk populations and executing appropriate interventions. The main aim of this study was to determine the epidemiology of EC in Eritrea. Methods: A retrospective (period: 2011 - 2021) study was carried out by abstracting data on EC patients from the logbook kept at the National Health Laboratory (ENHL). Information on socio-demographic, clinical history, and biopsy analysis findings was collected. For the statistical assessment of data, the End Results (SEER) Joinpoint Regression Program (V.4.5.0.1) was used to calculate crude incidence rate (CIR), age-adjusted incidence rate (ASR), and estimated annual percentage change (EAPC) by sex, age, and histotype. Results: A total of 189 patient's samples (134 (70.9%) females vs. 55 (29.1%) males, ratio 2.43 : 1) were evaluated. Of the 155 patients with EC, 44 (28.4%) and 111 (71.6%) were diagnosed with esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), respectively (AC/ESCC ratio, 0.4). The median age (IQR) of patients with EC was 60 years (46.0 - 70 years) - (males 62 (IQR: 49.0 - 77 years) vs. females 60 (IQR: 46 -67 years), p-value =0.43. Within age bands, the F: M ratios in patients with ESCC were as follows: >20 -29 years =2: 1; 30-39 years =8 : 1; 40 - 49 years =10.5 : 1; 50-59 years =6.67 : 1; 60-69 years =3.25.1; 70-79 years =1.5 : 1 and>80 years =2 : 1. The all-age CIR and ASR for EC were 0.468 per 100 000 and 2.281 per 100 000 persons, respectively. Similarly, the all-age ASR for both males and females was 2.88 per 100 000 and 1.61 per 100 000. Over the study period, the EAPC for all cases was -3.0% (95% CI, -11.3 to 6.1, p-value =0.455). Conclusion: In large part, EC is a women's disease in Eritrea. The unusually high incidence of ESCC and the high female-to-male ratio point at sex-dependent exposures as a major driver of the EAC epidemic in the country. Therefore, research on the risk factors of EC in Eritrea is urgently needed.

Terahertz near-field microscopy of metallic circular split ring resonators with graphene in the gap.

Optical resonators are fundamental building blocks of photonic systems, enabling meta-surfaces, sensors, and transmission filters to be developed for a range of applications. Sub-wavelength size (< λ/10) resonators, including planar split-ring resonators, are at the forefront of research owing to their potential for light manipulation, sensing applications and for exploring fundamental light-matter coupling phenomena. Near-field microscopy has emerged as a valuable tool for mode imaging in sub-wavelength size terahertz (THz) frequency resonators, essential for emerging THz devices (e.g. negative index materials, magnetic mirrors, filters) and enhanced light-matter interaction phenomena. Here, we probe coherently the localized field supported by circular split ring resonators with single layer graphene (SLG) embedded in the resonator gap, by means of scattering-type scanning near-field optical microscopy (s-SNOM), using either a single-mode or a frequency comb THz quantum cascade laser (QCL), in a detectorless configuration, via self-mixing interferometry. We demonstrate deep sub-wavelength mapping of the field distribution associated with in-plane resonator modes resolving both amplitude and phase of the supported modes, and unveiling resonant electric field enhancement in SLG, key for high harmonic generation.

Major trauma patients and their outcomes - A retrospective observational study of critical care trauma admissions to a trauma unit with special services.

INTRODUCTION: International data describes a changing pattern to trauma over the last decade, with an increasingly comorbid population presenting challenges to trauma management and resources. In Ireland, resource provision and management of trauma is being transformed to deliver a trauma network, in line with international best practice. Our hospital plays a crucial role within this network and is designated a Trauma Unit with Specialist Services (TUSS) to distinguish it from standard trauma units. METHODS: This study aims to describe the characteristics of patients and injuries and assess trends in mortality rates. It is a retrospective observational study of adult ICU trauma admissions from August 2010 to July 2021. Primary outcome was all-cause mortality at 30-days, 90-days, and 1 year. Secondary outcomes included length of stay, disposition, and complications. Patients were categorised by age, injury severity score (ISS), and mechanism of injury. RESULTS: In all, 709 patients were identified for final analysis. Annual admissions doubled since 2010/11, with a trough of 41 admissions, increasing to peak at 95 admissions in 2017/18. Blunt trauma accounted for 97.6% of cases. Falls <2 m (45.4%) and RTAs (29.2%) were the main mechanisms of injury. Polytrauma comprised 41.9% of admissions. Traumatic brain injury accounted for 30.2% of cases; 18.8% of these patients were transferred to a neurosurgical centre. The majority of patients, 58.1%, were severely injured (ISS ≥ 16). Patients ≥ 65 years of age accounted for 45.7% of admissions, with falls <2 m their primary mechanism of injury. The primary outcome of all-cause mortality reduced with an absolute risk reduction (ARR) of 8.0% (95% CI: -8.37%, 24.36%), 12.9% (95% CI: -4.19%, 29.94%) and 8.2% (95% CI: -9.64%, 26.09%) for 30-day, 90-day and 1-year respectively. Regression analysis demonstrated a significant reduction in mortality for 30-days and 90-days post presentation to hospital (P-values of 0.018, 0.033 and 0.152 for 30-day, 90-day and 1-year respectively). CONCLUSION: The burden of major trauma in our hospital is considerable and increasing over time. Substantial changes in demographics, injury mechanism and mortality were seen, with outcomes improving over time. This is consistent with international data where trauma systems have been adopted.

Safety and Efficacy of Radial Artery Access for Peripheral Vascular Intervention: A Single-Center Experience.

Radial artery (RA) access has been increasingly utilized for coronary procedures because of lower rates of access-site complications and improved patient satisfaction. However, limited data are available for RA access for peripheral vascular intervention (PVI). We performed a retrospective review of 143 patients who underwent PVI through RA access from February 2020 to September 2022 at a single institution. Baseline characteristics and follow-up data were ascertained from a prospectively maintained institutional database. Of 491 PVI, 156 (31.8%) were performed through the RA. Anatomical locations for intervention were the femoral (44.8%), iliac (31.1%), popliteal (9.6%) peroneal (2.7%), tibial (9.9%), and subclavian (1.9%) arteries. Procedural access was obtained through the right RA (92.9%), left RA (4.5%), or right ulnar artery (2.6%) using the 6 French R2P Destination Slender sheath in 85, 105, and 119 cm lengths. Atherectomy was used in 34.7%. Mean contrast volume was 105.5 ml and the average fluoroscopy time was 18.5 minutes. Conversion to femoral access occurred in 3 cases (1.9%) because of arterial spasm and noncrossable lesions. Concomitant pedal access occurred in 2 cases (1.3%). Periprocedural complication rate was 3.84%, of which access-site hematoma was most common (3.2%); none required blood transfusion, surgical intervention, or additional hospital stay. There was 1 case (0.64%) of in-hospital stroke. The mortality rate at 30-day, 6-month, and 1-year was 1.4%, 2.8%, and 4.2%, respectively. In conclusion, RA access is feasible for diverse PVI, and future studies are needed to assess safety and benefit compared with femoral artery access.

Myco-generated and analysis of magnetite (Fe3O4) nanoparticles using Aspergillus elegans extract: A comparative evaluation with a traditional chemical approach.

In the past few years, nanotechnology has emerged as one of the most interesting and cutting-edge research areas across all disciplines. Nanotechnology allows progress in all science fields to make novel materials and industry-different devices. Generally, nanoparticle synthesis methods are chemical, physical, and biological. The chemical and physical techniques use potentially harmful compounds, and the expense of these processes renders them unsuitable for nanoparticle synthesis. In light of this, it needs development strategies that are sustainable, economical, and eco-friendly viable. Through, biosynthesis, nanoparticles can overcome these disadvantages. One of the biological strategies is the myco-synthesis method, which connects the fields of mycology and nanotechnology. In this study, magnetite (Fe3O4) NPs have been synthesized using a myco-synthesis method by selecting Aspergillus elegans as a fungal species. Two extracts were used, growth medium and an aqueous extract. A comparative analysis between nanoparticles synthesized through myco-synthesis and those produced using conventional chemical methods has been conducted to substantiate the significance of the biological approach. The results of this study unequivocally establish that myco-synthesized nanoparticles exhibit superior and enhanced characteristics compared to those synthesized through chemical means, as ascertained through a comprehensive array of characterization techniques employed throughout the investigation. This contrast is observable in terms of the aggregation state, the existence of capping and stabilizing agents enveloping the nanoparticles, their magnetic and thermal attributes, and the enduring stability of these nanoparticles. These results highlight the significant promise of employing phytochemicals extracted from Aspergillus elegans as a highly suitable option for the biofabrication of Fe3O4 nanoparticles.

Causes and Clinical Outcomes of Patients Who Failed Screening for Transcatheter Tricuspid Valve Interventions.

Transcatheter tricuspid valve intervention (TTVI) has recently emerged as a promising alternative to surgery for tricuspid regurgitation (TR). However, a significant proportion of patients fail screening for TTVI, and little is known about their characteristics and natural history. This study sought to investigate causes of screen failure and outcomes of patients declined for TTVI. This was a retrospective single-center study of 32 patients who were ineligible for participation in transcatheter tricuspid valve replacement and tricuspid transcatheter edge-to-edge repair trials. Patients were classified into 2 groups according to the therapy they received: optimized medical therapy (OMT) group or intervention group. The mean age was 82 ± 7.8 years and 68.8% were women. The most common reasons for TTVI exclusion were anatomic/procedural impediment (53.1%), inclusion criteria not met (40.6%), and multivalvular disease (6.3%). Overall, 19 patients (59.4%) did not undergo subsequent tricuspid intervention. The clinical outcomes of these patients who received OMT alone were poor, with a 1-year composite of cardiac death or heart failure readmission of 47.4%. These rates were worse than in patients who subsequently underwent an intervention, albeit not statistically significant (OMT: 47.7% vs 23.1% interventions, p = 0.3), and were significantly more pronounced in the subgroup of patients who were excluded for anatomic/procedural limitations (OMT: 70% vs 14.3% interventions, p = 0.05). In conclusion, patients ineligible for TTVI, particularly, those with anatomic/procedural limitations, and treated medically have poor outcomes. These data underscore the importance of earlier referral and support the need for further transcatheter therapy iterations.

Compact terahertz harmonic generation in the Reststrahlenband using a graphene-embedded metallic split ring resonator array.

Harmonic generation is a result of a strong non-linear interaction between light and matter. It is a key technology for optics, as it allows the conversion of optical signals to higher frequencies. Owing to its intrinsically large and electrically tunable non-linear optical response, graphene has been used for high harmonic generation but, until now, only at frequencies < 2 THz, and with high-power ultrafast table-top lasers or accelerator-based structures. Here, we demonstrate third harmonic generation at 9.63 THz by optically pumping single-layer graphene, coupled to a circular split ring resonator (CSRR) array, with a 3.21 THz frequency quantum cascade laser (QCL). Combined with the high graphene nonlinearity, the mode confinement provided by the optically-pumped CSRR enhances the pump power density as well as that at the third harmonic, permitting harmonic generation. This approach enables potential access to a frequency range (6-12 THz) where compact sources remain difficult to obtain, owing to the Reststrahlenband of typical III-V semiconductors.

Terahertz microscopy using laser feedback interferometry based on a generalised phase-stepping algorithm.

In this paper we report an improved method of coherent sensing through the use of a generalized phase-stepping algorithm to extract magnitude and phase information from interferometric fringes acquired by laser feedback interferometry (LFI). Our approach allows for significantly reduced optical sampling and acquisition times whilst also avoiding the need for fitting to complex models of lasers under optical feedback in post-processing. We investigate theoretically the applicability of this method under different levels of optical feedback, different laser parameters, and for different sampling conditions. We furthermore validate its use experimentally for LFI-based sensing using a terahertz (THz)-frequency laser in both far-field and near-field sensing configurations. Finally we demonstrate our approach for two-dimensional nanoscale imaging of the out-of-plane field supported by individual micro-resonators at THz frequencies. Our results show that fully coherent sensing can be achieved reliably with as little as 4 sampling points per imaging pixel, opening up opportunities for fast coherent sensing not only at THz frequencies but across the visible and infra-red spectrum.

County-level variation in healthcare coverage and ischemic heart disease mortality.

BACKGROUND: Healthcare coverage has been shown to have implications in the prevalence of coronary artery disease. We explore the impact of lack of healthcare coverage on ischemic heart disease (IHD) mortality in the US. METHODS: We obtained county-level IHD mortality and healthcare coverage data from the CDC databases for a total of 3,119 US counties. The age-adjusted prevalence of current lack of health insurance among individuals aged 18 to 64 years were obtained for the years 2018 and 2019 and were placed into four quartiles. First (Q1) and fourth quartile (Q4) had the least and highest age-adjusted prevalence of adults without health insurance, respectively. IHD mortality rates, adjusted for age through the direct method, were obtained for the same years and compared among quartiles. Ordinary least squares (OLS) regression for each demographic variable was conducted with the quartiles as an ordinal predictor variable and the age-adjusted mortality rate as the outcome variable. RESULTS: We identified a total of 172,942 deaths related to ischemic heart disease between 2018 and 2019. Overall AAMR was higher in Q4 (92.79 [95% CI, 92.35-93.23]) compared to Q1 (83.14 [95% CI, 82.74-83.54]), accounting for 9.65 excess deaths per 100,000 person-years (slope = 3.47, p = 0.09). Mortality rates in Q4 for males (126.20 [95% CI, 125.42-126.98] and females (65.57 [95% CI, 65.08-66.05]) were higher compared to Q1 (115.72 [95% CI, 114.99-116.44] and 57.48 [95% CI, 57.04-57.91], respectively), accounting for 10.48 and 8.09 excess deaths per 100,000 person-years for males and females, respectively. Similar trends were seen among Hispanic and non-Hispanic populations. Northeastern, Southern, and Western regions had higher AAMR within Q4 compared to Q1, with higher prevalence of current lack of health insurance accounting for 49.2, 8.15, and 29.04 excess deaths per 100,000 person-years, respectively. CONCLUSION: A higher prevalence of adults without healthcare coverage may be associated with increased IHD mortality rates. Our results serve as a hypothesis-generating platform for future research in this area.

A Prospective Cohort Study Investigating Adverse Perinatal Outcomes in Mosul, Iraq, among Women with Grand Multiparity

@#Introduction: This prospective case-control study aimed to compare the incidence of fetomaternal complications between grand multiparous women under the age of 35 and pregnant women with low parity in the same age group. Methods: The study was conducted at Al-khansaa and Al-Batool Teaching Hospitals from October 1, 2020, to June 1, 2021. One hundred pregnant women with singleton pregnancies in all three trimesters, aged between 18 and 34 years, were selected from the outpatient clinic and the ward. The participants were divided into two groups: Group A consisted of 50 grand multiparous women (with five or more deliveries), and Group B comprised 50 pregnant women with low parity (2-4 pregnancies) in the same age group. Results: The study found that gestational diabetes, anemia, meconium-stained amniotic fluid, cesarean section rate, postpartum hemorrhage, and neonatal intensive care unit admissions were significantly higher in the grand multiparity group compared to the low parity group. The mean Apgar scores at 1 and 5 minutes were significantly lower in Group A compared to Group B. Conclusion: The findings suggest that grand multiparity among younger mothers poses additional risks to pregnancy outcomes, including increased rates of gestational diabetes, anemia, postpartum hemorrhage, cesarean section, and neonatal intensive care unit admissions, especially in cases with inadequate antenatal care. The findings of this study underscore the need for further research in this area. Understanding the underlying mechanisms and risk factors associated with grand multiparity among younger mothers can lead to more targeted interventions and improved outcomes.

Drug-Coated Balloon Venoplasty to Treat Iatrogenic Pulmonary Vein Stenosis.

Pulmonary vein stenosis (PVS) is a condition that has seen a decrease in incidence in recent years. Whereas balloon angioplasty and stenting are both acceptable treatment options for PVS, they are limited by the high rate of restenosis. This research paper presents 4 cases of severe symptomatic PVS that were successfully treated with the use of drug-coated balloons, resulting in positive outcomes. (Level of Difficulty: Advanced.).

Study the Anticancer Properties of Thymol-Loaded PEGylated Bovine Serum Albumin Nanoparticles Conjugated with Folic Acid.

Phenolic compounds such as Thymol have an effective role in suppressing cancer, however, their low solubility in aqueous solution has limited their use. This study aimed to prepare Thymol (TY)-loaded bovine serum albumin (BSA) nanoparticles surface-modified with polyethylene glycol (PEG) conjugated with folic acid (FA) and evaluate their inhibitory activity on cancer cells. The TY-BSA-PEG-FA was characterized using DLS, FESEM, and FTIR. The encapsulation efficiency (EE) was evaluated indirectly by using UV absorption. The antioxidant property of nanoparticles was evaluated by 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric reducing ability of plasm (FRAP) methods. The effects of nanoparticles against cancer cells were investigated by MTT, AO/PI, flow cytometry, and real-time qPCR methods. The results showed the spherical morphology of TY-BSA-PEG-FA with an average size of 70.0 nm, a PDI of 0.32, a zeta potential of -11.3 mV, and an EE of 89.0±2.3 %. The cytotoxicity effects of nanoparticles against all cell lines were in a concentration-dependent manner. AGS gastric cancer cells were reported to be the most vulnerable to treatment, while pancreatic cancer cells (PANC-1) and normal skin cells (HFF) would be the most resistant. The SubG1 phase arrest of about 66 % occurred at 85 µg/mL. An increase in apoptotic cells in fluorescent staining, along with decreased expression of Bcl-2 and increased expression of the BAX gene demonstrated the induction of apoptosis in treated cells. The powerful inhibitory effect of nanoparticles in inhibiting ABTS free radicals (IC50 =82 µg/mL) and DPPH free radicals (IC50 =844 µg/mL) and the ability to reduce iron ions indicated the antioxidant effects of TY-BSA-PEG-FA. Based on these results, the synthesized nanoparticles may be suitable for further investigation in the treatment of cancer, notably gastric cancer.

Recurrence of tuberculous tenosynovitis in wrist tendon of a butcher: rare case report.

Diagnosing of tuberculous arthritis can be challenging due to its insidious onset and non-specific clinical presentation. A high index of suspicion is required for early diagnosis. A 54-year-old butcher was admitted to an orthopedic clinic with complaints of pain, paresthesia and an enlarging mass in the left wrist, which limited finger flexion. Initially the patient was diagnosed with carpal tunnel syndrome (CTS); the patient had no history of tuberculosis (TB), but had direct contact with animals. On clinical examination, a small mass was found in the distal volar region of the forearm and no lymphadenopathy was observed. Despite the diagnosis the patient refused to receive TB treatment. After a period of 4 months, the patient once again exhibited symptoms of CTS. This case highlights the importance of considering TB as a potential etiology for persistent symptoms of carpal tunnel surgery. Early diagnosis and prompt initiation of TB treatment can result in favorable outcomes and can prevent future recurrence.

Assessment of Lower Limb Deep Vein Thrombosis: Characterization and Associated Risk Factors Using Triplex Doppler Imaging.

Background: Deep vein thrombosis (DVT) is a common health problem. Accurate diagnosis of DVT is essential to avoid potentially fatal acute consequences of pulmonary embolism. Aim: The study aims to assess deep venous thrombosis (DVT) of the lower limbs and to analyze the related risk factors. Methods: This is a retrospective study including 60 patients who were examined using Triplex Doppler imaging. The patients were referred to the imaging departments with symptoms of lower limb DVT. The risk of DVT was expressed as an odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value <0.05 was considered a significant statistic. Results: Among the Saudi patients in Najran, acute DVT was more prevalent than chronic one (56.7% vs 38.3%), while subacute is less frequent (5%). DVTs are more prevalent in females than males (60% vs 40%) and most commonly affect patients older than 40. DVTs affect the left lower limb veins more than the right limb (75% vs 15%) and are less frequent on both sides (10%). The left popliteal vein (PV) and left common femoral vein (CFV) were the most common sites for acute DVTs. Binary logistic analysis revealed the independent risk factors for developing lower extremity DVT; malignancy (OR = 2.84, 95% CI = 0.518-15.513), surgery (OR = 2.66, 95% CI = 0.411-17.281), trauma (OR = 2.30, 95% CI = 0.452-11.658), and diabetes and hypertension (OR = 1.53, 95% CI = 0.335-6.969). Conclusion: Acute lower limb DVT was more prevalent than chronic one. Malignancy, surgery, trauma, diabetes mellitus, and hypertension were the most common risk factors for lower limb DVTs. Left popliteal and left common femoral veins were the most common sites of acute DVTs.

Successful Revascularization of Critical Limb Ischemia: A Challenging Case of a Unilateral Tibial-to-Tibial Intervention.

Critical limb ischemia requires urgent diagnosis and intervention. Limitations to percutaneous revascularization therapy stem from multilevel diseased vasculature. Retrograde revascularization utilizing anterior tibial artery access in complex and proximal lesions is an alternative route for intervention that can lead to limb salvage and symptom resolution.

Impact of Social Vulnerability and Demographics on Ischemic Heart Disease Mortality in the United States.

Background: Cardiovascular disease is a leading cause of morbidity and mortality, largely dominated by ischemic heart diseases (IHDs). Social determinants of health, including geographic, psychosocial, and socioeconomic factors, influence the development of IHD. Objectives: This study aimed to evaluate yearly trends and disparities in IHD mortality and to assess the impact of social vulnerability. Methods: We performed cross-sectional analyses using United States county-level mortality data and social vulnerability index (SVI) obtained from the Centers for Disease Control and Prevention databases. Age-adjusted mortality rates (AAMRs) per 100,000 population were compared between aggregated U.S. county groups, stratified by demographic information and SVI quartiles. Log-linear regression models were used to identify mortality trends from 1999 to 2020, with inflection points determined through the Monte-Carlo permutation test. Results: We identified a total of 9,108,644 deaths related to IHD between 1999 and 2020. Overall AAMR decreased from 194.6 in 1999 to 91.8 in 2020. Males (AAMR: 161.51) and Black (AAMR: 141.49) populations exhibited higher AAMR compared to females (AAMR: 93.16) and White (AAMR: 123.34) populations, respectively. Disproportionate AAMRs were observed among nonmetropolitan (AAMR: 136.17) and Northeastern (AAMR: 132.96) regions. Counties with a higher SVI experienced a greater AAMR, with a cumulative excess of 20.91 deaths per 100,000 person-years associated with increased social vulnerability. Conclusions: Despite a decline in IHD mortality from 1999 to 2020, disparities persisted among racial, gender, and geographic subgroups. A higher SVI was linked to increased IHD mortality. Policy interventions should prioritize integrating the SVI into health care delivery systems to effectively address these disparities.