Comparing deep-sea polymetallic nodule mining technologies and evaluating their probable impacts on deep-sea pollution.

Deep-sea polymetallic nodules (PMN) hold promise as a future resource, with various consortia like MOES, IOM, GSR, KORDI, and COMRA actively exploring mining possibilities. However, current technologies lack environmental sustainability. This study comprehensively compares the technologies proposed by different consortia for deep sea mining (DSM). It evaluates the designs and prototypes of key components like crawlers, conveyor belts, crushers, riser pipes, and slurry tailing discharge mechanisms for their technical feasibility and environmental impact. Environmental concerns regarding sediment disturbances, nodules pick-up methods, crushing, and tailing material filtration are addressed in this article. It is suggested that further research and development efforts are needed to optimize technologies and integrate effective environmental protection measures into DSM operations.

All Hands on Deck. Transforming the Health System Requires Innovation, Through Individual- and Diffusion Efforts Comment on "Employee-Driven Innovation in Health Organizations: Insights From a Scoping Review".

Employee driven innovation (EDI) is essential in transforming hospitals and other providers, but the challenge is also to have impact on health systems as a whole. Usually a mix from top down measures and bottom up initiatives leads to an innovative culture. An important aspect is the innate difference between types of providers related to initiating, facilitating and rewarding innovation. Second the rewarding system within organisations but also in science and scientific journals. Especially nursing and other non-medical professions can be emancipated in this regard. Further there is a growing interdependence with digitalisation in all its forms and awareness of the related team effort is needed to actually realise innovative projects within a standing organisation. Lastly change the paradigm related to the spread of innovations from "not invented here" to "proudly copied from," create trust and organize collaboration between providers and spend sufficient attention to credible evidence on the effectiveness.

Evaluating physiological barriers to oral intake in hospitalized patients: A secondary analysis.

BACKGROUND: Oral intake in hospitalized patients is frequently below estimated targets. Multiple physiological symptoms are proposed to impact oral intake, yet many have not been quantified objectively. AIM: To describe the challenges of objectively measuring physiological nutrition-impacting symptoms in hospitalized patients. METHOD: A secondary analysis of data from a single-center, descriptive cohort study of physiological nutrition-impacting symptoms in intensive care unit (ICU) survivors and general medical patients was conducted. Demographic and clinical characteristics were extracted for patients who completed the original study and collected retrospectively for those who were screened and recruited but did not complete the original study. Reasons for patient exclusion from the original study were quantified from the screening database. Descriptive data are reported as mean ± SD, median [interquartile range], or number (percentage). RESULTS: ICU survivors and general medical patients were screened for inclusion in the original study between March 1 and December 23, 2021. Of the 644 patients screened, 97% did not complete the study, with 93% excluded at screening. Of the 266 ICU survivors and 398 general medical patients screened, 89% and 95% were excluded, respectively. Major exclusion criteria included the inability to follow commands or give informed consent (n = 155, 25%), the inability to consume the easy-to-chew and thin-fluid buffet meal, and imminent discharge (both, n = 120, 19%). CONCLUSION: Understanding physiological factors that drive reduced oral intake in hospitalized patients is challenging. Exclusion criteria required to objectively quantify physiological nutrition-impacting symptoms significantly preclude participation and likely act as independent barriers to oral intake.

The screening evaluation of environmental odors: a new dispersion modelling-based tool.

Odor pollution is the biggest source of complaints from citizens concerning environmental issues after noise. Often, the need for corrective actions is evaluated through simulations performed with atmospheric dispersion models. To save resources, air pollution control institutions perform a first-level odor impact assessment, for screening purposes. This is often based on Gaussian dispersion models (GDM), which does not need high computational power. However, their outputs tend to be conservative regarding the analyzed situation, rather than representative of the real in-site conditions. Hence, regulations and guidelines adopted at an institutional level for authorization/control purposes are based on Lagrangian particle dispersion models (LPDM). These models grant a more accurate simulation of the pollutants' dispersion even if they are more demanding regarding both technical skills and computing power. The present study aims to increase the accuracy of screening odor impact assessment by identifying the correlation function of the outputs derived from the two simulation models. The case study is placed in northern Italy, where a single-point source, with various stack heights, was considered. The case study is placed in northern Italy, where a single-point source, with various stack heights, was considered. The obtained correlation functions allow the practitioner to have a more accurate first-level odor impact assessment, to save time for training, and to reduce the site-specific meteorological data before proceeding with the simulation. The identified functions could allow institutions to estimate the results that would have been forecasted with the application of the more complex LPDM, applying, however, the much simpler GDM. This solution grants an accurate tool which can be used to address citizens' concerns while saving workforce and technical resources. Limitations are related to the specificity of the method regarding type sources, orography, and meteorological conditions. Comparison with other screening tools is also presented and discussed.

Examining the Effects of Land Use, Salinity Gradient, and Water Pollution on Greenhouse Gas Emissions in Urbanized Estuaries.

Estuaries are significant contributors to greenhouse gases (GHGs) in waterways. However, the effects of human activities and ecological variables on GHG emissions in estuaries remain poorly understood. This study examines the patterns and causes of GHG emissions in the Scheldt Estuary, focusing on the roles of salinity, water contamination, and land use. The findings indicate that salinity negatively impacts the release of carbon dioxide (CO2) and nitrous oxide (N2O), likely due to reduced salt levels and cleaner water upstream. Water contamination's influence on GHG emissions was more pronounced in cleaner, upriver sites compared to saltier downstream locations. Specifically, CO2 emissions quadrupled, and N2O emissions tripled as water conditions worsened from healthy (near the mouth, bordered by agricultural land) to polluted (farther downstream, bordered by urban areas). Methane (CH4) emissions were significantly higher in aquatic locations than in salty sites. The reduced impact of contamination from downstream to the river mouth may be due to increasing population density. Urban sites emitted about twice as much CO2 and N2O as those in natural and industrial areas. Machine learning analysis also showed that fertilizers and organic enrichment, along with salinity, significantly increased GHG emissions. These results highlight the importance of understanding the interplay of salinity, water contamination, and land use in influencing GHG emissions in coastal ecosystems.

Experimental study on the influence of turbulence on hail impacts.

Hailstorms, characterized by their intensity, are often accompanied by strong winds and heavy rain, posing significant destructive potential. Data indicate that the economic losses caused by hail to buildings, particularly solar panels, have been increasing annually. However, research on the hail resistance of photovoltaic panels has predominantly focused on the isolated effects of hail impacts and wind loads, neglecting the coupling effects between wind and hail. In this study, a device was designed to couple both wind and hail. The effects of turbulence, hail size, and velocity on hail impact behavior were systematically studied and quantified. A predictive formula for the peak load of hail impact on structures was established. The results indicate that the impact of turbulence on hail is significant. When turbulence intensity varies with hail velocity, hail impact force increases as turbulence decreases and hail velocity increases. When both turbulence and hail diameter vary, the impact force of smaller hailstones shows less variation with increasing turbulence. According to variance analysis, hail velocity is the most significant factor affecting hail impact, followed by hail diameter and finally turbulence. The regression equation is given by F = - 0.624 I u + 5116.25 D + 7.85 V hail - 259.709 , where F represents the peak impact force in Newtons (N), I u denotes the turbulence intensity, D is the hail diameter in meters (m), and V hail is the hail velocity in meters per second (m/s).

Modeling the population health impact of accurate and inaccurate perceptions of harm from nicotine.

BACKGROUND: Scientific evidence clearly demonstrates that inhaling the smoke from the combustion of cigarettes is responsible for most of the harm caused by smoking, and not the nicotine. However, a majority of U.S. adults who smoke inaccurately believe that nicotine causes cancer which may be a significant barrier, preventing switching to potentially reduced risk, non-combustible products like electronic nicotine delivery systems (ENDS) and smokeless tobacco (ST). We assessed the population health impact associated with nicotine perceptions. METHODS: Using a previously validated agent-based model to the U.S. population, we analyzed nationally representative data from the Population Assessment of Tobacco and Health (PATH) study to estimate base case rates of sustained (maintained over four waves) cessation and switching to non-combustible product use, by sex. Nicotine perception scenarios were determined from PATH data. The overall switch rate from smoking in Wave 4 to non-combustible product use in Wave 5 (3.94%) was stratified based on responses to the nicotine perception question "Do you believe nicotine is the chemical that causes most of the cancer caused by smoking cigarettes?", (four-item scale from "Definitely not" to "Definitely yes"). The relative percent change between the overall and stratified rates, corresponding to each item, was used to adjust the base case rates of switching, to determine the impact, if all adults who smoke exhibited switching behaviors based on responses to the nicotine perceptions question. The public health impact of nicotine perceptions was estimated as the difference in all-cause mortality between the base case and the four nicotine perception scenarios. RESULTS: Switch rates associated with those who responded, "Definitely not" (8.39%) resulted in a net benefit of preventing nearly 800,000 premature deaths over an 85-year period. Conversely switch rates reflective of those who responded, "Definitely yes" (2.59%) resulted in a net harm of nearly 300,000 additional premature deaths over the same period. CONCLUSIONS: Accurate knowledge regarding the role of nicotine is associated with higher switch rates and prevention of premature deaths. Our findings suggest that promoting public education to correct perceptions of harm from nicotine has the potential to benefit public health.

Mechanism of up-regulated H2O2 BPA-derived production and production of (poly)phenols by two seaweeds of the genus Ulva.

The present study provides information on the effects of BPA on ROS production-related phenomena in the chlorophytes Ulva rigida and U. intestinalis, and on the mechanism they establish against BPA toxicity, at environmentally relevant concentrations (0.1-3 µg L-1). Up-regulated H2O2 generation seems to be a key factor causing oxidative damage. Interspecific differences, in terms of the mechanism and the temporal response to BPA toxicity were observed. BPA effects on U. rigida were more intense and appeared earlier (on 1D at 0.1 µg L-1) compared to U. intestinalis and mostly after 7D (LOEC: 0.3 µg L-1, Terminal time, Tt: 7D). In U. rigida, on 1-5D, the 'mosaic' type effect patterns ('models' 3A/3B) with 'unaffected' and 'affected' areas (dark content, positive H2DCF-DA staining signal/H2O2 production and chlorophyll autofluorescence signal loss) indicated a time-dependent manner. After 7D, only U. rigida cells with dark content formed aggregates, showing positive H2O2 production ('model' 4) or in some cells oxidative damages triggering retrograde signaling in the neighboring 'unaffected' areas ('model' 5). H2O2 overproduction (CTCF ratio) in U. rigida, on 1D at the lowest concentration and after 7D at 0.3-1/3 µg L-1, respectively, seems to stimulate (poly)phenolic production, in a dose- and time-dependent manner. U. intestinalis did not display severe BPA impact (i.e., 'models' 4, 5) at any exposures, although at a later time indicated a lower LOEC (0.1 µg L-1, Tt: 9D) than that in U. rigida. In U. intestinalis, H2O2 production does not appear to stimulate high (poly)phenolic amounts.

Clinical and Economic Impact of Early Diagnosis of Chronic Kidney Disease in General Practice: The Endorse Study.

Introduction: The underdiagnosis of chronic kidney disease (CKD) remains a significant public health concern. The Early chroNic kiDney disease pOint of caRe Screening (ENDORSE) project aimed to evaluate the clinical and economic implications of a targeted training intervention for general practitioners (GPs) to enhance CKD awareness and early diagnosis. Methods: Data on estimated Glomerular Filtration Rate (eGFR) and Urinary Albumin-Creatinine Ratio (uACR) were collected by 53 Italian GPs from 112,178 patients at baseline and after six months. The intervention involved six months of hybrid training provided by 11 nephrologists, which included formal lectures, instant messaging support, and joint visits for complex cases. Results: The results demonstrated a substantial increase in the use of eGFR (+44.7%) and uACR (+95.2%) tests. This led to a 128.9% rise in the number of individuals screened for CKD using the KDIGO classification, resulting in a 62% increase in CKD diagnoses. The intervention's impact was particularly notable in high-risk groups, including patients with type 2 diabetes, hypertension, and heart failure. Discussion: A budget impact analysis projected cumulative five-year savings of €1.7 million for the study cohort. When these findings were extrapolated to the entire Italian CKD population, potential savings were estimated at €106.6 million, highlighting significant cost savings for the national health service. The clinical simulation assumed that early diagnosed CKD patients would be treated according to current indications for dapagliflozin, which slows disease progression. Conclusion: The ENDORSE model demonstrated that targeted training for GPs can significantly improve early CKD detection, leading to better patient outcomes and considerable economic benefits. This approach shows promise for broader implementation to address the underdiagnosis of CKD on a national and potentially international scale.

Impact of Performing Medical Writing/Publishing Workshops: A Systematic Survey and Meta-Analysis.

Objectives: Proficiency in medical writing and publishing is essential for medical researchers. Workshops can play a valuable role in addressing these issues. However, there is a lack of systematic summaries of evidence on the evaluation of their impacts. So, in this systematic review, we aimed to evaluate all articles published on the impact of such workshops worldwide. Methods: We searched Ovid EMBASE, Ovid Medline, ISI Web of Science, ERIC database, and grey literature with no language, time period, or geographical location limitations. Randomized controlled trials, cohort studies, before-after studies, surveys, and program evaluation and development studies were included. We performed a meta-analysis on data related to knowledge increase after the workshops and descriptively reported the evaluation of other articles that did not have sufficient data for a meta-analysis. All analyses were performed using Stata software, version 15.0. Results: Of 23 040 reports, 222 articles underwent full-text review, leading to 45 articles reporting the impacts of workshops. Overall, the reports on the impact of such workshops were incomplete or lacked the necessary precision to draw acceptable conclusions. The workshops were sporadic, and researchers used their own method of assessment. Meta-analyses of the impact on the knowledge showed that workshops could nonsignificantly increase the mean or percentage of participants' knowledge. Conclusion: In the absence of systematic academic courses on medical writing/publishing, workshops are conducted worldwide; however, reports on educational activities during such workshops, the methods of presentations, and their curricula are incomplete and vary. Their impact is not evaluated using standardized methods, and no valid and reliable measurement tools have been employed for these assessments.

Substantial contribution of transported emissions to organic aerosol in Beijing.

Haze in Beijing is linked to atmospherically formed secondary organic aerosol, which has been shown to be particularly harmful to human health. However, the sources and formation pathways of these secondary aerosols remain largely unknown, hindering effective pollution mitigation. Here we have quantified the sources of organic aerosol via direct near-molecular observations in central Beijing. In winter, organic aerosol pollution arises mainly from fresh solid-fuel emissions and secondary organic aerosols originating from both solid-fuel combustion and aqueous processes, probably involving multiphase chemistry with aromatic compounds. The most severe haze is linked to secondary organic aerosols originating from solid-fuel combustion, transported from the Beijing-Tianjing-Hebei Plain and rural mountainous areas west of Beijing. In summer, the increased fraction of secondary organic aerosol is dominated by aromatic emissions from the Xi'an-Shanghai-Beijing region, while the contribution of biogenic emissions remains relatively small. Overall, we identify the main sources of secondary organic aerosol affecting Beijing, which clearly extend beyond the local emissions in Beijing. Our results suggest that targeting key organic precursor emission sectors regionally may be needed to effectively mitigate organic aerosol pollution.

The Frequency and Clinical Impact of Synonymous HTT Loss-of-Interruption and Duplication-of-interruption Variants in a Diverse HD Cohort.

PURPOSE: To determine the frequency and clinical impact of loss-of-interruption (LOI) and duplication-of-interruption (DOI) modifier variants of the HTT CAG and CCG repeat in a cohort of individuals with Huntington disease (HD). METHODS: We screened symptomatic HD participants from the UBC HD Biobank and five research sites for sequence variants. Following variant identification, we examined the clinical impact and frequency in the reduced penetrance range. RESULTS: Participants with CAG-CCG LOI and CCG LOI variants have a similar magnitude of earlier onset of HD, by 12.5 years. The sequence variants exhibit ancestry-specific differences. Participants with the CAG-CCG LOI variant also have a faster progression of TMS by 1.9 units per year. Symptomatic participants with the CAG-CCG LOI variant show enrichment in the reduced penetrance range. The CAG-CCG LOI variant explains the onset of two symptomatic HD participants with diagnostic repeats below the pathogenetic range. CONCLUSION: Our findings have significant clinical implications for participants with the CAG-CCG LOI variant who receive inaccurate diagnoses near diagnostic cut-off ranges. Improved diagnostic testing approaches and clinical management are needed for these individuals. We present the largest and most diverse HTT CAG and CCG sequence variant cohort and emphasize their importance in clinical presentation in HD.

Causal association of dietary factors with five common cancers: univariate and multivariate Mendelian randomization studies.

Background: Daily dietary habits are closely related to human health, and long-term unhealthy dietary intake, such as excessive consumption of alcohol and pickled foods, may promote the development of cancers. However, comprehensive research on the causal relationship between dietary habits and cancer is lacking. Therefore, this study aimed to reveal the potential causal link between dietary risk factors and the prognosis of cancer-related to genetic susceptibility. Methods: GWAS (Genome-Wide Association Studies) summary data on dietary habits and five common types of cancer and their pathological subtypes were obtained from the UK Biobank and various cancer association consortia. A univariable two-sample Mendelian randomization (UVMR) and FDR correction analysis was conducted to explore the causal relationships between 45 dietary habits and five common types of cancer and their histopathological subtypes. In addition, multivariable Mendelian randomization analysis (MVMR) was performed to adjust for traditional risk factors for dietary habits, and the direct or indirect effects of diet on cancer were evaluated. Finally, the prognostic impact of selected instrumental variables on cancer was analyzed using an online data platform. Results: In the UVMR analysis, four dietary habits were identified as risk factors for cancer, while five dietary habits were identified as protective factors. Among the latter, one dietary habit showed a significant association with cancer even after FDR correction, indicating a potential causal relationship. The MVMR analysis revealed that weekly beer and cider intake, may act as an independent risk factor for cancer development. Other causal associations between dietary habits and cancer risk may be mediated by intermediate factors. In the prognostic analysis, the SNPs (Single Nucleotide Polymorphisms) of average weekly beer and cider intake were set as independent risk factors and were found to significantly impact overall survival (OS) and cancer-specific survival (CSS) in lung cancer. Conclusion: This causal relationship study supports the notion that adjusting daily dietary habits and specific dietary interventions may decrease the risk of cancer.

Impact of an Outpatient Word Catheter Program for Bartholin cysts and abscesses: A retrospective cohort study.

OBJECTIVE: To assess the impact of an Outpatient Word Catheter Program (OWCP) on outcomes in women presenting with Bartholin cysts or abscesses (BC/BAs). . METHODS: This retrospective cohort study reviewed 408 women presenting with BC/BAs to our tertiary unit from 2017-2022. Analysis of medical records, with subgroup analysis of pregnant patients, and comparative analysis between pre- and post-intervention groups, was completed. Financial impact analysis using national activity-based funding pricing guidance to estimate cost was conducted. RESULTS: Pre-intervention, 65% (n = 34) of procedures were completed in theater, but after the introduction of OWCP, 61% (n = 213) of cases were treated in the day ward (χ2 = 67.43, P <0.001). Similarly, inpatient admissions reduced; 94.2% (n = 49) pre-intervention versus 26% (n = 92) post-intervention (χ2 = 92.25, P <0.001). The mean all patient admission duration decreased from 1.52 ± 0.89 days to 0.69 ± 0.59 days (P <0.001). The mean cost for those women attending in the pre-OWCP period was €4798, versus €2704 in the women who attended post-OWCP introduction (P < 0.001). CONCLUSION: After OWCP introduction, there were significant decreases in inpatient admissions, surgical procedures in theater, general anesthetic exposure, and duration of admission. Financial impact analysis revealed a significant cost reduction of ~€2100 per patient. Outpatient or day-care Word catheter programs are feasible, affordable and acceptable services to provide to women presenting with BC/BAs.

Novel therapeutic targets: bifidobacterium-mediated urea cycle regulation in colorectal cancer.

BACKGROUND AND PURPOSE: Colorectal cancer (CRC) is a widespread malignancy with a complex and not entirely elucidated pathogenesis. This study aims to explore the role of Bifidobacterium in the urea cycle (UC) and its influence on the progression of CRC, a topic not extensively studied previously. EXPERIMENTAL APPROACH: Utilizing both bioinformatics and experimental methodologies, this research involved analyzing bacterial abundance in CRC patients in comparison to healthy individuals. The study particularly focused on the abundance of BA. Additionally, transcriptomic data analysis and cellular experiments were conducted to investigate the impact of Bifidobacterium on ammonia metabolism and mitochondrial function, specifically examining its regulation of the key UC gene, ALB. KEY RESULTS: The analysis revealed a significant decrease in Bifidobacterium abundance in CRC patients. Furthermore, Bifidobacterium was found to suppress ammonia metabolism and induce mitochondrial dysfunction through the regulation of the ALB gene, which is essential in the context of UC. These impacts contributed to the suppression of CRC cell proliferation, a finding corroborated by animal experimental results. CONCLUSIONS AND IMPLICATIONS: This study elucidates the molecular mechanism by which Bifidobacterium impacts CRC progression, highlighting its role in regulating key metabolic pathways. These findings provide potential targets for novel therapeutic strategies in CRC treatment, emphasizing the importance of microbiota in cancer progression.

The budget impact of implementing atrial fibrillation-screening in European countries.

A budget impact analysis estimates the short-term difference between the cost of the current treatment strategy and a new treatment strategy, in this case to implement population screening for atrial fibrillation (AF). The aim of this study is to estimate the financial impact of implementing population-based AF-screening of 75-year-olds compared with the current setting of no screening from a healthcare payer perspective in eight European countries. The net budget impact of AF-screening was estimated in country-specific settings for Denmark, Germany, Ireland, Italy, Netherlands, Serbia, Spain, and Sweden. Country-specific parameters were used to allow for variations in healthcare systems and to reflect the healthcare sector in the country of interest. Similar results can be seen in all countries AF-screening incurs savings of stroke-related costs since AF treatment reduces the number of strokes. However, the increased number of detected AF and higher drug acquisition will increase the drug costs as well as the costs of physician- and control visits. The net budget impact per invited varied from €10 in Ireland to €122 in the Netherlands. The results showed the increased costs of implementing AF-screening were mainly driven by increased drug costs and screening costs. In conclusion, across Europe, though the initial cost of screening and more frequent use of oral anti-coagulants will increase the healthcare payers' costs, introducing population screening for AF will result in savings of stroke-related costs.

Short-term microplastic effects on marine meiofauna abundance, diversity and community composition.

Background: Due to the copious disposal of plastics, marine ecosystems receive a large part of this waste. Microplastics (MPs) are solid particles smaller than 5 millimeters in size. Among the plastic polymers, polystyrene (PS) is one of the most commonly used and discarded. Due to its density being greater than that of water, it accumulates in marine sediments, potentially affecting benthic communities. This study investigated the ingestion of MP and their effect on the meiofauna community of a sandy beach. Meiofauna are an important trophic link between the basal and higher trophic levels of sedimentary food webs and may therefore be substantially involved in trophic transfer of MP and their associated compounds. Methods: We incubated microcosms without addition of MP (controls) and treatments contaminated with PS MP (1-µm) in marine sediments at three nominal concentrations (103, 105, 107particles/mL), for nine days, and sampled for meiofauna with collections every three days. At each sampling time, meiofauna were collected, quantified and identified to higher-taxon level, and ingestion of MP was quantified under an epifluorescence microscope. Results: Except for Tardigrada, all meiofauna taxa (Nematoda, turbellarians, Copepoda, Nauplii, Acari and Gastrotricha) ingested MP. Absorption was strongly dose dependent, being highest at 107 particles/mL, very low at 105 particles/mL and non-demonstrable at 103 particles/mL. Nematodes accumulated MP mainly in the intestine; MP abundance in the intestine increased with increasing incubation time. The total meiofauna density and species richness were significantly lower at the lowest MP concentration, while at the highest concentration these parameters were very similar to the control. In contrast, Shannon-Wiener diversity and evenness were greater in treatments with low MP concentration. However, these results should be interpreted with caution because of the low meiofauna abundances at the lower two MP concentrations. Conclusion: At the highest MP concentration, abundance, taxonomic diversity and community structure of a beach meiofauna community were not significantly affected, suggesting that MP effects on meiofauna are at most subtle. However, lower MP concentrations did cause substantial declines in abundance and diversity, in line with previous studies at the population and community level. While we can only speculate on the underlying mechanism(s) of this counterintuitive response, results suggest that further research is needed to better understand MP effects on marine benthic communities.

Potential Impact of COVID-19 on Medical Career Aspirations of Prospective Students.

This article describes the evolving landscape of medical education in the wake of the COVID-19 pandemic, emphasizing the renewed importance of public health, mental well-being, and career choices among medical students. The pandemic has prompted a significant shift in medical student's career aspirations, highlighting the need for mental health support mechanisms within the medical education framework. Medical students' career choices are influenced directly and indirectly by the challenges and experiences of the pandemic era, which are discussed in this article under four key themes: traditional values, global health interests and disparities, developing trends, and digital healthcare. There is an urgent need to adjust medical training to the new reality and share the future directions of the medical education landscape by embracing diverse career paths in medicine, integrating technology into medical training, adapting to the changing context of medicine, and strengthening collaboration and communication. The pandemic underscores the importance of evidence-based patient care, necessitating the preparation of tomorrow's doctors to address the emerging healthcare challenges with resilience, adaptability, and a comprehensive understanding of both local and global health challenges.

Natural product-based treatment potential for type 2 diabetes mellitus and cardiovascular disease.

BACKGROUND: Type 2 diabetes (T2D) is a metabolic disease of impaired glucose utilization and a major cause of cardiovascular disease (CVD). The pathogenesis of both diseases shares common risk factors and mechanisms, and both are significant contributors to global morbidity and mortality. Supplements of natural products for T2D mellitus (T2DM) and CVD can be seen as a potential preventive and effective therapeutic strategy. AIM: To critically evaluate the therapeutic potential of natural products in T2D and coronary artery disease (CAD). METHODS: By using specific keywords, we strategically searched the PubMed database. Randomized controlled trials (RCTs) were searched as the primary focus that examined the effect of natural products on glycemic control, oxidative stress, and antioxidant levels. We focused on outcomes such as low blood glucose levels, adjustment on markers of oxidative stress and antioxidants. After screening full-length papers, we included 9 RCTs in our review that met our inclusion criteria. RESULTS: In the literature search on the database, we found that various natural products like plant secondary metabolites play a diverse role in the management of CAD. American ginseng, sesame oil and cocoa flavanols proved effective in lowering blood glucose levels and controlling blood pressure, which are key factors in managing T2DM and CVD. In diabetic patients Melissa officinalis effectively reduce inflammation and shows diabetes prevention. Both fish oil and flaxseed oil reduced insulin levels and inflammatory markers, suggesting benefits for both conditions. The lipid profile and endothelial function were enhanced by Nigella sativa oil and Terminalia chebula, which is significant for the management of cardiovascular risk factors in T2DM. Additionally Bilberry extract also showed promise for improving glycemic control in patients with T2DM. CONCLUSION: The high level of antioxidant, anti-inflammatory, and anti-angiogenic properties found in natural products makes them promising therapeutic options for the management of CAD, with the potential benefit of lowering the risk of CAD.