Periodontal therapy for hopeless mandibular anterior teeth: a retrospective case report with a multidisciplinary approach and a 20-year follow-up

Introduction: This case report presents the intentional periodontal maintenance of two periodontal hopeless lower central incisors with a multidisciplinary approach and 20-year follow-up. Case presentation: A 36-year-old male, in 2001, was diagnosed with aggressive periodontitis, gingival swelling, bleeding, and mandibular central incisors with mobility and poor prognosis. Following periodontal therapy (phase I), root canal treatment, and occlusal adjustment, #31 and #41 were gently extracted to remove the granulation tissues, calculus, and infected cementum from the root surface. Then, tetracycline-HCl was applied for 5 minutes on the root surfaces. The teeth were repositioned into the sockets and splinted with a lingual bar. At 3 months, the bar was removed, and a free gingival autogenous graft was done to improve the local keratinized tissue width. Mobility scores, pocket depths, and clinical attachment levels were recorded, and radiographs were taken at 1, 5, and 20 years. The 5-year follow-up showed that the teeth were clinically and radiographically in function. There was a reduction in probing depth and a gain in clinical attachment and radiographic alveolar bone levels. After 20 years, #41 was stable, but #31 had external root resorption, leading to a new treatment plan (dental implants) and extraction. Conclusion: The clinical result of this case was satisfactory for 20 years. Intentional periodontal maintenance of the teeth may be an alternative treatment, even considering the high level of complexity.

Fusarium Keratitis: A Systematic Review (1969 to 2023).

BACKGROUND: Mycotic keratitis (MK) represents a corneal infection, with Fusarium species identified as the leading cause. Fusarium is a genus of filamentous fungi commonly found in soil and plants. While many Fusarium species are harmless, some can cause serious infections in humans and animals, particularly Fusarium keratitis, that can lead to severe ocular infections, prevalent cause of monocular blindness in tropical and subtropical regions of the world. Due to its incidence and importance in ophthalmology, we conducted a systematic analysis of clinical cases to increase our understanding of Fusarium keratitis by gathering clinical and demographic data. METHODS: To conduct an analysis of Fusarium keratitis, we looked through the literature from the databases PubMed, Embase, Lilacs, and Google Scholar and found 99 papers that, between March 1969 and September 2023, corresponded to 163 cases of Fusarium keratitis. RESULTS: Our analysis revealed the Fusarium solani species complex as the predominant isolate, with females disproportionately affected by Fusarium keratitis. Notably, contact lens usage emerged as a significant risk factor, implicated in nearly half of cases. Diagnosis primarily relied on culture, while treatment predominantly involved topical natamycin, amphotericin B, and/or voriconazole. Surprisingly, our findings demonstrated a prevalence of cases originating from the United States, suggesting potential underreporting and underestimation of this mycosis in tropical regions. This shows the imperative for heightened vigilance, particularly in underdeveloped regions with substantial agricultural activity, where Fusarium infections may be more prevalent than currently reported. CONCLUSION: Our study sheds light on the clinical complexities of Fusarium keratitis and emphasizes the need for further research and surveillance to effectively tackle this vision-threatening condition. Furthermore, a timely identification and early initiation of antifungal treatment appear to be as important as the choice of initial treatment itself.

Land use land cover and land surface temperature changes and their relationship with human modification in Islamabad Capital Territory, Pakistan.

Human activities are altering the existing patterns of Land Use Land Cover (LULC) and Land Surface Temperature (LST) on a global scale. However, long-term trends of LULC and LST are largely unknown in many remote mountain areas such as the Karakorum. . The objective of our study therefore was to evaluate the historical changes in land use and land cover (LULC) in an alpine environment located in Islamabad Capital Territory, Pakistan. We used Landsat satellite pictures (namely Landsat 5 TM and Landsat 8 OLI) from the years 1988, 2002, and 2016 and applied the Maximum Likelihood Classification (MLC) approach to categorize land use classes. Land Surface Temperatures (LST) were calculated using the thermal bands (6, 10, and 11) of Landsat series data. The correlation between the Human Modification Index (HMI) and LULC as well as LST was evaluated by utilizing data from Google Earth Engine (GEE). Over the study period, the urbanized area increased by 9.94%, whilst the agricultural and bare soil areas decreased by 3.81% and 3.94%, respectively. The findings revealed a significant change in the LULC with a decrease of 1.99% in vegetation. The highest LST class exhibited a progressive trend, with an increase from 12.27% to 48.48%. Based on the LST analysis, the built-up area shows the highest temperature, followed by the barren, agricultural, and vegetation categories. Similarly, the HMI for different LST categories indicates that higher LST categories have higher levels of human alteration compared to lower LST categories, with a strong correlation (R-value = 0.61) between HMI and LST. The findings can be utilized to promote sustainable urban management and for biodiversity conservation efforts. The work also has the potential of utilizing it to protect delicate ecosystems from human interference and to formulate strategies and regulations for sustainable urban growth, including aspects of land utilization and zoning, reduction of urban heat stress, and urban infrastructure.

Correlation of PD-L1 expression with different clinico-pathological and immunohistochemical features of ovarian surface epithelial tumors.

BACKGROUND: Primary carcinoma of the ovary (OCs) are responsible for a significant number of deaths related to cancer, and have the highest rate of death related to cancers of the female reproductive organs. Programmed cell death 1 (PD1) protein, acts as an immune checkpoint, and has an important role in the down-regulation of the immune system by preventing the activation of T-cells, which will weaken the autoimmunity and increases self-tolerance. This study aimed at the evaluation of the immunohistochemical (IHC) expression of PD-L1 in various primary surface ovarian epithelial tumours and to test its correlation with different clinicopathological parameters together with the expression of a panel of P53, ER and PR. METHODS: A set of 102 cases of primary ovarian surface epithelial neoplasms (benign, borderline and malignant) were collected to construct Tissue Microarray (TMA) using 3 tissue cores from each case. IHC for PD-L1, p53, PR and ER was performed. The expression of PD-L1 was evaluated in relation to some clinicopathological parameters and to the expression patterns of other markers. RESULTS: Expression of PD-L1 was detected in about 51% (n = 36) of malignant tumours. The malignant group significantly showed PD-L1 positivity compared to borderline and benign groups. The malignant tumours significantly showed PD-L1 and total p53 positivity in comparison to borderline group. Also, malignant tumours significantly showed higher combined positivity of PD-L1 and either PR or ER compared to borderline and benign lesions. No significant correlation was appreciated between PD-L1 expression and with any of the studied clinicopathological parameters. CONCLUSIONS: This study showed a significant PD-L1 expression in malignant primary surface epithelial tumours. Construction of a panel of IHC markers, including PD-L1, could have a potential value to define patients those would benefit from the addition of immunotherapy to the treatment plan.

Parâmetros de Strain Diastólico Estão Associados à Mortalidade em Curto Prazo e à Reinternação em Pacientes com Insuficiência Cardíaca Avançada / Diastolic Strain Parameters are Associated with Short Term Mortality and Rehospitalization in Patients with Advanced Heart Failure

Resumo Fundamento A insuficiência cardíaca é uma das principais causas de hospitalização e mortalidade em todo o mundo e representa um grande fardo económico para os sistemas de saúde. A identificação de fatores prognósticos em pacientes com IC é de grande importância para estabelecer estratégias de manejo ideais e evitar procedimentos invasivos e dispendiosos desnecessários em pacientes em estágio terminal. Objetivos No presente estudo, nosso objetivo foi investigar a associação entre parâmetros de strain diastólico, incluindo E/e' SR, e resultados de curto prazo em pacientes com IC avançada. Métodos O estudo populacional incluiu 116 pacientes com insuficiência cardíaca avançada com fração de ejeção reduzida (ICFEr) avançada. Avaliações clínicas, laboratoriais e ecocardiográficas dos pacientes foram realizadas nas primeiras 24 horas de internação. Os pacientes foram acompanhados por um mês e qualquer reinternação por piora dos sintomas de IC e qualquer mortalidade foi registrada. O nível de significância adotado na análise estatística foi de 5%. Resultados A E/e' SR foi significativamente maior no grupo de pacientes em comparação ao grupo controle (p=0,001). Durante o acompanhamento de um mês, 13,8% dos pacientes morreram e 37,1% dos pacientes foram reinternados. NT-ProBNP sérico (p=0,034) e E/e' SR (p=0,033) foram considerados preditores independentes de mortalidade e o uso de IECA (p=0,027) e strain 3C apical (p=0,011) foram considerados independentes preditores de reinternação no grupo de pacientes. Conclusão Os resultados do presente estudo prospectivo demonstram que a E/e' SR medida pela ecocardiografia com speckle tracking é um preditor independente e sensível de mortalidade em curto prazo em pacientes com ICFEr avançada e pode ter um papel na identificação de pacientes com ICFEr em estágio terminal.

Abstract Background Heart failure (HF) is a leading cause of hospitalization and mortality worldwide and places a great economic burden on healthcare systems. Identification of prognostic factors in HF patients is of great importance to establish optimal management strategies and to avoid unnecessary invasive and costly procedures in end-stage patients. Objectives In the current study, we aimed to investigate the association between diastolic strain parameters including E/e' SR, and short-term outcomes in advanced HF patients. Methods The population study included 116 advanced HF with reduced ejection fraction (HFrEF) patients. Clinical, laboratory, and echocardiographic evaluations of the patients were performed within the first 24 hours of hospital admission. Patients were followed for one month and any re-hospitalization due to worsening of HF symptoms and any mortality was recorded. The level of significance adopted in the statistical analysis was 5%. Results E/e' SR was significantly higher in the patient group compared to the control group (p=0.001). During one-month follow-up, 13.8% of patients died and 37.1% of patients were rehospitalized. Serum NT-ProBNP (p=0.034) and E/e' SR (p=0.033) were found to be independent predictors of mortality and ACEİ use (p=0.027) and apical 3C strain (p=0.011) were found to be independent predictors of rehospitalization in the patient group. Conclusion Findings of the current prospective study demonstrate that E/e' SR measured by speckle tracking echocardiography is an independent and sensitive predictor of short-term mortality in advanced HFrEF patients and may have a role in the identification of end-stage HFrEF patients.

Machine Learning Algorithms for Sex Classification by Using Variables of Orbital Structures: A Computed Tomography Study / Algoritmos de Aprendizaje Automático para la Clasificación del Sexo Mediante el Uso de Variables de Estructuras Orbitales: Un Estudio de Tomografía Computarizada

SUMMARY: Since machine learning algorithms give more reliable results, they have been used in the field of health in recent years. The orbital variables give very successful results in classifying sex correctly. This research has focused on sex determination using certain variables obtained from the orbital images of the computerized tomography (CT) by using machine learning algorithms (ML). In this study 12 variables determined on 600 orbital images of 300 individuals (150 men and 150 women) were tested with different ML. Decision tree (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), and Naive Bayes (NB) algorithms of ML were used for unsupervised learning. Statistical analyses of the variables were conducted with Minitab® 21.2 (64-bit) program. ACC rate of NB, DT, KNN, and LR algorithms was found as % 83 while the ACC rate of LDA and RFC algorithms was determined as % 85. According to Shap analysis, the variable with the highest degree of effect was found as BOW. The study has determined the sex with high accuracy at the ratios of 0.83 and 0.85 through using the variables of the orbital CT images, and the related morphometric data of the population under question was acquired, emphasizing the racial variation.

Dado que los algoritmos de aprendizaje automático dan resultados más fiables, en los últimos años han sido utilizados en el campo de la salud. Las variables orbitales dan resultados muy exitosos a la hora de clasificar correctamente el sexo. Esta investigación se ha centrado en la determinación del sexo utilizando determinadas variables obtenidas a partir de las imágenes orbitales de la tomografía computarizada (TC) mediante el uso de algoritmos de aprendizaje automático (AA). En este estudio se probaron 12 variables determinadas en 600 imágenes orbitales de 300 individuos (150 hombres y 150 mujeres) con diferentes AA. Se utilizaron algoritmos de AA de árbol de decisión (DT), K-Nearest Neighbour, regresión logística (RL), Random Forest (RF), análisis discriminante lineal (ADL) y Naive Bayes (NB) para el aprendizaje no supervisado. Los análisis estadísticos de las variables se realizaron con el programa Minitab® 21.2 (64 bits). La tasa de ACC de los algoritmos NB, DT, KNN y RL se encontró en % 83, mientras que la tasa de ACC de los algoritmos ADL y RFC se determinó en % 85. Según el análisis de Sharp, la variable con el mayor grado de efecto se encontró como BOW. El estudio determinó el sexo con alta precisión en las proporciones de 0,83 y 0,85 mediante el uso de las variables de las imágenes de TC orbitales, y se adquirieron los datos morfométricos relacionados de la población en cuestión, enfatizando la variación racial.

American mitogenome reference for the tropical brown dog tick, Rhipicephalus linnaei (Audouin, 1826).

The brown dog tick, Rhipicephalus linnaei (Audouin, 1826), is distributed across the American continent and is formerly known as the "tropical lineage". It belongs to the Rhipicephalus sanguineus (Latreille, 1806) species complex, referred to as R. sanguineus (sensu lato). Mitochondrial genome sequences are frequently used for the identification and represent reference material for field studies. In the present study, the entire mitochondrial genomes of R. linnaei (∼15 kb) collected from dogs in Mexico were sequenced and compared with available mitogenomes of R. sanguineus (s.l.). The mitochondrial genome is ∼90% identical to the reference genome of R. sanguineus (sensu stricto, former "temperate lineage") and > 99% identical to R. linnaei mitogenome derived from the neotype. Two additional mitogenomes were obtained and described as R. linnaei and R. turanicus from dogs in Saudi Arabia. The present study delivers a molecular reference for R. linnaei from America and complements R. linnaei mitogenomes from Africa, Asia and Australia. We propose to consider the complete mitogenome, as the reference for American R. linnaei, even when partial mitochondrial cox1, 12S rRNA or 16S rRNA genes are characterised.

Rate and Causes of Unplanned Hospital Returns within 60 Days following Head and Neck Surgery.

Introduction Unplanned hospital returns are frequent and may be preventable. Objective To comprehend the reasons for unplanned hospital readmission and return to the Outpatient Department (OPD) and Emergency Department (ED) within 60 days after discharge following head and neck surgery (HNS) at a tertiary care center in Saudi Arabia. Methods In the present retrospective study, the medical records of all patients who underwent HNS for benign and malignant conditions between January 2015 and June 2022 were reviewed in terms of demographic data, comorbidities, and reasons for hospital return. Results Out of 1,030 cases, 119 (11.55%) returned to the hospital within 60 days after discharge, 19 of which (1.84%) were readmitted. In total, 90 (8.74%) patients returned to the OPD, and 29 (2.82%), to the ED. The common reasons for readmission included infections (26.32%) and neurological symptoms (21.05%). For OPD visits, the common causes were hematoma (20%) and neurological symptoms (14.44%). For ED returns, the frequent causes were neurological symptoms (20.69%) and equipment issues (17.24%). Compared with nonreadmitted patients, readmitted patients had a higher preoperative baseline health burden when examined using the American Society of Anesthesiologists (ASA) score ( p = 0.004) and the Cumulative Illness Rating Scale (CIRS; p = 0.002). Conclusion The 60-day rates of unplanned hospital return to the OPD and ED were of 8.74% and 2.82% respectively, and 1.84% of the patients were readmitted. Hematoma, infections, and neurological symptoms were common causes. Addressing the common reasons may be beneficial to decrease postoperative hospital visits.

The effects of art therapy interventions on anxiety in children and adolescents: A meta-analysis.

OBJECTIVE: This study aimed to assess the effects of art therapy on anxiety among children and adolescents. METHODS: We searched several databases, including PubMed, Web of Science, Embase (via Ovid), PsychINFO (through EBSCO), and The Cochrane Library, comprising the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Additionally, Chinese databases such as CNKI (China National Knowledge Infrastructure) and Wan Fang Data were explored from their beginnings until October 22, 2023. Studies that investigated the impact of art therapy on anxiety compared to a control group were included. The methodological quality of these randomized controlled trials was evaluated using the Cochrane Handbook's risk of bias instrument. RESULTS: Six studies involving 422 participants were included. The findings indicated a notable decrease in anxiety symptoms due to art therapy, with a Standardized Mean Difference (SMD) of -1.42, 95% Confidence Interval (95%CI -2.33, -0.51), p < 0.002. Notably, there was pronounced heterogeneity, as evidenced by Tau2 = 1.41, Chi2 = 101.19, df = 6, and I² = 94%, with Z = 3.06. CONCLUSION: Art therapy significantly improved the anxiety symptoms of children and adolescents, positioning it as an effective means of treating anxiety.

Erector spinae plane block as a rescue therapy in following cholecystectomy: a historical cohort study.

OBJECTIVE: The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. MATERIALS AND METHODS: This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. RESULTS: One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. CONCLUSION: ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids.

OBJETIVO: Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. MÉTODO: Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. RESULTADOS: En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. CONCLUSIONES: El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.

Cochlear implantation outcomes in children with multiple disabilities: a topic that's worth revisiting.

OBJECTIVES: To determine the benefits of cochlear implantation in hearing loss children with multiple disabilities (MD) in terms of auditory outcomes, speech performance, and their quality of life. METHODS: This was a cross sectional study from January 2019 to December 2020 in which thirty-one children with hearing loss and multiple disabilities were evaluated. Their improvement in auditory and speech performances were assessed using Categories of Auditory Performance version II (CAP-II) and the Speech Intelligibility Rating (SIR) scales. The assessment was done at 6-month intervals, with the baseline evaluation done at least six months after activation of the implant. Parents were asked to fill the Parents Evaluation of Aural/Oral Performance of Children (PEACH) diary and Perceived Benefit Questionnaire (PBQ) to evaluate the child's quality of life. RESULTS: All 31 children have Global Developmental Delay (GDD), with 11 having an additional disability. Both mean CAP-II and SIR scores showed significant improvement with increased hearing age (p < 0.05) after 6-month intervals. In addition, 20 out of 31 children (64.5%) have achieved verbal communication after implantation. The mean PEACH score in quiet was significantly better than in noise (p = 0.007) and improved with the increased of hearing age. The majority of parents (96%‒100%) perceived a cochlear implant as beneficial to their child in terms of auditory response, awareness, interaction, communication, and speech development. CONCLUSIONS: Cochlear implantation had shown benefits in children with multiple disabilities. Outcome measures should not only focus on auditory and speech performances but the improvement in quality of life. Hence, individualized each case with realistic expectation from families must be emphasized in this group of children. LEVEL OF EVIDENCE: Level 3.

The Impact of Transcatheter or Surgical Defect Closure on Self-Reported Sleep Quality in Adults with Atrial Septal Defect.

OBJECTIVE: Sleep quality in those with cardiovascular disease is significantly lower than in the general population. This study aimed to explore the effect of transcatheter or surgical closure of atrial septal defect (ASD) on sleep quality. METHODS: One hundred nineteen adult patients with ASD who underwent transcatheter or surgical closure were included in the study. Sleep quality was investigated prospectively just before defect closure and six months after defect closure. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of these patients. RESULTS: PSQI scores were similar in both groups before the procedure in patients who underwent both transcatheter and surgical closure. The PSQI scores six months after transcatheter closure was significantly improved compared to the PSQI score before transcatheter ASD closure (3.5 ± 2.0 vs. 6.9 ± 3.4, respectively; P<0.001). The PSQI scores six months after surgical ASD closure was significantly improved compared to the PSQI score before surgical closure (4.8 ± 2.1 vs. 7.1 ± 2.0, respectively; P<0.001). Total PSQI scores were also statistically different at six months after transcatheter and surgical closure (3.5 ± 2.0 vs. 4.8 ± 2.1, P=0.014). However, six months after both transcatheter and surgical closure, PSQI scores were significantly decreased in both groups which was more pronounced in patients who underwent transcatheter closure. CONCLUSION: Transcatheter or surgical closure of the defect may be beneficial in improving the sleep quality of adult patients with ASD. Delayed improvement of sleep quality after surgical closure may be an important advantage for transcatheter closure.

The Impact of the Novel Coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Case Fatality Rates and Cost of Surgical Care in Brazil.

Background The coronavirus disease 2019 (COVID-19) pandemic provoked disruptions in healthcare delivery. Following the recommendations of major surgical societies and surgical departments globally, most surgeries were widely canceled or postponed, causing significant disruptions to healthcare delivery worldwide, including in Brazil. Brazil's public healthcare system - Sistema Único de Saúde (SUS) was particularly affected, with a substantial decline in elective procedures, especially during the pandemic's early stages. The impact of the pandemic on surgical services in Brazil has not been adequately studied since most studies only cover the early phases of the pandemic. Thus, this study aims to analyze the case fatality rates and costs, associated with the different surgical procedure subgroups performed during the pre-pandemic, pandemic, recovery, and post-pandemic periods in all five regions of Brazil. Methods A retrospective cross-sectional design was used to examine surgical cases from 2019 to 2022. Data was divided into four time periods, named as the pre-pandemic (March-December 2019), pandemic (March-December 2020), recovery (March-December 2021), and post-pandemic (March-December 2022), and was analyzed for the cost of surgical procedures in the aforementioned four periods. In addition, the case fatality rates and rate ratios in the four periods stratified according to region were calculated. Results The cost of surgical procedures decreased during the pandemic and recovery period compared with pre-pandemic for all procedures except thoracic surgery where it was higher in the recovery period than pre-pandemic. No statistically significant change in cost was observed in surgeries of the central and peripheral nervous system, circulatory system, obstetric, and oncology. Case fatality rates increased among all five regions of Brazil in pandemic and recovery periods compared to pre-pandemic and post-pandemic periods. Case fatality rates increased during the pandemic and/or recovery as compared to pre-pandemic in all procedures except visual apparatus and obstetric surgeries were not affected by the pandemic in terms of case fatality rates. Conclusion The COVID-19 pandemic had a significant impact on surgical care costs and case fatality rates for surgery in Brazil. There was a decreasing trend in the costs of procedures during the pandemic, followed by a gradual recovery to baseline values, except for thoracic surgery. Case fatality rates rose initially and then declined, ultimately reaching baseline levels. The pandemic posed significant challenges to the healthcare system, affecting medical services, including surgical care.

Sleep Patterns and Associated Insomnia in Junior and Senior Medical Students: A Questionnaire-Based Cross-Sectional Study.

Introduction Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes. Objectives To evaluate the sleeping patterns of medical students in Saudi Arabia and their relationships with psychological distress. Methods This was a cross-sectional, self-administered, questionnaire-based study. The study included medical students from a university in Jeddah, Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS) were used to evaluate the prevalence and burden of inadequate sleep quality and insomnia in the participants. Results The majority of the participants was women (76.6%). Furthermore, most participants (96.2%) were aged between 18 and 24 years old, while 54.4% of the participants were in their senior year. According to the AIS scores (mean: 15.85 ± 4.52), 98.7% of the participants exhibited insomnia symptoms. The PSQI scores (mean: 9.53 ± 5.67) revealed that 70.5% of the participants had poor sleep quality. Students in their fundamental and junior years had significantly higher percentages of insomnia symptoms and poor sleep quality compared with students in their senior years. Conclusion The prevalence of insomnia and poor sleep quality is high among medical students. Therefore, appropriate strategies for early detection and intervention are warranted.

Young Infant Mortality Associated with Preterm and Small-for-Gestational-Age Births in Rural Bangladesh: A Prospective Cohort Study.

OBJECTIVE: To assess the relative risk of mortality in infants born preterm and small for gestational age (SGA) during the first and second months of life in rural Bangladesh. STUDY DESIGN: We analyzed data from a cohort of pregnant women and their babies in Sylhet, Bangladesh, assembled between 2011 and 2014. Community health workers visited enrolled babies up to 10 times from birth to age 59 days. Survival status was recorded at each visit. Gestational age was estimated from mother's reported last menstrual period. Birth weights were measured within 72 hours of delivery. SGA was defined using the INTERGROWTH-21st standard. We estimated unadjusted and adjusted hazard ratios (HRs) and corresponding 95% CIs for babies born preterm and SGA separately for the first and second month of life using bivariate and multivariable weighted Cox regression models. RESULTS: The analysis included 17 643 singleton live birth babies. Compared with infants born at term-appropriate for gestational age, in both unadjusted and adjusted analyses, infants born preterm-SGA had the greatest risk of death in the first (HR 13.25, 95% CI 8.65-20.31; adjusted HR 12.05, 95% CI 7.82-18.57) and second month of life (HR 4.65, 95% CI 1.93-11.23; adjusted HR 4.1, 95% CI 1.66-10.15), followed by infants born preterm-appropriate for gestational age and term-SGA. CONCLUSIONS: The risk of mortality in infants born preterm and/or SGA is increased and extends through the second month of life. Appropriate interventions to prevent and manage complications caused by prematurity and SGA could improve survival during and beyond the neonatal period.

Fusariosis in burn patients: A systematic review of case reports.

Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.

Impact of aluminum phosphide on development of the forensically important fly, Chrysomya albiceps (Diptera: Calliphoridae).

Chrysomya albiceps (Calliphoridae) is among the earliest successional fauna on human and animal cadavers. Some immature Calliphoridae can be useful for determination of post-mortem interval. Toxins, particularly pesticides, can affect the rate of insect growth. Aluminum phosphide (AlP) is an affordable insecticide that has not been adequately entomotoxicologically evaluated. So, the impact of AlP on the developmental rate of different stages of C. albiceps was investigated. Larvae of C. albiceps were reared on the rabbit carcasses containing AlP as a treated group, and distilled water as a control group. The substances were administered by a gastric tube. The duration needed for development of C. albiceps stages was documented. Body length, width and weight of larvae were measured after 24, 48, 72 and 96 h from egg hatching. The duration of development increased significantly in the treated group compared to the control group. Larvae body measurements were significantly smaller in the treated group than in the control group. Therefore, it was demonstrated that AlP significantly influences the size of C. albiceps larvae and extends their development. During forensic application, interpretation of C. albiceps data should be used with caution when aluminum phosphide may be the cause of death.

Assessment of environmental pollution and human health risks of mine tailings in soil: after dam failure of the Córrego do Feijão Mine (in Brumadinho, Brazil).

The dam failure of the Córrego do Feijão Mine (CFM) located in Minas Gerais State, Brazil, killed at least 278 people. In addition, large extensions of aquatic and terrestrial ecosystems were destroyed, directly compromising the environmental and socioeconomic quality of the region. This study assessed the pollution and human health risks of soils impacted by the tailing spill of the CFM dam, along a sample perimeter of approximately 200 km. Based on potential ecological risk and pollution load indices, the enrichments of Cd, As, Hg, Cu, Pb and Ni in soils indicated that the Brumadinho, Mário Campos, Betim and São Joaquim de Bicas municipalities were the most affected areas by the broken dam. Restorative and reparative actions must be urgently carried out in these areas. For all contaminated areas, the children's group indicated an exacerbated propensity to the development of carcinogenic and non-carcinogenic diseases, mainly through the ingestion pathway. Toxicological risk assessments, including acute, chronic and genotoxic effects, on people living and working in mining areas should be a priority for public management and mining companies to ensure effective environmental measures that do not harm human health and well-being over time.