[Peripheral arterial disease in black African diabetics: epidemioclinical, ultrasonographic profile and determining factors]. / Artériopathie oblitérante des membres inférieurs chez le sujet diabétique noir africain : profil épidémioclinique, ultrasonographique et facteurs déterminants.

BACKGROUND: Diabetes can lead to micro and macro-angiopathies. The peripheral arterial disease (PAD) is a serious and an incapacitating disease. It is still under-estimated and under-treated throughout the world, particularly in sub-Saharan Africa. Doppler ultrasound, and in particular ankle brachial index (ABI), can be used to detect it. The aim was to determine the prevalence of PAD to study the clinical and ultrasonographic aspects and to identify the determining factors. PATIENTS AND METHODS: This was a descriptive and analytical study over a period of 5 years, including a total of 782 diabetic patients hospitalised in the diabetology department of the CHU la Reference Nationale. RESULTS: Among the 782 patients, 166 (21.2%) had an ABI < 0.9 reflected the PAD and 72 (9.2%) had an ABI > 1.3, suggestive of mediacalcosis. PAD of the lower limb was mild in 102 patients (61.4%), moderate in (26.3%) and severe in (12.3%). The mean age of the arteritic patients was 56.4 ± 10.2 years. Male gender predominated (59.6%) with a sex ratio of 1.6. All patients had type 2 diabetes (100%). The mean duration of diabetes was 13 ± 5.9 years. The majority of our patients with arterial disease had diabetes for at least 10 years (54.2%). The other cardiovascular in this population were obesity (45.2%), followed by hypertension and dyslipidaemia (32.5%). Diabetes was unbalanced (HbA ≥7%) in the majority of cases (75.3%). Clinically, the majority of patients had a trophic disorder (68%). Asymptomatic patients accounted for 24.6% of cases and those with intermittent claudication for 7.4%. Duplex doppler of the lower limbs showed that all patients with PAD had atheromatous lesions. The distal location was predominantly in the tibial arteries (54.8%). The determinants of PAD in this diabetic population were hypertension (p = 0.01) and obesity (p = 0.01). CONCLUSION: In our series, PAD was often discovered at an advanced stage, with a non-negligible prevalence. The determining factors found were hypertension and obesity. Screening and control of major cardiovascular risk factors is a priority in the management of this disease.

Physiological and molecular mechanisms of the inhibitory effects of artemisinin on Microcystis aeruginosa and Chlorella pyrenoidosa.

Artemisinin, a novel plant allelochemical, has attracted attention for its potential selective inhibitory effects on algae, yet to be fully explored. This study compares the sensitivity and action targets of Microcystis aeruginosa (M. aeruginosa) and Chlorella pyrenoidosa (C. pyrenoidosa) to artemisinin algaecide (AMA), highlighting their differences. Results indicate that at high concentrations, AMA displaces the natural PQ at the QB binding site within M. aeruginosa photosynthetic system, impairing the D1 protein repair function. Furthermore, AMA disrupts electron transfer from reduced ferredoxin (Fd) to NADP+ by interfering with the iron-sulfur clusters in the ferredoxin-NADP+ reductases (FNR) domain of Fd. Moreover, significant reactive oxygen species (ROS) accumulation triggers oxidative stress and interrupts the tricarboxylic acid cycle, hindering energy acquisition. Notably, AMA suppresses arginine synthesis in M. aeruginosa, leading to reduced microcystins (MCs) release. Conversely, C. pyrenoidosa counters ROS accumulation via photosynthesis protection, antioxidant defenses, and by regulating intracellular osmotic pressure, accelerating damaged protein degradation, and effectively repairing DNA for cellular detoxification. Additionally, AMA stimulates the expression of DNA replication-related genes, facilitating cell proliferation. Our finding offer a unique approach for selectively eradicating cyanobacteria while preserving beneficial algae, and shed new light on employing eco-friendly algicides with high specificity.

Community Structure and Water Quality Assessment of Benthic Macroinvertebrates in Hongze Lake.

This study investigated the species, density, biomass and physicochemical factors of benthic macroinvertebrates in Hongze Lake from 2016 to 2020. Redundancy analysis (RDA) was used to analyze the relationship between physicochemical parameters and the community structure of macroinvertebrates. Macroinvertebrate-based indices were used to evaluate the water quality conditions in Hongze Lake. The results showed that a total of 50 benthic species (10 annelids, 21 arthropods and 19 mollusks) were collected. The community structure of benthic macroinvertebrates varied in time and space. The dominant species were Limnodrilus hoffmeisteri (L.hoffmeisteri), Corbicula fluminea (C.fluminea), Nephtys oligobranchia (N.oligobranchia). In 2016, arthropods such as Grandidierella sp. were the dominant species of benthos in Hongze Lake while annelids and mollusks dominated from 2017 to 2020, such as L.hoffmeisteri, N.oligobranchia, C.fluminea. The benthic fauna of Chengzi Lake and Lihewa District were relatively abundant and showed slight variation, while the benthic macroinvertebrates of the Crossing the water area were few and varied greatly. RDA showed that changes in benthic macroinvertebrate structure were significantly correlated with dissolved oxygen (DO), Pondus Hydrogenii (pH) and transparency (SD). The Shannon Wiener, Pielou, and Margalef indices indicate that Hongze Lake is currently in a moderately polluted state. Future studies should focus on the combined effects of various physicochemical indicators and other environmental factors on benthic communities.

Tuning Surface, Phase, and Magnetization of Superparamagnetic Magnetite by Ionic Liquids: Single-Step Microwave-Assisted Synthesis.

Achieving colloidal and chemical stability in ferrofluids by surface modification requires multiple steps, including purification, ex situ modification steps, and operation at high temperatures. In this study, a single-step microwave-assisted methodology is developed for iron oxide nanoparticle (IONP) synthesis utilizing a series of imidazolium-based ionic liquids (ILs) with chloride, bis(trifluoromethylsulfonyl)imide, and pyrrolide anions as the reaction media, thus eliminating the use of volatile organics while enabling rapid synthesis at 80 °C as well as in situ surface functionalization. The characterized surface functionality, hydrodynamic particle size, magnetization, and colloidal stability of the IONPs demonstrate a strong dependence on the IL structure, ion coordination strength, reactivity, and hydrophilicity. The IONPs present primarily a magnetite (Fe3O4) phase with superparamagnetism with the highest saturation magnetization at 81 and 73 emu/g at 10 and 300 K, respectively. Depending on the IL coating, magnetization and exchange anisotropy decrease by 20 and 2-3 emu/g (at 35 wt % IL), respectively, but still represent the highest magnetization achieved for coated IONPs by a coprecipitation method. Further, the surface-functionalized superparamagnetic magnetite nanoparticles show good dispersibility and colloidal stability in water and dimethyl sulfoxide at 0.1 mg/mL concentration over the examined 3 month period. This study reports on the intermolecular and chemical interactions between the particle surface and the ILs under synthetic conditions as they relate to the magnetic and thermal properties of the resulting IONPs that are well suited for a variety of applications, including separation and catalysis.

Exogenous glutathione protected wheat seedling from high temperature and water deficit damages.

High temperatures (HT) and drought are two major factors restricting wheat growth in the early growth stages. This study investigated the role of glutathione (GSH) amendment (0.0, 0.5, 1.0, and 2.0 mM) to soil in mitigating the adverse effect of HT (33 °C, with 25 °C as a control), water regimes (60% of field capacity and control), and their combinations. HT decreased the length, project area, surface area, volume, and forks of the root, while drought had the reverse effect. Shoot length, leaf area, leaf relative water content, and shoot and root dry matter were significantly decreased by HT and drought, and their combined impact was more noticeable. GSH significantly promoted the root system, shoot growth, and leaf relative water content. The combined treatment reduced chlorophyll a, chlorophyll b, and total chlorophyll. However, 0.5 mM GSH raised chlorophyll a, chlorophyll b, and total chlorophyll by 28.6%, 41.4%, and 32.5%, respectively, relative to 0.0 mM GSH. At combined treatment, 0.5 mM GSH decreased malondialdehyde (MDA) by 29.5% and increased soluble protein content by 24.1%. GSH meaningfully enhanced the activity of superoxide dismutase, catalase, and ascorbate peroxide in different treatments. This study suggested that GSH could protect wheat seedlings from the adverse effects of HT and/or drought stresses.

Policy vs. practice in sport and climate change: the perspectives of key actors in global sport and international development.

Despite widespread, scientifically supported recognition of the scope of the climate crisis, and policies in place connecting sport to sustainable development, there remain concerns that the environment and climate change are rarely acknowledged within SDP activity and that even when they are, it is unclear how such policies are implemented, and to what effect. This raises the question of how and why the climate crisis and the attendant relationships between sport and sustainable development are understood and operationalized (or not) by stakeholders within the SDP sector. In this paper, therefore, we explore various perspectives and tensions around the environment and climate crisis within the SDP sector. To do so, we draw on interviews with SDP policy-makers (primarily from the United Nations and the International Olympic Committee) and SDP practitioners living and working in the global South in order to gauge the place of the environment and climate change in their everyday SDP policy-making, programming and practices. Overall, the data shows that while SDP stakeholders recognize the urgency of the climate crisis, the need for action, and the policy agenda linking sport to sustainable development, significant barriers, tensions and politics are still in place that prevent consistent climate action within SDP. Policy commitments and coherence are therefore needed in order to make climate action a core feature of SDP activity and practice.

Isolated Inferior Sagittal Sinus Thrombosis in Young Patient: Rare Case Report.

Cerebral venous thrombosis (CVT) is a less common type of stroke, mostly in young patients. The majority of these cases are due to thrombosis of superior sagittal sinus and transverse sinus. Isolated thrombosis of the inferior sagittal sinus is very rare. Here, we report a 22-year-old male patient with no significant past medical history who presented to the emergency department of our hospital with a convulsion, decreased level of consciousness, and right side weakness. His laboratory investigations, including the coagulation profile, were normal. A non-contrast brain CT showed a 5 × 3 cm hematoma in the left parasagittal parietal lobe with no associated midline shift or intraventricular extension. The cerebral magnetic resonance (MR) angiogram did not show any underlying aneurysm or vascular lesion. However, the cranial MR venogram showed inferior sagittal sinus thrombosis, while other cranial veins and dural sinuses were patent. The patient was admitted to the hospital and managed with low-molecular-weight heparin and warfarin sequentially. He had significant improvement (consciousness and weakness have improved, and seizures are under control). This present case illustrates a rare case of isolated cerebral venous thrombosis and also reviews the known literature on this condition.

Indications, Measurements, and Complications of Ten Essential Neonatal Procedures.

About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.

Impacts of Partial Substitution of Chemical Fertilizer with Organic Fertilizer on Soil Organic Carbon Composition, Enzyme Activity, and Grain Yield in Wheat-Maize Rotation.

This study explored the effect of the long-term partial replacement of chemical fertilizer with organic fertilizer on soil organic carbon composition, enzyme activity, and crop yields in the wheat-maize rotation area of northern Anhui, China. This study also specified the proper amount of organic fertilizer replacement that should be used for chemical fertilizer. Different fertilization modes were used (no fertilization, CK; chemical fertilizer, CF; chemical fertilizer and straw returning, CF + S; chemical fertilizer, straw returning, and straw decomposition agent, CF + S + DA; 70% chemical fertilizer and 50% organic fertilizer, 70% CF + 50% OF; 70% chemical fertilizer, 50% organic fertilizer and straw returning, 70% CF + 50% OF + S; 50% chemical fertilizer and 100% organic fertilizer, 50% CF + 100% OF; and 50% chemical fertilizer, 100% organic fertilizer, and straw returning, 50% CF + 100% OF + S). Variations in the organic carbon composition, enzyme activity, soil pH, and crop yields in the wheat-maize rotation under different fertilization treatments were analyzed. The results showed that the replacement of chemical fertilizer with organic fertilizer results in improved crop yields in wheat-maize rotation. The long-term partial replacement of chemical fertilizer with organic fertilizer can increase the quality of soil humus, alleviate soil acidification, and improve soil enzyme activity. Straw returning and organic fertilizer application can considerably raise the activities of urease, acid phosphatase, and nitrate reductase in soil. The soil pH of the CF treatment was reduced compared to the CK treatment, while organic fertilizer application alleviated soil acidification when compared to CF treatment. Organic fertilization increases the total organic carbon content of the soil, which was 19.6~85.5% higher than in the CK treatment. Applying straw and organic fertilizer significantly increased the ratio of the humic/fulvic acid in the soil. The soil active carbon forms of the soil with the application of organic fertilizer and straw returning were significantly higher than those of the CK and CF treatments. This study suggests that the optimal fertilizer management option in northern Anhui's wheat-maize rotation area is to replace 50% of the chemical fertilizer with organic fertilizer, and to fully return straw to the field. This would include 150 kg N h·m-2, 60 kg P2O5 h·m-2, 50 kg K2O h·m-2, 6000 kg organic fertilizer h·m-2, and full straw return to the field.

Prognostic Value of Hospital Frailty Risk Score and Clinical Outcomes in Patients Undergoing Revascularization for Critical Limb-Threatening Ischemia.

Background The impact of medical record-based frailty assessment on clinical outcomes in patients undergoing revascularization for critical limb-threatening ischemia (CLTI) is unknown. Methods and Results This study included patients with CLTI aged ≥18 years from the nationwide readmissions database 2016 to 2018 who underwent endovascular revascularization (ER) or surgical revascularization (SR). The hospital frailty risk score, a previously validated International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) claims-based score, was used to categorize patients into low- (<5), intermediate- (5-15), and high-risk (>15) frailty categories. Primary outcomes were in-hospital mortality and major amputation at 6 months. A total of 64 338 patients were identified who underwent ER (82.3%) or SR (17.7%) for CLTI. The mean (SD) age of the cohort was 69.3 (11.8) years, and 63% of patients were male. This study found a nonlinear association between hospital frailty risk score and in-hospital mortality and 6-month major amputation. In both ER and SR cohorts, the intermediate- and high-risk groups were associated with a significantly higher risk of in-hospital mortality (high-risk group: ER: odds ratio [OR], 7.2 [95% CI, 4.4-11.6], P<0.001; SR: OR, 28.6 [95% CI, 3.4-237.6], P=0.002) and major amputation at 6 months (high-risk group: ER: hazard ratio [HR], 1.6 [95% CI, 1.5-1.7], P<0.001; SR: HR, 1.7 [95% CI, 1.4-2.2], P<0.001) compared with the low-risk group. Conclusions The hospital frailty risk score, generated from the medical record, can identify frailty and predict in-hospital mortality and 6-month major amputation in patients undergoing ER or SR for CLTI. Further studies are needed to assess if this score can be incorporated into clinical decision-making in patients undergoing revascularization for CLTI.

[Management of heart failure at the CHU the National Reference of Ndjamena/Chad]. / Prise en charge de l'insuffisance cardiaque au CHU la Reference Nationale de Ndjamena/Tchad.

INTRODUCTION: Heart failure (HF) is a syndrome of diverse etiologies, and a real public health problem in both developed and developing countries. The aim of this study was to determine the clinical, etiological, therapeutic and evolutionary aspects of heart failure. MATERIALS AND METHODS: This was a descriptive and analytical study carried out in the cardiology department of the national referral university hospital in N'Djamena (Chad). RESULTS: Heart failure accounted for 30.84% of cardiovascular pathologies hospitalized in the cardiology department during the study period. The mean age of our patients was 52 ± 34 years, with extremes ranging from 18 to 87 years. Females predominated, accounting for 50.7% of cases, with a M/F sex-ratio of 0.97. Hypertensive heart disease (33.7%), valvular heart disease (16.6%) and ischemic heart disease (15.1%) were the most frequent etiologies. The drugs most frequently used were loop diuretics (97%), ACE inhibitors (96%) and beta-blockers (93.5%). The in-hospital mortality rate was 9% in our series.

The Golden Patient Initiative: A Systematic Review.

Operating theatres and surgical resource consumption comprise a significant proportion of healthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented among local trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.

[Prevalence of dyslipidemia in the biochemistry laboratory of the Reference National Teaching Hospital of N'Djamena, Chad.] / Prévalence des dyslipidémies au laboratoire de biochimie du CHU la Référence Nationale de N'Djamena/Tchad.

INTRODUCTION: les dyslipidémies constituent un facteur de risque majeur dans la survenue des maladies cardio-vasculaires. La recherche de ce facteur et sa prise en charge adéquate contribuerait à prévenir ces maladies qui sont la plus grande cause de décès dans le monde. L'objectif de cette étude était d'évaluer la prévalence des dyslipidémies au laboratoire de biochimie du Centre Hospitalier Universitaire de Référence Nationale de N'Djamena. MATéRIEL ET MéTHODES: il s'agissait d'une étude transversale d'une durée de cinq ans (2015-2020) portant sur tous les patients ayant au moins un paramètre lipidique dans le registre du laboratoire. Les méthodes enzymatiques sur un automate de biochimie de type Cobas Integra 400 (Roche Diagnostics) ont été utilisées pour le dosage de cholestérol total, LDL-c, HDL-c et de triglycérides. RESULTS: Au total 2038 patients avec une prédominance masculine (sex-ratio :1,33), ont été enregistrés, l'âge moyen de nos patients était de 56,45±8,8 ans. La prévalence des dyslipidémies était de 44,2%. Les différents types des dyslipidémies étaient repartis comme suit : l'hypercholestérolémie (40,52%) ; l'hyper LDLémie (33,02%) ; l'hypoHDLémie (14,72%) ; l%hypertriglyc%rid%mie (11,72%) et l'hyperlipidémie mixte (40,5%). On notait une évolution croissante de la prévalence de dyslipidemie au cours des cinq années de periode d'étude. CONCLUSIONS: la forte prévalence des dyslipidémies dans notre étude témoigne d'une situation préoccupante au Tchad, d'où l'intérêt d'étudier la prévalence des dyslipidémies et des autres facteurs de risque cardiovasculaire à l'échelle nationale et l'utilité d'organiser des campagnes d'éducations et d'informations sur les maladies cardiovasculaires et les facteurs de risque cardiovasculaire afin de r'duire cette pr'valence.

Interactions within the climate-vegetation-fire nexus may transform 21st century boreal forests in northwestern Canada.

Dry and warm conditions have exacerbated the occurrence of large and severe wildfires over the past decade in Canada's Northwest Territories (NT). Although temperatures are expected to increase during the 21st century, we lack understanding of how the climate-vegetation-fire nexus might respond. We used a dynamic global vegetation model to project annual burn rates, as well as tree species composition and biomass in the NT during the 21st century using the IPCC's climate scenarios. Burn rates will decrease in most of the NT by the mid-21st century, concomitant with biomass loss of fire-prone evergreen needleleaf tree species, and biomass increase of broadleaf tree species. The southeastern NT is projected to experience enhanced fire activity by the late 21st century according to scenario RCP4.5, supported by a higher production of flammable evergreen needleleaf biomass. The results underlie the potential for major impacts of climate change on the NT's terrestrial ecosystems.

The role of melatonin in plant growth and metabolism, and its interplay with nitric oxide and auxin in plants under different types of abiotic stress.

Melatonin is a pleiotropic signaling molecule that reduces the adverse effects of abiotic stresses, and enhances the growth and physiological function of many plant species. Several recent studies have demonstrated the pivotal role of melatonin in plant functions, specifically its regulation of crop growth and yield. However, a comprehensive understanding of melatonin, which regulates crop growth and yield under abiotic stress conditions, is not yet available. This review focuses on the progress of research on the biosynthesis, distribution, and metabolism of melatonin, and its multiple complex functions in plants and its role in the mechanisms of metabolism regulation in plants grown under abiotic stresses. In this review, we focused on the pivotal role of melatonin in the enhancement of plant growth and regulation of crop yield, and elucidated its interactions with nitric oxide (NO) and auxin (IAA, indole-3-acetic acid) when plants are grown under various abiotic stresses. The present review revealed that the endogenousapplication of melatonin to plants, and its interactions with NO and IAA, enhanced plant growth and yield under various abiotic stresses. The interaction of melatonin with NO regulated plant morphophysiological and biochemical activities, mediated by the G protein-coupled receptor and synthesis genes. The interaction of melatonin with IAA enhanced plant growth and physiological function by increasing the levels of IAA, synthesis, and polar transport. Our aim was to provide a comprehensive review of the performance of melatonin under various abiotic stresses, and, therefore, further explicate the mechanisms that plant hormones use to regulate plant growth and yield under abiotic stresses.

Pattern of Neurological Disorders among Patients Evaluated in the Emergency Department; Cross-Sectional Study.

Introduction: Neurologic disorders are common reasons for emergency consultations. Most neurologic disorders seen in the emergency department (ED) are life-threatening and require urgent treatment. The goal of this study is to investigate the pattern of neurological disorders among patients evaluated in the ED. Methods: This is a cross-sectional study conducted in the ED of Mogadishu Somali Turkish Training and Research Hospital, from July 2021 to February 2022. The clinical and epidemiological characteristics of adult patients with neurologic manifestations in the ED were evaluated. Age, gender, distribution of neurological disease manifestations, neurological examination findings, and neurological diagnoses made by consultant neurologists were assessed. Results: During the study period, 321 patients were assessed (3.7 % of all ED admissions). The majority of the patients in the study were above 50 years of age (62.6% male). Hypertension was the most common comorbidity among these patients with 122 (38%) cases, followed by diabetes mellitus with 65 (20.2%), and heart diseases with 26 (8.1%) cases. The main reasons for neurology consultations were altered mental status with 141 (44%) cases, motor weakness with 102 (31.8%), seizures with 33 (10%), headache with 17 (5.3%), and vertigo with 9 (2.8%) cases. 196 (61%) had hemiplegia, 60 (18.7%) had consciousness impairment, and 38 (11.8%) had normal neurological examination. The most frequent neurological diagnoses were ischemic strokes with 125 (39%) cases, hemorrhagic strokes with 65 (20.2%), epileptic seizures with 28 (8.7%), and metabolic encephalopathies with 13 (4%) cases. The median duration of the neurology consultations was 20 minutes. 251 (78%) of the patients were admitted to the hospital, while 70 (22%) were discharged from the emergency department. After neurology consultation, the neurology department made the most admissions with 226 (90%) cases, while 25 (10%) were admitted by other departments. Of those admitted, 186 (74.2%) were admitted to the neurology ward, and 65 (25.8%) were admitted to the intensive care unit. Conclusion: In our study, neurologic emergencies accounted for 3.7% of all emergency admissions. Stroke, epileptic seizures, cerebral venous thrombosis, encephalopathies, and acute spinal cord diseases were the most common neurological disorders.  The admission rate was very high following neurologic assessment by neurologists.

"I think that comes with experience": A thematic analysis exploring how dental students at a transitional stage of training understand and engage with reflection.

INTRODUCTION: Reflection is an important skill for dentists but there is little consensus about how reflection can most usefully be integrated into dental education. The aim of this study was to conduct focus groups to explore how students at a transitional point of dental education in one UK dental school had experienced, and conceptualised reflection. METHODS: Students at the beginning of their clinical studies were recruited by email and invited to attend a single focus group. Focus groups were co-facilitated by a team of staff and student researchers and analysed using thematic analysis. Students acted as research partners in planning a topic guide, recruiting students, conducting focus groups and considering the implications of research findings for the curriculum, and contributed their perspectives to other aspects of the research. RESULTS: Students primarily associated reflection with their clinical learning and valued the skill highly in this context. They were less familiar with the potential for reflection to support personal development and deeper learning. Themes were identified of learning, uncertainty, emotions and wellbeing, community and challenges and are discussed in detail. CONCLUSION: Reflection is highly valued within our dental education setting but many students may be missing out on using it to its' full potential. Changes to the undergraduate curriculum, including offering reflection from an early stage of education may be warranted.

Epidemiology and Risk Factors of Convulsive Status Epilepticus Patients Admitted in the Emergency Department of Tertiary Hospital in Mogadishu, Somalia.

Introduction: Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. Methods: This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0-18 years) and adult group (18 years and above). Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. Results: The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. Conclusion: CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.

Identifying molecular mechanisms of acute to chronic pain transition and potential drug targets.

INTRODUCTION: Chronic pain is pain that lasts more than the normal physiologic healing time at the time of initial insult. The transition from acute to chronic pain has been studied thoroughly. Understanding the mechanisms underlying chronic pain formation is essential for the development of novel treatments and therapeutics for chronic pain prevention. AREA COVERED: The transition from acute to chronic pain has been associated with the intracellular changes caused by repeated stimulus application, or neuronal priming, allowing for the chronicity of pain. Ongoing research studies have shown this priming to occur at various sites along the pathway for the neural transmission of pain. The purpose of this review is to not only elucidate the transition from acute to chronic pain and discuss current studies/trials related to this transition but also to highlight mechanisms involved in the process that could serve as potential targets for chronic pain prevention. EXPERT OPINION: We are providing an overview of novel treatment strategies for preventing the transition from acute to chronic pain. A multifaceted and multimodal approach that invokes multiple targets, at least one from each section (the periphery, the spinal cord, and the brain), would be the best option for tackling this problem.