A Strategy for the Formal C-N Cross-Coupling of Tertiary Amines.

We report a strategy for the C-N cross-coupling of tertiary amines via the in situ generation and displacement of N-acyl ammonium species. Specifically, treatment of diverse tertiary amines with TFAA or choroformates in the presence of NaI leads to the efficient generation of alkyl iodides, which can be engaged directly in Ni-catalyzed cross-couplings. The protocol is applicable to acyclic and cyclic systems, including highly hindered variants. Applications to the late-stage modification of complex heterocycles are presented.

Quantification of Gleason Pattern 4 Metrics Identifies Pathologic Progression in Patients With Grade Group 2 Prostate Cancer on Active Surveillance.

BACKGROUND: During active surveillance (AS) for Grade Group (GG) 2 prostate cancer, pathologic progression to GG3 on surveillance biopsy is a trigger for intervention. However, this ratio of GP3:GP4, may be obscured by increases of relatively indolent disease. We aimed to explore changes in GP4 quantity during AS and propose alternative definitions for progression based on GP4 changes. DESIGN, SETTING, AND PARTICIPANTS: We assessed patients enrolled on AS between November 2014 and March 2020 with GG2 disease on diagnostic biopsy and subsequent surveillance biopsy approximately 1 year later. Outcome measures included change in overall %GP4 and total length GP4 (mm). RESULTS AND LIMITATIONS: 61 patients met the inclusion criteria, the median change in total length of GP4 and %GP4 was -0.12 mm (IQR -0.31, 0.09) and -2.5% (IQR -8.6, 0.0), respectively. Excluding the 35 patients with no evidence of GP4 on surveillance biopsy, median change in total GP4 length and %GP4 was 0.19 mm (IQR -0.04, 0.67) and 1.2% (IQR -1.6, 6.6), respectively. Three patients progressed to GG3 disease on surveillance biopsy, one of whom had only a small increase in %GP4. Conversely, an additional 2 patients who did not meet the criterion for GG3 had a large increase (> 1 mm) in total GP4 length. CONCLUSIONS: Presence of GG3 disease on surveillance biopsy as a trigger for treatment in men on AS is of questionable use alone; we suggest including other measures that do not depend on a ratio, such as an increase in total GP4 length.

From Other Journals: A Review of Recent Articles by Our Editorial Team.

In this review we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address: 1- The use of AI in fetal echocardiography, 2- The role of Apixaban in thromboembolism prevention in pediatric congenital heart disease, 3- Cardiovascular events in childhood cancer survivors, and lastly 4- the new consensus statement on cardiac catheterization for pediatrics and adults with congenital heart disease.

Analysis of condylar positioning in the temporomandibular joint following mandibular reconstruction: Introduction of a new classification system and assessment of influencing factors on displacement.

OBJECTIVE: This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction. METHODS: A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction. RESULTS: The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328). CONCLUSION: The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.

Iodine and selenium: Dietary sources and nutritional status of the population of the Kurdistan Region in Northern Iraq.

AIM: The primary aim of this study was to determine the selenium (Se) and iodine (I) food concentrations and dietary intake of the population living in the Kurdish controlled region of northern Iraq. We also assessed the extent to which iodised salt contributes to dietary iodine intake. METHODOLOGY: Foods and samples of salt and drinking water were analysed, including 300 crops samples from 40 local farms. The results, supplemented by food composition data, were used to assess dietary Se and I intake for 410 volunteers using a semi-quantitative food questionnaire. To directly investigate the nutritional status of individuals, urine samples were also collected from participants. RESULTS: Selenium intake was mainly supplied by protein and cereal sources. Calculated median dietary intake of Se was 62.7 µg d-1 (mean = 66.3 µg d-1) with c. 72 % of participants meeting or exceeding dietary reference intake recommendations for age. Median dietary intake of I, excluding salt consumption, was 94.6 µg d-1 (mean 100.2 µg d-1), increasing to 607.2 µg d-1 when salt (of which >90 % was iodized) was included. Salt intake was estimated to be c.13.5 g d-1 (5400 mg Na d-1) which greatly exceeds WHO recommended intake (< 2000 mg d-1 of Na). Urine iodine concentrations indicated that 98 % of school aged children had excessive iodine intake (≥300 µg L-1) and 80-90 % of all study participants had above average or excessive iodine intake (≥200 µg L-1). CONCLUSIONS: Poultry and rice are the main sources of dietary Se to this population but around a third of children receive an inadequate Se intake. Fresh fruit and vegetables are the main sources of dietary I, but consumption of local foods cannot supply adequate I without iodised salt supplementation. Consumption of iodized salt well above recommended amounts is supplying this population with substantial iodine intake. Interventions to reduce salt intake would help to limit excessive iodine intake whilst also reducing cardio-vascular risks from Na consumption.

Performance of two laser motion modes versus conventional orthodontic ceramic brackets debonding technique on enamel surface topography.

The risk of enamel deterioration that frequently coexists with debonding of orthodontic teeth brackets elevates the mandate for finding an optimum approach for debonding them without harmful effects. This in-vitro study is intended to compare the effects of two different laser modes (scanning and circular) and a conventional method on the enamel surface after debonding orthodontic brackets. 66 extracted premolars were assigned into 3 groups. After that, light-cure composite resin was used to attach the ceramic brackets to the teeth. Amongst the test groups, Group I: specimens that were debonded using conventional debonding using pliers; Group 2: specimens that were debonded using Er, Cr: YSGG laser applications using the circular motion method; and Group 3: specimens that were debonded using Er, Cr: YSGG laser applications using the scanning motion method. Adhesive Remnant Index (ARI) assessment, intra-pulpal temperature increase, enamel surface roughness after polishing, and assessment of the microstructure of enamel were carried out with scanning electron microscopy. The gathered information was examined statistically. The conventional debonding method had a significantly higher proportion of adhesive remnant index (ARI) scores of 2 and 3 in comparison to the circular (p < .004) and scanning laser groups (p < .001). There was no significant difference in ARI scores between the circular and scanning laser groups (p > .05). Moreover, the circular and scanning laser debonding methods resulted in a significantly higher proportion of Enamel Surface Roughness (ESR) scores of 0 and a lower proportion of ESR scores of 3 compared to the conventional technique group (p < .001). However, there was no significant difference in ESR scores between the circular and scanning laser methods (p = .945). Lastly, the average intra-pulpal temperature was significantly higher in the circular laser group (1.9 ± 0.5 ) compared to the scanning laser group (0.9 ± 0.2) with p < .001. Er, Cr: YSGG laser irradiation is a tool that shows promise for debonding ceramic brackets with minimal harm to the enamel surface. The scanning laser technique is more desirable due to the lower intra-pulpal temperature increase.

The effect of aging on the translucency of contemporary zirconia generations: in-vitro study.

BACKGROUND: The translucency of different zirconia generations at each time point after thermocycling aging is still lacking. METHODS: Four zirconia materials were used with a total of 60 samples produced from monolithic third generation (5Y) 5 mol% yttria-stabilized zirconia polycrystalline ceramic and fourth generation zirconia (4Y) 4 mol% yttria-stabilized zirconia polycrystalline ceramic, represented by [group1:[CM-5Y] Ceramill Zolid fx (3rd generation zirconia) (Amann Girrbach, Koblach, Austria), group 2:[CM-4Y] Ceramill Zolid HT + (4th generation zirconia) (Amann Girrbach, Koblach, Austria), group 3:[CC-5Y] Cercon XT/ML (Dentsply Sirona, Germany) (3rd generation), and group 4:[CC-4Y] Cercon HT/ML (Dentsply Sirona, Germany) (4th generation)]. The L*a*b* figures were measured by using a spectrophotometer at baseline and after 10,000, 30,000, and 50,000 cycles of thermocycling. At each interval, the translucency of the samples was estimated by using the translucency formula CIEDE2000. The Scheffe post-hoc compared differences among each of the four materials. The Repeated measures ANOVA tested the differences between the materials at each of the different thermocycling intervals (p < .001). Data analyses were evaluated at a significance level of p < .05 (CI 95%). RESULTS: Two-way ANOVA revealed that at baseline the third and fourth generation's zirconia showed statistically significant differences in translucency (P < .001). Translucency values at baseline and after thermocycling exhibited statistically significant changes (p = .003). At each of the time interval; CM-4Y had the highest translucency values followed by CM-5Y, CC-4Y and CC-5Y had the least translucency values. CONCLUSIONS: The third and fourth generations of zirconia displayed different translucencies. Thermocycling affected the translucency of both third and fourth generations of zirconia. At each of the time intervals group 2:[CM-4Y] had the highest TP followed by group1:[CM-5Y], while, group 3:[CC-5Y] and group 4:[CC-4Y] had the least TP.

Plain language summary of the FOENIX-CCA2 study: futibatinib for people with advanced bile duct cancer.

WHAT IS THIS SUMMARY ABOUT?: This summary describes the results from a phase 2 study called FOENIXCCA2. The study evaluated treatment with futibatinib in people with a rare form of advanced bile duct cancer called intrahepatic cholangiocarcinoma (or iCCA), where the tumors have changes in the structure of a gene called FGFR2. These changes include FGFR2 gene fusions. Bile duct cancer often returns after surgery or cannot be treated by surgery because the tumor has spread, so it requires treatment with chemotherapy. People live for a median of 1 year after their first chemotherapy treatment and 6 months after their second treatment. This study included people whose cancer had grown/spread after one or more chemotherapy treatments. The aims of the study were to see if futibatinib could shrink the size of tumors and stop the cancer from growing/spreading and to see how long people lived when treated with futibatinib. Clinicians also looked at side effects from taking futibatinib and at how it affected people's quality of life. WHAT WERE THE RESULTS?: Futibatinib treatment shrank tumors in over 80% of people who received treatment. Tumors shrank by at least 30% in 42% of people. Futibatinib stopped tumors from growing/spreading for a median of 9.7 months. People who took the medicine lived for a median of 21.7 months, and 72% of people were still alive after 1 year. Side effects from taking futibatinib were like those reported for similar medicines, and clinicians considered the side effects to be manageable by adjusting the dose of futibatinib or treating the side effects. Most people reported that their quality of life stayed the same or improved during the first 9 months of taking futibatinib. WHAT DO THE RESULTS MEAN?: The results support the use of futibatinib for treating people with advanced bile duct cancer. Based on the results of this study, futibatinib is now approved in the US, Europe, and Japan. Futibatinib is approved for treating adults with advanced bile duct cancer who have received previous treatment for their cancer, and whose tumors have a gene fusion or other change in the FGFR2 gene.Clinical Trial Registration: NCT02052778 (FOENIX-CCA2).

Catalytic Activity of the Archetype from Group 4 of the FTR-like Ferredoxin:Thioredoxin Reductase Family Is Regulated by Unique S = 7/2 and S = 1/2 [4Fe-4S] Clusters.

Thioredoxin reductases (TrxR) activate thioredoxins (Trx) that regulate the activity of diverse target proteins essential to prokaryotic and eukaryotic life. However, very little is understood of TrxR/Trx systems and redox control in methanogenic microbes from the domain Archaea (methanogens), for which genomes are abundant with annotations for ferredoxin:thioredoxin reductases [Fdx/thioredoxin reductase (FTR)] from group 4 of the widespread FTR-like family. Only two from the FTR-like family are characterized: the plant-type FTR from group 1 and FDR from group 6. Herein, the group 4 archetype (AFTR) from Methanosarcina acetivorans was characterized to advance understanding of the family and TrxR/Trx systems in methanogens. The modeled structure of AFTR, together with EPR and Mössbauer spectroscopies, supports a catalytic mechanism similar to plant-type FTR and FDR, albeit with important exceptions. EPR spectroscopy of reduced AFTR identified a transient [4Fe-4S]1+ cluster exhibiting a mixture of S = 7/2 and typical S = 1/2 signals, although rare for proteins containing [4Fe-4S] clusters, it is most likely the on-pathway intermediate in the disulfide reduction. Furthermore, an active site histidine equivalent to residues essential for the activity of plant-type FTR and FDR was found dispensable for AFTR. Finally, a unique thioredoxin system was reconstituted from AFTR, ferredoxin, and Trx2 from M. acetivorans, for which specialized target proteins were identified that are essential for growth and other diverse metabolisms.

Menopausal hormone therapy and risk of venous thromboembolism: The story so far.

Menopausal hormone therapy (MHT) is known to increase the risk of venous thromboembolism (VTE), which includes deep vein thrombosis, pulmonary embolism, and less frequently cerebral vein thrombosis, but the absolute risk for a given patient is very low. After starting MHT, the risk of VTE seems to be at its highest, declining to the non-HRT user baseline level of risk after stopping. Whether estrogen-only or estrogen-progestin HRT combination is linked to a similar risk of VTE is unclear from the available evidence. The aim of this study is to evaluate the risks of developing VTE in relation to different types as well as different modes of administration of MHT through a database search including PubMed, MEDLINE, Google Scholar, Cochrane Library, and others in order to provide the women carers with the up-to-date and evidence-based guidelines and recommendations while counseling the post-menopausal women enquiring on use of hormonal therapies either to alleviate the menopausal symptoms or to prevent the long-term sequelae of estrogen deficiency.

On sait que l'hormonothérapie ménopausique (MHT) augmente le risque de thromboembolie veineuse (TEV), qui comprend la thrombose veineuse profonde, l'embolie pulmonaire et, moins fréquemment, la thrombose veineuse cérébrale, mais le risque absolu pour un patient donné est très faible. Après le début du MHT, le risque de TEV semble être à son plus haut niveau, diminuant jusqu'au niveau de risque de base des non-utilisatrices de THS après l'arrêt. Les preuves disponibles ne permettent pas de savoir si un THS à base d'œstrogène seul ou d'association œstroprogestative est lié à un risque similaire de TEV. Le but de cette étude est d'évaluer les risques de développer une TEV par rapport à différents types ainsi qu'à différents modes d'administration du MHT grâce à une recherche dans des bases de données comprenant PubMed, MEDLINE, Google Scholar, Cochrane Library et autres afin de fournir aux femmes les soignants avec les lignes directrices et recommandations à jour et fondées sur des preuves tout en conseillant les femmes ménopausées qui se renseignent sur l'utilisation de thérapies hormonales, soit pour soulager les symptômes de la ménopause, soit pour prévenir les séquelles à long terme d'une carence en œstrogènes.

Ageing and Mental Health in the Context of Social Isolation in Covid-19 Pandemic.

The Covid-19 pandemic has introduced the world to a new chapter in the last three to four years. The focus of this review is on a significant but often overlooked group and topic that has received limited research attention. Recent studies show that the psychological impact of the COVID-19 pandemic is still intense, even around three years later. This article will summarize and discuss the results of 52 studies on anxiety, depression, post-traumatic stress symptoms (PTSS), fear of loneliness, suicidal ideation, and resilience in the elderly population before and after the SARS-CoV-2 pandemic. In addition to detrimental effects, attention is also given to the improved coping abilities and lack of significant psychological distress among the geriatric population when compared to younger age groups. This review will encompass research conducted on both the population of Bangladesh and the global population as a whole.

Synaptic Plasticity and Cognitive Ability in Experimental Adult-Onset Hypothyroidism.

Adult-onset hypothyroidism impairs normal brain function. Research on animal models of hypothyroidism has revealed critical information on how deficiency of thyroid hormones impacts the electrophysiological and molecular functions of the brain, which leads to the well known cognitive impairment in untreated hypothyroid patients. Currently, such information can only be obtained from experiments on animal models of hypothyroidism. This review summarizes important research findings that pertain to understanding the clinical cognitive consequences of hypothyroidism, which will provide a better guiding path for therapy of hypothyroidism. SIGNIFICANCE STATEMENT: Cognitive impairment occurs during adult-onset hypothyroidism in both humans and animal models. Findings from animal studies validate clinical findings showing impaired long-term potentiation, decreased CaMKII, and increased calcineurin. Such findings can only be gleaned from animal experiments to show how hypothyroidism produces clinical symptoms.

Long-Term Safety and Efficacy of Pipeline Embolization Device in Anterior and Posterior Circulation Aneurysms: A Systematic Review and Meta-Analysis.

BACKGROUND: Flow diversion using the pipeline embolization device (PED) has been a paradigm shift for anterior circulation (AC) aneurysms. However, only a few studies report the long-term (≥1 year) angiographic and clinical outcomes for posterior circulation (PC) aneurysms. This study aims to compare the long-term safety and efficacy of treatment of AC and PC aneurysms with PED. METHODS: The databases included Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane, and Scopus. Studies with at least 10 patients and 1-year follow-up were included. Twenty-four studies met our inclusion criteria. A random effect meta-analysis was performed to estimate the ischemic and hemorrhagic complications. A meta-analysis of proportions was performed to estimate the pooled rates of long-term complete aneurysmal occlusion, symptomatic stroke, aneurysmal rupture, and intracranial hemorrhage. RESULTS: There were 1952 aneurysms, of which 1547 (79.25%) were in the AC and 405 (20.75%) in the PC. The 1-year occlusion rate was 78% in AC compared to 73% in PC aneurysms (P < 0.01). The symptomatic infarct rate was 5% in AC compared to 13% in PC (P < 0.01). While the rupture rate was 1% in AC compared to 4% in PC (P = 0.01), the rate of intracranial hemorrhage was 2% for both (P = 0.99). CONCLUSIONS: The long-term occlusion rate after PED was higher in AC aneurysms, and the cumulative incidence of stroke and aneurysm rupture was higher in PC aneurysms.

Identification and characterization of the low molecular mass ferredoxins involved in central metabolism in Heliomicrobium modesticaldum.

The homodimeric Type I reaction center (RC) from Heliomicrobium modesticaldum lacks the PsaC subunit found in Photosystem I and instead uses the interpolypeptide [4Fe-4S] cluster FX as the terminal electron acceptor. Our goal was to identify which of the small mobile dicluster ferredoxins encoded by the H. modesticaldum genome are capable of accepting electrons from the heliobacterial RC (HbRC) and pyruvate:ferredoxin oxidoreductase (PFOR), a key metabolic enzyme. Analysis of the genome revealed seven candidates: HM1_1462 (PshB1), HM1_1461 (PshB2), HM1_2505 (Fdx3), HM1_0869 (FdxB), HM1_1043, HM1_0357, and HM1_2767. Heterologous expression in Escherichia coli and studies using time-resolved optical spectroscopy revealed that only PshB1, PshB2, and Fdx3 are capable of accepting electrons from the HbRC and PFOR. Modeling studies using AlphaFold show that only PshB1, PshB2, and Fdx3 should be capable of docking on PFOR at a positively charged patch that overlays a surface-proximal [4Fe-4S] cluster. Proteomic analysis of wild-type and gene deletion strains ΔpshB1, ΔpshB2, ΔpshB1pshB2, and Δfdx3 grown under nitrogen-replete conditions revealed that Fdx3 is undetectable in the wild-type, ΔpshB1, and Δfdx3 strains, but it is present in the ΔpshB2 and ΔpshB1pshB2 strains, implying that Fdx3 may substitute for PshB2. When grown under nitrogen-deplete conditions, Fdx3 is present in the wild-type and all deletion strains except for Δfdx3. None of the knockout strains demonstrated significant impairment during chemotrophic dark growth on pyruvate, photoheterotrophic light growth on pyruvate, or phototrophic growth on acetate+CO2, indicating a high degree of redundancy among these three electron transfer proteins. Loss of both PshB1 and PshB2, but not FdxB, resulted in poor growth under N2-fixing conditions.

Evaluación de la condición física y salud escolar en niños y niñas de la provincia de San Luis, Argentina / Assessment of children's physical fitness and school health in the province of San Luis, Argentina

Introducción. La evaluación de la condición física (CF), junto con otros indicadores de salud, es una estrategia utilizada para conocer el estado actual de los escolares. El principal objetivo fue medir en escolares sanluiseños el estado de salud actual, los niveles de CF y construir tablas de referencias de CF. Población y métodos. Escolares entre 9 y 12 años de edad (ambos sexos) fueron evaluados con dos indicadores de salud: índice de masa corporal y presión arterial. La CF fue medida con la batería ALPHA-Fitness. El orden de las pruebas fue el siguiente: tensión arterial, masa corporal, estatura, longitud de pie y mano, salto en longitud, velocidad en 30 metros, agilidad 4 × 10 m y la prueba de ida y vuelta en 20 metros. Se calculó el índice de masa corporal (IMC) y la maduración biológica. Resultados. Fueron evaluados 15548 escolares. Los valores promedios fueron presión arterial sistólica 101 ± 10 mmHg y diastólica 66 ± 7 mmHg; IMC 20,2 ± 4,3 kg/m2. Para la CF fueron las siguientes: componente cardiorrespiratorio VO2 máx. 39,87 ± 3,2 ml/kg/min y velocidad alcanzada en la prueba de ida y vuelta en 20 m 8,9 ± 0,6 km/h; componente neuromuscular; salto en longitud: 120,6 ± 23,9 cm, velocidad 30 m: 6,56 ± 0,85 s, agilidad 4 × 10 m: 15,17 ± 1,82 s. El rendimiento siempre fue superior en el grupo masculino (p <0,001). Conclusión. Los escolares mostraron niveles saludables de presión arterial. El 50 % de la muestra fue clasificada con sobrepeso u obesidad según el IMC. En ambos sexos, se observaron bajos niveles de CF. Por primera vez, se elaboraron tablas de referencia de CF en escolares sanluiseños

Introduction. The assessment of physical fitness (PF), is useful strategy to know the current status of schoolchildren. Our primary objective was to measure the current health status and PF levels of schoolchildren in San Luis and to develop PF reference tables. Population and methods. Schoolchildren aged 9 to 12 years (boys and girls) were assessed based on 2 health indicators: body mass index and blood pressure. PF was measured using the ALPHA-Fitness test battery. Blood pressure, body mass, height, foot and hand length, standing long jump, 30 m sprint, 4 × 10 m agility test, and 20 m shuttle run test were assessed. The body mass index (BMI) and biological maturation were estimated. Results. A total of 15 548 schoolchildren were assessed. Average systolic blood pressure was 101 ± 10 mmHg and diastolic blood pressure, 66 ± 7 mmHg; BMI: 20.2 ± 4.3 kg/m2. Average PF was, in the cardiorespiratory component, VO2 max.: 39.87 ± 3.2 mL/kg/min and speed reached during the 20 m shuttle run test: 8.9 ± 0.6 km/h; in the musculoskeletal component, standing long jump: 120.6 ± 23.9 cm, 30 m sprint: 6.56 ± 0.85 s, 4 × 10 m agility test: 15.17 ± 1.82 s. The performance was better in the boys group (p < 0.001). Conclusion. Blood pressure was normal. Fifty percent of the sample was overweight or obese as per their BMI. Both boys and girls showed low PF levels. PF reference tables for schoolchildren from San Luis were developed for the first time.

From Other Journals: A Review of Recent Articles by Our Editorial Team.

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) A new index for prenatal diagnosis of total anomalous pulmonary venous return, (2) Outcomes of patients with Tetralogy of Fallot after pulmonary valve replacement (PVR), and (3) Short-term outcomes of the self expanding Harmony valve for transcatheter PVR.

Unmasking diphtheria in Nigeria: A multifaceted approach to tackle outbreaks and improve immunization rates among the Nigerian population-An updated correspondence.

Background and aims: The World Health Organization has recently declared the frequent outbreaks of diphtheria in Nigeria as a public health concern. Although vaccination efforts have been successful in Nigeria, unfortunately, the recent 2023 outbreak in Nigeria has been nothing short of distressing. Of course, cases of diphtheria incidence are under-reported in Nigeria. This present article aims to proffer a possible multifaceted approach to tackle outbreaks of diphtheria in Nigeria and improve immunization rates against the disease among the Nigerian population. Methods: In writing this study, literature search was done about diphtheria in Nigeria using the following keywords: "diphtheria, prevalence, vaccination, efforts, challenges, and Nigeria" on PubMed, Web of Science, Google Scholar, and ResearchGate within 10 years. Result: This study found that an estimated seven million people remain unvaccinated and are at risk for infection in the country, especially people living in the Northern part of the country. Between the June 30 and August 31, 2023, Nigeria recorded an unusual increase in the number of confirmed cases of diphtheria, where a total of 5898 suspected cases were reported from 59 local government areas in 11 states across Nigeria. The majority (99.4%) of suspected cases of the disease were reported from six states: Kano (1816), Katsina (234), Yobe (158), Bauchi (79), Kaduna (45), and Borno (33). Conclusion: If Nigeria is to emerge beyond these frequent epidemics of diphtheria, the Nigerian government must work on tackling this issue on multiple fronts simultaneously, that is, at the national and international levels, as we believe that these levels would give a holistic way to unmask diphtheria in Nigeria.

Poor haemorrhagic stroke outcomes during the COVID-19 pandemic are driven by socioeconomic disparities: analysis of nationally representative data.

Background: Nationally representative studies evaluating the impact of the COVID-19 pandemic on haemorrhagic stroke outcomes are lacking. Methods: In this pooled cross-sectional analysis, we identified adults (≥18 years) with primary intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH) from the National Inpatient Sample (2016-2020). We evaluated differences in rates of in-hospital outcomes between the prepandemic (January 2016-February 2020) and pandemic (March-December 2020) periods using segmented logistic regression models. We used multivariable logistic regression to evaluate differences in mortality between patients admitted from April to December 2020, with and without COVID-19, and those admitted from April to December 2019. Stratified analyses were conducted among patients residing in low-income and high-income zip codes, as well as among patients with extreme loss of function (E-LoF) and those with minor to major loss of function (MM-LoF). Results: Overall, 309 965 patients with ICH (47% female, 56% low income) and 112 210 patients with SAH (62% female, 55% low income) were analysed. Prepandemic, ICH mortality decreased by ~1% per month (adjusted OR, 95% CI: 0.99 (0.99 to 1.00); p<0.001). However, during the pandemic, the overall ICH mortality rate increased, relative to prepandemic, by ~2% per month (1.02 (1.00 to 1.04), p<0.05) and ~4% per month (1.04 (1.01 to 1.07), p<0.001) among low-income patients. There was no significant change in trend among high-income patients with ICH (1.00 (0.97 to 1.03)). Patients with comorbid COVID-19 in 2020 had higher odds of mortality (versus 2019 cohort) only among patients with MM-LoF (ICH, 2.15 (1.12 to 4.16), and SAH, 5.77 (1.57 to 21.17)), but not among patients with E-LoF. Conclusion: Sustained efforts are needed to address socioeconomic disparities in healthcare access, quality and outcomes during public health emergencies.