Context-dependency in medicine:how neuronal excitability influences the impact of dopamine on cognition

Dopamine,often termed the"feel-good"neurotransmitter,plays a crucial role in myriad physiological and psychological brain processes.While dopamine is primarily associated with pleasure,reward,and motivation,its effects can be quite complex;and this complexity is further compounded when examining how dopamine functions in typical versus disease-affected neural circuits.In pa rticula r,epilepsy,characte rized by heightened brain excitability,is linked to cognitive dysfunction,and dopamine is implicated in elements of both its pathology and treatment.Neuroscience has been successful in describing the synaptic abnormalities believed to contribute to memory issues in epilepsy,aiding in the search for effective therapies for what persists as a major medical issue.

Factors and Cut-Off Predicting Stone Passage under Medical Expulsive Therapy (MET)

Background: Ureteral stones are the most common leading cause of acute flank pain. This study aimed to identify sociodemographic and clinical variables predicting spontaneous ureteral stone passage and determine the optimal size cut-off for predicting such passage. Method: We conducted a retrospective evaluation of patients presenting with acute renal colic at a urology outpatient clinic. Patients with ureteral stones ≤ 10 mm and no surgical intervention post-initial diagnosis, who attended follow-up visits, were included. Exclusion criteria comprised stone size > 1 cm, fever due to obstructive pyelonephritis, acute kidney injury, single kidney status, or bilateral ureteral obstruction. Results: Of 124 included patients, the spontaneous stone passage rate was 57.3%, with a mean passage time of 11.1 (SD 6.25) days. Bivariate analysis revealed that factors predicting spontaneous passage were stone size (p Conclusions: Stone size < 7 mm, UVJ or distal ureter location, emerged as key predictors of stone passage in nephrolithiasis, and stone size below 6.85 mm is a reasonable cut off to initiate MET rather than 10 mm.

Origin of Traditional Chinese Medicine in Cuba in the 19th Century from Its Main Exponents and Some Notable Medical Descendants in the 20th Century

The Cuban people are made up of three major migratory currents, the Chinese are one of them. They brought their culture, the methods, and procedures of traditional Chinese medicine(TCM) in the 19th century. Few were able to return and so they created families in Cuba;some of their descendants dedicated themselves to medicine. In order to investigate the practices that were predecessors of TCM in Cuba in the 19th century, a qualitative phenomenological research was carried out, reviewing what was published by various sources, applying documentary analysis, logical historical analysis, abstraction, synthesis, and systematization of the results on the regularities of the work and human behavior of Chinese doctors in the Cuban 19th and 20th centuries. This made it possible to identify six Chinese doctors in the 19th century in Cuba who gave rise to the beginning of some practices of TCM in Cuba, and five from the 20th century, descendants of coolies who dedicated themselves to other specialties of medicine. It was found that despite their geographical and time disperse, they were all notorious for their outstanding professional and human behavior, with a trail of accumulated successes in achieving “almost the impossible” with the patient. They have left their mark on Cuban culture.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Psychometric evaluation of Iranian version of nursing faculty’s incivility questionnaire

Objective:Faculty incivility is a growing problem in nursing schools that disrupts the learning process and affects nursing care of patients.Fostering and managing faculty incivility requires knowing this problem using a valid and reliable instrument.The purpose of this research was to evaluate the validity and reliability of the faculty’s perceived incivility questionnaire in the Iranian community.Methods:In this methodological study,the participants involved were 357 nursing students.They were selected between October and December 2019.The faculty’s perceived incivility questionnaire was evaluated in terms of content and construct validity.McDonald’s omega and Cronbach’s alpha coefficients were calculated.Exploratory and confirmatory factor analyses were conducted to evaluate the construct validity of the questionnaire.Results:The content validity index(CVI)was 0.86-0.91 for the items and 0.87 for the whole instrument.In factor analysis,two factors of violent and irresponsible behaviors were extracted.These factors explained>41.769%of the variance.Model fit indices(Parsimonious Comparative Fit Index[PCFI]=0.783,Parsimonious Normed Fit Index[PNFI]=0.756,root mean square error of approximation[RMSEA]=0.051,Goodness-of-Fit Index[GFI]=0.955,Adjusted Goodness-of-Fit Index[AGFI]=0.932,Comparative Fit Index[CFI]=0.955,χ^(2)/df=2.26)indicated the proportion of factors.Internal consistency was 0.87-0.93.Conclusions:Faculty’s perceived incivility questionnaire is a valid and reliable tool with two factors that can be used to evaluate the incivility in Iranian faculty members.

The concept of gene therapy for glaucoma:the dream that has not come true yet

Gene therapies,despite of being a relatively new therapeutic approach,have a potential to become an important alternative to current treatment strategies in glaucoma.Since glaucoma is not considered a single gene disease,the identified goals of gene therapy would be rather to provide neuroprotection of retinal ganglion cells,especially,in intraocular-pressure-independent manner.The most commonly reported type of vector for gene delivery in glaucoma studies is adeno-associated virus serotype 2 that has a high tro pism to retinal ganglion cells,res ulting in long-term expression and low immunogenic profile.The gene thera py studies recruit inducible and genetic animal models of optic neuropathy,like DBA/2J mice model of high-tension glaucoma and the optic nerve crush-model.Reported gene therapy-based neuroprotection of retinal ganglion cells is targeting specific genes translating to growth factors(i.e.,brain derived neurotrophic factor,and its receptor TrkB),regulation of apoptosis and neurodegeneration(i.e.,Bcl-xl,Xiap,FAS system,nicotinamide mononucleotide adenylyl transferase 2,Digit3 and Sarm1),immunomodulation(i.e.,Crry,C3 complement),modulation of neuroinflammation(i.e.,e rythropoietin),reduction of excitotoxicity(i.e.,Com KIlα)and transcription regulation(i.e.,Max,Nrf2).On the other hand,some of gene therapy studies focus on lowering intra ocular pressure,by impacting genes involved in both,decreasing aqueous humor production(i.e.,aquaporin 1),and increasing outflow facility(i.e.,COX2,prostaglandin F2a receptor,RhoA/RhoA kinase signaling pathway,MMP1,Myocilin).The goal of this review is to summarize the current stateof-art and the direction of development of gene therapy strategies for glaucomatous neuropathy.

Reference values for selected hematological, biochemical and physiological parameters of Sprague‐Dawley rats at the Animal House, Faculty of Medicine, University of Colombo,Sri Lanka

Background: Lack of available reference values in a research setting under local conditions can be a drawback for beginners, as the accuracy of data from control samples cannot be checked at the beginning of a research project. This affects comparisons with data from test samples. To avoid these complications in their research projects,beginners tend to have a greater number of animals in the control group compared to test groups in order to have control group measurements within 2 SDs of the mean.Methods: As non-availability of reference values was a long-felt need, the described project was conducted in order to establish a reference database for selected haematological, biochemical and physiological parameters using apparently healthy Sprague-Dawley rats bred in the Animal House of Faculty of Medicine, University of Colombo(UCFM).Results: Differences in mean values of packed cell volume(PCV), mean corpuscular volume(MCV) and mean corpuscular hemoglobin concentration(MCHC), serum creatinine and blood glucose levels between the two genders were statistically significant. Lipid profile measurements did not differ significantly between genders, but mean and median values of triglycerides(TG) between male and female rats showed a difference of more than 10 mg/dL. The liver enzymes alkaline phosphatase(AP)and aspartate aminotransferase(AST) were also statistically significantly different between sexes. Despite wide variation in mean alanine aminotransferase(ALT)between sexes, the difference was not statistically significant.Conclusion: The findings of this project should support to a certain extent the"Reduction" aspect of the 3 Rs concept of Russell and Burch by reducing the number of Sprague-Dawley rats used in future research projects at UCFM.

The anti-neoplastic effects of metformin modulate the acquired phenotype of fbroblast cells in the breast cancer-normal fbroblast co-culture system

Intracellular communications between breast cancer and fibroblast cells were reported to be involved in cancer proliferation,growth,and therapy resitance.The hallmarks of cancer fibroblast interactions,consisting of caveolin 1(Cav1)and mono-carboxylate ransporter 4(MCT4)(metabolic coupling markers),along with IL-6,TGFB,and lactate secretion,are considered robust biomarkers predicting recurrence and metastasis.In order to promote a novel phenotype in normal fibroblasts,we predicted that breast cancer cells could be able to cause loss of Cavl and increase of MCT4,as well as elevate IL 6 and TGF in nearby nomal fibroblasts.We created a co culture model using breast cancer(4T1)and normal fibroblast(NIH3T3)cell lines cultured under specific experimental conditions in order to directly test our theory.Moreover,we show that long-term co-culture of breast cancer cells and normal fibroblasts promotes loss of Cavl and gain of MCT4 in adjacent fibroblasts and increase lactate secretion.These results were validated using the monoculture of each group separately as a control.In this system,we show that me tformin inhibits IL-6 and TGFB secretion and re expresses Cavl in both cells.However,MCT4 and lactate stayed high after treatment with metformin.In conclusion,our work shows that co-culture with breast cancer cells may cause signifcant alterations in the phenotype and secretion of normal fibroblasts.Metformin,however,may change this state and affect fibroblasts'acquired phenotypes.Moreover,mitochondrial inhibition by metformin after 8 days of treatment,signi ficantly hinders tumor growth in mouse model of breast cancer.

New insights into the cardio-renal benefits of SGLT2 inhibitors and the coordinated role of miR-30 family

Sodium-glucose co-transporter inhibitors(SGLTis)are the latest class of anti-hyper-glycemic agents.In addition to inhibiting the absorption of glucose by the kidney causing glycosuria,these drugs also demonstrate cardio-renal benefits in diabetic subjects.miR-30 family,one of the most abundant microRNAs in the heart,has recently been linked to a setting of cardiovascular diseases and has been proposed as novel biomarkers in kidney dysfunctions as well;their expression is consistently dysregulated in a variety of cardio-renal dysfunctions.The mechanistic involvement and the potential interplay between miR-30 and SGLT2i effects have yet to be thoroughly elucidated.Recent research has stressed the relevance of this clus-ter of microRNAs as modulators of several pathological processes in the heart and kidneys,raising the possibility of these small ncRNAs playing a central role in various cardiovascular complications,notably,endothelial dysfunction and pathological remodeling.Here,we review current evidence supporting the pleiotropic effects of SGLT2is in cardiovascular and renal out-comes and investigate the link and the coordinated implication of the miR-30 family in endo-thelial dysfunction and cardiac remodeling.We also discuss the emerging role of circulating miR-30 as non-invasive biomarkers and attractive therapeutic targets for cardiovascular dis-eases and kidney diseases.Clinical evidence,as well as metabolic,cellular,and molecular as-pects,arecomprehensively covered.

Fatal cases in pediatric patients after post-exposure prophylaxis for rabies:A report of two cases

Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.

A systematic review and meta-analysis of the prevalence of Leishmania infantum in sandflies in Iran

Objective:To determine the overall and pooled prevalence of Leishmania(L.)infantum in sandfly vectors in Iran.Methods:The present research conducted a systematic review and meta-analysis and searched regional databases such as PubMed,Scopus,Web of Science(WoS),Embase,PAHO Iris,LILACS,WHO Iris,and local databases named:SID,Magiran,Civilica,and also grey literatures.The current research included studies that were conducted in Iran and examined L.infantum in different sandfly vectors.The studies’quality assessment/risk of bias assessment was evaluated by the Joanna Briggs Institute Critical Appraisal Checklist for prevalence data studies,and the data were analyzed by Stata 14 software.In addition,we examined 22 primary studies to estimate the overall prevalence of L.infantum among various vectors of visceral leishmaniasis.Results:According to the meta-analysis,the pooled prevalence of Phlebotomus(Ph.)tobbi,Ph.alexandri,Ph.kandelaki,Ph.perfiliewi,Ph.major,Ph.keshishiani were 5.34%,4.36%,2.23%,1.79%,4.37%and 1.18%.Ph.tobbi has the highest infection rate(25.00%)of L.infantum among the sandfly vectors.Conclusions:Visceral leishmaniasis is widespread in Fars,Ardebil,and East-Azerbaijan provinces,which are the most important endemic regions in Iran.

The Coping Styles and Perception of Illness in Patients with Breast Cancer—Relation to Body Image and Type of Surgery

Breast cancer is considered one of the most frequent causes of morbidity and death in women.Individuals’response to information regarding health threats and illness can influence the adjustment of the treatment to existing conditions including the issues of non-completion of treatment or non-attendance at medical appointments.The study aimed to examine the relationship between illness perception,body image dissatisfaction and(mal)adaptive coping styles in breast cancer patients.A sample of 197 patients with diagnosed breast cancer hospitalized at the Center for Oncology and Radiology,Kragujevac,Serbia,was surveyed.The instruments included sociodemographic questionnaire,a Brief Illness Perception Questionnaire(BIPQ),a Body Image Scale(BIS),and a Mini-Mental Adjustment to Cancer Scale(Mini-MAС).Results showed that 52%of the variance of maladaptive coping style in women who underwent mastectomy was explained by the negative illness perception,while body image dissatisfaction reflected through this connection(CFI>.95,GFI>.95,RMSEA=.01,SRMR=.08).Similar results were found in patients with breast-conserving surgery but with lower percentage(36%)of variance explained(CFI>.95,GFI>.95,RMSEA<.02,SRMR<.05).If confirmed by further studies,these results would suggest that patients who underwent mastectomy tend to be more dissatisfied with their body image,have tendency to perceive illness as threatening and resort to maladaptive coping styles.However,any form of appearance modification,including breast-conserving surgery,carries the risk of body image dissatisfaction,and consequently the risk of maladaptive coping behaviors.Our results suggest that health professionals and public policies should put an additional focus on the assessment of the patient’s body image dissatisfaction,to improve the health and wellbeing of the affected women.

Global systematic review and meta-analysis of knowledge, attitudes, and practices towards dengue fever among the general population

Objective:To determine the global level of knowledge,attitudes,and practices towards dengue fever among the general population.Methods:To complete this systematic review and meta-analysis,a thorough search for pertinent English-language literature was undertaken during the study's extension until October 2023.The search used Google Scholar,Scopus,PubMed/MEDLINE,Science Direct,Web of Science,EMBASE,Springer,and ProQuest.A quality assessment checklist developed using a modified Newcastle-Ottawa Scale for the cross-sectional study was used to evaluate the risk of bias in the included papers.Inverse variance and Cochran Q statistics were employed in the STATA software version 14 to assess study heterogeneity.When there was heterogeneity,the Dersimonian and Liard random-effects models were used.Results:59 Studies totaling 87353 participants were included in this meta-analysis.These investigations included 86278 participants in 55 studies on knowledge,20196 in 33 studies on attitudes,and 74881 in 29 studies on practices.The pooled estimates for sufficient knowledge,positive attitudes,and dengue fever preventive behaviors among the general population were determined as 40.1%(95%CI 33.8%-46.5%),46.8%(95%CI 35.8%-58.9%),and 38.3%(95%CI 28.4%-48.2%),respectively.Europe exhibits the highest knowledge level at 63.5%,and Africa shows the lowest at 20.3%.Positive attitudes are most prevalent in the Eastern Mediterranean(54.1%)and Southeast Asia(53.6%),contrasting sharply with the Americas,where attitudes are notably lower at 9.05%.Regarding preventive behaviors,the Americas demonstrate a prevalence of 12.1%,Southeast Asia at 28.1%,Western Pacific at 49.6%,Eastern Mediterranean at 44.8%,and Africa at 47.4%.Conclusions:Regional disparities about the knowledge,attitude and preventive bahaviors are evident with Europe exhibiting the highest knowledge level while Africa has the lowest.These findings emphasize the importance of targeted public health interventions tailored to regional contexts,highlighting the need for region-specific strategies to enhance dengue-related knowledge and encourage positive attitudes and preventive behaviors.

Outcomes of long-acting injectable antipsychotics use in pregnancy:A literature review

BACKGROUND Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy.Long-acting injectable(LAI)antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders,but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy.AIM To summarize relevant data on maternal,pregnancy,neonatal,and developmental outcomes from published cases of LAI antipsychotic use in pregnancy.METHODS A literature search was performed through November 11,2023,using three online databases:PubMed/MEDLINE,Scopus,and Web of Science.Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy,with available full texts,were included.Descriptive statistics,narrative summation,and tabulation of the extracted data were performed.RESULTS A total of 19 publications satisfied the inclusion criteria:3 case series,15 case reports,and 1 conference abstract.They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies.The use of secondgeneration LAI antipsychotics was reported in the majority(n=47;61.0%)of pregnancies.First-generation LAI antipsychotics were administered during 30 pregnancies(39.0%).Most of the women(approximately 64%)had either satisfactory control of symptoms or no information about relapse,while approximately 12%of them had developed gestational diabetes mellitus.A minority of cases reported adverse outcomes such as stillbirth,spontaneous abortion,preterm birth,low birth weight,congenital anomalies,and neurological manifestations in newborns.However,there were no reports of negative long-term developmental outcomes.CONCLUSION Currently available data seem reassuring,but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

Enhancing Network Design through Statistical Evaluation of MANET Routing Protocols

This paper contributes a sophisticated statistical method for the assessment of performance in routing protocols salient Mobile Ad Hoc Network(MANET)routing protocols:Destination Sequenced Distance Vector(DSDV),Ad hoc On-Demand Distance Vector(AODV),Dynamic Source Routing(DSR),and Zone Routing Protocol(ZRP).In this paper,the evaluation will be carried out using complete sets of statistical tests such as Kruskal-Wallis,Mann-Whitney,and Friedman.It articulates a systematic evaluation of how the performance of the previous protocols varies with the number of nodes and the mobility patterns.The study is premised upon the Quality of Service(QoS)metrics of throughput,packet delivery ratio,and end-to-end delay to gain an adequate understanding of the operational efficiency of each protocol under different network scenarios.The findings explained significant differences in the performance of different routing protocols;as a result,decisions for the selection and optimization of routing protocols can be taken effectively according to different network requirements.This paper is a step forward in the general understanding of the routing dynamics of MANETs and contributes significantly to the strategic deployment of robust and efficient network infrastructures.

Anterior cruciate ligament reconstruction:Effect of graft tunnel position on early to mid-term clinical outcomes

BACKGROUND Patient reported outcome measures(PROMs)can be used to assess knee function following anterior cruciate ligament(ACL)reconstruction.Intra-operatively,femoral and tibial tunnels are created to accommodate the new ACL graft.It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position.AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction.METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee,Lysholm,Tegner,EuroQol-5 Dimension-5 level,and Short Form 12-item Health Survey.A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions.This data was analysed to assess for any correlations between graft tunnel position and postoperative PROMs.RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years(range 1 to 7 years).Posterior position of tibial tunnel was associated with improved KOOS quality of life(rho=0.43,P=0.002)and EQ-5D VAS(rho=0.36,P=0.010).Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index(rho=-0.38,P=0.028).There were no other significant correlations between any of the other radiological parameters and PROM scores.CONCLUSION Overall,graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction.A few(posterior)tibial tunnel and(anterior)EndoButton femoral tunnel measurements were associated with better PROMs.

Prevalence of Anemia in Patients with Diabetes Mellitus:A Systematic Review and Meta-Analysis

Objective Anemia is a common public health concern in patients with type 2 diabetes worldwide.This study aimed to identify the prevalence of anemia among patients with diabetes.Methods Electronic databases,including PubMed,Scopus,Web of Sciences,and Google Scholar,were searched systematically for studies published between 2010 and 2021.After removing duplicates and inappropriate reports,the remaining manuscripts were reviewed and appraised using theNewcastleOttawa Scale(NOS)tool.A random-effects model was used to calculate the pooled estimates of the extracted data using Stata version 17.Heterogeneity of the studies was assessed using the Q statistic.Results A total of 51 articles containing information on 26,485 patients with diabetes were included in this study.The articles were mainly from Asia(58.82%)and Africa(35.29%).The overall prevalence of anemia was 35.45%(95%CI:30.30–40.76),with no evidence of heterogeneity by sex.Among the two continents with the highest number of studies,the prevalence of anemia in patients with diabetes was significantly higher in Asia[40.02;95%CI:32.72–47.54]compared to Africa[28.46;95%CI:21.90–35.50](P for heterogeneity=0.029).Moreover,there has been an increasing trend in the prevalence of anemia in patients with diabetes over time,from[15.28;95%CI:9.83–22.21]in 2012 to[40.70;95%CI:10.21–75.93]in 2022.Conclusion Globally,approximately 4 in 10 patients with diabetes suffer from anemia.Therefore,routine anemia screening and control programs every 3 months might be useful in improving the quality of life of these patients.

Interest of Non-Invasive Markers (APRI, FIB-4) for Assessing Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B without Cytolysis and with Low Viral Replication

Background and Objectives: The indication for treatment in HBsAg-positive patients with low viral load and normal transaminases requires an assessment of fibrosis. In resource-limited settings, free hepatic fibrosis evaluation tests can aid in therapeutic decision-making. Our study aims to demonstrate the utility of assessing hepatic fibrosis using non-invasive markers (APRI and FIB-4) in patients with chronic B viral hepatitis without cytolytic activity and low viral replication in our context. Patients and Methods: This is a retrospective cross-sectional study conducted between January 2018 and December 2021 at the University Hospital Center of Bouaké. Included were all patients aged ≥18 with normal transaminases (Results: Our study included 241 patients, with a mean age of 36.19 years (±10.52 years) and a male predominance of 52%. The mean FibroScan® value was 6.44 ± 2.3 kPa, and 68 patients (28.22%) had fibrosis >7 kPa. To exclude significant fibrosis (FS Conclusion: A significant proportion of HBV-infected patients with normal ALT and low viral load have active liver disease. Both FIB-4 and APRI biological scores are useful in identifying individuals without significant fibrosis with a good negative predictive value (>50%).

Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report

BACKGROUND Aseptic acetabular loosening can result from various factors that can be categorized into groups:patient-related,surgeon-related and implant-related.We present a case of a 63-year-old patient who at first underwent a total hip arthro-plasty(THA)using a metal-on-metal bearing due to hip arthrosis.Follow-up visits revealed no complications after the procedure.Two years after the THA,acetabular component loosening occurred due to subsequent trauma of the opposite hip,necessitating a revision THA using a ceramic-on-ceramic bearing.CASE SUMMARY We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution.Following the revision arthroplasty,a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery:Harris Hip Score(before surgery:15;after surgery:95),Western Ontario and McMaster Universities Arthritis Index(before surgery:96;after surgery:0),and Visual Analogue Scale(before surgery:10;after surgery:1).CONCLUSION Opposite-hip trauma caused a weight transfer to the limb after a THA procedure.This process led to a stress shielding effect,resulting in acetabular component loosening.

Frequency of Rotavirus among under 5 Children Admitted to Wad Madani Pediatric Teaching Hospital with Diarrhea, Gezira State, Sudan (2021-2022)

Rotavirus is the leading cause of acute gastroenteritis and responsible for 20% of death in children under 5 years of age approximately 111 million episodes of gastroenteritis due to Rotavirus in under 5 children, which result in 25 million visits to clinic, 2 million hospitalization and 352,000 - 592,000 deaths. Children in the poorest countries account 82% of rotaviruses death. Diarrhea disease are major cause of death and disease among children under five years, a child on average suffers 2 to 3 attacks of diarrhea every year. Stools samples were collected from 196 children suffering from diarrhea and were tested for rotaviruses by immune chromatography test antigen (ICT-Ag), ELISA and RT PCR The data were analyzed using statistical package for the Social Sciences (SPSS). The results showed that prevalence of rotavirus was 26/196 (13.3%) by ICT Ag and ELISA and confirmed by RT-PC R. 87.8% of the children were vaccinated by Rota vaccine, 70% of their mothers not using soap for cleaning the children and thought diarrhea not infectious disease and believed it was caused by teething. In conclusion there was a decrease in prevalence of diarrhea by Rotavirus due to insertion of Rota vaccine in routine vaccination, rotavirus infection mostly occurs in poor family that not able to provide safe water and due to poor sanitation and low education of mother beside that some children suffered from malnutrition, so it recommended to incorporate ELISA as a diagnostic tool in routine diagnosis of rotavirus among children suffered from gastroenteritis.