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Association between presence of latrine and unclean child face on the prevalence of active trachoma among children aged 1 to 9 years in low-income setting: A systematic review and meta-analysis

Background Trachoma is the leading infectious cause of blindness worldwide, primarily affecting populations in low-income countries with poor sanitation and hygiene conditions. The World Health Organization has set a goal to eliminate trachoma as a public health problem. However, progress towards this goal has been uneven across different regions. This systematic review and meta-analysis aimed to synthesize the available evidence on the association between the presence of latrine facilities and unclean child faces with the prevalence of active trachoma among children aged 1 to 9 years in low-income country settings. The findings from this study can help guide the design of more targeted interventions to reduce the burden of trachoma in vulnerable populations. Materials and methods A total of 2695 articles were searched from PubMed, Hinari, African Online Journals, Google, Google Scholar, Science Direct, and Semantic Scholar and exported to STATA version 17 for analysis. The levels of heterogeneity among studies were assessed using I2 and p-values. The findings of the meta-analysis were presented using a table, graph, and forest plot with a 95% confidence interval. A P-value of less than 0.05 was considered statistically significant. Result Among 2695 articles searched, 16 of them were selected for meta-analysis. The pooled prevalence of active trachoma was 21.10 (95% CI; 14.18, 28.02). The finding indicated high heterogeneity among the included studies (I2 =99.3%, p<0.0001). There was a statistically significant association between the presence of a latrine (POR=0.10, 95% CI: 0.00, 0.19) and unclean child face (POR=1.30, 95% CI: 1.08, 1.53) and the pooled prevalence of active trachoma among children aged 1 to 9 years in low-income countries. Conclusion The present study revealed that the pooled prevalence of active trachoma was high as compared to the WHO trachoma eradication goal. The presence of latrine facility and unclean child face were significantly associated with the prevalence of active trachoma among children aged 1 to 9 years in low-income countries. Hence it is recommended to improve access to latrines, promote child facial hygiene, and intensify overall trachoma control in low-income countries.

Effects of Er: YAG laser and acid etching on bond strength of clear aligner attachments to fluorotic enamel

Background There is a lack of research on the bonding ability of attachments to fluorosis enamel. This study evaluates Er: YAG laser-assisted acid etching as a potential optimization protocol. Methods Twenty healthy teeth and ninety fluorotic teeth (Thylstrup-Fejerskov Index = 4) were divided into a control group (healthy enamel + acid etching) and a fluorotic group (acid etching 30/60/90 seconds vs. Er: YAG laser + acid etching). The enamel surface was analyzed using scanning electron microscopy, and the shear bond strength (SBS) of each group (n = 10/group) was tested. Results Attachments exhibited higher SBS than brackets (P < 0.01). Laser-acid etching enhanced SBS compared to acid etching alone (P < 0.01). Laser-treated surfaces exhibited predominantly mixed fracture and resin cohesion fractures, in contrast to adhesive interface fractures and mixed fractures in the acid-only groups. Conclusion Er: YAG laser (100mJ/30 Hz) with 60 seconds acid etching achieves excellent bonding for fluorotic enamel attachments, restoring adhesion to healthy enamel levels while preventing over-etching damage. This protocol shows clinical potential for bonding fluorotic enamel.

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Discontinuation rates and predictors of Medical Cannabis cessation for chronic musculoskeletal pain

Medical cannabis (MC) is increasingly used as a treatment for chronic musculoskeletal pain, but there is limited data on factors influencing its discontinuation. This study aims to investigate the rates of MC discontinuation and explore factors influencing it in patients with chronic musculoskeletal pain. A retrospective analysis was conducted on 78 patients certified for medical cannabis over a 2 year period. Patient demographics, pain origin, and Global Physical Health (GPH) and Global Mental Health (GMH) scores were collected before intervention. Discontinuation rates were measured at three-month and one-year follow-up. Statistical analyses, including Fisher’s Exact Test and two-sample t-tests, were performed to assess associations between variables and discontinuation. The overall discontinuation rate of MC use was 57.9% at one year, with 44.7% of patients discontinuing within the first three months. Older age was significantly associated with higher discontinuation rates. Pain origin categories did not significantly differ between those who discontinued and continued MC use, although a higher proportion of patients in the discontinued group reported low back pain. No significant differences were observed in baseline GPH and GMH scores between the two groups. This study demonstrates a high discontinuation rate of MC use in patients for chronic musculoskeletal pain. The absence of significant differences in pain origin or baseline health scores suggests that factors beyond pain location or general health may contribute to the decision to discontinue MC. Further research is needed to explore the long-term effects of MC on pain management and patient outcomes.

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Perceived causes of marital dissatisfaction among Nigerian immigrants in North America: A qualitative study

Marital dissatisfaction among Nigerian immigrants in North America (NINA) arises from a complex interplay of cultural transitions, acculturation stress, and socio-economic pressures. This cross-sectional study followed a phenomenological approach and the guidelines from the Consolidated criteria for reporting qualitative research (COREQ) to examine the perceived causes of marital dissatisfaction among NINA through in-depth interviews with 15 participants residing in the United States and Canada. Participants were adults with at least one year of living with a Nigerian spouse in North America. Ten themes emerged from the data analysis identifying key marital challenges faced by Nigerian immigrant couples in North America. These include cultural conflicts between patriarchal and egalitarian values, financial stress, job insecurity, and extended family obligations. Other challenges involve social norms discouraging open discussions, experiences of abuse, lack of relationship skills, peer and societal pressures, infidelity, parenting conflicts, immigration-related stress, and an overreliance on prayer without practical interventions. These findings highlight the need for culturally sensitive support systems for this population and policies focusing on providing culturally tailored marital counseling, financial literacy programs, and accessible culturally sensitive mental health support services.

Direct power control and back-stepping-based direct power control for dual-stator brushless doubly-fed wind power generator

This paper proposes a novel-structured Lyapunov-based back-stepping direct power control (BS-DPC) for an emerging dual-stator brushless doubly-fed wind power generator (DSBDFWPG). The DSBDFWPG features two coaxial stators (inner/outer) and a specially designed cage-barrier rotor separated by a non-magnetic ring, maximizing the internal space utilization of large-scale wind turbines to enhance power and torque density. The inner/outer power/control windings couple with corresponding rotor sections, respectively. Unlike traditional look-up table DPC (LUT-DPC) or generic nonlinear methods, the proposed BS-DPC is rooted in Lyapunov stability theory, ensures global asymptotic stability, while synergizing with SVPWM technology to suppress power fluctuations, reduce current THD, and enhance reliability/robustness. Comprehensive simulations and experiments conducted on a 50 kW DSBDFWPG prototype (12/8 poles) validate BS-DPC’s superiority overwhelming LUT-DPC in achieving variable speed constant frequency operation, maximum power point tracking, reactive power/unit power factor control, and harmonic distortion mitigation.

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The relationship between vitamin D levels, comprehensive geriatric assessment and anthropometric measurements

Introduction It is well-established that vitamin D deficiency increases with age. This study aims to investigate the relationship between vitamin D levels, comprehensive geriatric assessment and anthropometric measurements in elderly individuals. Methods In this retrospective cross-sectional analytical study, data from patients aged 65–100 registered with İzmir City Hospital Home Care Services were analyzed. The patients’ vitamin D levels were compared with their sociodemographic and clinical data, anthropometric measurements (BMI, ABSI, body fat percentage), and geriatric assessment results (activities of daily living, nutrition, mental status, depression, frailty, and sarcopenia). Data were analyzed using SPSS 26.0 Statistics program. Results This retrospective cross-sectional study included 439 elderly individuals aged 65–100 years receiving home healthcare services. In univariate analysis, no significant associations were found between vitamin D and other variables, except for hypertension (p = 0.049). ABSI values were higher in individuals vitamin D level with severe deficient and deficient compared to other groups, while BMI levels were found to be higher in the vitamin D deficient group (p < 0.001, p < 0.001, respectively). Additionally, the severe deficiency group had a higher frequency of pressure ulcers and lower Barthel Index scores (p = 0.033, p = 0.026, respectively). Correlation analysis revealed a significant negative relationship between vitamin D levels and ABSI (r = −0.184, p < 0.05) and the presence of pressure ulcers (r = −0.113, p < 0.05). Regression analysis confirmed these negative associations with ABSI (β = −0.179, p < 0.05) and pressure ulcers (β = −0.113, p < 0.05). Hypertension and BMI lost their significance in correlation and regression analyses. Conclusion Lower vitamin D levels were associated with higher ABSI values and a greater frequency of pressure ulcers. ABSI may be useful in predicting vitamin D deficiency, and monitoring vitamin D levels in patients with pressure ulcers is recommended.

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Taurine from tumour niche drives glycolysis to promote leukaemogenesis

Abstract Signals from the microenvironment are known to be critical for development, stem cell self-renewal and oncogenic progression. Although some niche-driven signals that promote cancer progression have been identified1–5, concerted efforts to map disease-relevant microenvironmental ligands of cancer stem cell receptors have been lacking. Here, we use temporal single-cell RNA-sequencing (scRNA-seq) to identify molecular cues from the bone marrow stromal niche that engage leukaemia stem-enriched cells (LSCs) during oncogenic progression. We integrate these data with our human LSC RNA-seq and in vivo CRISPR screen of LSC dependencies6 to identify LSC–niche interactions that are essential for leukaemogenesis. These analyses identify the taurine–taurine transporter (TAUT) axis as a critical dependency of aggressive myeloid leukaemias. We find that cysteine dioxygenase type 1 (CDO1)-driven taurine biosynthesis is restricted to osteolineage cells, and increases during myeloid disease progression. Blocking CDO1 expression in osteolineage cells impairs LSC growth and improves survival outcomes. Using TAUT genetic loss-of-function mouse models and patient-derived acute myeloid leukaemia (AML) cells, we show that TAUT inhibition significantly impairs in vivo myeloid leukaemia progression. Consistent with elevated TAUT expression in venetoclax-resistant AML, TAUT inhibition synergizes with venetoclax to block the growth of primary human AML cells. Mechanistically, our multiomic approaches indicate that the loss of taurine uptake inhibits RAG-GTP dependent mTOR activation and downstream glycolysis. Collectively, our work establishes the temporal landscape of stromal signals during leukaemia progression and identifies taurine as a key regulator of myeloid malignancies.

Management preferences of orthopedic surgeons in rickets patients in Turkey: Results of a nationwide survey

Aim Rickets remains a significant health issue, particularly in developing countries. This study evaluated the management preferences of orthopedic surgeons in Turkey regarding rickets and analyzed these approaches from a pediatric endocrinology perspective. Methods An online survey was developed based on a comprehensive literature review and previous similar studies. The survey link was distributed via email to members of the Turkish Orthopedic and Traumatology Association and the Pediatric Orthopedics Association. The questionnaire included 14 multiple-choice items addressing sociodemographic characteristics and the general approach to the diagnosis and treatment of rickets. Prior to dissemination, the survey was reviewed by 13 board-certified orthopedic surgeons from various institutions to ensure clarity and content validity. Results Of the 257 respondents, 198 met the inclusion criteria and were included in the analysis. Orthopedic surgeons with more than 10 years of experience (n = 111,56.1%) were significantly less likely to refer rickets patients to a pediatric endocrinologist (p = 0.009) and more likely to recommend oral or intramuscular 25-OH-vitamin D3 ampoule treatment rather than oral drops or capsules (p < 0.001). Surgeons who saw fewer than 25% pediatric patients in daily practice (n = 110,55.6%) were more inclined to refer patients without ordering diagnostic tests or initiating treatment (p = 0.011). The presence of a pediatric endocrinologist within the same institution (n = 96,48.5%) was also associated with increased referral rates without preliminary testing or treatment (p = 0.003/p = 0.002, respectively). Physicians who encountered at least one rickets patient per week (n = 78,39.4%) demonstrated better knowledge of normal serum 25-OH-vitamin D3 levels (p = 0.042) and were significantly less likely to refer patients to a pediatric endocrinologist (p < 0.001). Conclusion Management approaches to rickets among orthopedic and traumatology specialists in Turkey vary significantly depending on clinical experience, practice setting, and access to a pediatric endocrinologist. To prevent both undertreatment and unnecessary referrals, newly diagnosed rickets patients in orthopedic clinics should be appropriately evaluated and referred when necessary. Establishing a standardized diagnostic and referral algorithm based on international guidelines and incorporating it into orthopedic training programs is strongly recommended.

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First evidence of bronze production in the Iron Age I southern Levant: A direct link to the Arabah copper polity

This study presents new analytical data from the site of el-Ahwat, a short-lived Iron Age I settlement located at the northern edge of the Central Hill Country in Israel. The site’s substantial metal assemblage, including copper and bronze spills and slag, provides direct evidence for on-site bronze production. Microstructural features indicate that primary alloying of copper and tin—rather than the re-melting of scrap—was practiced at the site. Lead isotope analysis, chemical composition, and microstructure link some of the metal specifically to the Faynan ores, and other finds to the Timna ores, suggesting that both ores, possibly controlled by a joint polity, supplied copper to el-Ahwat. These findings challenge long-standing assumptions about the localization of bronzeworking in urban lowland centers, and open new perspectives on the inland trade routes and social organization of the early Iron Age southern Levant. We propose that el-Ahwat was part of a broader and more complex network of copper distribution and bronze production, extending from the Arabah to the coast, including also peripheral highland communities.

Impact of the WellCheck smartphone app linked to electronic health records on clinical outcomes in patients with type 2 diabetes: Study protocol for primary care-based, prospective, multicenter, cluster-randomized, pragmatic clinical trials

Diabetes, obesity, and dyslipidemia are significant contributors to cardiovascular diseases, necessitating effective strategies to manage blood glucose, blood pressure, and lipid levels through lifestyle interventions and pharmacotherapy. This study aims to assess the glycemic control and metabolic health outcomes achieved over 24 weeks with the use of the “WellCheck” digital healthcare application in patients diagnosed with type 2 diabetes mellitus (T2D) within real-world primary care settings. This is a primary care-based, prospective, multicenter, cluster-randomized pragmatic trial. Eligible participants include adults aged 19–80 with T2D who are treated with or planning to be treated with Envlo (enavogliflozin) or Envlomet (enavogliflozin/metformin). WellCheck links a mobile application for patients with a web platform for physicians and integrates with electronic health records to support the management of diabetes and hypertension. The primary outcome is the change in glycated hemoglobin levels at 24 weeks from baseline. We will conduct cluster randomization by grouping 24 participating primary care centers according to basic characteristics, such as the treating physician’s age (above or below 45 years) and the clinic’s location (metropolitan or non-metropolitan areas). The “App+Physician Support” group will use the WellCheck app for comprehensive digital monitoring and receive feedback supported by an investigator (primary care physician), and the “App-Only” group will rely on the WellCheck app for independent self-management without direct physician assistance. This study aims to explore the effectiveness of WellCheck app in improving glycemic control and metabolic outcomes, providing valuable insights into its potential as a digital tool for managing T2D. The wide age range of participants and cluster randomization of primary care centers into the intervention and control groups enhance the generalizability and robustness of the study, reducing bias and enabling a meaningful comparison of outcomes in diverse healthcare settings. Trial registration ClinicalTrials.gov NCT06419816. Registered on 14 May 2024.

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Behavioural rhythms of two amphipod species Marinogammarus marinus and Gammarus pulex under increasing levels of light at night

Artificial light at night (ALAN) is proliferating at an alarming rate across the globe, particularly around aquatic habitats. Natural and predictable light cycles dictate much of an individual organism’s life by acting as a major signal for their circadian clock, driving rhythmic behaviours and physiological changes throughout the body. Light cycles also help populations coordinate group behaviour and greatly impact the interspecies dynamics of a community. Research into the ecological impacts of ALAN has highlighted numerous effects on these biological processes, including higher predation rates, impaired growth and development, and diminished reproductive success. Invertebrates play an undeniable role in ecosystem functioning and show robust daily rhythms. As such, it is vital to understand how ALAN may disrupt their behavioural patterns. The aim of this study was to monitor the impacts of increasing levels of light at night (0 lux – 80 lux), as well as constant light and constant darkness, on the behavioural rhythms of the intertidal amphipod, Marinogammarus marinus, and the freshwater species, Gammarus pulex. Gammarus pulex activity was not strongly synchronised to any of the light at night treatments. Marinogammarus marinus, however, exhibited strong behavioural rhythmicity in diurnal cycles with dark night periods. All the ALAN treatments resulted in a significant decrease in M. marinus rhythmicity and overall activity. Moreover, ALAN between 1–50 lux disrupted nocturnality in this species. These results indicate that while some amphipods show some adaptive plasticity when it comes to light pollution, others may experience strong direct impacts on their activity. This may be relevant to individual and population level fitness of vulnerable species in more heavily urbanised areas.

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Early detection of cardiotoxicity in children receiving adriamycin: A comparison of tissue Doppler and standard echocardiography with Troponin I as an early marker

Background Adriamycin (doxorubicin hydrochloride) is a widely used chemotherapeutic agent for treating various malignancies. However, its most significant adverse effect is cardiac toxicity. Early detection of Adriamycin-induced cardiac dysfunction is crucial in preventing heart failure through interventions such as angiotensin-converting enzyme inhibitors and beta-blockers. Adriamycin-induced cardiotoxicity is classified into Type I (irreversible, involving cardiomyocyte necrosis) and Type II (potentially reversible, involving cardiomyocyte dysfunction). Type I toxicity is more common, leading to long-term heart cell necrosis. Monitoring cardiac function in children receiving Adriamycin is essential. Non-invasive imaging techniques like transthoracic echocardiography, cardiac magnetic resonance imaging, and computed tomography are used to evaluate left ventricular (LV) systolic and diastolic functions. However, the role of cardiac Troponin I for early detection of anthracycline-induced cardiomyopathy remains debated. Methods This prospective study included 50 children (26 males, 24 females) with a median age of 8 years (range: 2–14) receiving Adriamycin. Troponin I levels were measured before and 24 hours after Adriamycin administration. Standard Doppler Echocardiography and Tissue Doppler Imaging (TDI) were performed at baseline, one month, and six months’ post-treatment to assess LV function. Results Out of 50 patients, two showed a decrease in left ventricular ejection fraction (LVEF) below the normal range (<55%) one month post-treatment, along with significant increases in Troponin I levels. No significant decline in LVEF was observed at one or six months’ post-treatment using Standard Doppler Echocardiography. However, TDI revealed a decrease in LV systolic and diastolic function in all patients one month after Adriamycin administration. Conclusion TDI is more sensitive than Standard Doppler Echocardiography in detecting Adriamycin-induced cardiotoxicity. Elevated cardiac Troponin I levels correlate with a decline in LVEF, but subclinical cardiac dysfunction is better detected with TDI.

Conserve marine migratory species to protect ecological links between land and sea