This study aimed to expand the knowledge on maternal and perinatal parameters of donkeys of the Nordestino ecotype to support clinical and reproductive management. A sample of 29 jennies and their foals was assigned to two groups (primiparous and multiparous) in a completely randomized design. In the prepartum period, the pH of mammary secretion was monitored daily. During foaling and in the first hours of life of foals, gestational parameters including maternal weight, the length of gestation, of parturition, and of placenta release, placenta weight, and placenta/mother, newborn/mother, and placenta/newborn ratios were assessed. Perinatal parameters such as time for sternal recumbency, standing up, showing suckling reflex, first suckling, first urination, and meconium release were also assessed. In both groups, foaling proximity was characterized by a progressive reduction in the pH of mammary secretion, with parturition on average taking place 39 h after pH reached 6.4. No differences (p > 0.05) in gestational parameters were observed between primiparous and multiparous jennies. However, foals from multiparous mothers had higher weight at parturition (18.92 ± 1.99 kg) when compared with those from primiparous jennies (16.35 ± 2.27 kg) (p = 0.004). The former took less time to stand up (multiparous: 22.90 ± 11.63 min; primiparous: 46.25 ± 29.80 min) and for first suckling (multiparous: 57.00 ± 21.62 min; primiparous: 93.50 ± 28.20 min) (p = 0.01). It is concluded that monitoring mammary secretion pH is an efficient method to help predict foaling and that foals from multiparous jennies exhibit neonatal behaviors earlier.
Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is a major cause of neonatal mortality and morbidity worldwide. Its multifactorial etiology remains incompletely understood, and Cyprus reports among the highest PTB rates in Europe, highlighting the need for population-specific evidence. This study aimed to investigate the sociodemographic, behavioral, and obstetric history factors of PTB in Cyprus and to examine whether these factors differed according to the degree of prematurity. A matched case-control study was conducted at a tertiary referral hospital in Cyprus, designated as the national center for maternal and neonatal care. Eligible participants were women delivering between January 2019 and December 2022. Conditional logistic regression was conducted to determine the significant associations between sociodemographic, behavioral and obstetric history with PTB. Subgroup analysis of extreme to very (<32 weeks) vs moderate to late PTB (32 to <37 weeks) was also conducted. Participants were 978 women (489 cases <37 weeks, 489 controls ≥37 weeks). Maternal age increased PTB odds (AOR=1.21; 95% CI: 1.06-1.38), as did previous gynecological surgeries (AOR=1.74; 95% CI: 1.30-2.34), cesarean section (AOR=1.87; 95% CI: 1.28-2.73), and miscarriage (AOR=1.44; 95% CI: 1.03-2.00). Primiparous women had reduced odds versus nulliparous (AOR=0.71; 95% CI: 0.52-0.98). In subgroup analysis, higher BMI (AOR=0.96; 95% CI: 0.92-0.99), prior cesarean (AOR=0.54; 95% CI: 0.30-0.99), and asylum seeker status (AOR=0.19; 95% CI: 0.05-0.67) were linked to lower odds of extreme PTB. Future prospective studies are needed to further investigate and confirm the observed associations between sociodemographic, behavioral, and obstetric factors with PTB and degree of prematurity.
Congenital esophageal stenosis is a rare and heterogenous malformation often associated with esophageal atresia (EA). Failure of conservative endoscopic treatment leads to surgery. Transthoracic approach is rarely advocated due to the peridiaphragmatic localization of the stricture. Robotic-assisted thoracoscopic surgery (RATS) may offer enhanced precision in confined spaces; its application in patients under 10 kg is still considered a challenge. We report the first description of RATS resection of cartilaginous congenital stenosis and esophagoesophagostomy in a 9.5 kg patient. A female patient with a history of EA type III was corrected via videothoracoscopy, two cardiac surgeries via sternotomy, and laparoscopic treatment of duodenal atresia. During weaning, she did not tolerate thickened food, and endoscopy revealed a patent anastomosis but a distal esophageal stricture. A course of pneumatic dilation was attempted. Persistent clinical and radiological findings indicated the need for surgery. At 15 months, the patient underwent three-trocar thoracoscopy with the da Vinci Xi system. Esophagoscopy helped the identification of the stricture. A longitudinal incision exposed a 2-cm segment of thickened esophageal wall requiring complete excision. A tension-free end-to-end anastomosis was performed using 4/0 PDS. Tracheobronchial remnants were confirmed at histopathologIcal finding. Esophageal contrastography demonstrated a good diameter anastomosis. One month after the operation, she was able to swallow solid food. Surgery for congenital stenosis is indicated when endoscopic management fails. RATS for esophageal diseases in patients under 10 kg is feasible, and peridiahragmatic esophagus particularly suits to this technique. Previous accesses to the thorax seems not to be a limitation.
Infection prevention and control (IPC) behaviors among healthcare workers are influenced by multiple components and complex features of the work system. Complexity refers to the multicomponent, non-linear, and context-dependent characteristics of system elements, and is increasingly recognized as a key feature of healthcare delivery. However, evidence on the role of IPC complexity in these relationships remains limited. A cross-sectional survey was conducted in 3 branch hospitals of a tertiary hospital in Wuhan, China. A total of 833 healthcare workers completed a structured questionnaire assessing IPC person, organization, tools and technology, tasks, internal environment, external environment, IPC complexity, and IPC behaviors based on Systems Engineering Initiative for Patient Safety (SEIPS) model. Structural equation modeling and bias-corrected bootstrap analyses were used to evaluate direct and indirect associations. IPC complexity (β= 0.106, P=0.048) positively associated with IPC behaviors. IPC tasks (β= 0.172, P=0.003) and internal environment (β= 0.221, P<0.001) directly associated with IPC behaviors; IPC person (95% CI:0.001-0.033, P=0.015), internal environment (95% CI:0.009-0.088, P=0.015) and external environment (95% CI:0.007-0.075, P=0.018) indirectly associated with IPC behaviors through the complexity. IPC behaviors were linked to multiple work system factors, with complexity serving as an important intermediate correlate. Efforts to improve IPC practice should address task demands, environmental support, and perceived work complexity rather than focusing on individual behaviors alone.
Scars present repercussions beyond physical appearance, affecting emotional well-being and social interactions. Few studies have compared how different scar types, including keloids (K), hypertrophic scars (HS), and post-burn scars (BS), relate to psychosocial outcomes. Assess body appreciation and screening indicators of anxiety and depression in patients with scars of different etiologies. We conducted an exploratory cross-sectional study including 42 patients with scars allocated to three groups: K, HS, and BS. Body image perception was measured using the Body Appreciation Scale (BAS), and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Mean BAS and HADS scores were compared across groups, and associations with clinical features were explored. The combined prevalence of anxiety and depression symptoms increased descriptively from HS (0%) to K (5.9%) to BS (20%) (p = 0.11). Higher odds of combined anxiety and depression symptoms were associated with facial involvement (p = 0.017; OR = 19.8, 95% CI 1.70-229.65), and functional impairment (p = 0.039; OR = 18.0, 95% CI 1.59-202.95) features more frequent among burn patients, although confidence intervals were wide. BAS scores did not differ significantly among groups (p = 0.78), indicating moderate-to-high body appreciation across scar types (mean BAS: 3.68 burns, 3.77 hypertrophic, 3.85 keloids). Anxiety (p = 0.57) and depression (p = 0.43) scores were similar. Different scar types were associated with broadly similar psychosocial outcomes. Emotional vulnerability among patients with burn scars appears more closely related to scar-related features, such as facial location and functional impairment, than to scar etiology alone. Findings should be interpreted cautiously and regarded as hypothesis-generating. This study examined how different types of scars, including burns, hypertrophic scars, and keloids, may affect emotional well-being and body image. Adults with these scars completed questionnaires assessing body appreciation, anxiety, and depression. Overall, levels of body appreciation were similar across groups, suggesting that many people can adapt to visible or symptomatic scars over time.Participants with burn scars showed a tendency toward higher levels of anxiety and depressive symptoms. However, these emotional difficulties were more strongly associated with features such as facial involvement and functional limitations than with the type of scar itself. This highlights the importance of considering the broader clinical and social context in which scars occur.As this was an initial study with a relatively small number of participants, the findings should be interpreted as exploratory rather than definitive conclusions. Overall, the results suggest that while many people adapt well to scars, those accompanied by greater visibility or functional impact may be linked to emotional vulnerability. Comprehensive scar management should therefore address not only physical and psychological support but also promote recovery that considers the person as a whole.
Selective serotonin reuptake inhibitors (SSRIs) are widely used as first-line treatments for major depressive disorder (MDD) and anxiety disorders, with common adverse effects, including sexual dysfunction, anxiety, insomnia, and appetite changes, although seizures have also been reported, particularly in the presence of risk factors such as older age, family history of epilepsy, neurological comorbidities, and high antidepressant dosages. We describe two patients who developed generalized tonic-clonic seizures associated with SSRI therapy. The first case is a man with SSRI-resistant MDD and multiple medical comorbidities who experienced five generalized tonic-clonic seizures while receiving various antidepressants. The second case is a woman with generalized anxiety disorder (GAD) who developed two generalized tonic-clonic seizures temporally related to paroxetine use. In both cases, extensive investigations, including laboratory tests, electroencephalogram (EEG), CT, and MRI, yielded normal results, suggesting a potential drug-associated etiology. Both patients were subsequently switched to the atypical antidepressant agomelatine, which was followed by a complete cessation of seizures and marked improvement in mood and anxiety symptoms. These observations underscore the need to consider seizures as a potential adverse event of SSRIs and suggest that agomelatine could be considered an alternative pharmacological option for patients at risk of antidepressant-associated seizures.
Smoking is a well-established modifiable risk factor for tuberculosis (TB). However, the evolving smoking-attributable TB burden in China remains to be fully characterized. The objective was to examine temporal trends in the smoking-attributable TB burden in China from 1990 to 2021. A secondary analysis was conducted on the 2021 Global Burden of Disease Study data. Data on the number of deaths and disability adjusted life years (DALYs) due to smoking-attributable TB, as well as age-standardized rates, were extracted for the overall Chinese population, males, and females from 1990 to 2021. Joinpoint regression and age-period-cohort analyses described 32-year trends. A Bayesian age-period-cohort (BAPC) model was used to forecast the TB burden from 2022 to 2040. Drivers behind the burden trends were investigated through a decomposition analysis. Between 1990 and 2021, TB deaths, DALYs, age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed significant reductions, with the ASMR and ASDR declining from 5.10/100000 (95% UI: 3.64-6.73) and 158.48/100000 (95% UI: 114.49-203.94) in 1990 to 0.52/100000 (95% UI: 0.37-0.76) and 19.15/100000 (95% UI: 13.85-26.70) in 2021, respectively. Declines in ASMR (-95.26% vs -89.35%) and ASDR (-93.69% vs -87.35%) were larger in females than in males. Age-period-cohort analyses revealed that mortality and DALY rates peaked at ages 30-34 years and then declined. Male mortality increased slightly at ages 65-69 years. Both period and cohort effects demonstrated consistent downward trends. BAPC projections indicated that after 2022, deaths and DALYs would decline initially but rise again, whereas ASMR and ASDR would continue to fall. The smoking-attributable TB burden in China exhibits significant age- and sex-specific patterns. Despite overall attenuation, projected rebounds in deaths by 2040 call for sustained public health interventions.
Tobacco use is a major preventable cause of morbidity and mortality, and Cognitive Behavioral Therapy (CBT) may address the cognitive, behavioral, and relapse-related mechanisms that sustain smoking. This review evaluated the efficacy of CBT for smoking cessation by synthesizing controlled studies reporting smoking abstinence and smoking reduction outcomes. Within this systematic review and meta-analysis, a search was performed in PubMed, Web of Science, Scopus, ScienceDirect, SpringerLink, ACM Digital Library, IEEE Xplore, and Google Scholar for studies published from 1 January 2000 to 15 January 2026. Eligible studies were randomized controlled trials or controlled quasi-experimental studies of people who smoked and compared CBT, delivered face-to-face or remotely, with a non-CBT control condition. Outcome data were extracted for smoking abstinence and smoking reduction. Risk-of-bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized controlled studies. Odds Ratios (ORs) were pooled using DerSimonian and Laird random-effects models, with fixed-effect estimates used only as sensitivity analyses. Fourteen studies were included. Eleven studies contributed to the smoking abstinence meta-analysis, and five contributed to the smoking reduction meta-analysis. For smoking abstinence, the random-effects pooled OR was 1.60 (95% CI: 0.95-2.70; z=1.76; p=0.078; I2=83.70%). For smoking reduction, the random-effects pooled OR was 1.96 (95% CI: 0.66-5.81; z=1.21; p=0.226; I2=83.64%). Risk-of-bias assessments indicated low-risk, some-concerns, or moderate-risk ratings across included studies; no included study was judged to have a critical risk-of-bias. CBT showed a favorable direction of effect for smoking abstinence, but the random-effects estimate was imprecise, and heterogeneity was substantial. Evidence for smoking reduction was also not statistically conclusive. The findings should therefore be interpreted cautiously, and future trials should clarify treatment moderators, standardize outcome definitions, and refine CBT protocols for different cessation goals.
Caspofungin is an echinocandin antifungal agent widely used for the treatment of invasive candidiasis because of its broad antifungal activity. Although ocular adverse events are listed among uncommon reactions in the Summary of Product Characteristics, detailed clinical descriptions of acute visual impairment temporally associated with caspofungin therapy are scarce. We report the case of a 21-year-old man who developed candidemia due to Candida guilliermondii following complex spinal surgery. Antifungal therapy with caspofungin was initiated in accordance with current clinical guidelines. Within 24 hours of treatment initiation, the patient experienced a bilateral and symmetrical reduction in visual acuity, affecting both near and distance vision. Comprehensive ophthalmologic evaluation, including slit-lamp examination, fundoscopy, and optical coherence tomography, revealed no structural ocular abnormalities. Neurological assessment and neuroimaging were unremarkable. Visual symptoms persisted with fluctuating intensity during ongoing caspofungin administration and resolved completely within 48 hours after drug discontinuation, following a switch to micafungin. No recurrence of visual impairment was observed during follow-up. Causality assessment using the Naranjo algorithm indicated a probable association between caspofungin and the adverse event. This case describes a transient and fully reversible visual disturbance temporally associated with caspofungin therapy, in the absence of identifiable ocular or neurological pathology. While a causal relationship cannot be established based on a single observation, this report contributes descriptive safety data relevant to real-world clinical practice. Clinicians should consider careful evaluation of new-onset visual symptoms occurring during antifungal therapy and ensure appropriate pharmacovigilance reporting to support the identification of rare or unexpected adverse drug reactions.
Behavioral parent training (BPT) is an evidence-based intervention for children with attention-deficit/hyperactivity disorder (ADHD); however, evidence from low- and middle-income Asian countries remains scarce. This randomized controlled trial evaluated a culturally adapted blended BPT program for Vietnamese parents of elementary school-aged children with ADHD. Eighty-six parents of children (6-11 years) with a clinician-confirmed DSM-5 diagnosis of ADHD were randomized to a blended BPT program (n = 43) or treatment as usual plus psychoeducational materials (n = 43). The intervention comprised six weekly 2-h online group sessions, each followed within the same week by a 1-h individual home-based support session, and 12 weekly support telephone calls across a 3-month maintenance period. Parenting skills (Parenting Skills Assessment Scale), parent-rated child ADHD symptoms (Vanderbilt ADHD Diagnostic Parent Rating Scale), and parenting stress were assessed at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). The analyses included 80 participants with complete data (intervention, n = 37; control, n = 43). Parenting skills improved substantially in the intervention group relative to the control group (group × time interaction: F (2, 156) = 20.75, p < .001, partial η 2  = 0.21; baseline-adjusted between-group d = 1.28 at follow-up). Parent-rated ADHD symptoms decreased significantly within the intervention group (T1→T3: -4.14 points, p < .001), but the baseline-adjusted between-group differences were small and not statistically significant (T2: p = .057; T3: p = .075; adjusted d ≈ 0.28-0.30). Parenting stress declined similarly in both groups. Exploratory mediation analyses indicated a significant indirect effect on follow-up ADHD symptoms through improved parenting skills (ab = -1.86, 95% bootstrap CI [-4.01, -0.37]). The culturally adapted blended BPT program was feasible and produced large, sustained improvements in parenting skills among Vietnamese parents. The effects on parent-rated ADHD symptoms were small and require confirmation in adequately powered trials. Thai Clinical Trials Registry, TCTR20260212003 (retrospectively registered on February 12, 2026). Registration number: TCTR20260212003. Available at: https://www.thaiclinicaltrials.org/show/TCTR20260212003.
The key for nanozymes to achieving sequential infection-inflammation-repair in wound infection therapy and healing lies in how to resolve the contradiction of reactive oxygen species (ROS) regulation between antibacterial therapy and anti-inflammation. Herein, a freestanding pristine CuGeO3 (CGO) nanozyme film (NF) composed of nanowires is first designed and simply synthesized. Such a NF with flexibility, wet tissue adhesion properties, alongside water/blood absorbing capability could serve as a wound dressing and present superb antibacterial/antibiofilm efficacy for photothermal/chemodynamic synergistic therapy of wound infection owing to its extraordinarily outstanding photothermal performance, and glutathione depletion-enhanced peroxidase-like activity to generate ROS in acidic infection microenvironments (IMEs). Attractively, it is disclosed that after completing infection therapy, the enzyme activity of this CGO NF automatically and continuously switches into catalase-like activity to eliminate ROS as IMEs switches into neutral microenvironments. This promotes the M2 phenotype polarization of macrophages to relieve inflammation and accelerate wound repair. Furthermore, the longer and entangled nanowire structure of the CGO NF prone to retention in the wound site minimizes its toxicity to healthy tissues. Overall, it is the first paradigm to leverage a photothermal NF consisting of inorganic nanomaterials only as a wound dressing. Based on such a safe, effective, activity-switchable NF dressing, adaptive infection-inflammation-repair cascade in wound infection therapy and healing has been realized, achieving 98.7% wound closure within 10 days. We believe this work will foster the therapeutic application of activity-switchable nanozymes, and provide meaningful insights into nanozymes-based wound infection therapy and healing.
Evidence on the use, safety, and decision-making related to medication, vaccination, and complementary and alternative medicine during pregnancy and breastfeeding, remains limited. This uncertainty may influence women's health behaviors and perceptions during these stages. The aim of this study is to identify the needs related to the use of medication, vaccination, and alternative medicine during pregnancy and breastfeeding in Catalonia. A descriptive cross-sectional survey was conducted among 889 pregnant and recently postpartum women attending public Sexual and Reproductive Health Care Services in Catalonia (2024-2025). The questionnaire assessed use, opinions, information sources, and decision-making regarding medication, vaccination, and alternative therapies during pregnancy and breastfeeding. More than half of the participants reported health conditions requiring medication during pregnancy. Most women (84.6%) relied on healthcare professionals' prescriptions and recommendations, and about half felt safe and confident when using medication. Vaccination during pregnancy was widely accepted, with over 80% agreeing with it. Alternative therapy use was limited, with osteopathy being the most common. During breastfeeding, medication use remained cautious and largely guided by professional advice. Pregnant and breastfeeding women generally adopt a cautious approach to medication and rely heavily on healthcare professionals for decision-making. Trust and shared decision-making play a key role in adherence and perceived safety, highlighting the importance of clear, evidence-based guidance to support maternal and infant health.
Both arthroscopic and open surgical shoulder procedures are effective when nonoperative treatment of shoulder disorders fails. Understanding how utilization and reimbursement for these procedures have evolved is essential for informing health-care policy. A retrospective analysis was performed using Medicare data to extract utilization and reimbursement data for Current Procedural Terminology from 2005 to 2024 regarding arthroscopic and open shoulder surgeries. Arthroscopic procedures included diagnostic shoulder arthroscopy, arthroscopic rotator cuff (RTC) repair, biceps tenodesis, labral repair/capsulorrhaphy, superior labrum anterior-posterior repair, arthroscopy with limited débridement, arthroscopy with extensive débridement, subacromial decompression, and distal clavicle excision. Open procedures included open RTC repair for acute tears, RTC repair for chronic tears, complete RTC avulsion reconstruction, biceps tenodesis, anterior capsulorrhaphy, acromioplasty, and distal clavicle excision. Reimbursement values were adjusted for inflation. Procedure volumes were normalized to Medicare enrollment. Temporal trends in utilization and reimbursement were assessed using the two-tailed Mann-Kendall trend test. From 2005 to 2024, over 9 million shoulder procedures were performed for the selected Current Procedural Terminology codes. Overall normalized utilization demonstrated a significant decline (τ = -0.4, P < .05). Arthroscopic procedures demonstrated no significant utilization trend, whereas open procedures declined significantly (τ = -1.0, P < .001). Many procedures showed a decline in utilization in 2020, coincident with the COVID-19 pandemic. Arthroscopic RTC repair increased significantly by 92% (τ = 0.5, P < .05). All other open RTC repairs declined (τ = -1.0, P < .01). Both arthroscopic and open biceps tenodesis demonstrated significant increases (τ = 0.9, P < .01). Across the study period, open biceps tenodesis demonstrated significant increases in inflation-adjusted reimbursement (P < .01). Still, arthroscopic tenodesis consistently reimbursed at higher rates. From 2005 to 2024, arthroscopic RTC repair consistently had the highest reimbursement per service among all RTC repair procedures. Arthroscopic biceps tenodesis demonstrated higher reimbursement per service than open biceps tenodesis throughout the study period. Similarly, arthroscopic capsulorrhaphy maintained higher reimbursement per service compared with its open counterpart. Open acromioplasty demonstrated higher reimbursement per service than its arthroscopic equivalent, subacromial decompression. From 2005 to 2024, normalized utilization of shoulder procedures declined overall, driven primarily by a significant reduction in open surgical procedures. Inflation-adjusted Medicare reimbursement for both open and arthroscopic shoulder procedures remained stable. For most procedures, reimbursement per service was higher for arthroscopic procedures.
Primary mediastinal Ewing sarcoma is an exceptionally rare and aggressive malignancy that may rapidly lead to life-threatening compression of mediastinal structures. Management is particularly challenging when critical airway obstruction is present. A 38-year-old woman presented with progressive dyspnea and cough. Chest imaging revealed a large right paratracheal mediastinal mass causing severe extrinsic tracheal compression with near-complete airway narrowing. Diagnosis was established by EBUS-TBNA, and histopathological and immunohistochemical findings were consistent with Ewing sarcoma. Given the imminent risk of respiratory failure, diagnostic EBUS-TBNA and airway stenting were performed during the same procedural session under general anesthesia. A fully covered self-expanding metallic stent was placed to secure the airway and enable safe initiation of systemic chemotherapy. The patient subsequently received VAC/IE chemotherapy. Follow-up imaging demonstrated marked tumor regression, and the stent was successfully removed after three months. At 6-month follow-up, the patient remained asymptomatic without clinical or radiological evidence of recurrence. Temporary tracheal stenting may serve as an effective bridge to definitive therapy in selected patients with mediastinal Ewing's sarcoma and critical airway obstruction. Multidisciplinary management is essential in such high-risk cases.
Calcifying epithelial odontogenic tumor (CEOT), or Pindborg tumor, is a rare benign odontogenic neoplasm with a recognized risk of local recurrence. Management of anterior maxillary lesions is particularly challenging due to aesthetic and functional implications. We report the case of a 26-year-old woman who presented with a missing maxillary right canine. Cone beam computed tomography (CBCT) revealed a 2.2 × 1.5 × 1.2 cm, well-defined mixed lesion associated with an impacted tooth 13 with internal calcifications. Incisional biopsy suggested CEOT. Following a multidisciplinary discussion, a conservative surgical approach was selected. Enucleation with curettage and extraction of tooth #13 were performed. Histopathology confirmed CEOT. Complete bone healing was observed at eight months. Secondary reconstruction using guided bone regeneration with a customized titanium mesh was performed, followed by implant placement and prosthetic rehabilitation. At the 30-month follow-up, no evidence of recurrence or implant-related complications was observed. In effect, in selected anterior maxillary CEOTs, conservative surgery followed by staged reconstruction and implant rehabilitation may achieve satisfactory oncologic, functional, and aesthetic outcomes.
Neonatal mortality remains one of the most pressing global health challenges, disproportionately affecting low- and middle-income countries. In Ethiopia, complex interrelated factors contribute to high neonatal mortality rates, creating a multifaceted public health concern that demands comprehensive investigation. Despite the magnitude of this challenge, there exists a notable lack of longitudinal studies that examine the temporal patterns of neonatal deaths, survival, and associated risk factors throughout the complete neonatal period. This study addresses this gap by evaluating survival outcomes and identifying determinants of mortality among neonates admitted to the neonatal intensive care unit at Zewditu Memorial Hospital, a referral facility serving a high-burden urban population in Addis Ababa, Ethiopia. A retrospective cohort study of 1,014 neonates admitted to the neonatal intensive care unit from September 11, 2020 to September 10, 2023 was conducted. Systematic random sampling was used to select patients. An electronic data collection method was used, and the data were exported to STATA version 17.0 for cleaning and analysis. Bi-variable and multivariable Cox proportional hazard regression models were employed to identify mortality risk predictors. Kaplan-Meier survival estimates and log-rank tests were used to compare survival probabilities. Model adequacy was assessed using the Cox-Snell residual test. Over 7,945 neonate-days, the mortality incidence rate was 13.72 deaths per 1,000 neonate-days (95% confidence interval (CI) [11.37-16.55]), with most deaths occurring within the first week. Significant predictors of mortality risk were extremely low birth-weight (<1,000 g; Adjusted Hazard Ratio (AHR) = 18.94, 95% CI [7.89-45.23]), very low birth weight (1,000-1,499 g; AHR = 5.09, 95% CI [2.75-9.43]), perinatal asphyxia (AHR = 3.52, 95% CI [2.25-5.49]), neonatal sepsis (AHR = 2.47, 95% CI [1.28-4.77]), respiratory distress syndrome (AHR = 1.65, 95% CI [1.01-2.68]), and meconium aspiration syndrome (AHR = 2.35, 95% CI [1.20-4.57]). This study found associations between elevated neonatal mortality rates and birth weight and specific perinatal complications as key factors linked to survival. The predominance of deaths within the first week, particularly among neonates with low birth weight, perinatal asphyxia, sepsis, respiratory distress syndrome, and meconium aspiration syndrome, necessitates the implementation of risk-stratified care and intensive early monitoring. These findings provide evidence for targeted interventions that could substantially reduce neonatal mortality in resource-constrained healthcare settings.
Based on the Theory of Unpleasant Symptoms (TOUS), this study aimed to examine the relationship between premenstrual syndrome (PMS) and test anxiety among nursing college students, and to explore the serial mediating roles of bedtime procrastination and attention in this association. A multicenter cross-sectional survey was conducted among 791 female nursing students from eight medical and health vocational colleges in China. Participants completed the General Information Questionnaire, Premenstrual Syndrome Scale (PSS), Bedtime Procrastination Scale (BPS), Multi-Dimensional Attention Rating Scale (MARS), and Test Anxiety Scale (TAS). Pearson correlation analysis, multiple linear regression, and structural equation modeling with 5,000 bootstrap resamples were performed. Mean scores of PSS, BPS, MARS, and TAS were 6.26±4.85, 27.38 ± 6.022, 35.91±4.47, and 18.42±7.96, respectively. PMS was positively associated with bedtime procrastination and test anxiety and negatively associated with attention (all P<0.001). Multiple linear regression identified bottled drink intake frequency, menstrual cycle, thinking/feeling personality type, only-child status, PMS, bedtime procrastination, and attention as significant predictors of test anxiety (P<0.05). Structural equation modeling showed that PMS had a significant direct effect on test anxiety (β=0.20, 95% CI: 0.12-0.28). Bedtime procrastination and attention significantly mediated this association, including a serial mediation pathway (β=0.03, 95% CI: 0.01-0.06). The total indirect effect accounted for 50% of the total effect. PMS was associated with test anxiety among nursing students, both directly and indirectly through the serial mediating roles of bedtime procrastination and attention. Within the TOUS framework, these findings advance understanding of the physiological-behavioral-cognitive pathway underlying test anxiety and suggest potential intervention targets for improving mental health among nursing students.
Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder mediated by autoantibodies directed against acetylcholine receptors (anti-AChRs), in which thymic pathology plays a central pathogenic role. While thymomas predominantly arise in the anterior mediastinum, ectopic locations represent a rare and clinically distinct entity. Among these, preaortic ectopic thymomas are exceedingly rare, and their association with refractory MG has not previously been described. We report a 48-year-old woman with generalized MG with bulbar predominance, presenting with an eight-month history, confirmed by markedly elevated anti-AChR antibodies (91.1 nmol/L), a positive neostigmine test, and a pathological decrement exceeding 10% on repetitive nerve stimulation across three nerve-muscle pairs. The patient experienced a life-threatening myasthenic crisis requiring ICU admission and failed to achieve sustained remission despite corticosteroids, pyridostigmine, intravenous immunoglobulins (IVIg), and two cycles of rituximab (1000 mg at day 1 and day 15, followed by 1000 mg at six months), fulfilling criteria for refractory MG. After repeated immunotherapy failures and a normal chest X-ray, a prior external CT, initially interpreted as normal or possibly representing ectopic thyroid tissue, was followed by a dedicated thoracic CT at our institution, which identified a left-lateralized anterior mediastinal soft-tissue mass in close preaortic contact with the ascending aorta (42 × 28 × 41 mm). Complete surgical resection via median sternotomy was performed. Histopathological investigation confirmed a WHO type B2 thymoma (2021 WHO classification), with identification of Hassall's corpuscles confirming the thymic origin of the mass. The patient achieved complete clinical remission (Besinger score 100/100; MGC score 0/50) following postoperative IVIg and was subsequently tapered off corticosteroids. This case highlights the necessity of systematic thoracic CT in all refractory MG regardless of plain radiograph findings and prior imaging reports and underscores the potential importance of complete surgical excision of preaortic ectopic thymic tissue in achieving disease control. Following a systematic search of PubMed, Scopus, and Google Scholar, we did not identify any previously reported case of a WHO type B2 preaortic ectopic thymoma described as the underlying cause of refractory generalized MG.
Small-cell carcinoma of the bladder (SCCB) is a rare, aggressive neuroendocrine malignancy associated with early metastasis and poor survival. Due to its rarity, optimal management is not well defined and is generally extrapolated from small-cell lung cancer treatment paradigms. We report a rare case of SCCB with synchronous high-grade prostate adenocarcinoma managed with a bladder-preserving multimodal approach. An 82-year-old man presented with hematuria and urinary retention, who was diagnosed with limited-stage SCCB following transurethral resection of bladder tumor (TURBT). He received neoadjuvant cisplatin and etoposide, but definitive therapy was significantly delayed due to severe necrotizing perineal infection with fistula formation requiring multiple surgical interventions. During this period, he was also diagnosed with high-risk prostate adenocarcinoma (Gleason 4 + 5 = 9, prostate-specific antigen (PSA) > 100 ng/mL, with normal PSA range less than or equal to 4 ng/mL) and was initiated on androgen deprivation therapy. After recovery and surgical repair of a large inguinal hernia (that would have hindered external beam radiation therapy planning), he underwent definitive bladder-preserving radiotherapy using simultaneous integrated boost volumetric modulated arc therapy (VMAT), delivering 60 Gy in 20 fractions to the prostate and proximal seminal vesicles, 55 Gy in 20 fractions to the whole bladder, and 44 Gy in 20 fractions to the elective pelvic lymph nodes. Treatment was well tolerated with minimal toxicity. Follow-up cystoscopy and imaging demonstrated a complete response in both malignancies. More than three years after treatment, the patient remains without evidence of disease, with a low PSA and no evidence of local, distant, or intracranial recurrence on serial brain magnetic resonance imaging (MRI) studies. This case demonstrates that durable long-term disease control in SCCB may be achievable with individualized bladder-preserving multimodal therapy, even in the setting of significant treatment delays, severe intercurrent complications, and synchronous high-grade prostate cancer. It also highlights the feasibility of simultaneous integrated pelvic radiotherapy for dual malignancies and supports MRI surveillance as a reasonable alternative to prophylactic cranial irradiation in carefully selected patients with SCCB.
Although gout is traditionally conceptualized as an episodic disease characterized by acute flares and symptom-free intercritical periods, some individuals report persistent joint pain that extends beyond flares. This cross-sectional analysis aimed to explore factors associated with self-reported pain patterns (constant vs intermittent) in people with gout. This cross-sectional analysis was performed on data from 90 participants with physician-diagnosed gout who completed clinical assessments and patient-reported outcome measures. Pain patterns were classified using participant-selected validated graphical representations representing intermittent and constant pain patterns. Multivariable logistic regression was used to identify factors independently associated with constant pain. Model discrimination was assessed using the area under the receiver operating characteristic curve (ROC AUC). One-third of participants (34.4%) reported a constant pain pattern. The final regression model indicated that constant pain was independently associated with younger age of gout onset (adjusted odds ratio [aOR] 0.86, 95% confidence interval [CI] 0.79-0.93), greater activity limitation (aOR 5.75, 95% CI 1.43-23.01), and current co-existing anxiety or depression (aOR 9.21, 95% CI 1.39-60.91). The regression model demonstrated good discrimination between participants with constant and intermittent pain patterns with an ROC AUC of 0.82 (95% CI 0.73-0.91). A substantial proportion of people with gout experience constant pain, which is linked to early disease onset, functional impairment, and mood disturbance. These hypothesis-generating findings suggest that the model of pain-free intercritical gout may not apply to all people with gout and may emphasize the need for tailored management strategies for people with gout.