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Research findings are presented on the nutritional importance of aluminum, arsenic, boron, chromium, copper, iron, lead, magnesium, manganese, nickel, selenium, silicon, tin, vanadium, and zinc. This include findings from animal studies revealing beneficial effects of nutritional or ultra trace amounts of dietary arsenic, nickel, and silicon; showing the importance of zinc for bone health; initiating the study of boron as a possible essential nutrient; the likelihood that chromium and vanadium are beneficial in only pharmacological or supra nutritional amounts, and refuting the claims of essentiality for aluminum, lead and tin. Also, findings from human depletion/repletion experiments are presented showing the induction of boron deprivation signs that are alleviated by nutritional amounts of boron; providing evidence that a low boron status is prevalent in individuals consuming a Western diet; indicating a possible mechanism for the beneficial effects of boron; showing that zinc deficiency increases the need for copper; confirming that high dietary zinc exacerbates signs of copper deficiency; showing magnesium is prevalent in older individuals consuming a Western diet; presenting balance data to give an evidence based reason for updating the magnesium dietary reference intakes; evaluating various methods for magnesium status assessment; providing evidence that magnesium deficiency contributes to the risk of cardiovascular disease; and providing impetus for magnesium being declared an element of nutritional concern.

Pediatric hematologic malignancies, particularly leukemia and lymphoma, represent a major and growing contributor to childhood cancer mortality in low- and middle-income countries (LMICs). In sub-Saharan Africa, more than 100,000 children develop cancer annually, with survival rates estimated at 20-30%, compared with over 80% in high-income countries, largely due to delayed diagnosis and limited access to specialized care. This narrative and conceptual review, informed by prior empirical work conducted in Kenya and Uganda, examines challenges in implementing World Health Organization (WHO) hematologic malignancy classification frameworks in pediatric care settings in East Africa. Specifically, our research has revealed that cancer classification in this region, beyond the conventional binary of benign versus malignant status for the relevant clinical sample, in many instances requires relatively high-cost technologies that are not available and/or not affordable for non-affluent patients, thus precluding definitive WHO classification of many hematolymphoid malignancies. From our perspective, the significant challenges to applying the verbatim WHO classification in LMICs, for both hematolymphoid and non-hematolymphoid malignancies, underscores the immediate need for an alternative, somewhat simpler classification system designed to evolve in its complexity as increasing resources for both diagnosing and treating cancer reach in LMICs. Although approximately 85% of African countries are geographically located within the sub-Saharan region, cancer fatality rates continue to rise, particularly in LMICs. In addition to cancer, populations in these regions are burdened by high prevalence rates of human immunodeficiency virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and various chronic diseases. Our earlier research, conducted at Kenya's Moi Teaching and Referral Hospital and Uganda's Ministry of Health National Laboratory Diagnostic Services, revealed a significant number of pediatric patients suffering from hematological conditions, most notably leukemia and lymphoma. Despite presenting with clear signs and symptoms of these malignancies, many children lacked access to affordable and reliable diagnostic screening tools. As a result, children with presumptive cases of cancer often faced considerable barriers, including long-distance travel and costly diagnostic procedures such as flow cytometry and immunohistochemistry. These tests are not covered by the region's National Health Insurance Fund (NHIF), placing additional financial strain on families. Compounding these challenges are systemic issues such as limited staffing, supply shortages, and outdated diagnostic equipment lacking technical support. Collectively, these factors contribute to delayed or ineffective treatment and ultimately lower patient survival rates. In sub-Saharan Africa, rising cancer mortality occurs in the context of overlapping health-system challenges, including a high burden of infectious diseases such as HIV/AIDS alongside growing rates of noncommunicable diseases. Although Africa represents a smaller share of the global cancer burden, limitations in diagnostic capacity and cancer surveillance contribute to under recognition of many malignancies, particularly pediatric hematologic diseases. In our previous work at Moi Teaching and Referral Hospital in Kenya and within Uganda's Ministry of Health National Laboratory Diagnostic Services, we observed a substantial number of children presenting with suspected leukemia and lymphoma. Many of these patients exhibited advanced clinical features at presentation but lacked access to essential diagnostic tests necessary for accurate classification and risk stratification. Flow cytometry and immunohistochemistry were frequently unavailable or unaffordable, requiring long-distance travel and imposing significant financial strain on families. Additional barriers-including shortages of trained laboratory personnel, limited technical support, supply chain interruptions, and aging diagnostic equipment-further hindered timely diagnosis and appropriate disease classification. These findings underscore the gap between existing WHO classification frameworks and their practical implementation in pediatric care settings in East Africa. The primary challenge in pediatric hematologic malignancy care in East Africa is not the conceptual adequacy of WHO classification systems, but much rather the need for a more accessible and adaptable classification framework that evolves with diagnostic capacity, particularly in LMICs where such resources are limited. Investing in strengthened diagnostic capabilities and clinical resources are essential for achieving equitable implementation, especially with leukemia and lymphoma testing within such areas. Sustained investments of this nature are needed to combat disparities and improve pediatric cancer outcomes in disease classification and tailored therapies.

Diabetic foot ulcers (DFUs) pose a common and intricate challenge for individuals with diabetes. Conventional wound care approaches may not always yield successful healing, necessitating alternative methods. This case report details the experience of a 65-year-old male patient with type 2 diabetes who presented with a hard-to-heal DFU on his right foot, categorised as a Wagner grade 4 DFU. Despite standard wound care management, which involved regular cleaning, debridement and dressings, the wound exhibited no signs of improvement over a six-week period. The patient underwent a comprehensive assessment by a multidisciplinary team, comprising a wound care specialist, nurse and podiatrist, leading to the formulation of a tailored treatment plan. The treatment regimen encompassed four stages: cold atmospheric plasma therapy, maggot therapy, application of alginate dressing and continuous monitoring. Following eight weeks of treatment, notable enhancements were observed in the management of the DFU.

Cigarette smoke contains numerous toxicants, including cadmium, polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), and volatile organic compounds, all of which may contribute to hepato-renal injury. This study, conducted in Buea (Southwest Region, Cameroon), aimed to assess cadmium inhalation exposure from cigarette smoking as a contributing factor to altered liver and kidney function biomarkers in apparently healthy smokers, while acknowledging that combined exposure to multiple co-toxicants may potentiate organ dysfunction. A survey was used to recruit smokers and collect data on their smoking habits. Cadmium contents in the major cigarette brands selected were used to estimate the cadmium Daily Exposure (DE), Weekly Inhalational Exposure (WIE) and the percentage contribution to the Tolerable Weekly Intake (TWI) of cadmium. Serum alanine aminotransferase (ALT) activity, urea, creatinine contents, and urinary albuminuria and glucosuria were measured in blood and urine samples from smokers and nonsmokers. The 102 smokers enrolled were categorized respectively as light (37.3%; 38/102), moderate (38.2%; 39/102), and heavy (24.5%; 25/102) smokers, smoking an average number of 4.7&#x2009;&#xb1;&#x2009;0.5, 9.1&#x2009;&#xb1;&#x2009;1.5, and 19.1&#x2009;&#xb1;&#x2009;3.0 cigarettes/day, respectively. Cadmium levels in cigarette brands ranged from 0.72-1.08 &#xb5;g Cd per gram of tobacco removed from the cigarette. Heavy smokers exceeded the permitted cadmium No Significant Risk Level (NSRL) by up to 28-fold, contributing 4-8% to the cadmium TWI. Serum ALT activity and creatinine content were significantly higher (P&#x2009;<&#x2009;0.05) in smokers groups compared to non-smokers. Also, moderate and heavy smokers were at a significantly higher risk (relative risk 6.90-13.32; P&#x2009;<&#x2009;0.05) of displaying abnormal elevated serum urea content, positive albuminuria and glucosuria. Our findings demonstrate that healthy active smokers are highly exposed to cadmium (and potentially to other cigarette toxicants) and are at significantly higher risk of displaying abnormally elevated levels of biochemical markers of liver and kidney function, suggesting early signs of organ damage.

Globally, pneumonia remains the single biggest cause of mortality in children under 5 years of age. This study sought to train and test a prediction model for hospitalisation within 7 days after initial presentation in 2- to 59-month-old Malawian children with WHO-defined pneumonia in primary care and compare its performance to existing risk prediction models. BIOTOPE is a cohort study of children with pneumonia in a primary healthcare setting in Malawi. The training cohort involved nine primary care centres and the testing cohort involved two primary care centres in Northern Malawi. The training cohort was recruited between December 2022 and April 2023 while the testing cohort was recruited in 2016. Participants were consecutive children aged 2-59 months presenting with cough and/or difficulty breathing and who were diagnosed as WHO-defined pneumonia in primary care of any severity. The training cohort was used to train and validate a machine learning model with a prespecified primary outcome defined as hospitalisation and/or death within 7 days as the outcome. This model was then further evaluated in the testing cohort. Median age was 15 months (interquartile range 8-27) in the training and 17 months (interquartile range 9-29) in the external testing cohort (52.1% and 54.4% male, respectively). Hospitalisation occurred in 14.3% (294) of the training cohort and 12.1% (55) of the testing cohort. There was one death in the training cohort only. WHO danger signs were present in 17.6% (360) and 15.9% (70) of children in the training and testing cohorts, respectively. The optimal machine learning model achieved an area under the receiver operating characteristic and precision recall curves of 0.87 and 0.57, respectively, in the testing cohort outperforming existing risk prediction models; furthermore, this model produced an expected calibration error of 0.16 (a logistic regression model using severity status as the response variable and the log odds of the machine learning model's calibrated probabilities produced an intercept estimate of -0.32 and a slope estimate of 1.13). Key limitations include the use of hospitalisation and/or death as a severity outcome, which may reflect health system factors rather than true disease severity, that mortality-based comparisons were not possible due to low mortality in these primary care cohorts, and that comparator tools were developed for hospital populations rather than primary care populations. This machine learning score outperformed traditional pneumonia risk scores in predicting hospitalisation within 7 days in Malawian children presenting to primary care. Traditional pneumonia risk scores diminish in performance when externally applied to new datasets suggesting they may not generalise well beyond their original derivation settings. Mortality-related findings are not applicable as there was only one death in this cohort. Overall these findings support the potential of machine learning to meaningfully improve early identification of children at risk of severe pneumonia in low-resource primary care settings. Further external validation and clinical impact studies are needed to confirm these results.

The epidemiology of viral respiratory tract infections (RTIs) in children is constantly changing on the basis of transmission, seasonality, immunity, and disruptive events, such as pandemics. To describe the clinical characteristics and outcomes of children hospitalized with acute RTIs and to examine factors associated with risk of severe disease. This multisite, retrospective cohort study was conducted at 2 Canadian children's hospitals. Participants included children aged 0 to 18 years who were hospitalized with acute RTIs from July 1, 2022, to June 30, 2023. Follow-up for readmission was performed at 30 days after discharge. Analysis was conducted in June to November 2025. Clinical and demographic factors, signs and symptoms, diagnostic testing, viral testing, management, and interventions. The primary outcome was the proportion of patients who developed severe disease, defined as the need for noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation therapy, or kidney replacement therapy; cardiac arrest; or death. Demographics and clinical characteristics were also described. Multivariable robust Poisson regression was used to evaluate factors associated with risk of severe outcomes and was reported as adjusted risk ratios (aRRs) with 95% CIs. There were 2585 children hospitalized with acute RTIs, with a median (IQR) age of 2.5 (0.9-5.0) years. There were 1542 male children (59.7%), and 1307 patients (50.6%) had at least 1 chronic condition, with neurologic, developmental, or genetic conditions being the most common. More than one-third (879 children [34.0%]) were transferred from a referring institution. Viral testing was performed for 2332 patients (90.2%), with a viral pathogen identified in 1828 (70.7%) of those tested. Viral coinfections were detected in 338 children. The most common viruses were respiratory syncytial virus (709 children) and enterovirus-rhinovirus (598 children). The median (IQR) length of hospital stay was 3 (2-6) days. Nearly one-quarter of children (551 children [21.3%]) developed severe disease. Those with 2 or more comorbidities (aRR, 1.62; 95% CI, 1.36-1.93) or who were transferred from a referring hospital (aRR, 4.73; 95% CI, 4.01-5.59) were at increased risk of severe disease. This cohort study found that hospitalized children with acute RTIs frequently have underlying chronic conditions and often require intensive intervention. Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients.

Chronic pelvic pain (CPP) affects up to 24% of women worldwide, with musculoskeletal pain and dysfunction present in most cases yet often overlooked in traditional organ-focused approaches. Comprehensive musculoskeletal assessment, including movement pattern analysis, pelvic floor examination, and evaluation of hip, spine, and abdominal wall pathology is essential for accurate diagnosis. First-line treatment with pelvic floor physical therapy demonstrates significant efficacy, though multidisciplinary team-based care optimizes outcomes through coordinated treatment plans. Despite evidence supporting this integrated approach, barriers including insurance coverage gaps, limited specialists, and insufficient musculoskeletal education prevent widespread implementation, necessitating advocacy, curriculum expansion, and systematic changes prioritizing comprehensive patient-centered care.

Bereavement is a common and inevitable part of life. However, it is also difficult and disruptive. Prolonged grief disorder has recently been added to the International Classification of Diseases, 11th Revision, and the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Grief is a deeply cultural experience; however, most research about grief and grief intervention is conducted in Western, educated, industrialized, rich, and democratic (WEIRD) countries. Support for grief is often limited and difficult to access. We propose that ecological momentary interventions (EMIs) present an opportunity to widen access to grief support and develop culturally relevant interventions, given EMIs' easy accessibility and opportunity to offer self-help support in people's natural environments. This study aims to describe the development protocol of 2 EMIs for grief, one in China and one in Switzerland. he EMIs are intended for individuals seeking additional grief support without a diagnosis of prolonged grief disorder. The EMIs will be developed to be culturally relevant and appropriate for each country; therefore, contextual factors may prescribe slightly different protocols to fit the needs of each cultural group. Both interventions will be developed using a collaborative research approach. This means that the content for the app will be developed after consultation with grief experts, bereaved participants (potential end users), and the research team. After the initial content development, another round of feedback will be gathered to ensure acceptability. Funding for both studies has been secured through a grant in 2024. The scoping phase for both WEIRD and non-WEIRD contexts has been completed. At the time of submission, both studies have started recruitment, and the Chinese study has conducted interviews with 17 bereaved participants. The next steps are to continue recruitment and data gathering, analyze the collected data, and extract important themes for intervention components, and then begin the app content development. Results are expected by the end of 2026 and will subsequently be prepared for publication. The study presents 2 similar but nonidentical development protocols for EMIs for grief support in 2 countries, where one is a WEIRD country and the other is a non-WEIRD country. Similarities and differences in the developmental process across both countries are discussed, along with challenges associated with adapting grief interventions into an EMI format.

Pulmonary nodules are common on chest CT in bronchiectasis (BE) patients. This study identifies risk factors for nodule malignancy in BE patients with pulmonary nodules. We screened BE patients who underwent chest CT at Second Xiangya Hospital from Jan 1, 2019 to Mar 31, 2025. Only patients with pulmonary nodules and pathological results were enrolled. Univariate and multivariate logistic regression were performed to identify independent predictors of malignancy. , Of 143 patients, 28 had benign nodules and 115 had malignant nodules. Malignant nodules were more often pure ground&#x2011;glass/ground glass with a solid component nodule type (73.9% vs 28.6%, p<0.001) and upper lobe located (54.8% vs 32.1%, p=0.032). Benign nodules most commonly showed inflammation (60.7%), while malignant nodules were predominantly invasive adenocarcinoma (86.9%). Pure ground&#x2011;glass/ground glass with a solid component nodule type was the only independent predictor of malignancy (adjusted OR 8.53, 95% CI 3.14-25.81). Upper lobe location did not remain significant after adjustment. Reiff score and same&#x2011;lobe BE&#x2011;nodule coexistence were not significantly associated. Among BE patients with pulmonary nodules, pure ground&#x2011;glass/ground glass with a solid component nodule type independently predicts malignancy. This may aid clinical decision&#x2011;making.

Trans-sacral canalplasty (TSCP) is a minimally invasive epidural adhesiolysis technique positioned between conventional block therapy and open surgery. However, the relationship among MRI-defined levels of stenosis, epidurographic block patterns, and clinical effectiveness remains unclear. To investigate the clinical significance of mismatch between MRI-defined levels of stenosis and epidurographic block as well as to evaluate the short-term outcomes and feasibility of adhesiolysis in patients undergoing TSCP. A retrospective observational study. A university hospital in Japan and an affiliated institution. We reviewed all patients who underwent TSCP between October 2024 and August 2025. Baseline characteristics, diagnosis, surgical history, and minimum dural sac area at L3/4, L4/5, and L5/S (measured on MRI using ImageJ2) were assessed. Epidurography was performed to identify block levels, and cases were categorized as concordant (MRI-defined level of stenosis = block level) or discordant (mismatch). Discordant cases were subclassified into a "tail-stop" type (in which contrast stopped in a position caudal to the MRI-defined level of stenosis) and a "pass-through" type (in which these levels differed). Clinical effectiveness was defined as an improvement in low back pain or leg pain at one week after the procedure. Feasibility of adhesiolysis was also evaluated. Twenty-eight patients underwent TSCP during the study period. Nine (32.1%) showed concordance between MRI-defined levels of stenosis and epidurographic block sites, and 19 patients (67.9%) showed discordance (tail-stop, n = 11; pass-through, n = 8). Overall, 23 patients (82.1%) experienced clinical improvement. The effectiveness rate was 66.7% (6/9) in the concordance group and 89.5% (17/19) in the discordance group; however, the difference was not statistically significant (P = 0.290). In the discordance group, there was a significant difference in gender distribution between subgroups, with men predominating in the tail-stop subtype and women in the pass-through subtype (P = 0.024), but not in age, diagnosis, surgical history, or minimum dural sac area. Epidural dissection was successful in 21 patients (75.0%), with no significant difference between the effective and noneffective groups (73.9% vs 80.0%, P > 0.999). A single-center retrospective design, small sample size, and short-term follow-up of only one week. TSCP demonstrated favorable short-term clinical effectiveness, even in cases with mismatches between MRI and epidurographic findings. The feasibility of adhesiolysis may contribute to the clinical success of TSCP. Epidurographic mismatch should not be considered a contraindication for TSCP, and our findings support its role as a minimally invasive option for patients with degenerative disorders of the lumbar spine who are unsuitable for open surgery.

The efficacy of serum urea and creatinine concentrations in the diagnosis of kidney disease in cattle is limited because of their low sensitivity and specificity. Serum symmetric dimethylarginine (SDMA) concentration is correlated with glomerular filtration rate and has been reported to be useful for the diagnosis of kidney disease in other species. Test the hypothesis that SDMA may be an effective biomarker for diagnosing kidney disease in cattle. The objectives were to assess the analytical performance of SDMA measurement using a benchtop analyzer to establish an SDMA reference interval in cattle, and to evaluate the efficacy of plasma SDMA concentration for the diagnosis of kidney disease in cattle. A total of 199 healthy animals (53 male and 96 female beef cattle and 50 female dairy cows) and 27 azotemic cows with confirmed kidney disease. A partial analytical validation of SDMA measurement using bovine plasma was performed including assessments of short- and long-term imprecision, linearity, and stability. The reference interval was established following American Society for Veterinary Clinical Pathology (ASVCP) recommendations. Finally, the diagnostic efficacy of SDMA was assessed by determination of specificity, sensitivity, and the area under the receiver operating characteristic curve. The SDMA measurements showed acceptable analytical performance. The reference interval was 60-160&#xa0;&#x3bc;g/L. No significant differences were found according to sex, breed, or food supply. Using the upper limit of the reference interval (160&#xa0;&#x3bc;g/L) as the cut-off, sensitivity and specificity were 0.85 and 0.98, respectively. An SDMA cut-off of 160&#xa0;&#x3bc;g/L shows promise for diagnosing kidney disease in cattle, but requires confirmation in future studies.

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy with a five-year survival rate below 10%, largely due to late diagnosis and rapid metastasis. PDAC cells exhibit profound metabolic reprogramming, particularly enhanced aerobic glycolysis. Non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs), have emerged as key regulators of glycolysis in PDAC, although their integrated roles and clinical relevance remain incompletely understood. MiRNAs regulate glycolytic flux by targeting key enzymes and signaling pathways, thereby modulating glucose uptake and lactate production. LncRNAs promote glycolysis through pathways such as PI3K/AKT/mTOR, Wnt/&#x3b2;-catenin and p53, or by acting as competing endogenous RNAs. CircRNAs function as miRNA sponges or transcriptional regulators, contributing to metabolic adaptation and chemoresistance. Beyond glycolysis, ncRNAs also influence mitochondrial function, redox balance and tumor microenvironment remodeling. Clinically, several ncRNAs show promise as diagnostic and prognostic biomarkers. Therapeutic strategies targeting ncRNAs, including nano-delivery systems and RNA-based approaches, demonstrate potential for overcoming chemoresistance and enhancing treatment efficacy. NcRNAs play central roles in regulating glycolysis and metabolic adaptation in PDAC and represent promising targets for diagnosis and therapy. Further studies are required to validate key regulatory networks and translate these findings into clinical applications. NcRNAs regulate glycolytic enzymes HK2, PFK1, PKM2 and LDHA in PDAC.MiRNAs, lncRNAs and circRNAs modulate PI3K/AKT/mTOR and HIF-1&#x3b1; pathways.NcRNA-based strategies show promise for overcoming PDAC drug resistance.Metabolic reprogramming via ncRNAs drives pancreatic cancer progression.

Migraine, a disabling neurological disorder, poses a significant global burden, especially among women of reproductive age. In India, inconsistent diagnoses and the underutilization of evidence-based therapies present substantial challenges. This study evaluated the knowledge, attitudes, and practices of general neurologists and headache experts in India regarding migraine diagnosis and treatment, identifying barriers and opportunities for improvement in clinical care. A cross-sectional online survey was conducted among 137 clinicians in India (125 general neurologists and 12 headache experts). The questionnaire assessed diagnostic approaches, preferences for pharmacological and non-pharmacological treatments, utilization of guidelines, and readiness to adopt novel therapies. Data were analyzed using descriptive statistics. Headache experts reported a higher patient burden, with 9 (75.00%) seeing 25 or more headache patients per week, compared to 39 (31.2%) general neurologists. Migraines comprised over 50% of cases for 7 (58.33%) of the experts. The use of International Classification of Headache Disorders (3 rd edition) criteria was markedly higher among headache experts (91.67% vs. 38.71%), as was the Migraine Disability Assessment (66.67% vs. 24.20%). Nonsteroidal anti-inflammatory drugs and triptans were the most commonly prescribed therapies. Although triptans provided only moderate relief for most patients, newer agents, such as ditans, were rarely used (0-20%). Nonpharmacological interventions were widely adopted, with approximately 90% usage in both groups. Barriers included limited diagnostic standardization, therapeutic inertia, low familiarity with newer agents, and operational challenges such as time constraints. Both general neurologists and headache experts acknowledge the burden of migraine and practice holistic management. However, gaps remain in standardized diagnosis, optimal triptan use, and the adoption of novel therapies. Enhancing clinician education, promoting validated diagnostic tools, developing expert consensus, and increasing community awareness are crucial to optimizing outcomes and reducing therapeutic inertia.

Sciatic hernias containing adnexa are exceedingly rare and prone to misdiagnosis. This study reports the case of an 84-year-old multiparous female (body mass index: 18 kg/m 2 ) who presented with acute right lower abdominal pain. Initially, the patient was misdiagnosed clinically with an obturator hernia; however, rigorous multidisciplinary computed tomography re-evaluation confirmed a right-sided adnexal sciatic hernia. Laparoscopic exploration revealed the adnexa and a mesosalpingeal cyst herniating through a 2.0-cm suprapiriform defect. Given her advanced age and the mechanical risk posed by the cyst, a right salpingo-oophorectomy was justified. The defect was concurrently repaired using a transabdominal pre-peritoneal approach, with the mesh secured solely by continuous peritoneal suturing. Prior to mesh placement, the ureter was mobilised medially to maintain a safe distance from the repair site. The post-operative course was uneventful, and she was discharged on day seven. This case highlights the crucial role of accurate radiological differential diagnosis in high-risk women and demonstrates a safe, minimally invasive management strategy.

The geriatric nutritional risk index (GNRI) is an indicator of nutritional status and predicts overall survival (OS) in patients with myeloma. A low GNRI score indicates malnutrition associated with venous thromboembolism (VTE). This retrospective study aimed to investigate the clinical relevance of GNRI in VTE in patients with myeloma. We reviewed the medical records of 357 patients who were newly diagnosed with myeloma and treated with proteasome inhibitors and/or immunomodulatory drugs. VTE included deep vein thrombosis and pulmonary embolism diagnosed using imaging studies. The cutoff value for the GNRI was 92, according to previous studies. The median age of the patients was 71 years. The 1-year cumulative incidence of VTE was 4.9%. The median time from diagnosis to VTE was 2.8 months (range, 0.1-86.8 months). A low GNRI was associated with a high incidence of VTE (hazard ratio [HR], 3.885; P&#x2009;<&#x2009;0.001). During a median follow-up of 37.8 months, OS was significantly shorter in patients with low GNRI scores and those who developed VTE within 1 year than in those with high GNRI scores who did not develop VTE (log-rank test, P&#x2009;<&#x2009;0.001 and P&#x2009;=&#x2009;0.047, respectively). Multivariate analysis revealed that low GNRI (HR, 1.562; P&#x2009;=&#x2009;0.050) and VTE within 1 year (HR, 3.470; P&#x2009;=&#x2009;0.017) were associated with shorter OS. A low GNRI score is associated with a high incidence of VTE in patients with myeloma. The GNRI and VTE within 1 year were associated with mortality.

The elimination of cervical cancer has been identified by the World Health Organisation as an achievable goal worldwide. An important component of cervical cancer prevention is the successful diagnosis and treatment of precancerous lesions with colposcopy in women with positive cervical screening tests. Colposcopy services should be of a high-quality with well trained staff delivering appropriate care using agreed clinical management protocols. Poor-quality services are associated with increased risk of both undertreatment and overtreatment for women which can significantly impair the reduction of cervical cancer in screened women. Organisational systems should be in place to ensure access to skilled colposcopy services where practice can be reviewed, measured and compared to improve performance. The current review provides guidance on how quality assurance for colposcopy services can be provided. The Quality and Standards Group of the European Federation for Colposcopy and Cervical Cancer Prevention comprised of senior colposcopists who reviewed the progress of quality assurance processes to date throughout Europe. There was considerable variation in the implementation of quality assurance programmes between countries and insight has been provided into how such variations can be rectified by implementation of best practice in colposcopy. A roadmap is described to implement the recommendations of the World Health Organisation and reduce the inequalities of colposcopy services to establish equity of access to quality diagnosis and treatment across Europe.

Despite its importance in patient care, public awareness of histopathology and the role of histopathologists remain overshadowed. This study aimed to assess Jordanians' public awareness of histopathology and identify areas of misconception or lack of understanding. A cross-sectional survey was conducted among adults (>18 years) in Jordan through a web-based questionnaire. The survey evaluated participants' knowledge and perceptions of histopathology, including the nature of histopathologists' work, their educational requirements, and their role in patient care. Descriptive statistics, Chi-square tests, and multivariate linear regression were used to analyze the data. A total of 614 participants completed the survey, of which 41% did not recognize histopathology as a medical specialty. The majority identified pathologists as medical doctors whose main job is diagnosis of diseases among living patients, while some participants have misconceptions about associating histopathologists' work with performing autopsies or laboratory tests. Underestimation of the duration of training required to become a certified histopathologist and misconceptions regarding the diagnostic decision-making on selected sample procedures were noticed. Female gender, educational level, and medical background were associated with higher knowledge scores. Despite acceptable general knowledge, the observed misconceptions and lack of understanding regarding histopathology among the public necessitate interdisciplinary collaboration between pathologists and other healthcare professionals to increase the public awareness.

Yoga-based breathing exercises (pranayama) can be effective in improving symptoms such as pain, fatigue, and insomnia, and increasing self-efficacy after colorectal cancer surgery. To evaluate the effects of pranayama on pain, fatigue, insomnia, and self-efficacy after colorectal cancer surgery. This study was a randomized controlled trial comparing a yoga-based breathing intervention to a usual care control group. Participants who were taking the same type and dosage of postsurgical pain medication and not taking sleeping pills were randomly assigned to groups. This study was conducted with 80 adult patients with a recent diagnosis of colorectal cancer who were scheduled for surgical resection. The intervention group performed pranayama twice a day in the evening before surgery and for 7 days after surgery. In the intervention group, fatigue decreased (P = .012, &#x3b7;2 = 0.055) and sleep quality improved more (P = .033, &#x3b7;2 = 0.043) compared with the control group. Although pain levels decreased over time in the intervention group compared with the control group, this change was not statistically significant (P = .185, &#x3b7;2 = 0.021). Similarly, self-efficacy showed an upward trend in the intervention group; however, this increase was not statistically significant (P = .126, &#x3b7;2 = 0.026). Pranayama may be effective in reducing postsurgical fatigue and insomnia and improving self-efficacy. These findings support the integration of pranayama into holistic perioperative care as a complementary approach to managing postsurgical symptoms such as fatigue and insomnia.

When bacteria enter the bloodstream and grow, they produce toxins that cause systemic sickness; and this leads to bloodstream infections (BSIs). BSIs are a major contributor to morbidity and mortality in hospitals. Since infections produced by multidrug-resistant (MDR) organisms are linked to greater mortality rates, the situation becomes even more complicated. This study evaluated the bacterial agents found in Erbil septicemia patients and investigated how resistant they were to antibiotics. Blood cultures were obtained from 81 patients at Maryamana Private Hospital who were suspected of having septicemia between March and October 2024. Automated laboratory equipment was used to identify the isolates and assess their susceptibility to antibiotics. Standard criteria were followed for classification into MDR, extensively drug-resistant (XDR), or pan-drug-resistant (PDR) categories. Around 57 (70.3%) of the 81 blood samples had bacterial growth. Around 32 (56.1%) were male and 25 (43.9%) were female. The majority were in the 30-59 years age group. More Gram-negative organisms (59.7%) than Gram-positive species (40.3%) were isolated. Staphylococcus aureus (16.1%) and Burkholderia cepacia (17.9%) were the most common bacteria. Methicillin-resistant S. aureus (MRSA) strains made for more than half of the total (55.5%). PDR was found among the Gram-negative isolates; 65.5% were MDR and 34.5% XDR. The significant prevalence of resistant Gram-negative bacteria and MRSA highlights the critical need for quick diagnosis, careful antibiotic use, and improved infection control measures in healthcare environments.