Common Route Research Articles

Investigating MerR's Selectivity: The Crosstalk Between Cadmium and Copper Under Elevated Stress Conditions.

Bacteria respond to metal pollution through sensors that control the uptake and the detoxification machineries. Specificity in metal recognition is therefore a prerequisite for triggering the appropriate response, particularly when facing a mixture of metals. In response to Cu+, the purple bacterium Rubrivivax gelatinosus induces the efflux Cu+-ATPase CopA by the Cu+ regulator CopR. However, genetic analyses have suggested the presence of additional regulators. Here, we show that CadR, the Cd2+ sensor, is involved in Cd2+ and Cu+ tolerance and demonstrate that CopR and CadR share common target genes. Interestingly, expression of the Cu+ detoxification and efflux (CopI/CopA) system was induced by Cd2+ and downregulated in the double mutant copRcadR-. This double mutant was more sensitive to low Cu+ concentration than the single copR- mutant, and accumulation of coproporphyrin III pointed to a significantly decreased expression of CopA. Furthermore, analyses of Cd2+ toxicity in the cadR- mutant suggested that although CopR is Cu+ selective, CopR is involved in Cd2+ response since the addition of Cu+ alleviates Cd2+ toxicity. Based on our current knowledge of metal transport across the inner membrane, Cd2+ and Cu+ do not share common efflux routes nor do they share common regulators. Nevertheless, the crosstalk between Cd2+ and Cu+ tolerance systems is demonstrated in the present study. The modulation of Cu+ detoxification by a Cd2+ regulator in vivo places emphasis on the relaxed selectivity, under elevated metal concentration, in MerR regulators.

A 10-year retrospective review of exposures to volatile nitrites reported to the Victorian Poisons Information Centre

Introduction Volatile nitrites, such as amyl nitrite, are used recreationally to enhance sexual experience and provide a feeling of euphoria. They are associated with severe adverse reactions including methaemoglobinaemia and maculopathy. The aim of this study was to explore the epidemiology and clinical effects of volatile nitrite exposures reported to the Victorian Poisons Information Centre in Australia over a 10-year period. Methods This was a retrospective, observational study of poison centre call records. Data were extracted for all exposures to volatile nitrites reported from 2013 to 2022. Results There were 132 calls about volatile nitrites, representing 122 exposures, with a more than five-fold increase in the annual number of exposures (from five in 2013 to 26 in 2022). Ingestion (49.2%) and inhalation (27.9%) were the most common routes of exposure. Seventy-six (62.3%) patients reported one or more symptoms related to volatile nitrite exposure. The most common symptoms were light-headedness/dizziness (20.5%), oro-mucosal irritation (15.6%), ocular irritation (14.8%), nasal irritation (12.3%), and nausea/vomiting (9.8%). Less common, but potentially serious, adverse effects included methaemoglobinaemia (4.1%), hypoxia (1.6%) and hypotension (0.8%). Symptom severity was usually classified as minor (70/76, 92.1%) at the time of the poisons centre call. Fifty-four (44.3%) patients were either in the hospital when the poisons centre was contacted or were referred to the hospital by the poisons centre. Discussion The increase in reported volatile nitrite exposures observed in this study aligns with epidemiological data showing an increase in volatile nitrite usage in Australia. The findings about the nature of exposures and symptoms experienced can be used to inform harm reduction and education efforts for community members and health professionals. Conclusions Exposures to volatile nitrites reported to an Australian poisons centre increased between 2013 and 2022. More than 40% of exposures resulted in a hospital presentation. Methaemoglobinaemia was reported in 4.1% of cases.

New Dosage Form of Insulin: Review Article

Many patients with advanced type 2 diabetes mellitus (T2DM) and all patients with T1DM require insulin to keep blood glucose levels in the target range. The most common route of insulin administration is subcutaneous insulin injections. There are many ways to deliver insulin subcutaneously, such as vials and syringes, insulin pens, and insulin pumps. Though subcutaneous insulin delivery is the standard route of insulin administration, it is associated with injection pain, needle phobia, lipodystrophy, noncompliance, and peripheral hyperinsulinemia. Therefore, the need exists to deliver insulin in a minimally invasive or noninvasive way and in the most physiological way. Inhaled insulin was the first approved noninvasive and alternative way to deliver glucose, but it has been withdrawn from the market. Researchers are exploring technologies to enable noninvasive insulin delivery. Some of the routes for insulin administration that are under investigation are oral, buccal, nasal, peritoneal, and transdermal. This article has focused on different possible routes of insulin administration, their advantages and limitations, and the possible scope of the new drug development.

New Drug Delivery Systems for Stable Oral Absorption: Theory, Strategies, and Applications.

The oral dosage route still remains the most common and preferred route for drug administration due to convenient handling, high patient compliance, and cost-effectiveness. However, the oral absorption of drugs can be a complex process depending upon: (i) physicochemical properties of the drug (e.g., pKa, lipophilicity, solubility), (ii) pharmaceutical factors (e.g., dosage form), and (iii) physiological factors (e.g., gastrointestinal pH values, gastric emptying rate, gastric and intestinal pH, metabolism). Oral administration of drugs sometimes leads to poor and/or variable oral bioavailability, possible leading to unstable clinical outcomes. To offer stable and improved pharmacokinetic behavior of drugs, a number of formulation approaches have been developed with a focus on enhancement of the solubility, dissolution rate, and oral bioavailability of drugs. To provide new formulation platforms for better and safe medication, it is considered essential to understand the physicochemical, biochemical, metabolic, and biological barriers which limit overall drug bioavailability in more detail. The review article considers several crucial factors affecting oral absorption of drug substances. This article also describes the recent progress in formulation approaches to achieve stable and improved biopharmaceutical properties of orally-taken drugs.

ENERGY EFFICIENT ROUTING PROTOCOL FOR SECURITY ANALYSIS SCHEME USING HOMOMORPHIC ENCRYPTION

Wireless Sensor Networks (WSNs) have gained widespread interest as a result of developments in IT technology and the electronics industry. This ground-breaking sensing technology consists of multiple sensor nodes or motes that are placed in an atmosphere to detect constantly changing physical phenomena. These compact sensor nodes gather and interpret data via radio waves. The tiny size of these sensors is advantageous since they may be readily incorporated into any system or system. This capability has prompted the adoption of WSNs, particularly for form monitoring and tracking; most notably, monitoring apps. However, this small scale of sensor nodes limits the capacity of resources. Usually, the WSNs are installed in environments of unsafe or difficult human interference. Critical decisions in emergency applications can require sensible knowledge. It is necessary to check the network security. To extend the network security using Homomorphic Encryption effectively, the available resources must be expanded to a full view. This refers to the development of energy-efficient routing protocol strategies to ensure low energy consumption of common routing protocols and improve the availability and security of WSNs. Homomorphic encryption is effective in improving the security of wireless sensor networks.

The connection site of the Bachmann bundle to the left atrium affects atrial electrical and anatomical remodeling

Abstract Background A common route for the propagation of the conduction system from the right atrium to the left atrium (LA) is via the Bachmann bundle (BB) which is a parallel-aligned muscular structure. It is empirically known that the site of conduction from BB to LA differs depending on the patient. Purposes To clear the clinical significance of differences in the BB conduction sites in patients with atrial fibrillation (AF). Methods We studied 182 patients (90 non-paroxysmal AF, 121 males, and 68.2 ± 10.0 years) who received catheter ablation for AF. Clinical data, echocardiographic data, and blood samples were evaluated. High-density LA mapping during high right atrial pacing was constructed. The site of conduction from BB to LA, the global activation time, LA mean voltage, the abnormal conduction zone (ACZ), and the conduction block (CBZ) were evaluated. The conduction from BB was connected to the region surrounded by the left atrial roof line, the carina of the right pulmonary vein, and the base of the left atrial appendage in all patients (Figure 1). This area was divided into four regions (right-roof, mid-roof, right-anterior, and mid-anterior area), and BB conduction sites were classified into each area by three independent observers who did not know clinical data. Global activation time for the LA was calculated by subtracting the earliest from the latest activation within the LA. Isochronal activation maps were created at a 5-ms interval setting, and ACZ (Figure 2) and CBZ were identified on the activation map by locating a site with isochronal crowding of ≥3 isochrones and ≥8 isochrones, which were calculated as ≤27 cm/s and ≤10 cm/s. Results The conduction from BB was observed in 45 patients in the right-roof area, 24 in the mid-roof, 76 in the right-anterior, 23 cases in the mid-anterior, and 14 in multiple sites. Global activation time (right-roof 108±20, mid-roof 107±16, right-anterior 105±19, and mid-anterior 117±20ms, P=0.0781) was more prolonged and left atrium diameter was larger (42.1±6.6, 42.6±8.5, 42.5±6.6, and 46.4±6.6mm, P=0.0718) in patients with mid-anterior BB connections. LA mean voltage (4.90±1.94, 5.72±2.62, 4.13±1.58, and 4.88±1.96mV, P=0.0032) was higher and plasma brain natriuretic peptide level (139±138, 67±59, 128±139, and 164±197pg/mL, P=0.0861) was lower in patients with mid-roof BB connections. ACZ (41/45 91%, 20/24 83%, 73/76 96%, and 23/23 100%, P=0.0904) and CBZ (1/45 2%, 0/24 0%, 8/76 11%, and 2/23 9%, P=0.0850) appearance rates were lower in patients with mid-roof BB connections. Conclusion The connection site of the Bachmann bundle to the left atrium may affect atrial electrical and anatomical remodeling in patients with atrial fibrillation.

Nicotine and cannabis routes of administration and dual use among U.S. young adults who identify as Hispanic, non-Hispanic Black, and non-Hispanic White

BackgroundUse of cannabis and nicotine is at record levels among young adults, and health consequences vary by route of administration. However, there is a paucity of research characterizing use of both substances, especially among individuals of racial/ethnic minoritized identities. MethodParticipants (N = 1,032; age 18–25 years) completed a cross-sectional survey administered through an online panel in 2021 in eight U.S. states where cannabis was legal for both recreational and medical use and eight states where cannabis was not legal for medical or recreational purposes. Sampling was stratified by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White) and gender (male, female). Survey weighting was based on state-level gender and race/ethnicity data in the 2021 U.S. Census Bureau. ResultsOver one third (37.9%) of respondents reported current use of both cannabis and tobacco, more than double the proportion using tobacco (12.1%) or cannabis (4.1%) only. Vaporization was the most common method for using nicotine (40.2%). Disposable nicotine vape products were used more than any other method (27.1%). Smoking was the most common route of administration for cannabis (35.7%). Simultaneous use of tobacco and cannabis was common (27.0%) overall and greater among those who identify as non-Hispanic Black than non-Hispanic White. There were few differences in product use by gender or state legality. DiscussionDual cannabis and tobacco use is prevalent among young adults. Given the dynamic regulatory landscape, continued monitoring of specific cannabis formulations and tobacco products is recommended. Trends in simultaneous use of cannabis and tobacco and associated adverse effects warrant continued assessment.

Sex Chromosome Evolution: Hallmarks and Question Marks.

Sex chromosomes are widespread in species with separate sexes. They have evolved many times independently and display a truly remarkable diversity. New sequencing technologies and methodological developments have allowed the field of molecular evolution to explore this diversity in a large number of model and nonmodel organisms, broadening our vision on the mechanisms involved in their evolution. Diverse studies have allowed us to better capture the common evolutionary routes that shape sex chromosomes; however, we still mostly fail to explain why sex chromosomes are so diverse. We review over half a century of theoretical and empirical work on sex chromosome evolution and highlight pending questions on their origins, turnovers, rearrangements, degeneration, dosage compensation, gene content, and rates of evolution. We also report recent theoretical progress on our understanding of the ultimate reasons for sex chromosomes' existence.

Oral fentanyl consumption and withdrawal impairs fear extinction learning and enhances basolateral amygdala principal neuron excitatory-inhibitory balance in male and female mice

The number of opioid overdose deaths has increased over the past several years, mainly driven by an increase in the availability of highly potent synthetic opioids, like fentanyl, in the un-regulated drug supply. Over the last few years, changes in the drug supply, and in particular the availability of counterfeit pills containing fentanyl, have made oral use of opioids a more common route of administration. Here, we used a drinking in the dark (DiD) paradigm to model oral fentanyl self-administration using increasing fentanyl concentrations in male and female mice over 5 weeks. Fentanyl consumption peaked in both female and male mice at the 30 µg/mL dose, with female mice consuming significantly more fentanyl than male mice. Mice consumed sufficient fentanyl such that withdrawal was precipitated with naloxone, with males having increased withdrawal symptoms as compared to females, despite lower pharmacological exposure. We also performed behavioral assays to measure avoidance behavior and reward-seeking during fentanyl abstinence. Female mice displayed reduced avoidance behaviors in the open field assay, whereas male mice showed increased avoidance in the light/dark box assay. Female mice also exhibited increased reward-seeking in the sucrose preference test. Fentanyl-consuming mice of both sexes showed impaired cued fear extinction learning following fear conditioning and increased excitatory synaptic drive and increased excitability of BLA principal neurons. Our experiments demonstrate that long-term oral fentanyl consumption results in wide-ranging physiological and behavioral disruptions. This model could be useful to further study fentanyl withdrawal syndrome and behaviors and neuroplasticity associated with protracted fentanyl withdrawal.

School students’ awareness on air pollution and its health effects in the Sultanate of Oman

The current study aimed to investigate the level of Omani school students’ awareness of air pollution and its health effects due to gender and grade variables. A study was conducted in four governorates in Oman, viz. Muscat, Al Dakhiliyah, north and south Al Batinah, in the 2022/2023 academic year. A closed online questionnaire was used with a total of 1,337 respondents from grades 9<sup>th</sup>, 10<sup>th</sup>,<sup> </sup>& 11<sup>th</sup>. The results of the study showed that the level of students’ awareness regarding air pollution and its health effects was moderate. Significant differences in students’ awareness of air pollution and its health effects due to gender and grade variables were obtained. Female students were more vulnerable than males to the effects of air pollution, hence they were significantly careful about air quality when doing outdoor sports activities. In contrast, male students’ awareness of the schools’ role regarding air pollution awareness and reduction actions was significantly higher than female students. Social media was a main source of access to information about air pollution. Inhaling contaminated air was the most common route of exposure to the toxic air pollutants reported by participants.

A systematic review of case reports on mortality, modes of infection, diagnostic tests, and treatments for Nipah virus infection.

First identified in Malaysia in 1998, the Nipah virus is a paramyxovirus related to the Hendra virus. The clinical manifestation can vary from a silent infection to a life-threatening encephalitis. The World Health Organization (WHO) has documented 25 outbreaks in South Asia, resulting in 429 cases and 307 deaths to date. Currently, there are no approved treatments for the deadly Nipah virus infection, which is a serious threat to public health worldwide. Consequently, a review was conducted to examine the geographic distribution of the Nipah virus, mortality, transmission pathways, and available methods for diagnosis and treatment. PubMed, Scopus, Web of Science, and Google Scholar servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. A total of 12 studies (7 case series and 5 case reports) were included in the final analysis, and 92 cases were analyzed. The most frequent symptoms were fever (80%), myalgia (47%), headache (47%), shortness of breath/acute respiratory distress syndrome (n = 44.1%), altered sensorium (44.1%), and vomiting (42.6%). The most commonly used diagnostic test was RT-PCR (45.5%). The most common route of transmission reported is direct human contact with the infected patients. Treatment modalities include interventional procedures, antiviral drugs, and symptomatic treatment. The most common complications were seizures (39.2%) and altered sensorium (35.7%). The mortality rate was 73.9%. It is crucial to emphasize the importance of early Nipah virus infection diagnosis and treatment to prevent life-threatening consequences.

Wet-Chemical Synthesis of a Protective Coating on NCM111 Cathode: The Quantified Effects of Washing, Sintering and Coating

LiNixCoyMn1-x-yO2 (NCM) cathodes, especially with high Ni content, are widely expected to keep advancing the energy density of Li-ion batteries. However, ensuring a good cycle life remains a key challenge. Applying inert protective coatings on the surface of NCMs is a common route for mitigating surface-based degradation. In this study a sustainable ethanol-based wet-chemical coating method for covering the material with Al2O3 is developed and demonstrated on NCM111. The effect of the synthesis procedure is carefully evaluated to distinguish the benefits of the protective coating from the contributions of re-sintering and removal of surface contaminants, all taking place during the synthesis of the coated material. We show that while the cycling stability is significantly improved by the material regeneration alone (65% vs 79% state-of-health after 500 charge-discharge cycles at voltage range 2.7–4.3 V vs Li/Li+), the Al2O3-coated material displays further cycle life gains, maintaining 88% of initial capacity after 500 charge-discharge cycles. This work thus demonstrates both a sustainable wet-chemical coating method and the importance of establishing a proper baseline for characterization of inert protective coatings in general. The importance of both gains further prominence with the transition to inherently less stable higher Ni content NCMs.

Epidemiology of heart failure presentations to United States emergency departments from 2016 to 2023

IntroductionHeart failure (HF) is a common condition prompting presentation to the Emergency Department (ED) and is associated with significant morbidity and mortality. However, there is limited recent large-scale, robust data available on the admission rates, evaluation, and treatment of HF in the ED setting. MethodsThis was a cross-sectional study of ED presentations for HF from 1/1/2016 to 12/31/2023 using the Epic Cosmos database. All ED visits with ICD-10 codes corresponding to acute HF were included. We excluded congenital heart disease and isolated right-sided HF. Outcomes included percentage of total ED visits, admission rates, troponin, B-type natriuretic peptide (BNP), chest radiography, and diuretic and nitroglycerin medication administration. Subgroup analyses of medications were performed by medication and route of administration (transdermal, sublingual/oral, and intravenous). ResultsOut of 190,694,752 ED encounters, 2,626,011 (1.4 %) visits were due to acute HF. Of these, 1,897,369 (72.3 %) were admitted to the hospital. The majority of patients had a troponin (90.3 %), BNP (91.1 %), and chest radiograph (89.5 %) ordered. 82.5 % received intravenous diuresis, while 46.2 % received oral diuresis. The most common diuretic was furosemide (78.4 % intravenous, 32.5 % oral), followed by bumetanide (9.5 % intravenous, 7.1 % oral), and torsemide (0 % intravenous, 8.1 % oral). Nitroglycerin was given in 26.0 %, with the most common route being sublingual/oral (16.6 %), followed by transdermal (9.2 %) and intravenous (3.5 %). ConclusionHF represents a common reason for ED presentation, with the majority of patients being admitted. All patients received diuresis in the ED, with the majority receiving intravenous diuresis with furosemide. Approximately one-quarter received nitroglycerin with the sublingual/oral route being most common. These findings can help inform health policy initiatives, including admission decisions and evidence-based medication administration.

Antimicrobial Use in Cats in a University Veterinary Hospital in Central Italy: A Retrospective Study.

Background: Monitoring antimicrobial use is crucial for understanding current prescribing practices. Such information helps in establishing stewardship programs for effectively using antimicrobials and combating resistance to them. Objectives: This study describes how antimicrobials are prescribed at the Veterinary Teaching Hospital of the University of Pisa and compares how the internal medicine and intensive care units differ in their usage of antimicrobials. Methods: The study involved cats that were presented in the units in 2021 and 2022. Antimicrobial prescriptions were obtained via the hospital's management software (OCIROE). Results: In a population of 1164 non-surgical cats with 397 antimicrobials prescribed, the most prescribed ones were amoxicillin-clavulanic acid in the internal medicine unit and ampicillin in the intensive care unit. Twenty-five percent of all antimicrobials were Highest-Priority Critically Important Antimicrobials or Antimicrobial Advice Ad Hoc Expert Group Category B. The oral route was the main route of administration in the internal medicine unit, while parenteral was the most common route used in the intensive care unit. Most antimicrobials were prescribed to treat pathologic conditions affecting the urinary (39%), gastroenteric (21%), respiratory (13%), and integumentary (12%) systems. A diagnosis, accurate dosage, and the use of species-approved medications were recorded in the antimicrobial prescriptions. However, only 11% of these prescriptions were supported by antimicrobial susceptibility tests. Conclusions: These results suggest room for improvement, particularly in increasing the use of antimicrobial susceptibility testing to ensure more targeted antimicrobial therapy. Given the importance of antimicrobial resistance and the One Health approach, the study also highlights the need to consider the broader impact of antimicrobial use in animals, including the potential contribution to resistance in bacteria that affect both animal and human health.

Multimodal Hard X‐Ray Nanotomography Probes Pore Accessibility of Technical Catalysts after Coking

AbstractCoking is a common catalyst deactivation route in industrial processes involving carbonaceous species. While coking is easy to diagnose, this is often performed by bulk analysis. Understanding specific symptoms such as pore blockage and obstruction of active sites is especially challenging for technical catalysts and requires a spatially‐resolved approach. Here a combination of ptychographic X‐ray computed tomography (PXCT) and X‐ray fluorescence nanotomography (XRF‐CT) could identify and allocate regions of coke deposition within a technical zeolite‐based propane dehydrogenation catalyst. PXCT is sensitive to the quantitative electron density of the sample, therefore indirectly visualising coke deposition in meso‐ and macropores with 56–61 nm 3D spatial resolution. For more direct visualisation the catalysts were treated with Cu solution as fluorescent marker, whereby complementary XRF‐CT analysis could distinguish accessible and blocked pores based on the presence or absence of adsorbed Cu. This strategy was used to assess coking as a function of time on stream, to evaluate coke removal by oxidative regeneration, and to distinguish the presence of coke deposits separately within the zeolite and binder components. This strategy is applicable to virtually any porous solid catalyst and can deliver previously unknown insights into the common phenomenon of coke deposition particularly in technical catalysts.

PSX-11 Behavior of Kentucky beef producers towards controlling internal parasites

Abstract Internal parasites can reduce production efficiency in livestock grazing systems. Increased concern has been expressed regarding the potential loss of efficacy of available products currently available to livestock managers to control internal parasites. A survey was conducted during the spring of 2023 of Kentucky beef producers participating in a Fecal Egg Count Reduction Test (FECRT) study to gain insight related to their behavior toward managing internal parasites. A total of 70 individuals completed or partially completed the survey instrument. Similar numbers of operations had a single calving season of either spring (35.8%) or fall (37.3%) with these being more prominent than having both spring and fall calving seasons or a year-round calving season. When asked if they had ever performed a FECRT within their herd previously, 96.9% of respondents indicated they had not. Administering an anthelmintic twice annually was reported most often at 69.2%, while 16.9% indicated once per year and more than twice annually being reported by only 6.2%. Sixty percent of beef cattle managers indicated that they rotated products. When asked about the frequency of product rotation, 33.9% indicated they rotated products at each application while 25.8% switched products annually with another 21% never switching products. It is unclear as to why these two questions yielded slightly different outcomes. As all anthelmintics dosage is based on body weight (BW), determination of dosage was asked. More than 75% estimated BW for dosage while 15.4% used a scale to set the dosage for each animal and 7.7% used a scale to obtain an average BW to set the dosage for all animals. Route of administration of product most frequently utilized was pour-on at 66.3% either alone or in combination with another product. Oral drench (17.5%) and injectable (13.8%) were the next most common routes of administration with a single report of product being provided in the feed. This information provides Extension educators with insight regarding beef cattle managers’ behaviors towards anthelmintic use and aid in developing educational programs focused on controlling internal parasites.

Changes in the HIV Epidemic in Lower Silesia, Poland, Between 2010 and 2020: The Characteristics of the Key Populations.

The HIV (Human Immunodeficiency Virus) epidemic remains a significant public health issue, requiring ongoing access to preventive methods. This study aimed to analyze the evolution of the HIV epidemic in Lower Silesia from 2010 to 2020, focusing on the key populations. A retrospective analysis of the medical records from newly diagnosed HIV patients at a major HIV clinic in Wroclaw was conducted, examining demographic data, infection routes, and laboratory results. An 84% increase in newly diagnosed HIV cases was observed over the decade, with the most common route of infection being sex between men (70% among those with a known infection route). These patients were generally in better clinical condition compared to their heterosexual counterparts, as indicated by a higher median CD4+ T cell count (465/μL vs. 250/μL). The changes in clinical status and infection routes were statistically significant. The HIV epidemic in Lower Silesia has shifted, with a notable rise in new infections among men who have sex with men. Heterosexual patients were often diagnosed at more advanced stages. Prevention strategies should adapt to these changing trends, with education and testing accessibility remaining priorities nationwide.

Medication-Related Osteonecrosis of the Jaw: A Systematic Review of Case Reports and Case Series.

Medication-related osteonecrosis of the jaw (MRONJ) is a rare condition, typically seen in patients receiving antiresorptive or antiangiogenic drugs. This study aims to synthesize reports and case series of MRONJ regarding sociodemographic and clinical characteristics and to evaluate the effectiveness of the treatments applied. Following PRISMA guidelines, a search for case reports and case series was carried out in the PubMed-Medline database until March 2024. A total of 88 articles were included in this review, in a total of 151 cases. The key findings reveal that females were the most affected individuals (71% of the cases) with the average age at diagnosis being 66.27 years with a standard deviation of ±13.03. Stage 2 was the most observed stage, in 43% of cases, and zoledronic acid was the most commonly used drug (32% of cases). The oral route was the most common route of administration, in 26% of cases, with an average administration duration of 60.88 months (standard deviation ± 50.92). The mandible was the most commonly affected anatomical location (in 60% of cases). Amoxicillin + clavulanic acid (875 mg + 125 mg) and chlorhexidine (0.12%) were the most used antibiotics and mouthwash, with 16% and 26% of the cases, respectively. Surgical debridement was the most common surgical procedure, in 32% of cases, while the use of an L-PRF membrane was the most prevalent unconventional treatment, in 21% of cases. This study identified a statistically significant relationship between unconventional treatments and the cure of MRONJ (p < 0.001), indicating the need for further research to confirm these results.

Prevalence of Methamphetamine (Mkpurummiri) use in south east Nigeria: a community-based cross-sectional study

BackgroundMethamphetamine (MA) (Mkpurummiri) is seen as the most common, accessible and new drug of use/abuse in south east Nigeria. Despite the overwhelming evidence of the dire consequences of this drug to the users, there is lack of empirical research to determine its prevalence in this area where use is assumed to be common. This study aimed to determine the prevalence of MA use, characteristics of the users and the control measures.MethodsA descriptive cross-sectional survey research design was conducted from May through November 2023 among adolescents/adults at the age bracket of 15-64 years in the five states of south east, Nigeria. Three hundred and seventy-one (371) respondents were recruited using purposive/convenience sampling methods. A semi structured questionnaire was the instrument used. Data were analyzed using percentage, bivariate and multivariate logistics regression statistics. The Prevalence of MA was determined using percentages whereas the factors that are associated with MA use were expressed using multivariate logistics regression statistics AORs and 95%CIs. The level of significance was set at P < 0.05.ResultsThe prevalence of Methamphetamine (Mkpurummiri) was (21.8%). The most common reason for MA use was depression (86.5%), the most common route of administration was inhalation (64.9%). The most common characteristic of MA (Mkpurummiri) user was aggressive/violent behaviour (94.1%).The control measures were self-control (92.2%), parental monitoring (85.7%), drug education (83.1%) and legal control (80.8%). The multivariate logistics regression statistics AOR shows that off-campus were 3 times (AOR = 0.298; CI = 0.12–0.73 P = 0.008), family house 4 times (AOR = 0.241; CI = 0.09–0.65; P = 0.005 ≤0.05\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le 0.05$$\\end{document}) less likely than on-campus to predict MA use. Recently married were 3.25 times (aOR = 3.25; CI = 1.47–7.18), divorced 3.45 times (aOR = 3.45; CI = 1.23–9.58), polygamy 2.3 times (aOR = 2.3; CI = 1.08–4.90; P = 0.031 ≤0.05\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le 0.05$$\\end{document}), tradition 4.44 times (aOR = 4.44; CI = 1.77–11.15; P = 0.001 ≤0.05)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le 0.05)$$\\end{document}, more likely than others to use MA.ConclusionsMA use prevalence was relatively high, and marital status, living arrangements, family type and religion were the predictors. These findings underscore the need for concerted effort among the relevant government agencies, community stakeholders, families, religious bodies and school authorities to designing MA use policy/laws with special focus on adopting the punitive measure used in checking cocaine users. This may help to arrest and prosecute the manufacturers, distributors and users of MA.

Early economic evaluation of magnetic resonance imaging for prostate cancer detection in primary care.

To explore the potential impacts of incorporating prebiopsy magnetic resonance imaging into primary care as a triage test within the prostate cancer diagnostic pathway. Decision analytic modelling with decision trees was utilised for this early economic evaluation. A conceptual model was developed reflecting the common primary care routes to diagnosis for prostate cancer: opportunistic, asymptomatic prostate-specific antigen (PSA) screening or symptomatic presentation. The use of multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) as a primary care triage test following an elevated PSA result was evaluated. A health system perspective was adopted with a time horizon of 12 months. Health effects were expressed in terms of utilities drawn from the literature. The primary outcome was prostate cancer diagnosis. Evidence used to inform the model was drawn from published primary studies, systematic reviews, and secondary analyses of primary and secondary care datasets. Base case analysis showed that the PSA pathway was dominated by both mpMRI- and bpMRI-based pathways for patients undergoing opportunistic screening and symptomatic assessment. bpMRI pathways had greater improvement in cost and utility than mpMRI pathways in both clinical scenarios. Significantly more MRI scans would be performed using the modelled approach (66 626 scans vs. 37 456 scans per 100 000 patients per annum), with fewer subsequent urgent suspected cancer referrals for both mpMRI (38% reduction for screening and symptomatic patients) and bpMRI (72% reduction for screening; 71% for symptomatic) pathways, and a small increase in number of missed cancer diagnoses. Deterministic sensitivity analyses, varying each parameter to its upper and lower 95% confidence intervals, showed no significant change in the dominance of the MRI-based prostate cancer diagnostic pathways. Using prostate MRI as a second-level triage test for suspected prostate cancer in primary care could reduce health service costs without a detrimental effect on patient utility.