Precautionary Measures Research Articles

Clinical audit on postpartum hemoglobin levels: A study on postpartum anemia

Objectives: The present study was carried out to assess the prevalence of anemia with reference to the Hb levels during postpartum period. The study also investigates the influence of age and mode of delivery on postpartum Hb levels. Material and Methods: It is a hospital-based retrospective descriptive study. The postpartum patients’ data were obtained from the medical records department of a tertiary care hospital. Data of the patients registered for routine blood investigation in the period of December 2023 to January 2024 were collected from the records. Based on patient’s hospital ID, other details including age, Hb level, and mode of delivery data were obtained. Statistical analysis was performed to check the effect of age and mode of delivery on postpartum Hb level by Pearson correlation using IBM Statistical Package for the Social Sciences Statistics version 24.0. Results: About 64.3% of the patients belonged to the age group of 20–30 years and remaining 35.7% within 30–40 years. The percentage of postpartum patients who underwent lower segment cesarean section (LSCS) and normal vaginal delivery (NVD) were 85.7% and 14.3%, respectively. However, cumulative percentage of NVD was higher (100%) than LSCS (85.7%). The postpartum Hb level ranged from 7.9 to 15.2 g/dL. About 54% of patients showed moderate anemia (8–10.9 g/dL), followed by 24% mild (11.9–11 g/dL) and 2% with severe anemic (<8 g/dL) condition. Conclusion: The study highlights the prevalence of PPA associated with both LSCS and NVD modes of delivery. Although the number of anemic patients was higher in LSCS (48) compared to NVD (8), the percentage remains the same at 80% each considering the total number of patients in each category. These observations point out the risk of high-volume blood loss associated with both modes of delivery and emphasize the need for adopting precautionary measures.

Predictors of preventative behavior in the restaurant industry: learning from the COVID-19 pandemic

ABSTRACT This study used a structural model to analyze the health beliefs and prevention expectations of consumers in order to better understand their health risk behavior and their experience with restaurant precautionary measures. The findings indicated the perceived severity of COVID-19 during the pandemic led to a significant increase in the consumers’ preventative behaviors. Likewise, the customers’ perceived severity of the COVID-19 threat enhanced their concerns about the safety of restaurant service. Based on the moderating effect, we found that lower trust in restaurant precautionary measures weakened the otherwise positive relationship between the consumers’ perceived severity of the COVID-19 threat and their preventative behavior. Recommendations can help the restaurant prepare for future public health concerns.

Over-the-Top (OTT) video streaming services’ continuance adoption during and after Covid-19 pandemic: Mediation analysis combining two research frameworks

During and after the Covid-19 outbreak, people’s precautionary measures of not visiting public venues like cinema halls or multiplexes were replaced by watching treasured videos or films in private settings. People are able to watch their favourite video contents on a variety of internet-connected gadgets thanks to advanced technologies. As a result, it appears that the Covid-19 outbreak has had a substantial impact on people’s inclination to continue using video streaming services. This study attempted to establish an integrated framework that describes how people change their health behaviours during pandemic conditions using the health belief model (HBM), as well as the mediating effect of HBM constructs over ECM constructs such as continuous intention to subscribe to OTT video streaming services among subscribers. The study looked at the impact of three perceived constructs, susceptibility, severity, and self-efficacy, on the confirmation/adoption of over-the-top (OTT) video streaming services during the lethal pandemic (Covid-19). The study focused on new OTT video streaming service subscribers, and 473 valid replies were collected. Path analysis and multivariate analytical methods, such as structural equation modelling (SEM), were used to estimate construct linkages in the integrated framework. Perceived severity has been identified as the most influential factor in confirmation/adoption, followed by perceived susceptibility. The results also showed that satisfied users/subscribers are more likely to use OTT video streaming services. The mediators, confirmation/adoption, perceived usefulness, and satisfaction were used to validate the influence of perceived susceptibility on continuance intention. Furthermore, contactless entertainment enhances security for users/subscribers by allowing them to be amused across several internet-based venues while adhering to social distance norms.

A tutela provisória de indisponibilidade de bens no regime da lei de improbidade administrativa

This study aims to analyze the constitutionality of the current regime of provisional protection of unavailability of assets, sanctioned in the Brazilian legal system by Law n. 14,230/2021. The methodology used in the investigation was descriptive-exploratory, with emphasis on the analysis of the legal arguments built over the last 20 years by doctrine and jurisprudence. Firstly, the contours of administrative impropriety in the national order and the jurisprudential, doctrinal and legal aspects related to the precautionary measure of unavailability of assets in actions of improbity were presented. Next, the essential characteristics of precautionary measures within the scope of Civil and Criminal Procedure were discussed, which contributed to the analysis of the constitutionality of the current regime of provisional protection of unavailability of assets. Finally, in the last topic, an analysis was made of the constitutionality of the new regime of provisional protection of unavailability of assets in actions of administrative improbity, concluding that the new legal device, which demands the presence of the double requirement of precautionary measures (fumus boni iuris and periculum in mora), is the one that best conforms to the legal principles in force in the Brazilian normative system.

Advanced detection of foreign objects in fresh-cut vegetables using YOLOv5

The presence of foreign objects in fresh-cut vegetables has become a significant concern for the industry in recent years. Ensuring the safety of consumers and suppliers necessitates comprehensive precautionary measures. This study introduces a novel approach for detecting foreign objects in fresh-cut vegetables using YOLOv5. The results indicate that YOLOv5s excels in identifying foreign objects with a high detection accuracy of 98.30%, a rapid inference time of 2.6 ms, and a compact model size of 13.3 MB. The model effectively identified foreign objects such as transparent and colored plastic, paper, wood, stone, insects, glass, and metal. Moreover, YOLOv5s accurately detected foreign objects with color similarities to green onions, which is particularly challenging due to their wide color variation. Hence, the foreign objects dataset was tested and generated 98.63% and 98.67% for cabbage and green onion, respectively. Additionally, YOLOv5s successfully detected small foreign objects (2–3 mm) in two types of fresh-cut vegetables. Despite its excellent performance, the YOLOv5s model struggles to identify foreign objects that overlap with vegetable samples. To address this issue, installing an automatic conveyor unit could facilitate continuous sample movement, while a feeder unit could reduce the possibility of overlap. This research demonstrates the feasibility of implementing the YOLOv5s, as a non-destructive technique for detecting foreign objects in fresh-cut vegetables. The findings contribute to the development of an accurate, fast, and efficient real-time inspection system, with potential applications in the fresh-cut vegetable industry to enhance product quality and safety.

Knowledge, Attitude, And Practices on Infection Control Among Nursing Students in Biliran Province State University

Background: Nursing students in the Philippines have to undergo clinical rotation not only in Hospital wards but also at other hospital departments such as (DR) Delivery Room and OR Operating Rooms. These areas that they need to be skillful with as it is part of their requirements before graduation thus giving them a chance for eligibility to take the Philippine Nursing Licensure Examination. Good role modeling and clinical supervision are key to developing a strong commitment to strict adherence to Infection prevention and control protocols for nursing students. Hence, this study aimed to determine the knowledge, attitudes, and practices regarding infection control among Biliran Province State University student nurses. Methods: This study used a descriptive correlational research design. Survey questionnaires were administered to collect data from 255 BSN students at Biliran Province State University. Participants ranged from second-year to fourth-year students. Most were 19-21 years old, female, and single Roman Catholics. Results: The findings were therefore able to identify regard of knowledge as well as attitudinal towards infection control among the respondents. Over time majority of the students followed standard precaution measures most of the time. Interestingly, none of the six socio-demographic factors were found to have any relationship with the respondents’ level of knowledge, attitudes, and practices. Moreover, no correlation was evident which suggests that these variables are separate from each other between Knowledge, Attitude, and Practice. Conclusions: The research presented herein highlights the need for further advances made in the tweaking of the education interventions in matters concerning support and reinforcement of IPC measures despite boasting a healthcare safety environment.

Urgent Need for Real Time Web Mapping GIS Applications to Dengue Surveillance for Epidemic Control and Management in India

Dengue epidemics has been increased both horizontal and vertical structure across the country since 2006, and hence, urgent need for GIS based dengue surveillance for epidemic control and management in the nation. The dengue epidemic cases and the mortality caused by dengue has become essentially public health important in India, and the situation has become worse since 2006. Dengue cases were clinically confirmed with thousands of cases and hundreds of deaths annually. The report of dengue epidemics is becoming daily news nowadays and it was reported from 24 states and Union Territories in India. The spatial and seasonal occurrence of dengue epidemics were reported across the country during the period of April to November annually, however, the vulnerability of epidemics was reported between the periods of mid-July to mid-November of every year. The geo-environmental and climate variables are fuelling to create a conducive environment for profusion of dengue vector mosquitoes Aedes species (Ae. aegypti or Ae. Albopictus). The information relevant to the geographical site specification of dengue vectors breeding habitats, vector abundance, vector density, etc., could be collected using global positioning systems (GPS), and these information are mapped and overlay on the thematic layers of climate variables (Temperature, relative humidity, saturation deficiency and Rainfall) under the geographical information systems (GIS) software platform for spatial analysis (cluster analysis, nearest neighborhood analysis, fussy analysis, probability of maximum and minimum likelihood analysis etc.,) for spatial risk prediction. The Google based internet GIS mapping could be used to embedded web mapping real time situation and updating the information with online data base connectivity (ODBC) within the GIS spatial engine for providing the real time information relevant to the dengue epidemics, and hence, the appropriate precaution measures could be taken to control dengue epidemics in the nation early in advance.

Real-Time Road Safety: A Web and Mobile Application Approach to Mitigating Animal-Vehicle Conflicts in Sri Lanka

This research paper presents a pioneering web and mobile application aimed at mitigating the rising issue of animal-vehicle collisions in Sri Lanka, a concern that poses significant risks to both human safety and wildlife preservation. The application leverages a combination of knowledge-based case studies and crowd- sourcing techniques to enhance real-time road safety by identifying animal habitats and behaviors in proximity to users' locations. Through the web platform, users can input data on observed wildlife interactions and animal- vehicle conflicts, contributing to a comprehensive database for statistical analysis and predictive modelling. This information is used to generate real-time alerts and feedback, enabling drivers to take precautionary measures. The mobile application, utilizing geofencing and geotargeting technologies, provides real-time alerts, facilitates user feedback, and fosters community participation in ensuring safer roads. In addition to mitigating accidents, the application serves as an educational tool, offering guidelines and raising public awareness about the importance of road safety in areas rich in wildlife. By fostering a collaborative effort among users, this solution aims to reduce the frequency of animal-vehicle collisions, thereby promoting safer roads for both humans and animals in Sri Lanka.

Accidental Detection of Cocaine in Urine in Pediatric Patients: Case Series and Literature Review

Infantile occult exposure to cocaine in domestic environments represents a complex clinical and medico-legal problem, which can be associated with abuse and neglect and with potential short- and long-term health risks for children. The authors present a retrospective study on 764 children under 14 years old who accessed the Emergency Department of IRCCS Meyer from 2016 to 2023 and were included in the GAIA (Child and Adolescent Abuse Group) protocol for suspected maltreatment and abuse, and for which a urine toxicology analysis was performed. The aim is to discuss the medico-legal implications and highlight the need for a thorough evaluation and management of such situations. Urine screening tests for substances of abuse (e.g., cocaine, opiates, etc.) were performed with an EMIT® Siemens VIVA-E drug testing system (Siemens, Newark DE) in 124 cases for which the child’s clinical condition raised suspicion of intoxication, or the family context indicated distress or substance abuse dependency. The screening results revealed the presence of cocaine and its main metabolite, benzoylecgonine, in the urine of 11 children. In one case, a single girl was brought to the Emergency Department by staff from the facility where she and her mother were staying. In most of the cases, children were brought to the Emergency Department by their parents who accessed the Emergency Department due to various clinical manifestations (drowsiness, agitation, seizures, hypotonia, diarrhea, vomiting, etc.), except for one case of eye trauma suspected to be caused by abuse or neglect by one of the parents. Three of the children did not have signs or symptoms attributable to substance exposure, whilst eight of the cases presented some of the symptoms associated with occult infant exposure to cocaine, such as neurological manifestations, seizures, gastrointestinal symptoms, and respiratory depression. The probable mode of intake was mostly through breastfeeding and continuous environmental exposure due to domestic contamination or inhalation of “crack”. In the case of a 12-hour-old infant, there was probable prenatal in utero exposure. All the children were hospitalized, some for medical reasons and others solely as a precautionary measure for proper care. In all cases, a report was made to the Prosecutors as required by the Italian Penal Code, as well as to the Court of Minor. The study highlighted the importance of a multidisciplinary approach involving pediatricians, social workers, and forensics, as well as close collaboration with the relevant authorities, as the Gaia service at IRCCS Meyer offers. The occasional detection of cocaine in cases that showed no suspicion of intoxication led to a modification of the procedure and the development of a standardized protocol at IRCCS Meyer both in terms of prevention and in the detection and interception of hidden cases, in order to intervene early and initiate the necessary care pathways (secondary prevention). This protocol includes routine toxicological urine testing in all suspected or confirmed cases of child abuse, not just in those where symptoms might suggest a suspicion of intoxication.

Home-based nursing care for clients carrying multidrug-resistant organisms: a focus group study

Abstract Background The growing population of vulnerable clients receiving home-based nursing care, combined with the worldwide increase in the prevalence of multidrug-resistant organisms (MDROs), poses a new burden on nursing staff. This study aimed to gain insight into the experiences, attitudes, perceptions, dilemmas in daily practice and needs of nursing staff providing home-based nursing care for clients carrying MDROs. Methods Seven focus group discussions with home-based nursing staff (N = 34) were performed in the Netherlands between April and July 2022, using a semi-structured, open-ended topic list based on the I-change model and seven domains synthesized by Flottorp et al. Data were analysed using thematic analysis. Results Home-based nursing staff often considered infection prevention and control recommendations inconsistent, unclear or inapplicable in daily practice. Although participants acknowledged the importance of these precaution measures, their proportionality was sometimes questioned. Participants indicated to be influenced by perceptions, knowledge and behaviour of their colleagues and clients. In addition, they frequently experienced untimely, incomplete or inconspicuous information transfers about clients carrying MDROs. Concerns were expressed that clients were often insufficiently informed, debating the roles and responsibilities of involved healthcare professionals in providing and exchanging information. Finally, participants elaborated on the effect of the covid-19 pandemic and expressed the need for organisational support in providing education and sufficient resources regarding MDROs. Conclusions Insights of this study have aided in aligning upcoming MDRO guidelines for home-based nursing care in the Netherlands. Organisational support in expanding knowledge and providing sufficient resources is essential and clarity about roles and responsibilities of involved healthcare professionals regarding information transfer and informing patients is needed. Key messages • Expanding knowledge, sufficient resources and adequate information transfer about MDRO carriage are essential to ultimately prevent transmission and spread of MDROs. • The specific context of home-based nursing care for clients carrying MDROs should be acknowledged in MDRO guidelines.

10 Optimizing implementation and continuous monitoring of a newborn screening program for severe combined immunodeficiency

Abstract Background Severe Combined Immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell levels and function. Early diagnosis is essential to prevent serious infections and improve outcomes. Newborn screening (NBS) for SCID provides a way to detect SCID and other conditions associated with T cell lymphopenia in the neonatal period. Objectives 1) Optimize the implementation of a NBS program for SCID in British Columbia (BC), Canada; and 2) create a systematic method for monitoring the diagnoses and outcomes of infants with a positive screen to facilitate continuous improvement of the NBS program. Design/Methods An interdisciplinary working group comprised of immunologists, biochemical geneticists, and hematopathologists met at regular intervals prior to and after implementing NBS for SCID in BC. We developed an algorithm for the evaluation and initial management of infants with an abnormal NBS for SCID based on literature review and local expert consensus. Using a REDCap database, we tracked the prevalence, evaluation, diagnoses and outcomes of infants with a positive NBS. The database also monitored diagnoses and outcomes of children referred to Immunology outside of the NBS program. Plan-do-study-act cycles included creation of clinical and educational guidelines on SCID, optimization of abnormal NBS cut-off values, and reflex chromosomal microarray (CMA) testing of infants with confirmed T cell lymphopenia. Results Between October 3, 2022 and June 16, 2023, 28,816 initial samples were tested, and 30 infants had a positive screen for SCID. Of the 30 infants, 10 were ultimately diagnosed with conditions associated with T cell lymphopenia. Diagnosis led to avoidance of live viral vaccines and implementation of infection precaution measures. No infants experienced complications related to live viral vaccine administration, compared to 1 case in the preceding 12 months prior to NBS implementation. In February 2023, the threshold for an abnormal NBS was adjusted to achieve the goal positive screen frequency of 0.1%. Performing reflex CMA testing on infants with confirmed T cell lymphopenia led to rapid diagnosis of chromosomal microdeletion syndromes, avoiding unnecessary second tier testing. Since implementing NBS for SCID in BC, there have been no cases of SCID diagnosed outside of the NBS program. Conclusion Establishing an interdisciplinary working group and clinical database facilitated the smooth integration and continuous improvement of NBS for SCID in BC. This model can be applied to other healthcare systems to support teams and ensure the best possible outcomes for affected patients.

Prioritising Patients and Planet: Advocating for Change in Respiratory Care

The global burden of respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), continues unabated. Suboptimal management places a significant strain on both patients and urgent or emergency care services. With an ageing population in many countries, the demand for these services is set to increase further. At the same time, healthcare systems are striving to reduce their carbon footprint and achieve net zero emissions, as the healthcare sector is a significant contributor to carbon emissions worldwide. Although these two goals may appear contradictory, they need not be in conflict. This article reviews an industry-sponsored symposium held at the European Respiratory Society (ERS) Congress 2024 in Vienna, Austria, in September 2024. The session addressed the urgent need to change the delivery model for respiratory healthcare in response to the increasing prevalence of respiratory diseases and the challenges posed by climate change. Co-chair John Hurst, Professor of Respiratory Medicine at University College London (UCL), UK, underscored the importance of innovative solutions for managing respiratory diseases and highlighted the challenges faced by healthcare decision-makers. This was further elaborated on by Omar Usmani, Professor of Respiratory Medicine at Imperial College London, UK, who emphasised the importance of clinical choice. He stated that inhaled medicines, which form the cornerstone of treatment, should not be considered interchangeable. He also discussed ongoing efforts to maintain access to essential medicines by developing novel next-generation propellants (NGP) for pressurised metered-dose inhaler (pMDI) devices, which will reduce their carbon footprint to levels comparable with dry powder inhalers (DPI). Additionally, he described the European Chemicals Agency (ECHA) proposal to restrict a broad range of chemicals classed as per- and polyfluoroalkyl substances (PFAS). This precautionary measure would affect both current propellants in pMDIs and the transition to NGPs, with global implications for inhaled medicines. Erika Penz, Associate Professor of Respirology, Critical Care, and Sleep Medicine at the University of Saskatchewan, Canada, noted that suboptimal management of respiratory disease is associated with a disproportionately high burden on both patients and the environment. The forthcoming availability of pMDI medicines with NGPs alone will not resolve this larger issue. As every healthcare interaction carries a carbon footprint, which increases with the intensity of treatment, the implementation of guidelines into clinical practice would improve patient outcomes and reduce the demand on healthcare services and the associated carbon emissions. Co-chair Helen Reddel, Clinical Professor and Research Leader at the Woolcock Institute of Medical Research, Australia, concluded by re-emphasising the urgent need to implement guidelines immediately for the benefit of both patients and the environment.

The legal organization of the crime of child begging in light of Iraqi legislation

The crime of begging is spreading rapidly in most societies, especially in developing countries, where this crime has become a negative and dangerous impact on the social, economic and cultural levels. The reasons associated with this crime are many and varied, some of which may be due to the individual himself, in addition to the factors that affect society. Accordingly, our study deals with the topic of "the legal organization of the crime of child begging in the light of Iraqi and comparative legislation", especially since the category of children is characterized by its special and vulnerable nature, in addition to the fact that the impact of this crime is increasing in seriousness in light of modern technological and technological developments. In light of these challenges and in view of the importance of the child who enjoys protection and care in the majority of societies, many positive legislations have resorted to working to draw a legal structure that suits the special nature of the child "juvenile", by deciding reform measures that suit each juvenile individually and according to his circumstances and personality, which was followed by Iraqi legislation. The study raises the problem of combating begging crimes committed by children, because it deals with many legal, social and psychological aspects, in addition to preventive and precautionary measures, as well as demonstrating the ability of Iraqi legislation to confront. Our study was divided into two topics; we dealt in the first with the crime of child begging, and in the second we dealt with the elements of the crime of child begging and its penalties.

Oxaliplatin triggered hypersensitivity reactions in colorectal cancer patients: Case report

Colorectal cancer stands as a significant global health concern, encompassing adenocarcinoma of both the colon and rectum. Recognized risk factors include advancing age and medical history of inflammatory bowel conditions like Crohn's disease or ulcerative colitis. Oxaliplatin, a platinum-based chemotherapy agent, serves as the frontline treatment for colorectal cancer due to its cytotoxic effects on cancerous cells. However, its use is not without complications, as hypersensitivity reactions can occur, posing challenges in patient management. This case report discusses two instances where patients undergoing chemotherapy for colorectal cancer developed grade two hypersensitivity reactions following oxaliplatin administration, the Naranjo probability scale was used to analyze the causation of the adverse drug reactions (ADRs), and a score of 6 was obtained, indicating oxaliplatin as a probable cause of the hypersensitivity reactions. In both cases, treatment was promptly halted upon manifestation of symptoms, and patients were administered intravenous steroids along with anti-histamines. This intervention resulted in significant improvement in the patients' conditions. Both genders are equally susceptible to such reactions, emphasizing the need for gender-neutral awareness and precautionary measures among medical practitioners. This case report serves as a reminder of the potential adverse effects associated with oxaliplatin therapy in colorectal cancer patients. Heightened awareness among healthcare professionals regarding the risk of hypersensitivity reactions is imperative to ensure timely detection and appropriate management, thereby optimizing patient outcomes. Consequently, while giving oxaliplatin to cancer patients, healthcare professionals need to use extreme caution.

Swarm intelligent computing procedures to solve the novel precautionary measures in the nonlinear HIV system

Swarm intelligent computing procedures to solve the novel precautionary measures in the nonlinear HIV system

Maternal and Fetal Outcome of COVID-19 Infection among Pregnant Women.

Background and Objectives: Pregnant women face an increased risk of experiencing negative consequences due to COVID-19 infection. Our study aimed to identify outcomes for both mothers and fetuses associated with COVID-19 during each trimester, as well as to identify post-COVID symptoms in this population. Materials and Methods: Among the total population, 14 females were infected during the first trimester, 25 during the second, and 66 during the third trimester. Weekly follow-ups were conducted until delivery. Seventy-five females (71.4%; 95% CI:26.9-115.9%) were admitted to the hospital secondary to COVID-19 infection. Maternal hospitalization was independently associated with COVID-19 severity (adjusted odds ratio (aOR) = 3.9; 95% CI: 1.6-9.2 at p = 0.002 relative to the reference group (mild infection)) and the presence of dyspnea at initial assessment (aOR = 6.9; 95% CI: 1.7-28.2 at p = 0.007 relative to nondyspneic patients). Results: The duration of hospitalization (mean ± SD) was higher in the third trimester than the first and second trimesters (10.1 ± 0.8 vs. 4.0 ± 1.2 days and 10.1 ± 0.8 vs. 6.2 ± 1.4 days, respectively, at p < 0.05). The number of maternal deaths in the third trimester was higher than in the first and second trimesters (16 (24.2%) vs. no deaths and 16 (24.2%) vs. 1 (4%) deaths, respectively, at p < 0.05). In terms of fetal outcomes, a good fetal condition was more likely if the mother was infected during the first trimester (92.9%) than the second (80%) or third trimesters (66.7%), but the difference was not significant. The percentage of preterm deliveries was insignificantly higher in the second trimester (16%) than the first (7.1%) and third (4.5%) trimesters. Conclusions: The most common post-COVID symptoms included persistent loss of smell, dry eyes, post-partum depression, knee pain, and myalgia. Post-COVID symptoms were more prevalent in patients infected during the third trimester. The adverse outcomes of COVID-19 infection for both mother and fetus were more severe in cases where the infection occurred during the third trimester compared to the second and first trimesters. Therefore, it is crucial to adhere to precautionary measures against COVID-19, prioritize vaccination, and provide comprehensive care for pregnant mothers.

A geo-gender-based analysis of human health: The presence of cut flower farms can attenuate pesticide exposure in African communities, with women being the most vulnerable.

The rapid expansion of the cut flower industry in Africa has led to pervasive use and potential exposure of pesticides, raising concerns for local communities. Whether the risks associated with pesticide applications are localised or have broader implications remains unclear. We measured biomarkers of real and perceived pesticide exposure in two Kenyan communities: Naivasha, where the cut flower industry is present, and Mogotio, where the cut flower industry is absent. We measured real exposure by the percentage of acetylcholinesterase (AChE) inhibition and perceived exposure by assessing hair cortisol levels, a biomarker of stress. Additionally, we conducted a demographic survey to evaluate the health and socioeconomic status of participants, as well as their perceptions of pesticide risks associated with the cut flower industry. Perceived pesticide exposure was more common in Naivasha (n = 36, 56%) compared to Mogotio (n = 0, 0%), according to community surveys. However, Mogotio residents had significantly higher mean hair cortisol levels (mean (x̄) = 790 ng/g, standard deviation (SD) = 233) and percentage of AChE inhibition (x̄ = 28.5%, SD = 7.3) compared to Naivasha residents, who had lower mean hair cortisol levels (x̄ = 548 ng/g, SD = 187) and percentage of AChE inhibition (x̄ = 14.5%, SD = 10.1). Location (proximity to cut flower farms) and gender were significant factors influencing pesticide exposure, with individuals living outside the cut flower industrial complexes being at higher risk. Women in both communities were the most vulnerable demographic, showing significantly higher mean hair cortisol levels (x̄ = 646 ng/g, SD = 267.4) and percentage of AChE inhibition (x̄ = 22.5%, SD = 12.4) compared to men hair cortisol levels (x̄ = 558.2 ng/g, SD = 208.2) and percentage of AChE inhibition (x̄ = 10.4%, SD = 13.1). A heightened awareness of the potential risks of pesticide exposure was widespread within cut flower industrial complexes. This may have led to a reduction in exposure of both workers and non-workers living within or close to these complexes. In contrast, communities living outside these complexes showed higher levels of exposure, possibly due to limited chemical awareness and a lack of precautionary measures. Despite this contrast between communities, women remained the most vulnerable members, likely due to their socioeconomic roles in African society. Monitoring women's pesticide exposure is crucial for providing an early warning system for community exposure.

Incidence and effect of an extra root on the crown morphometry of the maxillary second molars among Malaysian Mongoloids.

This study aimed to investigate whether the presence of two palatal roots on permanent maxillary second molars (MSMs) can affect the crown size and crown's buccolingual and mesiodistal diameters. A retrospective study was conducted using 592 CBCT scans to investigate 1120 MSMs of Mongoloid Malaysians. 3D models were created to assess the four-rooted MSMs and other related teeth carefully. Crown size and crown's buccolingual and mesiodistal diameters were measured for the four-rooted MSM, the adjacent maxillary first molar (MFM), and their antimeres to investigate the effect of the presence of an extra root on the size and morphological features of the crown of these associated teeth. Only six out of the 1120 MSMs displayed four roots (0.53%). The incidence was 0.67% (2/298) for the Malay males and 0.4% (1/247) for the Malay females, with the Malay male having a bilateral occurrence of four-rooted MSM. The incidence was 0.34% (1/294) for the Chinese males, while 0.71% (2/281) was detected in Chinese females. Interestingly, the four-rooted MSMs showed a wider mesiodistal distance than their three-rooted antimeres in three out of four cases. The presence of two palatal roots may also increase the crown's buccolingual diameter. The presence of anatomical variations and the dramatic change in crown measurements can be good indicators of the presence of extra roots, including in some of their related neighbours. This might help dentists to take precautionary measures when performing tooth extractions and endodontic therapy.

Unnoticed freshwater leech as a hidden cause for recurring epistaxis: a case series and review of literature conducted at Tertiary Care Hospital Sikkim, North East India

BackgroundWhile leeches as intranasal foreign bodies are not frequently encountered, they can be one of the causes of epistaxis. The aim of the study is to raise awareness among healthcare professionals about the possibility of patients from leech endemic regions presenting with epistaxis.Case presentationWe present a series of epistaxis cases due to intranasal leech infestation. In our series of 10 cases, there were 7 male and 3 female patients, aged between 2 and 53 years old. The duration of the complaint ranged from 1 to 5 weeks. All patients experienced with blood-stain nasal discharge or frank nasal bleeding at some point and most of them have a history of leech infestation from spring water as a local source. This article presents our approach to managing nasal leech infestation as epistaxis and outlines the precautionary measures taken for the retrieval of this living foreign body.ConclusionDetails of the history must be taken before concluding the diagnosis. Maintain a high index of suspicion of leech infestation as a hidden cause of epistaxis especially in patients coming from endemic areas.

Anaesthesiologists’ knowledge of occupational risks and precautionary measures: a cross-sectional study

Anaesthesiologists’ knowledge of occupational risks and precautionary measures: a cross-sectional study