Significant Statistical Correlation Research Articles

Hormones, Age, and Erectile Dysfunction: Should Routine Testing Be Part of the Initial Evaluation?

Background/Objectives: The aim of this study was to investigate the relationship between age, the severity of erectile dysfunction (ED), and the various hormones that may influence erectile function. Methods: A multicenter cross-sectional study was conducted between January 2015 and December 2023. The study assessed age, sexual function using the IIEF-15 questionnaire, and the levels of total testosterone (TT), free testosterone (FT), FSH, LH, estradiol, prolactin (PRL), and SHBG. Results: A total of 411 patients were included in the study. The mean age of the patients was 63.19 years. The vast majority (91.73%) exhibited some degree of ED. The severity of ED increases with age, ranging from 56.26 years for patients without ED to 73.12 years for those with severe ED. A statistically significant negative correlation was observed between IIEF and age, while a positive correlation was observed between IIEF and serum levels of TT and FT (p < 0.05). Age was significantly correlated with all evaluated hormones (p < 0.01), except estradiol and prolactin. Total testosterone levels progressively decreased with the increase in the severity of erectile dysfunction, from a median of 7.05 ng/mL in patients with normal erectile function to 3.56 ng/mL in those with severe symptoms, remaining above the normal minimum threshold across all groups, whereas free testosterone (FT) levels also declined progressively. All erectile dysfunction groups had median FT levels below the normal minimum threshold. FSH, LH, and SHBG showed an increase with each progressive severity of erectile dysfunction. The multivariate linear regression revealed that IIEF scores are significantly associated with age, TT, and FT levels, while FSH did not present a statistically significant association in this model. Conclusions: Age shows a significant statistical correlation with both the severity of erectile dysfunction and the levels of total testosterone, free testosterone, LH, FSH, and SHBG. Total and free testosterone levels are significantly associated with the severity of erectile dysfunction, with free testosterone median values remaining above the normal minimum threshold in all patients with erectile dysfunction. Therefore, free testosterone should be considered a routine test, alongside total testosterone. In contrast, LH, estradiol, SHBG, and prolactin do not demonstrate any statistical correlation with erectile dysfunction and should not be recommended as routine investigations.

Segmental analysis of human hair reveals intra-annual variation in 25(OH)D3 concentrations in modern and archaeological individuals

Vitamin D is essential for healthy skeletal growth and is increasingly recognised for its role in chronic disease development, inflammation and immunity. 25-hydroxyvitamin D3 (25(OH)D3) concentrations are an indicator of vitamin D status and are normally analysed in plasma or serum samples in clinical settings, while archaeological studies rely on the identification of skeletal markers of vitamin D deficiency, such as rickets. Here, we determined 25(OH)D3 concentrations in hair specimens (‘locks’) that had been sampled close to the root, aligned by cut end, and sliced into sequential segments from participants (n = 16), from Aberdeen, Scotland, using a modified protocol designed to minimise sample size. Concentrations were above detectable levels in 14 of 16 individuals, generating a (~ monthly) time-series of 25(OH)D3 concentrations, with fluctuating intra-hair trends consistent with the bioaccumulation of 25(OH)D3. In three participants, fluctuations in intra-hair 25(OH)D3 appear linked to recent significant weight loss, potentially due to the release of stored 25(OH)D3 from adipose tissue and subsequent uptake in hair. For the remaining participants, no statistically-significant correlations were determined between mean hair 25(OH)D3 levels and self-reported data, including age, sex, BMI, vitamin D supplementation, frequency of oily fish consumption, and hours spent outside. For a subset of our cohort (n = 4) isotope analysis highlighted potential relationships between elevated δ18O values (which can indicate season of hair growth) and 25(OH)D3 concentrations in some individuals, which may reflect seasonally-increased UVB exposure. We also present data from an archaeological individual from the same city, with the addition of further isotope analysis (carbon, nitrogen, sulphur) to characterise diet. Results suggest possible positive correspondence of 25(OH)D3 levels with season in this archaeological individual, and possibly with marine protein consumption, highlighting the potential use of this approach in characterising the relationship between past vitamin D levels and diet. While results are promising, we recognise the limits of this study in terms of sample size and use of self-reported data, and further work is needed to better understand the relationship between serum and hair 25(OH)D3 before this approach can further be developed as either a non-invasive medical test or an archaeo-investigative technique.

Association of Non-Cardiac Comorbidities with the Outcomes of Admitting Acute heart failure Patients Tripoli, Libya

The patients with Acute heart failure (AHF) usually present with multiple interrelated comorbidities. These comorbidities play a major role in determining the prognosis and outcome of AHF patients, as well as affecting the management. Our study aimed to describe the Effect of the presence of non-cardiac comorbidities on the outcomes of the admitting patients with AHF in Tripoli University Hospital. From Jan- Oct 2022 we carried out this descriptive cross-sectional study in the cardiac department and cardiac care unit in Tripoli University Hospital. A self-constructed questionnaire was designed to collect the data from medical records, and then the data was analyzed by using SPSS version 20. 140 were enrolled in this study. The patients were 102 (72.9%) males and 38 (27.1%) females, their mean age was 60.08 yrs. ± SD 12.9. 128 patients (91.4%) were presented in the decompensated stage of their previous heart failure status and 5 (3,6%) presented as cardiogenic shock. Non-compliance to treatment was the leading aggrevating cause for decompensation with a percentage of 31.4% followed by infection at 29.2 %, and atrial fibrillation in 12.1% of the cases. Almost all enrolled patients had multiple comorbidities only 8 (5.7%) had no comorbiditiesThose comorbidities include D.M in 84 patients (60%), anemia in17 patients (12.1%), chronic kidney disease (CKD) in 43 patients (30.7%) and chronic obstructive pulmonary disease (COPD) 4 (2.9%). Regarding treatment, only 10.7% of our patients were on the guidelines-directed medical therapy of heart failure (GDMT) in their discharge to home, According to the patient outcomes in this study 14 (10%) of patients needed advanced management, 12 (8.6%) died. The rest of the 114 (81.4%) responded to standard medical management mainly diuretics and GDMT. This study showed a significant statistical correlation between CKD and the worse outcomes with a (p-value = 0.055).and between cardiogenic shock and in-hospital mortality with a (p-value = 0.057). Our patients were relatively young, mostly male, with a high prevalence of D.M, , more acute on chronic heart failure than denevo cases, and lower use of GDMT use, The presence of comorbidities, especially CKD as well as the presence of cardiogenic shock, are associated with increases the risk of in-hospital mortality.

Characterization of Renal OAT3 and Hepatic CYP3A Activities in Pregnant Women with Acute Pyelonephritis Using the Endogenous Biomarker Cortisol and 6β-Hydroxycortisol.

This study evaluates the impact of acute pyelonephritis in pregnant women on the in vivo activity of renal OAT3 using the endogenous biomarker (EB) 6β-hydroxycortisol (6β-OHF) renal clearance (CLrenal 6β-OHF) and AUC6β-OHF validated by correlating with the secretion clearance (CLsec) of the probe drug furosemide. Additionally, 6β-OHF formation clearance (CLformation 6β-OHF) as well as urinary (Ae6β-OHF/AeF) and plasma (AUC6βOHF/AUCF) ratios were also evaluated as EB for hepatic CYP3A activity. Pregnant women in their third trimester of gestation, diagnosed with acute pyelonephritis, were recruited before (pre-treatment, n = 8) and after (post-treatment, n = 8) cefuroxime treatment and resolution of acute pyelonephritis. All participants received a single dose of furosemide 40 mg for evaluation of OAT3 in vivo activity on both occasions followed by collection of urine and serial blood samples for 24 h. The CLrenal 6β-OHF (geometric mean and 95% CI) increased from 1.81 L/h (0.86-3.83) to 11.82 L/h (6.58-21.24), whereas the AUC6β-OHF decreased from 44.85 ng h/mL (30.96-64.98) to 24.20 ng h/mL (16.05-36.48) pre- and post-treatment. Significant statistical correlations were observed between furosemide CLsec and CLrenal 6β-OHF (R = 0.88, P =.01) and AUC6β-OHF (R = -0.66, P >.001). Additionally, the CLformation 6β-OHF was lower in pre-treatment 26.81 L/h (10.18-70.59) than in post-treatment 96.18 L/h (64.21-144.09), whereas AUC6βOHF/AUCF ratios were decreased from 0.014 (0.010-0.019) pre-treatment to 0.009 (0.006-0.013) post-treatment. Regarding Ae6β-OHF/AeF ratios, no differences were observed between pre-treatment and post-treatment. In conclusion, CLrenal 6β-OHF evaluates renal OAT3 activity when CYP3A is inhibited, whereas CLformation 6β-OHF evaluates hepatic CYP3A when OAT3 is inhibited, such as in pregnant women with acute pyelonephritis.

Diagnostic Accuracy Of Computed Tomography For Diagnosis Of Bladder Carcinoma Taking Histopathlogy As Gold Standard

Objectives: Its objective was to assess the performance of CT in diagnosing bladder carcinoma and comparing it with the gold standard – histopathology and to assess the interobserver variability of CT for early detection and staging of the disease. Study design: A cross sectional study. Place and Duration of Study: From January 2023 to June 2023 Diagnostic Radiology Department Bolan Medical Complex Hospital Quetta/ Sandeman Provincial Hospital, Quetta. Methods: The participants for this cross-sectional analysis consisted of 150 patients with clinically suspected bladder carcinoma who had undergone CT scan and transurethral resection of the bladder biopsy. Diagnostic accuracy, sensitivity, specificity and positive and negative predictive values were computed. Descriptive analysis was conducted and p < 0.05 indicated statistical significance, results presented by SD. Results: In 150 patients, CT succeeded in diagnosing bladder carcinoma in 120 cases. 120 histopathological examination showed positive cases according to WHO criteria. The sensitivity of CT was 92.3% and specificity 85%. The coefficient of variation between CT and histopathology in the identification of tumor size was ±0.5 cm. As for diagnostic accuracy, the resulting p-value of 0.03 permits to conclude about the statistical significance of correlations between CT and histopathological findings. Conclusions: Compared to enhanced CT, CT scanning shows great diagnostic efficacy and can be envisaged as a valuable noninvasive diagnostic method for bladder carcinoma, although histopathological examination is indispensable for the definitive diagnosis of the disease. Contrast-enhanced computed tomography (CECT) is especially advantageous in what concerns conducing initial screening, and assessment of the tumor’s stage before operation. Keywords: Bladder carcinoma, CT imaging, histopathology diagnosis and accuracy

Quality of Life in Pediatric Oncology Patients in Lebanon (2014-2019): A Multi-center Study.

Aim Cancer is one of the leading causes of death in pediatrics worldwide. The present study aimed to assess the quality of life (QOL) of pediatric oncology patients diagnosed within the last five years at Lebanese hospitals, and who are residing in Lebanon. Methods Pediatric oncology patients were asked to fill out a questionnaire collecting data on personal information, disease status, and QOL using the EORTC-QLQ-C30 (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire-Core 30-item version) after receiving their guardian's consent. IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, NY, USA)was used for statistical analysis. Results The study enrolled 146 patients; 82 (56.2%) were boys. The mean age was 11.39 ± 3.90 years. Significant statistical correlations were found between the mother's educational level and physical functioning (p-value = 0.006), the number of siblings and each cognitive functioning (p-value = 0.025), and financial difficulties (p-value < 0.0001). The father's salary was statistically correlated with the patient's emotional and social functioning and financial difficulties (p-value < 0.05). The type of treatment had a significant effect on cognitive functioning and financial difficulties (p-value < 0.05), with chemotherapy patients having lower scores for financial burden than combination therapy patients. A total of 77.4% (113 patients) had leukemia, 16 (11%) had lymphoma, and 17 (11.6%) had solid tumors. Solid tumor patients had higher cognitive functioning scores than leukemia patients (difference = 12.65 ± 4.74, p-value = 0.023). Conclusion Palliative care is needed to relieve the symptom burden and enhance the psycho-social functioning of pediatric oncology patients.

COVID-19 and renal allograft rejection: insight from controlled and non-controlled studies

Aim Kidney transplant recipients (KTRs), due to their immunosuppressed status, are potentially more susceptible to both the severe effects of COVID-19 and complications in their transplanted organ. The aim of this study is to investigate whether COVID-19 infection increases the risk of rejection in kidney transplant recipients (KTRs). Methods This study involved a detailed literature review, conducted using PubMed, with the search being completed by September 7th, 2023. The search strategy incorporated a combination of relevant keywords: ‘COVID’, ‘Renal’, ‘Kidney’, ‘Transplant’, and ‘Rejection’. The results from controlled and uncontrolled studies were separately collated and analyzed. Results A total of 11 studies were identified, encompassing 1,179 patients. Among these, two controlled studies reported the incidence of rejection in KTRs infected with COVID-19. Pooling data from these studies revealed no significant statistical correlation between COVID-19 infection and biopsy-proven rejection (p = 0.26). In addition, nine non-controlled studies were found, with rejection incidences ranging from 0% to 66.7%. The majority of these studies (eight out of nine) had small sample sizes, ranging from 3 to 75 KTRs, while the largest included 372 KTRs. The combined rejection rate across these studies was calculated to be 11.8%. Conclusion In conclusion, the limited number of published controlled studies revealed no statistically significant association between COVID-19 infection and biopsy-proven rejection among KTRs. However, the broader analysis of non-controlled studies showed a variable rejection incidence with a pooled rejection rate of 11.8%. There is insufficient high-quality data to explore the association of COVID-19 infection and rejection.

Relationship between cumulative blood pressure exposure within the early brain injury time window and delayed cerebral ischemia and rebleeding in patients with aneurysmal subarachnoid hemorrhage after aneurysm clipping: a retrospective study.

Delayed cerebral ischemia, one of the most common complications following aneurysmal subarachnoid hemorrhage, was strongly related to poor patient outcomes. However, there are currently no clear guidelines to provide clinical guidance for post-craniotomy management. Our research aims to explore the association between cumulative blood pressure exposure during the early brain injury phase and the occurrence of delayed cerebral infarction and rebleeding following surgical aneurysm clipping. All baseline characteristics of the patients were meticulously recorded. We collected blood pressure data 25 times in 48h after surgery for subsequent analysis. Cumulative blood pressure exposure is calculated by the product of the time spent below a specific blood pressure threshold and the cumulative exposure time. The principal outcome is the incidence of Delayed Cerebral Infarction, while the secondary outcome pertains to postoperative rebleeding. Logistic regression was utilized to examine the relationship. The cumulative exposure to mean arterial pressure at and below 85 mmHg demonstrated a significant association with DCI occurrence. However, no significant statistical correlation was found between hypertensive exposure and rebleeding events. The results from the sensitivity analysis remained consistent, and the lack of significant interactions further supports the robustness of the study findings. The identified threshold of 85 mmHg could potentially represent a critical blood pressure management parameter for post-surgical aneurysm clipping patients. These findings merit further investigation through larger prospective clinical trials.

Expression and correlation of Surfeit 4 gene in esophageal squamous cell carcinoma

BackgroudIn the previous era of functional genomics, it was widely believed that the expression levels of housekeeping genes (HKGs) remained relatively constant and were unaffected by variations in tissue type, cell development stage, cell cycle state, as well as internal and external cellular environments. With the improvement of gene microarray technology and quantitative polymerase chain reaction (qPCR) technology for expression analysis of high-throughput differential genes, changes in the expression levels of HKGs have been found in certain human cancers. The present study aimed to experimentally validate the expression of Surfeit 4 gene (SURF4), a member of HKGs, in esophageal squamous cell carcinoma (ESCC).MethodsThe experimental techniques employed in this study encompassed real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), Western blot (WB), and immunohistochemistry (IHC) to assess the mRNA and protein expression of SURF4 in ESCC, and their clinicopathological significance was statistically analyzed.ResultsAll three tests showed significant differences between the three groups (Kruskal–Wallis test, P < 0.05). The results of the three methods indicated a significantly higher expression of SURF4 in the tumor group compared to both the adjacent paracancerous tissue group and the normal esophageal mucosal tissue group distant from the tumor. There was no significant difference between the latter two groups. Chi-square and Rank-sum test revealed the expression of SURF4 was significant statistical correlation with tumor cell differentiation, tumor progression and Ki-67 index, as well as the survival prognosis of patients (P < 0.05).ConclusionsThe expression of SURF4 was up-regulated in ESCC and was associated with differentiation, proliferation, progression, and clinical prognosis of ESCC. This portended epigenetically that SURF4 may play a role in tumor progression in ESCC and could potentially serve as a novel therapeutic target.

Multi-parametric high resolution ultrasound assessment of tibial nerve in diabetic peripheral neuropathy

BackgroundDiabetic peripheral neuropathy (DPN) is a common and serious complication of diabetes occurring in about 50% of patients. It serves as a strong risk factor for disabling pain, foot ulcers and amputation that have a negative effect on the life quality and bring a heavy economic burden. Therefore, it is important to early diagnose DPN for taking influential targeted measures and preventing foot ulcers and amputations. The aim of this study was to assess the role of different high resolution ultrasound (HRUS) parameters in diagnosing DPN.ResultsThis study included 60 participants classified into three groups [20 diabetic cases with DPN, 20 diabetic cases without peripheral neuropathy (PN) and 20 age-/sex-matched healthy control]. All cases underwent full clinical and laboratory investigations. HRUS examination including shear wave elastography (SWE) of the tibial nerve was also performed. Our study revealed statistically significant difference as regard maximum thickness nerve fascicles (MTNF) between DPN and control groups (P = 0.005) with a cutoff value of 0.45 mm yielding 85% sensitivity and 75% specificity. As regard nerve cross-sectional area (CSA), there was significant statistical difference between each of the three studied groups. A cutoff value of 17.5 mm2 was excellent in differentiating DPN group from control group with 80% sensitivity and 95% specificity. The highest mean nerve stiffness was noted among DPN group compared to diabetics without PN and control groups with significant statistical difference between each of the studied groups. The mean nerve stiffness was excellent in differentiating DPN group from control group with 100% sensitivity and 100% specificity. There was significant statistical positive correlation between neuropathy disability score and diabetes duration, HbA1c levels, MTNF, nerve CSA and stiffness.ConclusionsMulti-parametric HRUS using MTNF, CSA and SWE is a promising quantitative technique that has an excellent additive value to the usual qualitative nerve examination. High image quality, real-time examination, non-invasiveness, low cost, wide availability and multi-parametric assessment make HRUS superior to nerve conduction test. It can serve as an accurate novel technique for screening and early diagnosis of DPN even with normal clinical and nerve conduction studies.

Depression, hopelessness, and coping strategies in partially penectomized patients for Penile Cancer

Penile cancer is a rare neoplasm in developed countries; however, it is more common in the male population of developing countries and has serious psychosocial repercussions. In Brazil, penile cancer represents 3% of all types of cancer in males. The objective of this article is to investigate the occurrence of emotional states of depression and hopelessness and identify the main coping strategies in men undergoing penectomy. The study design is descriptive and correlational. For data collection, field research was carried out and the results obtained were analyzed within a quantitative approach. The instruments used were: sociodemographic questionnaires, Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and Coping Strategies Inventory (CSI). The final sample consisted of twenty-one men, all partially penectomized for penile cancer. The study found that most emotional states of depression and hopelessness experienced by individuals were at minimal levels (BDI 48% and BHS 43%). The coping strategies that presented the highest means were positive reappraisal (M = 2.18 and SD = 0.30), distancing (M = 2.17 and SD = 0.37) and social support (M = 2.09 and SD = 0.46). No significant statistical correlations were found between the types of coping strategies and symptoms of depression and hopelessness (grouped by intensity), access to psychological assistance and the time elapsed since surgery. The findings confirm the complexity of the subjects' coping process, intensely focused on emotional regulation, and suggest the manifestation of important protective factors of mental health in the context of penectomy.

A 2-Year Longitudinal Neuropsychological Study in Relapsing-Remitting Multiple Sclerosis: A Selective Decline in Social Cognition?

Background/Objectives. Social cognition (SC), which implies the emotional and intellectual understanding of oneself and others, is an important facet of neuropsychological functioning concurrently to academic cognition (AC), which concerns non-social abilities (memory, language…). In relapsing-remitting multiple sclerosis (RRMS), it is not clear whether a cognitive decline occurs in both SC and AC nor whether a link exists between these two cognitive domains. The objective of the present longitudinal study was to conduct an extensive examination of both AC and SC in RRMS to document a 2-year evolution and to look for potential correlations between AC and SC. Methods. The neuropsychological results (AC and SC) of 48 RRMS patients obtained in clinical practice were retrospectively considered; 38 of the patients (30 females) were assessed again about 2 years later. Non-parametric tests were applied to test the intra-group cognitive evolution (Wilcoxon) and the link between AC and SC evolution (Spearman). Results. Whereas AC showed a stability or an improvement of performances during the retest, SC presented the reverse pattern, with a stability or a significant decline in facial emotion (recognition and discrimination) and humor perception. No significant statistical correlation was found between the significant modification of AC and SC during follow-up. Conclusions. The short-term deleterious evolution observed selectively for SC in the present study suggests that SC should be selected as a cognitive marker for RRMS follow-up, and that extensive examination may be preferred to investigate specific SC changes.

Are there links between nutrient inputs and the response of microbial carbon use efficiency or soil organic carbon? A meta-analysis

Microbial carbon (C) use efficiency (CUE) is a comprehensive parameter to measure the accumulation and loss of soil C caused by microbial growth and respiration, which is considered to determine the fate of soil organic C (SOC). Microbial CUE is sensitive to the changes in soil nutrients, such as nitrogen (N) and phosphorus, making it crucial to assess the response of microbial CUE to nutrient inputs caused by climate change and human activities, as well as its contribution to SOC accumulation. Here, we curated a dataset from 58 studies (389 paired observations) to examine the effects of nutrient inputs on global soil microbial CUE and the relationship between microbial CUE and SOC. The meta-analysis showed that nutrient inputs increased soil microbial CUE by 11.5%. The response of microbial CUE to nutrient inputs varied among different treatments (i.e., nutrient form, application rates in N, and experiment duration), ecosystems, and climatic factors. The variable response of microbial CUE to nutrient inputs was mainly affected by the changes of soil N availability and C-, N-related hydrolase activity, showing significant positive and negative relationships, respectively. There was no significant statistic correlation between microbial CUE and SOC under the condition of nutrient inputs. While a significant positive correlation was observed between microbial CUE and SOC under both inorganic and short-term nutrient inputs. The present study sheds light on a comprehensive understanding of microbial CUE in the global range of nutrient inputs, and highlights the need for more studies paying more attention to the role of microbial CUE in SOC sequestration.

The NACA score predicts mortality in polytrauma patients before hospital admission: a registry-based study

BackgroundThe early assessment of the severity of polytrauma patients is key for their optimal management. The aim of this study was to investigate the discriminative performance of the NACA score in a large dataset by stratifying the severity of polytraumatized patients in correlation to injury severity score (ISS), Glasgow Coma Scale (GCS), and mortality.MethodsThis study on the Swiss Trauma Registry investigated 2239 polytraumatized patient (54.3 ± 22.8 years) enrolled from 2015 to 2023: 0.5% were NACA 3, 76.7% NACA 4, 21.4% NACA 5, and 1.4% NACA 6. The NACA predictive value of patients’ mortality was investigated, as well as the correlation of ISS and GCS scores, and other factors influencing patients’ survival at discharge and after 28 days.ResultsIn NACA 4 and 5 the survival rate during hospitalization was 97.7% and 82.5%, respectively, and 28-day mortality 3.5% and 23.5%, respectively (p < 0.0005). NACA correlated with GCS in the prehospital phase and in the emergency room (p < 0.0005), as well as with ISS (p < 0.0005). NACA 4 and 5 presented different injury patterns (fall < 3 m vs vehicle accident) with NACA 5 requiring more CPR and intubation (p < 0.001, p < 0.0005). The ROC AUC analysis showed the prehospital NACA and GCS values as the strongest variables predicting patients’ survival.ConclusionsThis study provides valuable evidence supporting the effectiveness of the NACA score in assessing the severity of polytrauma patients in both the pre-ER and ER condition. Considering the statistical significant correlation with the GCS and with the ISS, NACA is a valid score for assessing polytrauma patients.

Titanium dioxide (TiO2) in herbal and health products registered by Saudi Food and Drug Authority (SFDA): A descriptive study

BackgroundTitanium dioxide (TiO2) is a brightening compound used as an additive in food and pharmaceuticals. TiO2 safety has been debated since evidence of carcinogenicity and genotoxicity emerged. While TiO2 is provisionally used as food additive by North America, it is banned by European Union (EU) countries and Saudi Arabia. There are no international regulations regarding TiO2 as an additive in medicinal, herbal or health products. In this study, the primary objective is to identify the percentage of herbal and health products containing TiO2 among all Saudi Food and Drugs Authority (SFDA) newly registered products during the period from 2018 to 2022. A secondary objective is to describe products containing TiO2 according to product type, pharmaceutical form, registration year and manufacturing country. MethodsThis study is a retrospective secondary data analysis using data derived from SFDA electronic products registration records (EURS) and drug management system (DMS). Descriptive analysis is conducted to describe the percentage of herbal and health products containing TiO2 among all SFDA- newly registered products during the period from 1st, Jan 2018 to 31st, Dec 2022. ResultsOne third [N:115, (31%)] of herbal and health products contain TiO2. Most TiO2-containing products were found in capsule pharmaceutical form [97 out of 115 (84%)], with significant statistical correlation (P=0.02). TiO2-containing products registration has peaked in 2020, then declined afterwards. Most products are provided by USA manufacturing companies, Spain and local companies, collectively. ConclusionTitanium dioxide is used as an additive in food and pharmaceutical products including health and herbal products. It has been banned in food products by countries and provisionally used by other countries. Concerning pharmaceutical products, regulatory authorities and policy makers are in need of insights for any potential TiO2 restriction in these products. One third of newly registered herbal and health products contain TiO2, of which market availability may be affected in case of restrictive regulatory actions. USA and local manufacturing companies are leading contributors to TiO2-containing herbal and health products registered by SFDA. Exploring alternatives for TiO2 and TiO2-free products is needed.

Elevated Interleukin-6 Levels as a Potential Marker of Neonatal Morbidity in Full-term Infants With Polycythemia: A Prospective Study.

To research and show that interleukin-6 (IL-6) and c-reactive protein (CRP), which can be used as infection markers, are also higher among newborns with polycythemia. The study took place in the neonatal intensive care unit of Zekai Tahir Burak Maternity Teaching and Research Hospital. Infants with a gestational age of >37 weeks were included in the study. Infants with chorioamnionitis, perinatal asphyxia, and positive blood culture were excluded from the study. Blood samples were obtained six hours after the delivery from the peripheral vein of the infants for measurements of central hematocrit, blood culture, IL-6, and CRP. Infants with a venous hematocrit value of >65% were grouped as the "polycythemia group," and the ones with a venous hematocrit value of <65% were designated as the "control group." Observation of significantly higher levels of CRP and IL-6 among newborns admitted to the neonatal intensive care unit due to different causes (such as respiratory distress, hypoglycemia, and feeding intolerance), but significantly higher IL-6 levels in newborns with polycythemia. Thirty-five newborns (18 infants in the polycythemia group and 17 infants in the control group) were enrolled in the study. The IL-6 values for the polycythemia group were higher than the upper normal limits (mean ± 2SD, 37.6 ± 55 vs 12 ± 5pg/dL, respectively; P = 0.00). The IL-6 values of the polycythemia group were found to be higher than the IL-6 values of the control group, with a mean ± 2SD of 37.6 ± 55 vs 6.3 ± 3.4pg/dL, respectively; this was significant (P = 0.00). Although the CRP values of the polycythemia group were found to be slightly higher than those of the control group (a mean ± 2SD of 3.06 ± 4.07 vs 1.54 ± 2.21mg/dL, respectively, P > 0.05), this was not significant. This study found a significant and robust statistical correlation between IL-6 and v. Hct values (P = 0.01, rs = 0.641). Contrary to IL-6 levels, however, a meaningful relationship was not found between CRP and v.htc values (P = 0.286; rs = 0.184).

The Impact of Triglyceride-Glucose (TyG) Index on Future Cardio and Cerebrovascular Events in Patients with Acute Coronary Syndrome, During 3 Years of Follow-Up.

Background: The triglyceride-glucose (TyG) index is a new alternative insulin resistance (IR) biomarker. The purpose of this study was to assess whether the TyG index can have a prognostic value in patients with acute coronary syndrome (ACS). Moreover, we wanted to compare the TyG index with HOMA index. Methods: We retrospectively enrolled 115 consecutive subjects, 81 males and 34 females, referred for ACS to our Unit of Cardiovascular Care of Policlinico Paolo Giaccone, Palermo. The subjects were divided into tertiles according to TyG index values and we performed a 3-year follow-up study. We considered as an end point new cardiovascular and cerebral events (MACCEs) during follow-up. Results: We found a significant statistical correlation between the HOMA index and the TyG index (p = 0.001). Patients with elevated TyG index have a higher incidence of MACCE at a 3-year follow-up. In our study the TyG index was an independent predictor of MACCEs (95% CI 1.8158 to 16.8068; P 0.0026) and the optimal TyG index cut-off for predicting MACCEs was 4.92 (sensitivity 76.56% and specificity 72.55%). Conclusions: The TyG index seems to significantly have an important prognostic role in patients with ACS and high values of TyG index are superior to HOMA-IR in predicting MACCEs.

Influence of Schneiderian membrane perforation during maxillary sinus floor augmentation with lateral approach on dental implant survival rates: a retrospective study in a university setting.

The primary objective of this study was to compare implant survival rates (ISR) in patients undergoing maxillary sinus floor augmentation (MSFA) with lateral approach with and without membrane perforation. Secondary objectives were to establish the percentage of perforations in these procedures and to evaluate the influence of perforation size on ISR. This retrospective study included patients requiring MSFA with lateral approach. Cases were assigned to two groups according to the occurrence or not of perforation. The exact size of each perforation was registered. Descriptive statistics and associations between the groups were calculated. This study analyzed data from 90 MSFA in 72 patients. Membrane perforation occurred in 24.44%. A total of 170 implants were placed; 72.35% were placed under intact membranes and 27.65% on repaired membranes. The overall ISR in MSFA procedures with intact membranes was 98.37%, and 93.62% in perforated membranes. No statistically significant relationship between groups was observed although the odds of implant failure increased by 4.125 times when perforation occurred. In turn, no statistically significant relationship was observed between perforation size and ISR. Implants inserted below repaired membranes had a lower ISR compared with implants inserted below intact membranes although the difference was not statistically significant. Moreover, no significant statistical correlation was observed between perforation size and ISR. Membrane perforation does not have a significant influence on subsequent implant survival rates. Knowledge of the exact size of the membrane perforation is essential for deciding on the right treatment plan.

The Prognostic Significance of Tumor Budding and Cell Nest Size in Laryngeal Squamous Cell Carcinoma.

Laryngeal squamous cell carcinoma (LSCC) is a commonly occurring malignancy in the head and neck region. However, due to the heterogeneity of primary tumor sites, tumor behavior, and molecular mechanisms, there is currently no consensus on the accuracy of clinicopathological prognostic factors for individual cases. Tumor histopathologic behavior remains a crucial factor in predicting aggressiveness. Recent studies have shown that peritumoral tumor budding (TB) combined with cell nest size (CNS) is a reliable marker for predicting lymph node metastasis, advanced cancer prognosis, and therapeutic response in SCCs of different origins. This study aims to investigate the relationship between TB and CNS in the context of nodal metastasis and overall prognosis in patients diagnosed with LSCC. Our objective is to establish the significance of TB and CNS status as a cost-effective, easily assessed, and highly reliable prognostic factor among this patient population. In this retrospective cross-sectional study, we analyzed 128 LSCC cases that underwent total laryngectomy at Amir Alam Hospital. We evaluated TB and CNS based on the Boxberg etal. Our study demonstrated a significant correlation between TB, and nodal involvement (p = 0.015), vascular invasion (p = 0.035), and mortality rate (p = 0.001), as well as a significant statistical correlation between high TB and extra-laryngeal extension (p = 0.006), clinical stage (p = 0.011), and mortality rate (p = 0.001). Moreover, small nest size was also associated with the clinical stage (p = 0.047), extra-laryngeal extension (p = 0.015), and mortality rate (p < 0.001). Based on our results, TB, CNS, and clinical stage are independent prognostic factors for mortality rate and are correlated with disease-specific survival. Given the effect of TB and CNS on the overall prognosis and survival of patients with LSCC, evaluating these two factors on routine H&E microscopic examination of LSCC specimens is recommended to facilitate individualized risk assessment and treatment planning.

The correlation between medical students’ clinical dishonesty, psychological distress, and moral intelligence

IntroductionClinical dishonesty is one of the components of academic dishonesty that deals with the unprofessional behavior of students in hospital and clinic environments (medical students, nursing students, etc.). Psychological distress and low moral intelligence among students can be known as predisposing factors in performing dishonest clinical behaviors. The present research addresses a gap in the scientific literature by investigating dishonest behavior among medical students.MethodsThis cross-sectional study examined medical students’ clinical dishonesty, psychological distress, and moral intelligence. Rafati et al.‘s questionnaire was used to investigate clinical dishonesty, Kessler’s Psychological Distress Questionnaire (K6) was used for psychological distress, and Lenik and Keil’s (2005) questionnaire was used to determine moral intelligence. Cochran’s formula was used to calculate the sample size and the simple random sample (SRS) method was used for sampling. Data were statistically analyzed in SPSS version 27 (SPSS Inc., Chicago, IL, United States). a P-value less than 0.05 was considered significant.Results317 medical students were included in this study, of which 176 (55.5%) were male and 141 (44.5%) were female. We found a direct and significant statistical correlation between clinical dishonesty and students’ distress (Correlation Coefficient: 0.162, P-value < 0.001). In addition, there was a statistically significant inverse correlation between clinical dishonesty and moral intelligence (Correlation Coefficient: -0.241, P-value: 0.004). Moreover, there was a higher rate of clinical dishonesty among senior medical students (P-value < 0.001). Moreover, the most dishonest clinical behaviors are as follows: [1] Disclosure of patient information in public or with non-medical personnel (76%), Incorrect examination of vital signs and physical examinations (69.4%), Not reporting incidents or errors of others involving patients (41.6%).ConclusionFinally, most students have experienced engaging in at least one clinically dishonest behavior. Such actions increase with the progress of the educational level so that it reaches its peak at the internship stage. Moral intelligence is a learnable concept, and mental distress also has its own treatments. Therefore, improving these two factors can reduce clinical dishonesty among medical students.