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Diabetes Mellitus (DM) is a frequent comorbidity in hospitalized patients, with prevalence ranging from 15% - 35%. However, in almost half of the cases, this antecedent is omitted in the medical records or even unknown by the patient. Furthermore, about 10% of hospitalized individuals may have hyperglycemia of stress, a condition characterized by transient and reversible elevation of blood glucose, in the presence of acute circumstances, such as trauma, surgery, medications, shock, or infections [1].

Due to the urgent need for water in all parts of industrial or developing societies, water supply, and transmission facilities are suitable targets for biological risks. Given that even a short interruption in water supply and water supply operations has a great impact on daily activities in the community, the deliberate contamination of urban water resources has irreparable consequences in the field of public health, and the economy of society will follow. Unfortunately, most officials in the public health control departments in our country have received limited training in detecting accidental or intentional contamination of water resources and dealing with the spread of waterborne diseases both naturally and intentionally. For this reason, there is low preparedness in the responsible agencies to deal with waterborne diseases during biological risks. In the first step of this research, a review study has been conducted on water biological risks and operational strategies to deal with them. In the following, it has studied how Escherichia coli (E. coli) bacteria spread in aqueous media. In this regard, the kinetic model of the studied microorganism was analyzed based on the implementation of (Fick Law) in polar coordinates and the combination of (Dirac Distribution) with (Legendre polynomial) distribution. Finally, after studying the factors affecting the microbial pollutant emission coefficient, the effects of all three factors of linear velocity, linear motion time period, and angle of motion on the pollutant emission flux and biofilm diffusion time in the water supply network environment were investigated. Studies have shown that the linear velocity parameter of Escherichia coli with a nonlinear relationship has the greatest effects on the release of microbial contaminants.

Background: Apert syndrome is a type 1 acrocephalosyndactyly, a rare syndrome characterized by the presence of multiple craniosynostoses, dysmorphic facial manifestations, and syndactyly of hand and feet. It affects 1:100.00 of birth and is the second most common of syndromic craniosynostosis. Molecular genetic tests that identify the heterozygous pathogenic variant in FGFR2 genes - identical with Apert syndrome cost too high to be applicable in developing countries. Therefore, the diagnosis of Apert syndrome should be suspected from the clinical findings. Three cases from the Community of Indonesian Apert Warrior Group were collected. These series were based on medical and surgical records. We obtained the patient characteristics from the phenotypic manifestations only. Case report: We present a case of a newborn baby girl, with similar anatomical findings, such as skull shape abnormality, midface hypoplasia, intraoral disfigurement, and hands and feet deformities that resemble Apert Syndrome. Our series presents similar Apert syndrome characteristics, such as typical craniofacial dysmorphic with symmetrical syndactyly of both upper and lower extremities. These clinical findings are essential to establish an initial diagnosis of Apert Syndrome.

Ms X is a 40-year-old gravida 12, para 2+9 woman, who was admitted for an elective caesarean section at 38 weeks gestation following the previous two caesarean sections. Ms X had abdominal distension and generalised abdominal tenderness in the postoperative period. On investigation, she was found to have an elevated white cell count (WCC), C - Reactive Protein (CRP) and creatinine with free fluid in the abdomen on imaging but there was no evidence of perforation of any visceral organ. Ms X was treated conservatively for sepsis, an Acute Kidney Injury (AKI) and post-operative ileus and her symptoms gradually resolved. This is a case of idiopathic ascites post caesarean delivery with no clear cause.

Many advances have been made in recent years in the development of hearing and cochlear implants. These use acoustic and electrical stimulation technologies to improve speech intelligibility for the hearing impaired. However, for cochlear prostheses, the results are not very promising and vary from one patient to another. Certain technical and sometimes physiological problems have limited the expected performances of these devices, especially for children and the elderly. These problems include cochlear malformation and ossification of the auditory channels. This led us to reduce the number of electrodes in order to allow quality deep insertion while preserving the low-frequency acoustic bands of the operated patient.

Aim: This study aimed to investigate the association between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and laboratory findings in patients presenting with the complaint of leg pain due to varicose veins.Materials and Methods: A total of 160 patients with leg pain were included in this study. Sleep quality was assessed using the PSQI, and laboratory tests were conducted to evaluate ferritin, iron, vitamin B12, Thyroid Stimulating Hormone (TSH), C-reactive protein (CRP), albumin, low-density lipoprotein (LDL), and hemoglobin levels. Statistical analyses were performed using the independent t-test or Mann-Whitney U test for continuous variables and the chi-square test for categorical variables.Results: Patients with poor sleep quality had a significantly higher prevalence of leg pain complaints compared to those with good sleep quality (p < 0.001). Females were more likely to report poor sleep quality (p = 0.006). No significant associations were found between sleep quality and age, smoking status, alcohol use, or pack/year of smoking. Patients with poor sleep quality had significantly lower ferritin levels (p = 0.008), lower albumin levels (p = 0.031), and lower hemoglobin levels (p = 0.036) compared to patients with good sleep quality. However, no significant differences were observed in other laboratory parameters.Conclusion: The findings suggest a significant association between poor sleep quality and leg pain complaints in patients with varicose veins. Lower ferritin, albumin, and hemoglobin levels in patients with poor sleep quality may indicate potential underlying mechanisms linking sleep quality and leg pain. Addressing sleep quality issues in patients with leg pain could improve overall well-being and treatment outcomes.

Related COVID-19 and new Variant and treatment like vaccine it is relevant to deeply verify the immunologic implication and in a special way regarding the innate immune sensor system and the evasion of the immune system. This can be crucial to search for new strategies to fight this severe disease under a Toxicology-antidotes point of view. The rapid emergence of a new variant is under study by researchers because some of these show different responses to antibodies as reported in literature (vaccine efficacy?). In this article after a review part it is submitted a collection of hypothesis of solution to contrast COVID-19. Spread and mortality and project hypothesis. A new toxicological approach also in a viral respiratory disease can be a novelty to adequately fight this severe condition and this focusing not only towards specific immunity but also a specific measures. A toxicological approach in drug- vaccine like products designing makes it possible to get the clinical outcomes needed.

The purpose of this pilot study was to evaluate the effectiveness of mold sanitation in homes that suffered hurricane-related water damage. After a home is flooded, sanitation of the structure for mold is necessary before the interior of the home can be rebuilt. In this study, homes (n = 6) in Houston, Texas that had been flooded by Hurricane Harvey were sanitized by volunteers. At either 6, 8, 15, 25, 34, or 56 days after the sanitation was completed, a Button™ sampler was used to collect a 48-hour air sample, so that the mold cells in the air could be quantified. Each air sample was then analyzed by quantitative PCR (qPCR) assays for the 36 molds in the Environmental Relative Moldiness Index (ERMI) panel of indicator molds. Quantifying the 36-ERMI molds in air samples results in “ERMI-like” values. The ERMI-like values in the sanitized homes were inversely correlated (Pearson p - value 0.04) with the log of the number of days after the sanitation was completed, an indication that it takes time after sanitation for the mold levels to stabilize. This pilot study demonstrated that the ERMI-like metric was useful in assessing post-sanitation mold levels in previously flooded homes. 

Introduction: Twin pregnancy, compared to a singleton pregnancy, is associated with a higher risk of preterm birth and other neonatal complications. This study aimed to compare neonatal mortality rates and risk factors among births with the gestational age of 34 weeks - 37 weeks in twin and singleton pregnancies.Methods: The study design was cross-sectional and population-based. We extracted the data from the birth information registry in Iran. Mothers' and neonates' information was removed from the registry systems between 2018 and 2020. We used Statistical R software to compare neonatal mortality rate, demographic variables, and risk factors between two groups of twin and singleton neonates.Results: Out of 579,873 live births with a gestational age of 34 weeks - 37 weeks, 729 (1.4/1000) singleton and 54(0.77/1000) twins (one out of two) neonates died in the delivery room in the first hour of life. Of the neonates who left the delivery room alive, 3129 (4.9 per 1000) neonates had died (5.7/1000 singleton and 3.04/1000 twin). The neonatal mortality rate in hospitalized singleton neonates (1.85%) was higher than twin group (1.06%). After adjustment of other variables, the mortality rate in twin pregnancy was significantly lower than in singletons (p value < 1/1000), with an odds ratio of 0.47 (CI: 0.39 - 0.55). Antenatal corticosteroid treatment in the twin group was significantly higher than in singletons.Conclusion: Twin neonatal mortality rate was lower than singletons in the neonates with gestational age 34 weeks - 37 weeks. Clinicians could consider these results for delivery timing in uncomplicated twin pregnancies. Antenatal corticosteroid therapy can be considered to reduce the mortality rate of late preterm neonates in resource-limited countries.

Background: Meclizine is a commonly prescribed medication for patients discharged from the Emergency Department (ED) with a diagnosis of peripheral vertigo, however it is on the Beers list of medications to avoid in elderly patients. Objectives: This study aims to determine the correlation between use of meclizine and return visits to the ED within 1 week in patients > 65 years old. Methods: This is a retrospective observational study conducted at 2 urban tertiary care EDs over 5 years. Inclusion criteria included patients > 65 years who were given meclizine in the ED or discharged with a prescription. Charts were reviewed for diagnosis, prescriptions and return visits within 7 days. Results: There were a total of 1608 patients over 65 years of age who met inclusion criteria, 669 patients identified as receiving meclizine in the ED and 962 who received no meclizine (ED or ED plus home prescription). Of the meclizine patients, 548 (84.8%) were given home prescriptions, of which there were 36 (6.6%) return visits within 7 days. Patients who were given meclizine while in the ED without home prescriptions (121) had 16 return visits (13.2%). Among the non-meclizine group, 102 patients (10.6%) had a return visit within 7 days. Conclusion: There was no increase in return visits in elderly patients discharged from the ED with a prescription for meclizine after a diagnosis of benign dizziness. Meclizine prescriptions at discharge were associated with fewer return visits to the ED within 1 week. Ongoing dizziness was the most common reason for return visits; there were no documented chief complaints of weakness, syncope/falls, or hypotension.