Using reflective writing to enhance empathy among medical students.

Reflection is a skill which has the potential to enhance higher order thinking such as empathy and compassion. We aimed to study reflective writing as a means to nurture empathy among medical students. An interventional study was conducted among 73 final-year medical students using the Toronto Empathy Questionnaire. The questionnaire was administered anonymously before and after a clinical clerkship. Reflective writing generated strong emotional responses but did not improve Empathy Questionnaire scores. Reflective writing about patient care experiences may be useful in clinical clerkships to develop certain constructs of empathy such as perspective taking and compassion among medical students, but it may not raise empathy scores in the short term.

La réflexion est une compétence qui a le potentiel de développer la pensée de haut niveau telle que l'empathie et la compassion. Nous avons voulu étudier l'écriture réflexive comme moyen de développer l'empathie chez les étudiants en médecine. Une étude interventionnelle a été menée auprès de 73 étudiants en dernière année de médecine à l'aide du Toronto Empathy Questionnaire. Le questionnaire a été administré de manière anonyme avant et après un stage clinique. L'écriture réflexive a suscité de fortes réactions émotionnelles mais n'a pas amélioré les scores au questionnaire sur l'empathie. L'écriture réflexive sur les expériences de soins aux patients peut être utile dans les stages cliniques pour développer chez les étudiants en médecine certains concepts d'empathie tels que la compréhension du point de vue de l'autre et la compassion, sans pour autant augmenter les scores d'empathie à court terme.

Students' perspectives on their early dropout of medical school.

BACKGROUND: Enrolling in medical school launches a more demanding and stressful way of life for newly admitted students. Some students will struggle academically and will ultimately drop out from medical school. The study aims to understand the perspectives that dropped-out students have and their opinion regarding possible preventative solutions. MATERIALS AND METHODS: This study uses a mixed-method approach. The results of students' examinations in the first 2 years of admission (within four academic years from 2016 until 2020) were collected from the medical school records. A questionnaire was developed to investigate the causes of early attrition during the study period. All dropped-out students who were admitted were included in this study. RESULTS: The study included 479 admitted students, 349 (72.9%) were females; 152 (31.7%) students dropped out in the premedical program (first two years); 104 (68.4%) of the dropped-out students were females. Thirty-five (23%) students responded to the questionnaire. Twenty-eight (80%) respondents believed that their low academic performance and leaving medical school was primarily related to psychological problems, 19 (54%) of respondents reported leaving for social reasons, and lack of self-organization in 13 (37.1%) respondents. Human anatomy was recorded as the most difficult course in the first year by 21 (63.6%) students. CONCLUSIONS: The cause of attrition is often multifactorial and complex. Psychological problems are one of the important factors in students with low academic performance and dropping out of the students. Some difficult courses in the curriculum may affect the students' academic performance leading to their attrition.

Effect of Calorie Restriction and Intermittent Fasting Regimens on Brain-Derived Neurotrophic Factor Levels and Cognitive Function in Humans: A Systematic Review.

Background: The potential positive interaction between intermittent fasting (IF) and brain-derived neurotrophic factor (BDNF) on cognitive function has been widely discussed. This systematic review tried to assess the efficacy of interventions with different IF regimens on BDNF levels and their association with cognitive functions in humans. Interventions with different forms of IF such as caloric restriction (CR), alternate-day fasting (ADF), time-restricted eating (TRE), and the Ramadan model of intermittent fasting (RIF) were targeted. Methods: A systematic review was conducted for experimental and observational studies on healthy people and patients with diseases published in EMBASE, Scopus, PubMed, and Google Scholar databases from January 2000 to December 2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statements (PRISMA) for writing this review. Results: Sixteen research works conducted on healthy people and patients with metabolic disorders met the inclusion criteria for this systematic review. Five studies showed a significant increase in BDNF after the intervention, while five studies reported a significant decrease in BDNF levels, and the other six studies showed no significant changes in BDNF levels due to IF regimens. Moreover, five studies examined the RIF protocol, of which, three studies showed a significant reduction, while two showed a significant increase in BDNF levels, along with an improvement in cognitive function after RIF. Conclusions: The current findings suggest that IF has varying effects on BDNF levels and cognitive functions in healthy, overweight/obese individuals and patients with metabolic conditions. However, few human studies have shown that IF increases BDNF levels, with controversial results. In humans, IF has yet to be fully investigated in terms of its long-term effect on BDNF and cognitive functions. Large-scale, well-controlled studies with high-quality data are warranted to elucidate the impact of the IF regimens on BDNF levels and cognitive functions.

Temporal trends of hemoglobin among pregnant women: The Mutaba'ah study.

BACKGROUND: Low hemoglobin (Hb) level is a leading cause of many adverse pregnancy outcomes. Patterns of changes in Hb levels during pregnancy are not well understood. AIM: This study estimated Hb levels, described its changing patterns across gestational trimesters, and identified factors associated with these changes among pregnant women. MATERIALS AND METHODS: Data from the ongoing maternal and child health cohort study-The Mutaba'ah Study, was used (N = 1,120). KML machine learning algorithm was applied to identify three distinct cluster trajectories of Hb levels between the first and the third trimesters. Descriptive statistics were used to profile the study participants. Multinomial multivariable logistic regression was employed to identify factors associated with change patterns in Hb levels. RESULTS: The three identified clusters-A, B and C-had, respectively, median Hb levels (g/L) of 123, 118, and 104 in the first trimester and 119, 100, and 108 in the third trimester. Cluster 'A' maintained average normal Hb levels in both trimesters. Cluster 'B', on average, experienced a decrease in Hb levels below the normal range during the third trimester. Cluster 'C' showed increased Hb levels in the third trimester but remained, on average, below the normal range in both trimesters. Pregnant women with higher gravida, diabetes mellitus (type 1 or 2), nulliparity or lower level of education were more likely to be in cluster 'B' than the normal cluster 'A'. Pregnant women who reported using iron supplements before pregnancy or those with low levels of education. were more likely to be in cluster 'C' than the normal cluster 'A'. CONCLUSION: The majority of pregnant women experienced low Hb levels during pregnancy. Changes in Hb levels during pregnancy were associated with parity, gravida, use of iron before pregnancy, and the presence of diabetes mellitus (type 1 or 2).

Prevalence of non-suicidal self-injury, suicidal ideation, suicide attempts, suicide mortality in eating disorders: a systematic review and meta-analysis.

Eating disorders have a wide and profound impact on psychological and general health. The study aims to provide a comprehensive and up-to-date review of non-suicidal self-injury, suicidal ideation, suicide attempts, and suicide mortality in a variety of eating disorders. A systematic search was conducted using four databases from inception until April 2022, limiting the search to English-language. For each of the eligible studies, the prevalence of suicide-related issues in eating disorders was calculated. The prevalence of non-suicidal self-injury, suicide ideation, and suicide attempts was then calculated for each anorexia nervosa and bulimia nervosa. The random-effects method was used for the pool of studies. Fifty-two articles were used for this study and included in the meta-analysis. The prevalence of non-suicidal self-injury is 40% with a confidence interval between 33-46% (I2 97.36%). The prevalence of suicide ideation is 51% with a confidence interval between 41-62% (I2 97.69%). The prevalence of suicide attempts is 22% with a confidence interval between 18-25% (I2 98.48%). The heterogeneity in the studies included in this meta-analysis was high. There is a high prevalence of non-suicidal self-injury, suicidal ideation, and suicide attempts in eating disorders. Thus, comorbidity between eating disorders and suicide issues is an important topic that can provide insights into etiology. Future studies must consider eating disorders along with other types of mental health issues, such as depression, anxiety, sleep problems, and aggression.

Perceived changes in the mental well-being among Nigerians due to Ramadan Intermittent Fasting during the COVID-19 pandemic.

INTRODUCTION: Muslims fast every year during the month of Ramadan from dawn until dusk. This study examined mental well-being and correlating factors among Nigerian adults who observed Ramadan intermittent fasting (RIF). METHODS: A validated generalized anxiety disorder-2 and Patient Health Questionnaire-2, the four-item spiritual well-being index, and the Islamic intrinsic religiosity questionnaire were used to collect data about mental well-being (depression, anxiety), spirituality, and intrinsic religiosity through a web-based survey between the May 9, 2021 (27th of Ramadan, 1442) and the June 4, 2021 (29th of Shawwal, 1442). We studied the mental well-being of respondents over a period of 4 weeks before Ramadan (BR) and during the 4 weeks of Ramadan between the April 12, 2021 and the May 12, 2021(DR). Multinomial regression analysis was used to determine the factors associated with depression and anxiety. This research did not receive any grant or funding. RESULTS: A total of 770 adult Nigerians who observed RIF study were included in this cross-sectional study. When compared to mental well-being BR, observing RIF by Nigerian adult respondents was associated with a significant improvement in their mental well-being. A higher proportion of respondents felt less depressed DR (61.3% vs. 56.5%. < .001). Interest and pleasure in doing things improved DR than BR (p= 0.007) and respondents felt less nervous and anxious (60.7% vs. 57.1%, respectively; p <.001). Mental well-being was independently associated with sociodemographic characteristics, physical activity, and perceived relationships. CONCLUSIONS: This study found significant improvement in mental well-being DR compared to BR despite the ongoing COVID-19 pandemic. The effect of RIF on mental well-being needs further research with multicentric studies among different sets of ethnic populations.

The Impact of COVID-19 on Primary Care: A Scoping Review.

The COVID-19 pandemic had a severe impact on various aspects of everyday life, including healthcare provision. The aim of the scoping review was to collate, summarize, and discuss this literature, in light of the impact COVID-19 had on Primary care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) four-stage process framework for reporting was followed. A total of 31 studies were included in this review. Based upon our review we found COVID-19 pandemic on Primary Care, has made significant effects on 1) service redesign, 2) long-term illness care provision, 3) healthcare staff well-being and 4) the post-pandemic future of Primary Care. The COVID-19 outbreak has demonstrated, how a pandemic can drastically change the process of healthcare provision within the community, as evidenced by the change in consultation styles with patients, the impact on the physical and mental wellbeing of health workers, a shift from isolated practice to teamwork, as well as the ability of healthcare workers to seek prompt help with their health. Studies have demonstrated progress in knowledge and experience gained by healthcare workers when tackling COVID-19, and how these can be implemented in possible future pandemics affecting Primary Care, however, further research is required within this sphere.

The attitudes and practices of United Arab Emirates consumers towards food waste: A nationwide cross-sectional study.

Background: Reducing global food waste is an international environmental, health, and sus-tainability priority. Although significant reductions have been achieved across the food chain, progress by UAE households and consumers remain inadequate. This study seeks to understand the association between consumer attitudes, knowledge, and awareness relating to food waste practice of residents living in the UAE. to help inform policy and action for addressing this national priority. Methods: A cross-sectional study was conducted using a validated semi-structured online questionnaire through stratified sampling (n =1052). The Spearman correlation coefficient was performed to determine the correlations. Two independent regression analysis were used to determine the association between food waste practice with: 1) knowledge and awareness and attitude subdomains, and 2) sociodemographic characteristics. Respondents (n=1072) largely reflect the socio-demographic characteristics and population distribution across the seven Emirates. Results: As expected, a significant and negative correlation was found between food waste practice knowledge and awareness and overall attitude. The regression models showed reduced food waste practice was associated with better knowledge, personal attitude, financial attitude (first model), older age and fewer adults in the household (second model). We found a significant and negative association of personal attitude (a commitment, intention), financial attitude (cost-saving motivation), and (existing) knowledge of Food waste (FW) with practice of food waste, indicating that better knowledge about FW, personal attitude or financial attitude was associated with reduction in undesirable food waste practice. While awareness and emotional attitude (moral concerns) were positively and significantly associated with food waste practice (undesirable behaviour). Conclusions: Food waste poses significant challenges in the UAE, and addressing it requires a comprehensive understanding of the multifaceted factors influencing consumer behavior. By promoting knowledge, fostering positive attitudes, and considering socio-cultural factors, policymakers can develop effective strategies to reduce food waste in households and contribute to sustainable development goals.

Relationship between gaming disorder across various dimensions among PUBG players: a machine learning-based cross-sectional study.

Background: PlayerUnknown's battlegrounds (PUBG), a widely played multiplayer online game, has sparked interest and concern regarding its impact on players. This study explored the relationship between factors such as cultivation level, motivation, religious engagement, gaming disorder, and addiction among PUBG players. Methods: This study employed a convenience sampling technique to select a sample of 500 PUBG players. An Artificial Neural Network (ANN) model was used to identify the primary factors contributing to the level of cultivation. Results: Male participants exhibited a higher level of cultivation than their female counterparts did. According to the ANN model, gaming disorder exhibited the greatest normalized importance, with a value of 100%. This was followed by the religious level, which had a normalized importance of 54.6%. Additionally, motivation level and gaming addiction demonstrated normalized importance values of 47.6 and 44.4%, respectively. This study revealed a statistically significant correlation between engaging in PUBG and the cultivation effect observed among respondents. Conclusion: This study highlights several noteworthy factors, including gaming disorder, religious affiliation, motivation level, and gaming addiction. These factors offer valuable insights into understanding gaming behavior and devising effective interventions.

Torsion of Epididymal Cyst: A Case Report With Review of Literature.

Torsion of an epididymal cyst is one of the rare and least-known causes of acute scrotal pain. Epididymal cysts, when large, can undergo occasional complications like infection or, rarely they might undergo torsion, needing emergency surgery. We present a case of a 37-year-old gentleman with acute scrotal pain to the scrotum. Testicular torsion was suspected clinically, but sonography revealed a normal-appearing testis and a large left-sided epididymal cyst with internal echoes and dependent debris. A diagnosis of epididymal cyst torsion was suspected based on sonographic findings. Exploratory surgery showed a reddish, inflamed epididymal cyst that had undergone torsion on its pedicle. The cyst was excised leading to symptomatic relief to the patient. Due to the rarity of this condition, such cases are often misdiagnosed clinically as testicular torsion. Ultrasonography helps in aiding the correct diagnosis and the radiologist needs to be familiar with the radiological aspects of diagnosing torsion of epididymal cysts.

Nigerian Muslim's Perceptions of Changes in Diet, Weight, and Health Status during Ramadan: A Nationwide Cross-Sectional Study.

The Islamic month of Ramadan is marked by fasting, when Muslims refrain from eating and drinking from dawn to sunset, which has an impact on their dietary habits. The study aimed to assess Nigerian Muslims' dietary modifications during Ramadan and their related changes in body weight and health status. A web-based cross-sectional study was conducted among Nigerian adult Muslims. The survey assessed sociodemographic, dietary habits, eating behaviors, food choices, perceived weight changes, and health status. The logistic regression model was used to assess the predictors of weight change and perceived health status. There were 770 participants, 62.9% of whom were women, ranging in age from 18 to 60 years with a mean age of 27.7 ± 6.4 years. Fruits, palm dates, homemade foods, milk products, and vegetables were more frequently consumed. There were fewer energy drinks, pastries, salty snacks, and carbonated or sugared drinks consumed during Ramadan than before. Over half (54.6%, 95% CI: 51.0-58.9%) of the respondents lost weight during Ramadan, 37.0% (95% CI: 17.4-38.6%) maintained their weight and 8.4% (95% CI: 6.6-10.6%) gained weight during the month. Nearly all (97.3%, 95% CI: 95.8-98.3%) reported having good health during Ramadan, and 2.7% (95% CI: 1.7-4.1%) reported having a poorer health state during Ramadan. There was a significant weight loss and healthy dietary change associated with Ramadan fasting in Nigeria. Public health measures must be in place to impart such positive health behaviors so that such healthy habits continue throughout the year.

Fibro-Adipose Vascular Anomaly: A Case Report and Literature Review.

A fibro-adipose vascular anomaly (FAVA) is a complex venous malformation characterized by intramuscular fibrofatty replacement and dilation of veins. As FAVA is a rare entity and associated with a complex constellation of vascular anomalies, it is often misdiagnosed. This report discusses a case of a 26-year-old woman who presented with swelling on the lateral aspect of the right thigh. FAVA was diagnosed on the basis of radiological and histopathological examinations. After en-bloc resection of the mass, the patient's pain and ability to move significantly improved. We describe the clinical, radiological, and pathological aspects of FAVA, as well as its management.

Risk factors associated with quadbike crashes: a systematic review.

BACKGROUND: Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs. METHODS: The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed  protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM). RESULTS: Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries. CONCLUSION: Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes. PROSPERO registration number CRD42020170245.

A Systematic Review of Insulin Management Recommendations to Improve Glycemic Control and Reduce Hypoglycemic Events During Ramadan Fasting in Patients With Insulin-Requiring Type 2 Diabetes.

Background: Muslims with insulin-requiring type 2 diabetes are at high risk of hypo- and hyperglycemia while fasting during the month of Ramadan. Although a few reviews on diabetic management during Ramadan have been published, surveys reveal knowledge gaps remain among physicians. Aim: This systematic review qualitatively analyzes what insulin dosing recommendations are likely to reduce hypoglycemic events and improve glycemic control during the Ramadan fasting for this high-risk group. Methods: A comprehensive search in six databases and gray sources was performed from August 10, 2001, to August 10, 2021, for studies assessing which types of insulin and/or what dosing recommendations reduce hypoglycemic events and improve glycemic control during Ramadan. We excluded studies focusing mainly on oral antihyperglycemic medications, type 1 diabetes, persons with insulin pumps, and studies older than 20 years. Hypoglycemic event rates, pre-, and post-iftar blood glucose levels, overall average blood glucose, and hemoglobin A1c were analyzed, and a narrative synthesis was performed. Results: Out of 1,101 collected articles, 14 eligible studies including 2,969 participants with an average age of 54.8 years, we found that insulin dose reduction may prevent hypoglycemia without causing subsequent hyperglycemia, and rapid-acting insulin analogs may improve post-iftar and overall blood glucose without incurring hypoglycemia. Conclusions: Though initial findings are promising, more research is needed to confirm the benefits of insulin dose reduction, rapid-acting insulin analogs, and ultra-long-acting insulins. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268943.

Health literacy and fear among Iranian medical students due to COVID-19: An observational study.

INTRODUCTION: The coronavirus disease of the 2019 (COVID-19) pandemic has created a sense of fear due to uncertainties in medical students' personal and professional lives. Medical education is challenging and poses a more significant academic and emotional rigor when compared with other professional programs. With the COVID-19 having limited treatment options, health literacy (HL) is crucial for managing and responding to the pandemic. This research aims to examine the impact of HL on COVID-19-associated fear among Iranian medical students. METHODS: A cross-sectional study was conducted measuring the HL and fear of COVID-19 using validated scales. Two hundred and seventy-eight survey responses were received and analyzed descriptively by using SPSS software inferential statistics. RESULTS: Mean age of participants was 22.93 ± 5.427 years. The correlation between students' total health literacy (HELIA) scores and their fear of COVID-19 (FCV-19S) scores was -0.279 (p value = .019). The FCV-19S has a negative correlation with total HELIA in the group of females and males, single and married people, bachelor and MD students, and students living in rural areas and urban areas. The negative correlation of FCV-19S with total HELIA in males and students who reside in rural areas was the only one that was not significant. In associate degree students, the correlation between FCV-19S and total HELIA was positive but not significant. Education grades had a significant impact on FCV-19S. Furthermore, the place of residence also had a significant impact on FCV-19S. However, the gender and marital status did not significantly impact FCV-19S. CONCLUSIONS: The present study showed that students with higher HL scores had lesser fear of COVID-19. The key stakeholders require several positive strategies to reduce fear and improve health, and such vital policies will assist in improving the students' health and achieving the sustainable developmental goals.

Systematic review of the effects of pandemic confinements on body weight and their determinants.

Pandemics and subsequent lifestyle restrictions such as 'lockdowns' may have unintended consequences, including alterations in body weight. This systematic review assesses the impact of pandemic confinement on body weight and identifies contributory factors. A comprehensive literature search was performed in seven electronic databases and in grey sources from their inception until 1 July 2020 with an update in PubMed and Scopus on 1 February 2021. In total, 2361 unique records were retrieved, of which forty-one studies were identified eligible: one case­control study, fourteen cohort and twenty-six cross-sectional studies (469, 362 total participants). The participants ranged in age from 6 to 86 years. The proportion of female participants ranged from 37 % to 100 %. Pandemic confinements were associated with weight gain in 7·2­72·4 % of participants and weight loss in 11·1­32·0 % of participants. Weight gain ranged from 0·6 (sd 1·3) to 3·0 (sd 2·4) kg, and weight loss ranged from 2·0 (sd 1·4) to 2·9 (sd 1·5) kg. Weight gain occurred predominantly in participants who were already overweight or obese. Associated factors included increased consumption of unhealthy food with changes in physical activity and altered sleep patterns. Weight loss during the pandemic was observed in individuals with previous low weight, and those who ate less and were more physically active before lockdown. Maintaining a stable weight was more difficult in populations with reduced income, particularly in individuals with lower educational attainment. The findings of this systematic review highlight the short-term effects of pandemic confinements.

Back Pain Due to Kummell's Disease.

Kummell's disease (KD) is a delayed post-traumatic avascular osteonecrosis of the vertebral body secondary to a vertebral compression fracture that can present with back pain. We discuss the importance of an accurate diagnosis and appropriate management of Kummell's disease. Additionally, we aim to increase awareness and promote early diagnosis and treatment to prevent serious complications. A 55-year-old man had been diagnosed with avascular necrosis (AVN) of both hips and had a history of trauma to the left hip ten years ago. Between the initial fall and subsequent presentation, he resumed independent physical activity. At approximately 10 months following his initial injury, he returned to a local emergency department with vague complaints of lower back pain. He was prescribed analgesics for pain and discharged. Subsequently, he experienced a progressive increase in pain and complained of motor deficits of the lower limbs. He presented to our emergency room with acute onset of worsening pain. Magnetic resonance imaging revealed multiple-level compression fractures and a fluid cleft in the L2 intervertebral disc. Surgery was advised, but he did not consent. Therefore, nonsurgical treatment included bed rest, wearing a brace, lumbar traction, analgesics, and medication to prevent osteoporosis. Prompt, accurate diagnosis of Kummell's disease is important for timely, appropriate treatment, which can improve quality of life and prevent comorbidities.

Gallbladder Agenesis Mimicking Chronic Cholecystitis in a Young Woman.

Gallbladder agenesis is a rare anatomic congenital abnormality caused by the cystic bud failing to develop into the gallbladder. Gallbladder agenesis has a variable presentation, with 50% of patients presenting with symptoms mimicking biliary colic and 35% being incidentally discovered during surgery or autopsy, while another 15% can present with fatal fetal anomalies. In this article, we present a case of gallbladder agenesis in a young woman who presented with biliary-colic-like symptoms suggesting cholecystitis. The gallbladder was not well visualized on ultrasonography, simulating chronic cholecystitis due to shrunken or contracted bladder. Further imaging with computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) helped in the successful diagnosis of gallbladder agenesis and helped prevent unnecessary surgical intervention. Due to the lack of clinical suspicion diagnosing gallbladder agenesis preoperatively is still rare. Persistent symptoms are often associated with biliary colic pain leading to surgery. Conservative management consists of using antispasmodic medications. MRCP may be required to rule out gallbladder agenesis and avoid unnecessary surgery. Gallbladder agenesis can present with symptoms similar to cholecystitis. If the gallbladder is not visualized well on the ultrasound, an additional radiological examination is required. Clinicians' understanding of the condition helps to accurately diagnose the condition preoperatively using the appropriate investigations, thereby minimizing the operative risk to the patient.

Global Epidemiology of HIV/AIDS: A Resurgence in North America and Europe.

We aimed to assess global trends in Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and evaluate progress toward eradication since the inception of the pandemic. Data were extracted from the Global Burden of Disease 2019 update and the UNAIDS Data 2019. The datasets included annual figures from 1990 to 2019 for HIV/AIDS in 204 countries and all world regions. We analyzed rates and trends for prevalence, incidence, mortality and disability adjusted life years. Analysis of age and gender distribution in different regions was used to assess demographic changes. Forecasting was used to estimate disease burden up to 2040. Although many countries have witnessed a decrease in the incidence, for Russia, Ukraine, Portugal, Brazil, Spain and the United States, the rates of new cases are rising since 2010. This trend is present even in age-standardized analysis, indicating a rise in excess of population growth. Over 0.5% of the world's population is infected. About 5000 new infections occur daily, of which 500 are children. Mortality rates are falling globally; currently at 11 deaths per 100,000 population, forecasted to decrease to 8.5 deaths by 2040. Prevalence continues to increase, with South Africa, Nigeria, Mozambique, India, Kenya and the United States having the highest burden. The total number as well as the rates of new HIV infections are rising every year in Europe, South America, North America and other regions over the last decade. Maternal-to-child transmission continues at high rates despite effective preventive regimens. There is an urgent need to develop programs to curb the rising incidence of HIV.

A community perspective of COVID-19 and obesity in children: Causes and consequences.

The pandemic of childhood obesity that has been increasing over the last decade has collided with the current pandemic of COVID-19. Enforced behavioural changes have resulted in a myriad of problems for children particularly in weight management. Restricted activity is the most obvious but many other aspects of life have exacerbated biological, psychosocial, and behavioral factors identified as risks for childhood obesity. Significant effort is required to turn around the prevailing tide of weight gain necessitating changes in personal and family behavior and diet, as well as high-level governmental and educational policy. Evidence-based, focused, long-term interventions which are adequately funded are required. Enthusiasm and optimism for change coupled with public engagement by utilization of new technology as well as traditional methods offers hope for change. Public health interventions in isolation are inadequate and bolder changes to central policies and social structure are needed for sustained change. This will allow some mitigation of the affects of COVID-19 but also reduce negative outcomes in future comparable situations.