Eco-friendly modified chitosan as corrosion inhibitor for carbon steel in acidic medium: Experimental and in-depth theoretical approaches.

The industrial and medical sectors have a great interest in chitosan due to its unique properties, such as abundance, renewability, non-toxicity, antibacterial activity, biodegradability, and polyfunctionality. In this work, two modified chitosan Schiff bases (ChSB-1 and ChSB-2) were made using condensation methods, and their potential as corrosion inhibitor for carbon steel in 1 M HCl was investigated using chemical and electrochemical techniques. The ChSB-1 and ChSB-2 inhibitors exhibited remarkable inhibitory performance, as evidenced by the mass loss data, which showed 89.3 % and 91.5 % efficacy at 1 mM concentration, respectively. Because of the electron-donor substituent of methoxy (-OCH3), ChSB-2's active sites have more delocalized electrons than ChSB-1's. The PDP results showed that both ChSB-1 and ChSB-2 inhibitors have anti-corrosion characteristics because heteroatoms caused a protective layer to develop that functioned as mixed-typed inhibitors. The calculated adsorption-free energy ∆Gadso for ChSB-1 and ChSB-2, respectively, was found -36.1 and - 37.1 kJ mol-1. The ChSB-1 and ChSB-2 inhibitors adsorb on carbon steel in acidic conditions through physisorption and chemisorption interactions, and their adsorption is in line with the Langmuir adsorption model. Inhibited and uninhibited metallic surfaces were subjected to surface morphological assessments using contact angle (CA), the scanning electron microscopy and the energy dispersive X-ray (SEM/EDX) analysis. The DMol3 part of Materials Studio 7.0 software was used to perform the quantum chemical calculations based on DFT to visualize the structural features. Studies from quantum chemistry suggest the possibility of surface interaction between the unoccupied orbitals of the metal surface and the inhibitors ChSB-1, ChSB-2, ChSB-1H+, and ChSB-2H+. The results clearly show that the two inhibitors work well as environmentally friendly carbon steel corrosion inhibitors in acidic medium. This could be advantageous for industrial procedures such as pickling, cleaning, acidizing oil drilling in oil wells, and using citrus to de-sediment boilers.

Large transethmoidal meningoencephalocele in a neonate involving three discrete defects in lamina cribriform: A case report.

Background: Intranasal meningoencephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyps or dermoid cysts. Transethmoidal meningoencephalocele is a rare congenital meningoencephalocele of the anterior skull base with diverse clinical presentation. The appropriate surgical intervention is chosen according to the meningoencephalocele type and location. Radiological examinations such as computed tomography and magnetic resonance imaging are helpful for the differential diagnosis of the encephalocele sac and localization of the cranial bone defect. Case Description: We are reporting a case of basal meningoencephalocele of the transethmoidal type, which was discovered in a 20-day-old boy presenting with cerebrospinal fluid rhinorrhea, respiratory distress, difficulty in feeding, and meningitis. The preoperative images showed a large herniated intranasal sac with bony discontinuity of the cribriform plate; however, three discrete defects of the cribriform plate with their related discrete herniated sacs were identified intraoperatively. Two staged surgeries were performed in succession: transcranial to separate the sacs from the cranial cavity and seal the anterior fossa floor, followed by transnasal to remove the remnant of the intranasal sacs. Patient symptoms and signs markedly improved after the surgeries. Conclusion: We highlight the need for urgent intervention at a very young age if the clinical presentation mandates, and also the importance of meticulous intraoperative identification of all bony and dural defects that might be missed in preoperative images to ensure complete repair and prevent recurrence.

Evaluation of Safety and Efficacy of Emicizumab Prophylaxis in Egyptian Pediatric Patients with Hemophilia A: Single Center Cross Sectional Study.

Purpose: Hemophilia A (HA) is an X-linked hereditary bleeding disorder caused by deficiency of coagulation factor VIII activity. Emicizumab is a bispecific monoclonal antibody that replaces the function of activated FVIII and prevents bleeds in patients with hemophilia A. Emicizumab is expected to reduce the risk of severe bleeds in those patients with their subsequent complications. However, data about its safety and efficacy in patients with hemophilia A is limited. We aimed to evaluate safety and efficacy of Emicizumab prophylaxis in Egyptian pediatric patients with HA. Methods: A prospective cohort study was conducted on 88 HA patient who received prophylaxis with Emicizumab. Breakthrough bleeding episodes as well as annualized bleeding rate(ABR) were reported for all patients before and after Emicizumab prophylaxis. All adverse events during prophylaxis were reported to evaluate the safety of Emicizumab. Results: Joint bleeds were present in 94 % of the patients. 58% of them had one target joint, 36.4% had more than one target joint while 5.6% had no target joints. 17% of patients were positive for FVIII inhibitors. The median annualized joint bleeding rate (AJBR) was reduced remarkably after Emicizumab prophylaxis (36 before versus zero after Emicizumab. Also, the median ABR was 48 before Emicizumab versus zero after Emicizumab. Eight patients developed mild breakthrough bleeding episodes. The most common adverse events were local reaction at the injection sites, headache, arthralgia, fever and diarrhea. Conclusion: Emicizumab prophylaxis was associated with significantly lower rate of bleeding events in patients with HA with and without inhibitors. The majority of patients had zero bleeds with Emicizumab prophylaxis.

Optimizing Cardiomyocyte Differentiation: Comparative Analysis of Bone Marrow and Adipose-Derived Mesenchymal Stem Cells in Rats Using 5-Azacytidine and Low-Dose FGF and IGF Treatment.

Mesenchymal stem cells (MSCs) exhibit multipotency, self-renewal, and immune-modulatory properties, making them promising in regenerative medicine, particularly in cardiovascular treatments. However, optimizing the MSC source and induction method of cardiac differentiation is challenging. This study compares the cardiomyogenic potential of bone marrow (BM)-MSCs and adipose-derived (AD)-MSCs using 5-Azacytidine (5-Aza) alone or combined with low doses of Fibroblast Growth Factor (FGF) and Insulin-like Growth Factor (IGF). BM-MSCs and AD-MSCs were differentiated using two protocols: 10 µmol 5-Aza alone and 10 µmol 5-Aza with 1 ng/mL FGF and 10 ng/mL IGF. Morphological, transcriptional, and translational analyses, along with cell viability assessments, were performed. Both the MSC types exhibited similar morphological changes; however, AD-MSCs achieved 70-80% confluence faster than BM-MSCs. Surface marker profiling confirmed CD29 and CD90 positivity and CD45 negativity. The differentiation protocols led to cell flattening and myotube formation, with earlier differentiation in AD-MSCs. The combined protocol reduced cell mortality in BM-MSCs and enhanced the expression of cardiac markers (MEF2c, Troponin I, GSK-3ß), particularly in BM-MSCs. Immunofluorescence confirmed cardiac-specific protein expression in all the treated groups. Both MSC types exhibited the expression of cardiac-specific markers indicative of cardiomyogenic differentiation, with the combined treatment showing superior efficiency for BM-MSCs.

Accuracy of oscillometric noninvasive blood pressure at the ankle in the lateral position during general anesthesia.

BACKGROUND: This study aimed to evaluate the accuracy of ankle blood pressure measurements in relation to invasive blood pressure in the lateral position. METHODS: This prospective observational study included adult patients scheduled for elective non-cardiac surgery under general anesthesia in the lateral position. Paired radial artery invasive and ankle noninvasive blood pressure readings were recorded in the lateral position using GE Carescape B650 monitor. The primary outcome was the ability of ankle mean arterial pressure (MAP) to detect hypotension (MAP < 70 mmHg) using area under the receiver operating characteristic curve (AUC) analysis. The secondary outcomes were the ability of ankle systolic blood pressure (SBP) to detect hypertension (SBP > 140 mmHg) as well as bias (invasive measurement - noninvasive measurement), and agreement between the two methods using the Bland-Altman analysis. RESULTS: We analyzed 415 paired readings from 30 patients. The AUC (95% confidence interval [CI]) of ankle MAP for detecting hypotension was 0.88 (0.83-0.93). An ankle MAP of ≤ 86 mmHg had negative and positive predictive values (95% CI) of 99 (97-100)% and 21 (15-29)%, respectively, for detecting hypotension. The AUC (95% CI) of ankle SBP to detect hypertension was 0.83 (0.79-0.86) with negative and positive predictive values (95% CI) of 95 (92-97)% and 36 (26-46)%, respectively, at a cutoff value of > 144 mmHg. The mean bias between the two methods was - 12 ± 17, 3 ± 12, and - 1 ± 11 mmHg for the SBP, diastolic blood pressure, and MAP, respectively. CONCLUSION: In patients under general anesthesia in the lateral position, ankle blood pressure measurements are not interchangeable with the corresponding invasive measurements. However, an ankle MAP > 86 mmHg can exclude hypotension with 99% accuracy, and an ankle SBP < 144 mmHg can exclude hypertension with 95% accuracy.

Spesolimab Reduces Inflammation in Generalized Pustular Psoriasis: Molecular Characterization of Flare Treatment in EFFISAYIL 1.

EFFISAYIL 1 was a randomized, placebo-controlled study of spesolimab, an anti-IL-36 receptor antibody, in patients presenting with a generalized pustular psoriasis flare. Treatment with spesolimab led to more rapid pustular and skin clearance versus treatment with placebo in approximately half of the patients. In this study, we present histologic, transcriptomic, and proteomic analyses of lesional and nonlesional skin and whole-blood samples collected from EFFISAYIL 1. Treatment with spesolimab led to a transition toward a nonlesional profile, with a downregulation of gene expressions in the skin of IL-36 transcripts (IL36α, IL36ß, IL36γ) and those associated with neutrophil recruitment (CXCL1, CXCL6, CXCL8), proinflammatory cytokines (IL6, IL19, IL20), and skin inflammation (DEFB4A, S100A7, S100A8). Changes were manifest at week 1 and sustained to week 8. At the systemic level, reductions in serum biomarkers of inflammation (IL-17, IL-8, IL-6) were sustained until 12 weeks after spesolimab treatment. Considerable overlap was observed in the spesolimab-induced changes in gene and protein expressions from skin and blood samples, demonstrating the molecular basis of the effects of spesolimab on controlling local and systemic inflammation. Data are consistent with the mode of action of spesolimab, whereby inhibition of the IL-36 pathway leads to subsequent reductions in the key local and systemic pathologic events associated with generalized pustular psoriasis flares.

Acute normovolemic hemodilution in cardiac surgery: rationale and design of a multicenter randomized trial

BACKGROUND: Minimizing the use of blood component can reduce known and unknown blood transfusion risks, preserve blood bank resources, and decrease healthcare costs. Red Blood Cell (RBC) transfusion is common after cardiac surgery and associated with adverse perioperative outcomes, including mortality. Acute normovolemic hemodilution (ANH) may reduce bleeding and the need for blood product transfusion after cardiac surgery. However, its blood-saving effect and impact on major outcomes remain uncertain. METHODS: This is a single-blinded, multinational, pragmatic, randomized controlled trial with a 1:1 allocation ratio conducted in Tertiary and University hospitals. The study is designed to enroll patients scheduled for elective cardiac surgery with planned cardiopulmonary bypass (CPB). Patients are randomized to receive ANH before CPB or the best available treatment without ANH. We identified an ANH volume of at least 650 mL as the critical threshold for clinically relevant benefits. Larger ANH volumes, however, are allowed and tailored to the patient's characteristics and clinical conditions. RESULTS: The primary outcome is the percentage of patients receiving RBCs transfusion from randomization until hospital discharge, which we hypothesize will be reduced from 35% to 28% with ANH. Secondary outcomes are all-cause 30-day mortality, acute kidney injury, bleeding complications, and ischemic complications. CONCLUSION: The trial is designed to determine whether ANH can safely reduce RBC transfusion after elective cardiac surgery with CPB. STUDY Registration: This trial was registered on ClinicalTrials.gov in April 2019 with the trial identification number NCT03913481.

Acute normovolemic hemodilution in cardiac surgery: Rationale and design of a multicenter randomized trial.

BACKGROUND: Minimizing the use of blood component can reduce known and unknown blood transfusion risks, preserve blood bank resources, and decrease healthcare costs. Red Blood Cell (RBC) transfusion is common after cardiac surgery and associated with adverse perioperative outcomes, including mortality. Acute normovolemic hemodilution (ANH) may reduce bleeding and the need for blood product transfusion after cardiac surgery. However, its blood-saving effect and impact on major outcomes remain uncertain. METHODS: This is a single-blinded, multinational, pragmatic, randomized controlled trial with a 1:1 allocation ratio conducted in Tertiary and University hospitals. The study is designed to enroll patients scheduled for elective cardiac surgery with planned cardiopulmonary bypass (CPB). Patients are randomized to receive ANH before CPB or the best available treatment without ANH. We identified an ANH volume of at least 650 ml as the critical threshold for clinically relevant benefits. Larger ANH volumes, however, are allowed and tailored to the patient's characteristics and clinical conditions. RESULTS: The primary outcome is the percentage of patients receiving RBCs transfusion from randomization until hospital discharge, which we hypothesize will be reduced from 35% to 28% with ANH. Secondary outcomes are all-cause 30-day mortality, acute kidney injury, bleeding complications, and ischemic complications. CONCLUSION: The trial is designed to determine whether ANH can safely reduce RBC transfusion after elective cardiac surgery with CPB. STUDY REGISTRATION: This trial was registered on ClinicalTrials.gov in April 2019 with the trial identification number NCT03913481.

Delayed Subaponeurotic Fluid Collection in a Neonate: A Case Report.

Delayed subaponeurotic fluid collection (DSFC) is a rare cause of scalp swelling that typically presents in healthy-term babies during the second month of life. It is a benign, self-limited condition that requires only conservative management. We present a case of DSFC in a male infant who was brought to our emergency department by his parents at the age of 52 days because of concerns about a newly noticed fluctuating scalp mass. The baby was managed conservatively, and the DSFC completely resolved after three weeks. We describe and discuss the diagnostic workup conducted and the management plan implemented in line with the scientific literature and similar cases previously reported. Given its benign but rare nature, pediatricians and neurosurgeons should be more aware of DSFC as a potential entity in the differential diagnosis of fluctuant scalp swellings. Early recognition can prevent unnecessary investigations or interventions and provide reassurance to parents regarding the condition's benign course. To the best of our knowledge, this is the first reported case in Saudi Arabia, the second reported case from the Middle East, and the second from Asia.

Durable graphene-based alkyd nanocomposites for surface coating applications.

Recently, the scientific community's main goal is the long-term sustainability. Vegetable oils are easily accessible, non-depletable, and cost-effective materials. Vegetable oils are used to prepare polymeric alkyd surfaces. Novel and exciting designs of alkyd/graphene nanocomposites have provided eco-friendly thermal stability and protective coating surfaces. This review has briefly described important graphene-based alkyd nanocomposites along with their applications as protective coatings. These alkyd composites have high hydrophobicity, corrosion resistance, and durability. Graphene-based alkyd nanocoatings have many industrial and research interests because of their exceptional thermal and chemical properties. This work introduces an advanced horizon for developing protective nanocomposite coatings. The anti-corrosion properties and coatings' longevity may be improved by combining the synergistic effects of hybrid nanofillers introduced in this work.

Pubourethral and uterosacral male analogues suggest parallel male/female pelvic anatomy and symptom pathogenesis.

The thesis that functional/dysfunctional male/female pelvic floor anatomy are parallel, originated from two studies: a successful retropubic perineal male sling for post-prostatectomy stress urinary incontinence (SUI) and discovery of a male uterosacral ligament (USL) analogue, we named "prostatosacral ligament" (PSL). In 25 out of the studied 27 males (92.6%), it starts on both sides of the median sulcus of the prostate the ligament passes lateral to the rectum being fused with the lateral margin of the mesorectum before leaving it as it thins out to be attached posteriorly similar to the USL. The ultrasound data during straining in men and women showed the same three oppositely acting muscle vectors contracting around analogous ligaments, puboprostatic ligament (PPL) (male), and pubourethral ligament (PUL) (female). Further parallels were pubovesical ligaments (PVLs) and arc of Gilvernet as part of the continence and micturition mechanisms. Impressive evidence for parallel anatomy came from the successful cure of 22 males with post-prostatectomy SUI using a perineal retropubic tissue fixation system (TFS) minisling applied to the PPL using a similar methodology to that used in the female for PUL midurethral sling repair for cure of SUI. Laparoscopic evidence confirmed the prostate as a male analogue of the cervix, and PSLs as analogues of USLs: PSL origin from the prostate attached laterally to the mesorectum and inserted into the sacrum. Histologically, PSLs had identical features with USLs: collagen, elastin, smooth muscle, blood vessels and nerves. Virtually identical symptoms for "chronic prostatitis" (CP) and "posterior fornix syndrome" (PFS), such as chronic pelvic pain, overactive bladder (OAB), abnormal emptying, gave birth to the hypothesis, of a common pathogenesis for "CP" and "PFS", USL (or PSL) laxity. If this could be proven by "simulated operations", "CP", at least in theory, may be potentially correctible by PSL repair.

A brief physiology and pathophysiology of the anorectum based on the Integral Theory paradigm.

The remit of this review is confined to the experimental scientific works and surgeries based on the Integral Theory paradigm. The video abstract summarizes the anorectal function, how ligaments cause dysfunction and cure of fecal incontinence and obstructed defecation by ligament repair. Anorectal function is reflex and binary, with cortical and peripheral components. The same three oppositely acting reflex muscle forces which open and close the bladder, contract against the pubourethral (PUL) and uterosacral (USL) ligaments: (I) to close the anorectum for continence when the puborectalis muscle (PRM) contracts forwards; (II) to open the anorectum prior to evacuation when the PRM relaxes; (III) to stretch the rectum in opposite directions to support the anorectal stretch receptors "N" to prevent premature activation of the defecation reflex, (fecal urgency). Weak or loose PULs or USLs may cause dysfunction of closure, of evacuation, and inability to control the defecation reflex (fecal urgency). Repair of the PUL and USL can improve or cure these dysfunctions. The perineal body (PB) acts as an anatomical support for the distal vagina, anorectum and external anal sphincter (EAS). It serves as an anchoring point for the forward action of the pubococcygeus muscle (PCM), which tensions the anterior rectal wall during closure and defecation. Bladder and bowel dysfunction have a similar pathogenesis, ligament laxity, mainly pubourethral and uterosacral, with added PB damage for anorectal dysfunction. PB damage can cause obstructive defecation and descending perineal syndrome (DPS). Repair of damaged PUL and USL can restore the closure and evacuation functions of both bladder an anorectum. DPS can be cured by repair of the PB's suspensory ligaments, deep transversus perinei.

Antimicrobial resistance of Pseudomonas aeruginosa: navigating clinical impacts, current resistance trends, and innovations in breaking therapies.

Pseudomonas aeruginosa, a Gram-negative bacterium, is recognized for its adaptability and opportunistic nature. It poses a substantial challenge in clinical settings due to its complicated antibiotic resistance mechanisms, biofilm formation, and capacity for persistent infections in both animal and human hosts. Recent studies revealed a potential zoonotic transmission of P. aeruginosa between animals, the environment, and human populations which highlights awareness of this microbe. Implementation of the One Health approach, which underscores the connection between human, animal, and environmental health, we aim to offer a comprehensive perspective on the current landscape of P. aeruginosa management. This review presents innovative strategies designed to counteract P. aeruginosa infections. Traditional antibiotics, while effective in many cases, are increasingly compromised by the development of multidrug-resistant strains. Non-antibiotic avenues, such as quorum sensing inhibition, phage therapy, and nanoparticle-based treatments, are emerging as promising alternatives. However, their clinical application encounters obstacles like cost, side effects, and safety concerns. Effectively addressing P. aeruginosa infections necessitates persistent research efforts, advancements in clinical development, and a comprehension of host-pathogen interactions to deal with this resilient pathogen.

Exploring sleep heart rate variability: linear, nonlinear, and circadian rhythm perspectives.

Background: Heart rate variability (HRV) is believed to possess the potential for disease detection. However, early identification of heart disease remains challenging, as HRV analysis in dogs primarily reflects the advanced stages of the disease. Hypothesis/objective: The aim of this study is to compare 24-h HRV with sleep HRV to assess the potential utility of sleep HRV analysis. Animals: Thirty healthy dogs with no echocardiographic abnormalities were included in the study, comprising 23 females and 7 males ranging in age from 2 months to 8 years (mean [standard deviation], 1.4 [1.6]). Methods: This study employed a cross-sectional study. 24-h HRV and sleep HRV were measured from 48-h Holter recordings. Both linear analysis, a traditional method of heart rate variability analysis, and nonlinear analysis, a novel approach, were conducted. Additionally, circadian rhythm parameters were assessed. Results: In frequency analysis of linear analysis, the parasympathetic index nHF was significantly higher during sleep compared to the mean 24-h period (mean sleep HRV [standard deviation] vs. mean 24 h [standard deviation], 95% confidence interval, p value, r-family: 0.24 [0.057] vs. 0.23 [0.045], 0.006-0.031, p = 0.005, r = 0.49). Regarding time domain analysis, the parasympathetic indices SDNN and RMSSD were also significantly higher during sleep (SDNN: 179.7 [66.9] vs. 156.6 [53.2], 14.5-31.7, p < 0.001, r = 0.71 RMSSD: 187.0 [74.0] vs. 165.4 [62.2], 13.2-30.0, p < 0.001, r = 0.70). In a geometric method of nonlinear analysis, the parasympathetic indices SD1 and SD2 showed significantly higher values during sleep (SD1: 132.4 [52.4] vs. 117.1 [44.0], 9.3-21.1, p < 0.001, r = 0.70 SD2: 215.0 [80.5] vs. 185.9 [62.0], 17.6-40.6, p < 0.001, r = 0.69). Furthermore, the circadian rhythm items of the parasympathetic indices SDNN, RMSSD, SD1, and SD2 exhibited positive peaks during sleep. Conclusion: The findings suggest that focusing on HRV during sleep can provide a more accurate representation of parasympathetic activity, as it captures the peak circadian rhythm items.

Primary Calvarial Lymphoma: A Case Report.

Calvarial lymphoma is radiologically similar in many respects to meningiomas, solid fibrous tumours, osteomyelitis, and metastatic carcinomas. Even though it is an extremely rare phenomenon, the initial suspicion and detection of calvarial lymphoma are paramount to establishing a correct diagnosis which helps to determine an appropriate management strategy. We present an illustrative rare case of primary calvarial lymphoma along with a literature review focusing on the best management strategy for this rare entity. A 45-year-old female presented to our center in March 2022. She had a history of forehead swelling, which was progressively increasing in size over time. The metastatic workup and bone marrow biopsy were negative. Initially, extensive surgery was planned to resect the lesion, but after a discussion with the multidisciplinary team, a biopsy of the lesion was taken, which revealed a large B-cell lymphoma. It is prudent to consider calvarial lymphoma in the differential diagnosis of a progressively growing skull lesion, which may obviate the need for large resective surgery. A biopsy plus chemoradiation may be all that is required.

A case report of an unusual cerebral hydatid cyst.

Background: Intracranial hydatid cyst is an exceedingly uncommon condition. Typically, it manifests as hydatid cysts in the liver, lungs, kidney, and spleen. In this report, we present a rare case of a hydatid cyst located in the brain, exhibiting atypical radiological characteristics, and successfully treated with complete microsurgical excision. Case Description: A 45-year-old male, a former smoker, presented with a new-onset seizure. Brain imaging revealed a solitary, intra-axial, and cystic lesion with wall enhancement in the right temporal region. The cyst extended into the temporal horn of the right lateral ventricle, surrounded by mild edema. Differential diagnoses included brain metastasis, abscess, and tuberculoma. However, following computed tomography (CT) scans of the chest, abdomen, and pelvis (CAP) and serological tests, the provisional diagnosis included a hydatid cyst. The CT CAP showed diffuse non-specific cystic lesions of variable sizes in the liver and spleen, along with numerous bilateral pulmonary cysts. A right temporal craniotomy was performed, and the cyst was microsurgically excised without rupture. Microscopic and histopathological examination confirmed the presence of a hydatid cyst. Conclusion: Intracranial hydatid cyst is an extremely rare condition and should always be considered a possible differential diagnosis in cases of cerebral cystic lesions. Hydrodissection is the preferred surgical method for resection; however, in atypical cases such as the one described here, meticulous dissection of the cyst capsule from the brain parenchyma may be successful with minimal risk of intraoperative rupture.

The Financial Impact of COVID on Radiology Health Systems.

The coronavirus pandemic of 2019 (COVID-19) was arguably the most pivotal global event that current generations have witnessed, with unprecedented global challenges, and colossal effects on health systems. The financial consequences, in particular, were profound and far-reaching. Staggering estimates of up to $50.7 billion dollars per month in lost revenue for the US health system were reported by the American Hospital Association (Kaye et al., 2021). The pandemic caused significant increases in cost of drugs, disruptions to medical supply chains, day-to-day workflow, and operations in all areas of medicine and various healthcare systems. Radiology experienced a significant burden of the damage, finding itself at the forefront of the pandemic's economic fallout (American Hospital Association).

Effects of pubic hair grooming on women's sexual health: a systematic review and meta-analysis.

BACKGROUND: Pubic hair grooming involves the partial or complete removal of pubic hair, and it is a common practice among men and women. Grooming is more prevalent in women, who employ various methods such as shaving, waxing and laser removal. However, it is associated with variable rates of post-grooming adverse outcomes including lacerations and sexually transmitted infections (STIs). To the best of our knowledge, this is the first systematic review and meta-analysis comparing women's sexual health outcomes between those who groom and those who don't. METHODS: We followed the MOOSE guidelines and conducted a computerized-based search using (PubMed, Web of Science, Scopus, and Ovid Medline), till June 20th, 2022, for eligible studies using the relevant keywords; (pubic hair grooming) OR (pubic hair removal OR Genital hairless OR Bikini hair removal OR pubic hair depilation). Cross-sectional studies included which compared grooming practices among women in terms of motivation and health outcomes. Women's satisfaction and incidence of STIs were pooled as standardized mean difference (SMD) and odds ratio (OR) respectively. RESULTS: Twenty-Two cross-sectional studies were included in our review with 73,091 participant.The odds of having gram-negative gonorrheal and chlamydial infection in Pubic hair groomers were found to be statistically significant (OR = 1.55, 95% CI [1.31, 1.84], P < 0.001) (OR = 1.56, 95% CI [1.32, 1.85], P < 0.001] respectively. There was no difference between groomer and non-groomer women regarding viral infections such as genital herpes (OR = 1.40, 95% CI [0.56, 3.50], P = 0.47) and Condyloma acuminata (OR = 1.75, 95% CI [0.51, 6.01], P = 0.37). The most common grooming side effect is genital itching (prevalence = 26.9%, P < 0.001). Non-electrical razor (prevalence = 69.3%, P < 0.001) is the most common grooming method. White women (prevalence = 80.2%, P < 0.001) remove pubic hair more frequently compared to black women (prevalence = 12.2%, P < 0.001). Women practice complete grooming (50.3%, P < 0.001) of the pubic hair more frequently than partial grooming (33.1%, P < 0.001). There are no differences in women's satisfaction between the two groups (SMD = 0.12, 95% CI [-0.16, 0.40], P = 0.39). CONCLUSION: This review aligns with previous observational studies regarding sexual health outcomes of pubic hair grooming. There is a need to raise awareness among women regarding the safe practice of pubic hair grooming, emphasizing the clarification of hazards and benefits.

The Impact of COVID on Health Systems: The Workforce and Telemedicine Perspective.

The COVID-19 pandemic significantly strained global health systems, leading to the rapid adoption of telemedicine and changes in workforce management. Previously underused, telemedicine became an essential means of delivering healthcare while adhering to physical distancing guidelines. This transition addressed longstanding barriers like connectivity issues. Simultaneously, the radiology sector innovated by widely implementing remote reading stations, which helped manage exposure risks and conserve human resources. Moreover, the pandemic highlighted the critical role of technological advancements beyond telemedicine, such as the accelerated integration of AI in diagnostics and management. This article examines these comprehensive effects, emphasizing the remote work adaptations and innovations in healthcare systems that have reshaped both healthcare delivery and workforce dynamics during the pandemic.