Search Results (2,620)

Suicide is a major public health concern worldwide, and identifying the spatial patterns associated with its occurrence is essential for designing effective preventive strategies. This study aimed to identify and characterize suicide locations in two provinces of Castilla-La Mancha, Spain, using a descriptive and retrospective analysis of 421 cases recorded by the Institutes of Legal Medicine and Forensic Sciences of Toledo and Albacete between 2020 and 2024. Locations were classified as critical or non-critical based on recurrence and public accessibility, and logistic regression was used to explore predictors of suicide in public settings. Results showed that 82% of cases involved men, yielding a 5:1 male-to-female ratio that exceeds the national average; the mean age was 56.6 years, and hanging was the most frequent method (56.1%). Most suicides occurred in private environments, and only one location met the criteria for a critical site. These findings indicate that spatial clustering plays a minimal role in the regional suicide burden and that prevention efforts should prioritize means restriction and early detection in private settings, along with broader measures for dispersed public cases rather than hotspot-focused interventions. The study underscores the importance of systematically incorporating spatial information into forensic records to improve regional suicide surveillance and inform more targeted, context-sensitive prevention policies. Full article

Background/Aim: This systematic review and meta-analysis aimed to evaluate the clinical efficacy of oxygen-based adjunct therapies in patients with periodontitis, including ozone therapy, hyperbaric oxygen therapy, and local oxygen delivery, as adjuncts to subgingival instrumentation. These interventions have been proposed to counteract tissue hypoxia and inflammation, which sustain an environment favorable to anaerobic pathogens in periodontitis. Methods: An electronic search was conducted in MEDLINE PubMed, the Cochrane Library, the Cochrane Central Register of Controlled Trials, and SciELO. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2. Standardized mean difference was calculated for gains in clinical attachment level, and a random effects model was applied due to high variability. Results: The meta-analysis of adjunct ozone therapies presented a pooled standardized mean difference of 0.53 (95% CI [−0.14, 1.19]), indicating a clinically relevant medium effect in favor of ozone therapies, though this effect was not statistically significant and substantial heterogeneity was observed (I² = 70%, p < 0.01). Meta-analysis was restricted to adjunct ozone therapies due to the limited availability of qualifying studies for hyperbaric oxygen therapy and local oxygen therapies. Conclusions: While the medium effect size in favor of ozone therapies could be clinically relevant, the statistical non-significance underscores the need for more evidence before widespread adoption. Individual studies reported significant benefits for adjunct HBOT and ozonated olive oil, but comparison between oxygen delivery modes was not possible due to heterogeneous protocols. Full article

Background/Objectives: Feeding difficulties are more common in children with autism spectrum disorder (ASD) or other developmental conditions and are associated with nutritional risk and caregiver stress. However, they may be overlooked as growth tends to be preserved. We aimed to identify clinical and behavioral features associated with feeding difficulties among children with developmental conditions. Methods: This cross-sectional study included caregiver–child dyads, with children aged 1–7 years with ASD and other developmental conditions. Caregivers completed the Repetitive Behavior Questionnaire, Second Edition (RBQ-2) to assess child restricted and repetitive behaviors (RRBs) and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) to assess feeding difficulties. Demographics, anthropometric measures and cognitive and adaptive scores were retrieved from medical records. Results: Of the 132 participants (mean age 41.8 months, range 15–67; 74.2% male) included, majority had normal weight (87.7%) and height (89.2%) z scores. Among participants, 54.5% had autism, 26.5% language delay and 18.9% other developmental diagnoses. Over half (53.0%) had elevated BPFAS scores. Children not enrolled in school showed significantly more feeding difficulties compared to those who were enrolled (32.6% vs. 16.7%, p < 0.05). The RBQ-2 total score positively correlated with the BPFAS total frequency score (r = 0.33, p = 0.01) after adjusting for gender, age and developmental diagnosis. Conclusions: Feeding difficulties were common in this sample. Higher RRBs and absence of formal schooling were associated with higher rates of feeding difficulties. Longitudinal studies are needed to ascertain the role of RRBs and school enrollment as clinical indicators associated with feeding difficulties. Full article

Background/Objectives: Augmented Reality (AR) is promising in dental education, yet its impact on caries detection training remains underexplored. This study aimed to compare the effect of a web-based AR (WebAR) learning object with a content- and interface-matched interactive 2D presentation on undergraduate students’ motivation to learn caries detection. Methods: Two learning objects were expressly designed using a real patient’s dental records: a WebAR image-tracking experience (built with Zapworks Studio^®) and a 2D interactive presentation (built with Genially^®). The WebAR object showed the patient’s 3D dental arches with tooth-level hotspots linking clinical and radiographic media. The 2D comparator mirrored the same assets and navigation, restricting visualization to 2D. Third-year dental students were randomly assigned to either the AR or Genially^® (G) group. After completing ICDAS-based caries identification, participants completed the 12-item Reduced Instructional Materials Motivation Survey (RIMMS) and provided open-ended feedback. Group differences were tested with the Mann–Whitney U test (p < 0.05). Results: Eighty-five students completed the study (AR n = 46; G n = 39). The AR group achieved a higher total RIMMS score (4.14 vs. 3.53 on a 5-point scale; p < 0.001), with significantly higher means in Attention, Confidence, Satisfaction, and Relevance (p < 0.05). Open-ended comments were more positive with AR (75.8% vs. 31.0%), while graphics-related complaints were more frequent with the Genially^® resource (34.5% vs. 75.0%). Conclusions: WebAR achieved higher RIMMS motivation scores than a content-matched interactive presentation. Adding 3D spatial interaction to otherwise equivalent materials can enhance learners’ motivation for caries detection training, while remaining low-cost and scalable. Full article

Background/Objectives: Measuring cardiac output (CO) is essential for diagnosis and therapeutic monitoring in pulmonary hypertension (PH). CO assessment based on thermodilution (TD) or Direct Fick (DF) during standard right heart catheterization (RHC) is impractical for regular follow-up. We evaluated the accuracy and agreement of non-invasive Modelflow (MF)-based CO assessment compared with TD and DF during rest and exercise RHC in PH. Methods: This post hoc analysis from a crossover RCT included 24 PH patients (7 females, 59 ± 14 years; mean pulmonary artery pressure 37 ± 11 mmHg) who underwent RHC with repetitive CO assessments at rest and during exercise. CO was measured by TD, DF, and non-invasive MF by fingertip pulse contour analysis at rest and during stepwise cycling to maximal exertion. Results: At rest, mean CO was comparable between methods: TD = 6.05 ± 1.80 L/min, DF = 5.68 ± 1.88 L/min, MF = 6.09 ± 1.84 L/min. At end-exercise, CO increased to TD = 11.18 ± 4.38 L/min, DF = 11.84 ± 4.74 L/min, MF = 8.38 ± 2.93 L/min. Bland–Altman showed minimal bias at rest (MF vs. TD: 0.04 L/min; MF vs. DF: −0.07 L/min) but substantial variability during exercise, with underestimation of CO by MF with increasing workloads (MF vs. TD bias = −2.80 L/min; MF vs. DF bias = −4.38 L/min). Limits of agreement were wide across all workloads. Linear regression confirmed an increasing CO with workload, but MF slope was shallower than TD/DF, suggesting proportional bias. Taffé analysis identified a significant differential (5.847) and proportional bias (0.195) indicative of CO overestimation by MF at low CO and underestimation at high CO. Conclusions: MF group-level agreement is acceptable, but individual-level accuracy is limited, indicating that MF may be suitable for trend monitoring but its applicability for clinical decision-making is restricted, especially during exercise. Full article

Background: Obesity is a risk factor for breast cancer mortality in postmenopausal women. However, it remains unclear which specific components of adipose tissue and skeletal muscle are associated with risk. This study assessed the associations between MRI-assessed adiposity, skeletal mass, and breast cancer risk in a population-based cohort. Methods: We analyzed data from 15,669 postmenopausal women in the UK Biobank who underwent MRI for body composition assessment. Age- and multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional-hazards regression to evaluate the associations between body composition and breast cancer risk, adjusting for relevant confounders. Sensitivity analyses were conducted by excluding breast cancer cases diagnosed within 2 years of the MRI scan. To explore nonlinear relationships, we applied restricted cubic splines with three knots to model associations between visceral adipose tissue (VAT), muscle-fat infiltration (MFI), and breast cancer risk. Results: The mean age of participants was 58.6 years (SD = 5.2; range = 40–69). Higher VAT was significantly associated with increased breast cancer risk (3rd vs. 1st tertile aHR = 1.24, 95% CI: 1.10–1.45). Elevated MFI was also linked with greater risk (3rd vs. 1st tertile aHR = 1.53, 95% CI: 1.25–1.87). These associations persisted after excluding early cancer cases. We observed a J-shaped relationship between VAT, MFI, and breast cancer risk. Conclusions: Higher levels of VAT and MFI are associated with elevated breast cancer risk in postmenopausal women, suggesting that imaging-derived body composition measures may enhance risk prediction and inform prevention strategies. Full article

Foot-and-mouth disease virus (FMDV) serotype SAT3 is a rarely studied serotype primarily circulating in southern Africa, with African buffalo (Syncerus caffer) serving as its key reservoir. In this study, we performed a comprehensive phylogenetic and phylodynamic analysis of SAT3 based on 81 full-length VP1 gene sequences collected between 1934 and 2018. Maximum likelihood and Bayesian analyses revealed five distinct topotypes, each with clear geographic and host associations. Notably, topotypes I, II and III were observed in both African buffalo and cattle (Bos taurus), while topotype IV appeared restricted to African buffalo. Likelihood mapping indicated moderate to strong phylogenetic signal, and the mean substitution rate was estimated at 3.709 × 10⁻³ substitutions/site/year under a relaxed molecular clock. The time to the most recent common ancestor (TMRCA) was traced back to 1875. Discrete phylogeographic reconstruction identified Zimbabwe as a major center, with multiple supported cross-border transmission routes. Host transition analysis further confirmed strong directional flow from buffalo to cattle (BF = 1631.09, pp = 1.0), highlighting the wildlife–livestock interface as a key driver of SAT3 persistence. Together, these results underscore the evolutionary complexity of SAT3 and the importance of integrating molecular epidemiology, spatial modeling, and host ecology to inform FMD control strategies in endemic regions. Full article

Background: Crowned dens syndrome (CDS) is characterized by acute neck pain and restricted motion due to calcium pyrophosphate (CPP) crystal deposition around the atlantoaxial joint. Although recognized as sufficient for the diagnosis of CPP deposition disease (CPPD), its prevalence remains uncertain. Given the high prevalence of CPPD in the general population, CDS may be more common than currently appreciated among patients with neck pain undergoing cervical spine imaging. Methods: This retrospective study included patients aged ≥40 years who underwent cervical spine CT for evaluation of neck pain between 2022 and 2024. Of 500 consecutive scans, 195 were eligible after excluding trauma-related, post-operative, and metastatic cases. Results: Periodontoid calcifications were identified in 29.2% of patients (mean age 61.5 ± 11.7 years; 37.4% male). Prevalence increased significantly with age (p < 0.001), reaching nearly 50% in those over 70 years. Linear calcifications were rare before 60 years (1.2%) but present in 24.5% of patients over 70. Calcifications were mentioned in only 3.5% of radiology reports. Conclusions: Periodontoid calcifications are relatively common in patients with neck pain, affecting nearly one-third of individuals over 40 and almost half of those over 70. Their frequent underreporting highlights a critical gap in recognition. Greater awareness and systematic reporting are warranted, as CDS may represent a common, underdiagnosed, and treatable cause of neck pain. Full article

Background: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The review was registered with PROSPERO, and a comprehensive electronic search was undertaken without language or date restrictions. Randomised and non-randomised trials and prospective cohort and cross-sectional studies along with case series were included. The Cochrane Collaboration’s Risk of Bias 2 Tool, Newcastle–Ottawa Scale and The Risk Of Bias In Non-Randomized Studies—of Interventions tools were used to assess quality. Data were grouped in terms of oral health-related quality of life, pain side effects and/or other complications. Results: Data from 35 studies were included; 9 were eligible for meta-analysis. Thus 2611 participants were included related to removable aligners (n = 513), fixed labial (n = 1816) and lingual (n = 218) appliances or a combination (n = 64) of appliances. The standardised mean differences in visual analogue scale pain reports between 24 h and 7 days were −10.02 (95% CI: −11.13, −8.91) for aligners and −6.40 (95%CI: −10.42, −2.38) for labial appliances (p = 0.09). There was a significant improvement in dental self-confidence following fixed labial appliance treatment (p = 0.001). Conclusions: No difference was detected in short-term pain with aligners and labial appliances. Aligners may have less impact on oral health-related quality of life measures compared to labial appliances. Lingual appliances have a persistent impact on speech, despite some adaptability. Any deterioration in oral health-related quality of life measures during treatment appears temporary. Further randomised trials using validated assessment tools and comparing aligners and labial and lingual appliances are required. Full article

Background: Interleukin-6 (IL-6) is a key inflammatory cytokine implicated in atherosclerotic plaque progression and carotid vulnerability. Although elevated IL-6 levels have been linked to cerebrovascular risk, its prognostic value in patients undergoing carotid endarterectomy (CEA) remains undefined. This systematic review aimed to investigate the available evidence on the relationship between IL-6 levels, surgical outcomes and mechanistic evidence in CEA patients. Materials and Methods: The review followed the PRISMA statement and AMSTAR-2 critical appraisal guidelines, with the protocol registered on PROSPERO (CRD420251120023). PubMed/MEDLINE, Scopus, and Web of Science were systematically searched up to July 2025 using the terms “interleukin-6” and “carotid endarterectomy”. Original studies in humans assessing IL-6 in relation to clinical outcomes after CEA or mechanistic evidence were included without language or date restrictions. Study quality was evaluated using the Cochrane Risk of Bias 2 and NHLBI tools, and evidence certainty was appraised using the GRADE framework. Given the heterogeneity of studies, only a qualitative synthesis was performed. Results: From 1232 records identified, 13 studies encompassing 1396 patients met the inclusion criteria. Most were prospective observational cohorts, with a mean participant age of 68.52 years and 81.16% male predominance. Perioperative stroke and mortality rates were uniformly low (≤2%), consistent with contemporary registry data. Across studies, elevated IL-6 levels—whether systemic or plaque-derived—were consistently associated with symptomatic carotid disease, plaque vulnerability, and adverse long-term outcomes. However, not all studies presented quantitative data on IL-6 levels, limiting the ability to draw definitive prognostic conclusions. Conclusions: Current evidence supports a mechanistic link between IL-6–mediated inflammation and carotid plaque instability, yet robust clinical validation in surgical populations is lacking. Future large-scale, prospective studies incorporating IL-6 measurement are warranted to establish its prognostic utility, guide anti-inflammatory therapeutic strategies, and refine postoperative risk stratification in patients undergoing CEA. Full article

Background/Objectives: This study explored the epidemiology of Status Epilepticus (SE) in Kazakhstan. Methods: Utilizing data from the National Health System from 2014 to 2023, we investigated the age-standardized incidence rate (ASIR) of SE. The authors employed restricted mean survival time (RMST) models to evaluate how sex, older age, epilepsy, history of cerebrovascular diseases (CVD), central nervous system (CNS) infections, brain tumors, and cancer affected survival during 30 days through the fifth year following hospital admission for SE. Results: This study included 14,010 patients. The ASIR per 100,000 increased threefold, from 4.15 (95% CI: 3.85; 4.46) in 2014 to 12.12 (95% CI: 11.64; 17.59) in 2023, with a sharp increase during the COVID-19 pandemic. The 30-day and 5-year mortality were 2.10% and 8.85%, respectively. The RMST identified that all-cause mortality was driven by elderly age, brain tumors, and cancer, where the difference in survival increased from one day at baseline to over a year by the fifth year. The effects of CVD, CNS infections, and sex on survival were substantially lower. However, epilepsy was associated with a better prognosis. Conclusions: We observed an incremental increase in the SE incidence over a decade. Our findings warrant actions to resolve issues related to rescue medicines to improve SE outcomes in both country and region. It may be a priority for elderly patients and those with systemic tumors. Further research is needed to understand the role of epilepsy in SE epidemiology, with emphasis on design-related biases. Full article

Background and Objectives: To evaluate whether regional climatic factors, particularly relative humidity (RH) and temperature, are associated with geographic variation in dry eye disease (DED) prevalence in Argentina. Materials and Methods: A secondary analysis of a nationwide voluntary online cross-sectional survey of DED in Argentina (April 2022; non-probability sample; n = 10,812) was performed. Participants were assigned to one of five standard geopolitical regions. DED prevalence (%) was estimated at regional levels. Monthly mean, maximum, and minimum temperature and RH for April 2022 were obtained from the National Meteorological Service; for each province/region, data corresponded to the principal synoptic station in the provincial capital. Because the survey and climate data were restricted to April, seasonal effects could not be evaluated. Region-level analyses of climate–DED patterns were prespecified as exploratory and descriptive given the small number of regional units (n = 5). Weighted descriptive models were used to compare RH–DED patterns while accounting for regional age and sex distributions. Results: Regional DED prevalence ranged from 37.7% (Northwest) to 49.8% (Cuyo). RH showed a clear inverse pattern with regional DED prevalence, whereas temperature showed no consistent relationship. Weighted descriptive models showed a similar qualitative RH–DED pattern, although residual confounding cannot be excluded. Conclusions: DED prevalence in Argentina shows geographic variability and a descriptive inverse pattern with ambient RH. These ecological findings are hypothesis-generating and must be interpreted cautiously due to sampling bias. Future seasonal, longitudinal, or individual-level studies are needed to confirm and quantify these preliminary signals. Full article

Traditional geological mapping is often time-consuming, labor-intensive, and restricted by rugged terrain. This study addresses these challenges by proposing a novel methodology for automated lithological identification in the Ququleke area of the eastern Kunlun Mountains, which pioneers the integration of portable UAV oblique photogrammetry with a Coordinate Attention-enhanced DeepLabV3+ (CA-DeepLabV3+) semantic segmentation framework for geological mapping. Using a DJI Mavic 3M quadcopter, high-resolution oblique photogrammetric orthophotos were captured to build a pixel-level lithology dataset containing four classes: sandstone, diorite, marble, and Quaternary sediments. The CA-DeepLabV3+ model, adapted from the DeepLabV3+ encoder–decoder framework, integrates a lightweight MobileNetV2 backbone and a Coordinate Attention mechanism to strengthen spatial position encoding and fine-scale feature extraction, crucial for detailed lithological discrimination. Experimental evaluation demonstrates that the proposed model achieves an overall accuracy of 97.95%, mean accuracy of 97.80%, and mean intersection over union of 95.71%, representing a 5.48% improvement in mean intersection over union (mIoU) over the standard DeepLabV3+. These results indicate that combining UAV oblique photogrammetry with the CA-DeepLabV3+ network enables accurate lithological mapping in complex terrains. The proposed method provides an efficient and scalable solution for geological mapping and mineral resource exploration, highlighting the potential of low-altitude UAV remote sensing for field-based geological investigations. Full article

Background: Syphilis can present with diverse clinical manifestations, earning the name “great imitator.” Malignant syphilis (MS) is a rare, severe form of secondary syphilis, typically reported in immunocompromised patients, particularly those living with HIV. However, MS can occasionally occur in immunocompetent individuals, posing diagnostic challenges due to its atypical presentation. Methods: A case report is presented alongside a PubMed literature search using the terms “(malignant syphilis OR lues maligna) AND (immunocompetent) AND (case report OR case series).” No language or temporal restrictions were applied, yielding 18 relevant publications. Results: A 60-year-old HIV-negative man presented with fever, weight loss, papular lesions, and a single ulcer on the sternum. Serology was positive for syphilis, and PCR confirmed T. pallidum DNA in the lesion. Treatment with a single intramuscular dose of benzathine penicillin G led to prompt clinical and serological improvement. Literature review (n = 18) showed that MS in immunocompetent patients affects both sexes (55% male; mean age 37.1 years), often presents with ulceronodular or rupioid crusted lesions, and frequently involves systemic symptoms. Molecular diagnostics were rarely reported, with most diagnoses relying on histopathology and serology. Treatment with benzathine penicillin G was effective in all cases, and full recovery was achieved. Conclusions: MS can occur in immunocompetent, HIV-negative individuals without obvious risk factors. Clinicians should maintain a high index of suspicion in cases of systemic, cutaneous, or ocular manifestations suggestive of MS. Molecular assays can facilitate diagnosis and prevent unnecessary invasive procedures. Benzathine penicillin G remains the treatment of choice, demonstrating high therapeutic effectiveness. MS should be considered in the differential diagnosis of ulcerative or nodular dermatoses, regardless of immune status. Full article

Background/Objectives: The primary outcome of a 12-week randomized controlled trial studying the effects of continuous high-soy-protein (HSP) soymilk consumption in Japanese frail and pre-frail elderly individuals has previously been reported. The authors of this post hoc study aimed to conduct a statistical analysis focusing on changes in the skeletal muscle index (SMI) and evaluate the effect of HSP soymilk intake on appendicular skeletal muscle mass (ASM). Methods: A full analysis of all subjects (n = 68, HSP group: n = 34, control group: n = 34) and a subgroup analysis of only pre-frail elderly individuals (n = 58, HSP group: n = 29, control group: n = 29) were performed. The following nine subgroup analyses were conducted: frailty phenotype, basal metabolic rate, walking speed, step counts, total energy expenditure (TEE), total energy intake (TEI), estimated protein intake, age, and sex. Results: In the overall analysis (primary combined cohort), the SMI showed no significant change between the HSP and control soymilk groups (p = 0.18); however, a significant difference in the change in the SMI between the HSP and control groups was revealed for pre-frail elderly subjects (mean difference in SMI change: 0.08 kg/m² [95% CI 0.004, 0.15], p = 0.044). Furthermore, in four distinct subgroups restricted to the pre-frail elderly individuals—step counts (≥5000 steps/day), TEE (≥30 kcal/kg BW/day), TEI (≥30 kcal/kg BW/day), and male sex—the HSP group also showed significant differences in SMI change. Conclusions: In this study, no significant improvement in the SMI was observed across all subjects (frail and pre-frail elderly individuals); however, an exploratory subgroup analysis suggested that continued daily HSP soymilk intake was associated with potential benefits in pre-frail elderly individuals with high physical activity and energy intake levels. These findings are preliminary and require further research. Full article