Objectives: Obesity is regarded as one of the most prominent health threats worldwide and a serious risk factor for non-communicable diseases, such as diabetes mellitus type 2, high blood pressure, cardiovascular diseases, and some types of cancer. Given the role that societal development—as reflected by the Human Development Index (HDI)—may play in the prevalence of obesity and overweight, this study aimed to investigate the degree to which the prevalence of obesity and overweight is affected by HDI and its components. Methods: In this ecological study, the required data on HDI and its components were gathered from the latest report of the United Nations Development Program, and data on obesity and overweight were acquired from the latest reports published on the World Health Organization website. Statistical analyses were conducted using SPSS version 24.0. Results: The prevalence of obesity was determined to be significantly higher among females than males, and the gross national index per capita was found to be significantly higher for males than females (p<0.05). Significant positive correlations were found between HDI and its components and sex, as well as indices of obesity and overweight. Conclusions A significant positive correlation exists between HDI and obesity. As policy-makers attempt to improve the general welfare of the people, they should be aware of potential unwanted effects of development on the risk of obesity and overweight among the population.

Background: Nasal sill is one of the components of the alar ring, affecting the esthetic outcomes of rhinoplasty; accordingly, we developed a novel technique to adjust defects in this area and compared it with the available techniques. Methods: Our technique was based on creating a tunnel access to the nasal sill area through an incision made in the lower third of the columella using the open approach or through a nostril base incision in patients, who underwent alar base reduction, followed by insertion of a cartilaginous graft into the marked defect area. Results: A total number of 54 patients with a defect in the nasal sill area were included in this study. Thirtyone patients underwent open rhinoplasty with the sill approach from the lower third of the columella, while 23 patients underwent rhinoplasty with a nostril base approach for nasal sill augmentation procedure. There were no reports of patient dissatisfaction, infection, bleeding, sensory dysfunction, or remaining asymmetry of the sill area. Conclusion Based on the findings of the present study, this technique can be successfully used in reconstructing the nasal sill area with minimal complications and morbidity.

Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting. Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days. Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037). Conclusions Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery.Level of evidence: III.

Among all head and neck (H&N) cancers, nasopharyngeal carcinoma (NPC) represents a distinct entity regarding epidemiology, clinical presentation, biological markers, carcinogenic risk factors, and prognostic factors. NPC is endemic in certain regions of the world, especially in Southeast Asia, and has a poor prognosis. In Indonesia, the recorded mean prevalence is 6.2/100 000, with 13 000 yearly new NPC cases, but otherwise little is documented on NPC in Indonesia. Here, we report on a group of 1121 NPC patients diagnosed and treated at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia between 1996 and 2005. We studied NPC incidence among all H&N cancer cases (n=6000) observed in that period, focusing on age and gender distribution, the ethnic background of patients, and the disease etiology. We also analyzed most prevalent signs and symptoms and staging of NPC patients at first presentation. In this study population, NPC was the most frequent H&N cancer (28.4%), with a male-to-female ratio of 2.4, and was endemic in the Javanese population. Interestingly, NPC appeared to affect patients at a relatively young age (20% juvenile cases) without a bimodal age distribution. Mostly, NPC initiated in the fossa of Rosenmuller and spreaded intracranially or locally as a mass in the head. Occasionally, NPC developed at the submucosal level spreading outside the anatomic limits of the nasopharynx. At presentation, NPC associated with hearing problems, serous otitis media, tinnitus, nasal obstruction, anosmia, bleeding, difficulty in swallowing and dysphonia, and even eye symptoms with diplopia and pain. The initial diagnosis is difficult to make because early signs and symptoms of NPC are not specific to the disease. Early-age Epstein-Barr virus (EBV) infection combined with frequent exposure to environmental carcinogenic co-factors is suggested to cause NPC development. Undifferentiated NPC is the most frequent histological type and is closely associated with EBV. Expression of the EBV-encoded latent membrane protein 1(LMP1) oncogene in biopsy material was compared between NPC patients of <30 years old and those of ≥30 years old, matched for sex and tumor stage. Higher LMP1 expression in patients of <30 years old was observed, which was related to more locoregional progressivity. Increased medical awareness of prevailing early stage signs and symptoms coupled to use of EBV-related diagnostic tumor markers may lead to down-staging and timely treatment to improve survival of patients with this aggressive disease.
Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Epstein-Barr Virus Infections ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Incidence ; Indonesia ; epidemiology ; ethnology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; epidemiology ; ethnology ; pathology ; virology ; Sex Factors ; Viral Matrix Proteins ; metabolism ; Young Adult

Aims: Chromium salt possesses unique characteristics that render it useful in numerous applications in several industrial processes, especially tanning of animal hides which act as a major source of hexavalent chromium toxicity in environment. This study aimed to evaluate the efficiency of loofah immobilized Cladosporium cladosporioides CEL14 in remediate tannery wastewater which contains hexavalent chromium. Methodology and results: A total of 18 fungal species were isolated from three different sites of tannery wastewater in Egypt, of which C. cladosporioides CEL14 was the most capable species of chromate remediation with 81% after 7 days of incubation as free cells. The experiments were conducted in minimum salt medium supplemented with 200 ppm chromate in the form of potassium dichromate. Different process parameters studies demonstrated that chromate was completely removed at 30 °C, pH 6, 0.1% malt extract and 0.2% glucose after 7 days of incubation with 20% inoculum size. After that, C. cladosporioides was immobilized on a natural support material (loofah). The removal ability of chromate was enhanced through permanent viable immobilization on loofah pieces, which showing complete removal of chromate within 3 days. The toxicity assessment of treated tannery effluents revealed that 74% of Brassica napus seeds were germinated upon exposure to the treated effluent. Conclusion, significance and impact of study This study revealed that C. cladosporioides CEL14 isolate has high potential as bioremediating agent against toxic hexavalent chromium. The removal ability of toxic chromate was enhanced through permanent viable immobilization on loofah pieces. This technology is simple, cost effective, efficient and environmentally friendly. The loofah immobilized with C. cladosporioides CEL14 has potential to be applied in wastewater treatment of small-scale tanneries after onsite trials.
Luffa ; Cladosporium ; Chromium ; Wastewater

Introduction: Breast cancer is the most common cancer and it is the second leading cause of cancer mortality for women after lung cancer in Iran. Given the high prevalence of breast cancer, it is of crucial importance to determine reproductive risk factors of breast cancer. Methods: A total of 139 female patients suffering from breast cancer (the case group) and 279 healthy females (the control group) who were age-matched participated in the study over the period from March 2018 to March 2019. Demographic and reproductive variables, including the number of pregnancies, breastfeeding, history of oral contraceptive use, abortion history, age at first menstruation and age at first childbirth, were all recorded via survey. Conditional Logistic regression was employed to calculate OR (CI: 95%). Results: The mean age of breast cancer patients was 50.8 ± 8.31. First degree family history of breast cancer, History of oral contraceptive use and delaying first pregnancy drastically increased the chance of breast cancer whereas breastfeeding and menstruation after the age of 14 reduced the chance of breast cancer. Conclusion: The findings of this study reveal that the age at first birth, use of oral contraceptives, first degree family history of breast cancer and lack of breastfeeding have a significant relationship with breast cancer. Thus, women who have experienced such factors are susceptible to breast cancer and need to be prioritized for preventive treatments and screening.

Introduction: The objective of this case series is to investigate the efficacy and safety of intravenous infusion of Pamidronate, a second generation bisphosphonate, in the treatment of active Charcot arthropathy. Materials and methods: All patients with active Charcot arthropathy treated at the medical centre from 1 January 2013 to 30 June 2020 were included in the study. Efficacy outcome was evaluated based on time to consolidate findings observed through radiographic examination, while safety outcome was evaluated based on the incidence of adverse event (AE) occurrence. Results: A total of 81 patients (37 male, 44 female) diagnosed with active Charcot arthropathy were included. 64.2% of patients were at stage 1 of Charcot arthropathy whereas 35.8% were at stage 2. The mean time to consolidate for stage 1 and stage 2 was 6.50 ± 4.21 months and 3.63 ± 2.92 months respectively (p-value = 0.139). No significant association was observed between gender, ethnicity and disease stage with the consolidation time (pvalue >0.05). The rate of AE incidence was 2.5%, observed in 2 patients who developed a fever during the treatment. No other serious AE was observed in the study. Conclusion: Intravenous Pamidronate infusion is a safe and effective treatment option for Charcot arthropathy.

Objective: To determine spatial distribution of sand flies (Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Ardabil province, Northwest of Iran. Methods: Sand flies were collected using sticky traps from the 30 selected points in Ardabil province, during May-November 2017. The MaxEnt model in GIS software was used for modeling. Results: A total of 2 794 specimens of sand flies were collected, of which 33% were Larroussius subgenus sand flies. Phlebotomus kandelakii and Phlebotomus wenyoni were the highest and lowest collected species respectively. Based on the modeling, four areas in the province were identified with more than 70% probability of the presence of Larroussius group vectors which were at risk of visceral leishmaniasis disease transmission. Conclusions: The distribution of Larroussius subgenus sand flies was observed in all parts of Ardabil. But the northern parts of the province (Germi and Bilesavar counties) as well as central part (Ardabil and Meshkinshahr counties) were of great importance in terms of the presence of Larroussius subgenus sand flies and the possibility of transmission of the visceral leishmaniasis.