Objectives: Postmenopausal females often experience genitourinary symptoms like vulvovaginal dryness due to estrogen decline.Hormone replacement therapy is effective in alleviating vaginal atrophy and genitourinary syndrome in this population. Evaluate local estrogen’s safety and effectiveness for alleviating postmenopausal vaginal symptoms, including endometrial thickness, dyspareunia, vaginal pH, and dryness. Methods: We searched Google Scholar, Cochrane Library, ClinicalTrial.Gov, PubMed, and ScienceDirect databases until July 2023. All randomized controlled trials (RCTs) linking intravaginal estrogen supplementation to vaginal atrophy or vaginitis were included. The risk of bias was evaluated with RoB 2, and publication bias was assessed using Egger and Beggs analysis. Results: All evidence pertains to females. Eighteen studies (n = 4,723) compared estrogen with placebo. Patients using estrogen showed a significant increase in superficial cells (mean differences [MD]: 19.28; 95% confidence intervals [CI]: 13.40 to 25.16; I2 = 90%; P < 0.00001) and a decrease in parabasal cells (MD: –24.85; 95% CI: –32.96 to –16.73; I2 = 92%; P < 0.00001). Vaginal pH and dyspareunia significantly reduced in estrogen users (MD: –0.94; 95% CI: –1.05 to –0.84; I2 = 96%) and (MD: –0.52; 95% CI: –0.63 to –0.41; I2 = 99%), respectively. Estrogen did not significantly affect vaginal dryness (MD: –0.04; 95% CI: –0.18 to 0.11; I2 = 88%). Adverse events like vulvovaginal pruritis, mycotic infection, and urinary tract infection were reported, but the association was insignificant (risk ratio: 0.95; 95% CI: 0.88 to 1.02; I2 = 0%). Conclusions Our meta-analysis of 18 RCTs suggests promising potential for intravaginal estrogen therapy in alleviating vaginal atrophy and vaginitis in postmenopausal females.

Objective: The study examined the efficacy of various generations of cephalosporins against biofilms developed by pathogenic S. aureus and E. coli. Methods: The development of biofilms by both bacteria was assessed using petri-plate and microplate methods. Biofilm hydrolysis and inhibition were tested using first to fourth generations of cephalosporins, and the effects were analyzed by crystal violet staining and phase contrast microscopy. Results: Both bacterial strains exhibited well-developed biofilms in petri-plate and microplate assays. Cefradine (first generation) showed 76.78% hydrolysis of S. aureus biofilm, while significant hydrolysis (59.86%) of E. coli biofilm was observed by cefipime (fourth generation). Similarly, cefuroxime, cefadroxil, cefepime, and cefradine caused 78.8%, 71.63%, 70.63%, and 70.51% inhibition of the S. aureus biofilms, respectively. In the case of E. coli, maximum biofilm inhibition (66.47%) was again shown by cefepime. All generations of cephalosporins were more effective against S. aureus than E. coli, which was confirmed by phase contrast microscopy. Conclusions and Relevance: Cephalosporins exhibit dual capabilities of hydrolyzing and inhibiting S. aureus and E. coli biofilms. First-generation cephalosporins exhibited the highest inhibitory activity against S. aureus, while the third and fourth generations significantly inhibited E. coli biofilms. This study highlights the importance of tailored antibiotic strategies based on the biofilm characteristics of specific bacterial strains.

Purpose: The purpose of this study was to compare the antigenic potency and stability of tetanus and diphtheria (Td) vaccines when combined with aluminum phosphate (AlPO 4) and liposome adjuvants. Materials and Methods: In vitro and in vivo analyses were conducted using the single radial immunodiffusion method and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The Td vaccines were prepared with AlPO 4 adsorption and liposome-mediated delivery, and protein antigens were characterized using these methods. Results: The results revealed that the liposome-mediated Td vaccines exhibited higher immunogenicity compared to the AlP 4-adsorbed Td vaccines. Additionally, the liposome-mediated Td vaccines demonstrated higher stability as native antigens. Conclusion This study highlights the importance of utilizing liposome adjuvants in vaccine development. The liposome-mediated Td vaccines showed enhanced immunogenicity and stability, making them a promising approach for improving vaccine efficacy. Understanding and optimizing adjuvant strategies can contribute to the development of effective vaccines against various diseases.

Good collateral circulation flow is a promising outcome for ischemic stroke patients. Collateral circulation is the vessels that flow in parallel to each other, perfusing the same target tissue. Different patients are shown to have different statuses of collateral. Good collateral circulation is expected to give significantly better clinical outcomes for stroke patients including acute stroke patients who underwent thrombectomy. Modern multimodal imaging techniques have encouraged neuroradiology to assess collateral flow. This paper presents the basic overview of CBCT technology and compares the usefulness of Cone Beam Computed Tomography (CBCT), Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) based on working principles, performance, cost and applications. In addition, the overview of collateral circulation and its characteristics will be discussed. In assessing collateral circulation, improvement of acquisition techniques and algorithm CBCT provides fast delineation of detail vasculature and improves spatial resolution. It is a three-dimensional (3D) imaging modality to investigate collateral flow. For ischemic stroke patients with clinical symptoms, CBCT improves the image quality for the assessment of collateral circulation in the brain. Precise evaluation of collateral circulation from the images will support the decision-making for suitable acute stroke treatment, benefiting both the patient and doctor.

Introduction: Despite the high prevalence of malnutrition in Yemen, little is known on malnourished Yemeni adolescents in Malaysia. This study aimed to assess the body weight status among Yemeni adolescents in Malaysia and its association with sociodemographic factors and body image. Methods: A cross-sectional study involving 364 Yemeni adolescents aged between 12 to 18 years were recruited from four schools in Selangor and Putrajaya, Malaysia. Sociodemographic factors and body image data were collected through face to face interview. Height and body weight were measured and body mass index (BMI) was calculated. Results: The prevalence of overweight and obesity was 23.6%, with 5.2% of thinness. Multivariable logistic regression revealed that a family income greater than RM5,001 (OR = 3.77, p = 0.004), body shape dissatisfaction (OR = 3.54, p = 0.001) and perception of overweight/obesity (OR = 5.75, p = 0.001) were associated with an increased risk of being overweight and obese. Whereas a positive perception of underweight (OR = 0.23, p = 0.009) was found to be a significant protective factor against overweight and obesity. Conclusion: Overweight and obesity are prevalent among Yemeni adolescents in Malaysia. These findings highlight the need for regular weight status assessments amongst adolescents. Additionally, an obesity intervention program that incorporates body image perception may improve the children’s body weight status.

Objective: To explore the efficacy of earthworm's coelomic fluid against gentamicin-induced hepatic and renal toxicity in rats. Methods: The animals were divided randomly into three groups (n = 6 per group): control, gentamicin, and Allolobophora caliginosa coelomic fluid-treated groups. Toxicity was established after injection of gentamicin daily for 8 days at a dose of 100 mg/kg. Aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total proteins, albumin, creatinine, urea, uric acid, malondialdehyde, glutathione, catalase and histopathology of tissues were investigated in the study. Results: Allolobophora caliginosa coelomic fluid significantly decreased urea, creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and malondialdehyde levels while significantly increasing levels of total proteins, albumin, glutathione and catalase. The histopathological investigation showed partial restoration of renal and hepatic architecture. Conclusions: This study shows the potency of Allolobophora caliginosa coelomic fluid in improving the biochemical and histopathological changes induced by gentamicin in the liver and kidney of the rats.

This study was aimed to determine the efficiency of synthetic protein-free media in spermatozoa washing, preparationand retention of the activity of washed spermatozoa over short periods in vitro. Normozoospermic semen samples (n =71) were equally apportioned and washed using synthetic protein-free medium (PFM), minimum essential medium + HSA(MEM) or commercial protein-containing medium (CPC). Washed spermatozoa were cultured in vitro using PFM, MEM orCPC media and held for 24 hrs at 4°C, 15°C, 22°C or 37°C. Spermatozoa activity was evaluated at 0 hr, 4 to 7 hrs and24 hrs post-wash. The effects of PFM on spermatozoa motility, vitality, membrane integrity and DNA fragmentation levelwere not significantly different from that of MEM and CPC media at 0 hr, 4 to 7 hrs and 24 hrs post-wash in vitro. SyntheticPFM, MEM and CPC retained spermatozoa activity highest when specimen were held at 22°C and it was significantly higher(p < 0.05) than that at 37°C after 24 hrs incubation in vitro. However, no significant changes (p > 0.05) were notedin spermatozoa DNA fragmentation (SDF) levels when specimen were held at 22°C or 37°C at 4 to 7 hrs and also after24 hrs post-wash in vitro in all media. The use of synthetic PFM as an alternative to the commercial protein-containingmedia in human spermatozoa washing and preparation procedure for an efficient and safer (Assisted ReproductionTechnology) ART outcome. Spermatozoa activity can be successfully retained at room temperature post-wash over shortperiods; spermatozoa may lose viability rapidly if held for long hours at 37°C in a

Glioblastoma, the most common primary malignant brain tumor in adults, is highly aggressive and associated with a poor prognosis. Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, has increasingly been used in the treatment of recurrent glioblastoma. It has achieved excellent rates of radiographic response, but most patients will progress after only a few months. Upon recurrence, tumors may not enhance, secondary to vascular normalization. We describe four patterns of radiographic progression commonly associated with Bevacizumab failure: 1) Distant enhancing tumor, 2) Local tumor progression without enhancement, 3) Diffuse gliomatosis-like infiltration, and 4) Local or multifocal progression, with enhancement. Some have noted an increased incidence of distant or diffuse disease upon recurrence, suggestive of a transition to a more aggressive phenotype, but a review of the literature suggests there is no conclusive evidence that Bevacizumab treatment is associated with an increased rate of distant or diffuse recurrence.
Adult ; Bevacizumab* ; Brain Neoplasms ; Glioblastoma ; Glioma* ; Humans ; Incidence ; Neuroimaging ; Phenotype ; Prognosis ; Receptors, Vascular Endothelial Growth Factor ; Recurrence ; Treatment Failure* ; Vascular Endothelial Growth Factor A

Diagnosis-related group (DRG) system is patient classification system designed to produce limited number of classes which are relatively similar in terms of resource consumption and clinical characteristics. The aim of this study was to assess the level of knowledge, attitude and practice (KAP) of Turkish health care providers toward DRG system implemented in Turkey.A total of 238 healthcare providers were randomly selected from two urbanand one rural hospital in Turkey.A questionnaire was used for data collection; contacting 32 items (10 items about knowledge, 12 items about attitude and 10 items about the practice) and its validity and reliability were confirmed. Data analysis was performed using chi-square and multivariate logistic regression.In this study,only one third of healthcare providers showed good knowledge (35.7%) and good practice (37.4%) about DRG system,compared to 54.2% of them showed good attitude.There was significant difference between age, gender, occupation groups and whether the respondents have attended a workshop for DRG system in terms of KAP (p > 0.05).These results indicated the need for further actions to implement DRG system in terms of creation of suitable environment and increasing awareness among healthcare providers, especially male, medical doctors, nurses, elderly, and those who have never attended a workshop, in addition to regular review to ensure the program would reach its targets.