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The earthquake hit early in the morning, causing hundreds of buildings to collapse and killing over 50,000 people, including 4,500 deaths and 8,500 injuries registered in Syria. 1 This earthquake in Turkey is considered to be the strongest since 1939 and among the rare earthquakes with magnitude 7.0 or greater world-wide, with few occurring each year. 2 While both countries have been affected, Turkey has a relatively stronger emergency response infrastructure and health care system, and received much more international attention. 3 However, the situation in Syria is direr, with the population already suffering from the long-standing conflict and economic crisis; yet, they received little international attention in comparison. The earthquake has also disrupted regular health care services and may impact the emergency care required for an estimated 5,000 pregnant women experiencing complications in affected areas. 6 The health system in Syria has already been devastated by the on-going conflict for over 12 years, with almost 30% of public health facilities out of operation. 7 The earthquake has compounded this crisis, causing significant damage to medical facilities and leaving thousands of injured people without access to care. The fragile health care system is struggling to provide adequate care for earthquake survivors and other patients, making the situation even more challenging. 8 The earthquake has also placed a significant strain on Syrians’ mental health, exacerbating the already limited availability of mental health services in Syria.

Asthma is a prevalent respiratory condition that poses a substantial burden on public health in the United States. Understanding its prevalence and associated risk factors is vital for informed policymaking and public health interventions. This study aims to examine asthma prevalence and identify major risk factors in the U.S. population. Our study utilized NHANES data between 1999 and 2020 to investigate asthma prevalence and associated risk factors within the U.S. population. We analyzed a dataset of 64,222 participants, excluding those under 20 years old. We performed binary regression analysis to examine the relationship of demographic and health related covariates with the prevalence of asthma. The study found that asthma affected 8.7% of the U.S. population. Gender emerged as a significant factor, with 36.0% of asthma patients being male and 64.0% female (p < 0.001). Individuals aged 60 and older having the highest asthma prevalence at 34.0%. Non-Hispanic whites had the highest prevalence at 46.4%, followed by non-hispanic blacks at 26.0%. In contrast, Mexican Americans and other hispanic individuals had lower rates, at 9.6% and 9.0%, respectively. Females were 1.76 times more likely to have asthma than males (p < 0.001). Obese individuals had a 1.74 times higher likelihood of current asthma compared to underweight individuals (p < 0.001). Notably, both Non-Hispanic Whites and Non-Hispanic Blacks showed higher odds of current asthma compared to Mexican Americans (with adjusted odds ratios of 2.084 and 2.096, respectively, p < 0.001). The research findings indicate that asthma is prevalent in 8.7% of the U.S. population. Our study highlights that individuals who are female, have low income, are obese, and smoke have the highest likelihood of being affected by asthma. Therefore, public health policies should prioritize addressing these risk factors in their preventive strategies.

BackgroundAcellular dermal matrices (ADMs) have become popularly used in implant-based breast reconstruction (IBBR) due to their potential to decrease the risk of implant complications such as capsular contracture and malposition. AlloDerm and DermACELL are two of the most commonly used human ADMs, each processed differently to enhance sterility and biocompatibility. Despite their widespread use, the comparative effectiveness and safety of these ADMs remain debatable among plastic surgeons, with conflicting evidence in the literature regarding their complication profiles. This systematic review and meta-analysis aims to evaluate the clinical outcomes associated with AlloDerm versus DermACELL in breast reconstruction.MethodsThis review will follow the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. The database search will be conducted using MEDLINE (PubMed), Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Clinicaltrials.org targeting studies from inception to search date. Studies will be screened using inclusion and exclusion criteria and data extracted into a spreadsheet. Screening, extraction, and risk-of-bias assessments will be performed independently by two reviewers and discrepancies resolved by a third independent reviewer. Primary outcomes include complication rates (e.g., capsular contracture, infection, implant malposition), patient-reported satisfaction (BREAST-Q), and drain time. Data analysis and meta-analysis will be performed using Microsoft Excel and Review Manager 5.4 software. Heterogeneity will be assessed using the I2 statistic. A random-effects model will be applied in cases of significant heterogeneity followed by a sensitivity analysis. This review will be reported in accordance with the PRISMA 2020 checklist.DiscussionWith the increasing use of ADMs in IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. This meta-analysis will help surgeons determine whether one ADM is better than the other. This could potentially minimize the risk of patient complications, improve patient satisfaction, and decrease unnecessary hospital readmissions or reoperations due to avoidable complications, thereby decreasing healthcare costs.Systematic review registrationPROSPERO CRD42024542928.

[...]crucial information on safety and evacuation is often not provided in accessible formats like Braille and sign language, making it difficult for individuals with sensory impairments to seek essential protection. 2 Disabled people are, on average, at greater risk of poor health and face barriers to health services and this is magnified by humanitarian crises. The mental health effects of conflict are well-recognized, and disabled people are particularly susceptible due to evacuation and resource access issues and exposure to violence and social isolation. 3 Women and girls, children, and older persons with disabilities are at higher risk related to their multiple intersecting social identities. Additionally, it puts a strain on the social affairs divisions in western Ukraine. Because of this, local disabled persons are unable to access adequate medical and social aids.

Brain metastasis in gastric cancer (GC) patients is a rare phenomenon that is associated with adverse clinical outcomes and poor survival rates. We conducted a retrospective cohort study to investigate the incidence, risk factors and prognostic factors of brain metastasis in GC patients. Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2019 was extracted from the Surveillance, Epidemiology and End-Results (SEER) database. Descriptive statistics, multivariable logistic and Cox regression were applied on SPSS. Kaplan–Meier-Survival curves and ROC curves were constructed. A total of 59,231 GC patients, aged 66.65 ± 13.410 years were included. Brain metastasis was reported in 368 (0.62%) patients. On logistic regression, the risk of brain metastasis was significantly greater in males, patients aged < 60 years and patients having concurrent bone and lung metastasis. High grade and high N stage were significant risk factors for development of brain metastasis. Patients who had undergone surgery for the primary tumor were at reduced risk for brain metastasis (adjusted odds ratio 0.210, 95% CI 0.131–0.337). The median OS was 3 months in patients with brain metastasis and 17 months in patients without brain metastasis (p < 0.05). On Cox regression, Grade IV tumors and primary antral tumors were significant predictable parameters for poor prognosis. Overall Survival (OS) and Cancer-Specific Survival (CSS) were prolonged in patients who had undergone surgery. Brain metastasis in gastric cancer is associated with significantly worse survival. Employing large-scale screening for high-risk patients holds a promising impact to improve survival rates, but it must be accurately balanced with a comprehensive understanding of clinicopathological aspects for accurate diagnosis and treatment.

The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance. Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy. These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

The author has highlighted the similar side effects of both the smallpox vaccine (after the first dose of ACAM2000 and Dryvax) and the coronavirus disease 2019 (COVID-19) vaccine (after the second dose of messenger RNA [mRNA] vaccine); the subsequent treatment with a high dosage of antipyretics; and has also commented on the possible role of frequent use of antipyretics in triggering postvaccine myocarditis. 1 While we do agree that both smallpox and mRNA vaccines share the feature of myocarditis being more common, however, the second dose of mRNA vaccine is associated with greater severity of side effects such as headaches, myalgias, fever, and chest pain. [...]it is important to note that the exact mechanisms underlying vaccine-induced myocarditis are not fully understood, and further research is needed to better understand this condition's pathophysiology. 8 Additionally, our review focused on incidence, clinical presentation, management, and any association of myocarditis and pericarditis with the COVID-19 vaccines in children and adolescents by incorporating the findings from case reports, case series, and observational studies. In our review, six observational studies and seven case series and case reports were included, where the latter comprised only 0.000016% of the total patient population and very limited information was available regarding the use of NSAIDs and other antipyretics for the treatment of disease.

Background Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its. Method This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study’s survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version. Results Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students. Conclusion Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra‐procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra‐arterial. A systematic review and meta‐analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43–0.77], p = .0003) and RAO (RR: 0.39 with 95% CI [0.16–0.98], p = .05). In contrast to the intra‐arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63–1.02], p = .07)‐ (RR: 0.78 with 95% CI [0.6–1.01], p = .06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42–1.24], p = .24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra‐arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost‐effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra‐arterial nitroglycerin administration.

We aimed to perform a meta-analysis to find out whether PCT and MDW could be used as accurate diagnostic markers for sepsis. We searched PUBMED, WOS, and SCOPUS databases. Inclusion criteria were any observational or clinical trials that compared monocyte Distribution Width [MDW] with Procalcitonin [PCT] as diagnostic markers in a patient with sepsis. Case reports, editorials, conference abstracts, and animal studies were excluded. RevMan software [5.4] was used to perform the meta-analysis. After the complete screening, 5 observational studies were included in the meta-analysis. The total number of patients included in the meta-analysis in the sepsis group is 565 and 781 in the control group. The pooled analysis between the sepsis group and controls showed a statistically significant association between sepsis and increased levels of MDW and PCT [MD = 3.94, 95% CI = 2.53 to 5.36, p-value < 0.00001] and [MD = 9.29, 95% CI = 0.67 to 17.91, p-value = 0.03] respectively. Moreover, the subgroup analysis showed that the p-value of MDW levels [< 0.00001] is more significant than the p-value of PCT levels = 0.03, the p-value between the two subgroups [< 0.00001]. Additionally, the overall ROC Area for MDW [0.790] > the overall ROC Area for PCT [0.760]. Our study revealed a statistically significant association between sepsis and increased MDW and PCT levels compared with controls and the overall ROC Area for MDW is higher than the overall ROC Area for PCT, indicating that the diagnostic accuracy of MDW is higher than PCT.MDW can be used as a diagnostic marker for sepsis patients in the emergency department. More multicenter studies are needed to support our findings.