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Serious flaws in the scientific evaluation in the RAR incorrectly characterise the potential for a carcinogenic hazard from exposure to glyphosate. Since the RAR is the basis for the European Food Safety Agency (EFSA) conclusion, 4 it is critical that these shortcomings are corrected. [...]the WG also saw a significant increase in the incidence of pancreatic islet cell adenomas in two studies in male Sprague-Dawley rats. 14-16 In one of these rat studies, thyroid gland adenomas in females and liver adenomas in males were also increased.

Comorbidity indices are often used to measure comorbidities in register-based research. We aimed to adapt the Charlson comorbidity index (CCI) to a Swedish setting. Four versions of the CCI were compared and evaluated by disease-specific experts. We created a cohesive coding system for CCI to 1) harmonize the content between different international classification of disease codes (ICD-7,8,9,10), 2) delete incorrect codes, 3) enhance the distinction between mild, moderate or severe disease (and between diabetes with and without end-organ damage), 4) minimize duplication of codes, and 5) briefly explain the meaning of individual codes in writing. This work may provide an integrated and efficient coding algorithm for CCI to be used in medical register-based research in Sweden.

Background Exploring longitudinal associations of blood biomarkers with left atrial (LA) structure and function can enhance our understanding of atrial fibrillation (AF) etiopathogenesis. Methods We studied 532 participants of the PREDIMED-Plus trial, a multicenter randomized trial in overweight and obese adults with metabolic syndrome. At baseline, 3 and 5 years after randomization, participants underwent transthoracic echocardiography and provided blood for serum biomarker measurements (propeptide of procollagen type I (PICP), high-sensitivity (hs) troponin T (hsTnT), hs C-reactive protein (hsCRP), 3-nitrotyrosine (3-NT), and N-terminal propeptide of B-type natriuretic peptide (NT-proBNP)). Outcomes of interest included LA peak systolic longitudinal strain (LA PSLS), LA volume index (LAVi), LA function index (LAFi), and LA stiffness index (LASi). We performed cross-sectional and longitudinal analyses to evaluate relationships between log-transformed biomarkers and echocardiographic measurements using multiple linear regression and mixed models. Results The participants in this analysis had a mean age of 65.0 (SD 4.8) years, and 40% were females. At baseline, increased NT-proBNP and hsTnT were associated with larger LAVi and worse LA function as measured by the LAFi, LASi, and LA PSLS. Longitudinally, higher NT-proBNP, but not higher hsTnT, was associated with increased LAVi and worsening LA function. Over 5 years, 1 unit increase in log(NT-proBNP) was associated with steeper decline in LA PSLS (-0.19%, 95% confidence intervals (CI) -0.35%, -0.02%) and greater increase in LAVi (0.28 mL/m , 95% CI 0.10, 0.45) each year. PICP, hsCRP, and 3-NT did not show consistently significant associations with LA outcomes at baseline and through 5 years. Conclusion In an overweight and obese population, higher NT-proBNP was associated with LA volume enlargement and worsening LA function over 5 years. The implications of these findings for the prevention and prediction of AF warrant further investigation.

The lockdowns imposed during the COVID-19 pandemic and social distancing measures may have decreased traffic and air pollution, which may contribute to reducing asthma exacerbation. However, there is not enough information about the relationship between asthma and COVID-19 lockdown, especially in children. Therefore, the aim of this study is to identify the effects of the COVID-19 lockdown on pediatric patients with moderate to severe bronchial asthma. This is a retrospective cross-sectional analytical study of pediatric patients with moderate to severe asthma who came to King Abdullah Specialist Children's Hospital (KASCH) in Riyadh, Saudi Arabia. The study was conducted for a period of 14 months from March 2019 to May 2020, using the charts of children aged 3 to 14 years. We investigated changes in the severity of asthma using indirect parameters including hospital visits, ER visits, and changes in medications used before and during the COVID-19 lockdown. A total of 343 asthmatic patients aged mean±SD of 8±3 years were included in the study. More than half 233 (68%) of them were male. The number of patients admitted to the hospital in 2019 was 46 patients (85%), while in 2020, it was only 17 patients (32%). In 2020, the usage of oral steroids has been decreased from 96 (28%) to 50 (15%). The number of people using the leukotriene inhibitor reduced from 171 in 2019 to 162 in 2020. The ER mean visit was 1.6±1.3 in 2019; however, ER visits in 2020 were 0.6 ±0.7 showing a considerable reduction in the ER visits (p < 0.001). The COVID-19 lockdown had a positive impact on asthma patients, with our study showing a significant reduction in ER visits, hospitalizations, and the use of oral steroids between March-May 2019 and 2020, suggesting lower asthma severity. However, a holistic approach is needed post-pandemic to improve asthma management, including increased awareness, better healthcare access, and reduction of environmental triggers to promote better control and overall well-being.

Background Obesity has detrimental personal, societal, and economic consequences and raises the risk of developing chronic diseases such as diabetes and cardiovascular diseases. Diet and exercise behaviors are frequently the focus of weight loss programs. Effective nutrition education is associated with a reduced risk of chronic diseases and body weight management. Individualized lifestyle and counseling sessions with follow-ups reduce weight loss compared to single combined sessions Objectives The objective of this study was to assess the effectiveness of nutrition education intervention on weight loss among adults aged 18-40 years in Lahore through an interventional study. Methods This study was conducted in Lahore. According to the inclusion criteria, overweight/obese (Body Mass Index (BMI) ≥ 23 kg/m²), young (18-40 years old) men and women were part of this study. A total of 50 participants were randomized into two groups, one as the control group and the other one as the intervention group. Group counseling was provided to the control group. The intervention group was assessed individually through follow-ups for 3 months of online and on-campus sessions. Data was collected at four intervals at baseline, month 1, month 2, and month 3 through a self-administered assessment form. Data was analyzed using the statistical package for social science, SPSS version 25 (IBM Corp., Armonk, USA). Results Out of the 50 participants, 54% (27) were women while 46% (23) were men (mean age 29.90, SD = 6.26, BMI at baseline 32.18 kg/m², 26. 49 kg/m²), and randomized by a blinded researcher. At three months, the mean differences in BMI, waist circumference, waist-to-hip ratio, and body fat percentage between the groups were 3 kg (23.44 ± 0.58, 95% CI 22.86-24.02), 33.90 cm (95% CI 32.50-35.30), 0.86 (95% CI 0.74-0.98), and 24.79% (95% CI 18.00-31.58), respectively, in favor of the intervention group (p < 0.005).  Conclusion This study demonstrates that a structured dietary intervention combined with physical activity guidance leads to significant weight loss and improved body composition in obese adults. These findings support the effectiveness of comprehensive weight loss strategies for managing obesity.

Background Cardiovascular diseases (CVD), including coronary artery disease, ischemic heart disease, stroke, cardiomyopathy, and atrial fibrillation and flutter, are the leading cause of mortality worldwide, resulting in significant economic and health costs. Recognizing trends and geographical differences in the global burden of CVD facilitates health authorities in particular nations to assess the disease burden and forecast future epidemiological trends. Public health authorities in each country can better understand the differences in disease data and, by learning from the experiences and practices of successful countries and considering the characteristics of their diseases, allocate health resources more rationally and formulate more targeted healthcare strategies to reduce the disease burden. This study aims to comprehensively assess CVD trends and geographic variations from 1990 to 2021. Methods This study focuses on analyzing global trends in the epidemiology of all-age CVD incidence and death over the past 30 years. A vital registration system, cause-of-death inference records, and a cause-of-death ensemble model (CODEm) were used to estimate cause-specific mortality for CVD, with CODEm estimates adjusted using a cause-of-death correction (CoDCorrect) algorithm. Incidence data were extracted from insurance claims and inpatient discharge sources and analyzed with Disease Modeling Meta-Regression, Version 2.1 (DisMod-MR 2.1). Data were extracted from the 2021 Global Burden of Disease Study (GBD 2021) on the number of incident cases and deaths, as well as age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) for CVD for each year from 1990 to 2021. We visualized and reported this data at the global, regional, and national levels. To explore the association between the burden of CVD and sociodemographic factors, we used the sociodemographic index (SDI), which categorizes the world's 204 nations into five SDI regions. Because the GBD results are a combination of data and estimates, 95% uncertainty intervals (UI) are provided for each count and rate (per 100,000 populations). Results Globally, the number of CVD incident cases and deaths increased from 34.74 million and 12.33 million in 1990 to 66.81 million and 19.42 million in 2021, representing a 92.3% and 57.5% rise, respectively. However, the global ASIR and ASDR for CVD have decreased by 10.4% and 34.3%, respectively, since 1990. Notably, among the 21 regions of the world, the ASIR for CVD is on a downward trend from 1990 to 2021, except for East and Central Asia, where the ASIR for CVD increased by 3% and 14.3%, respectively. Similarly, the global ASDR for CVD is only on an upward trend in sub-Saharan Africa, increasing by 12%, while all other regions are on a downward trend. Among the five SDI regions, the high SDI region has much lower ASIR and ASDR compared to the world average, and these rates have decreased significantly over the years. Conclusion Despite a significant increase in the number of CVD incident cases and deaths worldwide over the last three decades, ASIR and ASDR have been declining. Over the past 30 years, both ASIR and ASDR for CVD have declined significantly in high SDI areas, while CVD continues to pose a serious public health threat in regions with low SDI.

Aquagenic syringeal acrokeratoderma (ASA) is a rare dermatological condition characterized by the transient appearance of edematous, white, translucent papules on the palms following water exposure. While the condition is most commonly associated with cystic fibrosis (CF) and predominantly affects young women, this report presents a unique case in a 24-year-old man without a history of cystic fibrosis. The patient reported a 10-month history of painful, pruritic eruptions on the hands following exposure to water. Symptoms resolved within an hour post-exposure but were persistent and increasingly severe over time. The patient's medical history was unremarkable, except for the use of lisinopril for hypertension and propranolol for performance anxiety. Given the absence of CF, the etiology of the disease in this patient remains unclear; however, the use of an angiotensin-converting enzyme (ACE) inhibitor is hypothesized to have contributed to the onset of symptoms through mechanical mechanisms involving sodium retention and osmotic gradient disruption in keratinocytes. This case highlights the diverse clinical presentations and emphasizes the importance of considering ASA in the differential diagnosis of patients without CF or other traditional risk factors. This case underscores the need for further research to elucidate the underlying mechanisms and improve diagnostic accuracy for this rare but potentially debilitating condition.

Background Snakebite envenomation remains a significant public health challenge in tropical countries, particularly affecting the pediatric population. Children are especially vulnerable because of their smaller body mass, outdoor activities, and delayed presentation to healthcare facilities. This study aimed to analyze the clinical profile, demographic patterns, and envenomation characteristics of snakebites in children aged 1-16 years presenting to a tertiary care center. Additionally, the study sought to evaluate the spectrum of complications and clinical outcomes in pediatric snakebite cases while assessing the mortality rate and associated risk factors in pediatric snakebite envenomation. Methodology A retrospective medical record review was conducted analyzing all snakebite cases in children aged below 16 years admitted to the Department of Pediatrics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, Tamil Nadu (southern state in India), between January 2021 and December 2023. Data extracted included demographics, bite characteristics, clinical manifestations, time to healthcare presentation, and treatment details. Management protocols followed World Health Organization (WHO) guidelines for snakebite envenomation, including the administration of polyvalent anti-snake venom (ASV) when indicated. Results Among 202 pediatric snakebite cases, children aged 9-12 years constituted the majority (n = 110, 54.5%), with significant male predominance (n = 148, 73.3%). Unidentified snakes were responsible for the highest proportion of bites (n = 72, 35.6%), followed by vipers (n = 65, 32.2%) and cobras (n = 53, 26.2%). Lower limb bites were most frequent (n = 108, 53.5%), and seasonal analysis revealed peak incidence during January-April (n = 106, 52.5%). Common clinical manifestations included hematuria (n = 112, 55.4%), oliguria (n = 102, 50.5%), and renal failure (n = 80, 39.6%). Most patients (n = 120, 59.4%) received antivenom within six hours, with 46.6% (n = 94) requiring 5-10 vials. The overall mortality rate was 9.9% (n = 20). Statistical analysis revealed significant associations between mortality and snake species identification (p = 0.0014), with the highest mortality in unidentified snakebites (n = 15, 20.8%). Anatomical bite site (p = 0.042), renal failure (p = 0.001), respiratory paralysis (p = 0.001), and ptosis (p = 0.001) were also significantly associated with mortality. Time to antivenom administration significantly impacted survival (p = 0.001), with mortality rates of 0.8% (n = 1) for treatment within six hours, increasing to 38.5% (n = 10) for delays beyond 12 hours. Demographics and local manifestations showed no significant correlation with mortality. Conclusion Our study reveals distinct patterns in pediatric snakebites, predominantly affecting male children in pre-adolescent age. The high proportion of unidentified snakes remains challenging. With renal and hematological manifestations being frequent, mortality is significantly influenced by delayed treatment, respiratory paralysis, and renal failure. Early antivenom administration, proper snake identification, and prompt medical intervention remain crucial factors in improving outcomes and reducing mortality.

This study aimed to assess headache prevalence and the impact of lifestyle choices among medical students at Bahçeşehir University, Istanbul, Turkey. A cross-sectional survey of 180 participants was conducted, revealing that 78.80% reported headache occurrences. Tension-type headaches were the most common, with a prevalence rate of 59.50%. Lifestyle factors, such as irregular sleep schedules, dissatisfaction with academic performance, lack of exercise, and the use of electronic devices for studying, were correlated with headache occurrence. These findings underscore the need for tailored interventions to enhance sleep patterns, manage stress, promote balanced lifestyle habits, and encourage physical activity among medical students.

Cardiovascular disease (CVD) associated with intravascular thrombosis is emerging as a significant public health concern in India, driven by a complex interplay of lifestyle, genetic predisposition, and socio-economic factors. This review examines recent trends in the prevalence, risk factors, and epidemiology of these conditions within the Indian population. A systematic search and selection process was employed to identify relevant studies, focusing on articles published between 2007 and 2024. Key findings indicate that rapid urbanization, dietary shifts, and increased stress levels contribute significantly to the rising rates of CVD and thrombosis. This review also highlights the critical comorbidity of mental health and CVD where mental health disorders exacerbate cardiovascular risks and complicate treatment outcomes. Adopting healthy lifestyles, the early detection and diagnosis of intravascular thrombosis and its predisposing factors, timely prevention, increased public awareness about available treatments, accessibility to healthcare resources, and mental health integration are the keys to preventing mortality associated with cardiovascular diseases.