Background: Afghanistan is among the countries which have the highest maternal mortality in the world. The inadequate utilization of antenatal care (ANC) services increased the risk of maternal mortality in Afghanistan.

The goal of this study is to understand key associated factors with antenatal care and its impact on maternal mortality in Afghanistan. It also elaborates on the impacts and utilization of antenatal care services among women in Afghanistan.

Methods: For this research, data from the Afghanistan Demographic Health Survey 2015 has been used, the study participants were 18139 reproductive-aged women. The relevant variable was chosen, and data was analyzed for general descriptive, Chi-square, and logistic regression tests. Analysis was carried out using JAMOVI 2.2.5.

Results: The overall number of ANC visits among women was 10040 (55.4%) and 8099 women (44.6%) never used ANC visits. The utilization of one ANC visit was 11.2% and two ANC visits were most frequent among women with 17%. Women who undertook three or four and more than four were 11.6%, 7.1%, and 4.3% respectively.

In this study, we examined the socio-economic and demographic backgrounds of 18139 reproductive-aged women attending ANC clinics. The highest age group (30-39 years) represented 32.3% (OR=0.947, 95%CI: 0.885-1014), followed by the age group of over 40 which was 25.1% (OR=0.919, 95%CI: 0854-0.990) compared to age group under 29 among women. According to residency, urban areas represented 77.2% of the total (18139) women, and 22.8% were from rural areas (OR=1.097, 95%CI: 1.023-1.177) compared to urban areas. In terms of education, 86% of women had received no education, 6.5% received primary education (OR=1.159, 95%CI: 1.020-1.316), the number of secondary educations was 5.7% with (OR=0.981, 95%CI: 0.828-1.163) and higher education was 1.8%with (OR=0.917, 95%CI: 0.712-1.181) compared to not education women group in Afghanistan. ANC visits were used more frequently by Pashtuns, 38.8%, followed by Tajiks, 35.1%. (OR=0.192,95% CI:0.852-0.977), Uzbek was 10% (OR=1.224, 95% CI:0.869-1.068) followed by Hazara at 6.6% (OR=0.963, 95% CI:0.869-1.068) the Turkmen at 5.4% (OR=2.571, 95% CI:2.208-2.924), the percentage by Aimaq was 1.2% (OR=1.574, 95% CI:1.196-2.072) and for Baloch 0% (OR=1.917, 95% CI:0.320-11.4812.072) followed by others with 2.6% (OR=0.910, 95% CI:0.753-1.099) compared to Pashtun ethnic group. For media exposure the number of not listening to the radio per week was 58.1% and one time per week was 16% (OR=0.974, 95%CI: 0.897-1.058), for two times per week it was 25.8% (OR=0.854, 95%CI: 0.797-0.915) and more than three plus times per week was 0.1% (OR=0.970, 95%CI: 0.402-2.343) compared with the zero time of listening to radio per week. Also, for not watching TV was 56% and one time per week was 11.3% (OR=0.888, 95%CI: 0.807-0.977) also for two times per week it was 32.6% (OR=0.913, 95%CI: 0.856-0.974) and the number of three plus times of watching TV was 0.2% OR=1.188, 95%CI: 0.617-2.286) compared with zero time of watching the TV.

Conclusion: The most important key associated factors were residency, education level, ethnic groups, and media exposure. We suggest that the Afghanistan government and with international community improve their health policy, increasing accessibility of health care and equal distribution of health services in rural and urban areas in Afghanistan.

Recurrent spontaneous abortion (RSA), a significant reproductive challenge, involves multiple pregnancy losses and impacts fertility. Although various factors contribute to RSA, immune system dysfunction is frequently implicated. Recent technological advancements in bioinformatics, particularly high-throughput sequencing and computational modeling, have enabled a more detailed examination of immune responses associated with RSA. This text explores how bioinformatics tools, including gene expression analysis, machine learning, and network analysis, facilitate the prediction of immune factors relevant to RSA. Additionally, it reviews current progress and potential future applications in personalized treatment strategies.

Background

Asthma is a common chronic illness in children, contributing significantly to healthcare costs and morbidity. Despite the use of systemic corticosteroids (SC) as the standard treatment for acute asthma, their delayed onset and incomplete efficacy in reducing hospitalization have led to interest in inhaled corticosteroids (ICS) as adjunctive therapy.

Methods

This meta-analysis aimed to evaluate the efficacy of combining budesonide (an ICS) with SC in children with acute asthma. A systematic search of databases identified 10 studies involving 1,588 children, of whom 794 received budesonide in addition to SC, while the remaining 794 received SC alone.

Results

The addition of budesonide was associated with a non-significant reduction in hospital admission rates (OR 0.48, 95% CI 0.25–0.91, p=0.02) and length of stay. Studies with higher doses of budesonide (≥2mg) showed a greater but still non-significant improvement in asthma severity scores.

Conclusions

While combining ICS and SC resulted in a potential cost-effective benefit, further trials with higher doses of budesonide are needed. Major limitations include the absence of studies involving MDI-based ICS delivery, limited data on lung function, and the lack of recent trials after 2020.

“Myasthenia gravis” has its origins in Greek. The terms denote muscle weakening (myasthenia) and heaviness (gravis). Myasthenia gravis (myasthenia gravis) is an autoimmune disorder marked by muscle weakness that exacerbates with activity, predominantly impacting the oculobulbar muscles and principally targeting postsynaptic nicotinic acetylcholine receptors. ¹ This condition, characterized by a significantly high mortality rate due to respiratory failure, holds unique significance among neuromuscular disorders and within the broader field of neurology, as patients can enjoy perfectly normal lives with appropriate treatment. The prevalence of the condition in women is bimodal, with the highest incidence occurring between the ages of 20-30 and above 50 years. In contrast to males above the age of 50. The disease's most notable characteristic is muscle weakness, which exacerbates with tiredness and is at least partially alleviated by rest. Patients indicate improvement in the morning, with symptoms exacerbating in the evening or when fatigued ² The manifestation of disease progresses with periods of remission and exacerbation. Remissions can last for durations ranging from a few days to several years.

In recent years, enhanced artificial intelligence algorithms and more access to training data have enabled artificial intelligence to augment or supplant certain functions of physicians. Nonetheless, the interest of diverse stakeholders in the application of artificial intelligence in medicine has not resulted in extensive acceptance. Numerous experts have indicated that a primary cause for the limited adoption is the lack of openness surrounding certain artificial intelligence algorithms, particularly black-box algorithms. Clinical medicine, particularly evidence-based practice, depends on transparency in decision-making. If there is no medically explicable artificial intelligence and the physician cannot adequately elucidate the decision-making process, the patient's trust in them will diminish. To resolve the transparency concern associated with specific artificial intelligence models, explainable artificial intelligence has arisen.

Autism spectrum disorder encompasses a range of neurobehavioral and neurodevelopmental conditions marked by deficits in social interaction and communication, as well as restricted and repetitive behaviors or interests, alongside atypical sensory processing. Environmental, immunological, genetic, and epigenetic factors contribute to the pathophysiology of autism, triggering neuroanatomical and neurochemical changes early in central nervous system development. Numerous neurochemical pathways contribute to the etiology of autism spectrum disorder; however, the interactions among these intricate networks and their role in the emergence of core autism symptoms remain poorly understood. Additional research on neurochemical changes in autism is essential to elucidate the early neurodevelopmental differences that contribute to the significant heterogeneity of autism spectrum disorder, thereby informing new strategies for treatment and prevention.

Small cell lung cancer exhibits rapid proliferation and significant metastatic potential. There are significant epidemiologic and biological associations with tobacco carcinogens. While most small cell lung cancers display neuroendocrine characteristics, a significant subset of tumors does not possess these features. Genomic profiling of small cell lung cancer demonstrates genetic instability, nearly universal inactivation of the tumor suppressor genes TP53 and RB1, and a significant mutation burden. Due to early metastasis, a limited number of patients are suitable for curative lung resection, necessitating adjuvant platinum-etoposide chemotherapy for these individuals. Consequently, most patients are presently receiving chemoradiation, with or without the addition of immunotherapy. For patients with disease localized to the chest, standard treatment comprises thoracic radiotherapy alongside concurrent platinum-etoposide chemotherapy. Patients diagnosed with metastatic disease receive treatment that combines platinum-etoposide chemotherapy with immunotherapy utilizing an anti-programmed death-ligand 1 monoclonal antibody. Small cell lung cancer initially exhibits a strong response to platinum-based chemotherapy; however, these responses are temporary due to the emergence of drug resistance. Recent years have seen an accelerated accumulation of biological insights into the disease, resulting in a redefinition of the classification scheme for small cell lung cancer. The emerging understanding of molecular subtypes in small cell lung cancer may delineate distinct therapeutic vulnerabilities. The integration of these recent findings with existing knowledge of small cell lung cancer biology and clinical management could result in significant improvements in patient care for this condition. The authors provide an overview of multimodal clinical approaches in small cell lung cancer, emphasizing recent advancements in research that may expedite clinical development.

The use of beta-blockers (bisoprolol) and ACE inhibitors (perindopril) is pathogenetically and clinically justified in patients with stable coronary artery disease (CAD) and concomitant arterial hypertension (AH) . The study showed that prescribing a fixed combination of previously used drugs (perindopril, bisoprolol) for 4 weeks in patients with clinical symptoms or documented CAD can effectively reduce heart rate (HR) and blood pressure (BP) (heart rate levels ≤ 70 bpm were reached in 84.9%, blood pressure ≤ 140/90 mm Hg - 86.9% of patients), reduces the number of angina attacks from 4.4 to 2.6 per week and the need for nitroglycerin - from 4.8 to 2.7 tablets per week, and improve adherence to therapy (66.5% of patients). 

Joint trauma constitutes a substantial proportion of emergency room visits and patients requiring urgent care, imposing considerable financial burdens on society. Diagnostic imaging is essential in the evaluation and treatment of trauma victims. Diagnostic imaging constitutes a complex, multifaceted system, with numerous elements of its workflow susceptible to inefficiencies or human error. Recent advancements in artificial intelligence and machine learning have the potential to transform our medical care delivery systems. This review will offer a comprehensive analysis of the present status of artificial intelligence and machine learning applications in various facets of trauma imaging and propose a vision for how these applications could be utilized to improve diagnostic imaging systems and optimize patient outcomes.

Background

Eye is one of the primary sensory organs, responsible to provide the necessary visual information to the brain. Any abnormality in eye cause mild to severe vision issues and hence appropriate detection and treatment is preferred. Clinical level examination of the eye is commonly performed using image examination procedures and this work considered the Optical Coherence Tomography (OCT) for the study. In the present study, the proposed system aims to develop a tool to classify the OCT-images into normal and abnormal class using the traditional deep-learning (DL) and machine-learning (ML) features.

Methods

This tool consists the following stages; OCT-image collection and resizing based on the chosen DL scheme, image features extraction using DL and ML methods, DL feature reduction using 50% dropout and serially fusing the deep- and machine-features to generate hybrid-features, and binary classification using 5-fold cross-validation.

Results

The developed tool’s merit is verified using; (i) deep-features, (ii) machine-features, and (iii) hybrid-features. The merit of the developed scheme is verified using different binary classifiers and the overall quality metric is considered to verify the tool’s performance.

Conclusions

The study confirms that the hybrid-features based detection provides 97.6% accuracy, when Random Forest classifier is employed, which verifies the tool’s merit on the chosen OCT database. In the future, this tool can be considered to detect the common AEAs, like AMD and the DME.

Synopsis In a hyperbaric chamber pressurized to more than one atmosphere, 100% oxygen is inhaled as part of hyperbaric oxygen therapy. Several indications for this treatment, such as decompression sickness, carbon monoxide poisoning, serious burns, or chronic infections, have been approved. Based mainly on enhancing oxygen availability to injured brain cells with potential for recovery, especially in the event of a chronic injury, hyperbaric oxygen has been researched in the context of cerebral palsy. There is little data on hyperbaric oxygen in cerebral palsy due to methodological issues, lack of control groups, and precision. The results of three randomized controlled trials show that hyperbaric oxygen does not improve large motor skills compared to controls that used a waiting list or slightly pressurized room air. However, the nature of the power (pressurized room air, for example) and the small number of patients examined make these conclusions debatable. Although bias in their methodology limits observational before-and-after studies, they do raise interest in hyperbaric oxygen for cerebral palsy. Some bad effects of hyperbaric oxygen are middle ear barotrauma, which usually needs a myringotomy and tube insertion and a higher risk of seizures. Hyperbaric oxygen's use in cerebral palsy is still debatable.

A novel approach to offering stroke survivors rehabilitation services is telerehabilitation. Providing mainstream therapies for mobility, cognitive, speech and language, and other problems is a promising strategy. Information and communication technologies and stroke therapies are the two main pillars of telerehabilitation. Information and communication technology offer a platform for the delivery of therapies, which in turn leads to stroke recovery. We discussed stroke therapies that can be provided using telerehabilitation platforms in this mini-review, along with aspects of information and communication technologies that support telerehabilitation. Next, we looked at how telerehabilitation affected different types of stroke. According to the majority of research, telerehabilitation is a practical and efficient way to provide patients with interventions. With the same dosage and level of intensity, it is not less effective than standard care and in-clinic therapy. For certain illnesses, telerehabilitation may be more effective than standard care thanks to new technologies. However, telerehabilitation has a number of drawbacks that may make it less effective than traditional rehabilitation. At the conclusion, we talked about the main issues with telerehabilitation, potential fixes, and future paths for the field's growth.

Nonalcoholic fatty liver disease is a common liver disease, and the incidence increases year by year. The pathogenesis of nonalcoholic fatty liver disease is correlated with insulin resistance and oxidative stress, which induces varied inflammatory cytokines (tumor necrosis factor-α, interleukin-1, interleukin-6, etc). Different signal transductions, such as mitogen-activated protein kinase, nuclear factor κB, activated protein kinase, Janus kinase 2/signal transducer and activator of transcription 3, peroxisome proliferator-activated receptor, phosphatidylinositol 3-kinase/protein kinase B, toll-like receptor, were activated by the pathogenic factors to regulate correlative reactions. Thus, an in-depth study of the signal transductions will probably provide new suitable solutions for the prevention and therapy of nonalcoholic fatty liver disease.

On March 11, 2020, the WHO declared the new coronavirus disease 2019 (COVID-19) to be a worldwide pandemic. This pandemic has significant repercussions on the pharmaceutical industry and the health market. These effects could manifest in the short or long term and require planning and detection to lessen their socioeconomic cost.

This brief communication research evaluated the COVID-19 pharmaceutical market problem and discussed the immediate and long-term effects of the pandemic on the pharmaceutical industry.

Demand adjustments, regulatory changes, modifications to the research and development process, and a move toward telemedicine and telecommunication are some of the short-term effects of the COVID-19 pandemic. Additionally, the COVID-19 pandemic may have long-term effects on the pharmaceutical industry at both the global and local levels, including a slowdown in industry growth, delays in approvals, a shift toward self-sufficiency in the pharmaceutical production supply chain, changes in consumer trends for health-market products, and ethical quandaries.

The discovery of these consequences may help policymakers create more evidence-based plans to address the issues that the COVID-19 pandemic presents to the pharmaceutical industry and other health markets.

Obese people are susceptible to health complications and diseases, such as cardiovascular disorders, type 2 diabetes, hypertension, osteoarthritis, gallstone, hypoxia, certain cancers and even mental and intellectual and disabilities. Bariatric surgery is a prevalent weight loss approach, predominantly in situations where prior efforts towards weight reduction proved ineffective. It engages a modification in the digestive system by limiting food consumption, leading to decreased stomach capacity and physiological ability for nutrient absorption. Since obesity associates with morbidity, the pre, intra and post-operative care and post-discharge rehabilitation comprise key determining factors for a successful bariatric surgery. The process may involve short- and long-term recuperation in nursing homes and hospitals, which accord significant impact on patient’s well-being and psychology. Nursing care for these individuals with unique physiological and emotional problems is often an arduous task, requiring environmental modifications, mobility training facilities and bariatric program and care-related equipment. Special attention is required from nursing professionals towards minimum fall and injury, management of related problems, including arterial venous insufficiency, neuropathic ulcers, seromas, anastomotic leaks, abdominal wound dehiscence and post-surgery complications, together with increased hygiene and skin care. Through an interdisciplinary approach, regular monitoring of diet, nutritional parameters, including weight change, Body Mass Index, energy and protein requirement, medication, clinical complications, functional mobility, psychosocial issues, etc. can be essential. Overall, the current review enlightens the importance of bariatric surgery, and particularly offers critical assessment of nursing care systems and specialized rehabilitation services addressing physical and mental health care in obese and post-operative patients.

Backgrounds

The purpose of the meta-analysis was to evaluate and compare the effect of laparoscopy versus open appendectomy on wound infection in elderly subjects.

Methods

The results of this meta-analysis were analyzed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed effect models.

Results

For the current meta-analysis, 6 examinations spanning from 2004 to 2021 were included, encompassing 42675 people; of them, 15486 had a laparoscopy, and 27189 had an open appendectomy.

Laparoscopy had a significantly lower surgical site infection (OR, 0.27; 95% CI, 0.22-0.32, p<0.001) and intra-abdominal abscess (OR, 0.36; 95% CI, 0.31-0.42, p<0.001) compared to open appendectomy in elderly subjects.

Conclusions

The information that was looked at showed that in older people, laparoscopy had a much lower rate of surgical site infections and intra-abdominal abscesses than open appendectomy. However, given the small number of studies included, attention should be given to their values.

Backgrounds

The purpose of the meta-analysis was to evaluate and compare the effects of negative-pressure wound therapy (NPWT) with conventional therapy (CT) on wound infection and graft take rates in split-thickness skin (STS) after grafting surgery (GS).

Methods

The results of this meta-analysis were analyzed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed effect models. For the current meta-analysis, 16 examinations spanning from 2002 to 2023 were included, encompassing 1301 people with STSs after GS.

Results

NPWT had a significantly lower wound infection (OR, 0.29; 95% CI, 0.17-0.48, p<0.001), and higher graft take rate (MD, 8.70; 95% CI, 5.76-11.63, p<0.001) compared to CT in STSs after GS subjects.

Conclusions

The examined data revealed that NPWT had a significantly lower wound infection and a higher graft take rates compared to CT in STSs after GS subjects. However, given that several examinations had a small sample size, consideration should be given to their values.

The pyrrolizine nucleus is a bicyclic ring system that consists of a pyrrole ring fused to another pyrrolidin ring. It constitutes the basic skeleton in many natural and synthetic compounds with diverse biological activities such as the anti-inflammatory, nootropic, antiemetic, antibacterial, antiviral, anticonvulsant, antiarrhythmic, and anticancer activities. At least two of these derivatives, ketorolac and mitomycin C, have been approved for the treatment of inflammation and cancer, respectively. Licofelone, a dual inhibitor of COX and 5-LOX, was also evaluated in clinical trials for the treatment of osteoarthritis. On the other hand, a large number of the pyrrolizine-based derivatives have displayed anticancer activity against different types of cancer cells. In this review, the pyrrolizine-based derivatives with anticancer activity were classified based on their chemical structure into substituted, fused, and spiro-pyrrolizine. The mechanisms of action of these compounds included alkylation of the DNA, inhibition of COX, or alteration of the permeability of the cytoplasmic membrane in cancer cells. In addition, other pyrrolizines were found to act by inhibiting DNA replication, rRNA, Rac1 kinase, thioredoxin reductase, or oncogenic kinases. The last section of this review also focuses on the reported X-ray crystal structures of these compounds with different proteins. The binding modes and interactions of ketorolac and licofelone were illustrated in this review. To sum up, we anticipate that the data compiled in this review will be useful to researchers in the design of pyrrolizines with potent biological activities.

This review focuses on the mechanisms and methods involved in oral mucosal absorption, with a particular emphasis on drug delivery systems. It begins by discussing the protective role of saliva in the oral cavity, highlighting its importance in maintaining the health of the oral tissues and facilitating drug delivery. The review then delves into the mechanisms of oral mucosal absorption, including passive diffusion, which is the primary mechanism for drug transfer across the oral mucosa. It also explores the use of hydrophilic polymeric matrices as vehicles for oral transmucosal drug delivery systems, which are favored due to the water-rich environment of the oral cavity. The review further discusses the methods used to assess oral mucosal permeation, including both in vivo and in vitro approaches. In vivo methods, such as the buccal absorption test, are used to determine the bioavailability of drugs via this route, while in vitro methods are employed for high-throughput permeability screening. The review concludes by addressing the challenges and limitations associated with oral mucosal drug delivery, such as the difficulty in studying regional variation in drug absorption and the limitations of in vitro permeability models in predicting in vivo situations.

Background

Cardiac implantable electronic devices (CIED) represent established life-sustaining interventions for various cardiac conditions, but post-placement infections are associated with high morbidity and mortality. Although pre-procedural antibiotic prophylaxis effectively reduces CIED infection rates, limited data exist on post-procedural antibiotic use, especially beyond 24 hours. This study assesses the efficacy of post-procedural antibiotic usage in preventing CIED placement-related infections.

Methods

We conducted a systematic review and meta-analysis, including studies that examined the comparative outcomes among patients. The study cohorts were divided into two groups: (1) those who underwent preoperative antibiotic prophylaxis followed by a continuation of 24 hours or more postoperatively (intervention group); and (2) those who received either preoperative-only antibiotic prophylaxis or preoperative prophylaxis with a duration of less than 24 hours postoperatively (control group). Risk of bias was assessed with ROBINS-I and ROB-2 tools. Risk ratio (RR) was pooled using random-effect or fixed-effect meta-analyses with inverse variance method.

Results

Our analysis of ten studies, including four randomized controlled trials and six cohort studies with 27,375 participants, revealed no statistically significant differences in outcomes between two groups. These outcomes included (CIED) infection rates (RR 0.83, 95% CI 0.47, 1.44), mortality (RR 1.22, 95% CI 0.66, 2.25), pocket hematoma (RR 1.01, 95% CI 0.54, 1.92) and re-intervention (RR 0.71, 95% CI 0.20, 2.50). The larger randomized controlled trial had an obvious impact on the overall findings.

Conclusions

The present systematic review and meta-analysis found no advantage in extending postoperative antibiotic prophylaxis for more than 24 hours following (CIED) implantation. These findings align with prevailing guidelines which support antibiotic stewardship practices. This approach has the ability to reduce adverse drug events, curb the potential for antibiotic resistance and alleviate the financial burdens associated with prolonged postoperative antibiotic prophylaxis.