Abstract: Background/Objectives: Health care in preschools has gained increasing attention, particularly in the post-pandemic era, as educators face dual challenges in detecting emotional and physiological abnormalities among young children. Observation-based assessments are subjective and lack real-time data, often delaying the identification of potential health risks. This study aimed to construct an artificial intelligence (AI)-based model capable of recognizing the potential association between emotional abnormalities and physiological illnesses in preschool children. Methods: A mixed-method design was employed, integrating a literature review and the Delphi method. The literature review identified trends and feasibility in AI-assisted child health monitoring. Nine interdisciplinary experts in pediatrics, AI sensing, and early childhood education participated in three Delphi rounds to establish consensus on key physiological and behavioral indicators. Results: Experts reached consensus on five primary indicators—facial expression, speech prosody, heart rate variability (HRV), galvanic skin response (GSR), and skin temperature—and recommended using noninvasive wearable devices. A real-time risk alert system using red, yellow, and green levels was proposed. The final AI model included four modules: sensor input, data pre-processing, AI integration and analysis, and feedback interface. Conclusions: The developed AI-based recognition model demonstrates strong potential for early detection of emotional and physiological abnormalities in preschoolers. It provides timely, objective, and science-based support for caregivers, facilitating early intervention and individualized care. This model may serve as a practical framework for advancing digital transformation in preschool health care.

Abstract: Background: Therapeutic applications of saline solutions in oral healthcare range from mineral waters to standardized sodium chloride preparations. Despite widespread traditional use, their scientific foundation remains inadequately characterized. This scoping review aimed to map the available evidence for saline interventions in oral healthcare and identify research gaps. Methods: Following JBI methodology and PRISMA-ScR guidelines, four electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were systematically searched for publications from 2000 to 2025. Studies were classified along a spectrum from geological mineral waters to artificial preparations. Narrative synthesis was employed with systematic gap identification. Results: Seventeen studies met inclusion criteria, with a median sample size of 41 participants and median follow-up of 4 weeks. Evidence distribution revealed concentration on hypersaline Dead Sea derivatives (n=7, 41%) and European thermal waters (n=6, 35%), with limited representation of marine-derived (n=1, 6%) and simple saline solutions (n=3, 18%). Reported outcomes included periodontal parameters, xerostomia symptoms, viral load, mucositis severity, and dentin hypersensitivity, with variable methodological quality across studies. Heterogeneity in interventions, comparators, and outcome measures precluded direct comparisons. Conclusions: The current evidence base for salt-based oral interventions remains limited and methodologically heterogeneous. While preliminary findings suggest potential applications across multiple clinical domains, small sample sizes, short follow-up periods, and inconsistent outcome measures preclude definitive recommendations. Standardized protocols and adequately powered trials are needed before evidence-based clinical integration.

Abstract: Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia.

Abstract: Mothers play a crucial role in child nutrition, particularly in children under five. Their knowledge, attitudes, and practices significantly impact child health and development. Malnutrition can lead to severe health complications, making maternal understanding of nutrition necessary. Objective: This study aimed to assess mothers’ knowledge, attitudes, and practices (KAP) toward under-five children's nutrition, considering age, education, and economic status, and to propose sustainable strategies for reducing malnutrition. Methods: A descriptive cross-sectional study was conducted on 99 mothers of malnourished children in a Kabul City hospital. Data were collected via structured questionnaires and analyzed using SPSS v25. Chi-square tests examined associations between maternal KAP and Sociodemographic factors. Results: Nearly half of the mothers had moderate to good knowledge of nutrition, the majority had moderate attitudes, and almost all demonstrated good nutritional practices. Significant associations were found between maternal knowledge and education, attitudes and age, and practices and economic status. Conclusion: Findings highlight the need to integrate sustainable nutrition education programs into maternal and child health policies. Strengthening maternal nutrition knowledge is a cost-effective and sustainable approach that contributes directly to achieving SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being). These findings provide a baseline for developing culturally sensitive maternal nutrition education programs in resource-limited settings.

Abstract: Childhood obesity is an increasingly urgent public health issue with serious long-term implications. Despite greater awareness of its consequences, unhealthy behaviors related to diet, physical inactivity, poor sleep, and body composition persist in the pediatric population. Pediatric outpatient clinics offer a unique opportunity to promote healthy lifestyle habits from an early age, but current educational strategies often fail to engage children and families effectively or to produce lasting changes in behavior. In response to this challenge, we developed an innovative educational tool: the Mediterranean Lifestyle Tridimensional Pyramid. This model integrates three key components of a healthy lifestyle—balanced nutrition, regular physical activity, and adequate sleep—within a single, visually accessible structure. The pyramid also highlights the importance of a healthy muscle-to-fat body composition and encourages a comprehensive understanding of interconnected lifestyle factors. Its tridimensional format visually conveys the concept of health stability, which is achieved when all lifestyle pillars—nutrition, physical activity, and sleep—are built upon solid, interconnected foundations. The tool is designed to improve communication in clinical settings, enhance family engagement, and support the adoption of healthy habits. It is also adaptable for use in schools and community-based health promotion programs. By providing pediatricians and educators with a clear, flexible, and evidence-informed framework, the pyramid facilitates more effective primary and secondary prevention of obesity and related disorders. This approach may contribute to reducing the overall burden of lifestyle-related diseases and support national efforts aimed at improving the health of the pediatric population.

Abstract: Sodium (Na) is essential not only for maintaining extracellular fluid homeostasis as the dominant extracellular cation, but also for supporting the rapid tissue growth charac-teristic of the neonatal period. Despite its importance, the precise sodium requirements of preterm infants remain insufficiently defined. The immature renal tubules of preterm neonates lead to significant renal sodium losses, making negative sodium balance a common feature in this population. This issue has become increasingly relevant as sur-vival rates improve among extremely preterm infants, while most available data are derived from studies involving more mature preterm or even full-term neonates. Frac-tional excretion of sodium (FENa) shows a clear inverse correlation with both gestational age and postnatal age, highlighting the developmental limitations in sodium retention among the youngest and most vulnerable infants. Current guidelines on sodium sup-plementation aim to promote optimal growth and neurodevelopment but vary across organizations. For instance, the most recent ESPGHAN recommendations suggest higher sodium intakes, in the range of 3–8 mmol/kg/day, whereas the American Academy of Pediatrics (AAP) provides more conservative guidance. These discrepancies underscore ongoing uncertainty in determining optimal sodium provision. This narrative review examines both classic and contemporary data on sodium needs in preterm neonates, with the goal of clarifying existing evidence and offering practical insights for clinical care. It also emphasizes unresolved questions and the need for well-designed studies that address the unique physiology of extremely preterm infants. A deeper understanding of sodium metabolism in this population is crucial for improving outcomes and guiding evi-dence-based supplementation strategies.

Abstract: Background: Mental health literacy remains low in South Africa, particularly in nonurban settings. This study aims to determine the sociodemographic and geographic influences of mental health literacy among community health clinic attendees. Methods: This study adopted a quantitative, cross-sectional study design and was conducted between November 2019 and January 2020. A total of 385 participants were recruited through convenience sampling, with approximately 77 individuals per clinic across five sites. The participants’ responses regarding disorder recognition and perceived causes were analyzed via Pearson’s chi-square tests. To identify predictors of recognition and perceived causes, hierarchical logistic regression was performed. Statistical significance was set at p < 0.05. All analyses were conducted via STATA version 18.1 (StataCorp, Texas, USA). Results: The mean age of the study participants was 37.39±11.14 years (range: 13–80). Factors such as geographic location, gender and level of education were significant predictors of recognition. Participants attending urban clinics were more likely to correctly identify correct mental disorders than those attending township clinics were [OR = 0.32; 95% CI: (0.11, 0.93); p value = 0.036]. For correct causes, significant predictors included gender, education level, and geographic location. Urban clinic attendees were significantly more accurate at identifying the correct cause of mental disorders than township attendees were [OR = 0.42; 95% CI: (0.21, 0.83; p value = 0.013]. Conclusion: Mental health literacy in Tshwane community healthcare clinics reflects deep-rooted sociodemographic and geographic inequalities. Strengthening township clinic capacity, integrating culturally relevant health education, and prioritizing gender-sensitive outreach are essential to improve the recognition and understanding of mental disorders in underserved communities.

Abstract: Background: The triglyceride–glucose (TyG) index, calculated from fasting triglyceride and glucose levels, has emerged as a simple and cost-effective surrogate marker of insulin resistance (IR). Given that IR is a pivotal mechanism underlying cardiovascular disease (CVD), the TyG index has gained increasing attention in recent years. Objective: This review summarizes the current evidence on the association between the TyG index and cardiovascular risk, exploring its biochemical basis, role in metabolism, epidemiological findings, and clinical implications. Methods: A narrative review of published studies was conducted, focusing on the predictive value of the TyG index for insulin resistance, diabetes, metabolic syndrome, and CVD outcomes. Findings from cohort, cross-sectional, and meta-analysis studies were integrated to provide a comprehensive overview. Results: Multiple epidemiological and clinical studies demonstrate that higher TyG index values are associated with an increased risk of cardiovascular events, independent of traditional risk factors. Compared to the homeostasis model assessment of insulin resistance (HOMA-IR), the TyG index shows greater accessibility and predictive capacity. However, heterogeneity in cut-off thresholds and limited prospective and interventional trial data remain major challenges. Conclusions: The TyG index represents a promising biomarker for cardiovascular risk assessment and may serve as a supplementary tool for early screening, particularly in young and asymptomatic adults. Future large-scale prospective and interventional studies are warranted to standardize cut-off values and establish its role in clinical practice.

Abstract:

Stress- and inflammation-related disorders remain the dominant global health burdens, yet few preventive tools operate across molecular, psychological, and social scales. We hypothesize that OM-induced vibrational coherence functions as a mathematical–cum-biophysical regulator capable of harmonizing energy from cellular metabolism to genomic expression through the vagal–microbiome–brain axis. Following the physical law that energy transforms but is conserved, the OM-to-Genome continuum extends this principle to living systems, where metabolic, immune, reproductive, and neural energies represent biological analogues of potential, chemical, and kinetic forms. Mathematics provides the syntax of these transformations—frequency, proportion, and rhythm—governing energy construction and deconstruction from birth to death. Within the author’s Evolution-to-Solution framework, OM vibration mediates these conversions, translating conscious intent into physiological order. Evidence from neuroimaging, electrophysiology, and molecular biology supports this pathway as a low-cost, culturally neutral mechanism for stress regulation and immune balance. Integrating mathematics, physics, chemistry, and physiology thus yields a unified One Health model linking awareness and biology through a single law of energy coherence.

Abstract: Background/Objectives: The Manchester Colour Wheel (MCW) was developed as an alternative way of assessing health status, mood and treatment outcomes by Carruthers et al in 2010. There has been a dearth of research on this alternative assessment ap-proach. The present study examines the sensitivity of the MCW to pain, psychological factors and recovery status in 1098 people with insured injuries treated in an interdis-ciplinary clinic. Methods: A deidentified data set of clients treated in a multidiscipli-nary clinic were conveyed to the researchers containing results of MCW and injury specific psychometric tests at intake, and recovery status at discharge. Systematic ma-chine modeling was applied. Results: There were no significant differences between the four injury types studied, being motor crash related Whiplash Associated Disorder (WAD) and workplace related Shoulder Injury (SI), Back Injury (BI) and Neck Injury (NI) on the MCW. Augmenting the MCW with Machine Learning (ML) models showed overall classification rates for Classification and Regression Tree (CRT) of 75.6% for anxiety, 70.3% classified for depression, and 68.5% for stress, and Quick Unbiased Ef-ficient Statistical Trees could identify 68.5% of pain catastrophisation and 62.7% of kinesiophobia. Combining MCW with psychometric measurements markedly in-creased the predictive power with a CRT model predicting WAD recovery status with 80.7% accuracy, SI recovery status 81.7% accuracy, BI recovery status with 78% accu-racy. A Naïve Bayes Classifier predicted recovery status in NI with 96.4% accuracy. However, this likely represents overfitting. Conclusions: Overall, MCW augmented with ML offers a promising alternative to questionnaires and the MCW appears to measure some unique psychological features that contribute to recovery from injury.

Abstract: Photoplethysmography (PPG)-based heart rate variability (HRV) offers a cost-effective al-ternative to electrocardiography (ECG) for autonomic monitoring in wearable devices. We optimized signal processing on a 16-bit microcontroller by comparing 4th-order equiva-lent Butterworth and Elliptic IIR bandpass filters (0.8–20 Hz, zero-phase) at 1000, 500, and 250 Hz. Paired PPG–ECG recordings from 10 healthy adults were analyzed for ln HF, ln LF, and ln VLF using Lin’s concordance correlation coefficient (CCC), ±5% equivalence testing (TOST), and Passing–Bablok regression (PBR). Butterworth at 500 Hz preserved near-identity with ECG standard (CCC ≥ 0.94; TOST met equivalence; PBR slopes/intercepts: ln HF = 0.97x + 0.10, ln LF = 1.02x − 0.07, ln VLF = 1.01x − 0.03), while halving computational load. In contrast, Elliptic at 250 Hz degraded concordance (CCC ≈ 0.64) and failed equivalence, with greater bias from nonlinear phase and ripple-induced distortion. Elliptic performance improved at higher sampling but offered no benefit over Butterworth. These results support zero-phase Butterworth filtering at ≥500 Hz as the op-timal balance of fidelity, robustness, and efficiency, enabling reliable PPG-HRV monitor-ing on low-power devices. As a pilot investigation (n=10), this study establishes prelimi-nary design parameters and optimal configurations to guide subsequent large-scale clin-ical validation.

Abstract: Low-grade chronic inflammation (LGCI) is a central etiological factor and a persistent driver in the pathogenesis of non-communicable chronic diseases (NCCDs), notably obesity, cancer, and type 2 diabetes mellitus (T2DM) [1, 2]. This expanded and in-depth review proposes and critically analyzes an integrated and innovative therapeutic strategy, focusing on injectable administration, which combines agents with complementary and synergistic mechanisms of action: Dimethyl Sulfoxide (DMSO), Coenzyme Q10 (CoQ10), Alpha-Lipoic Acid (ALA), Curcumin, Resveratrol (RSV), Glutathione (GSH), and microRNA-146a mimetics (miR-146a) [3]. The choice of the injectable route of administration (intravenous, intramuscular, or subcutaneous) is justified by the need to optimize the systemic bioavailability and tissue targeting of these compounds, overcoming the severe limitations of absorption and first-pass metabolism of the oral route, especially for lipophilic nutraceuticals and oligonucleotides [4, 5]. The main focus of the approach lies in the modulation of the immunometabolic axis, with emphasis on restoring the negative feedback of miR-146a on the IRAK1/TRAF6/NF-κB signaling pathway, a molecular circuit crucial for immunological and metabolic homeostasis [6, 7]. Additionally, the article delves into the role of resveratrol in activating sirtuins (SIRT1) and modulating leptin and insulin resistance, comparing this multidimensional approach with current gold-standard therapies (e.g., GLP-1/GIP agonists). It is hypothesized that this synergy of agents, supported by nanomedicine for the efficient delivery of miR-146a mimetics, can modulate LGCI more comprehensively, optimize mitochondrial function and biogenesis, and restore central and peripheral metabolic balance. The critical analysis of safety and clinical evidence, notably for intravenous DMSO and miRNA mimetics, is an essential component of this review, positioning this approach as a potential new frontier in the treatment of these chronic immunometabolic diseases [8, 9].

Abstract: Refugee-serving primary health centres/clinics (PHCs) provide culturally safe, integrated care for refugee children, yet little is known about how their health conditions and outcomes are assessed. This scoping review examined the health conditions and outcomes of refugee children aged 0-5 years and how they are measured in refugee-serving PHCs in Canada. Conducted in partnership with the New Canadians Health Centre and guided by Joanna Briggs Institute methodological guidelines, we systematically searched Medline, CINAHL, Scopus, and Embase. Included studies focused on refugee children in Canada and reported health conditions, outcomes, and their measurements within PHCs. Twenty-five studies (2008–2024) met the inclusion criteria, most from Ontario (n=11), followed by Alberta and Saskatchewan (n=4 each). Reported health conditions or outcomes (n=24) spanned physical (n=19), developmental, and mental health domains (n=5). Communicable (e.g., gastrointestinal infections, hepatitis) and non-communicable conditions (e.g., malnutrition, vitamin D deficiency) were mostly reported. Although some standardized approaches were used, variability exists across provinces and conditions or outcomes measured. Findings reveal disproportionate focus on physical health and notable variability and gaps in child health measures, limited cultural adaptation, and lack of longitudinal data. Standardized, culturally responsive, and age-appropriate measurement approaches are needed to enhance health equity and inform evidence-based policy for refugee children in Canada.

Abstract: This study evaluates the dosimetric feasibility of hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) using IMRT compared to VMAT, with particular attention to clinical implementation in resource-limited settings. While 3D-CRT was used as a reference for conventional WBRT, the primary aim was to determine whether IMRT can serve as an effective and accessible alternative to VMAT for HA-WBRT in centers without advanced technology infrastructure. Ten patients undergoing WBRT for symptom relief were planned using 3D-CRT, IMRT, and VMAT on the Elekta Monaco 6.1.4 system. Key organs at risk (OARs) such as the optic nerves, chiasm, eyes, and lenses were considered in the treatment planning. Plans were evaluated based on PTV dose distribution, Conformity In-dex (CI), Homogeneity Index (HI), and OAR dose constraints (RTOG 0933, NRG-CC001). Gamma pass rate analysis was performed for IMRT and VMAT plans. Results showed that IMRT and VMAT significantly reduced the hippo-campal dose compared to 3D-CRT, with similar PTV coverage and OAR sparing. The mean Dmax for the hippocampus was 15.4 Gy for IMRT and 15.6 Gy for VMAT, compared to 31.03 Gy for 3D-CRT. The D100% for the hippocampus was 7.4 Gy for IMRT and 7.6 Gy for VMAT, both well below the RTOG 0933 threshold of 9 Gy, while 3D-CRT delivered 30.55 Gy. Additionally, IMRT and VMAT delivered lower doses to the optic nerves and chiasm. QA results showed gamma pass rates above 95% for all plans. Hippocampal-sparing WBRT with IMRT and VMAT significantly reduces hippocampal dose while maintaining optimal PTV coverage. VMAT is preferred for its balance of efficacy, protection, and treatment time, while IMRT-9F is a viable alternative for facilities without VMAT, though it requires stricter dose control and longer treatment times.

Abstract:

Background: Early diagnosis is key for improving outcomes of breast cancer cases. However, controversy remains regarding the lower age limits and non-personalized nature of screening programs. The main objectives of this study are to investigate the relevance of defining a new lower age limit for breast cancer screening, characterize risk factors not included in the Tyrer-Cuzick™ risk assessment calculator, and explore the feasibility of personalizing screening. Methods: This study is an observational case-control. The case group included 64 women with a breast cancer diagnosis. Breast cancer incidence by age group was obtained. Participants were characterized concerning cancer risk factors, namely smoking habits, alcohol consumption and breastfeeding. A risk score was attributed to each woman through the Tyrer-Cuzick™ risk model, and subsequent stratification into several risk groups was done. Finally, the relationship between intermediate to high-risk scores and breast cancer development was studied. Results: We found no statistically significant differences between breast cancer incidences in women between the ages of 40 and 49 vs. 50 to 69, in the Health Units under study. There was no statistically significant link between the studied risk factors and breast cancer development. We observed a statistically significant relationship between intermediate to high-risk scores and the development of breast cancer (OR 10.0 with p = 0.0009). Conclusion: These results support screening from the age of 40 and the applicability of a patient-centered model, given that the screening tool has high sensibility.

Abstract: Background. Genetic studies justified that germline BRCA1 gene mutation is the origin of highly increased cancer risk. Clinical studies suggested that increased cancer risk in type-2 diabetes maybe attributed to unhealthy lifestyle factors and bad habits. Purpose. Patients with either BRCA1 gene mutation or type-2 diabetes similarly exhibit increased cancer risk, insulin resistance and fertility disorders. It was suggested that these three alterations derive from a common genomic failure and its recognition may shed light on the unsolved secret of cancer. Results. 1. Germline mutations on ESR1, BRCA1, and CYP19A genes encoding estrogen receptor alpha (ERα), genome safeguarding BRCA1 protein and CYP19 aromatase enzyme, cause genomic instability. BRCA1 and ESR1 gene mutations cause particularly breast cancer, while the error of CYP19A gene leads to cancers in the endometrium, ovaries and thyroid. 2. ERα, BRCA1 and CYP19 aromatase proteins are transcription factors creating the crucial DNA stabilizer circuit driven by estrogen regulation. Liganded ERα drives a second regulatory circuit for controlling cell proliferation as well, in partnership with various growth factors. In a third regulatory circuit, liganded ERα drives cellular glucose supply in close interplay with insulin, IGF-1 and glucose transporters. 3. Weakening expression or activation of each transcription factor of the triad, leads to defective estrogen signaling and endangers regular cell proliferation, insulin sensitivity and fertility. 4. Weakening estrogen signaling caused by either genetic or lifestyle factor, is alarming for the hypothalamus and it sends neural and hormonal commands throughout the body so as to restoring estrogen signaling. 5. When the compensatory actions cannot restore estrogen guideline, the breakdown of genomic regulation leads to cancer initiation. 6. Lifestyle factors upregulating estrogen signaling, decrease, while downregulating estrogen signaling increases the risk for cancer. Conclusion. Increased cancer risk, insulin resistance and infertility all are originating from defective estrogen signaling.

Abstract: Osteoarthritis (OA) is a leading form of arthritis that significantly impacts individuals' quality of life and places an immense burden on healthcare systems globally. Traditional management strategies often fall short in addressing the disease's underlying pathophysiology. The emergence of robotic-assisted surgical techniques offers a promising avenue for enhancing both surgical precision and patient outcomes. Notably, AI-assisted robotics has the potential to bridge significant gaps in current surgical practices, such as personalized planning and intraoperative adjustments. This review critically analyzes the comparative efficacy of robotic-assisted techniques versus traditional methods in total knee arthroplasty (TKA) and discusses the integration of artificial intelligence (AI) in optimizing surgical outcomes. While early findings suggest improved postoperative performance and reduced length of hospital stays, significant challenges, including the generalizability of current algorithms and their integration into clinical practice, remain. This paper highlights the necessity for further research to solidify these technologies' role in future OA management.

Abstract: Background According to the World Health Organization (WHO), worldwide anemia prevalence in children of 6–59 months is 40% [1]. Though iron deficiency is recognized as a significant cause of anemia, vitamin B₁₂ (B₁₂) and folate deficiencies are also important causes. The previous Pakistan National Nutrition Survey (NNS) 2011 showed a high prevalence among women of reproductive age (WRA), which necessitated further investigation in follow-up surveys among children. Methods We performed a secondary analysis of the National Nutrition Survey (NNS) 2018–2019. Blood samples were obtained from 31,828 children (< 5 years), with a subsample analyzed for B₁₂ (n=2693) and folate (n=6690) deficiency. B₁₂ was assessed by electrochemiluminescence immunoassay, and folate by CDC’s microbiologic assay. Logistic regressions were applied to determine factors associated with deficiency. Results 35.1%, while 24.8% of children showed folate and B₁₂ deficiency, respectively. Higher odds of folate and B₁₂ deficiency were observed in Khyber Pakhtunkhwa, OR = 1.424 (95% CI 1.157, 1.752), and newly merged districts of Khyber Pakhtunkhwa, OR = 11.257 (95% CI 2.291, 55.314), respectively. Additionally, mother’s education was associated with B₁₂ deficiency i.e. uneducated OR = 2.017, (95% CI 1.229, 3.308), primary OR = 2.361 (95% CI 1.359, 4.103) and middle OR = 2.108 (95% CI 1.144, 3.882) while underweight was associated with folate deficiency only, OR = 1.181 (95% CI 1.016, 1.371). Conclusion This analysis highlights a considerable burden of folate (35.1%) and vitamin B₁₂ (24.8%) deficiencies among Pakistani children under five years of age, with regional disparities. Socioeconomic and nutritional factors, particularly maternal education and child undernutrition, further influence the risk of deficiency. These results emphasize the need for region-specific nutrition interventions, maternal education programs, and strengthened food fortification strategies.

Abstract: Patients with systemic lupus erythematosus (SLE) face a daunting journey accompanied by severe morbidity, a poor quality of life and potential damage to major organs including the kidneys, eyes, cardiovascular and cerebrovascular systems. Disease prevalence is highly skewed towards females of childbearing age - polarizing statistics pointing to a role for estrogen in disease origin and/or progression. Female patients of certain races/ethnicities are more predisposed to SLE while also presenting with more severe and aggressive disease. Unfortunately, this cohort also experiences the most delays in disease diagnosis. Herein we discuss SLE and its outcomes in the backdrop of estrogen and delays in diagnosis.

Abstract:

Background: Conventional CT- or US-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) often limits repeat contrast-enhanced imaging and provides suboptimal intraprocedural conspicuity, which can hinder precise targeting and margin assessment. Purpose: To describe a single-center angiography-assisted cone-beam CT (angio-CBCT) RFA workflow and report early outcomes versus an institutional conventional CT–guided cohort. Materials and Methods: In this IRB-approved single-center retrospective study, consecutive patients underwent angio-CBCT–guided RFA for HCC (n=14). Selective intra-arterial injections (≈20–40 mL iodinated contrast per CBCT) through a 5-Fr catheter permitted multiple intraprocedural CBCT acquisitions for targeting, verification, and endpoint assessment under general anesthesia. Primary outcomes were technical success, early local recurrence, and complications (CTCAE v6.0). For a secondary imaging analysis, within-patient change in lesion conspicuity (ΔHU = HU_tumor − HU_liver) from preprocedural contrast-enhanced CT to intraprocedural imaging was compared in available cases (angio-CBCT n=12; conventional CT n=13). Descriptive statistics were used. Results: Angio-CBCT RFA achieved technical success in 14/14 (100%) procedures; early local recurrence was 0/14 (0.0%); and one complication occurred (1/14, 7.1%; Grade 3). Intraprocedural refinements included immediate re-ablation in 3/14 (21.4%) and electrode repositioning in 2/14 (14.3%), with on-table detection of an additional lesion in 1/14 (7.1%). In the institutional conventional cohort, technical success was 19/20 (95.0%), early local recurrence 2/20 (10.0%), and complications 0/20 (0%). Lesion conspicuity improved with angio-CBCT (median ΔHU 290.1 HU, n=12) but not with conventional CT (−10.5 HU, n=13). Conclusion: Angio-CBCT–guided RFA for HCC is feasible and safe and enables repeatable, low-volume contrast–enhanced intraprocedural imaging that supports precise targeting, verification, and timely refinements. Early outcomes and markedly improved lesion conspicuity suggest potential advantages over conventional CT–guided workflows and warrant prospective validation in larger cohorts.