Web-based cultural midwifery education approaches can provide an effective and scalable method for developing the cross-cultural competencies of future midwives. To examine the effects of web-based intercultural midwifery training on students' cultural sensitivity and cultural effectiveness levels. This randomized controlled multicenter study was carried out at the midwifery departments of five different universities in different regions of Türkiye. In this study, the students in the intervention group completed the web-based intercultural midwifery training. In the study, a total of 1027 midwifery undergraduate students following the standard midwifery curriculum were randomly assigned to a web-based training program ( n = 522) and a control group ( n = 505) in a 1:1 ratio. Data were collected using the ISS and the IES. In this study, the cultural sensitivity and cultural effectiveness level mean scores of the students in the intervention group after web training were higher than those in the control group. Following the web-based educational intervention, the mean total Intercultural Sensitivity Scale and Intercultural Effectiveness Scale scores were found to be 97.19 ± 10.34 and 65.64 ± 5.24, respectively. After the intervention, the mean ISS (mean difference = 18.30; Cohen's d = 1.69) and IES (mean difference = 14.76; P < 0.001; Cohen's d = 2.71) scores of the students were found to be significantly higher than those of the control group ( P < 0.001). A web-based intercultural midwifery training program seems to be an effective approach for increasing the cultural sensitivity and intercultural effectiveness of midwifery students. ClinicalTrials.gov Identifier: NCT05766228.

Bone resorption progresses in the alveolar ridge after tooth loss. In extremely athropic maxillae, treatment options include quad-zygoma implants, iliac bone augmentation with intraosseous implants, (the All-on-4 concept), Group-SUB periosteal implant. In this study, extremely atrophic maxilla was defined as an edentulous ridge with 3 mm crest thickness, 6 mm nasal base-crest distance, and 5 mm sinus floor-crest distance. This study aimed to compare stress distribution of these protocols using finite element analysis. In this study, analyses were performed using the finite element method A total of three groups were included in the finite element analysis, each representing a different treatment configuration applied to an extremely atrophic maxilla. The AOF (All-on-4) configuration consisted of four conventional implants placed in the canine and first molar regions following iliac bone augmentation, supporting a metal-ceramic prosthetic restoration. The ZYG (Zygomatic) configuration consisted of four extra-maxillary zygomatic implants (quad zygoma), with two implants placed in the canine region and two in the posterior region on each half of the maxilla, supporting a metal-ceramic prosthetic restoration. The SUB (Subperiosteal) configuration consisted of a subperiosteal implant framework supporting a metal-ceramic prosthetic restoration. For all three configurations, three-dimensional finite element models were generated based on standardized geometric reconstruction of an extremely atrophic maxilla. Implant positioning, prosthetic design, material properties, boundary conditions, and loading scenarios were defined according to previously published finite element modeling protocols, and identical modeling assumptions were applied to all groups to allow direct comparison. In this study, vertical occlusal force of 150 N and an oblique force of 50 N at a 30° angle were applied. In the models created, minimum stresses in the cortical bone and minimum and maximum principal stresses (P max) in the spongiose bone were observed. The Von Mises Stress values of the implants and abutments were analyzed. Stress in the alveolar bone remained within the physiological limits of the bone. However, it was determined that Group-SUB created less stress on the alveolar bone than the other Groups. When the Von Mises Stress values on the implants and abutments were examined, it was determined that Group-AOF had the highest Von Mises Stress values, followed by Group-ZYG (and Group 3-SUB had the lowest Von Mises Stress values. When the stresses occurring in the prosthetic restoration were evaluated, similar results were observed. Our data suggest that zygoma implants may reduce stress concentration in extremely atrophic maxillae; however, clinical validation is required.

Parotid gland tumors constitute a significant proportion of head and neck neoplasms, and accurate non-invasive differentiation is essential for appropriate clinical management. Recent advances in ultrasound techniques, including shear-wave elastography (SWE), have shown promising diagnostic potential. To evaluate the diagnostic performance of long-to-short axis ratio (L/S) and shear-wave velocity (SWV) values obtained by virtual touch imaging quantification (VTIQ) in differentiating pleomorphic adenoma (PA), Warthin tumor (WT), and malignant tumors (MT) of the parotid gland. This study included 66 parotid masses from 63 patients who underwent conventional ultrasound and SWE examinations. B-mode features, Doppler vascular patterns, L/S ratios, and SWV values were recorded and compared with histopathological findings. Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values, sensitivity, and specificity. The cutoff value for differentiating WT and PA was 1.57 for the L/S ratio (sensitivity: 83.33%, specificity: 88.46%, p < 0.001). For distinguishing MT from PA, the L/S cutoff was 1.68 (sensitivity: 50.00%, specificity: 96.15%, p < 0.001). The optimal SWV cutoff for WT and PA differentiation was 5.02 m/s (sensitivity: 91.67%, specificity: 73.08%, p < 0.001), while for MT and PA differentiation, it was 6.30 m/s (sensitivity: 84.62%, specificity: 62.50%, p < 0.001). The combined use of L/S ratio and SWV values obtained by VTIQ provides a reliable and non-invasive diagnostic approach for differentiating parotid gland tumors and may help reduce unnecessary biopsies.

Recurrent aphthous stomatitis (RAS) is a common oral mucosal condition characterized by painful, recurrent ulcers that affect quality of life. Topical corticosteroids such as triamcinolone acetonide are the standard treatment due to their anti-inflammatory effects, but concerns about side effects and patient preference have prompted interest in alternative therapies. Aloe vera, known for its anti-inflammatory and wound-healing properties, has emerged as a potential natural option. However, comparative evidence with standard treatments remains limited, necessitating further evaluation of its clinical efficacy in RAS management. This study aims to show the clinical efficacy of Aloe vera as compared with triamcinolone acetonide in the management of recurrent aphthous stomatitis (RAS). This comparative study was conducted on 60 patients (17-40 years) with RAS, who were randomly divided into two groups: Group A ( n = 30) on triamcinolone acetonide paste, and Group B ( n = 30) on Aloe vera gel. Both were applied at 6-hour intervals daily for 7 days under blinded conditions. Pain was self-assessed daily using the Numerical Pain Rating Scale (0-10), and healing was evaluated on Day 7 with the WHO Oral Mucositis Grading Scale. Data were analyzed with SPSS version 21.0, applying Student's t -test for parametric and Mann-Whitney U test for non-parametric variables. Sixty participants completed the trial. Males predominated in Group A, females in Group B. Both groups showed significant improvement by Day 7 with no post-treatment scores above 2. Males in Group A showed faster mid-phase improvement (Days 3-6, P = 0.026-0.002), while females demonstrated similar progress across groups. Overall, Aloe vera achieved comparable efficacy to triamcinolone, though steroid therapy offered quicker relief in males. Both triamcinolone acetonide and Aloe vera were effective in managing minor RAS. Triamcinolone provided faster recovery in males, whereas Aloe vera was equally effective overall. Aloe vera offers a safe, natural alternative for patients unable or unwilling to use corticosteroids, while Triamcinolone may be preferable when faster symptom relief is desired.

Myocarditis attributable to immune checkpoint inhibitors is regarded as among the most serious complications of immunotherapeutic treatment. We report a case of gastric cancer who developed myocarditis, and subsequent late complications following treatment with nivolumab and ipilimumab. The patient was managed with corticosteroids, mycophenolate mofetil (MMF), and intravenous immunoglobulin G (IVIG), but later developed supraventricular tachycardia and deep vein thrombosis. This report emphasizes the need to enhance recognition of immune-related toxicities within non-oncology specialties to support prompt interdisciplinary collaboration and appropriate patient management. Additionally, patients can develop myocarditis-related complications even when clinically stable or near the end of treatment, underscoring the need for close and ongoing monitoring.

Dexamethasone, a potent glucocorticoid, induces immunosuppression. In contrast, nano-piperine enhances the form of piperine through nanotechnology, along with vitamin C, and exhibits immunomodulatory and antioxidant effects. The potential synergy of these compounds in alleviating immune suppression caused by dexamethasone is yet to be fully investigated. This study aimed to assess the histopathological, hematological, and immunomodulatory effects of nano-piperine/vitamin C on immune function in dexamethasone-treated male albino rats. Forty-eight male Wistar rats (150 ± 10 g, 90-day-old) were adapted to the environment and divided into six groups (n = 8/group). The drugs were administered orally for 30 days continuously. Control (C): Distilled water (0.5 mL). T1: Nano-piperine (15 mg/kg BW). T2: Vitamin C (25 mg/kg BW). T3: Dexamethasone (2 mg/kg BW). T4: Dexamethasone combined with nano-piperine. T5: Vitamin C in addition to dexamethasone. Nano-piperine and vitamin C significantly increased white blood cell (WBC) counts (by 47% and 26%, respectively), lymphocytes, and monocytes (P < 0.05) compared to the control group. Dexamethasone treatment resulted in a significant decrease in WBCs (by 37%), lymphocytes, and monocytes, with a corresponding increase in neutrophils. Co-administration of nano-piperine or vitamin C with dexamethasone partially reversed these effects, leading to a significant increase in WBCs (by 68% and 44%, respectively) compared to the dexamethasone-only group. Serum interleukin-6 (IL-6) and immunoglobulin (IgG, IgA, IgM) levels were significantly reduced in all treatment groups compared to the control group (P < 0.05). Histopathological analysis indicated significant lymphoid degeneration in the dexamethasone-treated group, which was characterized by the absence of germinal centers, vascular congestion, and vacuolated lymphocytes. In contrast, the groups co-treated with nano-piperine or vitamin C showed preserved tissue architecture and reduced damage, supported by semi-quantitative scoring. Nano-piperine and vitamin C mitigated dexamethasone-induced immunosuppression by increasing WBC counts, modulating leukocyte differentiation, reducing inflammation (IL-6), and maintaining the integrity of lymphoid tissue. These compounds demonstrate potential as supplementary treatments to reduce immune toxicity associated with glucocorticoids.

Anemia is a global public health problem, particularly in resource-constrained settings, such as Sub-Saharan Africa. However, there is a paucity of data on anemia among adolescents in Sudan. This study aimed to evaluate the prevalence of anemia and iron deficiency among adolescents in Eastern Sudan. A community-based survey was conducted from August to October 2023. Sociodemographic data were collected using a face-to-face questionnaire. Hemoglobin, serum ferritin, and C-reactive protein levels were measured. A multivariate binary analysis was performed. Of the 388 enrolled adolescents, 207 (53.4%) were female and 181 (46.6%) were male. The median (interquartile range [IQR] age was 14.0 (12.0-16.1) years. A total of 145 (37.4%) adolescents had anemia, which was severe in one (0.3%) adolescent. In the multivariate binary analysis, age (adjusted odds ratio [AOR] = 0.84, 95% confidence interval [CI] =0.77-0.92, P < 0.001) and level of serum ferritin (AOR = 0.99, 95% CI = 0.98-0.998, P = 0.013) were inversely associated with anemia; being male (AOR = 2.56, 95% CI = 1.64-4.00, P < 0.001) was associated with increased odds of anemia; and parents' education, parents' occupation, body mass index (BMI) z-score, and C-reactive protein levels were not associated with anemia. Moreover, 67 (17.3%) adolescents had iron deficiency, and 41 (10.6%) had iron deficiency anemia (i.e. iron deficiency and anemia). In the multivariate binary analysis, being male (AOR = 0.57, 95% CI = 0.33-0.99, P = 0.047) was associated with decreased odds of iron deficiency. Age, sex, parents' education, parents' occupation, and BMI z-score were not associated with iron deficiency. Two-fifths of adolescents in Eastern Sudan had anemia, a moderate public health problem. Younger age and males were the most affected groups. The introduction of screening programs for anemia and iron deficiency at the community level is recommended to ensure adolescents' health in the present and adulthood. Effective interventions in nutrition programs are needed to address adolescents' nutritional challenges and reduce anemia in the study area.

The numerous toxic substances present in cigarettes have a suppressive effect on the immune system, lowering antibody levels and making smokers more susceptible to diseases. To determine the effect of smoking on serum IgG, IgA, IgM, and IgE levels in those who smoke in Türkiye. This cross-sectional study was conducted over a 3-month period in individuals who visited the Family Medicine Outpatient Clinic. Those who smoked cigarettes were included as the case group, and non-smokers as the control group. The nicotine dependence levels of the smokers were recorded using the Fagerström Nicotine Dependence Test (FNBT). IgG, IgA, IgM, and IgE levels were measured in both groups. Comparisons were made between the two groups, and a significant P value was taken as <0.05. The study was completed with a total of 300 participants, with an average age of 34.28 ± 11.10 years (range: 18-65), and 69.7% (n = 209) were male. Of the participants, 51.0% (n = 153) were smokers, with a higher frequency of smoking among males (P < 0.001). IgG levels were found to be higher in non-smokers (P = 0.002). No significant differences were found in IgM, IgA, and IgE levels between smokers and non-smokers (P = 0.080). There was no significant correlation between nicotine dependence levels and Ig levels. While IgG levels were lower in smokers, IgA, IgM, and IgE levels were similar to those in non-smokers. This decrease in antibody levels may adversely affect the immune system, increasing susceptibility to diseases. The negative impact of smoking on the immune system should not be overlooked, especially in preventive medicine practices.

5-Fluorouracil (5-FU) is the second most common chemotherapeutic agent associated with cardiotoxicities. High fructose consumption has the potential to increase 5-FU cardiotoxicity through pathophysiological mechanisms such as inflammation and increased oxidative stress. This study evaluated the relationship between fructose consumption and 5-FU cardiotoxicity. A total of 40 male Wistar albino rats were divided into 4 groups consisting of 10 each (control = 10, high fructose diet = 10, 5-FU = 10, 5-FU + high fructose diet = 10 (5-FU-HF)). 5-FU and 5-FU-HF groups received 150 mg/kg 5-FU at the beginning and on the 39th day of the study. At the beginning and at the end of the study, rats were examined by echocardiography and electrocardiogram. Furthermore, the histopathological method was used to evaluate the level of cardiotoxicity. In the 5-FU-HF group, 11% more EF decrease in quantitative modified Simpson measurements, 15% more QRS prolongation, and 11% more corrected QT interval prolongation were detected compared to the 5-FU group (P < 0.001, <0.001, <0.001). Inflammatory cell infiltration, sarcomyolysis, and necrotic changes were detected more in the 5-FU-HF group compared to the 5-FU group (P < 0.001, <0.001, <0.001). Our study showed that a high fructose diet has the potential to increase the effects of 5-FU - induced cardiotoxicity.