Erosive lesions may occur in the gastric mucosa after exposure to toxic substances such as alcohol, non-steroidal anti-inflammatory drugs, or iron. Candies rarely contain compounds that cause mucosal erosions. However, Scotch mints in combination with carbonated sodas are known to cause vigorous effervescence. The microporous surface of Scotch mint candy allows for rapid release of dissolved carbon dioxide from carbonated soda that produces carbon dioxide bubbles. We report a case of a 3-year-old child who presented with abdominal pain and feeding refusal and was found to have erosive chemical gastropathy. Dietary history revealed ingestion of Scotch mint candies and lemon-lime soda for 2 days prior to the onset of symptoms. This case demonstrates the potential for mucosal injury when ingesting excessive amounts of Scotch mint candy and carbonated soda and the importance of a careful dietary history in children with gastrointestinal mucosal injury.
Social criticism is an analytical approach used to examine social structures, institutions, and power relations in order to reveal inequalities and injustices within a society. This study investigates the forms of social criticism presented in Charlotte Brontë’s novel Jane Eyre using a Marxist theoretical framework developed by Karl Marx. The data were collected from the novel through a qualitative descriptive method focusing on narrative events, character interactions, and social settings. The analysis reveals the rigid class hierarchy of Victorian English society, in which the bourgeoisie controlled economic resources and social power, while the proletariat experienced dependency, exploitation, and alienation. The findings show that the novel portrays various forms of social inequality through the experiences of Jane Eyre as an impoverished orphan and governess navigating a stratified social structure. Furthermore, the social criticism expressed in the novel remains relevant to contemporary societal issues, including gender oppression, power imbalances in the workplace, and struggles for individual autonomy. Therefore, Jane Eyre can be understood as a significant literary work that not only reflects social realities of its time but also encourages readers to critically examine injustice and inequality in modern society.
Andi Nurul Mawaddah Malik, Burhanuddin Arafah, Herawaty Abbas et al.
Objectives This study investigated the effects of a nanocomposite comprising N-acyl -homoserine lactonase Est816 and silver nanoparticles (Ag-Est816) on the microbial community of an enriched in vitro biofilm model derived from supragingival plaque of children with early childhood caries (ECC). Materials and methods Supragingival plaque samples were collected from 30 children aged younger than 6 years (15 males and 15 females) diagnosed with ECC. These samples were cultured in vitro to form biofilms, which were then treated with or without the Ag-Est816 composite for two days. The composition of the biofilms was analyzed by 16S rRNA sequencing to assess changes in α - and β -diversity, taxonomic composition, and predicted microbial functions. Biofilm morphology and biomass were evaluated using scanning electron microscopy (SEM) and crystal violet assays. Results The Ag-Est816 composite significantly reduced microbial α -diversity, including species richness and phylogenetic diversity (Chao1, Observed species, Faith's PD, p < 0.05). It also significantly altered overall bacterial community composition, as demonstrated by principal coordinate analysis (PCoA) and paired permutational multivariate analysis of variance (PERMANOVA), although the effect size was modest ( R 2 = 0.0286, P = 0.002). At the genus level, the abundances of Actinomyces , Lactobacillus , and Moryella were markedly decreased, whereas Haemophilus and Granulicatella were enriched. LEfSe analysis revealed Actinomyces and Lactobacillus as characteristic taxa enriched in the Control group, while Enterococcus and Granulicatella were significantly enriched following treatment. Functional prediction revealed that Ag-Est816 influenced pathways related to carbohydrate metabolism, amino acid biosynthesis, nucleotide metabolism, and nucleotide sugar biosynthesis. SEM imaging and biomass quantification confirmed that the Ag-Est816 composite disrupted biofilm architecture and significantly reduced total biomass. Conclusion The Ag-Est816 composite suppressed several low-abundance cariogenic genera while reducing overall community richness, altered microbial metabolic functions, and compromised biofilm structural integrity. These findings indicated this non-invasive nanocomposite has potential as an adjunctive therapy for caries prevention in children.
Background The progressive loss of kidney function is a major cause of morbidity and mortality in children with neurogenic bladder dysfunction. A consequent follow-up, including repeated urodynamics combined with detection of vesicoureteral reflux (VUR) is crucial for the individual treatment of the urinary tract. The aim of our study is to investigate whether contrast-enhanced voiding urosonography -urodynamics (ceVUS-UD) can be used in routine urological diagnostics. Due to its radiation-free nature in a more comfortable environment, this would allow the examination to be performed frequently enabling more accurate monitoring of bladder function. Methods Since January 2025, 19 patients with neurogenic bladder dysfunction have undergone simultaneous ceVUS as part of urodynamic follow-up. The children were 11.4 years old on average (9 male, 10 female) and showed one of the following underlying conditions: spina bifida, detrusor hyperactivity after spinal cord injury, caudal regression syndrome, epispadias, infantile cerebral palsy or myotonic dystrophy type 1. Two-thirds of the patients performed self-intermittent catheterization. Results CeVUS-UD can be safely performed as part of routine urodynamic testing without interfering with urological measurements. Previously unknown secondary VUR (sVUR) was detected in six patients (31.6%). In one case, a significant decrease of vesical pressure during the occurrence of reflux was observed. For five children, this led to a change in treatment . Conclusions In this study, CeVUS-UD provides a feasible, safe and radiation-free tool for characterizing neurogenic bladder dysfunction. Whether ceVUS-UD can serve as an alternative to video urodynamics (VUD), and whether routine monitoring of sVUR translates into improved long-term kidney outcomes, remains to be established in further studies.
Social-emotional learning (SEL) is increasingly recognised as an important approach to adolescent mental health promotion in school settings. However, evidence regarding culturally adapted and technology-supported SEL interventions in non-Western educational contexts remains limited. This study reports the expert-validation and pilot-feasibility components of the REAL™ (Read Emotion and Learn to Regulate) module, a culturally adapted, virtual reality (VR)-integrated SEL intervention developed for Malaysian lower-secondary students. These developmental phases preceded a subsequently completed and separately reported randomised controlled trial (RCT). A sequential two-phase design was used. In Phase 1, six Malaysian experts from psychiatry, psychology, education, and social-emotional learning completed a three-round Modified Delphi process evaluating 15 module structure and delivery components and 12 activity stations on a 5-point Likert scale. Content validity was assessed using the item-level content validity index (I-CVI), scale-level average content validity index (S-CVI/Ave), and interquartile range (IQR). In Phase 2, a single-session school-based feasibility pilot was conducted with 15 lower-secondary students, four facilitators, and one school administrator to assess practical implementation of one chapter from the initial 12-station module. In Round 1, the S-CVI/Ave across 15 module structure and delivery components was 0.92. In Round 2, five of 12 activity stations did not meet the I-CVI retention criterion of ≥0.83 (S-CVI/Ave = 0.65). Following module revision and reassessment, 11 of 12 stations met the retention criterion in Round 3. Manage Your Emotions VR improved following revision and was retained, whereas The Drama of Life received uniformly unfavourable ratings (I-CVI = 0.00) and was removed because of concerns regarding suitability, feasibility, and potential physical safety in school settings. The final S-CVI/Ave across the 11 retained stations was 0.85. The findings provide developmental evidence that informed refinement and subsequent evaluation of the REAL™ module. Pilot findings should be interpreted cautiously because of the small, teacher-selected, single-site sample and use of a researcher-developed feedback measure without established psychometric properties.
Aimi Nur Athira Putri Baharuddin, Nik Ruzyanei Nik Jaafar, Normala Ibrahim et al.
Introduction Parent-child physiological synchrony may reflect coordinated regulatory processes, but its meaning appears to vary across developmental and interactional contexts. Greater synchrony has been associated with more and less adaptive functioning, suggesting that synchrony should not be interpreted as inherently beneficial. The current study examined whether mother-youth trend-level physiological synchrony during a dyadic stressor was associated with multiple indicators of wellbeing in preadolescence. Method One hundred seventy-three mother-child dyads (Mothers: M age = 41.60 years; Youth: M age = 9.54 years, range = 8–12; 53% female) completed the Performance Challenge Task, during which youth attempted unsolvable puzzles while mothers observed. Respiration rate, root mean square of successive differences (RMSSD), and respiratory sinus arrhythmia (RSA) were assessed simultaneously in mothers and youth. Youth reported positive and negative affect, depressive symptoms, anxiety, and aggression; mothers reported youth internalizing and externalizing symptoms. Growth models estimated each participant's physiological trajectory across the task, and mother and youth trajectories were covaried to estimate trend-level synchrony. Results Greater RSA synchrony was associated with higher post-stressor positive affect after accounting for pre-stressor positive affect, higher mother-reported internalizing symptoms, and lower mother-reported externalizing symptoms. RMSSD synchrony showed a nonsignificant trend toward higher youth-reported anxiety ( p = 0.08), and respiration-rate synchrony showed a nonsignificant trend toward lower mother-reported externalizing symptoms ( p = 0.06). Most other associations were nonsignificant. Discussion Findings did not support a uniformly adaptive interpretation of physiological synchrony. Instead, associations varied across outcomes and physiological indices, underscoring the importance of considering what form of synchrony is measured and the context in which it occurs.
Christina Rowley, Juelle Ford, Frances Haofei Li et al.
Background Quality antenatal care (ANC) is essential for reducing maternal and neonatal mortality; however, access remains inequitable in Southern Africa. Women's empowerment is increasingly recognized as a key determinant of health-seeking behavior; however, its role in shaping ANC quality has not been adequately examined in the region. Methods This study used cross-sectional Demographic and Health Survey (DHS) data from 2015 to 2023 across seven Southern African countries ( n = 36,671). Women's empowerment was measured using the SWPER Global Index, which covers the domains of attitude toward violence, social independence, and decision-making. Quality ANC was defined as the receipt of four essential services: blood pressure measurement, urine testing, blood testing, and iron supplementation. Hierarchical models were fitted, and the measures of variation and model fit were evaluated. The significance level was set at p < 0.05, with a 95% confidence interval. Results Overall, 45.1% of the women received quality ANC, with wide variation between countries (27.4% in Malawi vs. 92.1% in South Africa). A high level of empowerment against violence and decision-making was observed among the women in most of the countries. Women with high social independence (aOR = 1.12, 95% CI: 1.01–1.24) and strong rejection of gender-based violence (aOR = 1.15, 95% CI: 1.05–1.26) were significantly more likely to receive high-quality ANC. Early ANC initiation, ≥8 visits, and doctor-led care were the most powerful predictors of quality ANC care. Conclusion Women's empowerment, particularly social independence and autonomy from violence, plays a critical role in improving the quality of ANC in Southern Africa. However, persistent socioeconomic and geographic inequities highlight the need for context-specific strategies. Policies that integrate gender equality frameworks with strengthened ANC service delivery, especially in rural and low-performing countries, are essential for achieving maternal health targets.
Background Data exist on adolescents’ screen time behavior, but are lacking on urban–rural differences. We compared daily screen time exposures and associated anthropometric parameters, frequency of outdoor physical activity, and psychological parameters of urban and rural school-going adolescents. Methods This was a cross-sectional study. Using five districts of one of the administrative divisions of a western Indian state as the sampling frame, the first two urban and first two rural schools were selected from a randomly reordered list of schools. We included 627 students from 5th, 7th, and 9th standards as representatives of the adolescent age group (10–19 years). Self-reported outdoor physical activity, psychological assessment using the Strengths and Difficulties Questionnaire (SDQ) and daily time spent on each were recorded. We determined associations between area of residence, frequency of outdoor physical activity, and SDQ scores and screen time using the chi-square test or Fisher’s exact test. Multivariable regression analysis was used to determine the predictors of excessive screen time (>2 h/day). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated. Results There were 334 (53.3%) urban and 293 (46.7%) rural students. The mean age was 12.5 ± 1.4 years. Mean daily total screen time was 111.9 ± 71.7 min. Urban compared to rural [121.5 ± 75.9 min vs. 100.9 ± 65.0 min; p = 0.001] and boys compared to girls [122.9 ± 81.9 min vs. 100.9 ± 58.0 min; p < 0.000] had longer total screen time exposure. Being a rural resident was significantly associated with a >2 days/week of outdoor physical activity [78.8% (rural) vs. 35.9% (urban), respectively; OR 6.64, 95% CI 4.64–9.51, p < 0.000]. Students with daily screen time of >2 h had some/high needs on the SDQ hyperactivity scale [11.4% vs. 5.7%; p = 0.022]. Males had significantly higher odds of >2 h of total daily screen time than females (aOR = 1.51, 95% CI 1.05–2.17; p = 0.026). Conclusion The associations between longer screen time exposure and worse physical and psychological factors warrant interventions with special attention to urban–rural differences.
Gauri A. Oka, Ashish S Ranade, Mayur Kiran Shinde et al.
BACKGROUND: Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality worldwide, yet effective pharmacological preventive strategies remain uncertain. Statins, metformin, and vitamin D, alone or combined with omega-3, have been investigated for potential protective effects, but comparative evidence is limited. OBJECTIVE: To compare the effectiveness of statins, metformin, and vitamin D in preventing preeclampsia and related adverse outcomes among high-risk pregnant women. METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted. PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos were searched from September 11, 2020, to September 11, 2025. Eight trials involving 4,078 high-risk pregnant women were included. Participants were randomized to statins, metformin, or vitamin D at different doses versus placebo. The primary outcome was the incidence of preeclampsia. Secondary outcomes included gestational hypertension, preterm birth, low birth weight, neonatal intensive care unit admission, gestational diabetes, respiratory distress syndrome, and perinatal outcomes. Risk ratios with 95% confidence intervals were calculated, and interventions were ranked using the surface under the cumulative ranking probabilities. RESULTS: Eight randomized controlled trials were analyzed. Compared with placebo, higher-dose vitamin D supplementation showed associations with lower estimated risks of preeclampsia, particularly vitamin D 4,000 IU/day (risk ratio 0.21, 95% confidence interval 0.06-0.72) and 60,000 IU monthly (risk ratio 0.36, 95% confidence interval 0.19-0.70). These relative effects corresponded to approximate absolute risk differences of 8% and 6%, respectively, based on observed baseline risks, and reflect associations rather than proven causality. Estimates were derived from limited direct evidence within sparse networks. These dose-specific vitamin D regimens had the highest probabilistic ranking for preeclampsia within the network, but these rankings should be interpreted as exploratory rather than definitive. Higher-dose vitamin D was also associated with trends toward lower event rates of preterm births and low-birth-weight infants, although estimates were imprecise. Evidence for statins and metformin was inconsistent, with wide confidence intervals. SUCRA rankings suggested vitamin D as the highest relative ranking probability overall intervention within the network, followed by statins; however, these rankings remain exploratory given the limited network structure. These associations were derived from limited direct evidence within sparse networks and should be interpreted cautiously. Probabilistic rankings and SUCRA values reflect relative positioning within the network rather than comparative effectiveness. CONCLUSION: In high-risk pregnancies, higher-dose vitamin D regimens were associated with lower estimated risks of preeclampsia compared with placebo; however, these findings are based on limited, heterogeneous, and partly indirect evidence from sparse networks. The certainty of evidence is low, and the observed effect sizes should not be interpreted as evidence of clinical effectiveness. These findings are best considered hypothesis-generating and are intended to inform the design of future studies rather than guide clinical practice. Evidence for statins and metformin remains limited and inconsistent. Overall, further large, well-designed randomized trials are required before firm clinical recommendations can be made.
Menna Alaa El-Khouly, Mazen Mohammed Mahgoub, Mahmoud E. Abd-Elkareem et al.
Gratitude, one virtue that reflects a person's high moral standards, is a culturally sensitive construct expressed differently across cultural contexts. Definitions and perceptions of gratitude among children may differ from one community to another and from one region of the world to another. This study used a phenomenological design, coupled with the Indigenous standpoint theoretical framework and related participatory methodologies, to understand the virtue of gratitude among children. Conducting a qualitative survey, the authors utilized focus group discussions and key informant interviews to investigate how adolescents and adults from the pastoralist Turkana of northern Kenya and the Amhara of central Ethiopia defined and perceived gratitude in children aged 4–8 years. The authors analyzed the data thematically. The findings indicate that gratitude is defined variously as an innate capacity, an action, an expression of other virtues, and a feeling used to commune with both humans and the spirit world. Thus, gratitude reflects appreciation, thankfulness, and a positive response to acts of generosity or opportunities provided. Participants noted that gratitude manifested in children through their emotional dispositions, social interactions and relationships with others; their moral values; their actions and behaviors; and other positive character virtues. The most frequent recurring theme was defining gratitude as a relational skill used with both people and the spiritual world. These findings have implications for programs that support children developing positive virtues: they should be rooted in local cultural traditions and stress values prioritized by local communities.
