Microscopic signs indicative of drowning are not specific to drowning but also to any other form of suffocation where mechanical obstruction is involved. Our study aimed to evaluate both macroscopic and microscopic findings across different groups sharing a common mechanism of death but differing causes and to compare the diatom test with pathohistological examination.Twenty-nine adult Wistar rats, weighing within recommended ranges, were divided into four groups (L1-L4). The diatom test followed established guidelines for diatoms in water from the Bosna River. Microscopic examination revealed diatoms in the lungs of rats in L3 and L4 groups. Pathohistological findings showed varying degrees of changes including consolidation and inflammatory cell infiltration, dominated by lymphocytes and macrophages, with some samples also showing eosinophilic leukocytes.Significant differences were observed between animals whose cause of death was mechanical asphyxia (suffocatio) and those that were submersed for1 hour versus those that were submersed for 72 hours after death. Diatoms identified in group L4 samples 3, 4, and 5 included Navicula sp. (U3 and U6) and Ulnaria ulna (U4).Our findings suggest combining the diatom test with pathohistological analysis to support a drowning diagnosis. Further examination of other organs could enhance result reliability.

Objective To evaluate the systemic immune-inflammation (SII) index in patients with rheumatoid arthritis (RA) stratified by systemic inflammatory status. Methods Seropositive patients with RA (n=58) were divided into two groups based on serum hs-C-reactive protein (hs-CRP) levels: RA patients with hs-CRP levels of at or 3 mg/L or above (high systemic inflammatory status; n=38) and RA patients with hs-CRP levels of less than 3 mg/L (low systemic inflammatory status; n=20). The control group comprised 31 healthy individuals. Blood samples were tested for the next parameters: leukocytes, neutrophilic granulocytes, lymphocytes, thrombocytes [platelet (PLT)], high-sensitivity hs-CRP, sed rate [erythrocyte sedimentation rate (ESR)], neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). The SII index was derived as Neu x PLT/Lym. Results In patients with RA, the SII index was elevated compared with that of healthy individuals and positively correlated with hs-CRP, erythrocyte sedimentation rate, NLR, MLR, PLR, tender joint count, and swollen-to-tender joint count ratio. Patients with RA who had hs-CRP levels of 3 mg/L above exhibited a statistically significant increase in the SII compared with those with hs-CRP levels below 3 mg/L. Additionally, within the cohort of RA patients with hs-CRP levels at or above 3 mg/L, a positive correlation was found between the SII index and both NLR and PLR. The SII index was positively correlated with NLR, MLR, and PLR in RA patients with hs-CRP levels below 3 mg/L. The cut-off point of the SII index for distinguishing between RA cases with hs-CRP levels 3 mg/L and those with hs-CRP levels 3 mg/L or higher was ≥323.4, with a sensitivity of 77.6% and a specificity of 54.8%. Conclusions The serum SII index can be a potentially useful marker for evaluating the inflammatory process and clinical progression of RA.

INTRODUCTION Cutaneous leishmaniasis (CL) is one of the neglected tropical diseases that affects impoverished communities throughout the world. In Pakistan CL is an endemic disease. AIMS AND OBJECTIVES This study aimed to determine the incidence of CL infection in the Baluchistan province of Pakistan from January 2020 to March 2022 during the COVID-19 pandemic. METHODOLOGY A total of 1047 clinically suspected cases of CL from Bolan Medical College Hospital, Quetta, were followed up in the study. The data regarding the epidemiological characterstics, pathological information, and treatment of patients was collected. RESULTS Out of 1047 probable cases of CL, 594 (56.73%) cases were found to be positive for CL. Females had the highest infection rate, with the majority of reported cases being in the 0-9-year age group. Most CL cases were reported in April in the year 2020, with a few cases reported in June. But in the year 2021, the highest number of cases were reported in December. The number of overall cases has gradually increased in the year 2022, most likely because of the reduction in COVID-19 pandemic restrictions. The p value for the positive as compared to suspected cases in the years 2020, 2021, and 2022 was calculated as 0.8925, 0.8763, and 0.8535 respectively. CONCLUSIONS Further epidemiological studies and health education campaigns are recommended to increase public awareness. It is strongly advised that local, provincial, and national health authorities establish and maintain effective leishmaniasis surveillance systems to promptly identify disease outbreaks and implement timely control measures.

Context: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic lung diseases and is an important cause of mortality and morbidity in the world. Chronic obstructive pulmonary disease is a heterogeneous and multisystemic disease. Aims of the study was to assess workability of patients with COPD in relation to the workplace. Settings and Design: Prospective study. Methods and Material: The study was conducted on 150 patients with COPD. Each patient was examined by an occupational medicine specialist and a standardized COPD Questionnaire was completed. A physical examination was performed with special emphasis on auscultatory findings on the lungs. Spirometric testing was performed. Using the statistical methods, the results of the parameters of temporary (number of lost working days) and permanent incapacity (exercised right to some kind of disability) of the examined group were analyzed. Statistical Analysis Used: Descriptive statistics. SPSS 10.0. Results of the study showed that out of 150 patients, 48.67% had preserved working capacity for jobs. There are mostly jobs without special working conditions. Out of 150 patients, 51.33% had reduced working capacity for jobs. Conclusions: These are mostly workplaces with special working conditions, where respondents are exposed to the harmfulness of the workplace. Reduced working capacity was found in 51.33% of examined simple.

In clinical practice, there is a very common discrepancy between the clinical findings of patients with lumboischialgia and the radiological findings. This research aimed to determine the degree of correlation between the ODI index and the VAS scale with degenerative changes in the lumbar spine found using MRI. The study included 100 patients, who were referred for an MRI of the lumbar spine and who had a clear clinical picture of lumboischialgia. Patients underwent MRI. Degenerative changes in the lumbar spine and discs were analysed. Patients were asked to answer the questions in the questionnaire about the subjective feeling of pain and functional status, and ODI and VAS scores were calculated. There has been a statistically significant correlation found between the answers to the survey questions and the VAS score (p < 0.001). There was a significant correlation obtained between the level of degeneration and the disability index (p = 0.022), while the correlation with the VAS score has not been found to be significant (p = 0.325). This study has demonstrated a significant correlation between the VAS pain score and the ODI, as well as a significant correlation between the level of degeneration on MRI scans and the disability index; however, the correlation of MRI scan results with VAS score has not been found to be significant.

Aim To determine the value of angles between the left coronary artery main trunk (LMT) and its branches, the anterior interventricular branch (LAD) and the circumflex branch (CX), and their possible relationship with the LMT length. Methods A total of 29 cadaveric hearts were used. The left coronary artery and its branches were dissected. The hearts were then classified according to the number of branches. The LMT length was measured with a digital gauge, and the LAD-CX angle, LMTLAD angle and LMT-CX angle with a manual goniometer. Results The average value of the LMT length was 9.0 mm (6.0-13.5). In 20 (68.97%) samples, the LMT was divided into two terminal branches. There was no statistically significant difference (p=0.321) in LMT length between the hearts with a bifurcation and without it. The average value of the LAD-CX angle was 89.0⁰ (74.5-93.0), with a statistically significant difference (p=0.020) comparing to hearts with trifurcation. The mean value of the LMT-LAD angle was 30.83±9.23⁰ and it was significantly lower (p=0.006) in the group of hearts with bifurcation compared to the group with trifurcation of the main trunk. Conclusion The LMT length shows great variability and is not related to the LAD-CX, LMT-LAD or the LMT-CX angle. Knowledge of the left coronary variation is essential in order to avoid misinterpretation of arteriogram.

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Background Understanding the anatomy and morphological variability of the orbital region is of great importance in clinical practice, forensic medicine, and biological anthropology. Several methods are used to estimate sex based on the skeleton or parts of the skeleton: classic methods and the geometric morphometric method. The objective of this research was to analyse sex estimation of the orbital region on a sample of skulls from a Bosnian population using the geometric morphometric method. Materials and Methods The research was conducted on three-dimensional models of 211 human adult skulls (139 males and 72 females) from the Osteological Collection at the Faculty of Medicine in Sarajevo. The skulls were recorded using a laser scanner to obtain skull 3D models. We marked 12 landmarks on each model to analyse sexual dimorphism. Landmarks were marked using the program Landmark Editor. After marking the landmarks, we used the MorphoJ program to analyse the morphological variability between male and female orbital regions. Results After Procrustes superimposition, generating a covariant matrix, and introducing sex as a variable for classification, a discriminant functional analysis (DFA) was applied which determined the estimation for males with 86.33% accuracy and for females with 88.89% based on the form of the orbital region. The results of regression analysis showed that the size of the orbital region has a statistically significant effect on its shape's sexual dimorphism. After excluding the influence of size and providing DFA, we concluded that sex estimation was possible with 82.01% accuracy for males and 80.55% accuracy for females based on the shape of the orbital region in the examined sample. Conclusion Sex estimation based on the orbital region was possible with more than 80% accuracy for both sexes, which is a high percentage of correct estimation. Therefore, we recommend using the orbital region of the skull for sex estimation.