We studied the relationship between fleas\' metabolic rate and their ecological traits, using data on standard metabolic rate (SMR), mean abundance, host specificity, and geographic range size in males and females of seven desert flea species. SMR was measured via mass-specific CO2 emission, whereas host specificity was measured as (a) the mean number of host species used by a flea per region in regions where this flea was recorded; (b) the total number of host species a flea exploited across its geographic range; and (c) the phylogenetic diversity of the flea\'s hosts. To control for confounding effects of phylogeny when analysing data on multiple species, we applied the Phylogenetic Generalised Least Squares (PGLS) model. We found that the only ecological trait significantly correlating with flea SMR was the phylogenetic diversity of hosts utilized by a flea across its geographic range. The strength of the association between SMR and host phylogenetic diversity was higher in male than in female fleas. We explain the relationship between flea SMR and their host specificity by the necessity of host-opportunistic species to compensate for the high energetic cost of neutralizing multiple defences from multiple hosts by increased SMR.

Sleep-related sexualized behaviors occur in the parasomnia known as sexsomnia, recognized as a variant of confusional arousals in the International Classification of Sleep Disorders, third edition. These instinctive behaviors of a sexual nature emerge from deep non-rapid eye movement sleep, and patients often present with distinguishing features within this sleep disorder category. There are often adverse psychosocial consequences and not uncommonly medicolegal implications. While associations to psychiatric consequences from the sexsomnia have been demonstrated and efforts to further typify this condition have been made, sexsomnia remains incompletely characterized in the more than 200 published cases to date, with male predominance. We now present the first reported case of an adolescent female with sexsomnia that was triggered by the onset of Crohn\'s disease and its treatment with azathioprine and with interpersonal consequences leading to an initial psychiatric consultation on account of depressive symptoms. These symptoms were deemed to be secondary to the sexsomnia. In addition to describing unusual and clinically relevant features in this case of sexsomnia, this original case provides insights into triggers, predisposing factors, perpetuating factors, and therapeutic considerations that are important for raising awareness in sleep clinicians, primary care providers, and mental health professionals.
Brás J, Schenck CH, Andrade R, et al. A challenging case of sexsomnia in an adolescent female presenting with depressive-like symptoms. J Clin Sleep Med. 2023;19(10):1845-1847.

OBJECTIVE: To determine the impact of having private health insurance during the period of maternity on low birth-weight (LBW) infants.
METHODS: This retrospective case-control study was carried out at a tertiary care hospital in Tabuk, Saudi Arabia, between January 2020 and January 2021. Using non-probability sampling, secondary medical data were obtained at the Department of Obstetrics & Gynecology from two groups: insured and non-insured mothers who had 150 LBW infants (LBWI) (<2.5 kg) as well as normal newborns. Data were analyzed using SPSS, version 24 (IBM Corp., Armonk, NY). A univariate analysis was performed for each variable followed by a logistic regression analysis to explain the relationship between the dependent (LBW) and independent variables (health insurance status, prenatal care, and inter-pregnancy interval).
RESULTS: Out of 300 mothers, the majority were in the age group 21-34 years (86%). The LBWI mothers were insured in about 55% of cases. Around 43% had insurance for 1-2 years, and 44.7% of insured mothers were covered by a \"class A\" health plan. The findings revealed a significant correlation between the duration of maternal insurance coverage period and LBW; it reduced the risk of LBW by 95% CI. The inter-pregnancy interval was 51.3%, with a p-value of 0.33.
CONCLUSIONS: Private health insurance offers coverage, stability, and consistency in Saudi Arabia, which results in better birth outcomes by decreasing both infant mortality and morbidity rates among insured females.

Rosacea has an overall female predominance; however, rhinophyma, a feature attributed to advanced rosacea, is exceedingly rare in females. The impact of this condition on quality of life can be profound. Multiple treatment modalities have been described. However fully ablative carbon dioxide (CO2) laser for moderate-severe rhinophyma has been shown to be most effective with good cosmetic outcome and high patient satisfaction. We describe a series of 7 female patients presenting with rhinophyma to a tertiary NHS laser centre and a private dermatology clinic. A retrospective case review of rhinophyma management was performed, assessing presentation, treatments and outcomes. The mean age at presentation was 47 years (27-62 years). Three patients developed rhinophyma before the age of 30 years. One patient had severe, 2 patients had moderate and 4 patients had minor rhinophyma. Four patients underwent fractional CO2 laser treatment with a good cosmetic outcome. Two further patients developed scarring following fully ablative CO2 laser. Long-term low-dose oral isotretinoin was used in 3 patients following laser treatment, to prevent relapse. One patient solely received isotretinoin with a good outcome. In our experience, females suffering with rhinophyma presented for treatment at an early age and stage of severity. Fractional or fully ablative CO2 laser alone or in combination with oral isotretinoin is a very effective treatment modality.

BACKGROUND: Turner syndrome (TS) is a chromosomal condition that affects development in females, resulted from a complete or partial absence of the second X chromosome or from structural anomalies (mosaicism) of one X chromosome. TS is one of the most common sex chromosome disorders among live-born female births.
METHODS: We presented with a 63 y.o. Female, who admitted to our Hospital with a chief complaint of pain when urinating and frequent haematuria. She has a history of Turner Syndrome (45 XO). Local examination in the lithotomy position revealed labial agglutination involving the labia majora. We did a Cystoscopy to evaluate the bladder and urethra, and then biopsied the tissues. Vaginal Reconstruction was performed to repair the Labial Synechiae. The biopsy showed that this histological finding is consistent with Follicular Cystitis that could cause by chronic UTIs.
CONCLUSIONS: Labial Synechiae (LS), or Labial agglutination is a disorder of the female genitalia characterized by thin, membranous adherence of the labia. LS usually noted in female with numerous UTIs and vaginal infections. Goel et al confirmed that LS is not a congenital disorder. In a retrospective study, they found out that LS is probably caused by multiple numerous UTIs that may cause a membrane to formed around the labia. The negligence and chronicity of this condition may have thickened the synechiae, making it persist for a long time, and can actually cause a symptom to appear.
CONCLUSIONS: There is no literature to suggest any link between TS and LS directly.

Asbestos is the primary known cause of malignant mesothelioma. Some cosmetic talc products have been shown to contain asbestos. Recently, repeated exposures to cosmetic talc have been implicated as a cause of mesothelioma.
Seventy-five individuals (64 females; 11 males) with malignant mesothelioma, whose only known exposure to asbestos was repeated exposures to cosmetic talcum powders, were reviewed in medical-legal consultation. Out of the 75 cases, 11 were examined for asbestiform fibers.
All subjects had pathologically confirmed malignant mesothelioma. The mean age at diagnosis was 61 ± 17 years. The mean latency from exposure to diagnosis was 50 ± 13 years. The mean exposure duration was 33 ± 16 years. Four mesotheliomas (5%) occurred in individuals working as barbers/cosmetologists, or in a family member who swept the barber shop. Twelve (16%) occurred in individuals less than 45 years old (10 females; 2 males). Forty-eight mesotheliomas were pleural (40 females; 8 males), 23 were peritoneal (21 females; 2 males). Two presented with concomitant pleural and peritoneal disease. There was one pericardial, and one testicular mesothelioma. The majority (51) were of the epithelioid histological subtype, followed by 13 biphasic, 8 sarcomatoid, 2 lymphohistiocytoid, and 1 poorly differentiated. Of the 11 individuals whose nontumorous tissues were analyzed for the presence of asbestiform fibers, all showed the presence of anthophyllite and/or tremolite asbestos.
Mesotheliomas can develop following exposures to cosmetic talcum powders. These appear to be attributable to the presence of anthophyllite and tremolite contaminants in cosmetic talcum powder.

UNASSIGNED: Lobular capillary hemangioma (LCH) is caused by exuberant neovascular response to infection, local irritation (e.g., trauma), or hormonal influence (e.g., pregnancy and consumption of oral contraceptive pills). Pyogenic granuloma is considered to be a misnomer. Although the gingiva is involved in most of the cases, there are is rare cases of extragingival involvement. Herein, we reported a case of LCH associated with the dehiscence of the underlying bony hard palate.
UNASSIGNED: A 50-year-old woman presented with a gradually increasing swelling over hard palate for 2 years. She was a hypertensive patient and mishri user (using tobacco-containing teeth cleaning powder) with known diabetes. She had undergone a teeth extraction 2 years ago. The palatine swelling was reddish-blue, sessile with a lobulated surface, firm in consistency, and non-tender with a of size 4×3 cm. The computed tomography (CT) scan revealed bony dehiscence of the underlying palate. Histopathological examination after excision and curettage was suggestive of LCH.
UNASSIGNED: The LCH is common in females due to cyclical hormonal changes. Our case was presented in the fifth decade of life. The etiological factors for the patient could be mishiri usage or iatrogenic trauma of teeth extraction rather than mere hormones. The dehiscence of the underlying palatine process of the maxilla could be due to the acquired invasive nature of the lesion. No recurrence was observed in our patient since the elimination of the lesion and strict abstinence from mishiri till this date.

Since stress fractures are common among adolescent athletes, it is important to identify bone assessment tools that accurately identify risk. We investigated the discriminative ability of two imaging technologies to classify at-risk athletes. Findings suggested that peripheral quantitative computed tomography (pQCT) has the ability to distinguish differences in bone structure in injured vs. uninjured limbs.
BACKGROUND: Given the high stress fracture (SFX) prevalence among adolescent girls, an understanding of the most informative assessment tools to identify SFX risks are required. We investigated the discriminative ability of pQCT vs. dual-energy X-ray absorptiometry (DXA) to classify athletes with or without SFX.
METHODS: Twelve adolescent athletes diagnosed with a lower-extremity SFX were compared with 12 matched controls. DXA measured areal bone mineral density (aBMD) and content of the total body, and lumbar spine. Bilateral tibiae were assessed with pQCT. At the metaphysis (3%), total density (ToD), trabecular density (TrD), trabecular area (TrA), and estimated bone strength in compression (BSIc), and at the diaphysis (38% and 66%), total bone area (ToA), cortical density (CoD), cortical area (CoA), estimated bone strength in torsion (SSIp), and peri- and endocortical and muscle area (MuA) were obtained. Cortical bone mass/density around the center of mass and marrow density (estimate of adiposity) were calculated using ImageJ software. General estimated equations adjusting for multiple comparisons (Holm-Bonferroni method) were used to compare means between (1) injured limb of the case athletes vs. uninjured limb of the control athletes and (2) uninjured limb of the case athletes vs. uninjured limbs of the controls and injured vs. uninjured limb of case athletes with a SFX.
RESULTS: aBMD and content showed no significant differences between cases and controls. When comparing the injured vs. uninjured leg in the case athletes by pQCT at the 3% tibia, unadjusted TrD, total density, and BSIc were significantly lower (p < 0.05) in the injured vs. uninjured leg. Marrow density at the 66% site was 1% (p < 0.05) lower in the injured vs. uninjured leg.
CONCLUSIONS: These preliminary data in athletes with SFX suggest that pQCT has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. No discriminative bone parameter classifications were identified between adolescent athletes with or without SFX.

BACKGROUND: Takotsubo syndrome is an acute heart failure syndrome often preceded by a trigger factor of physical or emotional origin, although the proportion is unclear. The aim of the present study was to determine how common different trigger factors are in takotsubo syndrome divided by sex and age in women.
METHODS: The study consisted of a systematic review of all available case reports in PubMed and Web of Science up to March 2018. Trigger factors were categorized into physical and emotional trigger factors.
RESULTS: Males had to a higher degree experienced a trigger factor (92.6%) compared to females (81.9%, p < .001). Physical trigger factors were most common (67.3%). Males had to a higher degree experienced a physical trigger factor (85.7%) compared to females (63.5%, p < .001). Females ≤50 years of age had to a higher degree experienced a trigger factor (90.8%) compared to females >50 years of age (79.2%, p < .001). Additionally, females ≤50 years of age had to a higher degree experienced a physical trigger factor (75.6%) compared to females >50 years of age (59.3%, p < .01).
CONCLUSIONS: A physical trigger factor is more common than an emotional trigger factor in takotsubo syndrome. Physical triggers includes drugs, surgery and central nervous system conditions. Furthermore, females ≤50 years of age and males more often have an evident trigger factor and it is more often physical, compared to the most common patient, a female >50 years of age.

BACKGROUND: Increase of MS prevalence in females compared to males, especially in reproductive age, highlights the important role of reproductive factors in MS pathology.
OBJECTIVE: We examined the association between females\' reproductive age-related factors and MS risk.
METHODS: A case-control study including 399 cases and 541 controls was carried out. The adjusted associations between MS risk and reproductive variables including age at menarche, oral contraceptive pills (OCPs) use history, OCP usage duration and age at first use, history of assisted reproductive technologies (ARTs) use, parity history, age at first childbirth and the number of parities, abortion and exclusive breast feeding > 2 months were assessed.
RESULTS: We found protective relationships between MS and older age at menarche (OR = 0.90 {95% CI = 0.82-0.98}), ART use history (OR = 0.45 {95% CI = 0.21-0.99}), older maternal age at first childbirth (OR = 0.94{95% CI = 0.89 - 0.99}) and higher number of parities(OR = 0.61 {95% CI = 0.49 - 0.75), whereas using OCPs was associated with higher risk of developing MS (OR = 1.80 {95% CI = 1.35-2.41}).
CONCLUSIONS: Links were noted between a number of reproductive factors and risk of MS.