Background: Case-based learning (CBL) and lecture-based learning (LBL) are two well-established instructional approaches in education. CBL emphasizes active participation, critical thinking, and problem-solving skills, while LBL relies primarily on lectures for knowledge transfer. The effectiveness of these methods has been a subject of ongoing research and discussion due to their respective strengths and limitations. Understanding the advantages and drawbacks of CBL and LBL is crucial in determining the most suitable approach for specific educational contexts and desired learning outcomes. Aim: This study aims to conduct a systematic review and meta-analysis to assess the effectiveness of case-based learning compared to traditional lecture-based learning in medical education. Methods: A comprehensive search was conducted using various databases, including PubMed, Google Scholar, African Journals OnLine, Scopus, Web of Science, Embase, and Wiley Online Library. The screening and selection process adhered to predetermined eligibility criteria using RAYYAN software. A mean difference metaanalysis was performed employing random-effects models and the DerSimonian Laird method to generate forest plots, evaluate heterogeneity, and assess publication bias. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the analysis was performed using STATA Version 18 software. Results: Seventeen studies meeting the inclusion criteria were analyzed, involving a total of 1,937 participants. Among them, 977 medical students were assigned to the case-based learning group, while 960 medical students were assigned to the lecture based learning group. The meta-analysis showed a pooled mean difference of 0.84 (95% CI: 0.54, 1.13), favoring the effectiveness of case-based learning over traditional lecture-based learning in medical education with significant heterogeneity (I2 > 89.05%, P < 0.001 and the H2 = 9.13) and no evidence of publication bias (Egger 0.1323 and Begg's P= 0.638). Conclusions: Our findings suggest that case-based learning is a more effective instructional method than lecture-based learning for medical students, leading to improved performance and case analysis abilities.

Introduction: Skin and soft tissue infections (SSTIs) are commonly encountered in clinical practice and mainly caused by gram-positive cocci such as S.aureus and β-hemolytic streptococci. Complicated SSTIs involving deeper tissues often necessitate surgical intervention and occur in patients with significant comorbidities such as diabetes or immunocom-promising conditions. Methods: In this study, we retrospectively reviewed the epidemiology, clinical characteristics, microbiology, and treatment of patients admitted with SSTI during a five-year period in the Internal Medicine Department of a tertiary hospital. Results: During the study period, 317 patients were recorded, with a mean age of 72.1 years. The most common underlying medical conditions were diabetes mellitus, chronic kidney disease, and heart failure. Cultures were positive in 23.3 % of cases, 62.2 % of which were polymicrobial. The most frequently isolated microorganisms were Enterococci, Escherichia coli, and Pseudomonas aeruginosa. Significant antimicrobial resistance rates were noted, in particular for gram-negative microorganisms. Mortality was higher than described in the literature and associated with age, comorbidities, and infection by gram-negative microorganisms. Conclusion: This study denotes the role of gram-negative bacteria in SSTI epidemiology. Therapeutic protocols regarding the empiric treatment of SSTIs should necessarily take into account the local epidemiology of isolated pathogens and antimicrobial resistance.

Normal aging results in subtle changes both in ACTH and cortisol secretion. Most notable is the general increase in mean daily serum cortisol levels in the elderly, without a noteworthy alteration in the normal circadian rhythm pattern. Glucocorticoid excess seen in the elderly population can have serious consequences in both the structural and functional integrity of various key areas in the brain, including the hippocampus, amygdala, prefrontal cortex, with consequent impairment in normal memory, cognitive function, and sleep cycles. The chronically elevated glucocorticoid levels also impinge on the normal stress response in the elderly, leading to an impaired ability to recover from stressful stimuli. In addition to the effects on the brain, glucocorticoid excess is associated with other age-related changes, including loss of muscle mass, hypertension, osteopenia, visceral obesity, and diabetes, among others. In contrast to the increase in glucocorticoid levels, other adrenocortical hormones, particularly serum aldosterone and DHEA (the precursor to androgens and estrogens) show significant decreases in the elderly. The underlying mechanisms for their decrease remain unclear. While the adrenomedullary hormone, norephinephrine, shows an increase in plasma levels, associated with a decrease in clearance, no notable changes observed in plasma epinephrine levels in the elderly. The multiplicity and complexity of the adrenal hormone changes observed throughout the normal aging process, suggests that age-related alterations in cellular growth, differentiation, and senescence specific to the adrenal gland must also be considered.

Objective The main objective of the study was to investigate major differences among European countries in implementing infection prevention and control (IPC) measures and reasons for reduced compliance. Design An online survey including experts in IPC and a gap analysis were conducted to identify major limitations in implementing IPC guidelines. Setting Europe. Main outcome measures Four areas were targeted: (1) healthcare structure, (2) finances, (3) culture and (4) education and awareness. Perceived compliance to IPC measures was classified as low (<50%), medium (50% to 80%) and high (>80%). Countries were classified in three regions: North-Western Europe (NWE), Eastern Europe (EE) and Southern Europe (SE). Results In total, 482 respondents from 34 out of 44 (77.3%) European countries participated. Respondents reported availability of national guidelines to control multidrug-resistant Gram-negatives (MDR-GN) in 20 countries (58.0%). According to participants, compliance with IPC measures ranged from 17.8% (screening at discharge) to 96.0% (contact precautions). Overall, three areas were identified as critical for the compliance rate: (1) number of infection control staff, (2) IPC dedicated educational programmes and (3) number of clinical staff. Analysis of reasons for low compliance showed high heterogeneity among countries: participants from NWE and SE deemed the lack of educational programmes as the most important, while those from EE considered structural reasons, such as insufficient single bed rooms or lacking materials for isolation, as main contributors to the low compliance. Conclusions Although national guidelines to reduce the spread of MDR-GN are reported in the majority of the European countries, low compliance with IPC measures was commonly reported. Reasons for the low compliance are multifactorial and vary from region to region. Cross-country actions to reduce the spread of MDR-GN have to consider structural and cultural differences in countries. Locally calibrated interventions may be fruitful in the future.

There is currently insufficient evidence of a beneficial effect to recommend vitamin D supplementation for optimizing glycemic status in patients with type 2 diabetes mellitus (T2DM). Taking into consideration the significant extra-skeletal effect of vitamin D on pancreatic β-cell function and insulin secretion and the large number of scientific evidence supporting the inverse association between vitamin D status and hyperglycemia, this review article aims to examine whether vitamin D supplementation therapies are beneficial to patients with T2DM considering specific factors through randomized controlled trials (RCTs). EBSCOhost and Medline databases were searched from the beginning of 2009 until the end of 2014 for RCTs in patients with T2DM. Parameters, such as baseline vitamin D levels, frequency/dosage of supplementation, length of the study and type of supplementation, were independently assessed, based on their effect on glycemic status. Although all different types of supplementation were safe and effective in the achievement of vitamin D sufficiency in a dose-dependent way, the impact on glycemic status was different. 14 RCTs were included with daily supplementations ranging from 400-11.200 IU/daily, 40.000-50.000 IU/weekly and 100.000-300.000 IU/intramuscularly or once given, for a period from 8 to 24 weeks. Daily supplementation of vitamin D (up to 11.200 IU) showed no effect, whereas combined supplementation, with calcium (≥300 mg), and with vitamin D doses similar to the RDA, showed positive effects. Additionally, high weekly doses of vitamin D (40.000-50.000 IU) were effective on glycemic outcomes but available data are limited.

Various anatomic structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN). The infratemporal fossa is a common location for MN compression and one of the most difficult regions of the skull to access surgically. Other potential sites for entrapment of the MN and its branches include, a totally or partially ossified pterygospinous or pterygoalar ligament, a large lamina of the lateral plate of the pterygoid process, the medial fibers of the lower belly of the lateral pterygoid muscle and the inner fibers of the medial pterygoid muscle. The clinical consequences of MN entrapment are dependent upon which branches are compressed. Compression of the MN motor branches can lead to paresis or weakness in the innervated muscles, whereas compression of the sensory branches can provoke neuralgia or paresthesia. Compression of one of the major branches of the MN, the lingual nerve (LN), is associated with numbness, hypoesthesia, or even anesthesia of the tongue, loss of taste in the anterior two thirds of the tongue, anesthesia of the lingual gums, pain, and speech articulation disorders. The aim of this article is to review, the anatomy of the MN and its major branches with relation to their vulnerability to entrapment. Because the LN expresses an increased vulnerability to entrapment neuropathies as a result of its anatomical location, frequent variations, as well as from irregular osseous, fibrous, or muscular irregularities in the region of the infratemporal fossa, particular emphasis is placed on the LN.

The education of Roma children presents many challenges throughout the world because of poverty, issues of isolation and discrimination. In many countries where Roma reside, laws exist that prohibit discrimination against this minority group. A variety of conflicting issues exist for Roma children. On one hand, the Roma communities practice cultural norms that are in conflict with a typical schooling environment that requires significant structure and lack of independent support. Conversely, schools fail to provide appropriate bilingual instruction for Roma children who usually do not speak the local language. In most countries discrimination attitudes create segregated schools and insufficient social services. Many efforts and organizations are in place to positively impact these challenges to provide quality education for all Roma children.

Με δεδομένη την έλλειψη καταλογισμού ποινικών ευθυνών στα νομικά πρόσωπα στην ελληνική έννομη τάξη, η συγκεκριμένη μελέτη αναδεικνύει συγκεκριμένα προβλήματα που αφορούν την ατομική ποινική ευθύνη των διευθυνόντων/ διοικητών, αλλά και των εκπροσώπων επιχειρήσεων, σε περιπτώσεις που με τις πράξεις των τελευταίων τελείται άδικη ποινική πράξη. Μετά την παρουσίαση κάποιων βασικών στοιχείων που αφορούν το ποινικό δίκαιο της επιχείρησης, γίνεται μία παρουσίαση κάποιων συγκεκριμένων ζητημάτων που ανακύπτουν κατά την απόδοση ατομικών ποινικών ευθυνών στα φυσικά αυτά πρόσωπα των επιχειρήσεων. Ακολουθεί μία προσπάθεια θεμελίωσης αυτών με τη βοήθεια των παγιωμένων κανόνων του Ποινικού Δικαίου, τόσο αυτών της ελληνικής, όσο και αυτών της γερμανικής θεωρίας και νομολογίας, παραθέτοντας κάθε φορά τις απαιτούμενες προϋποθέσεις για την πλήρωση της νομοτυπικής υπόστασης κάθε μηχανισμού απόδοσης ποινικών ευθυνών. Γενικότερος στόχος στη συγκεκριμένη μελέτη είναι να γίνει όσο το δυνατόν πιο σαφές για το αν και με ποιο τρόπο ευθύνονται τα παραπάνω πρόσωπα σε περιπτώσεις, που η επιχείρηση αναπτύσσει εγκληματική δραστηριότητα.