We describe the anaesthetic management of a 4-day-old premature infant presenting for urgent resection of a massive posterior intrapericardial teratoma. Anaesthetic challenges include anticipating cardiopulmonary collapse upon induction and hemodynamic instability associated with blood loss or tumor manipulation. Premature infants present unique challenges due to patient-to-tumor size discrepancy.

The benefits of opioid use in older adults to manage chronic non-cancer pain must outweigh the risks as these individuals are more susceptible to the side effects and drug interactions associated with opioids. Pharmacogenomic testing supports clinicians to select an appropriate opioid therapy while minimizing these risks.

Stevens-Johnson Syndrome (SJS) happen as a result of infection, side effects to medications or of unknown etiology. Carbamazepine is a common cause (SJS). Good history taking is crucial if clinically indicated treatment with carbamazepine. carbamazepine should be avoided with previous history of severe drug reaction like mast cell activation syndrome.

Community detection decomposes large-scale, complex networks ‘optimally’ into sets of smaller sub-networks. It finds sub-networks that have the least inter-connections and the most intra-connections. This article presents an efficient community detection algorithm that detects community structures in a weighted network by solving a multi-objective optimization problem. The whale optimization algorithm is extended to enabe it to handle multi-objective optimization problems with discrete variables and to solve the problems on parallel processors. To this end, the population’s positions are discretized using a transfer function that maps real variables to discrete variables, the initialization steps for the algorithm are modified to prevent generating unrealistic connections between variables, and the updating step of the algorithm is redefined to produce integer numbers. To identify the community configurations that are Pareto optimal, the non-dominated sorting concept is adopted. The proposed algorithm is tested on the Tennessee Eastman process to show its application and performance.

A spatially resolved 1-D pressure filtration model was developed for a slurry of edible fat crystals. The model focuses on the expression step in which a cake is compressed to force the liquid through a filter cloth. The model describes the local oil flow in the shrinking cake modeled as a porous nonlinear elastic medium existing of two phases, viz. porous aggregates and inter-aggregate liquid. Conservation equations lead to a set of two differential equations (vs time and vs a material coordinate ) for two void ratios, which are solved numerically by exploiting a finite-difference scheme. A simulation with this model results in a spatially resolved cake composition and in the outflow velocity, both as a function of time, as well as the final solid fat contents of the cake. Simulation results for various filtration conditions are compared with experimental data collected in a pilot-plant scale filter press.

The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to international health care systems. Management of the current pandemic puts a huge strain on health care sectors and leads to new strategies conducting by health care systems in countries across the world. In the present article, we review the epidemiologic data, Iranian health care system response, as well as the effects of COVID-19 pandemic on cardiac surgery practice in Iran

Embolism spreading in dehydrating angiosperm xylem is driven by gas movement between embolised and sap-filled conduits. Here, we examine how proximity to pre-existing embolism and hydraulic segmentation affect embolism propagation. Based on the optical method, we compared xylem embolism resistance between detached leaves and leaves attached to branches, and between intact leaves and leaves with minor veins cut (n = 6 species). Moreover, we directly compared the optical and pneumatic method on detached leaves. Embolism resistance of detached leaves was significantly lower than leaves attached to stems, except for two species with all vessels ending in their petioles. Cutting of minor veins showed embolism spreading in narrow vessels near the cuts prior to wide vessels in major veins. Moreover, embolism spreading between open and intact vessels occurred at largely similar xylem water potentials than embolism spreading between intact vessels, resulting in strong similarity between the optical and pneumatic method. We conclude that embolism spreading may depend on a direct connection to pre-existing embolism as gas source, is not exclusively pressure-driven, and indirectly related to conduit size. Hydraulic segmentation, however, can minimise embolism spreading due to confined and/or poorly interconnected conduits, which may increase hydraulic safety by slowing down gas diffusion.

A patient with heart failure due to dilated ischemic cardiomyopathy presented in cardiogenic shock for institution of veno-arterial extracorporeal membrane oxygenation as a bridge to cardiac transplantation. To provide adequate venous drainage and simultaneous decompression of the left atrium (indirect left ventricular venting) a single venous cannula was placed across the interatrial septum so the distal orifice and side ports were located within the left atrium and the proximal set of side ports at the cavoatrial junction. Three-dimensional transesophageal echocardiography demonstrated utility in guiding cannula placement and appropriate positioning within the left atrium.

The aim of our study is to know the rate of restoration, the reconstitution of the forest landscape and the impact of fires on the resilience of the soils of the Tenira forest. The frequent fires in the latter are one of the main major disruptive factors for the various components of the soil, regeneration and their dynamics. The uses of remote sensing data reduce the cost and time required to assess damage in the forest. It periodically and automatically provides information on very large areas and on several spectral bands. Our approach is based on the chronic study of this forest through the use of landsat sensor data, after collecting real field data. A supervised classification was applied to the selected images in order to identify the types of soils and the vegetation. The analysis of the results obtained showed remarkable of dominance agricultural soils of the type calcisols, calcaric fluvisols and the regeneration of the forest cover in the study area. There is also an increase areas cleared for agriculture which has accelerated soil erosion in this region. Indeed, the intensification of crops requires an increase in inputs which can lead to a decrease in the biological activities of the soil, in particular earthworms. This type of vegetation existing after this fire; indicates the low water storage capacity and the high risk of erosion. The final results generally showed that the rate of recovery of land use and type of soils in the Tenira forest has changed considerably.

Concerns about the prospect of a global pandemic have been triggered many times during the last two decades. These have been realized through the current COVID-19 pandemic, due to a new coronavirus SARS-CoV2, which has impacted almost every country on Earth. Here, we show how considering the pandemic through the lenses of the evolutionary ecology of pathogens can help better understand the root causes and devise solutions to prevent the emergence of future pandemics. We call for better integration of these approaches into transdisciplinary research and invite scientists working on the evolutionary ecology of pathogens to contribute to a more “solution-oriented” agenda with practical applications, emulating similar movements in the field of economics in recent decades.

The current COVID-19 pandemic offers a unique opportunity to examine the utility of Internet search data in disease modelling across multiple countries. Google Trends data (GTD) indicating the volume of Internet searching on ‘Coronavirus’ were obtained for a range of European countries along with corresponding incident case numbers. Significant positive correlations between GTD with incident case numbers occurred across European countries, with the strongest correlations being obtained using contemporaneous data for most countries. GTD was then integrated into a lag distributed model; this improved model quality for both the increasing and decreasing epidemic phases.

Those patients with progressive QT prolongation or QT interval exceeding >500 ms may complete the COVID 19 treatment protocol containing HCQ and/or AZM without serious arrhythmias and torsades de pointes by the adding the mexiletine or lidocaine as an adjunctive drug in those patients. Counterbalancing the QT prolongation by mexiletine in association with would further decrease the labor and stress of healthcare providers during the continuing COVID 19 pandemic. Although it is a big dilemma how the therapeutic or prophylactic use of HCQ will end up, the pathophysiologic effects of HCQ on QT interval and counterbalancing by antiarryhthmic drugs mexiletine and lidocaine is out of the current discussion of COVID 19 pandemics. Counter balancing effect of mexiletine and lidocaine on QT interval in patients receiving HCQ would be helpful in patients with not only COVID 19 but also in malaria and rheumatologic disease as well.

Background Many people are used to administering their drugs with food, beverages, or herbs, which may contain chemicals that interfere with the prescribed drugs that could potentially lead to changes in their efficacy or safety and alteration in their pharmacokinetic properties. Objective To assess the extent of perception and use of food, beverages and herbs alongside with conventional drugs and their potential interactions among Jordanian society. Methods This descriptive cross-sectional survey was conducted in Jordan (20 April - 5 May 2020). The survey was developed using Google forms, validated and distributed via social media platforms. Data was analyzed using Statistical Package for Social Sciences-24. Main outcome measure Use and perception of food, beverages, herbs and their drug interactions among Jordanians. Results Of all participants (n = 789), 77.8% were females, 46.2% were 50-year-old, 69.7% were married, 70.8% were medically insured, and 51.1% had a bachelor’s degrees. Seventy percent of the study participants reported use of medicinal plants. About 66% of participants agreed that medicinal plants or herbs could treat diseases and 58.6% thought that medications could interact with drugs. In general, the participants’ knowledge about food/beverage/herb-drug interactions was considered poor. However, linear regression analysis illustrated that the level of knowledge was significantly affected (p-value <0.05) by gender, marital status, social status, the educational level, and employment sector. Conclusion Jordanians have a positive perception towards herbs and their ability to treat diseases. However, their knowledge about food/beverage-drug interactions was poor. This call needs to enhance the community awareness on food/beverage/herb-drug interactions.

While most attention in cardiovascular disease has been traditionally focused on the morphology, function and prognostic role of the left ventricle, during the last decade studies have raised awareness of the crucial role that the right ventricle plays in a variety of cardiovascular settings, including diseases primarily linked to the left ventricle. The assessment of right ventricular performance with conventional echocardiography is challenging. Novel echocardiographic techniques improve the functional assessment of the right ventricle and they showed good correlation with the gold standard represented by cardiovascular magnetic resonance. However, there is no single universally accepted parameter that accurately defines right ventricular function; hence a thorough evaluation of the right ventricle needs an integrative, multi-parametric approach. This review summarizes the traditional and innovative echocardiographic techniques used in the functional assessment of the right ventricle, focusing on the role of right ventricular dysfunction in heart failure with reduced ejection fraction and providing a perspective on recent evidence from literature.

Ischemic mitral regurgitation (IMR) is one of the common complications of coronary heart disease. The primary underlying mechanism is ventricular myopathy rather than disease of the valve itself. The decrease of myocardial blood supply will lead to myocardial damage, which will lead to the left ventricular remodeling, left ventricular enlargement, annular dilation, papillary muscle displacement and limited leaflet activity, resulting in mitral regurgitation. IMR has a certain effect on the prognosis of coronary heart disease, and the incidence rate of IMR has been increasing in recent years. IMR is a complex dynamic process, and it is a great challenge to deal with IMR. For patients with moderate or severe IMR, there are still many challenges and controversies in the choice of surgical methods. This article reviews the pathological process of left ventricular remodeling, the evaluation of IMR, the choice of mitral valve (MV) repair or replacement, and the reserve of MV function. Our review suggests that assessment of MV reserve function may be a predictor of IMR. In the future, assessment of MV reserve function may provide further useful information for evaluating MV function and determining MV repair or replacement in patients with IMR.

As the world past the few months of the deadly COVID-19 pandemic, the number of new cases continues to rise in several countries. By July 15, the confirmed COVID-19 cases reached 13,119,239, with 573,752 confirmed deaths worldwide.

Objective To examine early and late pregnancy loss in women with and without polycystic ovary syndrome (PCOS) undergoing IVF/ICSI transfers. Design Retrospective cohort study. Setting Reproductive medicine center at a tertiary hospital. Population Records were reviewed for women with a positive β-hCG after IVF/ICSI treatment from May 2014 to April 2019. Methods Odds ratios (ORs) for early (13 ≤weeks) and late (13-24 weeks) pregnancy loss were calculated among women with and without PCOS for plurality of the pregnancy with adjustment for confounding factors. Main outcomes measures Early and late pregnancy loss. Results A total of 21,820 charts identified with a positive β-hCG, 2,357 (10.8%) subjects had PCOS, and 19,463 (89.2%) controls did not. Early pregnancy loss occurred in 12.4% of women with PCOS versus 12.8% in women with non-PCOS. Women with PCOS demonstrated a higher rate of late pregnancy loss (5.4% in PCOS vs 3.1% in non-PCOS, OR 1.79, 95%CI, 1.46-2.19, P<.001), regardless of the plurality of the pregnancy (one gestational sac: 4.1 vs. 2.7 percent, OR 1.56, 95%CI,1.18-2.05; ≥ two gestational sacs: 8.1 vs. 4.1 percent, OR 2.08, 95%CI,1.54-2.82, PCOS vs. Non-PCOS, respectively). Potential negative impact of PCOS was reduced to marginal level once BMI were taken into account (aOR 1.42, 95% CI, .99-2.03). BMI and maternal comorbidities were independently associated with late pregnancy loss (aOR 1.65, 95%CI, 1.26-2.17 and aOR 2.07,95%CI,1.43-3.00). Conclusions PCOS women with overweight and preexisting comorbidities would benefit from lifestyle intervention and close surveillance throughout the whole pregnancy.

Abstract A Wuhan province, of China, become a first region for the novel of coronavirus infection 2019 (COVID-19), it gradually has become a major challenge for public health in most of the countries all over the world. The World Health Organization revealed that the International concerns over the novel coronavirus outbreaks have led to the formation of a public health emergency. On February 26, 2020, the COVID-19 outbreaks appeared in more than 35 countries around the world which include many of the Gulf countries notably Iran have reported COVID-19 cases respectively, and the infectious cases with a higher laboratory-confirmed and became serious as well as more deaths were reported. In this research, we elucidated the infectious pandemic significantly in all Gulf countries, additionally to investigate the competition between various of ABO blood groups which one is more susceptible than others and high risk for others with the second disease. The effects of the disease have led to the formation of control protocol centers around the world as soon as possible. According to this research and relevant guidelines to collect the necessary information and introduces essential knowledge about COVID-19 as well as prevention and treatment are the most important task in the Gulf States.

Objectives: To study the complications of intratymapanic dexamethasone for Méniere’s disease. Study Design:a randomized controlled trial. Methods:124 patients with Méniere’s disease were randomly divided into two groups: Intratympanic dexamethasone(ITD) group (n=62) and Intratympanic lidocaine(ITL) group (n=62). According to the dose of dexamethasone used during treatment, the patients in ITD group were further divided intoITD1(2mg/ml) group (n=31) and ITD2(5mg/ml) group (n=31).The complications in each group were observed and evaluated after 10 times of intratympanic treatment with ear endoscopy. Results:3 patients suffered from the external auditory canal mycosis after ITD therapy. All the 3 patients were in the ITD2 group and the the infectious rate between patients who used 5mg/ml of dexamethasone and those who used 2mg/ml exhibited significant statistical difference. There were 5 cases of tympanic membrane atrophy thinning in ITD group , while no tympanic membrane atrophy thinning was observed in ITL group, the incidence rate between these two groups showed significant statistical difference. In addition, two patients in the ITD group had perforation accompanied by external auditory meatus mycosis, while no tympanic membrane perforation was observed in the ITL group. There was no statistical difference in the incidence of vertigo, pain, tongue numbness, tinnitus and other complications between the two groups. Conclusions: Our study suggests that the occurrence of external auditory canal mycosis and tympanic membrane atrophy thinning were significantly correlated with the use of dexamethasone and the occurrence of external auditory canal mycosis was closely related to the drug concentration, while the occurrence of tympanic membrane atrophy thinning showed not significantly correlated with the drug concentration. Further understanding of the clinical characteristics of complications after ITD will help clinicians select the appropriate concentration of dexamethasone in the therapy and better manage these complications.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder presented with social and communication deficits, restricted, repetitive behaviours and interest. Several recurrently mutated genetic risk-factors have been implicated in ASD manifestation. Chromodomain helicase remodeller (CHD8) is one such gene that is a master regulator mediating the expression of genes controlling neuron functions. We collected 8,124 exonic SNPs in CHD8 from 4 databases representing the general and ASD populations; subjected them to multi-layered analyses on >20 computational tools. We observed that nsSNPs were common in the general population. Distinct hotspots for truncating and nsSNPs were identified within exons encoding the N and C terminals, respectively. Evolutionarily conserved regions involving CHD8 core domains: Helicase-C-terminal, Helicase-ATP-binding and SNF2_N domains, recorded the lowest density but severely pathogenic SNPs. Conversely, evolutionarily variable regions- CHD7-binding and BRK domains- hosted the highest SNPs, but were benign. Post-Translational-Modifications (PTMS) occurred on residues outside domains (P<0.01) i.e., non-conserved regions of CHD8 including the N and C terminals that were determined to be Intrinsically-Disordered-Protein-Regions (IDPRs) with 9 Molecular-Recognition-Features sites. Contrastingly, ASD population recorded significantly higher incidences of truncating SNPs than general population (P<0.0001). ASD-SNPs frequently occurring within core domains were severely damaging and accounted for >30% of all ASD variations. The CHD7-DNA-binding motif, with most PTMs, recorded the highest recurring truncating ASD-SNPs. The CHD8 PPIs effortlessly recapitulated the phenotypes presented by children with CHD8 mutations. 11/13 (84.6%) interacting molecules were IDPs. We identified 9 CHD8 nsSNPs that produced the strongest long-range disturbances, altering the modelled protein’s global conformational dynamics.

Molecular dynamics (MD) simulations are a popular method of studying protein structure and function, but are unable to reliably sample all relevant conformational space in reasonable computational timescales. A range of enhanced sampling methods are available that can improve conformational sampling, but these do not offer a complete solution. We present here a proof-of-principle method of combining MD simulation with machine learning to explore protein conformational space. An autoencoder is used to map snapshots from MD simulations onto the conformational landscape defined by a 2D-RMSD matrix, and we show that we can predict, with useful accuracy, conformations that are not present in the training data. This method offers a new approach to the prediction of new low energy/physically realistic structures of conformationally dynamic proteins and allows an alternative approach to enhanced sampling of MD simulations.

To the editor, Coronavirus Disease 2019 (COVID-19) has emerged as a major new public health threat, with high rates of morbidity and mortality among patients with chronic medical conditions. The Disease was classified as pandemic by March 2020 after its widespread over the world.(1)Globally, up to 28th July 2020, there has been more than 16 millions of confirmed cases of COVID-19, causing more than 650,000 deaths with the fatality rate of almost 4%.(2)As of 28th July 2020, a total of 77,904 laboratory confirmed COVID-19 cases reported in Oman with mortality rate of 0.52%. Up to this date, 6315 children <14 years of age were diagnosed with COVID-19 which account for 8.1% of total confirmed cases with no recorded deaths.(3) In Oman, children with mild COVID-19 are managed at home and those with moderate and severe disease are managed as inpatients. Ludvigssonet al in their systematic review found that COVID-19 in children tend to have a milder course and better prognosis compared to adults. (4)There is a limited literature describing SARS-CoV-2 infection in children with cancers and post haematopiotic stem cell transplantations . (5)Despite extensive testing of any fever or URTI symptoms in these vulnerable children, there were only 3 children with cancersand post-haematopiotic stem cell transplantations (HSCT) tested positive and required admission for COVID-19 in Oman for the last 5 months; 2 with acute leukemia and one is post-HSCT for primary immune deficiency. Patients were tested for SARS-CoV-2 infection by sending nasopharyngeal specimens either for clinical suspicion of COVID-19 or as a screening following exposure to SARS-CoV-2. The first one has relapsed acute lymphoid leukemia (ALL) and was admitted for non-COVID-19 related issues. He has mild course of COVID-19 and chemotherapy was stopped with no additional management. Another child with ALL who has just completed his chemotherapy courses was admitted for pneumonia and started on oral azithromycin for 3 days and IV ceftriaxone for 1 week. His CBC remained normal with normal coagulation profile, D-dimers andCRP of 7 mg/l. He was discharged in excellent good general condition. The 3rd patient is post-HSCT for primary immunodeficiency tested positive for SARS-CoV-2 following surveillance done following exposure and was admitted for short period for non-COVID-19 related issues.Although there is a theoretical concern that children with cancers are at risk of severe COVID-19 because they are immunocompromized, the limited available data does suggest that COVID-19 in this population is generally mild with self-limited course similar to the presentationof SARS-CoV-2 infection in healthy children. (5)Our series of children with cancers and post-HSCT showed similar results to what have been described in Italy, France and United States. Boulad et al. reported a low overall morbidity of COVID-19 in children with cancer with only 5% (1/20) required hospitalization for management of COVID-19. (6)Rossoff et al described their experience from Chicago where they reported 6 children with cancers and post HSCT who got SARS-COV-2 infection. All of them had mild SARS-CoV-2-related symptoms and none were admitted for COVID-19 related issues. (5)Nazon et al described 6 children managed by their haematology/oncology unit at Strasbourg, France over 3 months period and all were either asymptomatic or have mild disease and none require admission for management of COVID-19.(7)Flash survey on children with cancer from 25 countries which follow up about 10,000 children at risk by March 2020, revealed that 9 out of >200 children tested for COVID-19 had the infection and 8/9 were either asymptomatic or have mild course.(8)Severe COVID-19 has been described among five children (5/33, 15%) by a prospective nationalsurvey conducted by the French society of pediatriconcology among 30 French centers by Mid-April. These children required intensive care for respiratory support following mild initial course of COVID-19. At the time of writing the report, 4 of them were still managed in ICU and none have died.(9)The Spanish Group of Transplantreported their experience of 8 children post HSCT with COVID-19; 5 required management as inpatients and 3 managed at home. Two children required intensive care admission for mechanical ventilation; one was still on extracorporeal membrane oxygenation (ECMO) and one died secondary to alveolar haemorrhage. Lymphopenia and low ratio CD4/CD8 was associated with severe COVID-19 in this small cohort. (10)Our case series and the available experience reported from different countries showed that most of the children with cancer and post-HSCT have either asymptomatic or mild COVID-19 and these children have similar vulnerability and risk morbidity resulting from COVID-19 to healthy children.(11). Decisions on whether or not to postpone chemotherapy/HSCT need to made on a case-by-case basis and according to the risk of cancer progression which can results in a poor outcome.(5, 6)

Background: Several studies have explored the predictive value of impulse oscillometry (IOS) for asthma exacerbations in childhood, but its specific parameters are still unclear. Therefore, we designed this meta-analysis to determine the related indicators of acute asthma attacks. Methods: A comprehensive literature search was performed in July 2020 based on Pubmed, Embase, and Web of science database. Weighted mean differences (WMD) were calculated using Fixed-or random-effects models. Results: A total of 615 patients from 6 trials were included in this analysis. IOS may be a useful tool to predict asthma exacerbations. And the results showed that R5 (WMD = − 1.21, 95%CI: −1.55 to −0.87, P＜0.001), Fres (WMD = − 1.34, 95%CI: −2.03 to −0.65,P=0.018) and AX (WMD = − 7.35, 95%CI: −9.94 to −4.76,P＜0.001) had significant correlation with asthma exacerbations. In addition, X5 may also predict the acute attack of asthma (WMD =0.81, 95%CI: 0.56 to 1.01, P＜0.001). Conclusion: R5, AX, Fres, and X5 may be able to identify the risk of an acute attack of asthma. Besides, our research further demonstrated that peripheral airway injury may play an important role in the acute attack of asthma.

Sphagnum mosses account for most accumulated dead organic matter in peatlands. Therefore, understanding their responses to increasing atmospheric CO2 is needed for estimating peatland C balances under climate change. A key process is photorespiration: a major determinant of net photosynthetic C assimilation that depends on the CO2 to O2 ratio. We used climate chambers to investigate photorespiratory responses of Sphagnum fuscum hummocks to recent increases in atmospheric CO2 (from 280 to 400 ppm) under different water table, temperature, and light intensity levels. We tested the photorespiratory variability using a novel method based on deuterium isotopomers (D6S/D6R ratio) of photosynthetic glucose. The effect of elevated CO2 on photorespiration was highly dependent on water table. At low water table (-20 cm), elevated CO2 suppressed photorespiration relative to C assimilation, thus substantially increasing the net primary production potential. In contrast, a high water table (~0 cm) favored photorespiration and abolished this CO2 effect. The response was further tested for Sphagnum majus lawns at typical water table levels (~0 and -7 cm), revealing no effect of CO2 under those conditions. Our results indicate that only hummocks, which typically experience low water table levels, benefit from the 20th century’s increase in atmospheric CO2.