Background: This study aimed to evaluate maternity leave from the point of view of physician fathers and examine the factors that affect their support for their colleagues. Methods: This is a descriptive research study with a self-report online survey design and was conducted among a social media group. A 20-item data-collecting tool used in this study consisted of four parts—demographic data section, questions about participant’s job, questions pertaining to his wife’s breastfeeding, and questions regarding his opinions and attitudes toward his female physician colleagues. Results: Of the total, 45.5% of the participants stated that they faced difficulties, as their female physician colleagues were on breastfeeding leave. Moreover, 60.3% of the participants asserted that they have always been supportive of their colleagues with regard to using breastfeeding leave. Furthermore, we noted an increase in the number of night shifts (negatively) and supportive attitude toward the spouse (positively) and that the status of the spouse using breastfeeding leaves (positively) affected the male physician’s supportive attitude toward their female physician colleagues. Conclusion: The physician fathers wanted to support their colleagues in using their breastfeeding leave; however, they faced an increasing amount of workload. Although it is obvious how important it is for mothers to use maternity leave, the health of the remaining workers should not be ignored.

Introduction: The unrelenting storm of coronavirus disease (COVID-19) since late 2019 has turned into a crucial health matter of the globe. There is increasing evidence in terms of a hypercoagulable state by this infection. Therefore, the current study aims to clarify the association between thromboembolic events in COVID-19 and the patient, the infection, and in-hospital related characteristics. Methods: The current case-control study has been conducted on 243 COVID-19 pneumonia patients (83 cases with thrombotic events and 160 controls without thrombosis) in 2020. The thrombotic events included deep venous thrombosis (DVT) (n=9), pulmonary thromboembolism (PTE) (n=48), acute myocardial infarction (AMI) (n=17), cerebrovascular accidents (CVA) (n=4) and arterial thrombosis (n=5). On admission, hemodynamic parameters, on admission laboratory assessments, mobility during hospitalization, type of oxygenation, intensive care unit (ICU) admission requirement, duration of ICU and hospital stay were recorded in the checklist. Results: According to logistic regression assessment, on admission O2 saturation (OR: 0.97, 95%CI: 0.94-0.99), hemoglobin level (OR: 0.87, 95%CI: 0.77-0.97) and albumin level (OR: 0.53, 95%CI: 0.3-0.86) were independently correlated with thrombosis due to COVID-19. Other factors, including demographic, infection severity, laboratory and in-hospital characteristics, were not significantly associated with thrombotic events. Conclusion: Based on this study’s findings, hemoglobin and albumin levels were the independent factors associated with the thrombotic events in COVID-19 patients.

Editor:As a little girl, I remember my traveling salesman father literally carrying his heavy suitcase.  Then someone patented the idea to put wheels under suitcases. This amazing idea was immediately adapted and in time, improved upon with better designs. No randomized trials were needed to test whether wheels attached to the bottom of suitcases were useful.  The same will hopefully be true of expedient delivery of the placenta in squatting. Expedient delivery of the placenta in squatting prevents all postpartum hemorrhage and results in very little postpartum bleeding.Human postpartum hemorrhage was eliminated by natural selection millions of years ago. Since it is a deadly trait at the time of birth, it cannot be passed on. Great apes and chimpanzees have the same placenta as humans and lose a spoon full of blood at birth except in the rare occurrence that the chimp or ape birth is interfered with by people.  I was motivated to prevent postpartum hemorrhage to optimize birth outcomes. I found that if the woman delivers the placenta like a chimpanzee, she never hemorrhages.  One minute after the birth, the woman gets into squatting and pushes the placenta out in squatting without waiting for a contraction.https://youtu.be/AAJPW4p6rzU  I have delivered 1,120 consecutive births in which this was done and not a single woman lost 1000 cc or more and only one (suicidal) woman lost more than 500 cc.  The protocol appeared in the literature in 2010. (1) It has not caught on like attaching wheels under suitcases.  For the past 100 years, throughout the high income world, 1 in 20 women has a postpartum hemorrhage,  losing at least one liter of her approximately 3 liter blood volume at birth.   Some of them need a blood transfusion which involves the risks of transfusions such as bloodborne diseases and transfusion reactions.  Women after hemorrhaging who do not get blood transfusions are more prone to infections.Attempts to publish this data retrospectively has been rejected because it is not a randomized controlled trial (RCT). This censorship of a logical, life saving protocol is dubious at best since a RCT could never be blinded.  The same doctor or midwife who assists the woman to deliver the placenta in squatting would also be measuring blood loss, making the study no more objective than a retrospective cohort study.  In addition, a RCT is only needed if there is risk of untoward effects from an intervention such as from a drug, vaginal checks or breaking the sac.  Here nothing is done to the woman.  The woman getting into a squat a minute or two after the birth and pushing out the placenta has no side effects other than limiting blood loss. Like suitcase wheels, there is no scientific justification for RCT testing for expedient squatting delivery of the placenta.To date, a reasonable explanation for not publishing this retrospective cohort study does not appear to exist.  Could it be the desire to maintain the status quo is due to the profitability of hemorrhage in all birth settings?  What I do know is, like wheels on suitcases, all you have to do is try it once to see how well it works.Judy Slome Cohain, CNMAlon Shvut, Israel 904331.Cohain JS. A Proposed Protocol for Third Stage Management-Judy’s 3,4,5,10 minute method. Birth 2010; 37(1)84-5.

Background The use of tranexamic acid to prevent postpartum hemorrhage has often been controversial. Objectives To evaluate evidence from randomised controlled trials on the efficacy and safety of tranexamic acid in preventing postpartum hemorrhage. Search Strategy PubMed, EMbase and Cochrane Library, and Chinese database including CNKI, VIP and WanFang were searched. Selection Criteria Randomized controlled trials regarding tranexamic acid for the prevention of postpartum hemorrhage were included. Data collection and analysis Pooled relative risk was determined as the effect analysis statistic for binary variables, while pooled mean difference and standard mean difference was chosen for continuous variables. Results Preventive use of tranexamic acid was effective in reducing the incidence of postpartum hemorrhage in both cesarean section and vaginal delivery patients (RR=0.58, 95%CI 0.52-0.66, P＜0.00001), as well as reducing the volume of intrapartum blood loss ( -121.97, 95% CI-147.39, -96.55, P < 0.00001), and the need for blood transfusion (RR=0.36,95%CI 0.24-0.53,P＜0.00001) and additional medical measures to control bleeding (RR= 0.47, 95% CI 0.32-0.68, P <0.0001) following postpartum hemorrhage. Concerning safety, the medication was not found to increase the incidence of serious adverse reactions (RR=0.66, 95%CI 0.31-1.42, P=0.29) or thrombotic events (RR=1.14, 95%CI 0.39-3.35, P=0.61), but could increase the incidence of mild adverse reactions (RR = 1.55, 95% CI 1.13-2.13, P = 0.007). Conclusion Preventive use of tranexamic acid can reduce the incidence of postpartum hemorrhage in cesarean section and vaginal delivery, without increasing the incidence of postpartum thrombosis and other severe adverse events.

Objective: To investigate relationships between maternal genes involved in one carbon metabolism and adverse pregnancy outcomes. Design: Prospective mother and child cohort study Setting: Wuqiang, China Population or Sample: Pregnant women (n=939). Methods: A structured questionnaire was used to collect pregnancy outcomes. The maternal serum folate concentration was measured by using Abbott Architect i2000SR chemiluminescence analyzer in the first prenatal care visit. The type of DNA was processed by Sequenom MassARRAY iPLEX Platform. Main Outcome Measures: Pregnancy outcomes (PTB, LBW and SGA), DNA genotyping of methylenetetrahydrofolate reductase (MTHFR), methionine synthase reductase (MTRR), methionine synthase (MTR) and thymidylate synthetase (TYMS). Results: Totally, 849 dyads of women and infants were included in the analysis. The prevalence of PTD, LBW, and SGA were 3.76%, 1.58%, and 5.31% respectively. The average serum folate concentration was 11.95 ng/ml and the folate deficiency rate was 0.47%. There were no significant associations between MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G, TYMS rs3819102 alleles and PTD, LBW, SGA (P>0.05). Conclusion: In the population with adequate folate status and low prevalence of adverse pregnancy outcomes, MTHFR C677T, MTHFR A1298C, MTRR A66G, MTR A2756G, TYMS rs3819102 alleles may not be related to PTD, LBW, and SGA. Funding: Program for Healthcare Reform from the Chinese National Health and Family Planning Commission. Keywords: Polymorphism, MTHFR, MTR, TYMS, Preterm delivery, Low birth weight, Small-for-gestational-age Tweetable abstract No significant relationships were found between MTHFR, MTRR, MTR, TYMS and PTD, LBW and SGA in the population with adequate folate status.

Background:Chest X-ray(CXR) is commonly used as a first line imaging method to diagnose the reason of respiratory distress in NICUs.Lung ultrasound is a new diagnostic tool for lung imaging.Objectives:We aimed to determine the decrease in the number of CXRs on the first day of life in newborns with respiratory distress,with the use of lung ultrasonography.Methods:From January 2019 to June 2020,104 newborn infants hospitalized in the NICU with respiratory distress on the first day of life enrolled in this study(ClinicalTrials.govIdentifier NCT04722016).We used ultrasound as the first line technique for lung imaging.CXR was taken to determine endotracheal tube and umbilical catheter position or if considered necessary by the physician in charge of the infant.We calculated decreased number of CXR for every patient and evaluated the estimated decrease in radiation exposure.Results:104 neonates with median 36 weeks(25-40)gestational age and birth weight 2410gr(600-4100) enrolled in the study.Seventy(67,3%)of these babies were male.In the study group,24(23,1 %)patients were diagnosed with respiratory distress syndrome(RDS),49(47,1 %) patients with transient tachypnea of newborn(TTN),27(26 %) with pneumonia,4(3,8 %)with congenital heart diseases.Lung ultrasonography were performed 210 times for all infants,but CXRs were performed a total of only 107 times.CXR wasnot taken in 27 of the patients with a diagnosis of TTN,in 2 of the patients with a diagnosis of congenital pneumonia,and in one of the patients with congenital heart disease.The rate of patients who have never had a chest x-ray was 28,8%.Conclusions:We observed that usage of lung ultrasonography decreased the number of chest X-ray and radiation exposure in newborns with respiratory distress.

Background and purpose:The purpose of this study was to find correlation between vitamin D,Physical exercise on glycaemic control in patients of type2DM.Experimental approach:The study was conducted from November 2019 to December 2020 among subjects above 40 years of age at sub-district hospital Sopore,North Kashmir.Total 400 patients diagnosed with diabetes were registered for the study.Questionnaire containing relevant patient information was collected at regular intervals.Statistical analysis were performed.Results: Biochemistry values in the studied subjects with Type2DM compared to healthy controls in the study revealed that fasting glucose level,HbA1c,LDL,triglycerides,uric acid were higher inT2DM group compared to the control group.The results of our study showed that Vitamin D deficiency,lack of physical exercise,family history of T2DM,hypertension and smoking were significant predictors of diabetes.In Type2DM patients,mean vitamin D value was 21.45ng/ml opposed to 40ng/ml in the control group.Also physical activity was found to be higher in control group when compared to cases with p -value less than 0.00001.Also family history of DM was significantly higher in cases when compared to control group with p-value of 0.044.There was also statistically significant difference when parameters like HTN and smoking were compared (both higher in cases as against the control group) between two groups with p value 0.044 and 0.029 respectively. Conclusion and implications: Vit D,physical exercise,family history of diabetes may be contributing factors for the rising burden of diabetes globally and in India.We need to take cognisance of factors leading to the rising global burden of DM and take appropriate and necessary measures to stop this growing menace

With the advent of the era of big data, the identification of ways to extract useful knowledge from massive amounts of data has become the key to the development of methods and application research analysis of knowledge graphs. Because the knowledge graph is a type of networked knowledge base with strong expressive ability. Applied in the field of engineering education, it can help students quickly find the learning focus and improve learning efficiency. Therefore, this study proposes the combination of the bidirectional long short-term memory–conditional random fields (BILSTM–CRF) model with the BERT model to build a knowledge graph in the field of engineering education. Given that BILSTM can capture an increased amount of contextual information from the sentence and solve the problem of gradient disappearance during training, the CRF layer can ensure the effectiveness of the final prediction result. The BERT model can fully describe character-level, word-level, sentence-level, and even inter-sentence relationship characteristics. It is considerably suitable for the data in the field of engineering education evaluated in this study. Since the extracted data will always be missing data, this study proposes to use the knowledge reasoning model TransE to supplement and improve the extracted knowledge map data to realize the continuous update of the knowledge map.

A narrow QRS complex tachycardia with irregular rhythm: what Is the mechanism?Liu Qifang MD, Tian Ye MD, Zhao Yidong MM, Yang Long MD.PHD,Department of Cardiology，Guizhou Provincial People’s Hospital, Guiyang , ChinaCorresponding anthor: Yang Long E-mail：yanglong1001@163.comDisclosures:（None）Funding： Clinical Research Center Project of Department of science and technology of guizhou province [NO. (2017)5405]Key Words: Atrioventricular nodal reentrant tachycardia；Catheter ablation；Irregular rhythmAbstractIn most patients with atrioventricular nodal reentrant tachycardia (AVNRT), mutiple slow pathways are involved in anterograde conduction，resulting in repetitive alternans or triplets in tachycardia cycle-length that display regularly irregular tachycardia. We describe a patient with AVNRT presenting completely irregular rhythm that may mimic atrial fibrillation. A single radiofrequency energy delivery in the posterior septum near the ostium of the coronary sinus effectively eliminated the tachycardia. The anisotropic conduction of the transitional area of the slow pathway can be responsible for anterograde AV node conduction intervals fluctuation and circle length variation.Case reportA 56-year-old man with a history of hypertension and recurrent palpitations was referred to our institution for electrophysiological examine. Physical examination, chest CT, and the baseline 12-lead electrocardiography (ECG) was normal. A 24-h Holter monitor did not record any arrhythmias. During the palpitation，the narrow QRS complex tachycardia with variable R-R intervals was recorded on surface electrocardiogram（figure 1）. This irregular narrow QRS complex tachycardia could be misinterpreted as multifocal atrial tachycardias or atrial fibrillation because varying RR intervals [1]. During the electrophysiological study, intracardiac electrograms revealed normal A-H interval 80ms and H-V interval of 45ms in sinus rhythm. Ventricular overdrive pacing at a cycle length of 400ms resulted in ventriculoatrial dissociation. Atrial programmed stimulation was introduced during sinus rhythm with a cycle length of 500 ms and the coupling interval was reduced from 420 to 300 ms(-10ms decrease).The A2 to V2 conduction curves were continuity and there was no a jump（>50 ms） at a critical range of A1 to A2 coupling intervals，indicating dual pathway physiology of AV node was not found in this case（figure 2）[2].An irregular, sustained, narrow-QRS complex tachycardia was induced by atrial overdrive stimulation with a cycle length of 280 ms，The atrial activation sequence during the tachycardia is concentric and atrial and ventricular activation are simultaneous（figure 3）. Overdrive ventricular stimulations during tachycardia did not affect the activation sequence of atria and there was no regular relation between ventricular and atrial activations. The diagnosis of atrioventricular reciprocating tachycardia was excluded. The premature atrial impulses were introduced with different coupling intervals，the His-atrial interval of the return cycle still remained constant. The diagnosis of atrial tachycardia is unlikely, AVNRT is by far the most likely mechanism. Interestingly，there were large fluctuations in the AH interval and HV interval remained constant during tachycardia（figure 4）. What is the mechanism for the AH interval fluctuation and irregular rhythm？DISCUSSIONIn this case. we reported a patient with AVNRT showing irregular rhythm and the large fluctuations in AH interval during the tachycardia. There are two reasons for the cycle length and A-H intervals beat to beat variability in a patient with AVNRT：1）The spontaneous transition of multiple different reentry circuits using different anatomic slow pathways with alternans pattern to interact with the retrograde fast pathway[1]. 2）The anisotropic conduction of the transitional area of the slow pathway. In our patient，the dual pathway physiology of AV node was not found during electrophysiologic study， indicating the absence of multiple anatomic slow pathway available for anterograde conduction. Furthermore, a single radiofrequency delivery in the posterior septum near the ostium of the coronary sinus effectively eliminated the tachycardia. If one cannot exclude the possibility of two or three anatomically distinct slow pathways with closely spaced insertion sites, it is possible to eliminate two or three antegrade slow pathways conduction by a single ablation lesion in posteroseptal region [2]. However， our patient exhibited too many AH conduction intervals during the tachycardia. therefore, we could not simultaneously eliminate all slow pathway with different anatomic distinction by a single lesion at the right posterior atrial septum. Therefore, these findings imply that anisotropic conduction of slow pathway with a single anatomic localization are more likely to be responsible for the tachycardia cycle length variety in this patient.In 1998, Becker demonstrated the presence of the inferior extensions of the AV node in the human heart. AVNRT is defined as a re-entrant tachycardia utilizing the AV node and the right and left inferior extensions as the substrate of their circuit. Recently, Anderson identified ubiquitous connections between the working myocardium of the atrial septum and the compact node through transitional cells. These anatomic features could provide an electrophysiological substrate for the development of irregular rhythm in our patient [3]. Circle lengths variation or AH intervals fluctuation result from spontaneous transition from one to another permutation of the different fast pathway and slow pathway [4]. However，It is impossible that the transition of different reentrant circuits can be responsible for cycle length variation，because the conduction properties of all slow pathways are not appropriate to simultaneously interact with the retrograde fast pathway in an episode of tachycardia. The reasonable explanation for this phenomenon is that the conduction velocity differences in slow pathway based on nonuniform anisotropy may form the irregular tachycardia substrate in our patient [5].The right inferior input has a higher Cx43 expression than the node itself, which provided histologic and electrophysiologic evidence for the anisotropic conduction of the transitional area of the AV node [6]. In our patients, the variability in the space construction of the AV node and the differential expression of connexin isoforms in the nodal area may be responsible for diversity conduction characteristics of slow pathways.Conference[1] Richter S, Berruezo A, Mont L, Boussy T, Sarkozy A, Brugada P, Brugada J. Pseudo–Atrial Fibrillation, Rare Manifestation of Multiple Anterograde Atrioventricular Nodal Pathways. Am J Cardiol 2007;100:154 –156.[2] Tai CT, Chen SA, Chiang CE, Lee SH, Chiou CW, Ueng KC, Wen ZC, Chen YJ, Chang MS. Multiple anterograde atrioventricular node pathways in patients with atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1996;28(3):725-731.[3] Anderson RH, Sanchez-Quintana D, Mori S, Cabrera JA, Back Sternick E. Re-evaluation of the structure of the atrioventricular node and its connections with the atrium. Europace 2020 May 1;22(5):821-830.[4] Katritsis DG, Camm AJ. Atrioventricular nodal reentrant tachycardia. Circulation. 2010 ;122(8):831-40.[5] Katritsis DG. A unified theory for the circuit of atrioventricular nodal re-entrant tachycardia. Europace. 2020 ;22(12):1763-1767.[6] Katritsis DG, Efimov IR. Cardiac connexin genotyping for identification of the circuit of atrioventricular nodal re-entrant tachycardia. Europace 2019 ;21(2):190-191.Lengend：Figure 1 The narrow QRS complex tachycardia with a completely irregular rhythm.Figure 2 There is no jump in A2-V2 interval at a critical range of A1-A2 coupling intervals.Figure 3 Intracardiac recordings during tachycardia showing tachycardia cycle length variation.Figure 4 Intracardiac recordings during tachycardia showing the fluctuation of A-H intervals and constant of H-A intervals.

According to a largest systematic review, COPD is a significant risk factor for hospitalization, ICU admission and mortality in patients with COVID-19. According to British Thoracic Society patients with severe COPD are considered Clinically Extremely Vulnerable and should receive COVID-19 vaccine. Pfizer's vaccine showed significant effectiveness against COVID-19. In our case patient had severe form of COPD exacerbation after vaccination, which required hospitalization and the non-invasive ventilation but without intubation and radiology verified pneumonia.

Objective To demonstrate the association between folate and gestational diabetes mellitus risk during the whole pregnancy. Design Retrospective cohort study. Setting A tertiary hospital. Population or Sample Pregnant women who received antenatal care. Methods A retrospective cohort study included 42478 women who received antenatal care in Shanghai, China from April 2013 to March 2017 was conducted. Serum folate and vitamin B12 were assayed before 24 gestational weeks and a diagnosis of gestational diabetes mellitus was made based on International Association of Diabetes and Pregnancy Study Groups criteria during 24-28 gestational weeks. General linear models were used to test the association between serum folate and plasma glucose and estimate the relative risks for gestational diabetes mellitus after controlling for different confounders. Restricted cubic spline was used to test the dosage-response relationship between serum folate and the risk of gestational diabetes mellitus. Main Outcome Measures Risks for gestational diabetes mellitus. Results Positive associations were observed between serum folate and plasma glucose levels consistently (fasting, 1-h, 2-h). The adjusted relative risks for gestational diabetes mellitus across serum folate quartiles were 1.00 (reference), 1.14 (95% CI: 1.04, 1.25), 1.41 (95% CI: 1.28, 1.54), 1.53 (95% CI: 1.40, 1.68), respectively (p for trend <0.001) regardless of vitamin B12 status and the gestational weeks when folate was measured. Conclusions The findings of the study are significant for improving the guidelines for folic acid supplementation during pregnancy from a gestational diabetes mellitus prevention perspective. Keywords Folate; Gestational diabetes mellitus; IADPSG; Restricted cubic spline; Cohort.

Yangpumicins (YPMs), eg. YPM A, F, and G, are newly discovered enediynes from Micromonospora yangpuensis DSM 45577, which could be exploited as promising payloads of antibody-drug conjugates. However, the low yield of YPMs in the wild-type strain (~1 mg/L) significantly hampers their further drug development. In this study, a combined ribosome engineering and fermentation optimization strategy has been used for yield improvement of YPMs. One gentamycin-resistant M. yangpuensis DSM 45577 strain (MY-G-1) showed higher YPMs production (7.4 ± 1.0 mg/L), while it exhibits delayed sporulation and slender mycelium under scanning electron microscopy. Whole genome re-sequencing of MY-G-1 reveals several deletion and single nucleotide polymorphism mutations, which were confirmed by PCR and DNA sequencing. Further Box–Behnken experiment and regression analysis determined that the optimal medium concentrations of soluble starch, mannitol, and pharmamedia for YPMs production in shaking flasks (10.0 ± 0.8 mg/L). Finally, the total titer of YPM A/F/G in MY-G-1 reached to 15.0 ± 2.5 mg/L in 3-L fermenters, which was about 11-fold higher than the original titer of 1.3 ± 0.3 mg/L in wild-type strain. Our study may be instrumental to develop YPMs into a clinical anticancer drug, and inspire the use of these multifaceted strategies for yield improvement in Micromonospora species.

Background: Lung ultrasound (LUS) is widely employed in children and neonates for diagnosing various thoracic conditions. Hence, and because of the accumulation of information and awareness regarding radiation exposure hazards of using chest x-ray with children, the LUS technique was introduced and examined as a possible, useful, and safe tool instead of using a chest radiograph. Objective: This meta-analysis aimed to assess the diagnostic accuracy of Lung ultrasound in pneumonia-affected pediatric patients. Methods: Literature search of published articles in Medline, Web of Science, Scopus, Embase, and Journal of Web till September 2020 were reviewed for the pre-described accuracy assessors. Meta disc software was used for the analysis of the study. Results: Of the 29 articles chosen, most of them were prospective studies. The overall pooled sensitivity was 0.83 (95% CI, 0.81-0.84), and specificity was 0.84 (95% CI, 0.81-0.86), depicting good diagnostic performance. Conclusion: Lung ultrasound depicts an efficient diagnostic accuracy in childhood pneumonia.

Obturator hernia is an infrequent pelvic hernia observed in elderly, emaciated and multiparous women. It often presents with nonspecific clinical symptoms, making it difficult to diagnose. We conducted a retrospective descriptive study on 11 patients admitted to our hospital for intestinal obstruction due to incarcerated obturator hernia from 2009 to 2020. Eight patients underwent laparotomy with low midline incision. Laparoscopic approach was tried on the other three patients with two patients converting to open surgery because of inadequate visualization, and only one patient received laparoscopic repair. Of the 10 patients receiving laparotomy, seven cases received hernia repair with a match and three cases were performed simple peritoneal closure following bowel resection. One patient died of multiple organ failure. Laparotomy with low midline incision is commonly used to manage obturator hernia in an emergency, whereas laproscopic approach may only apply to some selected cases.

Hydatid disease is a parasitic disease with a high incidence in pastoral areas in Tibet. The heart is an uncommon location of echinococcosis and involvement of the interventricular septum is even rarer. This disease can remain asymptomatic for a long time, but may result in cardiac tamponade and sudden death. We report a 55-year-old woman who was diagnosed with a giant cardiac hydatid cyst involving the interventricular septum associated with complete right bundle branch block. However, owing to insufficient treatment, spontaneous rupture of the cardiac hydatid cyst occurred 6 months after diagnosis, which caused sudden death of the patient.

Background Erythropoiesis-stimulating agent (ESA) hyporesponsiveness is an important cause for the undertreatment of anemia. This study aimed to investigate the effectiveness and safety of adding HIF-PHI (roxadustat) to ESA for the treatment of ESA-hyporesponsive anemia in Peritoneal Dialysis (PD) patients. Methods This was a single-center prospective-designed study in PD patients of Huashan Hospital, Fudan University. Patients with ESA-hyporesponsive anemia were enrolled from January 2020 to April 2020 with a 24-week follow-up period. Patients were added with roxadustat at a starting dose of 50 or 100 mg thrice weekly without changing the ESA dose. Roxadustat and ESA dose adjustments were made as needed to maintain Hb levels within 11.0–13.0 g/dL. Efficacy outcomes and safety were assessed. Results A total of nine patients were recruited in the study. Both the cumulative responsive rate and the maintenance rate of patients with Hb>11g/dL were 100%. Six out of nine patients had ESA dose reduced from 15,000 UI/week or more to 7000 IU/week or less at week 24. No drug-related severe adverse event was reported in this study. Conclusion The present study showed that the addition of roxadustat not only effectively corrected anemia in patients who were resistant to ESA, but also reduced the dose of ESA.

Five Key points COVID 19 treatment generate nose bleeding Covid 19 treatment necessitate prone position Nasal packing is useful but sometimes insufficient CAVI-T is a new treatment of epistaxis CAVI-T is especially adapted to COVID patient in prone position due to its specific form

Management of multiple episodes of internal & external bleeding associated with minimal injury in single patient diagnosed with HYPODYSFIBRINOGENEMIA with Fresh Frozen Plasma transfusion & CRYOPRECIPITATE transfusion is compared, which demonstrated that CRYOPRECIPITATE transfusion can manage bleeding very effectively than Fresh Frozen Plasma transfusion.

Primary pancreatic lymphoma is rare and mimics adenocarcinoma of the pancreatic head. A 47 year old lady presented with a pancreatic head mass , diagnosed as DLBCL and was treated with R-CHOP. This case is presented due to its rarity, and recognising NHL as a differential for a pancreatic mass.

Introduction: Although most children experience minor symptoms from SARS-CoV-2 infection, some develop complications including MIS-C. Neuroblastoma patients may be at higher-risk of infection. We hypothesized that ACE2, CD147, PPIA and PPIB are poor-prognosis and SARS-CoV-2 infection biomarkers in neuroblastoma. Results: In-depth gene-expression-dataset statistical analysis showed ACE2, CD147, PPIA and PPIB high-expression significantly associated with poor-prognosis neuroblastomas with amplified MYCN, unfavourable-tumors and patients older than 18 months of age. Low-expression was associated with the NTRK1-PTPN6-TP53 module, a good-prognostic marker. Conclusion: ACE2, CD147, PPIA and PPIB high expression is associated with poor-prognosis neuroblastomas. These patients may be at higher-risk of SARS-CoV-2 infection.

The microbiome is a virgin science and, in recent years, has gained lot of importance because of its pivotal role in the protection of human health. The microbiome actually deals with microorganisms that are associated with indigenous body parts and the entire gut system in all animals, including human beings. These microbes are linked with roles involving hereditary traits, defense against diseases, and strengthening overall immunity, which determines the health status of an organism. Considerable efforts have been made to find out the microbiome diversity and their taxonomic identification in finfish and shellfish and its importance has been correlated with various physiological functions and activities. In recent-past due to the availability of advanced molecular tools, some efforts have also been made on DNA sequencing of these microbes to understand the environmental impact and other stress factors on their genomic structural profile. There are reports on the use of next-generation sequencing (NGS) technology, including amplicon and shot-gun approaches, and associated bioinformatics tools to count and classify commensal microbiome at the species level. The microbiome present in the whole body, particularly in the gut systems of finfish and shellfish, not only contributes to digestion but also has an impact on nutrition, growth, reproduction, immune system and vulnerability of the host fish to diseases. Therefore, the study of such microbial communities is highly relevant for the development of new and innovative bio-products which will be a vital source to build bio and pharmaceutical industries, including aquaculture. In recent years, attempts have been made to discover the chemical ingredients present in these microbes in the form of biomolecules/bioactive compounds with their functions and usefulness for various health benefits, particularly for the treatment of different types of disorders in animals. Therefore, it has been speculated that microbiomes hold great promise not only as a cure for ailments but also as a preventive measure for the number of infectious diseases. This kind of exploration of new breeds of microbes with their miraculous ingredients will definitely help to accelerate the development of the drugs, pharmaceutical and other biological related industries. Probiotic research and bioinformatics skills will further escalate these opportunities in the sector. In the present review, efforts have been made to collect comprehensive information on the finfish and shellfish microbiome, their diversity and functional properties, relationship with diseases, health status, data on species-specific metagenomics, probiotic research and bioinformatics skills. Further, emphasis has also been made to carry out microbiome research on priority basis not only to keep healthy environment of the fish farming sector but also for the sustainable growth of biological related industries, including aquaculture.

Introduction: Benign Paroxysmal Positional Vertigo (BPPV), a neuro-otological disorder accounting for nearly one-half of patients with peripheral vestibular dysfunction, is commonly attributed to displaced otoconia. These have been shown to have a biomineralization close to that of bone, and Vitamin D deficiency has been associated with BPPV. Objective: We aim to systematically review the available literature on Vitamin D supplementation and BPPV intensity and recurrence in adults. Design: We systematically reviewed the available literature on Vitamin D supplementation and BPPV intensity and recurrence. Articles were identified through searches of PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials, and ClinicalTrials.gov as well as manual reviews of references, from 1947 to April 2020. The study protocol was registered in the PROSPERO database (Trial Registration: CRD42020183195). Results: A total of 179 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, six studies were selected and subjected to a quality assessment. In one randomized clinical trial (RCT), Vitamin D supplementation was found to reduce annual recurrence rate of vertigo in patient with BPPV and subnormal serum Vitamin D levels compared to placebo (odds ratio [OR] 0.69, 95% Confidence Interval [CI]: 0.54, 0.90). Non-randomized clinical trials demonstrated the possibility of a null effect in the random effects model (0.08[0.00, 1.56]). The RCT was the only study to be considered as low risk of bias in the overall evaluation. All of the non-randomized studies were assessed as serious risk of bias. Conclusions: The intervention studies identified consistently demonstrated a decrease in BPPV recurrence with supplementation of Vitamin D in patients with subnormal Vitamin D levels. Although there is a paucity of high-quality studies, the present literature does highlight a role for optimization of Vitamin D levels in patients with BPPV.

A corona virus infectious disease (COVID – 19) is spreading quickly throughout the globe. An exhaustive data available for this infectious disease on confirmed cases, active cases, recovered cases and fatal cases and relation between them will give us some information for future statistical analysis and modelling. In this research paper, the focus is on Modelling and forecasting the COVID – 19 cases for India and Karnataka. With this view an auto regressive model has been developed for the confirmed and fatal cases which are validated for the period of data which has not been used for modelling. While comparing to the other existing models this gives preferable results.

This paper deals with a class of backward stochastic differential equations driven by both standard and fractional Brownian motions with time deplayed generators. In this type of equation, a generator at time $t$ can depend on the values of a solution in the past, weighted with a time delay function, for instance, of the moving average type. We establish an existence and uniqueness result of solutions for a sufficiently small time horizon or for a sufficiently small Lipschitz constant of a generator.