Rationale, aims and objectives: Urinary incontinence has a high prevalence worldwide, ranging from 25 to 45%. Incontinence is often treatable with conservative interventions, which however demand a long and intensive commitment from the patient. Results are not immediate and relapses are possible; patients can experience uncertainty and difficulty to comply with rehabilitation programs, hence the importance of therapeutic relationship with a healthcare professional. Mishel’s theory of uncertainty can be used to measure uncertainty and the effects of such relationship, but no instrument currently exist to this purpose. We sought to create an Italian version of the MUIS (Mishel’s Uncertainty in Illness Scale) dedicated to people undergoing conservative rehabilitation for urinary incontinence. Method: a prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, exluding puerpera. A scale named MUIS-PF (pelvic floor) was created , based on previous versions of Mishel’s scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed and an exploratory factor analysis was conducted. Results: 109 patients enrolled (54 M, 55 F) aged 64±5 years, medial initial leakage 245 grams/day, IQR[90;370]. Seventy-nine percent of the patients obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%) and structure analysis yielded clear separation of the factors. Patients uncertainty decreased significantly at the end of the program, compared to the first consultation (p<0.001). Conclusions: The MUIS-PF is valid and reliable. Utilising the correct approach the nurse could significantly reduce the uncertainty of persons with incontinence during the process, by listening, giving clear information and searching for the best solution for their continence issues. Future studies could focus on specific features of programs run by professionals other than nurses.

I am a professor and attending pharmacist in the field of pharmaceutical sciences and writer or co-author of at least 5 manuscripts about different aspects of COVID-19. More than 15 months from the first report of COVID-19, over 120 million people all over the world infected by this virus, and more than 2.5 million of them have died. Although different treatment approaches have been proposed, management of the COVID-19 patients is steal remained controversial. In this regard, I want to share my personal experience from the exposure to the coronavirus and the consequence of this infection on my health status. I am a 51 years old male, known case of hypertension, dyslipidemia, and chronic kidney disease. During working hours of colleagues in the Faculty of Pharmacy, I visited one of my colleagues in his office. After leaving the Faculty, my colleague declares that his RT-PCR test of COVID-19 is positive and it took 3 days for me to experience the first sign of the COVID-19 as fever. Many complications have occurred for me during the different stages of COVID-19 infection that I shared and explained in detail with the suggested pharmacotherapies. According to the pathophysiology of COVID-19 infection and my personal experience during COVID-19 infection, I want to emphasize the necessity of early initiation of anti-inflammatory agents including corticosteroids and colchicine in high-risk patients with mild-to-moderate COVID-19 pneumonia who shows respiratory system involvement, in order to prevent progression to the severe and critical stages of this disease.

Animal prion diseases are a group of neurodegenerative, transmissible and fatal disorders that affect several animal species. The causative agent called prion, is a misfolded isoform of normal cellular prion protein, which is found constitutively in cells with higher concentration in the central nervous system. In this review, we explored the sources of infection and different natural transmission routes of animal prion diseases in susceptible populations. Chronic wasting disease in cervids and scrapie in small ruminants are prion diseases capable of maintain themselves in susceptible populations through horizontal and vertical transmission. The other prion animal diseases can only be transmitted through food contaminated with prions. Bovine spongiform encephalopathy is the only animal prion disease considered zoonotic, however, due to its inability to transmit within a population, it could be controlled. The emergence of atypical cases of scrapie and bovine spongiform encephalopathy, even the recent report of prion disease in camels, demonstrates the importance to understand the transmission routes of prion diseases in order to take measures to control them and to assess the risks to human and animal health.

Background: Identifying immune cells involved in COVID-19 disease progression and predictors of poor outcomes is important to manage patients adequately. Methods: A prospective observational cohort study enrolled 53 mild non-hospitalized and 48 hospitalized confirmed COVID-19 patients to a tertiary hospital in Oman. Results: Hospitalized patients were older (58 years vs 36 years, p <0.001) and had more comorbid conditions like diabetes (65 % Vs 21% p<0.001). Hospitalized patients had significantly higher inflammatory markers (p<0.001); C-reactive protein (CRP) (114 vs 4 mg/L), Interleukin-6 (IL-6) (33 vs 3.71pg/ml), lactate dehydrogenase (LDH) (417 vs 214 U/L), ferritin (760 vs 196 ng/mL), fibrinogen (6 vs 3 g/L), D-dimer (1.0 vs 0.3 mcg/mL), disseminated intravascular coagulopathy (DIC) score (2 vs 0) and neutrophil/lymphocyte ratio (4 vs 1.1), (p<0.001). In multivariate regression analysis, statistically significant independent early predictors of ICU admission or death were higher levels of IL-6 (OR 1.03, p=0.03), frequency of large inflammatory monocytes (CD14+CD16+) (OR 1.117, p=0.010) and frequency of circulating naïve CD4+ T cells (CD27+CD28+CD45RA+CCR7+) (OR 0.476, p=0.03). Conclusion: IL-6, frequency of large inflammatory monocytes, and circulating naïve CD4 T cells can be used as independent immunological predictors of poor outcomes in COVID-19 patients to prioritize critical care and resources.

Background: Follicular Unit Extraction (FUE) which is a newer hair transplant procedure was thought to be only usable in limited areas at the beginning. However, it is the most preferred technique these days. It is known transection rates have decreased with punch technology (and experience) over the years. Our clinical experience is that the total graft numbers and the number of follicular units (FUs) containing 3 or more hairs gained have increased over the years. Objectives: We analyzed the data from so-so many male patients who underwent hair transplantation by FUE method at our clinic retrospectively to elucidate how the development of punch technology affected the number of total grafts and FU containing multiple hairs. Methods: Between the years 2011 and 2020, the number of grafts obtained, in male androgenetic alopecia (AGA) hair transplant patients operated with the FUE method at the author’s dermatology clinic, was investigated retrospectively. Results: Overall 1415 cases were retrospectively included in the study. Over the years, the numbers of total grafts and multi-hair FU gained have increased in relation to the change in punch devices. Conclusion: Our study has shown that hair yield has been increased with new punch technologies.With an increasing hair yield by the aid of evolving punch technology, hair transplantation with the FUE method has become the first choice for hair transplantation preferred by both doctors and patients. Keywords: Hair Follicle / transplantation; Tissue and Organ Harvesting / instrumentation; Tissue and Organ Harvesting / methods; Alopecia / surgery; Transplantation, Autologous.

Aim of the study Since the beginning of the COVID-19 pandemic, empirical antibiotics prescription has increased globally in patients with COVID-19 for suspected or confirmed bacterial infection. Hence, concerns have been raised about potential rise in antibiotic resistance that will create further challenges for antimicrobial stewardship. This descriptive cross-sectional study was conducted to assess healthcare workers attitudes and practices regarding antibiotics prescription during the COVID-19 pandemic in Lebanon. Methods used to conduct the study The survey was distributed online using GOOGLE forms and included questions addressing socio-demographic characteristics, trainings in antibiotics use and healthcare workers attitudes and practices regarding antibiotics prescription during the pandemic. Results of the study In total, 399 healthcare workers responded to the survey. Less than half of them had already participated in antibiotic prescription trainings before or during the pandemic. However, only 11% participated, mostly nurses, in antibiotic stewardship program. Azithromycin was the most prescribed antibiotic with Vitamin C and Zinc used as second line treatments in COVID-19 patients. In addition, nearly two-third of the participants reported an increase in antibiotic use during the early phase of the pandemic and considered that COVID-19 patients are receiving unnecessary antibiotics. Conclusion This study showed excessive antibiotics prescription during the COVID-19 pandemic in Lebanon that needs to be tackled by raising awareness of antimicrobial stewardship and control measures.

Rationale, Aims and Objectives: Human Papilloma Virus is responsible for the disease of condylomata acuminata (CA), also known as genital warts. In men these lesions are superficial, involving the skin of the glans and prepuce, and are treated by dermatologists. When lesions involve the urethra and are not directly visible, the patients are referred to urologists for more advanced surgeries. Methods: between January 2012 – January 2017 133 cases of CA were addressed to our center; 64 non-complicated forms were further referred to the dermatologist, 45 were resected and cauterized, and 24 cases were operated in our center. Among these cases 21 patients presented warts at the levels of the urethral meatus and navicular fossa, while the other 3 had multiple urethral lesions after previous resections, up to the peno-scrotal junction. Results: surgery consisted in a limited ventral opening of the meatus and fossa navicularis till the lesions were completely exposed and was followed by electrocauterization of the tumor bed, no further urethral reconstruction being needed. In 3 cases with previous endoscopic treatment attempts (urethroscopy and resection), with the lesions progressed to the peno-scrotal junction, an extensive ventral incision of the urethra was required, in order to reveal and remove all the warts. To prevent recurrence and allow for healing, the penile urethra was kept open for 6 months, then reconstructed in a second procedure. No immediate or distant complications were encountered. The histopathological examination of the resected tissue did not reveal any signs of urethral carcinoma. After a follow-up period of 6 to 46 months no recurrence of the disease was observed. All patients have good functional and aesthetic results. Conclusions: While simple cases of genital warts can be successfully managed by dermatologist, the more severe forms that progress inside the urethra require surgical treatment.

In this paper, the stability analysis and controller design of a 2-D switched system with random disturbances are studied. First, based on the Fornasini-Marchesini local state-space model, a random discrete 2-D switched system model is proposed. Secondly, based on the method of switching quadratic Lyapunov function, Schur complement and linear matrix inequality the criterion of the sufficiency of the asymptotical stability under any switching signal is established. The extended average residence time method is used to obtain a sufficient criterion of the mean square exponential stability of the random discrete two-dimensional switching system under restricted switching conditions. According to the stability analysis results, the conditions for the existence of the state feedback controller are given and the corresponding state feedback controller is designed. Finally, two examples are given to illustrate the effectiveness of the proposed method.

In this paper, we investigate the following Chern-Simons-Schr\”{o}dinger system \begin{equation*} -\Delta u+u+\left(\int_{|x|}^{\infty} \frac{h(s)}{s} u^{2}(s) d s+\frac{h^{2}(|x|)}{|x|^{2}}\right) u=f(u) \quad \text { in } \mathbb{R}^{2}, \end{equation*} where $h(s)=\int_{0}^{s} \frac{t}{2} u^{2}(t) dt$ and the nonlinearity $f\in C(\mathbb{R}, \mathbb{R})$ satisfies the Ambrosetti-Rabinowitz type condition. By using a combination of invariant sets method and the Ljusternik-Schnirelman type minimax method, we prove the existence of infinitely many sign-changing solutions. It is worth mentioning that the nonlinear term may not be 5-superlinear at infinity. In particular, it includes the power-type nonlinearity $|u|^{p-2}u$ with $p\in (4, \infty)$. This work also answers the open problem raised by Liu, Ouyang and Zhang (Nonlinearity \textbf{32} (2019), 3082-3111).

Available therapeutic interventions for managing preterm labour have not been consistently successful due to controversies related to its aetiology. However, multiple mechanisms including inflammation play a significant role in the pathogenesis of preterm labour. The extracellular matrix of the amniochorion contains collagen fibres that maintain the tensile strength of the amniochorion, resisting mechanical stress and preventing rejection of the foetal allograft. Expression of pro-inflammatory mediators in the amniochorion triggers production of prostaglandins in the uterus and enzymatic degradation of the resilient extracellular matrix of the foetal membranes by matrix metalloproteinases leading to uterine contractions, cervical remodelling resulting in preterm labour.

It is not easy to find data in the scientific literature on the quantitative content of individual phytochemicals. It is possible to find groups of compounds and even individual compounds rather easily, but it is not known what their concentration is in cultivated or wild plants. Therefore, the subject of this study was to determine the content of individual compounds in the new Paulownia species - Oxytree, developed in a biotechnology laboratory in 2008 at La Mancha University in Spain. Six secondary metabolites were isolated, and their chemical structure was confirmed by spectral methods. An analytical method was developed, which was then used to determine the content of individual compounds in leaves, twigs, flowers and fruits of Paulownia Clon in Vitro 112®. No flavonoids were found in twigs and fruits of Oxytree, while the highest phenylethanoid glycosides were found in twigs.

Objectives: We evaluated the national prevalence of unnecessary GI drugs in the prescription for the common cold in ambulatory settings and the factors influencing this practice. Method: This cross-sectional study used the National Patients Sample data. We identified patients aged ≥20 years diagnosed with a common cold in a primary care clinic in December, 2018. We investigated whether the prescriptions for common cold of study subjects included any unnecessary GI medications. Demographic and clinical factors influencing the prescription of GI drugs were explored using multiple logistic regression analysis. Results: Unnecessary utilisation of GI medications in treating colds was estimated to be 43.80%. Women were more likely to be prescribed unnecessary GI medications (odds ratio [OR]=1.314). Among physician specialties, paediatricians showed the lowest odds (OR=0.479), whereas surgeons showed the highest (OR=1.655). Patients in urban and rural areas had higher odds than those in the metropolitan areas (OR=1.742). Non-steroidal anti-inflammatory drugs (NSAIDs) use was directly related to unnecessary GI medication prescription (OR=1.903) and the total number of cold drugs prescribed was inversely proportional to unnecessary GI medication use. Patients prescribed three and four or more cold medicines were less likely to receive GI drugs at odds of 0.568 and 0.471, respectively. Conclusion: This study demonstrates the high rate of unnecessary GI medication utilisation in common cold treatment in Korea. Factors influencing unnecessary GI drug utilisation were female sex, physician specialties (surgery), non-metropolitan areas, NSAIDs use, and prescription of fewer cold drugs.

The type III interferon family (IFN-III), including IFN-λ3 (IL-28B), has antiviral, anti-tumor, and immunomodulatory activities. Although IL-28B anti-tumor effect has been extensively explored, its underlying anti-tumor mechanism remains unclear. Here, we explored IL-28B effects on colon cancer. We found that IL-28B significantly inhibited colon cancer growth in a murine MC38 tumor cell engraftment model. Interestingly, IL-28B did not directly promote apoptosis or inhibit MC38 tumor cell proliferation in vitro. IL-28B treatment exerted indirect anti-tumor activity by downregulating M2 macrophages in the tumor microenvironment. Furthermore, IL-28B inhibited M2 macrophage polarization in vitro. It also halted M2 macrophage differentiation predominantly via inhibition of the STAT3 and JNK signaling pathways. Our findings revealed that IL-28B inhibited M2 macrophages in the tumor microenvironment to delay colon cancer progression. Our study provides new evidence of IL-28B anti-tumor and immunomodulatory activities.

Background: Immunostimulants are gradually being used in the prevention and treatment of recurrent respiratory tract infection (RRTIs) in susceptible children, but its drug effects has not been quantified. The purpose of this paper is to confirm the efficacy of immunostimulants in the prevention and treatment of RRTIs in susceptible children. Methods: Model-based meta-analysis (MBMA) was used to describe the time-course of placebo and immunostimulants in the prevention of RRTIs in children. The cumulative number of acute respiratory tract infections (ARTIs) was used as the indicator of efficacy. The single-arm meta-analysis was used to analyze the incidence of drug related adverse events. Results: A total of 14 articles with 2,400 pediatric subjects were finally included for analysis. The results showed that the cumulative number of ARTIs increased linearly with time, and the incidence of ARTIS in the placebo group was 0.65 (95% CI: 0.55 to 0.75) per month. OM-85 BV and pidotimod significantly reduced the incidence of ARTIs by 0.21 (95% CI: 0.16 to 0.26) and 0.19 (95% CI: 0.17 to 0.21) compared with placebo per month, respectively. The incidence of drug-related adverse events of pidotimod and OM-85 BV was comparable with that of placebo. Conclusions: Pidotimod and OM-85 BV can effectively reduce the incidence of ARTIs in susceptible children, and there is no significant increase in the incidence of drug-related adverse events. This study provides quantitative support for the application of immunostimulants for the prevention of recurrent respiratory tract infection in children.

Abstract Objective: To determine whether antepartum non-stress test (NST) and intrapartum FHR tracings in fetuses with heart block are reliable or not. Case series: This study describes three fetuses with second degree heart block (SHB) in the second half of pregnancy. They showed bradycardia (FHR: 65-80 bpm.) with reactive non-stress test (NST) and normal baseline variability. However, one subsequently developed complete heart block (CHB) and showed minimal FHR variability without accelerations in late gestation. The first two cases had intrapartum normal FHR variability with accelerations despite bradycardia. FHR tracings were readable and well-interpreted. They well tolerated labor and vaginal delivery, giving birth to the healthy babies with SHB. The third case with CHB showed intrapartum bradycardia with minimal FHR variability without acceleration, no response to acoustic stimulation. Because of difficulty in tracing interpretation, cesarean section in early labor at 37 weeks of gestation was performed, giving birth to a healthy newborn with CHB, though requiring pacemaker. Conclusion: FHR tracings of SHB fetuses still represent SA node function depending on sympathetic and parasympathetic tone, reflective of fetal hypoxic status. NST and intrapartum FHR tracings are reliable. On the contrary, FHR tracings of cases with CHB are independent from SA node impulses, representing solely ventricular rate, not reflective of SA node rate variability and CNS hypoxic status. Therefore, the interpretation in the fetuses with CHB is unreliable to determine fetal well-being.

Rhythm control strategies in patients with atrial fibrillation (AF) can bring many clinical benefits. However, there is still uncertainty regarding selection of the optimal rhythm control strategy for persistent AF. Chronicity, substrate alteration, and underlying bradyarrhythmias could influence the clinical outcomes. Current guidelines do not provide a distinct recommendation for electrical cardioversion in patients with AF with a slow ventricular response (SVR). We present two cases of sudden cardiac arrest due to sustained ventricular tachycardia/fibrillation after electrical cardioversion of persistent AF with SVR.

Polychlorinated Biphenyls (PCBs) pose health hazards to humans as environmental and occupational workplace pollutants. The pharmacokinetics and behavioral effects of PCBs after inhalation exposures of Aroclor 1232 in Swiss albino mice were assessed in this study, and these effects correlate with monoamine levels in brain. A whole-body inhalation chamber has been utilized to expose mice to different doses of Aroclor 1232 for single six-hour durations. The plasma and brain samples were used to estimate the corresponding concentration-time profiles of two representative congeners of PCBs (PCB 77 and PCB 180) and calculate their pharmacokinetic parameters. These variables were then correlated with mouse behavior using Irwin scale, and monoamine levels. A definite dose-dependence of PCB 77 and PCB 180 pharmacokinetic parameters was identified in plasma and brain. PCB 77 exhibited more accumulation in brain than plasma, whereas PCB 180 accumulated more in plasma than brain. Mood, autonomic scores, and miscellaneous sub domains were significantly different from control group scores, correlated with brain monoamine levels. Single duration-exposure toxicity and generation of PCB 77 and PCB 180 pharmacokinetic parameters in mouse brain and plasma after inhalation dosing of Aroclor 1232 have been successfully accomplished. The brain to plasma ratio was correlated to behavioral disruption in mice suggesting PCBs can alter monoamine levels. Finally, the study results could be used to extrapolate and model neurobehavioral risk hazards at human workplace occupational exposures to PCB mixtures, both indoor and outdoor.

The new coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are causing health crisis of the world. To control the pandemic SARS-CoV-2 infection, world-wide vaccination are under way. However, no specific therapeutic drugs are available in the treatment of COVID-19 yet. To find the effectively therapeutic targets for COVID-19, efforts should be focused on the pathogenesis of COVID-19. SARS-CoV-2 induced COVID-19 involves the processes of viral entry into the host cells, viral replication in the host cells, and induction of cytokine storm and cellular damage. Therefore, the potential targets may include the structural proteins of the virus that play roles in the pathogenesis, viral replication associated enzymes, inflammatory cytokines, and signaling proteins that mediate the induction of cytokine storm. Further exploring this strategy may benefit us in finding novel therapeutic targets and effective treatment of COVID-19.

A document by Mariam Riad. Click on the document to view its contents.

In this work, a two-dimensional (2D) kernel-based Gaussian process regression (GPR) method for the identification of batch process is proposed. Under the GPR framework, the estimate of the time-varying impulse response is a realization from a zero-mean Gaussian process (GP), wherein the kernel function encodes the possible structural dependencies. However, the existing kernels designed for system identification are one-dimensional (1D) kernels and underutilize the 2D data information of batch process. Utilizing the 2D correlation property of batch process impulse response, we propose the amplitude modulated 2D locally stationary kernel by means of addition / multiplication operation based on coordinate decomposition. Then, a nonparametric identification method using 2D kernel-based GPR for batch process is developed. Furthermore, the properties of the proposed 2D kernel are analyzed. Finally, we demonstrate the effectiveness of the proposed identification method in two examples.

An amphoteric polyacrylamide thickener was synthesized using 2-acrylamido-2-methylpropane sulfonic acid (AMPS), acrylamide (AM), and dimethyl diallyl ammonium chloride (DMDAAC). According to the experimental results, the best polymerization conditions were as follows: temperature of 45 ℃, AMPS:AM:DMDAAC mass ratio of 1:3:1, and monomer, initiator, guide agent, crosslinking agent, and urea concentrations of 27%, 0.6%, 0.15%, 0.3%, and 1%, respectively. The apparent viscosity, measured at room temperature with a six-speed rotational viscometer, was 135 and 45 mPa·s in the absence and presence of 20% HCl, respectively. The temperature resistance of the thickener solution was evaluated using an AR2000ex rheometer; at 120 °C and a shear rate of 170 s–1, its apparent viscosity was 99.7 mPa·s. Moreover, the chemical composition and morphology of the synthesized thickener were investigated via Fourier-transform infrared spectroscopy and scanning electron microscopy, respectively.

We study a model for the movement of surfaces, namely the conserved, restricted solid-on-solid model. The surface configurations are restricted such that the difference between the heights at adjacent sites is no more than one. In addition, the total number of particles is preserved by the dynamics of the model. Mean-field approximations are used to approximate the one-site probability function of the model.

This paper is devoted to applying a numerical method for solution of the 2D sine-Gordon equation. The bivariate multiple quadratic quasi-interpolation ( MQQI ) method is adopted to simulate this equations, which the first order spatial derivative is approximated by MQQI, the second spatial and time derivative are approximated by forward difference. One of the merit of this scheme is its simple structure and easy implementation. In the meanwhile, we present truncation and total error of this scheme, high accuracy and efficiency of the method are verified by numerical experiments. In addition, the optimal value of parameters are investigated in this article based on Luh [10, 11].

Background and Purpose: Plant derived antimalarials are indispensable for malaria treatment and a reliable source of new drugs. The present study first time explores antimalarial efficacy of sinigrin present in ethanolic whole plant extract of Thlaspi arvense (EWETA) using in vitro, in silico and in vivo strategies. Experimental Approach: From EWETA, sinigrin was revalidated and quantified using HPLC. Schizont maturation inhibition assay was used to assess its in vitro antiplasmodial activity followed by the determination of cytotoxicity. Further, docking study was performed on key metabolic enzymes of P. falciparum using V-Life MDS tool. Peter’s 4-day test was employed to assess in vivo suppressive activity. Key Results: Sinigrin exhibited promising activity against both chloroquine (CQ)-resistant (RKL-9) IC50 5.14 μg/mL and CQ-sensitive (3D7) IC50 5. 47 μg/mL strains of P. falciparum and was safe in both in vitro (CC50> 640 μg/mL) and in vivo (LD50 > 2 g/kg) toxicity studies. In addition, virtual screening showed hydrogen bonding, hydrophobic and van der Waals interactions with amino acid residues of 3BPM (falcipain-3). Sinigrin illustrated good (ED50< 50 mg/kg) suppressive activity against P. berghei in monotherapy and enhanced the activity of artesunate (50 mg/kg) in combination with 100% survival and no parasite recrudescence. These observations are further corresponded and supported by Differential Leucocyte Count (DLC), biochemical and histopathological studies. Conclusions and implications: The outcomes of in vitro, in silico and in vivo studies suggest sinigrin as a HIT molecule which may potentially be used in many ways in drug and vaccine development approaches.