Background: Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. It represents 2.5% of childhood cancers. Survival has been completely changed thanks to early diagnosis and modern treatment combining chemotherapy and surgery, resulting in survival rates of over 70%. However, a paucity of studies on the pattern of its occurrence in LMIC such as Morocco. The objective of this study is to analyze the epidemiological, clinical, histological and therapeutic profile in Moroccan children with osteosarcoma. Methods: We retrospectively studied 91 patients of osteosarcoma collected from 2013 to 2016 at the four pediatric oncology units in Morocco which treat bone tumors (CHU of Fez, Casablanca, Rabat, Marrakech). Results: Osteosarcoma accounted for 3% of all patients treated for cancer during this period. All patients are histologically proven osteosarcoma. The male/female ratio was 0.85 with a mean age at diagnosis of 13 years. Swelling and pain were the main symptom. The most frequent location of involvement was the knee. Among the 91 patients, 40 patients didn’t have metastasis, while 40 had metastasis (pulmonary, bone). For 11 patients, they didn’t be evaluated for distant spread of cancer. The treatment options were chemotherapy and surgery. The evolution was marked by 31% of deaths, 36% of abandonment , 9% of lost to follow-up, while only 20% of complete remission and 4% alive under palliative treatment and. The 3-year survival study was 50%. Conclusion: The alarming data obtained prompt a review of the management process for patients in all stage of care pathways.

Objectives: To evaluate possible associations between the genetic polymorphism of the STK 11 gene and response to metformin in women with polycystic ovary syndrome. Methods: This is a prospective longitudinal cohort study of 57 women with polycystic ovary syndrome. Baseline documentation of anthropometric measurements, menstrual history, hirsutism, hair loss, acne, and biochemical parameters, in addition to gene testing for STK11 polymorphism, were performed. Follow-up was arranged at 6 cycles following oral metformin therapy, 850 mg, twice daily. Results: Post-metformin therapy, there were statistically significant improvements in menstrual frequency, blood loss, acne, ultrasound findings, and a decrease in BMI, acne and hirsutism, but not in alopecia. Fasting insulin decreased significantly, but fasting blood sugar did not. Regarding Intron1 polymorphism, there was a significant response in the CC subgroup in menstrual regularity and blood loss. The CG subgroup showed a significant response in menstrual regularity and ultrasound findings. The GG subgroup showed a significant response in menstrual regularity, menstrual loss, acne and alopecia. Regarding Intron 6 polymorphism, there was a significant response in the CC subgroup in relation to menstrual regularity, blood loss, acne and ultrasound findings. The CT subgroup showed a significant response in menstrual regularity and ultrasound findings. The TT subgroup showed a significant response only in relation to alopecia. Conclusion: Polymorphism in STK11 is not predictive of response to metformin therapy at a dose of 850 mg, twice daily.

Entamoeba histolytica, like other Organismes, is characterized by diversity and heterogeneity in its genetic content, which is one of the most important reasons for survival, and the increase in susceptibility to infection.Non-condensation of chromosomes during the process of cell division and the ambiguity of the chromosomal ploidy makes predicting the exact chromosomal number difficult. Genes distributed across 14 chromosomes as well as many extra-chromosome elements. Most Genes composed of one axon only, with Introns in 25% of Genes. This genome is characterized by the presence of Polymorphic internal repeat regions, and several gene families, one of these large families encoding Transmembrane kinas, Cysteine protease (CP), SREHP protein, and others.

We propose that Heisenberg's uncertainty principle is a consequence of gravity. While quantum mechanics and gravity are widely considered incompatible, we show that Heisenberg's uncertainty principle, which is a central tenet in quantum mechanics, in fact, arises from non-diminishing finite gravity between a particle and another identical particle. We observe that it is impossible to know the position or momentum of the particle with unlimited precision, unless the gravity is infinite or zero, respectively, between the particles. We derive upper and lower bounds on the uncertainties in position and momentum of the particle, based on the uncertainty principle emerging from gravity. Accordingly, the quantum-classical boundary is identified, beyond which gravity behaves classically.

We propose that Schrödinger equation in quantum mechanics is a consequence of gravity. We derive the quantum Schrödinger equation for a gravitational wave from classical gravity, and accordingly present a classical Schrödinger equation in spacetime for the gravitational wave. We notice that the quantumness of Schrödinger equation arises from non-zero finite gravity of the classical Schrödinger equation in spacetime, by treating time separately from space at small enough scales compared to the actual masses. In other words, (mass-) energy curves spacetime, and the curvature of spacetime, in turn, gives rise to the quantum nature of the energy. We also observe that the wavefunction in Schrödinger equation corresponds to the state of the energy of a flat closed spacetime system and has non-zero fluctuations even when the masses are zero. These quantum vacuum fluctuations of a flat spacetime evidently arise only from the temporal profile of the wavefunction. Besides, our result naturally explains why the square of the magnitude of the wavefunction represents the probability of finding a given body at a spatial location upon position measurement.

We propose that what is gravity in curved spacetime yields quantum mechanics in flat spacetime. This implies that if there was no gravity, quantum mechanics would not exist. In other words, the universe is general relativistic, and therefore, classical and local, in curved spacetime, but the same universe is quantum and nonlocal (Newtonian), when projected onto special relativistic flat spacetime. We previously demonstrated how the quantum Schrödinger equation arises from a classical Schrödinger equation, which in turn arises from Newtonian gravity. Here, we illustrate that the classical Schrödinger equation corresponds to Einstein’s field equation of gravity for Schwarzschild metric in curved spacetime. Since the Schwarzschild metric is an exact solution of the vacuum Einstein equation, the Schwarzschild radius is for Ricci flat spacetime but with non-zero Riemannian curvature. It then follows that quantum mechanics arises from this Riemannian curvature of gravity.

Aim: In this study, we aimed to investigate anxiety, depression, and sleep problems in healthcare professionals during the pandemic. Materials and Methods: This descriptive and cross-sectional study was conducted with Diyarbakır Gazi Yaşargil Training and Research Hospital employees. A total of 170 people were reached for the research. The data collected by the on-line survey method consisted of demographic questions, questions about behavior change due to COVID-19, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI). Results: It was found that 72.9% of the healthcare professionals had anxiety, 83.5% had depression, and 87.1% had sleep problems. The total score of the GAD-7 scale was found to be significantly higher in those who used personal protective equipment (p=0.021) and those who received infection training (p<0.001). The PHQ-9 scale total score was higher in those 35 years of age and older (p=0.019) and college graduates (p=0.023). The total score of the insomnia severity scale (ISI) was significantly higher in those 35 years of age and older (p=0.040), in college graduates (p=0.049), and single/divorced (p=0.009). A significant difference was found between gender, occupation, smoking, fear of infection, burnout status, and total scores of all three scales (p<0.05). Conclusion: Healthcare professionals were found to have high levels of anxiety, depression, and sleep problems. Anxiety, depression, and insomnia problems were higher in women, health technicians, smokers, those with fear of infection, and those with burnout.

BACKGROUND Peanut allergy is a particularly common cause of anaphylaxis and utilization of hospital emergency room resources. Peanut protein allergens do not appear to denature under normal cooking conditions. We evaluated the effects of thermal processing on the protein allergens Ara h 2, associated with a risk for anaphylaxis, and Ara h 8, a protein analogous to birch pollen associated with oral allergy symptoms. METHODS Raw, roasted and autoclaved peanuts were evaluated. Solution 1H NMR spectroscopy was used to obtain molecular profiles and identify chemical changes across processing conditions. Western blot and ELISA analyses were used to detect relative levels of specific peanut allergens. RESULTS NMR analysis of peanut-soaked solutions demonstrated an overall reduction of total intact protein in autoclaved peanuts as shown by the broadening of peaks in the spectral regions corresponding to peptide fragments when compared to raw. The results also showed that autoclaving reduces the amount of allergenic proteins Ara h 2 (50% reduction) and Ara h 8 (100% reduction). Upon skin prick testing of allergic subjects, this differential degradation demonstrated that the autoclaved peanut could be used to categorize patients into two groups: those at risk for anaphylaxis and those who only experience oral symptoms to peanut (predominantly Ara h 2- and Ara h 8-specific IgE, respectively). CONCLUSION The data reported in this study suggest that high-pressure and temperature autoclaving reduces the amount of intact protein in the peanut, including allergenic proteins. This could be further developed into an improved diagnostic test for peanut allergy.

Inflammatory myofibroblastic tumors (IMTs) are a type of visceral non-malignant but invasive mass diagnosed in adolescents. Preferred management based on outcomes is surgical resection. We present a patient with successful non-surgical management due to multifocal IMTs of the lungs. After failing to respond to five combinations of previously first line therapies, rituximab was initiated with complete resolution and durable response. Follow up imaging at 19 months off therapy continue to show complete remission. We successfully treated a patient with multifocal and multiply refractory IMT using rituximab therapy which should be considered as a non-surgical option in the future.

Latitudinal diversity gradients are among the most studied macroecological phenomena. However, they tend to be described using large composite datasets that often show taxonomic and geographic sampling bias. Here we describe a latitudinal gradient in marine bivalves along the eastern coastline of Australia, spanning 2,667km of coastline and 20° of latitude. We utilise a large, structured field dataset (5,552 individuals) in conjunction with a routine macroecological dataset downloaded from the Ocean Biogeographic Information System (OBIS - 36,226 specimens). Diversity is estimated using a series of analytical methods to account for undersampling, and biogeographic gradients in taxonomic composition are quantified and compared to existing biogeographical schemes. A strong latitudinal gradient is present in both datasets. However, the strength of the gradient depends on the dataset and analytical method used. The inclusion of observational data in the macroecological dataset obscures any latitudinal pattern. The documented biogeographic gradients are consistent with global and regional reconstructions. However, we find evidence for a strong transition zone between two clusters. Although latitudinal gradients inferred from large macroecological datasets such as OBIS can match those inferred from field data, care should be taken when curating downloaded data as small changes in protocol can generate very different results. By contrast, even modest regional field datasets can readily reconstruct latitudinal patterns.

Rationale, aims and objectives Surgical-site infections (SSI) are associated with increases in hospital length of stay and hospitalization costs and patient’s poor quality of life. Eradication of S. aureus with nasal mupirocin could decrease the incidence of SSI by this pathogen. The primary purpose of our study was to evaluate the incidence of SSI before and after the implementation of a decolonisation program in orthopaedic patients. Methods A pre-post intervention study was conducted. A multidisciplinary group elaborated and implemented a standard procedure for nasal decolonisation, including a pharmacy visit. The proportion of patients who had a SSI and those infected by S. aureus were the primary outcome variables. The proportion of pre-screened patients, nasal carriers, and adequate prophylaxis (3 mupirocin applications) and decolonisation (5 applications) were recorded to analyse program implementation. Mupirocin resistance or adverse effect were also registered. Results 1,192 patients were included in the study (599 pre- and 593 post-intervention group) SSI were recorded in 2.5% vs 2.0% of patients (pre vs post-intervention), showing a relative risk (RR) of 0.81 (p=0.58). S. aureus infections were recorded in 0.7% vs 0.3% (p=0.420, RR=0.51). 59.2% vs 3.5% of patients were pre-screened (p<0.001). 63 patients (17.9%) were nasal carriers of S. aureus, of which 58 (92.1%) received an adequate prophylaxis and 32 (50.8%) an adequate decolonisation. No infection was reported regarding patients who received adequate nasal prophylaxis. Conclusions The nasal prophylaxis and decolonisation protocol were implemented in the orthopaedic patient flow. Eradication of S. aureus with nasal mupirocin seem to decrease the incidence of S. aureus infections.

Rationale, aims and objectives. Hospitals are at the frontline of the COVID-19 pandemic. In addition to infection control measures, effective administrative strategies are equally important. We aimed to present administrative measures implemented in a large community hospital in Taiwan. Methods. The strategies employed included regular administrative meetings, entrance control, outdoor fever screen station, ward control, proactive inpatient and outpatient case identification, outdoor walk through dispensary, resource relocation and supplies distribution, guidelines, telemedicine, and group quarantine. Results. After one year of effort, nosocomial infection in a large community hospital of over 7,000 staffs remained zero. Conclusion. In face of the re-emergence of COVID-19 pandemic, by sharing our experiences we may contribute to the global community.

Objective: To analyze the ultrasonography (USG) values of median nerve cross sectional area (MN-CSA) in pregnant women with and without clinically diagnosed carpal tunnel syndrome (CTS). Design: Prospective cross-sectional study. Setting: Third trimester pregnant women during their routine office visits. Methods: USG was performed by a perinatologist and the MN-CSA at the carpal tunnel inlet was measured. Then, the participants were asked about the presence of typical CTS symptoms. Participants with typical clinical symptoms were assigned to the CTS group. Remaining participants were assigned to the Control group. Main outcome measures: The groups were compared according to MN-CSA. Results: Of the 89 pregnant women, 25 participants were grouped in CTS group and the remaining 64 participants were grouped in Control group. The MN-CSA was higher in the CTS group (9.44 ± 2.68) than in the Control group (7.20 ± 1.99), p = 0.00004. There was a statistically significant linear trend, p = 0.003, with higher MN-CSA associated with a higher proportion of patients diagnosed as CTS. Conclusions: USG measurement of MN-CSA at the wrist appears as a convenient method to confirm CTS diagnosis in pregnant women. Further research is necessary to determine a clear cut-off value for MN-CSA. Obstetricians can measure MN-CSA to confirm CTS diagnosis and consequently can offer conservative management, which is the widely accepted treatment modality in this cohort.

The Covid-19 global pandemic and its containment strategies have had a huge impact on women’s healthcare. This review aims to explore the consequences that changes in healthcare provision have had on the mental health of new and expecting mothers. By considering these impacts in two key contexts: the woman as a patient and in her domestic setting, the risks and potential benefits of altered clinical interactions, telemedicine and lockdowns are investigated. The paper concludes by looking to the future, examining the long-term effects, for mother and baby, of recent interventions to curb the pandemic.

Noise pollution is an unprecedented evolutionary pressure on wild animals that can lead to alteration of stress hormone levels and changes in foraging behavior. Both corticosterone and feeding behavior can have direct effects on gut bacteria, as well as indirect effects through changes in gut physiology. Therefore, we hypothesized that exposure to noise will alter gut microbial communities via indirect effects on stress hormones and foraging behaviors. We exposed captive white-crowned sparrows to city-like noise and measured each individuals’ corticosterone level, food intake and gut microbial diversity at the end of four treatments (acclimation, noise, recovery, and control) using a balanced repeated measures design. We found evidence to support our prediction for a causal, positive relationship between noise exposure and gut microbiota. We also found evidence that noise acts to increase corticosterone and decrease food intake. However, noise appeared to act directly on the gut microbiome or, more likely, through an unmeasured variable, rather than through indirect effects via corticosterone and food intake. Our results help to explain previous findings that urban, free-living white-crowned sparrows have higher bacterial richness than rural sparrows. Our findings also add to a growing body of research indicating noise exposure affects stress hormone levels and foraging behaviors. Altogether, our study indicates that noise affects plasma corticosterone, feeding behavior, and the gut microbiome in a songbird and raises new questions as to the mechanism linking noise exposure to gut microbial diversity.

Long-lasting insecticidal nets are an effective tool in reducing malaria transmission. However, with increasing insecticide resistance little is known about how physiologically resistant malaria vectors behave around a human-occupied bed net, despite their importance in malaria transmission. This study assessed the host-seeking behavior of the major malaria vector Anopheles gambiae s.s, when an intact human-occupied treated bed net is in place, with respect to their insecticide resistance status under semi-field conditions. Pyrethroid resistant and susceptible females of Anopheles gambiae s.s were released inside a semi-field environment housing a hut which was occupied by a human host sleeping under treated or untreated bed net trap. Mosquitoes resting inside the hut or exiting and resting outside were collected using a prokopack aspirator, window exit trap and clay pots. The proportion of resistant females caught in the treated bed net trap was higher compared to the susceptible females (OR=1.445; P<0.00019). Resistant mosquitoes were less likely to exit the house when a treated bed net was present compared to the susceptible mosquitoes. The susceptible females were 2.3 times more likely to stay outdoors away from the treated bed net (OR=2.25; P<0.0001).The resistant mosquitoes showed significantly reduced avoidance behavior compared to the susceptible mosquitoes that were observed to exit the house and remained outdoors when a treated bed net was used. However, further investigations of the behavior of resistant mosquitoes under natural conditions should be undertaken to confirm these observations and improve the current intervention which are threatened by insecticide resistance and altered vector behavior.

Objective: To study the influence of the mode of delivery in uncomplicated monochorionic diamniotic (MCDA) twins ≥ 32 weeks of gestation. Design: Single-center retrospective cohort study. Setting: Department of Materno Fetal Medicine. Virgen del Rocío University Hospital. Population or sample: A total of 72 MCDA twins between 2012 and 2018. Methods: Outcomes were compared between women who underwent a trial of labor (TOL) (induced or spontaneous onset of labor) and those who underwent a planned cesarean section (PCS). Main outcome measures: (1) A composite of any of the following: neonatal death, 5-minute Apgar score <4, respiratory distress syndrome, bronchopulmonary dysplasia, sepsis, periventricular leukomalacia, intraventricular hemorrhage, and necrotizing enterocolitis. (2) Neurodevelopmental impairment (NDI) at 2 years of corrected age. Results: In this period, 42 women (58.3%) had a TOL and 30 women (41.7%) had a PCS. In the TOL group, 64.3% achieved vaginal delivery. The rate of successful vaginal delivery was similar regardless of whether the onset of labor was spontaneous or induced. Composite perinatal morbidity was higher in the PCS group (aOR 1.36, 95% CI 0.24-7.81) and, considering the onset of labor, it was more frequent in the spontaneous subgroup (8.3% vs. 0%). The rate of NDI was higher in the PCS group [10.2% vs. 4.9%, aOR 1.53 (95% CI 0.37-6.29)]. Conclusions: In uncomplicated MCDA twins at ≥ 32 weeks of gestation, when the first twin is in vertex presentation, trial of labor is a safe approach with a successful outcome and high vaginal delivery rate.

Objective: The eligibility criteria for cochlear implant (CI) are constantly changing. The aim of the current study was to show our department’s cochlear implant indications and to evaluate the longitudinal performance outcomes for patients with different types and degrees of sensorineural hearing loss, treated with CI. Methods: Between 2007–2019, 73 cochlear implantations were performed. Current CI indications allow us to categorize patients based on the type and degree of hearing loss. These can be grouped as follows: 1) Bilateral symmetric sensorineural hearing loss (SHL); 2) Bilateral profound hearing loss for high frequencies while maintaining low frequencies (EAS); 3) Asymmetric hearing loss (AHL); 4) Single-sided deafness (SSD) with intensive tinnitus in the deaf ear. For each group we evaluated the pre and post-operative pure tone audiometry and speech perception test in silence and with background noise. The patients also completed the speech, spatial and qualities of Hearing questionnaire (SSQ). Results: The four subgroups achieved significant benefits after CI, both in terms of speech performance and SSQ. Conclusions: According to literature, our data confirm that CI is an effective treatment for patients with different types of hearing loss. Key Points: 1) The eligibility criteria for cochlear implantation have regularly changed following the continuous progress in technology. 2) Schematically we divided our patients in 4 subgroups: 1) SHL; 2) EAS; 3) AHL; 4) SSD with intensive tinnitus in the deaf ear. 3) The criteria for AHL and SSD are in line with definitions suggested by Vincent et al. 4) Asymmetric hearing loss (AHL) and single-sided deafness (SSD) were traditionally treated with a contralateral routing of a signal hearing aid (CROS-HA) or a bone conduction device (BCD), even though CI is the only device capable of restoring bilateral stimulation to the auditory system and decreasing severity and incidence of tinnitus. 5) By treating patients with AHL or SSD and associated tinnitus, we saw that CI could not only improve hearing, but also drastically reduce tinnitus in most of the patients.

Introduction: In the COVID-19 era, demand is growing for remote ECG monitoring systems with less or no in-person contact. However, the practical usage of wearable ECG devices has been little studied in Japan. This study aimed to report our initial experience of using the postal system in the delivery of the self-wearable ECG device (Duranta) and long-term ECG monitoring in outpatient care. Methods:　　 The Duranta is small, light (35 g), and easy to attach to the chest with two patch electrodes. Real-time ECG data were automatically transmitted to a cloud server via iPhones. The devices were packed in prepaid envelopes that could be put in any postbox for delivery between the hospital and patients’ homes. Results: Twenty-five patients (61 ± 17 years) were enrolled. The median distance to the hospital from the patients’ homes was 10 km (range: 1.1–183). The patients had no difficulties with either the postal delivery or wearing the ECG devices. A total of 57 hours (range: 20–179) of ECG monitoring per patient was performed, and the data were successfully transmitted to the hospital. The median percentage of noise/artifact burden during the ECG monitoring was 0.9%. Arrhythmic events were observed in 8 patients. Most patients were satisfied with the ECG system and delivery via the postal service. Conclusion: The use of a postal delivery of a wearable ECG device could work in clinical practice with to achieve less or no in-person contact. This system can be applicable for telehealth, home care, and arrhythmia screening.

Background: Impaired renal function and atrial fibrillation (AF) can form a vicious cycle. Although there have been reports on improved renal function in patients who undergo successful AF ablation, renal function in patients with recurrence of AF has not been studied separately. We explored the changes in renal function in AF patients with mild renal dysfunction after an index failed catheter ablation and the influencing factors. Methods: We retrospectively recruited non-valvular AF (NVAF) patients with mildly impaired renal function admitted for catheter ablation and readmitted due to recurrence of AF. The estimated glomerular filtration rate (eGFR) was calculated before the index procedure and during readmission. △eGFR was defined as the difference between eGFR readmission and eGFR baseline. The same calculation applied for △CHA2DS2-VASc score. The primary endpoint was improved renal function (△eGFR > 0) after AF catheter ablation in patients with atrial arrhythmia recurrence. Results: A total of 132 NVAF patients were included in this study. The mean eGFR at readmission was significantly increased compared with the eGFR at baseline before the index ablation procedure (P < 0.01). The multivariable Cox regression analysis showed that a lower △CHA2DS2-VASc score (HR: 0.416, P = 0.003) and paroxysmal recurrent atrial arrhythmia (HR: 2.965, P = 0.001) were associated with better renal function. Conclusion: In NVAF patients with mildly impaired renal function, even those with recurrence after the initial catheter ablation, we observed improvements in renal function, which was associated with a lower △CHA2DS2-VASc score and paroxysmal recurrent arrhythmia.

Foot-and-mouth disease (FDM) is a disease of cloven-hoved animals with high costs in animal welfare and for production of animal products. Up to now transmission between farms in FMD-endemic areas has been given little attention. Between farm transmission can be quantified by distance independent transmission parameters and a spatial transmission kernel indicating the rate of transmission of an infected farm to susceptible farms depending on distance. The spatial transmission kernel and distance-independent transmission parameters were estimated from data of an FMD outbreak in Lumpayaklang subdistrict in Thailand between 2016 and 2017. The spatial between-farm transmission rate in Lumpayaklang subdistrict was higher compared with spatial between-farm transmission rate from FMDV in epidemic areas. The result can be explained by the larger size of within-farm outbreak in endemic area due to no culling. Inclusion of distance-independent transmission parameters improved the model fit, which suggests the presence of transmission sources from outside the area and spread within the area independent of distance between farms. The remaining distance dependent transmission was mainly local and could be due to over-the-fence transmission or other forms of contact between nearby farms. Farm size on the kernel positively effects the transmission rate, by increasing both infectivity and susceptibility with increasing farm size. From the results, we suggested more strict outbreak responses, as well as the outbreak communication to the farmers to reduce the between-farm transmission. Movement restrictions and enforced by checkpoints during the outbreak can prevent the transmission from outside and the distance-independent transmission within an area.

Altered Sphingolipid metabolism in Vernal Keratoconjunctivitis: Newer Insights

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection usually causes no or mild coryzal symptoms in the paediatric population. In this case report, we describe a 21-month-old boy infected with SARS-CoV-2 who presented atypically with features compatible with croup. With the current Coronavirus Disease 2019 (COVID-19) pandemic, infection control measures need to be appropriately heightened and early diagnostic sampling for SARS-CoV-2 should be carried out even in symptomatology that is atypical of COVID-19.

Combining drugs, a phenomenon called polypharmacy, can induce (new) adverse side effects. The identification of adverse combinations is a key task in pharmacovigilance. In this context, in silico approaches based on machine learning are promising as they can learn from a limited number of combinations to predict for all. In this work, we identify various polypharmacy prediction tasks and show how they can improve post-market surveillance systems or detect polypharmacy side effects earlier during drug development. We elaborate on model validation and propose a new model that obtains AUC-ROC=0.843 for the hardest “cold-start” task up to AUC-ROC=0.957 for the easiest task.