IntroductionInvasive mucinous adenocarcinoma (IMA) is a special subtype of adenocarcinoma according to World Health Organization classification. IMA accounts for an estimated 2–10% of all lung cancers [1, 2]. Overall, 60–90% of IMA cases present with solitary nodules, mass shadows, or ground-glass opacity lesions, but there are also cases of extensive extension with multiple nodules or diffuse alveolar shadows. Therefore, it is sometimes necessary to distinguish the lesions from benign pulmonary diseases such as pulmonary tuberculosis, sarcoidosis, lipoid pneumonia, and alveolar proteinosis [3, 4]. In addition, it is often detected at an advanced stage, which makes it difficult to treat surgically; however, limited reports of such cases have been described [2]. Here we describe a case of IMA that was detected preoperatively as an infiltrative shadow over the entire right lower lung lobe and treated with surgical resection along with a review of the literature.

Cervical Spinal Injury as a Presentation of Multiple Myeloma: A Case ReportLeon Smith, Vicky Li and Simon ChanRehabilitation and Aged Care Services, Hornsby Ku-Ring-Gai Hospital, Hornsby 2077, NSW AustraliaKeywordsCase Report Spinal Injury Multiple MyelomaAbstractSpinal cord injury is a devastating complication of cancers that exert physical compression on the spinal cord. Multiple myeloma is known predominantly as a condition that involves bony structures and can manifest with complications such as pathological fractures. However, involvement of other structures including the CNS or the spinal cord is a possible complication, with potentially catastrophic consequences. We describe a case of multiple myeloma presenting initially as spinal cord compression in a 79-year-old man.IntroductionMultiple myeloma is a condition characterized by malignant proliferation of plasma cells, with production of monoclonal immunoglobulin (most commonly of the IgG variety), affecting over 100 000 individuals worldwide per year(1). Approximately 2500 Australians are diagnosed with multiple myeloma every year(2). Median age at diagnosis in Australia is 67, and 60% of patients are male(3). Initial treatment in Australia usually consists of bortezomib based treatments, with the most common first line regimen being bortezomib, cyclophosphamide, and dexamethasone(3). Overall survival from diagnosis is averages approximately 5 years(3).Interactions between malignant plasma cells and osteocytes results in decoupling of bone absorption and formation, mediated through a number of pathways including RANK/L, OPG and Wnt, which leads to the presence of lytic bone lesions(4). Pathological fractures can result from skeletal disease; as such, skeletal surveillance is recommended in multiple myeloma and pathological fractures are a potential complication of skeletal disease(1). However, involvement of other organ systems by expansion of myeloma lesions is also a potential complication, with severe consequences. In the case of the spinal cord, compression from vertebral myeloma can lead to significant neurological compromise and functional impairment(5,6).We describe a case of multiple myeloma of T1 resulting presenting with severe paraplegia in a previously healthy 79-year-old man.Case PresentationA 79-year-old Caucasian man presented to the emergency department of his local hospital with a 4 week history of atraumatic thoracic back pain, localized between the scapulae, complicated by acute-onset paraplegia in the preceding 48 hours. He described 2 days of lower leg weakness and difficulty mobilizing with an unsteady gait, before developing severe lower limb weakness and inability to mobilise. At the time of presentation, he reported no bladder or bowel incontinence. He reported about 6 kg of unintentional weight loss in the preceding 4 weeks, and some months of atraumatic right elbow pain.His only medical history was hypertension and stable coronary artery disease. His medications at the time of presentation were rosuvastatin 20 mg daily, metoprolol 25 mg twice daily, amlodipine 5 mg daily, aspirin 100 mg daily, and Olmesartan 20 mg daily. He lived with his partner, had never smoked and consumed an average of 2 standard drinks of alcohol per night.On examination in the emergency department, he had MRC grade 5/5 power bilaterally in the upper limbs, but grade 0 in all movement in the lower limbs. Reduced sensation to light touch was present below the level of the umbilicus. Reflexes were absent in the left lower limb, and only the patellar reflex was present in the right lower limb. No anal tone was apparent on digital rectal exam. Saddle anaesthesia was also present.An urgent CT scan in emergency revealed a T1 vertebral lesion with involvement of the vertebral body and posterior elements with epidural extension causing severe canal narrowing, and numerous bony lesions suggestive of myeloma. The patient was urgently transferred to the nearest tertiary referral centre for neurosurgical involvement. A spinal MRI performed upon arrival confirmed the presence of severe cord compression at the T1 level, with complete infiltration of the T1 vertebra, and pathological T1 fracture with 50% loss of body height (Figure 1). An urgent posterior cervical decompression and fusion occurred within 12 hours of presentation.

A document by Valter Paixão. Click on the document to view its contents.

1. Understanding how diverse assemblages of scavengers can coexist on shared ecological resources is a fundamental challenge in community ecology. However, current approaches typically focus on behaviour at carcass provisioning sites, missing how important differences in movement behaviour and foraging strategies can facilitate sympatric species coexistence. Such information is particularly important for vultures - obligate scavengers representing the most endangered avian foraging guild. Their loss from ecosystems can trigger trophic cascades, mesopredator release, and disease outbreaks. 2. We use a combination of morphometric measurements and movement data from wild King (Sarcoramphus papa) and Greater yellow-headed (Cathartes melambrotus) vultures, coupled with carcass visitation data from animal carcass provisioning experiments to characterise scavenger community structure and strategies in the Peruvian Amazon. 3. King vulture body mass and tarsi length were larger (43% and 45% respectively), and tail shorter (22%) than the Greater-yellow headed vulture. King vultures also had substantially larger home ranges (~500%), flew higher than Greater yellow headed vultures (695m vs. 360 m), and despite flying similar distances each day, were active later in the day. At carcasses, Greater-yellow headed vultures typically arrived first, but were rapidly outnumbered by both King and Black vultures (Coragyps atratus). 4. We find that the movement behaviour of obligate apex scavengers in the western Amazon is linked to their ability to coexist - the Greater -yellow headed vultures, a smaller stature ‘scouting’ species adapted to fly low and forage early, arrive first, but are ultimately displaced by larger-bodied king vultures at large ephemeral carrion resources. Expansion of future GPS tracking initiatives should facilitate the exploration of direct facultative interactions from animal movement data and give further insight into how diverse communities assemble and interact.

The paper used field data to investigate the effect of child labour on educational outcomes among children of ages between 5-17 years in public basic schools in the Central Region of Ghana. The empirical result revealed that child labour participation significantly hinder child education outcomes. It again revealed positive relation between children from wealthiest households of the 4th and 5th quintiles and cognitive skills ability. Further, the empirical result also shows that children from mothers who are employed negatively and significantly influence child's cognitive skills ability. Also, their father's educational attainment is more likely to increase the child's cognitive skills ability. Based on the findings, Ministry of Education and Ghana Education Service through the Inspectorate Board should design truancy policy that would be enforced on parents to reduce child participation in economic activities and promote the free compulsory universal basic education policy.

Background/objectives: To assess the effect of humor on IGT decision-making as a function of gender, and to explore the neural correlates underlying this effect. Method: We randomly assigned participants (N = 60; 30 men and 30 women) to either an experimental Humor Group (Hg) or a control non-Humor Group (NHg) and asked them to perform a long-version (500 trials) of the Iowa Gambling Task (IGT). Participants’ EEG response was recorded while solving the IGT. Results: Men in the Hg demonstrated impaired monitoring and learning of the task compared to men in the NHg. Later, women in the Hg, exhibited more integrated attention to rewards and punishments along with a decrease in random choices when compared with women in the NHg. Behavioral and EEG results support that humor is beneficial for women’s cognitive control of IGT performance but impairs it in men.

Purpose - Purpose of this paper is to understand the interrelationship among the factors that are critical in the treatment of COVID-19 patients. An attempt to comprehend the essential requirement of the medical facilities to deal with the pandemic load on healthcare sector. Design/Methodology/Approach - Total Interpretive Structural Modelling (TISM) technique has been used to develop the hierarchical interrelationship among various factors of healthcare related to COVID-19 medical facilities. Impact Matrix Cross-Reference Multiplication Applied to a Classification (MICMAC) examines dependent and driving power of the factors. Findings - Total ten factors have been identified through literature review, which are essential for the medical facilities to prepare to deal with the pandemic load. ‘COVID-19 positive cases per day’ and ‘efficiency of covid-19 testing facility’ are factors that drives two dependent factors, ‘COVID-19 bed availability’ and ‘oxygen demand’ while remaining factors as intermediate linkage factors. Research Limitations/Implications - Examination of the interrelationships among factors can support in decision making about capacity building for COVID-19 medical facilities in hospitals. The impact of these resources on the recovery rate of COVID-19 patients can be studied further. The factors identification has been done from the perspective of India and region specific factors can be added or deleted from the TISM model. Originally/Value - An analytic study of the literature review demonstrates the relationship among the factors for healthcare accessibility to every COVID-19 positive patient and TISM examines “why” and “what” factors need more consideration for the development of the healthcare infrastructure for COVID-19 patients.

Prenatal maternal psychological stress is common in pregnant women. Heart rate variability (HRV) has recently become considered to be a potentially reliable stress biomarker in adults. Methods:In the current study, we evaluated ultra-short-term HRV (1-minute measurement) as a stress indicator among pregnant women (N = 230) by examining the association between HRV parameters and self-reported prenatal maternal psychological stress (emotional distress, and anxiety). Results: Prenatal emotional distress was associated with a lower root mean square of successive differences between normal heartbeats (RMSSD), pNN50, SDNN Index, and low-frequency power (LF) among healthy pregnant women participants. In addition, prenatal anxiety was related to a lower-than-normal high-frequency power (HF) and elevated LF/HF values. For high-risk pregnant women (with reported scores greater than or equal to the 90th percentile), prenatal emotional distress and anxiety were not significantly correlated with any HRV indicators. Conclusions: Low HRV (associated with reduced parasympathetic activity) can serve as an efficient biomarker for psychological stress in healthy pregnant women. However, the HRV indicators in pregnant women with a high risk of psychological stress problems may be affected by other mental or physical problems, thus decreasing the biomarker’s efficiency in predicting their prenatal psychological stress.

A document by Erin Su. Click on the document to view its contents.

Aim To evaluate the performance of ChatGPT in key areas of clinical pharmacy practice, including prescription review, patient medication education, adverse drug reaction (ADR) recognition, ADR causality assessment, and drug counseling. Methods Quantitative and qualitative analyses were conducted to assess the accuracy and quality of ChatGPT in comparison to those of the clinical pharmacist. Results The results indicate that ChatGPT is excellent in drug counseling and weak in prescription review, patient medication education, ADR recognition, and ADR causality. Conclusions While ChatGPT holds promise in clinical pharmacy practice as a supplementary tool, the ability of ChatGPT to handle complex problems needs further improvement and refinement.

Objectives: This study aimed to establish a population pharmacokinetic model for elderly individuals receiving intravenous voriconazole, and to assess and optimize the dosing regimens using a simulating approach. Methods: A population pharmacokinetic analysis was conducted using the NONMEN software based on 438 plasma concentrations from 150 elderly patients receiving multiple intravenous doses of voriconazole. The individualized optimal dosage regimen was proposed based on the obtained population pharmacokinetics parameters. The final model was assessed by the goodness of fit plots, non-parametric bootstrap method, and visual predictive check. Monte Carlo simulations were carried out to assess and optimize the dosing regimens with a therapeutic range of 2.0-5.0 mg/L as the target plasma trough concentration (Cmin). Results: A one-compartment model with first-order absorption and elimination fitted well to the concentration-time profile of voriconazole. The typical voriconazole clearance was 3.55 L/h, and the typical volume of distribution was 194 L. Covariate analysis indicated that the CL of voriconazole was substantially influenced by albumin (ALB), gamma glutamyl transpeptidase, and direct bilirubin, while the volume was associated with body weight. Conclusions: The first study on the population pharmacokinetics of voriconazole in Chinese elderly people was performed. Individualized dosing regimens were recommended for different ALB levels based on population PK model prediction. The proposed dosing regimens could provide a rationale for dosage individualization to improve clinical outcomes and minimize drug-related toxicities.

In this study, It was aimed to determine the effects of different production and preservation methods on the shelf life and quality of the Gemlik variety natural black table olives produced with low salt (2%). For this purpose the olives processed with traditional Turkis turning black olive using starter culture The MAP (Modified athmosphere packaging), vacuum and gamma irradiation method (1, 3 and 5 kGy) was applied for the first time in the preservation of table olives. The reducing effect of 5 kGy dose on total phenolic substance and DPPH antioxidant activity was found to be higher than other doses. During storage, pH (4.30-4.83) and titratable acidity (0.68-1.02%) values of black table olives changed in normal course. At the and of the fermentation and storage, total phenolic substance and DPPH antioxidant activity decreased and were found statistically significant (p<0.01). During the storage period, the total amount of phenolic matter in olives in normal production (without starter culture) decreased from 232 to 144 mgCAE/100g and in starter culture added table olives from 200 to 138 mgCAE/100g. As a result of the study, it was ensured that table black olives produced with less salt (2%) could be stored on the shelves for at least 6 months without using any preservatives. In addition, radiation effect on quality was relatively similar to other applications.

Introduction: Coronavirus disease-2019 (COVID-19) is a novel infection, that first appeared in Wuhan, China. It has been well established that different organs including the heart, kidney, pulmonary and gastrointestinal systems might be involved during or post COVID-19 infection. A possible reason is that the virus enters host cells through the angiotensin-converting enzyme 2 (ACE 2) receptor and this receptor is expressed by different human organs [1]. ACE 2 receptor is also expressed in different parts of the eyes including the conjunctiva, cornea, limbus, aqueous humor, and retina [2].In addition, COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) can affect different organ systems including skin, renal, cardiac, hematological, and gastrointestinal systems. But ocular involvement is not still a part of the world health organization (WHO) criteria or the Center for Disease Control and Prevention criteria for MIS-C [3].Whether uveitis or optic disk edema would be manifestations of acute COVID-19 infection or they can occur as a part of COVID-19-associated MIS-C is still unknown.

Fish often spawn eggs with ovarian fluids that have been hypothesized to support sperm of some males over others (cryptic female choice). Alternatively, sperm reactions to ovarian fluids could reveal male strategies. We used wild-caught lake char (Salvelinus umbla) to experimentally test whether sperm react differently to the presence of ovarian fluid, depending on male breeding coloration, male inbreeding coefficients (based of 4,150 SNPs), or the kinship coefficients between males and females. Male coloration was positively linked to body size and current health (based on lymphocytosis and thrombocytosis) but was a poor predictor of inbreeding or kinship coefficients. We found that sperm of more colorful males were faster in diluted ovarian fluids than in water only, while sperm of paler males were faster in water than in ovarian fluids. We then let equal numbers of sperm compete for fertilizations in the presence or absence of ovarian fluids and genetically assigned 1,464 embryos (from 70 experimental trials) to their fathers. The presence of ovarian fluids significantly increased the success of the more colorful competitors. Sperm of less inbred competitors were more successful when tested in water only than in diluted ovarian fluids. The kinship coefficients had no significant effects on sperm traits or fertilization success in the presence of ovarian fluids, although parallel stress tests on embryos had revealed that females would profit more from mating with least related males rather than most colored ones. We conclude that sperm of more colorful males are best adapted to ovarian fluids, and that the observed reaction norms suggest male strategies rather than cryptic female choice.

A document by * Hussan. Click on the document to view its contents.

Recent trials have highlighted the potential of oral antiviral VV116 in addressing mild COVID-19 patients. However, there are presently no comprehensive studies to assess the safety and efficacy of VV116. Thus, we conducted a systematic review to assess the safety and efficacy for VV116. A comprehensive search was conducted in PubMed, Scopus database, and Google Scholar website, with a cut-off date of March 23, to identify pertinent studies. The results from the three included studies indicated that no serious adverse events were reported in the VV116 experimental groups, which exhibited a 2.57-day faster time to viral shedding than the control group and demonstrated non-inferiority to the Nirmatrelvir-Ritonavir control group in alleviating major symptoms. Collectively, the available studies suggest a reliable safety and efficacy profile for VV116. However, the limited number of three trials is insufficient for meta-analysis, and the included population consists of younger individuals with mild and moderate symptoms, not encompassing the elderly who are severely impacted by COVID-19. We hope that more studies will be conducted in the future to ensure that VV116 has a more reliable safety and efficacy profile in the clinical setting, especially for severe or critical patients.

Human Adenoviruses (HAdV) are implicated in multiples pathologies causing mild to severe disease. The predominant genotypes detected in association with disease differ among different countries or regions, and change over time. In Spain and elsewhere little is known about the molecular epidemiology of HAdV. From a total of 250 HAdV, members of five species were present: A (1), B (126), C (87), D (27) and E (9). The most found genotypes were B3 (119), C2 (48), C1 (29) and D8 (26). Genotypes E4, C5, C6, B7, A31, B35 and D56 were also detected. HAdV diversity increases over the years until the B3 genotype displaces all other types in 2016 and 2023. HAdV detected in Asturias were similar to those already described in other countries, no new local genotype were observed. Genotypes 1-7 were more frequent in children under 15 years of age, while types 8-56 were more frequent in the elderly. Multiple HAdV introductions must have occurred given that only small transmission clades can be inferred. The diversity of the epidemic increased with the years until it disappeared one year periodically .The COVID-19 epidemic accelerated the loss of diversity suggesting that interventions during the pandemic were able to reduce HAdV transmission.

A document by Nicolas Thurin. Click on the document to view its contents.

Introduction Patients turn to foods, herbs, and medications to increase milk supply (i.e., galactagogues). Physicians may be asked to prescribe, recommend, or discuss perceived galactagogues despite a lack of evidence for their use. It is unclear how factors such as education, experience, and regulations influence clinical practice. The primary objective of this study was to document Canadian and US-based physicians’ attitudes towards, practice patterns surrounding, and utilization of pharmacologic, nutritional, and herbal products for the management of low milk supply. A secondary objective of this study was to determine factors that influence physicians’ decision-making with respect to the use of pharmacologic agents, foods, and vitamin, mineral, and herbal supplements for the treatment of low milk supply. Methods Physicians were recruited from two Facebook groups to complete an anonymous, online survey about their clinical use of pharmaceutical, supplemental, and nutritional substances perceived to increase milk production. The association between practice patterns and lactation medicine expertise or country for different perceived galactagogues was determined. Results A total of 307 physicians completed the primary portion of the survey. There was no difference in the proportion of physicians in Canada or the United States (US) who were defined as lactation medicine experts. Canadian physicians were more likely to prescribe metformin, levothyroxine, and domperidone, despite limited evidence of their effectiveness as galactagogues. Experts used all of the pharmacologic galactagogues. Canadians and experts were more likely than US-based and non-expert physicians, respectively, to include herbs in their practice. Numerous reasons for recommending or not recommending a given agent were cited, including patient request, personal and clinical experience, and lack of education, research, or access. Discussion The US FDA ban on domperidone affects which pharmacologic agents physicians in North America prescribe for low milk production. Despite having access to domperidone and limited evidence of their effectiveness, Canadian physicians are more likely than US physicians to also discuss, recommend, or prescribe herbal supplements as galactagogues. Conclusion In this online survey about medications, herbs, and foods commonly used in an effort to increase milk supply, Canadian and US-based physicians with and without lactation medicine expertise described their practice patterns and reported limitations in knowledge, medication access, and evidence. Though Canadian physicians prescribed domperidone without limitations, US physicians were less likely to incorporate it into clinical practice.

Several medications and treatments are being investigated for their potential effectiveness against coronavirus disease 2019 (COVID-19), including androgen and other sex hormones. However, the causal relationships between serum sex hormones and COVID-19 susceptibility and severity, particularly with regards to potentially sex-specific effects, remain largely unknown. In this study, we used the latest data from the UK Biobank (up to 424,907 individuals) and COVID-19 Host Genetics Initiative (up to 1,878,143 individuals) to systematically assess the sex-specific causal effects of serum sex hormone levels on COVID-19 outcomes within a two-sample Mendelian randomization (MR) framework. The inverse-variance weighted method was used in the main MR analysis. We additionally performed a series of sensitivity analysis to assess the robustness of MR effect estimates to potentially invalid genetic variants. Our MR analysis revealed novel causal associations between serum estradiol and bioavailable testosterone levels and SARS-CoV-2 infection in women, but not men, except for a suggestive inverse causal association between estradiol levels and COVID-19 severity in men. These novel findings improve our understanding of the sex-specific causal nature of sex hormones in relation to COVID-19 outcomes, and suggest that sex hormones may serve as potential therapeutic targets for preventing SARS-CoV-2 infection and improving patient outcomes.

Aims Information on breastfeeding and the safety of biologics in infants is lacking due to difficulties in case collection. We evaluated a method for determining the concentration of biologics in breast milk using a dry filter method that can simplify the collection, storage, and transport of breast milk. Methods To generate dried filter paper (DFP) samples, approximately 30 L of breast milk was placed onto a Whatman 903 card and punched out. After extraction, the supernatant was measured using an enzyme-linked immunosorbent assay. Three concentrations of each drug were prepared in liquid breast milk (LBM) and DFP samples for stability testing, which confirmed that samples were stable up to 28 days after storage at 2–8 ºC or -20 ºC for LBM and at 25±5 ºC for DFP. LBM and DFP samples were provided by lactating mothers using biologics during lactation. Drug concentrations were compared. Results Breast milk was provided by 12 lactating mothers (tocilizumab, n=4; abatacept, n=2; etanercept, n=1; golimumab, n=1; sarilumab, n=1; and belimumab, n=3). The accuracy and precision of measurements for the six drugs were within acceptable limits. After 28 days, concentrations remained at more than 90% under all storage conditions. The quantitative values of the provided LBM and DFP samples were similar. The maximum relative infant dose ranged from 0.09% to 1.12%, which was an acceptable range. Conclusion A method for determining the concentration of biologics using DFP is expected to help improve pharmacotherapy for lactating women.

Metformin is one of the most used antidiabetic drugs worldwide and is not often expected to develop serious side effects. Our study presents a case of abnormal uterine bleeding in a 19-year-old female patient who developed it after starting metformin. The patient was evaluated further, and no uterine or haematological pathology was detected. The Naranjo adverse drug reactions scale was used, and the patient was included in the possible group by scoring 7 out of 10. It should be remembered that metformin may cause bleeding in some patients due to its effects on the coagulation system.

Using Jensen's inequality and integration by parts, we derive some tight upper bounds on the Gaussian Q-function. The tightness of the bounds obtained by Jensen's inequality can be improved by increasing the number of exponential terms, and one of them is invertible. We obtain a piece-wise upper bound and show its application in the analysis of the symbol error probability of various modulation schemes in different channel models.

Restriction site-associated DNA sequencing (RADseq) allows the genotyping of thousands of single nucleotide polymorphisms (SNPs) in many individuals at a reduced cost. However, achieving the desired sequencing depth is challenging in non-model organisms, where the expected number of RADseq loci is unknown. The impact of low coverage sequencing in RADseq experiment on the estimated population genetic parameters has not yet been fully characterized. Here we performed an in silico RADseq experiment by extracting loci from whole genome sequences of diploid individuals simulated under various demographic scenarios. We generated fastq files from the extracted loci and evaluated the performance of three bioinformatics pipelines to discover genetic variants, namely STACKS v.1, STACKS v.2 and ANGSD. We specifically focused on the accuracy of each pipeline to produce datasets retrieving the genetic variability and the historical demography of the simulated populations for several average depth of coverage. For low coverage datasets (<15x) STACKS v.1 and, to a lesser extent, STACKS v.2, were highly sensible to assembly parameters, showing for all scenarios: i) deficit in genetic diversity; ii) site frequency spectrum (SFS) skewed toward low frequency variants. This led to a pronounced bias in the inferred demographic history, particularly for larger samples size, a parameter typically associated with greater confidence in the inferences. Conversely, ANGSD correctly retrieved the genetic variability for most of the simulated scenarios and assembly parameters. We confirmed our findings, based on simulated data, in an empirical RADseq dataset and provide practical guidelines to perform robust demographic inferences in low coverage experiments.