Abstract Objectives: This study aimed to determine success rate of tympanoplasty in CSOM patients & its prognosticating factors. Design and setting; A facility based retrospective cross sectional study design was employed to assess the characteristics of chronic suppurative otitis media patients and the success rate of tympanoplasty of patient who underwent surgery at ORL-HNS of SPHMMC, Addis Ababa, Ethiopia. Methods: Ninety patients who had undergone tympanoplasty in the year 2019 from a retrospective database were studied. Data was collected using a structured checklist and analysed using SPSS 25. Baseline profiles of participants were computed using descriptive statistics. Paired t-test was used to compare preoperative and postoperative ABG results. Multiple regression analyses of potential factors (intra-& pre-operative characteristics) were used to identify predictors for success of tympanoplasty while the level of significance was set at p<0.05. Anatomical success was defined as a complete integration of the graft and functional success as an ABG closure of ≤20dB after 6 months postoperatvely. Results: The postoperative anatomical & functional success rates for tympanoplasty were 81.1% and 60%, respectively. According to the statistical results of the study, neither the anatomic success nor the functional was found to be prognosticated by the potential factors analyzed. Conclusion: Tympanoplasty is an effective surgical procedure that can result in improved auditory function in patients and prevents complications satisfactorily irrespective of baseline characteristics. With tympanoplasty, the ear heals and the patient hears. Keywords: Tympanoplasty; CSOM; success rate; SPHMMC Succinct points: Endaural Tympanoplasty; temporalis fascia graft; air bone gap in dB; endoscopic tympanoplasty; 6months follow up period

Purpose: If the drugs are routinely required for therapeutic drug monitoring (TDM), they may be considered NTI drugs. By basing some criteria that affect the degree of separation of the concentrations that elicit the therapeutic and the adverse effects, an attempted to avoid the vagaries inherent in preparing a list of individual drugs themselves. Methods: I reviewed over 200 commonly prescribed drugs in the retail and hospital pharmacies in the US. As the Food and Drugs Administration (FDA) clinical pharmacologist and as practicing clinical pharmacist in hospitals for 25 years, there are no drugs that of concern than the Narrow Therapeutic Index (NTI) drugs. Results: NTI drugs are very dangerous in that any small change in the dose or concentration or interaction with any drugs, may end up with major consequences. That is why in hospitals, NTI drugs are routinely monitor such as vancomycin and gentamicin. Similarly, at the FDA, it is essential that labels specify the drug levels for certain conditions or diseases that are being monitoring. Conclusions: The plasma levels sometimes are required for in-patient and out-patient for drugs such as valproic acid, digoxin, and theophylline. It is essential that NTI must be monitored in-patient and out-patient.

Background and Purpose: Epigallocatechin-3-gallate (EGCG) has been considered an anticancer agent despite conflicting and discrepant bioavailability views. EGCG impairs the viability and self-renewal capacity of triple-negative breast cancer (TNBC) cells and makes them sensitive to estrogen via activating ER-α. Surprisingly, the mechanism of EGCG’s action on TNBC cells remains unclear. CCN5/WISP-2 is a gatekeeper gene that regulates viability, ER-α, and stemness in triple-negative breast cancer (TNBC) and other types of cancers. This study aimed to investigate whether EGCG (free or encapsulated in nanoparticles) interacts with the CCN5 protein by emphasizing its bioavailability and enhancing its anticancer effect. Experimental Approach: Nanoparticle preparation, immunohistochemistry, confocal microscopy, Western blotting, qRT-PCR, cell viability assay, apoptosis, and mammosphere techniques were used to investigate the role of CCN5 in EGCG mediated suppression of TNBC cells’ viability, and self-renewal capacity was investigated using appropriate in vitro and in vivo models. Key Results: We demonstrate that EGCG activates CCN5 to inhibit in vitro cell viability through apoptosis, the sphere-forming ability via reversing stemness of TNBC cells, and suppressing tumor growth in vivo. Moreover, we found EGCG-loaded nanoparticles to be functionally more active and superior in their tumor-suppressing ability than free-EGCG. Conclusion and Implications: Together, these studies identify EGCG as a novel activator of CCN5 in TNBC cells and beyond and a key player in anticancer therapy. Moreover, nanoparticle-mediated delivery of EGCG is a potentially attractive and effective therapeutic option for treating TNBC patients and other aggressive cancers.

Background and Purpose: Cardiovascular side effects from varenicline, and a case report of a hypertensive crisis event in a patient with pheochromocytoma being treated with varenicline, have been reported. The goal of the present study was to determine if such side effects might derive, in part, from increased exocytosis of secretory vesicles and subsequent catecholamine release triggered by varenicline in chromaffin cells of the adrenal gland. Experimental Approach: We performed electrophysiological plasma membrane capacitance (Cm) and carbon fiber amperometry experiments to evaluate the effect of varenicline on exocytosis and catecholamine release, respectively, at concentrations reached during varenicline therapy (100 nM). Experiments were conducted in the absence or presence of nicotine, at plasma concentrations achieved right after smoking (250 nM) or steady-state concentrations (110 nM), in chromaffin cells of the adrenal gland obtained from human organ donors or rats. Key Results: Varenicline increased the exocytosis of secretory vesicles and the release of catecholamines from human chromaffin cells in the presence of nicotine. Comparable results were found using rat chromaffin cells; varenicline alone or in the presence of acute or steady-state concentrations of nicotine found in human plasma increased exocytosis. These effects were not due to an increase of Cm or currents triggered by the nicotinic agonists alone. Conclusion and Implications: Therapeutic concentrations of varenicline in the presence of nicotine increased exocytosis and catecholamine release from human chromaffin cells. These results should be taken into account in nicotine addiction therapies when varenicline is used.

Brucellosis is the most common zoonotic infection over the world, caused by bacterial genus brucella. The disease is transmitted rarely via human-to-human transmission. Limited data support vertical transmission of human brucellosis. Herein, we reported a case of congenital brucellosis case. Brucella meliteusis DNA was detected by next-generation sequencing and bacterial identifying under microscope in mother’s placental specimen, which also proved chorioamnionitis. After the first course of rifampicin for 6 weeks and meropenem for 2 weeks, the disease relapsed within 3 weeks. The second course were rifampicin and SMZ/TMP for 8 weeks. The baby was still in following-up.

This paper investigates the problem of the global directed dynamic behaviors of a Lotka-Volterra competition-diffusion-advection system between two species in heterogeneous environments, where two species are competing for different fundamental resources, their advection and diffusion strategies follow a positive diffusion distribution, the functions of inter-specific competition ability are variable. By virtue of the principal eigenvalue theory, the linear stability of the co-existing steady state is established. Furthermore, the classification on all possible long-time dynamical behaviors is shown by utilizing the monotone dynamical system theory.

Langerhans cell histiocytosis (LCH) is a rare disease affects any age and any organ; its presentations and outcome vary from self-healing lesions to life-threatening disseminated disease. This study evaluates the outcome of treating children diagnosed with Langerhans cell histiocytosis (LCH) at Oncology Center, Saudi Arabia. Procedure: Through a retrospective study design, the researchers reviewed the medical records and electronic files of all children (aged from 0-≤ 14 years) who had been diagnosed and treated for LCH at Princess Norah Oncology Center (PNOC), King Abdelaziz Medical City, Saudi Arabia, in the period from January 2000 to December 2019 (n=33). Results Males constituted (66.7%), with remarkable dominance of Saudis (93.9%). The median age at diagnosis was 28 months (IQR=49 months); (42.4%) were diagnosed before reaching their second birthday. Fourteen patients (42.4%) had multisystem (MS-LCH) involvement, of which 13 patients with risk organ (RO) (+) and one patient without risk organ (RO) (-). Most of the patients received LCH III protocols. Reactivation occurred in 11 patients (33.3%), and two deaths (6.1%) occurred in cases with MS (RO) (+) progressive disease. The overall survival was 93.9%; with no statistically significant difference in event free survival observed between patients with multisystem compared to single system involvement. Conclusion Excellent outcome of LCH is associated with single system involvement and worse outcome (reactivations, or morality) is determined by multi-organ involvement especially at younger age less than 24 months. Understanding of pathophysiology and genetic molecular background could lead a novel therapy that warrants a prospective clinical trial.

Objective: The aim of this study was to investigate the characteristics of patients who applied to physical medicine and rehabilitation (PM&R) outpatient clinics of two pandemic hospitals despite the risk of COVID-19 infection. Methods: Patients who were admitted to PM&R outpatient clinics of two pandemic hospitals in April and May 2020 were retrospectively scanned from hospital records. Age, number of admissions, the reason of admission, diagnosis and the prescribed medications were recorded. The descriptive statistical methods were employed. For the comparison of means student-t test was used. Results: A total of 1078 patients (female 606, male 472) admitted to two tertiary referral hospitals’ PM&R outpatient clinics. The ages of patients ranged from 0 to 88 years with a mean age of 45.4±14.9 years. The most common reasons for admission were acute peripheral joint pain (290), follow-up and prescription (244) and acute low back pain (140), respectively. The most commonly affected joint was the shoulder and followed by the knee. Most frequent causes for follow-up and prescription were fibromyalgia and neuropathic pain, and pregabalin and duloxetine were mostly prescribed medications for these patients. Conclusion: Acute pain may be considered as the most important condition for admission of patients to PM&R outpatient clinics. Regardless of its source, pain has a negative impact on patients’ lives and causes hospital admissions despite the risk of infection. This effect is more prominent in patients with fibromyalgia and neuropathic pain.

Objectives: The aim of this study was to demonstrate the knowledge, attitudes, and behaviors of imams on Prostate Cancer (PC). Methods: This study was carried out on 287 imams serving in Kahramanmaraş province in Turkey. A questionnaire investigating the sociodemographic characteristics of the participants and their knowledge, attitudes, and behaviors on PC was conducted. Results: The mean age of imams was 40.46±8.93 (min=22, max=60). 266 (92.7%) of the participants said they had heard of PC and 16 (5.6%) had heard of the prostate-specific antigen (PSA) test. Knowledge score of imams about PC was 8.66±5.21 (min=0, max=21). Knowledge score of imams did not change according to marital status (p=0.304) and education level (p=0.16), but knowledge score significantly increased with age groups (as age increased) (p=0.010). 9 (3.1%) of the participants said they had previously received training on PC, and 208 (72.5%) wanted to get training. As a source of information about PC, 169 (58.9%) of the participants stated television/radio, 82 (28.6%) stated the internet, and 49 (17.1%) stated health workers. 208 of the imams (72.5%) stated that risk of PC increased with age and 114 (39.7%) participants stated that risk of PC increased with family history of PC. 120 (41.8%) of the participants stated that decreased urine quantity may be a sign of PC, 152 (53.0%) stated that burning and pain sensation while urination can be a sign of PC, and 41 (14.3%) stated that back pain may be a sign of PC. Conclusions: Results of the present study revealed that imams lack significant knowledge on PC. Trainings on PC should be organized for imams and the issuance of fatwa for PC should be encouraged. The coordinated work of media, medical personnel and religious officials on PC will be an important factor in the fight against PC.

Electrocardiogram (ECG) is the most readily available objective data from patients, it contains a wealth of connotation, but rapid and accurate identification of high risk ECG is still a challenge for most practitioners. We present an interesting case with two types high risk ECG patterns, de Winter like ECG pattern and J wave, which implied acute occlusion of coronary artery and sudden cardiac death. The patient was treated promptly and quickly (within 40 min, from first touch to complete the operation), and the patient took a turn to be out of danger.

Extant conifer species are adapted to a range of climate conditions, which would be reflected in their xylem structure, especially in tracheid characteristics of early-and-latewood. With an anatomical dataset of 79 conifer species native to China, an interspecific study was conducted within a phylogenetic context to find latitudinal patterns in tracheid cell dimensions in response to climate. The analyses showed that there is a significant difference in tracheid length and diameter between early-and-latewood, but no significant difference in cell wall thickness. An opposite divergence pattern was found based on the PC1 axis of tracheid traits, with species of Pinaceae showing strong divergence in their xylem structure in contrast to a conservative xylem structure for species of the other families studied. Except for tracheid diameter in earlywood, tracheid characteristics decreased as latitude increased. Mean annual temperature, precipitation, and their interaction could explain 24.7% to 49.2% of the variance of the tracheid features measured, while phylogeny accounted for 12.5 to 50.5%, suggesting that both temperature and precipitation play a major role in shaping conifer xylem structure. These results provide valuable insight into the effect of climate on the xylem structure of conifers, helping to further our understanding of trees’ adaptation to climate.

We consider a three-dimensional associative noncommutative algebra Ã2 over the field C, which contains the algebra of bicomplex numbers B(C) as a subalgebra. In this paper we consider functions of the form Φ(ζ)=f1(ξ1,ξ2,ξ3)I1+f2(ξ1,ξ2,ξ3)I2+f3(ξ1,ξ2,ξ3)ρ of the variable ζ=ξ1I1+ξ2I2+ξ3ρ, where ξ1, ξ2, ξ3 are independent complex variables and f1, f2, f3 are holomorphic functions of three complex variables. We construct in an explicit form all functions defined by equalities dΦ=dζ·Φ’(ζ) or dΦ=Φ’(ζ)·dζ. The obtained descriptions we apply to representation of the mentioned class of functions by series. Also we established integral representations of these functions.

In this paper, a class of finitely degenerate pseudo-parabolic equation, are studied. By a potential well method, we obtain a threshold result for the solutions to exist globally or to blow up in finite time for sub-critical and critical initial energy. The asymptotic behavior of the global solutions, blow-up rate, a necessary and sufficient condition for blow-up solution, a upper bound and a lower bound for blow-up time of local solution are also given. When the initial energy is super critical, an abstract criterion is given for the solutions to exist globally or to blow up in finite time, in terms of two variational numbers. These generalize some recent results obtained in \cite{chen-amse-2019} and correct the proof of some results obtained by R. Xu in \cite{xu-jfa-2013} and \cite{xu-jfa-2016}

In this paper we give Navier-Stokes system associated with the Weinstein operator $(NSW)$ (see.\eqref{11}), We study the existence and uniqueness of solutions to equations (NSW) in $L_{\alpha}^{p}\left(\mathbb{R}_{+}^{d+1}\right), 2 \alpha+d+2

Fusion of algorithms has recently taken attention in machine learning studies because of its power coming from community decision instead of single decision maker. One of the crucial questions in aggregation of algorithms is that which and how many models should be combined to achieve both best accuracy and low complexity. It is already knownn in machine learning that as the complexity of the model increases too much, prediction accuracy decreases. There is a trade of between these two features. In order to answer such questions, diversity notion gets involved to overall consensus models. It is also shown that diversity alone does not determine the best ensemble (fusion), so accuracy and diversity together has been taken into account recently in such problems. In this paper, we took in account of those two notions simultaneously so that number of algorithms and which algorithms should be in the ensemble are answered while solving feature selection problem. We have validated our algorithm on different domains of data sets which shows better prediction accuracy values than existing ensemble based feature selection methods.

Rapid emergency rescue measures are essential in reducing losses resulting from disasters. With the development of science and technology, remote sensing technology is gradually applied to emergency rescue work, especially SAR remote sensing technology, with its advantages of all-weather and all-time observation, which play an important role in emergency rescue. In this paper, we make use of the Polarization information and texture information of the full Polarimetric SAR(PolSAR) remote sensing image after the Yushu earthquake to accurately extract information of intact and collapsed buildings. Firstly, we separately extract the ridge and hillside information form (1-H)(1-A) and Yamaguchi Decomposition by method of CNN (Convolution Neural Network). Secondly, we successfully extract building area (Intact Building Area +Non-Building Area) combine Homogeneity and Second Moment based on previous information of ridge and hillside. Finally, extract the intact building and collapsed building from building area based on Anisotropy and Correlation by method of CNN (Convolution Neural Network) again. The accuracy of extractive information is 99.12% by method of CNN.

Background. Hydration and hydroxyurea (HU) can modify sickle cell disease (SCD) severity. Optimal nutrition and L-glutamine (Gln) may provide further amelioration. Procedures. EMR reviews and nutrition surveys were used to investigate pediatric SCD severity in relation to nutrition, growth, hematologic parameters, and disease-modifying agents. Results. Among 25 females and 25 males, mean age was 9.1±7 years, and mean BMI percentile was 56.4±32.6. Hemoglobinopathies were: HbSS/Sß0, 60%; HbSC, 32%; HbSß+, 8%. Annual pain crises rose with age (APC mean, 0.97±1.1 hospital visits or admissions per patient). HbF dropped to <10% in teenagers, while APC increased ≥2-fold. Proper hydration and nutrition correlated with younger ages and fewer APCs. Height and weight Z-scores were ≤ -1SD in 20% of 35 surveyed patients (12±7.8 years) with more APCs (2.5±2.5 vs. 1±1.3, p=0.03). Prealbumin was low overall. Twenty-two of 28 patients on HU reported ≥90% adherence – with higher MCVs (92±9.6 vs. 74±10 f/L, p<0.01) and HbF%, and younger ages. Most children aged ≥5 years were prescribed Gln (70% dispensed). A quarter of patients reported <50% Gln intake due to abdominal pain or taste. Gln compliance over 23 months was ≥70% in 12 patients, including 2 on chronic transfusion. Of 10 evaluable patients, 6 (8.8 ±2.2 years) had fewer APCs on Gln (mean 0.2 vs. 0.9, p=0.016), with higher prealbumin (14.1 to 15.8 mg/dL, p=0.1). Conclusions. Young, well-nourished/hydrated patients have a milder clinic course. Severe disease occurred in undernourished teenagers with suboptimal compliance. L-Glutamine should be further evaluated in pediatric SCD along with prealbumin measurements.

We present the case of a 3-year-old female with cyclic neutropenia and history of febrile seizures who died acutely from coronavirus disease 2019 (COVID-19). While most children with COVID-19 infection are asymptomatic or have mild symptoms, there may be increased risk of severe disease in immunocompromised children. To the best of our knowledge, this is the first reported case of a COVID-19-related death in a pediatric patient with cyclic neutropenia.

Alopecia totalis (AT) is a chronic disease that results in non-scarring hair loss of the entire scalp. This results from an autoimmune reaction involving the hair follicles due to genetic and environmental factors. The clinical course of AT is highly unpredictable. There are limited effective durable treatment options. Resolution of alopecia has been reported post-autologous and allogenic hematopoietic stem cell transplantation (HSCT). However, no cases of AT remission following chemotherapy alone have been described. Here, we present a case of complete remission of AT following chemotherapy for B-cell acute lymphoblastic leukemia (B-ALL) in a pediatric patient.

A combination of herbal medication and pharma-therapies is usual practice to treat chronic kidney disease especially in Asian region. Because of limited treatment options for chronic kidney disease (CKD), the use of traditional herbal medication to alleviate the urogenital problems is the alternate therapeutic selection. Only few studies are available in supporting the usefulness of medicinal plants for CKD, though people are using it since very long. Many active ingredients of traditional medicinal plants are unidentified which eventually results into undetermined toxicities. Here, we made attempt to summarize the recent outcomes for the use of herbal medicine in treatment of CKD in human and in animal studies. About 51 studies were found to describe the utilization of herbal drugs in treatment of CKD in both human and laboratory animals, 19 studies described the clinical application of about 14 medicinal plants used against CKD in human and 32 studies demonstrated the beneficial use of 19 medicinal plants in animal models and in vitro studies for CKD treatment. To embody the therapeutic use of herbal medications in CKD, molecular studies need to execute to identify active components of medicinal herbs and their mechanism of action. A well-designed clinical trials and rigorous pharmacological studies are warranted for determination of the safety standards required for therapeutic agents of herbal medicines.

In this paper, we are concerned with the existence of infinitely many fast homoclinic solutions for the following damped vibration system $$\ddot{u}(t)+q(t)\dot{u}(t)-L(t)u(t)+\nabla W(t,u(t))=0,\ \forall t\in\mathbb{R} $$ where $q\in C(\mathbb{R},\mathbb{R})$, $L\in C(\mathbb{R},\mathbb{R}^{N^{2}})$ is a symmatric and positive definite matix-valued function and $W\in C^{1}(\mathbb{R}\times\mathbb{R}^{N},\mathbb{R})$. The novelty of this paper is that, assuming that $L$ is bounded from below unnecessarily coercive at infinity, and $W$ is only locally defined near the origin with respect to the second variable, we show that $(1)$ possesses infinitely many homoclinic solutions via a variant symmetric mountain pass theorem.

A document by Seshadev Padhi. Click on the document to view its contents.

Aim: This study aimed to evaluate the attitudes of medical faculty sophomore students towards communication skills training module consists theory courses and simulated patient interviews. Methods: This study was planned in before-and-after intervention study and was carried out with 257 second-year medical students. The Communication Skills Attitude Scale (CSAS) were used for data collection. The scale was administered to the participants before the training (1), after the training (2), and after the simulated patient interviews (3). Results: The mean age of the students was 20.13±2.13 years, and 133 (51.8%) of them were female. PAS 1 and PAS 3 scores were 55.38±6.58 and 58.05±7.39, respectively, while NAS 1 and 3 scores were 30.25±4.49 and 28.88±4.96, respectively. PAS 3 was considerably higher than PAS 1 and 2 scores (p=0.037), while NAS 3 was significantly lower than NAS 1 and 2 scores (p=0.005). There was no difference between the positive and negative attitudes of females and males before the training. However, after the training, female’s positive scores significantly increased compared to men, and their negative scores decreased. Positive attitude scores of the female students increased after both the theory course and the simulated patient interviews. On the other hand, the negative attitude scores decreased significantly after the simulated patient interviews (p<0.05). Conclusion: Communication skills training improves students’ attitudes. In this improvement, the contribution of simulated patient interviews is more than theory instructions.

Objective: Indications and appropriateness of aspirin use have not been well investigated in Turkey. Therefore, the aim of this study is to investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. Methods: The ASSOS study is a cross-sectional, multicenter registry involving consecutive cardiology patients who were using aspirin. Patients were divided into two groups according to the use of aspirin; primary prevention and secondary prevention group. The indication of aspirin use was evaluated according to 2016 the European Society of Cardiology (ESC) and 2016 the United States Preventative Services Task Force (USPTF) guidelines in the primary prevention group. Results: A total of 5007 patients (mean age 62.15± 11.05, 39% female) were enrolled. The primary prevention group included 1132 (22.6%) patients and the secondary prevention group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71 % of the patients according to the USPTF guidelines. Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in primary prevention, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines.