Aim: The main objective is to incorporate the major foetal parameters – biparietal diameter, head circumference, abdominal circumference and femur length for prediction of gestational age through ultrasonography between 10th and 42nd weeks of gestation and try to do a simultaneous comparative study with gestational age predicted by last menstrual period. Methods: The study has been conducted particularly on the population of Bangladesh. It has been done on 229 Bangladeshi women who had usual singleton foetuses, with evidence of menstrual dates by sonography before fourteen weeks of gestation. Foetal anatomical structures have been scanned and measured at the time of sonographic inspection. For each patient, in addition to the four foetal parameters such as Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC) and Femur Length (FL), the other parameters like Gestational Age (GA) by Last Menstrual Period (LMP) as well as by Ultrasonography (USG) have been recorded. Here we have adopted non-linear regression models in order to predict the response on gestational age. Usually, different modelling methods have been used for this purpose. Results: The logarithmic models normally presented better results if gestational age was predicted based on a single parameter than polynomial models whereas if all predictor variables were considered together, then Nernst model may turn out to be the best one. Also, it was seen that the accuracy level of gestational age predicted by ultrasonography was slightly more accurate than that determined by last menstrual period. Conclusions: There is a high degree of association among the different foetal parameters. Further, there is a high degree of association between the gestational ages by LMP and that by USG. Prediction of gestational ages by USG technique gives a good degree of accuracy and hence can be a reliable technique for estimation of gestational ages.

The novel coronavirus disease 2019 (COVID-19) is a member of Beta coronaviruses that became pandemic by March of 2020. The hematological manifestations related to COVID-19 are mostly lymphopenia, thrombocytopenia, elevated D-dimer, and ferritin levels. Autoimmune hemolytic anemia (AIHA) associated with COVID-19 has been described rarely; however, to our knowledge, complement-mediated autoimmune hemolytic anemia (CM-AIHA) has not been reported in children. Here, we report a child with COVID-19 associated with CM-AIHA.

Background: Rosai-Dorfman disease (RDD) is a rare benign proliferative disease whose etiology is not clear and may be related to infection or unexplained immune dysfunction. The authors present a case of RDD with lung involvement in a 10-year-old patient.\\ Case description: a 10-year-old female found that the left lymph node was enlarged for more than 7 months, the larger range was about 6.5-5.9-8.1cm, and the cervical MR was considered as: malignant tumor, the possibility of lymph node metastasis was high. At the same time, lung CT conclusion: multiple nodules in both lungs, it is possible to consider metastatic tumor. Finally, RDD was diagnosed by pathology and immunohistochemistry.\\ Discussion: RDD involving the lung is very rare in clinic, and lung RDD clinical symptoms and imaging have no obvious specific manifestations, clinically easy to be misdiagnosed as malignant tumor, the final need for pathological diagnosis. The pathological manifestation of this case is typical, CD68, CD163 and Smur100 are all positive, and no other lesions are found in clinical and laboratory examination, so it is considered as the possibility of RDD involving the lung.\\ Conclusion: The simple use of imaging methods for diagnosis RDD is easy to lead to misdiagnosis, we need to comprehensively consider the use of different diagnostic methods; and according to the epidemiological characteristics of RDD, long-term follow-up of cases is necessary.

Introduction Survival of childhood cancer has increased over the past decades. This has led to the development of strategies aiming to enhance follow-up care and research, for which priorities may vary globally. We explored perspectives of an international healthcare workers panel. Methods Attendants of a meet-the-expert session on childhood cancer survivorship at the 2018 SIOP conference completed a survey about their view on important follow-up care and research aspects for survivors below and over 18 years. We analyzed overarching categories and subtopics, and compared Asian versus European and American healthcare workers. Results Fifty-eight participants from different medical specialties (67.2% pediatric oncologists) and continents (48.3% Asia, 39.7% Europe/America) responded. Follow-up care priorities for survivors below and over 18 years included physical care (39.3% ≤18 years, 35.9% >18 years) and healthcare structure (29.4%, 26.0%). Physical care was also the most important research aspect for both age groups (52.5%, 50.7%). Asian clinicians (n=22) primarily prioritized physical care aspects of follow-up care (48.0%, 45.6%), whereas European/American (n=19) clinicians underscored the importance of healthcare structure (43.9%, 34.4%). The main research priority category concerned physical care for all clinicians. Psychological support was the most frequently reported subtopic. Conclusion Physical care is the most important aspect of survivorship care and research according to clinicians from several continents. Asian and European/American respondents shared most priorities, however, healthcare structure was a more important category for European/American clinicians. The most common subtopic was psychological support, underlining also the need to involve psychologists in follow-up.

Background: As COVID-19 evolved into a global pandemic. Increasing numbers of reports have linked obesity to more severe COVID-19 illness and death (1-3). However, almost all the studies focused on the proportion of people entering the ICU or mortality. Is obesity also associated with severity of pneumonia in common pneumonia patients? How about underweight patients? The answer is lack. So, our research below will answer the question. Methods: We collected and analyzed epidemiological, demographic, clinical, and laboratory data from 193 confirmed cases of COVID-19 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China, between January 1, 2020, and March 13, 2020. They were followed up until April 15, 2020. Results: Among these patients, 5.70% were underweight, 58.03% were normal weight, 27.98% were overweight and 8.29% were obese. underweight patients were more likely to have headache (P=0.029) Obese patients were more likely to experience a decline in lymphocyte counts(P=0.042), an increase in CRP(P=0.020), bilateral multiple mottling and groundglass opacity (P=0.008). Besides, the proportion of patients receiving human immunoglobulin+systematic corticosteroids treatment is the highest among the obese group compared with other BMI groups. After adjusting for potential confounders, Underweight patients had 6.483-fold higher(P=0.012)，and obesity patients showed 5.965-fold higher odds developing acute lung injury(ALI) than normal weight patients(P=0.022). Underweight patients were 3.255 times more likely than normal-weight patients to develop secondary infections (P=0.041). Conclusions: Our study shows that in patients with common pneumonia, both underweight and obese people tend to develop ALI compared with normal weight patients.

In this article, we have discussed Bimedian and Biharmonic functions on an infinite network. Also, we have proved the Discrete Riquier problem in the setting of infinite networks.

Objective: The novel SARS-COV-2 virus affected millions worldwide, wreaking havoc, the likes of which can rarely be anticipated. Research is on the verge to counter dis disease. It is now known dat myocardial injury is one of its manifestations. However, Troponin-me lev- els(cTnI) for prognostication of disease severity and outcome remains determined. Methods: We conducted dis retrospective study on confirmed COVID-19 virus disease cases from 1st April 2020 till 31st October 2020. Data was acquired from the hospital’s electronic record. Cox proportional hazard regression model was conducted to perform a mortality survival analysis. The probability curves of survival were estimated using the Kaplan-Meier method and contrasted with the log-rank test. Results: A total of 466 patients were enrolled in our study. Most of them were male and elderly. The majority were both hypertensive and diabetic, and one third had a myocardial injury on arrival. Our study showed mortality rate was higher in patients with associated comorbidities, me.e., hypertension (HR2.13) and ischemic heart disease (IHD) (HR 2.02), and in those with elevated troponin-me level (HR 1.80) on admission. Conclusion: Our study concluded dat in confirmed COVID-19 virus disease cases, measuring troponin-me levels on arrival could help predict the severity and outcome. Keywords: SARSCoV2, Coronavirus, COVID19, Troponin, Cardiac enzymes, biomarkers, 2019 Novel Coronavirus Infection, COVID 19 Virus Disease

Objective: Strengthening the immune system constitutes an important part of struggling with COVID-19. The aim of this study was to evaluate the approaches of the teachers to strengthen their immunity during COVID-19 pandemic period in Turkey. Methods: This descriptive study was performed on teachers via social media between 15 and 23 June, 2020. Results: Of 500 participants, 47.4% stated that they gained weight during COVID-19 pandemic period. Vegetable and fruit consuming (52.8%), praying (36.2%) and sunbathing (26.0%) were the most common methods to strengthen immunity. Of the teachers, 46.2% were confident about their knowledge on immunity strengthening methods and only 61.2% stated that they would like to be trained. Discussion: Lifestyle changes strengthening immunity may help to come over Covid-19 pandemic period with less harm. In-service training should be provided to the teachers who would constitute a good sample for the society.

Dispensing errors in community pharmacies are common reasons for a patient’s injury and harm. Therefore, to improve patient safety in relation to the use of medicine in the primary care setting, the study sought to determine the attitude and perception of community pharmacists towards dispensing errors. A survey-based cross-sectional study consisted of 171 community pharmacists in different regions in Lebanon. This study retrieved information about demographic data, perceived factors associated with of dispensing errors, perceived strategies that might reduce the risk for dispensing error, perceived types of dispensing errors and reasons for underreporting dispensing errors. The majority of the pharmacists were young between 20 to 35 years (87.1%) and holding only BS degree in Pharmacy (66.7%). Poor prescription handwriting (90%), unreadable prescriptions (89.4%) and heavy workload (87.7%) were perceived as the main contributing factors for dispensing error. While Collaboration with physicians (96.4%) and double-checking (96%) of medications before dispensing were mainly appreciated to decrease error incidents. The main reasons for underreporting dispensing errors were non-mandatory reporting policy (58.5%) and absence of national reporting system (55.6%). Dispensing errors were highly associated with the quality of the prescription and heavy workload. Pharmacists’ main reason for underreporting dispensing errors was mainly due to lack of reporting systems that do not mandate the pharmacist to report it. These findings enlighten future interventions to improve pharmacy practices that aim in providing new directives for policies and procedures for reporting and managing dispensing errors in the Lebanese community pharmacies.

Background and Purpose Whereas whether metformin reduce all-cause, cardiovascular mortality, and incidence of cardiovascular events in patients with cardiac diseases remains inconclusive. Experimental Approach PubMed and Embase were searched up to May 2020 with a registration in PROSPERO (CRD42020189905) were collected. This article includes randomized controlled trials (RCT) and cohort studies. Hazard ratio (HR) with 95% CI was pooled across various trials by a random-effects model. Risk of bias was accounted as per Cochrane and Newcastle-Ottawa Scale (NOS) guidelines. Key Results This article enrolled 48 articles (1999-2020) for qualitative synthesis and identified 26 articles (33 studies in total, 61,704 patients) for final quantitative synthesis. Compared with non-metformin control, metformin is associated with reduced all-cause mortality (HR: 0.90; 95% CI: 0.83, 0.98; P = 0.01), cardiovascular mortality (HR: 0.89; 95% CI: 0.85, 0.94; P < 0.0001), incidence of coronary revascularization (HR: 0.79; 95% CI: 0.64, 0.98; P = 0.03), and heart failure (HR: 0.90; 95% CI: 0.87, 0.94; P < 0.0001) in patients with cardiac diseases, whereas metformin is not associated with reduced incidence of myocardial infarction (HR: 0.97; 95% CI: 0.80, 1.17; P = 0.73), angina (HR: 0.29; 95% CI: 0.04, 2.35; P = 0.25), and stroke (HR: 0.95; 95% CI: 0.78, 1.16; P = 0.59). Conclusion and Implications Metformin reduces all-cause mortality, cardiovascular mortality, incidence of coronary revascularization, and heart failure of patients with cardiac diseases, whereas metformin is not associated with reduced incidence of myocardial infarction, angina, and stroke.

This paper presents a study and comparison of the most used learning algorithms for nonlinear autoregressive neural network with external input (NARX). These networks are successfully used to predict the time series. For this study, the data of methane (CH4) and carbon dioxide (CO2) concentrations in the surface layer of atmospheric air on the Arctic island Belyy, Russia were used. A time interval of 190 hours was chosen with the one-hour lag. Methane and carbon dioxide concentrations corresponding to the first 170 hours of the interval were used for train the NARX network. Then the forecast was made for the next 20 hours. Three techniques were used as the learning algorithms: Levenberg-Marquart (LM), LM with Bayesian regularization (BR), and gradient descent with adjustable speed parameters (GDA). The NARX model, which using the LM learning algorithm, was the most accurate for the both greenhouse gases. The application of this learning algorithm improved the predictive accuracy of the models from 9% to 12% for the methane and from 7% to 21% for carbon monoxide. The predictive problems in the field of dynamics of changes in the concentration of greenhouse gases can be effectively solved using artificial neural networks, in particular, NARX with the Levenberg-Marquart learning algorithm.

Abstract: Congenital mesoblastic nephroma is a rare neoplasm of kidney. It is the most common renal tumor in the neonatal period. We report a case of mesoblastic nephroma in a term baby , who had presented with an abdominal lump and was treated with Nephrectomy. A brief review of literature is also added.

In this paper, we introduce a new class of Bi-topological space called Bi*-topological space. Also, introduce and study Bi*-topological properties of bi∗-open (bi∗∗-open) sets and bi∗-closed (bi∗∗-closed) sets, etc. Moreover, introduce and study some type of sets in Bi∗-topological space and also some type of continuous functions in Bi∗-topological space

This paper devotes to present analysis work on the fifth order Camassa-Holm (FOCH) model recently proposed in [28]. Firstly, we establish the local and global existence of the solution to the FOCH model. Secondly, the infinite propagation speed is obtained, in other words, when the initial data u0(x) has a compact support, the corresponding solution u(x, t) does not have a compact x-support any longer in its lifespan. Finally, we discuss the long time behavior of the support of momentum density with a compactly supported initial data.

This paper concerns the ground state solutions for the partial differential equations known as the Dirac equations. Under suitable assumptions on the nonlinearity, we show the existence of nontrivial and ground state solutions.

The recurrence of asthma is partly mediated by allergen-specific CD4 memory T cells that promote lung inflammation through recruitment of cellular effectors into the lung. Central memory T cells(Tcm), a subset of memory T cells following infection and allergen induction, can rapidly response to the allergen and produce inflammatory production which is the important role of the recall of allergy response. Targeting the expansion of pathogenic central memory immune cells is a promising therapeutic strategy to prevent chronic autoimmune recurrence. However, current common therapies cannot alter the frequency of central memory T cells subsets in adult atopic asthma patients. We previously carried out an animal study, which showed that Astragaloside (AST) could inhibit the recurrences of asthma attack, however, the underlying therapeutic mechanism were not completely clear. The important question of this research is whether AST, as an anti-inflammatory agent used in asthma therapy, may act on the memory T-cell subpopulation to prevent the recurrences of asthma attack. In this study, we dissect the treatment effectiveness and mechanism of AST on Tcms from generation and migration in the recurrences of asthma.

Title pageTitle: ”Case report of COVID-19 in pregnancy and viral presence in the vagina – recommendations for obstetric practice”

Objective: Compare pregnancy outcomes in patients with short cervix receiving vaginal progesterone, had preterm prelabor rupture of membranes (PPROM) and were switched intramuscular (IM) progesterone after PPROM, to historical data of patients with short cervix and PPROM who did not receive IM progesterone after PPROM. Design: A retrospective case control pilot study of singleton pregnancies complicated by short cervix, receiving vaginal progesterone, who subsequently had PPROM, and then switched to IM progesterone. Setting: All delivered at a regional perinatal and tertiary referral center, between 24-34 weeks of gestation, from January, 2015 to April, 2020. Sample: 11 singleton pregnancies complicated by short cervix, receiving vaginal progesterone, who subsequently had PPROM, and then switched to IM progesterone. Methods: Maternal and neonatal outcomes included gestational age at time of delivery, PPROM to delivery interval, chorioamnionitis, birthweight, APGAR score <7 at 1 and 5 minutes of life, NICU admission and significant fetal morbidity. Findings were compared to historical control Main outcome: PPROM to delivery interval. Results: Our patient population was significantly more premature at time of PPROM diagnosis (mean 21.4±2.4 compared to 31.5±1.125 in the control group). The group who received IM progesterone after PPROM had a longer PPROM to delivery interval, higher mean birth weight. There were two cases of neonatal death in the IM progesterone group. Conclusion: Administration of IM progesterone supplementation in the patients with short cervix after PPROM before 28 weeks of gestation may result in pregnancy prolongation, especially to benefit from steroid administration to improve fetal lung maturity.

Aim: Endometriosis is a disease affecting women of fertile age, with an estimated more than 176 million women worldwide suffering from their symptoms, with no correlation between the degree and symptoms of the disease. Although the initial treatment in endometriosis is medical treatment, patients with severe symptoms are candidates for surgery as the last choice. We contribute to the literature by publishing our 15 cases and to discuss surgical treatment methods. Method: Patients operated due to the endometriozis in Kartal Dr Lutfı Kırdar Training and Research Hospital between January, 2019 and January, 2020 were evaluated. 15 patients were found according to the criteria. and discussed according to the literature. All patients’ age, body mass index, gravida, parity, medications, chronic diseases,, past surgical history, duration of diagnosis time, ultrasonograph results, clinical symptoms, physical examinations,surgical procedure, operation time, complications, hospital discharge time, preoperative and postoperative pain scores [10-cm visual analogue scale (VAS)] were analyzed Results: When the postoperative VAS scores were evaluated, it was found that the scores improved significantly compared to preoperative VAS scores. Intraoperatively, ureter damage in one patient and bowel damage in one patient were detected. Wound infection was detected as a postoperative complication in one patient. Conclusion: Operations performed by experienced teams in cases resistant to medical treatment in endometriosis benefit the patient, as well as operations performed by inexperienced hands may harm the patient. Therefore, we think that patients who need endometriosis surgery should be directed to experienced centers.

Background Treatment of azithromycin in clinical infected of U.urealyticum-positive may enable to reduce BPD. We aim to investigate the association of clinical infected status on azithromycin treatment of U.urealyticum-positive with the risk of BPD in very preterm infants. Methods A single-centre retrospective study was performed on all very preterm infants who were admitted to a tertiary unit from 2017 to 2019. Does Real-time polymerase chain reaction (Rt-PCR) test for respiratory secretions at the 1-3 first days of life. Therapeutic or preventive regimen of azithromycin was gave when U.urealyticum-positive combining clinical symptoms and signs. Results At last, a total of 118 infants were included in our study. 29 infants developed bronchopulmonary dysplasia (supplemental oxygen needed at 36 PMA or discharge). The incidence of BPD was significantly higher in infants with UU clinical infected (43.6%) compared to infants with UU colonization (15.2%, P = 0.001). After evaluate the treatment effect on azithromycin, UU clinical infected status being cure has significantly lower incidence of BPD when compared to un-cure infants ((7/10) vs (19/3); OR 0.111; 95% CI: 0.023-0.523; p = 0.005). UU colonization un-cure status was protective factor when compared to clinical infected un-cure status in develop to PBD, statistically significant in difference ((1/10) vs (4/3); OR 0.075; 95% CI: 0.006-0.954; p = 0.047). It might indicate that there was other else cause the BPD in the UU colonization infants. Conclusion The efficacious treatment by azithromycin in clinical infected status of U.urealyticum-positive has a significant difference in developing of BPD compare to non-efficacious.

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. Two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related hepatitis but who did not meet the DILI criteria. Results: A total of 15 cases of DILI by VPA were found, 3(20%) of them fatal. Mean age was 45.7 years, 4(26.7%) were women and 5(33.34%) were children under 18 years. Polytherapy with other antiepileptic drugs (p=0.047) and alcohol consumption (p<0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p<0.001). The cases developed hepatocellular hepatitis (p<0.001), while the mild hepatitis controls had a higher rate of cholestatic hepatitis (p<0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p= 0.033 and p=0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

A document by Mahyar Ghanaat. Click on the document to view its contents.

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is caused by heterozygous germline mutations in the fumarate hydratase (FH) gene and is associated with increased susceptibility to cutaneous leiomyomas, uterine leiomyomas, and renal cell carcinoma (RCC). This report describes a seven-year-old male who developed a large right kidney tumor with multiple cystic lesions that contained enhanced solid components. Whole-exome sequencing identified his germline mutation in the FH gene and its loss of heterozygosity in the tumor. This was the youngest-onset case of HLRCC-associated RCC to date. This report may affect the starting age for future RCC-surveillance programs for patients with HLRCC.

Background Outcome and toxicity data in adolescent-adult Ewing’s Sarcoma (AA-ES) patients is sparse and merits exploration. Methods Histopathologically confirmed, non-metastatic AA- ES patients, who received standard institutional combination chemotherapy regimen (EFT-2001) comprising of ifosfamide plus etoposide and vincristine, doxorubicin, plus cyclophosphamide, lasting a total of 12 months between 2013 and 2018, were analyzed for treatment-related toxicities, event-free survival (EFS) and overall survival (OS). Results There were 235 patients (primary safety cohort, PSC) with median age of 23 (15-61) years; 159(67.7%) were males, 155 (65.9%) had skeletal primary and 114(48.5%) had extremity tumors. 196(83.4%) were treatment naïve (primary efficacy cohort, PEC) and of these 119 (60.7%) had surgery. In PEC, at a median follow up of 36.4 (IQR 20 – 55) months, estimated 5 year EFS and OS were 60.9% (95% CI 53.1% - 69.9%) and 84.5% (95% CI 77.7% - 91.9%) respectively. Of these, 158 (80.6%) complying with intended treatment, at a median follow up of 39 (IQR 26- 57) months had an estimated 5 year EFS of 63.1% (95% CI 54.8%-72.6%). In multivariable analysis good prognostic factors included, longer symptom(s) duration (HR=0.93, 95% CI 0.86-0.994), ≥ 99% necrosis (HR=0.30, 95% CI 0.11-0.77) and treatment completion (HR=0.32, 95% CI 0.14-0.74). Among PSC, grade 3-4 toxicities were febrile-neutropenia (119, 50.6%), anemia (130,55.3%), peripheral neuropathy (37,15.7%), with 3(1.3%) chemo-toxic deaths . Conclusions The outcomes of AA non-metastatic ES patients treated with EFT-2001 regimen were comparable to those reported by others, with acceptable toxicity. This regimen could be considered a standard-of-care in AA-ES.