Background Pediatric patients with cancer are at high risk for severe infections. Delayed diagnosis and treatment increases mortality. Infections can trigger changes of vital signs long before clinical symptoms arise. Continuous recording may detect such changes earlier than discrete measurements. We aimed to assess the feasibility of continuous recording of vital sings by a wearable device (WD) in pediatric patients undergoing chemotherapy for cancer. Methods In this prospective, observational single-center pilot study (NCT04134429) pediatric patients undergoing chemotherapy for cancer wore the Everion® WD for 14 days. Results Twenty patients were included (median age, 6 years; range, 2-16). Six patients (predefined feasibility criterion, ≥15 patients) aged 3-16 years fulfilled the patient specific goal, defined as heart rate recorded with good quality during ≥18 hours/day on ≥7 consecutive days. The quality of heart rate recording was good during 3992 of 6576 (61%) hours studied, poor during 300 (5%) hours, and no data was recorded during 2284 (35%) hours. Eighteen of 20 participants indicated that this WD is acceptable to measure vital sings in children undergoing chemotherapy for cancer. Conclusion We found that continuous recording of vital signs by the Everion® WD is feasible across a very wide age range in pediatric patients undergoing chemotherapy for cancer. In the configuration studied, however, the predefined feasibility criterion was not fulfilled. This was mainly due to important compliance problems and independent of the WD itself. These results will influence the design of future WD-studies including those aiming to identify patterns predicting fever or infection.

The paper urges to investigate the enhanced viscous behavior and the heat transfer phenomenon of the unsteady ionic-nano-liquid squeezing flow between the two infinite parallel concentric cylinders. The physical scenario is transformed into a partial differential equation system by the modified Navier stokes equation, the Poisson equation, the Nernst-Plank equations, and the energy equation. The PDE’s system is transformed into the coupled ODE’s system by opting for suitable/applicable transformation. The solution of the coupled differential equations system is carried out by the Parametric continuation method (PCM)and BVP4c Matlab based methods. The effect of the squeeze number, the nanoparticle volume fraction, the Prandtl number, Schmidt number, and the heat source parameter on nano-ionic liquid flow, heat transfer rate, and other physical variables are tabulated, graphed, and discussed. The analysis of the Nusselt number for Cu-water, Al2O3-water, and TiO2- water in response to the Prandtl number(Pr), the Squeeze number(S), and the heat source parameter(Hs) concludes that the Cu-nanoparticle is the best choice for the heat transfer function through the contracting flow channel with the increasing heat transfer parameter(Hs). It is also noticed that the thermal boundary layer tends to decrease for the increasing Prandtl number(Pr) in Cu-water, Al2O3-water, and TiO2-water, which indicates that the convection mode of heat transfer is not efficient in this whole flow set-up. Applications of this study involved in the demands to understand the interfacial electrokinetic phenomena in the liquid transport processes which increase significantly as various Micro-Electro-Mechanical Systems (MEMS) and MicroFluidic devices involve liquid transport processes.

Deficiency of trace metals exacerbates instability in the methanogenic phase of two-phase thermophilic AD. The addition of a micronutrient supplement containing calcium, magnesium, cobalt and nickel was found to help process recovery, increasing methane production by up to 40%. In this study, next gen sequencing was used to identify the changes brought by addition of the micronutrients in the bacterial community of the methanogenic phase of this process. The diversity of the community before supplementation was considerably low and a single species of Phylum Thermotogae was the sole dominant bacterial group. The addition of a micronutrient supplement comprising of Ca, Mg, Co and Ni caused a dramatic increase in the diversity of the community and species belonging to Arcobacter, Clostridium, Pseudomonas, Bacteroides and Coprothermobacter were particularly enriched. This suggested that the action of the micronutrients resulted in an increase in the functional diversity and redundancy of the bacterial community and limiting hydrogenotrophic methanogenesis in favour of acetotrophic methanogenesis. These factors would contribute to the observed increased stability and higher productivity in the micronutrient supplemented thermophilic AD process.

Live imaging based testing of ligands and identification of toxic dose range during in vitro studies is a time-intensive process due to the inherent heterogeneity present in cell responses. In this context, high magnification imaging and large-scale data visualization remains challenging for analysis of toxicity during the drug screening as well as selection of dose-range. To address this challenge, we propose the measurement of cytosolic calcium ion (Ca2+) using spinning disk confocal microscopy at a higher resolution for generation of imaging data that can be visualized using uniform manifold and projection (UMAP). First, we performed large scale experiments and showed norepinephrine induced increase in Ca2+ flux in HeLa cells for a large range of doses. Secondly, the time-series dataset was mapped in 2D plane using UMAP. We also show that the proposed framework can be used to depict the relative distribution of various responses corresponding to a range of drug doses. To the best of our knowledge, this is the first attempt for UMAP visualization of time-series dose-response and identification of Ca2+ signature in the toxic dose-range. Such quantitative microscopy can be used for prediction of toxic drug dose range, and identification of drugs that lead to lytic cell death.

In this paper, we present the idea of intuitionistic fuzzy ideals in intuitionistic fuzzy supra topological spaces. Also present the intuitionistic fuzzy S-local function in order to find a new intuitionistic fuzzy supra topologies from original one. Moreover, we introduce a Scompatible intuitionistic fuzzy ideal. Finally, we introduce and study some type of sets in intuitionistic fuzzy ideal supra topological spaces and introduce and study some of continuous functions in intuitionistic fuzzy ideal supra topological space.

Objective: Studies have examined the impact of race on infertility, but few have compared ethnic differences in infertility within a given race. We sought to determine whether infertility etiologies differ between Black ethnic subgroups. Design/Setting: Retrospective study in an urban safety net hospital. Population: Women seeking infertility care between 2005-2015. Methods: Charts of women with infertility and PCOS ICD-9 diagnoses were reviewed to confirm diagnoses. Data was stratified by race and subsequently by ethnicity to evaluate differences in infertility etiologies between Black American, Haitian, and African women. White American women were used as the comparison group. Main outcome measures: Infertility diagnoses between ethnic groups. Results: A total of 358 women met inclusion criteria including 99 Black American, 110 Black Haitian, 61 Black African, and 88 White American women. Anovulation/polycystic ovarian syndrome (PCOS) was the most common diagnosis in each ethnic group, accounting for 40% of infertility among White American, 57% among Black American, 25% among Haitian, and 21% among African women. There were no significant differences in individual infertility diagnoses between Black and White women. Between ethnic subgroups, multivariate analysis showed significantly higher odds of infertility due to anovulation/PCOS in Black American women compared to African women (odds ratio [OR]=4.9; 95% CI=1.4-17.0). Compared to African women, higher odds of tubal factor infertility were observed in Black American (OR=4.7; 95% CI=1.16-18.7) and Haitian women (OR=4.0; 95% CI=1.1-14.0). Conclusions: Causes of infertility weren’t homogeneous across Black ethnic groups. Studies examining infertility should specify ethnic subgroups within race as this may affect results.

Aims: To investigate the characteristics of prescriptions during pregnancy from Beijing Prescription Comment System from 2016 to 2018. Methods: Data was extracted and selected in the system with key words according to inclusion criteria. We examined patterns and assessed risks with FDA category categorization. Factors associated to D/X, C, N/A categories were explored through multivariate logistic regression. We re-classified the drugs with Briggs categorization of B, C, D, N/A categories. Results: From 5,446,561 prescriptions of Beijing Prescription Comment System, 647 varieties of chemical or biomedical drugs with 112,566 prescriptions were finally included. The prescriptions majorly distributed on patients from 25 to 35 years (68.17%), in 1st and 2nd trimesters (75.05%). Drugs in FDA category were followed by B (23.83%), C (13.37%), X (6.17%), A (3.26%), D (1.7%), while 51.68% not available. In D/X categories, estrogens, assisted reproductive drugs and imaging testing drugs were most. Within X category, prescriptions showed an increase in women under 25 years from 216 to 2018. In drugs of D/X categories, gestational week under 12 weeks (OR=3.259, 95%CI, 1.441-7.37) matters most among risk factors of specialized hospitals, gestational age between 30 and 35, and non-obstetrics and gynecology departments. Under Briggs categorization, FDA category C contains more risk drugs in animal or human tests (74.25%) according to Briggs categorization. Conclusions: This research explored exposure of pregnant women to potential risk drugs by FDA category and Briggs categorization. Main characteristics and risk factors revealed by this study should be monitored in the ongoing studies on pregnancy drug safety.

Introduction: Ivermectin is a commonly used antihelminthic agent with over 35 years of established safety data in humans. Recent data demonstrates antiviral activity in vitro against SARS-CoV-2, in addition to a range of viruses. In vitro and animal models also provide evidence of immunomodulatory action. These additional modes of action are supported by in silico modelling, which propose a number of viral and host targets that would mediate these effects. Objectives: The aim of this study is to systematically review the published and preprint clinical literature and study results that assessed the potential role of ivermectin as a COVID-19 therapeutic and prophylactic agent. Methods: We conducted a comprehensive review of PubMed, medRxiv, ClinicalTrials.gov, Global Coronavirus COVID-19 Clinical Trial Tracker, World Health Organization International Clinical Trials Registry Platform, EU Clinical Trials Register, ANZ clinical trials registry, and references from relevant articles. PRISMA guidelines for systematic reviews were employed. Results: Search keywords- “COVID-19 (and synonyms) AND ivermectin”- generated 86 articles on PubMed, 48 on medRvix and 37 on clinicaltrials.gov at the time of writing. Twelve of these were listed as completed clinical trials and of these, 8 were included as investigators had released results. Positive mortality benefit, reduced time to clinical recovery, reduced incidence of disease progression and decreased duration of hospital admission were reported in patients across all stages of clinical severity. Limitations: Due to the time-critical nature of the COVID-19 pandemic our review included preprint data, which must be interpreted with caution while it awaits peer review.

Aims This study aimed to compare the efficacy and safety of high-power (HP) ablation to conventional power (CP) in patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation (AF). Methods and Results A systematic literature search was performed using the Medline and EMBASE databases up to February 2020 without language restrictions. Studies comparing HP (≥ 50W) with CP (≤ 40W) radiofrequency ablation (RFA) for circumferential PVI were included. The primary efficacy endpoint was the rate of freedom from AF recurrence. The first-class isolation rate, the percentage of acute pulmonary vein reconnections (PVR), RFA time, and procedure time were assessed as secondary efficacy outcomes. Safety was measured as the incidence of complications. In total, 10 eligible studies (2912 patients) were included. The rate of freedom from AF recurrence was similar between the two groups (odds ratio (OR): 1.34, 95% confidence interval (CI): 0.94－1.91; P = 0.10). The first-class isolation rate was significantly higher in the HP group (OR: 2.65, 95% CI: 1.72－4.09; P < 0.001). The HP group showed significantly less acute PVR (OR: 0.19, 95% CI: 0.07－0.49; P < 0.001). RFA time and procedural time were significantly shorter in the HP group. The percentage of pericardial tamponade was similar in both groups. Conclusions RFA with HP did not improve the rate of freedom from AF recurrence, but significantly shortened RFA time and procedure time with a significantly higher rate of first-class PVI and lower rate of acute PVR. The HP ablation strategy demonstrated a comparable safety profile to CP ablation.

Coronavirus disease-2019 which is caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread rapidly around the world. The most common symptoms of COVID-19 in children are fever, cough, and fatigue. Herein, we discuss a case of COVID-19 with a history of laryngomalacia who presented with croup.

Epichloë endophyte can protect drunken horse grass (Achnatherum inebrians)s from pest and livestock by producing alkaloids, which are attributed to very high level ergonovine and ergine. In this and other plants, biotic and abiotic stresses can trigger alkaloid production but the relationship between the concentration of ergot alkaloids and endogenous hormones and how do climate factors affect ergot alkaloid content were not studied. Here, we analyzed the relationship between alkaloid production, endogenous hormones and climate factors by Pearson’s method and best Structural Equation Modeling (SEM) model. We observed that ergot alkaloids (ergonovine, ergine and total alkaloid) contents of A. inebrians from twenty sites were positively correlated with jasmonic acid (JA) and ethylene (ET) (P < 0.01), negatively correlated with salicylic acid (SA) (P < 0.05). The ergot alkaloids contents were not significantly affected by climate factors (mean annual rainfall, altitude and mean annual temperature) (P > 0.05). The SEM model indicated that climate factors could indirectly affect the concentration of ergot alkaloids by influencing endogenous hormones levels. These results concluded that endogenous hormones had mainly impacts on ergot alkaloids levels of A. inebrians, whereas the effects of climate factors were limited.

Background: Paranasal sinusitis is frequently encountered in clinical practice. The application of imaging techniques has highlighted the high incidence of incidental sinus abnormalities. Additionally, the adverse impact of smoking on paranasal sinusitis has been verified; however, few studies have compared the characteristics of affected sinuses between non-smokers and smokers. This study aimed to assess the prevalence of paranasal sinusitis detected by magnetic resonance imaging (MRI) and determine its characteristics and affected sinuses in smokers. Methods: This cross-sectional study involved 4813 participants from two communities in Shanghai, China. Demographic data were recorded, and participants underwent a physical examination and head MRI. Logistic regression analysis was used to examine the relationship between smoking and paranasal sinusitis and the Cochran–Armitage test to analyze age-specific prevalence of paranasal sinusitis in smokers versus non-smokers. Results: Among the 4813 participants (2368 men, 2445 women; mean age, 53.0±10.1 years), the prevalence of paranasal sinusitis was 15.4 %, being higher in men (20.1 %) than in women (10.8 %; p<0.001). Paranasal sinusitis was significantly associated with smoking (adjusted OR=1.37, 95 % CI=1.10–1.70), and in smokers, it occurred most often in the maxillary sinus (19.1 %), followed by ethmoid (2.9 %), frontal (2.2 %), and sphenoid (1.8 %) sinuses. Conclusion: The prevalence of paranasal sinusitis was 15.4 % in Chinese adults aged 35–75 years. This gradually increased with age, reaching a peak at 55 years and stabilizing thereafter. In smokers, sinusitis occurred more often in the anterior nasal sinuses. (Clinical Trials. gov number: NCT00926172)

Introduction Real-world data on Omalizumab (OMA) and Mepolizumab (MEPO) can inform their use in severe asthma (SA). We studied patients in the Wessex AsThma CoHort of difficult asthma (WATCH) to: 1. Phenotypically compare OMA or MEPO treated patients against a SA, non-biologic group (SNB). 2. Assess clinical responses to OMA and MEPO. 3. Assess the spectrum of responses to these biologics. Methods We retrospectively phenotyped biologic naïve patients from WATCH (N=478) commenced on OMA (N=105) or MEPO (N=62) compared to SNB (N=178). Biologic response was gauged using standard criteria and response features were identified using logistic regression. Results OMA and MEPO patients were phenotypically distinct. Both drugs significantly reduced exacerbations, acute healthcare encounters (emergency department or hospital admissions), maintenance oral corticosteroid dose, and improved Asthma Control Questionnaire 6 (ACQ6) scores. OMA patients with more exacerbations at baseline (P=0.024), less acute healthcare encounters (P=0.050), and no anxiety (P=0.008) were more likely to respond to it. Lower baseline ACQ6 was independently associated with higher odds of MEPO response (P=0.007). Combined (OMA or MEPO) non-responders had significantly more psychological co-morbidities and worse baseline subjective disease markers compared to responder groups. Current criteria used to measure trial outcomes for MEPO, but not OMA, missed some modalities of response. Conclusion In a difficult asthma cohort, OMA and MEPO were used for distinct SA phenotypes, yet both were multidimensionally efficacious. Among these phenotypes, some clinical features associated with response were identified which emphasized the importance of addressing treatable traits when considering biologic therapy.

Background: Pleural effusion is the pathological accumulation of fluid in the pleural space. Pediatric pleural effusion usually present with a dynamic profile over time both in terms of its etiology and the causative organisms. This study aimed to provide a description of the clinic-etiological profile of these patients with an emphasis to identify the bacteriological spectrum of the pleural fluid for an appropriate, and timely management of these children. Objectives: To study the clinical profile of hospitalised children 0-19years with pleural effusion. Materials and methods: A prospective hospital based observational study was conducted on 133 children diagnosed with pleural effusion to study its etiology and clinic-bacteriological profile in a tertiary care hospital in north India. Results: The most common etiology of pleural effusion observed in the study was tuberculosis (21.1%) followed by empyema (20.3%). Maximum patients were in the age group of 6-12 years (36.8%) with males (54.1%) being affected more frequently affected. Exudative effusion was more common than transudative effusion. Fever and cough were the most common symptoms. Right sided effusion was more common (49.6%).Parenchymal disease was associated in 22.6% of the exudative effusion. The most common organism isolated was Staphylococcus aureus followed by Streptococcus pneumonia. Significant association was seen between age and the etiology of pleural effusion Conclusion: Pleural effusion in children can have varied etiologies and proper clinical history, examination and evaluation of the characteristics of pleural fluid can help in identifying the etiology of pleural effusion and selecting the best treatment approach for a favourable outcome.

Background: No pathogen-specific prognostic biomarkers are yet available for SARS-CoV-2. We sought to assess whether SARS-CoV-2 cycle threshold value (Ct) at diagnosis may predict COVID-19 severity, clinical manifestations and 6-month sequelae. Methods: Hospitalised and outpatient cases were randomly sampled from the diagnoses of March and data collected after 6 months by interview and from the regional database for COVID-19 emergency. Patients were stratified according to their RNA-dependent-RNA-polymerase Ct in the nasal-pharyngeal swab at diagnosis: group A≤20.0, 20.028.0. Disease severity was classified according to a composite scale evaluating hospital admission, worst oxygen support required and survival. Results: One-hundred sixty-eight survivors and thirty-two deceased patients were included: 27.5% in A and B both, 45.0% in C. 90% of patients were symptomatic and 63.7% were hospitalised. Median time from COVID-19 onset to swab collection was 5 days. Lethality, number of comorbidities, disease severity, type and amount of signs and symptoms, as well as 6-month sequelae inversely distributed among the groups with respect to SARS-CoV-2 Ct. After adjusting for confounding, SARS-CoV-2 Ct at diagnosis was still associated with COVID-19-related death (p=0.023), disease severity (p=0.023), amount of signs and symptoms (p<0.01) and presence of sequelae (p<0.01). Conclusions: Early quantification of SARS-CoV-2 along the course of the disease may be a useful predictive marker to inform differential strategies of clinical management and resource allocation.

PURPOSE: This study was conducted to explore the value of noninvasive assessment of bedside ultrasound in diagnosing cardiac changes of COVID-19. METHODS: We performed a retrospective study in 34 patients with COVID-19 and analyzed their clinical data, biochemistry test results (creatine kinase-MB [CK-MB], cardiac troponin I [cTnI] and C-reactive protein [CRP]), and parameters of cardiac ultrasound (left atrium [LA], left ventricular end-diastolic dimensions [LVDD], right atrium [RA], right ventricle [RV], main pulmonary artery [MPA], left ventricular ejection fraction [LVEF], tricuspid valve [TV], pulmonic valve [PV] and pulmonary artery systolic pressure [PASP]). We classified the patients based on their clinical symptoms: mild, moderate, severe, and critical groups, and compared the parameters. RESULTS: As the disease progressed, the parameters of both biochemical blood tests and cardiac ultrasound changed regularly, manifested as enlargement of LA, LVDD, RA, RV, and MPA and increase of PASP, CRP, CK-MB, and cTnI. Of these parameters, CRP, LA, LVDD, MPA, and PASP of the severe group were more notably elevated than those of the mild and the moderate groups (p<0.05). The critical group increased more markedly in CK-MB, cTnI, and RA than the other groups (p<0.05), and rose more sharply in CRP, LA, LVDD, RV, MPA, and PASP than the mild and the moderate groups (p<0.05). CONCLUSION: As the disease progressed, the patients had the enlarged heart with expanded pulmonary arteries and elevated PASP. Bedside ultrasound can be a noninvasive assessment of the above changes and a guidance of clinical treatment.

Background: Patients with Down syndrome (DS) are more likely to exhibit immunological abnormalities that predispose them to infection. Among other anomalies, individuals with DS have altered serum concentrations of some subclasses of Immunoglobulin G (IgG), particularly the IgG4 subclasses The aim of the present study was to investigate the molecular mechanism of low serum IgG4 at the level of the heavy chain gene (IGHG4). Method: Quantitative real-time polymerase chain reaction (qPCR) was carried out to measure the number of IGHG4 copies and to compare those outcomes with a reference gene (36B4). An IGHG4/36B4 ratio was considered normal (two copies of IGHG4) when between 0.8 and 1.2. We studied 44 DS patients from 8 to 57 years of age, comprising 23 DS persons carrying severe low serum IgG4 (< 0.02 g /L), with five having an IgG4 level that was not detectable, and 21 DS patients with normal serum IgG4 (level > 0.1 g /L). The patient group was compared with 38 healthy donors (controls) without DS. Result: IGHG4 heterozygous deletion was found in 16 (69.6%) DS patients with low serum IgG4 versus in two (9.5%) DS with normal serum IgG4 (P =0.0001). In the control group, deletion was found in 5.26% (2/38) of the sample. Conclusion: IGHG4 haploinsufficiency is highly correlated with low serum IgG4 in our population with DS, but other relevant factors must to be assessed in future work.

Abstract Objectives; to evaluate the quality of life among patients with chronic rhino sinusitis and the risk of developing depression. Design; An observation cross section study. Setting; the quality of life was assessed using 2-item sinonasal outcome test (SNOT-22) while Patient Health Questionnaire-2 (PHQ-2) used for screen of depression and Stress was analyzed using the Kessler Psychological Distress Scale (10 items representing five psychological distress traits were assessed with a five-point scale) Participants; 1072 patients with chronic rhino sinusitis. Main outcome measures; Influence of Chronic Rhino sinusitis on Quality of Life and Risk of Depression and Lost Productivity. Results; the level of quality of life affection was moderate in 159 (24.77%) and severe in 483 (75.23%) of participants with CRS. The mean score of PHQ-2 for assessing the risk of major depression was 4.17 + 1.74 in participants with CRS. 135 (21.03%) were normal (not at risk of major depression) and 507 (78.97%) were at risk of major depression. According to the Kessler Psychological Distress Scale: 759 patients (70.8%) were positive with a mean total perceived stress score of 16.92 ± 7.34, whereas 313(29.2%) were negative with a mean total perceived stress score of 6.08 ± 2.7. The difference was statistically significant Conclusions; Patients with CRS are at risk of depression, poor quality of life and bad work performance. Despite the supportive treatment that used to provide to such patients, a clinical comprehensive approach should be considered to relief the impact on patients’ quality of life.

Objectives: To search into aetiological factors of nuchal cord (NC). To understand its relation with amniotic fluid levels and perinatal outcome. Design: A prospective case-control study. Setting: Shree Hospital and Research Institute (SHRI), Kolhapur, India. Population of sample: 95 non-complimented singleton pregnant women. Method: Maternal age, socioeconomic status, education level, and parity were noted. They underwent ultrasonography at 34 weeks onwards. NC, if present, along with amniotic fluid index were reported. They were followed until parturition. Intrapartum assessment of liquor, APGAR, fetal need for oxygen, Neonatal Intensive Care Unit (NICU), gender, and birth weight were noted. Participants were divided into nuchal cord at birth (NCB) and the no-nuchal cord (NNCB) groups. Parameters were analysed. Result: NC incidence is highest in young (≤ 24 yrs), low socioeconomic status, higher education, primigravida, excess liquor, and male fetus. It causes reduction in liquor level, low fetal birth weight, low 1 min APGAR, extended oxygen (> 30 min), and NICU support. Conclusion: The epidemiological factors and excess liquor play an essential role in NC. It may be related to maternal stress. However, NC results in oligohydramnios, low birth weight, and fetal distress. The nuchal cord is not a physiological condition.

The angiotensin-converting enzyme 2 (ACE2) and main protease (MPro), are the putative drug candidates for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we performed 3D-QSAR pharmacophore modeling and screened 1264479 ligands gathered from Pubchem and Zinc databases. Following the calculation of the ADMET properties, molecular docking was carried out. Moreover, de novo ligand design was performed. MD simulation was then applied to survey the behavior of the ligand-protein complexes. Furthermore, MMPBSA was utilized to re-estimate the binding affinities. Then, a free energy landscape was used to find the most stable conformation of the complexes. Finally, the hybrid QM-MM method was carried out for the precise calculation of the energies. The Hypo1 pharmacophore model was selected as the best model. Our docking results indicate that the compounds ZINC12562757 and 112260215 were the best potential inhibitors of the ACE2 and MPro, respectively. Furthermore, the Evo_1 compound enjoys the highest docking energy among the designed de novo ligands. Results of RMSD, RMSF, H-bond and DSSP analyses have demonstrated that the lead compounds preserve the stability of the complexes’ conformation during the MD simulation. MMPBSA data confirmed the molecular docking results. The results of QM-MM showed that Evo_1 has a stronger potential for specific inhibition of MPro, as compared to the 112260215 compound. In conclusion, our results showed that the de novo designed Evo_1 compound has the potential to be used as a drug for the treatment of COVID-19; however, further in vitro and in vivo validations are required.

Objective: This article aimed to report the potential protective effect of BCG vaccine against COVID-19 by presenting the follow-up report of individuals who voluntarily receive BCG vaccination (BCG group). In this direction, preliminary data from BCG group regarding participants’ SARS-CoV-2 infection status, and the side effects with complications of BCG vaccination is reported. Method: A total of 84 health professionals and their relatives who voluntarily received BCG vaccine included in the study. Participants completed an online questionnaire that consists of 14 questions regarding their characteristics, SARS-CoV-2 infection status, and effects of BCG. Results: 63 participants were healthcare workers, and 21 participants were relatives of a healthcare worker. 81(96.4%) participants stated that they consider themselves in the high-risk group for getting infected with SARS-CoV-2. 69(82.1%) participants declared that they had been in the same environment and contacted with a COVID-19 patient. 82(97.6%) participants had at least one BCG scar from childhood. 21(25%) participants declared one complication after BCG vaccination. As a complication, 8(38.1%) participants had local non-permanent sterile abscess, and 13(61.9%) of them had weakness, joint pain, and subfebrile fever. 31(36.9%) participants had a PCR test for COVID-19 at least 4 weeks after BCG revaccination, and the results of all 31 participants were negative. 82(97.6%) participants declared that they felt more protected against COVID-19 after BCG vaccination. Conclusion: Results from this study suggest that it is beneficial to administer BCG vaccine to protect the high-risk group against COVID-19 with no side effects and risks.

Background: Treatment outcomes for children and adolescents with Hodgkin lymphoma (HL) have improved over the past few decades. Most patients achieve long-term remission with a five-year survival of approximately 90%, as reported by different treatment groups in developed countries. However, there are limited data on the outcome of patients treated in developing countries. Here we report the outcomes of children and adolescents treated at a comprehensive cancer center in Riyadh, Saudi Arabia. Procedure: A retrospective review of the medical records of all pediatric patients younger than 16 years who were diagnosed with HL from July 2006 through December 2017 was performed. Results: Of the 54 patients with HL, 70.37% were boys with a median age of 9 years (mean ± SD, 9.11 ± 3.30). A total of 51.85% had B symptoms and 33.33% had bulky disease. The nodular sclerosis type was the most common histological subtype (48.15%). In total, 74.07% of the patients presented with advanced stage III and IV disease. The three-years relapse-free survival rate was approximately 82%, and the three overall survival (OS) rate was more than 95%. Conclusions: Survival outcomes in children and adolescents with HL in Saudi Arabia have improved with a five‐year OS rate now exceeding 85%. However, further prospective larger collaborative studies are necessary.

Neuroleptic malignant syndrome(NMS) is a lethal idiosyncratic reaction characterized by fever, rigidity, altered sensorium and autonomic disturbances. Antidopaminergic drugs such as haloperidol, dopamine depletors like reserpine and atypical antipsychotics such as risperidone, are the major drugs implicated in NMS. Levosulpiride belongs to the benzamide class of antiemetics and is a blocker of dopamine(D2) receptors. The drug is available in India, Korea and some European countries. Here we present an interesting case of Levosulpiride associated neuroleptic malignant syndrome in an elderly female. The case also reflects how a minor difference in the brand names can produce a major debilitating cascade in geriatric patients.

Introduction: Prolonged mechanical ventilation may be associated with various complications. Checklists and protocols have been made to increase the success of weaning from ventilation and reduce the complications; however, adherence to same and outcomes are not well documented in resource-limited, high burden settings. This study was conducted to assess the current weaning practices and impact of implementation of evidence-based weaning protocol in a high-burden tertiary care ICU setting. Materials and methods: A quasi experimental (pre-test, post-test design) study was carried out in the medical ICU of a tertiary care centre between January 2016 and June 2017.The study was done in three phases, in which 50 patients were recruited in phase one and phase three. Phase two involved training and education of residents in protocol-based weaning. The compliance to various steps of the protocol-based weaning was assessed and outcome parameters were assessed and compared between phases one and three. Results: The baseline demographic profile and comorbidities of the patients in both the groups were comparable. The compliance to weaning protocol was low in various steps. There was a significant improvement assessment of readiness criteria, post-SBT assessment and pre-extubation screening in the post-intervention as compared to the pre-intervention phase. There was an increase in the proportion of patients who were successfully extubated from 50% to 66% (p=0.10). There was no significant difference in duration of mechanical ventilation (10 days vs 7.3 days, p= 0.61), ICU stay (9.2 vs 8.2 days, p= 0.57), as well as hospital stay between the two groups (16.1 vs 17.1 days, p= 0.45).Frequency of re-intubations decreased from 14% to 6% and ventilator associated pneumonia decreased from 34% to 18%. Conclusion: The study revealed low compliance to various parameters assessed as a part of weaning; however, training of resident doctors was successful in improving compliance with protocol-based weaning.