Astroblastoma is a rare central nervous system tumor. We reported a case of a 24-years-old Nepalese woman with radiological features mimicking pilocytic astrocytoma which came out to be low grade astroblastoma in histopathological and immunohistochemistry examination after total excision of the tumor.

An alternative system to the well known RGB, based on a decomposition into luminance and chrominance of the image, is introduced. This system, which we call LME is obtained from spherical-like change of coordinates. A theoretical analysis of LME system shows it robustness and overcomes some of the usual objections which appear in literature about this kind of nonlinear systems. An algorithm for color deconvolution based on LME decomposition is introduced in order to verify the quality of this model.

Aims Although minor climatic forest refuges were important as key areas for the long-term persistence of species and genetic diversity, and can again function as refuges during present and future climatic changes, they have received little attention in sub-Saharan Africa. The objectives in this paper were to assess the Togolese montane riparian forests as minor sub-Saharan forest refugia, examine the contribution of minor sub-Saharan forest refugia to the larger forest refugia using the Togolese montane riparian forests as a model, and discuss the implication of these results for biogeography and forest biodiversity conservation in sub-Saharan tropical Africa based on the floristic approach. Location Southwest Togo, West Africa, sub-Saharan Upper Guinea Region Methods Floristic data were collected across Togolese mountain riparian forests through an intensive botanical inventory using the survey approach (n=198; 50×10 m2). A comparative analysis was performed on the basis of floristic criteria and attributes related to climatic forest refuges. Results According to floristic attributes, the riparian forests of the subhumid Togolese mountains were important minor refuges for rainforests during Pleistocene warming. They share about 60% of their current species richness (868 species) with the large sub-Saharan forest refuges. Main conclusions The floristic data were similar to that of previous studies focusing on the forest refugia around the DG and elsewhere worldwide. However, they seem to be incompatible with the ideas that the DG forest flora may be essentially a relic of the early Holocene, when the geographical distribution of the Guinean-Congolian forest was maximum. Efforts to maintain maximum species diversity in sub-Saharan Africa should therefore pay particular attention to the conservation of minor forest refugia. This study asks important questions about the patterns of disjunction, which should be focused on in further studies. Keywords Tropical biodiversity, Forest refuges, Floristic approach, Dahomey Gap (DG), Togolese Mountain, Vegetation

“Letter to the Editor: Emergency surgical treatment of total anomalous pulmonary venous connection”Dr Muhammad SohaibaaDepartment of Medicine, Allama Iqbal Medical College, Lahore, PakistanDr Arsalan NadeemabDepartment of Medicine, Allama Iqbal Medical College, Lahore, Pakistan

As growth of the elderly population continues to increase alongside improvements in percutaneous and minimally invasive interventions, cardiac surgeons question the role of high-risk surgery in treating these patients. TAVR has transformed the management of symptomatic severe aortic stenosis in elderly patients, and has become standard therapy for patients greater than 80 years of age. With improvements in procedural risks and technical complications for both transcatheter valves and percutaneous interventions, should we rethink the operative strategies for octogenarians and nonagenarians, particularly as they apply to concurrent high-risk operations?

The incidence of stroke after coronary artery bypass grafting (CABG) is around 1.3% in the Society of Thoracic Surgeons database but carries a mortality of almost 20% (1,2). The stroke rate is even higher with aortic valve replacements with the Determining Neurologic Outcomes from Valve Operations (DeNOVO) study reporting stroke rates as high as 17% (3). It is also likely that variations in definition of stroke leads to underreporting of this event. There is thus, no denying that stroke remains the Achilles heel of cardiac surgery and efforts must be made to mitigate its occurrence.

TITLE PAGETOPIC : “Letter to the Editor: Surgical Treatment of Primary Cardiac Tumors in the Contemporary era: A single-centre Analysis.”ARTICLE TYPE : LETTER TO THE EDITORCORRESPONDANCE :1. Name : Taha NadeemInstitute : ALLAMA IQBAL MEDICAL COLLEGE,LAHORE,PAKISTANContact : +923107033138 E-mail : Tahamodellian786@gmail.comAddress : House# 451, Jinnah Colony, Faisalabad,PakistanCO-AUTHORS: 2. Name : Fatima TanveerInstitute : ALLAMA IQBAL MEDICAL COLLEGE, LAHORE, PAKISTAN.Contact : +923468789469 E-mail : Fatimatanveer990@gmail.comAddress : House#101,Street 10,Block C, Canal Town, Gujranwala ,Pakistan.3. Mahima KhatriContact: +923472651872 Email: mahimakhatri12333@gmail.comInstitute: Dow University of Health Sciences, KarachiAddress: bridge view apartment, frere town, clifton block 8 karachi, 75600Word count: 442Conflict of interest: NoneDeclaration: NoneAcknowledgment: None

A document by Bilawal Nadeem. Click on the document to view its contents.

Possible theoretical basis for the hypothesis of prohibition of some electron configurations in atoms and molecules presented by one of the authors earlier is considered. Existence of such prohibited configurations follows from the wave function antisymmetry of atoms and molecules. Our hypothesis is as follows: the configurations, in which the potentials of any two electrons with the same spins are equal, are forbidden. If the hypothesis comes true, it will be possible to find the nodal surfaces of many-electron wave functions for atoms and molecules analytically a priori.

Mitigating soil nutrient depletion and increasing utilization efficiency is a prerequisite of sustainable agriculture. Therefore, a field experiment was carried out for 2 years in the midland agroecology of Ethiopia, to identify soil amendment types that can improved soil nitrogen (N) and phosphorus (P) balances at the same time maximize utilization efficiency and profitability under teff cultivation. Using RCBD with three replications, the soil amendments applied on the degraded acidic farmland plots were polyacrylamide (PAM = 40 kg ha−1), biochar (B = 8 t ha−1), lime (L = 4 t ha−1), gypsum (G = 5 t ha−1), PAM+B, PAM+L, PAM+G, and a control. N and P inflows from (atmospheric deposition, biological fixation, and fertilizers), and outflows by (water erosion, leaching, gaseous emissions, and harvested products) were monitored in the 24 plots via NUTrient MONitoring model. Results showed that all of the applied soil amendments improved nutrient balances (by 8–134%) compared with the control. Of the measured outflows, harvested products (43–60%) and water erosion (14–31%) were the major contributors to N depletion, followed by leaching (15–23%) and gaseous emissions (11–13%). Among the applied soil amendments, PAM+L appreciably reduced P loss from water erosion by 61% and N losses from erosion, leaching, and emissions by 55%, 10%, and 3%, respectively, and increased N use efficiency by 31% compared to control plot. Moreover, PAM+L provided a net benefit much higher compared with others. Thus, application of PAM+L would be an effective strategy to combat nutrient depletion and foster crop production in dryland agriculture.

Ductopenia is often regarded as a chronic process where ≥50% of portal tracts lack bile ducts, which is also known as vanishing bile duct syndrome (VBDS). One etiology is drug-induced liver injury. Cloxacillin, an anti-staphylococcal penicillin, typically causes “bland” cholestasis. We present the first case of cloxacillin-induced acute ductopenia or VBDS and a review of published cloxacillin-induced liver injuries. A 66-year-old woman with no prior liver disease, but known penicillin allergy, was treated for post-carotid angioplasty staphylococcal infection with 6 weeks of cloxacillin. She presented with a two-week history of weakness and jaundice. Laboratory work-up showed elevated liver enzymes, hyperbilirubinemia, and eosinophilia. She required ICU transfer for hypotension and was started empirically on prednisone. Liver biopsy revealed severe centrilobular cholestasis, mild necroinflammation, and ductopenia with epithelial injury, but no ductular reaction. Two-months later, she was discharged on hydrocortisone and ursodiol with persistently elevated alkaline phosphatase and bilirubin. She was considered for liver transplantation but died of liver failure four months later. Four additional articles were found with histopathologic descriptions of cloxacillin-related liver injury. These included portal inflammation, cholestasis and mild necroinflammation. Clinical features were reported in two cases; both had mild symptoms with cholestatic liver enzymes and hyperbilirubinemia. Both patients recovered completely within 10-60 days. Cloxacillin-induced cholestasis can be secondary to acute ductopenia, which can result in worse clinical outcomes than previously described “bland” cholestasis. Liver biopsy is recommended to identify cases with acute VBDS.

Lumbosacral agenesis is a rare and complex malformation characterized by a total or partial absence of the lumbosacral vertebrae. It is often associated with other malformations. Its etiology is poorly understood but factors such as gestational diabetes, genetic abnormalities and environmental factors are incriminated.

We report a rare case of a 50-year-old female with covid19 presented to the emergency department where supplementary oxygen is delivered via non-invasive face mask ventilation. x-ray imaging performed the existence of pneumoperitoneum. CT scan was not applicable due to the advanced status of the paient.

We described a rare presentation of synchronous extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma and invasive ductal carcinoma of the breast. This case highlights that one should keep an open mind to the possibility of synchronous multiple primary neoplasms in patients with carcinoma.

Nasopharyngeal teratomas (NPT) are rare and represent only 2% of all teratomas. They can lead to an embryopathogenic mechanical obstacle responsible for a cleft palate (CP). We report the case of a 14-month-old female with NPT associated with a CP.

Total intracranial shunt migration is an extremely rare complication following ventriculoperitoneal shunting and it occurs probably due to raised intra-peritoneal pressure, strong head movements, and inadequate shunt fixation. The best possible approach to prevent shunt migration would be better patient handling along with appropriate operative techniques.

The outcome of hybridization is of major interest in evolutionary and conservation biology. Here, we investigate (i) the genomic signal of the hybridization dynamics, (ii) the strength of reproductive barriers preventing copulation in heterospecific and hybrid crosses, and (iii) the population dynamics (stability of species proportions) of the two damselfly species Ischnura elegans and I. graellsii in two differently aged Spanish hybrid regions. RAD sequencing in these hybrid regions and in allopatric populations was used to generate 5,702 SNPs to quantify population diversity and population differentiation, and a subset of 381 species-specific SNPs to analyze individual ancestry and the proportion of individuals in different hybrid classes. Our individual ancestry results showed the presence of F1 and F2 hybrids, in line with on-going hybridization and bidirectional backcrossing in both hybrid regions, with almost complete absence of genetically pure I. elegans and I. graellsii. Different admixture-class distributions were in part explained by 1) different mean strength of reproductive barriers in the hybrid regions, with stronger barrier in the older hybrid region, 2) local dynamics (continuous recolonization events), 3) proximity to introduction site, and 4) time elapsed since colonization. Consistent with theoretical expectations, introgression maintained (in the younger hybrid region) or increased genetic diversity (in the older hybrid region), and reduced genetic differentiation between local populations in both hybrid regions. Whether this will facilitate the ongoing range expansion of I. elegans in Spain is an interesting avenue for future research.

Automating the generation of suitable kinetic models could dramatically improve its application to novel reactions. Therefore, a software tool was developed to automatically propose rate equations for a catalytic reaction, purely based on experimental data. The tool screens theoretical initial rate equations by comparing the trends predicted by theoretical equations (from a comprehensive library) with those present in the experimental data, thus eliminating the rate equations that cannot reproduce the trends in the data. Afterwards, the kinetic models associated to the feasible rate equations are ranked based on trend similarity, resulting in an ordered list of models ready for regression. For most of the tested literature datasets, the tool proposed the same rate equation as experienced researchers. This is a key first step into the automation of kinetic modelling that, once generalized, will allow to its widespread use in the understanding of catalytic reactions.

Author: Jaspreet Garcha – Deputy Postnatal Ward Manager at UHCW and Mary Seacole BAME Aspirant Leaders Programme ParticipantJaspreet.garcha@uhcw.nhs.uk

We reported a case of 68-year-old man suffering from follicular mucinosis. The dermoscopic examination showed multiple round brownish yellow dots with a whitish rim in the follicular ostium and red dots in the interfollicular area. This case report at first suggests that follicular mucinosis may show such dermoscopic findings.

The simultaneous occurrence of lichen planus in the mouth and on the scalp is rare in clinical practice. The dentist can play an important role in early diagnosis and immediate referral to a dermatologist to slow the progression of hair loss.

Although the extraordinary complex malocclusions and vulnerable periodontal status pose great challenges to orthodontists, orthodontic treatment combined with periodontal therapy is essential for patients with severe periodontitis and pathologic tooth migration. This case report describes the multidisciplinary orthodontic treatment of an adult with severe periodontitis.

Objective: To compare the laparoscopic enclosed electromechanical morcellation (LEM) with vaginal enclosed scalpel morcellation (VSM) in laparoscopic myomectomy procedures. Design: Prospective randomized interventional clinical study. Setting: Tertiary university hospital. Population or Sample: One hundred eighteen patients who underwent laparoscopic myomectomy. Methods: All myomectomy procedures were performed laparoscopically. After myomectomy, tissue removal was accomplished via either LEM using the previously described in-glove morcellation technique or VSM. In the VSM group, myoma was placed into an endoscopic bag and removed through the vagina via posterior colpotomy after scalpel morcellation. Main Outcome Measures: Primary outcome: tissue removal time. Secondary outcome: rescue analgesia requirement, postoperative Visual Analog Scale (VAS) scores, postoperative 3th month scores of Female Sexual Function Index (FSFI). Results: The median tissue removal time was longer in the LEM group (25 min (Range: 14-55)) than the VSM group (20 min (Range: 6-38) (p=.001). Rescue analgesia requirement was significantly higher in the LEM group than the VSM group (mean rank: 56.92 vs 40.92 doses, respectively; p<.001). There was no significant difference between the groups at postoperative VAS scores. There was no significant difference between preoperative and postoperative 3th month total scores of FSFI and subdomains in the LEM group. Conversely, all subdomains and total scores of FSFI (26.5 (16.7-34.8) vs. 22.7 (15.2-28.7) except pain significantly worsened three months after operation in the VSM group. Conclusion: LEM was associated with a longer tissue removal time and increased postoperative analgesic requirement. On the other hand, VSM was associated with worsened postoperative sexual function from baseline.

Attachment of one electron to 1,2-diBeX-benzene and 1,2-diZnX-benzene derivatives leads to the formation of stronger Be-Be and Zn-Zn interaction. This is reflected in the dramatic shortening of the Be-Be and Zn-Zn distance. The formation of these 2-center-1-electron bonds have also been confirmed by topological survey of electron density using quantum theory of atoms in molecules and electron localization function. The formation of these bonds is expected to render stability to these radical anions. These radical anions are stable towards electron detachment and computed bond dissociation energy values are also significant.