Mongolia and Eastern Siberia, Russia are border regions in Asia with high incidence of tuberculosis (TB). In this study, we aimed to investigate MDR -TB transborder transmission with a focus on endemic and epidemic Mycobacterium tuberculosis clones and drug resistance patterns. M. tuberculosis strains (291 from Mongolia and 754 from Russia) were collected within cross-sectional population-based surveys in 2010-2016. DNA was genotyped in 24 MIRU-VNTR loci and by PCR testing of the key SNP markers to discriminate within Beijing genotype. In total, 1045 isolates were divided into 435 MIRU-types that were assigned to Lineage 2 (Beijing isolates) and Lineage 4 (Ural, Haarlem, Latin-American-Mediterranean [LAM], S, and unclassified isolates). Beijing genotype was dominant in both countries, but most of Russian and all Mongolian Beijing strains belonged to different subtypes of the modern Beijing sublineage with only negligible overlap between the two countries. In particular, the Beijing types #342-32, #3819-32, #1773-32 (Asian African 2 group) were found only in Mongolia. LAM was the most common non-Beijing genotype (11.0% in Mongolia and 14.7% in Russia) and its isolates mostly belonged to LAM-RUS branch. MDR rate was higher in Russia compared to Mongolia among newly diagnosed patients: 29.4% versus 4.2% (p < 0.001) but similar and high in the retreatment subgroups (65.8% and 67.4%, respectively). In Russian collection, a higher MDR rate was observed in (i) Beijing compared to non-Beijing (47.5% versus 38.8%, p = 0.03), (ii) Beijing B0/W148 subtype compared to Beijing Central Asian/Russian subtype (64.5% versus 39.3%, p <0.001). In Mongolia, MDR rate was similar in Beijing (29.7%) and non-Beijing (27.5%) genotypes. In conclusion, population structures of the Beijing genotype in Mongolia and Russian borderline regions differ significantly including specific patterns of drug resistance. In contrast, largely overlapping LAM subtypes may correlate with historical endemic circulation of the LAM-RUS branch in Northern Eurasia.

A document by Jost Klawitter. Click on the document to view its contents.

H6H6 subtype avian influenza virus (AIV) is currently prevalent in wild birds and poultry. Its host range has gradually expanded to the mammals, such as swine. Some strains of H6N6 AIV have even acquired the ability to bind to human-like receptors SA-α2, 6Gal, thus increasing the risk of animal-human transmission. To investigate whether H6N6 AIV can cross interspecies barriers from poultry to mammals and even humans, we assessed the molecular characteristics, receptor-binding preference, replication in mice, and the human lung of three chicken-originated H6N6 strains. Among the three chicken-originated H6N6 strains, A/CK/ZZ/346/2014 (ZZ346) virus with P186T, H156R, S263G mutation of hemagglutinin (HA) showed the ability to bind to avian-like SAα-2,3Gal and human-like SAα-2,6Gal receptors. Moreover, H6N6 viruses, especially the ZZ346 strain, could replicate and infect mice and human lungs. Our study detected the H6N6 virus favorable to bind to both avian-like SAα-2,3Gal and human-like SAα-2,6Gal receptors, verified its ability to cross the species barrier to infect mice, and verified to infect human lungs without prior adaptation. This study emphasizes the importance of continuous and intense monitoring of the evolution of the H6N6 virus in the terrestrial bird.

Introduction. Dietary habits in developing countries are characterized in the last decades by low intake of fruits, vegetables, and high consumption of sweetened drinks. Most of the evidence linking carbohydrate intake and asthma comes from children over 6 years of age. The aim of this study was to examine the association of macronutrient intake with the severity of wheezing exacerbation in children aged 2 to 6 years Methods. We performed a prospective cohort study that included all children aged 2 to 6 years hospitalized by a wheezing exacerbation in two tertiary centers in Rionegro, Colombia. Dietary data were collected using a food frequency questionnaire (FFQ) validated in the Colombian population. Gina classification of acute wheezing in children 5 years and younger was to define the severity of the wheezing Results During the study period, 228 cases of patients with wheezing exacerbation were included. Wheezing severity was dose-dependently associated with protein and carbohydrate-rich intake. The variables included in the multivariable analysis included reactive C protein, smoking at home, atopic dermatitis, protein, and carbohydrate-rich food intake Conclusion High carbohydrate-rich food intake was associated with severity of wheezing exacerbation adjusted by other known risk factors such as atopic, smoking, and reactive C protein. Also, we found a negative association of severity of wheezing exacerbation with high protein-rich food intake adjusted by the factors mentioned above. This evidence should motivate the development of public health policies to control the consumption of sugar-rich products in children under 6 years of age.

Dose escalation to target volume during High Dose Rate brachytherapy was effectively employed to treat locally advanced cervical cancer patients who experienced prolongation of overall treatment time (OTT) due to the COVID-19 pandemic. It was tried to achieve acceptable oncological outcomesو while respecting the dose constraints of organs at risk.

This case report demonstrate concurrent of two rare complications of true silent inferior STEMI in the poorly controlled diabetic patient with de-novo heart failure, mimicking congenital VSD.This complication of myocardial infarction often have catastrophic manifestations and the presence of this complications of MI with smooth course is very scarce

This paper deals with an initial-boundary value problem of the planar compressible Hall-magnetohydrodynamic (for short, Hall-MHD) equations. For the fixed shear viscosity and Hall coefficients, it is shown that the strong solutions of Hall-MHD equations and corresponding MHD equations are global. As both the shear viscosity and the Hall coefficients tend to zero, the convergence rate for the solutions from Hall-MHD equations to MHD equations is given. The thickness of boundary layer is discussed by spatially weighted estimation and the characteristic of boundary layer is described by constructing a boundary layer function.

Background Bicuspid pulmonic valves are quite uncommon, being described in only 0.1% of donor hearts, while pulmonary artery aneurysms are even more rare, having been found in 8 out of 109,571 autopsies. This rarity makes it difficult to characterize the relationship between them. Materials & Methods We describe the case of a 66-year-old female who was found to have a bicuspid pulmonic valve and pulmonary artery aneurysm (5.1cm) on imaging by her cardiologist. Discussion & Conclusion This case raises the question of whether the association between bicuspid semilunar valve disease and vascular wall anomalies are more genetic or hemodynamic. Even on the aortic side, despite the robust association between bicuspid aortic valves and thoracic aortic aneurysms, the mechanism still remains unclear. In our patient there was no significant gradient across the bicuspid pulmonic valve, suggesting that hemodynamics are not the primum mobile of this association.

Dobhoff tubes, used for post-pyloric feedings, have a weighted metal end with a small diameter that enhances their flexibility to traverse the gastrointestinal tract. Unfortunately, the metal stylet can iatrogenically perforate surrounding structures in patients with diminished cough and gag (1); and extreme caution should be considered before its utilization.

Unidirectional cavo pulmonary shunt supplemented with systemic to pulmonary arterial shunt is often necessary for palliation of single ventricle with unilateral hypoplasia of a pulmonary artery. In rare instances, the adequately sized pulmonary artery is on the contralateral side as the superior caval vein making this anastomosis challenging. This report describes the operative technique involved in construction of the right superior caval vein to left pulmonary artery anastomosis.

Aim To describe the antiepileptic drug (AED) prescription pattern in pregnant women and women of childbearing age in the 2010-2019 period in the Lombardy region, Italy. Methods The Lombardy region administrative healthcare databases (2010-2019) were analysed. AEDs were classified as drugs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System. Women 15-49 years old were considered as women of childbearing age, while exposure during pregnancy was estimated taking into account the 12 months before delivery (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-9-CM codes in the diagnosis record from 650 to 659). Results During 2019, 16,605 women of childbearing age (prevalence: 14.8‰) received at least one AED prescription. Pregabalin was the most widely used antiepileptic in women of childbearing age (22.3%), followed by valproic acid (20.0%). The prevalence of AED prescription in pregnant women was 3.8‰, and levetiracetam and lamotrigine (16.6%) were the most commonly prescribed drugs. The prevalence of AED prescription did not change from 2010 to 2019 in women of childbearing age or in pregnant women. Valproic acid was one of the most used AEDs in pregnancy until 2016, after which its prescription declined from 19% to 14% of AED users. Conclusions Despite the decrease in valproic acid prescription over time, this drug is still among the most used AEDs, in particular in women of childbearing age. Educational interventions for healthcare professionals and women are needed in order to reduce the risk of unplanned pregnancy.

Introduction Catheter ablation is an established therapy for rhythm control in patients with drug-refractory atrial fibrillation (AF), however, recurrence is frequent particularly in persistent AF. There are no consistently confirmed predictors of AF recurrence after catheter ablation. Therefore, we aimed to study whether LAA volume (LAAV) and function influence the long-term recurrence of AF after catheter ablation, depending on AF type. Methods AF patients who underwent point-by-point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis. LAAV and LAA orifice area were measured by CT. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence. Results In total, 561 AF patients (61.910.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 9.3-43.1 months. Patients with persistent AF had significantly higher iLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment left ventricular ejection fraction (LVEF) <50% (HR=2.17; 95%CI=1.38-3.43; p<0.001) and LAAV (HR=1.06; 95%CI=1.01-1.12; p=0.029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF. Conclusion The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF.

Generalist predators exploit multiple food sources and it is economical for them to reduce predation pressure on a particular prey species when their density level becomes comparatively less. As a result, a prey-predator system tends to become more stable in the presence of a generalist predator. In this article, we investigate the roles of both the diffusion and nonlocal prey consumption in shaping the population distributions for interacting generalist predator and its focal prey species. In this regard, we first derive the conditions associated with Turing instability through linear analysis. Then, we perform a weakly nonlinear analysis and derive a cubic Stuart-Landau equation governing amplitude of the resulting patterns near Turing bifurcation boundary. Further, we present a wide variety of numerical simulations to corroborate our analytical findings as well as to illustrate some other complex spatiotemporal dynamics. Interestingly, our study reveals the existence of traveling wave solutions connecting two spatially homogeneous coexistence steady states in Turing domain under the influence of temporal bistability phenomenon. Also, our investigation shows that nonlocal prey consumption acts as a stabilizing force for the system dynamics.

Background and purpose. Venomous animals express numerous Kunitz-type peptides. The mambaquaretin-1 (MQ1) recently identified from the Dendroaspis angusticeps venom is the most selective antagonist of the arginine-vasopressin V2 receptor (V2R) and the unique Kunitz-type peptide active on a GPCR. We aimed to exploit other mamba venoms to enlarge the V2R-Kunitz peptide family and get insight into the MQ1 molecular mode of action. Experimental approach. We used a bio-guided screening assay to identify novel MQs and placed them phylogenetically. Several newly identified MQs were produced by solid phase peptide synthesis. They were characterized in vitro by binding and functional tests andin vivo by diuresis measurement in rats. Key results. Eight additional MQs were identified with nanomolar affinities for the V2R, all antagonists. MQs form a new subgroup in the Kunitz family, close to the V2R non-active dendrotoxins and to 2 V2R active cobra toxins. Sequence comparison between active and non-active V2R Kunitz peptides highlighted 5 specific V2R positions. Four of them are involved in V2R activity and belong to the 2 large MQ1 loops. We finally determined that 8 positions, part of these 2 loops, interact with the V2R. The variant MQ1-K39A showed specificity for the human versus the rat V2R . Conclusions and implications. A third function and mode of action is now associated with the Kunitz-peptides. The number of MQ1 residues involved in V2R binding is large and may explain its absolute selectivity. MQ1-K39A represents the first step in the improvement of the MQ1 design for medicinal perspective.

In this research, an integrated pest management model using impulsive differential equations has been investigated for Jatropha curcas plantation to control its natural pests through relying on the release of infective pest individuals and spraying of chemical pesticides. Using Floquet’s theory and the small amplitude perturbation method, it is obtained that there exists an asymptotically stable susceptible pest eradication periodic solution when the release amount of infected pest is larger than the critical maximum value (or strength of chemical pesticide spraying is larger than some critical maximum value). Also, we have established the permanence of the system. After comparison, it is explored that integrated pest management is more effective than biological control or chemical control. Finally, verify the analytical results through numerical simulation.

The present paper studies a fractional-order SEIR epidemic model for the transmission dynamics of infectious diseases such as HIV and HBV that spreads in the host population. The total host population is considered bounded, and Holling type-II saturation incidence rate is involved as the infection term. Using the proposed SEIR epidemic model, the threshold quantity, namely basic reproduction number R0, is obtained that determines the status of the disease, whether it dies out or persists in the whole population. The model’s analysis shows that two equilibria exist, namely, disease-free equilibrium (DFE) and endemic equilibrium (EE). The global stability of the equilibria is determined using a Lyapunov functional approach. The disease status can be verified based on obtained threshold quantity R0. If R0 < 1, then DFE is globally stable, leading to eradicating the population’s disease. If R0 > 1, a unique EE exists, and that is globally stable under certain conditions in the feasible region. The Caputo type fractional derivative is taken as the fractional operator. The bifurcation and sensitivity analyses are also performed for the proposed model that determines the relative importance of the parameters into disease transmission. The numerical solution of the model is obtained by the generalized Adams- Bashforth-Moulton method. Finally, numerical simulations are performed to illustrate and verify the analytical results.

The intention of this exertion is to inspect the flow heat and mass transfer of unsteady magnetite Casson nanofluid over a wedge. The peak theme of thermal radiation and chemical reaction are also incorporated. Slip effects are also assumed near the surface of the wedge along with the convective boundary restrictions. The governing equations are transmuted into dimensionless form first, the famous shooting technique is implemented. The obtained numerical outcomes are exhibited through graphs and tables. Fascinating features of various emerging parameters in flow, heat and nanoparticle concentration are discussed.

The time-fractional Gardner Burger (TFGB) equation is an efficient model for studying nonlinear fluctuations of different types of wave profiles, such as the gravity solitary waves in the ocean, ion-acoustic wave (IAW) in a plasma environment, etc. Here, to build an example of the existence of the classical Gardner Burger (GB) equation, a multi-component plasma environment is considered and a classical GB equation is derived by employing reductive perturbation technique (RPT) from the basic governing equation. Further, the classical GB equation is converted into the TFGB equation by applying Agrawal’s approach, where the Riesz fractional derivative is adopted on the time-fractional term. A new approach using the improved Bernoulli sub-equation function method (IBSEFM) is carried out to solve the TFGB equation. Finally, some $2D$ and $3D$ graphs are plotted through which the physical structures of the solution are explored and the effect of the Burgers term and fractional order of the equation are determined.

Objetives. To perform a description of the etiology of hospitalized children with community-acquired pneumonia (CAP) in Spain and analyze predictors related to etiology. Hypothesis. The different etiological groups of pediatric CAP are associated to different clinical, radiographic and analytical data. Design. Observational, multi-center, prospective study. Patient selection. Patients from 1 month to 17 years admitted because of CAP from April 2012 to May 2019. Methods. An extensive microbiological workup was done. Clinical, radiographic and analytical parameters were analyzed in order to differentiate viral, atypical bacteria (AB) and typical bacteria (TyB) pneumonia. Results. 495 children were enrolled. At least one likely causative pathogen was identified in 262 (52.9%). Pathogenic viruses in 155/262 (59.2%), AB in 84/262 (32.1%) and TyB in 40/262 (15.3%). Consolidation was found in 89/138 (64.5%) CAP attributed to virus only, in 74/84 (88.1%) of CAP attributed to AB and 40/40 (100%) of CAP attributed to TyB. Para-pneumonic pleural effusion (PPE) was found in 112/495 (22.6%) patients, 61/112 (54.5%) with a likely causative pathogen: virus 12/61 (19.7%), AB 23/61 (37.7%) and TyB 26/61 (42.6%). Viral etiology was significantly more frequent in younger patients and those with lower oxygen saturation, wheezing, no-consolidation and higher lymphocyte counts. Patients with AB were significantly more likely to have more days of fever at admission and a higher rate of use of antibiotics before admission. Conclusions. Viruses and AB are the main cause of pediatric CAP in Spain. Wheezing, younger age and no-consolidation on the X-ray support viral etiology. Viruses and AB can also cause PPE. The use of antibiotic in pediatric CAP can be restricted.

Background: Radiofrequency ablation(RFA) has emerged as a common approach to treatment of atrial fibrillation(AF) coupled with valve surgery. However, risk factors were rarely reported on recurrence after RFA of valvular atrial fibrillation . Methods: Retrospective study of a single-center database was performed in patients underwent valvular surgery combined with radiofrequency ablation. Follow-up was conducted from 3 months to 1 year after procedure. AF recurrence was defined as any episode of atrial arrhythmia lasting more than 30 seconds. Risk factors were analysis using Logistic regression and a predictive model was established. Results: 3-month follow-up was completed in 319 patients, 195 patients (61.1%) had AF recurrence. During the 1-year follow-up, 74 /166 patients(44.6%) had AF recurrence. Compared with sinus rhythm maintenance group, overweight(p=0.022), high BMI(p=0.024), large preoperative LAD(p<0.001), small MI area(p=0.019), large MI diameter(p<0.001) and other liver function parameter like low ALT level(p=0.023), high total bilirubin(p=0.013) and direct bilirubin level(p=0.033) were significantly correlated with AF recurrence after RF. In multivariate analysis, BMI(OR 1.12, 95% CI 1.04-1.21, p=0.003), LAD(OR 1.49, 95% CI 1.09-2.07, p=0.015), MI area(OR 0.41, 95% CI 0.18-0.85, p=0.023), MI diameter(OR 2.45, 95% CI 1.16-5.34, p=0.021), ALT(OR 0.98, 95% CI 0.97-0.99, p=0.002) and eGFR(OR 1.01, 95% CI 1.09-1.02, p=0.042) were significantly independent risk predictors of AF early recurrence. A predictive model was created with AUC of 0.720. Conclusions: BMI、LAD、MI area、MI diameter、ALT and eGFR were risk predictors of AF early recurrence. We established a predictive model and it devote to preoperative clinical health management of individual with valvular AF.

Background: Postpartum Haemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide, and the rate is increasing. Using a reliable predictive model could identify those at risk, support management and treatment, and improve maternal outcomes. Objectives: To systematically identify and appraise existing prognostic models for PPH and ascertain suitability for clinical use. Search strategy: MEDLINE, CINAHL, Embase, and the Cochrane Library were searched using combinations of terms and synonyms including ‘postpartum haemorrhage’, ‘prognostic model’, and ‘risk factors’ that were developed from a scoping review. Selection Criteria: Observational or experimental studies describing a prognostic model for risk of PPH, published in English. Data Collection and Analysis: The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist informed data extraction and Prediction Model Risk of Bias Assessment Tool guided analysis. Main Results: 16 studies met the inclusion criteria after screening 1612 records. All studies were hospital settings from 8 different countries. Models were developed for women who experienced vaginal birth (n=7), caesarean birth(n=2), any type of birth(n=2), hypertensive disorders(n=1) and those with placental abnormalities(n=4). All studies were at high risk of bias due to use of inappropriate analysis methods or omission of important statistical considerations or suboptimal validation. Conclusions: No existing prognostic models for PPH are ready for clinical application. Future research is needed to externally validate existing models and potentially develop a new model that is reliable and applicable to clinical practice. Funding: This study received no funding. Keywords: Postpartum haemorrhage, prognostic model, prediction tool.

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use. Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices. In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.

Wheezing is often occurred in infants and young children with respiratory infections. For children with recurrent wheezing, after controlling their wheezing, they should be alert to rare diseases. Here, We report a case of wheezing following the application of the patent ductus arteriosus occlusion device ADOII (AGA Medical Corporation, Golden Valley,MN) with the occlusion device pressing against the inner diameter of the adjacent left main bronchus. After the pressure end of the occluder was removed, the child’s wheezing was effectively relieved

Background: Lung ultrasound (LUS) has been shown to be a useful clinical tool in pediatrics. LUS has been well studied in other respiratory conditions, but very little is known about the LUS findings of asthma. Objectives: The primary objective was to characterize LUS findings of pediatric patients before and after a chemically-induced bronchospasm. The secondary objective was to evaluate the effect of bronchodilators on the LUS findings. Methods: Eligible patients 6 to 17 years old presenting for a methacholine challenge test (MCT) in a pediatric respiratory clinic were recruited. LUS was performed before and after the MCT as well as after bronchodilator administration. LUS were analysed by an expert blinded to the patient characteristics and MCT results. Results: 44 patients were included in the study. 5 patients had positive LUS findings at baseline. 15 patients had a positive LUS following the MCT. There was a significant association between having a chemically-induced bronchospasm and a positive LUS post-MCT (p=0.05, odds ratio 5.3, 95% CI [1.0-27.7]) . Among patients who developed positive LUS findings post-MCT, 4 out of 9 returned to having a negative LUS post-bronchodilator administration. Conclusions: This is the first known report of an association between LUS findings and bronchospasm in pediatric patients. It is also the first documentation of resolution of LUS findings post-bronchodilator administration. Most LUS findings observed were small and limited to one or a few intercostal spaces. Further research is required to evaluate the effect of bronchodilators on LUS in the emergency department.