Objective To describe the characteristics and outcomes of women with inherited bleeding disorder during pregnancy and birth. Design Retrospective cohort study. Setting Tertiary care hospitals, NSW and Victoria Australia. Population 100 women with inherited bleeding disorders, who birthed 134 live infants from 132 pregnancies. Methods Data was retrospectively obtained from the patient and neonatal medical records. Descriptive analysis was used to report maternal and pregnancy characteristics, birth and neonatal outcomes. Main outcome measures Factor replacement, neuraxial analgesia use and complications, post-partum haemorrhage and neonatal complications. Results PPH occurred in 22% of deliveries with primary PPH occurring in 20% and secondary PPH in 4% of births. 48% of PPHs were classified as major. PPHs occurred across the spectrum of IBD and was evenly distributed between women who had “normalised” their factor levels in pregnancy compared to those requiring factor at the time of birth. An obstetric cause was identified in more than half of PPHs. Conclusions Women with inherited bleeding disorders can deliver safely and receive neuraxial analgesia without complication when best practices are adhered to. PPH appears to occur at higher rates than the general population despite adequate factor levels or planned replacement. Whilst an obstetric cause was demonstrable in the many cases, these findings raise concern over the current definition of “adequate” factor levels at the time of birth.

Objective Determine the association of Non-alcoholic fatty liver disease(NAFLD) to the occurrence of GDM and miscarriages. Design Population-based prospective cohort study. Setting Anuradhapura district-Sri Lanka. Sample All pregnant women(gestational age<12 weeks) registered in the national pregnancy care programme(>98%coverage) during July to September-2019, recruited in the Rajarata Pregnancy Cohort(RaPCo)(included 80% of registered mothers). Method Clinical, biochemical parameters and ultrasound scan(USS) of liver were performed at the baseline to assess NAFLD. Excluding pregnant women who reported any type of hyperglycemia at the baseline, the cohort was followed up to assess the occurrence of GDM (using latest WHO criteria) during 24-28 weeks of gestation. Miscarriages were documented. Main outcome measures GDM and miscarriages. Results The prevalence of Fatty liver grade(FLG)-II and I was 14.2%(n=90), 37%(n=234), respectively. The incidence of GDM among the normoglycemic pregnant women with FLG-II, I, and 0 were 162.2, 43.9, 11 per 1000, respectively. After adjusting for age, BMI, and other known risk factors, women with FLG-II had a relative risk(RR) of 12.5(95%CI 2.2-66.4) for developing GDM compared to those with FLG-0. Pregnant women with FLG-I-(RR= 5.1,95%CI-1.7-15.1) and II-(RR=8.4,95%CI-2.6-27.1) had a very high risk of early pregnancy miscarriage compared to FLG-0. Conclusion FLG-2 is a significant risk factor for GDM and miscarriages. Incorporating pre-conceptional or early pregnancy identification of NAFLD using simple USS into routine care provision will enable early risk identification and appropriate action. Funding Accelerating Higher Education Expansion and Development(AHEAD) grant(World Bank-funded project through University grant commission-Sri Lanka) funded this study. Keywords–NAFLD, GDM, Pregnancy, Ultrasound-scan, Miscarriages

1. We focused on 175 patients operated on for otosclerosis. There were 89 in group 1 (preoperative 4000 Hz BC threshold better than 2000 Hz) and 86 in group 2 (preoperative 2000 Hz BC threshold better than 4000 Hz). 2. Preoperatively, there was no significant difference in terms of average bone conduction (BC) thresholds, average air conduction (AC) thresholds and air-bone gap (ABG) between the two groups. 3. Three months and 1 year after surgery, group 1 had better audiometric outcomes than group 2 in terms of average AC and BC thresholds and ABG. 4. Postoperative BC gain was better in group 1 than group 2, particularly at 500 Hz, 1000 Hz and 2000 Hz. 5. When the 4000 Hz BC threshold was preoperatively impaired (group 2), it was not worsened after stapes surgery. This was not the case in group 1.

Purpose: An Expert Panel on Breast Cancer and COVID-19 was convened to address the impact of the COVID-19 pandemic for early breast cancer management. Methods: In order to ensure the most clinically relevant information was addressed, essential information was drawn from several of the latest national and international guidelines and another technical document. The Expert Panel met in five virtual closed sessions from November 2020 to May 2021 to consult on the relevant data from evidence-based results. The data gathered were discussed on an online platform (Within3 ®). Results: This paper reports the Expert Panel's highlights of these meetings' discussions. In addition, it provides practical recommendations covering topics regarding diagnosis, treatment, and management of breast cancer patients in clinical settings routinely encountered by HCPs amid the COVID-19 pandemic. Conclusions: It was provided guidance on several topics regarding eBC management amid the COVID-19 pandemics to inform safer care practices.

Introduction: Although decompensated heart failure (DHF) can complicate catheter ablation of atrial fibrillation (AF), its incidence and risk factors have not been defined. We sought to investigate the incidence and risk factors for DHF in these patients. Methods: In total, 1004 consecutive patients who underwent initial ablation for AF (age, 68 ± 10 years old; females, 346 [34%]; and persistent AF, 513 [51%]) were enrolled. Δheart rate, which was defined as heart rate after ablation minus heart rate before ablation, were calculated. DHF was defined as heart failure requiring medical therapy during post-procedure hospitalization, or re-hospitalization due to heart failure < 90 days after the procedure. DHF was classified into early peri-procedual DHF, which occurring within 2 days after the procedure, and late peri-procedual DHF, which occurring ≥ 3 days after the procedure. Results: The incidence of DHF was 32/1004 (3%) patients. Patients with DHF had a higher prevalence of a past history of symptomatic heart failure (17/32 [53%] versus 154/972 [16%], P < 0.01) and lower Δheart rate after the procedure than those without (−16 ± 28 versus 2 ± 21 beats/min, P < 0.01). On multivariate analysis, lower Δheart rate was a significant independent predictor of early peri-procedual DHF, while early recurrence of AF was a significant independent predictor of late peri-procedual DHF. Conclusion: In patients with AF, lower Δheart rate was an independent predictor of early peri-procedual DHF, and early recurrence of AF was an independent predictor of late peri-procedual DHF.

In order to comprehensively understand the current situation of therapeutic drug monitoring in China, a questionnaire survey was conducted among doctors, pharmacists and laboratory doctors in hospitals at all levels by using Internet technology and mobile phone client.

This article analyzes and compares the two algorithms for the numerical solutions of the fractional isothermal chemical equations (FICEs) based on mass action kinetics for autocatalytic feedback, involving the conversion of a reactant in the Liouville-Caputo sense. The first method is based upon the spectral collocation method (SCM), where the properties of Legendre polynomials are utilized to reduce the FICEs to a set of algebraic equations. We then use the well-known method like Newton-Raphson method (NRM) to solve the set of algebraic equations. The second method is based upon the properties of Newton polynomial interpolation (NPI) and the fundamental theorem of fractional calculus. We utilize these methods to construct the numerical solutions of the FICEs. The accuracy and effectiveness of these methods is satisfied graphically by combining the numerical results and plotting the absolute error. Also, the absolute errors are tabulated, and a good agreement found in all cases. 2020 Mathematics Subject Classification: 34A08; 35A22; 41A30; 65N22.

A prominent Eustachian valve in the right atrium has been reported to pose significant challenges during device closure of atrial septal defects. We describe the procedural aspects of device closure in an ASD with deficient rims and a redundant Eustachian valve. The prominent Eustachian valve provided extra stability in the anteroinferior aspect during device deployment and hence proved to be helpful for the procedure. It is important to consider this aspect while planning device closure

With increasing digitalization and company infrastructure over the years, the attack vectors in computer security have been enormously metastasizing. In scope, several breaches and intrusions have been dominantly carried out by one common tactic, Social Engineering. The domain has gained momentum over the years in successful compromisation of assets. Metrically, Social Engineering proportionately, has been considered one of the most dangerous weapons of any threat actor and consecutively, one of the most dangerous threats to any company's human resources. As per Cobalt's Cybersecurity Statistics of 2021, 61% of organizations globally, have faced breaches carried out by Social Engineering attacks. Moreover, proofproint 2021 State of the Phish Report recognizes Social Engineering attacks as emerging attacks with devastating potential. These type of attacks are often undervalued by employees and the IT staff for majority of the companies. This paper will brief about the new tactics I used, as a threat actor, endeavouring to make the most out of a persuasive conversation, involving (i) physical hooking, (ii) telephonic attacks, and (iii) neuro-anatomical deductions briefing how the existing Social Engineering attacks can emulate the neurochemical processes inside the brain.

Tuberculosis of the upper gastrointestinal tract is a rare pathology. Stomach tuberculosis, particularly, can appear as a subepithelial gastric tumor. We describe a case of a Patient with tuberculous intraperitoneal lymphadenitis mimicking the submucosal gastric tumor. An exploratory laparotomy was performed, and the diagnosis was confirmed by frozen section examination.

This is response to a letter, so it does not contain structured abstract.

The rise of ideologies in the West that promote prejudicial treatment of others based on accidental (humanly uncontrollable) features (distinguishing ethnic physical traits, geographic origin, physical or mental capacities, or native cultures, viz., Western Civilization, that in all of its vicissitudes, has produced distinctive behavioral, socio-religious, and intellectual norms) is an illogical, cruel, and nationally  self-destructive worldview that must be exposed and rejected. The premise of “races” of human beings (Caucasian race, negroid race, mongoloid race, etc.) , rather than the “race of Mankind,” male and female, all originating from a common set of ancestors, created by God, with “in-species” genetic variety (e.g., melanin production creating darker or lighter skin color) is not only unsupported by the teachings of the Old and New Testaments, but singled out as sins against God. The author examines a recent case of a medical doctor dreaming of murdering white people. The statement is considered from both scientific and spiritual viewpoints. The author cites personal experience in the United States military, as well as peer-reviewed articles, to establish the hypothesis that the rise of violent tribalism (“Balkanization”) produces Socialistic authoritarianism, which forcibly reunites divided “tribes” under the flag of autocratic rule. This opinion-editorial article concludes by asserting that the Gospel of Jesus Christ is the powerful antidote that liberates people from the pestilent consequences of original sin to discover authentic fraternity in our common Imago Dei (the image of God in Man), and transformative freedom from the effects of the Fall, i.e., to embrace and be embraced by a divine love that transcends our sin. Only in knowing such love can we be free from the hatred that divides, the bitterness that excludes, and the pain and sorrow that inevitably follows.

Parenchymal sparing surgical (PSS) strategy allowed to plan a one-stage systemic extended posterior right sectionectomy with resection of the dorsal subsegment S1 in patient with 11 bilobar CRC metastases. PSS liver surgery has the greatest potential for implementation in modern medicine conditions.

Aims:Filgotinib is a potent, oral, JAK1-preferential inhibitor for the treatment of rheumatoid arthritis (RA). This report describes exposure-response (ER) analyses of filgotinib for dose confirmation based on three Phase 3 and two Phase 2 studies in moderate to severe RA patients. Methods:The PK exposures used in ER analyses were derived from population pharmacokinetic analysis. The relationship between filgotinib exposures and various efficacy endpoints (ACR20/50/70 and DAS28) was assessed over octile groups of exposures by using combined exposures of filgotinib and GS-829845 (major, active metabolite). For the ER analyses of safety, exposures were examined between subjects who experienced and who did not experience the evaluated safety events, which was conducted separately for filgotinib and GS-829845. Results:Exposure efficacy relationships consistently revealed high response rates across the exposure range for filgotinib 200 mg once daily dose. A trend of increasing response with increasing exposure was observed over the exposure range for the primary and multiple secondary efficacy endpoints, with exposures associated with the 200 mg dose primarily residing on the curve plateau. For exposure-safety analyses, filgotinib and GS-829845 exposures were similar irrespective of presence/absence of the evaluated safety endpoints, indicating no exposure-safety relationship for common TEAEs, common laboratory abnormalities, serious TEAEs, or serious infections. Conclusions:ER analyses confirmed that filgotinib produced more robust therapeutic effects across the exposure range observed at 200 mg once daily compared to lower doses. The positive exposure-efficacy relationship and a lack of exposure-safety relationship on the evaluated safety endpoints supported the 200 mg once daily dose for commercialization.

Background: The aim of our study was to characterize echocardiographic changes during pregnancy in women with known LVOT obstruction or AS compared to the healthy pregnancy controls, and to assess the relationship with pregnancy outcomes. Methods: We retrospectively studied 34 pregnant patients with congenital LVOT obstruction or AS with healthy age-matched pregnant controls. Patients with other significant valvular lesions, structural heart disease (LVEF <40%), or prior valve surgery were excluded. All LVOTO/AS patients underwent a minimum of 2 consecutive echocardiograms between 1 year pre-conception up to 1 year postpartum, with at least 2 studies during the pregnancy. Comprehensive echocardiographic evaluation was performed including speckle-tracking LV global longitudinal strain. Results: A total of 83 echocardiograms from the study group and 34 echocardiograms from the control group were evaluated. Over the range of LVOTO/AS, a significantly greater increase in the AV gradients and LV and LA volumes were observed as compared with the controls. In the sub-group of LVOTO/AS pregnant women with > moderate (n=8) vs.

The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) can reflect systemic inflammation and nutritional status simultaneously, with some evidence revealing its prognostic value for some tumors. However, the effect of HALP on recurrence-free survival (RFS) in patients of gastrointestinal stromal tumors (GISTs) has not been reported. Therefore, the present study aimed to investigate the prognostic value of HALP in GIST patients. Methods Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included. Clinicopathological data, preoperative albumin, blood routine information, postoperative treatment, and recurrence status were recorded. To eliminate the baseline inequivalence, the propensity scores matching (PSM) method was introduced. The relationship between RFS and preoperative HALP was investigated. Results The optimal cutoff value for the HALP was determined by the x-Tile analysis at 31.5. HALP was significantly associated with tumor site, tumor size, mitosis, Ki67, NIH risk category and adjuvant therapy (all P<0.001). Before PSM, GIST patients with an increased HALP had a significantly poor RFS (P < 0.001), and low HALP was an independent risk factor for poor RFS (HR=0.0551, 95% CI: 0.313 - 0.968, P=0.038). In NIH high-risk GIST patients, GIST patients with low HALP had a worse RFS than patients with high HALP (P<0.05). After PSM, 188 pairs of GIST patients were identified, GIST patients with an increased HALP still had a significantly poor RFS after PSM (P<0.001), and low HALP was still an independent risk factor for poor RFS (HR=0.585, 95% CI: 0.316 - 0.972, P=0.042). Conclusions HALP had a statistically significant correlation with postoperative pathology and postoperative treatment. Furthermore, HALP has a strong ability to predict the RFS in GIST patients with radical resection.

Purpose: This study aimed to identify drug-related problems at treatment in patients with sepsis and septic shock and to evaluate the contribution of the clinical pharmacist. Methods: This study was conducted at intensive care units(ICU) of a university hospital. A study group in which the clinical pharmacist participated in the treatment management of septic patients and a control group in which the clinic did not have a pharmacist was formed. In the treatment of the control group, interventions were made for drug-related problems detected by the clinical pharmacist. Study and control group were compared in terms of length of ICU stay, time to initiation of appropriate antimicrobial drug(s), appropriateness of antimicrobial dosing, and drug treatment costs. Results: Total of 65 patients were included in the study group prospectively in which the intervention of clinical pharmacist provided for the drug treatments and retrospectively 65 patients in the control group without any intervention. In the study group, 670 recommendations were made for 753 problems related to their drug therapy. Between groups, improvement in appropriateness of antimicrobials in terms of dose, time to initiation of appropriate antimicrobial therapy, daily antibiotic costs in all patients and antibiotic costs in patients with impaired renal function statistically significant difference were found. Conclusions: As a result of clinical pharmacist involvement in sepsis management, it has been shown to contribute to the prevention and management of drug interactions, to start antimicrobial therapies more quickly, to select the appropriate drug and dose, especially antimicrobials, and to save the costs of antimicrobial drugs.

Summary: Antibiotic-resistant bacteria are emerging threat to the global public health. Estimates suggests >10 million deaths by 2050 due to AMR alone. Six Indian institute collaborated along with 4 UK universities to address the issue of antimicrobial resistance (AMR) through One Health approach under NEOSTAR project jointly funded by Department of Biotechnology (DBT), Government of India and UK Research and Innovation (UKRI), United Kingdom. To address a question “Dose AMR in livestock contributes to AMR in people? A pilot study was conducted which is a collaborative effort to collect archival microbial isolates of Escherichia coli, Klebsiella spp., Staphylococcus aureus and coagulase negative S. aureus (CoNS). The current study deals with E. coli isolates collected from ICAR-NIVEDI, ICAR-CIFT, ICAR-IVRI, ICAR-RCNEH, IIT-Delhi and GMCH and were subjected to QC analysis at ICAR-NIVEDI’s BSL2+ facility, these isolates were further segregated into 5 components viz., Animal origin (including aquaculture) (n=50) food of animal origin (n=30), Human (community settings) (n=3), Hospital origin (n=15) and Environment origin (n=14). A total of 112 E. coli isolates sequenced for whole genome through Illumina’s HiSeq 2500 platform at Sangers Institute, UK and paired end libraries were generated for all the 112 isolates were assembled and subjected to genome characterization and gene mining through various bioinformatics tools revealed the frequency of resistance, co-resistance, and resistant genes are high and similar across Human-Animal-Aquaculture-Environment continuum in India. This emphasizes the need to collaborate and mitigate antibiotic resistance with a ‘One Health’ approach.

Objective: To investigate the frequencies and patterns of cardiovascular diseases (CVD), assessed by echocardiographic examinations in Mogadishu, the capital of Somalia. Material and Methods: This retrospective, descriptive registry reviewed the pathological echocardiographic findings of 1140 patients aged 0-100 years who were admitted to the cardiology outpatient clinic in a tertiary training hospital in Mogadishu. Results: Out of the 6782 patients reviewed, 1140 patients who met the inclusion criteria were enrolled in the study. Hypertensive heart disease (HHD) (39.8%) and degenerative valvular disease (34.6%) were the most common comorbidities. Congenital heart diseases (CHD)were detected in 13.2% of the patients, with the most common ones including atrial septal defect (ASD) (3.2%) and ventricular septal defect (VSD) (2.3%). Rheumatic heart disease (RHD) was detected in 84 (7.4%) patients, among whom the most common age range was 21-30 years (28.6%), followed by 31-40 years (25%) and 11-20 years (19.1%). Conclusion: In the present study, we found that HHD was the most common comorbidity (39.8%), followed by degenerative valvular disease (34.6%), HFrEF (%30.8), and IHD (24.4%). Moreover, the most common valvular disease was mitral insufficiency (47.5%) and the most common CHD was ASD(3.2%).

Integrated Kerr micro-combs are a powerful source of multiple wavelength channels for photonic radio frequency (RF) and microwave signal processing, particularly for transversal filter systems. They offer significant advantages featuring a compact device footprint, high versatility, large numbers of wavelengths, and wide Nyquist bands. We present our recent progress on photonic RF and microwave high bandwidth temporal signal processing based on Kerr micro-combs with comb spacings from 49GHz to 200GHz. We focus on integral and fractional Hilbert transforms, differentiators as well as integrators. The future potential of optical micro-combs for RF photonic applications in terms of functionality and ability to realize integrated solutions is also discussed.

We report world record high data transmission over standard optical fiber from a single optical source. We achieve a line rate of 44.2 Terabits per second (Tb/s) employing only the C-band at 1550nm, resulting in a spectral efficiency of 10.4 bits/s/Hz. We use a new and powerful class of micro-comb called soliton crystals that exhibit robust operation and stable generation as well as a high intrinsic efficiency that, together with an extremely low spacing of 48.9 GHz enables a very high coherent data modulation format of 64 QAM. We achieve error free transmission across 75 km of standard optical fiber in the lab and over a field trial with a metropolitan optical fiber network. This work demonstrates the ability of optical micro-combs to exceed other approaches in performance for the most demanding practical optical communications applications.

The Sawada-Kotera equations illustrating the non-linear wave phenomena in shallow water, ion-acoustic waves in plasmas, fluid dynamics etc. In this article, the two-mode Sawada-Kotera equation (tmSKE) occurring in fluid dynamics is addresses. The improved F-expansion and generalized exp$(-\phi(\zeta))$-expansion methods are utilized in this model and abundant of solitary wave solutions of different kinds such as bright and dark solitons, multi peak soliton, breather type waves, periodic solutions and other wave results are obtained. These achieved abundant novel solitary and other wave results have significant applications in fluid dynamics, applied sciences and engineering. By granting appropriate values to parameters, the structures of few results are presented in which many structures are novel. The graphical moments of few solutions helps the engineers and scientist for understanding the physical phenomena of this model. To explain the novelty between the present results and the previously attained results, a comparative study has been carried out. Furthermore, the executed techniques can be employed for further studies to explain the realistic phenomena arising in fluid dynamics correlated with any physical and engineering problems.

An analysis has been done to scrutinize the existence of dual solutions of the Casson nanofluid caused due to an exponential form of stretching surface which is situated in porous medium and second order velocity slip. An uniform magnetic field is considered in the transverse dirction of the flow. A suitable similarity transformation is employed to amend the model equations into solvable form and hence solved by adopting the MATLAB built-in bvp4c solver scheme. Results are discussed through both graphical mode and tabulations with respect to some novel flow parameters. The stability analysis has been studied and found two solutions, one is stable in nature and physically tractable. From the study, we have seen that the flow parameters associated with nanofluid enhance the heat transfer of the fluid. The Casson fluid parameter has also a power to increase temperature of the system.

Aim: Mask use has a substantial role in reducing the spread of COVID-19 in confined spaces. However, the use of masks is controversial in cases where intense effort is required, such as the treadmill exercise test. Since the majority of subjects undergoing this test are elderly individuals with comorbidities, the safety and reliability of the test are critical matters that must be elucidated in the post-COVID-19 era. In this study, the safety of the treadmill exercise test performed using a mask and the diagnostic reliability of the test were questioned. Methods: In our clinic, before March 11, 2020, treadmill exercise tests were performed without a mask; whereas, after this date, patients were supplied with a standard surgical mask during the test. These two groups were compared with regard to various characteristics to assess diagnostic reliability and safety. Results: The diagnostic reliability and the safety of the stress test performed with a mask was found to be similar to that of tests performed without a mask. However, we noted that shortness of breath was more common in the mask-wearing group. Conclusion: The treadmill exercise test performed by wearing surgical masks is safe and its results are reliable for diagnosis.