ABSTRACT Introduction: Sjögren syndrome is a chronic, systemic, inflammatory disease characterized with lymphocytic infiltration of the exocrine glands, frequently manifested by dryness in the region affected. Although the most common extraglandular involvement in SS is pulmonary involvement. Early diagnosis and treatment is considered to be important. It was aimed to evaluate the frequency of early lung involvement, high resolution computed tomography (HRCT) findings and data of pulmonary function test (PFT) in SS in this study. Material-Method: Thirty five patients diagnosed with SS and referred by the Department of Rheumatology to determine potential lung involvement to the 8th chest diseases outpatient clinic of our hospital between September 2015 and December 2018 were included in this study. Respiratory signs, demographic features, length of disease and treatment regimens, PFT, data of 6-minute walk test (MWT) and findings of HRCT of the patients were retrospectively obtained from hospital information system and patient files. Results: The mean age of the patients was 54.4 ± 9.2. The majority of the patients were women (94.3%). When the HRCT findings were evaluated, 28 (80%) patients had CT findings, while 7 (20%) patients had no CT findings. The most common HRCT findings found in patients were peribronchial thickening (48.6 %), ground glass appearance (28.6%) and prominence in interstitial scars. Conclusion: We think that the evaluation of HRCT and PFTs in patients diagnosed with SS for assessing early pulmonary involvement will be guiding in terms of follow-up and treatment.

Introduction COVID-19 shows similar clinical and radiological findings with other viral pneumonias. This study designed to explore the likelihood of the existence of COVID-19 pneumonia in our country before March 11th, date of first official COVID-19 case detected in Turkey, by using a diagnostic model designed with radiologic and laboratory findings. Materials and Methods 273 patients were aggrouped according to hospitalization date, naso-oropharyngeal swab PCR results. Thoracic tomographies, C-reactive protein (CRP), leukocyte, lymphocyte, monocyte, eosinophil, platelet values of all patients were evaluated. Results Laboratory findings of lymphocyte, eosinophil counts (p<0.05) were significantly low; radiologic findings of round opacity, cobblestone, nodüle, subpleural line were significant in COVID-19 group (p<0.05). ‘Round opacity’, ‘subpleural line’, ‘nodule’, ‘lymphocyte’ variables were found to be statistically significant for final model (p<0.05). COVID-19 diagnosis possibility; increases 302.9% by ‘round opacity’, 355.6% by ‘subpleural lines’; and decreases 59.1% by ‘nodule’ presence, 31.7% by one unit increase in lymphocyte level. Based on final model; 49.3% of the participants before 11 March 2020 were predicted to be positive for COVID-19. Conclusion According to these findings, we can say that COVID-19 patients existed before March 11th, 2020 in Turkey, for the first time. Also subpleural lines, presence of cobblestone, round opacity appearances and absence of nodules on tomography, and the presence of lymphopenia and eosinopenia in the cell count can also be used to support the diagnosis of COVID pneumonia.

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.

Background This study aimed to examine the hemogram parameters, including the neutrophil/lymphocyte ratio (NLR), which is fast, easy and practical to determine, in stroke patients who present with more physiological stress and inflammation and compare them with patients presenting other neurological diseases. Methods The demographic, laboratory and imaging features of all patients who were admitted to the Neurology Service within a three-year period and met the study criteria were retrospectively analyzed. A hemogram from peripheral venous blood samples was taken at the time of admission, and the NLR was calculated. Results A total of 3,152 patients, 1,604 of whom were women (50.9%), with a mean age of 66.1 ± 14 (18-100) years who were hospitalized in the neurology clinic between January 1, 2015 and January 1, 2018, comprised the study’s sample. Mean age, mean leukocyte-neutrophil count and NLR were significantly higher in stroke patients than in those without stroke (p <0.001, p <0.001 and p <0.001, respectively), but mean red blood cell, platelet and lymphocyte counts, and hemoglobin and hematocrit values were found to be significantly lower (p <0.001, p <0.001, p <0.001, p <0.001 and p<0.001 respectively). When the hemogram parameters were compared according to stroke type, red blood cell, hemoglobin, hematocrit and NLR values in patients with hemorrhagic stroke (p = 0.019, p = 0.002, p = 0.002 and p = 0.001, respectively) and platelet and lymphocyte values in ischemic stroke patients were found to be significantly higher (p = 0.002 and p <0.001, respectively). Conclusion In this study, significant data obtained by comparing the hemogram parameters of those with stroke and other neurological diseases are presented. All neurological diseases, especially acute stroke and its types, should be examined in future prospective, randomized and controlled studies with all hemogram parameters, especially the NLR (low cost)

Objectives Diagnostic challenges during the COVID-19 pandemic forced the radiology regulating body to adopt the use of CT Chest as a triage and diagnostic tool, which was subsequently abandoned. The Royal Wolverhampton hospital followed both protocols. Here, we investigate the evidence behind this decision within the context of surgical admissions during the COVID-19 peak in our hospital. Methods Retrospective data collection and analysis of all surgical admissions between the 1st of March to the 31st of May. Data was collected from the radiology and electronic portal looking into patients undergoing CT chest to diagnose the presence of C-19 as well as swab results. Results 78 patients fulfilled our inclusion criteria. The scan either confirmed the presence or absence (4, 63 patients) of C-19 but was sometimes inconclusive (11 patients). Comparing these to the results of the swabs; CT showed sensitivity 42.86 %, Specificity 97.92%, and accuracy 90.91 %. In the inconclusive CT report group, chances of having a positive swab result were 45%: None of the scan results changed any of the surgical planning. Lymphocyte count in the context of surgical presentation did not have any statistical significance to predict the presence of C-19 (P=0.7). Cost implications on our cohort of patients for adding the chest CT is estimated to be around £31,000. Conclusion CT Thorax during the pandemic was a good negative predictor but had limited diagnostic value and did not change patient management. Newer, faster techniques of PCR swabs and antibody testing would be a better and cheaper alternative. Advances in knowledge This paper provides evidence to support the decision from the regulatory bodies not to use CT scan as a screening tool for COVID 19 diagnosis.

Objective: Abdominal hernia repair is a common surgery, with 15% of patients presenting as incarcerated hernias. In these cases, early diagnosis of intestinal ischemia and necrosis is crucial for mortality and morbidity. Biomarkers that can predict ischemia or necrosis status are vital. In this study, we aimed to reveal the roles of basic blood parameters in determining ischemia or necrosis status. Methods: The patients were divided into three groups as normal bowels (Group I: 24 patients), intestinal ischemia without necrosis (Group II: 31 patients), and Group III who underwent bowel resection because of necrosis (10 patients). Patients’ demographic characteristics and blood parameters were retrospectively analyzed. Results: 65 patients operated for incarcerated abdominal hernias. There was no significant difference between the groups in terms of age, sex, comorbidity, or complications (p>0.05). The highest length of stay was observed in Group III (p<0.001). There were significant differences between the groups in terms of serum white blood cell (WBC), neutrophil, lymphocyte (LYM), neutrophil-lymphocyte ratio (NLR), urea, creatinine, total bilirubin, indirect bilirubin, lipase, C-reactive protein (CRP), and CRP/LYM levels (p<0.05). Conclusion: Preoperative WBC, neutrophil, NLR, urea, creatinine, and total bilirubin levels can be used to predict the onset of intestinal ischemia. Serum creatinine, total bilirubin, indirect bilirubin, phosphorus, lactate dehydrogenase (LDH), and lipase levels can be used for bowel resection.

Objective: Medication nonadherence (MNA) is a main problem in patients with asthma and COPD. Association of anxiety and MNA is confusing and is not clear. Improper inhaler technique is an unintentional component of inhaler MNA. In this study, we aimed to investigate the association between inhaler medication usage skills and general anxiety or coronavirus anxiety scales. Materials and methods: Inhaler usage techniques of 70 asthma and COPD patients were evaluated by three clinical pharmacists. The anxiety scores of the patients were calculated by a pulmonologist according to the Hamilton Anxiety Rating Scale (HAM-A) and Coronavirus Anxiety Scale (CAS). Results: Only 32.9% of the patients were using their inhalers properly. There were only 10 (%13.3) patients who had all steps correct. CAS score, age, comorbidity and inhaler type were not found to be associated with proper inhaler technique. Only the HAM-A stage (p=0.096) and educational status (p=0.074) approached statistical significance in affecting the proper inhaler technique. A weak correlation was found between age and CAS score (r=-0.278, p=0.02). Coronavirus anxiety rate is higher in asthma patients than in COPD patients (p=0.036). HAM-A and CAS scores of female patients were higher than men (p<0.05). There was a moderate correlation between HAM-A score and CAS score (r=0.407, p<0.001). The correlation between HAM-A score and inhalation skills score approached statistical significance (r=-0.208, p=0.083). Conclusion: Most COPD and asthma patients use their inhalers improperly. More attention should be paid to inhaler use skills training, especially in the low education level group and moderate-severe anxiety group.

In recent years, several studies suggested that HBsAg titers in blood samples obtained during Hepatitis B treatment could be used to estimate the treatment outcomes. The present study aims to discuss the correlation between HBsAg quantification levels and the virological, serological and histopathological findings in chronic hepatitis B patients.The study included chronic hepatitis B patients who underwent liver biopsy between 2011 and 2013 at Dicle University, Faculty of Medicine, Infectious Diseases and Clinical Microbiology Clinic.. The patient demographics were recorded (age, gender). Patient AST tests were conducted with the spectrophotometric method. After the DNAs were isolated with AmplipPrep Total Nucleic Acid Isolation Kit, DNA level was determined with the COBAS® Amplip / Cobas® Taqman® HBV test V2.0 for HBV. The patient HBV DNA levels were recorded as IU / ml. HBsAg quantitation was studied with the Access device and the Elisa method.The study was conducted with 53 patients. The mean patient age was 28,73 ± 8.15. Out of the 53 patients, 35 (66%) were male and 18 (34%) were female. The mean patient HBsAg quantitation was 631,42 ± 406.55, fibrosis score was 1,35 ± 0.87, ALT index score was 67,07 ± 53.37, and HAI index score was 4,54 ± 1.55. In the statistical analysis, it was determined that there were negative correlations between the HBsAg DNA level (R: -0,273, P: 0.048) and HBSAG quantitation (R: -0,273, P: 0.048), fibrosis score , ALT (R: -0,477, P: 0.001), and HAI index scores (R: -034, P: 0,013), while there was a positive correlation with the HBeAg positivity (R: 0.477, p: 0.001). There were negative correlations between the HBsAg quantitation level and virological (HBV DNA level), histopathological (fibrosis score, HAI index) findings and a positive correlation with serological (HBeAg positivity) findings. As HBsAg quantitation level increased, fibrosis score and HBV DNA level decreased.

Vaccination created a breakthrough towards the improvement to the global health. The development of vaccine and their practice made a substantial control in infectious diseases. The emergence of new vaccines has facilitated targeting populations to alleviate and eliminate contagious pathogens from their innate reservoir. However, along with the infections like malaria and human immunodeficiency virus (HIV), effective immunisation remains obscure and imparts a great challenge unto the realm of science. The vaccines developed after utilizing plant based system supported technology comprises the incorporation of the preferred genes to express the specific protein (antigen) for a particular disease condition into the genome of plant tissues using several techniques. Though plant-supported vaccines propose several benefits to the vaccine industry, still there remain challenges that limit the rate of effective production of vaccines of this third-generation. A novel Corona virus SARS-CoV-2 reason for causing Corona virus diseases 2019 (COVID-19) crashed the human population and rapidly spread round the world within the half of 2020 created a worldwide epidemic. The need for establishing a protected and compelling COVID-19 immunization is a global requirement to end this pandemic. Even though there exist lot of limitations, continuous efforts has put forward so as to develop highly competent and effective vaccine for many human and animal linked diseases due to its unlimited prospective. This review article focus on the historical outlook and the development of the vaccine as it is a crucial area of research where the life of the human is saved from various potential dise

Background: Ruptured aneurysms of sinus of Valsalva are defects of the aortic media, which are uncommon yet present concomitantly with either ventricular septal defect, aortic insufficiency or both. Here, we analyse retrospectively outcomes of patients operated on in the last two decades. Patients and Methods: 151 cases of ruptured aneurysms of sinuses of Valsalva were treated here between January 2000 and December 2020. The majority (96%) arose from the right coronary sinus. The right ventricular outflow was the most common site of rupture (56.2%). Ventricular septal defect was associated in 24 patients (16%) all of whom had ruptured right sinus, of which 8 (33%) were of subpulmonic subtype. Aortic incompetence was found in 45 patients (43.3%). Elective surgery was offered to 78 patients (51.6%), while the rest had defects closed by interventional devices. Surgical conversion for device embolization occurred in 12 patients (7.94 %). The defect was closed through the aortic root in 13 patients (14.4% of 90) and employing the bicameral technique (root and ruptured chamber) in the remaining 87 patients. 18 patients (20%) underwent aortic valve repair while 5 (5.5%) underwent aortic valve replacement. Results: We had no hospital deaths, however 4 operated patients (2.6%) had comorbidities. Follow‐up ranged from 1 to 20 years (mean 13 ± 5). There were 3 deaths in this period, and among the majority, quality of life was uneventful. Conclusion: Surgical correction for ruptured aneurysms of Valsalva provides prudent results and must be the preferred modality of treatment in acute and chronic presentation.

We present a case of a young patient who presented with unstable angina due to coronary-pulmonary fistula caused by a nail-gun injury that stayed asymptomatic for 3 years. The patient has a successful surgical resection of the fistula and removal of the foreign body.

Pandemics are epidemics or disease outbreaks, which rampage across countries and continents. The ongoing corona virus disease 2019 (COVID-19) has been a full-fledged pandemic for over a year now. With the death count mounting above two million, COVID-19 has globally impacted the economy, society, public health and all spheres of human life. COVID-19 is the third type of coronavirus disease outbreak after Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome. This review paper discusses the medical perspectives of COVID-19 along with a recount on the numerous pandemics that have wreaked havoc in the past. AIDS which is ongoing, and cholera, influenza and plague have been recurring pandemics and merciless killers. Even with tremendous advancement in medical science, new pathogens continue to cause uncontrollable infections and deaths worldwide. Research in the fields of medicine, health and social sciences, psychology and so on is soaring as the world battles with COVID-19. Additionally, scientometric analysis has been performed using the Web of Science platform, a global citation database, to project the impact of COVID-19 on research in terms of scientific publications. As of 04th April 2021, 98,020 scientific works have been published of which 28 % are from the USA. Medical and health sciences have been the major focus of research globally, as the world works tirelessly to develop the ‘right’ vaccine that will make COVID-19 a disease of the distant past.

Aim: Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomized cross-over study aimed to compare intra-oral and classic face mask in terms of ventilation success of patients, practitioners’ workload and anxiety assessments. Also we analyzed potential risk factors of difficult mask ventilation for both masks. Methods: 24 anesthesiology residents and 12 anesthesiologists participated in the study. Each of the practitioners ventilated 4 patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analyzed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-BANG score. Results: Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of Han Scale (Easy mask ventilation percentage 84/144 (58.3%); 123/144 (85.4%); respectively) and tidal volume (481.92±173.99; 430.85±154.87mL; respectively). Leak volume in intraoral mask ventilation was significantly lower than classic face mask (71.50±91.17 /159.38±146.31 respectively). Diffucult mask ventilation risk factors were high weight, neck circumference, Mallampati score and STOP-BANG score>3 for classic face mask (at the utmost neck circumference 95% CI, OR=1.180, p= 0.002) Risk factors were high body mass index and Mallampati score for intraoral mask (at the utmost Body mass index 95% CI, OR=1.162 p=0.006). The anxiety ratings of practitioners were similar between two masks. The work-load rating is higher with intraoral mask comparing to classic face mask. Conclusion: Intraoral mask may be an effective alternative device for bag-valve mask ventilation.

The patient was an 18-year-old man who suffered frequent supraventricular premature complexes (SVPCs)　and atrial fibrillation. Catheter ablation was performed and left pulmonary vein had been isolated, although firing from within the left inferior pulmonary vein remained. After that, the patient did not exhibit SVPCs and atrial fibrillation.

Introduction: Early recognition of critical patients in crowded environments such as emergency departments is required in Covid 19 pandemic and many early recognition scoring systems are used. In this study, we aimed to determine the prognostic values of these scoring systems. Material and method: This retrospective study was performed between March 2020 -May 2020 and 212 patient who have Covid 19 pneumonia were enrolled the study. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated at the time of admission to the emergency department. Demographic data, mortality, intensive care unit (ICU) admission rates and the prognostic values of the scores were calculated. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by using Youden Index. Results: 23 (10.8%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882(0.741-1.000) and 0.879(0.768-0.990) and >65 years old, 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. While < 65 years old; MEWS and qSOFA’s optimal cut-off values for mortality were ≥2 with %90.0 sensitivity %74.7 specificity and ≥1 with %90.0 sensitivity %74.7 specificity, for ≥ 65 years NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity. Conclusion: All these three scores have good predictive value for mortality and ICU admission, but NEWS is better than MEWS and qSOFA especially in ≥ 65 years old patient with Covid 19 pneumonia.

Abstract Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.

Background: The prevalence of positive SARS-CoV-2 nucleic acid in recovered COVID-19 patients has attracted attention. We aimed to investigate the repositive rate of SARS-CoV-2 and the clinical features of discharged COVID-19 patients. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, China National Knowledge Internet, Wanfang Data, China BioMedical Literature, VIP, and Google Scholar. Fixed or random-effect models were used to determine effect estimates. Results: Eleven studies were included. The pooled positive rate of viral RNA in discharged patients was 11% (95% CI 7-15; I2=90.4%). The median days from discharge to repositivity were 7 to 8 days. Coughing was the most common clinical symptom, occurring in 16% (95% CI 11-20; I2=0%) of patients at readmission. Chest CT and laboratory indicators of positive retest (PR) patients showed significant recovery trends. The prevalence of comorbidities between the PR patients and the negative retest patients were not significant (OR 0.86 [95% CI 0.38–1.95]; p=0.002; I2=76.5%). No close contacts were positive for SARS-CoV-2 RNA. Conclusion: PR patients were uncommon. The repositive result was likely due to the incomplete clearance of virus from a previous disease course. PR patients were less likely to be contagious. However, close monitoring and quarantine after discharge from the hospital are necessary. Registration: The protocol has been registered on PROSPERO, registration ID: CRD42021239650 Keywords: COVID-19, SARS-CoV-2, discharged patients, positive retest rate

Microplastics (MPs) can now be found in all the Earth's biomes, thereby representing a global change phenomenon with largely unknown consequences for biodiversity and ecosystem functioning. Soil protists are eukaryotic, primarily single celled organisms that play important roles in the soil food web. Microplastics have been shown to affect protist populations in freshwater and marine environments, yet the interactions between soil protists and MPs remains largely unknown. Here we examined whether phagotrophic soil protists can ingest MPs and experience declines in abundance. We exposed protists to soil treatments with different concentrations of MPs using commercial polymer fluorescent microspheres and used fluorescence microscopy to find evidence of MP ingestion. In addition, we quantified the total number of active phagotrophic protists over time. We show that most soil protists (>75% individuals) can readily ingest and keep MP within their food vacuoles, even at relatively small MP concentrations (0.1% w/w). There was a trend for higher prevalence of ingestion and for declines in protist abundance at the highest concentration of MPs (1% w/w). However, more data are necessary to further ascertain cause-effect relationships. This is the first report indicating that soil protists can play an important role in the transport and uptake of MPs in the soil food web.

In this paper, the critical condition to achieve rational solutions of the multi-component nonlinear Schr\”odinger equation is proposed by introducing two nilpotent Lax matrices. Taking the series multisections of the vector eigenfunction as a set of fundamental eigenfunctions,an explicit formula of the $n$th-order rational solution is obtained by the degenerate Darboux transformation, which is used to generate some new patterns of rogue waves. A conjecture about the degree of the $n$th-order rogue waves is summarized. This conjecture also holds for rogue waves of the multi-component complex modified Korteweg-de Vries equation. Finally, the semi-rational solutions of the Manakov system are discussed.

H63D syndrome is a unique phenotype (clinical picture) of a homozygous mutation of the HFE gene H63D, which is otherwise known to cause at most mild classical hemochromatosis. H63D syndrome is associated with iron overload in the body (especially in the brain, heart, liver, skin and male gonads), but in the form of non-transferrin bound iron (NTBI), not as ferritin. It is an incurable multi-organ disease, leading to permanent disability, which can only be influenced by early diagnosis and a very careful reduction of iron intake (under constant monitoring) as early as in childhood and youth. Our goal was to better highlight the characteristic symptoms of this rare disease to further reduce the risk of missing diagnosing this dangerous condition correctly, even on a primary care level.

Introduction: Cognitive, behavioral, and psychiatric disorders associated with dementia cause stigma against Alzheimer’s disease (AD) in both patients, caregivers, and healthy individuals in public. To the best of our knowledge, since stigma against AD is not investigated in the Turkish public, we wanted to evaluate the stigma of healthy Turkish people according to their demographic characteristics in our study. Materials and Methods: 439 healthy participants without any history of neurological and/or systemic disease were included in this cross-sectional observational study. Demographic characteristics and knowledge about the AD of the participants were recorded. A ten-question survey was applied to the participants to assess the stigmatization against AD. Factors associated with the stigma score were evaluated in regression analysis. Results: 253 men and 186 women were included in this study (mean age: 35.7 ± 9.8 years ). Most of them had knowledge about AD (94.3%). Only 18.5% had a family history of AD. Sixty-five percent had married. 95 of 439 persons (21.6%) worked in health fields. 60.6% of healthy participants had a moderate-high stigma against AD. The mean stigma score was 8.95 ± 4.79. Total stigma scores were higher in women and single persons (p = 0.001 / p< 0.001). Healthcare workers expressed the highest levels of stigma (p < 0.001). Age, knowledge, and family history of AD did not influence stigma. Shame, loss of self-esteem, and fear of exclusion were expressed the most. Conclusion: To the best of our knowledge, this is the first study that evaluated perceived stigma against AD in the Turkish healthy population. The higher incidence of stigma among women and single persons can be explained by cultural reasons. Stigma in health professionals may lead to delay in early diagnosis and management of AD. Further studies of perceived stigma are necessary to improve intervention strategies.

Before the Activity: Introduction to PlasticsObjectives: Students will Have Students Watch a Plastic Ocean and complete a Video Worksheet.Discuss Students thoughts and reactions to the video.Did they realize the effects of plastics?How do you feel after watching the film?Why is it not practical to just ban everything made of plastic?Do you think we have plastics in our local waterways?Microplastic Sampling Students are trained in Microplastics Sampling at the beginning of the school year. Students will sample local watershed using the Florida Microplastic Awareness Project Procedures to sample for Microplastics in local watersheds and collect data once a month. Students will identify which types of microplastics are present in local watersheds and which types are most abundant. (Students should find the microfibers from clothing and wash machines are typically the most common) Students will make a graph of the number of microplastics in a 1L sample Students will upload data into the Microplastics Awareness Project Database (citizen science project)

Unusual ovarian leukemic relapse in a girl with history of B cell lymphoblastic leukemiaACH Fung, KKY WongTo the editor:Extramedullary leukemic recurrence mostly occurs in the central nervous system and occasionally in the skin. [1] Here, we report an unusual case of a girl with relapsed lymphoblastic leukemia involving the ovary, presenting as a large pelvic mass.A 10-year-old girl with history of B cell lymphoblastic leukaemia treatment and in remission 1 year ago presented to oncology clinic with an enlarging pelvic mass for 2 months. Magnetic resonance imaging revealed a large lobulated solid heterogeneous pelvic mass (measuring 12cm in greatest dimension) with mass effect on pelvic organs (Figure 1a). Bone marrow aspirate at conventional site confirmed absence of lymphoblastic cells, which would have suggested leukaemia relapse. In view of the suspicion of a second primary tumour in the ovary with complication, exploratory laparotomy and left salpingo-oophorectomy were performed (Figure 1b). Histology showed diffuse infiltration of the ovary by B cell lymphoblastic leukaemia. Hematoxylin and eosin staining showed sheets of lymphoid cells with irregular nuclei. The tumour cells are positive for TdT, CD19, CD79a and CD34. (Figure 1c) She was well after operation. In view of extramedullary relapse, bone marrow aspirate was repeated after operation at anterior iliac spine which confirmed bone marrow relapse. She received treatment according to high risk protocol of CCCG Relapsed Acute Lymphoblastic Leukemia 2017 Study in Children [2].Acute lymphoblastic leukaemia (ALL) is responsible for one-third of childhood malignancy. Despite efforts in the treatment of ALL, 15-20% of patients developed relapse with highest risk immediately after cessation of treatment and diminishes with time. [3] Extramedullary involvement constitutes 2-5% of all relapses with the majority in the central nervous system. It seldom involves other sites, such as the eye, kidney, and omentum. Ovarian leukemic relapse is rarely reported in children with scarce case reports in the literature [4, 5] It is insidious and not usually detected until symptoms arise. Patient most commonly presents with lower abdominal pain or a palpable large abdominal mass. [6] Timely detection is important as it often coincides with marrow recurrence. Routine surveillance pelvic sonography is recommended for timely detection of pelvic extramedullary relapse.[7] In patients with background of leukaemia presenting with an ovarian mass, a higher level of suspicion needs to be kept. In the absence of evidence in bone marrow relapse at conventional site, repeat marrow aspirate at another site would be warranted since this affect the choice of management. Previous reports shown that mainly chemotherapy had a beneficial effect, while neither local radiation nor extensive surgical resection of the leukaemic mass had any obvious effect on overall outcome [8]. Operation could have been avoided if marrow relapse is confirmed at the time of ovarian mass detection. However, surgical excision was reported to have role in situation when bone marrow had good response but no signs of regression of ovarian mass. [9]Reference1. Kim, J.W., et al., Ovarian and multiple lymph nodes recurrence of acute lymphoblastic leukemia: a case report and review of literature. Pediatr Surg Int, 2008. 24 (11): p. 1269-73.2. CCCG Relapsed Acute Lymphoblastic Leukemia 2017 Study in Children .https://ClinicalTrials.gov/show/NCT04224571.3. Berretta, R., et al., Isolated ovarian relapse of pre-B acute lymphoblastic leukemia: a case report. J Pediatr Adolesc Gynecol, 2009.22 (4): p. e65-8.4. Kantekure, K., et al., A unique case of relapsed B-acute lymphoblastic leukemia/lymphoma as an isolated omental mass. Case Rep Hematol, 2014. 2014 : p. 425163.5. Sava, C.N., et al., Unusual extramedullary relapses in a case of common B-cell acute lymphoblastic leukemia. Case report and review of literature. Rom J Morphol Embryol, 2019. 60 (1): p. 249-254.6. Turial, S., et al., Ovarian tumours: late extramedullary recurrence of acute leukaemia. Eur J Pediatr Surg, 2009.19 (3): p. 184-6.7. Lane, D.M. and R.L. Birdwell, Ovarian leukemia detected by pelvic sonography. A case report. Cancer, 1986. 58 (10): p. 2338-42.8. Pais, R.C., et al., Ovarian tumors in relapsing acute lymphoblastic leukemia: a review of 23 cases. J Pediatr Surg, 1991.26 (1): p. 70-4.9. Till, H., O. Muensterer, and U. Graubner, Laparoscopic adnexectomy of a persistent ovarian tumor in a girl with acute lymphoblastic leukemia relapse. Pediatr Hematol Oncol, 2003.20 (5): p. 417-20.

AbstractThis course will allow students to integrate STEM concepts and critical thinking into engineering design, circuit building and programming to build an eco-friendly robot with a public service purpose.Building a RobotSuggested Time: 120 minutes OverviewStudents will apply their STEM knowledge to build a real robot. Define: What is Robotics?Students will collaborate in groups to research and derive their own definition of what is a robot, what are the various types of robots (both fiction and real life), how robots can help in our daily life through an inquiry based learning approach and present to the class. They will learn and be guided by Teachers to explore how Science, Technology, Engineering, Arts, Math could be applied to the design, development and application of robots. VocabularyArduinoRaspberry Pi Objectives Students will acquire basic electrical engineering, mechanical engineering and programming skills.Students will gain 21st century key skills such as problem solving, creativity, analytical thinking, collaboration, communication, ethics when they design and make their robots.Students will think about the real-world beneficial and practical applications of robotics. Science Topics coveredForces and InteractionsForces and MotionTypes of InteractionsDefinitions of EnergyDefining and Delimiting Engineering ProblemsOptimizing the Design Solution EnergyDefinitions of EnergyConservation of Energy and Energy TransferRelationship Between Energy and Forces Science and Engineering Practices:Planning and Carrying Out InvestigationsAnalyzing and Interpreting DataUsing Mathematics and Computational ThinkingConstructing Explanations and Designing SolutionsScience Models, Mechanisms, and Theories Explain Natural Phenomena Human Sustainability:Natural ResourcesHuman Impacts on Earth SystemsDeveloping Possible Solutions Cross-Cutting Concepts:Influence of Science, Engineering, and Technology on Society and the Natural WorldScience Is a Human EndeavorScience Addresses Questions About the Natural and Material WorldEnergy and Matter Science StandardsInquiry, Reflection, and Social Implications Technology StandardsCreativity and InnovationResearch and Information LiteracyCritical Thinking, Problem Solving, and Decision MakingDigital Citizenship Required Project MaterialsArduino and Raspberry Pi supplies, depending on the projects chosenRequired ResourcesArduino: https://www.arduino.ccRaspberry Pi: https://www.raspberrypi.orgPre Lesson HomeworkTeachers to ask students to brainstorm on the ethical use of robots and how can the public /society at large benefit from a robot and guide the class toward building a feasible prototype. Lesson 1: Idea GenerationPart 1: Engineering Design Process: Define, Identify, Brainstorm, Select, Prototype (60 mins)Students to list down the pros and cons of the various robots used by the different industries. Why do we need robots? Does the benefits outweigh the risks? What are their limitations or challenges and any ethical or privacy concerns?Teachers to guide the students on the robot concepts with a public-service objective. With the students basic knowledge in circuit work, and programming, are the robot models workable? Teachers to work with students to build on some prototype models in which they envisioned to build. It is ok for them to fail and rebuild.Teachers to get students to think and compile a list of materials needed for the project. Recommended recyclables from home. Teachers to conclude on the feasible materials for students to bring to create their robots.Students to collaborate in groups and come up with a design draft for the project. Every group to have a distinct robot. Lessons 2: Idea BuildingPart 2: Engineering Design Process: Test, Iterate, and Communicate (60 mins)Teachers to review and discuss the groups’ designs and trigger their inquisitive minds by asking open ended questions on the limitations and explore endless possibilities. Teachers to get groups to do a cross review on each other groups’ designs so students can explore other possibilities and make adjustments.Students will then construct their robots.Teachers to give ample time for construction, testing, revisions and improvement suggestions for their robots. Students to showcase their robots demonstration in a school exhibition and allow them to bring back to discuss and show their parents for a review.