Context: Multisystem Inflammatory Syndrome in Children (MISC) is a newly and rising condition, particularly in SARS-CoV-2 high transmission communities. Objective: Analyze current literature and reported cases of MISC, concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes. Data Sources: Extensive literature research was performed in MEDLINE (trough PubMed), Scopus and Web of Science from December 2019 to December 2020.Study Selection: First analysis included all article titles and abstracts screening to identify relevant studies and second analysis included a full text screening of previous selected studies. Eligibility was assessed independently by two authors and disagreements were resolved by discussion and consensus. Data Extraction: Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis andimaging, therapeutical approach and outcomes. Results: Common symptoms included: gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki Disease were identified including age, clinical presentation and cardiac involvement. 30% presented positive SARS-CoV-2 2 reverse transcription polymerase chain reaction and 51% positive serologies. 62% received intravenous immunoglobulin and 42% glucocorticoids. 62% required intensive care, 21 children died (<2%). Severe presentations were associated with neurological symptoms, hepatitis and acute kidney injury. Limitations: As a recently documented disease, there was limited prospective and follow-up studies, therefore disregarding long-term sequelae and prognosis. Conclusions: MISC raises concern on its severe cardiac involvement at presentation, with frequent intensive care and immunomodulatory therapy need. Short term outcomes seem to be favorable, with cardiac disfunction recovery and low mortality rates.

Introduction: The covid-19 disease is a pandemic threat for humanity’s healthcare system, social, economic, and psychological well-being for both developed and developing nations. In the case of developing nations such as the resource of Ethiopia, however, the key obstacle is to buy the vaccine and administer it to their people.. In the study area, however, the degree of adherence to the covid-19 preventive measure was not well established. The aim of this study is to determine adherence to covid-19 prevention measures in Hossana town. Methods: From 3 to 29 January 2021, a community-based cross-sectional study was conducted among individuals living in the Hosanna town. We used a sample size of 384. The sample size was distributed to all 8 kebeles in proportion to the size of the households contained in each kebele in the town of Hossana. Systematic sampling methods were used and both descriptive and advanced analysis, data was entered into Epi-data and exported to SPSS. Binary logistic regression was used to identify variables associated with adherence to preventive measures for covid-19. Result: 50.4% of the study participants had good adherence with the COVID-19 preventive measures. 145 (38.5%) of all respondents had poor knowledge on COVID-19 preventive measures and 40.3 % had poor COVID-19 transmission methods knowledge. Age [AOR: 0.34; 95 % CI (0.131-0.912)], educational status [AOR: 0.32; 95% CI (0.165-0.632)], marital status [AOR: 2; % CI (1.191-3.803)], family size [AOR: 2.4; % CI (1.322-4.366)]] and covid-19 complication [AOR: 0.49: 95% CI (0.242-0.979)]] were significantly associated with covid-19 prevention measurement adherence in multivariate analysis. Conclusion: This study found that approximately half of the participants had poor adherence to COVID-19 preventive measures. Factors associated with covid-19 preventive measures were age, educational age, marital status, family size, and heard about complication of COVID-19 were associated with preventive measures.

Background: Small-bowel obstruction (SBO) is a common emergency worldwide and adhesions are the main cause. Oleaster-leafed pear (Pyrus elaeagnifolia Pall.) is an endemic wild pear species in Anatolia. The wild pear fruits are consumed for the treatment of diarrhea in traditional medicine in Turkey. Here, we aimed to describe SBO caused by excessive consumption of wild pear and compare clinical features of it with those in adhesive SBO. Methods: The medical records of patients who were followed with a diagnosis of SBO between May 2018 and September 2019 were reviewed. Patients with wild pear-related SBO (Group 1) and patients with adhesive SBO (Group 2) were included in the study. Patient characteristics, blood parameters and clinical features were compared. Results: A total of 74 patients including 16 in Group 1 and 58 in group 2 were included. Amount of wild pear consumed was median 600 grammes (range, 450-800 gr). The median age in Group 1 and Group 2 was 55 and 60.5, respectively. History of previous SBO was more common in Group 2 (p=0.032). Increased levels of WBC, CRP and BUN were significantly more frequent in Group 2 (all p<0.05). Group 1 was associated with a shorter duration of complaints and faster recovery (all p<0.05). Surgical intervention was required for six patients (10.3%) in only Group 2. Conclusion: The potential adverse effects of over-consumed traditional medicines should be kept in mind. Questioning the last food consumed before the complaints start may be a clue for food-induced SBO.

Background: Many treatments for COVID-19 are currently under studying, such as combination therapies with hydroxychloroquine plus antiviral drugs. In this study, we compared the efficacy and side effects of two types of combination therapy including atazanavir /ritonavir (ATV/r) or lopinavir /ritonavir (LPV/r) plus hydroxychloroquine among COVID-19 patients. Methods: In a non-randomized clinical trial, 108 eligible patients with moderate and severe form of COVID-19 were divided into two groups. Each group consisted of 54 patients. One group received ATV/r plus hydroxychloroquine and the other group received hydroxychloroquine plus LPV/r. Then, the two groups were evaluated and compared for clinical symptoms, recovery rates and complications of treatment regimens. Results: The findings of this research showed a significant increase in bilirubin in ATV/r receiving group compared to LPV/r receivers (p<0.001). there was also a significant increase in arrhythmias in the LPV/r group compared to ATV/r group during the treatment period (p=0.019). Other findings including length of hospital stay, outcome, and treatment complications were not statistically significant. Conclusions: There is not statistically significant difference between protease inhibitor drugs including ATV/r and LPV/r in the treatment of COVID-19 regarding to progress and clinical outcomes. However, some side effects such as hyperbilirubinemia and arrhythmia was significantly different by application of atazanavir or lopinavir.

Purpose: The novel coronavirus disease 2019 (COVID-19) has spread all over the world. The diagnosis of COVID-19 in asymptomatic patients and patients with non-respiratory symptoms remains a big concern. In this study, we aimed to evaluate the incidence of missed diagnosed COVID-19 pneumonia on abdominal computed tomography (CT) performed in patients admitted to our urology outpatient clinic. Methods: We reviewed the files of patients who were admitted to the urology outpatient clinic from 1 April to 1 November retrospectively. We included the patients who performed abdominal CT at the urology outpatient clinic for any reason and recorded demographic data and abdominal CT findings. We excluded patients with pulmonary symptoms and previously diagnosed with COVID-19. Also, patients without abdominal CT were excluded. We evaluated the rates of missed diagnosed COVID-19 pneumonia detection on the lung base images of abdominal CT. Results: 1024 patients were included in this study. We observed that 99 (9.7%) of these patients had findings related to COVID-19 pneumonia on the lung base images of abdominal CT. Although 885 (86.4%) patients had no pathological pulmonary findings, 40 (3.9%) patients had other pathological pulmonary findings. Conclusion: COVID-19 disease has become a pandemic all over the world. All healthcare professionals, including urologists, play an active role in the diagnosis and treatment of this disease. So, it should be kept in mind that COVID-19 pneumonia should be evaluated in patients admitted to the urology outpatient clinic with renal colic or abdominal pain.

Objective: This study aimed to assess effectiveness and safety outcomes of antiplatelet therapy for secondary prevention among patients with ischaemic stroke or transient ischaemic attack (TIA) in Malaysia. Method: Patients with a first ischaemic stroke/TIA between 2014 and 2017 were identified from stroke registry and data was linked with other data sources for information on antiplatelet exposure and outcome events. Exposure was defined as antiplatelet therapy at discharge from the index stroke hospitalisation and categorised into single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) groups. Primary outcome was composite events of stroke, myocardial infarction, and all-cause death at up to one year after the index stroke in an intention-to-treat analysis. Results: Of 4434 patients included in the analysis, 6.7% were treated with DAPT and 93.3% were in SAPT group. During the 1-year follow-up, composite events occurred in 5.7% of patients in DAPT group and in 12.3% of SAPT (p<0.001). The rates of individual events were lower in DAPT group compared to SAPT: recurrent stroke (3.4% versus 4.8%), myocardial infarction (0.7% versus 1.9%), and all-cause death (1.7% versus 6.0%). Bleeding occurred in 1.3% of the DAPT group versus 1.6% of the SAPT. Multivariable-adjusted Cox regression analysis showed that rates of composite outcome was lower in the DAPT group compared to SAPT (HR 0.53, 95%CI 0.32, 0.86). Conclusion: In patients with ischaemic stroke/TIA, treatment with DAPT following the index stroke was associated with reduced risk of the composite events of stroke, myocardial infarction, and death. There appears to be similar risk of bleeding with DAPT versus SAPT.

Background Dietary inflammatory index (DIP) is a new dietary index designed to evaluate individuals’ diets. In addition, adhesion molecules are important biomarkers for assessing endothelium inflammation that they related to atherosclerosis and cardiovascular disease. Also, there is no study for assessing the association between adhesion molecules and DIP until now as well as other studies that assessed the relationship between dietary inflammatory index or DIP have controversy. Aim of the Work The purpose of this cross-sectional study was to determine the correlation between DII and endothelial markers such as E-selectin, intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) among female nurses from Isfahan. In this study, dietary inflammatory potential (DIP) was used instead of DII. Patients and Methods This study was performed on 420 healthy nurses. The nurses were selected by random cluster sampling method from private and public Isfahan hospitals. A validated food frequency questionnaire (FFQ) was applied to assess the dietary inflammatory potential. A fasting blood sample was collected for measuring the plasma levels of the endothelial markers and other variables. Results After adjusting different potential confounders, no statistical association was found between DIP and sICAM-1, E–selectin and sVCAM-1 in model I (P=0.57, 0.98 and 0.45), model II (P=0.57, 0.98 and 0.45) and model III (P=0.67, 0.92 and 0.50) in comparison to the crude group (P=0.35, 0.83 and 0.49, respectively). Conclusion The results revealed that the plasma levels of endothelial markers including E-selectin, sICAM-1, and sVCAM-1 were not significantly associated with DIP in female nurses.

Object: This study aimed to retrospectively assess dexamethasone utility in pediatric CNS tumor patients over a 10-year period, to better understand dosing variability, and highlight optimal practice. Methods: All pediatric CNS tumor cases managed operatively for a ten year period at a single center were reviewed. Information was gathered on demographics, dexamethasone doses, course durations, weaning regimes, PPI co-prescription, adverse events, and route of administration. Comparison within these groups was analyzed through use of statistical testing. Results: 127 patients received 193 dexamethasone courses. Median age was 7 years, with a median weight of 27.9kg. Most common tumor type was astrocytoma (24.8%). Median daily dose was 8mg, with twice daily dosing most common. Median course duration was 8 days,. Median weaning duration was 11.5 days. Daily dose was not correlated with patient weight and the median daily dose per kg was 0.2319mg/kg. Dexamethasone dose per kg was significantly inversely correlated with age. 44.9% of patients received intravenous dexamethasone only. 32.7% received oral dexamethasone only. 22.4% received multiple different routes of administration throughout their course. Intravenous dexamethasone was more commonly used in young age groups. Incidence of adverse effects was 14.5% with Cushing’s syndrome most common. Dexamethasone dose per kg was not significantly different between patients with and without adverse effects; however, average dexamethasone course duration was significantly different between these groups. No relationship was noted between adverse effects incidence and administration route. 64.2% of patients received concurrent PPI with 35.8% receiving no PPI. Conclusions: Large variation was seen in practice, with prescriptions appearing based on clinician preference and symptom severity rather than patient age or weight. Dexamethasone administration route interestingly showed no relationship with incidence of adverse effects. Future guidelines should consider lower dose regimens with less frequent dosing as these may benefit quality of life.

Background Transurethral resection of bladder tumour (TURBT) is associated with a perioperative morbidity of 5-10% which can lead to unplanned readmissions. In this study, we aim to identify factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT. Methods A retrospective study was conducted to identify patients who had their primary TURBT at our institute from 2011-2019. The clinico-demographic factors, history of smoking, intake of anti-platelet drugs, co-morbidities, tumour size (< 3 cm or > 3cm), multifocality and histopathological type were abstracted. The patients who had a readmission were identified and reasons for admission were recorded. Results A total of 435 patients were identified. The median age was 66 years. There were 378 (86.9%) males, 110 (25.3%) had history of smoking and 37 (8.5%) had history of intake of an anti-platelet agent. In the cohort 166 (38.2%) were diabetic, 239 (54.9%) were hypertensive, 72 (16.6%) had COPD, 78 (7.9%) had hypothyroidism. A total of 206 (47.4%) had a tumour of >3cm, multifocality was seen in 140 (32.2%) while muscle invasive tumour was present in 161 (37%) patients. A total of 22 (5.06%) had re-admissions within 30 days with hematuria being the commonest etiology. On the univariate and multivariate analysis, history of smoking ( p=0.006 and 0.008, respectively) or intake of anti-platelet agents (p<0.001 and <0.001, respectively) were significantly associated with increased unplanned readmission. Conclusion Our study revealed smoking and intake of anti-platelet agents as the factors leading to increased risk of unplanned readmissions.

Background There are limited data in paediatric populations evaluating whether chronic cardiorespiratory conditions are associated with increased risk of COVID-19. We aimed to compare the rates of chronic cardiac and respiratory disease in children testing positive (SARS-CoV-2[+]) compared to those testing negative (SARS-CoV-2[-]) at our institution. Method Prospective cohort with nested case-control study of all children tested by PCR for SARS-CoV-2 by nasopharyngeal/oropharyngeal sampling between March and October 2020. Children were identified prospectively via laboratory notification with age and sex-matching of SARS-CoV-2[+] to SARS-CoV-2[-] (1:2). Clinical data were extracted from the electronic medical record. Results In total, 179 SARS-CoV-2[+] children (44% female, median age 3.5 yrs, range 0.1 to 19.0 yrs) were matched to 391 SARS-CoV-2[-] children (42% female, median age 3.7 yrs, range 0.1 to 18.3 yrs). The commonest co-morbidities showed similar frequencies in the SARS-CoV-2[+] and [-] groups: asthma (n = 9, 5% vs n = 17, 4.4%, p = 0.71), congenital heart disease (n = 6, 3.4% vs n = 7, 1.8%, p = 0.25) and obstructive sleep apnoea (n = 4, 2.2% vs n = 10, 2.3%, p = 0.82). In the SARS-CoV-2 group, the prevalence of symptomatic disease was similar amongst children with and without cardiorespiratory comorbidities (n = 12, 75% vs n = 103, 57%, p = 0.35) who tested positive. A high proportion of children hospitalised with SARS-CoV-2 infection had cardiac comorbidities (23.8%). Conclusions In this single site dataset, rates of pre-existing cardiorespiratory disease were similar in SARS-CoV-2[+] and SARS-CoV-2[-] children. High rates of comorbid cardiac disease were observed amongst hospitalised children with COVID-19, warranting further research to inform public health measures and vaccine prioritisation.

The Qinghai-Tibetan Plateau (QTP) is one of the amplifiers of global climate change. The headwater area of the Yellow River Basin (HYRB) on the QTP is the dominant water source region for the whole Yellow River Basin (YRB). However, the sensitive responses of hydrological processes to the intensifying climate change are exerting high uncertainties to the water cycle in the HYRB. The aim of this study was to investigate the potential climate change under three Representative Concentration Pathways (RCP 2.6, 4.5, and 8.5) and their hydrological impacts in this region using the ensemble climate data from eight general circulation models (GCMs) and the Soil and Water Assessment Tool (SWAT). Compared to the baseline (1976–2015), the projected climate indicated a rise of 7.3–7.8% in annual precipitation, 1.3–1.9°C in maximum air temperature, and 1.2–1.8°C in minimum air temperature during the near future period (2020–2059), and an increment of 9.0–17.9%, 1.5–4.5°C, and 1.3–4.5°C in precipitation, maximum and minimum temperature, respectively, during the far future period (2060–2099). The well-simulated SWAT modeling results suggested that due to a wetter and warmer climate, annual average actual evapotranspiration (AET) would increase obviously in the future (31.9–35.3% during the near future and 33.5–54.3% during the far future), which might cause a slight decrease in soil water. Water yield would decrease by 16.5–20.1% during the near future period, implying a worsening water crisis in the future. Till the end of this century, driven by the increased precipitation, water yield would no longer continue to decrease, with a decline by 15–19.5%. Overall, this study can not only provide scientific understanding of the hydrological responses to the future climate in both semi-arid and alpine areas, but also contribute to the decision support for sustainable development of water resources and protection of eco-environment in the HYRB.

Levee breach-induced flooding occurs occasionally but always causes considerable losses. A serious flood event occurred due to the collapse of a 15-m-long levee section in Qianbujing Creek, Shanghai, China, during typhoon “Fitow” in Oct, 2013. Heavy rainfall associated with the typhoon intensified the flood extent. This study investigates the flood evolution to understand the dynamic nature of flooding and the compound effect using a well-established 2D hydro-inundation model (Floodmap) to reconstruct this typical event. Our simulation results provide a comprehensive view of the spatial patterns of the flood evolution. The worst-hit areas are predicted to be low-lying farmland. Temporal evaluations suggest that the most critical time for flooding prevention is in the early hours after dike failure. In low-elevation areas, temporary drainage measures and flood defenses are equally important. The validation of the model demonstrates the reliability of the approach.

Complex networks of both natural and engineered flow paths control the hydrology of streams in major cities through spatio-temporal variations in connection and disconnection of water sources. We used spatially extensive and temporally intensive sampling of water stable isotopes to disentangle the hydrological sources of the heavily urbanized Panke catchment (≈ 220 km²) in the north of Berlin, Germany. The isotopic data enabled us to partition stream water sources across the catchment using a Bayesian mixing analysis. The upper part of the catchment streamflow here is dominated by groundwater from gravel aquifers underlying surrounding agricultural land. In dry summer periods, streamflow becomes intermittent; possibly as a result of local groundwater abstractions. Urban storm drainage is also an important part of runoff generation, dominating the responses to precipitation events. Although this dramatically changes the isotopic composition of the stream, it only accounts for 10-15% of annual streamflow. Moving downstream, subtle changes in sources and isotope signatures occur as catchment characteristic vary and the stream is affected by different tributary inflows. However, effluent from a wastewater treatment plant (WWTP) serving 700,000 people dominates the stream in the lower catchment where urbanisation effects are more dramatic. The associated increase in sealed surfaces downstream also reduces the relative contribution of groundwater to streamflow. The volume and isotopic composition of storm runoff is again dominated by urban drainage. As a result, only about 10% of annual runoff in the lower catchment comes from urban storm drains. The study shows the potential of stable water isotopes as inexpensive tracers in urban catchments that can provide a more integrated understanding of the complex hydrology of major cities. This offers an important evidence base for guiding the plans to develop and re-develop urban catchments to protect, restore and enhance the ecological and amenity value of these important resources.

Coronary dissection is an extremely rare but known complication of coronary catheterization and angioplasty. Due to its rarity, there are no management recommendations. However, surgery immediately after an endovascular procedure is frequently carried out under major antithrombotic treatment. The surgery and the postoperative consequences are therefore very complex. We report here the documented case of a type A aortic dissection after coronary catheterization. Despite extension to the entire ascending aorta which indicated surgical management, the benefit-risk balance argued for armed surveillance to avoid surgery under antiplatelets drugs without known antidote. We believe this case should lead us to systematically weigh the data before considering that any iatrogenic dissection of Dunning class 3 should be operated.

Background: Aortic root aneurysm involves dilatation of sinuses of Valsalva, sinotubular junction and proximal ascending aorta. It is a rare complication after aortic valve replacement surgery. Giant aneurysm is defined as aneurysm of size> 10 cm. Surgical treatment involves Bentall’s procedure. Case Detail: A 40 year old gentleman with severe aortic regurgitation and moderate aortic stenosis underwent aortic valve replacement with a mechanical prosthetic valve of size 25 mm, 13 years ago. At the time of this surgery the ascending aorta was mildly dilated, measured 3.5 cm in size. Patient came with complaints of breathlessness on exertion from past two months, NYHA class III. Echocardiography and CECT revealed giant ascending aortic aneurysm about 12.8 cm in diameter with intimal flap suggestive of dissection. Prosthetic valve function and other cardiac structures were assessed as normal. Elective surgery was planned. CPB established via right axillary artery and right femoral vein. Ascending aortic aneurysm was excised along with prosthetic mechanical valve. Bentall’s procedure was done using 27 mm Dacron composite graft. Patient required permanent pacemaker for complete heart block in post operative period. Thereafter patient was discharged in stable condition. Conclusion: Aortic aneurysm should be tackled surgically in order to decrease the morbidity and mortality. Regular follow up of such patients should be done.

New insights in diagnostic thresholds for total serum bile acid (TSBA) in intrahepatic cholestasis of pregnancy (ICP)

Aims: In our study,we aimed to investigate whether end-expiratory vena cava inferior (expVCI) diameter and vena cava inferior collapsibility index predicted post-spinal hypotension in geriatric patients undergoing spinal anesthesia, the correlation between them and other parameters. Material and methods: Our prospective study included ASA I-4,73 patients over 65 years of age, who were scheduled for operation using spinal anesthesia. According to the expVCI diameter displayed with USG before spinal anesthesia, patients; those with an expVCI diameter less than 1.8 cm previously determined as the threshold value are grouped as 1.(Small-VCI) Group,those greater than 1.8cm as 2.(Large-VCI) Group. Demographic characteristics of the patients, comorbidities, duration and type of operation, basal (preoperative) heart rate, systolic, diastolic, mean blood pressure, peripheral oxygen saturation values before spinal anesthesia and after spinal anesthesia in supine position (0 min) and 5th, 10th, 15th, 20th, 25th, 30th min and preoperative arterial blood gas parameters, amount of peroperative urine and bleeding, inotropic and fluid requirement, complications were recorded. Results: Hypotension developed in 28(38.4%) patients and bradycardia in 14 (19.2%) of patients. The patients who developed hypotension had more ASA 2 and ASA 3 (p=0.01), shorter height (p=0.02), and smaller expVCI diameter (p=0.004).It was observed that they had higher lactate (p=0.03), lower pH (p=0.006) values, and more inotropic agents were administered (p<0.001). While the rate of developing hypotension was 51.1% (n=23) in the patients in the Small-VCI group, this rate was 17.9% (n=5) in the patients in the Large-VCI group (p=0.004). Conclusion: It was concluded that the expVCI diameter value measured by USG before spinal anesthesia in elderly patients is effective in predicting post-spinal hypotension with lactate and pH values, which are among the blood gas parameters, and expVCI can be preferred to invasive methods due to its noninvasive, easy and fast application.

Ultra-light Mg-Li alloy is a promising alloy in aerospace since it is known to the lightest structural alloy at present, but its fatigue behaviors remain to be explored. This work focuses on very-high cycle fatigue (VHCF) strength and small crack initiation behaviors of an extruded dual-phase Mg-Li alloy (LZ91). The fatigue strength of the LZ91 alloy at 109 cycles is about 78 MPa, and the fatigue ratio is approximately 0.46. Microstructure characterization demonstrates that fatigue crack tends to initiate from the β-Li phase-enriched region. The α-Mg phase, presenting <10−10 >  fiber texture with the basal plane, deforms hardly along the extrusion direction and acts as an enhanced phase compared with the β-Li phase. The deformation discrepancy localizes cyclic plasticity at the Li phase and finally leads to the fatigue crack initiation.

In this paper, we consider a singular limit problem of Cauchy problem for Patlak-Keller-Segel equation coupled with Stokes equation in scalling critical space. Precisely, by taking advantage of a coupling structure of equations and using a scale decomposition technique, it is shown that when the relaxation time parameter ε →∞, a solution of Patlak-Keller-Segel system coupled with nonstationary Stokes equation converges to that of Patlak-Keller-Segel system coupled with stationary Stokes equation in the critical Fourier-Besov space under certain conditions.

The whole world is facing the COVID-19 pandemic caused by (SARS-CoV-2) virus, which was first reported in December 2019 in Wuhan, China, which was classified by the World Health Organization (WHO) as a public health emergency of international concern On January 30, 2020. Because of the exponential increase in the number of cases and deaths, many countries have adopted pandemic preparedness measures and proactive approaches, such as entry restrictions from affected countries; temperature screening; quarantine of those who have contacted with infected people, or those deemed to be in the incubation period; and public education.

This study was conducted to evaluate the antimicrobial activity of tow extract of Eryngium creticum plant belonging to the Apiaceae family collected from the coastal surrounding, Tartous, Syria. Many efforts have been made to discover new antimicrobial activity from a variety of sources such as microorganisms , animals and plants. One such source is Folk medicine. Systematic screening of them may result in the discovery of new effective compounds. These extracts were prepared with polar solvent (methanol and ethanol) by steeping extraction method. The antimicrobial activity of the extracts was assessed using the disk diffusion method against gram-positive (Staphylococcus aureus), and gram-negative (Escherichia coli) bacteria. The methanolic extracts of Eryngium creticum have shown antimicrobial activity against tested bacteria. The activity was compared with potent broad spectrum antibiotics such as Cefipime, Amecasine and ceftriaxon.

Background & local problem: Acute wheezing attacks are a leading cause of Pediatric Emergency Department (PED) attendances and inpatient admissions and are a considerable burden on the healthcare providers. Almost one-third of children vomit prednisolone in the PED, requiring anti-emetics and repeat dosing. Aim: This quality improvement (QI) intervention aimed to improve oral corticosteroid (OCS) tolerability, reduce emergency department length of stay (LOS), and reduce OCS drug costs for acute wheeze attendances in a PED, while not adversely affecting admissions, re-attendance, or mortality rates. QI Interventions: Included (1) a departmental protocol and (2) modification of the OCS type and dosage from prednisolone (3-day course of 1 mg/kg) to dexamethasone (600 mcg/kg, then single dose 300 mcg/kg). Methods: The study team reviewed the evidence and implemented the interventions. To assess the scale of improvement, we retrospectively collected data on attendance records for patients aged 2-14 years with acute wheeze requiring OCS. We collected data on 100 children who attended the PED between October and December for each year (2016, 2017, and 2018). We then assessed OCS tolerability, LOS, OCS drug costs, and, admission, re-attendance, and mortality rates. Results: Over a 48-month period, we increased OCS tolerability by 67.2% and achieved an 85.8% reduction in OCS drug costs (saving £41,553.14). There was no change in the LOS, admission, re-attendance, and mortality rates. Conclusions: Improved tolerability and substantial cost savings can be achieved by implementing a structured acute pediatric wheeze protocol and modifying the OCS to single-dose dexamethasone (300 mcg/kg).

Cu-Ni-Si alloys have been widely applied in electronic and electrical industries.The effect of precipitation on the microstructure and properties of the alloys are still not well understood. In this study, Cu-Ni-Si alloys were prepared by hot-pressed sintering and elemental copper powders, nickel powders and silicon powders as raw materials. The results show that, there were no Ni-Si intermetallic compounds except the δ-Ni2Si phase in the microstructure by hot-pressed sintered preparation of Cu-Ni-Si alloys. And the distribution of the δ-Ni2Si phase in the alloy was more uniform and smaller. After aging treatment, when the mass ratio of Ni and Si were 2:1 and 3:1, the precipitation of δ-Ni2Si phase was significantly less, and when the mass ratio of Ni and Si were 4:1 and 5:1, the precipitation of δ-Ni2Si phase particles increased significantly.The test results by electrical conductivity and vickers hardness show that after ageing treatment, both the electrical conductivity and vickers hardness of the alloys were greatly improved. When the electrical conductivity was 39.33%IACS, the vickers hardness was 230.95HV, and the Cu-Ni-Si alloy had the best comprehensive performance.

Congenital lymphatic leak may develop in patients with maldeveloped lymphatics and result in life-threatening fluid and electrolyte imbalance, protein deficiency and immunodeficiency. Rapid diagnosis and therapy are necessary to prevent these complications; however, the field lacks clinical trials to support standardized diagnostic treatment guidelines. We present our current multidisciplinary approach to the diagnosis and management of congenital lymphatic leak including chylous pleural effusion and ascites. Depending on the rate of lymphatic leak, therapy can range from observation with nutritional modifications to surgical and interventional procedures aimed to reduce lymphatic drainage. Modalities to image central and peripheral lymphatics have advanced considerably. Genetic variants and subsequent targets that drive lymphatic maldevelopment have expanded the repertoire of possible pharmacotherapeutic options.