Background: A crucial balance exists between oxidant and antioxidant mechanisms in the functional immune system. We aimed to evaluate the contributions of balance between these systems to coronavirus disease 2019 (COVID-19), a devastating pandemic caused by viral infection. Method: We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic characteristics of children and adults with COVID-19 and compared them against the values of healthy controls. Serum native thiol (NT), total thiol (TT), disulfide, total antioxidant status, total oxidant status, and ischemia-modified albumin levels were evaluated and compared between groups. Results: A total of 79 children and 74 adults were evaluated in the present study, including 46 children and 40 adults with COVID-19, 33 healthy children, and 34 healthy adults. TT, NT, and disulfide levels were significantly lower in the adult COVID-19 group than in all other groups (p = 0.001, p = 0.001, and p = 0.005, respectively). Additionally, TT and NT levels were significantly lower in both pediatric and adult COVID-19 cases with severe disease course than mild/moderate course. TT and NT levels were identified as predictors for the diagnosis of the adult COVID-19 cases and as independent predictors for disease severity in both children and adults with COVID-19. Conclusion: Parameters that reveal the oxidant and antioxidant capacity, including TT and NT, appear to be good candidates for the accurate prediction of the clinical course among patients with COVID-19.

This paper is devoted to an approximate analytical solution of an integro-differential model describing the process of nucleation and growth of particles in crystallizers, taking into account the thermal-mass exchange with the environment and the removal of product crystals from the metastable medium. The method developed in this work for solving model equations (kinetic equation for the particle size distribution function and balance equations for temperature/impurity concentration) is based on using the saddle point method for calculating the Laplace-type integral. It is shown that the degree of metastability of the liquid decreases with time at a fixed value of the mass inflow from the outside (heat flow to the outside). The crystal size distribution function has the form of an irregular bell-shaped curve, which increases with the intensification of heat and mass exchange with the environment.

Pericarditis is a rare but debilitating complication of cytarabine therapy. While echocardiography can aid with the diagnosis, cardiac MRI has superior accuracy in establishing the diagnosis. In this case, we describe a 65-year-old patient receiving cytarabine as part of induction chemotherapy for acute myeloid leukemia who developed acute pericarditis. Her cardiac MRI revealed pericardial edema on T2-weighted STIR imaging and pericardial late gadolinium enhancement which confirmed the diagnosis.

Background: Cardiac resynchronization therapy (CRT) in heart failure patients has been shown to improve patient outcomes in some but not all patients. A few studies have identified that septal flash on imaging is associated with response to CRT but there has yet to be systematic review to evaluate consistency of the finding across the literature. Methods: A search of MEDLINE and EMBASE was conducted to identify studies which evaluate septal flash and its association with CRT response. Studies that met the inclusion criteria were statistically pooled with random-effects meta-analysis and heterogeneity was assessed using the I2 statistic. Results: A total of nine studies were included with 2,307 participants (mean age 76 years, 67% male). Septal flash on imaging before CRT implantation was seen in 53% of patients and the proportion of CRT responders from the included studies varied from 52% to 77%. In patients who were CRT responders, septal flash was seen in 40% of patients compared to 10% in those deemed to be CRT non-responders. Meta-analysis of the eight studies suggests that the presence of septal flash at pre-implant was associated with an increased likelihood of CRT response (RR 2.55 95%CI 2.04-3.19, p<0.001, I2=51%). Septal flash was also reported to be associated with left ventricular reverse remodelling but the association with survival and symptomatic improvement was less clear. Conclusions: Septal flash is a well-defined and distinctive contraction pattern which is consistently associated with CRT response and should be evaluated when assessing for appropriateness of CRT device.

The objective of this study was to determine whether a caries management by risk assessment (CAMBRA) tool improves oral self-care behaviors and decreases caries diagnoses as compared to traditional oral health education strategies. Findings show patients with a CAMBRA lowered their caries risk as evidenced by lower plaque index scores.

A four year old boy was diagnosed with hypertrophic cardiomyopathy with moderate degree of obstruction of the left ventricular outflow tract, secondary to asymmetric septal hypertrophy and no features of congestive heart failure, at the age of the 7 months. He was also found to have myxomatous mitral valve, systolic anterior motion of anterior mitral leaflet and moderate mitral regurgitation. There was no evidence of ventricular septal defect at this point in time.In view of phenotypic features suggestive of Noonan syndrome, he underwent genetic evaluation with target gene sequencing and was detected to have a novel heterozygous mutation in exon 13 of LZTR 1 (Leucine- zipper-like transcriptional regulator 1) gene. Echocardiogram on follow up showed increase in left ventricular outflow tract obstruction and appearance of an aneurysm in the membranous portion of interventricular septum. There were no features of right ventricular outflow obstruction, tricuspid regurgitation or aortic regurgitation. The appearance of the membranous septal aneurysm may be related to the direction of jet arising from the point of contact of the anterior mitral leaflet with the hypertrophied basal septum and hitting this part of the interventricular septum. It is an unusual mechanism for formation of membranous septal aneurysm, given its absence in the earlier echocardiograms and absence of any left to right shunt across the aneurysm. He has been initiated on beta blockers due to severe left ventricular outflow tract obstruction and is planned for septal myomectomy, resection of membranous septal aneurysm and mitral valve repair.

Introduction: The risk of developing left atrial (LA) thrombi after initial catheter ablation for atrial fibrillation (AF) and requirements for imaging evaluation for thrombi screening at repeat ablation is unclear. This study aimed to assess the occurrence of thrombus development and frequency of any imaging study evaluating thrombus formation during repeat ablation for AF. Methods: Of 2,066 patients undergoing initial catheter ablation for AF with uninterrupted oral anticoagulation, 615 patients underwent repeat ablation after 258.0 (105.0-882.0) days. We investigated which factors were associated with safety outcomes and requirements for thrombi screening. Results: All patients underwent at least one imaging examination to screen for thrombi in the first session, but the examination rate decreased to 476 patients (77%) before the repeat procedure. The frequency of imaging evaluations was 5.0%, 11%, 21%, 84%, and 91% for transesophageal echocardiography and 18%, 33%, 49%, 98%, and 99% for any imaging modality at repeat ablation performed ≤60 days, ≤90 days, ≤180 days, >180 days, and >1 year after the initial procedure, respectively. Three patients (0.5%) developed LA thrombi at repeat ablation due to identifiable causes, and no patients had thromboembolic events when no imaging evaluation was performed. Multivariate analysis revealed that repeat ablation >180 days, non-paroxysmal atrial arrhythmias, and lower left ventricular ejection fraction were predictors of the risk of thrombus development. Conclusions: The risk development of thrombus at repeat ablation for AF was low. There needs to be a risk stratification for the requirement of imaging screening for thrombi at repeat ablation for AF.

Background: Acute malnutrition is a frequent comorbidity in children with cancer and is associated with poor cancer treatment outcomes.This study describes the prevalence of acute malnutrition and its predictors at time of cancer diagnosis at Mbarara Regional Referral Hospital (MRRH). Methods: This was a retrospective chart review of children <15 years of age at diagnosis of cancer seen at the Children’s Cancer Unit of MRRH between May 2017 and May 2019. Using a data extraction tool, information regarding demographics, anthropometry at admission and cancer diagnosis was extracted from the children’s medical records. Descriptive statistics and logistic regression analysis were used to determine the prevalence and patterns of acute malnutrition among children at diagnosis of cancer and the factors associated with acute malnutrition, respectively. The study was approved by the Mbarara University of Science and Technology Research and Ethics Committee. Results: One hundred and thirty-three children were included in the study with a mean age of 6.6 years (SD 3.9).54.9% of the children were male. Overall, 46 (34.6%) of subjects had acute malnutrition at time of cancer diagnosis. Of these, 25 (54.3%) had moderate acute malnutrition and 21/46 (45.7%) had severe acute malnutrition.The factors independently associated with acute malnutrition after multivariate logistical regression analysis were age >5 years (p<0.0001) and reduced appetite (p=0.002). Conclusion: Acute malnutrition is common among children with cancer at diagnosis, especially in older children and those reporting poor appetite. Nutrition assessment and care should be incorporated into routine childhood cancer care to improve cancer treatment outcomes.

Oropharyngocutaneous fistula is an unfavorable complication that may occur after head and neck reconstruction. The authors used a “stick-shaped platysma flap” technique to close these narrow and deep intractable fistulas. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.

The diagnosis of autoimmune hepatitis remains difficult in low-income countries due to the unavailability of the biopsy. autoimmune hepatitis must be retained on the basis of clinical-biological, radiological and immunological criteria. Careful trial corticosteroid therapy and diagnostic scores are essential for diagnostic autoimmune hepatitis.

The similarity between intestinal tuberculosis and Crohn's disease could lead us to erroneously prescribe corticosteroid therapy. Therefore, it is essential to differentiate the two pathologies because of the therapeutic implications of Crohn's disease, which can lead to an explosion of tuberculosis symptoms.

Spatial rainfall data is an essential input to physically based, parametrically distributed hydrological models, and a main contributor to hydrological model uncertainty. Two important issues should be addressed before use of satellite and reanalysis rainfall product at basin level: 1) how useful are these rainfall estimates as forcing data for regional hydrological modeling? 2) which should be preferred for hydrological modelling at high flow and low flow seasons? To this end, rainfall estimates from a satellite-based product, CHIRPSv8, and reanalysis data, EWEMBI, were used as input to SWAT model, and mode performances were evaluated against streamflow measured at three gauge stations in the Upper Tekeze River basin, northern Ethiopia for the period of 2006-2015. Results showed that (I) the daily rainfall from both CHIRPSv8 and EWEMBI are close to the rain gauge data, with relative errors 2.12% and 3.85%, respectively; (II) the monthly streamflow simulated by the SWAT model driven by the CHIRPSv8 and EWEMBI had a Kling-Gupta Efficiency value of 0.6-0.79 and 0.58-0.64, respectively; (III) the SWAT model calibrated with the CHIRPSv8 and EWEMBI rainfall estimates has shown an improvement in hydrological performance compared with that calibrated with interpolated ground observations; (IV) the hydrological performance during high flow seasons is superior to low flow seasons for both CHIRPSv8 and EWEMBI, thus promoting the use of the products for applications focusing on the high flow conditions. In particular, CHIRPSv8 showed relatively better hydrologic performance than EWEMBI. This study provides insight on the usefulness of the gridded rainfall products for hydrological modeling and under which conditions they can be used to generate a plausible level of adequacy and reliability over the Upper Tekeze River basin.

Saltwater intrusion has become one of the most concerning issues in the Vietnamese Mekong Delta (VMD) due to its increasing impacts on agriculture and food security of Vietnam. Reliable estimation of salinity plays a crucial role to mitigate the impacts of saltwater intrusion. This study developed a hybrid technique that merges satellite imagery with numerical simulations to improve the estimation of salinity in the VMD. The salinity derived from Landsat images and by numerical simulations was fused using the Bayesian inference technique. The results indicate that our technique significantly reduces the uncertainties and improves the accuracy of salinity estimates. The Nash-Sutcliffe coefficient is 0.73, which is much higher than that of numerical simulation (0.69) and Landsat estimation (0.67). The correlation coefficient between the merged and measured salinity is relatively high (0.75). The variance of the ensemble salinity errors (2.57 ppt2) is lower than that of Landsat estimation (3.65 ppt2) and numerical simulations (8.69 ppt2). The proposed approach in this study shows a great potential to combine multiple data sources of a variable of interest to improve its accuracy and reliability wherever these data are available.

Excess nutrients in aquatic ecosystems is a major water quality problem globally. Worsening eutrophication issues are notable in cold temperate areas, with pervasive problems in many agriculturally dominated catchments. Predicting nutrient export to rivers and lakes is particularly difficult in cold agricultural environments because of challenges in modelling snow, soil, frozen ground, climate, and anthropogenic controls. Previous research has shown that the use of many popular small basin nutrient models can be problematic in cold regions due to poor representation of cold region hydrology. In this study, the Cold Regions Hydrological Modelling Platform (CRHM), a modular modelling system, which has been widely deployed across Canada and cold regions worldwide, was used to address this problem. CRHM was extended to simulate biogeochemical and transport processes for nitrogen and phosphorus through a complex of new process-based modules that represent physicochemical processes in snow, soil and freshwater. Agricultural practices such as tillage and fertilizer application, which strongly impact the availability and release of soil nutrients, can be explicitly represented in the model. A test case in an agricultural basin draining towards Lake Winnipeg shows that the model can capture the extreme hydrology and nutrient load variability of small agricultural basins at hourly time steps. It was demonstrated that fine temporal resolutions are an essential modelling requisite to capture strong concentration changes in agricultural tributaries in cold agricultural environments. Within these ephemeral and intermittent streams, on average, 30%, 31%, 20%, and 16% of the total annual load of NO3, NH4, SRP and partP occurred during the episodic snowmelt freshet ~9 days, accounting for 21% of the annual flow), but shows extreme temporal variation. The new nutrient modules are critical tools for predicting nutrient export from small agricultural drainage basins in cold climates via better representation of key hydrological processes, and a temporal resolution more suited to capture dynamics of ephemeral and intermittent streams.

Aim: To analyze the ureteral injury and incidence of ureteral stricture in a series of patients who underwent retrograde intrarenal surgery with using smallest ureteral access sheath. Materials and Methods: Between September 2016 and March 2019, 154 consecutive retrograde intrarenal surgery procedures with adjunctive use of an ureteral access sheath for kidney stone were prospectively included the study. A 9.5/11.5-F ureteral access sheath was used during procedures. The patients were evaluated in terms of intraoperative postoperative and late complications. Ureteral injuries after retrograde intrarenal surgery were assessed visually with flexible and semirigid ureterorenoscope. All patients were evaluated by computed tomographic urography in the first year after treatment for detection of ureteral stricture. Results: The mean age of the patients was 47±15 (12-81) years. Of the patients, 86 were male and 68 were female. Mean stone size was 17.1±8 (7-40) mm and mean operative time was 56±23 (30-120) minutes. Overall 79.9% of patients had evidence of injury to the ureter wall. Non-significant lesion (grade 0) was seen in 39.0% of patients. Grade 1 lesions were assigned in 40.9% of patients. There were no grade 2 and higher lesions detected. A total of 5 patients (3.2%) had minor complications. Urinary sepsis developed as a major complication in 3 patients (1.9%). No ureteral stricture was detected in the patients at first year control. Conclusions: The results of our series indicate that the 9.5/11.5-F ureteral access sheath is safe for routine use to facilitate flexible ureteroscopy and there was no long-term adverse effect.

Despite many studies explored the effect of livestock grazing on plant communities, the response of species composition and diversity to livestock grazing in arid rangelands remain ambiguous. This study examined the effects of livestock grazing on plant communities in arid steppe rangelands of North Africa. Plant diversity of annual species, perennial species and all species combined was measured and compared between grazed and grazing-excluded areas. We also examined the relative importance of species turnover and community nestedness. Moreover, the effects of livestock grazing on beta diversity at local among transects and landscape among sites scales were examined using the multiplicative diversity partitioning. Results revealed that livestock grazing significantly decreased the alpha diversity of all species combined and the diversity of annual plants. Livestock grazing induced a shift in plant community composition where most of species composition variation (~74%) was due to infrequent species replacement ‘turnover’ between the two management types rather than nestedness (~26%). Results revealed also that among transects, beta diversity was higher in grazed steppes than in grazing-excluded steppes. Whereas, among sites, beta diversity was lower in grazed steppes compared to grazing-excluded steppes. These findings suggest that livestock grazing in arid steppe rangelands increases the variation in plant species composition at a local spatial scale and engenders vegetation homogeneity at landscape spatial scale. Therefore, the implementation of appropriate management practices such as short-term grazing exclusion is mandatory to prevent these ecosystems from large scale biotic homogenization.

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

We present a case of complete atrioventricular (AV) block following slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT) treated only by colchicine administration. The patient’s electrocardiogram showed complete AV-block at two weeks after catheter ablation. Colchicine is effective for late-onset AV-block caused by catheter ablation for AVNRT.

We present the case of a 35-year-old male with no medical history who presented with pancytopenia and melena and was found to have PNH in the setting of acute COVID-19 infection. Other infectious, autoimmune, and malignant etiologies were ruled out. It is unclear if this was an acquired PIG-A mutation.

Anthroponotic cutaneous leishmaniasis (ACL) due to Leishmania tropica is spreading to new areas. Exposure to the vector, Phlebotomus sergenti, is the only proven risk factor. Our objective was to compare the densities and genetic characteristics of P. sergenti populations in two nearby localities in Morocco, one within an ACL endemic area (El Borouj) and another undamaged (Sidi Hajjaj). Statistically significant differences were detected between P. sergenti densities with a higher density of P. sergenti in the endemic town (p≤ 0.032). A different main P. sergenti mitochondrial lineage was evidenced in each one of the 2 localities, and for the first time, the lineage of P. sergenti specimens that are acting as a vector of L. tropica has been identified. Bioclimatic differences were detected between both localities. In conclusion, between an ACL endemic locality and another ACL free there are differences in both the density of P. sergenti and the mitochondrial lineage that may explain the different epidemiological situation. Given that the density of P. sergenti in the locality without ACL cases seems sufficient to allow transmission, the main factor that would justify its ACL undamaged character could be the absence of P. sergenti Lineage IV, which seems to prefer warmer and drier climates.

Research of Occult Hepatitis B Infection in HIV-infected Patients, Schindler Study ABSTRACT Objective: Occult hepatitis B infection seems to be more prevalent among subjects at high risk for HBV infection and with concomitant liver disease. The aim of this study was to assess the prevalence of OHBI in group of HIV-1+/HBsAg- Turkish patients. Methods: Ten centers in Turkey have been included in the study. Gender, age, occupation, place of residence, treatment status, clinic, immunodeficiency panel, eliza tests, hemogram, biochemistry and coagulation laboratory results of the patients were evaluated retrospectively. Results: The number of HIV-infected patients followed in these centers is 3172. The mean age of the patients was 37.2 ± 13.1, and they were 235 males (84.5%) and 43 (15.5%) females. 278 (99.6%) of the patients are patients who received antiretroviral treatment. included in the s Of the 279 patients included in the study, it was determined that HBsAg was negative in all of them, 169 were positive for Anti HBs and 125 were positive for Anti HBc IgG. HIV RNA (203/278) was detected in 203 of the patients. 4 (1.4%) of the patients were diagnosed with OHB. In our study, no significant difference was found in hemoglobin and bilirubin levels and complete blood count in patients with HIV-OHB co-infection. However, albumin values were found to be <3.5 in three OHD patients (p = 0.043). Conclusion: Reasearch the presence of OHB infection in HIV-infected patients is important in determining treatment options and predicting the survival of patient. Hypoalbuminemia could be showing hepatic failure and we can suggest the importance of treatment that diseases.

An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.

Attacks on humans by Asian elephant (Elephas maximus) is an extreme form of Human-elephant conflict. It is a serious issue in southern lowland Nepal where elephants kill more humans than any other wildlife. Detailed understanding of elephant attacks on humans in Nepal is still lacking which affected in devising appropriate strategies and actions for human elephant conflict mitigation. This study documented spatio-temporal pattern of elephant attacks on humans, factors associated with the attacks and human/elephant behaviour contributing to deaths of victims when attacked. We compiled all the documented incidences of elephant attacks on humans in Nepal for last 20 years across Terai and Siwalik region of Nepal. We also visited and interviewed 412 victim families (274 fatalities and 138 injuries) on elephant attacks. Majority of the victims were males (87.86%) and had low level of education. One fourth of the elephant attacks occurred while chasing the elephants. Solitary bulls or group of sub-adult males were involved in most of the attack. We found higher number of attacks outside the protected area. People who were drunk and chasing elephants using fire-crackers were more vulnerable to the fatalities. In contrast, chasing elephants using fire was negatively associated to the fatalities. Elephant attacks were concentrated in proximity of forests primarily affecting the socio-economically marginalized communities. Integrated settlement, safe housing for marginalized community and community grain house in the settlement should be promoted to reduce the confrontation between elephants and humans. Conservation of elephant should be carried out in entire landscape, extending beyond the boundary of protected areas to reduce threats of elephant extinction.

Numerical simulation of the proximal femur could provide an effective approach to predict the femoral fracture risk. However, most of the extant numerical simulations are static simulations, which cannot accurately reflect the dynamic growth process of cracks. In this study, the dynamic simulation by incremental element deletion (IED) based finite element analysis (FEA) was developed on femur fracture analysis and compared with two widly-used approaches (XFEM and USDFLD). It was also evaluated using the in-vitro loading test. Moreover, the effects of different impact speeds, fall postures, and cortical thicknesses on fracture types and mechanical responses were investigated. Impact speeds cause different crack propagation behaviors of the femoral neck. Falling forward was less likely to cause proximal femoral fracture compared with falling backward. The model with thin cortical bone was prone to fracture. These provides a theoretical basis and method for predicting femoral fracture risk in the elderly.