Proposals for SARS-CoV-2 virus vaccination priorities in the UK and in many other countries are heavily influenced by epidemiological models, which use outcome measures such as deaths or hospitalisation. Limiting the values under consideration to those attributable to the direct effects of infection has the advantage of simplifying the models and the process of decision-making. However, the consequences of the pandemic extend beyond outcomes directly attributable to SARS-CoV-2 infection. The alternative to vaccination (in addition the threat of illness and death) is restrictions on educational and work opportunities, access to services, recreational activities, affiliations and relationships with others, freedom of movement (including escaping abusive relationships), and other determinants of human experience. Capability theory gives emphasis to the freedoms that individuals have to express themselves (in doings and beings). Restrictions on freedoms restrict our capabilities. Capability theory has been used to provide a framework for the evaluation and comparison of international development approaches and in the evaluation of public health policy. There is a clustering of disadvantages associated with this pandemic that adds to pre-existing inequalities. Much of the disadvantage engendered in the SARS-CoV-2 pandemic is left out when public health policy is based on a limited range of metrics. Acknowledging the impact of policy across the range of human freedoms at both a national and international level has the potential to improve policy, facilitate the mitigation of direct and indirect adverse consequences, and improve public confidence in vaccine deployment strategies.

Background: Human papilloma virus (HPV) infection is the most common sexually transmitted viral disease. It was aimed to evaluate the knowledge levels and attitudes of medical faculty students about HPV infection and vaccine. Methods: Our descriptive cross-sectional study; was made with the medical faculty students studying at the Harran University Faculty of Medicine in the 2019-2020 academic year. A total of 645 students were reached, excluding those who refused to participate in the study and those who were not at the faculty or hospital for any reason. Data were collected using a questionnaire method. NCSS 2007 program was used for statistical analysis. Results: 645 students were included in this study ( 52.9% (n = 341) is male, 47.1% (n = 304) is female, and average age of them is 21.46 ± 2.39 years). 75.3% of the students stated that they have information about HPV infection. The HPV infection knowledge level scores of the married were higher than the singles (p = 0.005; p <0.01). 51.2% of the students stated that they had knowledge about the HPV vaccine. HPV vaccine knowledge level scores of women were compared to men (p = 0.019; p <0.05); and the scores of married people were also higher than singles (p = 0.016; p <0.05). Only 1.9% of the students had the HPV vaccine. Conclusion: In our study, it was seen that the medical faculty students’ knowledge about HPV infection and vaccine was not sufficient, and the methods that should be used to provide more effective education should be determined. We believe that it will be beneficial to add the HPV vaccine to the national vaccine program in our country.

Aim: Red eye, a frequent cause of presentations to ophthalmology clinics, is an important indicator of ocular inflammation. Although the prognosis is generally good and self-limiting, it is possible to distinguish possible serious conditions and prevent important situations such as blindness, with detailed examination and correct treatment approach. The purpose of this study was to evaluate patients with red eye presenting to the eye diseases clinic in terms of clinical and sociodemographic characteristics. Material-method: The records of patients presenting to the Şanlıurfa Harran University Hospital Ophthalmology Clinic with red eye were investigated retrospectively. Diseases causing red eye were classified according to the International Classification of Diseases (ICD 10) coding system. Demographic characteristics such as age and sex and clinical findings were examined. Results: A total of 2625 patients, 1775 males (67.61%) and 850 females (32.38%), who presented with red eyes, were evaluated. The incidence of viral conjunctivitis, the most frequently observed condition in patients presenting due to red eye, was 15.08% (n=396). The most common cause of red eye resulting in decreased vision and increased intraocular pressure (IOP) was acute angle closure glaucoma (AACG). The most common symptom was stinging-burning (70.36%), and the most frequent finding was follicular hyperplasia (74.17%). Five hundred and seventy-one (21.75%) patients who applied to the clinic with red eye had previously applied to a family physician and 289 patients (11.0%) to an emergency physician. Conclusion: Although prognosis is usually good in red eye, and the condition is self-limiting, the detection of serious conditions through a detailed history, examination, and therapeutic approach can be enhanced with early and appropriate intervention. In addition to family physicians and emergency physicians, the first to examine patients with red eye, important morbidities such as blindness can also be prevented by increasing the awareness of ophthalmologists and cooperation between these.

Under consideration in this paper is rogue waves on the general periodic travelling waves background of an integrable extended modified Korteweg-de Vries equation. The general periodic travelling wave solutions are presented in terms of the sub-equation method. By means of the Darboux transformation and the nonlinearization of the Lax pair, we present the first-, second- and third-order rogue waves on the general periodic travelling waves background. Furthermore, the dynamic behaviors of rogue periodic waves are elucidated from the viewpoint of three-dimensional structures.

Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, Lung Ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low-to-middle income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality and sustainability of the provision of ultrasound services in every setting.

Abstract: Objectives: Our work assessed the prevalence of co-infections in patients with SARS-CoV-2. Methods: All patients hospitalized in a Parisian hospital during the first wave of COVID-19 were tested by mPCR if they presented ILI symptoms. Results: A total of 806 patients (21%) were positive for SARS-CoV-2, 755 (20%) were positive for other respiratory viruses. Among the SARS-CoV-2 positive patients, 49 (6%) had viral co-infections. They presented similar age, symptoms, except for fever (p=0.013) and headaches (p=0.048), than single SARS-CoV-2 infections. Conclusions: SARS-CoV-2 infected patients presenting viral co-infections had similar clinical characteristics and prognosis than patients solely infected with SARS-CoV-2.

We congratulate Kar et al. on their elegant study evaluating ex-vivo temperature profiles and the resulting thermal injury formation on the epiesophageal surface during radiofrequency (RF) ablation. In addition to being the first study to detail temperature profiles inclusive of the epiesophageal surface during RF ablation, we believe that the results add further concern to the use of temperature sensing technology in the quest to reduce esophageal injury. Three recent clinical trials have evaluated the efficacy of luminal esophageal temperature (LET) monitoring and found either no benefits, or signals of harm. On the other hand, two pilot RCTs suggest benefits of active cooling, and a large RCT, the IMPACT study, further confirms this benefit by finding an 83% reduction in esophageal lesion formation using an active cooling device. With no degradation in ablation efficacy, as well as a reduction/elimination of the need for fluoroscopy and reports of shortened procedure time with active cooling technology, the data of Kar et al., combined with growing clinical data, suggest that continued use of LET monitoring may be unjustified.

Introduction The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice. Methods and Results A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients’ family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua – 100; Pakistan – 493; Ecuador – 252; Lebanon – 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P<0.001). Conclusions Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices.

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and results in significant morbidity and mortality. The Cox-Maze IV procedure (CMP-IV) has been shown to have excellent efficacy in returning patients to sinus rhythm, but there have been few reports of late follow-up in sizable cohorts of patients with longstanding persistent AF, the most difficult type of AF to treat. Methods & Results: Between May 2003 and March 2020, 174 consecutive patients underwent a stand-alone CMP-IV for longstanding persistent AF. Rhythm outcome was assessed postoperatively for up to 10 years, primarily via prolonged monitoring (Holter monitor, pacemaker interrogation, or implantable loop recorder). Fine-Gray regression was used to investigate factors associated with atrial tachyarrhythmia (ATA) recurrence, with death as a competing risk. Median duration of preoperative AF was 7.8 years (interquartile range [IQR] 4.0-12.0 years), with 71% (124/174) having failed at least one prior catheter-based ablation. There were no 30-day mortalities. Freedom from ATAs was 94% (120/128), 83% (53/64), and 88% (35/40) at 1, 5, and 7 years, respectively. On regression analysis, preoperative AF duration and early postoperative ATAs were associated with late ATAs recurrence. Conclusion: Despite the majority of patients having a long-duration of preoperative AF and having failed at least one catheter-based ablation, the stand-alone CMP-IV had excellent late efficacy in patients with longstanding persistent AF, with low morbidity and no mortality. We recommend consideration of stand-alone CMP-IV for patients with longstanding persistent AF who have failed or are poor candidates for catheter ablation.

Changes in telomere dynamics could underlie life-history trade-offs among growth, size and longevity, but our ability to quantify such mechanistic processes in natural, unmanipulated populations is limited. We investigated how 4 years of artificial selection for either larger or smaller body size affected early-life telomere length in two insular populations of wild house sparrows. A negative correlation between telomere length and structural size was evident under both selection regimes. The study also revealed that male sparrows had longer telomeres than females, after controlling for size, and there was a significant negative effect of harsh weather conditions on telomere length. The long-term fitness consequences of these changes in early-life telomere length induced by the artificial size selection were explored over a period of 11 years. These analyses indicated disruptive selection on telomere length because both short and long early-life telomere length tended to be associated with the lowest mortality rates and highest life expectancy. There was also weak evidence for a negative association between telomere length and annual reproductive success, but only in the population where body size was increased experimentally. Our results suggest that natural selection for optimal body size in wild animals will affect early-life telomere length during growth, which is known to be linked to longevity in birds, but also that the importance of telomeres for long-term somatic maintenance and fitness is complex in a wild bird species.

Racial Differences in Timing of Food Allergen IntroductionAudrey Brewer, MD MPH 1; Jialing Jiang, BA2; Christopher M. Warren, PhD 2; Hemant P. Sharma, MD, MHS 3; Mary C. Tobin, MD4; Amal Assa’ad, MD 5; Ruchi S. Gupta, MD MPH 1,2* on behalf of the FORWARD Team1. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States3. Children’s National Hospital, Washington, District of Columbia, United States4. Rush University Medical Center, Chicago, Illinois, United States5. Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States

This report demonstrates a method for shaping the soft-tissue of pontic and future implant sites before implants placement. After non-restorable teeth were extracted, soft-tissue was contoured to achieve ovate-shape on pontic and implant areas. These initial contouring procedures allowed the shape of the soft-tissue to be evaluated before implant placement.

Introduction: Sickle cell anemia (SCA) results in numerous adverse effects on the brain, including ischemic lesions and neurocognitive dysfunction. Hydroxyurea has been utilized extensively for management of SCA, but its effects on brain function have not been established. Methods: We examined prospectively the effects of one year of treatment with hydroxyurea on brain function in a cohort of children with SCA (HbSS/HbSβ0-thalassemia) by baseline and exit evaluations, including comprehensive neurocognitive testing, transcranial Doppler ultrasound (TCD), and brain MRI [silent cerebral infarcts (SCI), gray matter cerebral blood flow (GM-CBF), and blood oxygen level dependent (BOLD) signal from visual stimulation]. Results: Nineteen patients with SCA, mean age 12.4 years (range 7.2-17.8), were evaluated. At baseline, subjects had these mean values: full scale IQ (FSIQ) 81.9, TCD velocity 133 cm/sec, GM-CBF 64.4 ml/100g/min, BOLD signal 2.34% increase, and frequency of SCI 47%. After one year of hydroxyurea, there were significant increases in FSIQ (+2.8, p=0.036) and reading comprehension (+4.8, p=0.016), a significant decrease in TCD velocity (-11.4 cm/sec, p=0.007), and no significant changes in GM-CBF, BOLD, or SCI frequency. Furthermore, FSIQ was associated with higher hemoglobin F (HbF) and lower GM-CBF, but not with hemoglobin level. Discussion: Significant improvement of neurocognition and decreased TCD velocity following one year of treatment support the use of hydroxyurea for improving neurocognitive outcomes in SCA. Understanding the mechanisms of benefit, as indicated by relationships of neurocognitive function with HbF, hemoglobin, and CBF, requires further evaluation.

Identifying local adaptation in bottlenecked species is essential for conservation management. Selection detection methods have an important role in species management plans, assessments of adaptive capacity, and looking for responses to climate change. Yet, the allele frequency changes exploited in selection detection methods are similar to those caused by the strong neutral genetic drift expected during a bottleneck. Consequently, it is often unclear what accuracy selection detection methods have across bottlenecked populations. In this study, simulations were used to explore if signals of selection could be confidently distinguished from genetic drift across 23 bottlenecked and reintroduced populations of Alpine ibex (Capra ibex). The meticulously recorded demographic history of the Alpine ibex was used to generate comprehensive simulated SNP data. The simulated SNPs were then used to benchmark the confidence we could place in outliers identified in empirical Alpine ibex SNP data. Within the simulated dataset, the false positive rates were high for all selection detection methods but fell substantially when two or more methods were combined. True positive rates were consistently low and became negligible with increased stringency. Despite finding many outlier loci in the empirical Alpine ibex SNPs, none could be distinguished from genetic drift-driven false positives. Unfortunately, the low true positive rate also prevents the exclusion of recent local adaptation within the Alpine ibex. The baselines and stringent approach outlined here should be applied to other bottlenecked species to ensure the risk of false positive, or negative, signals of selection are accounted for in conservation management plans.

Fetal ventricular aneurysm is a rare congenital cardiac malformation that can occur in various cardiac cavities and often exists in isolation without other malformations. Modern ultrasound technology can assist the prenatal diagnosis of ventricular aneurysm. Herein, we will present a rare case of a giant left ventricular aneurysm detected by prenatal ultrasonography.

We report the first case with central retinal artery occlusion (CRAO), which is a rare but ophthalmic emergency complication, in periprocedural periods of atrial fibrillation ablation. In this case, sudden visual loss occurred after the procedure and visual loss was persisted. Operators should know the incidence and management of CRAO.

Rationale, Aims & Objectives COVID-19 mandated a rapid and dramatic transformation of general practice. ‘Total Triage’ (TT), where all consultations should be triaged first, and ‘Remote-by-Default’ (RbD) consulting, where a clinician should consult remotely unless there is a “clinical exception”, were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. This service evaluation aimed to assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies using a mixed methods service evaluation in Lewisham, London, an area of high deprivation. Method Three parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices. Results Barriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs, to enable better tailoring of care provision. Conclusion We identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting in Lewisham. We recommend immediate steps that can be implemented at a local level to mitigate some of these impacts, and propose further work to gain better insights into the issues identified.

Background and aim: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

Background: Despite major advances in basic and advanced life supports, patients who survived from out of hospital cardiac arrest (OHCA) has still poor prognosis. Several inflammatory parameters have been used to determine early and long-term prognosis in patients with OHCA. C-reactive protein-to-albumin ratio (CAR) is also a novel marker of systemic inflammation. To our knowledge, there is no study evaluating the clinical importance of CAR in OHCA patients. Aims: To evaluate the effect of CAR on mortality in patients with OHCA. Methods: A total of 102 patients with OHCA were included in this study. The study population were divided into two groups as survivor (n = 43) and non-survivor (n = 59) during follow-up. Complete blood cell counts, biochemical and blood gas analysis were recorded for all patients. Neutrophil to lymphocyte ratio (NLR) was calculated as the ratio of neutrophil to lymphocyte. CAR was calculated as the ratio of CRP to the albumin. Results: NLR (P=0.012), CAR (P<0.001) and serum lactate level (P =0.002) were significantly higher whereas lymphocyte (P=0.008) and serum albumin (P<0.001) were significantly lower in non-survivor group compared to survivor group. Multivariate logistic regression analysis showed that NLR (odds ratio [OR]: 1.044, 95% confidence interval [CI]: 1.044-1.437, P=0.013), CAR (OR: 1.971, 95% CI: 1.327-2.930, P=0.001), and lactate level (OR: 1.268, 95% CI: 1.095-1.469, P=0.002) were independent predictors of mortality. Conclusions: We have demonstrated for the first time that CAR was an independent predictor of in-hospital mortality in OHCA patients.

Introduction:To evaluate the efficacy, safety and postoperative outcomes of the BiVap saline vaporization and Twister™ Diode Laser systems with benign prostatic obstruction (BPO) in prostate volüm between 90-150 ml. Methods:In total, we included 131 patients treated with BiVap system (n=68) and Twister system (n=63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Statistical analyses were performed with SPSS version 18. A P-value<0.05 was considered significant. Results:Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. There was no significant difference between the two groups in terms of IPSS, Qmax, Qave, QoL score, PSA, PVR, IIEF-EF and IIEF-OS during the 1 year follow-up period postoperatively. Conclusions:BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90-150ml.

Ovarian immature teratoma is a rare tumor during pregnancy. In this disease, the role of adjuvant chemotherapy for initial stage 1, grade 2 and 3 is essential in pregnancy. Two cases of ovarian immature teratoma grade 2 in pregnancy with two different managements and outcomes have been illustrated down below.

When formulating a hydrologic model, scientists rely on parameterizations of multiple processes based on field data, but literature review suggests that more frequently people select parameterizations that were included in pre-existing models rather than re-evaluating the underlying field experiments. Problems arise when limited field data exist, when “trusted” approaches do not get reevaluated, and when processes fundamentally change in different environments. The physics and dynamics of snow interception by conifers, including both loading and unloading of snow, is just such a case. The most commonly used interception parameterization is based on data from four trees from one site, but field study results are not directly transferable between environments. The process varies dramatically between locations with relatively warmer versus colder winters. Here, we combine a comprehensive literature review with a model to demonstrate essential improvements to model representations of snow interception. We recommend that, as a first and essential step, all models include increased loading due to increased adhesion and cohesion when temperatures rise from -3 and 0°C. The commonly used parameters of a fixed maximum value for loading and an e-folding time for unloading are not supported by observations or physical understanding and are not necessary to reproduce observations. In addition to unloading based on physical processes, such as wind or canopy warming, all models must represent melting of in-canopy snow so that it can be unloaded in liquid form. As a second step, we propose field experiments across climates and forest types to investigate: a) a representation of the force balance between adhesion and cohesion versus gravity for both interception efficiency and rates of unloading, b) wind effects during and between storms, and c) lubrication when snow melts. For greatest impact, this framework requires dedicated field measurements. These processes are essential for models to accurately represent the impacts of dynamically changing forest cover and snow cover on both global albedo and water supplies.

We present and analyze comprehensive measurements of the evaporation behavior, E, of a thinning liquid film during a hydrodynamic-evaporative spin coating experiment. E, ω (the rotation speed), and ν (the liquid viscosity) are the main control parameters of the process. The entire film thinning process can be described theoretically quite well if these parameters are known. Values of ν are easily accessible in advance (calculations, literature values, measurements). Values for E can essentially not be found in the literature. They are hard to measure and specific for the experimental conditions. There is also no generally accepted strategy to calculate E. Our experimental results are compared with a theoretical prediction for E based on ideas by Bornside, Macosco, and Scriven, which were presented long ago. Their approach was never tested experimentally. Theory and experiment agree well for many solvents and different ω. This approach permits in advance the quantitative calculation of the evolution of the entire hydrodynamic-evaporative film thinning process. We also derive a general formula to predict ab initio, with literature data only, the amount of final deposit (film thickness) of solute in the case of spin coating mixtures of volatile solvents and nonvolatile solutes.

Achilles tendon rupture is a well-documented adverse effect of Fluoroquinolones; however, herein we present a case of complete iliopsoas and Achilles, and partial semimembranosus tendon rupture secondary to Levofloxacin.