Objective: The aim of this study is to assess the protective measures taken by the Jordanian population in order to decrease the risk of the first cardiovascular event using Framingham score risk classification to assess cardiac event risk. Methods: Several nationally representative models of adult Jordanians were recruited in this study. Demographic data and anthropometric parameters were documented. Framingham risk score was calculated. Accordingly, cardiac event risk has been determined. Google form was created to generate a survey. Social media was utilized to extend the survey. Key findings: As expected, taking lipid lowering medications has decreased the Framingham score significantly, patients with high HDL value have lower Framingham score. Significant difference in Framingham score between diploma and patients with high school or less education level p-value 0.043. There was a significant difference in Framingham score between nonsmokers and sometimes smokers. The study revealed that 90% of the participants were having low risk for developing CVD, 5% were at intermediate risk and 5% were at high risk for developing CVD. This was expected as the average age was between 20-30 years. Conclusion: This study presented no advantage and even some harm because of consuming daily low-dose aspirin in some groups of people formerly thought to benefit from such treatment. This new piece of information applies to patients who do not have identified cardiovascular disease. If you have not had one of the above situations or events and are older than 70 years, younger than 40 years, or at higher danger of bleeding because of a medical condition or treatments, you should not consume aspirin for principal prevention of heart disease. If you are between 40 and 70 years old, at decreased risk of bleeding, and thought to be at increased risk of heart disease, you might get advantage from using aspirin.

How historical and concurrent drought regulate plant diversity-productivity relationships through altering soil microbial communities remains a key knowledge gap. We addressed this gap with plant diversity-productivity relationship experiments under drought and ambient conditions over two phases (Phase I: soil conditioning, and Phase II: plant response). Our results reveal that plant diversity and drought interacted and caused divergent soil microbial communities in Phase I, leading to soil microbial legacies. These soil legacies interacted and caused more pronounced plant diversity-productivity relationships in Phase II, reflecting increased net biodiversity effects over time. Complementarity effects were most positive in plant communities with highest plant richness and in the Drought-Ambient (Phase I-II) treatment, and selection effects were most negative in these communities. Our results highlight the importance of soil microbial communities in driving positive plant diversity effects, and future rainfall changes can cause complicated patterns in the biodiversity-ecosystem functioning relationships through soil microbial legacy.

In the western United States, the population of migratory monarch butterflies is on the brink of collapse, having dropped from several million butterflies at coastal overwintering sites in the 1980’s to about 2000 butterflies in the winter of 2020-21. At the same time, a resident (non-migratory) monarch butterfly population in urban gardens seems to be expanding northward. If anything, this urban population has been growing in recent years. We explore the meaning of these changes. The new resident population is not sufficient to make up for the loss of the migratory population; there are still orders of magnitude fewer butterflies now than in the recent past. The resident population also probably lacks the demographic capacity to expand its range inland during summer months, due to higher levels of infection by a protozoan parasite, and subsequently lower survival and fecundity. Nonetheless, the resident population may have the capacity to persist. This sudden change emphasizes the extent to which environmental change can have unexpected consequences. It also demonstrates how quickly these changes can happen. We hope it will provoke discussion about how we define resilience and viability in changing environments.

DNA metabarcoding is an important tool for molecular ecology. However, its effectiveness hinges on the quality of reference sequence databases and classification parameters employed. Here we evaluate the performance of MiFish 12S taxonomic assignments using a case study of California Current Large Marine Ecosystem fishes to determine best practices for metabarcoding. Specifically, we use a taxonomy cross-validation by identity framework to compare classification performance between a global database comprised of all available sequences and a curated database that only includes sequences of fishes from the California Current Large Marine Ecosystem. We demonstrate that the curated, regional database provides higher assignment accuracy than the comprehensive global database. We also document a tradeoff between accuracy and misclassification across a range of taxonomic cutoff scores, highlighting the importance of parameter selection for taxonomic classification. Furthermore, we compared assignment accuracy with and without the inclusion of additionally generated reference sequences. To this end, we sequenced tissue from 605 species using the MiFish 12S primers, adding 253 species to GenBank’s existing 550 California Current Large Marine Ecosystem fish sequences. We then compared species and reads identified from seawater environmental DNA samples using global databases with and without our generated references, and the regional database. The addition of new references allowed for the identification of 16 native taxa and 17.0% of total reads from eDNA samples, including species with vast ecological and economic value. Together these results demonstrate the importance of comprehensive and curated reference databases for effective metabarcoding and the need for locus-specific validation efforts.

Global change alters ecological communities with consequences for ecosystem processes. Such processes and functions are a central aspect of ecological research and vital to understanding and mitigating the consequences of global change, but also those of other drivers of change in organism communities. In this context, the concept of energy flux through trophic networks integrates food-web theory and biodiversity-ecosystem functioning theory and connects biodiversity to multitrophic ecosystem functioning. As such, the energy flux approach is a strikingly effective tool to answer central questions in ecology and global-change research. This might seem straight forward, given that the theoretical background and software to efficiently calculate energy flux are readily available. However, the implementation of such calculations is not always straight forward, especially for those who are new to the topic and not familiar with concepts central to this line of research, such as food-web theory or metabolic theory. To facilitate wider use of energy flux in ecological research, we thus provide a guide to adopting energy-flux calculations for people new to the method, struggling with its implementation, or simply looking for background reading, important resources, and standard solutions to the problems everyone faces when starting to quantify energy fluxes for their community data. First, we introduce energy flux and its use in community and ecosystem ecology. Then, we provide a comprehensive explanation of the single steps towards calculating energy flux for community data. Finally, we discuss remaining challenges and exciting research frontiers for future energy-flux research.

1. Trait differences among plant species can favor species coexistence. The role that such differences play in the assembly of diverse plant communities maintained by frequent fires remains unresolved. This lack of resolution results in part from the possibility that species with similar traits may coexist because none has a significant fitness advantage and in part from the difficulty of experimental manipulation of highly diverse assemblages dominated by perennial species. 2. We examined a 65-year chronosequence of losses of herbaceous species following fire suppression (and subsequent encroachment by Pinus elliottii) in three wet longleaf pine savannas. We used cluster analysis, similarity profile permutation tests and k-R cluster analysis to identify statistically significant functional groups. We then used randomization tests to determine if the absence of functional groups near pines was greater (or less) than expected by chance. We also tested whether tolerant and sensitive species were less (or more) likely to co-occur by chance in areas in savannas away from pines in accordance with predictions of modern coexistence theory. 3. Functional group richness near pines was lower than expected from random species extirpations. Wetland perennials with thick rhizomes and high leaf water content, spring-flowering wetland forbs (including Drosera tracyi), orchids, Polygala spp., and club mosses were more likely to be absent near pines than expected by chance. C3 grasses and sedges with seed banks and tall, fall-flowering C4 grasses were less likely to be absent near pines than expected by chance. Species sensitive to pine encroachment were more likely to co-occur with other such species away from pines at two of the three sites. 4. Results suggest that herb species diversity in frequently-burned wet savannas is maintained in part by a weak fitness (e.g., competitive) hierarchy among herbs, and not as a result of trait differences among co-occurring species.

Sexual size dimorphism (SSD) is caused by differences in selection pressures and life-history tradeoffs faced by males and females. Proximate causes of SSD may involve sex-specific mortality, energy acqui-sition, and energy expenditure for maintenance, reproductive tissues, and reproductive behavior. Using a quantitative, individual-based, eco-genetic model parameterized for North Sea plaice, we explore the importance of these mechanisms for female-biased SSD, under which males are smaller and reach sexual maturity earlier than females (common among fish, but also arising in arthropods and mammals). We consider two mechanisms potentially serving as ultimate causes: (1) male investments into male repro-ductive behavior might detract energy resources that would otherwise be available for somatic growth, and (2) diminishing returns on male reproductive investments might lead to reduced energy acquisition. In general, both of these can bring about smaller male body sizes. We report the following findings. First, higher investments into male reproductive behavior alone cannot explain the North Sea plaice SSD. This is because such higher reproductive investments require increased energy acquisition, which would cause a delay in maturation, leading to male-biased SSD contrary to observations. When account-ing for the observed differential (lower) male mortality, maturation is postponed even further, leading to even larger males. Second, diminishing returns on male reproductive investments alone can qualitative-ly account for the North Sea plaice SSD, even though the quantitative match is imperfect. Third, both mechanisms can be reconciled with, and thus provide a mechanistic basis for, the previously advanced Ghiselin-Reiss hypothesis, according to which smaller males will evolve if their reproductive success is dominated by scramble competition for fertilizing females, as males would consequently invest more into reproduction than growth, potentially implying lower survival rates relaxing male-male competition. Fourth, a good quantitative fit is achieved by combining both mechanisms while accounting for costs males incur during spawning.

The populations of the endemic gelada outside protected areas are less studied and population estimates are not available. As a result, a study was conducted to investigate population structure and distribution of geladas in Kotu forest and associated grasslands, in Northern Ethiopia. The study area was stratified into five habitats namely; grassland, wooded grassland, plantation forest, natural forest and bushland based on dominant vegetation type. Each habitat type was further divided into blocks and total counting technique was employed to count the individuals of geladas. The total mean number of gelada in the Kotu forest was 229 ± 6.11. The mean ratio of male to female was 1:1.178. Age composition of geladas comprised: 113 (49.34%) adults, 77 (33.62%) sub adults and 39 (17.03%) juveniles. The mean group size of gelada was 18± 2.0, out of which 2.5± 0.5 (13.89%) was all- male unit (AMU) and 15.5± 1.5 (86.11%) was one male unit (OMU) social system. The average band size was 45.0± 2.53. The highest number of geladas was recorded from grassland habitat 68 (29.87%) and the lowest from plantation forest habitat 34 (14.74%). Even though, the sex ratio was female biased, the proportion of juveniles to other age classes was very low, indicating negative consequences for the future viability of the gelada populations in the area. Geladas were widely distributed over open grassland habitat. For sustainable conservation of the geladas in the area there is a need for integrated management of the area with special attention on the conservation of the grassland habitat.

In this paper, we consider the general energy decay for weak viscoelastic equation of Kirchhoff type containing Balakrishnan-Taylor damping with nonlinear delay and acoustic boundary conditions. By introducing suitable energy and Lyapunov functionals, we establish the general decay estimates for the energy, which depends on the behavior of both sigma and g.

Background: Bacterial biofilm is a major virulence factor that posses a threat to patients leading to chronic infections. Therefore, it is crucial to identify biofilm production as well as their inhibition and reduction. This study was an attempt to investigate biofilm production among gram-negative isolates and assessment of inhibitory and reduction potential of EDTA and DMSO towards them and also observe the antimicrobial resistance pattern among biofilm producers and biofilm non-producer. Methods: Isolation and identification of bacterial isolates were performed by standard microbiological methodology. The antibiotic susceptibility pattern was determined by the Kirby Bauer disk diffusion method and β-lactamases by the combination disk method. Biofilm formation was detected through Tissue Culture Plate(TCP) method, and different concentrations of EDTA and DMSO were used to determine their inhibitory and reduction property against biofilm. Both inhibition and reduction by the various concentration of EDTA and DMSO were analyzed using paired t-test. Results: Among the 110 clinical isolates 61.8% were found to be Multidrug resistance(MDR) with the 33 (30%) produced Extended-spectrum β-lactamases(ESBL), 16 (14.5%)Metalloβ-lactamases(MBL) and 9 (8%)Klebsiella pneumonia carbapenemase(KPC). Biofilm formation was detected in 35.4% of isolates. Biofilm producing organisms showed antibiotics resistance to Cephalosporins, Chloramphenicol, Gentamycin, and Carbapenem. The inhibition and reduction of biofilm were significantly lower (p<0.05) for 1mM of EDTA and 2% of DMSO. Conclusions: EDTA and DMSO were found to possess potential activity against biofilm. Hence, EDTA and DMSO might be used invitro as an effective antibiofilm agent to control the biofilm-associated infection and for a possible therapeutic approach.

INTRODUCTION: Children undergoing complex cranial vault reconstruction (CCVR) for craniosynostosis experience high rates of bleeding and transfusion, increasing risk for perioperative complications. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are antifibrinolytic agents that have been shown to reduce intraoperative hemorrhage and transfusion requirements during CCVR. However, the relative efficacy of these two agents has not yet been evaluated. The aim of this study was to compare perioperative blood loss and transfusion rates in children receiving EACA vs. TXA. METHODS: All patients who underwent CCVR from September 2015 to December 2019 at a single center were retrospectively evaluated. Primary outcome measures included intraoperative estimated blood loss, postoperative drain output, transfusion volumes, and calculated blood loss. Secondary outcome measures included hematologic and coagulation parameters. RESULTS: 95 patients were included, with 47 patients in the EACA cohort and 48 patients in the TXA cohort. There were no significant differences in demographics, surgical outcomes, blood loss, transfusion requirement, or perioperative hematologic and coagulation laboratory values between the two cohorts. Adverse events were similar between the groups, but did include two seizure events and two thromboembolic events related to vascular access devices. DISCUSSION: We found no significant difference in blood loss, transfusion requirements, hematologic parameters, or outcomes between pediatric CCVR patients who received EACA vs. TXA. Further research is needed to define optimal antifibrinolytic dosing and duration of therapy. While standard laboratory parameters were similar between groups, future studies investigating coagulation-based and inflammatory assays may be useful in defining surgical-induced coagulopathy.

Objective: During the COVID-19 pandemic, quarantine and staying at home is advised. The social relationship between people has become deficient, and human social isolation (SI) has become the consequence of this situation. It was shown that SI has made changes in hippocampal neuroplasticity, which will lead to poor cognitive function and behavioral abnormalities. There is a connection between SI, learning, and memory impairments. In addition, anxiety-like behavior and increased aggressive mood in long-term isolation have been revealed during the COVID-19 outbreak. Methods: Term searches was done in Google Scholar, Scopus, ScienceDirect, Web of Science and PubMed databases as well as hand searching in key resource journals from 1979–2020. Results: Studies have shown that some drug administrations may positively affect or even prevent social isolation consequences in animal models. These drug treatments have included opioid drugs, anti-depressants, Antioxidants, and herbal medications. In addition to drug interventions, there are non-drug treatments that include an enriched environment, regular exercise, and music. Conclusion: This manuscript aims to review improved cognitive impairments induced by SI during COVID-19.

BACKGROUND AND OBJECTIVES: The ‘Basic filling materials’ Amalgam and glass ionomer have been well accepted for posterior restorations, but have multifarious drawbacks such as low flexural strength, surface wear, porosity of glass ionomer cements, intrinsic grey unaesthetic appearance of amalgam, its inability to bond tooth and concerns about mercury content. Hence, newer materials were introduced in the market with better biomechanical properties. The present study aimed to evaluate and compare the compressive strength of Ceramic-Reinforced Glass Ionomer cement, Zirconia-Reinforced Glass Ionomer cement, High Strength Glass Ionomer Posterior restorative material, Alkasite restorative material, and Amalgam when used as posterior restorative materials. METHODOLOGY: Fifty cylindrical specimens measuring 6mm in height and 4mm in diameter were fabricated using test materials. Class II cavity was prepared on fifty intact permanent human molar teeth and randomly divided into five groups based on the material to be filled with ten specimens each: Group 1- Ceramic-Reinforced Glass Ionomer cement, group 2- Zirconia-Reinforced Glass Ionomer cement group 3- High Strength Glass Ionomer Posterior restorative material group 4- Alkasite restorative material and group 5- amalgam. All the specimens were thermocycled and stored in artificial saliva for 24 hours. The specimens were subjected to compressive strength testing using Universal Testing Machine (Zwick Roell, Z020, Zwick, Ulm, Germany). Data were analyzed statistically using IMB SPSS Statistics, Version 22 (Armonk, NY: IBM Corp). RESULTS: The present study reveals a significantly high compressive strength of cylindrical specimens of Group 4, followed by Group 5, Group 3, Group 1, and least by Group 2. The highest maximum compressive load was supported by teeth restored with the material of Group 4, Group 1, Group 5, Group 2, and least by Group 3. CONCLUSION: Within the limitations of the study, alkasite restorative material showed the highest compressive strength in cylindrical and tooth specimens.

Background: Sweat conductivity (SC) is a semi-automated method widely used as a screening test for Cystic Fibrosis. Quantity not sufficient (QNS) is defined when collecting a volume lower than 15 μl of sweat during 30 minutes. Objective: To verify the rate and factors related to QNS for SC in newborns and young infants. Methods: Newborns and infants aged less than three months that had undergone sweat conductivity after two abnormal immunoreactive trypsinogen results, were recruited prospectively and consecutively. Statistical analysis included descriptive statistics, univariate and multivariate logistic regression. Results: A total of 1020 individuals were included. Among them, the rate of QNS was 8.9%. Subjects with gestational age <37 weeks (OR=5.0), birth weight <2.000g (OR=3.5), and daily weight gain <25g/day (OR=3.4) were more likely to produce an insufficient quantity of sweat. Conclusion: Our results suggest that QNS rates for SC could successfully fulfill the Cystic Fibrosis Foundation standards in newborns and young infants. In cases of QNS, SC should be scheduled as early as possible when the infant is older than 37 weeks (corrected age).

Objectives: Transcutaneous Tibial Nerve Stimulation (TTNS) is a non-invasive method used in OAB treatment. We aimed to compare the effectiveness of the once a week and three times a week TTNS procedure in women diagnosed with wet type refractory OAB. Methods: A total of 60 patients diagnosed with wet type OAB was refractory to medical treatment included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a time duration of 30 minutes for 12 weeks, once a week to Groıp-I and three times a week to Group-II. Pre and post-treatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. Results: Four patients in Group-1 and eight in Group-2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group-1 and group-2 (p<0.001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group-1, and on the 3rd week in group-2. Complete response was observed in 6 patients (23.1%) in Group-1 after 12 weeks of TTNS procedure. In group-2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. Conclusion: TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week.

Background: The use of Google search engine has been widely used in public health-related concerns. Previous studies found that Google search trends (GST) can predict influenza, mortality, Zika epidemics, Ebola, etc. This study examines the relationship between the timing of Coronavirus-related Google search trends, lockdown, and new cases of COVID-19 in Bangladesh. Methods: We use national-level Google search trend data to examine whether the timing of Google search terms, i.e., their lag effects are associated with actual COVID-19 new cases from March 2, 2020, to December 7, 2020. We examine the effects of search terms (facemasks, handwash, n95) on the actual COVID-19 new cases using the vector autoregression (VAR) model. Results: Our general recursive vector autoregression model shows that search on facemasks and hand-wash can potentially decrease the risk communication of COVID-19 new cases. We find that the search on facemasks can substantially reduce that risk in the sense that search can increase the use of facemasks. We also examine the lag effect of lockdown and find that the effects are not sizeable on the risk communication because their lag-effects are different. The results of the impulse-response functions show that among the protective measures, lag effects of facemasks can substantially decrease the future risk communication of COVID-19 new cases. Conclusion: Because wearing facemasks can substantially reduce the risk of COVID-19 new cases, the government can utilize the Google search trends related to COVID-19 to disseminate the preventive information on COVID-19 and thus minimize the new cases and deaths.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common X-linked enzyme disorder associated with hemolytic anemia after exposure to certain medications or foods. Activity testing is the gold standard for detecting G6PD deficiency; however, this test is affected by various hematologic parameters. Clinical G6PD genotyping is included in pharmacogenetic arrays and clinical sequencing and may be reconciled with activity results. Methods: Patients (n=1,391) enrolled on an institutional pharmacogenetic testing protocol underwent clinical G6PD genotyping for 164 G6PD variants. For the 446 patients with G6PD activity results, algorithms were designed to assign G6PD status, accounting for known interferences with the activity assay and for G6PD genotype results. We developed clinical decision support alerts to inform prescribers when high-risk medications were prescribed, warning of gene-drug interactions and recommending therapy alteration. Results: Of 1,391 patients with genotype, 1,334 (95.9%) patients were predicted to have normal G6PD activity, 30 (2.1%) were predicted to have variable G6PD activity, and 27 (2%) were predicted to have deficient G6PD activity. Of the 417 patients with a normal genotype and an activity result, 415 (99.5%) had a concordant normal G6PD phenotype. Of the 21 patients with a deficient genotype and an activity result, 18 (85.7%) had a concordant deficient activity result. Genotyping reassigned phenotype in 5 patients with discordant genotype and activity results: 3 switched from normal to deficient, and 2 switched from deficient to normal. Conclusion: G6PD activity and genotyping are two independent testing methods which can be used in conjunction to assign a more informed G6PD phenotype.

Cardiac haemangiomas are rare entities and very few cases have been reported where they originate from the main arteries of the heart. We present a case of haemangioma arising from the main PA, which was completely resected with clear margins on the beating heart.

The manifestations of COVID-19 as outlined by echocardiography, lung ultrasound (LUS) and cardiac magnetic resonance (CMR) imaging are yet to be fully described. We conducted a systematic review of the current literature and included studies that described cardiovascular manifestations of COVID-19 using echocardiography, LUS and CMR. We queried PubMed, EMBASE and Web of Science for relevant articles. Original studies and case series were included. This review describes the most common abnormalities encountered on echocardiography, LUS and CMR in patients infected with COVID-19.

The global decline in biodiversity driven by anthropogenic factors necessitates biomonitoring of ecosystems. However, current approaches are limited to targeted detection of taxa and fail to capture the total biodiversity of ecosystems. We postulated that extracellular environmental DNA (eDNA) represents a genetic repertoire of all the life forms in an ecosystem, which can be retrieved by deep sequencing. The feasibility and effectiveness of this approach were tested through a spatiotemporal study in Chilika Lagoon, a large and biodiverse Ramsar wetland ecosystem in India. Extracellular eDNA was enriched from large-volume filtered water samples using lysis-free methods and PCR-free shotgun sequencing libraries were generated. Based on the saturation of unique k-mers, over 10.96 billion extracellular eDNA fragments were sequenced from 16 libraries and taxonomically classified to the lowest common ancestor of the best hits of the paired-end reads. The results show that organisms from all the domains of life, including the low-abundant non-microbial taxa, can be detected with high sensitivity for taxonomic families with representative genomes. Interestingly, despite Bacteria representing a large proportion (87%) of the taxonomically classified reads, Eukaryotes showed the highest taxonomic diversity (73%). Further, using incidence-based asymptotic richness analysis, the total taxonomic diversity of Chilika was estimated to be 1071 families across the tree of life, comprising approximately 799 families of Eukaryotes, 230 families of Bacteria, 27 families of Archaea, and 13 families of DNA Viruses. We also quantified the compositional changes using Bray-Curtis dissimilarity and showed that extracellular eDNA can resolve the broad-scale spatiotemporal variation of biodiversity across the tree of life. These results demonstrate that PCR-free deep sequencing of extracellular eDNA is an effective approach for taxonomic diversity assessment across the tree of life in large ecosystems. With the increasing genomic resources and decreasing sequencing costs, we foresee its widespread application to monitor future biodiversity loss and support conservation, restoration, and management efforts in the Anthropocene.

Background: Community-acquired pyogenic liver abscesses due to Klebsiella pneumoniae is increasingly recognized across the world with more incidence in East Asian countries. Cases of endogenous endophthalmitis secondary to pyogenic liver abscesses with K1 serotype K. pneumoniae have been reported in the literature. We report a case of endogenous panophthalmitis along with cerebellar abscess occurring in a newly diagnosed diabetic patient secondary to pyogenic liver abscess. Case presentation: A middle-aged male of east Asian descent presented with sudden onset right eye vision loss associated with fever. Workup revealed newly diagnosed diabetes mellitus, panophthalmitis, cerebellar abscess, and pyogenic liver abscess due to K. pneumoniae. The patient, unfortunately, underwent right eye evisceration. Conclusion: Endogenous panophthalmitis due to K. pneumoniae is a fatal complication and can result in blindness. Multiple foci of infection can be present in such cases. Thorough workup, prompt antibiotics as well as surgical treatment may improve prognosis.

News and Views: Groundbreaking Discoveries in Immunology

Posterior reversible encephalopathy syndrome (PRES) is identified on magnetic resonance imaging by posterior predominant white and gray matter lesions. PRES secondary to spinal disease is very rare. We report a case of clinical and imaging findings about PRES associated with spinal epidural hematoma.

Parry-Romberg syndrome (PRS) is a rare facial deformity characterised by slowly progressive hemifacial atrophy. We present a new case of hemifacial atrophy in an 18-year-old lady. Rudimentary understanding of the pathogenesis poses a challenge in deciding optimal timing and surgical intervention. Current suggested management are reviewed and discussed.