Lymphangiomas of the tongue are very rare tumors usually diagnosed in infancy and early childhood. Children with Lymphangiomas of the tongue may require multidisciplinary care and a close collaboration between physician and dentist to be able to eradicate any sources of dental infections before undertaking medical treatment.

Key point: • Being one of the commonest presenting emergencies, epistaxis can increase the pressure on the health service; in times similar to COVID-19 pandemic such pressure can be crucial and challenging to deal with. • Non-absorbable nasal packing and home discharge for selected patients can be a safe and efficient alternative treatment method with low readmission rates (5.3 %); such management can be of tremendous help when the hospital capacity is overwhelmed. • Although such protocols can be challenging to generalize, the presented protocol seems safe, easily adoptable without any significant complications.

Oggigiorno si è continuamente esposti a sostanze potenzialmente tossiche per la salute, come nel caso dei composti organici volatili (COV); in questo lavoro sono state individuate le origini di queste sostanze, i possibili danni derivati dall'esposizione con esse, oltre ad alcune tipologie di trattamento per il loro abbattimento. Ci si è soprattutto soffermati sul confronto tra una tecnologia biologica convenzionale, con filtro biotrickling (BTF) ed una innovativa, rappresentata da un fotobioreattore tubolare algale-batterico (TPBR), prendendo in esame l'abbattimento del toluene, uno dei COV più diffusi, appartenente alla famiglia dei BTEX. Il TPBR ha mostrato efficienze medie di rimozione del toluene vicine a quelle del BTF ma è risultato più stabile, a differenza di quest'ultimo che risulta influenzato dalla presenza di metaboliti secondari.

Objective: To calculate maternal mortality ratio (MMR) for 2006-2018 in the Netherlands and compare with 1993-2005. Describe women’s and obstetric characteristics, causes of death and improvable factors. Design: Prospective cohort study. Setting: Nationwide. Population: 2,304,271 livebirths. Methods: Analysis of all maternal deaths between January 1st, 2006, and December, 31st, 2018 as reported to and audited by the national Audit Committee Maternal Mortality and Morbidity. Main outcome measures: MMR, causes of death, improvable factors. Results: Overall MMR was 6.2 per 100,000 livebirths, a decrease from 12.1 in 1993-2005 (Odds Ratio (OR) 0.5, 95%CI 0.4-0.6). Women with non-Western ethnic background had a slightly increased MMR compared to Dutch women (MMR 6.5 vs 5.0, OR 1.3, 95%CI 0.9-1.9), and was particularly increased among women with a background from Surinam/Dutch Antilles (MMR 14.7 OR 2.9, 95%CI 1.6 – 5.3). Half of all women had an uncomplicated medical history (79/161, 49.1%). Of 172 pregnancy-related deaths within one year postpartum, 103 (60%) had a direct and 69 (40%) an indirect cause. Leading causes within 42 days postpartum were cardiac disease (n=21, 14.8%), hypertensive disorders (n=20, 14.1%) and thrombosis (n=19, 13.4%). For deaths up to one year postpartum, suicide was the third commonest cause (n=20, 11.6%). Improvable factors in care were identified in 76 (47.5%) of all deaths. Conclusions: Maternal mortality halved in 2006-2018 compared to 1993-2005. Unlike before, cardiac disease outnumbered hypertensive disorders as main cause of death. Women with a background from Surinam/Dutch Antilles had a threefold higher risk of death compared to Dutch women.

Simultaneous thoracic and abdominal aneurysms comprise approximately 10–20% of all cases of aortic aneurysms. Whether simultaneous or staged therapy can be used to treat multilevel aortic aneurysms remains controversial. Herein, we report the case of a 79-year-old woman with both huge abdominal and saccular thoracic aortic aneurysms who was referred to our hospital. Multiple stenotic lesions were observed in the major cerebral arteries; moreover, triple-vessel disease was observed on the coronary angiogram. Although this case required immediate primary surgery, cardiopulmonary bypass was difficult due to multiple stenoses in the cerebral arteries. We performed simultaneous surgery with total debranching thoracic endovascular aortic repair, endovascular aortic repair, and off-pump coronary artery grafting. Total debranching thoracic endovascular aortic repair is useful for avoiding neurological complications in cases where cardiopulmonary bypass is difficult. Furthermore, it helps devise an intraoperative cervical branch reconstruction method.

The construction of apartment buildings after the disaster and the way of living there fostered the social capital of the original area. Community formation made it possible for elderly people living alone to respond to emergencies and prevent lonely death. It can be proposed to the future super-aging society.

We present a unique Richter's transformation case in CNS with identical to CLL clonal origin in a patient treated with Venetoclax. With our case we make implications on whether Venetoclax penetrates the blood-brain barrier and we address the debating issue of the appropriate Venetoclax dose in case of drug-drug interactions.

Phytate is the storage form of phosphorus in angiosperm seeds and plays vitally important roles during seed development. However, in crop plants phytate decreases bioavailability of seed-sourced mineral elements for humans, livestock and poultry, and contributes to phosphate-related water pollution. However, there is little knowledge about this trait in oilseed rape B. napus (oilseed rape). Here, a panel of 505 diverse B. napus accessions was screened in a genome-wide association study (GWAS) using 3.28 x 106 single nucleotide polymorphisms (SNPs). This identified 119 SNPs significantly associated with phytate concentration (PA_Conc) and phytate content (PA_Cont) and six candidate genes were identified. Of these, BnaA9.MRP5 represented the candidate gene for the significant SNP chrA09_5198034 (27kb) for both PA_Cont and PA_Conc. Transcription of BnaA9.MRP5 in a low -phytate variety (LPA20) was significantly elevated compared with a high -phytate variety (HPA972). Association and haplotype analysis indicated that inbred lines carrying specific SNP haplotypes within BnaA9.MRP5 were associated with high- and low-phytate phenotypes. No significant differences in seed germination and seed yield were detected between low and high phytate cultivars examined. Candidate genes, favorable haplotypes and the low phytate varieties identified in this study will be useful for low-phytate breeding of B. napus.

A 68-year-old male presented with a difficult airway secondary to a firm mass at the base of the tongue on intubation for an emergency general surgical procedure. Further workup confirmed a lingual thyroid with previous upper airway obstruction requiring a temporary tracheostomy. The mass was excised using transoral robotic surgery.

The evaluation of exercise-induced dyspnea (EID) in otherwise healthy children and adolescents is often limited to a specific cause such as exercise-induced asthma or vocal cord dysfunction. However, modest degrees of bronchospasm or vocal cord dysfunction may occur in the absence of dyspnea. Testing that does not include concurrence of dyspnea with an abnormality may provide misleading information to the detriment of the patient. This commentary describes the limitations of two recent publications in Pediatric Pulmonology. Reproducing the patient’s dyspnea during cardiopulmonary monitoring provides the etiology of at least 7 causes of EID.

Thrombosis within the microvasculature and medium to large vessels is a serious and common complication among critically ill individuals with COVID-19. While children are markedly less likely to develop severe disease than adults, they remain at risk for thrombosis during acute infection and with the post-acute inflammatory illness termed multisystem inflammatory syndrome in children. Significant knowledge deficits in understanding COVID-19 associated coagulopathy and thrombotic risk pose clinical challenges for pediatric providers who must incorporate expert opinion and personal experience to manage individual patients. We discuss clinical scenarios to provide framework for characterizing thrombosis risk and thromboprophylaxis in children with COVID-19.

Background The role of percutaneous repair of functional mitral regurgitation (MR) is evolving. Left ventricle remodeling is known to be different between men and women; however, outcomes following percutaneous repair of functional MR have not considered the impact of sex. Methods Between 2012 and 2018, 175 patients underwent percutaneous repair of functional MR with the Mitra Clip NT/NTR (Abbott, Irvine CA) at our institution. Patients were assessed in a dedicated clinic with a follow-up that averaged 0.7±1.2 years and extended to 5.7 years. Results Men had a larger body surface area than women (p<0.001), whereas women were more likely than men to have diabetes preoperatively (p=0.02). There were no deaths or instances of single leaflet detachment. Immediate post-procedure MR was <2+ in 158 (90%) with a mean trans-mitral valve repair gradient of 3.4±1.0 and 3.5±2.1 mm Hg, respectively for women and men (p=0.8). One- and 2-year freedom from MR >3+ was 86.0±3.5% and 77.6±5.1%, respectively. After adjusting for differences between male and female patients, women were more likely to have recurrent MR >3+ (hazard ratio 4.7, 95% confidence interval 1.2-18.4, p=0.03). Upon adjusted analysis, there was also no association between gender and survival (p=0.2). One- and 2- year survival was 69.8±4.3% and 54.3±5.5%, respectively. Conclusion Women are more likely to have recurrent severe MR after percutaneous repair of functional MR. The mechanism for this remains undetermined.

Hepatorenal syndrome is a rare life-threatening complication of acetaminophen toxicity. It is not responsive to fluid therapy and need performing an emergent liver transplantation. Here, we introduce a 24-year-old woman with a history of chronic high doses of acetaminophen consumption, presenting with nausea, vomiting, lethargy, oliguria, and severe metabolic acidosis.

Between late December 2019 to early September 2020, over 10 million people globally were reportedly infected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the coronavirus disease-2019 (COVID-19). In Africa, more than 300,000 infection occurred within the period, from which several viral genetic sequences were generated. Phylogenetic reconstruction of genomic data can provide epidemiological inferences about time of pathogen introduction, epidemic growth rate and temporal-spatial spread of the infection during disease outbreak. In this work, we studied the genetic epidemiology of COVID-19 in Africa. Genetic sequence data of SARS-CoV-2 and metadata from African countries were obtained from open-source sequence database hosted by the GISAID initiative. Whole genome sequences were subjected to multiple sequence alignment, from which Maximum Likelihood phylogenetic tree was constructed based on the general time reversible model. Of the 227 genetic sequences obtained for 9 African countries (DRC=133, Senegal=23, South Africa=20, Ghana=15, Tunisia=6, Algeria=3, Gambia=3, Egypt=2 and Nigeria=2), 220 were whole genome sequences while 7 were partial genome sequences of the surface glycoprotein S. Phylogenetic analysis confirmed multiple introductions of the virus to the continent from multiple external sources prior to local adaptation and spread. The very close alignment of three viruses - Ghana/1659_S14/2020|EPI_ISL_422405, DRC/KN0054/2020|EPI_ISL_417437, and South_Africa/R05475/2020|EPI_ISL_435059 – to the reference Wuhan strain on the time tree, suggests possible introduction and circulation of the virus into the continent much earlier than when the first case was announced on February 15 2020. In conclusion, this study provided evidence to support multiple introductions of SARS-CoV-2 into Africa, and further suggests that the virus may have already been circulating in the continent prior to official reporting of the first case. Also, there is strong impression to infer likely genetic adaptation of the virus in the continent that may account for the close clustering of isolates from different countries.

Monitoring infectious diseases is one of the most important pillars of preventive medicine in zoological collections. Screening for parasitic and bacterial infections is obligatory for keeping animals and equipment safe from pathogens that may pose a risk to animal and human health. Zoological collections usually contain many different animal species, living in close proximity with people and wild animals. As an epidemiological probe, 188 animals (122 mammals, 65 birds, and one reptile) from a zoo in Slovenia were examined for selected pathogens. Antibodies to Toxoplasma gondii and Neospora caninum were detected by ELISA in 37% and 3% of mammals, and in 0% and 3% of birds, respectively; the reptile was negative. A statistically significant difference in T. gondii prevalence was found in Carnivora (78%) compared to Cetartiodactyla (33%, p = 0.0227) and Primates (25%, p = 0.0084). Antibodies to Encephalitozoon cuniculi were detected by IFAT in 55% of mammals and 34% of birds, respectively; the reptile was negative. Herbivores had a higher chance of being infected with E. cuniculi compared to omnivores (p = 0.0015). Antibodies to Chlamydia abortus and Coxiella burnetii were not detected in any of the zoo animals. The sera of 39 wild rodents found in the zoo were also examined; they were negative for all three parasites. The parasite T. gondii was detected by PCR in the tissue of two mute swans (Cygnus olor), one laboratory mouse, two Mus musculus, one Apodemus flavicollis, and one Apodemus agrarius. Positive samples were genotyped by a single multiplex PCR assay using 15 microsatellite markers; one sample from a mute swan was characterized as type II. This micro-epidemiological study offers a better understanding of pathogens in zoo animals and an understanding the role of zoos in biosurveillance.

A document by Majlona Aliaj. Click on the document to view its contents.

Analisi e confronto delle principali metodologie, tecniche e indicatori di monitoraggio applicabili per la valutazione ed il controllo delle pressioni ambientali indotte dalla progettazione, realizzazione ed esercizio di grandi opere di Ingegneria Civile, localizzate in aree sensibili. Proposizione di una metodologia avanzata di controllo in continuo e tempo reale

Background: Pediatric B-Lymphoblastic lymphoma(pB-LBL) is a rare entity, and appropriate treatment for pB-LBL is not well defined. While intensive Acute Lymphoblastic leukemia(ALL) type regimens achieve long term event free survival of 90% across western co-operative group trials, published data from Asian studies on long term outcomes in pB-LBL are scarce. We evaluated the outcomes and prognostic factors of pediatric B-LBL patients treated at our center. Methods: We retrospectively analyzed the data of pediatric B-LBL patients treated between January 2010 and December 2017 on a uniform protocol(modified BFM 90). Patients were evaluated for early response post-induction and monitored for toxicity and long term outcomes. Kaplan-Meier method was used to estimate the event free survival(EFS) and overall survival(OS). Cox regression models were performed to identify prognostic factors. Results: Of 21 patients who received treatment on the modified BFM 90 protocol, 17(81%) were alive in remission, 3(14%) had relapse, and 1(4%) had treatment-related mortality(TRM) while in remission. Two of 3 relapsed patients subsequently expired. With a median follow-up of 66 months(range 6–114), 5-year Event free survival(EFS) and overall survival(OS) were 80%(95% CI:71–89%) and 91% (95% CI:85–97%), respectively. While delayed presentation (≥3 months) had inferior EFS(p-0.030), patients with elevated baseline Lactate Dehydrogenase(LDH) had a worse OS(p-0.037). Age, gender, site of origin, stage, and post-induction response had no bearing on outcome. Conclusions: Outcomes of pB-LBL patients treated on modified BFM 90 protocol are excellent. Higher disease burden manifested by elevated baseline LDH and delayed presentation(≥3 months) portend poorer survival.

Objective: to compare the vaginal birth rate in women with previous one lower segment caesarean section when induced at 40 weeks compared to expectant management till 41 weeks. Design: A randomized controlled trial Setting: Department of Obstetrics and Gynaecology, JIPMER, a tertiary care teaching institution in the south of India. Population or Sample: Low-risk women with previous one single lower segment caesarean section with a singleton foetus in vertex presentation and eligible for a trial of labour (TOLAC) at 40 weeks gestation. Methods: Block randomization to two groups of thirty each. The induction group was induced at 40 weeks with low dose oxytocin infusion or ripening with a single application of a single balloon Foley catheter followed by oxytocin infusion 24 hours later. The expectant group was managed in the hospital with maternal and foetal surveillance and induced at 41 weeks if they had not delivered by then. Main Outcome Measures: Vaginal birth after caesarean section (VBAC). Results: The demography and pregnancy variables were comparable in the two groups. Twenty out of thirty women (66.67%) had a successful vaginal birth after caesarean section in the induction group compared to ten out of 30 (33.33%) in the expectant group. This difference was significant (RR 2.0, 95% CI: 1.13-3.52; P=0.016) Conclusions: Among low-risk women with previous one lower segment caesarean section willing and eligible for TOLAC, the successful VBAC rate is significantly higher among those induced at 40 weeks compared to those managed expectantly till 41 weeks.

Myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder. Though MG was diagnosed four centuries ago, its rational management started in 1930s. In the present era, MG is managed by both medical means and surgical techniques. In this article, the concise history of MG and its management is being described.

Background: Congenital pulmonary stenosis (PS) is a progressive disease. Balloon pulmonary valvuloplasty (BPV) is the treatment of choice in valvular PS. Aim: We aim to study the relationship between biomarkers and echocardiographic markers in valvular PS and to assess the impact of BPV on these markers. Patients & Methods Patients with moderate and severe valvular PS amenable for BPV were recruited. Serum troponin I was measured. Echocardiographic assessment of PS and right ventricular (RV)function were done. All patients underwent BPV. Troponin level and echocardiographic data were re-assessed two weeks & six months after BPV. Results: Fifty patients with valvular PS were recruited. There was significant correlation between peak SPG and troponin (p < 0.001). Troponin was significantly decreased 2 weeks after BPV. Similarly, there was an initial improvement in RV function. After 6 months of follow up, we divided patients into 2 groups: Group-A: 36 patients with no restenosis. Group-B: 14 patients with restenosis. There were high significant differences between both groups regarding troponin level and RV functions with re-elevated troponin in group-B that correlated with peak PG (r= 0.9, p < 0.001). RV function parameters in group-B became significantly worse 6 months after BPV than those after the initial 2 weeks. Conclusion Troponin correlates with the severity of PS and associates with RV dysfunction. Both troponin & RV functions improved with BPV. Recurrent elevation of troponin and impairment of RV function are associated with PV restenosis and could be set as an indication for repeated balloon dilatation of PV.

Chinese Hamster Ovary (CHO) cell lines are grown in cultures with varying asparagine and glutamine concentrations, but further study is needed to characterize the interplay between these amino acids. By following 13C-glucose, 13C-glutamine, and 13C-asparagine tracers using metabolic flux analysis (MFA), CHO cell metabolism was characterized in an industrially relevant fed-batch process under glutamine supplemented and low glutamine conditions during early and late exponential growth. For both conditions MFA revealed glucose as the primary carbon source to the tricarboxylic acid (TCA) cycle followed by glutamine and asparagine as secondary sources. Early exponential phase CHO cells prefer glutamine over asparagine to support the TCA cycle under the glutamine supplemented condition, while asparagine was critical for TCA activity for the low glutamine condition. Overall TCA fluxes were similar for both conditions due to the trade-offs associated with reliance on glutamine and/or asparagine. However, glutamine supplementation increased fluxes to alanine, lactate and enrichment of glutathione, N-Acetyl-Glucosamine (NAG) and pyrimidine-containing-molecules. The late exponential phase exhibited reduced central carbon metabolism dominated by glucose, while lactate reincorporation and aspartate uptake were preferred over glutamine and asparagine. These 13C studies demonstrate that metabolic flux is process time dependent and can be modulated by varying feed composition.

Hemoglobin S (HBS) and hemoglobin E (HBE) are common hemoglobinopathies, but combined heterozygosity of HBS and HBE (HBSE) is relatively a rare disease. Most reports suggest that HBSE is generally benign condition. In this report we describe a 17-year-old male patient presenting with acute chest syndrome treated with exchange transfusion.

Wind erosion is one of the desertification results and is among the natural processes that mostly occur under dry conditions and high wind velocity. Using oil-mulches is one of the common methods to stabilize sand dunes. The current study aimed to investigate the short-term effects of oil-mulch on vegetation attributes (i.e., cover and diversity) and rangeland condition score (RCS) using integrated ecological and remote sensing-based approaches in arid regions of Southwestern Iran. A vegetation survey was carried out in 2019 in the oil-mulched and control area, and a remotely sensed vegetation index (MSAVI) was calculated for 2017 and 2019. The results indicate that one year after treatment, compared to the control area, vegetation cover (30 ± 17.11 vs. 17 ± 5.44 %) and litter (4.6 ± 2.18 vs. 0.94 ± 1.55 %) increased significantly in the oil-mulched area, while bare soil (65.20 ± 17.34 vs. 82.31 ± 5.84 %) decreased. Further, diversity indices (Species evenness, Shannon, and Simpson indices) declined by applying oil-mulch (88%, 63%, and 71%, respectively). The rangeland condition score was significantly higher in the oil-mulched area than in the control area (22 ± 1.86 vs. 12 ± 0.88; P < 0.001). Comparing MSAVI between 2017 and 2019 showed that vegetation cover increased 44.8%. Based on the results, it can be suggested that planting native palatable species in an oil-mulched area with the exclusion of livestock grazing is likely to increase the benefits of oil-mulch treatment and will lead to better rangeland condition score.