A 26-year-old patient was admitted with a 6-month history of fever,fatigue,and unintentional weight loss.Abdominal CT described an heterogeneous hepatosplenomegaly.Laboratory studies revealed leucopenia,anemia and elevated CRP.Bone marrow aspirate revealed amastigotes compatible with Leishmania spp.Was treated with liposomal amphotericin B with favourable outcome.Authors intend to raise awareness of VL in immunocompetentpatients.

This paper is devoted to study the discrete Sturm-Liouville problem $$ \left\{\begin{array}{ll} -\Delta(p(k)\Delta u(k-1))+q(k)u(k)=\lambda m(k)u(k)+f_1(k,u(k),\lambda)+f_2(k,u(k),\lambda),\ \ k\in[1,T]_Z,\\[2ex] a_0u(0)+b_0\Delta u(0)=0,\ a_1u(T)+b_1\Delta u(T)=0, \end{array}\right. $$ where $\lambda\in\mathbb{R}$ is a parameter, $f_1, f_2\in C([1,T]_Z\times\mathbb{R}^2, \mathbb{R})$, $f_1$ is not differentiable at the origin and infinity. Under some suitable assumptions on nonlinear terms, we prove the existence of unbounded continua of positive and negative solutions of this problem which bifurcate from intervals of the line of trivial solutions or from infinity, respectively.

This paper presents a new framework based on geometric algebra (GA) for solving and analysing three-phase balanced electrical circuits under sinusoidal and non-sinusoidal conditions. The proposed approach is an application of the geometric algebra power theory (GAPoT) to three-phase systems. Calculations are performed in a multi-dimensional Euclidean space where cross effects between voltage and current harmonics are taken into consideration. A definition of geometric apparent power for three-phase systems that complies with the energy conservation theorem is introduced. By using the proposed framework, the current can be easily decomposed into active- and non-active components for current compensation purposes. The paper includes detailed examples in which electrical circuits are solved and the results are analysed. This work is a first step towards a more advanced polyphase proposal with realistic cases, where unbalance and asymmetry is included.

La Valutazione di Impatto sulla Salute (VIS) è una metodologia di valutazione che, assieme ad altri strumenti, permette di valutare gli effetti che determinati interventi possono produrre sulla salute umana e sull'ambiente, al fine di individuare eventuali impatti positivi e/o negativi.  Questa ha dunque il ruolo di collegare il tema della salute, che costituisce un diritto fondamentale, con quello ambientale, poiché permette di valutare i rischi di un progetto sulla salute umana.  

Thrombocytosis, an uncommon side effect of all-trans retinoic acid (ATRA) treatment, occurs in some patients with acute promyelocytic leukemia. Our case showed thrombocytosis on day 26 to day 32 of ATRA and arsenic trioxide therapies and then started to decrease gradually without changing ATRA dosage. Thrombocytosis may associate with cytokine.

Objectives: Allergic rhinitis ( AR) has been recently increasing in prevalence, and traditional treatment strategies sometimes show limited effectiveness for patients with intractable AR. Botulinum toxin type A (BTX-A) is among the increasingly used alternative treatment options. This study was conducted aiming at clinical assessment of the effect of combined septal and turbinate injection of BTX-A for management of uncontrolled AR. Design and setting: A single-arm pilot study enrolled 40 patients having moderate to severe uncontrolled AR were recruited in between October 2018 and August 2019. Each patient received 45 units of BTX-A injected in 3 fixed points of each side of the nose: inferior turbinate (15IU), middle turbinate (15IU) and nasal septum (15IU). All patients were evaluated in terms of nasal hypersecretions, congestion and sneezing with visual analogue scale prior to treatment and at weeks 1, 2, 4, 8 and 12 during the follow-up period. Results: Throughout the 12 weeks follow-up period, a significant difference in the degree of nasal hypersecretions could be identified before and after BTX-A injection. Sneezing differed significantly only in the first 4 weeks while nasal congestion did not differ significantly, before and after BTX-A injection. BTX-A was well tolerated by the patients, with no serious adverse or systemic effects. Conclusion: Combined septal and turbinate injection of BTX-A, in patients with uncontrolled AR, may be a long-lasting therapeutic option for the treatment of nasal hypersecretions, but not as effective as for sneezing and nasal congestion.

Background Prematurity and bronchopulmonary dysplasia can modify lung function in children and adults. Postnatal nutrition and rapid growth catch-up may influence the long-term development of lung function. Methods This prospective observational study was based on a cohort of 334 very-low-birth-weight (VLBW) neonates, born between 1 January 2008 and 12 December 2015. Patients with severe neurological damage, death or incomplete data record were excluded. When these infants reached a mean age of 7.7 years, a spirometry evaluation was performed, to determine FEV1, FEF25-75%, FVC and the FEV1/FVC ratio. The relation between these parameters and nutritional intake in the early neonatal period was determined by regression analysis. Results In total, 40 spirometry tests were performed. The results obtained, after adjusting for age and sex by Z-scores for the spirometry variables, showed that the schoolchildren who had been VLBW recorded significantly lower spirometry results (FVC, FEV1, FEF25-75%) than the reference values. Furthermore, there was a significant association between the FEV1/FVC ratio and the intake of macronutrients and energy in the first week of life. It is hypothesised that increasing energy intake and achieving a higher protein/energy ratio in the first week of life would improve the FEV1/FVC ratio by the time these VLBW infants reach school age. Conclusions Active nutritional management in the early neonatal period is associated with improved lung function, as reflected by the spirometry findings obtained.

Synthetic microbial communities have the potential to enable new platforms for bioproduction of biofuels and biopharmaceuticals. However, using engineered communities is often assumed to be difficult because of anticipated challenges in establishing and controlling community composition. Cross-feeding between microbial auxotrophs has the potential to facilitate co-culture growth and stability through a mutualistic ecological interaction. We assessed cross-feeding between 13 Escherichia coli amino acid auxotrophs paired with a leucine auxotroph of Bacillus megaterium. We developed a minimal media capable of supporting the growth of both bacteria and used the media to study co-culture growth of the 13 interspecies pairs of auxotrophs in batch and continuous culture, and on semi-solid media. In batch culture, eight of thirteen pairs of auxotrophs were observed to grow in co-culture. We developed a new metric to quantify the impact of cross-feeding on co-culture growth. Six pairs also showed long-term stability in continuous culture, where co-culture growth at different dilution rates highlighted differences in cross-feeding amongst the pairs. Finally, we found that cross-feeding-dependent growth on semi-solid media is highly stringent and enables identification of the most efficient pairs. These results demonstrate that cross-feeding is a viable approach for controlling community composition within diverse synthetic communities.

Introduction Pleuropulmonary blastoma (PPB) is an aggressive primary neoplasm of pleuropulmonary mesenchyme occurring in children. Given its rarity, the International Pleuropulmonary Blastoma Registry (IPPBR) was established in 1988 to collect and assess data on PPB worldwide. We assessed the clinical characteristics, histopathology, genetic studies, management, and treatment outcomes of patients with PPB in our institution, and compared with the published literature. Materials and Methods We retrospectively reviewed the medical records of all PPB cases diagnosed at Princess Margaret Hospital for Children in Western Australia over a period of 26 years (1990-2016). Results Seven children (4 boys and 3 girls) were treated for PPB at a mean age of 11.5 months (ranges 1 month to 3.55 years). Histopathology showed type I PPB in five, type II in one, and type III in one. All seven patients underwent thoracotomy/lobectomy of the corresponding site. One patient required additional bladder resection for coexisting rhabdomyosarcoma. One patient was found to be positive for DICER1 gene mutation. Six patients received adjuvant chemotherapy with vincristine, adriamycin, cyclophosphamide (VAC) regime, with the mean duration of treatment for five patients being 9.4 months excluding one patient who deceased without completion of chemotherapy. During a mean follow-up time of 9 years, the overall survival rate for this cohort was 85.7% (6/7). Conclusions Our results are similar to those reported in the literature. It is crucial for clinicians to consider PPB in the evaluation of patients presenting with a cystic lung abnormality, especially in cases with DICER1 mutation or a strong family history of unusual cancers.

Lung infections caused by COVID-19; it can progress to severe ARDS with a high mortality.ECMO treatment is among the treatments applied in ARDS due to COVID-19.In this case report; It was aimed to discuss the results of ECMO treatment in ARDS developing due to COVID-19.

Management of nutritional needs is of paramount importance in cancer patients and nasogastric feeding is the most common method. Nasal cavity being a richly innervated region, is also a hallway for the exposure of the same to external environment. Any trauma or pressure to these nerve endings result in unilateral headache mimicking Sluder’s neuralgia. Nasogastric tube may irritate the nasal mucosa and exert pressure on the nasal turbinates. We believe that the persistent headache in patients with NG tube is distinctly significant that it interferes with the physical comfort of patient. It also influences the sleep patterns, thereby causing repercussions in the emotional well-being. Head and neck oncologists being the primary clinicians, it is imperative to consider the Sluder’s neuralgia in patients with nasogastric tube feeding. This mandates a prospective study to describe the clinical features and the treatment of ‘NGT neuralgia’.

To determine whether root-supplied ABA alleviates saline stress, tomato (Solanum lycopersicum L. cv. Sugar Drop) was grafted onto two independent lines overexpressing the SlNCED1 (9-cis-epoxycarotenoid dioxygenase) gene (NCED OE) and wild type rootstocks. After 200 days of salinity irrigation (EC = 3.5 dS m-1), plants with NCED OE rootstocks had 30% higher fruit yield, but root biomass and lateral root development was reduced. Although NCED OE rootstocks upregulated ABA-signalling (AREB, ATHB12), ethylene-related (ACCs, ERFs), aquaporin (PIPs) and stress-related (TAS14, KIN, LEA) genes, downregulation of PYL ABA receptors and signalling components (WRKYs), ethylene synthesis (ACOs) and auxin responsive factors occurred. Elevated SlNCED1 expression enhanced ABA levels in reproductive tissue while ABA catabolites accumulated in leaf and xylem sap suggesting homeostatic mechanisms. NCED OE also reduced xylem cytokinin transport to the shoot and stimulated foliar 2-isopentenyl adenine (iP) accumulation and phloem transport. Moreover, increased xylem gibberellin GA3 levels in growing fruit trusses was associated with enhanced reproductive growth. Improved photosynthesis without changes in stomatal conductance was consistent with hormone-mediated alteration of leaf growth and mesophyll structure, which combined with lower assimilate requirement in the roots and systemic changes in hormone balances could explain enhanced vigour, reproductive growth and yield under saline stress.

A document by Isabella Annesi. Click on the document to view its contents.

We describe a case of dynamic obstruction of the mesenteric arteries caused by aortic dissection. The flow pattern demonstrates a periodic flow variation, during which peak systolic velocity varied fourfold.

Background: Tens of thousands of Australians become ill with influenza annually, causing thousands of severe infections that require hospitalisation. However, only 40% of adults receive the annual influenza vaccine. We surveyed Australian adults to provide up-to-date data on the predictors and barriers of seasonal influenza vaccination. Methods: We administered an online survey to a nationally representative sample of Australian adults. We designed survey questions using the constructs of the health belief model. Using simple and multivariable Poisson regression, we identified attitudes and beliefs associated with influenza vaccination in 2019. Results: Among 1,444 respondents, 51.7% self-reported influenza vaccination in 2019. We estimated vaccine coverage to be 44% for adults under 45, 46% for adults aged 45 to 64, and 77% for adults aged 65 and over. The strongest individual predictors of self-reported vaccination were believing the vaccine is effective at preventing influenza (APR = 3.71; 95% CI = 2.87-4.80), followed by recalling their doctor recommending the vaccine (APR = 2.70; 95%CI = 2.31-3.16). Common perceived barriers that predicted self-reported vaccination included believing the vaccine could give you influenza (APR = 0.59; 95% CI = 0.52-0.67), believing the vaccine can make you ill afterwards (APR = 0.68; 95% CI = 0.62-0.74), and preferring to develop immunity “naturally” (APR = 0.38; 95% CI = 0.32-0.45). Conclusion: Although vaccine uptake in 2019 appears to be higher than previous years, there are perceived barriers which may limit uptake among Australians. Tailored interventions are needed to combat widespread influenza vaccine hesitancy, particularly among high risk grou

Effects of K deficiency have been investigated for several decades and recently, progress has been made in identifying metabolomics signatures thereby offering potential to monitor the K status of crops in the field. However, effects of low K conditions could also be due to the antagonism with other nutrients like calcium (Ca) and the well-known biomarker of K deficiency, putrescine, could be a response to Ca/K imbalance rather than K deficiency. We carried out experiments in sunflower grown at either low or high K, at high or low Ca, with or without putrescine added to the nutrient solution. Using metabolomics and proteomics analysis, we show that a significant part of the low-K response such as lower photosynthesis and N assimilation, is due to calcium and can be suppressed by low Ca conditions. Putrescine addition tends to restore photosynthesis and N assimilation but but aggravates the impact of low-K conditions on catabolism. We conclude that (i) effects of K deficiency can be partly alleviated by the use of low Ca and not only by K fertilization, and (ii) in addition to its role as a metabolite, putrescine participates in the regulation of the content in enzymes involved in carbon primary metabolism.

While pulmonary vein isolation (PVI) remains the cornerstone for invasive treatment of atrial fibrillation (AF), patients with persistent AF still have a high rate of recurrence with this method. Stochastic Trajectory Analysis of Ranked signals (STAR) mapping uses data from multiple individual wavefronts during ongoing AF to identify local drivers of persistent AF. In this non-randomized study, STAR mapping and ablation showed significantly lower recurrence of atrial arrhythmias compared to a consecutive PVI-only cohort and a propensity-matched ‘conventional ablation’ cohort (consisting of PVI plus complex fractionated atrial electrogram ablation or linear ablation). This benefit was driven by a much lower rate of AF recurrence in the STAR (6.2%) cohort vs PVI-only (44%) or ‘conventional’ (40%) with no significant difference in atrial tachycardia recurrence. Additionally, AF termination rates during ablation were approximately three times higher in the STAR cohort. While the analysis is retrospective and not randomized, the STAR cohort was also the only cohort with complete cessation of anti-arrhythmic drugs at three months and Holter monitoring at 6 and 12 months post-ablation per protocol. While STAR mapping appears to be a very promising new tool for treating persistent AF, history predicts at least some regression to the mean when future randomized comparisons are made. The authors have planned a multicenter randomized trial of PVI plus STAR mapping vs PVI-only for persistent AF. The global community of electrophysiologists and patients with AF eagerly awaits the results.

Cryoballoon technology is a well-established method to provide pulmonary vein isolation in the treatment of atrial fibrillation. Additional lesions such as roof line, posterior wall isolation or left atrial appendage isolation also possible with the same technique. We report a case with roof dependent atrial tachycardia successully terminated by using cryoballoon following pulmonary vein isolation.

Childhood interstitial lung diseases (chILD) are a rare presentation. We report case of siblings diagnosed with combined pulmonary fibrosis and emphysema (CPFE) attributable to ABCA 3 mutation. It highlights the progressive nature of the disease as it unfolds itself in both the siblings at around the same age. This is the second case of chILD with CPFE reported in literature and the first evidence of its occurrence in siblings adds to the novelty.

Object: To compare the clinical data of sternotomy and left intercostals incision, combined with the literature, to provide the best surgical incision for committed subarterial ventricular septal defect（DCS-VSD）. Methods: From July 2016 to July 2020, a total of 117 cases of occlusion surgeries for DCSVSD, which guided by transoesophagel echocardiography(TEE) were completed, including 34 cases with sternotomy incision and 83 cases with left intercostal incision. Statistics and analysis of the operation and follow-up. Results: 115 cases successfully occluded, the successful rate was 98.29%, and 1 case failed in each group. Pericardial effusion occurred in 5 children after the drainage device was removed, and the pericardial effusion disappeared after diuretic treatment. There was no statistical difference between the two groups in operation time, occlusion time, thoracotomy time and postoperative hospital stay. All the children recovered and were discharged from the hospital, and were followed up for 2-30 months after operation. Conclusion: TEE-guided intercostal DCS-VSD occlusion is safe and effective. There is no statistical difference between two approach with the operation time, chest opening and closing time, occluder placing time, and postoperative hospital staying. At the same time, the surgical incision by intercostal incisionis smaller and the operation invasion is less, it is a surgical approach which worth to develop.

Objective: Acute bronchiolitis is one of the most common causes of hospitalization for children younger than 1 year. Although the prognosis for these children is generally good, the condition involves a risk of mortality. Here, we evaluate the immature platelet fraction (IPF) as a biomarker for the severity of acute bronchiolitis. Material and Methods: In total, 179 children who had been diagnosed with acute bronchiolitis were classified into three groups: mild, moderate, and severe bronchiolitis, and 80 healthy children were included as a control group. The diagnostic capacity of the IPF, mean platelet volume (MPV), platelet distribution width (PDW), white blood cell count (WBC), and platelet count (PLT) values to predict bronchiolitis was evaluated using receiver operating characteristic (ROC) curves and their respective areas under the curves (AUCs) calculated with 95% confidence intervals. Results: Patients with acute bronchiolitis had a larger IPF than their healthy counterparts (p < 0.001). Additionally, a positive correlation was observed between the clinical severity of the disease and the IPF. The ROC curve analysis indicated that the IPF cut-off point for predicting acute bronchiolitis was >3.2%, with a sensitivity of 84% and specificity of 97%. Our results clearly demonstrate that the AUCs for IPF, MPV, PDW, WBC, and PLT were statistically significant for the bronchiolitis versus the control group. The AUC was greatest for the IPF. Conclusion: The IPF is a new marker for diagnosing and evaluating the clinical severity of acute bronchiolitis.

Inhaled nebulised unfractionated heparin (UFH) has a strong scientific and biological rationale that warrants urgent investigation of its therapeutic potential in patients with COVID-19. UFH has antiviral effects and prevents the SARS-CoV-2 virus’ entry into mammalian cells. In addition, UFH has significant anti-inflammatory and anti-coagulant properties, which limit progression of lung injury and vascular pulmonary thrombosis. Methods and intervention The INHALEd nebulised unfractionated HEParin for the treatment of hospitalised patients with COVID-19 (INHALE-HEP) meta-trial is a prospective individual patient data analysis of on-going randomised controlled trials and early phase studies. Individual studies are being conducted in multiple countries. Participating studies randomise adult patients admitted to the hospital with confirmed SARS-CoV-2 infection, who do not require immediate mechanical ventilation, to inhaled nebulised UFH or standard care. All studies collect a minimum core dataset. The primary outcome for the meta-trial is intubation (or death, for patients who died before intubation) at day 28. The secondary outcomes are oxygenation, clinical worsening and mortality, assessed in time-to-event analyses. Individual studies may have additional outcomes. Analysis We use a Bayesian approach to monitoring, followed by analysing individual patient data, outcomes and adverse events. All analyses will follow the intention-to-treat principle, considering all participants in the treatment group to which they were assigned, except for cases lost to follow-up or withdrawn. Trial registration, ethics and dissemination The meta-trial is registered at ClinicalTrials.gov ID NCT04635241. Each contributing study is individually registered and has received approval of the relevant ethics committee or institutional review board.

SARS-CoV-2 infection may present with numerous neurological manifestations. We report the case of a young obese lady, recently discharged after treatment for COVID-19 infection, who later presented with headache and blurred vision, diagnosed to have pseudotumor cerebri and concurrent bilateral optic neuritis.

We report a patient with cardiogenic shock (CS) in the course of acute right ventricular myocardial infarction (MI). Our case highlights the use of continuous veno-venous hemofiltration as a novel treatment option for acute kidney injury in the setting of CS and the use of rotational_atherectomy in patients with MI.