TYPE OF THE ARTICLE: LETTERTITLE: BIOLOGICAL THERAPIES IN CHILDREN WITH RHEUMATIC DISEASES DURING THE COVID-19 PANDEMIC: A SINGLE CENTER EXPERIENCERUNNING TITLE: BIOLOGICAL THERAPIES DURING THE COVID-19 PANDEMIC

Background: Levofloxacin and ciprofloxacin are more commonly used among fluoroquinolone class and the question of cardiac safety and glucose hemostasis of this class has been raised. Objective: To compare intravenous levofloxacin and ciprofloxacin regarding their risk on QTc prolongation and dysglycemia in diabetic and non-diabetic patients. Methods: A randomized prospective study at Beni-Suef university hospital was conducted on 200 adult patients over 6 months. The patients received intravenous levofloxacin 750mg once daily or ciprofloxacin 400mg twice daily. Electrocardiogram and fasting blood glucose were obtained from each patient before starting antibiotic, 24 hours, 72 hours after the first dose and 72 hours after antibiotics cessation. Results: The results of the current study showed the relative risk for QTc prolongation with levofloxacin was more than ciprofloxacin by about 4 and 1.5 in diabetic and non-diabetic patients, respectively. The relative risk for dysglycemia with levofloxacin was 2.28 and 1.39 times more than ciprofloxacin in diabetic and non-diabetic patients, respectively. Conclusion: The present study showed that the risk for QTc prolongation and hyperglycemia was greater with levofloxacin than ciprofloxacin in diabetic and non-diabetic patients. In addition, the risk for hypoglycemia was greater with levofloxacin than ciprofloxacin in non-diabetic patients.

Background: Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah’s potentially detrimental effects are underestimated due to the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. Methods: Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients’ prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. Results: The entire cohort included 270 patients. The mean patient age was 29.2±5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers, and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (p=0.326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. Conclusion: Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.

Background: The possible differences in characteristics and prognosis, among patients with coronavirus disease 2019 (COVID-19), with vs. without changes in red cell distribution width (RDW) during hospitalization, have not been investigated. Methods: For 477 adults hospitalized with COVID-19, demographic, laboratory and clinical characteristics, in-hospital outcomes and all-cause mortality were compared according: to high (>14.7%, n=146) vs. normal (≤14.7%, n=331) RDW values at admission, and according to RDW changes (n=150) vs. stable RDW (n=262) during hospitalization. Results: Both high RDW at admission and change in RDW during hospitalization were significantly associated with older age, more severe clinical and laboratory characteristics, and poor in-hospital outcomes. On median follow-up lasting 83 days, the mortality rates were higher among patients with high vs. normal RDW on admission (26.7% vs. 10.0%, P < .001) and RDW changes vs. stable RDW (34.7% vs. 5.7%, P < .001). On multivariate analysis, change in RDW was strongly associated with decreased survival (relative risk 1.50 and 95% confidence interval 1.29–1.75), while high RDW on admission was not found to be most significantly associated with mortality. Conclusions: Among patients with COVID-19, RDW changes during hospitalization were associated with a severe clinical profile, poor in-hospital outcomes and increased short-term mortality. Repeated assessment of RDW may provide useful information for improving the care of hospitalized patients with COVID-19.

Задание 1Разложить в ряд Лорана по степеням \((z-2)\) функцию: \[f(z)= \frac{z(1-2i)+4i}{z^2-(1-2i)z-2i}\]в кольце, к которому принадлежит точка \(z=0\). Указать границы кольца сходимости.Решение:Перепишем знаменатель в виде:\[ z^2-(1-2i)z-2i = (z-1)(z+2i)\]И разлагая на простые дроби получаем представление для нашей функции в виде:\[f(z)= \frac{1}{z-1}-\frac{2i}{z+2i}\]Обратимся к картинке, чтобы понять в каком кольце нужно смотреть разложение.

Algal associated bacteria are fundamental to the ecological success of green macroalgae such as Caulerpa. The resistance and resilience of algal-associated microbiota to environmental stress can promote algal health and genetic adaptation to changing environments. The composition of bacterial communities has been shown to be unique to algal morphological niches. Therefore, the level of response to various environmental perturbations may in fact be different for each niche-specific community. In situ experiments were set up to investigate the effect of nutrient enrichment and temperature stress on the bacterial communities associated with Caulerpa cylindracea. Bacteria associated with separate morphological niches along the thallus were characterised using the 16S rRNA gene and community similarities were compared. Resistance and resilience were calculated to further understand the initial changes and recovery of microbial composition in response to different abiotic stresses. The results of this study provide evidence that nutrient enrichment has a significant influence on the taxonomic and functional structure of the epimirocbiota. Temperature stress had a significant effect on the rhizomicrobiota taxonomic composition, with the combined stress potentially having additive effects on the functional performance of the rhizomicrobiota over time. This further contributes to our understanding of algal microbiome dynamics in response to environmental changes.

    Gerçek hayattan uyarlanan filmlerin kurgu olanlara nispeten daha etkileyici olduklarını söyleyebiliriz. Benzer hayatlarımız olmasa bile izlediğimiz bu hayatları örnek almak ve onlardan  ders çıkarabilmek mümkün. MMMT olarak bu içeriğimizde Hintli Matematikçi Srinivasa Ramanujan’ın hayat hikayesinin anlatıldığı Sonsuzluk Teorisi veya orijinal ismiyle The Man Who Knew Infinity filmini inceleyeceğiz. Hem kendi sınırlarını hem de matematiğin sınırlarını zorlayan bir matematikçinin hayat hikayesini matematikçi bakış açısıyla izlemek pek çok öğreti çıkarmayı mümkün kılıyor."Doğru biçimde ifade edilen matematik, sadece gerçeği değil aynı zamanda ilahi güzelliği de haizdir."Bertrand Russel    SPOILER  Yazımız filmdeki olaylara dair bilgiler içermektedir. 

    Mustafa Kemal Atatürk'ün geometri öğrenmeyi kolaylaştırmak amacıyla Osmanlıca geometri terimlerini Türkçe'ye çevirdiğini ve çalışmalarını "Geometri" adıyla bir kitapta toplayarak yayınladığını biliyor muydunuz? 

Bromus tectorum (cheatgrass) is an invasive annual grass that has colonized large portions of the Intermountain Western United States. Cheatgrass stand failures have been observed throughout the invaded region, the cause of which may be related to the presence of several species of pathogenic fungi in the soil or surface litter. In this metagenomic study, we compared the fungal communities between sites that have and have not experienced stand failure. Samples were taken from the soil and surface litter near Winnemucca, Nevada and in Skull Valley, Utah. Our results show distinct fungal communities associated with stand failure based on both geography and sample type. In both the Winnemucca and Skull Valley surface litter, there was an elevated abundance of the endophyte Ramimonilia apicalis in samples that had experienced a stand failure. Winnemucca surface litter stand failure samples had increased abundance of a potential pathogen in the genus Comoclathris. Skull Valley surface litter stand failure samples had increased abundance of the known cheatgrass pathogen Clarireedia capillus-albis while the soils had increased abundance of potential pathogens in the genera Olpidium and Monosporascus.

BACKGROUND The success rate after cryoballoon ablation (CB-A) performed for paroxysmal atrial fibrillation (PAF) might be underestimated by traditional noninvasive monitoring techniques. The purpose of this study was to evaluate the mid-term outcome of CB-A in patients with PAF implanted with an implantable loop recorder (ILR) after the procedure. METHODS Between January 2017 and March 2019, all patients who underwent CB-A for PAF and who were subsequently implanted with an ILR were retrospectively included. All devices were equipped with remote monitoring. All ILR-documented atrial tachycardia (AT) or AF episodes ≥ 6 minutes were considered as recurrence; both true and false episodes were collected. A 3-month post-procedural blanking period (BP) was applied. RESULTS A total of 102 patients (77 male, mean age 60.6 ± 9.6 years) who underwent pulmonary vein isolation (PVI) by CB-A were included; mean time from first diagnosis of AF to PVI was 51.5 ± 46.9 months. Mean follow-up was 29.3 ± 8.1 months; at 12-month follow-up, the success rate was 64.7%, while at 2-year follow-up, freedom from AT/AF recurrences was achieved in 44.1% of the patients. In the follow-up, a total of 4987 ECG strips were analyzed; true-positive episodes were confirmed in 2026 cases (40.6%), while 2961 episodes (59.4%) were considered false-positive. CONCLUSION In patients with PAF implanted with an ILR, CB-A results in freedom from any AT/AF recurrence in 64.7% of patients at 12-month follow-up and in 44.1% of patients when evaluated at 2-year. Careful adjudication of all ILR-documented AF episodes is required to avoid misdiagnosis.

Introduction: The sinoatrial node (SAN) should be identified before superior vena cava (SVC) isolation to avoid SAN injury. However, its location cannot be identified without restoring sinus rhythm. This study evaluated the usefulness of the anatomically defined SAN by comparing it with the electrically confirmed SAN (e-SAN) and aimed to establish a safe and more efficient anatomical reference for SVC isolation than the previously reported reference of the roof of the right superior pulmonary vein (RSPV roof). Methods and Results: The e-SAN was identified as the earliest activation site in the electro-anatomical map obtained during sinus rhythm. The anatomically defined SAN, the cranial edge of the crista terminalis (CT) visualized with intracardiac echocardiography (CT top), and the RSPV roof were tagged on one map. The distance from the e-SAN to each reference was measured. Among 81 patients, the height of the e-SAN from the CT top was −3.5 ± 10.3 mm. The e-SAN existed below 10 mm above the CT top in 78 (96%) patients and below the RSPV roof in 77 (95%) patients. A longer SVC sleeve was measured from 10 mm above the CT top compared to the RSPV roof (28.7 ± 11.2 vs. 22.5 ± 11.3 mm, p <0.001). Faster heart rate predicted an e-SAN location higher than the CT top (adjusted OR [95% CI]; per 10 bpm increase: 1.6 [1.15–2.22], p <0.01). Conclusion: The CT top is useful in predicting the upper limit of the e-SAN and can provide a useful reference for SVC isolation.

Introduction Why some individuals with similar demographic characteristics develop syncope during tilt testing (TT) and others do not is unknown and low test sensitivity is claimed. We sought an alternative explanation; resting cardiovascular physiology differs in patients with positive and negative TT. Methods We analyzed age, gender, systolic (SBP), diastolic blood pressure (DBP), and heart rate (HR) using three large syncope patient databases comparing tilt-positive with tilt-negative results after excluding orthostatic hypotension. Positive tilt-response, confirming reflex syncope, was defined as reproduction of spontaneous symptoms with characteristic bradycardia and/or hypotension. Impact of demographic, hemodynamic parameters and prevalent hypertension on TT positivity were assessed using logistic regression models. Results Records of 5236 patients (45% males; mean age, 60±22 years; 32% on antihypertensive therapy) were analyzed. TT was positive in 3129 (60%) and tilt-positive patients had lower SBP (127.2±17.9 vs 129.7±18.0 mmHg, p<0.001), DBP (76.2±11.5 vs 77.7±11.7 mmHg, p<0.001) and HR (68.0±11.5 vs 70.5±12.5 bpm, p<0.001) compared with tilt-negative patients. SBP was similar in males and females but males had higher DBP and lower HR than females (p<0.001). In multivariable analysis, tilt-test positivity was independently associated with younger age (p=0.016), SBP≤128 mmHg (p<0.001), HR≤69 bpm (p<0.001), and absence of hypertension (p<0.001). Conclusions Patients developing reflex syncope during tilt-testing have lower systolic and diastolic blood pressure and heart rate compared with tilt-negative patients. Tilt-test positivity is independently associated with younger age, lower blood pressure, lower heart rate and absence of hypertension but not with gender. These hemodynamic differences imply hypotensive susceptibility.

Botrytis cinerea is a fungal pathogen that causes necrotic disease on more than a thousand known hosts widely spread across the plant kingdom. How B. cinerea interacts with such extensive host diversity remains largely unknown. To address this question, we generated an infectivity matrix of 98 strains of B. cinerea on 90 genotypes representing eight host plants. This experimental infectivity matrix revealed that the disease outcome is largely explained by variations in either the host resistance or pathogen virulence. However, the specific interactions between host and pathogen account for 16% of the disease outcome. Furthermore, the disease outcomes cluster among genotypes of a species but are independent of the relatedness between hosts. When analyzing the host specificity and virulence of B. cinerea, generalist strains are predominant. In this fungal necrotroph, specialization may happen by a loss in virulence on most hosts rather than an increase of virulence on a specific host. To uncover the genetic architecture of Botrytis, a genome-wide association study (GWAS) was performed and revealed 124 genes associated with host specificity and virulence. The genetic architecture of these traits is distinct, polygenic and widespread across B. cinerea genome. The complexity of the disease outcome is best explained by the additivity of small effect genes that adjust the infection to diverse hosts.

In patients presenting with transient ischaemic attack and acute minor noncardioembolic ischemic stroke (NIHSS score ≤3) who did not receive IV alteplase, treatment with dual antiplatelet therapy with aspirin and clopidogrel, started within 24 hours after symptom onset and continued for 21 days is effective in reducing recurrent ischemic stroke up to 90 days from symptom onset. However, as the long-term risk of major disabling bleeding with aspirin-based antiplatelet treatment is higher in patients aged 75 years or older, routine co-prescription of proton pump inhibitor should be encouraged.

Key Points • Clinical N3b staging is defined as unequivocal and unambiguous signs of extra nodal extension (ENE), such as skin involvement, muscle invasion or nerve dysfunction, supported by radiological evidence. • There is a paucity of studies determining interobserver reliability of clinical detection of overt ENE. • A prospective comparative cohort study assessing 12 Head and Neck surgeons’ inter-observer agreement in detecting the components of overt ENE. • We reveal high surgeon agreement in the ability to detect lymph nodes, the presence of skin involvement and in surrounding nerve involvement. • Variability of surgeon assessment was seen in the assessment of overt muscular involvement.

The surgical approach and choice of drainage veins for uterus transplantation living-donor surgery have been investigated to reduce invasiveness. Of the 51 operations within 26 articles reviewed, the mean operative time was shortest in the laparoscopic approach, and longest in the robot-assisted approach. The mean blood loss was less in the laparoscopic and robot-assisted approaches than in the open approach. In cases where the uterine veins were not preserved, the mean operative time was shortened by each approach and the mean blood loss decreased with the laparoscopic and robot-assisted approaches. These procedures may contribute to less invasive living-donor surgery.

In recent months, since the Sars-Cov-2 pandemic has hit the entire world landscape, one of the most heated debates involving researchers has concerned the potential role that vitamin D could play in relation to infection by COVID-19.In particular, numerous scientific studies have shown that the deficiency of this vitamin is present in a large part of the sick subjects, in a Spanish study1 this association was reported in about 80% of the sample considered, furthermore other studies2,3,4 attribute to this hormone a potentially protective role by stimulating type I interferon and enhancing innate immunity.This review of the literature investigating, through a bibliographic search in the Pubmed - Medline database, aims to evaluate the possible association between vitamin D and Sars-Cov-2 infection in terms of outcomes such as: association between levels of vitamin D and infection, disease severity, mortality, analyzing a total of 274 studies, of which 8 reviews were finally evaluated, which allowed, through a review of the literature, to demonstrate a positive association of vitamin D in the prevention and treatment of infection from Sars-Cov-2 and in other pathologies such as flu, pneumonia and chronic diseases such as diabetes, obesity and arterial hypertension, or conditions favorable to complications during Covid-19 infection.

Nickel allergy was detected in approximately 15% of the population. Despite this rate, very few patients developed symptoms related to nickel allergy after cardiac device insertion. In this case report, pericardial effusion due to nickel allergy that develops after the insertion of Atrial Septal Defect (ASD) device is described. The patient was discharged with ibuprofen. In some cases, dramatic conditions up to the tampon after effusion may develop. These patients responded to high-dose steroid; however, devastating side effects developed. However, more detailed and comprehensive advanced research is needed on this subject.

Scale insects are hemimetabolous, showing “incomplete” metamorphosis and no true pupal stage. Ericerus pela, commonly known as the white wax scale insect (hereafter, WWS), is a wax-producing insect found in Asia and Europe. WWS displays dramatic sexual dimorphism, with notably different metamorphic fates in males and females. Males develop into winged adults, while females are neotenic and maintain a nymph-like appearance, which are flightless and remain stationary. Here we report the de novo assembly and analysis of the WWS genome. From these data, we constructed a robust phylogenetic analysis of 24,923 gene families from 16 representative insect genomes, which indicates that holometabola evolved from hemimetabolous insects in the Late Carboniferous, about 50 million years earlier than previously thought. To study the distinct development of males and females, we analyzed the methylome landscape in either sex. Surprisingly, WWS displayed high levels of methylation (4.42%) when compared to other insects. We observed differential methylation patterns for genes involved in steroid and sesquiterpenoids production as well as related fatty acid metabolism pathways. We show here that both males and females produce distinct profiles of ecdysone (the principal insect steroid hormone) and juvenile hormone (a sesquiterpenoid), consistent with their different development fates. Our results provide a comprehensive genomic and epigenomic resource of scale insects that provide new insights into the evolution of metamorphosis and sexual dimorphism in insects.

Objective To assess pain scores and requirement for parenteral and oral analgesia in the postoperative period following vulval surgery with blockade of the ilioinguinal nerve (IIN) and pudendal nerve (PN). Design An observational study of consecutive patients undergoing major vulval and/or related groin surgery. Sampling biopsies were excluded. Setting Women undergoing vulval surgery in a tertiary cancer centre. Population or Sample Eighteen women were included in the analysis. Median age 67 (range 34-81) years and thirteen (72%) were >60 years. Methods Levobupivacaine 0.25% (2.5mg/ml) or 0.5% (5mg/ml) was administered at four sites (2 sites abdominally for IIN block and 2 sites for PN block) with dosage calculated based on the patient’s weight. Patients were invited to record visual analogue pain scores (VAS) days 1-5 postoperatively. Use of postoperative analgesia was recorded. Main Outcome Measures VAS and use of postoperative analgesia. Results VAS ranged from 0 to 3 for seventeen patients from day 0 to day 1 and fifteen patients from day 2 to day 5. Two patients had pain scores >4 on one or more postoperative days: one had chronic arthralgia and one had received a lower volume of bupivacaine. Conclusions Ilio-inguinal and pudendal nerve block is a feasible and effective strategy for postoperative pain management in women undergoing vulval surgery.

In this paper, we introduce the definition of the generalized reduced biquaternions and propose a real representation of a generalized reduced biquaternion matrix. By using the matrix representation, we discuss the least-squares problems of the classic generalized reduced biquaternion matrix equation $AXC=B$. The least-squares solution to the above matrix equation is formulated by a least-squares real solution of its corresponding real matrix equation. Furthermore, two numerical examples are given to illustrate our results.

Clarifying the impact of underlay (i.e., the combination of understory vegetation and surface micro-topography) on the surface runoff process under different rainfall intensities would provide a significant theoretical basis for controlling soil and water loss on steep slopes in mountainous areas of southwestern China. In the current study, the runoff process under different rainfall intensities was observed based on 10 natural runoff plots, and the correlation between the spatial pattern of cypress (Cupressus funebris), micro-topography and runoff characteristic parameters was tested using the Pearson correlation coefficient method. The effects of the spatial pattern of cypress and micro-topography on surface runoff also were analyzed using the Response Surface Method (RSM). The results indicated that the blocking effects of different underlay conditions on surface runoff decreased with the increase of rainfall intensity. The impact of the spatial pattern of cypress and micro-topography on the runoff process was mainly reflected in the impact on peak flow. Under the condition of moderate rainfall (30-50 mm/24 h) or rainstorm (50-70 mm/24 h), topographic relief, surface roughness, runoff path density, contagion index of cypress, and stand density of cypress were the key factors that affected the peak flow, whereas under the condition of severe rainstorms (> 70 mm/24 h) none of the foregoing factors had a significant correlation with peak flow. Under the conditions of moderate rainfall or rainstorm, when the composite indexes of the spatial pattern of cypress and micro-topography were small, the peak flow would not be significantly affected. When the micro-topography reached the conditions required to significantly increase the peak flow, increasing the composite index of the spatial pattern of cypress within a certain range promotes the peak flow, and when the composite index of the spatial pattern of cypress exceeded a certain value, as the composite index of micro-topography increased, the dominant factor affecting the peak flow gradually changed from the spatial pattern of cypress to that of micro-topography.

In the context of an evolving understanding of early T-cell precursor (ETP) lymphoma and leukemia, we present a case of concurrent T cell lymphoblastic lymphoma and ETP lymphoma in an adolescent female. To our knowledge, this represents the first reported case of both lymphoblastic lymphoma and ETP lymphoma as distinct and conjoined components of the same neoplasm. As an exception to current literature, our patient had only ETP lymphoma with no marrow involvement. Her ETP component remained viable following induction, supporting ETP resistance to chemotherapy. The patient remains in remission 4 years post allogeneic matched sibling donor bone marrow transplant.

Abstract Objective: The purpose of this study is to investigate the relationship between microvascular dysfunction and the presence of fragmented QRS(f-QRS) in patients with acute inferior myocardial infarction(MI) who underwent primary percutaneous coronary intervention(PPCI). Methodology:274 consecutive patients with a mean age of 56.8 ± 9.8 who met the inclusion criteria were enrolled; patients with TIMI 2-3 flow after PPCI were divided into two groups according to the myocardial blush grade (MBG) 0-1 and MBG 2-3. The f-QRS includes different morphologies of the QRS and includes an additional R wave (R ’) or notching at the lowest end of the S wave in two adjacent leads releasing the infarct area. ECG records were taken to assess f-QRS and ST segment resolution was assessed in the first hour after the procedure. During angiographic examination, myocardial blush grade (MBG) and TIMI flow were measured in the right coronary artery due to post-procedure infarction. Results:The patients were divided into two groups as MBG 0-1 and MBG 2-3. In general, the median age was 56.8 ± 9.8,and 49 patients(17.9%) were women. Among all study patients, f-QRS count was 36(13.1%). In this study, 62 and 212 patients had MBG 0-1 and MBG 2-3, respectively. f-QRS was detected in 23(21.7%) patients in the MBG 0-1 group and 13(10.7%) patients in the MBG 2-3 group. In multivariate logistic regression, f-QRS [OR: 2.3(1.13-5.06),p = 0.027],ST segment resolution at first hour [OR: 0.62 (0.39-0.90),p = 0.04], and TIMI frame number [OR: 1.05(1.01-1.09),p = 0.004] were found to be associated with MBG 0-1. Conclusion:Our study showed that the presence of f-QRS after PPCI was associated with microvascular dysfunction in patients with inferior MI who underwent successful PPCI.F-QRS, a simple and inexpensive parameter, can be used to assess microvascular dysfunction in MI patients who underwent PPCI. Keywords:microvascular dysfunction,fragmented QRS,myocardial infarction