we reported an18 years old male with beta thalassemia major who presented with back pain progressive over 1 month associated with numbness in thighs, together with lower limbs weakness and difficulty walking. he also mentioned having difficulty in passing urine. he received radiotherapy which results in significant improvement in symptoms

Acute epibulbar infections are one of the most frequently diagnosed ophthalmologic infections. They are usually self-limiting but can lead to a viral preseptal cellulitis mimicking a severe bacterial infection. Early diagnosis is important to shorten the course of recovery.

Tonsillectomy is the most common surgery in children. Post-tonsillectomy pain is universal and associated with considerable morbidity. Dipyrone is banned in some countries and the analgesic most commonly used in others. Evidence of the effectiveness of dipyrone in postoperative analgesia of tonsillectomy are scarce. Serious adverse effects such as agranulocytosis and anaphylaxis are rare and their incidence varies in different populations.

Background: Flexible nasendoscopy is the principle method of assessment of vocal cord movement. As this procedure is inherently subjective it may be that it is not possible for clinicians to grade degree of vocal cord movement reliably. Aim: The aim of this study was to assess the accuracy and consistency of grading of vocal cord movement viewed via flexible nasendoscopy. Design: Prospective video analysis study. Methods: Thirty flexible nasendoscopy videos, without sound or clinical information, were assessed by 6 consultant Head and Neck surgeons. They were asked to assess and grade right and left vocal cord movement independently, based on a 5-category scale. This process was repeated three times at separate time intervals. Agreement and reliability were assessed. Participants: 6 consultant head and neck surgeons. Results: The mean overall percentage of observed inter-rater agreement was 67.7% (SD 1.9) with the 5-categories scale, increasing to 91.4% ( SD 1.9) when a 3-category scale was derived. The mean overall percentage of observed intra-rater agreement was 78.3% (SD 9.7) for 5 categories, increasing to 93.1% (SD 3.3) for 3 categories. Discriminating vocal cord motion using the 5-category scale is less reliable (k= 0.52) than with the 3-category scale (k = 0.68). Conclusion: This study demonstrates quantitatively that it is challenging to accurately and consistently grade subtle differences of vocal cord movement as proven by lesser agreement and reliability when using a 5 point scale instead of a 3 point scale. It highlights the need to have an objective measure to help in the assessment of vocal cord movement.

A 63-year-old woman was diagnosed with a giant atrial septal aneurysm (ASA) protruding into the right atrium and thrombus attached to the left side of the ASA pouch. We surgically resected the ASA, and the resection site was closed with pericardial patch. The postoperative course was uneventful.

Background: Globally, the emergence of antibiotic/ antimicrobial resistance became a tremendous public health concern. The inappropriate practices of antibiotic usage have a profound impact on antibiotic/ antimicrobial resistance. Medical students are the future prescriber who responsible for monitoring and counselling the patient on the antibiotic usage pattern. Hence, it is crucial to explore their knowledge, attitudes and perception pertaining to the use of antibiotics and AR. Methods: A cross-sectional study was conducted among the final year medical students at a private medical university. A total of 41 questions with varying responses such as true or false, specific answer type and Likert’s scale (5-point responses) were used in this study. Results: Out of 130 questionnaires distributed, 113 responses were received, and the response rate was 86.92%. Among the respondents, 95% (101) had used antibiotics in the last year. Surprisingly, all the students know that the full course of antibiotics should be taken and finished as directed. Overall, the respondents demonstrated moderate to good knowledge, attitudes, and perception on the use of antibiotics and its resistance. Still, some of them are unaware of their roles and responsibilities as a prescriber on antibiotic practice. Conclusion: In the present study, medical students practice widespread use of antibiotics for various illness and some accesses antibiotics without prescription. There is an alarming situation as some medical students did not know the exact role of healthcare providers on antibiotics usage and the common terminologies used in routine practice. The study provides a clear implication that more comprehensive training and educations on antibiotics and its resistance need to include in the medical curriculum to minimise antibiotics related complications.

Coronavirus can lead to overcoagulation, blood stasis, and endothelial damage resulting in thromboembolic disorders. We report a 22-year-old pregnant woman with coronavirus admitted due to the pulmonary emboli. This case highlights the importance of considering a new category for COVID-19 pregnant patients with venous and arterial thromboembolic disorders.

Acute transverse myelitis is a rare disease that can behave either in a benign course where it may end up in full neurologic recovery, or permanent neurologic sequelae and death. This report describes a 52-year-old male who presented with features of acute transverse myelitis associated with COVID-19.

Euglycemic DKA (euDKA) is a serious side effect associated with SGLT2 inhibitors. We present a case euDKA in a patient on an SGLT-2 inhibitor likely precipitated by COVID-19 infection. We suspect that COVID-19 led to euDKA. We pose the question of whether these medications should be discontinued proactively.

A document by Alessandra Romano. Click on the document to view its contents.

Right heart thrombus and pulmonary embolism is a condition that requires emergent treatment with reported fatal outcomes. Endovascular mechanical thrombectomy of right heart clot has been described with the use of AngioVac. We describe the use of FlowTriever device as a feasible alternative to treat clot in transit.

Background: To evaluate COVID19 patients treated within our academic medical system to determine if history of malignancy, both in general and specifically in genitourinary oncology patients, is associated with adverse clinical outcomes, including AKI and mortality. Methods: We conducted a retrospective cohort study among patients with confirmed SARS-CoV-2 infection in a multi-hospital, academic medical institution in New York City. Outcomes included mortality, ICU admission and AKI among hospitalized patients. We also evaluated risk of hospitalization among all patients with SARS-CoV-2 infection. Multilevel logistic regression models were used for analysis. Results: We identified 6,893 patients who met inclusion criteria, of which 4,018 were hospitalized. Among hospitalized patients 374 (9%) had a history of cancer, 281 (7%) experienced AKI, and 1,045 (26%) died. In adjusted analyses, patients with a history of cancer had 1.33 (95% CI = 1.05, 1.69) times the odds of death compared to those without cancer and this appeared to be driven by lung cancer (OR= 2.44, 95% CI= 1.05, 4.39). Patients with a history of genitourinary cancer were not at higher risk of mortality compared to those without cancer (OR=0.99, 95% CI= 0.61, 1.62). History of cancer was not associated with ICU admission or AKI in overall and subgroup analyses. Conclusions: Patients with a history of cancer who are hospitalized with SARS-CoV-2 infection are not at greater risk for AKI, though they are at higher risk for mortality as compared to patients without a history of cancer. The increased risk in mortality appears driven by patients with pulmonary neoplasms. Patients with a history of genitourinary malignancies do not appear to be at higher risk for AKI or for mortality compared to the general population.

Purpose: Pancreatic cancer (PC) is a devasting disease of which mortality almost parallels its incidence. Pancreatic cancer tissue may express aberrantly methylated NPTX2, but it is unclear what the consequences of this are. The purpose of the present study was to assess the diagnostic performance of methylated NPTX2 in PC diagnosis. Methods: We conducted a comprehensive search of PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and the Cochrane Library for published studies from inception to July 15, 2020. Using STATA 13.0, diagnostic OR (DOR) and AUC (Area Under the Curve of Receiver Operating Characteristic) were calculated to evaluate the diagnostic efficacy. Results: Nine studies were found eligible for the meta-analysis. The overall results of DOR and AUC were 11 (95%CI: 4-26) and 0.80, respectively. These data indicate that aberrantly methylated NPTX2 can correctly predict PC. Subgroup analysis revealed that quantitative real-time methylation-specific PCR (QMSP) had the highest diagnostic value for differentiating pancreatic cancer from chronic pancreatitis using a laboratory method. Furthermore, the detection of hypermethylated NPTX2 found in plasma was suggested to be a promising diagnostic biomarker, though a meta-analysis was not feasible due to the limited number of samples. The Deeks’ funnel map revealed no obvious public bias in the literature. Conclusion: aberrantly methylated NPTX2 has high sensitivity and specificity for the diagnosis of pancreatic cancer. However, further research is required to validate the use of methylated NPTX2 as a biomarker in the clinical diagnosis of pancreatic cancer.

Background Chronic kidney disease (CKD) has become a major global health issue, and abnormalities of glucose metabolism are a risk factor responsible for development of CKD. We aimed to investigate associations between glucose metabolism indices and CKD in a Chinese population, and determine which index is superior for predicting incident CKD. Methods This community-based population study included 5232 subjects aged ≥40 years without baseline CKD. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or urinary albumin-to-creatinine ration (UACR) ≥30 mg/g. We examined the associations of glucose metabolism indices, including fasting plasma glucose (FPG), 2-hour (2h) oral glucose tolerance test (OGTT), haemoglobin A1c (HbA1c), fasting insulin level, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-β and the development of CKD. Results With an average follow-up of 3.6 years, 6.4% of the subjects developed CKD. Pearson’s correlation analysis revealed that FPG, HbA1c, fasting insulin, and HOMA-IR were all significantly correlated with UACR and eGFR. The association persisted in multivariate linear regression analysis adjusted for age and sex. Compared with other glucose indices, HOMA-IR exhibited the strongest associations with CKD in COX multivariate regression analysis (HR = 1.17, 95% CI: 1.04-1.31). Conclusion HOMA-IR is superior to other routine indices of glucose metabolism for predicting the development of CKD in middle-aged Chinese persons. Screening with HOMA-IR may help prevent the development of CKD in the general population.

Objectives: To investigate lung volume and density in patients with SSc and changes in these parameters due to PF, using a software-aided image quantification method, and compare this with a matched healthy control group. Methods: Thoracic high-resolution computed tomography (HRCT) images of patients and controls were analyzed using Myrian XP Lung 3D software. Right, and left lung densities and volumes were calculated separately by a blinded operator. Results were analyzed between subgroups to investigate associations with the clinical features. Results: A total of 135 patients with SSc and 38 healthy controls (HC) were included. Characteristics of the SSc patients were 94 (69.6%) without PF, 85.4% female, mean age 49.8 (15.4) years; 41 (30.4%) with PF, 88.3% female, mean age 50.2 (11.5) years and HC group were 89.5% Female, mean age 52.2 (5.8) years. The right and left lung densities were significantly higher, and right and left lung volumes were significantly lower in the SSc patients with signs of fibrosis than those without and HC (p<0.001 and p<0.001; p=0.006 and p=0.002, respectively). After excluding patients with PF, right and left lung densities and volumes differed significantly between diffuse cutaneous SSc, limited cutaneous SSc, and HC (p=0.002 and p<0.001; p=0.045 and p=0.044, respectively). Patients who developed PF during follow-up had significantly lower baseline right and left lung densities than those who did not (p=0.018; p=0.014, respectively). Forced vital capacity and carbon monoxide diffusing capacity showed weak correlation with lung densities and volumes in patients without PF and moderate to high correlation in PF patients. Conclusion: Lung density and volume in SSc patients changed significantly in those with PF and those without. Quantitative information extracted by soft-ware aided methods may contribute more to the detection, screening, and risk prediction in SSc related PF.

Background: We aimed to determine the importance of urinary biochemical parameters in predicting the severity of COVID-19 disease. Methods: Totally 133 individuals diagnosed with COVID-19 in our clinic were included in the study. The groups were formed according to the severity of COVID-19 disease (moderate 85, severe 29, and critical 19), and an additional control group was created from 50 healthy individuals. The correlation between urine biochemical parameters and the severity of disease was investigated. Results: Erythrocyturia, proteinuria, and glucosuria rates were significantly higher in patients than controls. In patients, the median urine specific gravity (SG) value was found to be lower (p<0.001), and median potential of hydrogen (pH) value was found to be higher compared to the controls (p<0.001). In the severe group age, erythrocyturia, proteinuria, and glucosuria were significantly higher than the non-severe group. On multivariate analysis, proteinuria (OR: 4.66, 95%CI 1.02-21.4, p=0.047) and age (OR: 1.06, 95% CI 1.03-1.10, p<0.001) were independent predictive factors for disease severity. Conclusion: Some urine biochemical parameters especially proteinuria and advanced age may be useful for predicting the COVID-19 disease severity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a extremely infectious disease, and the current outbreak has been declared by WHO as a global public health threatening. Researches have showed that transmission of SARS-CoV-2 is mainly from person to person via airborne droplets. It is unclear whether SARS-CoV-2 can be shed into human milk and transmitted to a child via breastfeeding. Here we investigated SARS-CoV-2 RNA in breast-milk samples of three mothers with SARS-CoV-2 and their infant. The human milk sample of one mother for SARS-CoV-2 RNA was positive. By contrast, SARS-CoV-2 RNA was not detected in human milk of two mothers.The throat swab sample was also positive in the infant of the mother whose SARS-CoV-2 RNA was detected in human milk. By contrast, throat swab of others infants was negative. Because the mother with SARS-CoV-2 RNA detected in human milk sample is not breastfeeding, the risk of contagion from the infant to the mother is eliminated. To date, in the literature, the presence of SARS-CoV-2 RNA has only been detected in the breast milk of two mothers with SARS-CoV-2. To the best of our knowledge, our case is third case with SARS-CoV-2 RNA detected in human milk. On the other hand, this is first case with SARS-CoV-2 RNA detected in human milk of mother who does not breastfeed her infant.The existing data indicates that SARS-CoV-2 can be rare transmitted through human milk.

Aim: In this study,we aim to present the clinical features of patients with Rectus Sheath Hematoma (RSH), therapeutic management and results. Methods: The study included patients who were diagnosed with and received treatment due to spontaneous rectus sheath hematoma between the years 2010 and 2020. The demographic and clinical features of the patients,history of anticoagulant drug use and indication for anticoagulant drugs, laboratory parameters and radiological findings at the time of admission to the hospital, diameter of the hematoma, treatment modalities, follow-up parameters were analyzed retrospectively. Results: Our study included fifty-three patients. The median age was 65.7±14,68 years and 63.3% of the patients were over the age of 65 years. Number of female patients was 35. Cases most often had an American Society of Anesthesiologists score of 3 (64.3%). The most frequently used anticoagulant was warfarin (30.1%) and it was most often used due to heart diseases (54.7%).International Normalized Ratio value at the time of admission to the hospital was 1.93+1.18 and the hemoglobin value was 11.2 gr/dl. Average hematoma diameter was 74 mm and the most common stage was Type 1 (75.6%). 90.6% of the patients were followed up conservatively. Average duration of hospital stay being 15.1 days, mortality developed in 8 patients during their hospital stay. Conclusion: Spontaneous RSH should come to mind in elderly female patients who apply to the hospital with acute abdominal pain and are on anticoagulant therapy. Suspecting RSH can render early and true diagnosis possible, thus reducing morbidity and mortality in these patients.

Background: The pathogenesis of type 2 diabetes (T2D) is associated with chronic oxidative stress and inflammation. It is well known that the expression of some miRNAs such as miRNA-146a up- regulate in diabetic and hyperglycemic patients whereas, circulating miRNA-126 reduces. Therefore, the purpose of this study was to determinate the effects of Astaxanthin supplementation on the expression of miR-146a and miR-126, MDA and inflammation in patients with type 2 diabetes. Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 44 type 2 diabetes patients who were randomly assigned to received 8mg of oral Astaxanthin/d (n=22) or placebo(n=22) for 8 weeks. Results: We observed that Astaxanthin supplementation could decrease plasma levels of MDA and IL-6 (P < 0.05) and declined the expression level of miR-146a over time (Fold change: -1/388) (P < 0.05). Conclusion: Astaxanthin supplementation might be beneficial for improving circulating MDA and IL-6 and down regulation of miR-146a. However, future investigations are suggested to confirm these results.

This study reports the development of multiplex real-time PCR assays for differential detection of capripoxvirus (CaPV), parapoxvirus (PaPV), and foot-and-mouth disease virus (FMDV) in sheep, goats and cattle. Three multiplex assays were developed, a capripox (CaP) rule-out assay for simultaneous detection and differentiation of CaPV and PaPV, a FMD rule-out assay for simultaneous detection and differentiation of FMDV and PaPV, and a FMD/CaP rule-out assay for simultaneous detection and differentiation of CaPV, PaPV and FMDV. All multiplex assays included -actin gene ACTB as an internal positive control to monitor PCR inhibition and accuracy of nucleic acid extractions. The optimized assays were highly specific to the target viruses (CaPV, PaPV, and FMDV) with no cross-reactivity against other differential viruses. Using positive control plasmids as template, the limit of detection (LOD) of the multiplex assays were estimated as 2 (CaPV), 7 (PaPV), and 15 (FMDV) copies per assay. The amplification efficiency (AE) and correlation co-efficient (R2), estimated from the standard curves (Ct vs. log10 template dilution), were 94-106% and >0.99, respectively, for CaP and FMD rule-out assays, 96-116% (AE) and >0.98 (R2), respectively, for CaP/FMD rule-out assays and 91-102% and >0.99, respectively, for the corresponding singleplex assays. The diagnostic sensitivity (DSe) of the multiplex assays was assessed on 35 (CaPV), 36 (PaPV) and 39 (FMDV) clinical specimens collected from experimentally (CaPV and FMDV) and naturally (PaPV) infected animals, and all tested positive (DSe 100%) except two FMDV specimens that were tested negative (37/39; DSe 95%). The newly developed multiplex assays offer a valuable tool for differential detection of clinically indistinguishable CaPV, PaPV, and FMDV in suspected animals and animals with mixed infections.

Recently, a wound dressing formulation, (Tri-Solfen®, Medical Ethics Pty Ltd, Australia; TS) registered for use in ruminant husbandry in Australia, was registered for Foot-and-Mouth Disease (FMD) therapy in large ruminants in Laos, following clinical observations of improved welfare and healing following treatment of FMD lesions. In November 2019, an FMD outbreak in Cameroon provided an opportunity for a field trial, comparing clinical responses and recoveries to treatments on a sample of cattle (n = 36) comprising three equal groups of animals (n = 12), comparing responses to three treatments:(i) the application to lesions of TS, (ii) the administration of parenteral oxytetraycline commonly used for FMD in Cameroon; and (iii) an untreated control group (C). Appetite scores, lesion healing scores, and changes in dimensions of lesions, were recorded over a 15-day study period. Cattle treated with TS achieved both superior appetite and lesion healing scores with more rapid reduction in dimensions of lesions than other groups. Farmer observations indicated the TS treatment group had a more rapid return to eating with cessation of excessive salivation, and more rapid return of mobility (walking) with absence of overt lameness. The findings indicate that although mortality is usually low in FMD outbreaks, the disease is a debilitating and painful disorder with negative animal welfare impacts that should be addressed. All farmers expressed their desire that the product be made available for use in their region and modelling indicates that TS therapy imposes no additional financial burden on farmers, with the treatment likely to be provided at a similar or reduced cost to current treatment choices. As use of antibiotics for treatment of a viral disease potentially increases pressures for development of antimicrobial resistance and residues in the food chain, TS as an alternative non-antimicrobial therapy should be promoted for wider use in FMD outbreaks.

Many emerging infectious diseases are zoonotic and transmitted by an arthropod vector; thus, the Global One Health perspective is necessary for a better understanding of these diseases. Bartonellosis, one of those emerging infectious diseases, is caused by bacteria of the genus Bartonella, and can have different clinical manifestations in humans and animals. Opossums and their ectoparasites have been linked to human-wildlife conflicts. Knowing this, we aimed to evaluate infection by Bartonella spp. in free-living opossums seized or rescued from Atlantic Forest biome of Rio de Janeiro (southeastern Brazil). Whole blood was obtained from seven Didelphis aurita and eight D. albiventris, and DNA was assessed by conventional and quantitative polymerase chain reactions (PCR and qPCR). Positivity was achieved in 40.0% (PCR) and 46.7% (qPCR) of the samples, revealing, possibly for the first time, the presence of Bartonella spp. DNA in opossums from peri-urban areas of Atlantic Forest biome. Studies should continue, in order to elucidate synanthropic mammals importance in bartonellosis epidemiology.

To compare the rhizosphere communities under Masson pine trees with different carbon sequestration abilities, we sampled three families of Masson pine that showed significant differences in their carbon sequestration ability and conducted high-throughput sequencing of the 16S rRNA and ITS in the corresponding soil samples. The diversity of rhizosphere soil microorganisms, the patterns of differences in relative abundance among the different samples and the responses of microorganisms to environmental factors were analyzed. There was no significant difference in the diversity of soil bacteria or fungi among the different samples from Masson pine families with different carbon sequestration abilities, but with the increase in carbon sequestration, the dominant phyla of bacteria and fungi changed. The dominant phylum of soil bacteria changed from Proteobacteria to Acidobacteria, and that of fungi changed from Ascomycota to Basidiomycota. In addition, we investigated the core microbial communities at the genus level among the different samples, and a significant portion of the core genera were involved in carbon metabolism. The microbial communities were greatly influenced by environmental factors such as soil carbon content, soil moisture and altitude. Soil fungi were more sensitive than soil fungi to the rhizosphere activity of Masson pine.

Soil erosion by snow or ice melt waterflow is an important type of soil erosion in many high-altitude and high-latitude regions. The snowmelt waterflow erosion process, affected by soil freeze and thaw, is highly dynamically variable. In this study, field experiments were conducted to investigate the effects of thawed depth of frozen soil profile on snowmelt waterflow erosion of alpine meadow soil in the spring. The experiments involved five thawed depths from 0 to 100 mm under two snowmelt waterflow rates of 3 L/min and 5 L/min. The unthawed soil or shallow-thawed depth of 10 mm significantly altered the runoff and sediment production mechanism, including a significant delay of the runoff generation time and change of hydrograph and sedigraph. When the soil was frozen, the topsoil was structured with large open voids, to retain water and impede flow. This resulted in runoff generation time that was greatly lagged and soil erosion in the initial stage that was inhibited. The relationship curve of runoff and sediment concentration showed two-stage patterns that characterized a limited sediment supply in the early stage and hydrodynamic-controlled processes in the later stage. The deep-thawed cases (≥ 30 mm) showed similar hydrograph and sedigraph patterns with unfrozen soil condition. The findings of this study provide guidance for the future improvement of erosion model of partially thawed soil. Keywords: snowmelt waterflow erosion; thawed soil depth; soil freeze and thaw; runoff generation; sediment rating curve