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COVID 19 - The Swiss Perspective
Juri Sromicki
Martin Schmiady

Juri Sromicki

and 3 more

July 31, 2020
The current COVID-19 pandemic has a huge impact on society and economy and represents one of the biggest challenges for healthcare systems all over the world. Reports from health-care-institutions in different countries show a variety of crisis exit strategies. Although experiences in handling of the pandemic have accumulated over the last 7 months, it is clear that measures to prevent a collapse of the health-care-systems have to be adapted to local political and socioeconomic structures. The aim of this review is to give insight in crisis exit strategies in Switzerland, highlighting the role and impact of COVID-19 in the field of cardiac surgery.
Evaluation of postoperative complications associated  with tobacco use in thoracic su...
Mehmet Degirmenci
Celal Kus

Mehmet Degirmenci

and 1 more

March 04, 2021
Introduction: Tobacco products can make thoracic diseases more complicated by affecting their respiratory functions in a short or long time and can increase mortality and morbidity related to these diseases. While smoking causes many diseases that require surgical treatment, especially thoracic surgery, on the other hand, it affects surgical results. This study aims to determine the relationship between tobacco use and postoperative complications in thoracic surgery patients and contribute to public health by supporting tobacco cessation programs.Method: Patient characteristics and tobacco use habits of the patients, and the types of tobacco they used were determined. Postoperative complications, admission to the intensive therapy unit, reintubation, death, and length of stay in hospital were defined as surgical outcomes. These results were compared and analyzed with tobacco use.Results: Retrospectively, 754 patients consisting of 536 (71.1%) males and 218 (28.9%) females were evaluated.  Tobacco use was more common in men (X2=223.216, p<0.001) and younger ages (X2=45.342, p<0.001). Complications occurred in 96 patients, 76 (79.2%) of whom used tobacco. Tobacco use (p<0.001, OR=3.547), ASA score (p=0.029, OR=2.004), major surgeries (p<0.001, OR=4.458), and minimally invasive surgeries (p=0.027, OR=2.323) are associated with complications. Length of hospital stay is related to the amount of tobacco (p <0.001, OR = 3.706), size of surgery (p <0.001, OR = 14.797), over 65 years (p <0.001, OR = 2.635), and infectious diseases (p = 0.039, OR: 1.939)Conclusion: Tobacco use is related to poor outcomes in thoracic surgery patients, and it is a severe health problem, especially at young ages. Tobacco control programs should be supported to prevent the effects of tobacco use on thoracic diseases and postoperative complications.Keywords: tobacco use, postoperative complications, thoracic surgery, tobacco products, pulmonary diseases, smoking.
Decreased eosinophil counts and elevated lactate dehydrogenase predict severe COVID-1...
Dian Chen
Lingling Yi

Dian Chen

and 7 more

July 31, 2020
Background: Several predictors for the severity of coronavirus disease 2019 (COVID-19) have been reported. However, chronic airway inflammation characterized by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19. Methods: In this retrospective cohort study, we reviewed medical records of all laboratory confirmed COVID-19 patients with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted in Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from January 26th to April 3rd. The Tongji Hospital ethics committee approved this study. Results: There were 59 patients with underlying chronic airway inflammation including chronic bronchitis, COPD and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6vs.1.1×10⁹/L, p<0.001), eosinopenia (<0.02×10⁹/L, 73%vs.24%, p<0.001), increased lactate dehydrogenase (LDH) (471.0vs.230.0 U/L, p<0.001) and elevated IL-6 level (47.4vs.5.7 pg/ml, p=0.002) on admission. Eosinopenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models included the above variables. Eosinopenia was also an independent risk factor for mortality of this cohort in a multivariate model included the above variables. Moreover, eosinophil counts and LDH levels tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially eosinophil counts. Conclusions: Eosinopenia and elevated LDH are potential predictors of disease severity in COVID-19 patients with underlying chronic airway diseases. Theses predictors may help clinicians identify the severe COVID-19 patients with chronic bronchitis, COPD and asthma.
Characterization of asthma and risk factors for delayed SARS-CoV-2 clearance in adult...
Sujeong Kim
Chang Gyu  Jung

Su-Jeong Kim

and 5 more

July 31, 2020
BACKGROUND: The coronavirus disease-2019 (COVID-19) is still rapidly spreading worldwide, and remains a global health crisis. We investigated the impact of asthma on the prevalence and outcomes of COVID-19 and identify the risk factors for delayed viral clearance. METHODS: Adult patients with COVID-19 admitted to 10 hospitals in Daegu were retrospectively registered, and their clinical information was collected. Delayed viral clearance was divided into two groups based on 30 days. RESULTS: A total of 2,200 patents were evaluated, and the prevalence of asthma in COVID-19 was 3.2%. Compared with Korea nationwide survey data, there were no differences in asthma prevalence. In the univariate analysis, the risk of death (13.6% vs 6.4%, P = 0.021) and high flow oxygen therapy (18.2% vs 10.5%, P = 0,048) was increased in asthma patients, with a stronger tendency among elderly, women, and overweight patients. However, in a multivariate analysis using the logistic regression model, any clinical outcomes according to asthma was not significant. The risk factors for delayed viral clearance were older age >65 years (Odds ratio [95% confidence interval] 2.002 [1.292–3101]), dementia (3.123 [1.833–5.321]), skin rash (15.943 [1.613–157.535]), and anemia (2.156 [1.061–2.377]), whereas headache (0.673 [0.485–0.932]) lowered the risk. CONCLUSIONS: There may be a difference depending on phenotypes, but asthma prevalence was not significantly different in patients with COVID-19, and asthma did not affect outcomes of COVID-19. Older age, dementia, headache, skin rash, and anemia were independently associated with delayed viral clearance.
Right superior vena cava draining into the left atrium in a patient with sinus venosu...
Meletios Kanakis
Thomas Martens

Meletios Kanakis

and 6 more

July 31, 2020
Right superior vena cava draining in the left atrium is a rare anomaly, commonly associated with other cardiac defects. Herein we present the case of a 9 year old patient, asymptomatic but with right heart dilation with sinus venous defect, bilateral superior vena cavas with the right draining into the left atrium.
Identification of the metabolites of ivermectin in humans
Phornpimon Tipthara
Kevin Kobylinski

Phornpimon Tipthara

and 9 more

July 31, 2020
BACKGROUND AND PURPOSE Mass drug administration of ivermectin has been proposed as a possible malaria elimination tool. Ivermectin exhibits a mosquito-lethal effect well beyond its biological half-life, suggesting the presence of active slowly eliminated metabolites. EXPERIMENTAL APPROACH Human liver microsomes, primary human hepatocytes, and whole blood from healthy volunteers given oral ivermectin were used to identify ivermectin metabolites by ultra-high performance liquid chromatography coupled with high resolution mass spectrometry. The molecular structures of metabolites were determined by mass spectrometry and verified by nuclear magnetic resonance. Pure cytochrome P450 enzyme isoforms were used to elucidate the metabolic pathways. KEY RESULTS Thirteen different metabolites (M1-M13) were identified after incubation of ivermectin with human liver microsomes. Three (M1, M3, and M6) were the dominant metabolites found in microsomes, hepatocytes, and blood from volunteers after oral ivermectin administration. The chemical structure defined by LC-MS/MS and NMR indicated that M1 is 3″-O-demethyl ivermectin, M3 is 4-hydroxymethyl ivermectin, and M6 is 3″-O-demethyl, 4-hydroxymethyl ivermectin. Metabolic pathway evaluations with characterized cytochrome P450 enzymes showed that M1 was produced by CYP3A4 and CYP3A5, and that M3 and M6 were produced by CYP3A4. CONCLUSIONS AND IMPLICATIONS Demethylated and hydroxylated ivermectin are the main human metabolites in vivo. Further study to characterize their pharmacokinetic properties and mosquito-lethal activity is now needed.
Theoretical Studies on How to Tune the π-hole Pnicogen Bonds by Substitution and Coop...
Lijuan Zhang
Dazhi Li

Lijuan Zhang

and 1 more

July 31, 2020
A systemic investigation of the substitution and cooperative effects on the P…N π-hole pnicogen bond were performed via theoretical calculations. The structural and energetic properties of the binary complexes between a series of substituted benzonitrile and PO2F have been examined to study the substitution effect. The stability of the binary complexes increases in the order of CN
Properties and Molecular docking of Antiviral to COVID-19 Chloroquine combining DFT c...
Silvia Brandan
Elida Romano

Silvia Brandan

and 3 more

July 31, 2020
Structural, electronic, topological, vibrational and molecular docking studies have been performed for both enantiomeric S(-) and R(+) forms of potential antiviral to COVID-19 chloroquine (CQ) combining DFT calculations with SQMFF methodology. Hybrid B3LYP/6-311++G** calculations in gas phase and aqueous solution predict few energy differences between both forms. Solvation energies of S(-) and R(+) form are predicted in -55.07 and 59.91 kJ/mol, respectively. Low solvation energies of both forms are justified by the presence of only four donor and acceptor H bonds groups, as compared with other antiviral agents. MK charges on the Cl1, N2, N3 and N4 atoms and AIM calculations could support the high stability of R(+) form in solution according to the higher reactivity predicted for the S(-) form in this medium. Antiviral to COVID-19 niclosamide shows higher reactivity than both forms of CQ. Complete vibrational assignments of 153 vibration modes for both forms and scaled force constants have been reported here. Reasonable concordances were found between predicted and available 1H-NMR, 13C-NMR and UV-Vis spectra. Additionally, NMR and UV-visible spectra suggest the presence of two forms of CQ in solution. A molecular docking study was performed to identify the potency of inhibition of Chloroquine molecule against COVID-19 virus
International barriers and facilitators for cervical cancer screening among young peo...
Abirami Kirubarajan
Shannon Leung

Abirami Kirubarajan

and 4 more

March 11, 2021
Background Though cervical cancer is one of the leading causes of death globally, its incidence is nearly entirely preventable. Young people have been an international priority for screening. However, in both high-income and low-income countries, young people have not been screened appropriately according to country-specific guidelines and in many countries, screening rates for this age-group have even dropped. Objectives The aim of this systematic review was to systematically characterize the existing literature on barriers and facilitators for cervical cancer screening among young people globally. Search Strategy We conducted a systematic review following PRISMA guidelines of four databases: Medline-OVID, EMBASE, CINAHL, and ClinicalTrials.Gov. Selection Criteria We only examined original, peer-reviewed literature. Databases were examined from inception until the date of our literature searches (12/03/2020). Articles were excluded if they did not specifically discuss cervical cancer screening, were not specific to young people, or did not report outcomes or evaluation. Data Collection and Analysis All screening and extraction was completed in duplicate with two independent reviewers. Main Results Of the 2177 original database citations, we included 36 studies that met inclusion criteria. Our systematic review found that there are three large categories of barriers for young people: lack of knowledge/awareness, negative perceptions of the test, and practical barriers to testing. Facilitators included stronger relationships with healthcare providers, social norms, support from family, and self-efficacy. Conclusions Health systems worldwide should address the barriers and facilitators to increase cervical cancer screening rates in young people. Further research is required to understand this age group.
Pregnancy with submucous myoma
Ying Peng

Ying Peng

July 31, 2020
Hysteromyoma is a common benign tumor in females. While pregnancy with submucous hysteromyoma is rare in the clinical setting, it often results in abdominal pain, red degeneration, abortion, placental abruption, premature rupture of membranes, premature delivery, fetal malformation, postpartum hemorrhage, and endometritis because of the tumor location, which in turn increases the incidence of cesarean section and hysterectomy. Submucosal myomectomy is not recommended during pregnancy because of the risk of miscarriage, bleeding, and premature delivery. Moreover, whether submucous myoma should be removed during cesarean section remains controversial. Thus, this study aims to review the diagnosis and treatment of pregnancy with submucous myoma.
Comparative efficacy of respiratory personal protective equipment against viral respi...
Xinbo Yin

Xinbo Yin

July 31, 2020
Background: With the epidemic of COVID-19, the health care workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases. However, there is little published evidence comparing their efficacy. Therefore, we conducted a network meta-analysis (NMA) to compare the efficacy of rPPEs and the wearing manner preventing from the viral respiratory infectious diseases (VRID). Methods: This NMA protocol was registered in PROSPERO (CRD42020179489). PubMed, the Cochrane Library, Web of Science, and EMBASE were searched by computer to collect cluster randomized control trials of comparing the effectiveness of rPPEs and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection. The secondary outcome was the incidence of CRI. The Bayesian NMA was conducted to use the control group as the comparison group. Incidence of the VRID and CRI were reported as network odds ratio (network OR) and 95% credibility interval (CrI). Results: Six studies encompassed 11,828 HCWs and seven interventions were included. In terms of the incidence of laboratory-confirmed viral respiratory infection, the continuous wearing of N95 respirator (network OR, 0.48; 95% CrI 0.27 to 0.86; SUCRA score, 85.4) showed more effective than the control group. In terms of the incidence of CRI, there are no interventions that showed more effective than the control group. Conclusion: There are significant differences in preventive efficacy among current rPPEs. Our result suggests that continuous wearing of N95 respirator can serve as the best preventive rPPE for HCWs from the VRID.
Oncofertility treatment of adult granulosa cell tumor in adolescent with risk of thro...
Dražan Butorac
Ana-Meyra Potkonjak

Dražan Butorac

and 4 more

July 31, 2020
Adult granulosa cell tumor is predominant form of granulosa cell tumor, typically diagnosed after the age of 40 years. We report a case of a 16-year-old girl with an AGCT who presented with raised testosterone levels. After fertility sparing surgery, patient was commenced on combined oral contraceptives (COCs) due to the menstrual cycle irregularities. Subsequently, patient’s father developed pulmonary embolism caused by venous thromboembolism. Hematologic evaluation in our patient, revealed decreased protein S levels. Nevertheless, COCs were continued for up to the six months. Since menstrual cycles irregularities reoccurred, we are starting with progesterone-only oral contraceptives at present time.
Differentiating characteristics of asthmatic patients in the SARS-CoV2 infection
Jose Lemus Calderon
Pedro Beneyto Martin

Jose Lemus Calderon

and 5 more

July 31, 2020
INTRODUCTION: The SARS-CoV-2 coronavirus pandemic has caused more than fifteen million infections worldwide. Our aim is to investigate the differentiating characteristics in asthmatic patients with SARS-CoV-2 infection in the community of Castilla la Mancha. METHODS: We used the Savana® software and its algorithm based on Big Data and artificial intelligence, performed a retrospective search of the diagnoses of COVID 19 and asthma in the digitized medical records with positive RT-PCR results for SARS-CoV-2, and analysed the demographic characteristics, comorbidities, hospitalization data and deaths. RESULTS: 6,310 patients with positive RT-PCR for SARS-CoV-2 were selected, of which 577 had a diagnosis of asthma with a prevalence of 9.14%. The mean age in SARS-CoV-2 (SC2) was 59 ±19 years of age and in SARS-CoV2-asthma (SC2-A) 55 ±20 years of age. SC2 included 2983 (41%) men and 3327 (59%) women, while SC2-A included 198 (31%) men and 379 (69%) women. High blood pressure (BP) was the most common comorbidity in both groups (51%). 2,164 SC2 (34.2%) and 131 SC2-A (22.7%) required hospitalization with an asthma prevalence of 6.05%. 250 SC2 (3.96%) and 21 SC2-A (3.64%) died. CONCLUSION: The prevalence of asthma in our SARS-CoV-2 positive RT-PCR population was 9.14% and 6.05% in hospitalized patients. HBP is the most frequent comorbidity in both groups, and smoking is the only one with significant differences, more frequent in asthmatics. Mortality is lower in patients with asthma
The complexity of drug hypersensitivity reactions
María José Torres

María José Torres

July 31, 2020
Drug hypersensitivity reactions (DHRs) represent a global threat to healthcare systems due to their incidence, with a significant increase over last years1. DHR figures are overestimated in the general population since less than 40% of cases initially labelled as allergic can be confirmed as such when evaluated in an allergy unit2. Achieving an accurate diagnosis is complex and time consuming; besides, tests must be tailored to specific clinical manifestations and underlying mechanisms and will depend on the culprit drugs. Diagnosis often requires performing drug provocation tests (DPTs), which are especially problematic for severe reactions, making management of these patients challenging and expensive for the health care system.Clinically, DHRs are classified into immediate and non-immediate, based on the time interval between drug exposure and onset of the symptoms3. The most severe immediate reaction is anaphylaxis. This issue of the journal has been dedicated o drug hypersensitivity, which is becoming a major public health issue during the last decade, especially with the introduction of biologicals to medicine. Bilo et al. 4 evaluated the anaphylaxis mortality rate in Italy from 2004 to 2016 and found an average mortality rate for definite anaphylaxis (ICD-10 code) of 0.51 per million population per year, mostly due to the use of medications (73.7%), although in 98% of the cases culprit drugs were not identified. Regarding non-immediate reactions, one of the most challenging diagnoses is drug reaction with eosinophilia and systemic symptoms (DRESS), which is sometimes difficult, at an early stage, due to overlapping clinical symptoms with maculopapular exanthema (MPE). Pedruzzi et al. 5 identified 7 microRNAs (miRNAs) that correctly classified DRESS or MPE patients and were associated with keratinocyte differentiation/skin inflammation, type I IFN pathway viral replication, ATP-binding cassette transporters, and T lymphocyte polarisation, being all of them potential biomarkers. Non-immunologically mediated adverse reactions, such as attention-deficit/hyperactivity disorder (ADHD) are reported by Fuhrmannet al. 6 in association with systemic H1-antihistamines administration in school-age children, especially the 1st generation agents.The mechanism underlying DHR and the reason why patients treated with the same drug develop a tolerance response or an immediate or non-immediate DHR is not completely understood (Figure 1). Therefore, the prediction of who may experience a DHR, and if so, in what form, remains clinically obscure for most drugs. Goh SJR et al. 7 elegantly analyse this complexity, using non-immediate reactions to penicillins as a model. They focus on the understanding of the role of nature of the lesional T cells, the characterisation of drug-responsive T cells isolated from patient blood, and the potential mechanisms by which penicillins enter the antigen-processing and presentation pathway to stimulate these deleterious responses.Regarding specific drugs involved in allergy, betalactam antibiotics (BL) are the most frequent culprit, being many reactions mediated by IgE. This type of reaction varies among patients, with some reacting only to one BL and others to several of them; it tends to change over time and differs between European countries, depending on BL consumption. Nowadays, amoxicillin (AX), alone or in combination with the β-lactamase inhibitor clavulanic acid (CLV), is the most often prescribed BL worldwide (Figure 2) and the most common elicitor of reactions in both children and adults. It is unclear why patients after the administration of AX-CLV develop selective hypersensitivity to AX, while tolerating CLV and vice-versa. Ariza et al. 8 generated drug-specific T-cell clones from AX- or CLV-selective immediate hypersensitivity patients and found that both AX- and CLV-specific clones were generated irrespective of whether AX or CLV was the culprit, although a higher secretion of Th2 cytokines (IL-13 and IL-5) was detected when clones were activated with the culprit BL compared with clones stimulated with the tolerated BL, in which higher secretion of Th1 cytokines (IFN-γ) was observed. Regarding selective non-immediate reactions to CLV, Copaescu A et al. 9 report on a cohort of patients with a history of non-immediate reaction to CLV, who demonstrated a delayed intradermal skin test response to CLV, 17% were allergic to both CLV and ampicillin, and 83% were selective reactors with good tolerance to AX. IFN-γ release enzyme-linked immunospot (ELISpot) was performed giving a sensitivity of 33%. Other drugs such as sulphonamides, either antibiotic or non-antibiotics are important triggers of non-immediate DHRs. Vilchez-Sanchez et al. 10 showed that lymphocyte transformation tests (LTT) can help avoid the performance of DPT with a sensitivity of 75%, a specificity of 100%, and negative and positive predictive values of 72.7% and 100%, respectively.There has been a great expansion in the use of biological agents (mainly monoclonal antibodies (mAbs)), and they have greatly improved the treatment landscape of hemato-oncologic, autoimmune, inflammatory and rheumatologic diseases. In parallel, the incidence rate of reported DHRs associated with these products has increased considerably within the last years, ranging from mild to life-threatening. Yang BC et al. 11 recommend risk stratification as the first step for managing patients with DHRs to these drugs. In cases with negative skin test and mild reactions, DPT is an option, and in moderate or severe reactions, desensitisation becomes the preferred approach. In cases with positive skin test, desensitisation is the recommended course of action, especially when there is no alternative medication. Desensitisation is also widely used in the management of immediate hypersensitivity reactions to chemotherapy agents, such as platinums. There is suspicion about the presence of a longer memory of tolerance in subsequent desensitisation protocols partially resembling the regulatory tolerance mechanisms induced by allergen immunotherapy. Tüzer et al. 12 demonstrate the possible role of IL-10 in desensitisation with platinums, as they found a dynamic change in serum IL-10 levels observed as an increase during desensitisation and a decrease in between the protocols.Finally, a wide spectrum of drugs has been considered for treatment of coronavirus disease 2019 (COVID-19) and all of them can potentially induce DHRs. Gelincik A et al .13 reviewed DHRs in COVID-19 times to these drugs, with knowledge mainly coming from previous clinical experience in patients not infected with COVID-19. As in other viral infections, skin symptoms, including exanthemas, may appear during the evolution of the disease, leading to differential diagnosis with DHRs. Whether COVID-19 can aggravate T–cell mediated DHRs reactions as some viruses is at present unknown.We can conclude that new drugs are continuously introduced into the markets and confirmed as inducers of hypersensitivity reactions. We still do not completely understand the mechanisms underlying many of these reactions and further studies for improving diagnostic and management are needed even in classic and well-studied drugs as BLs.Abbreviations: AX: Amoxicillin; CLV: Clavulanic acid; COVID-19: Coronavirus disease 2019; DHR: Drug hypersensitivity reactions; DPT: Drug provocation tests; DRESS: Drug reaction with eosinophilia and systemic symptoms; ELISpot: enzyme-linked immunospot; LTT: Lymphocyte transformation tests; MPE: Maculopapular exanthema.
Incubation period of COVID-19: a meta-analysis
Christelle Elias
Abel Sekri

Christelle Elias

and 4 more

July 31, 2020
A valid measurement of the SARS-CoV-2 incubation period is needed for case definitions and for adapting appropriate isolation measures but is challenging in an emergency context. The objective was to systematically review recent literature of reported estimates of the distribution of incubation period of SARS-CoV-2 for describing the distribution and its variability and dispersion through meta-analysis. A systematic review search was carried out up to July 1st 2020 of all identified references available reporting the SARS-CoV-2 incubation. Individual mean and standard deviation were used to produce the pooled estimate. Heterogeneity was also assessed using I2 statistics and sources of heterogeneity were explored using a meta-regression. The main outcome was the SARS-CoV-2 incubation period defined as the time from exposure to onset of clinical illness. In total, 43 studies were eligible, including 12 (27.9%) cohorts and 31 (72.1%) case reports and series. The pooled estimate of the mean incubation period across the studies was 6.24 days, 95% CI [5.80;6.69] ranging from 2.33 to 17.60 days. Shorter incubation periods were reported in cohorts compared to case series (p<0.01) and among studies with high proportions of males (p<0.05). The mean incubation period will help for identification times of exposure but determinants of its variations/range might be explored for potential links with clinical outcome or early pathogenic steps. The impact of individuals with extreme values of incubation on the outbreak dynamic should be evaluated taking account for the basic reproductive number. A real time of meta-analysis, called the InCoVid Lyon, is proposed.
Children with cancer during COVID-19 pandemic. Early experience in Mexico.
Javier López-Aguilar
Rocío Cárdenas-Navarrete

Javier López-Aguilar

and 8 more

July 31, 2020
Reports of children with cancer and COVID-19 from U.S.A and Europe had informed most patients presented with mild disease. Experience from upper and lower middle-income countries is needed to corroborate these findings. This report describes the experience with cancer patients in a tertiary care level hospital, in Mexico City. Of 24 symptomatic patients, 14 had a positive RT-PCR test. Eight required low-flow supplemental oxygen. None required critical care. One patient died due to pulmonary hemorrhage. Even though the infection seems to have an uncomplicated clinical course, it is necessary to ensure that all seeking medical attention do so safely.
Fractal pull-in instability for a micro-electromechanical device with a current-carry...
Dan Tian
Qura-Tul  Ain

Dan Tian

and 2 more

July 31, 2020
Pull-in effect always occurs in a micro-electromechanical system, and its pull-in analysis is essential for the normal operation. This paper aims at studying the environment effect on the pull-in instability, especially the nano/micro particles in air. A fractal model is established using a fractal derivative, and the pull-in instability can be converted into a novel state of pull-in stability when the fractal dimension tends to be very small.
An iterative method for optimal control of bilateral free boundaries problem
Youness EL YAZIDI
Abdellatif ELLABIB

Youness EL YAZIDI

and 1 more

July 31, 2020
The aim of this paper is to construct a numerical scheme for solving a class of bilateral free boundaries problem. First, using a shape functional and some regularization terms, an optimal control problem is formulated, in addition, we prove its solution existence's. The first optimality conditions and the shape gradient are computed. the proposed numerical scheme is a genetic algorithm guided conjugate gradient combined with the finite element method, at each mesh regeneration, we perform a mesh refinement in order to avoid any domain singularities. Some numerical examples are shown to demonstrate the validity of the theoretical results, and to prove the robustness of the proposed scheme.
Gender specific decline in perioperative allergic reactions after withdrawal of pholc...
Lars Malvik
Gerrit De Pater

Lars Malvik

and 3 more

July 31, 2020
Background: There is a known female predominance in immunological conditions. Gender differences have also been demonstrated in perioperative hypersensitivity. The aim of this study was to investigate gender differences in the incidence of perioperative allergic reactions in Norway from 1997 to 2017. Methods: Spontaneous reports on allergic reactions during anesthesia were collected, and information about demographic, clinical and laboratory findings were recorded. Results: Women account for 66% of reported cases, and gender difference was most pronounced in fertile women (ages 14 to 51), where 74% of reports were from women. After withdrawal of the only pholcodine containing cough syrup on the market in 2007, the female predominance fell from 72 to 60% in all age groups. We found no differences in severity of the reaction or in laboratory findings between men and women. Conclusions: Women are at increased risk of suffering perioperative hypersensitivity reactions. The gender difference was less pronounced after the withdrawal of pholcodine.
COMPARISON BETWEEN EQUINE AND RABBIT ANTI-THYMOCYTE GLOBULIN (ATG) USED IN CONDITIONI...
Sunil Bhat
Ruchi Chaudhary

Sunil Bhat

and 4 more

July 31, 2020
Background: HSCT related complications and disease relapse are major obstacles in successful transplantation. Addition of ATG has shown to reduce rejection and Graft Vs Host Disease (GVHD) incidence significantly. Procedure: Here we report single center retrospective analysis for relative efficacy of rabbit and equine ATG during conditioning of pediatric patients who underwent HSCT. Results: Rabbit or Equine ATG were used as a part of conditioning regimen in 117 pediatric patients. Equine ATG group was labeled as group-1 and rabbit ATG as group-2. Both groups were analyzed for transplant related complications and outcome. In thalassemia, outcomes were comparable except Group-1 had more cases of proven bacterial infection (p=0.07) and veno-occlusive disease (p=0.03). In SAA, Group-1 had early neutrophil and platelet engraftment with less number of proven bacterial infections. Acute GVHD, chronic GVHD, median chimerism at day+30 and day+90 and overall survival (OS) was comparable in two groups, both in thalassemia and SAA patients. Analysis of 7 hematological malignancy cases and 10 immunodeficiency disorders also showed similar results. Conclusion: In conclusion, effectiveness of rabbit and horse ATG were similar in thalassemia, primary immunodeficiency patients and hematological malignancy while in SAA equine ATG use was associated with early neutrophil engraftment but OS in both groups were comparable.
Almost sharp global well-posedness for the defocusing Hartree equation with radial da...
Xingjian Mu
Xingdong Tang

Xingjian Mu

and 3 more

July 31, 2020
We show global well-posedness and scattering for the defocusing, energy-subcritical Hartree equation \begin{equation*} iu_t + \Delta u =F(u), (t,x)\in\mathbb{R}\times\mathbb{R}^5 \end{equation*} where $F(u)= \big( V* |u|^2 \big) u$, $V(x)=|x|^{-\gamma}$, $3< \gamma< 4$, and initial data $u_0(x)$ is radial in almost sharp Sobolev space $ H^{s}\left(\R^5\right)$ for $s>s_c=\gamma/2-1$. Main difficulty is the lack of the conservation law. The main stategy is to use I-method together with the radial Sobolev inequality, the interaction Morawetz estimate, long-time Strichartz estimate and local smoothing effect to control the energy transfer of the solution and obtain the increment estimate of the modified energy $E(Iu)(t)$.
New Class of Spherical Pearson Type Family Distributions to Model Asymmetric Spherica...
Mousa Golalizadeh

Mousa Golalizadeh

July 31, 2020
The Pearson type family densities are among the most important classes of distributions that play a key role in the directional statistics. Their particular structures make them suitable candidates to analysis data on non-Euclidean space, such as sphere. To model data scattered asymmetrically on such spaces, the researchers confined themselves to extend particular distributions from the class of the Pearson type family densities. Those specific distributions are symmetric in nature but their extended versions are usually heavy tailed. In this paper, we introduce some alternative probability density functions in the class of Pearson type distributions on the sphere having the spherical Student’s $t$, Fisher and Chi-square densities as the subfamilies. Via investigating various theoretical properties of this new subclass, we show that it is inheritably asymmetric. To further evaluating this subclass, some simulation studies are conducted. Also, modeling of two real-life data using the proposed densities and then comparing their fitting consequences with those resulted from invoking other common spherical distributions are considered.
The numerical solution of fractional Korteweg-de Vries and Burgers' equations via Haa...
Laique Zada
Imran Aziz

Laique Zada

and 1 more

July 31, 2020
In this article, Haar wavelet collocation technique is adapted to acquire the approximate solution of fractional KdV, Burgers' and KdV-Burgers' equations. The fractional order derivatives involved are described using the Caputo definition. In the proposed technique, the given nonlinear fractional differential equation is discretized with the help of Haar wavelet and reduced to the nonlinear system of equations, which are solved with Newton's or Broyden's method. The proposed method is semi-analytic as it involves exact integration of Caputo derivative. The proposed technique is widely applicable and robust. The technique is tested upon many test problems. The results are computed and presented in the form of maximum absolute errors which shows the accuracy, efficiency and simple applicability of the proposed method.
Role of specific IgE on staphylococcal enterotoxin B in chronic rhinosinusitis severi...
Suk Won Chang
Jeong Jin Park

Suk Won Chang

and 8 more

July 31, 2020
Objective: To investigate the clinical significance of specific IgE-staphylococcal enterotoxin in CRS. Design: Retrospective analysis of patients who were positive for specific IgE-staphylococcal enterotoxin B. Setting: Tertiary rhinology clinic. Participants: A total of 965 patients who were positive for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017 Main outcome measures: We retrospectively reviewed the records of 965 patients who were positive for specific IgE-staphylococcal enterotoxin B from December 2016 to December 2017. Patient demographics, titre specific IgE to staphylococcal enterotoxin B (IgE-SEB) levels, MAST, serologic test, and medical records were reviewed. Results: IgE-SEB (KU/L) was higher in CRS patients than Non-CRS patients (0.13±0.37 vs 0.08±0.22, respectively; p-value: 0.044), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 4.46%, respectively; p-value: 0.030). IgE-SEB (KU/L) was higher in the CRS group than in the fungal sinusitis group (0.13±0.37 vs 0.03±0.05, respectively; p-value: <0.001), and the IgE-SEB (+, ≥0.35) rate was also higher (10.06% vs 0 %, respectively; p-value: 0.015). Between the CRSsNP (chronic rhinosinusitis without nasal polyps) and CRSwNP (chronic rhinosinusitis with nasal polyps) groups, there were no differences in IgE-SEB (KU/L) or IgE-SEB (+) rates. As the values of IgE-SEB(KU/L) and the IgE-SEB (+,>0.1) rate increased, the CRS severity also increased. Conclusions: IgE-SEB showed a positive correlation with CRS severity but not with postoperative recurrence or nasal polyps. Further studies are needed to obtain clear evidence that IgE-SEB can be considered as an independent CRS endotype.
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