Erosion negatively affects crop yields and decreases crop productivity. It removes nutrients, reduces rooting depth, and damages soil structure, resulting in negative nutrient balances and lower crop yields. A study for two years was conducted using three soil erosion control methods to appraise the method which could effectively control erosion and improve bean production characteristics on a hill more prone to erosion. Designed on three different plots ( P1, P2, P3) divided in four sub plots (S1, S2, S3, S4), these methods were traditional plowing method (M1); anti-erosive hedges planting method (M2) and anti-erosive hedges coupled with anti-erosive ditches (M3). The recorded parameters were the number of: pods, full pods and grains, as well as the average yield weight. After analysis with SPSS and Advanced excel, results showed no significant difference between M1 and M2 but highlighted the significant effects of M3 method in improving the number of: pods, full pods and grains. Likewise, this method has somehow enhanced the average yield weight. These outcomes suggest M3 as the most effective method in enhancing bean production characteristics and yield at Buhoro hill.

A document by Kholoud Agag. Click on the document to view its contents.

Objective: This study aimed to compared general anesthesia and combined spinal and epidural anesthesia (CSEA) for gasless laparoscopic surgery in gynecologic field. Study design: We matched patients with type of surgery who underwent gasless single port access (SPA) laparoscopic surgery under general anesthesia (GA) and CSEA. The medical records of 90 patients between March 2018 and June 2020 were reviewed. Gasless laparoscopic surgery was performed in all patients with a single-port access (SPA) using a J-shaped retractor Results: No significant differences were observed for age, body mass index, parity, and previous abdominal surgery between GA and CSEA group . During operation under CSEA, six patients (20%) experienced nausea/vomiting. Hypotension (systolic blood pressure < 90 mmHg) was observed in five patients (16.7 %). Intravenous analgesics was administrated in four of the patients (13.3 %) who suffered from shoulder pain or abdominal discomfort. One patient developed bradycardia. The duration of hospital admission was shorter in the CSEA group than in the GA group (p value = 0.014). There was no difference between the groups in terms of surgery type, surgical specific finding, operation time, estimated blood loss, laparotomy conversion rate and use of additional trocar. No major complications such as urologic, bowel, or vessel injuries were found in both groups. Conclusions: CSEA is a safe and feasible technique for application in non-obese patients undergoing gasless laparoscopic surgery in gynecologic field.

There is growing evidence that climatic factors could influence the evolution of the current COVID-19 pandemic. Here, we build on this evidence base, focusing on the southern hemisphere summer and autumn period. The relationship between climatic factors and COVID-19 cases in New South Wales, Australia was investigated during both the exponential and declining phases of the epidemic in 2020, and in different regions. Increased relative humidity was associated with decreased cases in both epidemic phases, and a consistent negative relationship was found between relative humidity and cases. Overall, a decrease in relative humidity of 1% was associated with an increase in cases of 7-8%. Overall, we found no relationship with between cases and temperature, rainfall or wind speed. Information generated in this study confirms humidity as a driver of SARS-CoV-2 transmission.

Background In the current COVID-19 climate, a face to face (F2F) ear nose and throat examination is not possible. ENTs are among the highest risk specialties for the infection. The majority of physicians involved in medicolegal examinations lie in the vulnerable status. Some claimants may need early access to funds in the current situation. Methodology is provided to invoke the available epidemiological data to inform insurance payment decisions. Methods Predictions of ISO (2013) for noise‐induced threshold shifts can be used in calculating the noise‐induced threshold shifts. The 90 percentile figures are used. Methodology for Australia is detailed. Other jurisdictions can modify the methodology as appropriate. Results The possibility of a mathematical model is highlighted Conclusion Given a worker’s occupational noise exposure history, the methodology can estimate the expected contributions of noise and can replace the audio-clinical examination entirely. Keywords: noise-induced hearing loss (NIHL); COVID-19

Anti-tumor necrosis factor (TNF) agents have revolutionized the treatment of several immune-mediated inflammatory diseases, including Crohn’s disease and ulcerative colitis. Although greatly effective, theses biologics put the patients at increased risk for developing serious and opportunistic infections and some types of cancer as lymphomas, the latter one especially when on combination of anti-TNF and thiopurines. Here we report a male who developed an atypical presentation of a severe opportunistic infection when using anti-TNF agent for Crohn’s disease treatment.

Key points 1- We report otitis media in eight patients with coronavirus disease-2019 (COVID-19) and no background history of otologic problems. 2- Otitis media was the first manifestation of COVID-19 in the majority of patients in this case series. 3- Effusion in the middle ear was present in six patients, three patients had typical signs of acute otitis media, with one patient having tympanic membrane perforation. 4- Hearing loss was present in majority of patients, with conductive and mild sensory-neural loss at high frequency as the underlying mechanisms. 5- Our findings suggest that otitis media should be considered a possible manifestation of COVID-19 during the current pandemic.

Stem cell-derived extracellular vesicles (EVs) have shown great promise in the field of regenerative medicine and tissue engineering. Recently, human bone marrow-derived mesenchymal stem cell (BMSC)-derived EVs have been considered for bone tissue engineering applications. In this study, we evaluated the osteogenic capability of placental stem cell (PSC)-derived EVs and compared them to the well-characterized BMSC-derived EVs. EVs were extracted from three designated time points (0, 7, and 21 days) after osteogenic differentiation. The results showed that the PSC-derived EVs had much higher protein and lipid concentrations than EVs derived from BMSCs. The extracted EVs were characterized by observing their morphology and size distribution before utilizing next-generation sequencing to determine their miRNA profiles. It was identified that 306 miRNAs within the EVs, of which 64 were significantly expressed in PSC-derived EVs that related to osteogenic differentiation. In vitro osteogenic differentiation study indicated that the late-stage (21-day extracted) derived EVs higher osteogenic enhancing capability when compared to the early-stage derived EVs. We demonstrated that EVs derived from PSCs could be a new source of EVs for bone tissue engineering applications.

Background Same-day cancellation of cardiac surgeries is a disheartening experience for patients. The primary aims of this study were to determine the frequency and reasons for same-day cancellations, and associated patients’ outcomes. The secondary aims were to evaluate patients’ reactions to cancellations and to propose measures to reduce cancellations. Methods We prospectively reviewed all elective and urgent in-patient adult cardiac surgeries performed from August 2017 to March 2018. Procedures were divided into cancelled (C) and not cancelled (NC) groups. A qualitative patient satisfaction survey was undertaken. Results Overall, 1388 patients were scheduled for cardiac surgery during this period. Elective surgeries constituted 70.7% (981/1388) and urgent 29.3% (407/1388). 231/1388 (16.7%) procedures were cancelled for the following reasons: 30.5% lack of ITU beds, 20.1% patient medically unfit, 8.2% ITU staff shortage, 6.9% emergency case intervention and 34.2% other. There was no significant difference in mortality between groups (2.6% in C vs 1.6% in NC, p=0.62). In group C, 36% (84/231) of patients underwent surgery within 72 hours of cancellation, 47% (110/231) of procedures were rescheduled, and 6.9% (16/231) were not performed. 30.7% (71/231) were potentially preventable. All cancelled patients were asked to complete the survey; 43.7% (101/231) responded, with 22.8% (23/101) describing feeling upset. However, 92.1% (93/101) felt the cancellation was justified. Conclusion This single institutional study suggests a relatively high number of planned same-day surgeries are being cancelled. A third of these may be preventable. Despite this, patients were understanding. Actions to decrease cancellations should be identified to improve efficiency.

Objectives: Graft patency and completeness of revascularization were analyzed in patients who underwent off-pump minimally invasive coronary artery bypass grafting via left small thoracotomy. Methods: We retrospectively reviewed the invasive angiography findings and clinical data of 186 consecutive patients who underwent off-pump minimally invasive coronary artery bypass grafting via left small thoracotomy. The left internal thoracic artery and saphenous vein were used to bypass two or more of three coronary artery systems: the left anterior descending artery, left circumflex artery, or right coronary artery. Before hospital discharge, invasive angiography was performed to assess graft patency and completeness of revascularization. Clinical variables during hospitalization and follow-up were collected and analyzed. Results: All 186 patients successfully underwent off-pump minimally invasive coronary artery bypass grafting without conversion to sternotomy or assistance of cardiopulmonary bypass. The mean graft number was 2.81 per patient (range, 2–5), and the total number of grafts was 522. The in-hospital mortality rate was 1.6% (3/186). A total of 181 of 186 (97.3%) patients underwent postoperative invasive angiography. Among the 510 grafts assessed by angiography, the total graft patency rate was 96.3% (491/510) [98.3% (171/174) for left internal thoracic artery grafts and 95.2% (318/334) for saphenous vein grafts]. The rate of complete revascularization was 98.8% (510/516) of the total grafts in 180 of 186 (96.8%) patients. Conclusions: Minimally invasive coronary artery bypass grafting using left internal thoracic artery and saphenous vein grafts provides acceptable graft patency and completeness of revascularization for patients with multivessel disease.

Aortic arch and hemiarch surgery necessitate the temporary interruption of blood perfusion to the brain. Despite its complexity, hemiarch and ascending aortic surgery can be performed via a minimally invasive approach. Due to the higher risk of neurological injury during circulatory arrest, several techniques were developed to further protect the brain during this surgery. We searched the Embase, Medline, and Cochrane databases and identified articles reporting outcomes of antegrade and retrograde cerebral perfusion strategies. Herein, we outline surgical approaches, intra-operative technical considerations, and clinical outcomes of hemiarch and ascending aortic surgery.

A document by Pio Stellato. Click on the document to view its contents.

Background: The objective of this study was to compare liberal and prophylactic transfusion, acute normovolemic hemodilution plus a restrictive on-demand regimen and ROTEM®-guided transfusion protocols to optimize use of blood products and in-hospital outcomes in adult cardiac surgery. Methods: Three cohorts of patients were retrospectively analyzed: 131 patients undergoing all types of cardiac surgery were assigned to liberal transfusion, 117 to normovolemic hemodilution, and 100 to ROTEM-guided transfusion. Eligibility for one or the other protocol was based on the anesthesiologists’ preferences. Results: Utilization of total packed red blood cells was significantly higher in the liberal transfusion protocol (2 units IQR 1-3), with respect to hemodilution and ROTEM® protocols (1 unit, IQR 0-3 and 1 unit, IQR 0-2, respectively) (p<0.001). Median utilization of fresh-frozen plasma was 2 (IQR 1-2), 0 (IQR 0-0), and 0 (IQR 0-0) units in the liberal, hemodilution, and ROTEM® groups (p<0.001), whereas median consumption of platelets was 6 (IQR 5-7), 0 (IQR 0-6), and 0 (IQR 0-0) units, respectively (p<0.001). Hematocrit and hemoglobin levels at discharge were similar in all groups. Reduction in use of blood products did not affect early surgical outcomes. Conclusions: Two combined protocols including restrictive on-demand transfusion associated with acute hemodilution or ROTEM®-guided transfusion decisions significantly decreased total blood product consumption in adult cardiac surgery compared with liberal transfusion. Considering the three approaches, the ROTEM®-guided transfusion protocol was associated with the lowest transfusion requirement for any blood product. This reduction in blood product utilization did not affect early surgical outcomes.

Introduction: Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate-type allergy to PEGs including anaphylaxis are reported with low but increasing frequency. Low awareness of the allergenic potential of PEGs among consumers, manufacturers and doctors leads to under-diagnosis and under-reporting of PEG allergy, putting patients at risk of repeated severe reactions. The aims of this study were to investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on daily life of patients. Method: Ten PEG allergic patients answered a questionnaire about clinical manifestations, causes and impact on daily life of a PEG allergy, scored on a likert scale (0-10) before and after diagnosis. Results: Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was caused by depot-steroids, antibiotic/analgesic tablets, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2-6). Median time from first reaction to diagnosis was 20 months (range 2-120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared to 4 after diagnosis. Conclusion: Daily life of PEG allergic patients is improved after diagnosis. Detailed information about the allergy, an allergy warning card, education in checking labels of new products, continued follow-up and advice from the Allergy Department were reported by patients to be important. Improved awareness about PEG allergy, clear product labelling and a standardized nomenclature is needed to improve care for these patients.

Dear Editor,We read the article on BCG vaccination policy and COVID-19 spread by Ozdemir et al. with interest and found it very thoughtful.1 Our few concerns are as follows.Firstly, the authors have classified the countries in two groups according to the presence or absence of recent routine childhood BCG vaccination policy. The countries having universal BCG coverage above 90% previously and stopped routine vaccination practice in the last one or two decades only (Czechia, Finland, France, Ireland, Norway, Slovakia, United Kingdom) were classified into the countries with “no BCG-vaccination policy”. On the contrary, some of the countries with routine BCG vaccination policy but poor coverage (Nigeria, Somalia, South Sudan) were included in the category of countries following “routine BCG-vaccination policy”. Do the authors mean to confer that the protection offered by BCG (by its non-specific effects on immunity) is sustained for one to two decades only post vaccination and the actual immunization coverage of a country does not play a role? In that scenario, BCG vaccination shall be protective for children only (the least-affected age-group with COVID-19), whereas the adults and geriatric population (most-affected) will not be benefitted by it against COVID-19. Such classification (according to recent BCG vaccination status) that completely ignores the previous vaccination status, actual BCG-vaccination coverage, and generalizes the results across all age-groups is scientifically wrong and leads to false conclusions. Therefore, an age-specific comparison of COVID-19 and BCG immunization coverage might be more meaningful.2Secondly, the authors did not adjust for any confounding factors like the number of tests done at that time, population demographics, co-morbidities, health infrastructure, reporting bias, etc. (though they mentioned it in limitations) that can significantly alter the results.3 A recent study observed positive correlation (opposite to what we think) between the COVID-19 related parameters (cases, death-rate, and case-fatality rate) and BCG vaccination coverage of various countries across the span of four decades. However, with adjustment of confounders, there was actually no correlation between COVID-19 and BCG coverage.4Thirdly, at the time of analysis (April 16, 2020) the pandemic was limited to the northern hemisphere which now has rapidly evolved. For now, four (India, Brazil, Russia, Peru) out of the five most affected countries have routine BCG vaccination policy with more than 90% coverage.5,6 Therefore, the analysis favouring BCG vaccination in the initial stages of pandemic was too early to predict and was affected by the limited spread of COVID-19. To test this hypothesis, we analyzed the correlation between BCG coverage (2010-2018) and COVID-19 related parameters (Cases per million, and deaths per million) of various countries at two different time-points (March 01, 2020, and June 29, 2020) using various datasets.5,6 We observed a weak but significant positive correlation (spearmen rho= +0.2-0.4, p< 0.05) between the BCG vaccination coverage and COVID-19 cases and deaths(as of March 01, 2020). However, this correlation was not seen on June 29, 2020 (Table 1).Based upon the above facts and observations, we conclude that as of now there is no correlation between recent BCG vaccination coverage of a country and COVID-19. As the protective efficacy may not last beyond childhood, we should not equate the childhood vaccination policy of a country with the recent vaccination being done in ongoing trials. Until we have the results of ongoing randomized clinical trials, routine use of BCG vaccine in COVID-19 management should be discouraged and restricted to research purpose only.

The prevalence, heterogeneity and severity of type 2 inflammatory diseases, including asthma and atopic dermatitis, continue to rise, especially in children and adolescents. Type 2 inflammation is mediated by both the innate and adaptive immune cells and sustained by a specific subset of cytokines, such as interleukin(IL)‐4, IL‐5,IL‐13, and IgE. IL-4 and IL-13 are considered signature type 2 cytokines, as they both have a pivotal role in many of the pathobiological changes featured in asthma and atopic dermatitis. Several biologics targeting IL-4, IL-5, and IL-13, as well as IgE, have been proposed to treat severe allergic disease in the pediatric population with promising results. A better definition of type 2 inflammatory pathways is essential to implement targeted therapeutic strategies.

The patient, a 32- year-old female, was admitted in our emergency department at 00:00 after a quarrel accompanied. Physical examination: pulse73times/min, blood pressure 130/70mmHg. The mind is clear, unwilling to speak, nasal lip ditch was normal,The heart boundary was found to be normal.the limbs is weak, can hold the examiner’s hands, Bilateral sense symmetry existed, both pathological signs were negative and meninges was negative. Electrocardiogram(ECG) and skull CT had no obvious abnormal. The patient appeared increasing consciousness disorder, vomited several times at 15:00, MRI: large cerebral infarction in the left basal ganglia region and left frontal temporal parietal lobe.Because of brain edema, increasing intracranial pressure, cerebral hernia,Then she was administered an operation of Left craniotomy. When the condition was stable , she returned to her hometown for surgery, pathology was confirmed as myxoma.

Cardiac imaging plays an important role in detection and differential diagnosis of cardiac masses. We report a 43-year-old male presented with palpitations. Clinical examination, ECG and chest x-ray were unremarkable. Trans-thoracic echocardiography showed a well-defined, large left ventricular mass at the anterolateral papillary muscle with multiple chordal insertion into the mass. Cardiac computed tomography showed heterogenous contrast enhancement. Cardiac magnetic resonance imaging showed high signal intensity, and early heterogeneous enhancement hyperintense on T2, with regional variations in vascularity, as well as late gadolinium enhancement. Post-surgical excision pathological examination confirmed cardiac hamartoma.

A patient was admitted to the hospital due to chest tightness and shortness of breath. B-ultrasound revealed a space-occupying lesion in the right atrium. After reviewing the patient's previous data, this space-occupying space was considered to be a normal atrial structure---terminal crest.

Objective To compare rates of vaginal delivery and adverse outcomes of instrumental delivery trials in obstetric theatre compared to primary emergency full dilatation Caesarean section Design Retrospective cohort study Setting University teaching hospital Population Women with singleton, non-anomalous, pregnancy undergoing instrumental delivery trial in obstetric theatre Methods Data was collected from consecutive cases during 2014 until 2018 using clinical records. Multivariate regression analysis was used comparing groups per first delivery attempt. Main Outcome Measures Primary outcome was completion of vaginal delivery between all methods of instrumental delivery. Secondary outcome was a composite of immediate perinatal adverse outcomes for instrumental delivery modes and primary full dilatation Caesarean section. Results From 971 deliveries analysed: ventouse delivery was significantly less likely to achieve vaginal delivery compared to Keilland’s forceps delivery (OR 0.42, 95%CI 0.22-0.79). Once confounding factors were adjusted for, adverse outcome rates were less frequent in the Keilland’s forceps group compared with primary full dilatation Caesarean section (OR 0.37, 95% CI: 0.16-0.81), however the receiver operating characteristic curve produced from this model demonstrated low predictive value (AUC 0.64). Conclusions Attempting instrumental delivery in delivery suite theatre, as an alternative to primary emergency full dilatation Caesarean section, is both reasonable and safe. Ventouse delivery in this situation may be associated with a higher chance of failure than other modes of instrumental delivery, thus making appropriate choice of delivery method of paramount importance according to each clinical situation. Funding None Keywords Caesarean section, Keilland’s forceps, ventouse, trial of instrumental delivery

Corals show spatial acclimatisation to local environment conditions. However, the various cellular mechanisms involved in local acclimatisation and variable bleaching patterns in corals remain to be thoroughly understood. In this study, the modulation of a protein implicated in cellular heat stress tolerance, the Heat shock protein 70, was compared at both gene (hsp70) and protein (Hsp70) expression level in bleaching tolerant near-coast Acropora muricata colonies and bleaching susceptible reef colonies, in the lagoon of Belle Mare (Mauritius). The relative Hsp70 levels varied significantly between colonies from the two different locations, colonies having different health conditions and the year of collection. Before the bleaching event of 2016, near-coast colonies had higher basal levels of both Hsp70 gene and protein compared to reef colonies. During the bleaching event, the near-coast colonies did not bleach and had significantly higher relative levels of both Hsp70 gene and protein compared to bleached reef colonies. No significant genetic differentiation between the two studied coral populations was observed and all the colonies analysed were associated with Symbiodiniaceae of the genus Symbiodinium (Clade A) irrespective of location and sampling period. These findings provide further evidence of the involvement of Hsp70 in conferring bleaching tolerance to corals. Moreover, the consistent expression differences of Hsp70 gene and protein between the near-coast and reef coral populations in a natural setting indicate that the modulation of this Hsp is involved in local acclimatisation of corals to their environments.

Biomolecules are increasingly attractive templates for the synthesis of functional nanomaterials. Chief among them are the plant Tobacco mosaic virus (TMV) and Barley stripe mosaic virus (BSMV) due to their high aspect ratio, narrow size distribution, diverse biochemical functionalities presented on the surface, and compatibility with a number of chemical conjugations. These properties are also easily manipulated by genetic modification to enable the synthesis of a range of metallic and non-metallic nanomaterials for diverse applications. This article reviews the characteristics of TMV, BSMV, and their virus-like particle (VLP) derivatives and how these may be manipulated to extend their use and function. A focus of recent efforts has been on greater understanding and control of the self-assembly processes that drive biotemplate formation. We briefly outline how these features have been exploited in engineering applications such as sensing, catalysis, and energy storage, and discuss emerging advances that promise to accelerate the development of these biotemplates for widescale industrial use.

We present a rare case of atrial septal defect and ventricular septal defect with a vascular ring. The ring was formed by a right-sided aortic arch with an aberrant left subclavian artery that gave rise to a patent ductus arteriosus connecting to the main pulmonary artery. We performed a single-stage repair of the intra-cardiac defects and division of vascular ring with a novel sternotomy approach instead of the traditionally practised dual approach. Our novel approach included implantation of the aberrant left subclavian artery to the left carotid artery after transection. We could perform single-stage division of vascular ring along with the closure of both septal defects.

Objective: To examine the anxiety caused by COVID-19 pandemic and antenatal care quality of pregnant women during the isolation times. Study Design: Single center cross-sectional study. Setting: Okmeydani Training and Research Hospital. Istanbul, Turkey Population: We studied 174 pregnant, and 117 non-pregnant patients between 05 May (after the start of restrictions) and 31 May (the date restrictions eased) during the covid 19 outbreak. Methods: The data was obtained from both qualitative and quantitative methods using the State-trait anxiety inventory (STAI) and life style change questionnaire. Main outcomes and measures: We assesed anxiety levels, behavioral changes and antenatal care quality of pregnant women during Covid-19 pandemic. Results: Pregnant women had higher anxiety STAI state (STAI-S) scores than the nonpregnant women (43,67±10,77 vs. 39,71±9,55, p=0,01). The STAI trait (STAI-T) anxiety scores were similar between the two groups (43,57±8,07vs43,07±9,41, p=0,74). In pregnant women under age 20, STAI-S score was lower (35,86±2,13, p=0,031). 60 of pregnant women were in first trimester, 53 were in second and 61 were in third trimester. STAI-S and STAI-T scores were not statistically different between trimester groups. Cancelling appointments of prenatal care and the fear of going to hospital is obviously high in third trimester (46,9%, p=<0,001; 41,5%, p=0,002). Conclusion: In pregnant women, fear and anxiety felt even more due to quarantine period for covid 19. Evaluation and disseminated use of online health services may be helpfull in patient information and empowerment for situations such as pandemic and isolation times.