Swine-origin influenza (H1N1) virus appeared in 2009 which spread worldwide, and it still circulates in the population. This study aimed at exploring the clinical manifestations and results in admitted patients having H1N1 influenza. All patients with confirmed or suspected influenza (H1N1) who reported to NWGH & RC, Peshawar, Pakistan from January 2018 till December 2019 were included in the study. Data was collected on demographics, preexisting medical conditions, duration of hospital stay, clinical laboratory data, outcome, and clinical features. Distribution of variables was assessed using histograms, comparison of continuous variables was done via independent Student’s t-test and of categorical variables using Chi Square test. A p value of ≤0.05 was set as cut-off for significance. A total of 39 patients presented to the hospital during the study period. Mean age was 52 (15.8) years and the proportion of male and female participants was 43.6% and 56.4% respectively. Clinical features included fever, shortness of breath, cough, chest pain, body aches and sore throat. The most commonly occurring comorbidities were hypertension [21 (53.8%)], diabetes [11 (28.2%)], and chronic kidney disease [3 (7.7%)]. Real time PCR positivity was present in 36 (92.3%) patients. Overall, 30 (76.9%) survived while 09 (23.1%) died. Comparison of the clinical parameters of survivors and non-survivors showed that non-survivors had significantly higher risk of renal failure (p=0.01), ionotropic disturbances (p=0.001), secondary infection (p=0.03), septic shock (p=0.001), and respiratory problems, requiring non-invasive ventilation and invasive mechanical ventilation (p=0.001).

A 19-month-old female with a right temporal bone tumor was diagnosed with diffuse large B-cell lymphoma by tumor biopsy. Leukemic conversion occurred after chemotherapy for mature B-cell lymphoma. Additional chemotherapy was unsuccessful and resulted in death of the patient owing to disease progression. We detected the KMT2A-MLLT3 fused transcript in the bone marrow of the patient with primary and recurrent cancer. RNA sequencing of the bone marrow with recurrent cancer showed similarities with KMT2A-rearranged leukemia, such as overexpression of MEIS1 and MEF2C, which was attributable to the aggressive course.

With the increasing demand for water resources, the utilization of marginal water resources of poor-quality has become a focus of attention. The brackish water developed in the Loess Plateau is not only salty but also famous for its “bitterness”. In the present work, multi-isotope analysis (Sr, B) was combined with geochemical analysis to gain insight into the hydrogeochemical evolution and formation mechanisms of brackish water. These results demonstrate that groundwater in the headwater is influenced by carbonate weathering. After the confluence of several tributaries in the headwater, the total dissolved solids (TDS) of water is significantly increased. The dissolution of evaporates is shown to be the main source of salinity in brackish water, which also greatly affects the Sr isotopic composition of water. This includes the dissolution of Mg-rich minerals, which is the main cause of the bitterness. Furthermore, the release of calcium from the dissolution of gypsum may induce calcite precipitation and incongruent dissolution of dolomite, which also contributes to the enrichment of magnesium. The highly fractionated boron isotopic values observed in the upstream groundwater were explained by boron interacting with clays, illustrating the important role played by the cationic exchange reaction. The inflow of brackish groundwater is the source of the observed quality of the river water. River water with relatively enriched 11B contents reflects the occurrence of evaporation along the flow path of the river. This process further aggravates the salinization of river water, with water quality evolving to saline conditions in the lower reach. When the river reaches the valley plain, the 87Sr/86Sr ratios decreases significantly, which is primarily related to erosion of the riverbanks during runoff. These results indicate that water resource sustainability could be enhanced by directing focus to mitigating salinization in the source area of the catchment.

Background: With a possible increased risk of iron absorption for those with thalassemia, many clinicians hesitate to adopt a universal iron supplementation program for all infants. Therefore, we aimed to determine thalassemia prevalence in 6 to 12-month old infants, along with the iron status of those with and without thalassemia. Procedures: We performed a cross-sectional descriptive study of healthy infants attending the Well Baby Clinic at Thammasat University Hospital. All enrolled were evaluated for complete blood count, hemoglobin electrophoresis, iron parameters, and molecular genetics for common α- and β-thalassemia. Results: Overall, 97 of 206 (47%) participants had thalassemia minor, Hb E traits being the majority; none had thalassemia intermedia or major. Familial history of anemia or thalassemia was an increased risk for detecting thalassemia minor in offspring (OR 5.18; 95% CI 2.60-10.33, P=0.001). Between normal and iron-replete thalassemia minor infants, there were no statistical differences in transferrin saturation, serum ferritin, and hepcidin. However, one-third of those with thalassemia minor (31/97) also had iron deficiency anemia (IDA) with a similar risk of having iron deficiency to infants without thalassemia. There was no hepcidin suppression in our infants with thalassemia minor compared to healthy controls. Conclusions: In Southeast Asia, thalassemia and IDA are endemic, and infants with thalassemia minor, particularly Hb E and β-thalassemia trait, are also at risk of IDA; thus, our short-term universal iron supplementation program for 6 to 12-month old infants should not increase the risk of those with thalassemia minor developing iron overload in the future.

Background: Mobile applications are playing an increasing role in patient care, and their use in the oncologic field opens up promising possibilities in the fields of supportive cancer care and patient education. The objective of our study was to determine the effects on quality of life (QOL) of a mobile app–based training for supportive care of women with breast cancer using adjuvant endocrine hormonal therapy. Material and Methods: A single-blinded and randomized design was used. Participants were randomly assigned to either control group that receives routine care or intervention group that receives routine care plus access to mobile app–based training support for 12 weeks. QOL and symptom distress were measured before intervention (T0), after 12 weeks (T1) of intervention. This study is the application of three modality combinations: mobile app-based patient education (1), web-based management application (2), and nurse’s tracking over the phone and mobile app (3). The mobile app-based training also provides basic information about breast cancer, symptom diary and lifestyle recommendations (adequate and balanced nutrition, regular physical activity, deal with stress effectively). Results: QOL of the treatment group after intervention increased and distress level was low compared to the control group; these results were statistically significant. The majority of the patients reported that the mobile application was “informative and useful”. Conclusions: This demonstrated that the mobile app is an effective intervention for supportive care in women with breast cancer. The mobile app–based training, which is an innovative intervention, is recommended as a supportive care initiative for women with breast cancer.

Coronavirus pandemic is the present concern worldwide. The virus is transmitted via a droplet route; however, transmission through blood products had not been reported. We present a 22-month-old boy with leukemia who developed fever and liver veno-occlusive disease 22 days post allogeneic hematopoietic stem cell transplantation coincidently after receiving apheresis platelets from a donor who tested positive for COVID-19 shortly after donation. The patient’s nasal swab and blood PCRs remained negative two weeks after the event. Although this case did not show viral transmission through platelet transfusion, objective donor screening and viral deactivating techniques are practical options to ensure safety.

Objectives: To analyse and report the utilisation of Red Blood Cell (RBC) transfusion in a tertiary Otolaryngology, Head and Neck Centre. Design: Retrospective cohort review. Setting: Large tertiary care centre in England. Participants: All in-patients (n = 89) admitted primarily under the care of Otolaryngology, Head and Neck service between January 2015 and December 2019 that required RBC transfusion. Main Outcome Measures: Number of units of Red Blood Cell transfused over 5 years and distribution across clinical indications. Cost of RBC transfusions over the same time period. Results: Most patients receiving transfusions are aged in their 6th and 7th decades. Epistaxis patients utilised 105 RBC units over the 5 years with 78 % being for emergency epistaxis. Post-operative Head & Neck Cancer surgery with reconstruction required 32 RBC units over 5 years in 12 patients. The cost incurred by the department has fallen by over £2000 over the 5 year period. Conclusions: Blood transfusion use has fallen over the last five years. Epistaxis and post-operative Head and Neck cancer cases account for significant use compared with other patient groups. Prehabilitation strategies will add value towards mitigating future consumption of RBC.

Scientific activities including university classes, wet lab research activities, fieldwork, and seminars/conferences have been cancelled in response to the ongoing COVID-19 pandemics. While the public health priority was to contain and mitigate the outbreak, the science sector swiftly adopted technologies to stay connected and continue the scientific activities as much as possible. Creativity, ingenuity, and resilience abound in the science community manifested in successful examples of truly global activities such as seminar series and conferences. While these platforms were initially concerned with maintaining the continuum of science education and dissemination, they attracted participants beyond the boundaries of their respective institutions and countries and thereby increased the equity. While the communities and countries are easing the societal restrictions and the scientific community returns to on-site work, it is important to learn the lessons and ensure equity in science education and dissemination moving forward.

Background and purpose: Drug addiction is a chronic and recurrent brain disease, which has become a social problem in recent years. Our study investigated Bulleyaconitine A (BAA) inhibition in physical and psychological dependence and explored underlying mechanisms of action. Experiment approach: Naloxone-induces withdrawal signs in morphine mice and conditioned place preference (CPP) paradigm were used. Prodynorphin gene expression and dynorphin A level were measured in nucleus accumbens (NAc) and hippocampal CA1. Double immunofluorescence staining of dynorphin A with glia and neuronal cellular biomarkers was detected in NAc and hippocampal CA1. Key results: 1 Multiple daily injections of morphine in mice induced withdrawal signs and conditioned place preference (CPP) acquisition. 2 Single subcutaneous injection of BAA (30-300 μg/kg) dose-dependently and attenuated morphine withdrawal signs, and BAA (300 μg/kg) also totally alleviated morphine CPP acquisition. 3 BAA specifically stimulated the expression of dynorphin A in microglia in NAc and hippocampal CA1, measured by gene and protein expression and double immunofluorescence staining. 4 BAA-inhibited naloxone-induced withdrawal signs and CPP acquisition were totally blocked by the microglial activation inhibitor minocycline, dynorphin A antiserum and specific κ-opioid receptor antagonist GNTI. Conclusions & implications: Our results, for the first time, illustrate that BAA attenuates morphine-induced physical and psychological dependence by stimulation of microglial dynorphin A expression in brain and suggest that BBA may be a potential candidate for the treatment of opioid drug addiction. Keywords: BAA, dynorphin A, κ-opioid receptor, nucleus accumbens (NAc), hippocampal CA1, microglia

Coronavirus disease 2019, an infectious viral disease caused by severe acute respiratory syndrome coronavirus 2 has been declared a global pandemic by World Health Organisation. The race to find an effective cure for it is on. Most of the candidate drugs in various clinical trials are being re-purposed but none has been approved as at date. It is pertinent for the bedside physicians to understand the mechanisms of action of these agents and their peculiar adverse effects so they are properly guided on the risk/benefit of the drugs they choose in managing COVID-19 patients. In this review, we aimed to review the mechanisms of action and adverse effects of the major drugs in clinical trials for COVID-19 therapeutics. Clinicaltrials.gov, the international clinical trials platform of the WHO, the EU clinical trials register and the Cochrane Central Register of Controlled Trials were searched for registered clinical trials. Studies in therapeutic trials were considered eligible for the work. Frequency table was made for the most common trialled drugs and the mechanisms of actions and adverse effects of the selected drugs were reviewed. 10 studies were selected for review in a descending order of their frequency in different therapeutic trials and these are ritonavir, lopinavir, chloroquine/hydroxychloroquine, interferon, remdesvir, favipravir, umifenovir, darunavir, tocilizumab and methylprednisolone. The bedside physicians need to understand the mechanisms of action of these agents and their peculiar adverse effects so they are properly guided on the risk/benefit of the drugs they choose in managing COVID-19 patients.

Background: Cysteinyl leukotrienes are pro-inflammatory mediators with a clinically established role in asthma and a potential human genetic and preclinical role in cardiovascular diseases. Given that cardiovascular disease has a critical inflammatory component, the use of a leukotriene antagonist may represent an innovative therapy to target inflammation in cardiovascular prevention. Methods: We performed an observational retrospective (three years) study on eight hundred asthmatic patients 18 years or older in Albania, equally classified in two cohorts, exposed or non-exposed to montelukast, matched by age and gender. Patients with a previous history of myocardial infarction or ischemic stroke were excluded. Results: we considered eight hundred asthmatic patients (368 male and 432 female) 18 years or older. Overall 37 (4.6%) of the asthmatic patients, 32 non-exposed and 5 exposed, suffered a major cardiovascular event during the 3 years observation period. All the cardiovascular events occurred among patients with an increased cardiovascular risk. Thus, we used both a propensity score (PS) matching and a PS adjusted Cox model for analysis. In both analyses exposure to montelukast remained a significant protective factor for incident ischemic events (HR = 0.222; HR = 0.241, respectively), independently from gender. The event-free Kaplan-Meier survival curves confirmed the lower cardiovascular incidence of patients exposed to montelukast (p = <0.0001). Conclusion: Collectively, our data indicates that there is a potential protective role of montelukast for incident ischemic events in the older asthmatic population, suggesting a co-morbidity benefit of montelukast in asthmatics and possible innovative therapy to target inflammation for cardiovascular prevention.

In tetanus patients Levodopa and Carbidopa combination (which is usually used to relieve the signs of extrapyramidal) causes respiratory muscles spasm relief thereby the need for sedatives is decreased and patient saved later on via central nervous system mechanism, by providing the inhibitory neurotransmitters at Anterior Horn cells.

In rabies patient on blowing on any ear, the respiratory muscle spasms is increased. This “KD EAR BLOW SIGN IN RABIES” is due to increase in humidity (examiners moist air blow) in the auditory canal which in turn sends impulses via those auditory nerves to temporal lobe thus stimulating reflex

We reviewed the types of monoclonal antibodies being repurposed for COVID-19 therapeutics, the clinical outcomes and adverse effects so as to provide evidence the bedside physicians, the health policy-makers and the general public could employ in the COVID-19 management protocol. This systematic review was conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Joanna Briggs Institute’s critical appraisal checklists for evaluation of the quality of studies were employed to assess the quality of the different types of primary studies included in the review. Our search strategy identified 396 potentially relevant articles which decreased to 322 after duplicates were removed. 281 articles were screened out due to lack of relevance. The full text of the remaining 41 relevant papers were retrieved for full text evaluation after which only 19 studies from eight countries met our eligibility criteria and were included in the review. Majority (42%) of the studies emanated from Italy. Also, 94.7% of the studies used tocilizumab. A total of 698 patients were included in all the studies with a male/female ratio of 1.94:1. 78.9% of the studies stated patients’ co-morbidities which include hypertension (80%), diabetes mellitus (73.3%), cardiovascular disease (53.3%) and obesity (26.7%). 75.9% of the patients recovered. Adverse effects reported included viral myocarditis, bacteraemia, candidaemia and invasive aspergillosis. Monoclonal antibodies, especially tocilizumab and eculizumab hold some promise in the treatment of the disease but controlled clinical trials using them as monotherapy are needed to further evaluate this finding.

Background and Purpose Coordinated endothelial control of cardiovascular function is proposed to occur by endothelial cell communication via gap junctions and connexins. To study intercellular communication, the pharmacological agents carbenoxolone (CBX) and 18β glycyrrhetinic acid (18βGA) are used widely as connexin inhibitors and gap junction blockers. Experimental Approach We investigated the effects of CBX and 18βGA on IP3-evoked intercellular Ca2+ waves in the endothelium of intact mesenteric resistance arteries. Key Results Acetylcholine (ACh)-evoked IP3-mediated Ca2+ release and propagated waves were inhibited by CBX (100µM) and 18βGA (40µM). Unexpectedly, the Ca2+ signals were inhibited uniformly in all cells, suggesting that CBX and 18βGA reduced Ca2+ release. Localised photolysis of caged IP3 (cIP3) was used to provide precise spatiotemporal control of site of cell activation. Local cIP3 photolysis generated reproducible Ca2+ increases and Ca2+ waves that propagated across cells distant to the photolysis site. CBX and 18βGA each blocked Ca2+ waves in a time dependent manner by inhibiting the initiating IP3-evoked Ca2+ release event rather than block of gap junctions. This effect was reversed on drug washout, and was unaffected by small or intermediate K+-channel blockers. Furthermore, CBX and 18βGA each rapidly and reversibly collapsed the mitochondrial membrane potential. Conclusion and Implications CBX and 18βGA inhibit IP3-mediated Ca2+ release and depolarise the mitochondrial membrane potential. These results suggest that CBX and 18βGA block cell-cell communication by acting at sites that are unrelated to gap junctions.

Objective: To investigate the impact of Dehydroepiandrosterone(DHEA) combining Metformin on IVF-ET outcomes in poor ovarian responders(PORs). Materials and Methods: This is a retrospective cohort study. There were 237 women undergoing IVF-ET cycles. A total of 106 cycles met the Bologna criteria (44.8%) as poor responders in this study period. They were divided into two groups according to with or without supplementation. Results: The number of oocytes retrieved (3.5±2.5 vs. 1.5±0.8, p = 0.027), the clinical pregnancy rate(21.7 vs. 11.5, p = 0.008) and the live birth rate(16.7 vs. 8.7, p = 0.007) were significantly higher in the group with supplementation than in the group without. Conclusion: The adjuvant agents: DHEA and Metformin for ovulation induction seemed to improve the number of oocytes retrieved, clinical pregnancy rate and live birth rates in poor ovarian responders.

Background: Even though preventive stoma is unlikely to ensure primary healing in women with juxtaposed rectal and vaginal sutures, it may be considered, in selected patients at risk of rectovaginal fistula, to reduce fistula related complications. Objective: To assess whether a generalized use of preventive stoma reduces the rate of rectovaginal fistula in women with excision of deep endometriosis requiring concomitant vaginal and rectal sutures. Study Design: Retrospective comparative study including 363 patients with deep endometriosis infiltrating the rectum and the vagina. They were managed by either rectal disk excision or colorectal resection, concomitantly with vaginal excision, in two centers (Rouen and Bordeaux) each following differing policies concerning the use of stoma. The prevalence of rectovaginal fistula was assessed, and risk factors analysed. Results: 241 and 122 women received surgery in respectively Rouen and Bordeaux. The rate of preventive stoma was 71.4% in Rouen (N=172) and 30.3% in Bordeaux (N=37). Rectovaginal fistula were recorded in 31 cases (8.5%): 19 women in Rouen and 12 women in Bordeaux. Performing rectal sutures less than 8 cm above the anal verge increased the risk of rectovaginal fistula more than 3-fold, independently of other risk factors (OR 3.4, 95%CI 1.3-9.1). Conclusions: No statistically significant differences were found in terms of risk of rectovaginal fistula between women with rectovaginal endometriosis managed respectively by a generalized or restrictive use of preventive stoma. A higher risk of rectovaginal fistula independently related to a low rectal stapled line, less than 8 cm above the anal verge.

Objective To determine the effects of antenatal corticosteroids treatment for congenital diaphragmatic hernia (CDH). Design A multicenter retrospectively study Setting Guangzhou Women and Children’s Medical Center, Guangdong Women and Children Hospital, Third Affiliated Hospital of Guangzhou Medical College. Methods Antenatal corticosteroids treatment was administered by intramuscular injection to mothers at 32 weeks of gestation (5mg twice a day for two days) depending of the clinical course and attending physician. Patients were divided into the observe group (39 cases) and the control group (40 cases). Main outcome measures Primary outcome was mortality. Secondary outcome was pulmonary arterial hypertension (PAH) Results: 79 cases (50 male and 29 females) were enrolled at 3 center. Of note, there was no significant difference in prenatal evaluation and the severity of PAH between this two group. The mortality of this two group was 17.% and 38.5% respectively (P=0.038). Observe group was associated with a lower survival(OR=0.3,95% CI=0.1-1.0, P=0.042). After adjusting for potential confounders, prenatal corticosteroids treatment was associated with a lower survival (OR=0.7, 95% CI=0.1 to 3.8, p=0.640）. Conclusion Antenatal corticosteroids treatment cannot improve the severity of PAH, nor improve the mortality. Instead,Antenatal corticosteroids treatment have been linked to increased mortality. Therefore, Antenatal corticosteroids treatment cannot be recommended in this data. Funding This study was supported by Guangdong Basic and Applied Basic Research Foundation, 2020A1515010296 Key words Congenital diaphragmatic hernia, prenatal corticosteroids intervention, mortality, pulmonary arterial hypertension Tweetable abstract Antenatal corticosteroids treatment seems cannot improve prognosis in patients with CDH.

In 1891 Georg Cantor published his Diagonal Method which, he asserted, proved that the real numbers cannot be put into a one-to-one correspondence with the natural numbers. In this paper we will see how by varying the initial conditions of Cantor’s proof we can use the diagonal method to produce a one-to-one correspondence between the set of natural numbers and the set of infinite binary decimals in the interval (0, 1). In the appendix we demonstrate that using the diagonal method recursively will, at the limit of the process, fully account for all the infinite binary decimals in (0, 1). The proof will cement the one-to-one correspondence between the natural numbers and the infinite binary decimals in (0, 1).

The tumor of a patient with Bowen’s disease exhibited expression of the tumor suppressors p53 and p16INK4a(p16), which correlated with cytoplasmic expression of the histone deacetylase sirtuin 1(SIRT1). Epigenetic regulation of p53 and p16 by SIRT1 may play a role in the carcinogenesis of Bowen’s disease.

This chext x-ray (CXR) shows a large right sided pneumothorax with a degree mediastinal shift suggesting tensioning (The CXR you should never see!). Furthermore, features of pneumomediastinum are present including the continuous diaphragm sign, and subcutaneous emphysema around the neck and right side of the thorax

The cell free system has been paid more attention due to its potential of facilitating more efficient catalysis of multistep reactions. In this study, an efficient enzymatic cascade of GSH production was developed through the evolution of bifunctional glutathione synthetase (GshF), coupled with polyphosphate kinase (PPK). First, the stability and activity of GshF were enhanced by loop interchange and site-directed mutagenesis. As a result, the GshF half-value period increased 163.3-fold, and its activity raised 18 %. PPK from Jhaorihella thermophile (PPKJT) was characterized and used to regenerate ATP in the GSH synthesis, with hexametaphosphate (PolyP(6)) as the phosphate donor. After the process optimization, 99.9 mM GSH and 7.6 mM oxidized glutathione (GSSG) were produced within 2 h. The molar yield was 95.9 mol/mol based on the amino acid added, while the productivities of GSH achieved 49.95 mM/h, which was the highest yield and productivity ever reported about GSH synthesis.

Primary thyroid angiosarcoma (TAS) is a rare mesenchymal tumor with poor prognosis, that should be differentiated from anaplastic thyroid carcinoma. We present the 60th case of this rare tumor and highlight the importance of early diagnosis, undelayed surgery and complementary radiation in order to improve prognosis and overall survival.

Bone hemangiomas are extremely rare benign tumors. We hereby present a case of 41-year old woman, that had a sever thyrotoxicosis, associated with severe GO which has necessitated glucocorticoid treatment. A link between hemangioma and sever thyrotoxicosis and/or IV GC might have resulted in endothelial alterations, and/or bone loss.