Continued instances of serious birth asphyxia following intermittent auscultation (IA) need not wholly imply inherent limitations. This review uses analytical modelling to establish a safer and improved regime. It demonstrates that the Doppler-device is superior to Pinard stethoscope, with observation of the numerical read-out of fetal heart rate (FHR) from the later part of contraction till the onset of next contraction. Current recommendation of actually counting heart tones for 1 minute has many fallacies. IA should focus on the baseline FHR and late decelerations. Detection of additional FHR changes like accelerations, overshoots or cycling is cumbersome and adds little value.

Background: COVID-19 is a new pandemic disease with severe respiratory outcome. However, there is little evidence of this condition during pregnancy based on small case series reports. Objective: to perform a systematic review and meta-analysis of proportions of case series focused on maternal and perinatal outcomes of COVID-19 during pregnancy. Search strategy: LILACS and Medline were searched from inception until April 24th, 2020. Selection criteria: all case series or case control studies involving SARS-CoV2 infection during pregnancy and neonatal period were identified. Excluded were duplicated data, case reports of individual patients or without clinical data. Data collection and analysis: a total of 14 studies were included. When possible, pooled proportions with 95% confidence interval through a random effect model were estimated. Heterogeneity was estimated with the use of I2 statistics and Tau2 test. Main results: Most common symptoms were fever (58%; I2= 69%) and cough (33%; I2= 65%). A pathognomonic CT-Scan was observed in 92% of patients (I2= 0%). Lymphopenia and increased D-dimer were observed in 50% (I2= 82%), and 80% (I2= 0%) of patients at admission, respectively. There were no maternal deaths, with 2 cases of neonatal death, both with negative SARS-CoV2 PCR. Vertical transmission was observed in 5 neonates. Conclusions: This systematic review and meta-analysis confirms that COVID-19 during pregnancy is associated with good maternal and perinatal outcome. Evidence of vertical transmission should be confirmed with larger cohorts. Funding: none. Key words: meta-analysis, COVID-19, vertical transmission, perinatal outcome, pregnancy.

The manuscript aims to describe the effect of COVID-19 virus on the patients suffering with neurological diseases. The outbreak of COVID-19 is serious and it becomes epidemic worldwide. It is observed from the literature survey that COVID-19 virus can easily affect the persons having neurological diseases. The manuscript also focuses on the mechanism of action of the COVID-19 virus on the nervous system with precaution majors. Patients with COVID-19 show various symptoms of neurological manifestations including stroke, impaired consciousness, seizures, agitation, unsteadiness, dizziness, confusion, localized neuralgia and cognitive impairment. The COVID-19 virus affect the Central Nervous System, makes the patients clinical condition worse and it may cause the death of the patient. It can be concluded from the literatures that COVID-19 virus versen the neurological condition of patients and may leads to severe manifestations.

Objective: Appropriate use of oral anticoagulants (OACs) reduces the risk of stroke in patients with atrial fibrillation (AF). The study characterised the prescribing of OACs in people with AF in the Australian primary care setting over 10 years. Methods: We performed 10 sequential cross-sectional analyses of patients with a recorded diagnosis of AF between 2009 and 2018 using nationally representative general practice data from the NPS MedicineWise’s dataset, MedicineInsight. The proportion of patients with AF who were prescribed an OAC based on their stroke risk was examined. Results: The sample size of patients with AF ranged from 9,874 in 2009 to 41,751 in 2018. The proportion who were prescribed an OAC increased from 39.5% (95% CI 38.6%-40.5%) in 2009 to 52.0% (95% CI 51.5%-52.4%) in 2018 (p for trend <0.001). During this time, the proportion of patients with AF and high stroke risk who were prescribed an OAC rose from 41.7% (95% CI 40.7%-42.8%) to 55.2% (95% CI 54.7%-55.8%; p for trend <0.001) with the direct-acting oral anticoagulants accounting for over three-quarters of usage by 2018. There was substantial variation in OAC prescribing according to stroke risk between general practices. In 2018, the proportion of moderate to high stroke risk patients who were prescribed an OAC was 38.6% (95% CI 37.2%-40.1%) in the lowest practice site quintile and 65.6% (95% CI 64.5%-66.7%) in the highest practice site quintile. Conclusions: Over the ten years, OAC prescribing in high stroke risk patients with AF increased by one-third.

Oral cavity and oropharynx squamous cell carcinoma: CT texture analysis as an independent predictor of survival Brief running title: CT texture analysis in oral cavity and oropharynx squamous cell carcinomaConflict of Interest, acknowledgment: The authors have no conflicts of interest and no acknowledgment to disclose.

Objectives The primary aim of the study is to provide recommendations for the investigation and management of patients with new onset anosmia during the COVID-19 pandemic Design After undertaking a literature review, we used the RAND/UCLA methodology with a multi-step process to reach consensus about treatment options, onward referral imaging. Setting and participants An expert panel consistent of 15 members was assembled. A literature review was undertaken prior to the study and evidence was summarised for the panellists. Main outcome measures The panel undertook a process of ranking and classifying appropriateness of different investigations and treatment options for new onset anosmia during the COVID-19 pandemic. Using a 9-point Likert scale, panellists scored whether a treatment was: Not recommended, optional, or recommended. Consensus was achieved when more than 70% of responses fell into the category defined by the mean. Results Consensus was reached on the majority of statements after 2 rounds of ranking. Disagreement meant no recommendation was made regarding one treatment, using Vitamin A Drops. Alpha lipoic acid was not recommended, olfactory training was recommended for all patients with persistent anosmia of more than 2 weeks duration, and oral steroids, steroid rinses and omega 3 supplements may be considered on an individual basis. Recommendations have been made regarding the need for referral and investigation have been made. Conclusion This study identified the appropriateness of olfactory training, different medical treatment options, referral guidelines and imaging for patients with COVID-19 related anosmia. The guideline may evolve as our experience of COVID-19 develops.

COVID-19 pandemic presents an unprecedented challenge to identify effective drugs for treatment. Despite multiple clinical trials using different agents, there is still a lack of specific treatment for COVID-19. Having the possible role in suppressing inflammation, immune modulation, antiviral and improving respiratory symptoms, this review discusses the potential role of methylxanthine drugs like pentoxifylline and caffeine in the management of COVID-19 patients. COVID-19 pathogenesis for clinical features like severe pneumonia, acute lung injury (ALI) / acute respiratory distress syndrome (ARDS), and multi-organ failures are excessive inflammation, oxidation, and cytokine storm by the exaggerated immune response. Drugs like pentoxifylline have already shown improvement of the symptoms of ARDS and caffeine has been in clinical use for decades to treat apnea of prematurity (AOP) in preterm infants and improve respiratory function. Both pentoxifylline and caffeine are well-known anti-inflammatory and anti-oxidative molecules that have already shown to suppress Tumor Necrosis Factor (TNF-α) as well as other inflammatory cytokines in pulmonary diseases, and this may be beneficial for better clinical outcomes in COVID-19 patients. Pentoxifylline enhances blood flow, improves microcirculation and tissue oxygenation, and caffeine also efficiently improves microcirculation, reduces cardiovascular disease, and an effective analgesic. There are significant shreds of evidence that proved the properties of pentoxifylline and caffeine against virus-related diseases as well. Along with the aforementioned evidences and high safety profiles, both pentoxifylline and caffeine offer a glimpse of considerations for future use as a potential adjuvant to COVID-19 treatment. However, additional clinical studies are required to confirm this speculation.

High-resolution colonic manometry and biopsy immunohistochemistry revealed that 5-HT4 receptors in the lumen of the human colon are present exclusively on enterochromaffin cells and the 5-HT4 receptor agonist prucalopride, evokes all major propulsive motor patterns, associated with significant anal sphincter relaxation, when given intraluminally.

53-year-old male with iMCD developed hematoma at biopsy site. He was diagnosed with acquired hemophilia A and Hashimoto’s both were associated with iMCD. He has been in remission without recurrence of hemophilia after Rituximab 375 mg/M² weekly for 1 month, and 375 mg/M² every 2 months for maintenance.

Rosai Dorfman disease is a rare cause of sinus histiocytosis with massive lymphadenopathy, in developing countries it mimics tuberculosis and malignancies like lymphoma and its often mismanaged. A high index of suspicion is necessary for its diagnosis. It resolves spontaneously therefore observation is currently the advocated approach for its management.

Key Points:We describe a novel procedure, Endopharyngeal Ultrasound (EPhUS) and EPhUS-guided FNAEPhUS requires an operator and an assistant, can be performed transnasal or transoral, and utilizes a Endoscopic Ultrasonography BronchoscopeEPhUS is a safe and effective method for biopsy of deep space neck masses inaccessible to transcutaneous FNAKey Words: Endoscopic, Ultrasound, Fine needle aspiration, Neck mass, Biopsy, minimally invasiveEthical Considerations: The patient presented below was informed that this procedure has not been reported in the past and agreed to proceed following standard informed consent. The patient consented to having their case published in the literature.

Objectives: Second primary esophageal squamous cell neoplasms (ESCNs) are common in hypopharyngeal squamous cell carcinoma (HPSCC) patients and are associated with poor prognoses. The effectiveness of image-enhanced endoscopy (IEE) has not been well established. Design: Retrospective study with patients proven HPSCC between April 2016 and April 2018 receiving ESCNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy. Setting: Data were collected from an electronic medical record at a single medical center in Taiwan. Participants: The study population included a total number of 130 patients with HPSCC receiving ESCNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy Main Outcome Measures: Clinical data, incidence, and stage of second primary malignancy in HPSCC patients were obtained for statistical comparison. Results: Of 99 eligible patients, second primary ESCNs prevalence was 31%. Of the 69 patients assigned to the follow-up group, 23 with positive findings showed significantly increased previous histories of second primary malignancies in the upper aerodigestive tract. Among them, patients without symptoms at the time of IEE screening showed less advanced T stages and higher percentages of receiving minimally invasive therapy. Conclusions: Routine IEE screening is strongly recommended for HPSCC patients and can improve the detection rate of ESCNs and facilitate early-stage identification.

This is an atypical presentation of a rare diagnosis. It emphasizes the need for thorough medical history, family history, physical examination and workup. It also demonstrates how even nonfunctional paragangliomas can cause mass effect leading to symptoms.

Noodles a Roar, Stop that Snore!Objective : Students will understand the effects of acoustics, which includes how sound is measured (decibels) and how sound travels. After reading Two Problems for Sophia, by Jim Averbeck and Yasmeen Ismail, students will create and design a device that decreases the volume of noise heard on a speaker.Grade Level(s): Kindergarten – Second GradeGroup/Team Size: 3 per teamTime Required: 45 -60 minutesEducational Standards:From the North Carolina Essential Science Standards: (http://www.ncpublicschools.org/docs/acre/standards/new-standards/science/k-2.pdf)Students develop simple skills of observation, measurement and number sense as they actively participate in simple investigations. During investigations, students must have opportunity to use tools such as magnifiers, thermometers, rulers, or balances to gather data and extend their senses. They must have ample time to talk about their observations and compare their observations with those of others. They should be encouraged to employ oral language, drawings and models to communicate results and explanations of investigations and experiment2.P.1 Understand the relationship between sound and vibrating objects.From the Common Core Math Standards: (http://www.corestandards.org/Math/Content/2/MD/)NC.K.MD.1: Describe measurable attributes of objects; and describe several different measurable attributes of a single object.NC.K.MD.2: Directly compare two objects with a measurable attribute in common, to see which object has “more of”/“less of” the attribute, and describe the differenceNC.1.MD.4: Organize, represent, and interpret data with up to three categories.1.MD.D.10: Draw a picture graph and a bar graph (with single-unit scale) to represent a data set with up to four categories.NC.2.MD.10: Organize, represent, and interpret data with up to four categoriesFrom STEM Connected Through Engineering (K-2):EG K-2 H 1: Infer that engineering has a way of thinking and solving problems that includes: systems thinking; communication; collaboration; optimism; creativity and ethical considerationsEG K-2 D 1: Use the engineering design process of ASK-IMAGINE-PLAN-CREATE-IMPROVEEG K-2 P 2: Use critical thinking to suggest solutions to problemsSTEM Learning Objectives:To represent and interpret data using a bar graph.To analyze the relationship between sound and objects that vibrate as a result of sound produced.To utilize the engineering design process.Materials: Each group of students will need at least the following materials.2 ft of Ribbon1 Roll of Duct tape1 Fabric Scrap1Cardboard Square 6” x 6” Square1 Styrofoam Cup1 BalloonPlay-dough

In this work, the mass transfer performance of a new eductor liquid-liquid extractor is investigated experimentally and modeled by dimensional analysis and response surface methodology (RSM) with utilization of water/acetic acid/toluene system. A correlation is derived for overall mass transfer coefficient versus the Reynolds number, throat to nozzle area ratio, projection ratio, and the two phases flow rates ratio. Based on obtained results, Reynolds number is known as a most effective parameter. As well, different hydrodynamic and geometrical parameters, giving the same Sauter mean dimeter, have different mass transfer coefficients due to differences in droplet size distribution. Also, the RSM studies shows that effects of the parameters are in the order of the two phases flow rates ratio, the venturi throat to nozzle tip distance, nozzle diameter, and venturi throat diameter. The maximum overall mass transfer coefficient is obtained equal to 0.000278 m/s for the studied system.

This research investigated comprehensively the fundamental science of estimating sorption, diffusion, and permeation of 1,3-butadiene and nitrogen in polydimethylsiloxane (PDMS), and zeolitic imidazolate frameworks (ZIFs) filled mixed-matrix membranes (MMMs). ZIF-8 and Ni-ZIF-8 nanocrystals were synthesized at room temperature and incorporated into PDMS at different loadings. The physical and chemical properties of both ZIFs have been studied by XRD, FTIR, SEM, EDX, and TGA, respectively. Synthesized Ni-ZIF-8/PDMS MMMs demonstrated homogeneous particle dispersion, improved particle-polymer adhesion, and better butadiene permeation under various testing conditions. 15% Ni-ZIF-8/PDMS MMM exhibits 1,3-butadiene permeance 323 GPU, which improved by 60% compared with PDMS, and 32% with 15% ZIF-8/PDMS MMM, while BD/N2 ideal selectivity of 19.5was higher 81% than PDMS, and 32% than 15% ZIF-8/PDMS MMM at 40°C and 1.5 bar. Additionally, Ni-ZIF-8/PDMS MMMs have improved the solution-diffusion properties of butadiene and decreased sorption enthalpy, entropy change, activation energies of diffusion, and permeability from PDMS and ZIF-8/PDMS.

In order to further improve the accuracy in liquid-phase state and get a simpler algorithm, the Martin-Hou Equation of State is modified after rigorous data analyses in different cases. A new revision factor h, a function of critical compression factor, is introduced into the novel M-H EOS. According to the derivation of the new EOS, only a few number of physical properties are needed to characterize a given substance, which greatly reduced the difficulty of the solution about the EOS. The novel M-H EOS is applied to argon, methane, nitrogen, propane, benzene and water to verify the applicability and the accuracy in liquid-phase state. The overall average deviation for the six substance is 1.29% by the novel M-H EOS; as a comparison, the overall average deviation is 2.51% by Hou’s M-H EOS, the novel M-H EOS obviously reduces the deviation and can universally be applied to most kinds of substances.

Disguising agents for transmitting Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): Mobile phone & Paper currency

La problematica dei siti contaminati è di grande attualità e assume un’importanza estremamente rilevante nell’ambito del rischio ambientale e della salute pubblica. I contaminanti del suolo, infatti, possono essere caratterizzati da alti livelli di tossicità, di persistenza nell’ambiente e da una certa mobilità che può portare alla contaminazione delle acque sotterranee e alla catena alimentare, fino a diventare fonte di pericolo per la salute umana. I siti contaminati necessitano, quindi, di interventi di bonifica che si differenziano in funzione delle caratteristiche sito-specifiche, di fattori economici e degli obiettivi della bonifica. Tra le diverse tecniche si inserisce la Phytoremediation, che sfrutta le proprietà ecofisiologiche di particolari tipi di piante per ridurre le concentrazioni di inquinanti nel suolo. Il presente elaborato tratta un caso studio in cui tale tecnica è stata adottata con particolare efficacia per bonificare un sito contaminato da metalli pesanti (Cd, Hg, Zn).

The outbreak of COVID-19 as a pandemic has shaken the global health system and economy by their roots. This epidemic is still spreading and showing no signs of decreasing trend. Vaccination is the only effective and economical means to control this pandemic. A number of research institutions and pharmaceutical companies have plunged into the race of vaccine development against COVID-19 which are in various stages of development. An intriguing fact of coronavirus infections is that in every decade of 21st century there is a new major coronavirus epidemic viz. SARS in 2002, MERS in 2012, and now COVID-19; and such epidemics are expected in future too. Since, maximum biological characteristics of SARS-CoV-2 are still obscure the scientists are relying on the information available on SARS-CoV and to some extent on MERS-CoV for designing and development of COVID-19 vaccines. But there is a need of vigorous testing for immunogenicity, safety, efficacy, and level of protection conferred in the hosts. This review focuses on the challenges and prospects of vaccine development against COVID-19. It highlights seriousness, bottlenecks in vaccine development, possible vaccine candidates, different vaccine strategies, safety evaluation issues, and vaccine production process pertaining to COVID-19 based on the knowledge acquired on SARS and MERS vaccine development in the past.

Influenza A virus (IAV), a deadly zoonotic pathogen, occasionally cross-species transmission among humans, swine and avian. The ectodomain of matrix protein 2 (M2e) is highly conserved in IAV and has been widely concerned in the development of universal influenza vaccines. Due to low immunogenicity, multi-copy M2e are usually displayed on the surface of nanoparticles to constitute universal nanovaccines. Here, we report that the permutation of the M2e affects the immune effect of the nanovaccine. Three M2e derived from humans, swine and avian IAV were inserted into the C-terminal of the Cap protein of porcine circovirus type 2 (PCV2) to form self-assembled nanovaccine. Immunoprotective effects of different M2e arrangements were explored in mice. Results showed that the M2e closest to the surface of nanoparticle induced the most efficient protection against IAV derived from corresponding species. The results will help in the development of more effective universal influenza vaccines, especially for specific species.

Il sistema di Biopile è una tecnica di risanamento biologico dei terreni incentrata sulla capacità dei microrganismi autoctoni del terreno di rimuovere particolari tipi di contaminanti, come idrocarburi policiclici aromatici (IPA) e idrocarburi di petrolio (TPH), in determinate condizioni ambientali. La gestione dei siti contaminati è stata oggetto di trattazione sia a livello europeo che nazionale, con la finalità di scongiurare gravi rischi ambientali potenzialmente derivanti da attività antropiche quali attività industriali, stoccaggio di rifiuti, attività minerarie, perdite da serbatoi e linee di trasporto degli idrocarburi. In particolare, a livello europeo la normativa si è concretizzata nella Strategia Tematica sul Suolo, mentre in ambito nazionale, trova larga applicazione il Decreto Legislativo 3 aprile 2006, n. 152 "Norme in materia ambientale", con particolare riferimento alla parte IV del Titolo V - Bonifica di siti contaminati. 

Social disparity in magnifying glass: the inequality among the vulnerable people during COVID-19 pandemicKeywords: COVID-19; SARS-COV-2; social disparity; vulnerable peopleThe editorial written by Stein and Ometa, (2020) [1] about the dilemma between health system and socioeconomic conditions created by the Covid-19 pandemic has called our attention as a very appropriated topic. Indeed, there are different repercussion in all aspects in unequal societies, which goes from financial issues to the chances to adhere of the current recommended measures of the WHO. For instance, social distancing and basic personal hygiene without proper social, economic and healthcare support may contribute to exacerbate disparity in fragile societies.In Brazil, the virus SARS-COV-2 is spreading fast and crashing our healthcare system and economy. The government is struggling to pay the financial supporting defined by the congress of 600 Brazilian real per month (about 100USD) for all the living costs and only reached around 15% of the population.Demographic data show that 48% of Brazilians live in places without sewage and 35 million do not have access to running water in their homes [2]. Furthermore, 5-10% live in slum-like areas known as “favelas” [3], where most residences accommodate an average of 5 individuals per room with a housing density 10x higher than the rest of the city [4]. Finally, 40.6% of the Brazilian working-age population are in the informal economy, living without social protection [5]. Keeping these in mind, how can these vulnerable people protect themselves in times of COVD-19? How can they keep basic hygiene without regular running water and sewage? How to accomplish social distancing living in over-crowded places?If the COVID-19 wasn´t challenging enough, Brazil still struggles with other important infectious diseases, such as Dengue fever, Zika e Chikungunya. These viral mosquito-borne infections (Aedes aegypti mosquito) are endemic in Brazil and can show initial similar signs and symptoms to COVID-19. The rainy season is the most favourable time for mosquito proliferation and disease spread [6], which this year the seasonality (usually peaks in April) is coinciding with the spread of SARS-COV-2 in Brazil [7]. Socially vulnerable people are more prone to acquire Aedes aegypti-related infections due to poor housing, poor sanitation and high-density population housing in “favelas” [8] [9].Current recommendations for people with COVID-19 mild illness is to stay at home. However, the panic-state created by the COVID-19 pandemic is taking these vulnerable people, which may be suffering of mosquito-borne infections, to health units and exposing them to SARS-COV-2. Thus, the overlapping of infections is overburdening even more the health system and increasing the transmission rate of COVID-19 in Brazil. Furthermore, many people in the informal market don´t have bank accounts and are agglomerating in huge lines in bank branches to get the financial aid. While many developed countries have struggled to give assistance to COVID-19 patients, Brazil must battle against two powerful enemies. So, the hard question to answer is: how many extra souls will be lost due to Brazil´s chronic problems?Brazil was used as an example we know well, but many other non-developed countries, especially the African ones may be struggling with some of these problems as well.

The continuous flow synthesis of ibuprofen is simulated taking into account the main process modelling issues. The most appropriate thermodynamic models were revised to account for the properties of the unconventional reactants and complex molecules. Furthermore, in some reaction steps ionic properties may be needed rather than those of the neutral molecules. All these points need a careful optimisation of the methods for the estimation of the properties, with possible huge discrepancies of the results. The products separation and purification steps in continuous mode was also added, but, again, the key issue is the correct selection of the thermodynamic package, relying on very complex cases where experimental equilibrium data are missing. Improper previsions can neglect important issues, such as the unpredicted precipitation of salts, not predicted during the simulation, but observed experimentally by us