Objectives: To clarify the association between incense and mosquito coils burning and the risk of nasopharyngeal carcinoma (NPC), we performed this systematic review of epidemiological studies. Methods: A search of studies published through October 2022 in MEDLINE and EMBASE databases was performed, supplemented by searches of reference lists, recent reviews, and Chinese databases. The quality of the included studies was assessed with special reference to exposure assessment. Random-effect meta-analysis estimated the pooled odds ratios (OR) and 95% confidence interval (CI) whenever applicable. Results: One cohort and 12 case-control studies were identified. The cohort study found no association between incense burning and NPC risk. In meta-analysis of six case-control studies with reasonable quality, the pooled OR for incense burning during adulthood was 1.61 (95% CI 1.43-1.81). Five studies assessed association between exposures to incense smoke during childhood and NPC risk, and the pooled OR was 1.22 (95% CI 0.76-1.96) associated with incense burning at birth and was 1.37 (95% CI 1.10-1.71) for exposure at the age of 10 years. The pooled OR for mosquito coils burning during adulthood was 1.30 (95% CI 1.04-1.62). None of the four previous case-control studies found an increased risk of NPC associated with mosquito coils burning during childhood. Conclusions: Our findings suggest an increased NPC risk associated with incense burning and mosquito coils. More epidemiological studies with refined exposure assessment are still warranted.

Reforestation is pivotal in mitigating climate change, preserving biodiversity, and safeguarding ecosystems. Precision reforestation implies efficiently using materials and human resources to conduct this intensive task. In this sense, using unmanned aerial vehicles (UAVs), also known as drones, improves the accuracy of dispensed seeds while increasing coverage and reducing labor. However, drone-based reforestation still presents technological challenges that need to be addressed. An important challenge is the presence of disturbances during flights due to environmental conditions, primarily unexpected wind, and the unavoidable loss of mass presented by the vehicle caused by the dispensing task. This paper evaluates the use of an observer-based controller to reject the particular disturbances caused by the sowing activity. Through meticulous experimentation and analysis, the study demonstrates the observer’s adeptness in mitigating external disturbances, thereby enhancing the precision and stability of UAV operations. This technological advancement holds promise for diverse practical applications and has implications for environmental conservation efforts, particularly reforestation. The obtained experimental results confirm the viability of the proposed controller and observer framework, highlighting its potential to improve the robustness of environmental monitoring, conservation, and sustainable resource management practices.

In this work, we have performed first-principle calculations to investigate the electronic properties, structural stability, and lithium migration pathway of 2D Ti 2CY 2/Graphene (Y = O, S) van der Waals (vdW) Heterostructure. The heterostructure formed by O and S functionalized MXene and graphene layers are separated by 3.04 and 3.40 Å exhibiting weak vdW interaction. It is found that the intercalation of lithium (Li) atoms in between the Ti 2CY 2/Graphene layers is thermodynamically more favorable in comparison with intercalation on the top or below the heterostructures. The Bader charge transfer analysis confirms that O atoms gain less charge -0.13 e during Li intercalation compared to S atoms with charge transfer of -0.47 e due to the larger size of the 3p orbital of S atoms. Each Li atom contributes ~0.88-0.89 e during the intercalation process. As O is more negatively charged in comparison with S atoms in the heterostructures, Li atoms are more localized on the Ti 2CO 2 layers with a tendency to form chemical bonds with Ti 2CO 2 layers while they are less localized on the Ti 2CS 2 layers creating lesser chemical bonds. The diffusion energy barrier is lower for Ti 2CS 2/graphene than Ti 2CO 2/graphene during Li intercalation. The NEB study also confirms that the activation energy barrier decreases with the increase of intercalated Li atoms for both the heterostructures indicating that Li atoms exhibit weak repulsive interaction causing weak Li binding with the heterostructures as they increase in number. Both the Ti 2CO 2/graphene and Ti 2CS 2/graphene heterostructures can be considered promising anode materials for Li-ion batteries due to their structural stability, and lower diffusion energy barrier.

In this work, we demonstrate the formation of local boron doped, p+ SiO x/ poly-Si structures using wet chemical etching by direct printing of boron-ink FlexTrail printing. This process is a mask free approach for the formation of local TOPCon structures for high efficiency tunnel oxide passivated contact (TOPCon) solar cells. Factors affecting the etch back selectivity between intrinsic and boron doped poly-Si are studied. It is found that pre-treatment by diluted HF (1 wt%) before poly-Si removal by a KOH solution is the most crucial process to ensure etch selectivity. Etching the native oxide on intrinsic and keeping the boron silicate glass (BSG) layer on p+ poly-Si is the optimum condition for removing intrinsic poly-Si while having p+ TOPCon structure. Line widths in the range of of 86-100 µm and 24-40 µm were achieved on planar and textured surfaces, respectively. FlexTrail printing allows for significantly lower (and higher) feature sizes, but its fine-line potential wasn’t fully exploited here for alignment reasons of post-processing. Test structures with a line grid of local TOPCon structures featured a maximum open circuit voltage ( iV OC) value of 720 mV and lowest saturation current density of local p+ SiO x/ poly-Si (J 0SE) ~ 90-120 fA/cm 2. The developed local p+ poly-Si will be integrated in high efficiency TOPCon solar cell where p+ poly-Si will be placed under the metal contact in the very near future.

Pleistocene climate oscillations influenced the biogeographical history of most species. In the European Alps, mountain plants were restricted to refugial areas during cold phases of glacial cycles and recolonized newly available habitats during warm periods. The current ranges of alpine plants represent a transient stage of a continuous and dynamic recolonization process that started after the last glaciations. Differences in recolonization rate and range filling are observed between different mountain plant species, but the reasons remain insufficiently explored. Here, we investigated hybridization between two related willow species pairs that came into secondary contact to assess contemporary dynamics of selection and the potential effects of hybrid zones on range expansion. RAD sequencing data was used to infer the biogeographical history of each species pair, to characterize individuals across the whole distribution area including the secondary contact zones, and to quantify patterns of genomic clines. Genetic results were supported by morphometric measurements, ecological data, and species distribution modeling. Results suggest that peripheral glacial refugia played a major role in the history of the species. For both species' pairs, the secondary contact zones showed homoploid hybridization between parents, which is also supported by the morphometric analyses. Habitat preferences showed large overlaps of parental species and a broad range of niches for the hybrids. One hybrid zone is geographically broader than expected and characterized by introgression, while the other one is narrow and shows asymmetric patterns. Current projections of species distributions identified suitable habitats beyond the secondary contact zone, suggesting an incomplete range filling.

Diversity in life histories within species profoundly influences biological interactions and resonates throughout food webs, yet quantifying these intricate processes is challenging. To explore the impact of intraspecific diversity on food web functioning, we applied century-long observational dataset of the fish community in the coastal Skagerrak to an allometric trophic network model. Representing fish, zooplankton, and phytoplankton taxa as 148 guilds interlinked by 2054 feeding links, we constructed the Skagerrak food web and quantified the roles of two Atlantic cod (Gadus morhua) ecotypes. Our results revealed a compelling dynamic: the coastal Fjord cod ecotype had a pronounced intraspecific influence on the biomass growth of the offshore North Sea cod ecotype, whereas the North Sea cod ecotype exerted stronger interspecific top-down control on other fish species. The coexistence of these ecotypes enhanced ecosystem robustness and connectivity. These findings highlight the critical importance of incorporating intraspecific diversity into sustainable fisheries management practices.

Anthraquinone (AQ) dyes are utilized extensively in the textile industry due to their ability to fasten fabrics. The intricate and rigid structures of AQ dyes, however, prevent them from bio-degradation. They also create nitrate residues, which persist as effluents in textile wastewater and harm aquatic vegetation by obstructing light from entering the water, which affects both flora and fauna. The use of bio-remediation technique is most popular because it is environmentally beneficial and economical. The aim of this study was to isolate white rot fungi (WRF) for their ability to decolorize AQ dyes and their mixtures. The current study shows the decolorization of the mixture of AQ dyes namely Remazol Brilliant Blue R(RBBR), Acid Blue 129 (AB129), and Alizarin Cyanin Green (ACG) (200ppm) in 24h by using suspended fungal isolates, WF2 (92.76%) and VS12 (93.71%) isolated from decaying wood, under optimized parameters like pH7, temperature 30˚C and shaking speed 80 rpm. The highest manganese peroxidase activity (2391.77 U/mL) was found in WF2 followed by VS12 (2318.28U/mL) in 24h. Moreover, the study revealed that manganese peroxidase is one of the causes for decolorization of AQ dyes since decolorization was directly proportional to manganese peroxidase activity. On the basis of morphological features and a complete sequence analysis of 18S rRNA gene and ITS region, the isolates were identified as Trametes cubensisWF2 and Polyporus umbellatusVS12. This is the first report of white rot fungal isolates T. cubensisWF2 and P. umbellatusVS12 used in efficient decolorization of mixture of AQ dyes (RBBR, AB129, ACG). Practitioner Points White rot fungal isolates T. cubensis WF2 and P. umbellatus VS12 offer an effective and eco-friendly solution for decolorization of mixture of AQ dyes (RBBR, AB129, ACG). The ligninolytic enzyme system gives white rot fungus the ability to degrade AQ dyes Optimizing operational parameters and techniques enables efficient decolorization of AQ dyes by WRFs

Background: Parkinson’s disease (PD) is a common progressive neurodegenerative disorder characterized by substantial loss of neurons in the substantia nigra pars compacta and depletion of dopamine. Cognitive impairment is one of the primary non-motor symptoms in PD patients. It has been reported that cordycepin (Cor) can alleviate cognitive impairment in neurodegenerative diseases, but it is susceptible to degradation by adenosine deaminase (ADA). This study aims to synthesize Cordycepin-Nano-Particles (CNP) which has resistance to ADA enzyme degradation, and investigate the effects of CNP on PD hippocampal slice models. Methods: Cor was chemically coupled with mPEG and mPEG-biotin to prepare CNP. CNP were determined using infrared spectroscopy, particle size measurement, and transmission electron microscopy. Extracellular electrophysiological recordings were used to record the field excitatory postsynaptic potential (fEPSP) in Schaffer-CA1 pathway of hippocampal slices in mice. An in vitro PD brain slice model was established with 1-methyl-4-phenylpyridinium (MPP+). Results: The proposed CNP was a spherical surface morphology, with an average particle size of about 220 nm. CNP resist the ADA enzyme degradation, exhibit higher viability in HT22 cells compared to Cor, and significantly alleviate cell damage induced by MPP+. CNP enhanced synaptic transmission in the Schaffer-CA1 pathway of hippocampal slices through A2AR pathway, reduced the excitability and tissue activity induced by 40 μM MPP+. Conclusion: CNP was successfully prepared with higher safety compared to Cor, and can protect Cor from ADA degradation. CNP primarily enhances synaptic transmission in mouse hippocampal slices through the adenosine A2AR pathway and reduces the excitability induced by MPP+.

As the world’s climate changes, species are undergoing range shifts. Range shifts are generally documented using databases such as the Global Biodiversity Information Facility (GBIF), which largely contain data from monitoring schemes and wildlife surveys. Such databases have two major limitations: i) data may be spatially biased because traditionally surveyed areas are in rural habitats, ii) there is a time lag between data collection and assimilation into GBIF, which means rapid range shifts cannot be tracked. Alternative data sources, such as social media, could provide information on species distributions and range shifts that compensate for spatial biases in GBIF records because social media data may be collected outside traditional surveyed areas. Such data are also usually shared online immediately after a wildlife sighting. The complementarity of GBIF and social media data, however, has rarely been assessed, particularly when tracking range shifts. Despite their potential utility, social media data may be particularly prone to temporary trends or geographic variation in behaviour that are not understood. We lack tools with which to counter these biases. To address these knowledge gaps, we compare the habitat usage revealed by biological records of the Jersey tiger moth from GBIF and from multiple social media data sources (Instagram, iNaturalist, and Flickr). We develop a novel method to account for recorder bias in social media data. We find that biological records from iNaturalist and Instagram reveal greater than expected occurrence in urban environments, greatly affecting the accuracy of habitat suitability models. We also develop a method for comparing recorder effort between multiple data sources. Recorder effort differs notably between data sources, and Instagram complements GBIF by recording species in areas unaccounted for by GBIF. By incorporating recorder effort metrics, data from social media sources could be used to improve monitoring of range shifting species in urban spaces.

The elongate ilisha (Ilisha elongata) is a significant commercial species found along the Northwestern Pacific Coast. A sharp decline in the annual catch of I. elongata over recent decades implies a concerning situation regarding its fishery stocks. Nonetheless, inadequate knowledge of the genetic diversity, population structure, and historical demography of this species has hindered the establishment of sustainable fishery policies and appropriate conservation measures. In this study, the genetic structure and population demography of I. elongata stocks along the Northwestern Pacific Coast were examined using target-gene enrichment data from 144 I. elongata individuals collected from 18 locations. The findings reveal that with an average value of 0.2173, I. elongata maintains a notable level of nucleotide diversity despite facing considerable fishing pressure. Furthermore, inter-population differentiation is relatively low, with most geographical populations displaying minimal genetic distinctions or none from one another. Population clustering analysis identified four lineages of I. elongata stocks. Through historical demography simulations, it was proposed that the Yalu River Estuary population diverged initially around 19500 generations before present, while the remaining lineage split into two about 18800 generations ago. One lineage represents the southern population, while the other further separated into the northern population and the Japanese population approximately 3000 generations ago. These results underscore that the current phylogeographic patterns of I. elongata may result from directional selection due to low temperatures and geographic barriers during glacial periods, followed by recent expansions.

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory gastrointestinal disease that affects premature neonates with high morbidity and mortality. We aimed to evaluate the potential of IgG anti-tissue transglutaminase antibodies (IgG tTG) as biomarkers for NEC and to explore their applicability in the early diagnosis, monitoring prognosis. Method: We conducted a prospective observational study on 60 neonates with abdominal distension, dividing into the NEC(n=30) and the control(n=30) groups according to the follow-up results. We collected plasma samples within 48 h of the onset of abdominal distension, and used the autoantigen microarray to screen for NEC-associated autoantibodies. Additionally, an Enzyme-linked immunosorbent assay (ELISA) was utilized to measure the levels of IgG tTG in a validation study that included 43 neonates with NEC and 20 gestational age- and weight-matched controls. Results: The autoantibody microarray analysis indicated that plasma levels of IgG tTG were significantly higher in neonates with NEC compared to controls ( P< 0.001). ELISA confirmed the significant elevation of plasma IgG tTG in neonates with NEC ( P<0.001). Plasma IgG tTG were able to distinguish NEC from the control group, with an area under the curve (AUC) of 0.8674 (95% confidence interval (CI): 0.7794 - 0.9555, sensitivity of 72.09% and specificity of 95%). Encouragingly, IgG tTG levels were significantly higher in NEC stage I than in the controls ( P < 0.001). Furthermore, as neonates with NEC showed clinical improvement, the levels of IgG tTG decreased ( P=0.0159). Conclusion: IgG tTG may serve as a biomarker for diagnosis early NEC and predict its prognosis.

Letter to the EditorComment on: van der Rijst LP et al

Objective: This study aimed to describe the evolution of pressure ulcers (PU) in older patients treated with an ointment containing cod liver oil and lanolin. Materials and Methods: A one-year prospective observational study was conducted on patients with stage 1 and 2 PUs who were admitted to an adult hospital. The ointment was applied once daily on the heels or twice on the sacral areas. Data on age, sex, PU location, stage, and risk assessment using the Braden scale were collected. The PUSH and RESVECH scales were used to assess the PU evolution. Results: Twenty-six patients with 35 PUs were included in this study. The treatment led to a daily reduction of PUSH=0.89 and RESVECH=0.62 for sacral areas, and PUSH=0.97 and RESVECH=0.77 for heel areas. While patients with diabetes exhibited a slower rate of reduction in both PUSH and RESVECH scores than non-diabetic patients, they still demonstrated a favorable evolution with the treatment. In addition, the use of air mattresses improved healing. Complete healing was achieved in 4 sacral cases, with an average treatment duration of 6.00 ± 5.66 days for stage 1 and 7.5 ± 0.71 days for stage 2. Similarly, 12 heel PUs healed with an average treatment duration of 7.63 ± 3.42 days for stage 1 and 13.25 ± 1.26 days for stage 2. Conclusion: Our results suggest that cod liver oil and lanolin-based ointment may be effective for treating stage 1 and 2 PUs in older patients, with potential benefits, including faster healing rates, particularly in conjunction with air mattress use.

INTRODUCTION:The cerebellopontine angle is a triangular space located behind the pyramid, just below the tentorium, anterior to the pons, and ventral to the cerebellum. It is formed by the top and bottom extremities of the cerebellopontine rupture. The CPA consists of the CPA cistern and contains the trigeminal, adductive, facial, and vestibulocochlear nerves, the cerebellar above and anterior cerebellar arteries below the cerebellum flocculus and the choroidal plexus that sticks out from the Lustra foramen.1 CPA tumors make up 5–10 percent of all intracranial neoplasms2,3 A most common vestibular schwannomas accompanied by meningiomas and tumors of the epidermis. Certain cranial nerves, glomus jugular tumors, cavernomas, and congenital, renal, and metastatic lesions are rare primary CPA lesions. Tumors from adjacent structures-gliomas, ependymomas, choroid plexus papilloma, and vascular malformations involve the CPA secondarily.4 CPA is a region between the pons & cerebellum and the lateral portion of the temporal petrous bone, 5th, 7th & 8th cranial nerves & AICA Important structures of the CPA include most CPA lesions.5

A document by Nils Freitag. Click on the document to view its contents.

Background Over the past 30 years the prevalence of atopic diseases has been increasing worldwide, especially in developed Western countries. It is not known if the prevalence of atopic diseases in the Netherlands has continued to rise, decreased, or plateaued since 2014. We aimed to determine the incidence and prevalence of childhood atopic dermatitis, asthma, allergic rhinoconjunctivitis, and the atopic triad in primary care. Methods A retrospective cohort study within the Rijnmond Primary Care Database consisting of electronic primary care health records. Results Between 2013-2021 22,123 children were available for analysis. The prevalence rate for atopic dermatitis was 8.4 per 100 patient years (PYs); for asthma 4.2 per 100 PYs; and for allergic rhinoconjunctivitis 5.3 per 100 PYs. The average prevalence of the atopic triad was 0.22 per 100 PYs. Median age of disease-onset and peak prevalence for atopic dermatitis was at three years for both outcomes; for asthma at nine and seventeen years; and for allergic rhinoconjunctivitis at 10 and 17 years, respectively. Conclusions Atopic diseases are prevalent among the childhood primary care population of Rijnmond and we observed increasing incidence and prevalence rates for allergic rhinoconjunctivitis. Atopic dermatitis had its peak prevalence at the youngest age, and is followed by asthma and allergic rhinoconjunctivitis. Further, we found a significant sex disparity for all atopic diseases.

Delayed diagnosis of Granulomatosis with Polyangiitis in a 39-year-old woman with situs inversus totalis: A Case Report   Authors: Hanie Forouzandeh¹Ahmadreza Rajabi¹, Abbas Ali Torfeh Esfahani², Farzin Khorvash², Mansoor Karimifar³  Affiliations: ¹ School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. ² Department of Infectious Diseases and Tropical Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. ³ Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.Corresponding author: Abbas Ali Torfeh Esfahani Department of Infectious Diseases and Tropical Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Email Address: abas1793@gmail.com Full postal address: P.O. Box 791 – Al-Zahra Hospital – Soffe St. – Isfahan - Iran Tel: (+98) 31-36202086 https://orcid.org/0000-0002-4950-5806-haniforouzandeh80@gmail.com Ahmadreza Rajabi : https://orcid.org/0009-0002-7584-9124-ahmadrezarajabi96@gmail.com Abbas Ali Torfeh Esfahani : https://orcid.org/0000-0001-9713-1549-abas1793@gmail.com Farzin Khorvash : https://orcid.org/0000-0003-2542-9885-khorvash@med.mui.ac.ir Mansoor Karimifar: https://orcid.org/0000-0003-4688-991X-karimifar@med.mui.ac.irCompliance with Ethical Standards Data availability statement: Data sharing is not applicable to this article as no new data were created or analyzed in this study.Funding statement: None.Conflict of interest disclosure: None.Ethics approval statement: not applicable.Patient consent statement: Written informed consent was obtained from all individual participants included in the study.Permission to reproduce material from other sources: not applicable.Clinical trial registration: not applicableAuthor Contributions Hanie Forouzandeh: Writing – original draft, Data curation, study design, Supervision, Project administration Ahmadreza Rajabi: Writing – original draft, Data curation Abbas Ali Torfeh Esfahani: Supervision, Writing – review & editing, Conceptualization, Project administration Farzin Khorvash: Writing – review & editing, Conceptualization Mansoor Karimifar: Writing – review & editing, ConceptualizationAcknowledgments Conflict of interest All the authors have declared no competing interests.Human and Animal Rights This article does not contain any studies with human participants or animals performed by any of the authors.Informed consent Informed consent was obtained from all individual participants included in the study. Author’s contribution All authors contributed to the study design, data collection, and writing the draft of the study. All read and confirmed the final version of the manuscript.AbstractSitus inversus totalis (SIT) is a rare congenital condition characterized by the transposition of both abdominal and thoracic organs. Individuals with Situs inversus totalis (SIT) may also have Kartagener syndrome, which is characterized by a triad of situs inversus, bronchiectasis, and recurrent sinusitis. Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is a rare condition. GPA involves granulomatous inflammation in tissues and blood vessels, potentially leading to organ damage. To date, no cases of Situs inversus totalis (SIT) individuals with Wegener’s granulomatosis have been reported in the literature. Our study aims to report a case with misleading information in medical history, leading to a delayed diagnosis of Granulomatosis with polyangiitis (GPA). Keywords: situs inversus totalis, Kartagener syndrome, Granulomatosis with polyangiitis, Wegener’s granulomatosiskey clinical message: The main clinical point in this article is being aware of all possible differential diagnoses despite all misleading data on the patient’s history. It is also very interesting that we have a patient who has a rare congenital condition with a diagnosis of a rare disease.IntroductionSitus inversus totalis (SIT) is an extremely rare congenital condition characterized by the transposition of both abdominal and thoracic organs. This rare condition occurs in approximately 1:10,000 individuals(1). Even most professional surgeons may encounter only 1 to 2 cases throughout their entire career(2). Typically, these cases are discovered incidentally during medical procedures or imaging tests(3). Sometimes these people have Kartagener Syndrome which is defined by a triad of situs inversus, bronchiectasis, and recurrent sinusitis(1). Granulomatosis with polyangiitis (GPA), also known as Wegener’s granulomatosis, is a rare condition with an unknown cause. It affects approximately 3 in every 100,000 people and typically occurs around the age of 45 in both males and females. Granulomatosis with polyangiitis (GPA) is characterized by inflammation in the tissues, known as granulomatous inflammation, as well as inflammation in the blood vessels (vasculitis), which can lead to organ damage. While the sinuses, lungs, and kidneys are the most commonly affected areas, GPA can impact any part of the body(4).We herein present a patient with situs inversus totalis who has been diagnosed with GPA (Wegener’s granulomatosis) at Alzahra Medical & Educational Center \RL of Isfahan.Case presentationWe present a case of a 39–year–old woman with situs inversus totalis and a previous history of Kartagener syndrome and hypothyroidism. She came to the emergency department with intermittent petechiae and purpura in her lower limbs and intermittent high-grade fever and true chills from 3 months ago. She was giving a history of traveling to the Malaria-endemic region. Rashes and fever started right after her trip. She was giving a history of mild weight loss, nausea, and vomiting. Vital signs demonstrated a fever of 38.5°C, blood pressure (BP) 95/60, pulse rate (PR) 100, respiratory rate (RR) 24, and O2sat 88%. In the physical examination, we found a mild crackle in lung auscultation. Rashes were non-blanching. Laboratories were remarkable for leukocytosis of 14.05 with left shifting and thrombocytosis of 535. ESR was 101 and CRP was 88. Serum creatinine was 1.4 at first and then rose to 1.7 in three days. CXR showed evidence of mild infiltration in the lower lobe of the left lung and mild pleural effusion on the left side (Figure1). We tapped the pleural effusion. It had an exudative pattern in analysis. With a suspicion of Malaria, we performed PBS but it didn’t confirm Malaria. We requested blood culture, sputum culture, wright test, PPD skin test, Widal test, and viral markers, which all were negative. U/A was remarkable for protein (++), blood (+++), RBC (many, 40% dysmorphic), and granular casts (1-2). Urine culture was negative. The stool exam was normal and the stool culture was negative. Endoscopy was performed for continuous nausea and vomiting and food intolerance, too. It showed erosive gastropathy. We also ruled out endocarditis with a normal echocardiography with no evidence of vegetation. Then we changed our approach from infectious diseases that were related to her travel, to rheumatologic diseases. So, we requested rheumatologic tests, and C-ANCA (Anti PR3) and ANA and RF were positive among them (The results are in Table1). We also performed a Chest M.D.C.T that showed cystic bronchiectasis(Figure2), mild infiltration in the lower lobe of the left lung, and mild pleural effusion on the left side (figure3) and we did a normal Abdominal M.D.C.T Scan.Differential diagnosis:Differential diagnoses of fever and rash included infectious diseases like mononucleosis, Meningitis, Endocarditis, Malaria, Dengue fever, Scarlet fever, malignancies like Lymphoma, or autoimmune diseases like Vasculitis, SLE, and Still’s.Treatment plan:At first, we had started antibiotics for her because of our suspicion of infectious diseases but she had a fever for the next 3 days despite antibiotic therapy, then after the positivity of autoimmune tests, we changed our treatment. First, the patient was started on three consecutive pulse doses (1gr) of Methylprednisolone Sodium Succinate then she received 1gr Rituximab, and this dose was repeated fourteen days later. We continued her therapy with a Prednisolone Tab (10mg/three times a day), Azathioprine Tab (daily), and Calcium D Tab (daily). Then a month after the second dose of Rituximab, we increased the dose of Azathioprine Tab to 50mg twice a day and we slowly tapered Prednisolone. This is important to mention that we chose Rituximab among other common treatments because the patient was of reproductive age and treatments like Cyclophosphamide could lead to infertility. We also added Cotrimoxazole 400/80mg Tab for prevention of Pneumocystis Carinii.Follow up:To date when we write this report, the patient’s signs and symptoms are improved. Serum creatine decreased to 1.3 and urine analysis turned to normal.DiscussionAntineutrophil cytoplasmic antibody ANCA-associated vasculitis (AAV) encompasses a group of multisystem disorders that cause inflammation in the small blood vessels. This group includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA)(5)\RL. As described in the classification criteria for granulomatosis with polyangiitis, PR3-ANCA is most frequently linked with granulomatosis with polyangiitis (GPA), but MPO-ANCA is more prevalent in microscopic polyangiitis (MPA)(6)\RL. Advances in the diagnosis and treatment of ANCA-associated vasculitis (AAV) have significantly improved outcomes, changing it from a rapidly fatal disease with an untreated 1-year mortality rate of 80% to a condition that has relapsing and remitting episodes, albeit with ongoing morbidity and mortality in the long term. Pulmonary complications, both acute and chronic, are common in ANCA-associated vasculitis (AAV), affecting 25% to 80% of cases according to references. Lung involvement is increasingly recognized as a key contributor to the persistent morbidity and mortality in ANCA-associated vasculitis (AAV), with early pulmonary manifestations being linked to severe organ damage and poor outcomes in GPA(6)\RL.Conclusion Although there are few articles about the association between ANCA-associated vasculitis (AAV) and pulmonary involvements such as bronchiectasis(6), there is no published article about situs inversus individuals with GPA or association between Kartagener syndrome and ANCA-associated vasculitis (AAV). Additionally, our case had a history of traveling to malaria-endemic regions, which misled us in our approach to limb petechiae and fever and it made our case more noteworthy to report. However, further tests led to the diagnosis of ANCA-associated vasculitis (AAV).

This paper provides a review of research on robotics in search and rescue operations in caverns, underground coal mines, disaster zones, and environments where the Global Navigation Satellite System (GNSS) is unavailable. The majority of applications for Simultaneous Localization and Mapping (SLAM), despite its maturity, are still restricted to indoor structured scenes or outside conventional weather conditions. The standard SLAM technology will experience malfunctions and perhaps fail as the robot encounters increasingly complicated environments. Three main issues that robots encounter in search and rescue (SAR) environments are outlined in this review, along with an introduction to the classic SLAM framework and a range of sensors used for SLAM. These issues include robots encountering increasingly complex terrain, changing environments and visibility, and autonomous exploration requirements. A thorough analysis of methods for resolving these problems is also included; they include multi-sensor fusion, active SLAM, and SLAM on uneven terrain. Also, a prospective path for future study is presented.

A hybrid depth neural network model is proposed to predict the drillability to increase the drilling speed and reduce the drilling cost. The drillability of rocks can directly reflect the difficulty of drilling in the formation. The prediction effects of CNN(Convolutional Neural Network)-BiGRU(Bidirectional Gated Recurrent Unit)-attention, CNN-BIGRU, and CNN-GRU-attention models on the evaluation indexes of rock drillability before and after adding rock properties were compared, finally, the CNN-BiGRU-attention model with better effect was selected. The model extracts the features of the data through CNN, then the data is processed by the BIGRU for time series features to establish a long-term dependency on the features. Finally, the Attention mechanism is introduced to focus the data to improve the accuracy of the model prediction. The coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE) were used as the evaluation parameters of the model. The results show that the prediction accuracy of the deep neural network model is improved by 0.06, 0.08, and 0.1 when the formation properties are added as input parameters to the model. The results show that the physical properties of the rock have an important effect on the drillability of the formation. Therefore, taking the rock properties as the input of the model can improve the accuracy of the model, and the CNN-BIGRU-Attention model has a good effect. It is believed that this method can be popularized in areas similar to this formation and is conducive to guiding the block to improve drilling efficiency.

The paper focuses on the simulation and testing of a hybrid solid desiccant vapor compression air conditioning system under different hot-humid climates. The simulation is carried out by a BLUEJ programming framework. Air at the lowest achievable air temperatures from a solid desiccant cooling system is supplied to a standard vapor compression air conditioning system. The cooling capacities of the hybrid system under three modes indicating different supply air conditions to the cabin, are reported in the paper. From the performance study, it is inferred that the hybrid system provides significant energy savings compared to a standard air conditioner, especially in hot-humid ambient conditions. The solid desiccant cooling system thus establishes itself as an effective pre-cooler unit to a standard vapor compression air conditioning system.

Subserosal Ectopic Pregnancy: A Rare Case ReportAhmed Sabry 1,2, Gamal Sayed 3,4, Reda Youssef, 1,2,3, Samah Kohla 2,5, Sana Badr 1, Hashem Alakshar 1, Thomas Farrell 4, and Amal Alobaidly 1.1-Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar2- Weill Cornell Medical College, Doha, Qatar.3- Clinical Department, Qatar University, College Of Medicine, Doha, Qatar4- Department of Obstetrics & Gynecology, Women’s Wellness and Research Center, Doha, Qatar5- Department of Laboratory Medicine and Pathology, Hematology Division, Hamad Medical Corporation, Doha, Qatar

“Reimagining Pain Management: SZM Nerve Block in Pediatric Adenotonsillectomy”Dear Editor! With approximately 289,000 procedures performed in 2010 alone, adenotonsillectomy is one of the most common surgeries among the pediatric patient population (1). Despite its reputation for favorable perioperative outcomes, a substantial body of research indicates that adenotonsillectomy is also one of the most painful pediatric surgeries (2). The current insufficient and potentially unsafe treatment options for managing postoperative pain after adenotonsillectomy compel patients to resort to high doses of opioids, posing long-term adverse effects. In this critical context, suprazygomatic maxillary (SZM) nerve block, an intricate anesthetic technique, emerges as a promising solution.An SZM nerve block is a regional anesthesia technique predominantly employed to provide analgesia for surgeries involving the midface, such as procedures on the maxillary sinus, upper lip, and upper teeth. This anesthetic nerve block targets the maxillary nerve (V2), which is the second branch of the trigeminal nerve (cranial nerve V).A recently published randomized clinical trial in JAMA Otolaryngology-Head & Neck Surgery evaluated the SZM nerve block for patients undergoing adenotonsillectomy. This first-of-its kind, groundbreaking trial demonstrated that SZM block was effective in minimizing postoperative pain and significantly reducing postoperative opioid consumption (3). Furthermore, the SZM nerve block also had a higher opioid-free postanesthesia care unit (PACU) stay compared with placebo, reflecting its efficacious impact on postoperative opioid utilization (3). These findings are corroborated by a case report by Smith et al., which showed clinically meaningful analgesic benefit from SZM nerve block for adenoidectomy and tonsillectomy, as the patient did not require any postoperative opioid drugs (4).Opioids remain a major part of postoperative pain management for pediatric patients after adenotonsillectomy. However, the black box warning and contraindication statements from the US Food and Drug Administration stress that opioids are known to result in serious postoperative consequences, including respiratory depression and even death (5). The SZM nerve block offers a highly effective and safe alternative for managing postoperative pain in these patients. To fully establish if the SZM nerve block is the silver bullet for opioid-free postoperative pain management, more clinical trials with larger patient populations are required. Adopting this technique could address the urgent need for safer pain management methods in pediatric surgery, as well as improve recovery outcomes and patient safety.Keywords: adenotonsillectomy, suprazygomatic maxillary nerve block, opioids, analgesiaDisclaimer: None to declareConflict of Interest: None to declareFunding Disclosure: None to declareREFERENCESHall MJ, Schwartzman A, Zhang J, Liu X. Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010. Natl Health Stat Report. 2017 Feb;(102):1-15. PMID: 28256998.Persino PR, Saleh L, Walner DL. Pain control following tonsillectomy in children: A survey of patients. Int J Pediatr Otorhinolaryngol. 2017 Dec;103:76-79. doi: 10.1016/j.ijporl.2017.10.016. Epub 2017 Oct 7. PMID: 29224770.Lin C, Abboud S, Zoghbi V, Kasimova K, Thein J, Meister KD, Sidell DR, Balakrishnan K, Tsui BCH. Suprazygomatic Maxillary Nerve Blocks and Opioid Requirements in Pediatric Adenotonsillectomy: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2024 May 23:e241011. doi: 10.1001/jamaoto.2024.1011. Epub ahead of print. PMID: 38780948; PMCID: PMC11117150.Smith L, Balakrishnan K, Pan S, Tsui BCH. Suprazygomatic maxillary (SZM) nerve blocks for perioperative pain control in pediatric tonsillectomy and adenoidectomy. J Clin Anesth. 2021 Aug;71:110240. doi: 10.1016/j.jclinane.2021.110240. Epub 2021 Mar 20. PMID: 33756446.FDA updates safety review of codeine use in children; new Boxed Warning and Contraindication on use after tonsillectomy and/or adenoidectomy. FDA; [cited 2024 Jun 3]. Available from: https://www.fda.gov/science-research/pediatrics/fda-pediatric-safety-communications

Recent national guidelines have highlighted the safety of day-case tonsillectomy. This study evaluates the outcomes of paediatric tonsillectomy at a UK tertiary centre during the COVID-19 pandemic. A retrospective analysis was conducted on patients <18 years who underwent tonsillectomy between April 2021-September 2022. Data on post-operative events until discharge and re-attendance within 14 days were recorded. High-risk subgroups were analysed: Subgroup A (aged 2 and weighing 12-15 kg) and Subgroup B (severe OSA on polysomnography). Binary logistic regression assessed whether age, weight, sex, or procedure time predicted extended hospital stay (>1 night) or need for oxygen. A total of 117 patients underwent tonsillectomy, median age 4 (62% male). OSA/SDB accounted for 88% and 68% had a pre-operative sleep study. Same-day discharge rate was 26%. Post-operatively, 86 patients were admitted; 44 required overnight oxygen saturation monitoring, 35 for weight extremes and 7 for poor oral intake. Of those admitted, 70 (81%) remained well overnight, and 76 patients (88%) were discharged the next day. In Subgroup A (n=17), average weight was 13.4 kg; two had transient desaturations. Fourteen were discharged the next day. In Subgroup B (n=34), four had transient desaturations with a further two requiring oxygen. Weight (p=0.071) and procedure time (p=0.052) approached significance for predicting outcomes. This study offers early insights into paediatric tonsillectomy outcomes during the COVID-19 pandemic at a tertiary centre. Although the same-day discharge rate was lower than the national average, most patients, including high-risk groups, remained clinically stable and were discharged within 24 hours.

Plants are naturally affected against wide range of human diseases. They were used from ancient times for several purposes including cooking, preserving food, for treating a wide range of health conditions including cold, dysentery, anemia, wound heeling, curing insect bites and injuries. Nowadays people prefer products derived from natural sources more then products that are made from chemical methods. The plant Ocimum basilicum has a very range of health benefits including its potency to cure several skin conditions. This study aims to develop ,evaluate ,and determine the effectiveness of the herbal ointment made from Ocimum basilicum without alcohol and bees wax, using chea butter as thickening agent with the main focus on determining its outcome on common dermatological conditions such as acne(bacterial infection),eczema, inflammation, minor cuts, scrape wound. The prepared ointment was then evaluated for physiochemical characteristics including safety assessment of skin and stability tests. Then In Vivo experiments were carried in a group of volunteers including teenage and adults(two boys and three girls) skin, it reduced redness, inflammation and cured acne. The results showed the wound heeling ,anti-inflammatory and anti-bacterial activity of this ointment .In conclusion ,no adverse reaction of this ointment was observed on skin , The thorough evaluation of this ointment has confirmed its anti-bacterial activity because of its ability to kill bacterial strains causing acne. Further research is needed for its commercial usage and clinical trials to use for Post surgery wounds, serious bacterial and fungal infections.