Recent Articles

Pediatric cancer overall survival has increased due to improvements in treatment. However, long-term adverse effects are a challenge for this population. Secondary myeloid neoplasm (MN) is one of the complications of solid tumor treatment. Therapy-related myeloid neoplasms (t-MN), therapy-related acute myeloid leukemia (t-AML), and therapy-related myelodysplastic syndrome (t-MDS) are the most common events. The aim of this study was to report a large pediatric sample and the relevance of t-MN after pediatric solid tumor therapy. We conducted a retrospective study between 2000-2016 in a cohort of pediatric patients treated for solid tumors who developed a secondary MN by medical records review and analysis. Seven from 2178 pediatric patients who were previously treated for solid tumors, were diagnosed with t-MN in a reference cancer center in Brazil. The median age at primary tumor diagnosis was 12.8 years old. Osteosarcoma, atypical primitive neuroectodermal tumor (PNET), Ewing sarcoma, and retinoblastoma were the most frequent solid tumors associated with t-MN. Three patients had a story of familiar cancer, and one patient with osteosarcoma had Li-Fraumeni syndrome confirmed. The median latency period to secondary MN was ten months and the prevalence rate was 0.32%. Two patients developed t-MDS and five, t-AML. All these patients received cytotoxic agents’ high doses that may have been associated with t-MN development. t-MN initial control, as well as unfavorable cytogenetic abnormalities, may have contributed to the poor outcome. We described the rarity of t-MN related to previous solid tumor therapy in a large pediatric sample in a Brazilian Cancer Center and their poor prognosis.

Non-exhaust road transport emissions, particularly tyre-pavement abrasion, contribute to poor air quality. This original work is on particle emissions caused by tyre-pavement abrasion in real driving conditions in urban, suburban and motorway areas. The collected data were analyzed according to the size, the number and chemical identification. Multivariate analysis provided clusters of size and chemical elements. Results showed the predominant particles (diameter φ < 1 μm and φ ε]1-2 μm]) for urban and suburban experiments, and ]1- 3 μm] on motorways. A confirmed shift phenomenon at the close-to-the-source showed particles of large sizes [5- 10 μm]. The obtained clusters were: 1. Aluminosilicate, iron compounds, silicate free of aluminum (70%). 2. Ferrosilicon, silica, compounds of calcium, manganese, iron oxide, compounds of aluminum, sulfur, copper and zinc (29%). 3. A mix of various traces (1%). This paper will contribute to the development of new green technologies dedicated to improving sustainable road transport.

In order to successfully counter the ever-growing drug problem, there is an increasing need, to identify conspiracy links and trafficking routes and to gather background intelligence concerning both the number of sources of drugs and whether those sources are within a country or are “internationally” based and also the points of distribution and distribution networks. A scientific tool to complement routine law enforcement investigative work in this field is the characterization and impurity profiling and cutting agents of seized drugs. Drug characterization studies have shown that it is possible to link samples, to classify material from different seizures into groups of related samples and to identify the origin of samples. Such information can be used for evidential (judicial, court) purposes or it can be used as a source of intelligence to identify samples that may have a common origin or history.

The Aims: The retro-prospective clinical study was to compare these two methods of laparoscopic and classical cholecystectomy. To prove the postoperative benefits of laparoscopic treatment are, less pain, aesthetic aspect without surgical scarring and shorter hospital stay, faster return to social activities as well as more cost effective. Material and Methods: The operated patients, from January 2017 to December 2019 in the abdominal surgery ward in Gjilan. Important data for the study are taken from the operative list, history of the disease, adequate list compiled specifically for this study. The study included 389 patients with chronic calculous cholecystitis. Results: According to the results obtained for calculous diseases of the biliary system are predisposed persons with blood group O, Rh-positive, with 44.2%, followed by group A + with 29.5%, group B + with 14.7%. Other blood groups and Rh factors are below 6.5%. Statistical point of view is significant (p 6, while 23.1% of males. The percentage difference in statistical terms is significant p

Background: Primary hyperparathyroidism (PHPT) is a frequently diagnosed endocrine disease and nowadays it is asymptomatic in the majority of patients. The management of asymptomatic PHPT is still debated in some cases, although there are evidences that asymptomatic patients may have improved outcomes after curative surgery. In this paper we show one of the longest follow-ups of surgically treated asymptomatic PHPT, focusing on skeletal long-term effects of surgery. Methods: We included in the study 21 patients that underwent parathyroidectomy for asymptomatic PHPT at our Institution from 2006 to 2010 with a complete follow-up at 10 years. Data about age, BMI, preoperative serum and urinary calcium, vitamin D, alkaline phosphatase parathormone, bone densitometry, surgical procedure and histological examination were collected and analyzed. Results: At follow-up we observed a normalization of PTH, serum calcium and alkaline phosphatase in all patients. Moreover, in all cases the T-score at 1 year increased significantly both at lumbar spine and femoral neck and this is maintained at long-term follow-up. Conclusions: Parathyroidectomy can be proposed as a safe therapeutical option in the majority of cases of asymptomatic PHPT considering the good results of surgery in terms of bone demineralization reduction

Data on illness in preterm infants due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is limited. Duration of viral shedding and treatment options including use of dexamethasone to treat SARS-CoV-2 pneumonia in preterm newborns are scarce and not-well reported. We are reporting SARS-COV-2 positive sick preterm twins vertically infected from SARS-COV-2 positive unvaccinated mother. Twin B initially tested negative at 24 & 48 hours of life (HOL) but subsequently tested positive at 72 HOL and developed SARS-COV-2 pneumonia and required a longer duration of respiratory support. We treated her with 10 days of dexamethasone and noted a good clinical response. To our knowledge, we are first to report the use dexamethasone in a premature newborn with SARS-COV-2 pneumonia. Additionally, the duration of viral shedding in both Twin A and Twin B was between 4-5 weeks.

Autoimmune Myasthenia gravis is a neuromuscular junction disease caused by destruction of the acetylcholine receptor on the postsynaptic membrane, mediated by autoantibodies and clinically characterized by skeletal muscle weakness. This can be triggered by drugs, infections, and in rare cases by vaccines. During the COVID pandemic, de novo cases and exacerbations of myasthenia gravis due to viral infection have been documented. Although few cases related to COVID vaccination. A 69-year-old female patient with blurred vision, a clinic that began 10 days later after receiving first dose of COVID vaccine, and diplopia and right palpebral ptosis after the second dose, 30 days later. In the examination, Edrophonium test was clearly positive, treatment with pyridostigmine and prednisone was started and after 14 days the clinic showed improvement until the resolution of the symptoms There are few reports of exacerbations or triggers for the appearance of myasthenia gravis, a series of 27 cases has been published where there are outbreaks of immune-mediated diseases or the new appearance of autoimmune diseases, in which it is observed that the time of appearance of the outbreak was on average 4 days up to a maximum of 25 days. In conclusion, Myasthenia gravis is a rare complication of the BNT162b2 COVID-19 vaccine. Its potential severity and the current lack of knowledge of the real incidence after vaccination makes it necessary to maintain an attitude of vigilance in the face of symptoms that suggest it.

Overweight and obesity continue to be health-related issues in Alabama Black-Belt Counties with rates ranging from 35 to 48%. We aimed to determine the impact of a web-based nutrition education and physical activity intervention on participants’ health in Alabama Black Belt counties during the COVID-19 pandemic. Nutrition education was delivered to participants through a zoom online platform for 12 weeks. Participants’ knowledge, attitudes, and practices as well as changes in nutrition knowledge, anthropometry, and blood pressure were determined through online surveys. Of the participants, (100%) indicated that overweight and obesity are a result of unhealthy lifestyles, whereas 90.7% reported that obesity increased the risk of high blood pressure (90.7%), diabetes (86.04%), and heart disease (90.7%). Results showed that participants’ income was a significant determinant of their perception for the role of schools in fighting obesity (χ2=0.04). Similarly, data revealed that the age of participants was a significant factor for: their desire to learn more about obesity (χ2=0.04), perception of their knowledge of overweight and obesity compared to the average person (χ2=0.01), and the perception that they had an excellent knowledge of overweight and obesity (χ2=0.05). There were significant improvements in knowledge scores. Results showed a significant decline in waist circumference (p

Background: In Multiple Sclerosis, more efficient disease modifying treatment (DMT) are often accompanied by higher risks and side effects. Selecting the optimal DMT demands from patients and doctors therefore a complex decision-making process weighing risks and benefits. Patients and doctors often prefer to share responsibility when making these treatment decisions, but this shared decision-making model requests decision-making competence on both sides. The aim of our online study was to investigate whether patients’ decision-making competence relates to DMT selection. Method: 197 patients participated in the online survey, advertised by two patient organizations. Patients reported their DMT and who decided for or against a DMT: their neurologist, themselves, or both. We measured decision-making competence with two tasks from the Adult Decision-Making Competence Battery (A-DMC), the ability to follow decision rules and the consistency of risk perception. Perceived impairment of the disease was measured with Patient Determined Disease Steps (PDDS). Results: The ability to follow decision rules varied with the potency of the DMT. Patients receiving basic DMT were better able to follow decision rules compared to patients receiving medium DMT. Patients who did not take any DMT stated more frequently that this decision was their own choice and independent of their doctor’s advice. Conclusions: If patients without DMT decided against this treatment on their own behalf, doctors and caregivers potentially have to strengthen their effort to reach out to the patient and to ensure the decision is well taken.

Minor salivary glands are present in most parts of the mouth. They are the important components whose secretion directly bathe the tissues of the oral cavity. Smoking is the most commonly seen deleterious habit among men which directly affects minor salivary glands in the palate. Smoking also causes stomatitis nicotina in the oral cavity.

Backgrounds: Neurolathyrism is a disease, which is linked with the consumption of Lathyrus sativus ( L. sativusi) pulse that contain the neurotoxin-beta-N-oxalyl-L-alpha-beta-diamino propionic acid (beta-ODAP). Patients with Lathyrisum suffer with gradual enhancement in spasticity and bony changes, which are responsible for appearing the crippling condition throughout life. Objective: The present study has been done as to establish the present situation of L. sativusi consumption and Lathyrisum. Materials and Methods:We performed the survey in the village of Mohammadabad Block of Gazipur district in Eastern Uttar Pradesh (a state with maximum population in India) which have population of million, and L. sativusi is the main pulse of the year, which sustains the economy of these populations. Results:Out of 21,234 subjects L. sativusi eating population for more than 10 years, none had Lathyrisum. On contrary, to popular belief, this population enjoys various dishes made by L. sativusi pulse which in popular are local delicacy. Conclusions:There is no evidence of L. sativusi causing Lathyrisum in 2021. On contrary, L. sativusi pulses have become an inheriting part of the food habits in these populations.

Hyperglycaemia is a key symptom in diabetes mellitus associated with long term damages, dysfunction and eventually failure of organs, especially the eyes, kidneys, nerves, heart and blood vessels. This study is to evaluate the hypoglycaemic potential of orally administered aqueous and ethanol extracts of Zyziphus spina-christ fruit on alloxan induced hyperglycaemic Wistar rats. The plant was extracted using maceration using aqueous and 80% ethanol as extraction solvents. Qualitative phytochemical analysis was done. An in vitro assessment of both aqueous and ethanol extract to demonstrate hypoglycaemic activity via inhibition of alpha amylase enzyme and alpha glucosidase enzymes were done. Total of 45 albino rats were used in the study of both sexes divided in 9 groups. Group 1: normal control group, group 2: diabetic control group, group 3: positive control group (metformin 300mg/kg), group 4-6: (150mg/kg, 300mg/kg and 600mg/kg) aqueous extract and group 7-9: (150mg/kg, 300mg/kg and 600mg/kg) ethanol extract. Groups were compared using one way ANOVA for significant differences and Dunnet’s posthoc test was deployed were differences exit. Data were represented as mean ± SEM and p value

Objective: To determine the prevalence of minority drug resistance variants in the protease and Gag regions among patients failing a protease inhibitor (PI) based regimen with or without a susceptible genotype based on Sanger sequencing technology. Methods: Samples were obtained from patients who were failing on a protease inhibitor-based regimen (n = 500). Sanger based sequencing was performed as part of the standard of care. Mutation analysis was performed using the Stanford HIV drug Resistance database. A subset of these patient samples was grouped into two categories: those failing a PI based with mutations in the protease region (n = 100) and those failing on a PI based regimen without mutations in the protease region (n = 128). These samples were then analyzed in the protease and Gag regions using Next Generation Sequencing (NGS) technology and analysis of the drug resistance mutations was performed at the 20% and 1% cutoffs. Results: An initial analysis of the protease region for patients failing with drug resistance mutations revealed that most patients harbored mutations that confer resistance to Lopinavir and Atazanavir, but these mutations had little effect on Darunavir. Furthermore, NGS revealed that in patients failing with and without drug resistance mutations, minority drug resistance mutations were present at each of the drug resistance codons and at codons that confer multi-drug resistance to protease inhibitors. Further analysis of the Gag gene revealed more genetic diversity among patients failing with no mutations in the protease as evidenced by the proportion of polymorphisms at each codon. Conclusion: Based on Sanger sequencing, a proportion of patients fail a PI based regimen with a susceptible genotype. However, these patients harbor minority variants in the protease and numerous polymorphisms in the Gag region which when combined these could explain their poor response to therapy. Therefore, in order to improve patient care in low resource settings, there is need to adapt NGS as the standard genotyping technique so that minority variants are captured much earlier. In addition, since mutations in the Gag region also play a role in response to PIs, this region should be included in the routine monitoring for response to therapy in patients on a PI based regimen.

An internist with an eagle’s eye can diagnose many hidden diseases through careful examination. One such hereditary metabolic disorder is Albright’s Hereditary Osteodystrophy (AHO). Characteristic presentations in an individual affected by AHO were short stature, obesity, mild mental retardation and brachydactyly especially of 4th and 5th digits, which are the phenotypic features of genetic mutation. Pseudohypoparathyroidism (PHP) is characterized by inability of the body to respond appropriately to parathormone, mainly characterized by hypocalcaemia, increased serum parathormone concentration, insensitivity to the biological activity of parathormone and hyperphosphatemia. AHO when seen in association with resistance to parathormone (PTH), it is called PHP. Here is a case report of 22-year-old female patient with AHO with distinctive physical characteristics who presented to us with recurrent hypocalcaemic tetan

Diagnosis and choice of therapeutic rational tactics in patients with closed pancreatic injuries still remain and actual problem of urgent abdominal surgery. The results of treatment of 70 patients with pancreatic injuries being treated in a surgical department of RSCUMA of Uzbekistan Public Health and its branches during 2009-20021 with analyzed. Intraoperative inspection of omental bursa is still a single reliable method to reveal injuries to the pancreas. Depending on the character and localization the differ following kinds of surgical treatment of pancreatic injuries were used: based on adequate drainage of the impaired zone; removal of lifeless pancreatic tissues; restoration of passage or rational derivation of pancreatic juice. It is necessary to underline that in all cases of pancreatic injuries antisecretory, antianzymatic, antibacterial and desintoxicating therapy must be carried out.

Dengue is a prevalent arthropod-borne viral disease in tropical and subtropical areas of the globe. Dengue clinical manifestations include asymptomatic infections; undifferentiated fever; dengue fever, which is characterized by fever, headache, retro orbital pain, myalgia, and arthralgia; and a severe form of the disease denominated dengue hemorrhagic fever/dengue shock syndrome, characterized by hemoconcentration, thrombocytopenia, and bleeding tendency. However, atypical manifestations, such as liver, central nervous system, and cardiac involvement, have been increasingly reported called expanded dengue syndrome. The renal complications of dengue virus infection cover a wide spectrum of manifestations from acute kidney injury to glomerular injury with nephritic/nephrotic syndrome. Majority of cases remain symptom free and show full recovery. We report a 55 years old lady with atypical and rare presentation of dengue disease marked by rapidly progressive glomerulonephritis. Condition improved after initial 5 days pulse methylprednisolone followed by oral prednisolone therapy and mycophenolate mofetil. The main mechanism of dengue glomerulonephritis is still unknown though both direct viral infection and immune mediated damage have been suggested to be the cause. To avoid otherwise preventable morbidity and mortality, physicians should have a high index of suspicion for renal complications in patients with dengue illness and should manage this accordingly

Progressive supranuclear palsy (PSP) is a rare neurodegenerative parkinsonian syndrome with distinct clinical features which tends to be progressive, causing vertical supranuclear gaze palsy, frontal lobe cognitive decline, postural instability and progressive axial rigidity. Clinical examination typically reveals ocular motor dysfunction including restricted vertical gaze, slow vertical saccades and “eyelid opening apraxia” with intact vestibule ocular reflex. PSP falls under the rubric of Parkinsonism plus syndromes that are a group of heterogeneous degenerative neurological disorders that differ from the classical idiopathic Parkinson’s disease. PSP is often underreported, making it important for clinicians to be aware of this disorder. Here we report a case of PSP, which presented primarily with speech disturbances and recurrent falls due to postural instability. On investigating, the magnetic resonance imaging (MRI) revealed a classical sign diagnostic of PSP. This teaching case report describes management and prognosis of the disease

The Lord-Shulman theory with one relaxation time and the dual-phase-lag model with two relaxation times of thermoelasticity are used in this article to study the influence rotation micro-elongated thermoelastic layer, when a piezo electric layer is above it. To convert a partial differential equation to an ordinary differential equation, the normal mode method is utilized. Numerical computations are implemented for aluminum epoxy, and the results are charted. A comparison is made among the two theories in the complete absence and the presence of a rotation. The presence of a rotation has a major effect on all physical quantities.

Traditionally, a typical phase II trial has been conducted using a single-arm design recruiting patients only to the experimental therapy to be compared with a historical control. Due to a small sample size and heterogeneity of patient population, the patient characteristics of the patients in a new phase II trial is often different from that of the selected historical control, so that the single-arm phase II trial may lead to biased conclusions. A randomized phase II trial can resolve such problems by randomizing patients between an experimental arm and a control arm. We propose a software package for designing and analyzing randomized phase II trials. We develop a user-friendly Java software that will help us find optimal two-stage phase II trial designs. Although the programs accommodate trial designs based on various statistical methods and different types of early stopping rules, the main part of our paper is focused on randomized phase II trials based on Fisher’s exact test with futility and superiority early stopping values. If users enter input parameter values, the software generates a graphical output displaying all efficient two-stage designs. Minimax, optimal, and admissible designs are highlighted as good designs, but users can select any of the displayed designs. When the circle representing a design is clicked, all the specifics of the selected design are displayed. Fisher’s test is an exact method whose critical values depend on the total number of responders from two arms. So, the computations required to search for optimal randomized multi-stage phase II trial designs based on Fisher’s exact test is very heavy. By using efficient algorithms, our software provides output at almost real time speed