We study in this article the blow-up of solutions to a coupled semilinear wave equations which are characterized by linear damping terms in the scale-invariant regime, time-derivative nonlinearities, mass and Tricomi terms. The latter are specifically of great interest from both physical and mathematical points of view since they allow the speeds of propagation to be time-dependent ones. However, we assume in this work that both waves are propagating with the same speeds. Employing this fact together with other hypotheses on the aforementioned parameters (mass and damping coefficients), we obtain a new blow-up region for the system under consideration, and we show a lifespan estimate of the maximal existence time.

A document by Ilir Sharka. Click on the document to view its contents.

Introduction BK polyomavirus-associated nephropathy (BKPyVAN) is a well-known complication of kidney transplantation (KTx).The mainstay of prevention is reduction of immunosuppression upon detection of BK polyomavirus (BKPyV) viremia, which precedes BKPyVAN. However, this reduction may inadvertently increase the risk of alloimmunity particularly in patients with a high BKPyV load, where significant immunosuppression reduction is often necessary. This single-center, retrospective cohort study assesses the risk of de novo donor-specific antibodies (dnDSA) development and biopsy-proven acute rejection (BPAR) following high and low BKPyV viremia. Methods All patients who underwent KTx at Leiden University Medical Center between 2011 and 2020 were included. Patients were grouped according to high (maximum BKPyV serum load >10E4 copies/ml), low (maximum serum BKPyV load <10E4 copies/ml) and absent BKPyV viremia, and analyzed for the development of dnDSA and BPAR, using Cox regression. Results Of 1076 KTx recipients included, 108(10%) developed a BKPyV viremia with a maximum serum load below 10E4 copies/ml, whereas 121(11.2%) developed a BKPyV viremia exceeding 10E4 copies/ml. The risk of dnDSA development was higher in patients with a high BKPyV viremia, compared to patients without viremia (adjusted Hazard Ratio of 1.9(95% CI1.1-3.2, p=0.017). No significant difference in dnDSA risk was observed between patients with low and absent BKPyV viremia. Risk of BPAR did not differ between groups. Conclusion Our study shows that higher BKPyV loads in KTx patients are associated with a higher risk for dnDSA development, highlighting the importance of exploring additional strategies for the prevention and treatment of BKPyV infections in KTx recipients.

Key Clinical Message :Endometriosis, though typically a pelvic disease, can rarely present with small bowel obstruction due to involvement of the terminal ileum. Awareness of this possibility can aid in accurate diagnosis with appropriate imaging modalities and surgical management, potentially avoiding extensive resections.

Stevens-Johnson Syndrome as an initial presentation of Systemic Lupus Erythematosus with Antiphospholipid Syndrome: Case ReportAhmed K. A. Yasin, MD (a), Ma’in Abumuhfouz, MD (b), Rana A. Mohammed, MD (c), Mohammed Almadani, MD (d)

TITLE: Diagnosis and treatment of idiopathic bone cavity in the mandible: a case report  

Title: “Venom and Vision- Unilateral Subhyaloid Hemorrhage as an Unusual Snake Bite Sequela”

Title: Antineutrophil cytoplasmic antibodies (ANCA)-Associated Vasculitis in Chronic Hepatitis B: Unraveling the Immune Puzzle” A RARE CASE REPORT WITH REVIEW OF LITERATURE

Organic soils, particularly peatlands, are important carbon sinks. In Europe, almost half of its area has been drained and is primarily used for agriculture as grasslands. In Poland, 86% of the drained peatland area causes problems with high carbon dioxide emissions due to organic matter oxidation. The aim of the study was to analyze changes in organic soils between 1975 and 2017 using data from 476 reference soil profiles. The results showed a significant decrease in organic soils (≥12% SOC) from 62% to 35%, and an increase in organo-mineral (6.0-12.0% SOC) and non-humose mineral soils (≤1.75% SOC) by a similar percentage. The depth of SOC rich layers also decreased significantly, with deep soils (>100 cm) dropping from 20% to 5% and shallow soils (21-50 cm) increasing from 24% to 58%. The average SOC stock loss was almost 273 Mg C·ha -1 (from 500.42 Mg C·ha -1 to 228.04 Mg C·ha -1), with the median being four times lower. A decrease in SOC stock was observed in 64% of sites, while an increase was seen in 36%. The most significant decrease in SOC stock, by 64.67% compared to 1975, occurred in organic soils (from 762.19 Mg C·ha -1 to 269.26 Mg C·ha -1). There was an increase in SOC stock in organo-mineral, humose, and non-humose mineral soils, although it was not statistically significant. Moreover, the results indicated that continuous grassland use on organic soils does not offset carbon losses from organic matter oxidation due to drainage.

CYCLIC THROMBOCYTOPENIA TREATED WITH PLATELET TRANSFUSION AND ORAL PREPARATION CONTAINING HYALURONIC ACID (ORALVISC®)M. Benjamin1, R. Kotchetkov2*1University of Ottawa, Faculty of Science, Ottawa, ON, Canada, K1N 6N52Royal Victoria Regional Health Centre, Barrie, Ontario, Canada, L4M 6M2Short Title: A case of cyclic thrombocytopenia*Corresponding Author: Rouslan Kotchetkov, M.D., Ph.D.Royal Victoria Regional Health Centre, Barrie, Ontario, Canada L4M 6M2Tel: +1-705-728-9090;Fax: +1-705-739-5630;Email: [email protected] of Tables: 0Number of Figures: 1Word count: 1495Key words: thrombocytopenia, cyclic, anti-inflammatory, transfusion, hyaluronic acid, OralviscKEY CLINICAL MESSAGECyclic thrombocytopenia is a rare disorder characterized by periodic platelet fluctuation with amplitude from low to high. There are no standardized treatment guidelines. We present a patient who had resolution of mucocutaneous bleeding with platelet transfusion at platelet nadir, normalization of platelets with an oral preparation containing hyaluronic acid (Oralvisc®).INTRODUCTIONCyclic thrombocytopenia (CTP) is a rare disorder characterized by intense fluctuations of platelet counts in a cyclical pattern repeating on an average of a 3-week basis.1 Platelet nadir can be complicated by hemorrhage, and thrombocytosis can cause hypercoagulable state and thrombosis. Initially, most CTP patients are typically misdiagnosed as having primary immune thrombocytopenia (ITP). Currently it is considered to be heterogenous in cause. Clinical presentation is similar to immune thrombocytopenia (ITP), however most treatments seem to be ineffective or even harmful if applied to patients with CTP. CTP is a diagnosis of exclusion and is usually established, if at all, much later, often at a time when ITP-specific therapies have failed. Due to its rarity, in addition to the lack of research and documentation surrounding it there are no standardized guidelines on treatment. Here we present a case of chronic CTP, who reached significant improvement in quality of life after initiation of supportive platelet transfusions at platelet nadir. Moreover, platelet count fluctuations decreased and eventually normalized after application of oral preparation containing hyaluronic acid (Oralvisc®) for concomitant arthropathy. With this case we want to illustrate challenging aspects of non-standard management for such a rare disease.CASE HISTORY / EXAMINATION64-year-old female was referred to our institution for management of chronic CTP. She was diagnosed at the age of 45, initially as ITP, when routine blood work was performed prior to minor surgery. Past medical history included calcium pyrophosphate deposition disease (CPPD), hypertension, hearing impairment, myopia, peripheral neuropathy, atrial fibrillation, chronic back pain, cholecystectomy, and excised squamous cell carcinoma on floor of mouth. There was no history of alcohol or substance abuse. She had 20 pack year history of smoking, quit one year before CTP diagnosis. Family history was unremarkable. Platelet fluctuations were not synchronized with patient’s menstrual cycle. At the time of initial assessment at our institution her platelet count fluctuated from mild thrombocytosis (~600,000 x 109/L) to severe thrombocytopenia (5,000 x 109/L) as shown in Figure 1. Bone marrow examination at diagnosis did not reveal myelodysplastic changes, abnormal lymphoid or plasma cell population. There was mild megakaryocytic hypoplasia. At the time of diagnosis, she was asymptomatic, but after 12 months started developing muco-cutaneous bleeding around nadir time of the platelet. She has no major bleeding, including hemarthroses, hematuria, hematoschezia.METHODS (TREATMENT)Given CHADS2 score of 1 at diagnosis of atrial fibrillation, she was anticoagulated with warfarin. However, due to bleeding episodes it was switched to low molecular dose heparin, and later to apixaban. That allowed a better balance of bleeding and thrombosis risks during thrombocytopenia and thrombocytosis.After taking Prednisone 1 mg/kg she achieved partial response but discontinued it due to recurrent mouth thrush. She switched to a pulse dose of dexamethasone; however it was stopped because of vaginal pain and bleeding, and feeling generally unwell. She had normalization of platelet count on oral cyclophosphamide 100 mg daily and was able to stop it. However, she relapsed shortly after discontinuation and had no significant clinical response following restarting of cyclophosphamide. Next line of therapy was course of intravenous infusion of Rituximab, 375 mg/m2 weekly x4. There was no platelet improvement, but she developed significant daily headaches, visual hallucinations, and blue vision discoloration. She declined splenectomy and was on active surveillance until bleeding symptoms at her platelets nadir progressed and started significantly affect her quality of life . High doses of tranexamic acid (1,000mg three times a day) were given at platelet nadir to improve symptomatic bleeding, but the patient had only marginal improvement and it was discontinued. Due to risk of thrombosis at platelet high, we considered it unsafe to administer thrombopoietin receptor agonists, like eltrombopag or romiplostim.OUTCOMEDue to lack of other options, we offered her platelet transfusion around nadir time which led to marked improvement in bleeding episodes. Since the timing of nadir was quite predictable, platelet transfusion improved quality of life. When the patient required dental extraction, we chose a time when the patient had a normal platelet count which resulted in an unremarkable procedure with no bleeding or thrombosis. After 2 years of platelet transfusion, the patient started taking oral preparation containing hyaluronic acid (Oralvisc®) for worsening hip and knee arthropathy. After five months her platelet count fluctuations improved, ranging from 100,000 to 150,000 x 109/L and she became transfusion independent. After 26 months the patient discontinued Oralvisc® due to supply issues and switched to colchicine. For over 19 months platelet count remains within the same range, and she remains asymptomatic and transfusion independent. Her physical examination is unremarkable.DISCUSSIONITP or immune thrombocytopenia is a platelet disorder defined by a low platelet count thought to be a result of the immune system destroying platelets either alone or in conjunction with thrombopoeisis inhibition. Common symptoms include skin and mucocutaneous hemorrhage, bruising, fatigue. ITP is diagnosis of exclusion and requires an extensive work up to rule out secondary causes and other platelet disorders. Corticosteroids (prednisone or dexamethasone) are standard frontline therapy. Platelet transfusions are not usually effective, since there is rapid destruction of transfused platelets. For relapsed disease rituximab, steroid-sparing immunosuppressants, or splenectomy are used.CTP is a similar platelet disorder however it is characterized by periods of low and high platelet counts in a reoccurring wave-like pattern every few weeks. Currently CTP is considered to be heterogenous in cause and the pathophysiology is largely unknown1. Germline heterozygous loss-of-function thrombopoietin receptor MPL mutation and pathogenic somatic gain-of-function (GOF) variants in signal transducer and activator of transcription 3 (STAT3) were shown in two patients with CTP. Interesting that 2 patients had also clonal T-cell populations. It was suggested that these mutations along with clonal T cells trigger exaggerated persistent thrombopoiesis oscillations of their intrinsic rhythm upon homeostatic perturbations2.Many patients are usually treated for ITP initially prior to diagnosis3. Two clinical features relatively unique to CTP besides periodic thrombocytopenia are rebound thrombocytosis unrelated to recent splenectomy and platelet nadirs occurring during menses4. To establish a proper diagnosis, platelet count needs to be measured every week over a period of 1-3 months to establish the presence of a cyclical pattern to diagnose CTP, however it is usually a diagnosis of exclusion. Currently it is considered to be heterogenous in cause.1Due to rarity of disease and alternating thrombocytopenia and thrombocytosis the treatment options for CTP are limited. In addition to detailed medical history and physical examination to rule out secondary causes, in non-bleeding patients serial blood count check to establish the platelet profile is recommended. In a patient with active bleeding, platelet transfusion with post-transfusion blood count check would be beneficial to assess whether platelets are actively destroyed as seen in ITP or maintain the count, which would ne more suggestive as CTP. For asymptomatic patients active surveillance is recommended until they develop clinically significant and recurrent hemorrhage affecting organ function or quality of life. Patients with CTP generally do not respond to standard ITP treatments, including corticosteroids, splenectomy, and intravenous immunoglobulin1,4. A recent publication showed normalization of platelet count in a female patient treated with danazol5. Hormonal contraceptive showed efficacy in alleviating patient’s symptoms6.Platelet transfusions in ITP patients are generally reserved for critical bleeding when there is a need to raise the platelet count immediately7. Due to antiplatelet antibodies that destroy circulating platelets and megakaryocytes in the bone marrow the response is transient and attenuated8. Based on our experience, supportive single platelet transfusion per cycle at the nadir of platelet is efficacious in long-term management of CTP. It helps to minimize bleeding and improve quality of life. Given predictable pattern of platelet count fluctuation, it is feasible to arrange blood count check and transfusions. Transfusion of platelets does not increase risk pf thrombosis. In contrast to ITP, there is not rapid platelet destruction in CTP patients and the longevity of transfused platelet is longer. This approach could also be used perioperatively prior to major or minor surgeries. The sustained response to platelet transfusion in CTP patient preoperatively was shown recently9.Efficacy of anti-inflammatory medications in ITP has not been shown. Oralvisc® is an anti-inflammatory oral preparation containing hyaluronic acid that reduces the levels of pro-inflammatory mediators leptin and bradykinin10. Bradykinin receptors exist in chondrocytes and on stimulation increase Interleukin-1. Bradykinins are known to participate in innate immunity, inflammation, and pain11. Hence, evidence of reduction in bradykinin levels is clinically relevant. Though prior to starting Oralvisc® the patient had no elevated markers of inflammation (C-reactive protein, erythrocyte sedimentation rate, fibrinogen and ferritin were normal), the anti-inflammatory effect may have contributed to normalization of platelet count and clinical improvement. Alternatively, in our case Oralvisc® may triggered spontaneous recovery, a feature previously described in CTP1.CONCLUSIONCTP is a rare disease, different from ITP, however it should be considered at the initial presentation. In patients with recurrent fluctuation in their platelet count, CTP should be considered. Serial blood count check is recommended to establish a proper diagnosis and avoid unnecessary therapies used for ITP but not effective in CTP. Supportive platelet transfusion at the nadir of thrombocytopenia is an effective management option in some symptomatic patients. Anti-inflammatory medications, suppressing bradykinin and leptin may be applied to alleviate platelet fluctuation and improve symptoms.AUTHOR CONTRIBUTIONSMarek Benjamin: Writing – original draft; writing – review and editing. Rouslan Kotchetkov: Writing – review and editing, Supervision.ACKNOWLEDGMENTSNone.FUNDING INFORMATIONThis research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.CONFLICT OF INTEREST STATEMENTNone Declared.CONSENTComplete written informed consent was obtained from the patient for the publication of this study and accompanying images.FIGURE LEGENDFigure 1: Fluctuating platelet count/µL over a period of the last 5 years. Arrow represents the point at which the patient started Oralvisc®. Red line – lower limit of norm, grey line – upper limit of norm

javascript:void(0) The northern Humboldt Current System (nHCS) is an area with high environmental variability that impacts key demographic and community-scale processes. Understanding the role and ecological implications of these interannual or long-term events is crucial in describing the dynamics of the nHCS community. Using catch data from pelagic assessment surveys from 1983 to 2019 and the community trajectory analysis framework, we tested and characterised the patterns and compositional dynamics of the nHCS pelagic fish community over space and time. Spatially, changes were evaluated for ecological regions with similar community composition identified through hierarchical clustering with spatial constraint. We found that the community is in constant inter-annual variability consistent with the long-term warm and cold periods of the system. A long trajectory segment suggests a community regime shift between 1994 and 1999, years associated with a change in the average oceanographic conditions in the system and an extreme El Niño event (1997-98). After 1999, we identified a period where the community was constantly changing and dominated by coastal species. These long-term community changes were not homogeneous over the ecological areas, finding a lower temporal variability in the coastal area than in the northern and offshore. The main factor controlling the spatial and temporal dynamics of the nHCS pelagic fish community seems to be the long and short-term environmental conditions in the system. This study helps to understand the magnitude and direction of pelagic fish community changes and define the community’s recovery process after an event-driven change.

IntroductionEisenmenger syndrome was initially described in 18971, when Eisenmenger reported a patient with dyspnea and cyanosis since childhood that later developed heart failure and hemoptysis, dying. His autopsy revealed a ventricular septal defect. This syndrome represents the most severe phenotype of pulmonary arterial hypertension in patients with congenital heart disease. A left-to-right shunt triggers a severe growth of pulmonary vascular resistance, which with time results in shunt reversal and cyanosis. It can lead to multiorgan disease, with cardiac, hematological, neurological, respiratory, gastrointestinal, urinary, immunological, musculoskeletal and endocrinological manifestations2. A multidisciplinary approach is the best strategy to those patients3, with both prevention and management of complications at the core of treatment. The improvement of exercise tolerance, a better quality of life and longevity are the main goals and supportive measures, in order to reduce symptoms and prevent complications, have an extraordinary importance. Complications related to hypoxaemia, coagulation disorders and congestive heart failure are among the most common. However, anticoagulants and antiplatelets are not usually prescribed, unless in some cases (with specific indications). Diuretics and pulmonary hypertension therapies are the most commonly used - bosentan, macitentan, sildenafil and prostanoids are some examples. The definitive treatment for Eisenmenger syndrome is lung transplantation and shunt closure or heart-lung transplantation.Our case report aims to mark the importance of being aware of subtle signs of cardiorespiratory distress in young patients.

Pangolins are under severe threat from illegal trade and habitat loss. Despite their conservation significance, these elusive creatures remain poorly understood, particularly in the context of phylogeography and genetic diversity. In this study DNA was isolated from two types of pangolin scat (faeces) samples (whole scat and swabs) which had been stored frozen for up to 3 years between the time of collection and our analyses. A mitochondrial sequence for the cytochrome b gene (424 bp) region was reliably generated from both sample types, for scats which appeared in ‘good’ or ‘poor’ condition at the time of collection. Sanger sequencing revealed four new cytochrome b haplotypes for pangolin, with variations in distinct sampling regions in Nepal (central and east). Comparison to reference sequences for pangolin originating from China, Taiwan and Thailand, indicated a distinct variant of Chinese pangolin in Nepal (15-19 base pair difference). Genetic differentiation of Chinese pangolin in Nepal has broader conservation significance for this species. Methods described here are robust and could be applied to broader genetic studies of pangolin populations across Nepal, allowing for genetic mapping of pangolin variations to assist in identifying populations of significance, evaluation of conservation interventions, and forensic applications supporting the fight against illegal poaching.

Introduction: The study aims to assess awareness, attitude, apprehension, action expected from policy makers, and acceptability towards HPV vaccination amongst health care providers (HCP), medical students, paramedical staff and administrative personnel. Methods: A cross-sectional study was conducted with 501 participants, including HCP, medical students, paramedical and administrative staff. Their awareness, attitudes, apprehensions, actions expected from policymakers, and acceptability towards HPV vaccine were assessed through a Google Form survey. Results: Of the 501 participants, 92.4% were aware of HPV vaccines, 24.6% had a thorough understanding of HPV, but only 5.8% had received the vaccine. Most participants held a positive attitude toward cervical cancer prevention and HPV vaccination, although 46.7% expressed apprehensions. Initially, 278 participants (55.8%) were willing to receive the HPV vaccine, while 116 (44.2%) were not. After viewing the educational video, willingness increased to 394 participants (78.6%), and those unwilling decreased to 107 (21.4%). Factors such as age, gender, marital status, education, and professional role did not significantly predict knowledge or apprehension regarding HPV and the HPV vaccine. However, professional role and younger adult (20-39 years) groups were statistically significant predictors of a positive attitude as well as stronger expectations for action from policymakers towards HPV vaccine. Conclusion: The study reveals significant gaps in HPV vaccine awareness and uptake among medical professionals, paramedics, and administrative staff. It highlights the need for broad educational programs to address these knowledge gaps, emphasizing HPV’s health impacts and preventive measures. Multimedia educational interventions effectively boost vaccine acceptance among the groups and the general public.

Food proteins, essential ingredients in food products, extend product structuring and health-promoting benefits. The objective of the current study is to improve the bio- and techno-functionalities of food proteins simultaneously through non-thermal plasma exposure. Four different food proteins (pea, rice, wheat gluten, and milk proteins) were exposed to plasma at voltage 240V, frequency 1.5 kHz, and 30 min exposure time. The structural, digestibility, bioactivity, and techno-functional properties were analyzed. Plasma treatment alters the secondary structure of proteins by increasing β-structures and random coils by 3-4 times while decreasing α-helices by half, reducing surface hydrophobicity. The study found that longer treatment times and higher voltage intensities enhance protein digestibility and increase amino acid release, with gluten showing the highest improvement in both digestibility and free amino acid content among the proteins examined. The proteins also showed a loss of radical scavenging capacity after treatment due to oxidation reactions. Cold plasma treatment improved protein solubility but reduced emulsifying and foaming properties. The enhancements in digestibility and bioactivity can be attributed to structural unfolding and the exposure of reactive sites on the proteins. In summary, the effects of cold plasma treatment depend on the specific protein, treatment parameters, and the degree of oxidation.

A document by Aki Kawano. Click on the document to view its contents.

Does APC gene mutation In Familial Adenomatous Polyposis patient predispose to Medication-related Osteonecrosis of Jaw? A case report and proposed genetic pathogenesis.Sandeep Gurav, MDS, FDPO a; Gurkaran Preet Singh, MDS, FDPO b; Radhika Jain, MDS, FDPO c; Suryaveer Singh, MD d; Prachi Bhatia, MDSe, Vinita Patil, DNB fa Professor, Dental and Prosthetic Surgery, Tata Memorial Hospital, A CI Of Homi Bhabha National Institute, Mumbai- 400012, India. [email protected] Associate Professor, Dental and Prosthetic Surgery, Tata Memorial Hospital, A CI Of Homi Bhabha National Institute, Mumbai- 400012, India. [email protected] Senior Resident, Dental and Prosthetic Surgery, Tata Memorial Hospital, A CI Of Homi Bhabha National Institute, Mumbai- 400012, India. [email protected] Fellow, Radiodiagnosis, Tata Memorial Hospital, A CI Of Homi Bhabha National Institute, Mumbai- 400012, India.

Neuroendocrine Carcinoma of the Gallbladder: A Rare Case Report from BangladeshMd Osman Goni1, Shanjida Akter2,