Background: Enterovirus (EV) infections, being among the most prevalent viruses worldwide, have been associated with reduced risk of allergic diseases. We sought to determine the association of EVs with allergic sensitization and disease in early childhood. Methods: The study was carried out in a nested case-control setting within a prospective birth cohort in Finland. We included 138 case children who had specific IgE (s-IgE) sensitization at the age of 5 years and 138 control children without s-IgE sensitization. Allergic disease was recorded at study visits and asked with ISAAC questionary. We screened for the presence of serotype specific antibodies against 41 EVs at 1 to 5 years of age and assessed their association with allergic sensitization and disease. Results: The overall number of EV infections did not differ between s-IgE-sensitized children and non-sensitized control children. However, there was a tendency of case children with an allergic disease having less EV infections than their controls. This observation was statistically significant for species A EVs in case children with atopic dermatitis vs. control children: OR 0.6 (95 % CI 0.36-0.99), P = 0.048. Conclusion: This study supports the evidence that EV exposure and development of allergic disease are inversely associated. Interestingly, the inverse association was not observed for bare atopic IgE sensitization, but for IgE sensitization coupled with clinical atopic disease. This suggests that environmental factors influencing IgE sensitization may differ from those influencing progression to clinical allergic disease.

In this paper, a conserved domain decomposition method for solving convection-diffusion equations with variable coefficients is analyzed. The interface fluxes over the sub-domains are firstly obtained by the explicit fluxes scheme. Secondly, the interior solutions and fluxes over each sub-domains are computed by the modified upwind implicit scheme. Then, the interface fluxes are corrected by the obtained solutions. We prove rigorously that our scheme is mass conservative, unconditionally stable and of second-order convergence in spatial step. Numerical examples test the theoretical analysis and efficiencies. Lastly, we extend our scheme to the nonlinear convection-diffusion equations and give the error estimate.

A middle aged female presented with a large flank mass, was initially reported to be a renal cell carcinoma of the sarcomatoid variant. Discordant presentation lead to further pathological work-up and a primary renal synovial sarcoma was diagnosed. We present our journey in images.

Disseminated tuberculosis (TB) in the pediatric population is relatively rare in the United States with variable nonspecific presentations. In this letter we discuss the case of 2-year-old child with a lung mass and central neurogenic hyperventilation with primary respiratory alkalosis as a rare pediatric presentation of disseminated tuberculosis with TB meningitis and pulmonary tuberculosis.

Background: A crucial balance exists between oxidant and antioxidant mechanisms in the functional immune system. We aimed to evaluate the contributions of balance between these systems to coronavirus disease 2019 (COVID-19), a devastating pandemic caused by viral infection. Method: We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic characteristics of children and adults with COVID-19 and compared them against the values of healthy controls. Serum native thiol (NT), total thiol (TT), disulfide, total antioxidant status, total oxidant status, and ischemia-modified albumin levels were evaluated and compared between groups. Results: A total of 79 children and 74 adults were evaluated in the present study, including 46 children and 40 adults with COVID-19, 33 healthy children, and 34 healthy adults. TT, NT, and disulfide levels were significantly lower in the adult COVID-19 group than in all other groups (p = 0.001, p = 0.001, and p = 0.005, respectively). Additionally, TT and NT levels were significantly lower in both pediatric and adult COVID-19 cases with severe disease course than mild/moderate course. TT and NT levels were identified as predictors for the diagnosis of the adult COVID-19 cases and as independent predictors for disease severity in both children and adults with COVID-19. Conclusion: Parameters that reveal the oxidant and antioxidant capacity, including TT and NT, appear to be good candidates for the accurate prediction of the clinical course among patients with COVID-19.

This paper is devoted to an approximate analytical solution of an integro-differential model describing the process of nucleation and growth of particles in crystallizers, taking into account the thermal-mass exchange with the environment and the removal of product crystals from the metastable medium. The method developed in this work for solving model equations (kinetic equation for the particle size distribution function and balance equations for temperature/impurity concentration) is based on using the saddle point method for calculating the Laplace-type integral. It is shown that the degree of metastability of the liquid decreases with time at a fixed value of the mass inflow from the outside (heat flow to the outside). The crystal size distribution function has the form of an irregular bell-shaped curve, which increases with the intensification of heat and mass exchange with the environment.

Pericarditis is a rare but debilitating complication of cytarabine therapy. While echocardiography can aid with the diagnosis, cardiac MRI has superior accuracy in establishing the diagnosis. In this case, we describe a 65-year-old patient receiving cytarabine as part of induction chemotherapy for acute myeloid leukemia who developed acute pericarditis. Her cardiac MRI revealed pericardial edema on T2-weighted STIR imaging and pericardial late gadolinium enhancement which confirmed the diagnosis.

The objective of this study was to determine whether a caries management by risk assessment (CAMBRA) tool improves oral self-care behaviors and decreases caries diagnoses as compared to traditional oral health education strategies. Findings show patients with a CAMBRA lowered their caries risk as evidenced by lower plaque index scores.

Oropharyngocutaneous fistula is an unfavorable complication that may occur after head and neck reconstruction. The authors used a “stick-shaped platysma flap” technique to close these narrow and deep intractable fistulas. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.

The similarity between intestinal tuberculosis and Crohn's disease could lead us to erroneously prescribe corticosteroid therapy. Therefore, it is essential to differentiate the two pathologies because of the therapeutic implications of Crohn's disease, which can lead to an explosion of tuberculosis symptoms.

Despite many studies explored the effect of livestock grazing on plant communities, the response of species composition and diversity to livestock grazing in arid rangelands remain ambiguous. This study examined the effects of livestock grazing on plant communities in arid steppe rangelands of North Africa. Plant diversity of annual species, perennial species and all species combined was measured and compared between grazed and grazing-excluded areas. We also examined the relative importance of species turnover and community nestedness. Moreover, the effects of livestock grazing on beta diversity at local among transects and landscape among sites scales were examined using the multiplicative diversity partitioning. Results revealed that livestock grazing significantly decreased the alpha diversity of all species combined and the diversity of annual plants. Livestock grazing induced a shift in plant community composition where most of species composition variation (~74%) was due to infrequent species replacement ‘turnover’ between the two management types rather than nestedness (~26%). Results revealed also that among transects, beta diversity was higher in grazed steppes than in grazing-excluded steppes. Whereas, among sites, beta diversity was lower in grazed steppes compared to grazing-excluded steppes. These findings suggest that livestock grazing in arid steppe rangelands increases the variation in plant species composition at a local spatial scale and engenders vegetation homogeneity at landscape spatial scale. Therefore, the implementation of appropriate management practices such as short-term grazing exclusion is mandatory to prevent these ecosystems from large scale biotic homogenization.

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

We present the case of a 35-year-old male with no medical history who presented with pancytopenia and melena and was found to have PNH in the setting of acute COVID-19 infection. Other infectious, autoimmune, and malignant etiologies were ruled out. It is unclear if this was an acquired PIG-A mutation.

Research of Occult Hepatitis B Infection in HIV-infected Patients, Schindler Study ABSTRACT Objective: Occult hepatitis B infection seems to be more prevalent among subjects at high risk for HBV infection and with concomitant liver disease. The aim of this study was to assess the prevalence of OHBI in group of HIV-1+/HBsAg- Turkish patients. Methods: Ten centers in Turkey have been included in the study. Gender, age, occupation, place of residence, treatment status, clinic, immunodeficiency panel, eliza tests, hemogram, biochemistry and coagulation laboratory results of the patients were evaluated retrospectively. Results: The number of HIV-infected patients followed in these centers is 3172. The mean age of the patients was 37.2 ± 13.1, and they were 235 males (84.5%) and 43 (15.5%) females. 278 (99.6%) of the patients are patients who received antiretroviral treatment. included in the s Of the 279 patients included in the study, it was determined that HBsAg was negative in all of them, 169 were positive for Anti HBs and 125 were positive for Anti HBc IgG. HIV RNA (203/278) was detected in 203 of the patients. 4 (1.4%) of the patients were diagnosed with OHB. In our study, no significant difference was found in hemoglobin and bilirubin levels and complete blood count in patients with HIV-OHB co-infection. However, albumin values were found to be <3.5 in three OHD patients (p = 0.043). Conclusion: Reasearch the presence of OHB infection in HIV-infected patients is important in determining treatment options and predicting the survival of patient. Hypoalbuminemia could be showing hepatic failure and we can suggest the importance of treatment that diseases.

An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.

Attacks on humans by Asian elephant (Elephas maximus) is an extreme form of Human-elephant conflict. It is a serious issue in southern lowland Nepal where elephants kill more humans than any other wildlife. Detailed understanding of elephant attacks on humans in Nepal is still lacking which affected in devising appropriate strategies and actions for human elephant conflict mitigation. This study documented spatio-temporal pattern of elephant attacks on humans, factors associated with the attacks and human/elephant behaviour contributing to deaths of victims when attacked. We compiled all the documented incidences of elephant attacks on humans in Nepal for last 20 years across Terai and Siwalik region of Nepal. We also visited and interviewed 412 victim families (274 fatalities and 138 injuries) on elephant attacks. Majority of the victims were males (87.86%) and had low level of education. One fourth of the elephant attacks occurred while chasing the elephants. Solitary bulls or group of sub-adult males were involved in most of the attack. We found higher number of attacks outside the protected area. People who were drunk and chasing elephants using fire-crackers were more vulnerable to the fatalities. In contrast, chasing elephants using fire was negatively associated to the fatalities. Elephant attacks were concentrated in proximity of forests primarily affecting the socio-economically marginalized communities. Integrated settlement, safe housing for marginalized community and community grain house in the settlement should be promoted to reduce the confrontation between elephants and humans. Conservation of elephant should be carried out in entire landscape, extending beyond the boundary of protected areas to reduce threats of elephant extinction.

Rosai-Dorfman disease (RDD) is a rare non-malignant histiocytosis disorder, commonly manifesting with massive painless cervical lymphadenopathy. Renal involvement develops in only four percent of patients with RDD. Generally, RDD is self-limiting and has a good prognosis; however, in patients with renal involvement, mortality rate can be as high as 40%.

A non-refined, organic pumpkin seed oil (PSO) was chosen for the isolation and structure verification of the rare vitamin E compound γ-tocomonoenol (γ-T1). Initial measurements indicated the presence of ~0.4 mg γ-T1 per 100 g pumpkin seed oil. Saponification of ~2 L pumpkin seed oil, followed by repeated countercurrent chromatography (CCC) with the solvent system n-hexane/benzotrifluoride/acetonitrile (10:3.5:6.5, v/v/v) and silica gel column chromatography enabled the isolation of 6.8 mg γ-T1 with a purity of 96.0%. Structural analysis by 1H NMR spectroscopy and gas chromatography with mass spectrometry (GC/MS) of the γ-T1 isolate confirmed the presence of a double bond in C-11´-position (11´-γ-tocomonoenol). Next to γ-T1, CCC fractionation enabled the detection of 18 different tocochromanols, many of which were reported for the first time in pumpkin seed oil. This unmatched variety covered among others α-/γ-tocopherol, α-/γ-tocomonoenol, two α- and two γ-tocodienol isomers, α-/γ-tocotrienol as well as the rare 11´-β-tocomonoenol (β-T1) and δ-T1. Three uncommon tocochromanols were also detected whose origins and structure remained unclear.