Objective: Multi-dose dexamethasone pretreatment prevents postextubation airway obstruction (PEAO), however, its optimal dose in children is not known. We planned to compare effect of 24h pretreatment of low dose (LD) (0.25mg/kg/dose) versus high dose (HD) (0.5mg/kg/dose) dexamethasone for prevention of PEAO. Design: Stratified (for age and intubation duration) randomized open-label non-inferiority trial. Setting: 15-bed Pediatric Intensive Care Unit in a tertiary care teaching hospital of a lower-middle income country. Patients: Children (3mo-12yrs) intubated for ≥48h and planned for first extubation over 26 months (Feb’17 to Mar’19). Children with preexisting upper airway conditions, chronic respiratory diseases, steroid or IVIG therapy in last 7 days, gastrointestinal bleeding, hypertension and hyperglycemia were excluded. Interventions: Low dose (n=144) or high dose (n=143) dexamethasone (q6h) for 6 doses. Extubation was planned after 5th dose. Measurements and Main Results: Patients were monitored for PEAO (Westley’s Croup Score >4) for 24 hours. 238 patients were included in per-protocol analysis. 78 patients (33%) developed PEAO; both groups were similar (LD, 41/121, 34% vs HD, 37/117, 32% p=0.71). Risk difference of LD vs HD touches the non-inferiority margin of 0.12 and hence the overall result is non-significant. Incidence of reintubation was also similar (LD, 10/121, 8.3% vs HD, 9/117, 7.7%; p=0.87). Intubation for more than 7 days was an independent risk factor for development of PEAO. Conclusions: Multi-dose 24-hour pretreatment with low dose dexamethasone is not inferior to high dose in preventing PEAO and reintubation among unselected patients in the studied clinical setting. Multi-centric trials with larger sample size among children at high risk of developing PEAO are needed.

Wind erosion is the main form of soil erosion in arid and semi-arid areas. It leads to soil loss and land degradation, which aggravates ecosystem vulnerability and threatens regional sustainable development. The assessment of wind erosion and the study of its driving factors can reduce soil wind erosion and provide decision-making assistance to solve environmental problems. Southern Africa is affected by severe soil erosion, which has brought a series of development problems, such as food crises and poverty. This study used meteorological and remote sensing data, and the revised wind erosion equation model to explore the temporal and spatial dynamics of soil erosion in southern Africa from 1991 to 2015. The impact of climate dynamics on soil wind erosion was also analyzed. The results showed that wind erosion fluctuated during the study period, and it first showed a downward trend and then stabilized at a relatively low level after 2010. Soil wind erosion across 66.65% of the study area significantly decreased (p < 0.05) and near-surface wind speed was the most important factor. The change in wind speed had a positive impact on soil wind erosion across 68.18% of the area. Temperature and precipitation were significantly related to soil wind erosion over 18.96% and 24.63% of the area, respectively. Both can also indirectly affect soil wind erosion through their effects on vegetation cover. This study will help decision-makers to evaluate areas that are at high-risk from soil erosion in southern Africa and enable them to effectively protect fragile ecosystems.

It was recently reported that due to the COVID-19 pandemic, in the European winter 2020-2021, bronchiolitis had practically disappeared. But early reports from the southern hemisphere (Australia) raised concerns about a late spring / summer peak. After a full winter season and now ending the summer, we report that there was no peak of common respiratory viruses in late spring / summer in South America.

Objective To compare the safety and efficacy of Veregen® ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN). Design A Phase II randomised control trial. Setting A tertiary gynaecological oncology referral center. Population All women diagnosed with primary and recurrence uVIN. Methods Eligible patients were randomised to receive either Veregen® or placebo ointment (applied 3 times daily for 16 weeks), and were followed up at 2, 4, 8, 16, 32 and 52 weeks. Main outcome measures Outcome measures, recorded at 16 and 32 weeks, were histological (HR) and clinical (CR) response (as measured by ≥30% reduction in the sum of the longest diameter of all lesions when compared to baseline), toxicity and changes in quality of life and pain scores. Results 26 patients were randomised and all 13 patients who received Veregen® showed either complete (n=5) or partial (n=8) CR with a trend towards an improvement in baseline symptoms. In placebo group, 3 patients had complete CR, 2 had partial CR and 6 had stable disease. Patients in the Veregen® group showed a significant improvement in CR as compared to the placebo group (P=0.0026). There was no evidence of difference in HR and toxicity reported in both groups. Conclusion Our study indicates that Veregen application is safe and leads to at least a partial clinical resolution of uVIN lesions and symptoms improvement, thus warranting a phase III multi-centre RCT.

Background: The health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The historical lack of support in the United States for primary health care, universal health coverage, population health, addressing the social determinants of health, and community empowerment, creates opportunities for community health scientists to develop innovative solutions for addressing community health needs. Methods: We developed a model community health science approach combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. Results: From 2000-2020, we established partnerships with community organizations to reduce the risk of chronic disease in vulnerable minority communities. Our programs have provided structured community health science training for hundreds of physicians and other health care workers in training. Conclusion: As the U.S. begins to seek solutions to chronic health disparities and health inequities, community health science provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest error that U.S. health care systems could make in trying to better address population health and the social determinants of health, would be ignoring the important community initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for reducing health disparities. This has been the greatest lesson we have learned during the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.

Tunnels had been undergone accidental and intentional blast in the past. An analysis of a rock tunnel when subjected to internal blast loading has been presented in this paper. A three-dimensional finite element model of a huge rock mass comprising the tunnel has been developed in Abaqus/CAE. Diameter of the tunnel has been kept constant to a two-lane transportation tunnel. However, liner thickness of the concrete, overburden pressure on the tunnel has been varied to observe the response in different possible conditions. To incorporate the elastoplastic response of rock mass, Mohr-Coulomb constitutive material model has been considered. For modelling of trinitrotoluene (TNT), Jones-Wilkins-Lee material model has been adopted. Concrete Damage Plasticity material model has been adopted for tunnel lining. For the blast loading, Coupled-Eulerian-Lagrangian (CEL) model has been considered. Results highlight the importance of tunnel lining thickness and overburden depth while designing the tunnel in rocks. Under any amount of explosive, deep tunnels have been found to be safer than shallow tunnel.

Horizontal gene transfer via plasmids is important for the dissemination of antibiotic resistance genes among medically relevant pathogens. Specifically, the transfer of IncHI1A plasmids is believed to facilitate the spread of antibiotic resistance genes, such as carbapenemases, within the clinically important family Enterobacteriaceae. The microbial community of urban wastewater treatment plants has been shown to be highly permissive towards conjugal transfer of IncP1 plasmids. Here, we tracked the transfer of the P1 plasmid pB10 and the clinically relevant HI1A plasmid R27 in the microbial communities present in urban residential sewage entering full-scale wastewater treatment plants. We found that both plasmids readily transferred to these communities and that strains in the sewage were able to further disseminate them. Furthermore, that R27 has a broad potential host range, but a low host divergence. Interestingly, although the majority of R27 transfer events were to members of Enterobacteriaceae, we found a subset of transfer to other families, even other phyla. Indicating, that HI1A plasmids facilitate horizontal gene transfer both within Enterobacteriaceae, but also across families of especially Gammaproteobacteria, such as Moraxellaceae, Pseudomonadaceae and Shewanellaceae. pB10 displayed a similar potential host range as R27. In contrast to R27, pB10 had a high host divergence. By culture enrichment of the transconjugant communities, we show that sewage strains of Enterobacteriaceae and Aeromonadaceae can stably maintain R27 and pB10, respectively. Our results suggest that dissemination in the urban residual water system of HI1A plasmids may result in an accelerated acquisition of antibiotic resistance genes among pathogens.

We prove that the uniform radius of spatial analyticity $\sigma(t)$ of solution at time $t$ to the one-dimensional fourth order nonlinear Schr\”odinger equation $$ i\partial_tu-\partial_x^4u =|u |^2u $$ cannot decay faster than $1/ \sqrt{t}$ for large $t$, given initial data that is analytic with fixed radius $\sigma_0$. The main ingredients in the proof are a modified Gevrey space, a method of approximate conservation law and a Strichartz estimate for free wave associated with the equation.

This case report demonstrate concurrent of two rare complications of true silent inferior STEMI in the poorly controlled diabetic patient with de-novo heart failure, mimicking congenital VSD.This complication of myocardial infarction often have catastrophic manifestations and the presence of this complications of MI with smooth course is very scarce

BACKGROUND: Initially identified in December 2019 in China, the 2019 Coronavirus disease (COVID-19) is now affecting more than 200 countries and territories around the world. Given the current unavailability of an effective medical cure for COVID-19, a public health strategy of reduced social contact and shelter in place has been adopted worldwide. Nonetheless, social distancing and isolation could also represent risk factors for mental disorders, determining loneliness, reduced social support and under-detection of mental health needs. Along with this, social distancing determines an insurmountable obstacle for direct access to psychiatric care services. The pandemic generates the urgent need for integrating technology into innovative models of mental healthcare. AIMS: In this paper we discuss the potential role of telepsychiatry and other cutting-edge technologies in the management of mental health assistance. We narratively review the literature to examine advantages and risks related to the massive application of these new therapeutic settings, along with the possible limitations and ethical concerns. RESULTS: Telemental health services are particularly feasible and appropriate for the support of patients, family members and health-care providers during this COVID-19 pandemic. The integration of telepsychiatry with other technological innovations (e.g., mobile apps, virtual reality, big data and artificial intelligence) opens up interesting future perspectives for the improvement of mental health assistance. CONCLUSION: The COVID-19 pandemic situation shows us how vast the amount of untreated mental illnesses can be. The pandemic crisis can contribute to spread, among numerous mental health professionals, the knowledge of the possibilities offered by the digital era.

Background: In atrial fibrillation patients undergoing left atrial appendage occlusion with a Watchman device, surveillance imaging with a transesophageal echocardiogram (TEE) is typically performed at 45 days and 1 year to evaluate for device-related thrombus (DRT) and peri-device leak (PDL) before cessation of oral anticoagulation. The incidence of these complications is relatively low, and the ideal timing and duration of surveillance is unknown. We sought to evaluate the incidence of DRT and PDL after Watchman placement at 45 days and 1 year to determine the necessity of surveillance TEEs. Methods: We retrospectively analyzed 361 patients who received a Watchman device between January 2016 and January 2020. Baseline clinical and echocardiographic data, post-procedure antithrombotic therapy and surveillance echocardiographic data were collected from the NCDR LAAO Registry. Nested backward variable elimination regression was performed to derive independent predictors of the composite outcome of DRT and PDL. Results: A total of 286 patients who had post-procedure TEEs were included in the analysis. At 45 days, 9 patients had DRT (3.2%) and 44 patients had PDL (15.0%). At 1 year, 5 patients had DRT (5.6%) and 8 patients had PDL (8.9%). All DRT at 45 days was treated with continued anticoagulation while no change in protocol occurred with PDL. All DRT at 1 year occurred in new patients without prior thrombus. A history of prior transient ischemic attack (TIA) and thromboembolism were significantly associated with DRT or PDL at 1 year. Conclusions: We identified several patients with device-related complications at 45 days and 1 year despite appropriate device sizing and adequate use of antithrombotic therapy. The incidence of DRT increased from 45 days to 1 year and occurred in patients without prior thrombus. These findings highlight the importance of surveillance imaging and suggest the potential need for extended surveillance in select patients.

There is a growing interest in the psychiatric properties of the dissociative anesthetic ketamine, as single doses have been shown to have fast-acting mood-enhancing and anxiolytic effects, which persist for up to a week after the main psychoactive symptoms have diminished. Therefore, ketamine poses potential beneficial effects in patients with refractory anxiety disorders, where other conventional anxiolytics have been ineffective. Ketamine is a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) glutamate receptor, which underlies its induction of pain relief and anaesthesia. However, the role of NMDA receptors in anxiety reduction is still relatively unknown. To fill this paucity in the literature, this systematic review assesses the evidence that ketamine significantly reduces refractory anxiety and discusses to what extent this may be mediated by NMDA receptor antagonism. We highlight the temporary nature of the anxiolytic effects and discuss the high discrepancy among the study designs regarding many fundamental factors such as administration routes, complementary treatments, and other treatments.

An 11 years-old male mixed-breed cat, with exclusively indoor life, presented 3 cough episodes after the owners tested positive by RT-PCR for SARS-CoV-2. The house is inhabited by 5 people (3 adults and 2 children), and 2 of the adults have shown mild symptoms associated with throat discomfort. The cat was vaccinated, had no history of any previous disease, and tested negative for Feline Coronavirus (FeCoV), Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV). Rectal sample collected from the cat was positive for SARS-CoV-2 by RT-PCR. Viral genome sequences recovered from human and cat samples showed an average 99.4% sequence identity. This is the first report of genome sequences of SARS-CoV-2 recovered from a cat and its owner in Latin America.

Objectives The aim of this study was to assess the potential of noninvasive and repeated monitoring of rhACE2 distribution and content in organs using the ACE2-specific nuclide probe 68Ga-HZ20. Methods We optimized the labeling conditions of the probe and evaluated its safety. A mouse organ in situ rhACE2 high-aggregation model was constructed for the first time, and in vivo real-time PET imaging of rhACE2 was performed using the ACE2-specific PET agent 68Ga-HZ20. The distribution and uptake of the probe were analyzed, and the model was validated. Results This radiotracer exhibited reliable radiochemical properties in vitro and maintained a high affinity for rhACE2 in vivo. In terms of probe uptake, 68Ga-HZ20 showed a good target-to-nontarget ratio, and the correlation between the uptake value of the probe and the dose of rhACE2 was >90% in both models; the probe was rapidly cleared from the circulatory system and excreted by the kidneys and urinary system. No organs were damaged after the injection of high doses of probe. Conclusions This technology for noninvasively and repeatedly monitoring the content and distribution of rhACE2 in vivo aids in clarifying the resident capacity of rhACE2 in organs and in analyzing the preventive effect of rhACE2 against SARS-CoV-2 and the effectiveness of therapies for COVID-19.

The set of hybrid numbers is a noncommutative number system unified and generalized the complex, dual and double(hyperbolic) numbers with the relation IH = − HI = ε + I. Two hybrid numbers P and Q are said to be similar if there exist a hybrid number X satisfying the equality X−1QX = P. And it is denoted by p ∼ q. In this paper, we study the concept of similarity for hybrid numbers by solving the linear equations PX = XQ and QX − XP = C for P, Q, C ∈ 𝕂. KEYWORDS : Hybrid numbers, quaternions, coquaternions, dual and double numbers. MSC CLASSIFICATION : 15A66, 11R52, 15A18, 15A06, 16S50.

Background We estimated the secondary attack rate of SARS-CoV-2 among household contacts of PCR-confirmed cases of COVID-19 in rural Kenya and analysed risk factors for transmission. Methods We enrolled incident PCR-confirmed cases and their household members. At baseline, a questionnaire, a blood sample, and naso-oropharyngeal swabs were collected. Household members were followed 4, 7, 10, 14, 21 and 28 days after the date of the first PCR-positive in the household; naso-oropharyngeal swabs were collected at each visit and used to define secondary cases. Blood samples were collected every 1-2 weeks. Symptoms were collected in a daily symptom diary. We used binomial regression to estimate secondary attack rates and survival analysis to analyze risk factors for transmission. Results A total of 119 households with at least one positive household member were enrolled between October 2020 and September 2022, comprising 503 household members; 226 remained in follow up at day-14 (45%). A total of 43 secondary cases arose within 14 days of identification of the primary case, 81 household members remained negative. The 7-day secondary attack rate was 4% (95%CI 1-10%), the 14-day secondary attack rate was 28% (95%CI 17-40%). Of 38 secondary cases with data, 8 reported symptoms (21%, 95%CI 8-34%). Antibody to SARS-CoV-2 spike protein at enrolment was not associated with risk of becoming a secondary case. Conclusion Households in our setting experienced a lower 7-day attack rate than a recent meta-analysis indicated as the global average (23-43% depending on variant), and infection is mostly asymptomatic in our setting.

This paper introduces version one of an assessment tool developed to address the challenges posed by the assessment of data thickness and richness in primary qualitative studies for Qualitative Evidence Syntheses (QES). The tool has been in development since 2014. Three pilot versions from three review teams have been used in six Cochrane reviews. Key members from the original three review teams came together to create a consensus-based definitive version 1 of the tool for publication. Four review authors piloted the version 1 tool. The definitive version 1 assessment tool consists of two components: assessing the thickness of contextual data and assessing the richness of conceptual data. A sliding scale with four points is used to rate these aspects, offering nuanced and qualitative judgments. The accompanying guidance emphasizes the importance of assessing data that addresses the review question. Paragraph locked by Heather Melanie R Ames The paper provides guidance on how to apply the tool, emphasizing the importance of reaching a consensus among review authors, and fostering a shared understanding of what constitutes rich and thick data in the context of the review. The potential challenges related to the time and resource constraints of this additional review process are acknowledged. Version 1 of the data thickness/richness assessment tool represents a significant development in QES methodology, filling a critical gap in tools for evaluating the richness of conceptual data and the level of contextual detail in primary qualitative studies. It enhances the transparency and rigor of the sampling process and offers valuable insights for assessing the thickness and richness of data in primary qualitative studies that addresses the review requestion, objectives and context as specified in the review protocol. The authors invite feedback from the research community to further test, refine and improve this tool based on wider user experiences.

Microsporidia are obligate intracellular eukaryotic parasites that infect nearly all animal groups, including humans. The most common molecular methods for Microsporidia detection rely on species-targeting qPCR or end-point PCR using group-specific primers. However, these methods could be not specific enough or fail in case of mixed infections. We developed a method for parallel detection of both microsporidian infection and the host species. We designed new primer sets: one specific for the classical Microsporidia (targeting hypervariable V5 region of ssu rDNA), and a second one targeting a shortened fragment of the COI gene (standard metazoan DNA-barcode); both markers are well suited for a NGS approach. The analysis of ssu rDNA dataset representing 607 microsporidian species (120 genera) indicated that the V5 region enables identification of >98% species in the dataset (596/607). To test the method, we used microsporidians that infect mosquitoes in natural populations. Using mini-COI data, all field-collected mosquitoes were unambiguously assigned to seven species; among them almost 60% of specimens (127/212) were positive for at least 11 different microsporidian species, including a new microsporidian ssu rDNA sequence (Microsporidium sp. PL01). Phylogenetic analysis of Microsporidium sp. PL01 ssu rDNA showed that this species belongs to one of the two main clades in the Terresporidia. In addition, the level of microsporidian mixed infections was relatively high (9.4%). The numbers of sequence reads for the OTUs suggest that the occurrence of Nosema spp. in co-infections could benefit them; however, this observation should be re-tested using more intensive host sampling. The proposed method for detection of Microsporidia can be applied to all types of DNA extracts, including medical and environmental samples.