In this paper, we consider the asymptotic behavior of the Boussinesq equation with nonlocal weak damping when the nonlinear function is arbitrary polynomial growth. We firstly prove the well-posedness of solution by means of the monotone operator theory. At the same time, we obtain the dissipative property of the dynamical system (E ,S( t)) associated with the problem in the space H 0 2 ( Ω ) × L 2 ( Ω ) and D ( A 3 4 ) × H 0 1 ( Ω ) , respectively. After that, the asymptotic smoothness of the dynamical system (E ,S( t)) and the further quasi-stability are demonstrated by the energy reconstruction method. Finally, different from [21] we show not only existence of the finite global attractor but also existence of the generalized exponential attractor.

Background: An effective chemotherapy calendar system between the clinician and the patient/caregiver can improve patient centered outcomes. There is lack of research on how chemotherapy calendars are created and what aspects are important to pediatric oncology providers. Procedure: In an online survey of pediatric oncology providers, we evaluated institutional practices, perceptions of chemotherapy calendar creation, and desires for future tools. 220 survey participants provided data, with a 10.4% response rate. Results: Participants indicated that 72% always or most of the time their institution provides a chemotherapy calendar, most commonly at the start of a new cycle (90%) or with a dosing change (68%). Factors such as the health literacy of the family, prior non-adherence, type of cancer, and desire of the family affected the creation decision. Advanced practice providers (45%) or nurse coordinator/navigators (43%) were most likely to create the calendar. No significant difference was found between the likelihood of creating a calendar and institutional size (p=0.09) or provider years in practice (p=0.26). About 95% of participants indicated chemotherapy calendar creation software that improved ease and efficiency would be moderately to extremely useful. Conclusion: Future efforts should focus on patient and caregiver perspectives of chemotherapy calendar elements and utilization.

Fibrodysplasia ossificans progressiva is a rare condition with an estimated prevalence of one in two million individuals. The condition is characterised by widespread heterotrophic ossification of skeletal muscles and ligaments. We report the case of an eight-year-old female patient and show the radiological progression of the condition.

Safety and Effect on Length of Stay of Intravenous Sotalol Initiation for Arrhythmia ManagementDiane H. Rizkallah, BS; Marwan M. Refaat, MDDivision of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LebanonRunning Title: Safety and Effect on LOS of IV SotalolWords: 598 (excluding the title page and references)Keywords: Heart Diseases, Cardiovascular Diseases, Cardiac Arrhythmias, Safety, Length of StayFunding: NoneDisclosures: NoneCorresponding Author:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FRCPTenured Professor of MedicineTenured Professor of Biochemistry and Molecular GeneticsVan Dyck Medical Educator and Director of the Cardiovascular Fellowship ProgramDepartment of Internal Medicine, Cardiovascular Medicine/Cardiac ElectrophysiologyAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonUS Address: 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USAOffice: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)Email: [email protected] is a class III antiarrhythmic drug with beta-adrenergic blocking activity, used to manage both supraventricular and ventricular arrhythmias. It is available in both oral and intravenous formulations[1]. The FDA approved intravenous Sotalol in March 2020. Sotalol is known to cause QTc prolongation with serum sotalol concentration linearly correlating with QTc length regardless of the route of administration [2,3], with women being at higher risk than men[4]. QTc interval prolongation is one of many parameters that is associated with cardiovascular mortality [5]. QTc prolongation may lead to polymorphic ventricular tachycardia/Torsade de Pointes which is a potentially lethal condition that is acquired from medications or due to an underlying channelopathy predisposing to sudden cardiac arrest[6]. Additional adverse effects of sotalol may include hypotension, bradycardia and AV block[7,8]. Nevertheless, since its approval, IV sotalol has been successfully and safely used in both adult and pediatric patient populations for the management of arrhythmias in acute and chronic settings [9,10,11,12]. Initiation of sotalol therapy with PO loading requires 5 successive oral doses over a 3-day hospital stay for monitoring, at an estimated cost of $2931.55 per day [13]. In 2020, a protocol for IV loading of sotalol was developed using data modeling. This protocol was hypothesized to allow a significant reduction in the length of hospitalization, and thus in the incurred costs[14]. However, there has not been any large-scale implementation of this protocol, nor any comparison of its safety profile and efficacy to that of the traditional oral loading protocol.This study by Liu et al. is a nonrandomized clinical trial in which 29 patients underwent IV sotalol loading. They were compared by chart review to 20 patients who underwent PO sotalol loading in the same timeframe. The indication for sotalol initiation in both cases was for primary atrial or ventricular arrhythmias. The study’s main aim was to assess the safety profile of IV sotalol loading while comparing the length of hospitalization to that required for PO sotalol loading. The same exclusion and inclusion criteria were applied to both groups. Notably, patients with significantly depressed LVEF and creatinine clearance were excluded. The study revealed that safety outcomes were similar in both groups but that IV sotalol loading led to significantly shorter hospital stays. It also found that QT or QTc in patients receiving IV sotalol was similar at the conclusion of the one-hour infusion to that at discharge.These findings support the use of IV loading for sotalol initiation, as they suggest it requires shorter hospital stays than PO loading with similar safety profiles. As shorter hospital stays translate into lower patient days, lower costs, and these results suggest IV sotalol loading is more cost-efficient than its oral counterpart. They also suggest that the maximal increase in QT or QTc length following sotalol initiation is attained by the end of IV loading, thus indicating that patients may be discharged within less than 24 hours of drug initiation.While this study offered valuable insight, its design had significant limitations. Firstly, this was not a randomized clinical trial. A comparison of baseline characteristics between the two populations studied revealed a significantly higher proportion of females in the oral group, which may have inherently skewed outcomes related to QT and QTc length.Secondly, the sample size was small, with no long-term follow-up. Lastly, patients with significantly depressed GFR or LVEF, particularly prone to developing adverse effects with sotalol use, were excluded from the study. Randomized clinical trials examining the short-term and long-term safety of IV sotalol loading and the optimal length of hospitalization are needed, and such efforts are already underway.References:Batul, S. A., & Gopinathannair, R. (2017). Intravenous Sotalol - Reintroducing a Forgotten Agent to the Electrophysiology Therapeutic Arsenal. Journal of atrial fibrillation , 9 (5), 1499. https://doi.org/10.4022/jafib.1499Somberg, J. C., Preston, R. A., Ranade, V., & Molnar, J. (2010). QT prolongation and serum sotalol concentration are highly correlated following intravenous and oral sotalol. Cardiology , 116 (3), 219–225. https://doi.org/10.1159/000316050Barbey, J. T., Sale, M. E., Woosley, R. L., Shi, J., Melikian, A. P., & Hinderling, P. H. (1999). Pharmacokinetic, pharmacodynamic, and safety evaluation of an accelerated dose titration regimen of sotalol in healthy middle-aged subjects. Clinical pharmacology and therapeutics , 66 (1), 91–99. https://doi.org/10.1016/S0009-9236(99)70058-5Somberg, J. C., Preston, R. A., Ranade, V., Cvetanovic, I., & Molnar, J. (2012). Gender differences in cardiac repolarization following intravenous sotalol administration. Journal of cardiovascular pharmacology and therapeutics , 17 (1), 86–92. https://doi.org/10.1177/1074248411406505Al-Kindi SG, Refaat M, Jayyousi A, Asaad N, Al Suwaidi J, Abi Khalil C. Red Cell Distribution Width is Associated with All-Cause and Cardiovascular Mortality in Patients with Diabetes. Biomed Res Int 2017; 2017: 5843702Refaat MM, Hotait M, Tseng ZH: Utility of the Exercise Electrocardiogram Testing in Sudden Cardiac Death Risk Stratification.Ann Noninvasive Electrocardiol 2014; 19(4): 311-318.Marill, K. A., & Runge, T. (2001). Meta-analysis of the Risk of Torsades de Pointes in patients treated with intravenous racemic sotalol. Academic emergency medicine,  8 (2), 117–124. https://doi.org/10.1111/j.1553-2712.2001.tb01275.xMacNeil, D. J., Davies, R. O., & Deitchman, D. (1993). Clinical safety profile of sotalol in the treatment of arrhythmias. The American journal of cardiology , 72 (4), 44A–50A. https://doi.org/10.1016/0002-9149(93)90024-7Malloy-Walton, L. E., Von Bergen, N. H., Balaji, S., Fischbach, P. S., Garnreiter, J. M., Asaki, S. Y., Moak, J. P., Ochoa, L. A., Chang, P. M., Nguyen, H. H., Patel, A. R., Kirk, C., Sherman, A. K., Avari Silva, J. N., & Saul, J. P. (2022). IV Sotalol Use in Pediatric and Congenital Heart Patients: A Multicenter Registry Study. Journal of the American Heart Association , 11 (9), e024375. https://doi.org/10.1161/JAHA.121.024375Borquez, A. A., Aljohani, O. A., Williams, M. R., & Perry, J. C. (2020). Intravenous Sotalol in the Young: Safe and Effective Treatment With Standardized Protocols. JACC. Clinical electrophysiology , 6 (4), 425–432. https://doi.org/10.1016/j.jacep.2019.11.019Kerin, N. Z., & Jacob, S. (2011). The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis. The American journal of medicine , 124 (9), 875.e1–875.e8759. https://doi.org/10.1016/j.amjmed.2011.04.025Milan, D. J., Saul, J. P., Somberg, J. C., & Molnar, J. (2017). Efficacy of Intravenous and Oral Sotalol in Pharmacologic Conversion of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Cardiology , 136 (1), 52–60. https://doi.org/10.1159/000447237Varela, D. L., Burnham, T. S., T May, H., L Bair, T., Steinberg, B. A., B Muhlestein, J., L Anderson, J., U Knowlton, K., & Jared Bunch, T. (2022). Economics and outcomes of sotalol in-patient dosing approaches in patients with atrial fibrillation. Journal of cardiovascular electrophysiology , 33 (3), 333–342. https://doi.org/10.1111/jce.15342Somberg, J. C., Vinks, A. A., Dong, M., & Molnar, J. (2020). Model-Informed Development of Sotalol Loading and Dose Escalation Employing an Intravenous Infusion. Cardiology research , 11 (5), 294–304. https://doi.org/10.14740/cr1143

As we approach the three-year anniversary of the pandemic, we are now facing a seasonal influenza epidemic after two years without one. In light of growing concerns over the potential risk of a “twindemic,” the Republic of Korea is currently experiencing the first peak of seasonal flu and the overall pattern is quite similar to that observed before the COVID-19 pandemic. Notably, no sudden or early increase in cases has been detected, which is unique compared to other countries.

A 7-year-old American short-haired cat was presented with blepharospasm in the right eye. The case was finally performed with orbital exenteration, leading to the diagnosis of feline restrictive orbital myofibroblastic sarcoma. Adjuvant chemotherapy with toceranib was given for one month after surgery. However, the case died four months after surgery.

Title : Distinct and mutually exclusive Ca++ flux- and adenyl cyclase-inducing gene expression profiles of G-Protein-Coupled Receptors on human antigen-specific B cellsAuthors : Iris Chang1,2†, Abhinav Kaushik, PhD1,2†, Pattraporn Satitsuksanoa PhD1, Minglin Yang1, Laura Buergi Msc1, Stephan R. Schneider Msc1, Cezmi A. Akdis, MD1, Kari Nadeau MD, PhD2, Willem van de Veen, PhD1, Mübeccel Akdis, MD, PhD1*1 Swiss Institute of Allergy and Asthma Research (SIAF), University of Zürich, Davos, Switzerland.2 Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Palo Alto, CA, USA.† Contributed equally* Corresponding authorB cells play an essential role in allergies by producing allergen-specific IgE, which is a prerequisite for allergen-induced degranulation of mast cells (MCs) and basophils. MCs, basophils, dendritic cells and bacteria are capable of releasing inflammatory mediators including histamine. Histamine is a bioactive amine that exerts its function through binding to histamine receptors (HRs), which are 7-transmembrane G-protein-coupled receptors (GPCRs). There are four types of HRs (HR1-4), wherein HR1 ligation triggers Ca2+ mobilization, HR2 stimulates and increases cAMP concentrations, and HR3 and HR4 inhibit cAMP accumulation1. In the presence of histamine in the environment, high affinity HR1is triggered causing cellular activation, followed by expression of 10 times lower affinity HR2 to regulate the over-inflammatory events. These HRs trigger different intracellular events upon activation, with HR1 as a Ca2+ flux-inducing activating receptor and HR2 as an adenyl cyclase-stimulating suppressive receptor 1,2. Therefore, to explore the response of B-cells in allergic diseases, we analyzed the expression profile of HRs and other GPCRs in B cell clones. We hypothesized that the expression profile of HRs (HR1+ vs HR2+ B cell clones) is associated with significant changes in the expression profile of other GPCRs that govern the downstream cascade of pathways associated with cAMP signaling or Ca2+ mobilization.A total of 27 IgG1 and IgG4 expressing B cell clones were isolated for gene expression analysis under BCR stimulated and unstimulated conditions (Figure 1A and Online Supplementary Methods) . Interestingly, we observed B-cell clones with mutually exclusive expression profile of HRH1 and HRH2 genes (Figure 1B), with more HRH1+ B-cell clones in BCR-stimulated samples than unstimulated samples. The subsequentHRH1+ vs HRH2+ differential gene expression analysis (Figure 1C ), reveal 27 differentially expressed (DE) GPCRs in unstimulated samples, with up-regulated P2RY13  and C5AR1genes  in HRH2 + B-cell clones (Figure 2A) , which are associated with the cAMP signaling and suppressive pathway3,4. To further prioritize the DE GPCRs specifically associated with Ca2+ and cAMP signaling pathways, we reconstructed the co-expression networks and performed the weighted degree analysis across HRH1+ vs HRH2+ clones. The analysis reveals that the purinergic receptor family of GPCRs (i.e. P2RY1 , P2RY13 )  and complement component 5a receptor family of genes (i.e. C5AR1  and C5AR2 ) share highest degree of interactions. These genes are up-regulated inHRH2+ samples and are well-known to affect cAMP signaling pathway3,4 (Figure S1A ). Intriguingly, we also observed upregulation of GPR35  in HRH2 + B cells, which is associated in maintaining a low baseline Ca2+ level5. Similarly, we also observed up-regulation of GPR68 and GPR171 in HRH1 + B cells; both are known to stimulate Ca2+ flux (Online Supplementary Discussion) .Similarly, 28 GPCRs were differentially expressed in BCR-stimulated samples (Figure 2B ), including higher expression of serotonin receptor type 1A (HTR1A ) and HCAR1  (or GPR81 ) inHRH2+ samples, with a cAMP-linked suppressive function. In addition, we also observed upregulation of complement component 5a receptor family of genes (i.e., C5AR1  and C5AR2 ) and GPR35 , in agreement with the trend observed in unstimulatedHRH2 + B-cell clones. Surprisingly, we observed a higher expression of prostaglandin E2 receptor subtype EP4 (PTGER4)  and adenosine A2A receptor (ADORA2A ) in HRH2+ samples3,6, which are known to be associated with activation of cAMP production and share the highest strength of interactions with the cAMP signaling sub-network (Figure S1B ). Among the up-regulated genes in HRH1 + samples, we found three Ca2+ mobilizing genes, i.e., GPR34 ,P2RY10  and PTAFR .The results reported in this study provides data for a novel hypothesis suggesting investigation of co-expressed genes that may play important synergistic or antagonistic regulatory roles in B-cell function.

Although there has been an effective seasonal influenza vaccine available for more than 60 years, influenza continues to circulate and cause illness. The Eastern Mediterranean Region (EMR) is very diverse in health systems capacities, capabilities, and efficiencies, which affect the performance of services, especially vaccinations, including seasonal influenza vaccination. In this article, we have analyzed data from a regional seasonal influenza survey conducted in 2022, Joint Reporting Form (JRF), and verified their validity by the focal points. We also compared our results with those of the regional seasonal influenza survey conducted in 2016. This analysis provides a comprehensive overview on country-specific influenza vaccination policies, vaccine delivery, and coverage in EMR. Fourteen countries (64%) had reported having a national seasonal influenza vaccine policy. About (44%) countries recommended influenza vaccine for all SAGE recommended target groups. Up to (69%) of countries reported that COVID-19 had an impact on influenza vaccine supply in the country, with most of them (82%) reporting increases in procurement and supply of influenza vaccine, with the other countries reporting decreases in procurement due to COVID-19. We suggest supporting countries to develop a roadmap for influenza vaccine uptake and utilization, assessment of barriers and burden of influenza, including measuring the economic burden to enhance vaccine acceptance.

A document by Gabriele Pradel. Click on the document to view its contents.

To alleviate the ill-posed of the inverse problem in Fluorescent molecular tomography (FMT), many regularization methods based on L 2 or L 1 norm have been proposed. Whereas, the quality of regularization parameters affect the performance of the reconstruction algorithm. Some classical parameter selection strategies usually need initialization of parameter range and high computing costs, which is not universal in the practical application of FMT. In this paper, an universally applicable adaptive parameter selection method based on maximizing the probability of data (MPD) strategy was proposed. This strategy used maximum a posteriori (MAP) estimation and maximum likelihood (ML) estimation to establish a regularization parameters model. The stable optimal regularization parameters can be determined by multiple iterative estimates. Numerical simulations and in vivo experiments show that MPD strategy can obtain stable regularization parameters for both regularization algorithms based on L 2 or L 1 norm and achieve good reconstruction performance.

Microbial life in an ecosystem with low energy supply has been considered to employ two energy utilization strategies. The first is energy conservation at an individual level, while the second is energy use optimization in response to the availability of energy resources. Here, using an oxidation-reduction (redox) reaction network model where microbial metabolic pathways are established through multiple species-level competition and cooperation within a redox reaction network, we hypothesize that microbial ecosystems can move forward to increase energy use efficiency, namely an energy efficiency strategy at the community level. This strategy is supported by microbial functional diversity that enables species to interact with others in various ways of metabolic handoffs. Moreover, the high energy use efficiency is attributable to the mutualistic division of labor that increases the complexity of metabolic pathways, which actively drives material cycling to exploit more energy.

Background and Purpose: The ionotropic purinergic trimeric receptor P2X3 is a new drug target other than the opioid receptor for the treatment of refractory chronic cough (RCC). However, the only marketed P2X3 antagonist, Gefapixant/AF-219, has a side effect of taste disorders due to simultaneous action on the human P2X2/3 (hP2X2/3) heterotrimer. Therefore, selective molecules with high affinity for the hP2X3 homotrimer and low affinity for the hP2X2/3 heterotrimer have potential in iteration 2.0 RCC drug development, such as Sivopixant/S-600918, a clinical phase II RCC candidate with lower taste disturbance than Gefapixant. S-600918 and its analogue (3-(4-((3-chloro-4-isopropoxyphenyl)amino)-3-(4-methylbenzyl)-2,6-dioxo-3,6-dihydro-1,3,5-triazin-1(2H)-yl)propanoic acid (DDTPA) exhibit both high affinity and high selectivity for hP2X3 homotrimers compared to hP2X2/3 heterotrimer. The mechanism of its druggable site and this high selectivity is not clear. Experimental Approach: Here, we reveal a novel allosteric mechanism that distinguishes this drug candidate from other P2X3 inhibitors through chimera construction, site covalent occupation, metadynamics, mutagenesis, and electrophysiology. Key Results: We suggest that the tri-symmetric site adjacent to the upper vestibule determines the high affinity and selectivity of S-600918/DDTPA for hP2X3. Only four amino acids of the hP2X2 upper body domain swapped with hP2X3, allow the hP2X2/3 heterotrimer to gain comparable affinity for S-600918/DDTPA as the hP2X3 homotrimer. Conclusion and Implications: Thus, we have revealed the molecular basis for the cough suppressive effects and reduced side effects of new RCC clinical candidates from the perspective of receptor-ligand recognition, which may provide information critical for the development of new drugs targeting P2X3 for indications such as RCC, idiopathic pulmonary fibrosis (IPF), and primary hypertension.

Medication reviews focusing on deprescribing can reduce potentially inappropriate medication; however, evidence regarding the effects on health-related outcomes is scares. In a real-life, quality improvement project, we aimed to investigate how a general practitioner-led medication review intervention with focus on deprescribing affected health-related outcomes. We performed a before-after intervention study including care home residents and community-dwelling patients affiliated with a large Danish general practice. The primary outcomes were changes in self-reported health status, general condition, and functional level from baseline to 3-4 months follow-up. Of 105 included patients, 87 completed follow-up. From baseline to follow-up, 255 medication changes were made, of which 83% were deprescribing. Mean self-reported health status increased from 7.3 to 7.9 (0.6 [95% CI: 0.2 to 0.9]); the proportion of patients with general condition rated as “average or above” was stable (74.7% to 80.5% (5.7% [95% CI: -3.4 to 14.9]); and the proportion of patients with functional level “without any disability” was stable (58.6% to 54.0% (-4.6% [95% CI: -10.1 to 1.0]). In conclusion, this general practitioner-led medication review intervention led to deprescribing and increased self-reported health status without deterioration of general condition or functional level in real-life primary care patients.

Plants perceive environmental stresses as whole organisms via distant signals conveying danger messages through their vasculature. In parallel to vascular transport, airborne plant volatile compounds, including green leaf volatiles (GLVs), can bypass the lack of vascular connection. However, some small volatile compounds move through the vasculature; such vascular transport is little known about GLVs. Here we illustrate GLV alcohols as solutes move within xylem vessels in Zea mays. We describe GLV alcohols, including Z-3-hexenol and its isomer E-3-hexenol, which is not synthesized in maize, is mobilized through the transpiration stream via xylem vessels. Since transpiration is mediated by stomatal aperture, closing stomata by two independent methods diminishes the transport of GLV alcohol and its isomer. In addition, lower transport of GLV alcohols impairs their function in inducing terpenoid biosynthesis suggesting xylem transport of GLV alcohols plays a significant role in their systemic function. Our study not only shows that GLV alcohols can be transported in the xylem but points to stomatal regulation as a mechanism that climatic factors such as drought, heat, flooding, and high CO 2 levels affect systemic signaling functions of GLVs.

This case report describes the clinical and diagnostic imaging findings, treatment, and outcome of a three-month-old Thoroughbred foal referred for the evaluation of severe left forelimb lameness and presents the acquisition of a novel radiographic projection of the scapula used to achieve the diagnosis. No abnormalities were found with the standard radiographic examination of the left shoulder. Ultrasound and a dorsal 45° lateral‐ventral lateral oblique radiographic view were performed to evaluate the body of the left scapula. A longitudinal, minimally displaced fracture of the infraspinous fossa was diagnosed with this projection that was not detected in the routine projections. Ultrasound was used in conjunction to confirm the diagnosis, assess the displacement of the fracture in the frontal plane, and evaluate soft tissue damage. The foal was treated conservatively with anti-inflammatory drugs and stall rest. A radiographic follow-up and clinical reassessment were performed, and the horse appeared sound, no atrophy of the region was appreciated, and no radiographic abnormalities were found.

Background: Saudi Arabia (SA) reported its first case of COVID-19 on 2 March 2020. Mortality varied nationwide: by 14 April 2020 Medina had 16% of SA’s total COVID-19 cases and 40% of all COVID-19 deaths. A team of epidemiologists investigated to identify factors impacting survival. Methods: We reviewed medical records from two hospitals: Hospital A in Medina and Hospital B in Dammam. All patients with a registered COVID-related death between 1 March -22 April 2020 were included. We collected data on demographics, chronic health conditions, clinical presentation and treatment. We analysed data using SPSS. Results: We identified 76 cases: 38 cases from each hospital. More fatalities were among non-Saudis at Hospital A (89%) versus Hospital B (82%, p<.001). Hypertension prevalence was higher among cases at Hospital A (42%) versus Hospital B (21%) (p<.05). We found statistically significant differences (p<.05) in symptoms at initial presentation among cases at Hospital A versus Hospital B, including: body temperature (38º C vs 37º C), heart rate (104 bpm vs 89 bpm), and regular breathing rhythms (61% vs 55%). Less cases (50%) at Hospital A received heparin versus Hospital B (97%, p-value< 0.001). Conclusion: Patients who died at Hospital A typically presented with more severe illness and were more likely to have underlying health conditions. Migrant workers may be at increased risk due to poorer baseline health and reluctance to seek care. This highlights the importance of cross-cultural outreach to prevent deaths. Health education efforts should be multilingual and accommodate all literacy levels.

ABSTRACT Introduction: Influenza is an acute viral infection with significant morbidity and mortality. Its occur annually each winter is called seasonal influenza and is preventable through safe vaccine. Aim: To know the epidemiological pattern of patients with seasonal influenza in Iraqi sentinel sites. Methods: A cross- sectional study carried out on records of patients who attended four sentinel sites and registered to have influenza-like illness (ILI) or severe acute respiratory infection (SARI), and laboratory investigated. Results: The total number of cases was 1124, 36.2% of them aged 19-39 years; 53.9% were female; 74.9% lived in urban areas; 64.3% diagnosed as ILI and 35.7% as SARI. 15.9% had diabetes, 12.7% had heart disease, 4.8% had asthma, 3% had a chronic lung disease, and 2% had hematological disease. 94.6% did not get influenza vaccine. About COVID-19 vaccine, 69.4% did not vaccinated, 3.5% get only 1 dose, and 27.1% completed 2 doses. Only the SARI cases needed admission, among them 95.7% were cured. 6.5% were diagnosed as influenza- A virus, 26.1% had COVID-19, and 67.5% were negative. Among those with influenza, 97.3% had H3N2 subtype, and 2.7% had H1N1 pdm09. Conclusions: The percentage of influenza virus in Iraq is relatively small. The age, classification of case (ILI or SARI), having diabetes, heart disease, or immunological disease, and taking COVID-19 vaccine have a significant association with influenza. Recommendations: It’s needed for similar sentinel sites in other health directorates and for rising health education about seasonal influenza and its vaccine.

Background: Outcomes for children with high-risk renal (HRR) and INI-1-deficient (INI-) tumors are unacceptably poor. Concerns about excessive toxicity – as many are infants and/or undergo nephrectomy – have resulted in decreased chemotherapy dosing and omission of the nephrotoxic drug ifosfamide in collaborative group studies. As cause of death for children with these cancers remains overwhelmingly more from progressive disease rather than treatment toxicity, we examined the tolerability of an intensive ifosfamide-containing-regimen. Procedure: Retrospective review of children with HRR/INI- tumors treated at a single institution with vincristine, doxorubicin, cyclophosphamide alternating with ifosfamide, carboplatin, etoposide (VDC-ICE) from 2006-2016. The primary outcome was regimen tolerability including kidney injury and grade 3-5 non-hematologic toxicities. Results: Fourteen patients with a median age of 1.7 years (range 0.1-10.5) treated with VDC-ICE were identified. Diagnosis included malignant rhabdoid tumor (n=9) [primary renal (n=2)]; diffuse anaplastic Wilms tumor (n=3); clear cell sarcoma of the kidney (n=1); and anaplastic chordoma (n=1). All children with primary renal tumors (43%) underwent complete (n=5) or partial nephrectomy (n=1) before chemotherapy. Nine (64%) completed all intended cycles of chemotherapy; n=5 (36%) did not due to disease progression. Unplanned hospitalizations occurred in 13 (93%) patients, most commonly for febrile neutropenia. No patient experienced severe organ toxicity, diminished renal function, treatment discontinuation due to toxicities, or treatment-related death. Conclusions: In children with HRR/INI- tumors, VDC-ICE chemotherapy was well-tolerated without excessive toxicities, even amongst young patients with solitary kidneys. Concerns about toxicity should not preclude an intensive ifosfamide-containing regimen from use in future trials in this population.