Pustular psoriasis is a rare, acute form of psoriasis. It can be triggered by pregnacy, infection, hypocalcemia, and medications. We describe a case of annular pustular psoriasis Milian Katchoura type, a rare variant of pustular psoriasis, that occurred secondary to reducing the dose of oral corticosteroids.

The role of Immunotherapy in Chronic Urticaria is unclear, except for isolated circumstances. Hymenoptera sting causes acute urticaria and no report of CU after Hymenoptera sting can be found in the literature. We describe a case of onset of CU after multiple wasp stings that remitted during venom immunotherapy.

Background: The role of combination regimens in the treatment of invasive fungal infections (IFI) in patients with hematologic malignancies remains unclear. This study was aimed to demonstrate experience data about combined antifungal therapy (CAT) in pediatric IFI patients with haematological malignancies. Methods: Between January 2014 and December 2017, a total of 33 IFI episodes in 28 patients with hematological malignancies were analyzed retrospectively. Results: Of the patients (19 with acute lymphoblastic leukemia, and 9 with acute myeloblastic leukemia), 21 (75%) had leukemia relapse and 7 (25%) had remission. IFI was classified as possible in 26 (78.8%) episodes, probable in 5 (15.1%) episodes, and proven in 2 (6.1%) episodes. LamB (%50) was the most preferred agent in monotherapy. Mean duration of monotherapy was 12.84 ± 4.28 (5-24) days. LamB plus voriconazole (54.5%) were the most common combination preference in CAT. Mean duration of CAT was 42.36 ± 36.4 days, and unchanged according to combination regimen type (p = 0.571). Total mortality rate and IFI attributable mortality rate were 60.7% vs 76.5%. Mortality rate was significantly higher in patients with relapse (p = 0.006). Complete response was obtained in 81.8% of surviving patients. Duration of neutropenia and CAT, and recovery time were not found statistically different in the episodes with/without death and according to relapse or remission status. Side effects due to CAT use were observed quite low level. Conclusion: CAT has been found to be safe in IFI episodes of pediatric leukemia. The result will contribute to the data about combined antifungal use in daily clinical practice in pediatric haematological patients with IFI.

Objective: The novel coronavirus SARS-CoV-2 (COVID-19) rapidly escalated from its origin in an animal market in Wuhan, China in December 2019 to a global pandemic, and the lungs are the most frequently affected organ. The aim of this study was to investigate the relationship between pulmonary function test parameters and laboratory parameters in COVID-19. Method: A total of 60 patients who were admitted to the chest diseases department and intensive care unit of our hospital and were diagnosed with COVID-19 by real-time PCR analysis of nasopharyngeal swabs were evaluated. Pulmonary function tests and laboratory parameters at admission and on day 7 of treatment were analyzed. Results: On day 7 of treatment, white blood cell count, CRP, and fibrinogen level were significantly lower than at admission (p=0.002, 0.001, and 0.001, respectively), while forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) values were significantly higher compared to admitting values (p=0.001 for both). Correlation analysis of the changes in respiratory function values and laboratory parameters during follow-up (day 1 to day 7 of treatment) revealed that CRP level was positively correlated with FEV1 (r=0.616, p=0.01) and FVC values (r=0.51, p=0.01). Fibrinogen level was also positively correlated with FEV1 (r=0.345, p=0.01) and FVC (r=0.357, p=0.01). Conclusion: Fibrinogen and CRP levels are easily accessible parameters that may help identify improvement or deterioration in pulmonary function in COVID-19 patients during follow-up and discharge while reducing the risk of transmission.

Aim: In this feasibility study, we aimed to implement a pilot telemedicine service at our healthcare facility in Faisalabad, Pakistan, and describe our experience. Methods: Telemedicine service was established by Faisalabad Medical University at two of its affiliated locations: 1) A 24-hour COVID-19 Telephone Helpline was established at Director Emergency Office, Allied Hospital and District Headquarter (DHQ) Hospital. 2) A Telemedicine Clinic comprising consultants and postgraduate residents from different specialties was established at Chief Office, Allied Hospital. The data related to the number and categories of calls and advice provided was collected from 27th March 2020 till 31st July 2020. Results: A total of 4582 calls were received, at both locations, during the study period, out of which 2325 callers (51%) were male, and 2257 (49%) were females. At Allied Hospital, 172 patients were advised accordingly for their complaints, whereas, at DHQ Hospital, 320 patients were advised accordingly for their complaints. At the telemedicine clinic only, a total of 2436 calls were received during the study period, 1474 (60%) callers were male, and 962 (40%) were female. The majority of the calls were received by medicine (43%), dermatology (21%), and pediatrics (11%) specialties, respectively. Conclusion: Despite some limitations, the benefits of telemedicine in this COVID-19 era are enormous and it is feasible to implement telemedicine services in developing countries. The developing countries must invest in the internet and technology access to facilitate telemedicine and other e-health services for not only curbing this pandemic but also to promote a more efficient healthcare system after the pandemic.

Land development is rapidly occurring on sand--dominant soils that cover substantial areas of the Lower Mekong Basin. Sands are at risk of degradation on sloping uplands where agriculture is expanding and on lowland landscapes where intensification of cropping is occurring. Sandstone and granitic geology explain the prevalence of sand-dominant texture in profiles. The sand terrains in uplands of Cambodia and southern Laos mostly have not been comprehensively mapped and their diversity and edaphic properties are poorly understood. On high permeability sands, lowland rainfed rice crops are drought-prone, while nutrient losses from leaching are also a risk. Furthermore, waterlogging, inundation and subsoil hardpans are significant water-related hazards that influence the choice of field crops and forages for lowland soils. Land use change in the lowlands to alternative field crops and forages on sands is contingent on their profitability relative to rice, the amounts and reliability of early wet season rainfall and amounts of stored water available after harvesting rice. Soil acidity, low nutrient status, hard-setting and shallow rooting depth are significant constraints for crops and forages on sands in the lowlands. Low soil fertility and soil acidity are limitations to the productivity of farming systems on the sand profiles in uplands, while erosion, low soil organic matter levels and water balance are concerns for their sustainable use. There is a need for widespread land suitability assessment and the development of sustainable farming systems before uncontrolled expansion of agriculture causes degradation of sandy terrain of the Lower Mekong Basin.

Periphyton plays an indispensable role in coastal saline-alkali land, but its function is poorly understood. Soil physical and chemical properties (pH value, salinity, soil organic matter), enzyme activity and microbial diversity (based on 16s rDNA, ITS and functional genes) were measured in periphyton formed on rice-growing coastal saline-alkali soil modified by a new type of soil conditioner. The results showed that the content of organic matter and catalase activity in periphyton were significantly higher than in the unplanted control soil. Soil pH and salinity were decreased in periphyton compared to the unplanted control soil. Based on the relative abundance, bacterial genera Desulfomicrobium, Rhodobacter, cyanobacterium_scsio_T−2, Gemmatimonas, and Salinarimonas as well as fungal genus Fusarium were more abundant in periphyton than the unplanted control soil. In terms of functional genes, the cbbM and cbbL sequencing showed higher abundance of Hydrogenophaga, Rhodovulum, Magnetospira, Leptothrix, and Thiohalorhabdus, whereas the nifH sequencing indicated higher abundance of Cyanobacteria in the periphyton compared to the unplanted soil. The relative abundance and community structure of soil microorganisms were improved by periphyton, thus reducing soil salinity and pH, increasing soil organic matter and enzyme activity. This indicated that the periphyton can improve the conditions and offer a suitable environment for plant growth in coastal saline-alkali soil.

Background: Three-dimensional echocardiography (3DE) evaluation of left ventricular (LV) volume and function in pediatrics compares favorably with cardiac magnetic resonance imaging. The aim of this study was to establish from a multicenter, normal pediatric z-score values of 3DE left ventricular volumes and function. Methods: Six hundred and ninety-eight healthy children (ages 0 to 18 years) were recruited from five centers. LV 3DE was acquired from the 4-chamber view. A vendor independent software analyzed end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF) using semi-automated quantification. Body surface area (BSA) based z-scores were generated. Intraobserver and interobserver variability were calculated using intraclass correlation (ICC) and repeatability coefficient (RC). Results: Z-scores were generated for ESV, EDV, and SV. The ICC for intraobserver variability for EDV, ESV, and SV were 0.99, 0.99, and 0.99 respectively. The ICC for interobserver variability for EDV, ESV, and SV were 0.98, 0.94, and 0.98 respectively. The RC for intraobserver and interobserver variability for LV EF was 4.39% (95% CI: 3.01, 5.59) and interobserver was 7.08% (95%CI: 5.51, 8.42). Conclusions: We report pediatric Z-scores for normal LV volumes using the semi-automated method from five centers, enhancing its generalizability. 3DE evaluation of LV volumes and EF in pediatric patients is highly reproducible.

This study presents the case of a 9-year-old girl for whom complete resolution of recalcitrant warts was achieved with acupuncture and moxibustion treatment. This result suggests that acupuncture and moxibustion could be effective therapeutic strategies for plantar warts in the paediatric patient population.

In semi-arid environments, aperiodic rainfall pulses determine cycles of plant production and resource availability for higher trophic levels, creating strong bottom-up regulation. The influence of climatic factors on population vital rates often shapes the dynamics of small mammal populations in such resource-restricted environments. Using a 21-year biannual capture–recapture dataset (1993 to 2014), we examined the impacts of climatic factors on the population dynamics of the brush mouse (Peromyscus boylii) in semi-arid oak woodland of coastal-central California. We applied Pradel’s temporal symmetry model to estimate capture probability (p), apparent survival (φ), recruitment (f), and realized population growth rate (λ) of the brush mouse, and examined the effects of temperature, rainfall, and El Niño on these demographic parameters. The population was stable during the study period with a monthly realized population growth rate of 0.993 ± SE 0.032, but growth varied over time from 0.680 ± 0.054 to 1.450 ± 0.083. Monthly survival estimates averaged 0.817 ± 0.005 and monthly recruitment estimates averaged 0.175 ± 0.038. Survival probability and realized population growth were positively correlated with rainfall and negatively correlated with temperature. In contrast, recruitment was negatively correlated with rainfall and positively correlated with temperature. Brush mice maintained their population through multiple coping strategies, investing in high recruitment during warmer and drier periods and allocating more energy towards survival during cooler and wetter conditions. Although climatic change in coastal-central California will favor recruitment over survival, varying strategies may serve as a mechanism by which brush mice maintain resilience in the face of climate change. Our results indicate that rainfall and temperature are both important drivers of brush mouse population dynamics and will play a significant role in predicting the future viability of brush mice under a changing climate.

Background: Ultrasound techniques are generally not used as a primary tool in the evaluation of mediastinal tumors and cysts. This study aimed to identify factors associated with pulmonary hypertension (PH) measured by transthoracic echocardiography (TTE) in patients with a mediastinal tumor. Methods: This retrospective, observational study was performed from January 2015 to December 2020. Fifty-five patients (mean age, 62 ± 13 years; 31 [56%] women) who had a mediastinal tumor and underwent TTE were included. Patients were classified as with PH or without PH. We analyzed clinical factors and echocardiographic parameters. Results: PH was found in 21 (38%) patients. Twenty-two patients were asymptomatic, and none had symptoms associated with PH. Forty-seven (86%) patients underwent surgery, and 23 (42%) patients were diagnosed with malignant tumors. The presence of PH was not related with malignancy. Patients with PH were older than those without PH (67 ± 10 versus [vs.] 59 ± 14 years, p = 0.017). Small left ventricular (LV) systolic dimension (29.4 ± 3.6 vs. 31.6 ± 3.6 mm, p = 0.040) and dimension (4.2 ± 0.3 vs. 4.5 ± 0.3 mm, p = 0.004) and hyperdynamic LV ejection fraction (EF, 69 ± 6 vs. 65 ± 5%, p = 0.019) were associated with PH. Among them, older age, small LV dimension, and high EF were independently associated with PH. Conclusion: The presence of PH had no significant effect on patients’ clinical manifestation or malignancy.

Aims To provide evidence for the clinically rational administration of bupropion (BUP), the effects of high-fat diet and CYP2B6 mutants on BUP and hydroxybupropion (HBUP) among 44 healthy Chinese subjects. Methods The concentrations of BUP and HBUP in plasma were determined with a high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) analysis. Genotypes were ascertained after amplified by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Results The maximum plasma concentration (Cmax) and time to Cmax (tmax) of BUP as well as the concentration–time curve (AUC(0→96)) and Cmax of HBUP all increased by 1.18-, 1.41-, 1.38-, and 1.33-fold in the feeding group relative to the fasting group, respectively. Interestingly, the Cmax and terminal half-life (t1/2) of BUP increased by 1.33- and 1.39-fold among those subjects carrying the CYP2B6*1/*1 genotype in the feeding group relative to those in the fasting group. Similarly, the apparent volume of distribution (Vd) and clearance (CL) of HBUP increased by 1.38- and 1.59-fold, respectively, while the Cmax and AUC(0→96) of HBUP decreased by 1.44- and 1.49-fold among those subjects carrying the CYP2B6*1/*1 genotype in the feeding group relative to those in the fasting group. Concliusion These data suggest that high-fat diet and CYP2B6 mutants can influence the pharmacokinetic parameters of BUP and HBUP, thereby offering clear evidence for the rational administration of BUP among Chinese subjects in clinical settings.

Introduction: Several studies on late effects of childhood cancer have been conducted during the past decades. To ensure external validation of a study population, the participation rate must be high. This study investigated demographic data in late effect studies and potential factors impacting on participation rates such as cancer type, time since diagnosis and duration of clinical examinations. Procedure: By searching the databases PubMed, Embase and Web of Science and by contacting researchers and clinicians, we identified studies including an invitation to a clinical examination for late effects after childhood cancer. Studies conducted from January 2010 - March 2020 in the Nordic countries were included. Results: We found 80 published studies originating from 16 cohorts. The overall participation rates ranged between 27 and 100%. The majority of studies (eleven studies) were conducted more than ten years after the cancer diagnosis and primarily on hematologic malignancies (seven studies). The highest participation rates were seen in studies of survivors with solid tumors (92%) and the lowest in survivors with hematologic malignancies (67%) and central nervous system tumors (73%). Neither duration of the clinical examination nor time since diagnosis seemed to affect the participation rate. Conclusion: A trend of lower participation rates when recruiting survivors of hematologic malignancies and central nervous system tumors was found. We encourage future studies to describe the recruitment process more thouroughly to improve understanding of the factors influencing participation rates.

The Shannon, R\’enyi, and Tsallis entropies of normalized electron density in position and momentum spaces are studied for the 1s${}^{2}$ state of Helium-isoelectronic series. Within single-zeta $\beta$-type orbitals ($\beta$TOs), the Hartree-Fock-Roothaan (HFR) calculations are considered and condensed on the most features of the physical results. The information quantities with atomic number deal with the interactions between the core and valence regions of the atom and thus enhance a geometrical understanding for the difference. It is assumed that the presented result might be a significant reference for further research topic on theoretical information quantities of atomic and molecular. Indeed, Our results have a good agreement in comparison with the previous published results.

Invasive ants shape assemblages and interactions of native species, but their effect on fundamental ecological processes is poorly understood. In East Africa, Pheidole megacephala ants have invaded monodominant stands of the ant-tree Acacia drepanolobium, extirpating native ant defenders and rendering trees vulnerable to canopy damage by vertebrate herbivores. We used experiments and observations to quantify direct and interactive effects of invasive ants and large herbivores on A. drepanolobium photosynthesis over a 2-year period. Trees that had been invaded for ≥ 5 years exhibited 69% lower whole-tree photosynthesis during key growing seasons, resulting from interaction between invasive ants and vertebrate herbivores that caused leaf- and canopy-level photosynthesis declines. We also surveyed trees shortly before and after invasion, finding that recent invasion induced only minor changes in leaf physiology. Our results from individual trees likely scale up, highlighting the potential of invasive species to alter ecosystem-level carbon fixation and other biogeochemical cycles.

Purpose: It has been suggested, on a theoretical basis, that ultrasound screening of thyroid nodules in obese patients with additional risk factors (family history, thyroiditis or high thyrotropin) might be cost-effective for the early detection and treatment of thyroid cancer. The present study evaluates if this approach can be validated in a real clinical setting. Methods: Patients with obesity attended in hospital-based clinics were evaluated for risk factors of thyroid cancer and ultrasound screened for thyroid nodularity. Detected nodules were evaluated according to current guidelines. Results: A total of 429 patients were evaluated (70.2% women, mean age 49.1±11.0, mean body mass index 42.6±5.8 kg/m2). Risk factors were present in 129 (30.1%) patients. Thyroid nodules with indication for fine needle aspiration biopsy were detected in 69 (16.1%). We did not find differences in the risk of harbouring thyroid nodules according to the presence of risk factors (no risk factors 16.6%, risk factors 14.1%, p = 0.64). No single risk factor conferred an increased risk for thyroid nodules During the screening procedure 4 cases of thyroid cancer were detected, none of them with the evaluated risk factors. Conclusion: The present study, has been unable to demonstrate that the use of known risk factors for thyroid cancer is helpful to discriminate obese patients with higher risk of harbouring thyroid nodules.

Ankylosing spondylitis (AS) a seronegative inflammatory disease that often presents with co-existing issues like bilateral hip replacements, nephrolithiasis, skin lesions, peripheral vascular disease and coronary artery disease.. We describe a patient with ankylosing spondylitis with bilateral hip replacements in the past who was waiting for an elective coronary artery bypass grafting (CABG) but needed urgent admission with renal colic and unstable angina. In the current COVID pandemic in order to reduce hospital stay and risk of hospital acquired COVID infection we decided to perform simultaneous CABG and removal of ureteric stone. In this case report we discuss the issues in relation to management of patients with coronary artery disease and ankylosing spondylitis.

The logarithmic representation of infinitesimal generators is generalized to the cases when the evolution operator is unbounded. The generalized result is applicable to the representation of infinitesimal generators of unbounded evolution operators, where unboundedness of evolution operator is an essential ingredient of nonlinear analysis. In conclusion a general framework for the identification between the infinitesimal generators with evolution operators is established. A mathematical framework for such an identification is indispensable to the rigorous treatment of nonlinear transforms: e.g., transforms appearing in the theory of integrable systems.

Background and Purpose: Azithromycin (AZM) is a macrolide antibiotic with well-described anti-inflammatory properties. This study aimed to substantiate its treatment potential in rheumatoid arthritis (RA). Experimental Approach: Gene expression profiles were collected by RNA-sequencing and the effects of AZM were assessed in functional assays. In vitro and vivo assays for examining the blockade of glucose-regulated protein 78 (GRP78) actions by AZM: assays for defining the anti-inflammatory activity of AZM using fibroblast-like synoviocytes (FLSs) from RA patients as well as collagen-induced arthritis (CIA) in DBA/1 mice. Identification and characterization of the binding of AZM to GRP78 using drug affability responsive target stability assay, proteomics and cellular thermal shift assay. Detect AZM inhibition of GRP78 and dependence of AZM’s anti-arthritis activity on GRP78. Key Results: AZM reduced pro-inflammatory factor production, cell migration, invasion and chemo-attractive potential, enhanced apoptosis, thereby reducing the deleterious inflammatory response of RA FLSs in vitro. AZM ameliorated the severity of CIA lesions. Transcriptional analyses implied that AZM treatment causes impairments in signaling cascades associated with cholesterol and lipid biosynthetic process. GRP78 was isolated as a novel target of AZM. AZM-mediated activation of unfolded protein response (UPR) via inhibiting GRP78 activity is required not only for inducing the expression of C/EBP-homologous protein (CHOP), but also for activation of sterol-regulatory element binding protein (SREBP) and its targeted genes involved in cholesterol and lipid biosynthetic process. Further, deletion of GRP78 abolished AZM’s anti-arthritis activity. Conclusion and Implications: These findings confirmed that AZM is an anti-arthritis therapeutic drug for RA treatment.

Background: Typical murine models of allergic inflammation are induced by the combination of ovalbumin and aluminum hydroxide. However, accumulating evidence indicates that, in models of asthma and atopic dermatitis, allergic inflammation can be generated in the absence of aluminum hydroxide. Moreover, co-administration of S. aureus enterotoxin B with ovalbumin can enhance inflammation. Objective: The objective of this study was to establish a rapid and mast cell-dependent murine model of allergic inflammation by inducing allergic peritonitis using ovalbumin and S. aureus enterotoxin B. Methods: Allergic peritonitis was induced in C57BL/6 mice by subcutaneous sensitization and intraperitoneal challenge with ovalbumin and S. aureus enterotoxin B. Disease characteristics were assessed by flow cytometry, ELISA, Trypan Blue exclusion and colorimetric assays. Results: Time course of the allergic peritonitis revealed a peak of peritoneal inflammation 48h after challenge, as assessed by total cells and eosinophil counts. Decrease of cell numbers started 96h post challenge with complete clearance within 168h. Moreover, significantly higher levels of tryptase and increased vascular permeability were found 30 min following challenge. Allergic inflammation induction by ovalbumin and S. aureus enterotoxin B was impaired in mast cells deficient mice and partially restored by mice reconstitution with bone marrow derived mast cells, indicating the mast cell role in this model. Conclusion: We present a novel model of allergic peritonitis that is mast cell-dependent, simple and robust. Moreover, the use of S. aureus enterotoxin B better resembles human allergic inflammation, which is known to be characterized by the colonization of Staphylococcus aureus.

Background and Purpose. Pseudomonas aeruginosa is a main cause of ventilator-associated pneumonia (VAP) with drug-resistant bacteria. Bacteriophage therapy has experienced resurgence to compensate for the limited development of novel antibiotics. However, phage therapy is limited to a compassionate use so far, resulting from lack of adequate studies in relevant pharmacological models. We used a pig model of VAP caused by P. aeruginosa that recapitulates essential features of human disease to study the antimicrobial efficacy of nebulized-phage therapy. Experimental Approach. (i) Lysis kinetic assays were performed to evaluate in vitro phage antibacterial efficacy against P. aeruginosa and select relevant combinations of lytic phages. (ii) The efficacy of the phage combinations was investigated in vivo (murine model of P. aeruginosa lung infection). (iii) We determined the optimal conditions to ensure efficient phage delivery by aerosol during mechanical ventilation. (iv) Lung antimicrobial efficacy of inhaled-phage therapy was evaluated in pigs, which were anesthetized, mechanically ventilated and infected with P. aeruginosa. Key Results. By selecting an active phage cocktail and optimizing aerosol delivery conditions, we were able to deliver high phage concentrations in the lungs, which resulted in a rapid and marked reduction in P. aeruginosa density (1.5 Log reduction, p<0.001). No phage was detected in the sera and urines throughout the experiment. Conclusion and Implications. Our findings demonstrated: (i) the feasibility of delivering large amounts of active phages by nebulization during mechanical ventilation, (ii) rapid control of in situ infection by inhaled bacteriophage in an experimental model of VAP with high translational value.

Antiphospholipid syndrome (APS) classically presents with venous or arterial thrombosis and pregnancy morbidity. Although clinical manifestations with fever of unknown origin and intracardiac masses are unusual, in a patient with prolonged fever and multiple intracardiac thrombi, systemic inflammatory diseases such as APS should be considered.

Let X and Y be two Banach spaces. A bounded operator T : X −→ Y is said to be a BS-compact operator whenever T sends Banach-Saks subsets of X onto norm compact sets of Y ([20]). In this paper, our central focus is upon introducing the class of almost BS-compact operators. The paper rests essentially on two parts. The first is devoted to the connection of this new class of operators with classical notions of operators, such as BS-compact operators, AM-compact operators, and Dunfort-Pettis operators. The second part is dedicated to the domination problem within the framework of (almost) BS-compact operators. Mathematics Subject Classification. 46B42, 47B60, 47B65.

Foraging by consumers has direct effects on the community of their resource species, and may serve as a biotic filtering mechanism of diversity. Determinants of foraging behaviour may thus have cascading effects on abundance, diversity, and functional trait composition of the resource community. Here we propose giving-up diversity (GUDiv) as a novel concept and simple measure to quantify community effects of foraging at multiple spatial diversity scales. GUDiv provides a framework linking theories of adaptive foraging behaviour with community ecology. In experimental resource landscapes we showcase effects of patch residency of foraging wild rodents on α-GUDiv, ß-GUDiv and γ- GUDiv, and on functional trait composition of resources. Using GUDiv allows for prediction-based investigation of cascading indirect predation effects (ecology of fear) across multiple trophic levels, of feedbacks between functional trait composition of resource and consumer communities, and of effects of inter-individual differences among foragers on the diversity of resource communities.