Background: The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI). Methods: The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP received intranasal midazolam (0.2 mg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group MK received intranasal midazolam (0.2 mg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. Group DP received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent. Group DK received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium. Results: The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. Delirium only developed in two patients in Group MP (5.7%) at 5 mins after anaesthesia. Conclusion: In our study, delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency with this result.

Human activity and natural processes have led to widespread dissemination of metals and metalloids, many of which are toxic and have a negative impact on agronomic production. Roots, as the first point of contact, are essential in endowing plants with tolerance to excess metal(loid) in the soil. The most important root responses include: adaptation of transport processes that affect uptake, efflux and long distance transport of metal(loid)s; metal(loid) detoxification within root cells via conjugation to thiol rich compounds and subsequent sequestration in the vacuole; plasticity in root architecture; the presence of bacteria and fungi in the rhizosphere that impact on metal(loid) bioavailability; the role of root exudates. In this review we will provide details on these processes and assess their relevance for the detoxification of arsenic, cadmium, mercury and zinc. Furthermore, we will assess if any of these methodologies has been tested in field conditions and whether they are effective in terms of improving crop metal(loid) tolerance.

Renal coloboma syndrome (RCS) is an autosomal dominant disorder associated with the PAX2 gene. With variable expressivity, renal and ocular abnormalities are reported in a majority of individuals affected. We highlight a mother and her newborn with RCS, both presenting prenatally, showing self-resolving severe oligohydramnios as an early prenatal finding.

Neurological manifestation and complications are common due to COVID-19. It affects higher functions, cranial nerves and the motor system. The authors report a case of GBS as an example of a success story in managing a complicated case of COVID-19 in an elderly male with signs of a poor prognosis.

Background: We hypothesized that the geographic distributions of COVID-19 prevalence and risky alpha-1-antitrypsin allele prevalence are similar. We aimed to investigate whether there is a relationship between the geographical density of the COVID-19 pandemic and the distributions of risky alpha-1-antitrypsin alleles. Methods: This research is a cross-sectional study. Alpha-1-antitrypsin PI*SZ and PI*ZZ genotypes frequencies of European and American countries were compared with the case and death data related to the COVID-19 pandemic as of March 30, 2021. The relationship between the data was evaluated using Linear regression analysis. Results: According to the linear regression analysis results, a significant relationship was found between the number of COVID-19 cases in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Similarly, according to the linear regression analysis results, a significant relationship was found between the COVID-19 death numbers in both European and American countries and the sum of PI*SZ and PI*ZZ genotypes. Conclusions: The findings showed that the prevalence distribution of the risky alleles of the gene defect that causes alpha-1-antitrypsin insufficiency is related to the prevalence of COVID-19 pandemic data.

Abstract Background It is not clear if there is a inaccurate effect of obesity and pneumoperitoneum on non-invasive monitoring parameters Objectives To determine the effects of CO2 pneumoperitoneum and desufflation on non-invasive monitoring variables between obese and non-obese patients undergoing laparoscopic surgery. Methods Sixty patients were included in the study who underwent laparoscopic cholecystectomy between February 2019-November 2019. After anesthesia induction, systolic and diastolic blood pressures, heart rate(HR), operation and pneumoperitoneum durations, PVI and SpHg data were recorded. Results The patients were divided into two groups. There was no statistically significant difference between the groups in terms of chronic diseases, operation and pneumoperitoneum durations. Statistically no significant difference was found between the groups for PVI and SpHb values. In comparison of PVI measurement values according to T0, a significant difference was found in T3,T4 and T5 in Group 2 compared to T0 (p=0.010;0.012;0.041). In comparison of SpHb measurement values according to T0, a statistically significant difference was found in T1,T2 and T3 in Group 2 compared to T0 (p=0.008;0.010;0.037). In comparison to T5, there was a significant difference in T1,T2 and T3 in Group 2 (p=0.023;0.005;0.006). Conclusion In obese people, pneumoperitonium can lead to inaccuracies in monitoring PVI and SpHb. Although these two parameters are very valuable in intraoperative follow-up, they should be used carefully during laparoscopic procedures in obese patients. If these parameters (PVI and SpHb) are considered to be used in bariatric surgeries, this information should be considered.

A document by Andrea Leonardi, written on Authorea.

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Transcatheter aortic valve implantation (TAVI) is the more common choice of procedure for the severe aortic stenosis patients with high surgical risk. While the popularity of TAVI increases, TAVI related complications, such as infective endocarditis (IE) increase in number. There are no specific guidelines for TAVI-IE, so shaping a path according to patient’s clinical status is more reasonable. With different advantages for each, multiple imaging modalities should be used for follow-up. In our case, repeated multiple imaging modalities were used to decide early surgery versus conservative approach by detecting periaortic pseudoaneurysm after TAVI.

Left atrial intramural hematoma (LAIH) is an uncommon entity for which a timely diagnosis is critical for decision making. Cardiac surgical or catheter-based procedures are potential causing factors. Though cardiac computerized tomography and magnetic resonance are highly accurate diagnostic modalities, their role is limited by the lack of widespread availability. The present clinical case illustrates the diagnostic features of LAIH that can be obtained using echocardiography at the bedside in critically ill patients. We report a case of LAIH, that followed a catheter ablation procedure and was complicated by cardiac and cerebral ischemia. Cardiac surgical management was required.

The goal of this paper is to study fractional differential equations involving instantaneous and non-instantaneous impulses with Sturm-Liouville boundary conditions. By using critical point theory and variational approach, infinitely many solutions are obtained. The interesting point is that the potential has an oscillating asymptotic behavior. Also one example is presented to illustrate the main result.

Concomitant presence of acute type A dissection and coactation of aorta is rare (1). Levoatriocardinal vein has shown to be associated with left sided hypoplastic lesions as well as with normal hearts (2, 3 ). However, concurrent presence of levoatriocardinal vein with acute type A dissection, severe aortic regurgitation and Coarctation of aortic isthmus was not described. We here described a case of 20 year male presented to emergency department with acute chest pain radiating to back. On evaluation, he was found to have acute type A dissection with dilated aortic root, severe aortic regurgitation, normal mitral valve, severe coarctation of aorta and levoatriocardinal vein. Patient was managed successfully with composite valve conduit replacement of ascending aorta with ascending aortic to descending aortic graft (16mm graft) with levoatriocardinal vein ligation.

Let $\mathcal{S}$ be the Sierpi\’nski gasket in $\mathbb{R}^2$ and $\mathcal{S}_{0}$ denote the boundary of $\mathcal{S}$. In this paper, we study the following non-homogeneous $p$-Laplacian equation \begin{align*} -\Delta_p u &= \lambda |u|^{q-2} u + f \text{~in}\; \mathcal{S}\setminus\mathcal{S}_0\\ u &= 0\;\mbox{~on}\; \mathcal{S}_0, \end{align*} where $p$, $q$, $\lambda$ are real numbers such that $\lambda >0$, $1

ABSTRACT: Background: Cauda equina syndrome secondary (CES) to primary sacral diffuse large B cell lymphoma (DLBCL) is an uncommon condition, and few cases have been reported in the medical literature. After an extensive literature review related to these topics, we did not find a reported case like our patient.

Many publications on COVID-anosmia and asymptomatic COVID-stroke have been released, and plenty of studies on novel therapeutic approach have been published. Here we report an atypical case, our findings from review the medical literature, and comment on the treatment modalities

Neurosarcoidosis and thyroid abnormalities are reversible causes of dementia in the elderly. We present a case of a patient with rapidly progressive dementia due to neurosarcoidosis and sarcoid involvement of the thyroid improved by corticosteroids and Methimazole.

This clinical case is showing a potential synergistic neuroprotective interaction of Cerebrolysin and high doses of aspirin. The case describes the significant recovery of neurological deficits in a patient with moderate ischemic stroke caused by right posterior cerebral artery thrombosis after treatment with Cerebrolysin in combination with aspirin

A child with a A350V IQSEC2 missense mutation resulting in drug resistant epilepsy stops having seizures when he has a fever. We demonstrate that raising the body temperature of the child using a commercial Jacuzzi dramatically reduces his seizures and appears to improve his social behavioral interactions.

Hybrid repairs for pseudoaneurysms after previous surgical coarctation repair are becoming a well-accepted and widespread method especially in patients with complex aortic disease. We report two cases that performed two different hybrid repair methods for pseudoaneurysm associated with previous aortic coarctation.

One of the first lines in controlling diseases and malnutrition is diet therapy and currently, due to tool limitations, for designing the patients’ diet plan, the food groups and the list of food substitutes are being used while suitable databases of foods composition are available. Methods of designing individuals’ diet and total of 8791 foods are reviewed to calculate the nutrients of mixed foods and design a suitable method of diet therapy with more freedom for the patients in the future. Food groups because of their simplicity are suitable for public health educations but have limitations that could be better covered using nutrient balances. The main cause of developing the list of food substitutes was the limitations in calculating nutrients in a designed diet that currently could be run using applications. Patients also by using self-management nutrition applications that based on the nutrient balancing method shown they are ready to accept this method. A well-designed application can make using nutrient balancing method which is the future of diets possible. However, the main limitation is still the needs for a big, validated, and accurate foods composition database that needs to be developed.Keywords : Diet, Food Groups, Nutrients, Diet therapy, Nutrition

The denatured state of several proteins has been shown to display transient structures that are relevant for folding, stability and aggregation. To detect them by nuclear magnetic resonance (NMR) spectroscopy, the denatured state must be stabilized by chemical agents or changes in temperature. This makes the environment different from that experienced in biologically relevant processes. Using high-resolution heteronuclear NMR spectroscopy, we have characterized several denatured states of a monomeric variant of HIV-1 protease induced by different concentrations of urea, guanidinium chloride and acetic acid. We have extrapolated the chemical shifts and the relaxation parameters to the denaturant-free denatured state at native conditions, showing that they converge to the same values. Subsequently, we characterized the conformational properties of this biologically relevant denatured state under native conditions by advanced molecular dynamics simulations and validated the results by comparison to experimental data. We show that the denatured state of HIV-1 protease under native conditions displays rich patterns of transient native and non-native structures, which could be of relevance to its guidance through a complex folding process.

This study aimed to compare the infection dynamics of three genotype II African swine fever viruses (ASFV) circulating in Europe. Eighteen domestic pigs divided into three groups were infected intramuscularly or by direct contact with two haemadsorbent ASFVs (HAD) from Poland (Pol16/DP/ OUT21) and Estonia (Est16/WB/Viru8), and with the Latvian non-HAD ASFV (Lv17/WB/Rie1). Parameters such as symptoms, pathogenicity, and distribution of the virus in tissues, humoral immune response, and dissemination of the virus by blood, oropharyngeal and rectal routes were investigated. The Polish ASFV caused a case of rapidly developing fatal acute disease, while the Estonian ASFV caused acute to subacute infections in the presence of surviving animals. In contrast, animals infected with the ASFV from Latvia developed a more subtle, mild, or even subclinical disease. Oral excretion was sporadic or even absent in the attenuated group, whereas in animals that developed an acute or subacute form of ASF, oral excretion began at the same time as in the blood, or even 3 days earlier, and persisted up to 22 days. Regardless of virulence, blood was the main route of transmission of ASFV and infectious virus was isolated from persistently infected animals for at least 19 days in the attenuated group and up to 44 days in the group of moderate virulence. Rectal excretion was limited to the acute phase of infection. In terms of diagnostics, the ASFV genome was detected in contact pigs from oropharyngeal samples earlier than in blood, independently of virulence and, together with blood, both samples could cover a longer range to detect ASFV infection. The results presented here provide quantitative data on the spread and excretion of ASFV strains of different virulence among domestic pigs that can help to better focus surveillance activities and thus increase the ability to detect ASF introductions earlier.

Conjugated open ended cones in which the configured pentagons are consistent, lies in the circle of Fries Kekule structure [8]. This non-adjacent tightest configuration of pentagons as shown in the Fig. 1 is consistent with a Fries Kekule structure and thus provides the most stable cone. In the study, various topological indices of the same structure in regard of physico-concoction resources and bioactivity of substance mixtures are studied which further helps to study the behavior of chemical compounds. In this regard, Zagreb indices M_1^* (G) and M_2^* (G) of a molecular graph G are used to evaluate the complexity in chemical systems and biological organisms. In this manuscript, we consider two complex families of stable carbon nanocones and compute their ECI, TEI and eccentricity-based Zagreb indices.

We located ‘hidden’ S-character chirality in formally achiral glycine using a vector-based interpretation of the total electronic charge density distribution. We induced the formation of stereoisomers in glycine by the application of an electric field. Control of chirality was indicated from the proportionate response to a non-structurally distorting electric field. The bond-flexing was determined to be a measure of bond strain, which could be a factor of three lower or higher, depending on the direction of the electric field, than in the absence of the electric field. The bond-anharmonicity was found to be approximately independent of the electric field. We also compared the formally achiral glycine with the chiral molecules alanine and lactic acid, quantifying the preferences for the S and R stereoisomers. The proportional response of the chiral discrimination to the magnitude and direction of the applied electric field indicated use of the chirality discrimination as a molecular similarity measure.