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Dengue impacts 129 nations, threatens over 50% of the global population, and results in around 400 million illnesses annually. The purpose of this paper was to build the global stability and sensitivity analysis of a vector-host dengue mathematical model with compartments of symptomatic and hospitalized infected humans. Additionally, it aimed to assess the impact of the immunological response of vulnerable individuals, through the ingestion of natural foods, on the transmission of the disease. The solution's positivity and boundedness proved the model's mathematical well-posedness. To examine endemicity, the reproduction number was calculated using the next-generation technique. The Lyapunov function approach was employed to illustrate the model's global stability. Our mathematical discoveries were illustrated through numerical simulations of the dengue epidemic. The dynamical system sensitivity analysis suggests that the best way to control illness is to increase the immune system rate of susceptible hosts by consuming natural foods.

In this paper, an analytical and numerical technique are examined in order to analyse the Stokes flow determination problem due to a viscous sphere droplet moving at a concentric instantaneous position inside a spherical interface separating finite and semi-infinite immiscible fluid phases. Here, when only one of the three phases of the fluid (micropolar fluid) has a microstructure, attention is focused on this case. The motion is considered when Reynolds- and capillary-numbers are low, and the droplet surface and the fluid-fluid interface have insignificant deformation. A general solution is obtained in a spherical coordinate system based on a concentric position to analyse the slow axisymmetric movement of the micropolar fluid, considering microrotation and velocity components. Boundary conditions are initially fulfilled at the fluid-fluid interface and subsequently at the droplet surface. The normalised hydrodynamic drag force applying to a moving viscous droplet appears to be a function of the droplet-to-interface radius ratio, which increases monotonically and becomes unbounded when the droplet surface touches the fluid-fluid interface. The numerical outcomes of the normalised drag force acting on the viscous droplet are derived for different values of the parameters, and are presented in a tabular and graphical framework. A comparison was made between our numerical outcomes for the drag force and the pertinent data for the special cases found in the literature.

This research investigates the dynamics of higher-order nonlinear difference equations, specifically concentrating on seventh-order instances. Analytical solutions are obtained for particular equations, a formidable task owing to the absence of explicit mathematical techniques for their resolution. The qualitative characteristics of solutions, such as their stability, boundedness, and periodicity, are analysed by theoretical methods and numerical simulations. The results indicate that equilibrium points frequently lack local asymptotic stability, leading to intricate phenomena such as unbounded solutions and periodic attractors. These findings augment our understanding of nonlinear difference equations, offering significant implications for their use across various scientific fields.

In this paper, we explore the existence of fixed points, local dynamical characteristics at fixed points, the existence of bifurcation sets at fixed points, and bifurcations of a three-species discrete prey-predator system with the scavenger. More specifically, it is proved that for all parameters, the discrete system has trivial and boundary fixed points; two more boundary fixed points, and an interior fixed point under a certain model's parametric restriction(s). Further, by the theory of linear stability, we examined local dynamics at fixed points. In order to understand the dynamics of the understudied system thoroughly, we studied the occurrence of certain bifurcations at fixed points by the bifurcation theory. Finally, theoretical results are numerically verified.

The principle purpose of this paper is to investigate the long-term behaviors of some nonlinear systems of difference equations and obtain these solution expressions and periodicity character. Furthermore, we use MATLAB programming to simulate the dynamics and confirm our results.

The theory of difference equations got a significant position in the applicable analysis. Therefore, studying the qualitative behavior of the difference equations is a fruitful area of research that has increasingly attracted many researchers. In this paper, we demonstrate the stability and the existence of periodic solutions of the nonlinear difference equation. Moreover, we provide some numerical simulations to confirm our results.

This study aimed to compare the amount of fluoride uptake and the recharge and release characteristics of conventional glass ionomer cement (GIC) without any additives in comparison to conventional glass ionomer cement supplemented with silver nanoparticles (AgNPs) at two concentrations: 0.1% and 0.2% (w/w). A total of 60 specimens were used in this in vitro study. The sample was divided into six groups—including three groups without fluoride charge: Group 1 (conventional GIC), Group 2 (GIC with 0.1% silver nanoparticles), and Group 3 (GIC with 0.2% silver nanoparticles; and three groups with fluoride charge: Group 4 (conventional GIC with fluoride); Group 5 (GIC with 0.1% silver nanoparticles with fluoride); Group 6 (GIC with 0.2% silver nanoparticles with fluoride), where Group 1 is considered the control group and the other five groups are used as the test groups. The amount of fluoride released was measured on days 1, 2, 7, 15, and 30. The comparisons were made between the groups with and without fluoride and among all the groups. A significant difference in the amount of fluoride released was observed between the groups, with the highest amount occurring in Group 1, followed by Group 2; the lowest amount of fluoride released was observed in Group 3 (p < 0.05). The groups with fluoride recharge (Groups 4, 5, and 6) exhibited a higher amount of fluoride release than the groups with no recharge (Groups 1, 2, and 3); however, Group 1 has more fluoride release compared to all other groups on days 1, 2, 7, 15, and 30 (p < 0.05). The amount of released fluoride decreased from day 1 to day 30 in all of the groups in the study. Despite the antimicrobial and anticariogenic benefits of adding silver nanoparticles to GIC, it seems that fluoride release characteristics are significantly affected by the addition of this material. This may force the clinician to a compromise between the antimicrobial benefit of silver nanoparticles and the remineralizing advantage of fluoride.

This research investigates the dynamics of higher-order nonlinear difference equations, specifically concentrating on seventh-order instances. Analytical solutions are obtained for particular equations, a formidable task owing to the absence of explicit mathematical techniques for their resolution. The qualitative characteristics of solutions, such as their stability, boundedness, and periodicity, are analysed by theoretical methods and numerical simulations. The results indicate that equilibrium points frequently lack local asymptotic stability, leading to intricate phenomena such as unbounded solutions and periodic attractors. These findings augment our understanding of nonlinear difference equations, offering significant implications for their use across various scientific fields. [ABSTRACT FROM AUTHOR]

Dengue impacts 129 nations, threatens over 50% of the global population, and results in around 400 million illnesses annually. The purpose of this paper was to build the global stability and sensitivity analysis of a vector-host dengue mathematical model with compartments of symptomatic and hospitalized infected humans. Additionally, it aimed to assess the impact of the immunological response of vulnerable individuals, through the ingestion of natural foods, on the transmission of the disease. The solution's positivity and boundedness proved the model's mathematical well-posedness. To examine endemicity, the reproduction number was calculated using the next-generation technique. The Lyapunov function approach was employed to illustrate the model's global stability. Our mathematical discoveries were illustrated through numerical simulations of the dengue epidemic. The dynamical system sensitivity analysis suggests that the best way to control illness is to increase the immune system rate of susceptible hosts by consuming natural foods. [ABSTRACT FROM AUTHOR]

In this paper, an analytical and numerical technique are examined in order to analyse the Stokes flow determination problem due to a viscous sphere droplet moving at a concentric instantaneous position inside a spherical interface separating finite and semi-infinite immiscible fluid phases. Here, when only one of the three phases of the fluid (micropolar fluid) has a microstructure, attention is focused on this case. The motion is considered when Reynolds- and capillary-numbers are low, and the droplet surface and the fluid-fluid interface have insignificant deformation. A general solution is obtained in a spherical coordinate system based on a concentric position to analyse the slow axisymmetric movement of the micropolar fluid, considering microrotation and velocity components. Boundary conditions are initially fulfilled at the fluid-fluid interface and subsequently at the droplet surface. The normalised hydrodynamic drag force applying to a moving viscous droplet appears to be a function of the droplet-to-interface radius ratio, which increases monotonically and becomes unbounded when the droplet surface touches the fluid-fluid interface. The numerical outcomes of the normalised drag force acting on the viscous droplet are derived for different values of the parameters, and are presented in a tabular and graphical framework. A comparison was made between our numerical outcomes for the drag force and the pertinent data for the special cases found in the literature. [ABSTRACT FROM AUTHOR]

In this paper, we explore the local dynamics, chaos, and bifurcations of a discrete Rosenzweig–Macarthur prey–predator model. More specifically, we explore local dynamical characteristics at equilibrium solutions of the discrete model. The existence of bifurcations at equilibrium solutions is also studied, and that at semitrivial and trivial equilibrium solutions, the model does not undergo flip bifurcation, but at positive equilibrium solutions, it undergoes flip and Neimark–Sacker bifurcations when parameters go through certain curves. Fold bifurcation does not exist at positive equilibrium, and we have studied these bifurcations by the center manifold theorem and bifurcation theory. We also studied chaos by the feedback control method. The theoretical results are confirmed numerically. [ABSTRACT FROM AUTHOR]

This study aimed to compare the amount of fluoride uptake and the recharge and release characteristics of conventional glass ionomer cement (GIC) without any additives in comparison to conventional glass ionomer cement supplemented with silver nanoparticles (AgNPs) at two concentrations: 0.1% and 0.2% (w/w). A total of 60 specimens were used in this in vitro study. The sample was divided into six groups—including three groups without fluoride charge: Group 1 (conventional GIC), Group 2 (GIC with 0.1% silver nanoparticles), and Group 3 (GIC with 0.2% silver nanoparticles; and three groups with fluoride charge: Group 4 (conventional GIC with fluoride); Group 5 (GIC with 0.1% silver nanoparticles with fluoride); Group 6 (GIC with 0.2% silver nanoparticles with fluoride), where Group 1 is considered the control group and the other five groups are used as the test groups. The amount of fluoride released was measured on days 1, 2, 7, 15, and 30. The comparisons were made between the groups with and without fluoride and among all the groups. A significant difference in the amount of fluoride released was observed between the groups, with the highest amount occurring in Group 1, followed by Group 2; the lowest amount of fluoride released was observed in Group 3 (p < 0.05). The groups with fluoride recharge (Groups 4, 5, and 6) exhibited a higher amount of fluoride release than the groups with no recharge (Groups 1, 2, and 3); however, Group 1 has more fluoride release compared to all other groups on days 1, 2, 7, 15, and 30 (p < 0.05). The amount of released fluoride decreased from day 1 to day 30 in all of the groups in the study. Despite the antimicrobial and anticariogenic benefits of adding silver nanoparticles to GIC, it seems that fluoride release characteristics are significantly affected by the addition of this material. This may force the clinician to a compromise between the antimicrobial benefit of silver nanoparticles and the remineralizing advantage of fluoride. [ABSTRACT FROM AUTHOR]

Bone marrow biopsy is an important tool for the evaluation of malignant and benign hematologic disorders. Performed blindly, usually with a Jamshidi biopsy needle penetrating the posterior iliac crest bone, the procedure is generally considered safe but rarely complications are observed; vascular complications associated with bleeding are the most serious and potentially life-threatening. We describe 3 cases of arterial injury following a bone marrow biopsy procedure, all treated successfully with minimal invasive endovascular management, and emphasize the need for clinical awareness and recognition of this rare complication in order to facilitate rapid diagnostic and minimal invasive therapeutic interventions, when appropriate, for successful outcomes.

In this paper, we explore the existence of fixed points, local dynamical characteristics at fixed points, the existence of bifurcation sets at fixed points, and bifurcations of a three-species discrete prey-predator system with the scavenger. More specifically, it is proved that for all parameters, the discrete system has trivial and boundary fixed points; two more boundary fixed points, and an interior fixed point under a certain model's parametric restriction(s). Further, by the theory of linear stability, we examined local dynamics at fixed points. In order to understand the dynamics of the understudied system thoroughly, we studied the occurrence of certain bifurcations at fixed points by the bifurcation theory. Finally, theoretical results are numerically verified. [ABSTRACT FROM AUTHOR]

Chicken can be used for the production of hyper-immune serum for many type of antigens specially, the antigens of mammals and other species. Therefore, the current study aimed to use the chickens for the productions of anti-camel IgY- antibodies using ammonium sulphate and ammonium sulphate - caprylic acid methods for detection of any infectious disease affecting camels.One ml of purified camel IgG of mixed with complete freund's adjuvant was injected intramuscularly and S/C to four groups of laying hens (Hisex strain, 140 days old). The first booster dose was administrated two week after first immunization with one ml of purified camel IgG mixed with incomplete freund's adjuvant and the hens were repeatedly boostered (three times) at two weeks intervals. During the immunization periods we collect the eggs every day and the anti-camel immunoglobulins Y was separated by using two extraction methods; the ammonium sulphate precipitation method and the ammonium sulphate caprylic acid method, the sensitivity and the specificity of the recovered antibody against the camel IgG were evaluated using SDS-PAGE and ELISA.Two weeks after the initial dose of immunizing the hens the anti-camels IgY-antibodies were detected then the mean antibody titer increased significantly (P 0.05) up to 12 weeks after the first dose of immunization then started to decrease.Therefore, there are several benefits of using immunized chicken to produce IgY antibodies rather than using other species such as mammals in order to prepare anti-camels antibodies conjugates for diagnosis of infectious disease affecting camels.

This study aimed to develop a new water quality index for routine assessment of the river water quality for drinking purpose based on fuzzy logic artificial intelligence method. Four water quality parameters were involved in light of their significance to Iraqi waters, these parameters are biological oxygen demand, and total dissolved solids, total hardness, and fecal coliform. Fuzzy logic inference system with specific rules was developed by Matlab software using Mamdani fuzzy logic Max–Min inference system method. To evaluate the performance of this new fuzzy water quality index (FWQI), tests were conducted using the Iraqi standards for drinking water quality and the 2017 data set of Tigris River within Baghdad. Results revealed the FWQI ability to assess the water quality of Tigris River during the period of the study and that the method of fuzzy inference system was a simple, valuable and applied water quality evaluation tool for human drinking water of Iraqi rivers.

Studies of the structural, magnetic and magnetocaloric properties of polycrystalline La0.8Ca0.2Mn1-xCoxO3 compounds (0 ≤ x ≤0.3) perovskite manganites were carried out. Samples were synthesized by sol–gel process and then heated at 1000°C for 3 h. X-ray powder diffraction and magnetic measurements were used to investigate the structural and magnetic properties. Rietveld analysis shows that the samples crystallize in the orthorhombic structure with Pnma space group. Crystallographic analysis shows a variation in lattice parameters as cobalt substitution increases, accompanied by a variation in the interatomic distances and a small increase in MT–O–MT angles (MT = cobalt and manganese). Magnetocaloric studies on La0.8Ca0.2Mn1-xCoxO3 compounds with x = 0 and x = 0.2 have been investigated by measuring the magnetization as a function of temperature. At 2 T, the maximum magnetic entropy⎢ΔSmaxM⎢ is about 3.09 J⋅Kg-1⋅K-1 and 1.123 J⋅Kg-1⋅K-1 for x = 0 and 0.2, respectively. Besides, the RCP value decreases with increasing Co content from 55.845 J⋅Kg-1 to 49.971 J⋅Kg-1. Also, the existence of Griffiths Phase and its influence in the phase transition is discussed. [ABSTRACT FROM AUTHOR]

The current research was carried out to study the incidence of Escherichia coli (E. coli) in Egyptian cheese (Kariesh and Ras) and molecular characterization of certain E. coli virulence genes (stx1, stx2, eaeA, hlyA and fimH) using multiplex PCR technique. Biocontrol of E. coli with essential oils (clove and thyme oil) was also studied. A total of 150 random samples of Kariesh and Ras cheese (75 each) were collected from various areas in Governorate of Menoufia. According to our results, the frequency of E. coli isolated from Kariesh and Ras cheese was 16% and 5.3%, respectively. Serological identification classified the E. coli strains into two groups, enterohemorrhagic E. coli (EHEC) serogroup (O26: H11, O91: H21, O111: H2 and O103: H2). While the enterotoxigenic E. coli (ETEC) serogroup were detected as O125: H21 which is the most prevalent strain. O171: H2, O86 and O119: H6 belonging to enteropathogenic E. coli (EPEC). The most prevalent gene detected in E. coli strains was stx1 (87.5%) followed by stx2 (86%), fimH (75%), hlyA (50%) and eaeA (25%) genes. Concerning the antimicrobial activity with essential oils, thyme oil (1%) is considered as the bactericidal effect against E. coli (ATCC35150) with improved the sensory evaluation than clove oil (1%). In conclusion, Kariesh and Ras cheese are extremely tainted with pathogenic E. coli strains, which represent a strong hazard on the human health.

Background: Hip fractures are defined as any fracture of the femur between the articular cartilages of the hip joint to 5 cm below the distal point of the lesser trochanter. Hip fracture is a worldwide public health problem that primarily affects osteoporotic individuals and the elderly. Up to 30 % of the elderly patients with a hip fracture die within the first year. Objective: to show the risk factors and post-operative complications of hip fracture in cases attending orthopedic department of Arar Central Hospital in Arar city. Methods: a cross sectional study conducted during the period from 1 December 2017 to 31 March 2018. A predesigned questionnaire was used for data collection, and included inquiries about sociodemographic data of the studied patients, performing muscular exercise, osteoporosis, diminished vision and disorders in equilibrium, causes of fracture, type and site of fracture, occurrence of complications of surgery, postoperative care and the final outcome of treatment. Results: Most (70.1%) of the studied population aged 22-59 years, males constituted 59.8%. Causes of hip fracture were accident in 66.7% and fall in 25.0%. Among hip fracture cases, 43.9% were obese, 13.1% have osteoporosis, and 17.8% have disorders in equilibrium. Males reported insignificant higher percentage of hip fracture than females (25.0% Vs. 18.6%). Osteoporosis, diminished vision, chronic diseases, continuous use of medications and smoking showed significant relation with hip fracture (P<0.05). While BMI, disorders in equilibrium and performing muscular exercise showed insignificant relation. Complications after surgery was osteomyelitis in 12.6%, early fixation failure in 4.2%, wound infections in 8.4% and hospital acquires pneumonia in 4.2%. Only two thirds of the cases were completely cured. Conclusion: in our study population in Arar city, males reported insignificant higher percentage of hip fracture than females. Osteoporosis, diminished vision, chronic illnesses, continuous use of medications and smoking were significant risk factors of hip fracture. Complications after surgery was included, osteomyelitis, early fixation failure, wound infections and hospital acquire pneumonia. Only two thirds of the cases were completely cured, the rest of cases showed disability and movement limitation. [ABSTRACT FROM AUTHOR]

Background: The increased incidence of cardiovascular disease between patients nowadays led to upsurge in the number of cardiac operations. After coronary artery bypass surgery, most patients remain free of symptoms for up to 15 years. The surgery also reduces the risk of heart attack and improves survival. Objective: to determine the predictors and outcome of coronary artery bypass surgery in patients attending the cardiac center in Arar, KSA all over the study period. Methods: The current study is a cross sectional study conducted during the period from September 2017 to March 2018. The current study included 72 individuals attending the cardiac center in Arar City. Collecting patients' data was conducted through interviewing the patients included in the study and reviewing their medical files. A predesigned questionnaire was used for data collection. Results: We found that 81.9% of cases were males, 61.1% aged from 30 to 39 years old, 34.4% of cases have a myocardial infraction as a clinical diagnosis before the operation, 25% had angina pain, and 50.0% were smokers. Hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease were found in 59.7%, 83.3% and 77.8% respectively. There were 41.6% who had postoperative arrhythmia, 13.9% had bacterial infection in the site of operation and another 13.9% had hypotension, 11.1% re-operated due to bleeding, and 6.9% got postoperative acute myocardial infarction. After 6 month of the operation, 69.4% of cases were quite good while recurrence of chest pain found in12.5%, heart failure in 2.8% and 8.3% died. There was significant association between outcome of cases after 6 months of operation and patients age (P<0.05) and all the dead cases were males. Conclusion: Our findings indicated that, among cardiac patients attending the cardiac center in Arar, KSA, the preoperative characteristics are suggestive of 30 to 39 years old males with myocardial infraction, angina pain, smokers, have hyperlipidemia, chronic kidney disease, and chronic obstructive lung disease is undergoing coronary artery bypass surgery. The death rate was low and 69.4% of cases were quite good. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy and safety of Carbetocin compared to oxytocin in prevention of postpartum hemorrhage (PPH) after low-risk cesarean delivery (CD)., Search Strategy: Screening of Medline, Web Of Science, Scopus, Google scholar, and clinical trials registry till January 2024 using the key words related to carbetocin, blood loss, PPH, Cesarean section and their MeSH terms was done., Selection Criteria: This study included all RCTs conducted on women with low risk for developing PPH after CD and compared the administration of carbetocin to oxytocin without any language limitation. These studies compared carbetocin to oxytocin alone or oxytocin combined with misoprostol. The review included all doses and routes of carbetocin and oxytocin administration., Data Collection and Analysis: The extracted data included study settings, the participants' size and characteristics, intervention details of both the study and control groups especially data about the dose route and timing of drug administration, the outcome parameters and trial registration details The reported outcomes included the requirement of additional uterotonic agents or blood transfusion, the difference between preoperative and postoperative hemoglobin, the occurrence of PPH, blood loss and drug adverse effects., Main Results: Seventeen studies including 3667 participants were included. The need for additional uterotonic agents was evaluated in 14 studies with 3154 participants and revealed an OR of 0.53 with 95% CI of 0.39 and 0.72 (p < 0.001, I 2 41%). The incidence of PPH was reported in 11 studies with 2228 participants and revealed an Odd ratio of 1.08 with 95%CI of [0.81, 1.44] (p = 0.61, I 2 0%). The hemoglobin drop after the operation was evaluated in 3 studies with 1240 participants and revealed an MD of -0.08 with 95% CI of -0.10 and - 0.06 (p < 0.001, I 2 0%). The need for blood transfusion was evaluated in 9 studies with 1936 participants and revealed an OR of 0.57 with 95% CI of 0.34 and 0.97 (p = 0.04, I 2 0%)., Conclusion: Carbetocin administration during CD in women with low risk for PPH is associated with less need for additional uterotonic agents (moderate evidence), less need for blood transfusion (high evidence) and lower hemoglobin drop (high evidence) when compared to those who underwent oxytocin administration without an increase in adverse effects., (© 2024 Japan Society of Obstetrics and Gynecology.)

Introduction: Ischemic Stroke in young adults is a real public health problem; it's a major cause of disability, alters quality of life and has a great socio-economic impact., Aim: determine risk factors and specify the etiology of arterial ischemic stroke in young Tunisian adults., Methods: In this 5 years retrospective study (2015-2020), we included all young adults (18-50 years) admitted for arterial ischemic stroke (AIS). Risk factors were registered and analyzed. All patients were investigated using a standard protocol: biological tests, brain imaging, carotid ultrasound and cardiac assessment. Additional investigations were carried out at the discretion of the treating physician. The cause of ischemic stroke was classified according to the TOAST criteria., Results: We collected 200 patients with AIS. The mean age was 41.37 years ± 6.99. Traditional vascular risk factors were observed in more than 1⁄4 patients. A definite cause of stroke was identified in 120 patients. Cardio-embolic causes were the most common among our patients (19%) followed by atherosclerosis of the large arteries (11.5%). Other determined etiologies were found in 27.5% of patients. The etiology remained unclear in 40% of cases: undetermined despite complete investigation in 17.5%, undetermined and incompletely investigated 14.5 % and more than one potential pathomechanisms in 8%., Conclusion: Through this study, we demonstrated the diversity of etiology of stroke in young Tunisian adults. Changes of lifestyle are responsible for the occurrence of the traditional risk factors at an early age. Rheumatic heart diseases remain a frequent cause of AIS in our area.

Floorplan energy assessments present a highly efficient method for evaluating the energy efficiency of residential properties without requiring physical presence. By employing computer modelling, an accurate determination of the building's heat loss or gain can be achieved, enabling planners and homeowners to devise energy-efficient renovation or redevelopment plans. However, the creation of an AI model for floorplan element detection necessitates the manual annotation of a substantial collection of floorplans, which poses a daunting task. This paper introduces a novel active learning model designed to detect and annotate the primary elements within floorplan images, aiming to assist energy assessors in automating the analysis of such images-an inherently challenging problem due to the time-intensive nature of the annotation process. Our active learning approach initially trained on a set of 500 annotated images and progressively learned from a larger dataset comprising 4500 unlabelled images. This iterative process resulted in mean average precision score of 0.833, precision score of 0.972, and recall score of 0.950. We make our dataset publicly available under a Creative Commons license., (© 2023. Springer Nature Limited.)

Pial arteriovenous fistulas (AVFs) are rare neurovascular malformations. They differ from arteriovenous malformations (AVMs) in that they involve single or multiple feeding arteries, draining directly into a dilated cortical vein with no intervening nidus. Pial and dural AVFs differ in blood supply, as the first originate from pial or cortical arteries and the latter from outside the dural leaflets. Unlike dural AVFs, most of the pial AVFs are supratentorial. The vast majority are congenital, manifesting during infancy. Acquired pial AVFs are significantly rarer and occur after vasculopathy, head trauma, brain surgery, or cerebral vein thrombosis. We describe a unique case of an acquired pial AVF in a 50-year-old man secondary to a cortical vein thrombosis manifesting as a focal-onset seizure with secondary generalization. A cerebral digital subtraction angiography revealed a low-flow pial AVF fed by a postcentral branch of the left middle cerebral artery draining to the superior sagittal sinus via a cortical vein. It also showed a collateral venous circulation adjacent to the previously thrombosed left parietal vein. There was no evidence of an associated dural AVF or venous varix. Endovascular treatment was scheduled three months later, but the angiogram preceding the embolization showed spontaneous and complete closure of the malformation. To our knowledge, this is the first case illustrating acquired pure pial AVF unaccompanied by a dural component following cortical vein thrombosis, eventually resulting in an unprompted closure.

Background: The involvement of traditional risk factors and combined genetic markers of recurrent arterial ischemic stroke (AIS) in adults remains unclear., Objective: This study aims to determine significant clinical and genetic factors of AIS recurrence, and to investigate the combined effect of genotypes on the occurrence of a second cerebral ischemic attack., Methods: We investigated a cohort study of AIS patients (18-50 years old) followed in the neurology department over 5 years. Traditional and genetic risk factors were carried through a multivariable logistic regression model. We used a Cox proportional hazard model for identifying predictors of recurrence., Results: Two hundred and seventy patients were enrolled in our study. The risk of AIS recurrence was 36.2% within 5 years. The potential risk of recurrence of AIS increased with traditional and genetic risk factors such as hypertension, diabetes mellitus, heart failure, and family history of cerebrovascular diseases. This risk increased with increasing number of genetic factors. The hazard ratio (HR) was 0.66 (95% confidence interval [CI] 0.97-2.67) for the subject with one genetic factor, 1.61 (95% CI 0.97-2.25) for combined methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and 2.57 (95% CI 1.32-4.99) for combined factor V Leiden (FVL) and MTHFR polymorphisms (677 or 1298). The HR for the three polymorphisms combined was 6.04 (95% CI 2.40-15.16)., Conclusions: Our findings suggest that cumulative effect of both traditional and common genetic risk factors was associated with recurrence of ischemic stroke. We demonstrated for the first time that a combined genotype FVL/MTHFR profile increase the risk of a second cerebral ischemic attack., (© 2021 International Society on Thrombosis and Haemostasis.)

Arterial ischemic stroke (AIS) in young adults is less common in older adults, but the underlying pathogenesis and risk factors are more multi-faceted. The role of inherited thrombophilia such as 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, (C677T and A1298C), factor V of Leiden (FVL) polymorphism, and the prothrombin G20210A mutations remains unclear. This study aims to evaluate the role of prothrombin genetic factor in AIS among young adults in Tunisia and to assess the synergistic effect between thrombogenic mutations in the pathogenesis of AIS. In this case-control study, blood samples were collected from patients and healthy controls, all matched for age and gender. The difference between them is evaluated by using the chi-square test. The odds ratio (OR) was carried out to evaluate the associations between each polymorphism and AIS risk using a binary logistic regression model. Values were considered statistically significant when p < 0.05. Patients carrying simultaneously the MTHFR polymorphisms (677T and 1298C) have a higher risk to develop AIS compared to controls. The heterozygous variants FVL increased the risk of AIS only when it is associated with MTHFR C677T or MTHFR A1298C polymorphisms. In conclusion, our study confirmed the involvement of MTHFR polymorphisms as AIS's important risk factors. The existence of FVL polymorphism or prothrombin G20210A mutation alone doesn't correlate with the occurrence of stroke. We assume that the presence of both MTHFR and FVL polymorphisms has a synergistic effect and increased the risk of the AIS.