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In this study, abnormal levels of myeloid activation, endothelial damage, and innate immune markers were associated with severe coronavirus disease 2019 (COVID-19), while higher levels of metabolic biomarkers (irisin, leptin) demonstrated a protective effect. These data support a model for COVID-19 immunopathogenesis linking robust inflammation and endothelial damage in metabolically predisposed individuals.

Purpose A case of severe bilateral sensorineural hearing loss associated with oral morphine is reported. Summary A 52-year-old Spanish man was admitted to the intensive care unit with a Glasgow Coma Scale score of 3, a fever, and sudden hearing loss with tinnitus in both ears. His medical history included type 2 diabetes mellitus, depression, sleep disorder, and hypertension. The patient also had pyelonephritis in 2011 and pulmonary embolism in 2014, requiring the placement of an inferior vena cava filter and chronic anticoagulation. His hearing loss appeared after the initiation of oral morphine, specifically on the eighth day of treatment, with increasing dosages of up to 120 mg daily. We did not find any other possible causes of the hearing loss. Ototoxicity is an adverse reaction of ibuprofen and acetaminophen, but the patient received only three doses of ibuprofen 600 mg and did not require acetaminophen. The patient’s other medications did not have ototoxicity as an adverse reaction, and the patient confirmed not to have received any salicylate product. Brain magnetic resonance imaging discarded other possible causes of hearing loss. Our patient’s hearing loss did not resolve after opioid discontinuation, and the use of hearing aids was necessary. According to the Naranjo et al. adverse drug reaction probability scale, this event would be classified as “probable.” Conclusion A 52-year-old man developed tinnitus and hearing loss after receiving high doses of oral morphine sulfate. His hearing loss did not fully resolve after the discontinuation of morphine, and he required the use of hearing aids.

Herein, we report a case of post-transfusion purpura after the reversal of anticoagulation for surgical purposes in a 66-year old ethnic Asian man who was undergoing long-term warfarin therapy for antiphospholipid syndrome. The patient experienced a sudden decrease in platelet count, from 308,000 per μL from the day of admission to 38,000 per μL the following day. Follow-up testing revealed unremarkable red blood cell (RBC) morphology, no evidence of platelet clumping, and negative heparin-induced antibody test results. Platelet antibody testing revealed anti-HPA15a antibodies.

† Background and Aims It has traditionally been considered that the flowers of Scrophularia are mainly pollinated by wasps. We studied the pollination system of four species which stand out for their large and showy flowers: S. sambucifolia and S. grandiflora (endemics of the western Mediterranean region), S. trifoliata (an endemic of the Tyrrhenian islands) and S. calliantha (an endemic of the Canary Islands). Our principal aim was to test whether these species were pollinated by birds or showed a mixed pollination system between insects and birds. † Methods Censuses and captures of insects and birds were performed to obtain pollen load transported and deposited on the stigmas. Also, a qualitative and quantitative analysis of the flowers and inflorescences was carried out. † Key Results Flowers were visited by Hymenoptera and by passerine birds. The Canarian species was the most visited by birds, especially by Phylloscopus canariensis, and its flowers were also accessed by juveniles of the lizard Gallotia stehlini. The most important birds in the other three species were Sylvia melanocephala and S. atricapilla. The most important insect-functional groups in the mixed pollination system were: honey-bees and wasps in S. sambucifolia; bumble-bees and wasps in S. grandiflora; wasps in S. trifoliata; and a small bee in S. calliantha. † Conclusions The species studied show a mixed pollination system between insects and passerine birds. In S. calliantha there is, in addition, a third agent ( juveniles of Gallotia stehlini). The participation of birds in this mixed pollination system presents varying degrees of importance because, while in S. calliantha they are the main pollinators, in the other species they interact to complement the insects which are the main pollinators. A review of different florae showed that the large showy floral morphotypes of Scrophularia are concentrated in the western and central Mediterranean region, Macaronesia and USA (New Mexico).

As most plants of the Mediterranean region bloom in spring, there have been few studies of the reproductive biology of species with autumn–winter flowering. In this study, we investigate the breeding system of Anagyris foetida, one of the few shrubs that blooms at this time. The floral, phenological, and reproductive aspects of two populations of this Mediterranean legume from south-west Spain were studied via field and laboratory experiments. The variability of fruit and seeds was studied in another 12 Iberian populations with respect to certain meteorological parameters (temperature and rainfall). Anagyris foetida shows cauliflory, marked floral longevity, and adichogamy. The peak of flowering is in January–February. It is self-compatible, with no clear advantage of cross- over self-pollination, and with virtually no autonomous self-pollination. This is because the stigma, like some other legumes, prevents the germination of pollen if its surface is not ruptured by pollinators. The number of seeds per fruit under natural pollination was positively correlated with the total rainfall during the fruiting period (from January to May), and significantly influenced the percentage of fruit weight represented by the pericarp, in the sense that the smaller the number of viable seeds in the fruit, the greater the percentage of pericarp weight. © 2008 The Linnean Society of London, Botanical Journal of the Linnean Society, 2008, 157, 519–532.

5 x 0.5–1.7(2) mm, in whorls of 4, elliptic, ovate, orobovate, obtuse, attenuate or shortly petiolate, some-what fleshy, with the main vein more conspicuous,especially on the abaxial surface, and the lateral veinshardly visible, leaf margins occasionally slightly rev-olute, glabrous, finally reflexed, with ± abundant lin-ear oblique bundles of raphides, whitish, generally dryor absent in flowering. Partial inflorescences cymose,axillary, with 3 flowers, arranged in whorls, 4 in each,± approximate along the stems, on very short pedun-cles

Two new species of the genus Galium are described from the Iberian Peninsula: G. moralesianum OrtegaOlivencia & Devesa, and G. talaveranum Ortega-Olivencia & Devesa. The first grows on limestone or dolomiticlimestone outcrops in south-east Spain (the Segura and Gador mountain ranges) and shows morphological similarities with G. boissieranum Ehrend. & Krendl, which is endemic to southern Spain (mountains of Malaga). The second inhabits the margins of water courses, alder stands and cork-oak dehesas (parkland-type systems) of the west of the Iberian Peninsula, and is morphologically reminiscent of G. mollugo L. The chromosome numbers of these two species and of G. boissieranum are given. © 2003 The Linnean Society of London, Botanical Journal of the Linnean Society, 2003, 143, 177–187. ADDITIONAL KEYWORDS: Flora Iberica – karyology – taxonomy.

The productivity and morphology of fruit and seeds were studied in 30 species (and subspecies) of the tribe Genisteae (Fabaceae) in south-west Spain. The morphological characters of greatest taxonomic value both for the segregation of the two subtribes (Genistinae and Lupininae) recognized in Genisteae and for the delimitation of the lower taxonomic levels (genus and species) are the size of the pod and characters of the pericarp, the colour and weight of the seeds, whether or not an aril exists, and the shape, size, and position of the hilum. In contrast, characters of little taxonomic interest are pod colour, shape and number of seeds, and characters of the lens. There were also found to be major relationships between fruit and seed, and between these and other floral (e.g. corolla size) or reproductive (e.g. pollen/ovule [P/O] and seed/ovule [S/O] ratios) attributes. Thus in this tribe, pod size was positively correlated with corolla size, seed size, the number of viable seeds/fruit, and the S/O and P/O ratios. Corolla size was positively correlated with the number of viable seeds/fruit and with the seed weight. Similarly, the number of seeds/fruit was positively correlated with the fruit's weight and with the number of ovules/ovary. Also, the weight of the seeds was positively correlated with the pollen/ovule ratio. There was also positive correlation between the S/O and P/O ratios.

We studied the morphology of the androecium in 168 species and subspecies of Fabaceae from SW Europe and its relationship with nectar production. Six androecium types were recognized: monadelphous; pseudomonadelphous without basal fenestration; pseudomonadelphous with basal fenestration; diadelphous; reduced diadelphous; and androecium with free stamens. The monadelphous androecium appears in the tribe Genisteae, in Ononis , and in Galega officinalis, and the pseudomonadelphous without basal fenestration only in the genus Coronilla, with both types having the same functionality—they are linked to the absence of nectar from an intrastaminal nectary, their taxa being mostly polliniferous. The pseudomonadelphous androecium with basal fenestration appears in around 38% of the taxa studied and has the same functionality as the diadelphous androecium: there is nectar secretion from an intrastaminal nectary in both. The reduced diadelphous androecium only appears in three species ( Biserrula pelecinus, Vicia pubescens and Astragalus epiglottis ), and its functionality could be related to the syndrome accompanying autogamy in Angiosperms. The free stamen androecium may imply a greater nectar production than other types.

A new species of the genus Scrophularia , S. fontqueri Ortega-Olivencia & Devesa, is described for the Western Rif mountains in Morocco. Similarities and differences with the most closely related species ( S. auriculata Loefl. ex L. and S. viciosoi Ortega-Olivencia & Devesa) are indicated, and ecological and distribution data are provided. The new species displays a high degree of polyploidy (2 n =56), and has palynological characteristics similar to those of other species in this genus. The new species shows protogynous dichogamy and produces considerable amounts of nectar in both sexual phases. Nectar secretion was maximum during the early hours of the morning. Mean longevity of the flowers was 2.66 days. Both nectar secretion and floral longevity correlated strongly with mean daytime air temperature. Pollination experiments showed that interaction with pollinators is necessary for reproduction, and gametophytic homomorphic self-incompatibility was documented. This feature was confirmed by observation of pollen tubes after hand self-pollination. The seed/ovule ratio was very low.

We studied the floral and reproductive biology ofDrosophyllym lusitanicum(Droseraceae), a species endemic to the western Iberian Peninsula and northwest Morocco. Flowering lasted from March to August, peaking in April. The species is clearly homogamous, with pollen germination and stigma receptivity occurring even in preanthesis. This was reflected in the high rates of fruit set and seed set in bagged inflorescences. Fructification did not differ significantly between different pollination treatments, although we did find differences between some treatments in the numbers of viable seeds per flower and fruit. However, seed weight did not differ significantly. The importance of self-pollination over cross-pollination was also supported by the low percentages of fructification (24.67%) after emasculation and open pollination. Metameric deviations were seen in flowers, although this abnormality was not translated as any reproductive benefit or disadvantage (fructification, number or weight of seeds) in comparison with normal flowers.

We studied the floral and reproductive biology of Drosophyllym lusitanicum (Droseraceae), a species endemic to the western Iberian Peninsula and northwest Morocco. Flowering lasted from March to August, peaking in April. The species is clearly homogamous, with pollen germination and stigma receptivity occurring even in preanthesis. This was reflected in the high rates of fruit set and seed set in bagged inflorescences. Fructification did not differ significantly between different pollination treatments, although we did find differences between some treatments in the numbers of viable seeds per flower and fruit. However, seed weight did not differ significantly. The importance of self-pollination over cross-pollination was also supported by the low percentages of fructification (24.67%) after emasculation and open pollination. Metameric deviations were seen in flowers, although this abnormality was not translated as any reproductive benefit or disadvantage (fructification, number or weight of seeds) in comparison with normal flowers.

The following abstracts are compiled from Check Sample exercises published in 2008. These peer-reviewed case studies assist laboratory professionals with continuing medical education and are developed in the areas of clinical chemistry, cytopathology, forensic pathology, hematology, microbiology, surgical pathology, and transfusion medicine. Abstracts for all exercises published in the program will appear annually in AJCP. # 1 Fetal Lung Maturity Testing Clinical Chemistry No. CC 08-1 (CC-367) {#article-title-2} Neonatal respiratory distress syndrome (RDS) is a disorder of pulmonary immaturity with a high mortality characterized by low levels of pulmonary surfactant. Gestational age determines risk based on concentration of pulmonary surfactant, ie, as gestation progresses the concentration of pulmonary surfactant increases. As a result, newborns delivered at fewer than 28 weeks have a more than 60% risk of RDS, whereas those delivered at more than 34 weeks have a less than 5% risk of RDS. In situations where gestational age alone is not sufficient to determine RDS risk and preterm delivery is medically needed, amniotic fluid analysis can be performed to determine pulmonary surfactant concentration. Four common methods are the lecithin-sphingomyelin ratio, phosphatidylglycerol measurement, surfactant-albumin ratio, and lamellar body count. All of these tests have excellent negative predictive values but poor positive predictive values, ie, they are great at confirming maturity but poor at confirming immaturity. # 2 Alkaline Phosphatase Isoenzyme Analysis: Guiding the Differential Diagnosis of Elevated Serum Total Alkaline Phosphatase Clinical Chemistry No. CC 08-2 (CC-368) {#article-title-3} The measurement of alkaline phosphatase (ALP) has long been used in clinical medicine, primarily to aid the diagnosis and monitoring of liver and bone diseases. Its diagnostic utility is limited by the enzyme’s wide tissue distribution and by a variety of potential nonpathologic causes. Isoenzyme analysis is one of several tools available to the clinician hoping to further characterize an elevated total ALP. It provides differentiation among liver, bone, intestinal, placental, and tumor-related forms as the cause of an elevation. The case presents a patient with persistent elevated ALP and atypical bands in the isoenzyme electrophoresis gel. An atypical ALP may be the result of a macroenzyme, which, if present, complicates interpretation of the test result and may cause additional, unnecessary testing or procedures. Recognizing and reporting a macroenzyme is an important service the clinical laboratorian can provide a clinician. # 3 Indirect Phlebotomy: Is It Good Practice? Clinical Chemistry No. CC 08-3 (CC-369) {#article-title-4} Indirect phlebotomy, the collection of blood samples through vascular infusion devices, is a common practice adopted to minimize needle-stick pain and discomfort in hospitalized patients. However, this practice can lead to alteration of the specimen and medical errors associated with misrepresentation of the blood test values. Among the possible problems, dilution or concentration of a particular analyte may occur, depending on the contents of the line’s infusate. Although some studies may indicate that blood collection from lines can be acceptable for isolated laboratory tests, there are insufficient data to demonstrate the reliability of line draws as routine practice. Use of lines for specimen collection should be reserved only for those patients with truly poor vascular access or those patients who require multiple phlebotomies in a short time period. Samples should be collected from lines only under a direct physician order, with careful attention to technique and established protocols that take many variables into account, including the analytes, contents of the line, type of line, discard blood volume, time interval between interruption of infusion and sampling, and catheter size. Even with careful attention to these details, clinicians must remain wary of the potential for medical errors related to misinterpretation of laboratory test results based on such samples.