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Background: Complications observed during pregnancy affect both mother and fetus, and are more commonly observed among pregnant women from developing countries. The study aims to identify the most common pregnancy and fetal complications during pregnancy, and associated risk factors with these complications. Methods: A longitudinal study was conducted from September 2017 to July 2018 among pregnant women attending and registering in primary health care clinics of the Palestinian Ministry of Health in Nablus city. Data were collected through interviews and by reviewing medical records. Women were followed up during their regular visits to the primary health care clinics. Any complication affecting either the fetus or the mother during the pregnancy period was recorded. Binary logistic regression was used to identify independent risk factors for pregnancy and fetal complications. Results: A total of 380 pregnant women were included in the study. The most common complications seen among women during pregnancy were preterm labor (PTL) (11.3%), followed by an equal number of gestational diabetes (GDM) and pregnancies induce hypertension (PIH), i.e. (7.9%). Large for gestational age (LGA) (11.6 %) and small for gestational age (SGA) (10.5%) were the most commonly observed fetal complications. Pregnant women living in camps (O.R 2.35, 95% [CI] 1.02- 5.45), nulliparity (O.R 14.9, 95% [CI] 1.09-202.5) and low parity women (O.R 16.8, 95% [CI] 1.47- 192.5) were at higher risk of having pregnancy complications. However, lower risk was noticed between women with gravida 4 (O.R 0.11, 95% [CI] 0.03-0.47) compared to women having more than 6 pregnancies. Age younger than 41 years was a protective factor against fetal complications, while parity (≤ 6 parities) especially 4 to 6 parities (OR 36.17; 95% CI 4.88-268) and active smoking mothers (OR 1.25; 95% CI 1.0-3.07) were identified as risk factors that are associated with an increased risk of fetal complications. Conclusions: Fetal and pregnancy-related complications are prevalent among Palestinian pregnant women. Increasing the awareness and improving the understanding of the identified risk factors related to these complications among the public, and specifically, females may help to reduce the prevalence of these conditions and the associated risk of these complications.

Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health; females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p≤0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.

Background Childhood obesity is rising in developed and developing countries, while childhood underweight is rising mainly in developing countries. Childhood underweight has been shown to increase a child’s risk of rapid weight gain. Overweight and obese children are more likely to become obese adults, which increases the risk of type-II diabetes and cardiovascular diseases. Studies concerning obesity among Palestinian children are scarce. The prevalence of obesity among Palestinian children has increased from 3 to 6% within 5 years in comparison to the worldwide rise from 1 to 7%, within 41 years. We aim to determine the current prevalence of underweight, overweight and obesity among Palestinian school-age children and to assess the role of dietary and sociodemographic factors. Methodology A cross sectional study was conducted in Palestine in 2017. A total of 1320 school-age children and their 2640 corresponding parents were recruited. A written questionnaire was filled out by the parents. Anthropometric indices were measured and categorized according to the Center for Disease Control and prevention (CDC). Results The mean ± SD age of the children was 9.5 ± 1.5 years and 48.8% were females. The prevalence of underweight, overweight and obesity among the children was approximately 7.3% (95% CI = 5.9–8.8%), 14.5% (95% CI = 12.7–16.6%) and 15.7% (95% CI = 13.8–17.8%) respectively. Multinomial logistic regression analysis demonstrated a significant correlation of waist circumference, age, gender and living place with the body mass indexes of the students. Conclusion Our findings highlighted the accelerated increase in the prevalence of underweight, overweight and obesity (37.5%) among Palestinian children within a very short time in comparison to the globe. Therefore, Interventions aiming to prevent obesity and underweight at an early stage might be vital to avoid obesity later in life and its health-related co-morbidities, e.g. type-II diabetes and cardiovascular diseases.

Introduction The elderly, with chronic obstructive pulmonary disease (COPD), are at a higher risk of hospitalisation due to acute exacerbation of COPD (AECOPD). They also often encounter multiple co-morbidities. Objectives This study was aimed to explore the occurrence of anxiety, depression and to identify the factors associated with hospital readmission among older patients after AECOPD discharge. Methods A multicentre prospective study was conducted in Malaysia (from 1st September 2012 till 31st September 2013) among older patients (≥60 years) hospitalised for AECOPD. Anxiety and depression were assessed on discharge using previously validated questionnaires, Generalized Anxiety Disorder-7 (GAD-7 and Geriatric Depression Scale (GDS-15), respectively. Patients were followed up for a period of 3 months after discharge. Results A total of 81 patients with a median age of 72 years (IQR 66.40-78.00) were recruited. Anxiety was observed in 34.57% while 38.27% had depression. Both anxiety and depression were detected in 25.93% of the patients. A history of frequent AECOPD admissions was found to be associated with developing depressive symptoms, while anxiety scores were associated with severe dyspnoea. Severe depression was more commonly identified among patients aged 60-75 and in those with a history of tuberculosis. A high readmission rate (40.74%) during the 3-month period was noticed. History of frequent AECOPD admissions (OR = 2.87; 95% CI 1.05-7.85, P = 0.040) and ischemic heart disease (IHD) (OR = 4.04; 95% CI 1.1-14.6, P = 0.032) were identified as the factors associated with the risk of hospital readmission. Conclusions Anxiety and depression were found to be relatively common among older patients with AECOPD. IHD and history of frequent COPD hospitalisation were associated with short-term readmission among the elderly.

Background: Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cysts (GHC) of the lung are a special clinical entity in children and are related to higher lung tissue elasticity. Aim: To compare the characteristics on presentation, location of the cyst, type of the intervention, postoperative complications and long-term results in GHC and non-giant pulmonary hydatid cysts (NGHC) in children. Methods: A retrospective study was undertaken. The data analyzed were taken from medical records of pulmonary hydatid cyst (PHC) children hospitalized in a Pulmonary Department between 2004 and 2016. Cysts were divided according to their size into GHC (>10cm) and NGHC (≤10cm). Results: In the period of study, 94 PHC were recorded in 74 children. GHC accounted for 13 (13.8%) and NGHC for 81 (86.2%). Mean age of children was 11.21 years (9.5 in GHC vs 11.5 years in NGHC). Hemoptysis was founded in 25% of children with GHC vs 45.2% in those with NGHC (p=0.19). Cysts were unique in 61.7% of cases and predominated at right in 59.1% and in inferior lobes in 70% of cases. GHC were significantly less frequently complicated (46.2% vs 76.6% in NGHC, p≤0.05). Parenchymal resection was realized in 61.5% of GHC vs 14.8% of NGHC. No significant difference in post-operative complications was found between the two groups. Sequels were found in 58.3% of GHC vs 45.2% of NGHC (p>0.05). Any child had recurrent cyst. Conclusions: GHC is a frequent clinical entity in children because of lower frequency of complications (hemoptysis and rupture) and thus delayed diagnosis. They are associated with more frequent sequels, require major surgery with parenchymal resection and therefore require early diagnostic and therapeutic management.

Pulmonary hydatid disease is a significant health problem in children in endemic areas such as Tunisia. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease in children in our province which is endemic for echinococcosis. It9s a retrospective study conducted between 2002 and 2013 by reviewing the medical records of patients (≤18 years) who were diagnosed with pulmonary hydatid disease. A total of 70 patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 11.36 (4 to 18) years. Symptoms were present in 57.7% of patients and dyspnea was the major complaint. Hydatoptosis was noticed in 15.7% of cases. An important diagnosis delay was found and estimated to 131.78 days. Misdiagnosis as benign bronchitis was the major cause of diagnosis delay. Hydatid cyst rupture was found at diagnosis in 61% of cases. Hepatopulmonary hydatidosis was found in 31.42% of cases. Diagnosis was easy in 58.6% of cases and made on clinical, Chest X ray and ultrasonography data and CT scan was necessary in 41.4% of cases because of atypic presentation. Surgical treatment was performed in all cases except one case of multiple hydatidosis and lobectomy was necessary in 13 cases (18.5%) . Although it9s a frequent disease in our country, diagnosis delay of pulmonary hydatid cyst remains important leading to complicated forms and a high rate of lobectomies.

It9s now admitted that vitamin D deficiency is associated with allergic diseases and asthma. Recently, IL33, an IL1 family cytokine was described as an “alarmin” that promotes TH2-type cytokines and airway inflammation in asthma. Recent data showed a possible interaction between IL33 and vitamin D levels when vitamin D supplementation increased sST2 levels a soluble IL33 receptor and inhibitor in situ of IL33. The aim of our study was to investigate the link between serum levels of IL33 and vitamin D (by ELISA) according to disease severity and control in winter and summer in 38 asthmatic children (17 mild asthmatics and 21 moderate asthmatics) compared to 30 healthy controls (HC). Our results showed that vitamin D levels were lower in asthmatics compared to HC in summer (p=0.004). These levels were lower in winter and in more severe asthma (p These results suggest that vitamin D deficiency may increase IL33 levels and thus induce TH2 inflammation. Vitamin D supplementation may reduce inflammation through sST2 production.

Transmission of M. ulcerans, the etiological agent of Buruli ulcer, from the environment to humans remains an enigma despite decades of research. Major transmission hypotheses propose 1) that M. ulcerans is acquired through an insect bite or 2) that bacteria enter an existing wound through exposure to a contaminated environment. In studies reported here, a guinea pig infection model was developed to determine whether Buruli ulcer could be produced through passive inoculation of M. ulcerans onto a superficial abrasion. The choice of an abrasion model was based on the fact that most bacterial pathogens infecting the skin are able to infect an open lesion, and that abrasions are extremely common in children. Our studies show that after a 90d infection period, an ulcer was present at intra-dermal injection sites of all seven animals infected, whereas topical application of M. ulcerans failed to establish an infection. Mycobacterium ulcerans was cultured from all injection sites whereas infected abrasion sites healed and were culture negative. A 14d experiment was conducted to determine how long organisms persisted after inoculation. Mycobacterium ulcerans was isolated from abrasions at one hour and 24 hours post infection, but cultures from later time points were negative. Abrasion sites were qPCR positive up to seven days post infection, but negative at later timepoints. In contrast, M. ulcerans DNA was detected at intra-dermal injection sites throughout the study. M. ulcerans was cultured from injection sites at each time point. These results suggest that injection of M. ulcerans into the skin greatly facilitates infection and lends support for the role of an invertebrate vector or other route of entry such as a puncture wound or deep laceration where bacteria would be contained within the lesion. Infection through passive inoculation into an existing abrasion appears a less likely route of entry., Author Summary Buruli ulcer, a severe skin disease in West and Central Africa results in significant disability. The causative bacterium, M. ulcerans has been detected in many aquatic sources, but how bacteria enter the skin is an enigma. Two major hypotheses for infection are 1) that bacteria are injected into the skin through the bite of an aquatic insect, or 2) that bacteria enter open wounds on a person's body. In this study, we use a guinea pig infection model to evaluate whether application of M. ulcerans to an open abrasion produces Buruli ulcer. Our results show that despite topical application of very large numbers of M. ulcerans, we are unable to produce infection in open abrasions. These results are extremely surprising because most bacteria such as Staphylococcus or Streptococcus can readily infect abrasions. In contrast, intra-dermal injection of M. ulcerans into the skin of guinea pigs consistently produced an ulcer. Our studies are the first to explore the route of infection of M. ulcerans in an experimental model. These results suggest that Buruli ulcer is not likely to be due to passive entry of bacteria into pre-existing abrasions and supports the role of biting invertebrates, puncture wounds, or lacerations as a requirement for infection.

Posterior epidural migration of a lumbar disc herniation is rare. Clinical symptoms frequently indicate severe radicular compression. Cauda equina syndrome is very unusual. Three cases of cauda equina syndrome from posterior epidural migration of a lumbar disc herniation along with a review of the literature are presented to illustrate the Imaging features of this entity and related diagnostic difficulties. Finaly, early surgical management is the treatment of choice for optimal symptomatic recovery.

Background We previously established a congenic mouse strain with TALLYHO/Jng (TH) donor segment on chromosome 6 in a C57BL/6 (B6) background that harbors an obesity quantitative trait locus, tabw2. The B6.TH-tabw2 congenic mice developed increased adiposity that became exacerbated upon feeding a high fat-high sucrose (HFS) diet. To fine map the tabw2, in this study we generated and characterized subcongenic lines with smaller TH donor segments. Results We fixed four subcongenic lines, with maximum size of donor segment retained in the lines ranging from 10.8 – 92.5 Mb. For mapping, all the subcongenic mice, along with B6.TH-tabw2 congenic and B6-homozygous control mice were fed either chow or HFS diets, and their post-mortem fat pads were weighed. Mice were also characterized for energy expenditure, respiratory exchange ratio, locomotor activity, and food intake. As previously reported, B6.TH-tabw2 congenic mice showed a significantly larger fat mass than controls on both diets. On chow, a subcongenic line retaining the distal region of the TH donor congenic interval exhibited significantly larger fat mass than B6-homozygous controls, and comparable that to B6.TH-tabw2 congenic mice. Two nested subcongenic lines within that region suggested that the effect of tabw2 on obesity could be attributed to at least two subloci. On HFS diets, on the other hand, all the subcongenic mice had significantly larger fat mass than controls without genotype differences, but none of them had fat mass as large as the original congenic mice. This possibly implicates that further genetic complexity involves in the effect of tabw2 on diet-induced obesity. Significantly reduced locomotor activity was exhibited in B6.TH-tabw2 congenic and subcongenic mice compared to controls when animals were fed HFS diets. B6.TH-tabw2 congenic mice, but not subcongenic mice, also had significantly increased food intake on HFS diets. Conclusions It appears that at least two subloci explaining the tabw2 effect under chow feeding map to the distal region of the congenic interval, whereas the diet-induced obesity mediated by tabw2 is attributed to more complex genetic mechanism.