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Leigh's syndrome is a rare cause of young-onset parkinsonism with dystonia in adults. The case presented a 23-year-old male who developed symptoms such as dragging of the right foot, slowness in daily activities, abnormal hand posturing, and falling backwards. The patient was diagnosed with adult-onset Leigh's syndrome based on clinical symptoms, MRI brain findings, MR spectroscopy, muscle biopsy, and genetic testing. Treatment with various medications did not result in significant improvement after one year of follow-up. Clinicians should be aware of Leigh's syndrome as a potential cause of parkinsonism and dystonia in young adults. [Extracted from the article]

Human society faces problems of a global scale today, as a result of which the priorities of environmental research are shifting to the macro level, and ecology has entered the era of "big data". The authors have created a database of 1,717 model trees of Betula spp. with measured indicators of diameter at breast height (DBH), tree height, age, and aboveground biomass growing in the territory of Eurasia. Regression models for aboveground biomass components are calculated, including the dendrological indices mentioned, and two climate indicators as independent variables. Based on the theory of space-for time substitution, the obtained patterns of changes in aboveground biomass in the territorial climatic gradients of Eurasia are used to predict changes in biomass due to climate shifts. In accordance with the law of the limiting factor by Liebig, it is established that in sufficiently moisture-rich climatic zones, an increase in temperature by 1°C with a constant amount of precipitation causes an increase in biomass, and in water-deficient zones — its decrease. In warm climatic zones, a decrease in precipitation by 100 mm at a constant average January temperature causes a decrease in biomass, and in cold climatic zones - its increase. [ABSTRACT FROM AUTHOR]

Background: Pistacia chinensis is extensively employed in traditional medicine. This study aimed to isolate and evaluate the therapeutic effects of 3’4’78-tetrahydroxy-3-methoxyflavone from P. chinensis crude extract. Materials and Methods: The study utilized column chromatography for isolation. The plant extract and its isolated compound were assessed for in vivo analgesic (hot plate model), anti-inflammatory (carrageenan-induced paw edema), sedative (open field model), and muscle relaxing properties (inclined plane and traction test). Results: In the thermal-induced analgesic model, a significant analgesic effect was observed for the extract (25, 50, and 100 mg/kg) and the isolated compound (2.5, 5, 10, and 15 mg/kg) at higher doses. The extract (100 mg/kg) significantly prolonged latency time (21.98 seconds) after 120 minutes of administration. The isolated compound elevated the latency time (20.03 seconds) after 30 minutes, remaining significant up to 120 minutes with a latency time of 24.11 seconds. The anti-inflammatory effect showed a reduction in inflammatory reactions by 50.23% (extract) and 67.09% (compound) after the fifth hour of treatment. Both samples demonstrated significant sedative effects, with the extract hindering movement by 54.11 lines crossed compared to the negative control (180.99 lines). The isolated compound reduced the number of lines crossed to 15.23±SEM compared to the negative control. Both samples were also significant muscle relaxants. Docking studies indicated that the compound’s therapeutic effect is due to inhibiting COX and nociceptive pathways. Conclusion: The isolated compound from Pistacia chinensis exhibits significant analgesic, anti-inflammatory, sedative, and muscle relaxing properties, with potential therapeutic applications by inhibiting COX and nociceptive pathways.

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Background Aims This study was undertaken to evaluate our tracheostomy service and identify reasons for any delays. Methods A retrospective study in an academic tertiary-care hospital in Jeddah, Saudi Arabia. Inclusion criteria were any patients in ICU who required a surgical tracheostomy over a 2-year period (January 2014 to December 2015). The primary outcome was delayed tracheostomy referral and secondary outcomes included the number of days between referral and consultation, days between consultation and tracheostomy placement, and mortality rates. Results Ninety-nine patients had a tracheostomy between January 2014 to December 2015 and could be analysed, mean age of 52.7 years, 44.5% females. The average duration from referral to tracheostomy was 5.12 days (SD 6.52). Eighteen patients (18.2%) had delayed tracheostomy (> 7 days from referral). The main reasons for the delay were the patient’s medical condition (50%, n = 9), followed by low haemoglobin (38.9%, n = 7). Administrative reasons were recorded in 5 cases only (28%); 2 due to operating room lack of time, 2 due to multidisciplinary issues, and 1 due to family refusal. Laboratory-confirmed low haemoglobin, a prescription of anti-platelets, or a prescription of anti-coagulation were not associated with a longer duration between referral and tracheostomy placement. An increase of 1 day in the time between referral and tracheostomy corresponded to an increase in delay in discharge from ICU of 1.24 days (95% CI 0.306 to 2.18). Conclusion Although most delays related to the clinical condition of the patient, administrative and multidisciplinary factors also play a role. Early tracheostomy (less than 14 days) from intubation increases the survival rates of patients and improves their clinical outcomes. Further prospective evaluation is needed to confirm the impact of delay in performing surgical tracheostomy among ICU patients whose bedside percutaneous tracheostomy is contraindicated.

Background: Coronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is currently a major cause of intensive care unit (ICU) admissions globally. The role of machine learning in the ICU is evolving but currently limited to diagnostic and prognostic values. A decision tree (DT) algorithm is a simple and intuitive machine learning method that provides sequential nonlinear analysis of variables. It is simple and might be a valuable tool for bedside physicians during COVID-19 to predict ICU outcomes and help in critical decision-making like end-of-life decisions and bed allocation in the event of limited ICU bed capacities. Herein, we utilized a machine learning DT algorithm to describe the association of a predefined set of variables and 28-day ICU outcome in adult COVID-19 patients admitted to the ICU. We highlight the value of utilizing a machine learning DT algorithm in the ICU at the time of a COVID-19 pandemic. Methods: This was a prospective and multicenter cohort study involving 14 hospitals in Saudi Arabia. We included critically ill COVID-19 patients admitted to the ICU between March 1, 2020, and October 31, 2020. The predictors of 28-day ICU mortality were identified using two predictive models: conventional logistic regression and DT analyses. Results: There were 1468 critically ill COVID-19 patients included in the study. The 28-day ICU mortality was 540 (36.8 %), and the 90-day mortality was 600 (40.9 %). The DT algorithm identified five variables that were integrated into the algorithm to predict 28-day ICU outcomes: need for intubation, need for vasopressors, age, gender, and PaO2/FiO2 ratio. Conclusion: DT is a simple tool that might be utilized in the ICU to identify critically ill COVID-19 patients who are at high risk of 28-day ICU mortality. However, further studies and external validation are still required.

Gibbus deformity is defined by the collapse of one or more vertebral bodies, which results in kyphosis and is often the consequence of infection, metabolic, or congenital irregularities in the vertebrae. In this report we present a unique case of a young male with inadequately treated MRSA bacteremia complicated by lumbar osteomyelitis with progression to severe joint destruction and a marked Gibbus deformity.

It is well known that when an unprotected steel structure is exposed to fire, depending on the section factor, the temperature of the steel increases rapidly. This increase affects the mechanical properties of the steel and could result in deformation/failure of the structure depending on the temperature, time, and applied load. Therefore, conventionally, intumescent-based coatings are used as protective coatings on steel. However, poor weathering resistance of these coatings is a major problem. Even the slightest changes in chemical composition due to weathering reduce the fire performance of these coatings. This review focuses on elaborating and exploring the protective coatings for steel, the environmental interaction of these polymer-based coatings, sorption kinetics of moisture/water, leaching of flame-retardant additives, subsequent changes in chemical composition of the coatings, and the resulting effect on fire performance of coatings. Discussions on UV degradation of polymeric materials, blister formation in weathered coatings, and corrosion susceptibility of the substrates are also incorporated in these topics. [ABSTRACT FROM AUTHOR]

Background & objectives: Shoes are no more mere accessories of the feet, but the essential part of a woman's fashion that reflects her personality. As the high heel shoes have always been in fashion statements for women, many women going crazy about them, ignoring the postural effects that the shoes can create. The aim of this study to compare between the quadriceps angle at zero and 3-inch heel heights during the standing position in normal adult female. Methods: It is a case control study located in the Faculty of physical therapy at Kafrelsheikh University, between June to July 2015. Twenty-two adult females (age range 18-20 years) were selected randomly. The quadriceps angle was measured for all participants using radiographs in anteroposterior standing position at zero and 3-inch heel heights. Result: There was statistically significant increase in participant's quadriceps-angle of the right or left knees (P< 0.05) from zero to 3-inch heel height. There were no statistically significant changes in the participant's quadriceps-angle between the right and left knees (P>0.05) at zero and 3-inch heel heights. Conclusions: During standing position, the value of quadriceps angle was increased when the heel height was increased. [ABSTRACT FROM AUTHOR]

Abstract Introduction Data are lacking on impact of Middle East Respiratory Syndrome (MERS) on health-related quality of life (HRQoL) among survivors. Methods We conducted a cross-sectional survey of MERS survivors who required hospitalization in Saudi Arabia during 2016–2017, approximately 1 year after diagnosis. The Short-Form General Health Survey 36 (SF-36) was administered by telephone interview to assess 8 quality of life domains for MERS survivors and a sample of survivors of severe acute respiratory infection (SARI) without MERS. We compared mean SF-36 scores of MERS and non-MERS SARI survivors using independent t-test, and compared categorical variables using chi-square test. Adjusted analyses were performed using multiple linear regression. Results Of 355 MERS survivors, 83 were eligible and 78 agreed to participate. MERS survivors were younger than non-MERS SARI survivors (mean ± SD): (44.9 years ±12.9) vs (50.0 years ±13.6), p = 0.031. Intensive care unit (ICU) admissions were similar for MERS and non-MERS SARI survivors (46.2% vs. 57.1%), p = 0.20. After adjusting for potential confounders, there were no significant differences between MERS and non-MERS SARI survivors in physical component or mental component summary scores. MERS ICU survivors scored lower than MERS survivors not admitted to an ICU for physical function (p = 0.05), general health (p = 0.01), vitality (p = 0.03), emotional role (p = 0.03) and physical component summary (p

Alan Kaplan,1 Kenneth R Chapman,2 Syed M Anees,3 Irvin Mayers,4 Driss Rochdi,5 Michel Djandji,5 David Préfontaine,5 Andrew McIvor6 1Family Physician Airways Group of Canada, University of Toronto, Toronto, ON, Canada; 2Division of Respiratory Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; 3Schulich School of Medicine & Dentistry – Western University, University of Windsor, ON, Canada; 4Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada; 5Novartis Pharmaceuticals Canada Inc., Montreal, QC, Canada; 6Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, ON, Canada Purpose: In contrast to randomized controlled trials (RCTs), changes in maintenance pharmacotherapy in clinical practice occur without a washout period. The Prospective cohort study for the real-life effectiveness evaluation of glycOpyrronium With indacatERol combination in the management of COPD in Canada (POWER) study evaluated the real-life effectiveness of indacaterol/glycopyrronium (IND/GLY) following a direct switch from a long-acting muscarinic antagonist (LAMA, tiotropium) or long-acting β2-agonist (LABA)/inhaled corticosteroid (ICS) maintenance treatment (salmeterol/fluticasone [SFC]).Methods: POWER was a single-cohort, prospective, multicenter, interventional study in which patients with moderate-to-severe COPD, who remained symptomatic on their current treatment of once-daily (od) tiotropium 18 µg or twice-daily (bid) SFC (any dose), were switched to treatment with open-label IND/GLY 110/50 µg od for 16 weeks. Effectiveness end points were change from baseline in trough FEV1, transition dyspnea index (TDI) total scores, and COPD assessment test (CAT) scores at 16 weeks.Results: Trough FEV1 improved by 175 mL at Week 16 in patients who switched to IND/GLY. The change was 176 mL (95% CI: 135–217) when switched from tiotropium and 172 mL (95% CI: 85–258) when switched from SFC fixed-dose combination (FDC). At Week 16, significant improvements were observed in the mean TDI total scores (Δ=2.5) and CAT scores (Δ=-6.5) after the switch to IND/GLY treatment (both P

Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.

Abstract Background Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. Methods We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. Results Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P

Developing an effective treatment plan that promotes learning-generalization beyond treated stimuli remains a challenging task in language rehabilitation. Many specific treatments have been used to document therapeutic gains in learned lexical behaviors and now learning generalizations beyond practiced stimuli are being forged (Boyle, 2004 and Kiran & Thompson, 2003).Accordingly, generalization beyond practiced structures still remains an exciting therapeutic strategy. As major elements of cognitive processing, the perceptual representations embedded within mental imagery (MI), have long been recognized for their healing potential (Thomas, 2008), and training mindfulness. MI is also known to modulate the brain’s neural-circuitry in new learning (Davidson, 2000). It also acts as a mean to access memories and passes undistorted through mental resistances (Singer 1974). Purpose We integrated blocked and random presentations of MI with our treatment of anomia with three goals in mind: (1) to evaluate whether activation of the neural circuitry through controlled MI facilitated word finding skills; (2) to determine if the blocked or random modes of MI presentation facilitate learning equally or not; and, (3) to evaluate if the effects of evoked MI generalize to untrained lexical items. Subject The participating subject was a three-year post-onset, right-handed, 68-year old University-educated male with chronic aphasia secondary to a MRI confirmed large left temporal-parietal infarct in addition to an earlier left frontal infarct. These strokes resulted in moderately impaired comprehension and verbal expression. He made gains in both aspects of language following two years of SLP treatment. However, he continued to exhibit moderate to severe word finding (Goodglass & Kaplan, 1983). Methods We incorporated MI with random and blocked presentations in ABA format to explore the learning and generalization of trained mental representations that comprised of both typical and atypical words from various lexical categories (Rosch, 1975). These stimuli were divided into treated and untreated groups. A PowerPoint presentation of each target lexical image was prepared with recorded directions. On each slide, the patient was cued with the object name and was directed to think about the perceptual-cognitive image of the pictured object but to refrain from naming it verbally. The patient practiced the pictured-objects, three times daily for six weeks without verbally naming objects verbally. Results The post-treatment assessment yielded a favorable impact of MI training on the naming of both typical and atypical words, after both random and blocked presentations. This learning further generalized crucially to the untrained words. Conclusion MI has proven to be facilitator for lexical learning and generalization. It involved the activation of the same neural circuitry or some vicarious circuitry that is associated with the verbal use of the lexicon. In our opinion, this circuitry activation assisted to link pictured objects to the sub-verbal mental representations. Further, we assumed throughout the study that the suppression of any would-be erroneous verbal attempts to name would help the patient remain focused and indeed would prevent the formation of unwanted, off-target circuitry, scaffolded off of disrupted verbal searching. Moreover, the improved writing that we observed may have resulted from some serendipitous generalization.