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Abstract Background COVID-19 is a global pandemic that has highly impacted the healthcare system and patients, especially patients with epilepsy, due to the fact that the success of their treatment depends on obtaining sustainable access to medical professions, diagnostic services, facilities, and medications. The epidemiology and presence of neuro-pediatric emergencies in the setting of COVID-19 in XXX have not been thoroughly described. This is a barrier to planning and providing quality emergency care within the local health systems. The objective of this study is to provide a comprehensive description of the epidemiology of neurological cases encountered in the pediatric emergency unit. Methods This is a retrospective study to analyze the flow pattern of Emergency Department (ED) visits among pediatric patients with neuro-related complaints. Participants were filtered, and a total of 108,000 visits were reduced to 960 patients with a neurological provisional diagnosis. Patients were grouped into pre- and post-pandemic visits according to their age group. We identified demographic and clinical variables. Results The study included 960 patients with a provisional neurological diagnosis, consisting of 542 (56.5%) males and 418 (43.5%) females. The mean age of admission was 5.29 ± 4.19 years. The majority of patients were triaged as “priority 1—resuscitation” (n = 332, 34.6%), and seizures were the most frequent chief complaint (n = 317, 33.0%). Statistical significance was observed for patients with vascular issues (p = 0.013) during the pre-COVID-19 period after adjusting for odds ratio. The most common outcome was discharge (n = 558, 58.1%). The mean length of stay during the pre-COVID-19 pandemic was 16.48 ± 33.53 h, which was significantly longer compared to a mean length of stay of 7.76 ± 7.27 h during the COVID-19 pandemic (P

The present study interprets the high resolution of the biostratigraphy across the Cretaceous/Paleogene (K/Pg) boundary from Sulaymaniyah, Kurdistan Region, and north-east Iraq, based on planktic foraminifera. The Dartw section was selected for this study, within the High Folded Zone. The biozone contact consists of lithostratigraphic resemblance and is represented by the upper part of the Tanjero Formation (late Maastrichtian) with the overlying Kolosh Formation (Danian). Four late Maastrichtian planktic foraminiferal biozones have been recorded from the Tanjero Formation: Racemiguembelina fructicosa Interval Zone (CF4), Pseudoguembelina hariaensis Concurrent Range Zone (CF3),Pseudoguembelina palpebra Partial Range Zone (CF2), and Plummerita hantkeninoides Total Range Zone (CF1), while three Danian planktic foraminiferal biozones and two subzones have been recorded from the Kolosh Formation: (Guembelitria cretacea (P0) Interval Zone, Parvularugoglobigerina eugubina (Pα) Total Range Zone, and Parasubbotina pseudobulloides (P1) Partial-Range Zone (Globoanomalina archaeocompressa (P1a) Partial Range Subzone, and Subbotina triloculinoides (P1b) Interval Subzone). High biostratigraphic resolution indicates a complete K/Pg transition with no hiatus at the studied section in the Sulaymaniyah area. The ranges of the species recognized in this study are given. Correlations with other sections in Iraq and other parts of the world, including the typeMaastrichtian and Danian areas, are discussed and represented in correlation charts, together with the ranges of the important Upper Maastrichtian and Paleocene species.

Background: Pulmonary TB is a relatively common disease in developing countries including Iraq . A relatively small proportion (5–10%) of the approximately 2 billion people infected with M. tuberculosis worldwide will develop TB. Objective: To show the prevalence of T.B. among children in Abu-Ghraib city Patients and Methods: A descriptive retrospective center-based study in the Abu-Ghraib health sector (chest and respiratory disease unit) was conducted to show the distribution of TB in children ≤ 18 years from the 1st January 2001 till the 31st December 2020. Results: A total sample of 248 patients which represents 15.1% of all patients with TB in Abu-Ghraib (1642) from1st January 2001 till 31st December 2020. Female (152; 61.2%) and male (96; 38.8%). Most common age group affected was 13-18 years which represents 71.7% of patient. The prevalence of TB in Abu-Ghraib during the study period for children was (3.4/100,000). Conclusion: The prevalence of all forms of TB in Abu-Ghraib during the study period was (3.4/100000). Females were affected more than males with a mean of 6.7+/-1.5 Extra-pulmonary TB was found to be more common than pulmonary TB.

In this case study, we describe a case of a subdural haemorrhage in an acutely severe asthmatic patient in a suspicious circumstance. A woman in her early 40s came to the emergency department with an acute asthmatic exacerbation. The autopsy showed subdural hemorrhage in the parieto-temporal area and slightly congested, overinflated lungs with mucus plugs and a thickened bronchiolar wall. This case report emphasizes the medicolegal aspect of the presence of subdural haemorrhage in an asthmatic patient who died in a suspicious circumstance.

Reconstruction of the depositional environment of the Paleocene-Eocene Sinjar Formation from two outcrop sections in northwestern and northeastern Iraq has been evaluated using the traditional petrographic and facies analysis supported by X-ray diffraction and scanning electron microscopy with a focus on the Paleocene-Eocene (P-E) transition boundary. To this end, major and trace elemental geochemistry was conducted and various paleoenvironmental proxies for the paleoredox, paleoclimate, paleosalinity and paleoproductivity were determined in order to evaluate the changes in widely acknowledged environmental and climatic indicators and the elemental enrichment/depletion across the P–E boundary. The redox-sensitive trace element enrichment and the ir ratios (V/V + Ni, V/Cr, and U/Th) indicate that normal oxygenated circumstances prevailed during the late Paleocene deposition, and that anoxic conditions and a gradual commencement of oxygen depletion occurred during the early Eocene deposition. The coeval increase in the P2O5 content, P/Ti, and P/Al ratios in the Eocene sediments suggests an increase in nutrients and primary productivity due to the effect of upwelling currents during early Eocene. The conditions can be verified by observing a small change in salinity levels from low to high across the P-E boundary, which can be indicated by the Sr/Ba ratios. In addition, certain minerals such as Mg-calcite, dolomite, and palygorskite are commonly present, and paleoclimatic changes can be observed across the P-E transition from arid to semiarid and then to humid conditions, which can be recorded from C-values, Sr-Cu, Rb/Sr ratios, and clay mineralogy. These conditions were noted in the Sinjar Formation, which is made up of many microfacies such as lime mudstone, wackstone, packstone, grainstone and boundstone. These microfacies were deposited in a shallow marine environment that extended from tidal flats to reef slopes, with a developed reef environment that included back reef, reef core, and fore reef environments.

Cancer is an elaborate sequence of disease grades that include uncontrolled cell growth and division, invasion, and metastasis. Overexpression of the epidermal growth factor receptor (EGFR) causes an abnormal signal transduction and is directly linked to cancer development. Most EGFR tyrosine kinase inhibitors (TKIs) are ATP-competitive inhibitors that frequently cause EGFR mutations or chemoresistance. Therefore, targeting the EGFR TK allosteric site has become a highly sought after cancer treatment strategy. Ten new derivatives of 4-(tert-butyl)-3-methoxybenzoic acid containing carbothioamide (compounds 3a-e), triazole (compounds 4a-d) or oxadiazole (compound 5) moieties were designed as EGFR TK allosteric site inhibitors as deduced in silico. The structures of these derivatives were characterized by chemical spectroscopic methods (ATR-FTIR, 1HNMR, 13CNMR and HRESI-MS). According to the molecular docking studies, compounds 3e and 3d showed the highest docking scores (ΔG), which was confirmed by molecular dynamic (MD) simulation studies. The synthesized derivatives, specifically compounds 3d and 3e, exhibited favorable pharmacokinetic profile. In vitro, the newly synthesized derivatives were evaluated for their cytotoxicity against A549 (lung adenocarcinoma), HepG2 (hepatocellular carcinoma), and HCT-116 (colorectal) cancer cell lines via the MTT assay, flow cytometry, RT-PCR, immunoblotting, and kinase inhibition assay. The cytotoxicity results showed that compound 3d was cytotoxic to the three tested cell lines, achieving the lowest IC50 concentration against A549 cancer cells. Compound 3d targeting EGFR tyrosine kinase caused cell cycle arrest at the G2/M phase and induction of the ER-mediated apoptosis pathway. In silico and in vitro antitumor activity findings of compound 3d demonstrated that it is a promising EGFR tyrosine kinase allosteric site inhibitor.

Background Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19–positive autopsies performed in Jordan. Methods The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples. Results Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings. Conclusions The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.

Cystic echinococcosis (hydatid disease) is a neglected tropical disease common in Asia, South America and Sub-Saharan Africa. It is a parasitic disease caused by larval stage of Echinococcus granulosus. The commonest organs affected by hydatidosis are the liver and the lung. Primary bone hydatidosis in humans is a rare disease accounting for 1–2% of echinococcosis cases. To our knowledge secondary hydatidosis of joints is uncommon and few cases of hydatid disease of the knee joint have been reported. We present a case of primary cystic echinococcosis of the knee joint occurring in a 43-year-old female presenting mainly as disabling right knee arthritis in the form of chronic (13 years) painful swelling, which ultimately led to her inability to walk. Imaging and histopathologic examination revealed cystic echinococcosis of the right knee joint. Subsequent pulmonary, liver and bone screening for primary lesions were negative. To our knowledge, this is the first ever report on primary knee hydatid disease. It is possible that pre-existing arthritis modulated the local environment of the knee, rendering it susceptible to hydatidosis. This should be taken into account in the differential diagnosis of arthritis particularly in endemic areas.

Abstract Memory dysfunction is prevalent in temporal lobe epilepsy (TLE), but little is known about the underlying molecular etiologies. Single-nucleus RNA sequencing technology was used to examine differences in cellular heterogeneity among left (language-dominant) temporal neocortical tissues from patients with TLE with (n = 4) or without (n = 2) impairment in verbal episodic memory. We observed marked cell heterogeneity between memory phenotypes and identified numerous differentially expressed genes across all brain cell types. The most notable differences were observed in glutamatergic (excitatory) and GABAergic (inhibitory) neurons with an overrepresentation of genes associated with long-term potentiation, long-term depression, and MAPK signaling, processes known to be essential for episodic memory formation.

The resistance spot welding (RSW) method was used to join aluminum alloy AA 1050 and copper alloy UNS C50100 sheets. Mechanical properties of the joints were examined. The influence of welding process parameters on tensile shear force of the joints was discussed. The design of experiments (DOE) method was used to analyze the influence of welding parameters on the mechanical properties of the joints. Three RSW parameters were used: welding current, squeeze time, and welding time. The results showed that the joint shear stress increased with increasing the welding current until a value of 12000 Amp. Then the shear stress decreased. The tensile shear stress increased with increasing the welding and squeeze time. As a consequence, it can be possible to weld copper with aluminum by RSW.

Background: Post-acute COVID-19 syndrome (PACS) is an important healthcare burden. We examined persistent symptoms in COVID-19 patients at least four weeks after the onset of infection, participants’ return to pre-COVID-19 health status and associated risk factors. Methods: Cross-sectional study was conducted (December 2020 to January 2021). A validated online questionnaire was sent to randomly selected individuals aged more than 14 years from a total of 1397,386 people confirmed to have COVID-19 at least 4 weeks prior to the start of this survey. This sample was drawn from the Saudi ministry of health COVID-19 testing registry system. Results: Out of the 9507 COVID-19 patients who responded to the survey, 5946 (62.5%) of them adequately completed it. 2895 patients (48.7%) were aged 35–44 years, 64.4% were males, and 91.5% were Middle Eastern or North African. 79.4% experienced unresolved symptoms for at least 4 weeks after the disease onset. 9.3% were hospitalized with 42.7% visiting healthcare facility after discharge and 14.3% requiring readmission. The rates of main reported persistent symptoms in descending order were fatigue 53.5%, muscle and body ache 38.2%, loss of smell 35.0%, joint pain 30.5%, and loss of taste 29.1%. There was moderate correlation between the number of symptoms at the onset and post-four weeks of COVID-19 infection. Female sex, pre-existing comorbidities, increased number of baseline symptoms, longer hospital-stay, and hospital readmission were predictors of delayed return to baseline health state (p

Background: Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. We therefore aimed to determine predictors of different functional outcomes after hospital discharge in patients with COVID-19. Methods: An ambidirectional cohort study was conducted between May and July 2020, in which PCR-confirmed COVID-19 patients underwent a standardized telephone assessment between 6 weeks and 6 months post discharge. We excluded patients who died, had a mental illness or failed to respond to two follow-up phone calls. The medical research council (MRC) dyspnea scale, metabolic equivalent of task (MET) score for exercise tolerance, chronic fatigability syndrome (CFS) scale and World Health Organization-five well-being index (WHO-5) for mental health were used to evaluate symptoms at follow-up. Results: 375 patients were contacted and 153 failed to respond. The median timing for the follow-up assessment was 122 days (IQR, 109–158). On multivariate analyses, female gender, pre-existing lung disease, headache at presentation, intensive care unit (ICU) admission, critical COVID-19 and post-discharge ER visit were predictors of higher MRC scores at follow-up. Female gender, older age >67 years, arterial hypertension and emergency room (ER) visit were associated with lower MET exercise tolerance scores. Female gender, pre-existing lung disease, and ER visit were associated with higher risk of CFS. Age, dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms were negatively associated with WHO-5 score. Conclusions: Several risk factors were associated with an increased risk of PACS. Hospitalized patients with COVID-19 who are at risk for PACS may benefit from a targeted pre-emptive follow-up and rehabilitation programs.

Hydranencephaly is a central nervous system disorder at birth in which brain's cerebral hemispheres are absent and replaced by sacks filled with CSF. The prevalence of hydranencephaly is less than 1 in 10,000 births, with 0.2 percent of children autopsies showing the condition. A case of hydranencephaly is described in this report. This was discovered during the medicolegal autopsy of a newborn male infant who was accidentally found dead in a wastebasket. Presented here are the results of external examination, autopsy, histological, and toxicological findings. The fact that hydranencephaly was the accused mother's sole and most potent defense in proving her innocence was underlined here, since the presence of such an argument was enough to arouse suspicion that it was a case of infanticide committed by the mother.

This research paper studies the use of an environmentally and not expensive method to degrade Orange G dye (OG) from the aqueous solution, where the extract of ficus leaves has been used to fabricate the green bimetallic iron/copper nanoparticles (G-Fe/Cu-NPs). The fabricated G‑Fe/Cu-NPs were characterized utilizing scanning electron microscopy, BET, atomic force microscopy, energy dispersive spectroscopy, Fourier-transform infrared spectroscopy and zeta potential. The rounded and shaped as like spherical nanoparticles were found for G-Fe/Cu‑NPs with the size ranged 32-59 nm and the surface area was 4.452 m2/g. Then the resultant nanoparticles were utilized as a Fenton-like oxidation catalyst. The degradation efficiency of OG dye highly depends on H2O2 concentration (1.7-5.28 mM), catalyst dose (0.4-1.6 g/L), pH (2-7), initial OG concentration (25-75 mg/L), and temperature (20-50 ℃). Batch experiments showed that 94.8 % of 50 mg/L of OG dye was removed within the optimum peroxide concentration, dose, pH and temperature which were 3.52 mM, 1 g/L, 3, and 40℃ respectively along with 30 min contact time. The results of kinetic models showed that OG removal followed the second-order model. Finally, the thermodynamic study of reaction was also examined and concluded to endothermic reaction with 29.725 kJ/mol activation energy.

Abstract Background This article examines the patterns of death in migrant domestic workers (MDWs) in Jordan. Abuse and difficult circumstances may lead to attempts to escape, neglect, or suicide, but the current literature on death in this population is limited. We systematically explored all medico-legal cases of MDW deaths referred between 2006 and 2016 to the forensic department of one of the main tertiary medical centers in Jordan. Results Sixty-three recorded cases of MDWs death were found. Forty-seven (74.6%) died due to unnatural causes, 15 (23.8%) died naturally, and 1 (1.6%) was undetermined. The rate of suspected suicide comprised 58.3% of unnatural deaths. The most common methods of suicide were hanging and falling from a height. Conclusions This study shows high rates of unnatural death among MDWs in Jordan, many of which with suspicious circumstances. It also indicates that natural deaths are largely attributed to preventable causes. Future studies should include other referral sites (hospitals and forensics departments), to better address the complexity and magnitude of this population’s death circumstances, gain a comprehensive understanding of their issues, and work toward finding a solution. We recommend that special attention is given to MDWs in Jordan and the region to protect their rights on all levels.

Background: Human herpes virus type-6 (HHV-6) is increasingly recognised as a febrile agent in children. However, less is known in sub-Saharan African countries, including Sudan. Objective: We investigated the involvement of HHV-6 in paediatric central nervous system (CNS) infections in Khartoum, Sudan. Methods: Febrile patients aged up to 15 years with suspected CNS infections at Omdurman Hospital for Children from 01 December 2009 to 01 August 2010 were included. Viral DNA was extracted from leftover cerebrospinal fluid (CSF) specimens and quantitatively amplified by real-time polymerase chain reaction (PCR) at Umeå University in Sweden. Results: Of 503 CSF specimens, 13 (2.6%) were positive for HHV-6 (33.0% [13/40 of cases with proven infectious meningitis]). The median thermal cycle threshold for all HHV-6-positive specimens was 38 (range: 31.9–40.8). The median number of virus copies was 281.3/PCR run (1 × 105 copies/mL CSF; range: 30–44 × 103 copies/PCR run [12 × 103 – 18 × 106 copies/mL CSF]). All positive patients presented with fever and vomiting; 86.0% had seizures. The male-to-female ratio was 1:1; 50.0% were toddlers, 42.0% infants and 8.0% teenagers. Most (83.0%) were admitted in the dry season and 17.0% in the rainy season. Cerebrospinal fluid leukocytosis was seen in 33.0%, CSF glucose levels were normal in 86.0% and low in 14.0%, and CSF protein levels were low in 14.0% and high in 43.0%. Conclusion: Among children in Sudan with CNS infections, HHV-6 is common. Studies on the existence and spread of HHV-6 chromosomal integration in this population are needed.

Abstract Many meta‐analyses have been published about the efficacy of hydroxychloroquine (HCQ) in coronavirus disease 2019 (COVID‐19). Most of them included observational studies, and few have assessed HCQ as a prophylaxis or evaluated its safety profile. We searched multiple databases and preprint servers for randomized controlled trials (RCTs) that assessed HCQ for the treatment or prevention of COVID‐19. We summarized the effect of HCQ on mortality, viral clearance, and other clinical outcomes. Out of 768 papers screened, 21 RCTs with a total of 14,138 patients were included. A total of 9 inpatient and 3 outpatient RCTs assessed mortality in 8596 patients with a pooled risk difference of 0.01 (95% confidence interval [CI] 0.00–0.03, I2 = 1%, p = 0.07). Six studies assessed viral clearance at 7 days with a pooled risk ratio (RR) of 1.11 (95% CI 0.86–1.42, I2 = 61%, p = 0.44) and 5 studies at 14 days with a pooled RR of 0.96 (95% CI 0.89–1.04, I2 = 0%, p = 0.34). Several trials showed no significant effect of HCQ on other clinical outcomes and. Five prevention RCTs with 5012 patients found no effect of HCQ on the risk of acquiring COVID‐19. Thirteen trials showed that HCQ was associated with increased risk of adverse events. We observed, with high level of certainty of evidence, that HCQ is not effective in reducing mortality in patients with COVID‐19. Lower certainty evidence also suggests that HCQ neither improves viral clearance and other clinical outcomes, nor prevents COVID‐19 infection in patients with high‐risk exposure. HCQ is associated with an increased rate of adverse events.

Objective: To determine the association between chronic statin use and mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). Patients and Methods: We identified a retrospective cohort of patients requiring admission at the Mayo Clinic using our enterprise-wide COVID-19 registry from March 1, 2020, through September 30, 2020. Available information included age, sex, use of statins, medical comorbidities, and 30-day mortality. We estimated the association of statins with 30-day mortality using odds ratios and 95% CIs from logistic regression modeling. Results: Patients (N=1295) between the ages of 30 and 80 years tested positive for COVID-19 and required admission during the study period, of whom 500 (38.6%) were taking statins at admission. Patients taking statins were older and more likely to have diabetes mellitus or congestive heart failure. Within 30 days of diagnosis, 59 (4.6%) died. In multivariable analysis, statin users did not have statistically different odds of death within 30 days with an odds ratio of 1.14 (95% CI, 0.64 to 2.03; P=.67) compared to nonusers. Conclusion: Patients with COVID-19 taking statins had similar 30-day mortality to those not taking statins after adjusting for relevant covariates. Although this is partly influenced by a higher prevalence of risk factors for more severe COVID-19 presentation not entirely adjusted for by the Charlson comorbidity index, these data would not support statins as a likely therapeutic intervention for COVID-19 in the hospital setting.

Objective: To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19). Methods: We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences. Results: A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; I2=96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; I2=98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; I2=97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity. Conclusion: Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.

Background: To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. Methods: We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach. Results: Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69–1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23−0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11–1.93, I2 = 43.38%). Conclusion: In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients’ population that could benefit from CST.

Background: Direct anterior hip replacement is a slightly aggressive surgical procedure but potentially widespread. It involves opening on the front of the hip to allow the joint to be substituted by moving muscles aside along their ordinary tissue planes without removing any tendons. Nevertheless, there is diminutive consent concerning the threats and profits of this method compared to the posterior approach (PA) regarding the rates of dislocation and infection. Methods: This research is a prospective study conducted in Erbil city from September 2015 to September 2017 on 57 patients, including 28 females and 29 males, with primary total hip arthroplasty (THA). Twenty-nine patients were enrolled in the direct anterior approach (DAA: First group), and 28 patients were registered in the PA group (PA: Second group). Their age ranged between 49 and 80 years, and the regular follow-up was 12 months for all patients. Results: It was found that using the DAA, there was a significantly (P ≤ 0.05) lower incidence rate of dislocation in patients undergoing THA than the PA. No significant difference in the rates of infection was noticed between both groups. However, slightly shorter operational time and extent of the incision were noticed in the DAA group, and less blood loss was found in the PA group (non-significant). Conclusion: We realized that DAA has a clear advantage over PA regarding the lower incidence in the dislocation risk and without variance in the infection rates.

Fifteen albino mice were subjected to three days dehydration and fifteen albino mice were given 1% NaCl in their drinking water. Control animals were given drinking water All animals were sacrificed and kidneys were fixed in different fixatives and processed for light microscopy Section were stained for juxtaglomerular cells demonstration and the juxtaglomerular index (GI) and percentage of granulated nephron(%GN) were calculated. Kidneys from dehydrated and sodium-loaded animals showed significant decrease in both JGI and % GN and was discussed in relation to renin secretion and release.

Aim To provide a contemporary analysis of incidence trends of infective endocarditis (IE) with its changing epidemiology over the past two decades in Europe.Methods A systematic review was conducted at the Mayo Clinic, Rochester. Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus and Web of Science were searched for studies published between 1 January 2000 and 30 November 2020. All studies were independently reviewed by four referees and those that included a population-based incidence of IE in patients, irrespective of age, in Europe were included. Least squares regression was used to estimate pooled temporal trends in IE incidence.Results Of 9138 articles screened, 18 studies were included in the review. Elderly men predominated in all studies. IE incidence increased 4.1% per year (95% CI 1.8% to 6.4%) in the pooled regression analysis of eight studies that included comprehensive and consistent trends data. When trends data were weighted according to population size of individual countries, an increase in yearly incidence of 0.27 cases per 100 000 people was observed. Staphylococci and streptococci were the most common pathogens identified. The rate of surgical intervention ranged from 10.2% to 60.0%, and the rate of inpatient mortality ranged from 14.3% to 17.5%. In six studies that examined the rate of injection drug use, five of them reported a rate of less than 10%.Conclusion Based on findings from our systematic review, IE incidence in Europe has doubled over the past two decades in Europe. Multiple factors are likely responsible for this striking increase.Trial registeration number CRD42020191196.

More than one year since its emergence, corona virus disease 2019 (COVID-19) is still looming large with a paucity of treatment options. To add to this burden, a sizeable subset of patients who have recovered from acute COVID-19 infection have reported lingering symptoms, leading to significant disability and impairment of their daily life activities. These patients are considered to suffer from what has been termed as “chronic” or “long” COVID-19 or a form of post-acute sequelae of COVID-19, and patients experiencing this syndrome have been termed COVID-19 long-haulers. Despite recovery from infection, the persistence of atypical chronic symptoms, including extreme fatigue, shortness of breath, joint pains, brain fogs, anxiety and depression, that could last for months implies an underlying disease pathology that persist beyond the acute presentation of the disease. As opposed to the direct effects of the virus itself, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be largely responsible for the appearance of these lasting symptoms, possibly through facilitating an ongoing inflammatory process. In this review, we hypothesize potential immunological mechanisms underlying these persistent and prolonged effects, and describe the multi-organ long-term manifestations of COVID-19.

Patients infected with COVID-19 virus, show a highly variable symptomatology which can include central nervous system (CNS) dysfunction. One of the most disabling CNS manifestations is persistent severe encephalopathy seen for weeks after the resolution of the acute viral pneumonia and associated acute systemic illnesses. The precise pathophysiology of this persistent Post COVID Encephalopathy is unknown but may involve direct viral invasion of microvascular endothelium, microvascular thrombosis, toxic neuronal effects of inflammatory products, vasoactive pathology at arteriolar level or leptomeningeal inflammation. Currently, there are no established specific treatments for Post COVID -19 encephalopathy. We present a case series of three patients that underwent Therapeutic Plasma Exchange (TPE) with salinized albumin that suggests a positive therapeutic effect. We believe that the results warrant further evaluation for the role of TPE with a prospective randomized trial in persistent Post COVID -19 encephalopathy syndrome.

Objectives Our study aims at comparing the efficacy and safety of IFN-based therapy (lopinavir/ritonavir, ribavirin, and interferon β-1b) vs. favipiravir (FPV) in a cohort of hospitalized patients with non-critical COVID-19. Methods Single center observational study comparing IFN-based therapy (interferon β-1b, ribavirin, and lopinavir/ritonavir) vs. FPV in non-critical hospitalized COVID-19 patients. Allocation to either treatment group was non-random but based on changes to national treatment protocols rather than physicians’ selection (quasi-experimental). We examined the association between IFN-based therapy and 28-day mortality using Cox regression model with treatment as a time-dependent covariate. Results The study cohort included 222 patients, of whom 68 (28%) received IFN-based therapy. Antiviral therapy was started at a median of 5 days (3–6 days) from symptoms onset in the IFN group vs. 6 days (4–7 days) for the FPV group, P Conclusion Early IFN-based triple therapy was associated with lower 28-days mortality as compared to FPV.

Background Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. The risk factors associated with PACS remain largely unclear. The aim of this study was to evaluate the frequency of new or persistent symptoms in COVID-19 patients post hospital discharge and identify associated risk factors. Methods Our prospective cohort comprised of PCR-confirmed COVID-19 patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia between May and July 2020. The patients were interviewed through phone calls by trained physicians from 6 weeks up to 6 months post hospital discharge. Multivariate Cox proportional hazards and logistic regression models were used to examine for predictors associated with persistence of symptoms and non-return to baseline health. Results 222 COVID-19 patients responded to follow-up phone interviews after a median of 122 days post discharge. The majority of patients were men (77%) with mean age of 52.47 (± 13.95) years. 56.3% of patients complained of persistent symptoms; 66 (29.7%) experiencing them for >21 days and 64 (28.8%) reporting not having returned to their baseline health. Furthermore, 39 patients (17.6%) reported visiting an emergency room post discharge for COVID-19-related symptoms while 16 (7.2%) had required re-hospitalization. Shortness of breath (40.1%), cough (27.5%) and fatigue (29.7%) were the most frequently reported symptoms at follow-up. After multivariable adjustments, female gender, pre-existing hypertension and length of hospital stay were associated with an increased risk of new or persistent symptoms. Age, pre-existing lung disease and emergency room visits increased the likelihood of not fully recovering from acute COVID-19. Patients who were treated with interferon β-1b based triple antiviral therapy during hospital stay were less likely to experience new or persistent symptoms and more likely to return to their baseline health. Conclusions COVID-19 survivors continued to suffer from dyspnea, cough and fatigue at 4 months post hospital discharge. Several risk factors could predict which patients are more likely to experience PACS and may benefit from individualized follow-up and rehabilitation programs.

INTRODUCTION: Endothelin1 (ET1) is 21- amino acid vasoconstrictor peptide secreted by endotheliumwhich has an important role in the pathoohysiology of preeclampsia (PE). The objective of this study was to evaluate the binding sites and quantitative changes in ET1 in umbilical cord vessels of PE patients. METHOD: This study recruited 40 pregnant women between 20-40 years old at 3rd trimester. All cases selected for this study underwent an elective cesarean section, grouped into 2 groups; PE group of 20 pregnant women (at 3rd trimester) who proved to have pregnancy induced hypertension and proteinuria. The control group was of 20 healthy pregnant females at the same average of gestational age and with the same exclusion criteria and no PE, underwent elective caesarean section. Umbilical cord tissues were taken from the maternal side, fixed with formalin, paraffin, embedded sections of umbilical cord were treated with Endothelin1 antibody. The immunoreactivity of ET1 was assessed using Aperio image scope software. Statistical analysis was done using SPSS program. RESULTS: The results demonstrated a significant increase (P = 0.001) of ET1 expression in cord vessels of PE group with respect to control group (mean 28.5±1.7, 2.6±0.4 respectively). CONCLUSION: It is concluded that ET1 is markedly increase in PE and may be the cause behind promoted vascular smooth muscle cell contraction and blood pressure elevation in PE.

Objective: Endothelin1 (ET1) is 21- amino acid vasoconstrictor peptide secreted by endotheliumwhich has an important role in the pathoohysiology of preeclampsia (PE). The objective of this study was to evaluate the binding sites and quantitative changes in ET1 in umbilical cord vessels of PE patients. Methods: This study recruited 40 pregnant women between 20-40 years old at 3rd trimester. All cases selected for this study underwent an elective cesarean section, grouped into 2 groups; PE group of 20 pregnant women (at 3rd trimester) who proved to have pregnancy induced hypertension and proteinuria. The control group was of 20 healthy pregnant females at the same average of gestational age and with the same exclusion criteria and no PE, underwent elective caesarean section. Umbilical cord tissues were taken from the maternal side, fixed with formalin, paraffin, embedded sections of umbilical cord were treated with Endothelin1 antibody. The immunoreactivity of ET1 was assessed using Aperio image scope software. Statistical analysis was done using SPSS program. Results: The results demonstrated a significant increase (P = 0.001) of ET1 expression in cord vessels of PE group with respect to control group (mean 28.5±1.7, 2.6±0.4 respectively). Conclusion: It is concluded that ET1 is markedly increase in PE and may be the cause behind promoted vascular smooth muscle cell contraction and blood pressure elevation in PE.

Background: There is no histological study evaluating the effects of insulin-containing cream on skin injury. The goal of this study was to examine the effects of insulin-containing creams on wound healing. Methods: Creams consisting of nine parts of oil and one part of aqueous phase (9:1) mixed with 1.5 mL human insulin were prepared. Eighteen male guinea pigs were divided into three groups; the control (9:1 C) group received cream without insulin. The experimental groups received Humulin N (9:1 N) and Humulin R (9:1 R) respectively. A 1 cm2 wound of 1-2 cm thickness was created in the skin. Each animal received 0.5 g of the respective creams which was topically applied once a day for 14 days. The progress of wound healing was monitored daily. Skin tissues were excised at the 14th days from the wound sites and processed for light microscopy. Results: Skin wound treated with the long acting insulin Humulin N had an accelerated wound healing process with restoration of vascular network, increased collagen deposition and early complete wound remodeling. Conclusion: Insulin cream with long acting mechanism facilitates in normalizing cell permeability, promoting vascularization, reducing exudation and stimulate proliferation of cells. These properties render insulin cream suitable for expediting wound healing.

Background: The aims of this study were to explore the antihyperglycemic effect of curry leaves, Murraya koenigii "MK" aqueous extract, and to examine its possible protective effects on the islets of Langerhans and kidneys of streptozotocin (STZ) diabetic rats. Methods: Thirty healthy adult male Sprague Dawley rats were randomized into five groups (n=6); normal control, normal treated with "MK" control, diabetic control (non-treated with "MK"), diabetic treated with 200 mg/kg MK aqueous leaf extract and diabetic treated with 400 mg/kg MK aqueous leaf extract. Blood glucose levels and body weight were monitored gravimetrically. The animals were sacrificed on the 30th day; the kidney and pancreatic tissues were processed for histological studies. Results: The diabetic group showed considerable loss of body weight and increase in blood glucose levels and degeneration of the glomeruli and renal convoluted tubules and atrophied islets with disintegration of β-cells. Treatment of diabetic rats with MK extract showed significant (p < 0.001) improvement in blood glucose levels and body weight gain. The MK extract also caused an improvement in tissue injury induced by STZ injection in the kidney and islets of Langerhans. Conclusions: These findings highlighted the beneficial effects of MK aqueous extract against cellular oxidative damage in STZ-induced diabetic rats.

Existing of drug resistance bacteria in meat is a series of health concern and beta-lactamase is responsible to generate multi drug resistances in bacteria. Meat is a source of delivering food born pathogen bacteria including Proteus species. Recently Proteus bacteria developed drug resistance against many antimicrobial drugs and it causes difficulty in patient’s treatment. Hence its important to indicate the rate of Proteus species, P. mirabilis and P. Vulgaris, in the meat of different animals and to find the prevalence of b-lactamase resistance genes (blaTEM-1, blaCMY, blaCMY2, blaShv, blaOXA, and blaCTX) in Proteus species. Molecular identification of Proteus bacteria was confirmed by PCR amplification of part of 16S rRNA using Proteus specific set of primers. 70 meat samples (cattle, sheep, chicken, turkey, goat, and fish) were collected in local meat shops in the center of Sulaimani city. 29 (41.4%) samples were positive to Proteus species and 22 (75.87%) isolates were P. mirabilis and seven (24.13%) were P. vulgaris based on conventional biochemical tests. The drug sensitivity test was performed for all isolates using a disk diffusion assay (Kirby Bauer test). The multidrug resistance was found in all isolates and the most common drug resistance phenotype were against tetracycline, rifampin, and doxycycline, while the imepenem, tobramycin, and meropenem remain more effective against the bacteria. Resistance genes, blaTEM-1, and blaShv were found in five isolates (17.2%) of Proteus. Three isolates (10.3%) were positive to blaTEM-1 resistance gene and two isolates (6.8%) were positive to blaShv. All resistance genes recorded in this study were recovered in P. mirabilis and none of them was reported in p. vulgaris. None of the isolates was positive to beta-lactamase genes, blaCMY, blaCMY2, blaOXA, and blaCTX.

Background: Placental morphology and cellular arrangement can be altered in maternal diseases. Rheumatic heart disease (RHD) is a chronic heart condition that can lead to death in pregnant women. The aim of this study is to determine the histological changes of the placenta in pregnant women suffering from RHD. Methods: Placentae were collected from 10 healthy pregnant women, and 31 pregnant women with heart conditions (26 with RHD and 5 with NRHD) who had been admitted to the Baghdad Teaching Hospital. Placental tissues were fixed in 10% formal-saline and were processed for light microscopy. Measurements including the placental weight and diameter of the chorionic villi capillaries were recorded. Results: The results indicate that there are many histological changes in pregnant women with RHD such as hyalinisation, fibrosis of the chorionic villi, proliferation of trophoblastic cells, and thickening of its membrane. Additionally, expectant mothers with RHD experience a reduction in capillary diameter and thickening of the capillary walls, and decreased size and weight of their placenta when compared with the control. Conclusions: Heart diseases, especially RHD, are associated with developmental damage of the placenta in pregnant women by injuring the endothelial cells of the placentas capillaries.

Background: The purpose of this study was to provide a reference of chronic diabetes complications by investigating the prolonged hyperglycemia effects on hematological, biochemical and histopathological changes (liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas) in diabetic rats induced by streptozotocin. Methods: Ten adult female Sprague-Dawley of uniform age were divided into two Groups. Group 1 was made diabetic by single intraperitoneal injection of streptozotocin (60 mg/kg/bw) whereas Group 2 served as control. After six months, the rats were anaesthetized using pentobarbital. Cardiac puncture was performed to get 3 ml of the blood sample; following 12 hours of an overnight fast. Serum chemistry test and complete blood analysis for lipid profile and blood glucose test; liver and renal functions were performed. Tissue specimens of liver, kidney, spleen, cardiac muscle, adrenal gland, and endocrine pancreas were fixed in 10% formal saline and processed for histological study. Results: There were severe histopathological changes in the affected organs; and the presence of a significant abnormality of lipid profile, liver, and renal functions. Conclusions: The presence of histopathological changes with abnormal biochemical changes is related to the chronic absence of insulin production in the destroyed β-cells which reflect the diabetic complications in a human being.

Background and Purpose: Surgical management of patients with cingulate epilepsy (CE) is highly challenging, especially when the MRI is non-lesional. We aimed to use a voxel-based MRI post-processing technique, implemented in a morphometric analysis program (MAP), to facilitate detection of subtle epileptogenic lesions in CE, thereby improving surgical evaluation of patients with CE with non-lesional MRI by visual inspection.Methods: Included in this retrospective study were 9 patients with CE (6 with negative 3T MRI and 3 with subtly lesional 3T MRI) who underwent surgery and became seizure-free or had marked seizure improvement with at least 1-year follow-up. MRI post-processing was applied to pre-surgical T1-weighted volumetric sequence using MAP. The MAP finding was then coregistered and compared with other non-invasive imaging tests (FDG-PET, SPECT and MEG), intracranial EEG ictal onset, surgery location and histopathology.Results: Single MAP+ abnormalities were found in 6 patients, including 3 patients with negative MRI, and 3 patients with subtly lesional MRI. Out of these 6 MAP+ patients, 4 patients became seizure-free after complete resection of the MAP+ abnormalities; 2 patients didn't become seizure-free following laser ablation that only partially overlapped with the MAP+ abnormalities. All MAP+ foci were concordant with intracranial EEG ictal onset (when performed). The localization value of FDG-PET, SPECT and MEG was limited in this cohort. FCD was identified in all patients' surgical pathology except for two cases of laser ablation with no tissue available.Conclusion: MAP provided helpful information for identifying subtle epileptogenic abnormalities in patients with non-lesional cingulate epilepsy. MRI postprocessing should be considered to add to the presurgical evaluation test battery of non-lesional cingulate epilepsy.

ObjectiveTo investigate the neuroimaging and clinical features associated with sleep-related epilepsy (SRE) in patients with focal cortical dysplasia (FCD) type II.MethodsPatients with histopathologically proven FCD type II were included from three epilepsy centers. SRE was defined according to the video EEG findings and seizure history. Cortical surface reconstruction and volume calculation were performed using FreeSurfer. The lesions were manually delineated on T1 volumetric MRI using the ITK-SNAP software. The lesion volumes were normalized by the intracranial volume of each patient. The lesions were classified as small or large by placing a threshold based on quantitative (whether the lesion was detected on MRI report) and qualitative (volume) criteria.ResultsA total of 77 consecutive patients were included. Of them, 36 had SRE and 41 had non-SRE. An earlier age of epilepsy onset, high seizure frequency, regional interictal EEG findings, and favorable surgical outcome were characteristic in both groups. Small lesions were defined as those having a volume

The incidence of one or other rearrangement in chronic myeloid leukemia (CML) patients varies in different reported series. In this study we report the frequencies of BCR-ABL1 fusion transcript variants studied in 43 CML patients from Sudan. The study includes 46 Sudanese patients, three of which negative for the BCR-ABL1 fusion transcript. More than half of 43 positive patients showed b2a2 fusion transcript (53.5%), while (41.9%) showed b3a2 transcript and the remaining (4.6%) coexpression of b3a2/ b2a2 and b3a2/b2a2/e19a2. We detected neither coexpression of p210/p190 nor e1a2 alone. Male patients showed a tendency to express b2a2, while female tende to express b3a2 (p = 0.017). Moreover, a single nucleotide polymorphism was detected in BCR exon 13 in one out of four patients and this patient showed only b2a2 expression. In conclusion, we observed a significant correlation between sex and type of BCR-ABL1 transcript, an observation that deserves further investigation.

BackgroundClostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.PurposeWe sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.Data sourceWe searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.Study selectionTwo authors independently reviewed the studies for eligibility.Data extractionData about studies characteristics, adjusted effect estimates and quality were extracted.Data synthesisThirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22-1.7), I(2) = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15-1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).ConclusionIn this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics.

Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications.Performed a systematic review to address the role of statins in the prevention or treatment of CAP.Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies.Two authors independently reviewed studies that examined the role of statins in CAP.Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted.Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I(2) = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I(2) = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder.Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias.