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Ilio-iliac arteriovenous fistula is an unusual complication of aorto-iliac aneurysms that can occur spontaneously, traumatically or iatrogenically. The typical clinical presentation includes the characteristic triad of high-output heart failure, a pulsatile abdominal mass with unilateral limb ischemia, or signs of venous congestion. We describe a rare case of spontaneous rupture of an aortoiliac aneurysm into the left common iliac vein of a 65-year-old man, easily diagnosed by angiography. We highlight here the angiographic findings of the ilio-iliac fistula, which was the means of diagnosis in this presentation, especially in patients with atypical clinical features at the outset, and we report the difficulties in choosing the optimal vascular approach.

Biomass residues and industrial waste are of great interest for their potential to produce a wide range of bioenergy and value-added products. Crude glycerol can be valorized into value added products by several microorganisms through microbial fermentation. Thus, Significant efforts have been made to develop biological methods to convert crude glycerol into various valuable chemicals and fuels, including 1, 3-propanediol, hydrogen and ethanol. In this context, our work have use glycerol medium as source of carbon for investigate bioethanol and 1, 3-propandiol production, using a microbial consortium. All experiments was carried out in sealed bottles, the reaction medium is placed in the shaker incubator at 37°C with stirring at 130 rpm. . Nitrogen gas was injected to create anaerobic conditions. The highest concentration of ethanol and 1,3 – propanediol obtained were 3.47 (g/l) and 4.8 mg/l respectively . These results highlight promising avenues for the valorization of biomass residues and industrial wastes in sustainable bioenergy production.

The main metastatic sites of renal cancer are the lungs, bone, liver, and brain. Dissemination of clear cell renal carcinoma to the rectum is very rare, with only a few sporadic cases published in the literature. The clinical presentation is usually dominated by lower gastrointestinal haemorrhage. We report the 5th case in the literature of a rectal metastasis of clear cell renal carcinoma, revealed by a lower gastrointestinal haemorrhage occurring 8 years after the initial nephrectomy.

Résumé: Notre étude explore l’impact de la télécollaboration et de l'interactivité entre deux groupes d'apprenants franco-algériens. En mettant l’accent sur le développement de la compétence orale en FLE chez les apprenants algériens discutant en ligne, nous adoptons une approche quantitative et qualitative pour analyser les interactions orales. Cela nous permet de mesurer le degré d'interactivité et les progrès réalisés en matière de compétence orale. L'utilisation des supports numériques révèle que les interactions en ligne améliorent la qualité des productions orales et stimulent la motivation des apprenants algériens. Les environnements virtuels d'apprentissage offrent ainsi une opportunité précieuse aux apprenants afin de développer leurs compétences orales grâce à l'interactivité et à la co-production. Mots-clés : télécollaboration, interactivité, support numérique, compétence orale, amélioration

This essay highlights how Toni Morrison’s Paradise (1998) proposes aging as either consciousness or disengagement with sustainability. The narrative presents a revisitation of the historical development of America starting with the Great Depression in the 1890s, then the racial discrimination and the drought of the 1930s, leading to the National Environmental Act in 1970. This period refers to America’s aging that is marked with environmental damage, drastic decline of outputs, farm closures, stringent racial exclusion, and infectious diseases. Paradise contextualizes the nation’s depressive aging to visualize its translation in the American identity’s perception of somatic and mental aging and re-imagine an alternative philosophy of aging as awareness of continuities. As such, aging is presented in the narrative as a new recognition of the body in light of two opposing epistemologies of living. In particular, Paradise foregrounds one’s choice of either a subversive sustainable aging that activates human/non-human, natural, and communal connection or inherent non-sustainable aging that degenerates into a pathology of genetic and racial rift, environmental damage, and mortality. The symptomatic presence of such varied epistemologies of aging is extended into architectural aging and narratological aging. Paradise presents Ruby and the Convent as two exemplary communal designs that reflect the struggle of negotiating aging within the existing historical, social, and economic contexts. As such, the narrative reveals how unsustainable aging constructs a design of genetic isolation, detrimental memory, and reductive chronology. On the other hand, Paradise presents sustainable aging as the perception of a biophilic design that displays tendency of connectivity and renewal through its architectural features of regenerative biomimicry and biodiversity, circadian re-memory, and openness.

Abstract Background WHO recommends attending minimum four ANC consultations during pregnancy to ensure early detection of complications. The objective of this study was to quantify ANC attendance and factors associated with it. Methods Participants were randomly selected using the WHO Cluster survey methodology in Southern and Central Somalia. A paper-print questionnaire was used to collect all data. Outcomes of interest were: access to at least one ANC consultation, completion of at least four ANC consultations, initiation of breastfeeding and place of delivery, while exposures included factors related to the latest pregnancy and demographic characteristics. Associations were assessed through logistic regression. Results Seven hundred ninety-two women answered the questionnaire; 85% attended at least one and 23% at least four ANC consultations, 95% started breastfeeding and 51% had an institutional delivery. Encouragement to attend ANC increased the odds of attending at least one consultation (aOR = 8.22, 95%CI 4.36–15.49), while negative attitude of husband or family decreased the odds (aOR = 0.33, 95%CI 0.16–0.69). Knowing there is a midwife increased the odds of at least four visits (aOR = 1.87, 95%CI 1.03–3.41). Attending at least four consultations increased the odds of delivering in a health structure (aOR = 1.50, 95%CI 1.01–2.24), and attending at least one consultation was associated with higher odds of initiating breastfeeding (aOR = 2.69, 95%CI 1.07–6.74). Conclusions Family has a strong influence in women’s ANC attendance, which increases the likelihood of institutional delivery and initiating breastfeeding. Women and families need to have access to information about benefits and availability of services; potential solutions can include health education and outreach interventions.

Cannabis use is widespread and is one of the most common drugs encountered in forensic-related analysis (antemortem and postmortem cases). However, the correlation between illicit cannabis use and death is rarely investigated, even while taking into consideration its role in the central nervous system depression and cardiovascular disorders. Few studies have discussed other non-blood specimens; this has brought a special interest in analyzing THC and its metabolites in different body parts in order to make precise forensic decisions. Herein, we are investigating the presence of Δ9-tetrahydrocannabinol (THC) and its metabolites:(11-hydroxy-Δ9-tetrahydrocannabinol (THC-OH) and 11-nor-Δ9- tetrahydrocannabinol-9-carboxy (THC-COOH)) in different postmortem specimens. Forty-three cases of bodily fluids and tissue post-mortem samples, previously found to be cannabinoid-positive were analyzed in the current investigation using alkaline hydrolysis followed by solid phase extraction and LC-MS/MS for THC and its metabolites concentration. In the current study, the highest median THC-COOH and THC-OH concentrations were detected in bile samples (1380 ng/mL and 8 ng/mL, respectively), while the highest THC median concentration was detected in gastric contents (48 ng/mL). This can be explained due to the postmortem distribution of blood to other bodily fluids and tissues and the accumulation in bile following multiple doses. Furthermore, high THC levels in gastric contents can be explained by the undergoing cycles of entero-hepatic circulation which resulted in a significant increase in THC in gastric contents. THC-COOH can be the best indicator to detect cannabinoids in toxicology studies, thus the inclusion of active THC metabolites is essential in death investigations. Additionally, THC-OH concentrations in postmortem cases could be influenced by body mass index. In this study, all types were specimens found to be suitable for testing cannabinoid metabolites, except for vitreous humor which showed low rates of detectability for cannabinoid metabolites.

Background: The 2017 Infectious Diseases Society of America (IDSA) Clostridioides difficile infection (CDI) guidelines recommendation for oral vancomycin as preferred treatment was based on studies conducted in North America, Australia, and Europe. According to recent published data, metronidazole remains a reasonable option. No studies have been conducted in Saudi Arabia to compare prescribing patterns before and after the release of the guidelines. Due to low CDI burden in Saudi Arabia, the aim is to assess the effectiveness and outcomes of vancomycin vs metronidazole treatment options. Methods: This was a retrospective cohort study conducted in a tertiary care hospital in Jeddah which was approved by the Institutional Review Board (IRB 2020–53). Data was collected from January 2017 to April 2020. Eligible patients were adults (>18 years old) diagnosed with CDI who either received oral metronidazole (500 mg 3 times daily) or oral vancomycin (125–500 mg 4 times daily). Patients who received a combination of treatment or who were diagnosed with fulminant CDI were excluded. Demographic data were collected. The primary outcome was to assess treatment response to initial therapy with oral metronidazole versus oral vancomycin. Secondary outcomes included assessing early treatment response, time to discharge after diagnosis, proportion of patients with a positive VRE surveillance culture within 6 months of diagnosis, 30-day recurrence and 30-day all-cause mortality. Chi-square or Fisher's exact test were used to examine differences in categorical variables while student t-test or Mann–Whitney test, were used to examine differences in continuous variables. P value 0.99) and 30-day all-cause mortality (P = 0.782). Of note, the vancomycin versus metronidazole use before the 2017 IDSA guidelines (26 % versus 74 %) was completely reversed after the release of the guidelines (83.3 % versus 16.7 %), p

Global greenhouse gas emissions are constantly increasing, despite the partial replacement of fossil fuels by renewable energies. The transport sector is responsible for almost 24% of direct CO2 emissions from the combustion of fossil fuels, generating greenhouse gas emissions, highlighting the need for a greater focus of international policies to encourage the production and the use of biofuels. Bioethanol is the most consumed biofuel in the world; it is produced by fermentation from materials rich in sugar (glucose, starch, cellulose). However, the controversy around the use of first and second generation have forced the transition to the third generation based on marine and freshwater algae; the latter have the advantage of being abundant, even invasive, easy to cultivate with good energy potential. This study proposes a life cycle analysis (LCA) of bioethanol production from the macro algae Ulva Lactuca, it was carried out after the introduction of several data into the SimPro8.1 software (e.g. quantity of water, consumed electricity, used chemicals) using the Impact 2002+ methodology. The results show a positive energy balance reflecting high-energy efficiency since the system produces about 1.44 times the energy consumed.

Physical attractiveness has an important and great influence in human social life as it was widely linked to the possession of a variety of positive qualities that makes an individual better than the others, as well as offering many advantages to the individual’s life especially in a society obsessed with beauty and attractiveness. As consequences to the attractiveness influence, people tend to look more and more attractive using makeup or in most of the time plastic surgeries. In parallel to the increased need to plastic surgeries, the need to simplify and show how the face will look like after the surgery is recommended, to plan the procedures, verify the satisfaction of the patient, and reduce the risks during the surgery as well. In this paper, we introduce a novel system to analyze and enhance the attractiveness of 3D faces using a Free Form Deformation technique based on the Bézier function. This system was tested on two 3D face datasets and the experimental results show that the edited 3D faces are more attractive compared to the original faces in terms of respecting the beauty canons which are: facial symmetry, golden ration, neoclassical proportions, and the angular profile.

ABSTRACT: Objectives: The aim of this study was to compare the safety and effectiveness of ceftolozane-tazobactam (C-T) to colistin-based regimen for treating infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa. Methods: This was a retrospective, multicentre, observational cohort study of inpatients who received either C-T or intravenous colistin for treating infections caused by MDR P. aeruginosa. The study was conducted in five tertiary care hospitals in Saudi Arabia. The main study outcomes included clinical cure at end of treatment, in-hospital mortality, and acute kidney injury (AKI). Univariate analysis and multivariate logistic regression model were conducted to evaluate the independent effect of C-T on the clinical outcome. Results: A total of 184 patients were included in the study: 82 patients received C-T, and 102 patients received colistin-based regimen. Clinical cure (77% vs. 57%; P = 0.005; OR, 2.52; 95% CI, 1.32–4.79) was significantly more common in patients who received C-T. After adjusting the difference between the two groups, treatment with C-T is independently associated with clinical cure (adjusted OR, 2.47; 95% CI, 1.16–5.27). In-hospital mortality (39% vs. 49%; P = 0.175; OR, 0.67; 95% CI, 0.37–1.20) was lower in patients who received C-T, but the difference was not significant. AKI (15% vs. 41%; P < 0.001; OR, 0.25; 95% CI, 0.12–0.51) was significantly less common in patients who received C-T. Conclusion: C-T is associated with a higher rate of clinical cure and lower rate of AKI compared to colistin. Our findings support the preferential use of C-T over colistin-based regimen for treating these infections.

ABSTRACTThe inhibition vigor of natural lettuce oil against corrosion of mild steel (MSt) 1.0 M H2SO4 solutions was investigated using chemical, electrochemical, and computational studies. The anti-corrosion efficacy (%AE) increases with the increase in the amount of doses of lettuce oil and reaches 95.83% from the galvanostatic polarization. The anti-corrosion process was demonstrated by the adsorption of lettuce oil onto the surface of MSt. The adsorption is spontaneous due to the negative signs of free energy of adsorption. The adsorption is subjected to Langmuir isotherm. Lettuce oil inhibits the pitting corrosion of MSt in chloride -containing solutions by transferring the pitting potential to the noble directions. Density functional theory (DFT) and Monte Carlo (MC) simulations were performed on the four components of natural lettuce oil. The adsorption of the inhibitors on the Fe(110) in the solutions is in parallel form. The results obtained from DFT and MC simulations predicted that α-Lactucerol and Lactupicrin give the MC simulations were performed on the four components of natural lettuce oil. The adsorption of the inhibitors on the Fe(110) in the solutions is in parallel form. The results obtained from DFT and MC simulations predicted that α-Lactucerol and Lactupicrin give the highest %AE.

Le monde, actuellement, est confronté à deux crises majeures ; l’épuisement des ressources énergétiques fossiles accompagné d’une dégradation de l’environnement. Le biodiesel, c’est-à-dire les mélanges de mono alkyle d’esters d’acides gras obtenus par les procédés d’estérification d’huiles végétales, est un biocarburant d’origine renouvelable qui peut se substituer au gazole issu de ressources fossiles. En outre, le biodiesel est un biocarburant non toxique, biodégradable, doué d’une excellente lubricité et d’un bilan de carbone théoriquement nul. Le choix de la matière première pour la production d’un biodiesel propre et durable est crucial. L’Algérie, par son immense diversité en matière d’écosystèmes, dispose de ressources potentielles prometteuses qui ne demandent qu’à être valorisées et développées. L’objectif de ce travail est de présenter quelques espèces végétales rencontrées à l’état sauvage en Algérie et parmi lesquelles les espèces Pistacia lentiscus, P. terebinthus, P. atlantica et Salvadora persica, qui peuvent être considérées comme sources prometteuses pour la production du biodiesel dans une perspective de développement durable et de valorisation des ressources locales.

Candida utilis and Stenotrophomonas maltophilia co-infections connected to meningitis are uncommon. We describe a patient who developed C. utilis and S. maltophilia after undergoing neurosurgery and received effective nosocomial meningitis treatment. Multiple neurosurgeries were required for a 16-year-old girl due to complications. For probable nosocomial meningitis, she was treated with cefepime with vancomycin. Meropenem and liposomal amphotericin B were prescribed after her seizure and positive CSF culture for Candida utilis. Consequently, S. maltophilia was discovered in the CSF, and ceftazidime and trimethoprim-sulfamethoxazole were prescribed. The patient has been hemodynamically stable for the past two months, and consecutive CSF cultures have been negative. To the best of our knowledge, this is the first case of C. utilis and S. maltophilia co-infection that has been successfully handled.

Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities. An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11). Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.

يوضّح هذا البحث كيف أن رواية "انتهت الحكاية، فما رأيك أيها القرد؟" للكاتبة ميرل هودج تبرز معرفة بصدمة الخزي في السياق الكاريبي للسفر العابر للحدود كما تسهم في إضفاء فهم لإبستيمولوجيا الخزي الثقافي. تقدّم رواية هودج مفهوم الصدمة الهدّامة بهدف اختبار إمكانية تخطّي الصدمة عن طريق استحضار الأسلوبين الذين ناقشهما دومينيك لاكابرا في نظريته عن تذكّر الصدمة وهما "إعادة تمثيل أو إحياء الصدمة" و "التعامل مع الصدمة". في هذا السياق، تعتبر رواية ميرل هودج قراءة لمفهومي هومي بابا عن المحاكاة والصور النمطية إذ تقترح استراتيجية علاجية غير معروفة بالنسبة لبطلة الرواية المصابة بالصدمة. إن قراءة إحياء صدمة الخزي الثقافي في رواية هودج تقدّم آلية سرد قصصي مقاوم ومشجّع على التغيير من خلال دراسة الطرق الممكنة للتعامل مع الصدمة.

The inhibitory impacts of two expired drugs, namely, azithromycin (AZM) and roxithromycin (RXM) towards the corrosion of mild steel (MS) in 1.0 M H2SO4 solution were examined exploiting potentiodynamic polarization, electrochemical impedance spectroscopy and weight loss techniques. The results obtained from various employed techniques indicate that increasing the concentration of examined expired drugs and reducing the temperature increased the inhibition efficiencies. Potentiodynamic polarization indicated that the expired AZM and RXM drugs acted as mixed-type inhibitors, but the cathode was highly polarized, βc > βa. The inhibiting power of these compounds is interpreted based on their adsorption on the surface of MS. The adsorption process obeys Langmuir isotherm. Impedance data confirmed that MS corrosion is under charge transfer control and the adsorption of both expired drugs on the MS surface led to the formation of protective film. The inhibition efficiency of RXM is greater than that of AZM due to the increased molecular weight and number of electron donating group within the expired drug. Activation and adsorption thermodynamics parameters were computed and interpreted. The adsorption process is spontaneous and endothermic.

The inhibition impacts of two novel synthesized green biosurfactants (B-Surf.), namely, sodium N-dodecyl asparagine (AsS) and sodium N-dodecyl arginine (ArS), on the dissolution of mild steel alloy (MS-37-2), in aqueous sodium chloride solutions was inspected using various techniques. Increased concentration of NaCl solution resulted in an increase in the corrosion rate of MS-37-2. Inhibition efficiencies of B-Surf. compounds were found to increased with increase inhibitor concentrations. The synergistic inhibition action between B-Surf. inhibitors and Zn2+, Al3+ and Ce4+ on the dissolution behavior of steel alloy in NaCl solutions was investigated and interpreted. The surface morphology of the MS-37-2 surface was observed using a scanning electron microscopy (SEM). This adsorption follows Langmuir isotherm. The evaluated thermodynamic functions supported the mechanism of physical adsorption of the inhibitors. The mechanisms of corrosion and its inhibition of MS-37-2 in NaCl solutions were interpreted.

Abstract Background Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality. Methods A retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included. Results A total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02–1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08–1.57); P = 0.005). The median length of ICU stay was 29 days [range 12–49 days] in the antifungal-resistant group and 18 days [range 6.7–37.5 days] in the antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21–138 days] in the antifungal-resistant group and 35 days [range 17–77 days] in the antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84–1.21); P = 0.89). Conclusions Our results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding.

Objectives: We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization. Methods: A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients. Results: We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p =0.029). Conclusions: Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions.

The eyelids are important structures that maintain the health of the ocular surface and have an important role in facial esthetics. Any interruption in eyelid development can lead to congenital eyelid deformities. Eyelid abnormalities in children may present at birth due to abnormal embryogenesis (congenital) or may occur at a later stage as the child matures (developmental). These abnormalities, in general, can be classified into three different categories depending on the location: malformation of the margins, malformation of the folds, and malformation of the position. Congenital and developmental eyelid abnormalities are among the most challenging problems encountered by ophthalmic reconstructive surgeons. Additional considerations include social factors regarding the patient’s self-awareness of their deformities and associated medical issues, which often coexist and maybe multisystem in nature. This article briefly reviews eyelid embryology, the most common congenital eyelid anomalies, and the management options available to address these conditions.

Dans un contexte de crise, et sur un marché saturé d’offres concurrentes agressives, les opérateurs Télécom se trouvent dans une situation où l’immobilisme est à proscrire et où l’action est de mise. Nous pouvons nous demander alors: Quelle stratégie marketing un opérateur devra-t-il adopter afin de réussir à lancer une offre innovante sur le marché? C’est à cette question majeure que nous avons essayé de répondre dans cet article, à travers tout d’abord un processus de recherche théorique qui met en exergue le concept de marketing de l’innovation dans les services en tant que discipline à part entière. Par la suite nous avons tenté, grâce à une recherche empirique, de déterminer l’intérêt stratégique pour un opérateur à commercialiser un service innovant en prenant comme cas spécifique le service Vidéo à la demande. Enfin cet article s’est penché sur la démarche marketing de lancement de ce service et le business model à retenir afin d’en faire un succès commercial

Microalgae have been recently recognized as a promising alternative for the effective treatment of anaerobic digestion effluents. However, to date, a widely applied microalgae-based process is still absent, due to several constraints mainly attributed to high ammonia concentrations and turbidity, both hindering microalgal growth. Within this scope, the purpose of the present study was to investigate the performance of two Chlorella strains, SAG 211-11b and a local Algerian isolate, under different nitrogen levels, upon ammonia stripping. The experiments were performed on cylindrical photobioreactors under controlled pH (7.8 ± 0.2) and temperature (25 ± 2 °C). Cultures were monitored for biomass production and substrate consumption. After sampling at the beginning of the stationary phase of growth (12th day) and after the maturation of the cells (24th day), an analysis of the produced biomass was conducted, in terms of its biochemical components. The local isolate grew better than C. vulgaris 211-11b, resulting in 1.43 mg L−1 biomass compared to 1.02 mg L−1 under 25 mg NH4-N L−1, while organic carbon and nutrient consumption varied between the two strains and different conditions. Concerning biomass quality, a high initial NH4-N concentration led to high protein content, while low nitrogen levels favored fatty acid (FA) accumulation, though the production of pigments was inhibited. In particular, the protein content of the final biomass was determined close to 45% of the dry weight in all experimental scenarios with adequate nitrogen, while proteins decreased, and the fatty acids approached 20% in the case of the local isolate grown on the substrate with the lowest initial ammonium nitrogen (25 mg NH4-N L−1). The novelty of the present work lies in the comparison of a microalga with industrial applications against a local isolate of the same species, which may prove to be even more robust and profitable.

L´inversion utérine est la pénétration à l´intérieur de la cavité utérine du fond de l´utérus qui se retourne en doigt de gant et fait saillie dans le vagin ou hors de la vulve. C´est un accident très rare, mais grave de la délivrance, qui peut aboutir à des complications redoutables voire le décès maternel. Sa fréquence rapportée dans la littérature varie de 1/2000 à 1/20 000 accouchements. C´est aussi une grande urgence dont la morbidité et la mortalité dépendent de la précocité de la prise en charge. Parmi les facteurs favorisants, on retrouve en premier lieu une hypotonie utérine associée à une insertion fundique du placenta, ce qui provoque une dépression du fond utérin en cas de manœuvres intempestives (traction sur le cordon, expression utérine). Une réduction manuelle est tentée en première intention, menée de façon conjointe aux mesures de réanimation, Elle fait appel à plusieurs méthodes manuelles consistant à retourner l´utérus après éventuelle utilisation de procédés myorelaxants le traitement chirurgical par voie haute ou voie basse est réservés aux échecs de cette réduction. Nous rapportons deux cas d´inversion utérine puerpérale subaiguë et chronique après un accouchement par voie basse ou on a procédé à un traitement conservateur pour la première et non conservateur basé sur l´hystérectomie pour la deuxième après échec des techniques conservatrices.

Background: We aim to determine the level of general knowledge and attitudes among the population of Saudi Arabia regarding sexually transmitted illnesses (STI). In addition, we aim to educate participants about the most common STIs, and explore how this influences the participants’ attitudes and perceptions. Methods: This study is a cross-sectional web-based survey of the general population of Saudi Arabia. The sample was enrolled randomly by distributing the survey through social media over a two-month period. 420 subjects between the ages of (15–60) participated in the study. Results: Among the 420 total responses, 405 (96%) participants were included based on the absence of missing data in their answers. Most of the participants (77%) were females. More than half of the respondents were single (59%), 24 years old or more (57%), Saudi (52%), and had a bachelor’s degree (65%). Forty-eight percent (48%) of the participants were related to the medical field. Only 11% knew someone previously diagnosed with STIs. The mean score of overall knowledge about STI was 8.79 ± 3.17 (median = 9) out of a maximum score of 20. The scores ranged from 2–16. A higher percentage of the participants (48.6%) had a low level of knowledge. Two-hundred eighty-one participants showed interest in viewing the attached educational material and subsequently completed questions on attitude regarding STI education. The mean score for attitude was 5.89 ± 1.52 out of a total of 7 (median = 6). Around 73% of all participants had a positive attitude towards STI education. Conclusion: Our findings suggest that targeting the younger population by incorporating STI-related educational material into school curricula would overcome the stigma associated with these illnesses by raising awareness and improving attitude towards them.

This essay addresses subversive female responses in certain African and African American texts which imagine a decolonial modernity and creatively perceive possibilities for realizing tradition and communal awareness in architecture. In this regard, Paradise, by African American critic and novelist Toni Morrison, envisions a persistent spatial bondage that is reflected in the design of modernity and ultimately suggests an architectural freedom that is realized through narratological activation of effaced historical continuity in the isolative modern design. On the other hand, Half of a Yellow Sun, by Nigerian novelist Chimamanda Ngozi Adichie, presents the architecture of postcolonial modernity as precipitator of the warring African community’s rift that blocks any cultural expression of collective agency. Adichie’s narrative suggests a liberatory osmosis of domestic and educational architectures to disrupt the traumatic ideologies of class and gender and initiate communal healing. So, both Morrison’s and Adichie’s narratives propose a utopian possibility for renovating modern architecture to recognize continuity in culture and community.

Our objective was to evaluate the impact of using an imipenem de-escalation protocol for empiric febrile neutropenia on the development of carbapenem resistance.A pre-post intervention design was used. The intervention was adopting the imipenem de-escalation approach, which began on January 1, 2012. A retrospective chart review of cases of febrile neutropenia bacteremia was performed one year before and one year after the intervention. We compared the development of carbapenem resistance between the two study periods.Seventy-five episodes of febrile neutropenia bacteremia were included in the study. They had similar demographics, clinical features and outcomes. There were 78 and 12 pathogens in the primary and follow-up blood cultures, respectively. Approximately 61% and 66% of the primary and follow-up blood cultures, respectively, were gram-negative bacteria with similar carbapenem resistance profiles in the two study periods. In our study population, 57% of the gram-negative bacteria were ESBL pathogens. The resistance of the gram-negative bacteria to piperacillin/tazobactam (72% versus 53%, p = 0.161), imipenem (16% versus 11%, p = 0.684), and meropenem (8% versus 16%, p = 0.638) did not significantly change after our policy change.In conclusion, the use of the carbapenem de-escalation approach for febrile neutropenia in our institution was not associated with an increase in carbepenem resistance. Future prospective multi-center studies are recommended to further confirm the current findings. Keywords: De-escalation, Febrile neutropenia, Carbapenem resistance

Skin apocrine carcinoma is a rare malgnancy of epidermal adnexa, most frequent in axillary seat, where apocrine sweat gland are abundant, the neoplasm can arise in groin, anogenital, lips, eyelid, characterized by a plate or surface area of nodules hummocky. Etiology and incidence are not known. The prognosis is influenced by the risk of locoregional recurrence and metastatic evolution. We describe the case of 61-year-old man who presented a left axillary slow-growing mass since 2 years ago. The cutaneous biopsy objectified an apocrine adenocarcinoma. The paraclinic exams performed to detect primary breast were tumor negative, first step before confirming the diagnosis. Standard treatment is surgical excision with margins of 2 to 3cm for local tumor, for apocrine adenocarcinoma regional lymph node dissection if nodes were clinically positive is wide surgical excision. This kind of tumour is chemoresistant. In this case, adjuvant chemotherapy was indicated, before surgery to reduce tumoral volume. This case illustrates the importance clinicopathological correlation of skin cancer, particularly apocrine one. Clinical particularity and careful analyses histology helps diagnosis approach.