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Background. Pediatric co-infections are an emerging clinical problem due to their increasing prevalence and tendency to transform a typical clinical presentation of particular diseases. Thereafter, it tangles the accurate estimation of etiology, complicates the management and negatively impacts the outcome. Given the climatic changes, significant migratory flows and international tourism, tropical helminthiases, previously not common in Ukraine, are a real threat to the public health, especially in combination with other pathogens. Materials and methods. We observed a case of strongyloidiasis and salmonellosis in a Ukrainian 5-month-old female infant who had no history of visiting any of the sub- or tropical territory of the globe. The girl came from a socially vulne­rable family and was abandoned by her homeless parents immediately after admission. The girl presented with severe toxic manifestations, diarrhea, developmental delay, moderate-to-severe malnutrition and dehydration, and maculopapular rash on the trunk and lower extremities. Direct light microscopy of feces revealed Str. stercoralis in the number of more than 10 mobile larvae per high-power field, at different stages of development. Bronchial lavage fluid contained no larvae of Str. stercoralis. Fecal culture revealed group D S. enteritidis. Chemotherapy with ceftriaxone IV and oral albendazole resulted in elimination of both pathogens. Conclusions. The given case of S. enteritidis and Str. stercoralis co-infection should be considered as a probable case of autochthonous Str. stercoralis infection, as it was not confirmed by more reliable diagnostic methods (e.g. PCR for Str. stercoralis DNA), and demonstrates a doubtful epidemiological history. Consequently, to improve the diagnosis of endemic parasitic infections, it is necessary to introduce such a verification as compulsory, and mandatory registration of relevant cases in the Ukrainian National System of Epidemiological Surveillance and Biosecurity is required., Актуальность. Сочетанные инфекции в педиатрии являются клинической проблемой, приобретающей актуальность из-за их распространенности и тенденции к изменению типичной клинической картины отдельных заболеваний. Соответственно, это затрудняет точную оценку этиологии, процесс лечения и негативно влияет на результат. Учитывая изменения климата, значительные миграционные потоки и международный туризм, тропические гельминтозы, которые ранее не были распространены в Украине, являются реальной угрозой для здоровья населения, особенно в сочетании с другими патогенами. Материалы и методы. Мы наблюдали случай стронгилоидоза и сальмонеллеза у 5-месячного ребенка, который не посещал никаких суб- или тропических территорий земного шара. Ребенок происходит из социально незащищенных слоев общества и оставлен бездомными родителями сразу после госпитализации. У девочки отмечались выраженные тяжелые токсические проявления, диарея, задержка развития, нарушение питания и обезвоживание от умеренной до тяжелой степени, пятнисто-папулезные высыпания на туловище и нижних конечностях. Прямая световая микроскопия фекалий обнаружила Strongyloides stercoralis в количестве более 10 подвижных личинок в поле зрения, на разных стадиях развития. Промывные воды бронхиального лаважа не содержали личинок Str. stercoralis. Фекальная культура обнаружила Salmonella enteritidis группы D. Химиотерапия цефтриаксоном внутривенно и альбендазолом перорально привела к элиминации обоих патогенов. Выводы. Данный случай смешанной инфекции S. enteritidis и Str. stercoralis может рассматриваться только как вероятный случай аутохтонной инфекции Str. stercoralis, поскольку она не была подтверждена более надежными методами диагностики (например, ПЦР-определение ДНК Str. stercoralis) и демонстрирует сомнительную эпидемиологическую историю. Соответственно, для улучшения диагностики эндемичных паразитарных инфекций необходимо ввести такую верификацию как обязательную и обязательно регистрировать соответствующие случаи в национальной системе эпидемиологического надзора и биологической безопасности., Актуальність. Поєднані інфекції в педіатрії є клінічною проблемою, що набуває актуальності через їх поширеність і тенденцію до зміни типової клінічної картини окремих захворювань. Відповідно, це ускладнює точну оцінку етіології, процес лікування та негативно впливає на результат. Враховуючи зміни клімату, значні міграційні потоки та міжнародний туризм, тропічні гельмінози, які раніше не були поширені в Україні, є реальною загрозою для здоров’я населення, особливо в поєднанні з іншими патогенами. Матеріали та методи. Ми спостерігали випадок стронгілоїдозу та сальмонельозу в 5-місячної дитини, яка не відвідувала будь-якої суб- або тропічної території земної кулі. Дівчина походить із соціально незахищених верств суспільства і була залишена безпритульними батьками відразу після госпіталізації. У дівчини відмічались виражені тяжкі токсичні прояви, діарея, затримка розвитку, порушення харчування та зневоднення від помірного до тяжкого ступеня, плямисто-папульозні висипання на тулубі й нижніх кінцівках. Пряма світлова мікроскопія фекалій виявила Strongyloides stercoralis у кількості понад 10 рухливих личинок у полі зору, на різних стадіях розвитку. Промивна рідина бронхіального лаважу не містила личинок Str. stercoralis. Фекальна культура виявила Salmonella enteritidis групи D. Хіміотерапія цефтріаксоном внутрішньовенно й альбендазолом перорально призвела до елімінації обох патогенів. Висновки. Цей випадок змішаної інфекції S. enteritidis і Str. stercoralis може розглядатися лише як імовірний випадок автохтонної інфекції Str. stercoralis, оскільки вона не була підтверджена більш надійними методами діагностики (наприклад, ПЛР-визначення ДНК Str. stercoralis) і демонструє сумнівну епідеміологічну історію. Отже, для поліпшення діагностики ендемічних паразитарних інфекцій необхідно запровадити таку верифікацію як обов’язкову та обов’язково реєструвати відповідні випадки в національній системі епідеміологічного нагляду та біологічної безпеки.

Background: Febrile illness is considered a frequent medical syndrome of dengue. Due to the increasing prevalence of dengue infectivity, appropriate diagnosis among patients helps regarding timely medical intervention, etiological examination as well as disease control. Objective: To estimate the frequency of suspected and probable cases of dengue in febrile patients and their knowledge about dengue fever, presenting at outdoor of Jinnah Hospital, Lahore. Methodology: It was a cross-sectional study, in which 400 adult febrile patients visiting at outdoor of Jinnah Hospital, Lahore were included. A convenient sampling technique was carried out. Among the total febrile patients included, the frequency of suspected and probable cases was calculated. Data was collected through a questionnaire, which was entered and analyzed using SPSS version 20.0. Results: Out of 400 patients, 36.5% were 21-30 years old and 53.5% were female. Among these patients, 100% had fever (>2 and

Objective This study presents evidence of a probable case of holoprosencephaly with cyclopia, which has been rarely reported in the paleopathological literature. Materials The skeletal remains of a male fetus between 36 and 40 gestational weeks from the Collezione Antropologica LABANOF (CAL) Milano Cemetery Skeletal Collection were studied. Methods The bones were macroscopically examined, and pathological anomalies were recorded and evaluated alongside paleopathological and clinical literature. Results Developmental anomalies were observed. In particular, a single orbit and optical canal were present, and the frontal, sphenoid and palatine bones were prematurely fused. These changes altered the normal morphology of the midline structures of the cranium and face. Conclusions The developmental anomalies observed are consistent with a case of holoprosencephaly associated with cyclopia. Significance Holoprosencephaly is a fatal congenital condition caused by the failure of the prosencephalon to separate in two halves. This condition is clinically well-known, with an estimated modern incidence of 1/16,000 births; however, the paleopathological literature lacks reports that would help anthropologists and paleopathologists interpret these anomalous signs on dry bone. This report documents a rare paleopathological case of the condition on a full-term fetus from a modern skeletal collection. Limitations Taphonomic and anthropic factors may have impaired the observation of all pathological features. Suggestions for further research Comparative studies with cases from documented collections could improve knowledge of the appearance of this condition on dry bones.

BACKGROUND: The resurgence of COVID-19 cases in Saudi Arabia, despite ongoing control measures, warrants further analysis. AIM: We aimed to investigate the prevalence and sociodemographic risk factors of COVID-19 in Al Qassim Province, Saudi Arabia. We explored perceptions toward vaccination, social isolation and community adherence to social distancing measures. METHODS: We collected data reported by the Weqaya, Saudi Centre for Disease Prevention and Control, and conducted a cross-sectional study within the province. RESULTS: Up to 9 May 2021, 15 497 positive cases were detected, comprising a prevalence of 1.46%. Uyun Al-Jiwa and Riyadh Al-Khabra had the highest infection rate. Our sample of 511 participants revealed an exposure rate of 52.1% (n=266) with no specific sociodemographic risk factor. Self-isolation following exposure to a confirmed or probable case occurred less among older age groups and married participants, and was not influenced by the presence of underlying chronic diseases. The majority of participants perceived community compliance with social distancing measures to fall within the ‘sometimes’ category. Finally, the vaccination acceptance rate was 72.6% (n=371). CONCLUSION: The findings of the current study emphasise the need to adopt further measures to encourage adherence to social distancing and self-isolation, especially among vulnerable groups.

Cardiac infection with Toxocara is rarely diagnosed, especially in children, and corresponding cardiac magnetic resonance imaging (CMR) has not been reported. We present a probable case, a 9-year-old girl with myopericarditis, eosinophilia, positive Toxocara serology, and CMR findings consistent with myocardial edema.

Objective To describe the oral pathological conditions of Ohalo II H2, an Early Epipaleolithic human from southwest Asia. Materials The dentognathic skeleton of Ohalo II H2 and relevant comparative data from similar chronological and/or geographic contexts. Methods Gross and x-ray observations of oral pathological conditions and occlusal wear were made following published protocols. A differential diagnosis of antemortem tooth loss is provided. Results Ohalo 2 has two carious lesions on the right M3, pulpal exposure of left M1, and mild to moderate anterior alveolar bone loss. The right I1 was lost antemortem, and there is probably agenesis of the left M3. Conclusions The pathological conditions noted are not exceptional for a Late Upper Paleolithic forager. However, the antemortem missing right I1 is most parsimoniously explained by intentional dental ablation. Significance Ohalo 2 could represent the oldest example of dental ablation from the Late Pleistocene circum-Mediterranean world – predating the earliest examples from both North Africa and southwest Asia by several thousand years. The similarity of the Ohalo 2 ablation pattern with later Natufians provides further evidence of potential long-term behavioral trends related to the embodiment of social identities through international body modification within the Epipaleolithic of southwest Asia. Limitations The pre-Natufian (∼23,000–14,500 cal BP) human fossil record is relatively sparse, making comparisons with the Natufian (∼14,500−11,500 cal BP) phases of the Epipaleolithic difficult. Suggestions for Further Research Documentation of oral pathological conditions for other pre-Natufian fossils would provide greater resolution of the temporospatial patterning of oral health and embodied social identities during the Epipaleolithic of southwest Asia.

At Mietków Reservoir (SW Poland), during the breeding season of 2019, we found 52 dead swallows in Caspian Gull (Larus cachinnans) colony. Most of them were Barn Swallows (Hirundo rustica). The bodies of swallows were fresh and torn with traces of bill. We assume that swallows might have been in weak condition and hunted by gulls. They also could die because of bad weather conditions and hypothermia, fell into the water and then were taken. However, to our knowledge, it was the first mass event of feeding on migrating birds by Caspian Gull.

E-cigarette or vaping product use-associated lung injury is a recently recognised, acute pulmonary syndrome which has been reported (particularly from June to October 2019) throughout the USA, but not in Europe (although one probable case, in the UK, has been reported; Medicines and Healthcare products Regulatory Agency, 2020 ). It presents acutely, most often in young men, as severe pulmonary consolidation, usually with respiratory failure. The mortality is around 2%. The cause(s) are unknown, but it is associated with vaping, particularly using unlicensed cannabis-containing products with tetrahydrocannabinol. Vitamin E acetate, often present in tetrahydrocannabinol-containing vape products as a solvent, has been implicated, as it has been identified in the bronchoalveolar lavage fluid of patients with e-cigarette or vaping product use-associated lung injury. This article reviews the recent literature, including clinical features, presentation and investigations, and possible mechanisms, in the context of vaping practices in the USA and the UK.

Background:Cardiac tumors are very rare and most frequently benign. Myxomas are the most common primary cardiac tumors accounting for about 50% of cases. The clinical presentation of atrial myxomas depends on size, anatomical location and their effects on the surrounding structures rather than the histological type. Restrictive cardiomyopathy can present with features of heart failure with typical massive ascites out of proportion to peripheral oedema known as egg on stick appearance. We present a case of a probable right atrial myxoma in a 20year old lady mimicking restrictive cardiomyopathy. Case report: Mrs. HD, a 20-year old Fulani lady was referred to us with 3 years history of progressive abdominal swelling, dyspnea on exertion and easy fatiguability. No orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitation or syncope. Relevant examination findings include a chronically ill looking young lady, with egg on stick appearance and mild pitting pedal edema. She had tachycardia, blood pressure 90/70mmHg and elevated Jugular venous pressure. The liver was palpable about 4cm below the right costal margin and there was massive ascites demonstrable by fluid thrill. Transthoracic echocardiography revealed huge, well-defined right atrial mass measuring 64 x 35 x 56.8 mm attached to the superior wall of the atrium on apical four chamber view. Conclusion: Atrial mass should be considered in the differential diagnosis of a patient presenting with features of restrictive cardiomyopathy. Echocardiography and histology are required for definitive diagnosis

Powassan virus (POWV) is an emerging tick-borne arbovirus that is found widely in Canada, the Northeastern and Northcentral United States, and the Russian Far East. While still rare, there has been an increase in reported cases of POWV disease over the last decade; most (>90%) cases have been neuroinvasive and the associated fatality rate is high (>10%). Transfusion-associated risk of POWV remains uncertain; while no intervention is likely indicated, one probable case of transfusion-transmitted POWV in the context of an increase in the incidence of POWV and other tick-borne infections, merits vigilance.

This paper explores the potential role of Urban Air Mobility to reduce commuting travel time and replace car travel. It looks at the eleven largest US Combined Statistical Areas. By utilizing open commuting data, the paper presents potential travel time savings and reduction of generalized cost for commuting trips in the USA. The findings show that while the potential to reduce travel time is substantial, this is not the case for generalized cost. In the best case, under the circumstances described in the paper, the market share is potentially close to 2% of all commuting trips, while in the more probable case, it would be closer to 0.1%.

Tick-borne encephalitis (TBE) is a neurotropic flaviviral disease. TBE was previously thought to be absent from the United Kingdom. We report the second probable case of United Kingdom-acquired TBE and demonstrate deer TBE-serocomplex seropositivity in the surrounding area, providing further evidence of the presence of TBE in England.

Italy is fighting against one of the worst medical emergency since the 1918 Spanish Flu. Pressure on the hospitals is tremendous. As for official data on March 14th: 8372 admitted in hospitals, 1518 in intensive care units, 1441 deaths (175 more than the day before). Unfortunately, hospitals are not prepared: even where a plan for massive influx of patients is present, it usually focuses on sudden onset disaster trauma victims (the most probable case scenario), and it has not been tested, validated, or propagated to the staff. Despite this, the All Hazards Approach for management of major incidents and disasters is still valid and the “4S” theory (staff, stuff, structure, systems) for surge capacity can be guidance to respond to this disaster.

Objective This study aims to discuss the differential diagnosis for the pathological alterations displayed on an infant skeleton from Romania. Materials One infant skeleton retrieved form the bathhouse of an abandoned Roman fort and dated between the 2nd and the 4th centuries AD. Methods All available skeletal elements were analyzed macroscopically. In addition, the isotopic signatures (δ13C and δ15N) and the control region of the human mitochondrial genome for this archaeological sample were analyzed. Results Based on dental development and long bone length, the skeleton was aged between birth and 2 months of age. Pathological lesions were noted on the mandible and diaphyses of long bones, but spared the metaphyses. Conclusions The perinatal age of the individual, along with lesion morphology and location, suggests a diagnosis of infantile cortical hyperostosis. Limitations The analysis would benefit from further stable isotope and mitochondrial genome analyses, which was limited due to the absence of comparative human and faunal remains from the site. Suggestions for further research Further multidisciplinary research on human archaeological remains from Romania would provide a clearer image of past disease and life histories in this geographic area.

In 1983, Pounder et al. described the burial of a woman and fetus as a probable case of mercy killing due to obstructed labor. In this article we reanalyze Burial 110 using multiple strands of evidence, including reconsideration of the trauma, reanalysis of the burial position and the age of the child, ethnohistoric and ethnographic evidence relating to violence and childbirth, historical and epidemiological data on maternal causes of death, and comparative bioarchaeologicalanalyses from Australia.The woman was estimated to be between 30 and 40 years of age at the time of death with a fetus possibly 36–40 weeks in her abdominal cavity. While we support Pounder et al.’s (1983) interpretation of two injuries to the cranial vault, the woman’s burial position is ambiguous and probably not indicative of obstructed labor. Based on the comparative data, we argue that her injuries are more consistent with violence in late pregnancy than with mercy killing due to a difficult childbirth. However, this story is not uncomplicated. This woman was certainly killed, but what the burial itself demonstrates is how multifaceted violence and care can be. Our argument is that, in the desire to reconstruct past lives, bioarchaeologists need to give due weight to the ambiguities of reconstruction and the likelihood that the past was as complex as the present. En 1983, Pounder et al, describieron el entierro de una mujer y su feto como un caso probable de muerte intencional por compasion debido a dificultades durante el parto. En este articulo analizamos Entierro 110 utilizando varias lineas de evidencia. Estas incluyen la reconsideracion del trauma, reanalisis de la posicion y edad del feto, evidencia etnohistorica y etnografica en relacion a la violencia y el parto, informacion historica y data epidemiologica sobre causas de muerte maternal, y analisis bioarqueologicos comparativos provenientes de Australia.La edad de la mujer se estima ser entre 30 y 40 anos al momento de su muerte presentando dentro de su cavidad abdominal un feto de 36 a 40 semanas. Mientras concordamos con la interpretacion de Pounder et al (1983) respecto a dos lesiones en el craneo, su posicion de entierro es ambigua y probablemente no indicativa de un parto obstruido. Basandonos en data comparativa, proponemos que sus lesiones son mas consistentes con actos de violencia durante la etapa final del embarazo que originadas por muerte por compasion debido a un parto dificultoso. Aun asi, esta historia no es sin complejidades. Esta mujer fue sin duda asesinada, pero las caracteristicas del entierro demuestran el caracter multifacetico de la violencia y el cuidado. Nuestro argumento es que, en el deseo de reconstruir vidas pasadas, los bioarqueologos necesitan otorgar la debida importancia a las ambiguedades en la reconstruccion y aceptar la posibilidad que el pasado fue tan humano y complejo como lo es en la actualidad.

Introduction: Central nervous system (CNS) manifestations in children with rickettsial diseases are increasingly being reported from various parts of India but still rickettsial disease, as a cause of central nervous system (CNS) infections are underdiagnosed because of lack of freely available rapid and cheap diagnostic tests and varied clinical spectrum of rickettsial fever. Objective: To report CNS manifestations in probable cases of rickettsial diseases so as to increase awareness amongst pediatricians. Materials and Methods: A retrospective analysis of children (birth to 18 years) hospitalized in Bapuji Child Health Institute, which is secondary referral centre catering to children from five districts of Karnataka, with diagnosis of rickettsial disease from January 2016 to December 2018. The diagnosis of rickettsial infections was made by scoring system proposed by Rathi Goodman Aghai (RGA), weil felix test, prompt response to doxycycline within 48 hours and exclusion of differential diagnoses. Results: Out of 278 patients, who were diagnosed as probable case of rickettsia, 172 patients had neurological involvement. Out of 172 patients with diagnosis of rickettsial disease having symptomatic neurological involvement, 148 (86%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of rickettsial diseases too, along with neurological manifestations. The youngest patient was 3 month old infant. The various neurological manifestations seen were altered mental status (76%), irritability (61%), headache (48%), meningeal signs (32%), seizures (31%), papilloedema (26%), focal neurological deficits (18%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (28%). Conclusions: The myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in rickettsial infections and should have high index of suspicion for rickettsial diseases in febrile patients having neurological features specially in endemic areas.

International audience; Zika virus (ZIKV) is a Flavivirus transmitted by Aedes mosquitoes, and was responsible for a worldwide outbreak between 2013 and 2016. However, no ZIKV outbreak has been described in Southeast Asia since 2017. In this study, we report the first microcephaly case with probable ZIKV infection during pregnancy in Lao People's Democratic Republic.

* Abbreviation: COVID-19 — : coronavirus disease 2019 In this issue of Pediatrics , Sisk et al1 used state and territory health department data to describe temporal and geographic trends in coronavirus disease 2019 (COVID-19) among children over a 4-month period. The authors found that in the latter half of the study period, the proportion of cases identified in children increased threefold to fourfold from the start of the study period. We were struck by several features of this report, which we feel have implications for COVID-19 surveillance. First, there was substantial heterogeneity across the data sources aggregated regarding definitions (including the chronological definition of a child) and the data reported. There was also variation across surveillance methods regarding which tests were used and reported. For example, Texas only reports confirmed cases, defined by polymerase chain reaction, and does not report rapid antigen tests, which define a probable case,2 … Address correspondence to Andrea T. Cruz, MD, MPH, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St, Suite A2210, Houston, TX 77030. E-mail: acruz{at}bcm.edu

A cluster of 18 scarlet fever cases and large illness absenteeism (32%, 58/184) in a school prompted concern and further investigation. We conducted telephone interviews with parents to ascertain cases and better comprehend parents' views. We identified 19 cases, of which 13 reported scarlet fever diagnosis by a physician and only seven fulfilled the probable case definition. We concluded that the outbreak was far smaller than suspected and found that communication and reporting could be improved. Accurate information and communication is essential in an outbreak; the school's concern could have been alleviated sooner and response measures better targeted.

This issue of N2 highlights the diversity of autoimmune disorders that affect the nervous system. Whether you are interested in T–cell- or B–cell-mediated disorders or prefer white matter or gray matter, you will likely find an article of interest. In addition for the medical sleuths among our readers, we have the likely resolution of a 190-year-old unresolved diagnosis.

Objective To document and differentially diagnose facial pathology found in an isolated skull from St. Vincent and the Grenadines, southeastern Caribbean. To directly date this individual using radiocarbon dating. Materials Isolated skull recovered from Petite Mustique Island. Methods Describe facial pathology occurring in this individual and compare with known diseases or disease processes that impact the craniofacial complex. Results Features of the rhinomaxillary syndrome are present, indicating a diagnosis of leprosy. Dating places the time of death to the late 18th or early 19th centuries. Conclusions Analysis of the rhinomaxillary syndrome produces a diagnosis of early-stage leprosy in an individual that correlates with the apparent attempt to locate a leprosarium on Petite Mustique Island in the first decade of the 19th century. Significance Location and time corroborate historical records of at least one attempt to locate a leprosarium on Petite Mustique Island. Only directly dated individual with leprosy in the western hemisphere and possibly the earliest yet recorded. Limitations This is an isolated find that is archaeologically unprovenienced. Suggestions for further research Professional archaeological survey of Petite Mustique.

We propose a new compartmental epidemic model taking into account people who has symptoms with no confirmatory laboratory testing (probable cases). We prove well-posedness of the model and provide an explicit expression for the basic reproduction number (ℛ0). We use the model together with an extended Kalman filter (EKF) to estimate the time-varying effective reproduction number (ℛt) of COVID-19 in West Java province, Indonesia, where laboratory testing capacity is limited. Based on our estimation, the value of ℛt is higher when the probable cases are taken into account. This correction can be used by decision and policy makers when considering re-opening policy and evaluation of measures.

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory joint disease mainly characterised by the ossification of the right anterior longitudinal ligament and the presence of enthesopathies. Studies have shown that the disease typically affects malesof advanced age. This is a case report of a female individual, aged between 40-60 years, dating to 1472-1635 AD and found in Eastern Germany. A differential diagnosis was completedfollowing macroscopic examination and radiographicimaging of the affected bones. The resultsshowseveral pathological features that resemble skeletal characteristicsof DISH, besides other diseases. Therefore, we discuss DISH and provide a differential diagnosis of additional pathologies. Our case is particularly important becauseancient female DISH cases are underrepresented and the burial location indicatesa possible noble or monastic context, both linkedwith a lifestyle knownto be related to DISH.

Sarcoptic mange has been anecdotally reported in Chilean wildlife during the last decade. Although this disease can have devastating outcomes for biodiversity, there is no comprehensive assessment of this potential threat in Chile. Because the current capacity to monitor sarcoptic mange and other wildlife diseases is limited in this country, we used abnormal alopecia to search for suspect cases across several sources of information to identify, to the extent available data allow, the location and temporal trends of wild mammals with this characteristic across Chile. We surveyed park rangers, examined rehabilitation center databases, and collated citizen and media reports. The information gathered suggests that observations of alopecic wild mammals, mainly foxes (Lycalopex sp.), their presence in the country, and the number of species fulfilling our case definition have increased over the last 15 years. Moreover, abnormally alopecic mammals are currently located broadly in Chile. We also confirmed the utility of abnormal alopecia to define a suspect sarcoptic mange case in the most commonly affected group, Lycalopex foxes. Our findings are highly concerning from a conservation perspective. We thus emphasize the need for an urgent surveillance and management plan for sarcoptic mange and other diseases that may be threatening Chilean biodiversity.

Bickerstaff brainstem encephalitis is a rare, often postinfectious, syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and altered consciousness. Here, we present a probable case of recurrent, pediatric Bickerstaff encephalitis, whereby the patient acutely developed loss of consciousness and eventually brain death despite optimal management.A 3-year-old male patient initially presented to the emergency department with progressive ataxia, following history of upper respiratory tract infection. He deteriorated within 12 hours of hospitalization, requiring cardiopulmonary resuscitation. The patient had decreased consciousness thereafter, showing minimal signs of brain activity. He was then deemed to be suffering a second episode of Bickerstaff encephalitis, the first being a year prior, and intravenous immunoglobulins were administered immediately. Magnetic resonance imaging of the brain on day 2 of admission showed signs of diffuse, bilateral encephalitis in the brainstem, thalami, and basal ganglia. Brain death was confirmed on day 11 of admission, following 2 brain death examinations.Although Bickerstaff brainstem encephalitis tends to involve the brainstem, outcomes of brain death have been rarely reported, even more so in the pediatric age group. This case report sheds light on, possibly, the first reported fatality of Bickerstaff encephalitis among children.

The Southeast Asian speciesMus (Mus) cookiiRyley 1914 has been previously reported from southern China, Nepal, northeastern and peninsular India, Myanmar, north and central Thailand and Vietnam. A cytochromeb(Cytb) gene analysis revealed the presence ofM. cookiiwhich significantly expands the known western range of this species. However, it is unclear whether theM. cookiipopulation in the Pothwar region represents a historical or recent westward range expansion or, on the contrary, a relictual source population that further experienced an historic eastward range expansion into Southeast Asia.

Objective To describe a case of Listeria monocytogenes rhombencephalitis in a patient receiving fingolimod. Methods This is a case study. Results Our patient developed acute rhombencephalitis with hydrocephalus induced with Listeria monocytogenes while on fingolimod. Shunt surgery was performed for the hydrocephalus and patient recovered partially after medical and surgical therapy. Conclusion We describe the first probable case of fingolimod-associated Listeria monocytogenes rhombencephalitis in a patient with multiple sclerosis. Clinicians should be aware of listeriosis and implement measures for its prevention.

This case report highlights the potentially serious side effects of hyoscine and how a seemingly innocuous patch may confound patients and doctors alike. It demonstrates how easy it is to miss an obvious diagnosis when in fact a thorough medical history including an exhaustive drug history can easily point us in the direction of the diagnosis fairly quickly. Finally, hyoscine may cause potentially serious side effects and patients who are taking it, either orally or transdermally, should be made aware of these.

This study describes a probable proportionate dwarf from a Third Intermediate Period cemetery at Ain Tirghi in the Dakhleh Oasis, Egypt. The skeleton (Burial 22 or B22) is an adult female estimated to be in her mid to late thirties. Most medical literature defines an adult stature of 2 standard deviations below the population mean as an indicator for clinically short stature, with some bioarchaeologists and clinicians identifying severe short stature at 3 standard deviations below the population mean. B22 satisfies either criteria when compared with the Ain Tirghi adult female population mean for measurements of the radii and femora, as well as the summed measurements of the femora and tibiae. Her limb proportions were normal and this, with a lack of morphological abnormalities, eliminated several possible causes of small stature (e.g. achondroplasia). The differential diagnosis for an individual with short stature and normal proportions indicates that she represents a probable case of pituitary dwarfism, or hypopituitarism. B22 was buried in the same fashion as adjacent burials in a family group burial and showed no differential indication of physiological stress or illness. Contextualized with the Egyptological and archaeological evidence of dwarfism in Egypt, this case study considers the social perceptions of dwarfism in ancient Egypt and suggests that pituitary dwarfs, like disproportionate dwarfs, likely led normal, if not privileged lives. Therefore, according to the social theory of disability, B22 was not necessarily disabled despite her impairment.

A single water molecule is known to significantly lower the potential energy barrier in the atmospheric reactions of hydroxyl radical with volatile organic compounds but except at extremely low temperatures, it has never been observed to accelerate the reactions investigated so far. This quantum–mechanical computational work reveals a probable case of observing a single water molecule accelerating the atmospheric reactions of Trifluoroacetic acid and Trifluoroacetaldehyde at temperatures near 200 K under tropospheric conditions.

El síndrome de Werner es una patología poco frecuente, de herencia autosómica recesiva, caracterizado por signos de envejecimiento prematuro y tendencia a desarrollar tumores malignos. El diagnóstico de esta enfermedad es principalmente clínico, con hallazgos predominantes como talla baja y envejecimiento precoz. En este artículo se presenta el caso de un paciente de 49 años de edad, con signos tempranos de envejecimiento desde los 15 años y ateroesclerosis temprana asociada, que lo lleva a amputación quirúrgica de extremidad inferior derecha. De acuerdo con los criterios diagnósticos del síndrome de Werner este es el primer caso probable en el suroccidente colombiano.

The Ottoman empire is known for its ethnically and religiously pluralistic social fabric, but also for defending the mainstream Sunni branch of Islam in opposition to its Iranian Safavid rival. This article revisits the Ottoman construction of Sunnism and suggests that, despite strict state policies from above to exclude Shi‘ites and communal pressures from below in the sixteenth and seventeenth centuries, channels of dialogue could not be closed down in the long term. By focusing on a specific intra-religious dialogue of 1743, that aimed at reconciliation between Sunnis and Shi‘ites, this article highlights a probable case of ‘de-confessionalization’. Close examination of the textual account of this inter-communal meeting demonstrates how the Ottomans were torn between defending their Sunni identity and the need for rapprochement to avoid further sectarianism in broader Muslim society.

Alloimmunization to platelet antigens exposes to a serious immunological incident. We report a probable case of a post-transfusion purpura from homozygous sickle cell child alloimmunized against platelet antigen. We detail the challenges of alloantibody identification and transfusion management. These challenges are due to the lack of laboratory techniques for typing HLA and HPA system and the use of leukocyte-depleted (filtered) blood products.

Our current understanding of immigration and diasporic disease in Roman Britain has been\ud greatly enhanced by the recent identification of thalassaemia in the non-adult skeletal record.\ud The wide phenotypic variation in the clinical expression of β-thalassaemia, however, means\ud that additional cases may go unrecognised. A probable diagnosis for β-thalassaemia\ud intermedia or a mild form of major in a 1.0-1.5 year old skeleton from Butt Road, Colchester,\ud dating to the 4th century AD is discussed here. The assessment was undertaken using\ud macroscopic and radiographic analysis. Several conditions were apparent, including trauma\ud and probable β-thalassaemia and active vitamin D deficiency. Diagnosis proved difficult due\ud to the challenges that non-adult thalassaemia poses for identification in the skeletal record, as\ud in the absence of the cranium only ‘rib-within-a-rib’ is currently considered as\ud pathognomonic of the condition. This case demonstrates the variations in expression of this\ud type of genetic anaemia and adds emphasis to a more widespread presence of this important\ud condition in Roman Britain.

The United Kingdom (UK) has thus far been considered to be free from tick-borne encephalitis (TBE), yet in July 2019, a German infant developed serologically diagnosed TBE following a tick bite in southern England. This first report of a probable human case together with recent findings of TBE virus in ticks in foci in England suggest that TBE may be acquired in parts of England and should be considered in patients with aetiologically-unexplained neurological manifestations.

The Canadian Notifiable Disease Surveillance System (CNDSS) provides data on diseases that have been identified as priorities for public health monitoring and control. Several advances that have been made on Notifiable Diseases Online, the CNDSS interactive website, are consistent with the Government of Canada’s commitment to Open Data. This article provides an update on changes in case definitions that have been made since the case definitions were last published in 2009, and describes updates that have been made to the interactive website since 2013. Changes were made to the case definitions of five diseases. For hepatitis C, the new case definition now distinguishes between acute and chronic infection. For cyclosporiasis, the probable case definition requires an epidemiologic link, with the clarification that this would likely be due to exposure to a common food source. For rabies, the probable case definition now refers to detection of rabies-neutralizing antibody instead of specific antibody titres. For Lyme disease, the revised confirmed and probable case definitions now identify five options for Lyme disease risk areas instead of endemic areas. For tuberculosis the revised case definition now includes nucleic acid amplification testing in addition to culture for diagnosis. The Notifiable Diseases Online website is an interactive tool that enables users to create customized figures and tables. Since a major redesign in 2013, numerous changes have been made to the look and feel of the site. Figures and tables can now be extracted as Excel or PDF files and large datasets are exportable into Excel files for further analysis. Case definitions in the national surveillance system will be updated as needed and its interactive website will continue to be improved and updated in response to user comments.

The absence of written evidence from prehistoric periods makes it difficult to understand the origins of sacrifice or offering ceremonies. Archaeological finds from prehistoric periods are the only solid evidence for these acts and rituals. One probable case of animal sacrifice or offering in the Neolithic period has been found at the site of Tepecik-Çiftlik Höyük in central Turkey. This study is focused on a single unique pit, which contained only animal bones and was found in an open space. The contents clearly indicate that this pit can not be interpreted simply as mixed kitchen garbage since an almost complete cattle skeleton as well as sixteen left front leg remains from sheep were placed in the pit after a social, or more specifically, ritual act. Similar pit with similar content was found neither in the close region to Tepecik-Çiftlik nor within Anatolia. The main aim of this study is to introduce a special archaeological find group, those were left after certain prehistoric activity., Tarih öncesi dönemlere ait yazılı kanıtların bulunmaması, kurban etmenin veya tören sunmanın kökenini anlamayı zorlaştırıyor. Tarih öncesi dönemlerden arkeolojik buluntular, bu eylemler ve ritüellerin tek sağlam kanıtıdır. Türkiye'nin merkezinde Tepecik-Çiftlik Höyük mevkiinde Neolitik dönemde olası bir hayvan kurban etme veya sunma vakası bulunmuştur. Bu çalışma, yalnızca hayvan kemiklerini içeren ve açık bir alanda bulunan tek bir benzersiz çukura odaklanmıştır. İçindekiler, bu çukurun basitçe karışık mutfak çöpü olarak yorumlanamayacağını açıkça göstermektedir, çünkü neredeyse tam bir sığır iskeleti ve koyunun on altı sol ön bacak kalıntısı, sosyal veya daha spesifik olarak bir ritüel eylemden sonra çukura yerleştirilmiştir. Benzer içerikli benzer çukur ne Tepecik-Çiftlik yakınında ne de Anadolu'da bulunamamıştır. Bu çalışmanın temel amacı, belirli bir tarih öncesi faaliyetten sonra kalan özel bir arkeolojik buluntu grubunu tanıtmaktır.

In this study, we report three cases of sporadic Creutzfeldt–Jakob disease in China, two confirmed cases and one probable case. The aim of this study was to enrich the data regarding clinical and epidemiological features of this disease and to provide reference for the diagnosis, control, and prevention of sporadic Creutzfeldt–Jakob disease.

The coronavirus pandemic has spread to all provinces in Indonesia within a few months. Coronavirus has entered East Kalimantan province in early March 2020. The number of people confirmed as COVID-19 increased dramatically after March. In this paper, we propose a simple mathematical model to predict coronavirus cases in East Kalimantan province. We applied the Richards growth model to the active case and probable case (PDP case) curves. We used the initial parameter values obtained from China’s Jiangsu province. This means that the strategy for handling coronavirus in East Kalimantan province is assumed to be the same as in China’s Jiangsu province. We have presented the final prediction for the coronavirus pandemic over a range of periods.

To date there has been a lack of palaeopathological evidence for the presence of scurvy in ancient Egypt. In this paper we describe one of, if not the first, differentially diagnosed bioarchaeological cases of subadult scurvy in the region in the skeleton of a 1-year +/- 4-month old infant recovered from the Predynastic site of Nag el-Qarmila (c. 3800-3600 BCE) in Aswan, Egypt. Bony change was observed on the left maxilla and greater wing of the sphenoid bone, left and right mandibular rami, orbits, and zygomatic bones, as well as on the humeri, radii, and femora, all of which appear to be suggestive of scurvy. While the cause of this infant's probable scorbutic state is unknown, various circumstances such as diet and cultural behaviors may have contributed to the condition. Given the current lack of evidence of scurvy from ancient Egyptian contexts, this case study informs on the antiquity of ascorbic acid deficiency in the Old World.