Aim: This study was conducted to determine the effect of hot water application by immersion method to the legs of pregnant women with Restless leg syndrome (RLS) on their complaints about RLS. Methods: The study is a pretest-posttest randomised controlled. The study was performed with pregnant 29 women. The data were collected using Personal Information Form, International RLS Study Group Diagnostic Criteria, and the International RLS Rating Scale (IRLS). Hot water application was made of intervention group (IG). No application was made in the control group (CG) other than routine care and follow-up. The application was made for 20 minutes before bedtime for seven days. No application was made in the CG other than routine care and follow-up. Results: Descriptive and gestational characteristics of the pregnant women in both groups were similar (p>0.05). In pretest measurements, IRLS total score of the IG was 26.38±6.82, the score of the CG was 22.06±5.56 and the groups were similar to each other (p>0.05). While posttest total score was 8.23±6.84 in the IG and 21.18±6.32 in the CG and the difference between the groups was statistically significant (p<0.001). Discussions: Hot water application made to the legs of the pregnant women with RLS decreased the severity of RLS. Clinical trials name and ID: The Effect of Hot and Cold Water Application on Pregnant Women with Restless Leg Syndrome (RLS); NCT04786314

Aim: In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalized patients with COVID-19. Material and Method: In this multicentric retrospective study, a total of 269 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for the treatment were enrolled. Demographic features, complete medical history, and laboratory findings of the study participants at admission were obtained from the medical records. Patients were grouped regarding their ICU requirements during their hospitalization periods. Results: Among all 269 participants, 106 were hospitalized in the intensive care unit (ICU) and 66 died. The patients hospitalized in ICU were older than patients hospitalized in wards (p=0.001) and expired patients were older than alive patients (p=0.001). Age, elevated serum D-dimer, creatinine, and gamma-glutamyl transferase (GGT) levels at admission were independent factors predicting ICU hospitalization and mortality in COVID-19 patients. Conclusion: In conclusion, in hospitalized patients with COVID-19, laboratory data on admission, including serum, creatinine, GGT and d-dimer levels have an important predictive role for the ICU requirement and mortality. Since these tests are readily available in all hospitals and inexpensive, some predictive formulas may be calculated with these parameters at admission, to define the patients requiring intensive care.

Abstract Aims: This study aimed to explore the validation and the diagnostic value of multiple right ventricle (RV) volumes and functional parameters parameters derived from a novel artificial intelligence (AI)-based three-dimensional echocardiography (3DE) algorithm compared to cardiac magnetic resonance (CMR). Methods and Results: 51 patients with a broad spectrum of clinical diagnoses were finally included in this study. AI-based RV 3DE was performed in a single-beat HeartModel mode within 24 hours after CMR. Whether in the entire population or the patients with moderate and poor image quality, RV volumes and right ventricular ejection fraction (RVEF) measured by AI-based 3DE showed a statistically significant correlation with the corresponding CMR analysis (P<0.05 for all). The Bland-Altman plots indicated that these parameters were slightly underestimated by AI-based 3DE. Based on CMR derived RVEF<45% as RV dysfunction, end-systolic volume (ESV), end-systolic volume index (EDVi), stroke volume (SV), and RVEF showed great diagnostic performance in identifying RV dysfunction, as well as some non-volumetric parameters, including tricuspid annular systolic excursion (TAPSE), fractional area change (FAC), RV septum and free-wall longitudinal strains (LS) (P<0.05 for all). The cutoff value was 43% for RVEF with a sensitivity of 94% and specificity of 67%. Conclusion: AI-based 3DE provide rapid and accurate quantitation of the RV volumes and function with multiple parameters. Both volumetric and non-volumetric measurements derived from AI-based 3DE contributed to the identification of the RV dysfunction, even in the patients without excellent image quality of RV 3DE. Keywords: artificial intelligence, three-dimensional echocardiography, right ventricle, multiple parameters

Aging is a part of human life, often accompanied by serious illnesses. Nowadays, people sometimes do not live up to the biological aging of the body at all due to late-timed diagnosis of diseases. Unfortunately, the methods of early detection of diseases associated with aging do not yet have the technical equipment that would allow them to be fully implemented. This article provides an overview of methods for defining and analyzing the aging of the body. This is a review article of a novel hardware and software complex for health monitoring developed by a scientific group, which analyzes human bio parameters using artificial intelligence algorithms. The relevance of the proposed system is undeniable due to the used algorithms of artificial intelligence, with the help of which it is possible to quickly and accurately analyze a large amount of data related to human aging. The article will be of interest to developers of artificial intelligence, biostatisticians and scientists working on the definition of aging in the human body.

This report presents a rare case of multiple Cl.VI carious lesions developed in a young female patient due to full-time wearing of an Essix retainer combined with poor oral hygiene and high acidic intake. The demineralization during orthodontic retention and the hygiene instructions, including the retainer cleaning protocol, are highlighted.

The population numbers of taiga bean goose (Anser fabalis fabalis) have halved during recent decades. Since this subspecies is hunted throughout most of its range, the decline is of management concern. Knowledge of the genetic population structure and diversity is important for guiding management and conservation efforts. Genetically unique subpopulations might be hunted to extinction if not managed separately, and any inbreeding depression or lack of genetic diversity may affect the ability to adapt to changing environments and increase the extinction risk. We used microsatellite and mitochondrial DNA markers to study the genetic population structure and diversity among taiga bean geese breeding within the Central flyway management unit using non-invasively collected feathers. We found some genetic structuring with the maternally inherited mitochondrial DNA between four geographic regions (ɸST = 0.11-0.20) but none with the nuclear microsatellite markers (all pairwise FST-values 0.002- 0.005). These results could be explained by female natal philopatry and male-biased dispersal, which completely homogenizes the nuclear genome. Therefore, the population could be managed as a single unit. Genetic diversity was still at a moderate level (average HE = 0.69) and there were no signs of past population size reductions, although significantly positive inbreeding coefficients in all sampling sites (FIS = 0.05-0.10) and high relatedness values (r = 0.60-0.86) between some individuals could indicate inbreeding. In addition, there was evidence of either incomplete lineage sorting or introgression from the pink-footed goose (A. brachyrhynchus). The current population is not under threat by genetic impoverishment but monitoring in the future is desirable.

Diabetes mellitus is rare in infants and causes a high mortality when complicated with diabetic ketoacidosis (DKA).The concomitant of COVID-19 and DKA in four-month infant with first presentation of neonatal diabetes shows that COVID-19 can accelerate the onset of DKA, and we should consider this in the clinical context.

The binary fluidization of Geldart-D type non-spherical wood particles and spherical LDPE particles was investigated in a laboratory-scale bed. The experiment was performed for varying static bed height, wood particles count, as well as superficial gas velocity. The LDPE velocity field were quantified using Particle Image Velocimetry (PIV). The wood particles orientation and velocity are measured using Particle Tracking Velocimetry (PTV). A machine learning pixel-wise classification model was trained and applied to acquire wood and LDPE particle masks for PIV and PTV processing, respectively. The results show significant differences in the fluidization behavior between LDPE only case and binary fluidization case. The effects of wood particles on the slugging frequency, mean, and variation of bed height, and characteristics of the particle velocities/orientations were quantified and compared. This comprehensive experimental dataset serves as a benchmark for validating numerical models.

Cerebral sinovenous thrombosis (CSVT) is an uncommon neurological disease in newborns. Literature data report the association between prothrombotic risk factors and CSVT. This correlation can help the clinician make an earlier diagnosis of this subtle disease. Herein, we describe a severe neonatal CSVT in the absence of significant risk factors.

We reported a case of a 14-months-old girl with erythematous and papulovesicular pink to red lesions on the face, the upper and the lower limbs. The history and the morphological features confirmed the dignosis of Gianotti Crosti syndrome.

Traditional palatal and vestibular surgical approaches for removing deeply impacted mesiodens with a crown facing the nasal floor are accompanied by significant complications. Herein, we describe a novel modified intranasal approach to minimize the complications. Also, it can be performed under local anesthesia with proper preoperative workup.

Leflunomide is a prodrug for teruflunomide and used for rheumatic diseases. Teriflunomide is considered to be teratogenic and should be avoided in pregnancy. We describe a case of teriflunomide exposure up to the third trimester of pregnancy. A healthy baby was delivered, despite substantial drug exposure. Multiple washout procedures were required to reduce teriflunomide concentrations below the safe target concentration 0.02 mg/L.

Lipomatous hypertrophy of the interatrial septum is a relatively common disorder that occasionally presents as cardiac mass. Here, we present a case of extreme lipomatous hypertrophy up to 4 cm in diameter and extending into the epicardium, posterior wall of the right atrium and the atrioventricular sulcus. Diagnosis was confirmed by transesophageal echocardiography and cardiac magnetic resonance imaging.

Background Influenza A(H1N1)pdm09 virus entered the human population in 2009 and evolved within this population for more than ten years. Despite genetic evolution no remarkable changes in the antigenic reactive pattern of these viruses were observed so far. Methods Primary respiratory samples of the German influenza virological sentinel were investigated by qPCR. Influenza virus-positive samples were characterized genetically and antigenetically. Results In December 2019, a antigenic drift variant characterized by an N156K substitution in the hemagglutinin of influenza A(H1N1)pdm09 virus emerged in Germany, which exhibited a reactivity to ferret antiserum that was an average 6 log2 lower than the vaccine virus A/Brisbane/02/2018 and the other A(H1N1)pdm09 viruses circulating in the influenza season 2019-2020. These viruses accounted for 20% of all A(H1N1)pdm09 viruses characterized in the German influenza sentinel. Patients infected with these viruses had a shorter median time period of medical consultation after onset of symptoms and were more frequently treated with neuraminidase inhibitors in comparison to patients infected with other A(H1N1)pdm09 viruses. Conclusions This parallel circulation of two antigenic variants of A(H1N1)pdm09 viruses which differ remarkably in their antigenic reactive pattern contributes to a greater variability in circulating influenza viruses and challenges vaccination.

Schizophrenia is associated to somatic disorders especially cardio-vascular and auto-immune. Through this case report, we describe an association with hypertrophic osteoarthropathy (HPO). For this patient it was a paraneoplastic paraneoplastic syndrome secondary to lung cancer. This syndrome is rare but important to recognize since it could hide a life-threatening condition.

Time for action- oxytocin & uterotonics are life-saving AND dangerous: a commentaryDeborah ArmbrusterUnited States Agency for International DevelopmentWashington, DC (currently based in Indonesia)Global Health Bureau/Maternal, Child and Nutrition Office/Maternal and Newborn Division+1 202 746-5453darmbruster@usaid.gov

Background: Respiratory syncytial virus (RSV) is understood to be a cause of significant disease in older adults and children. Further analysis of RSV in younger adults may reveal further insight into its role as an important pathogen in all age groups. Methods: We identified, through laboratory data, adults who tested positive for either influenza or RSV between January 2017 and June 2019 at a single Australian hospital. We compared baseline demographics, testing patterns, hospitalisations and outcomes between these groups. Results: Of 1128 influenza and 193 RSV patients, the RSV cohort was older (mean age 54.7 vs. 64.9, p<0.001) and were more comorbid as determined by the Charlson Comorbidity Index (2.4 vs. 3.2, p<0.001). Despite this, adults under 65 with RSV were equally likely to be admitted compared with their influenza counterparts (70.3% vs. 77.3%, p=0.174). Testing occurred later in RSV hospitalisations as measured by the proportion tested in the emergency department (80.3% vs. 69.2%, p<0.001) and this was strongly associated with differences in presenting phenotype (the presence of fever). RSV was the biggest predictor of 6 month representation, with age and comorbidities predicting this less strongly. Conclusion: RSV is a significant contributor to morbidity and hospitalisation, sometimes outweighing that of influenza, and is not limited to elderly cohorts. Understanding key differences in the clinical syndrome and consequent testing paradigms may allow better detection and potentially treatment of RSV to reduce individual morbidity and health system burden. This growing area of research helps quantify the need for directed therapies for RSV.

At present times, the drastic advancements in the 5G cellular and internet of things (IoT) technologies find useful in different applications of the healthcare sector. At the same time, COVID-19 is commonly spread from animals to persons, but today it is transmitting among persons by adapting the structure. It is a severe virus and inappropriately resulted in a global pandemic. Radiologists utilize X-ray or computed tomography (CT) images to diagnose COVID-19 disease. It is essential to identify and classify the disease through the use of image processing techniques. So, a new intelligent disease diagnosis model is in need to identify the COVID-19. In this view, this paper presents a novel IoT enabled Depthwise separable convolution neural network (DWS-CNN) with Deep support vector machine (DSVM) for COVID-19 diagnosis and classification. The proposed DWS-CNN model aims to detect both binary and multiple classes of COVID-19 by incorporating a set of processes namely data acquisition, Gaussian filtering (GF) based preprocessing, feature extraction, and classification. Initially, patient data will be collected in the data acquisition stage using IoT devices and sent to the cloud server. Besides, the GF technique is applied to remove the existence of noise that exists in the image. Then, the DWS-CNN model is employed for replacing default convolution for automatic feature extraction. Finally, the DSVM model is applied to determine the binary and multiple class labels of COVID-19. The diagnostic outcome of the DWS-CNN model is tested against Chest X-ray (CXR) image dataset and the results are investigated interms of distinct performance measures. The experimental results ensured the superior results of the DWS-CNN model by attaining maximum classification performance with the accuracy of 98.54% and 99.06% on binary and multiclass respectively.

Amit K. Chowdhury1, Arnab Mondal2, Suvendu Manna3, Paulami Ghosh4, Surajit Mondal51Power System Operation Corporation Ltd.2CSIR-National Physical Laboratory, Dr. KS Krishnan Marg, New Delhi, India

Will the people with demyelinating diseases ever be able to use CAR Treg cells to be cured, if it proves effective in the future? Probably not, considering its gigantic price. Researchers should focus on developing an affordable safe Treg-specific viral vector to produce CAR Treg’s in-vivo.  

Background: Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO. Methods: We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification. Results: Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs. 0.5 ± 1.1, P < .01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs. 29%, P < .01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added. Conclusion: Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.

Coronary artery perforation (CAP) is a potentially fatal complication following percutaneous coronary intervention. The suspicion for post-procedural CAP typically arises from the development of clinical hemodynamic instability of the patient and evidence of new or worsening pericardial effusion in bedside echocardiography. Following such suspicion, emergent pericardiocentesis and immediate repeated coronary angiography should be performed to assess for coronary perforation. The use of echo-contrast material, currently used to improve echocardiographic resolution and provide real-time assessment of intracardiac blood flow evaluation, has yet been described to facilitate diagnosis of such infrequent complication without delaying invasive treatment in this setting.

Airway management of patients with difficult airways is a challenge to the anesthesiologists and awake tracheal intubation is the recommended strategy. A safe, comfortable, unconscious, and satisfied intubation with spontaneous breathing keeping was achieved by intermittent sevoflurane inhalation and the modified spray-as-you-go technique for airway topicalization and intubation.

AIM Ropeginterferon alfa-2b is a new site-specific conjugated 40 kDa branched polyethylene-glycol recombinant interferon (IFN). The aim of the study was to determine its safety, pharmacokinetics (PK) and pharmacodynamic (PD). METHODS Ropeginterferon alfa-2b was evaluated first in human in 48 healthy male volunteers after a single dose subcutaneous injection by either 24, 48, 90, 180, 225, 270mcg of the product or 180mcg of marketed pegylated (peg)-IFN alfa-2a. Within each dosing group, 6 subjects received ropeginterferon alfa-2b and 2 subjects received peg-IFN alfa-2a. RESULTS Dose-related increases in ropeginterferon alfa-2b PK parameters (Cmax, AUC, and AUC0-t) were observed over the dose range 24 to 270mcg. The geometric mean values for these PK parameters of ropeginterferon alfa-2b were higher than that of peg-IFN alfa-2a at the 180mcg dose level of 176%, 166%, and 182%, respectively. Mean PD parameters (Emax, Tmax, and AUC0-t) for ropeginterferon alfa-2b increased with dose for both biomarkers neopterin and 2’, 5’-OAS. Ropeginterferon alfa-2b has similar PD profiles as peg-IFN alfa-2a. The treatment related adverse events are similar between the two study drugs, but the overall incidence was numerically lower for ropeginterferon alfa-2b (83%) than peg-IFN alfa-2a (100%) at the 180mcg dose level. CONCLUSIONS Single subcutaneous dose of Ropeginterferon alfa-2b of up to 270mcg is safe and well tolerated. It displays dose related increase in PK and PD parameters, potentially less frequent injection, and better safety profiles. Ropeginterferon alfa-2b is being developed for diseases in which previous peg-IFN use has been limited by side effects.