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A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.

Aim: To examine the relationship between the levels of HbA1c and hospital admission rates.Methods: We recorded HbA1c levels of all diabetic patients in Tripoli University Hospital over one year.Results: The mean HbA1c was 8.03%, with no difference between males and females. Over half of patients (56.5%) were admitted through their diabetes was well-controlled. Over half of the patients with type 1 diabetes (57/102, 55.9%) had a high HbA1c at admission compared to 42.1% of patients with type 2, who were mainly admitted with HbA1c level within the acceptable range set for this study. The HbA1c level was positively and significantly correlated with the length of hospital stay (R = 0.93, p = 0.000), and was significantly associated with hyperglycemia, diabetic ketoacidosis, coronary artery disease, limb ischemia, cataract, osteomyelitis, and non-alcoholic steatohepatitis.Conclusion: HbA1c is correlated significantly with hospitalization in type 1 diabetes but not in type 2.

Moringa oleifera which is also known as horseradish or drumstick tree is a rapidly growing, drought-tolerant tree that can tolerate poor soil conditions. It is presently broadly cultivated and has turned out to be naturalized in numerous geographical areas of the tropics. The objective of this study was to evaluate the growth performance and survivability of Moringa seed origins in the North Florida region of the United States of America. Seedlings were prepared in the George Conoly Greenhouse at the Florida A&M University, Tallahassee, FL. The seed origins were Ghana, Texas PKM1, Haiti PKM1, Colombia, Nigeria, Jamaica, Nigeria Local, Impex PKM1, Peela Medu, India EOA PKM1, and Belton. A randomized completely block design (RCBD) was used in this study to compare the performance of eleven seed origins of M. oleifera Height and Stem diameter. Nigeria Local had the best performance in terms of height for 2018 and 2019 growing seasons, 191.98 ± 7.42 cm and 123.19 ± 26.67 cm, respectively. Colombia had the best performance in terms of stem diameter for the 2018 and 2019 growing seasons, 2.6 ± 0 cm and 2.08 ± 0 cm, respectively. However, DMRT revealed that the height and stem diameter of the seed origins were not significantly different (p ≤ 0.05). Therefore, the results revealed that the alternative hypotheses (Ha) that the Moringa oleifera seed origins were significantly different in heights and stem diameter were rejected.

ems. Preliminary field tests may be used for screening the debris on the explosion site. They include commercially available explosive vapor detectors and chemical color tests. Like post-explosion residues, personal items suspected to contain traces of explosives and hand-swabs, are often heavily contaminated. It is therefore of major importance that the analytical procedures have to include good screening, clean-up, and extraction methods. The main explosives dealt with in this chapter include nitroaromatic explosives, such as 2,4,6-trinitrotoluene (TNT) and 2,4,6, N-tetranitro-N-methyl aniline (tetryl), nitrate esters, such as ethylene glycol dinitrate (EGDN), glycerol trinitrate (nitroglycerin, NG), and pentaerythritol tetranitrate (PETN), and nitramine explosives, such as 1,3,5- trinitro-1,3,5-triazacyclohexane, (RDX) and 1,3,5,7-tetranitro-1,3,5,7-tetrazacyclooctane (HMX), as well as mixtures containing one or more of these explosives. Additional explosives include triacetone triperoxide (TATP) and ammonium nitrate (AN), NH4NO3.

In this work, α-induced 59Co reactions in the energy range from 11- 41MeV were used in order to study the role of pre-equilibrium emission. The experimentally measured excitation functions for residues populated via (α, n),(α, 2n),(α,3n),(α,2p),(α, 3n 2p) and (α, 4n 2p) channels in the interaction of  + 59Co system available in the literature [13] were compared with theoretical predictions obtained using the statistical model code COMPLET. It was observed that at higher energy points the pure compound nucleus predictions, in general, failed to reproduce the measured data at projectile energies ~11-41MeV, this shows significant contributions from pre-equilibrium emission. The study signified both equilibrium and pre-equilibrium emissions were required to reproduce the presently measured excitation functions. An attempt was made to deduce the contribution coming from pre-equilibrium emission. It was found that the pre-equilibrium contribution increases with increasing projectile energy. Furthermore, the present result revealed a strong correlation between pre-equilibrium contribution and particle multiplicity.

As I considered the exciting life of Little Snow-White, I started to think that the Grimm Brothers placed in that novel many hints that grouped the current knowledge of some features related to symptoms shown by allergic people.

There are global concerns in the dissemination and transmission dynamics of emerging and reemerging infectious diseases and the underlying features of gain-of-function research and geopolitics within and across borders. These concerns have become pertinent in the management of local and global health because the disease is perspicuously a geopolitical issue ostensibly linked to gain-of-function research where health diplomacy focuses on the present and future global emergence and re-emergence of infectious diseases, pandemics, and microbiome variants. These have generated vehement reactions with a propensity for extreme geopolitics and gain-of-function natural and anthropogenic activities. Geopolitical parameters and gain-of-function issues impact the social determinants of health and vice versa. The convening and convergence of countries for unprecedented epidemic or pandemic treaty settings or other formulations to confront emerging and reemerging infectious diseases will afford considerable opportunities concerning challenges in action, preparedness, and response. Provisions are pertinent for legal instruments, effective and efficient systems to curb future threats and outbreaks of infectious diseases. 

Stems of Santalum album (Sandalwood), Mangiferra indica (Mango wood), and Tinospora cordifolia (Giloy) are widely used in the preparation of herbal medicines and formulations in the traditional Indian health care system called Ayurveda. These were analyzed for 4 minor (K, Ca, Cl, Mg) and 13 traces (As, Ce, Co, Cr, Cu, Fe, Hg, La, Mn, Na, Se, V, and Zn) including toxic elements by instrumental neutron activation analysis (INAA). Samples in powder form along with reference materials (NIST SRM 1547 and INCT MPH-2) as comparators were irradiated for 1 min/6 h in Dhruva/CIRUS reactors at BARC, Mumbai. Gamma activity was measured by high-resolution gamma-ray spectrometry. In general, K, Ca, Fe, Mn, and Zn contents are very high in all the samples but Santalum album, widely used as a perfume, is more enriched in K, Ca, Cr, Zn, and Se. The concentration of Ca is always high as a major constituent (> 10 mg/g) in all the stem/bark of plant species. A strong inverse correlation (R2 = 0.9999) was observed between Fe and Zn in all three samples and that may be useful in drug manufacturing.

A new design system is introduced to generate clean eco-friendly electricity from rain fall water. The majority of traffic roads in the world has constructed water ditches for one aim. This is for the accumulation of rain fall water from the roads.

Central Diabetes Insipidus (CDI) results from the inability to secrete ADH secreted by the neurohypophysis system to control water-electrolyte metabolism. In the etiology of CDI in childhood, many congenital and acquired central nervous system (CNS) tumors (germinoma, pinealoma, craniopharyngioma, optic glioma, acute myeloid leukemia), infiltrative diseases (Langerhans cell histiocytosis, sarcoidosis), infections (meningitis, tuberculosis, encephalitis), autoimmune events, head trauma, idiopathic) can be responsible [1]. Hibernomas, which are very rare in childhood, may also rarely involve the central nervous system.

Laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) is a technically challenging operation that requires extensive surgical dissection, transection and restoration of intestinal continuity, and advanced laparoscopic suturing skills.

In pregnancy, the incidence of pulmonary embolism (PE) is increased fivefold when compared to nonpregnant women of the same age, and PE is one of the leading causes of death during pregnancy.However, the diagnosis of PE among pregnant women is complicated by concerns regarding radiation exposure. Systemic lupus erythematosus (SLE) is an autoimmune disorder with a wide array of presentations and a predilection to affect women of certain ethnic backgrounds. The hallmark of the disease is multisystem involvement, dispersed in time and severity. Usual pulmonary involvement includes pleuritis, pleural effusions, pneumonitis, shrinking lung syndrome, pulmonary hypertension, and alveolar hemorrhage. Pulmonary embolism (PE) is a relatively unusual presentation of SLE. We report the case of a 20-year-old primi at 21 weeks gestation with an acute PE with central chest pain and shortness of breath. The absence of overt signs and symptoms and traditional risk factors prompted a fragmentary workup. This led to the detection of antibodies sensitive for SLE, in the absence of overt signs and symptoms. We revive the concept of latent lupus, a condition construed as early lupus. We firmly suspect direct causation between SLE and PE. Further studies are needed to establish pathogenesis to facilitate early diagnosis and prevent morbidity and mortality from PE. Due to persistent hypotension, thrombolytic therapy with streptokinase was administered and the clinical and hemodynamic response was excellent, with no maternal or fetal hemorrhagic complications. The clinical presentation of pulmonary embolism is sometimes camouflaged by the physiological changes that occur in pregnancy and diagnosis is often delayed by a reluctance to expose the fetus to ionizing radiation. 

Aim: Accumulating data imply that glaucoma may represent a neurodegenerative disorder affecting the entire visual system. We evaluated retrobulbar glaucomatous damage with favorable techniques for 1.5T diffusion-tensor magnetic resonance imaging and we compared those techniques with clinical data in a large case series. Material and methods: This Cross-sectional study included 130 eyes of 65 patients with primary open-angle glaucoma. Patients with no known ocular or systemic concomitant disorders, neurological diseases, previous glaucoma surgeries, or antioxidant usage were selected. A decrease in thickness and deterioration in the optic nerve diffusion of severely glaucomatous eyes of patients with asymmetrical involvement was observed in optic nerve tractography. Optical coherence tomography and visual field results of the subjects were recorded. Glaucoma analysis with optical coherence tomography and standard automated perimetry results of the subjects were recorded. Diffusion-tensor magnetic resonance imaging analysis of optic nerves and radiations were performed, computing fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. Correlation between the diffusion-tensor magnetic resonance imaging and clinical eye parameters of glaucomatous neurodegeneration were statistically evaluated. Results: The correlations between diffusion parameters and age were highly significant. Statistically significant correlations were found between ganglion cell complex and apparent diffusion coefficient, axial and radial diffusivities of optic nerves. Conclusion: Eye-brain connection in glaucoma can be evaluated with routine clinical instruments. Our study also revealed a limited correlation of retrobulbar glaucomatous neurodegeneration with ophthalmic damage. A better understanding of retrobulbar damage will enable us to develop more efficient strategies and a more accurate understanding of glaucoma.

SARS-CoV-2 revisits a children’s fairy tale, the Emperor’s New Clothes. The swindler- salesmen are Biden, Fauci, et al. The magical clothes are their deliberate “pandemic of fear,” and the duped emperor is the American public.Extensive evidence is presented here of a great scam. The data details the true and low health risks of SARS-CoV-2; viral biology of natural immunity and the immune response from experimental mRNA gene therapy; side effects of the “jab;” and the draconian consequences of federal mandates. Differences between official pronouncements and scientific data are highlighted.The goal of the SARS-CoV-2 Big Con or scam is the nullification of the U.S. Bill of Rights in order to restore tyranny over the American public. We the People can fight for freedom with ballots and dollars.

Background: An association between Atrial Fibrillation (AF) and Metabolic Syndrome (MS) a constellation of abnormalities (high blood pressure, hyperglycemia, dyslipidemia, and abdominal obesity), has been demonstrated. There have been many studies that have shown that elevated blood pressure (BP), was significantly associated with an increased risk of AF. It is uncertain whether maintaining the optimal BP levels can prevent AF in the patients with MS categorized as ‘high-risk’ patients.Objective: The aim of this study was to evaluate the influence of control of BP on the occurrence of new-onset atrial fibrillation in patients with Metabolic Syndrome.Methods: Into this observational study, was enrolled 435 consecutive patients (210 males and 225 females) aged 45-79 years who fulfilled criteria for MS. Participants were selected among primary and secondary care patients, who were receiving ongoing care for arterial hypertension in the period from November 2018 till November 2021. The study was conducted at outpatients in 5 Health Care Clinics (3 Secondary Health Care Clinics and 2 Primary Health Clinics). Patient were categorized according to their BP levels as Group 1-patients with controlled BP, {(patients aged < 65 years Systolic Blood Pressure (SBP) of 120 - 130 mmHg, patients aged ≥ 65 years SBP of 130 - 139 mmHg)} and Diastolic Blood Pressure (DBP), {(patients aged < 65 years of < 80 mmHg. but not < 70 mmHg; patients aged ≥ 65 years of 85 - 89 mmHg)}, or Group 2-patients with uncontrolled BP(> 130/80 mmHg),and in patients aged ≥ 65 years BP (≥ 140/90 mmHg ). Results: New-onset of AF, was more frequent in participants with uncontrolled BP, respectively (34.7% vs. 19.5%, p = 0.009).Patients with uncontrolled BP have more frequent persistent AF (15.2% vs. 0.04%) and permanent AF (0.08% vs. 0.02%), whereas there was not significant changes between groups in relation to frequency of paroxysmal AF, respectively (12.8% vs. 10.9%, p = 0.29). There was observed significant association of uncontrolled BP with: increased frequency of AF (OR = 2.193; 95% CI 1.390 - 3.439), persistent AF (OR = 3.931; 95% CI 1.771 - 8.084), permanent AF (OR = 4.138; 95% CI 1.383-12.381), LA. Dimension ≥ 2.2 cm/m2 (OR = 2.089, 95% CI 1.330 - 3.252), BMI (OR = 5.226, 95% CI 3.155 - 8.659) and 5-risk factors for MS, respectively (OR = 2.998, 95% CI 1.833 - 4.901).Conclusion: Optimal BP levels, can reduce the frequency of new-onset AF in patients with MS categorized as ‘high-risk’ patients. Uncontrolled BP was associated with an increased risk of both subtypes of AF (persistent and permanent) in the patients with MS categorized as ‘high-risk’ patients.

Purpose: Adding dydrogesterone (DYD) to vaginal micronized progesterone (VMP) and postponing embryo transfer in order to improve outcomes in patients with low progesterone (P) levels in hormonally substituted cycles prior to frozen/thawed embryo transfer (FET). Methods: Endometrial preparation comprised sequential administration of vaginal estradiol until endometrial thickness reached 7 mm, followed by transdermal estradiol combined with 800 mg/day VMP. Our previous analysis of serum P levels on FET day showed that the optimal P level was > 11 ng/mL for live birth. Serum P was measured on day1 (D1) following exogenous VMP introduction in the evening. When P levels were > 11 ng/mL, FET was performed “in phase” on day-2, day-3, or day-5 depending on embryo stage at cryopreservation (n = 139 cycles). When P levels were < 11 ng/mL, DYD 10 mg three times a day orally, was added to VMP and FET was postponed by one day (n = 237 cycles, 63%). The primary endpoint was the comparison of live birth rates (LBR) between the two groups.Results: Mean serum P level on D1 was 10.2 + 3.7 ng/mL. Characteristics of patients in both groups were similar for age, body mass index, endometrial thickness prior to P introduction, quality of transferred embryos, and embryo transfer stage. Regarding the primary endpoint, LBR was similar between the VMP+DYD group and the VMP group (26.1% vs. 27.3%, NS). Conclusion: These results suggest that adding DYD to VMP and postponing the transfer in patients with low P levels in hormonally substituted FET cycles might optimize outcomes.

Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.

Background: Many institutional factors predispose University students to mental health issues, including depression. However, with no central database for depression in Uganda, literature on depression and associated institutional factors among undergraduate students is scarce. This study examined the prevalence of and institutional factors associated with depression among undergraduate students at Gulu University.Methods: This was a cross-sectional survey among 452 undergraduate students at Gulu University in the academic year 2018/2019 in February and March 2019. A stratified simple random sampling was used to identify the participants. A self-administered questionnaire was used to collect data. Descriptive statistics, including mean and frequency, were used. We conducted a bivariate analysis to determine the association between variables employing Pearson’s chi-square test or Fischer’s exact test. We conducted a multivariate analysis with factors that had significant P-values of less than 0.05.Results: The average age of the respondents was 22.4 (SD - 2.4), more than half (53.1%) were male and 38.50% were in the second year. The results show that 31.19% reported depression. After controlling for age and sex, the results showed that there was a statistically significant correlation between depression and faculty (aOR - 1.15), year of study (aOR - 0.77), happiness with the course (aOR - 0-0.49), satisfaction with academic performance (aOR - 0.45), and satisfaction with academic quality (aOR - 0.61). The results indicated that the predictors of depression among undergraduate students were faculty, year of study, satisfaction with academic performance, and satisfaction with academic quality. Conclusion: A substantial proportion of Gulu University undergraduate students reported high levels of depression. The results, therefore, showed that depression in undergraduate students is an identifiable disorder that needs diagnosis, prevention, and treatment. Faculty, year of study, satisfaction with academic performance, satisfaction with academic quality were predictors of depression. Thus there is an urgent need for counseling, psychoeducation, and preventive mental health services as an essential part of the university setup.

Fish-borne parasitic zoonoses are primarily found in people living in developing and underdeveloped countries. The parasites that cause such zoonoses like Trichinella and Taenia are well-known in developed nations, but few people are familiar with fish-borne parasitic zoonoses, which are largely caused by helminths and protozoans. In general, parasitic zoonoses transmitted by fish are rarely life-threatening, although cases and reports of such infestations have increased over the world. The list of parasitic organisms is extensive. This article attempts to provide a complete overview of the many fish-borne parasites that can cause zoonosis among humans and animals alike.

Injuries at the elbow are fairly common. Fractures require the immediate attention of the skills of a surgeon. As the fracture heals and motion at the fracture is permissible, the physical therapist can provide important treatment to help the patient gain range of motion, strength, and function.