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Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) [12], metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].  Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness. 

Delayed cerebral ischemia (DCI) is one of the main complications of spontaneous subarachnoid haemorrhage and one of its causes is the cortical spreading depolarizations (CSDs). Cortical spreading depolarizations are waves of neuronal and glial depolarizations in which there is loss of neuronal ionic homeostasis with potassium efflux and sodium and calcium influx. In damaged brain areas and brain areas at risk, such as those adjacent to subarachnoid haemorrhage (SAH), CSDs induce microvascular vasoconstriction and, therefore, hypoperfusion and spread of ischemia. Several studies have been devoted to minimize secondary injuries that occur hours to days after an acute insult. Ketamine, a drug until recently contraindicated in the neurosurgical population for potentially causing intracranial hypertension, has re-emerged as a potential neuroprotective agent due to its pharmacodynamic effects at the cellular level. These effects include anti-inflammatory mechanisms, and those of microthrombosis and cell apoptosis controls, and of modulation of brain excitotoxicity and CSDs. A literature review was performed at PubMed covering the period from 2002 to 2019. Retrospective studies confirmed the effects of ketamine on the control of CSDs and, consequently, of DCI in patients with SAH, but did not show improvement in clinical outcome. The influence of ketamine on the occurrence/development of DCI needs to be further confirmed in prospective randomized studies

Objectives: To describe a patient with facial-onset sensory-motor neuronopathy (FOSMN) that later developed Huntington’s disease (HD). Case report: A 62-year-old woman complained of progressive dysphagia 8 years before referral. At initial evaluation, there was excessive salivation, dysphagia, and sensory-motor trigeminal impairment. Denervation was noted on the upper limbs and the tongue. Blink reflexes were abolished. Genetic study of amyotrophic lateral sclerosis (ALS)-related genes was normal. She was diagnosed with FOSMN syndrome. Her clinical state progressively worsened with corneal anesthesia, severe denutrition, right arm and axial weakness. Seven years after referral, she was unable walk and developed generalized chorea. Abnormal huntingtin gene repeat expansion confirmed the diagnosis of HD. She died 16 years after onset of dysphagia. Conclusion: Cases with both HD and ALS have already been reported but not FOSMN and HD, to our knowledge. Some FOSMN cases have been linked to ALS-related gene mutations and HD phenocopies have been associated with C9ORF72 repeat expansions. Recently, huntingtin repeat expansions were described in the ALS population. Although a chance association cannot be excluded, data from the literature are in favor of a pathogenic relationship between FOSMN and HD in this particular case. We suggest that huntingtin gene be more systematically studied in patients with FOSMN.

Background: End-Stage Kidney Disease and its maintenance hemodialysis treatment force patients to make several lifestyle changes to cope with this debilitating illness. These changes often trigger the onset of notable psychological distress and depressive symptoms. Furthermore, these negative psychological experiences can undermine the effectiveness of the treatment and consequently worsening the health and quality of life of patients. Objective: The study assessed the psychological well-being among hemodialysis patients in Kumasi Metropolis. Further, it explored the relationship between these psychosocial factors and demographic characteristics.Materials and Methods: 30 hemodialysis patients were recruited from two dialysis units in Kumasi, Ghana. Participants were aged 18 and above and had been on hemodialysis treatment for more than three months. The Hospital Anxiety and Depression scale (HADS) was used to assess depression and anxiety whiles the Multidimensional Scale of Perceived Social Support was used to assess perceived social support of participants. Results: The majority of respondents were males (60%), relative to females. The study revealed that 80% were severely depressed, 20% met the criteria for severe anxiety.  Some participants reported moderate social support 53.3%; perceived social support being inversely correlated with both depression (r = 0.41; n = 30; p < 0.05) and anxiety (r = -0.59; n = 30; p < 0.05). Income levels were inversely correlated with depression (r = -0.41, n = 30; p < 0.05). Conclusion: Findings of the study suggest that the psychological wellbeing of hemodialysis patients is compromised. Social support appears to alleviate depression and anxiety. Implications for patient treatment are discussed.

Extant studies have labelled persons-with-addiction and the homeless as ‘invaders’ of public parks, aggressive/violent with psychiatric and medical disorders, a burden to the society, and transmitters of most deadly airborne or chronic diseases. Literature subtly discuses that such people must be chased out of the public. Yet, such studies have not concurrently analyzed from the viewpoint of urban parks users, the persons-with-addiction and the homeless people what needs to be done to improve the situation. Therefore, the study aims to explore whether problematic communities and subcultural factors make the disadvantaged resort to negative copping strategies when their legal means are blocked: how the other park users respond to the homeless drug addicts’ hardship: and the possible suggestions from all the park users. This is done with reference to social disorganization and Sub-culture theory, and through ethnographic research approach (8 months field observation) and in-depth-interviews with 27 participants. Our study found that persons-with-addiction and the homeless are not always aggressive/violent/harmful as they have been labelled. But only disadvantaged individuals who desire to emulate the ideals and ambitions of the middle class but lack resources to achieve such success. Being overwhelmed with such frustrations from their dilemmas, they consider themselves ‘double-failures’ and retreat into drug addiction and find abode in the public spaces. We therefore conclude that persons with addiction and the homeless people are not always violent and criminal persons who are to be chased out of public parks. But only disadvantaged individuals who need help for choosing a negative coping strategy.

Cadmium is one of the transition metals, known by the scientific name Cd. One of its main characteristics is the high toxicity, even in very little amounts. Cadmium is often released through industrial effluents, pesticides, chemical fertilizers, and the burning of fossil fuels. Since the presence of cadmium ions in the living organisms’ body, especially humans, can cause serious damage to the liver and pancreas, and also because its role in causing cancer has been proven, measuring very low amounts of this metal is of high importance. In the first step, this study has reviewed and analyzed common laboratory methods for measuring small amounts of cadmium. Then, according to economic, environmental, feasibility, speed, and accuracy factors, all available methods were evaluated using the ELECTRE technique. The results showed that the extraction methods using Dowex Optipore V-493 resin and extraction system in Triton X-114 surfactant, placed in the first and second positions.

Cadmium is naturally present in the mineral cadmium sulfide which is a rare form of this element and the highest amount of cadmium is obtained from the extraction process of other minerals such as lead, copper and zinc. The release of this metal into the environment leads to widespread epidemiological effects. Therefore, measuring small amounts of this metal is also of particular importance. Small amount measuring methods of this metal are such as,preconcentration using solid phase extraction system using adsorbents. The main part of the preconcentration process is achieved by adsorption processes. In this study, the behavior of Freundlich and Langmuir adsorption isotherms for the capacity of TMON and IMNM adsorbents in cadmium adsorption has been evaluated by Power and Rational statistical distributions. At the end of the study, the constant coefficients of the Freundlich and Langmuir models were compared in both linear and non-linear modes. The results showed; the linearization method for the Kf coefficient of the Freundlich isotherm can cause errors equal to 41.6% in TMON adsorbent and 39.3% in IMNM adsorbent. Also, in parameter b, errors of 66.66% are obtained in TMON adsorbent and 32.45% in IMNM adsorbent.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan, China, and caused coronavirus disease-19 (COVID-19), which is still a global pandemic. Dermatologic manifestations have increasingly been identified as significant extrapulmonary manifestations of COVID-19. The dermatologic manifestations associated with COVID-19 infection reported to date include maculopapular rash, vesicular lesions, urticaria-like lesions, and chilblain-like lesions. Knowledge of dermatologic manifestations of COVID-19 may be essential for early diagnosis and a better prognosis in COVID-19 patients. This review summarizes the current understanding of common COVID-19-associated dermatologic manifestations.

We report a case of a right gluteal mass from the sacroiliac joint to the knee of an infant girl. Biopsy showed histopathological features similar to infantile fibrosarcoma (IFS). However, unlike most IFS, no ETV6-NTRK3 fusion gene abnormality was detected. Molecular analysis with TruSight RNA Pan-Cancer Panel detected the presence of KIAA1549-BRAF translocation and an oncogenic NF2p.Q459* SNV with potential clinical significance. A review revealed that the combination of this patient’s tumor site with the presence of a KIAA1549-BRAF translocation abnormality and an accompanying single nucleotide variant has not been previously described. The detection of this translocation abnormality raises the possibility that the spindle cell tumors in infants with an absence of the ETV6-NTRK3 fusion gene abnormality might have a distinct pathogenetic mechanism different from the previously known IFS and congenital mesoblastic nephroma. Furthermore, the discovery of BRAF translocation and its aberrant signaling of the mitogen-activated protein kinase (MAPK) pathway in this tumor contributes to the promise of clinical benefit of using the MEKi trametinib for the treatment of progressive disease that is refractory to conventional chemotherapy. 

The global identities of parents’ popularity in rural communities to make-decision effects of their attitudes to transfer their Early Childhood from Child Development Centres and Local Primary School for moving study into the schooling cities that looks like children’ asylum of their educational conditions, problems, administration’ school directors, teachers, and schools’ environments to protect that described. The involving CDCs’ perceptions got using the 25-item My CDC Identity Inventory (MCDCII) in five scales, three options. Teacher and Caregiver-Early Childhood interactions have assessed with the 30-item Questionnaires on Teacher Identity Interaction (QTII) in five scales on five options. The 10-item Local Identity-Related Attitude (LIRA) has been associated with a sample of 300 children’s parents, teachers, and caregivers. The determination of efficient predictive value (R2) shows that 30% of accepted the identities on cohesiveness, competitiveness, physical indoor and outdoor environmental development, satisfaction, and strong-sense identity. 74% of their CDCs can protect the educational asylum of early childhoods from rural communities. The R2 value shows 49% of the variance in children’s parents’ perceptions was because of the MCDCII have associated. Despite Thailand’s success in expanding educational access, new empirical evidence suggests that much more needs to be done to maximize the potential of its students. The performance gaps among schools have disadvantaged and poorer-performing students have concentrated in small rural village schools. The Thai pre-primary school system is dramatically lacking in qualified the CDCs’ learning environments and achievements, and teachers. It allocated small rural schools teachers with lower qualifications and teaching experience.

The impression of frictional ridges of the finger is known as fingerprints. Owing to this uniqueness, the fingerprints have long been used to identify a person since Ancient times. In any crime scene the presence of fingerprint makes the identification of the Culprit very easy. The fingerprints can also easily be embedded on any item such as paper, Clothing and body of the victim. To utilize this uniqueness of fingerprints forensic experts devised many techniques to obtain a clear fingerprint. These come under two categories i.e. Conventional and modern methods. The conventional methods are although important but there are limitations of them. Just take the example of powder method. Powder method require different powders for different Surfaces and colors, but modern method like quantum dots method can easily detect Fingerprints on all surfaces regardless of their color giving great resolution in seconds. Other methods like physical developer method is very time consuming and expensive, carbon Black method creates mess and does not work on porous surface, iodine fuming and Naphthaloflavin does have an advantage that it can bring up prints on skin also but it does not Work on metallic surfaces. VMD also fails on heavy plastic polymers and body oils. But some modern methods like nanotechnology can obtain high resolution prints old and dried prints also within 3 minutes. Laser technology is very fast, accurate and can be used for Fingerprints up toten years old also on any surface without any mess. Multimetal deposition Method can even be used to identify smokers and drug addicts and can be used Porous, non-porous and wet surfaces.

Development of genetic profiles from the biological mixtures has remained challenging, although modern-day technologies may help forensic scientists to attain a reliable genetic profile in the identification of the accused. In the case of rape, vaginal swab exhibits usually contain epithelial cells of victims and sperm cells of accused, such samples are more challenging when there is more than one contributor. In such cases, separation of distinct cells from a mixture that includes blood cells, epithelial cells and sperm cells for their single genetic profile is important. In the last ten decades several new techniques were developed and invented for the separation of single cell from the biological mixture that includes differential lysis, laser micro-dissection, cell sorting (FACS), sieve-based filtration, (vi) micro-fluidic devices or immunomagnetic beads cell separation of fresh samples, and the magnetic activated cell sorting (MACS). Out of them, some techniques have been commonly applied for cell separation in forensic biology. Each technique has its own limitation. Some recent studies showed, magnetic activated cell sorting (MACS), laser capture microdissection (LCM), DEPArray technology and fluorescence activated cell sorting (FACS) has proved to be effective in separation of single cell from cell mixtures. Therefore, in this review we have evaluated these four alternative methods and their potential application in the modern-day over the others for the separation of a single cell from the mixture. In this review we also discuss the advantage of these methods and their modern–day applicability and acceptance in the forensic world.

Purpose: The sinusoidal obstruction syndrome (SOS) of the liver is an obliterative vasculitis that involves the terminal branches of the hepatic venules and sinusoids. When it is not treated, it will be a serious risk of mortality. Here, we aim to present our patient who has been associated with recurrent cholangitis attacks due to cholelithiasis and choledocholithiasis and is associated with sinusoidal obstruction syndrome with the literature.Description of the case: A 30 years old male patient had complaints of abdominal pain and nausea for a long time. The patient had a history of choledocholithiasis and cholangitis attacks. Although ERCP was performed and a stent was placed in the biliary tract, his jaundice did not disappear. Liver function tests were high. Tumor markers were negative.Methods: We could not make a definitive diagnosis with imaging methods and biopsy and we planned surgery. We performed segmental liver resection and biliary diversion in the surgery. Histopathological examination of the resected liver tissue was compatible with SOS.Conclusion: Many studies have been done on the etiology of SOS and different causes have been revealed. Accompanied with clinical findings, a definitive diagnosis is made with the exclusion of the presumptions considered. Surgery can be performed for both diagnostic and therapeutic purposes. If patients with elevated liver function tests and bilirubin have long-term abdominal pain, SOS should be bear in mind.

Background: Varied clinical manifestations, complex pathogenesis, and different viral serotypes make it difficult to predict the course of dengue disease. Many studies have been conducted on the prognostic factors for the occurrence of dengue shock syndrome (SSD), but all use the 2017 World Health Organization (WHO) guidelines. Aim: This study aims to determine the prognostic factors for the occurrence of SSD based on WHO guidelines in 2011. Method: Retrospective study using medical record data of pediatric patients aged 0 to <18 years with a diagnosis of dengue fever dengue (DHF), SSD, and expanded dengue syndrome (EDS) that meet WHO criteria in 2011 at the reputable database from 2017 to December 2020. Independent variables, namely gender, age, nutritional status, secondary dengue infection, leukopenia, abdominal pain, gastrointestinal bleeding, hepatomegaly, and plasma leakage. Shock is the dependent variable. Multivariate analysis using logistic regression analysis. Results: Subjects who met the study criteria were 145 patients, 52 (35.8%) of whom had SSD. Five of 52 SSD patients went into shock during hospitalization. The bivariate analysis yielded significant factors including, malnutrition, overnutrition and obesity, gastrointestinal bleeding, hemoconcentration, ascites, leukocytes 5,000 mm 3, encephalopathy, enzyme elevation heart, and overload. The results of multivariate analysis showed that hemoconcentration variables and elevated liver enzymes were factors of SSD Prognosis. Conclusion: Hemoconcentration and elevated liver enzymes are prognostic factors for SSD. 

SARS-CoV-2 a virulent disease that established the entire wide world due to its severity. Its 1st case was rumored in Wuhan, China within the year 2019 and it had been the beginning of this pandemic. This virus killed virtually a complete of 4,465,683 folks round the globe until date. Despite the fact that viral co-infections have the ability to alter the host’s illness pattern, few research have looked at the disease outcomes in patients who are infected with HIV and hCoVs. Despite the fact that HIV-positive people can be infected with hCoVs, researchers are now revealing that their chances of acquiring serious CoV-related disorders are typically similar to what is seen in the general population. The relation between SARS-CoV-2 and HBV was summarized rather HBV effects the severity of COVID patient or not. SARS-CoV-2 could be a severe acute metabolic process syndrome. Scientists found ways in which to treat this virus, some were useful and alternative weren’t that a lot of effective. Immunizing agent was one among the most important considerations for the entire world. This virus conjointly fashioned an entry for alternative co-infections too. SARS-CoV-2 and influenza virus, both causes respiratory diseases which confer as an extensive array of illness from asymptomatic or benign to critical disease and death. Also the mode of transmission and symptoms of influenza virus and SARS-CoV-2 are same. Viral and bacterial rate is higher in SARS-CoV-2 negative patient but are comparable. Serologies facts confirmed that patients with effective results for dengue virus (DENV) NS1 antigen and anti-dengue IgM were also attentive to COVID-19 speedy antibody tests, suggesting dengue COVID-19 co-infection. Mixed infection of dengue and COVID-19 needs unique interest from all dengue-common nations in Asia, especially the ones with limited resources. To our knowledge, this is the primary showed case of co-infection of dengue and COVID-19 in Indonesia. During patient’s TB course, COVID-19 can occur at any time with worse consequences for the patients who are affected by active pulmonary disease.

The lockdown, implemented in response to the COVID-19 epidemic, restricted the operation of various sectors in the country and its highlights a good environmental outcome. Thus, a comparison of air pollutants in India before and after the imposed lockdown indicated an overall improvement air quality across major Indian cities. This was established by utilizing the Central Pollution Control Board’s database of air quality monitoring station statistics, such as air quality patterns. During the COVID-19 epidemic, India’s pre-to-post nationwide lockdown was examined. The air quality data was collected from 30-12-2019 to 28-04-2020 and synthesized using 231 Automatic air quality monitoring stations in a major Indian metropolis. Specifically, air pollutant concentrations, temperature, and relative humidity variation during COVID-19 pandemic pre-to-post lockdown variation in India were monitored. As an outcome, several cities around the country have reported improved air quality. Generally, the air quality, on a categorical scale was found to be ‘Good’. However, a few cities from the North-eastern part of India were categorized as ‘Moderate/Satisfactory’. Overall, the particulate matters reduction was in around 60% and other gaseous pollutants was in 40% reduction was observed during the lockdown period. The results of this study include an analysis of air quality data derived from continuous air quality monitoring stations from the pre-lockdown to post-lockdown period. Air quality in India improved following the national lockdown, the interpretation of trends for PM 2.5, PM 10, SO2, NO2, and the Air Quality Index has been provided in studies for major cities across India, including Delhi, Gurugram, Noida, Mumbai, Kolkata, Bengaluru, Patna, and others.

Pseudofungus structures in lymph node tissues have been reported on multiple occasions. Despite a variety of investigative tests including histochemical special stains and energy dispersive spectral analysis, the underlying nature and origin of these pseudofungus structures has never been clearly defined. The most common hypothesis suggests that they represent collagen fibers that become coated with iron and calcium. Herein, evidence is given that the pseudofungus structures identified in the lymph node tissues represent fragments of polyurethane catheters. The evidence includes both a comparison of these pseudofungus structures to fragments of polyurethane well documented in the literature and a comparison of polyurethane catheter scrapings to the pseudofungus structures identified in the literature. In both of these comparisons, the morphology of the polyurethane fragments are identical to the pseudofungus structures. This is the first definitive report identifying polyurethane catheter fragments as representing the true nature and etiology of pseudofungus structures in lymph node tissues.

Treatment options in multiple myeloma (MM) based on novel agents are often limited by dose-related neurotoxicity. Bortezomib, a highly active reversible proteasome inhibitor, frequently causes peripheral neuropathy (PN). Bortezomib-induced PN (BIPN) is characterized by a length-dependent, sensory, axonal polyneuropathy (PNP) with predominant small fiber-affection. Following dose reduction or drug discontinuation, BIPN resolves within 3-4 months in the majority of patients. The pathophysiological mechanisms of BIPN are unclear. Rare cases of a severe demyelinating or mixed BIPN with prominent motor involvement have been attributed to autoimmune or inflammatory reactions. A case report, including nerve pathology, is presented of a 59-year-old man with stage III IgG-κ MM who was treated with bortezomib on the occurrence of progressive disease. After the fourth cycle, he developed a painful distal symmetric sensory PNP followed by gait instability and muscle weakness increasing over 3 months despite early cessation of bortezomib.Neurological examination revealed a distal flaccid tetraparesis mainly of the lower limbs with sensory loss and severe ataxia, electrophysiological features of a mixed axonal-demyelinating PNP, and pathomorphological evidence of neuritis. Steroid treatment was initiated, and partial recovery of the neurological symptoms within 6 months was observed. While a neurotoxic effect may explain the initial distal sensory disturbances, the worsening of neurological dysfunction after bortezomib withdrawal and the clinical pattern with steroid-responsive muscle weakness predominantly of the legs are consistent with an immune-mediated mechanism. This is in line with the sural nerve biopsy findings. Toxic BIPN followed by an immune-mediated BIPN in the same patient has not been reported before.

The incidence of COVID-19 in children has been variable. Although now the number of infected children worldwide, and in particular nationally, is small, they are not protected from the infection. Moreover, in the most severe cases septic shock, metabolic acidosis, irreversible bleeding, and coagulation dysfunction have been registered.In February 2021 a 17-year-old boy showed for examination with complaints of pain in the upper part of the abdomen, accompanied by involvement of the ankle joints, the appearance of a rash on the lower extremities with the characteristic of hemorrhagic vasculitis, and a positive test for COVID-19. The characteristics of the skin purpura, the abdominal pain, and the arthralgia led us to the diagnosis of Schönlein-Henoch purpura. The verification of past COVID-19 infection was done by the established high titer of specific IgG antibodies. The clinical evolution of the disease went beyond its generally accepted benign nature - the first manifestation of the illness had been followed by four more relapses, which necessitated new hospitalizations and a change in the therapeutic approach.COVID-19 infection is the cause of a more aggressive course of vasculitis.

Intrasellar meningioma (IM) is a rare occurrence that is difficult to distinguish preoperatively from the most common non-functioning pituitary adenoma. Here we describe a case of psammomatous IM occurring in a 68-year-old woman, presented with visual defects. On magnetic resonance imaging (MRI) she was found to have an intrasellar mass with suprasellar extension that was approached with transsphenoidal surgery. Subtle radiological hints, namely dural tail sign, intralesional calcifications and a marked and homogenous early enhancement of IM on MRI after gadolinium administration, may aid clinicians in achieving an accurate pre-operative diagnosis and choosing the proper surgical approach. The clinical and neuroradiological features of IM described in the literature has been reviewed.