Abstract Objective: Total laryngectomy (TL) is a life-saving procedure for individuals with advanced laryngeal cancer or those suffering from recurrence after initial treatment. The present study aims to evaluate the differences between stapler closure (SC) and manual closure (MC) of the pharynx during TL for patients with laryngeal cancer. Design/Setting: A systematic literature search was performed using the PubMed, Embase and Cochrane Library. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI). Main outcome/Results: A total of 7 studies (535 patients) were included in this meta‐analysis. Pooled analysis showed that the operative time of TL was significantly reduced in the SC group (MD, -63.2; 95% CI, -106.0 to -20.4). Moreover, the SC group had a lower incidence of pharyngocutaneous fistula (OR = 0.38; 95% CI, 0.18-0.83; P = 0.016) and hospital stay (MD, -2.9; 95% CI, -5.6 to -0.1). The incidence of postoperative surgical site infection (OR = 0.41; 95% CI, 0.02-8.73; P = 0.565) was comparable between the two groups. Conclusion: Based on these results, SC may be a useful option for patients who need TL.

Objectives: To distinguish between primary mild COVID-19 patients and the patients with recovery positive virus detection after discharge (recovery positive patients), the clinical characteristics and biochemical indicators were analyzed. Methods: By evaluation of correlations between biochemical indicators and serum ferritin (FE) through univariate and multivariate analyses, we evaluated the differences of FE index and analyzed the effectiveness of the FE* pre-albumin (PA) on discrimination between primary mild and recovery positive COVID-19 patients. The area under curve (AUC) and a predictive nomogram were further employed to evaluate the effectiveness of discrimination. Results: In comparison with recovery positive patients, liver damage-related indicators such as serum FE and PA were significantly lower in primary COVID-19 patients with mild symptoms. Area under the ROC curve values of FE, PA and FE*PA were 0.81, 0.78 and 0.83, respectively. In combination with multivariate analysis and nomogram, FE and FE*PA can be considered as reasonable evaluation systems for predicting primary mild and recovery positive patients. Conclusions: FE*PA was an independent predictive biomarker for distinguishing primary mild and recovery positive COVID-19 cases.

COVID-19 causes significant hypoxia along with an inflammatory milieu, which may lead to secondary myocardial infarction and also atherosclerotic plaque rupture. Here we present a case of COVID-19 presented with ACS followed by PTE and CVA.

The report discusses Atypical metallic tooth discolouration in 5 and 11-year-old children. We did not find any clear literature pertinent to the ones that we encountered. This is especially important since there is no relevant history to these cases in terms of any identified causes of the stains.

The current study is based on the assessment of sugarcane farming in Khyber Pakhtunkhwa province. From the study, it is clear that the region has high potential of sugarcane production if the right inputs are provided since the demand for sugar in Khyber Pakhtunkhwa and other countries is high. The study is based on both primary and secondary information gathered from the region. Econometric methods of data analyses have been employed. In the study, the goals are to establish the cost and revenue gain in sugarcane cultivation, establish the resource use efficiency in sugarcane production and to examine the constraints faced by Farmers and the appropriate suggestion to overcome these constraints and improve their earnings. From the study, it is evident that efficient production of sugarcane is profitable as revenues exceed costs. Nevertheless resource use efficiency is low due to lack of modern production processes. Low rainfall, labor shortage and lack of access to inputs are the key constraints. To address these challenges irrigation should be enhanced and modern production processes adopted.

Female Sexual Interest/Arousal Disorder (FSIAD) deprives humans of the natural pleasure they need to get from intimacy. It is prevalent but often not addressed by healthcare providers and patients. As clinicians, we need to move beyond our unease to adequately address our patients’ sexual problems and implement appropriate treatment.

Adam Klocperk1, M.D., Ph.D., Zuzana Paračková1, MSc., Jitka Dissou2, M.D., Hana Malcová3, M.D., Ph.D., Petr Pavlíček4, M.D., Tomáš Vymazal4, M.D., As. Prof., Pavla Doležalová5, M.D., Prof., Anna Šedivá1, M.D., Prof.1Department of Immunology, 2ndFaculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic2Emergency Department for Children, University Hospital in Motol, Prague, Czech Republic3Department of Children and Adult Rheumatology, University Hospital in Motol , Prague, Czech Republic4Department of Anesthesiology and Intensive Care Medicine, 2nd Faculty of Medicine, Charles University in Prague and University Hospital in Motol, Prague, Czech Republic5Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Adolescent Medicine, General University Hospital in Prague and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic

Introduction: The new SARS-CoV2 pandemic is not equally affecting all ages. Children are showing milder symptoms across the globe. We reviewed the incidence and the severity in the pediatric populations of several Middle Eastern countries. Materials and Methods: We contacted the Lebanese Ministry of Health and colleagues in different countries of the region for information about their local cases, we reviewed updated information from the CDC and searched Pubmed for publications related to COVID-19 in pediatric patients till the end of April 2020. Results: Different countries had different number of affected children and different percentage of pediatric versus adult cases confirmed to be tested positive. Qatar showed the highest number of total cases but had one of the lowest percentage of pediatric infection versus adults. Conclusion: Our local experience was similar to other affected countries worldwide with children less than 18 years old showing milder symptoms and are less affected than adults.

Background: Over 2,000,000 infected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Although there are more and more reports on coronavirus disease 2019 (COVID-19), it is unclear why infected children show the milder symptoms than adults. Methods:A retrospective case study was performed in two designated hospitals for COVID-19 .Patients (56 children and 63 adults) with confirmed SARS-CoV-2 infection and mild pneumonia were randomly enrolled in this study. Results: The median age of children was 7.0 years, and 51.79% of them were boys. For the adults, the median age was 57 years, and47.62% were men.The most common symptoms were fever , cough , sputum and diarrhea.There were not significant different in symptoms between children and adult patients.In immunological indices on admission , adult patients displayed typical leukopenia, and markedly higher lever of IL-2, IL-4, IL-6 compared to child patients. The elevation of IL-2,IL-4 and IL-6 in adult induced to more extensive lung injury. Conclusion: The effective and non-aggressive immune response successfully resisted SARS-CoV-2 invasion to maintain the mild symptom in child patients.The correlation of higher IL-2,IL-4,IL-6 to lung injury distribution might be a evidence to prevent the excessive cytokine for avoiding further lung damage.

Background Guidelines as Global Initiative for Asthma(GINA) recommend disease control as the mainstay of asthma management. The performance of the tools assessing in asthma control is challenging in real-life. Methods Children and adolescents with asthma followed at a tertiary research hospital were enrolled in the study after evaluation of adherence to treatment. Asthma Control Test(ACT)/Pediatric Asthma Control Test(PACT), Pediatric Asthma Quality of Life Quesstionnaire(PAQLQ), fractional exhaled nitric oxide(FeNO) and lung function were evaluated. Patients were examined by asthma specialists blinded to the results of the tools and their control status were evaluated based on GINA. Results The median age(interquartile range,IQR) of the patients was 10.7(8.4-12.9) years, 57.9% were boys. Of 228 children, 84.2%, 9.6% and 6.1% had “well-controlled”, “partially-controlled” and “uncontrolled” asthma, respectively. The patients with “partially-controlled “ and “uncontrolled” asthma were grouped as “not well-controlled”. The cut-off levels were 22, 21 and 5.9 for PACT, ACT and PAQLQ for determining “well-controlled” asthma(p<0.001). With these cut-off values, ACT had the higher compatibility with GINA than PACT and PAQLQ(κ=0.221, 0.473 and 0.150, respectively, p<0.001). Correctly classified patients with PACT, ACT and PALQLQ based on GINA with these cut-off levels were 93(64.1%), 63(75.9%) and 139(62.9%), respectively. FeNO and lung function were unsuccessful at revealing control status according to GINA. Conclusion ACT is better than PACT at compatibility with GINA. Probably, it is because older children have a longer recall period than younger ones. It would be better to use these tools for each patient by comparing their own scores in real-life, instead of cut-off values.

Background and Purpose: Although human blood flows are redistributed into the mesenteric circulation after meals, it is not well understood how postprandial nutrients induces vasorelaxation of mesenteric micro-arterioles and whether this process is involved in the pathogenesis of colitis.  Experimental Approach: We used an auto dual wire myograph system, fluorescence imaging system and DSS-induced colitis mouse model to investigate the roles and mechanisms of nutrient-induced mesenteric relaxation in health and disease. Key Results: We found that acute application of glucose and sodium induced endothelium-dependent relaxation of human and mouse mesenteric micro-arterioles via a hyperosmotic action, which also stimulated Ca2+ influx through endothelial TRPV1 channels. The nutrient-induced vasorelaxation was almost abolished by selective blockers for TRPV1, IKCa and SKCa channels, but marginally altered by inhibition of nitric oxide production. The nutrient-induced hyperosmosis also activated functional activities of Na+/K+-ATPase and Na+/Ca2+-exchanger to further reduce [Ca2+]i in vascular smooth muscle cells. Moreover, hyperosmosis-induced endothelium-dependent hyperpolarization was significantly impaired in colitis mouse model. Conclusion and Implications: Our study provides the first evidence that nutrient-induced hyperosmosis stimulates endothelial TRPV1/Ca2+/EDH signaling pathway to eventually evoke vasorelaxation of mesenteric micro-arterioles, which may contribute to the pathogenesis of colitis as well.

Physical/social distancing, handwashing, respiratory hygiene, and face-masking have been recommended as realistic counterstrategies to control the COVID-19 pandemic. These strategies have been critical in the fight against the present pandemic in many countries. Here, we detail the background to such countermeasures, present some examples in different settings, and finally emphasize that they should remain in place worldwide as a cultural and behavioral “new normal” until a vaccine or a decisive treatment for COVID-19 is developed and made available globally.

The emergence of new type of viral pneumonia cases in China, on December 31, 2019; identified as the cause of human coronavirus, labeled as “COVID-19,” took a heavy toll of death and reported cases of infected people all over the world, with the potential to spread widely and rapidly, achieved worldwide prominence but arose without the procurement guidance. There is an immediate need for active intervention and fast drug discovery against the 2019-nCoV outbreak. Herein, the study provides numerous candidates of drugs (either alone or integrated with another drugs) which could prove to be effective against 2019-nCoV, are under different stages of clinical trials. This review will offer rapid identification of a number of repurposable drugs and potential drug combinations targeting 2019-nCoV and preferentially allow the international research community to evaluate the findings, to validate the efficacy of the proposed drugs in prospective trials and to lead potential clinical practices.

Background and Purpose: Tetanus neurotoxin has many potential therapeutic applications, due to its ability to increase localised muscle tone when injected directly into a muscle. It is a closely related molecule to botulinum neurotoxin (most commonly known as Botox), which has been widely used to release muscle tension for therapeutic and cosmetic applications. However, tetanus toxin has been relegated to the “maybe pile” for protein therapeutics — as most of the population is vaccinated, leading to highly effective antibody-mediated protection against the toxin. The potential for tetanus-based therapeutics remains substantial if the problem of pre-existing immunity can be resolved. Experimental Approach: A well-established murine model of localised muscular contraction was utilised. We administered functional tetanus toxin combined with an immunogenic, but functionally inactive, decoy molecule. Key Results: Incorporation of the decoy molecule greatly reduces the dose of active toxin required to induce a localised increase in muscle tone in mice vaccinated with the human toxoid vaccine. Conclusion and Implications: Our results clearly demonstrate that the barriers to developing a tetanus toxin therapeutic are not insurmountable and the technology presented here is the first major step towards realising the therapeutic potential of this powerful neurotoxin. Opening the therapeutic potential of tetanus toxin will have huge implication for the wide range of diseases caused by low-tone muscle.

Abstract: The number of infected cases with COVID-19 increase gradually, and some of the COVID-19 patients present with concomitant cardiovascular problems that might require surgical intervention. However, we do not have sufficient evidence of optimum timing for cardiac surgery in patients with COVID-19 whose surgery cannot be postponed or who cannot be treated percutaneously. Here we discuss the management of a patient that diagnosed with COVID-19 and required urgent cardiac surgery for symptomatic moderate aortic and severe mitral valve regurgitation.

A 6.5-month-old girl presented to a pediatrician for a second opinion regarding worsening macrocephaly and developmental regression. She then underwent neurosurgical evaluation. Rapid-sequence magnetic resonance imaging was significant for benign enlargement of the subarachnoid space of infancy. A complete blood count was significant for 33% blasts in the peripheral blood. Flow cytometry of the peripheral blood established a diagnosis of T-cell Acute Lymphoblastic Leukemia (ALL). T-cell ALL has been rarely reported and our patient’s presentation with macrocephaly is particularly unique.

Objective To explore patients’ attitudes and acceptability of universal screening for COVID-19 in a maternity population. Design Pre-screening and post-screening patient surveys Setting London Population Women admitted to the Maternity Unit at Newham Hospital during a two-week trial period of universal screening. Methods Cluster random sampling was used to select participants to complete the pre-screening questionnaire. Post-screening questionnaires were performed over the telephone. Main outcome measured Agreement to statements regarding patient’s acceptability of the SARS-CoV-2 screening test and the impact screening had on the care provided to themselves and their babies. Results During the two-week period, 180 women underwent universal screening. 81 participants completed the pre-screening questionnaire and 79 participants completed the post-screening survey (72-85% completion rate). More than 70% of women agreed that routine screening resulted in a positive effect on their care, the care of their babies and on their families. More than 80% of women agreed that they would be happy with their care if all pregnant women were offered testing for COVID-19 on admission to hospital. However, 50.62% of women agreed that having a COVID-19 screening swab test taken was uncomfortable and 35.80% were worried about the test results. Nulliparous women were more likely to perceive the positive impacts of screening on their care, their babies care, and their families as compared to multiparous women. Conclusion Our study provides evidence that patient acceptability and tolerance to COVID-19 screening is high, which is key for future implementation of universal screening across maternity services in the UK.

COVID-19: The heart of the issue Beth Woodward BMedSc (Hons)1, Muhammed Kermali2College of Medical and Dental Sciences, University of Birmingham, Birmingham, UKSt. George’s, University of London, London, UKCorresponding author:Beth WoodwardBMedSc (Hons)College of Medical and Dental SciencesUniversity of BirminghamBirmingham, UKe-mail: blw472@student.bham.ac.ukTel: 07947766140Funding: none obtainedConflict of Interest: none to be declaredKey words: COVID-19, angiotensin, ACEiBW and MK contributed equally.

Background: Sickle cell anemia is an autosomal recessive inherited disorder that affects approximately 5% of the world population. These patients are at greater risk for developing Hodgkin’s lymphoma. Cardiopulmonary bypass can trigger lethal vaso-occlusive crises in those patients if they are subjected to hypoxia, hypothermia, acidosis, or low-flow states. Case presentation: This case report describes a patient with sickle cell anemia and history of stroke was diagnosed with Bicuspid aortic valve stenosis and aneurysmal dilatation of the ascending aorta complicated with infective endocarditis. During routine workup he was discovered to have Hodgkin’s Lymphoma. He successfully underwent mechanical aortic valve and aortic root replacement. He underwent exchange transfusion preoperatively and one time immediately before initiating of Cardiopulmonary bypass. There was no major vaso-occlusive crisis occurred throughout the surgery. Patient was discharged in stable condition, and was scheduled for involved site radiation therapy for Hodgkin’s Lymphoma management. Conclusion: Sickle Cell Disease can be very challenging during cardiopulmonary bypass. Exchange transfusion can reduce HbS, and increase hematocrit level. Mild hypothermia can be used if sufficient CPB flows and venous saturation are maintained.

The impact of wearing a mask on face-touching behavior is unknown. We conducted a brief survey and observational study to assess the perception and to quantify how masks affect face-touching behavior. Most felt that the mask would alter their face-touching behavior with only 18.3% feeling that masks would not affect it. During a total of 330 person-minutes of observation, overall face-touching rate was 15.1 face touches/hour (FT/hr), 6.4 FT/hr while wearing a mask and 20.1 FT/hr without a mask (p <0.01). Masks are an effective barrier and reduce face-touching behavior amongst healthcare professionals.

Background: Among pediatric hematopoietic stem cell transplant (HSCT) recipients, abnormal glycemic control is shown to be associated with increased risk of transplant-related mortality, death from any cause, risk of infection, increased hospitalized and intensive care days. Independent effects of higher glycemic variability, a component of glycemic control, have not been described. This study aimed to characterize risk factors for, and consequences of, higher glycemic variability in HSCT patients. Procedure: Medical records for a cohort of 344 patients, age 0-30 years, who underwent first HSCT from 2007–2016 at Children’s Hospital Colorado were retrospectively reviewed. Glucose coefficients of variation (CV) were analyzed for HSCT days -14 to 0 and 0-30, and patients were assessed for potential risk factors and outcomes. Results: Roughly one third of patients had pre-HSCT and day 0-30 glucose CV above the reported healthy adult range. Independent of HSCT type, doubling of pre-HSCT glucose CV was associated with a 4.91-fold (95% CI 1.40-17.24) increased hazard of infection, as well as increased risk for intensive care hospitalization for allogenic HSCT patients. Multivariable analysis demonstrated that allogeneic HSCT patients had a 1.40- and 1.38-fold (95% CI 0.98-1.99 and 1.00-1.91) increased hazard of death for every doubling of pre-HSCT and Day 0-30 glucose CV, respectively. Conclusions: Just as with higher mean glucose, higher glycemic variability in the pediatric HSCT population is independently associated with significantly increased morbidity. Additional research is required to evaluate the utility of glucose control to mitigate these relationships and improve HSCT outcomes.

Our patient was diagnosed with multisystemic Langerhans Cell Histiocytosis (LCH) at 5 months of age. She received an allogeneic matched unrelated transplant for refractory haematopoietic disease. 2 years later she represented with raised intracranial pressure and an MRI confirmed the presence of a large left posterior fossa mass with homogenous enhancement and cystic areas, abnormal spectroscopy pattern, minor diffusion restriction and associated triventricular hydrocephalus. With the exception of CD1a and Langerin negativity, in contrast with initial diagnostic skin biopsy, the lesion was consistent with a diagnosis of LCH. BRAF V600E mutation was present on the cerebellar and skin sample.

Rice cake is a traditional Japanese food. Interestingly, rice cake can stay in the intestine due to its stickiness and cause food-induced ileus. This case shows an example of intestinal obstruction caused by rice cake. Globalization of Japanese food culture necessitates a deeper understanding of such a characteristic disease.

Aortic valve disease is frequently associated with ascending aorta dilatation and can be treated either by separate replacement of the aortic valve and ascending aorta or by a composite valve graft. The type of surgery is depending on the exact location of the aortic dilatation and the concomitant valvular procedures required. The limited evidence for elective aortic surgery in elderly high-risk patient remains challenging and therefore alternative strategies could be warranted. We describe an alternative strategy for the treatment of ascending aortic aneurysm and aortic valve pathology with the use of a sutureless, collapsible, stent mounted aortic valve prosthesis.