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This paper aims to identify the optimum level of factors or parameters that affect the energy absorption of conoidal structures by grey relational examination. To optimize crashworthiness parameters of conical structures, the L9 orthogonal array has been adopted to design the experiments. The tailor-made thin-walled conical structures were fabricated by three most important factors, such as base diameter, height, and thickness, as design variables, and they were subjected to axial compression in a quasi-static method. The important responses of crashworthiness indicators such as the mean crushing force and specific energy absorption (SEA) were calculated with the help of a load-displacement curve. Experimental results showed that the crushing behaviours of conical structures were fairly significant. Grey relational analysis (GRA) and analysis of variance are used toobtain the optimal levels of parameters. From the results, the optimum levels of parameters are found to be a base diameter of 180 mm, a height of 120 mm, and a thickness of 1.5 mm.

Investing in green bonds has been recognized as a strategy that not only promotes environmental performance but also offers attractive investment returns. However, macroeconomic factors, such as geopolitical risk (GPR), climate policy uncertainty (CPU), and global economic policy uncertainty (GEPU), play a substantial role in shaping green bond returns. Using the returns of US green bonds as a proxy for the returns of green bonds, we argue in this paper that these heterogenous uncertainty measures might have asymmetric impacts on the returns of green bonds (GB). By employing monthly data from January 2016 to August 2022, we apply the nonlinear autoregressive distributed lags model (NARDL) to examine the asymmetric impact of these heterogenous uncertainty measures on the returns of GB. The NARDL findings reveal evidence of short-run asymmetric impacts of GPR, GEPU, and CPU on the returns of green bonds. In the long run, there is an asymmetric impact of GPR and CPU on the returns of GB. However, there is a symmetric impact of CPU on the returns of GB in the long run. Specifically, in the short run, we found that a positive CPU shock causes a decline in the returns of green bonds. A similar magnitude of negative CPU shock causes an increase in the returns of green bonds. Moreover, a positive shock to GPR increases the return of green bonds, while a comparable negative shock to GPR reduces the return of GB. Furthermore, only negative shocks to GEPU have an impact on GB returns in the short run. Specifically, a negative GEPU shock reduces GB returns. In the long term, the returns of GB are positively impacted by negative shocks in GPR and both positive and negative shocks in GEPU, whereas positive shocks in GPR affect the returns of GB negatively.

Background. Type 2 diabetes mellitus and metabolic syndrome represent two closely intertwined public health challenges that have reached alarming epidemic proportions in low- and middle-income countries, particularly in sub-Saharan Africa. Therefore, the current study aimed to determine the weighted pooled prevalence of metabolic syndrome and its components among individuals with type 2 diabetes mellitus in sub-Saharan Africa as defined by the 2004 National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III 2004) and/or the International Diabetes Federation (IDF) criteria. Methods. A systematic search was conducted to retrieve studies published in the English language on the prevalence of metabolic syndrome among type 2 diabetic individuals in sub-Saharan Africa. Searches were carried out in PubMed, Embase, Scopus, Google Scholar, African Index Medicus, and African Journal Online from their inception until July 31, 2023. A random-effects model was employed to estimate the weighted pooled prevalence of metabolic syndrome in sub-Saharan Africa. Evidence of between-study variance attributed to heterogeneity was assessed using Cochran’s Q statistic and the I2 statistic. The Joanna Briggs Institute quality appraisal criteria were used to evaluate the methodological quality of the included studies. The summary estimates were presented with forest plots and tables. Publication bias was checked with the funnel plot and Egger’s regression test. Results. Overall, 1421 articles were identified and evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and 30 studies that met the inclusion criteria were included in the final analysis. The weighted pooled prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa was 63.1% (95% CI: 57.9–68.1) when using the NCEP-ATP III 2004 criteria and 60.8% (95% CI: 50.7–70.0) when using the IDF criteria. Subgroup analysis, using NCEP-ATP III 2004 and IDF criteria, revealed higher weighted pooled prevalence among females: 73.5% (95% CI: 67.4–79.5), 71.6% (95% CI: 60.2–82.9), compared to males: 50.5% (95% CI: 43.8–57.2), 44.5% (95% CI: 34.2–54.8), respectively. Central obesity was the most prevalent component of metabolic syndrome, with a pooled prevalence of 55.9% and 61.6% using NCEP-ATP III 2004 and IDF criteria, respectively. There was no statistical evidence of publication bias in both the NCEP-ATP III 2004 and IDF pooled estimates. Conclusions. The findings underscore the alarming prevalence of metabolic syndrome among individuals with type 2 diabetes mellitus in sub-Saharan Africa. Therefore, it is essential to promote lifestyle modifications, such as regular exercise and balanced diets, prioritize routine obesity screenings, and implement early interventions and robust public health measures to mitigate the risks associated with central obesity.

A combination of inorganic and organic hybrid systems is of high research interest as they provide novel hybrid systems for the improvement of existing properties, overcoming limitations of the parent materials, and for the optimization of their controlled release potential. This study sorted to develop and pharmaceutically assess the release profile of diclofenac sodium using cocoa pod husk (CPH) blended with different proportions of either talc or bentonite as multiparticulate composite release modifiers. Preformulation investigations of the multiparticulate hybrid systems included pH, swelling index, moisture content, elemental contents, and flow properties. The FTIR was also used to investigate the compatibilities between pectin and bentonite (PB), pectin and talc (PT), and diclofenac and pectin-talc (DPT), as well as diclofenac and pectin-bentonite (DPB). The diclofenac content, uniformity of the weight of capsules, in vitro drug release, and the kinetics and mechanism of release of diclofenac from the hybrid systems were also investigated using mathematical models. The pectin yield was 23.3%, with the water-holding capacities of pectin-talc (PT) and pectin-bentonite (PB) hybrid systems being 6.4% and 5.0%, respectively. The swelling indices of PT and PB were 110.0 and 130.0 in 0.1 M HCL at pH 1.2 and 130.0 and 149.0 in phosphate buffer at pH 6.8, respectively. This system was also found to exhibit excellent flow properties, and there were no diclofenac-excipient interactions. All formulated batches passed the pharmacopoeial and nonpharmacopoeial tests. They also demonstrated controlled release properties via different release kinetics and mechanisms. This study shows that the pectin-talc and pectin-bentonite multiparticulate composites could be used as release modifiers in pharmaceutical preparations.

Objectives. Fibroblast activation protein alpha (FAP) is highly expressed by cancer-associated fibroblasts in multiple epithelial cancers. The aim of this study was to characterize FAP expression in sarcomas to explore its potential utility as a diagnostic and therapeutic target and prognostic biomarker in sarcomas. Methods. Available tissue samples from patients with bone or soft tissue tumors were identified at the University of California, Los Angeles. FAP expression was evaluated via immunohistochemistry (IHC) in tumor samples (n = 63), adjacent normal tissues (n = 30), and positive controls (n = 2) using semiquantitative systems for intensity (0 = negative; 1 = weak; 2 = moderate; and 3 = strong) and density (none, 75%) in stromal and tumor/nonstromal cells and using a qualitative overall score (not detected, low, medium, and high). Additionally, RNA sequencing data in publicly available databases were utilized to compare FAP expression in samples (n = 10,626) from various cancer types and evaluate the association between FAP expression and overall survival (OS) in sarcoma (n = 168). Results. The majority of tumor samples had FAP IHC intensity scores ≥2 and density scores ≥25% for stromal cells (77.7%) and tumor cells (50.7%). All desmoid fibromatosis, myxofibrosarcoma, solitary fibrous tumor, and undifferentiated pleomorphic sarcoma samples had medium or high FAP overall scores. Sarcomas were among cancer types with the highest mean FAP expression by RNA sequencing. There was no significant difference in OS in patients with sarcoma with low versus high FAP expression. Conclusion. The majority of the sarcoma samples showed FAP expression by both stromal and tumor/nonstromal cells. Further investigation of FAP as a potential diagnostic and therapeutic target in sarcomas is warranted.

Carrot production is expensive since approximately 51% of the total costs are allocated to the nutrition of the crop. Bacterial inoculants are a promising alternative for crop fertilization. This research aimed to evaluate the effect of Gluconacetobacter diazotrophicus on the performance of carrot cultivar “Royal Chantenay” and its interaction with nitrogen and phosphorus fertilization. An experimental design of sub-subdivided plots was applied, where the largest plot consisted of the reference strain (ATCC 49037) and a native Colombian isolate of the bacterium (GIBI029); two concentrations of the bacterium were applied in the subplots (8.8 × 107 and 18 × 107 CFU/mL), and the levels of nitrogen and phosphorus were sorted within each one of them. The best positive effect was observed with the application of G. diazotrophicus ATCC49037 and GIBI029 at a concentration of 18 × 107 CFU/mL without the application of phosphorus or nitrogen in which yields of 37,417 and 30,606 kg/ha were obtained, respectively, exceeding the national average production in Colombia. In contrast, conventional treatment had a yield of 27,909 kg/ha. Additionally, higher quality was evidenced in the product weight with values of 126.48 g (ATCC49037) and 104.98 g (GIBI029), compared with the conventional treatment (93.19 g). G. diazotrophicus was shown to exhibit growth-promoting properties not only in crops such as sugarcane but also in economically important vegetable crops. The results obtained may contribute to the development of a novel microbial inoculant for vegetables under agroecological conditions in tropical areas.

Erdheim–Chester disease (ECD), a rare form of non-Langerhans histiocytosis, is a multisystem disorder. The case reported here refers to a 49-year-old man presenting at the emergency room with respiratory symptoms. While undergoing diagnostic tests for COVID-19 infection, tomography revealed asymptomatic bilateral perirenal tumors, while renal function remained unaltered. ECD was suggested as an incidental diagnosis and confirmed by core needle biopsy. This report provides a brief description of the clinical, laboratory, and imaging findings in this case of ECD. This diagnosis, albeit rare, should be taken into consideration in the context of incidental findings of abdominal tumors to ensure that treatment, when required, is instituted early.

The new coronavirus (COVID-19) pandemic has resulted in the unprecedented production of vaccines. In this context, the possible adverse effects remain to be identified and reported. In this article, we report the case of a young female patient who developed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMG-CoA) immune-mediated necrotizing myositis (IMNM) after receiving the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. The diagnosis of probable post-vaccination IMNM was made due to the absence of other factors that may have led to the development of autoantibodies (medicines; e.g., statins, drugs) and the temporal relationship between exposure and event. This case report is the first to suggest that a COVID-19 vaccine may trigger anti-HMG-CoA reductase necrotizing myopathy.

Geopolymer concrete and mortar have evolved over the years as potential alternatives for reducing the greenhouse gases associated with cement production. This current research was aimed at investigating the optimum dosage and concentration of sodium hydroxide required to leach out silica and alumina oxides in the fly ash for geopolymerization to take place. Blackish grey fly ash from Morupule, Botswana, was synthesized by varying sodium hydroxide (NaOH) of 98% purity between 8 M and 14 M, respectively. The ratio influence of sodium hydroxide to fly ash in dissolving the oxides was carried out at the values of 0.55, 0.62, and 0.75. The results showed that the workability of the geopolymer mortar and paste decreased with the increase in the ratio of fly ash to alkaline activator. The highest workability was achieved at a ratio of 0.75 : 1. The compressive strength, setting time, and workability of geopolymer mortar and paste can be controlled by adjusting the ratio of fly ash to alkaline activator. A ratio of 1.5 : 1 was found to be the most suitable for achieving high compressive strength, while a ratio of 0.75 : 1 was found to be the most suitable for achieving high workability. Furthermore, the workability values were in the range of 105 to 143 mm, while the ranges of initial and final setting times were found to be between 280–350 and 950–1170 minutes, respectively. This study is significant because no previous study has carried out geopolmerization of the Morupule fly ash as a result of its unique characteristics. These findings have important implications for the development of sustainable construction materials. The main finding was that for optimum reaction to take place, and NaOH/fly ash ratio should be kept at 0.55 and molarity of 12 to avoid leaching of other oxides that might weaken the strength.

Aim. The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. Methods. We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. Results. We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. Conclusions. In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.

Aging leads to several geriatric conditions including osteoporosis (OP) and associated frailty syndrome. Treatments for these conditions are limited and none target fundamental drivers of pathology, and thus identifying strategies to delay progressive loss of tissue homeostasis and functional reserve will significantly improve quality of life in elderly individuals. A fundamental property of aging is the accumulation of senescent cells. Senescence is a cell state defined by loss of proliferative capacity, resistance to apoptosis, and the release of a proinflammatory and anti-regenerative senescence-associated secretory phenotype (SASP). The accumulation of senescent cells and SASP factors is thought to significantly contribute to systemic aging. Senolytics—compounds which selectively target and kill senescent cells—have been characterized to target and inhibit anti-apoptotic pathways that are upregulated during senescence, which can elicit apoptosis in senescent cells and relieve SASP production. Senescent cells have been linked to several age-related pathologies including bone density loss and osteoarthritis in mice. Previous studies in murine models of OP have demonstrated that targeting senescent cells pharmacologically with senolytic drugs can reduce symptomology of the disease. Here, we demonstrate the efficacy of senolytic drugs (dasatinib, quercetin, and fisetin) to improve age-associated degeneration in bone using the Zmpste24−/− (Z24−/−) progeria murine system for Hutchinson–Gilford progeria syndrome (HGPS). We found that the combination of dasatinib plus quercetin could not significantly mitigate trabecular bone loss although fisetin administration could reduce bone density loss in the accelerated aging Z24−/− model. Furthermore, the overt bone density loss observed in the Z24−/− model reported herein highlights the Z24 model as a translational model to recapitulate alterations in bone density associated with advanced age. Consistent with the “geroscience hypothesis,” these data demonstrate the utility of targeting a fundamental driver of systemic aging (senescent cell accumulation) to alleviate a common condition with age, bone deterioration.

Graphene and niobium oxide are used in biomaterial coatings. In this work, commercially pure titanium (cp Ti) was coated with graphene oxide (GO), niobium pentoxide (Nb2O5), and a mixture of both materials (NbGO) by the electrochemical deposition method. The surface morphology, roughness, wettability, and degradation of coated and uncoated samples were analyzed by scanning electron microscopy, interferometry, and contact angle. The results showed that the specimens coated with NbGO (cp Ti-NbGO) showed the highest surface roughness (Ra = 0.64 μm) and were hydrophobic. The contact (θ) angle between water and the surface of uncoated specimens (cp Ti), coated with GO (cp Ti-GO), coated with a mixture with GO and Nb2O5) (cp Ti-NbGO), and coated with Nb2O5 were 50.74°, 44.35°, 55.86°, and 100.35°, respectively. The electrochemical corrosion tests showed that coating with graphene oxide increased the corrosion resistance and coating with Nb2O5 decreased the corrosion resistance. The negative effect of the effect of Nb2O5 coating in corrosion resistance compensated for the release of Nb2O5, which helps osseointegration, increasing cell viability, and proliferation of osteoblasts. The NbGO coating may be a good way to combine the bactericidal effect of graphene oxide with the osseointegration effect of Nb2O5.

Background. Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM). Methods. A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A p value

This study evaluated the physicochemical properties and phosphorus adsorption characteristics of surface soils (0–30 cm) of Meupi on the flank of Mount Lefo-Awing. In volcanic-influenced soils, usually characterized by high acidity, phosphorus is often not readily available to plants, and this deficit tends to limit plant growth. Soil physicochemical properties and phosphorus adsorption studies were carried out using standard techniques. Results of soil physicochemical studies showed that the soils were strongly acidic (pH ranged from 4.7 to 5.1), with low available phosphorus (5.47 to 6.97 mg/kg). The apparent equilibrium time for phosphorus to be adsorbed in the analyzed soils was 24 hours. Phosphorus sorption studies revealed that the rate of phosphorus adsorption increased with an increase in the concentration of added phosphorus but decreased at a certain level at higher concentrations because the soil had no more capacity to adsorb phosphorus. The degree of fitness (R2) of the phosphorus adsorption data for the different adsorption models was in the order Langmuir

Introduction. The proliferation of prenatal ultrasound has enhanced the detection of adnexal masses during pregnancy. The presentation necessitates a clear approach to investigation and treatment that balances both maternal and fetal risk. Laparoscopy is a safe approach to surgical management in the pregnant patient, and SILS may contribute to minimising perioperative complications. Case Presentation. We present the case of a 21-year-old female in her second trimester of pregnancy presenting with a large 20 cm right adnexal cyst. We proceeded with laparoscopic cystectomy via the SILS technique. There were no intraoperative complications, and she recovered well postoperatively. Conclusion. Laparoscopic resection of adnexal lesions is safe during pregnancy and should be favoured over the open approach. SILS minimises incision sites and has potential for reduction in perioperative morbidity.

Cytogenetic aberrations may emerge in human mesenchymal stromal cells (MSC) during ex vivo expansion for cell therapy. We have detected clonal trisomy 5 in two distinct autologous MSC products expanded from bone marrow which, based on the current quality control criteria, could not be released for clinical use. Although a safety concern, it is still unclear to what extent recurrent aneuploidies detected in MSC products may affect the threshold for neoplastic transformation or the medicinal properties of these cells. We have carried out an exploratory preclinical study to evaluate these MSC products with clonal trisomy 5, regarding their oncogenic and immunomodulatory potential. Cell population growth in vitro was reduced in MSC cultures with clonal trisomy 5 compared with the population growth of their euploid MSC counterparts, based on a lower cumulative population doubling level, reduced cell proliferation index, and increased senescence-associated beta-galactosidase activity. Subcutaneous injection of clinically relevant amount of MSC population, either with or without clonal trisomy 5, did not generate tumors in immunodeficient mice within a follow-up period of six months. Most importantly, MSC population with clonal trisomy 5 kept immunomodulatory properties upon interferon gamma (IFNγ) licensing, displaying overexpression of IDO, CXCL9, CXCL10, and CXCL11, in a similar fashion than that of IFNγ-licensed euploid MSC. Our findings suggest that bone marrow MSC products with clonal trisomy 5 may retain their therapeutic potential, based on poor tumor initiating capability and preserved immunomodulatory potency. This preclinical evidence may further support the definition of release criteria of autologous MSC products for cell therapy under critical clinical scenarios. This trial is registered with Clinical Study registration number: RBR-29x2pr.

ABSTRACT The reactions of R2GeCl2 and R3GeCl with 9,10-phenanthrenequinone dioxime in 1:1 and 1:2 molar ratios to form a series of organogermanium complexes of the general formula R2GeL and (R3Ge)2L [R=Me, Et, Ph] have been investigated. The physical and spectral properties of all derivatives are described. In addition, the nature of Ge─O bond has been studied by using the DFT/B3LYP method. [ABSTRACT FROM AUTHOR]

We present a method for estimating the fundamental frequency of harmonic signals, and apply this method to human speech. The method is based on cross-spectral methods, which provide accurate resolution of multicomponent FM signals in both time and frequency. The fundamental is re-introduced to the spectrum by a frequency-lag autocorrelation of the spectrum, even if the fundamental is completely missing in the original spectrum. By combining the different perspectives of the Fourier spectral representation and the time-lag autocorrelation function we suppress all components of harmonic signals except for the fundamental. [ABSTRACT FROM AUTHOR]

We present a method for obtaining a time-varying spectrum that is particularly suited when the data are in event-based form. This form arises in many areas of science and engineering, and especially in astronomy, where one has photon counting detectors. The method presented consists of three procedures. First, estimating the density using the kernel method; second, highpass filtering the manifestly positive density; finally, obtaining the time-frequency distribution with a modified Welch's method. For the sake of validation, event-based data are generated from a given distribution and the proposed method is used to construct the time-frequency spectrum and is compared to the original density. The results demonstrate the effectiveness of the method. [ABSTRACT FROM AUTHOR]

A new technique is proposed in this study to correct the gummy smile (GS) with myotomy, combining lip repositioning with the insertion of polyester threads at the surgical site to act as a physical barrier and control relapse. 11 patients were clinically assessed (30.2 ± 7.43 years old, 90.9% females and 9.10% males). All patients presented gingival display (GD) greater than 4 mm. Hypermobile upper lip (HUL), vertical maxillary excess (VME) + HUL, altered passive eruption (APE) + HUL, and VME + APE were the etiologies identified. Three polyester threads were inserted in each patient one month after the surgery. The GS was measured before, 6 months, and 12 months after the surgery. The results showed a reduction in the mean GD of the patients, 4.42 mm after 6 months (p value = 0.000) and 4.13 mm after 12 months (p value = 0.000). The largest relapse was 0.29 mm and was not statistically significant (p value = 0.07). The Friedman test with pairwise comparisons was used to determine the existence of statistically significant differences in GD between the periods analyzed. The results showed that the proposed technique was successful in treating GS, presenting significant reductions in the GD 12 months after surgery and controlling the relapse.

Background. Over 50% of individuals with multiple sclerosis (MS) have moderate or severe sleep disturbances, insomnia being the most common. In-person cognitive behavioral therapy for insomnia (F2F-CBTi) is currently the first-line treatment for insomnia. However, given potential limitations to access including mobility difficulty, fatigue, or living in a rural area, telehealth-delivered CBT-I (tele-CBTi) has been considered as an alternative treatment. The purpose of this study was to assess the feasibility and treatment effect of tele-CBTi in people with MS and compare it to outcomes from a F2F-CBTi study in individuals with MS. Methods. 11 individuals with MS and symptoms of insomnia participated in 6 weekly CBT-I sessions with a trained CBT-I provider via live video. Insomnia severity (ISI), sleep quality (PSQI), and fatigue severity (FSS and MFIS) were assessed pre- and posttreatment as primary outcomes. Sleep onset latency (SOL), sleep efficiency (SE) and total sleep time (TST) from the PSQI, depression (PHQ-9), anxiety (GAD-7), sleep self-efficacy (SSES), and quality of life (MSIS-29) were also assessed pre- and posttreatment as secondary outcomes. Results. Participants resided in 9 different states. Retention and adherence rates were 100%. There were significant improvements in ISI, PSQI, MFIS, FSS, SOL, SSES, PHQ-9, and MSIS-29, but not SE, TST, or GAD-7. There were no significant differences between the F2F-CBTi group and tele-CBTi group for magnitude of change in the primary outcomes (ISI, PSQI, MFIS, and FSS) or the secondary outcomes (SOL, SE, TST, SSES, PHQ-9, GAD-7, and MSIS-29). Conclusions. Tele-CBTi is feasible and has outcome measures that are similar to that of in-person CBT-I treatment. Tele-CBTi may increase access to insomnia treatment in individuals with MS.

Mucormycosis has been reported increasingly in patients affected by COVID-19, especially in India where the first cases were described. In Latin America, there is limited information about this association, mainly coming from Brazil, Mexico, and Peru. Herein, we report the case of a 66-year-old female that presented with rhino-orbital-cerebral mucormycosis, diabetic ketoacidosis, and COVID-19. The patient had the compromise of all the sinuses, orbital invasion, and intracranial extension. Isavuconazole was promptly initiated because amphotericin B was not available. She had a single open surgical debridement of necrotic tissues at the beginning of the diagnosis then multiple manual sessions to clear the residual or recurrent disease during approximately 5 months. Isavuconazole was effective and well-tolerated for 10 months without side effects. We highlight the importance of considering mucormycosis in post-COVID-19 patients with uncontrolled diabetes. The report emphasizes the favorable outcome of isavuconazole as an alternative therapy.

The nutritional composition and toxicity of native plants with food potential like Capsicum chacoense are important for the safe use of populations and could be used as a source for searching for new drug candidates. Infections produced by parasites such as helminths are a public health concern for many countries. The drugs used for treating these diseases are few, and the emergence of resistance is a risk. In this work, the nutritional composition, acute toxicity, antioxidant activity, and anthelmintic activity of crushed C. chacoense fruits were evaluated. The composition was analyzed by standard procedures. Antioxidant activity was evaluated using the ABTS radical and the total phenolic compound (TPC) tests. The toxicity was evaluated on Swiss albino mice by the single-DL50-dose procedure. The anthelmintic activity was tested against Eisenia foetida. The samples presented high levels of dietary fiber (47.05-49.19 g/100 g), proteins (14.43-15.60 g/100 g), and potassium (1708-1733 mg/100 g). In the samples, the absence of acute lethal effects in doses lower than 2000 mg/kg was observed. A rich composition of TPC (517.26-543.32 mg GAE/100 g sample), total carotenoids (125.72-239.57 mg/kg), β-carotene (3.29-5.60 mg/kg), and good TAC was observed (154-158 mM TEAC/g SMTC). The methanolic extracts at the doses tested (2.5 to 40 mg/mL) showed good anthelmintic activity. The presence of alkaloids was demonstrated in the methanolic extract, consistent with the levels of capsaicin (131.85 and 98.80 mg/100 g) and dihydrocapsaicin (80.75 and 63.68 mg/100 g), with significant statistical differences between samples (p

The objective was to evaluate the bending strength, phase transformation, roughness, and color stainability by coffee and red wine of opaque and high translucency yttria-stabilized zirconia before and after hydrothermal degradation in saline solution or oral mouthwash. Presintered zirconia blocks with medium opacity (ZrO2-3 mol. % of Y2O3) designed as ZrOp and high translucency zirconia (5.2 mol. % of Y2O3) designed as ZrTrans were used. Specimens (n = 80/group) were cut and sintered at 1500°C for 2 h. The specimens were hydrothermally degraded in an autoclave (134°C–1.8 kg/cm2) for 20 h in saline solution (0.5 g/L) and oral mouthwash solution (0.02% sodium fluoride, without alcohol and with 21.6% alcohol). After hydrothermal degradation, the samples were immersed in containers with coffee or red wine for 14 days to determine their color stainability. The results showed that the ZrOp had a higher bending strength than the ZrTrans before and after hydrothermal aging. In ZrOp and ZrTrans, the roughness increased after hydrothermal degradation. ZrOp samples had a higher Ra roughness than the ZrTrans samples. Roughness did not change after immersion in coffee or red wine. The X-ray diffraction (XRD) results showed that ZrOp samples underwent a tetragonal to monoclinic phase transformation, while ZrTrans samples were unchanged. Both ZrOp and ZrTrans samples changed color after immersion in coffee and red wine.

In this work, a novel method for producing ultrafine tantalum and hafnium carbide fibers using the ForcespinningTM technique via a nonhalide-based sol-gel process was investigated. An optimal solution viscosity range was systematically determined via rheological studies of neat PAN/DMF as a function of fiber formation. Subsequently, ForcespinningTM parameters were also systemically studied to determine the optimal rotational velocity and spinneret-to-collecting rod distance required for ideal fiber formation. TaC and HfC fibers were synthesized via ForcespinningTM utilizing a mixture of PAN and refractory transition metal alkoxides (i.e., tantalum (V) ethoxide and hafnium (IV) tert-butoxide) in DMF solution based on optimal conditions determined from the neat PAN/DMF. In all instances after calcination, powder X-ray diffraction (PXRD) and energy dispersive spectroscopy (EDS) indicated that TaC and HfC fibers were produced. TGA/DSC confirmed the chemical stability of the resulting fibers.

Background. Ear infections in children often cause abnormal postural stability. However, the long-term effects of recurrent ear infections on postural stability have not been investigated. Purpose. The purpose of this study was to examine the long-term effects of multiple ear infections on pediatric postural stability. Methods. Forty children aged 10-12 years were divided into two groups (18 participants with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five and 22 participants without a history of tympanostomy tubes and/or 0-2 ear infections prior to age five). Computerized Stability Evaluation Test (SET) and noncomputerized postural stability were measured for all participants. Results. A significant difference was found in median postural stability scores in the SET during a tandem stance on an unstable surface between the two groups (median (minimum, maximum) of 9.1 (1.4, 11.4) versus 5.8 (1.7, 12.8), p=0.04). In addition, there was a significant difference in median Pediatric Balance Scale scores between participants with versus without ear infection (54 (47, 56) versus 56 (55, 56), p=0.001). Conclusions. Results suggest that children ages 10-12 with a history of tympanostomy tubes and/or 3 or more ear infections prior to age five have decreased postural stability.

This paper presents a mathematical model that describes the transmission dynamics of schistosomiasis for humans, snails, and the free living miracidia and cercariae. The model incorporates the treated compartment and a preventive factor due to water sanitation and hygiene (WASH) for the human subpopulation. A qualitative analysis was performed to examine the invariant regions, positivity of solutions, and disease equilibrium points together with their stabilities. The basic reproduction number, R0, is computed and used as a threshold value to determine the existence and stability of the equilibrium points. It is established that, under a specific condition, the disease-free equilibrium exists and there is a unique endemic equilibrium when R0>1. It is shown that the disease-free equilibrium point is both locally and globally asymptotically stable provided R01 using the concept of the Center Manifold Theory. A numerical simulation carried out showed that at R0=1, the model exhibits a forward bifurcation which, thus, validates the analytic results. Numerical analyses of the control strategies were performed and discussed. Further, a sensitivity analysis of R0 was carried out to determine the contribution of the main parameters towards the die out of the disease. Finally, the effects that these parameters have on the infected humans were numerically examined, and the results indicated that combined application of treatment and WASH will be effective in eradicating schistosomiasis.

To explore the reinforcement effects of different reinforcement methods, kraft paper was used as reinforcement material, and shear tests were carried out in sand to study the reinforcement effects of kraft paper perpendicular and parallel to the shear plane. The test results show that the two reinforcement methods can effectively improve the strength of sand and the orthogonal reinforcement form is more superior. The existence of reinforced materials greatly improves the cohesion of sand, but does not significantly improve the internal friction angle. The width of reinforcement material has little effect on the reinforcement effect and shows different variation laws under different reinforcement forms.

Background. Over the last few years, the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) has increased substantially in medical practice due to their documented benefits in cardiorenal and metabolic health. In this sense, and in addition to being used for glycemic control in diabetic patients, these drugs also have other favorable effects such as weight loss and lowering blood pressure, and more recently, they have been shown to have cardio and renoprotective effects with anti-inflammatory properties. Concerning the latter, the individual or associated use of these antihyperglycemic agents has been linked with a decrease in proinflammatory cytokines and with an improvement in the inflammatory profile in chronic endocrine-metabolic diseases. Hence, these drugs have been positioned as first-line therapy in the management of diabetes and its multiple comorbidities, such as obesity, which has been associated with persistent inflammatory states that induce dysfunction of the adipose tissue. Moreover, other frequent comorbidities in long-standing diabetic patients are chronic complications such as diabetic kidney disease, whose progression can be slowed by SGLT2i and/or GLP-1RA. The neuroendocrine and immunometabolism mechanisms underlying adipose tissue inflammation in individuals with diabetes and cardiometabolic and renal diseases are complex and not fully understood. Summary. This review intends to expose the probable molecular mechanisms and compile evidence of the synergistic or additive anti-inflammatory effects of SGLT2i and GLP-1RA and their potential impact on the management of patients with obesity and cardiorenal compromise.

Objectives. Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin disease, with a vast drug arsenal and guidelines available for its management and diagnosis and different medical specialties engaged in providing care. This study aimed to outline the therapeutic and diagnostic approaches to the AD of allergists, dermatologists, and pediatricians and verify whether they are compliant with the guidelines. Methods. A cross-sectional study using an electronic questionnaire administered through the SurveyMonkey® platform was disclosed by participating medical societies to their medical associates. Results. Of the 1,473 participating physicians, the use of moisturizers as part of AD treatment was observed among pediatricians (91.9%), dermatologists (97.5%), and allergists (100%; p=0.07). The preference for the use of new emollients was lower among pediatricians (57%) than dermatologists (75.9%) and allergists (71.4%; p

Globally, shigellosis remains the second leading cause of diarrhea-associated deaths among children under five years of age, and the infections are disproportionately higher in resource-limited settings due to overcrowding, poor sanitation, and inadequate safe drinking water. The emergence and global spread of multidrug-resistant (MDR) Shigella are exacerbating the shigellosis burden. We adopted a cross-sectional study design to determine the distribution and antimicrobial susceptibility (AST) patterns of Shigella serogroups among children aged below five years presenting with diarrhea at Banadir Hospital in Mogadishu, Somalia, from August to October 2019. Stool and rectal swab samples were collected from 180 children consecutively enrolled using a convenient sampling technique and processed following standard bacteriological methods. AST was determined using the Kirby–Bauer disc diffusion method and interpreted as per the Clinical Laboratory Standard Institute (2018) guidelines. Shigellosis prevalence was 20.6% (37/180), and S. flexneri (26/37 (70.3%)) was the predominant serogroup. All the serogroups were 100% resistant to ampicillin (AMP), trimethoprim-sulfamethoxazole (SXT), and tetracycline (TE). Ceftriaxone (CRO) resistance was the highest among S. sonnei (66.7%) isolates. 19.2% of S. flexneri and S. sonnei (50%) serogroups were resistant to ciprofloxacin (CIP), but all S. dysenteriae type 1 isolates remained (100%) susceptible. Forty percent of CIP-susceptible S. dysenteriae type 1 were resistant to CRO. Seven MDR Shigella phenotypes were identified, dominated by those involving resistance to AMP, SXT, and TE (100%). Our findings showed a high prevalence of shigellosis with S. flexneri as the most predominant serogroup among children under five years of age in Banadir Hospital, Somalia. AMP and SXT are no longer appropriate treatments for shigellosis in children under five years in Banadir Hospital. MDR Shigella strains, including those resistant to CIP and CRO, have emerged in Somalia, posing a public health challenge. Therefore, there is an urgent need for AMR surveillance and continuous monitoring to mitigate the further spread of the MDR Shigella strains in Banadir Hospital and beyond.

Convulsion is a typical symptom associated with epilepsy. Jatropha gossypifolia, a common plant in Ghana, has been used traditionally for the management of epilepsy. This study was carried out to ascertain the scientific basis for the traditional utility of Jatropha gossypifolia for various convulsive disorders and also determine the part of the plant with the most anticonvulsant activity. The anticonvulsant activity of the leaf, root, and fruit extracts in doses of 30–300 mg/kg was assessed using the picrotoxin-induced seizure models in mice. The drugs and chemical preparations used included diazepam, picrotoxin, ethanol (70%), and normal saline. GraphPad Prism 6 was used for all statistical analysis and plotting of graphs. Data were analyzed using one-way ANOVA, followed by Bonferroni’s multiple comparison test. The leaf extract significantly and dose-independently reduced the frequency of myoclonic jerks (P=0.0001) and decreased the duration of clonic convulsions (P=0.019). The root extract also significantly and dose-dependently reduced the frequency of myoclonic jerks (P=0.001) but only decreased the frequency of tonic convulsions at 100 mg/kg (P=0.006). It also significantly decreased the duration of tonic convulsions (P=0.0001). The fruit extract only significantly and dose-independently reduced the frequency of myoclonic jerks (P=0.0001). It, however, showed an increase in the duration of both clonic and tonic convulsions. The study shows that the leaves and roots of Jatropha gossypifolia produce anticonvulsant activity which may be through enhancement of GABAergic transmission or activation of GABA receptors which support the traditional use of the plant to treat epileptic fits.

Medicinal plants serve as a lead source of bioactive compounds and have been an integral part of day-to-day life in treating various disease conditions since ancient times. Withaferin A (WFA), a bioactive ingredient of Withania somnifera, has been used for health and medicinal purposes for its adaptogenic, anti-inflammatory, and anticancer properties long before the published literature came into existence. Nearly 25% of pharmaceutical drugs are derived from medicinal plants, classified as dietary supplements. The bioactive compounds in these supplements may serve as chemotherapeutic substances competent to inhibit or reverse the process of carcinogenesis. The role of WFA is appreciated to polarize tumor-suppressive Th1-type immune response inducing natural killer cell activity and may provide an opportunity to manipulate the tumor microenvironment at an early stage to inhibit tumor progression. This article signifies the cumulative information about the role of WFA in modulating antitumor immunity and its potential in targeting prostate cancer.

Background. Xanthoma of the Achilles tendon, even though being benign, is a surgically challenging orthopaedic condition. Causality is believed to be due to a pathological error in the metabolism of low-density lipoprotein and their resultant accumulation, as foam cells within the tendon. Tendon xanthomas are often found to accompany heterozygous familial hypercholesterolemia. Case Presentation. A 19-year-old girl presented to our institution (a District General Hospital), with soft tissue lumps over posterior aspect of the ankle on both sides for several years. She had noticed a rapid increase in size in recent 3 months and sought medical advice. During investigation, she was diagnosed having bilateral Achilles tendon xanthomas clinically, confirmed by ultrasound scan and magnetic resonance imaging, and familial hypercholesterolemia concomitantly. The former was managed with intralesion subtotal resection where the histology further confirmed the diagnosis. The patient was commenced on statins and followed up while assessing the functional outcome and recurrences up to 2 years, with favourable results. Conclusion. Subtotal resection of Achilles tendon xanthoma (tendon sparingly) offers cosmetically and functionally acceptable outcomes, with faster recovery and no recurrences over 2 years.

Corynebacteria are ubiquitous and reside as skin and mucosa commensals in animals. They are considered contaminants in clinical specimens, but significant clinical data points to their virulence and pathogenic potential over the last two decades. Corynebacteria can cause both community-acquired and nosocomial infections. Corynebacterium diphtheriae (C. diphtheriae) responsible for diphtheria has declined over the previous two decades with an increase in a similar clinical syndrome by Corynebacterium ulcerans (C. ulcerans) in Europe. As per recent studies, C. ulcerans shares similar virulence factors with C. diphtheriae. C. ulcerans has been implicated in airway infections, skin and soft tissue infections, lymphadenitis, wound infections, and rarely necrotizing fasciitis. Pet or farm animals have been the source of these infections to humans, as per recent reports. Strains can be either toxigenic or nontoxigenic. Due to recent advances, methods to characterize strains have become easier with mass spectrometry. Antimicrobial susceptibility testing is a must for definite treatment as C. ulcerans can be resistant to first-line antibiotic therapy. If resources are available, it is prudent to find if there is any toxin production. Here, we describe a rural farmer in central Missouri presenting with acute-onset right knee pain diagnosed with right prepatellar bursitis with abscess due to C. ulcerans infection. He recovered with surgical debridement and antimicrobial therapy. This is the first case of C. ulcerans causing prepatellar bursitis with an abscess as per medical literature review.

In this study, the efficiencies of the use of rice husk, cypress, and Eucalyptus leaves biocoagulants as alternative to alum as chemical coagulant in reducing turbidity and stabilizing the pH of slaughterhouse wastewater and three other local drinking water sources were investigated. Two systems were used: one involving individual coagulants and the second involving mix alum and biocoagulant with fixed alum dose of 0.05 g and varying amounts of each biocoagulant type (0.05 to 5 g). Turbidity reduction, coagulation activity, and pH variation were used to characterize each system. Results show reduction in turbidity is higher in mixed coagulants than with individual coagulants. At 5 g each of alum, rice husk, cypress, and Eucalyptus leaves, the corresponding turbidity values, 8.3, 13.6, 14.5, and 20.3 NTU, were obtained compared to 7.3 with 0.05 alum and 5 g rice husk mixture, 8.7 NTU with 0.05 g alum and 5 g cypress leaves mixture, and 16.1 NTU with 0.05 g alum and 5 g Eucalyptus leaves mixture, for 37.3 NTU initial turbidity. The used biocoagulants individually show insignificant effect on the pH of coagulation-treated water. Alum has an insignificant effect up to 2 g. 0.05 g of each biocoagulant stabilizes the pH between 6.57 and 7.34 against 4.14 for alum. 0.05 g alum/0.05 g biocoagulant stabilized the pH of water between 6.32 and 7.41. The coagulation activities for individual systems follow the order alum > rice husk > cypress > Eucalyptus, and for mixed systems, alum/rice husk > alum/cypress > alum/Eucalyptus. Water with turbidity and pH values within the World Health Organization’s guideline value of

Thyroid hormone (TH) perturbation is a common medical problem. Because of substantial public health impact, prior researchers have studied hyper- and hypothyroidism in animal models. Although most prior research focused on in utero and/or developmental effects, changes in circulating TH levels are commonly seen in elderly individuals: approximately 20% of persons older than 80 years have clinically impactful hypothyroidism and up to 5% have clinical hyperthyroidism, with women being more often affected than men. TH disease model methodology in mice have varied but usually focus on a single sex, and the impact(s) of TH perturbation on the adult brain are not well understood. We administered thyroxine to middle-aged (13 to 14 months) male and female mice to model hyperthyroidism and TH-lowering drugs propylthiouracil (PTU) and methimazole, to induce hypothyroidism. These pharmacological agents are used commonly in adult humans. Circulating TH-level changes were observed when thyroxine was dosed at 20 µg/mL in drinking water for two weeks. By contrast, PTU and methimazole did not elicit a consistent reproducible effect until two months of treatment. No substantial changes in TH levels were detected in brain tissues of treated animals; however, pronounced changes in gene expression, specifically for TH-processing transcripts, were observed following the treatment with thyroxine. Our study indicated a robust compensatory mechanism by which the brain tissue/cells minimize the TH fluctuation in CNS by altering gene expression. Neurobehavioral changes were related to the TH perturbation and suggested potential associations between cognitive status and hyper- and hypothyroidism.

The effectiveness of 1, 5, and 10% w/v of aqueous extracts of Croton dichogamus, Tephrosia vogelii, and Syzygium aromaticum and their mixture (2.5 and 5%) was evaluated against Myzus persicae on Brassica oleracea under field conditions. The synthetic chemical insecticide, chlorpyrifos, was used as positive control, and water and water plus soap were used as negative controls. Aqueous extracts significantly (P≤0.05) lowered M. persicae population compared with negative controls. The 5% of the aqueous extract from mixed plants and 10% of each plant used in this study significantly (P≤0.01) reduced aphid, M. persicae population comparable to chlorpyrifos in 2019 and 2020. However, the 1 and 5% concentrations of aqueous extracts of C. dichogamus, T. vogelii, and S. aromaticum and 2.5% of aqueous extracts from the mixed plants significantly lowered the population of M. persicae compared with negative controls in 2019 and 2020 wet seasons. The weekly observations revealed that, at weeks 1, 2, 3, 4, and 5 after application of treatments, the population of M. persicae differed significantly (P≤0.05). Also, the aqueous extracts from the mixed plants at 5% concentrations significantly (P≤0.01) reduced M. persicae population as compared with other treatments. It was as effective as synthetic chemical pesticide (chlorpyrifos). Also, 1 and 5% of C. dichogamus, T. vogelii, and S. aromaticum and the 2.5% of aqueous extracts from the mixed plants significantly reduced the population of M. persicae for all 6 weeks of study compared with negative controls. Therefore, these pesticidal plants can be recommended to smallholder farmers for the control of M. persicae in B. oleracea crops.

Alpha-thalassemia is highly prevalent in the plural society of Brazil and is a public health problem. There is limited knowledge on its accurate frequency and distribution in the Amazon region. Knowing the frequency of thalassemia and the prevalence of responsible mutations is, therefore, an important step in the understanding and control program. Hematological and molecular data, in addition to serum iron and serum ferritin, from 989 unrelated first-time blood donors from Amazonas Hemotherapy and Hematology Foundation (FHEMOAM) were collected. In this study, the subjects were screened for −α3.7/4.2/20.5, −SEA, −FIL, and −MED deletions. Alpha-thalassemia screening was carried out between 2016 and 2017 among 714 (72.1%) male and 275 (27.9%) female donors. The aims of this analysis were to describe the distribution of various alpha-thalassemia alleles by gender, along with their genotypic interactions, and to illustrate the hematological changes associated with each phenotype. Amongst the patients, 5.35% (n = 53) were diagnosed with deletion –α−3.7 and only one donor with α−4.2 deletion. From the individuals with –α−3.7, 85.8% (n = 46) were heterozygous and 14.20% (n = 7) were homozygous. The frequency of the –α−3.7 deletion was higher in male (5.89%) than in female (4.0%). There is no significant difference in the distribution of –α−3.7 by gender (p=0.217). The –α20.5, −SEA, and −MED deletions were not found. All subjects were analyzed for serum iron and serum ferritin, with 1.04% being iron deficient (n = 5) and none with very high levels of stored iron (>220 µg/dL). Alpha-thalassemia-23.7kb deletion was the most common allele detected in Manaus blood donors, which is a consistent result, once it is the most common type of α-thalassemia found throughout the world. As expected, the mean of hematological data was significantly lower in alpha-thalassemia carriers (p

This research focused on the quality of domestic water in Bangolan, Northwest Cameroon, in order to ascertain its potability based on World Health Organisation (WHO) guidelines. Inhabitants of this locality, as well as others in rural areas, consume water from these sources without any prior treatment which can lead to contamination and infections. Sampling was conducted, and physicochemical and bacteriological properties of ten water sources were examined in November 2017 and January, April, and July 2018 using standard methods. The results showed that the sampled water sources were moderately acidic to weakly basic falling within the WHO specification. The values of electrical conductivity and total dissolved solids were low, suggesting low mineralised waters which could lead to a shortage of essential mineral elements in humans. Water turbidity was high in July, attributable to the rains. Major ions analysed fell within the WHO guideline values except iron and aluminium, whose values fell above guideline values in both seasons due to the nature of the soils. Faecal coliforms were found in all the sources, and specific bacteria identified were Escherichia coli, Enterobacteria, Streptococcus, Salmonella, and Shigella spp., suggesting recent contamination by faecal matter due to poor hygienic conditions, and hence, treatment was recommended. Statistical analyses revealed significant influence of heavy rains on most water parameters (p

Cystic echinococcosis (CE) is a neglected helminthic disease and major public health problem in several regions of the world. The zoonosis is caused by the larval stage of different cestode species belonging to the genus Echinococcus. CE can affect any organ with the liver and lungs being most commonly involved. The brain is involved in less than 2% of the cases. We report a case of a CE1 echinococcal cyst of the brain in an Iranian patient.

Pneumocystis jirovecii is recognized as an opportunistic pathogen in immunosuppressed patients. We report a case of severe Pneumocystis pneumonia (PCP) in an infant with acquired combined immunodeficiency secondary to maternal chemotherapy exposure during the second and third trimesters of pregnancy. The infant required cardiorespiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. This case highlights the potential for severe acquired immunodeficiency in this patient cohort and further postnatal surveillance is highly recommended.

Nonresponse is a potential source of errors in sample surveys. It introduces bias and large variance in the estimation of finite population parameters. Regression models have been recognized as one of the techniques of reducing bias and variance due to random nonresponse using auxiliary data. In this study, it is assumed that random nonresponse occurs in the survey variable in the second stage of cluster sampling, assuming full auxiliary information is available throughout. Auxiliary information is used at the estimation stage via a regression model to address the problem of random nonresponse. In particular, auxiliary information is used via an improved Nadaraya–Watson kernel regression technique to compensate for random nonresponse. The asymptotic bias and mean squared error of the estimator proposed are derived. Besides, a simulation study conducted indicates that the proposed estimator has smaller values of the bias and smaller mean squared error values compared to existing estimators of a finite population mean. The proposed estimator is also shown to have tighter confidence interval lengths at 95% coverage rate. The results obtained in this study are useful for instance in choosing efficient estimators of a finite population mean in demographic sample surveys.

Cutaneous blastomycosis is not rare, but progressively enlarging nasal mass as the only presentation with nondiagnostic biopsy results, presence of pulmonary fibrosis, nodules and lymphadenopathy, and urinary sediments, as well as ANA and p-ANCA positivity, can make things more cryptic than expected.

Coronavirus disease 2019 (COVID-19) has attained a pandemic status and is associated with a high morbidity and mortality. Social isolation, fear of ostracization, and illness itself and limited access to care can lead to worsening of mental illnesses. We report a case from the United States describing a young male with a suicidal attempt who was subsequently found to have COVID-19 infection. Further research is needed to evaluate potential factors for this unique association.