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Purpose of Review This review summarizes recent literature defining tissue-resident memory T cells (TRM) and discusses implications for HIV pathogenesis, vaccines, and eradication efforts. Recent Findings Investigations using animal models and human tissues have identified a TRM transcriptional profile and elucidated signals within the tissue microenvironment leading to TRM development and maintenance. TRM are major contributors to host response in infectious diseases and cancer; in addition, TRM contribute to pathogenic inflammation in a variety of settings. Although TRM are daunting to study in HIV infection, recent work has helped define their molecular signatures and effector functions and tested strategies for their mobilization. Summary Exclusive reliance on blood sampling to gain an understanding of host immunity overlooks the contribution of TRM, which differ in significant ways from their counterparts in circulation. It is hoped that greater understanding of these cells will lead to novel approaches to prevent and/or eradicate HIV infection.

Absenteeism due to low back pain increases the financial burden on society. Therefore, the assessment of LBP-related absenteeism and its associated factors can be helpful. In this cross-sectional study, 771 workers with history of low back pain during last year have been evaluated. Information was collected from examinations carried out by physicians. About 29.2% of the participants had a history of absenteeism, and regression analysis showed that number of children, medication use, and doing MRI were associated with absenteeism. A high frequency of absenteeism was observed (about 30% of workers had LBP), which could be due to the lack of proper management or correct treatment. The other interesting results were the lack of use of medications and primary treatments for the improvement, along with the need to perform an MRI. In terms of the variable of the number of children, higher daily costs and the need for more income can be attributed to their lower absenteeism.

Patienten im hohen Lebensalter unterliegen einer Reihe von Besonderheiten in der medizinischen Behandlung. Dies gilt insbesondere auch fur den ischamischen Schlaganfall. Die dabei in der Akuttherapie bestehende Evidenz sowie mogliche Strategien bei Fehlen einer studienbasierten Handlungsempfehlung sollen im folgenden Artikel vorgestellt und diskutiert werden.

The contamination status of H5 avian influenza viruses and distribution of subtypes of H5N1 and H5N6 in poultry-related environment of Hubei areas were investigated. Urban and rural live poultry markets, poultry farms, intensive livestock farms and other monitoring types of 103 counties in 17 cities were selected in Hubei. Wiping samples from cage surface, wiping samples from chopping board, fecal specimens and other environmental samples were collected and tested by real-time RT-PCR using primers and probes of influenza A, avian influenza of H5, N1 and N6 from December 2017 to March 2018. The avian influenza virus positive rate was compared among different monitoring sites, samples, time and regions. Totally, 7132 environmental samples were collected in 1634 monitoring points with a positive rate of 2.24%. The positive rate of H5 avian influenza virus was the highest in urban and rural live poultry markets (3.44%, χ2=61.329, P

Arsenic from environmental contamination is a risk factor for kidney disease, and the clinical use of arsenic also triggers a new concern that the potential kidney damage caused by exposure to clinical doses of arsenic trivalent. So far, the undergoing mechanisms contributing to arsenic nephrotoxicity mostly remain unclear, and universally accepted methods for preventing this complication are limited too. Ancient Chinese medical scientists recognized the toxicity of arsenic long ago, and there were some records of Chinese herbs against arsenic poisoning in ancient books of Chinese medicine. In the past decade, several herbal formulations, as well as some potentially active compounds extracted from Chinese herbs, have been employed to prevent arsenic nephrotoxicity both in vivo and in vitro and showed better therapeutic effects. The present paper thus summarizes and discusses these Chinese medicine methods in preventing such a public health problem. In addition, we call for large, well-designed, randomized, and controlled clinical trials to be performed to further assess the efficacy and safety of these potential methods of Chinese medicine against arsenic nephrotoxicity.

Die Einschatzung des perioperativen Risikos spielt insbesondere in Anbetracht des demographischen Wandels eine entscheidende Rolle in der chirurgischen Indikationsstellung. Auch vor diesem Hintergrund sind heute Prahabilitationskonzepte zur Senkung des postoperativen Risikos zunehmend von Bedeutung. Darstellung der aktuellen Empfehlungen zur praoperativen Diagnostik bei thoraxchirurgischen Eingriffen sowie Prahabilitationskonzepte und deren praktischer Anwendbarkeit. Es erfolgte eine selektive Literaturubersicht durch Recherche in den elektronischen Datenbanken PubMed, Cochrane Library und ISRCTN sowie in den aktuellen Leitlinien des American College of Chest Physicians (ACCP) und der European Society of Thoracic Surgery (ESTS). Die Prakonditionierung umfasst die konservative Therapie von Grunderkrankungen, Rauchentwohnung und Prahabilitation. Prahabilitation ist ein immer weiter in den klinischen Alltag drangendes Konzept, wenngleich die Evidenzlage aufgrund sehr heterogener Studienlage nur eingeschrankt vorhanden ist. Insgesamt gibt es jedoch die Tendenz zu positiven Effekten auf Lebensqualitat und postoperative Komplikationen sowie Rekonvaleszenz. Neben der praoperativen Diagnostik zur Einschatzung des perioperativen Risikos ist auch eine effektive Prakonditionierung der Patienten erforderlich. Hierzu ist ein interdisziplinarer Ansatz unter Einbezug von Anasthesie, Pneumologie, Psychotherapie und Physiotherapie notwendig. Neben der konservativ-medikamentosen Optimierung gewinnen Prahabilitationskonzepte an Bedeutung und werden sich sicherlich im klinischen Alltag etablieren. Von chirurgischer Seite dienen minimal-invasive Zugange und parenchymsparende Resektionen ebenfalls der Risikoreduktion.

Das Pankreaskarzinom ist ein Tumor mit einer jahrlichen weltweiten Inzidenz von ca. 340.000 Neuerkrankungen. Die Prognose ist mit Funfjahresuberleben von 2–6 % extrem ungunstig. Bei Diagnosestellung ist die Resektion als die einzig kurative Option bei nur etwa 30 % der Patienten primar moglich. Sowohl zur Herstellung von Operabilitat bei zunachst nicht resektablem Befund und zur Verbesserung des Operationsergebnisses als auch zur Erhohung der Lebenserwartung definitiv inoperabler Patienten auch in fortgeschrittenen Stadien kann die Radio(chemo)therapie angewandt werden. Diese Arbeit gibt eine aktuelle Ubersicht uber die Rolle der Radiotherapie bei der Behandlung des Pankreaskarzinoms. Es wurde eine Literaturanalyse von grundlegenden Arbeiten, Original- und Ubersichtsarbeiten und aktuellen Studien durchgefuhrt. Daten aus prospektiven und retrospektiven Studien zeigen, dass die neoadjuvante Radiochemotherapie die Zahl der operablen Patienten erhohen und ihr Uberleben verbessern kann. Vergleichbare Hinweise gibt es in der adjuvanten Radiochemotherapie von operierten Patienten mit zusatzlichen Risikofaktoren (R1, N +). Bei definitiver Inoperabilitat und in der Rezidivtherapie kann die Radiochemotherapie ebenfalls einen positiven Beitrag zur lokalen Tumorkontrolle und Verbesserung der Therapiefreiheit leisten, evtl. auch zur Prognose. In der palliativen Situation kann die Bestrahlung zur lokalen Schmerzbehandlung eingesetzt werden. Die Rolle der Radiotherapie im Rahmen multimodaler Therapiekonzepte wird derzeit kritisch diskutiert. Eine Reihe von retrospektiven und prospektiven Studien geben jedoch deutliche Hinweise fur einen zusatzlichen Nutzen der Radiotherapie zur Operation und Chemotherapie. Dies muss in prospektiven Studien, bei denen moderne gewebeschonende Bestrahlungstechniken wie Stereotaxie und intensitatsmodulierte Radiotherapie zum Einsatz kommen, jedoch noch weiter abgeklart werden.

ZusammenfassungFür Lungenkarzinome mit bestimmten molekulargenetischen Veränderungen desALK-,BRAF- oderEGFR-Gens gibt es zielgerichtete Therapien, die auch in der Erstlinientherapie zugelassen sind. Oftmals steht für die molekularpathologische Testung nur ein begrenztes Probenmaterial in Form von Biopsien zur Verfügung. In einigen Fällen weisen die Biopsien nach Standardfärbungen und immunhistochemischen Färbungen keinen oder einen zu geringen Tumoranteil auf, um PCR-basierte Untersuchungen oder FISH(Fluoreszenz-in-situ-Hybridisierung)-Analysen damit durchzuführen. In solchen Fällen kann auf zytologische Präparate wie Bronchusbürstenausstriche, transbronchiale Nadelaspiration (TBNA), Bronchiallavage, Punktionsausstriche von Lymphknotenmetastasen oder peripheren Metastasen, Pleuraerguss, Aszites und Perikarderguss zurückgegriffen werden. Standardfärbungen wie HE, Pappenheim und Papanicolaou sowie immunhistologische Präparate können nach der morphologischen Analyse und Diagnosesicherung verwendet werden, um daraus DNA zu extrahieren. Ein Zytopathologe markiert hierfür die Tumorzellareale vorher auf dem Objektträger. Nur bei ausreichend hohem Tumorzellanteil ist es möglich, diese Areale zu dissezieren und DNA zu extrahieren. Um eine FISH-Analyse mit den zytologischen Präparaten durchzuführen, müssen vom Zytopathologen möglichst kleine Areale mit mehr als 100 Tumorzellen eingezeichnet werden. Bereits gefärbte Schnitte werden vor der Hybridisierungsreaktion entfärbt. Ziel ist es, auch bei begrenztem Ausgangsmaterial eine umfangreiche Diagnostik zu erreichen und Rebiopsien zu vermeiden. In der Pathologie der Uniklinik Köln wurden im Zeitraum von 2016 bis Juli 2019 1711 NGS(Next Generation Sequencing)- und FISH-Analysen an zytologischen Präparaten durchgeführt. Dabei lag die Erfolgsrate der NGS-Untersuchungen mit 85,9 % leicht über der Erfolgsrate der FISH-Analysen mit 82,8 %.

ZusammenfassungDie Therapie der Lungenkarzinome hat binnen der letzten 15 Jahre einen revolutionären Wandel erfahren. Dank zielgerichteter Therapien, insbesondere Thyrosinkinaseinhibitoren (TKI), konnte die Prognose der Patienten deutlich verbessert werden. Aktuell rekrutierende Studien testen unter anderem neue MET-, KRAS-, ROS1-, RET- und NTRK-Inhibitoren. Erste klinische Daten sind vielversprechend, sodass es auch zukünftig Pathologen und Onkologen vor eine Herausforderung stellt, stets alle Facetten differenzierter Therapieentscheidungen im Blick zu halten. Die präzise Klassifikation von Lungenkarzinomen anhand immunhistochemischer und molekularpathologischer Analysen ist heute für die weitere Therapie und Prognose des Patienten von zentraler Bedeutung. Hinzu kommt, dass neue Technologien der Biopsiegewinnung Minihistologien oder zytologische Proben in höchster diagnostischer Qualität liefern. Aufgrund der Komplexität der notwendigen Diagnostik ist daher ein strategisches Vorgehen erforderlich, um unnötigen Materialverlust zu vermeiden. Ziel dieser Abhandlung ist es, eine aktuelle Übersicht für eine effiziente und zielgerichtete Diagnostik unter Berücksichtigung der aktuellen Studienlage zu erstellen.

Background Among all available dosage form, tablet is most widely used because of its stability and patient acceptability. The better aesthetic quality like color, texture, mouth feel, and taste masking depended on film and sugar coatings, so the coating is an important part in the formulation of the tablet. The present work aims to comprehensively review the formulation, characterization, and challenges in the development of Tablet in Tablet dosage form. Main text Film and sugar coatings have the number of disadvantages; most important one is the utilization of aqueous or organic solvent that leads to toxicity. To overcome this problem in the year 1896, Noyes firstly introduced the compression coating or Tablet in Tablet technique. In the development of Tablet in Tablet dosage form, substantial attention among researchers and various research reports and patents inputs can be found in the literature. Also, we focused on the recent advancements in techniques like one-step dry-coating (OSDrC®) for manufacturing Tablet in Tablet dosage form. Conclusion The current review gathered information on the latest patent, formulation, advantages, and disadvantages of Tablet in Tablet or compression coating. The review also elaborates on the importance of Tablet in Tablet techniques in the development of a modified release system. Graphical abstract

Background Endoscopic harvest of the radial artery avoids long forearm incisions and has better cosmesis compared to the open technique. The objective of this study was to compare the short-term results and wound-related complications of endoscopic radial artery harvest versus open technique. Results From 2013 to 2017, 800 patients had coronary artery bypass grafting; 88 patients of them had radial artery harvesting (11%). Two groups were included in the study according to the surgeon preference, endoscopic radial harvest (group 1, n = 30; 3.75% of total CABG patients) and open harvest (group 2, n = 58; 7.25% of total CABG patients). Group 1 had more males (25 (83.33%) vs. 35 (60.34%); p = 0.028). There was no difference in the preoperative comorbidities between both groups. The duration of the harvest was significantly longer in group 1 (median 40 min ranges from 38 to 42 min vs. 49 min ranges from 47 to 52 min in groups 1 and 2, respectively; p < 0.001). The operative time was longer in group 1 (median 302.5 min ranges from 295 to 310 min vs. 277 min ranges from 273 to 280 min in groups 1 and 2, respectively; p < 0.001). The hospital stay in the endoscopic radial artery harvest group was significantly shorter than that of open technique (median 7 days ranges from 6 to 7 days vs. 7.5 days ranges from 7 to 9 days; p < 0.001). There was no significant difference in the postoperative complications between both groups. One case (3.3%) was transformed from the endoscopic to open technique due to uncontrolled bleeding. Endoscopic technique was associated with more patients presenting with hand numbness (6 cases; 20% versus 3 cases 5.2%) and radial nerve injury (2 cases; 6.6% versus none), while open technique showed more cases of local hematoma (8 cases; 13.8% versus 1 case; 3.3%) and wound infection (6 cases; 10.34% versus none); p > 0.05. Conclusion Endoscopic radial artery harvest is associated with shorter harvest time and shorter hospital stay. Endoscopic radial artery harvest is a safe technique with good short-term outcomes. Longer follow-up is recommended.

Background Based on bioisosteric similarities with thiacetazone, a series of 7-chloro-4-aminoquinoline derivatives have been designed and synthesized. The target compounds were elucidated by NMR, mass, and FTIR spectral data. All synthesized compounds were evaluated for their in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv (MTB), and human dermal fibroblast cell lines were used to assess toxicity of selected ligands. Results All of the designed compounds showed inhibition of MTB with MIC of 1.56–50 μM. Among the tested compounds, 7c and 7g proved to be most potent MTB inhibitors (MIC = 1.56 μM). Conclusions The outcome of present study suggests that most of the synthesized compounds are sensitive to Mycobacterium tuberculosis and showed acceptable range for molecular parameters. Thus, 7-chloro-4-aminoquinolines could be a useful lead for the development of new MTB inhibitory agents.

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been recently introduced as a new technique for sampling the hilar/ mediastinal lesions [lymph node (LN) enlargement or masses] with a potential to improve the diagnostic yield as it allows direct visualization of lesion beyond the tracheobronchial wall allowing real-time sampling. EBUS-TBNA diagnostic yield has been satisfactory for both benign and malignant lesions. Aim To evaluate the utility of convex probe EBUS-TBNA in the diagnosis of hilar and mediastinal lesions (LN enlargement or masses). Patients and methods This is a prospective study in which EBUS-guided TBNA via a real-time ultrasound bronchoscope was used to diagnose 25 patients with mediastinal or hilar LN enlargement or masses. Results EBUS-guided TBNA was performed on 15 patients with enlarged mediastinal/hilar LNs and 11 patients with mediastinal masses, achieving specific diagnosis in 73.3% (11/15) and 81.8% (9/11), respectively. The overall diagnostic yield of EBUS-TBNA was 76% (19/25). Overall sensitivity was 82.6%, specificity 100%, positive predictive value 100%, and negative predictive value 33.33%. EBUS-TBNA procedure had no complications in 76% of cases. Conclusion EBUS-TBNA is a minimally invasive, safe, yet still underutilized diagnostic technique with adequate diagnostic yield. Its nationwide application in the field of diagnostic bronchoscopy should be encouraged.

Background Existing models for estimating children’s exposure to chemicals through mouthing currently depends on the availability of chemical- and material-specific experimental migration rates, only covering a few dozen chemicals. Objective This study objective is hence to develop a mouthing exposure model to predict migration into saliva, mouthing exposure, and related health risk from a wide range of chemical-material combinations in children’s products. Methods We collected experimental data on chemical migration from different products into saliva for multiple substance groups and materials, identifying chemical concentration and diffusion coefficient as main properties of influence. To predict migration rates into saliva, we adapted a previously developed migration model for chemicals in food packaging materials. We also developed a regression model based on identified chemical and material properties. Results Our migration predictions correlate well with experimental data (R2 = 0.85) and vary widely from 8 × 10−7 to 32.7 µg/10 cm2/min, with plasticizers in PVC showing the highest values. Related mouthing exposure doses vary across chemicals and materials from a median of 0.005 to 253 µg/kgBW/d. Finally, we combined exposure estimates with toxicity information to yield hazard quotients and identify chemicals of concern for average and upper bound mouthing behavior scenarios. Significance The proposed model can be applied for predicting migration rates for hundreds of chemical-material combinations to support high-throughput screening.

Patienten mit onkologischen Erkrankungen, insbesondere mit hamatologischen Neoplasien, haben ein erhohtes Risiko fur allgemeine Infektionen und spezielle therapieassoziierte Komplikationen mit hoher Morbiditat und Mortalitat. Die jahrliche Inzidenz und Pravalenz fur Krebserkrankungen steigt in Deutschland. Moderne Therapieverfahren haben zu einem verbesserten Uberleben gefuhrt, jedoch erfordern steigendes Alter, Komorbiditaten und Gebrechlichkeit der Patienten multidisziplinare Strategien zur Durchfuhrung komplexer Therapiekonzepte und zur Behandlung von deren Komplikationen. Eine selektive Literaturrecherche sowie die Leitlinien der European Society for Medical Oncology (ESMO), der Deutschen Gesellschaft fur Hamatologie und Medizinische Onkologie (DGHO), der Arbeitsgemeinschaft Infektionen in der Hamatologie und Onkologie der DGHO (AGIHO) und der American Society of Clinical Oncology (ASCO) sind die Grundlage fur den vorliegenden Artikel. Das Erkennen schwerer Infektionen bei Krebspatienten und deren Unterscheidung von therapieassoziierten Komplikationen stellt eine Herausforderung fur den behandelnden Arzt dar. Neutropenisches Fieber ist der haufigste infektiologische Notfall in der Onkologie. Fruhzeitige empirische Therapie mit Breitspektrumantibiotika und eskalierende diagnostische Masnahmen sind notwendig fur die erfolgreiche Therapie dieser Risikogruppe. In diesem Beitrag wird eine Reihe von lebensbedrohlichen Infektionen bei immunkompromittierten Patienten diskutiert.

Orbital varices represent a rare type of venous malformation composed of a single or multiple abnormally enlarged veins communicating to the systemic venous system. Clinical presentation is often nonspecific. Potential complications including intraorbital bleed and venous thrombosis may lead to a permanent visual loss. Multimodality imaging is important for proper interpretation and accurate diagnosis as well as timely management of the lesion. We report two acute cases of bilateral and unilateral partially thrombosed orbital varices in which the correct diagnosis was made based on an integrated imaging approach.

The structural integrity of the cornea and transparency are critical for normal vision. Corneal evaluation in ophthalmology and clinical research requires fast and user-friendly techniques allowing accurate diagnoses and follow-up of pathologies, injuries or surgery. Macroscopic irregularities in the anterior corneal surface are the main cause of irregular refractive vision problems. The microscopic and nanoscopic irregularities within the three-dimensional architecture of cornea are the cause of loss of optical transparency and scattering. In this review, the state of the art of the different corneal imaging techniques with three-dimensional capabilities will be detailed and discussed according to the descriptive level of analysis: macroscopic, microscopic and nanoscopic scales.

Background Adenanthera pavonina L. is an important medicinal plant and its barks are used in traditional medicine for treating different diseases. Therefore, a phytochemical investigation was carried out to isolate and identify secondary metabolites from its barks. Results Seven compounds namely ethyl 3,3-dimethyl-13-hydroxytridecanoate (1), stigmasta-5,22-dien-3β-ol (2), tert.butyl tridecanoate (3), 6-α-hydroxy stigmast-20(21)-en-3-one (4) of dichloromethane extract and 18-(2′, 3′-dihydroxyphenyl)nonadec-17-en-2-ol (5), 1-(N-propyl amino)-2-henecosanone (6), and stigmast–5(6), 20(21)-diene-3-one (7) were isolated from the barks of Adenanthera pavonina Linn. Of these compounds, 1, 4, 5, 6, and 7 appear new. The structures of these compounds were elucidated by spectroscopic techniques, mainly by NMR. Conclusions Five new and two known compounds have been isolated and characterized from the bark of A. pavonina. The isolated compounds could be a potential template for the synthesis and development of new lead compounds with interesting pharmacological properties. Graphical abstract

SummaryAs a rapidly progressing field in oncology, the adoptive transfer of T cells that have been genetically modified with chimeric antigen receptors (CARs) has shown striking efficacy in the management of hematological malignancies and has been reported in a number of clinical trials. Of note, CAR T cell therapy has shown extraordinary potential, especially in relapsed/refractory patients. However, there are still challenges regarding the further development of this strategy, spanning from engineering and manufacturing issues, to limited applications, to accompanying toxicities. In this review, we will summarize the general knowledge of this novel method, including receptor composition, applications, adverse events and challenges. Additionally, we will propose several comprehensive recommendations.

Remarkable progress has been achieved for prophylactic and therapeutic interventions against human immunodeficiency virus type I (HIV-1) through antiretroviral therapy. However, vaccine development has remained challenging. Recent discoveries in broadly neutralizing monoclonal antibodies (bNAbs) has led to the development of multiple novel vaccine approaches for inducing bNAbs-like antibody response. Structural and dynamic studies revealed several vulnerable sites and states of the HIV-1 envelop glycoprotein (Env) during infection. Our review aims to highlight these discoveries and rejuvenate our endeavor in HIV-1 vaccine design and development.

In schizophrenia, electroconvulsive therapy is most often given to improve the antipsychotic drug effect. Here, we address the potential function of electroconvulsive therapy’s early augmentation role in a woman suffering from schizophrenia with misidentification syndrome. Electroconvulsive therapy administration along with antipsychotic medication culminated in early remission.

Partizipation erhoht die Gesundheitskompetenz von Patientinnen und Patienten und verbessert deren Gesundheitsversorgung. Das Beispiel Diabeteszentrum Wienerberg.

Auricular pseudocysts are an uncommon, benign cystic lesion of the auricular cartilage that most commonly occur at the triangular fossa or scapha. Few reports of bilateral cases are present in the literature. Etiology of both unilateral and bilateral auricular pseudocysts is unknown. We report a case of bilateral auricular pseudocysts presenting synchronously in a 2-month-old female. Surgical deroofing with bolstering of the auricles led to an excellent aesthetic outcome with no evidence of recurrence, and we therefore recommend this treatment for the management of bilateral auricular pseudocysts.

Pulmonary embolism, a life-threatening cause for dyspnoea and hemodynamic compromise, is difficult to diagnose and is often missed because of non-specific clinical presentation. Point of care ultrasound can help in a quick diagnosis of pulmonary embolism. A 29-year-old lady who was admitted with dyspnoea and hemodynamic compromise. Point of care ultrasound helped us confirm the diagnosis of pulmonary embolism with choriocarcinoma. Point of care ultrasound helps to diagnose even very rare conditions like pulmonary embolism with choriocarcinoma at the bedside.

Purpose To determine the relationship between the genotypes of the TaqI polymorphism of VDR gene and the clinical forms of COVID-19 in Cuban patients. Methods TaqI polymorphism was determined by the PCR in 104 Cuban patients, who suffered different clinical forms of COVID-19. Results There was a greater possibility of presenting symptomatic forms [OR = 2.081, 95% CI: 0.243–17.842], even severe [OR = 1.200, 95% CI: 0.217–6.638], related to the tt genotype. Conclusion There are signs of association between the risk of developing COVID-19 and the genotypes of the TaqI polymorphism of the VDR gene in the studied Cuban patients.

Background The literature has always been controversial on the use of gonadotropin-releasing hormone agonists in preserving fertility in women of childbearing age after chemotherapy; thereby, in this article, we will be discussing its use in preserving fertility. Main body of abstract When it comes to preserving fertility, it is crucial to consider all available options in this topic due to its very sensitive nature, thereby we have found that while a lot of trials favor the use of gonadotropin-releasing hormone agonists, the lack of proper follow-up and long-term trials renders its use highly debatable, and since the longest follow-up trial showed non-significant results, it also opens the floor for debate on whether this short-term benefit is worth adding another drug to the regimen or not. Short conclusion As described in this review, while the use of gonadotropin-releasing hormone agonists is beneficial in a lot of studies, the lack of long-term reports still makes its use debatable, thereby more trials should be done.

Background Due to delay in obtaining approval from insurance institution, performing PCI after successful reperfusion using streptokinase was postponed for ˃24 h-1 week. The study was conducted to investigate safety and efficacy of such delay in comparison to the ideal guidelines of PCI (≤ 24 h) in 129 STEMI patients received streptokinase followed by PCI. Patients were divided into two groups: (group 1 = 57; early PCI ≤ 24 h.) and (group 2 = 72; late PCI > 24 h.). Results Primary end point was death, congestive heart failure and reinfarction up to 30 days. Secondary end point was TIMI flow p = 0.003). Conclusions The study suggests that relatively late PCI (> 24 h–1wk) after successful reperfusion using streptokinase in STEMI patients seems to be safe and effective in 30-day follow-up, provided that patients received DAPT and were subjected to close observation. The results seem safely applicable when we are forced to this choice; however lack of more investigations to this hypothesis is considered a limitation.

BackgroundCancer is a complex and most widespread disease and its prevalence is increasing worldwide, more in countries that are witnessing urbanization and rapid industrialization changes. Although tremendous progress has been made, the interest in targeting cancer has grown rapidly every year. This review underscores the importance of preventive and therapeutic strategies.Main textNatural products (NPs) from various sources including plants have always played a crucial role in cancer treatment. In this growing list, numerous unique secondary metabolites from marine sources have added and gaining attention and became potential players in drug discovery and development for various biomedical applications. Many NPs found in nature that normally contain both pharmacological and biological activity employed in pharmaceutical industry predominantly in anticancer pharmaceuticals because of their enormous range of structure entities with unique functional groups that attract and inspire for the creation of several new drug leads through synthetic chemistry. Although terrestrial medicinal plants have been the focus for the development of NPs, however, in the last three decades, marine origins that include invertebrates, plants, algae, and bacteria have unearthed numerous novel pharmaceutical compounds, generally referred as marine NPs and are evolving continuously as discipline in the molecular targeted drug discovery with the inclusion of advanced screening tools which revolutionized and became the component of antitumor modern research.ConclusionsThis comprehensive review summarizes some important and interesting pipeline marine NPs such as Salinosporamide A, Dolastatin derivatives, Aplidine/plitidepsin (Aplidin®) and Coibamide A, their anticancer properties and describes their mechanisms of action (MoA) with their efficacy and clinical potential as they have attracted interest for potential use in the treatment of various types of cancers.

Background Piperidine is an essential heterocyclic system and a pivotal cornerstone in the production of drugs. Piperidine byproducts showed several important pharmacophoric features and are being utilized in different therapeutic applications. Main text Piperidine derivatives are being utilized in different ways as anticancer, antiviral, antimalarial, antimicrobial, antifungal, antihypertension, analgesic, anti-inflammatory, anti-Alzheimer, antipsychotic and/or anticoagulant agents. Conclusions This review article sheds a light on the most recent studies proving the importance of piperidine nucleus in the field of drug discovery.

Although public engagement in research is increasingly popular, the involvement of citizens living in vulnerable circumstances is rarely realized. This narrative review aims to describe and critically analyse concerns and corresponding strategies, tools, and methods that could support the inclusion of these citizens in health research. The 40 studies that are included were thematically analysed using the socioecological model. Concerns originate most often on the intrapersonal level of the socioecological model, but concerns were also identified at institutional, community, and policy levels. It is thought-provoking that there is a lack of attention for the research and policy structure in which engagement practices are designed, implemented and evaluated. More research is needed to explore how these cultures could be changed in a way that promotes rather than restrains the engagement of citizens living in vulnerable circumstances in research and policymaking. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00306-w., Plain English summary Unfortunately, citizens living in vulnerable circumstances are seldom engaged in research or policymaking. Think of, citizens living in poverty, those with an ethnic minority background or citizens with mental health issues are often excluded. Their involvement is, however, crucial to prevent growing (health) inequalities. To support the engagement of people living in vulnerable circumstances we conducted a literature review. We looked for strategies, tools, and methods that could support the inclusion of these citizens in research or policymaking. In total, 40 studies were identified and analysed. The main finding is that strategies tools, and methods are always context depended. Researchers should always ask: What works for whom in which context? We, therefore, stress the importance of close collaboration with experienced owners and community based organisations from the start. Also, more attention should be paid to how engagement practices are designed, implemented and evaluated. Think of, strict deadlines which limit the time to build trust. Or low budgets that limit the options to create the right preconditions, think of recruitment and data collection in multiple languages. To make sure that not only the ‘usual suspects’ but also citizens living in vulnerable circumstance will be engaged attention is needed from advocacy groups, research funders and researchers. All these actors need to reflect more often on the question what they can do to change the current research and policymaking culture in such a way that it will support the engagement of citizens living in vulnerable circumstances. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00306-w.

Right heart thrombus (RHT) in transit is an uncommon condition associated with high mortality. Increased use of echocardiography has allowed an easier detection of RHT; however, there is no consensus about the most appropriate management of this critical situation. Therapeutic strategy should be decided according to patient’s haemodynamic parameters, clinical data, and bleeding risk. This paper, referring to the most current evidences, underlines the difficulty to establish the best therapeutic strategies in RHT among complex patients as there are no relevant guidelines. In some conditions, multidisciplinary management is the best way to find the most correct therapy despite the bad prognosis.

Emphysematous pyelonephritis (EPN) can be lethal and organ threatening if not recognized and treated promptly. We report a case of EPN presenting with extensive subcutaneous emphysema. A 42-year-old patient presented with severe sepsis and impending diabetic ketoacidosis. Investigations showed ruptured right EPN which resulted in pneumo-retroperitoneum, pneumo-mediastinum, and extensive subcutaneous emphysema. Emergency open retroperitoneal surgical drainage in addition to targeted antibiotics was started. Patient recovered well clinically and radiologically without a need for nephrectomy. Prompt diagnosis and timely treatment are of utmost importance. Clinical suspicion should be heightened in at-risk patients who present in sepsis state with a diagnosis of pyelonephritis or those who are not responding to the routine management of pyelonephritis.

Laparoscopic cholecystectomy (LC) is the gold standard operation for cholelithiasis. However, even in the best of hands, it always carries a chance of conversion to open procedure, morbidity, and mortality. Bile duct injury is the most widely documented complication of LC, and any patient with abdominal complaints after the procedure is usually suspected and investigated to be a bile duct injury unless proven otherwise. Such instances are a cause of much surgical angst, but on occasion, the “lucky” surgeon encounters rare but benign causes of post LC abdominal pain, and one such case is reported here.

Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic brain infection caused by the John Cunningham (JC) virus, the cardinal feature of which is typically multifocal demyelination. In April 2019, pembrolizumab was investigated as a treatment for PML. We describe a case of a patient with progressive multifocal leukoencephalopathy in an Irish tertiary hospital, who experienced clinical improvement following one course of pembrolizumab.

Endovascular treatment is currently the treatment of choice for many intracranial aneurysms. Based on a case report and literature review, we wish to call attention to a potential complication. Delayed coil migration is rare but can lead to stroke and needs to be known.

Background Herbal medicines and their preparations have been mostly used since from thousands of years in all developing and developed countries in the primary health care of society and community. Flavonoids are the class of polyphenolic compounds, which are mainly distributed throughout the plant kingdom. Quercetin is a flavonoid which shows major pharmacological activities and effectively used for the management and treatment of various diseases and disorders. Many herbal medicines and their formulations containing Quercetin are available in market and hence quality control of Quercetin in is very important and essential in manufacturing industries Main body of the abstract We have reviewed various scientific research published on quality control analysis and standardization of Quercetin in its isolated form, extract or any other herbal or polyherbal preparation. We have mainly focused on the spectroscopic and chromatographic methods for qualitative and quantitative analysis of Quercetin and they were comprehensively presented in the present review work. Short conclusion The present review concludes that the spectroscopic and chromatographic methods play great role in the quality control and standardization of Quercetin in its isolated form, extract and in its herbal and polyherbal preparation.

Background Till now, there is no universal agreement on the best management of women with unilateral blocked tube. The aim of this study was to evaluate the use of high dose letrozole in infertile women with one blocked tube. This prospective non-randomized study was conducted at a university-affiliated infertility unit. It included 15 women with one blocked tube (proximal or mid segmental block) with a period of 1–6 years of infertility. Letrozole (10 mg/day for 5 days) was prescribed for all of them for a maximum of three cycles. The primary outcome was Live birth rate. Results Nine out of the 15 women conceived (60%). Live birth rate was 53% (8/15). All women had a good response to this regimen. None complained of side effects of this dose. No multiple pregnancies and/or congenital anomalies were reported. Conclusions This preliminary report showed that treatment of infertile women, with unilateral tubal block, with high dose letrozole is effective. To our knowledge, this is the first report in the English literature on the use of high dose of letrozole in such cases.

Background Temperament is an important issue that must be taken into consideration when purchasing horses for leisure, racing, or even work in the fields. Those who work with horses have various opinions about the relationship between a horse’s body characteristics and its temperament, but few scientific papers on this issue have been published. The objective of this study was to clarify the relationships of horse temperament with sex, breed, age, and body characteristics to help purchasers when selecting a horse with the desired temperament. A web-based survey consisting of a 32-item questionnaire was used to clarify the associations of sex, breed, age, and body characteristics with a horse’s temperament. The owners of a total of 112 horses from different countries (Egypt, Jordan, Palestine, and Iraq) were recruited to fill in the questionnaire about their horses. Results The results showed statistically significant associations of sex and breed with temperament with 89.7% and 108.3%, respectively (p values p value 0.58). The results also clarified significant associations between body characteristics (color, head and body marks, leg marks, and whorls) and temperament (all chi-square p-values Conclusion Purchasers can predict a horse’s temperament from its sex, breed, and body characteristics, including coat color, body and leg marks, and whorls

Scientific collaboration has been a critical aspect of the development of all fields of science, particularly clinical medicine. It is well understood that myriads of benefits can be yielded by interdisciplinary and international collaboration. For instance, our rapidly growing knowledge on COVID-19 and vaccine development could not be attained without expanded collaborative activities. However, achieving fruitful results requires mastering specific tactics in collaborative efforts. These activities can enhance our knowledge, which ultimately benefits society. In addition to tackling the issue of the invisible border between different countries, institutes, and disciplines, the border between the scientific community and society needs to be addressed as well. International and transdisciplinary approaches can potentially be the best solution for bridging science and society. The Universal Scientific Education and Research Network (USERN) is a non-governmental, non-profit organization and network to promote professional, scientific research and education worldwide. The fifth annual congress of USERN was held in Tehran, Iran, in a hybrid manner on November 7-10, 2020, with key aims of bridging science to society and facilitating borderless science. Among speakers of the congress, a group of top scientists unanimously agreed on The USERN 2020 consensus, which is drafted with the goal of connecting society with scientific scholars and facilitating international and interdisciplinary scientific activities in all fields, including clinical medicine.

Background Recently reported cases of Covid-19 globally remind us that new diseases are coming while we are unable to provide the treatment for the same. The entire world is facing this viral attack; deaths are increasing day by day as well as infected patients too. Today, in the period of this disease, can we go to the shelter of our traditional medicines? Main body In this article, we have taken medicines related to corona and conceptualized their mechanism, which gave us a chance to understand Garlic's mechanism of action, how Garlic can be a weapon in the lane with this disease. This article also tells how we can treat new diseases with our traditional herbs if no modern medicine has been discovered yet. Conclusion The present review is based on the structure of the virus and the targeted site for the drug discovery process with important constituents of Allium sativam. The review work also explains the allicin chemical constituent of Allium sativam which has targeted therapeutic sites related to Covid-19.

Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19-associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly ( 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.