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Two years ago, coronavirus COVID-19 spread all over the world. This virus causes the death of many people. The main problem is the way to maintain healthy hand wash in the circumstance of physical touch to the bottle that causes infection. The purpose of this paper is to design and implement a movable touchless hand sanitizer dispenser mobile robot that identifies the human body by processing the images taken from the camera to estimate the distance between the mobile robot and the human. A microcontroller board which is used to control four DC motors. The all design shows better activity than the usual and manual fixed touchless hand sanitizer design because the movable one can move with an acceptable error to the patient or a healthy person anywhere, he found. People can be protected from any virus or germs by using this proposed design. The main contribution of this work that our design system is useful in Anti-Covid-19 application and the total method has been collected the use of image processing, mobile robot, sensor hardware design, and the overall algorithm that control the application work.

In vitro harnessing of immune cells is the most important advance in the field of cancer immunotherapy. Results shown in the current paper may be used to harness natural killer (NK) cells in vitro. It is observed that drugs used to treat multiple sclerosis such as glatiramer acetate, dimethyl fumarate and monomethyl fumarate up-regulate the expression of chemokines receptor 10 (CCR10) on the surface of human IL-2-activated NK cells. This is corroborated with increased chemotaxis of these cells towards the concentration gradients of the ligands for CCR10, namely CCL27 and CCL28. It is also demonstrated that these three drugs enhance NK cell cytotoxicity against tumor target cells, an activity that is abrogated by prior incubation of the cells with anti-CCR10 antibody. Because CCL27 and CCL28 are secreted by selective tumor types such as malignant melanoma, squamous cell carcinomas and colorectal cancer, respectively, it is hypothesized that activated NK cells may be harnessed in vitro with any of these drugs before utilizing them as a therapeutic modality for cancer.

Several drugs have been approved for treatment of multiple sclerosis. Dimethyl fumarate (DMF) is utilized as an oral drug to treat this disease and is proven to be potent with less side effects than several other drugs. On the other hand, monomethyl fumarate (MMF), a related compound has not been examined in greater details although it has the potential as a therapeutic drug for multiple sclerosis and other diseases. The mechanism of action of DMF or MMF is related to their ability to enhance the antioxidant pathways and to inhibit reactive oxygen species. However, other mechanisms have also been described which include effects on monocytes, dendritic cells, T cells, and natural killer cells. It is also reported that DMF might be useful for treating psoriasis, asthma, aggressive breast cancers, hematopoeitic tumors, inflammatory bowel disease, intracerebral hemorrhage, osteoarthritis, chronic pancreatitis, and retinal ischemia. In this article we will touch on some of these diseases with an emphasis on the effects of DMF and MMF on various immune cells.

Prolonged exposure to glucocorticoids (GC) disrupts neuronal architecture, hinders neuroplasticity, and triggers neuroinflammation. However, the precise underlying mechanisms have not been studied yet. The current study aimed to investigate the mechanisms of GC-induced neuroinflammatory effects by stimulating the miRNA let7b, aryl hydrocarbon receptor (AhR)/ARNT, HMGB1/RAGE, and other downstream targets. Rats were divided into 4 groups; control, GC (20 mg/kg, S.C.), 3,3'-diindolylmethane (DIM) 50 mg/kg/day, and donepezil (DNZ) 4 mg/kg/day for 21 days. Behavioral tests and histopathological investigations of cerebral cortex were done. Let7b, AhR, ARNT, and cytochrome A1A were estimated using qRT-PCR. HMGB1, RAGE, NQO1and NRF2 were estimated using ELISA, whereas GFAP and TNF-α by immunohistochemical analysis. Keap1 was estimated using Western technique. GSH and TBARS were assessed by colorimetric assay. In the current study, GC elevates the gene expressions of let7b, AhR, ARNT, and cytochrome A1A, along with the protein contents of HMGB1, RAGE, NQO1and NRF2. In addition, GC showed increased GFAP, TNF-α, and TBARS, together with decreased Keap1 and GSH. On the other side, DIM and DNZ reversed all the above-mentioned findings. Collectively, the study documents for the first time the effect of GC in upregulating let7b and activating the AhR/ARNT loop which subsequently stimulates RAGE/HMGB1 and NRF2/Keap1 cascade leading to stimulating further inflammatory and oxidative signaling pathways. Certainly, these effects are responsible for the behavioral fluctuations, the brain's histological disruption, altered neuroplasticity, and neuroinflammation induced by GC. Moreover, DIM conquers GC-induced neuroinflammation due to its characteristic role in modulating AhR and its downstream targets., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background/objectives: Controlling colonoscopic quality is important in the detection of colon polyps during colonoscopy as it reduces the overall long-term colorectal cancer risk. Artificial intelligence has recently been introduced in various medical fields. In this study, we aimed to validate a previously developed artificial intelligence (AI) computer-aided detection (CADe) algorithm called ALPHAON ® and compare outcomes with previous studies that showed that AI outperformed and assisted endoscopists of diverse levels of expertise in detecting colon polyps., Methods: We used the retrospective data of 500 still images, including 100 polyp images and 400 healthy colon images. In addition, we validated the CADe algorithm and compared its diagnostic performance with that of two expert endoscopists and six trainees from Gachon University Gil Medical Center. After a washing-out period of over 2 weeks, endoscopists performed polyp detection on the same dataset with the assistance of ALPHAON ® ., Results: The CADe algorithm presented a high capability in detecting colon polyps, with an accuracy of 0.97 (95% CI: 0.96 to 0.99), sensitivity of 0.91 (95% CI: 0.85 to 0.97), specificity of 0.99 (95% CI: 0.97 to 0.99), and AUC of 0.967. When evaluating and comparing the polyp detection ability of ALPHAON ® with that of endoscopists with different levels of expertise (regarding years of endoscopic experience), it was found that ALPHAON ® outperformed the experts in accuracy (0.97, 95% CI: 0.96 to 0.99), sensitivity (0.91, 95% CI: 0.85 to 0.97), and specificity (0.99, 95% CI: 0.97 to 0.99). After a washing-out period of over 2 weeks, the overall capability significantly improved for both experts and trainees with the assistance of ALPHAON ® ., Conclusions: The high performance of the CADe algorithm system in colon polyp detection during colonoscopy was verified. The sensitivity of ALPHAON ® led to it outperforming the experts, and it demonstrated the ability to enhance the polyp detection ability of both experts and trainees, which suggests a significant possibility of ALPHAON ® being able to provide endoscopic assistance.

An intricate relationship exists, and interactions occur between the gut microbiota and colorectal cancer (CRC). Recent studies have indicated that inflammatory reactions stimulated by Fusobacterium nucleatum ( Fn ) lead to the development of CRC. Radical surgery combined with adjuvant chemotherapy is the primary treatment approach for most CRC patients. This study was designed to evaluate the abundance of Fn as part of the gut microbiota in patients with CRC compared to healthy individuals and to assess the effect of the gut microbiota Fn on patients undergoing adjuvant chemotherapy and those experiencing CRC relapse. There were 201 participants, comprising 50 healthy controls and 151 CRC patients. Stool samples were collected from three CRC groups (postoperatively, chemotherapy and relapse), and the fourth was the healthy control group. The amount of Fn in each sample was analyzed using quantitative loop-mediated isothermal amplification-phenol red (QLAMP-PhR), a novel biomolecular method that targets regions encoding the specific Fn FadA gene. Compared with healthy control stool samples, the Fn levels were significantly elevated in all CRC patient groups ( P  < 0.001), and it was significantly more frequent in the CRC relapse patients (group C) ( P  < 0.001). In addition, Fn abundance increased significantly in the distal colon compared to the proximal colon ( P  < 0.001). Both CRC relapse and chemotherapy exert significant reciprocal effects on the gut microbiota Fn of CRC patients. Microbiota-based intervention may be beneficial for patients during postoperative care, especially in CRC relapsing cases. Registration : This study of the clinical trial has been registered in the ISRCTN registry with study registration number ISRCTN53358464. https://www.isrctn.com/ISRCTN53358464., Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-024-01279-6., Competing Interests: Conflict of interestThe authors have no relevant financial or nonfinancial interests to disclose., (© Association of Microbiologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background/objectives: Gastric cancer ranks fifth for incidence and fourth in the leading causes of mortality worldwide. In this study, we aimed to validate previously developed artificial intelligence (AI) computer-aided detection (CADe) algorithm, called ALPHAON ® in detecting gastric neoplasm., Methods: We used the retrospective data of 500 still images, including 5 benign gastric ulcers, 95 with gastric cancer, and 400 normal images. Thereby we validated the CADe algorithm measuring accuracy, sensitivity, and specificity with the result of receiver operating characteristic curves (ROC) and area under curve (AUC) in addition to comparing the diagnostic performance status of four expert endoscopists, four trainees, and four beginners from two university-affiliated hospitals with CADe algorithm. After a washing-out period of over 2 weeks, endoscopists performed gastric detection on the same dataset of the 500 endoscopic images again marked by ALPHAON ® ., Results: The CADe algorithm presented high validity in detecting gastric neoplasm with accuracy (0.88, 95% CI: 0.85 to 0.91), sensitivity (0.93, 95% CI: 0.88 to 0.98), specificity (0.87, 95% CI: 0.84 to 0.90), and AUC (0.962). After a washing-out period of over 2 weeks, overall validity improved in the trainee and beginner groups with the assistance of ALPHAON ® . Significant improvement was present, especially in the beginner group (accuracy 0.94 (0.93 to 0.96) p < 0.001, sensitivity 0.87 (0.82 to 0.92) p < 0.001, specificity 0.96 (0.95 to 0.97) p < 0.001)., Conclusions: The high validation performance state of the CADe algorithm system was verified. Also, ALPHAON ® has demonstrated its potential to serve as an endoscopic educator for beginners improving and making progress in sensitivity and specificity.

Introduction: Systemic lupus erythematosus (SLE) is a diverse autoimmune disease that arises from a combination of complex genetic factors and environmental influences. While circRNAs and miRNAs have recently been identified as promising biomarkers for disease diagnosis, their specific expression patterns, and clinical implications in SLE are not yet fully understood., Aim of the Work: The aim of the present study was to determine the role of a panel of noncoding-RNAs specifically circRNAs (circ-TubD1, circ-CDC27, and circ-Med14), along with miRNA (rno-miR-146a-5p) and mRNA (TRAF6), as novel minimally invasive diagnostic biomarkers for experimentally induced SLE. Additionally, the study involved an insilico bioinformatics analysis to explore potential pathways involved in the pathogenesis of SLE, aiming to enhance our understanding of the disease, enable early diagnosis, and facilitate improved treatment strategies., Materials and Methods: SLE was induced in rats using single IP injection of incomplete Freund's adjuvant (IFA). The Induction was confirmed by assessing the ANA and anti-ds DNA levels using ELSA technique. qPCR analysis was conducted to assess the expression of selected RNAs in sera collected from a group of 10 rats with induced SLE and a control group of 10 rats. In addition, bioinformatics and functional analysis were used to construct a circRNA-miRNA-mRNA network and to determine the potential function of these differentially expressed circRNAs., Results: SLE rats demonstrated significantly higher expression levels of circ-CDC27, circ-Med14, and rno-miR-146a-5p as well as TRAF6, with lower expression level of circ-TubD1 in sera of SLE rats relative to controls. ROC curve analysis indicated that all the selected non-coding RNAs could serve as potential early diagnostic markers for SLE. In addition, the expression level of circ-TubD1 was negatively correlated with rno-miR-146a-5p, however, rno-miR-146a-5p was positively correlated with TRAF6. Bioinformatic analysis revealed the incorporation of the circRNAs targeted genes in various immune system and neurodegeneration pathways., Conclusions: Therefore, circRNAs; circ-TubD1, circ-CDC27, and circ-Med14, in addition to the miRNA (rno-miR-146a-5p) and mRNA (TRAF6) may be involved in the development of SLE and may have promising roles for future diagnosis and targeted therapy., (© 2024 The Author(s).)

The study aimed to develop a quantitative colorimetric loop-mediated isothermal amplification technique using the phenol red indicator (QLAMP-PhR) for detecting Fusobacterium nucleatum (Fn) levels in colorectal cancer (CRC) patients and healthy individuals. QLAMP-PhR assays were conducted on 251 stool samples specific for the Fn FadA gene. Six primers were synthesized and utilized with master mix reagents, and a phenol red indicator was employed to enhance the QLAMP-PhR technique. A standard quantitative analysis curve was generated using a logarithmic function (absorbance vs. concentration) by serially diluting the copy number of genomic DNA templates (Fn ATCC25586). The CRC group exhibited a significantly higher abundance of Fn compared to the healthy control group (P < 0.001). These findings suggest that the QLAMP-PhR technique effectively identifies Fn specifically by its gene for the key virulence factor FadA. Additionally, ideas for developing a real-time QLAMP-PhR test were presented. Compared to the traditional polymerase chain reaction (PCR) technique, QLAMP-PhR offers several advantages including rapidity, simplicity, specificity, sensitivity, and cost-effectiveness method that can quantitatively screen for Fn presence in normal populations. The QLAMP-PhR method represents a sensitive and specific amplification assay for the rapid detection of the Fn pathogen. To the best of our knowledge, this study is the first to report the application of QLAMP-PhR for detecting FadA in Fn., (© 2024. The Author(s).)

Rural tourism has been widely recognized as a means of promoting the revival of traditional villages and has been supported by numerous researchers. It has the potential to provide significant social and economic advantages, making it a popular strategy for rural development in both developed and developing countries. Nevertheless, a growing body of research has substantiated the significant disruptions that rural tourism has imposed on traditional villages. This study employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) qualitative method to systematically analyze 92 papers from WOS and SCOPUS that investigate the impact of rural tourism on traditional villages. The papers were categorized into five groups: spatial, economic, sociocultural, and holistic. This categorization allowed for the identification of the purpose, theme, sub-topics, research methods, and data sources used in these papers, which in turn provided an overview of the characteristics and overall trends in research in this field. It compensates for the deficiencies of lesser reviews that just emphasize rural tourism as the primary catalyst for the sustainable development of traditional villages. Based on a thorough investigation, this paper asserts that the development of tourism in traditional villages should be differentiated from typical rural tourism sites that prioritize the preferences of tourists. The primary objective should be to prioritize the preservation of community values, with a strong emphasis on community participation. This should be done while considering the interests of various stakeholders and promoting a diverse range of livelihoods that are rooted in traditional practices. By doing so, the essence of authenticity in traditional villages can be reinforced, leading to a greater sense of connection and loyalty among tourists. The preservation of traditional village genes fosters a symbiotic relationship with rural tourism, resulting in a mutually beneficial cycle., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

The present work reported the synthesis of novel benzopyrimido[4,5- d ]azoninone analogs using a biosynthesized Ag-TiO 2 core/shell magnetic nanocatalyst. Accordingly, three-component one-pot reactions of benzoazonine-dione with thiourea and aryl aldehyde derivatives under nanocatalytic and optimized conditions afforded reasonable to brilliant yields of the target products (57-91%). The nanocatalyst was synthesized by a facile method using turmeric ethanol extract as a reducing and chelating agent. The synthesized nanocatalyst was verified by FT-IR, XRD, zeta potential, EDX, SEM, and TEM. The nanocatalyst presented remarkable catalytic activity for the synthesis of the target products. The procedure provided biosynthesis of the nanocatalyst, accessible reagents, high yields and rates of the reactions, nanocatalyst recyclability, and ease of product isolation and purification. The novel products were characterized by FT-IR, 1 H-NMR, 13 C-NMR, mass spectra, and 2D NMR analysis (COSY, NOESY, HMQC & HSQC) spectral analyses. The antioxidant activity was assessed by DPPH and phosphomolybdate assays, in which the compounds exhibited excellent potency. Overall, this approach could be used to develop new and sustainable methods for the synthesis of antioxidants and other biologically active molecules., Competing Interests: The authors assert no conflict of interest., (This journal is © The Royal Society of Chemistry.)

The preparation of poly (vinyl alcohol)/chitosan/ZnO (PVA/Cs/ZnO) nanocomposite films as bioactive nanocomposites was implemented through an environmentally friendly approach that included mixing, solution pouring, and solvent evaporation. The nanocomposite films were characterized using various techniques such as X-ray diffraction (XRD), Fourier-transform infrared (FT-IR) spectroscopy, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and UV-Vis spectroscopy. The XRD study revealed the encapsulation of nanoparticles by the PVA/Cs blend matrix. The DSC results showed that the addition of ZnO NPs increased glass transition and melting temperature values of the PVA/Cs blend. ATR-FTIR spectra detected an irregular shift (either red or blue) in some of the characteristic bands of the PVA/Cs nanocomposite, indicating the existence of intra/intermolecular hydrogen bonding creating an interaction between the OH groups of PVA/Cs and ZnO nanoparticles. A thermogravimetric (TGA) analysis demonstrated that the nanocomposites achieved better thermal resistance than a pure PVA/Cs blend and its thermal stability was enhanced with increasing concentration of ZnO nanoparticles. UV analysis showed that with an increase in the content of ZnO NPs, the optical bandgap of PVA/Cs was decreased from 4.43 eV to 3.55 eV and linear and nonlinear parameters were enhanced. Our optical results suggest the use of PVA/Cs/ZnO nanocomposite films for various optoelectronics applications. PVA/Cs/ZnO nanocomposites exhibited significant antibacterial activity against Gram-positive and Gram-negative bacteria. It was found that nanocomposite samples were more effective against Gram-positive compared to Gram-negative bacteria.

Acute compartment syndrome is a surgical emergency that, if unrecognised, leads to tissue and muscle ischaemia, necrosis, multi-organ failure and even death. Gluteal compartment syndrome is a rare type of compartment syndrome that typically occurs as a sequela of trauma, and its presentation may be difficult to recognise. We describe a case of a patient who developed gluteal compartment syndrome following a prolonged renal surgery in lateral decubitus position. Our case report aims to raise clinicians' awareness to consideration of this rare syndrome in patients presenting with lower extremity or back pain after prolonged surgery.

White, green, and oolong teas are produced from the tea plant ( Camellia sinensis (L.) Kuntze) and are reported to have anti-obesity and hypolipidemic effects. The current study aims to investigate the anti-obesity effects of a tea mixture nano-formulation by targeting the AMPK/Sirt-1/GLUT-4 axis in rats. In vitro lipase and α -amylase inhibition assays were used to determine the active sample, which was then incorporated into a nanoparticle formulation subjected to in vivo anti-obesity testing in rats by measuring the expression level of different genes implicated in adipogenesis and inflammation using qRT-PCR. Moreover, metabolomic analysis was performed for each tea extract using LC/ESI MS/MS coupled to chemometrics in an attempt to find a correlation between the constituents of the extracts and their biological activity. The in vitro pancreatic lipase and α -amylase inhibition assays demonstrated more effective activity in the tea mixture than the standards, orlistat and acarbose, respectively, and each tea alone. Thus, the herbal tea mixture and its nanoparticle formulation were evaluated for their in vivo anti-obesity activity. Intriguingly, the tea mixture significantly decreased the serum levels of glucose and triglycerides and increased the mRNA expression of GLUT-4, P-AMPK, Sirt-1, and PPAR-γ, which induce lipolysis while also decreasing the mRNA expression of TNF-α and ADD1/SREBP-1c, thereby inhibiting the inflammation associated with obesity. Our study suggests that the tea mixture nano-formulation is a promising therapeutic agent in the treatment of obesity and may also be beneficial in other metabolic disorders by targeting the AMPK/Sirt-1/Glut-4 pathway.

The present study was carried out to explore the possible role of kinetin and gibberellic acid (GA3) on faba bean under chromium (Cr) stress. Cr treatment negatively affected growth and biomass production, reduced photosynthetic pigments, and inhibited photosynthesis, gas exchange parameters, antioxidant enzymes, and the glyoxylase cycle. Moreover, Cr stress enhanced the production of malondialdehyde (MDA, 216.11%) and hydrogen peroxide (H 2 O 2 , 230.16%), electrolyte leakage (EL, 293.30%), and the accumulation of proline and glycine betaine. Exogenous application of kinetin and GA3 increased growth and biomass, improved pigment contents and photosynthesis, as well as up-regulated the antioxidant system by improving the antioxidant enzyme activities and the content of nonenzymatic components, and the glyoxylase cycle. Additionally, kinetin and GA3 application displayed a considerable enhancement in proline (602.61%) and glycine betaine (423.72), which help the plants to maintain water balance under stress. Furthermore, a decline in Cr uptake was also observed due to kinetin and GA3 application. Exogenous application of kinetin and GA3 ameliorated the toxic effects of Cr in faba bean plants, up-shooting the tolerance mechanisms, including osmolyte metabolism and the antioxidant system.

Agricultural crops are facing major restraints with the rapid augmentation of global warming, salt being a major factor affecting productivity. Tomato ( Solanum lycopersicum ) plant has immense nutritional significance; however, it can be negatively influenced by salinity stress. Nanoparticles (NPs) have excellent properties, due to which these particles are used in agriculture to enhance various growth parameters even in the presence of abiotic stresses. The objective of this study was to investigate the effects of silicon NPs (Si-NPs) through root dipping and foliar spray on tomato in the presence/absence of salt stress. Plant root and leaf were used for the measurements of morphological, physiological, and biochemical parameters treated with Si-NPs under salt stress. At 45 days after sowing, the activity of antioxidant enzymes, photosynthesis, mineral concentration, chlorophyll index, and growth attributes of tomato plants were measured. The developmental processes of tomato plants were severely slowed down by salt stress upto 35.8% (shoot dry mass), 44.3% (root dry mass), 51% (shoot length), and 62% (root length), but this reduction was mitigated by the treatment of Si-NPs. Application of Si-NPs significantly increased the growth attributes (height and dry weight), mineral content [magnesium (Mg), potassium (K), copper (Cu), iron (Fe), manganese (Mn), zinc (Zn)], photosynthesis [net photosynthetic rate ( P N ), stomatal conductance (gs), transpiration rate ( E ), internal CO 2 concentration (Ci)], and activity of antioxidative enzymes including superoxide dismutase and catalase in salt stress. Foliar application of Si-NPs in tomato plants appears to be more effective over root dipping and alleviates the salt stress by increasing the plant's antioxidant enzyme activity., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

An efficient and environmentally friendly method was established for designing novel 3-amino-1,4-dihydroquinoxaline-2-carbonitrile ( 1 ) via the reaction of bromomalononitrile and benzene-1,2-diamine under microwave irradiation in an excellent yield (93%). This targeted amino derivative was utilized for the construction of a series of Schiff bases ( 8 - 13 ). A new series of thiazolidinone derivatives ( 15 - 20 ) were synthesized in high yields (89-96%) via treatment of thioglycolic acid with Schiff bases ( 8 - 13 ) under microwave irradiation in high yields (89-96%). Moreover, new pyrimidine derivatives ( 26 - 30 and 35 - 38 ) were prepared by treatment of compound 1 with arylidenes ( 21 - 25 ) and/or alkylidenemalononitriles ( 31 - 34 ) using piperidine as a basic catalyst under microwave conditions. Based on elemental analyses and spectral data, the structures of the new assembled compounds were determined. The newly synthesized quinoxaline derivatives were screened and studied as an insecticidal agent against Aphis craccivora . The obtained results indicate that compound 16 is the most toxicological agent against nymphs of cowpea aphids ( Aphis craccivora ) compared to the other synthesized pyrimidine and thiazolidinone derivatives. The molecular docking study of the new quinoxaline derivatives registered that compound 16 had the highest binding score (-10.54 kcal/mol) and the thiazolidinone moiety formed hydrogen bonds with Trp143., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

Previous case reports have described patients with COVID-19-associated autoimmune hemolytic anemia (AIHA), and cold agglutinin disease (CAD) which is characterized by a positive direct antiglobulin (DAT) or "Coombs" test, yet the mechanism is not well understood. To investigate the significance of Coombs test reactivity among COVID-19 patients, we conducted a retrospective study on hospitalized COVID-19 patients treated at NMC Royal Hospital between 15 April and 30 May 2020. There were 27 (20%) patients in the Coombs-positive group and 108 (80%) in the Coombs-negative group. The cold agglutinin titer was examined in 22 patients due to symptoms suggestive of cold agglutinin disease, and all tested negative. We demonstrated a significant association with reactive Coombs test results in univariate analysis through clinical findings such as ICU admission rate, the severity of COVID-19, and several laboratory findings such as CRP, D-dimer, and hemoglobin levels lactate dehydrogenase, and RDW-CV. However, only hemoglobin levels and disease severity had a statistically significant association in multivariate analysis. A possible explanation of COVID-19-associated positive Coombs is cytokine storm-induced hyperinflammation, complement system activation, alterations of RBCs, binding of SARS-CoV-2 proteins to hemoglobin or its metabolites, and autoantibody production. Coombs-positive patients were tested for hemolysis using indirect bilirubin, consumed haptoglobin, and/or peripheral smear that ruled out any evidence of hemolysis. Understanding this etiology sheds new light on RBC involvement as a pathophysiological target for SARS-CoV-2 by interfering with their function; consequently, therapies capable of restoring RBC function, such as erythrocytapheresis, could be repurposed for the treatment of worsening severe and critical COVID-19., (Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Background: Neonatal lung disease has a multifaceted etiopathology, including an explosive inflammatory sequence in the immature lung. Complement component 1 Esterase INHibitor (C1INH) is implicated in controlling inflammation in response to infection/injury., Aim: To explore for the first time the association of the C1INH rs4926 (Val480Met) variant and circulatory transcript expression levels in the neonates that had evidence of lung disease and the clinic-laboratory data., Methods: A total of 139 unrelated neonates were enrolled in this case-control study. C1INH genotyping and expression analyses were done using TaqMan Genotyping and Real-Time qPCR, respectively., Results: A/A genotype carriers were two times more likely to develop in newborns with lung disease under homozygote (A/A vs. G/G: OR = 2.66, 95%CI = 1.03-6.87, p = 0.039) and recessive (A/A vs. G/G-A/G: OR = 2.42, 95%CI = 1.07-6.06, p = 0.047) models. Also, a higher frequency of A/A genotype was observed in the patient's cohort complicated with sepsis (44.2 vs. 14.3%, p = 0.002). Neonates with lung disease with A variant had more risk for developing sepsis under homozygote (A/A vs. G/G: OR = 5.19, 95%CI = 1.73-15.6, p = 0.002), dominant (A/G-A/A vs. G/G: OR = 2.39, 95%CI = 1.02-5.58, p = 0.041), and recessive (A/A vs. G/G-A/G: OR = 5.38, 95%CI = 1.86-15.5, p < 0.001) models. Regression analysis revealed rs4926 * A/A genotype as an independent predictor risk factor for sepsis development in cohorts with lung disease (adjusted OR = 4.26, 95%CI = 1.38-13.1, p = 0.012). The circulatory transcript was significantly downregulated in neonates with lung disease in whom rs4926 * A/A carriers had the least expression levels (median: -2.86, IQR: -3.55 to -1.71; p < 0.001). ROC curve analysis revealed C1INH expression could differentiate between cohorts with/without subsequent development of sepsis, and the discrimination ability was enhanced when combined with circulatory IL-6 and CRP levels (AUC = 0.926, 95%CI = 0.87-0.97)., Conclusion: The C1INH rs4926 variant might play an essential role in the susceptibility to neonatal lung disease and could predict sepsis development in this cohort. Furthermore, the circulatory expression levels of this gene were downregulated in the neonatal lung disease cohort, supporting its potential role in the pathophysiology of this disorder, and highlighting its promising role in future targeted therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Elngar, Azzam, Gobarah, Toraih, Fawzy and AbdAllah.)

Background: Low ADAMTS13 activity has been suggested to be an interplaying factor in the pathogenesis of COVID-19, considering that it is a thromboinflammatory disease with high risk of microthrombosis., Objectives: The study aimed to explore the correlation between ADAMTS13 activity and the pathophysiological pathway of COVID-19., Methods: We carried out a retrospective observational study of 87 patients with COVID-19 in NMC Royal Hospital, Abu Dhabi, UAE. ADAMTS13 activity was measured and compared with patients' characteristics and clinical outcomes., Results: Low ADAMTS13 activity was associated with pneumonia (p = 0.007), severity of COVID-19 (p <0.001), and mechanical ventilation rates (p = 0.018). Death was more frequently observed among patients (5 patients) with low ADAMTS13 activity compared with normal activity (1 patient), as well as inflammatory markers. Decreased ADAMTS13 activity increased with the risk of pneumonia, severity of COVID-19, need for mechanical ventilation, and use of anticoagulants ([OR = 4.75, 95% CI 1.54-18.02, p = 0.011], [OR = 6.50, 95% CI 2.57-17.74; p <0.001], [OR = 4.10, 95% CI 1.29-15.82; p = 0.024], [OR = 8.00, 95% CI 3.13-22.16; p <0.001], respectively). The low ADAMTS13 activity group had a slightly longer time to viral clearance than the normal ADAMTS13 activity group, but it was not statistically significant (20 days, 95% CI 16-27 days vs 17 days, 95% CI 13-22 days; p = 0.08; Log rank = 3.1)., Conclusions: Low ADAMTS13 activity has been linked to pneumonia, COVID-19 severity, use of anticoagulants, and need for mechanical ventilation but not to mortality. We propose rADAMTS13 as a novel treatment for severe COVID-19., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

(1) Background: Severe COVID-19 outcomes are associated with cytokine release syndrome, characterized by the release of several immune modulators, including Interleukin-6 (IL-6). Tocilizumab (TCZ) is an IL-6 receptor antagonist used to treat rheumatic arthritis. The study aimed to evaluate the efficacy and safety of TCZ against COVID-19. (2) Methods: This was a retrospective study including 49 severe COVID-19 patients who received TCZ therapy in NMC Royal Hospital, UAE. (3) Results: Before Tocilizumab administration, the median temperature was 37.0 (IQR 36.0-39.6), and after day seven, the median reduced to 36.5 (IQR 35.8-37.9), p > 0.001. Thirty (61.2%) patients were admitted to the ICU, of which, eight (16.3%) were on WHO scale 4, sixteen (32.6%) on scale 5, and six (20.0%) on scale 6. TCZ reduced inflammatory markers over time, including CRP, D-Dimer, Ferritin, and Fibrinogen. By the end of week seven, 14 patients died (28.6%) while 35 (71.4%) improved and were discharged. (4) Conclusions: The study showed limited improvements in COVID-19 outcomes with TCZ therapy and highlighted the importance of D-Dimer monitoring for possible risk of thrombosis. Additionally, it could be recommended to upgrade the anti-coagulation dose to therapeutic levels once TCZ therapy is decided upon.

The interplay between the compositional changes in the gastrointestinal microbiome, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) susceptibility and severity, and host functions is complex and yet to be fully understood. This study performed 16S rRNA gene-based microbial profiling of 143 subjects. We observed structural and compositional alterations in the gut microbiota of the SARS-CoV-2-infected group in comparison to non-infected controls. The gut microbiota composition of the SARS-CoV-2-infected individuals showed an increase in anti-inflammatory bacteria such as Faecalibacterium ( p -value = 1.72 × 10 -6 ) and Bacteroides ( p -value = 5.67 × 10 -8 ). We also revealed a higher relative abundance of the highly beneficial butyrate producers such as Anaerostipes ( p -value = 1.75 × 10 -230 ), Lachnospiraceae ( p -value = 7.14 × 10 -65 ), and Blautia ( p -value = 9.22 × 10 -18 ) in the SARS-CoV-2-infected group in comparison to the control group. Moreover, phylogenetic investigation of communities by reconstructing unobserved state (PICRUSt) functional prediction analysis of the 16S rRNA gene abundance data showed substantial differences in the enrichment of metabolic pathways such as lipid, amino acid, carbohydrate, and xenobiotic metabolism, in comparison between both groups. We discovered an enrichment of linoleic acid, ether lipid, glycerolipid, and glycerophospholipid metabolism in the SARS-CoV-2-infected group, suggesting a link to SARS-CoV-2 entry and replication in host cells. We estimate the major contributing genera to the four pathways to be Parabacteroides , Streptococcus , Dorea , and Blautia , respectively. The identified differences provide a new insight to enrich our understanding of SARS-CoV-2-related changes in gut microbiota, their metabolic capabilities, and potential screening biomarkers linked to COVID-19 disease severity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Al Bataineh, Henschel, Mousa, Daou, Waasia, Kannout, Khalili, Kayasseh, Alkhajeh, Uddin, Alkaabi, Tay, Feng, Yousef and Alsafar.)

Purpose: Transcranial Doppler (TCD) ultrasound is a non-invasive monitor of cerebral blood velocity that can be used intraoperatively. The purpose of this report is to describe how different patterns seen on TCD can help identify the cause of cerebral desaturation when near-infrared spectroscopy (NIRS) oximetry is used concomitantly., Clinical Features: A 69-yr-old male patient undergoing coronary revascularisation and aortic valve replacement developed perioperative complications that were detected using a combination of transtemporal TCD of the middle cerebral artery along with cerebral and somatic NIRS. Initial brain desaturation was secondary to hypocapnia during which TCD-derived blood velocity and somatic NIRS values remained unchanged. After the procedure, a second episode of brain desaturation occurred secondary to a technical issue with the aortic valve prosthesis requiring a return to cardiopulmonary bypass (CPB); there were no high-intensity transient signals (HITS) on TCD. Brain desaturation occurred a third time following the second attempt to separate from CPB at which time TCD detected a significant amount of HITS suggesting air emboli that were associated with acute right ventricular dysfunction; there was also a reduction in somatic NIRS., Conclusions: Combining TCD with cerebral NIRS allows for the rapid identification of three different mechanisms of brain desaturation. An algorithm is proposed to help identify the origin of NIRS cerebral desaturation. Prospective clinical trials are needed to investigate potential benefits of multimodal brain monitoring and its impact on short and/or long-term clinical outcomes.

Background: In the context of a new but busy Pediatric Emergency Department, the risk of missing patients who need more emergent care can be reduced by timely and accurate triaging. In the emergency department of King Fahad Armed Forces Hospital, the Canadian Triage and Acuity Scale had already been implemented, including the pediatric version (PaedCTAS). However, a common observation remained that critical patients did not always receive priority with subsequent delays in management. To improve this accuracy, a training course was administered to health care professionals responsible for triaging of pediatric patients., Aim: To determine the effectiveness of a training course on accuracy of triaging of Pediatric Patients., Methods: A triage training course was conducted over two months, with patient encounter sheets reviewed before the course for 6 months and after the course for 12 months. Accuracy was calculated by comparing it to level as determined by two pediatric emergency physicians. Also, admission rates were used as a surrogate marker to also determine accuracy., Results: A total of 31 053 patient sheets were reviewed. There was a considerable improvement in the correct determination of all triage levels, with accuracy ranging from 56.5% to 78.3% before the course, and reaching from 79.1% to 90.8% after the course with a statistically significant difference. Triaging errors still present were mainly in the form of down-triage., Conclusion: Our training course in triage has a significant impact on the accuracy of triaging of ill pediatric patients. Further improvement can be obtained by repeated courses and direct feedback with debriefing sessions on challenges to triage level determination., (Copyright: © 2019 Mona A. Azzam, Enas F. Elngar, Ayman A. Gobarah.)

Circulating miRNAs have recently emerged as attractive candidates for biomarker discovery. However, they have a variant distribution in circulation, and the diagnostic significance of their compartmentalization is yet to be elucidated. This study explored the time-course expression profile and the diagnostic potential of miRNAs-122a-5p, 192-5p, 193a-3p and 194-5p in exosomal and total serum compartments in two rat models of acute liver injury (ALI) 1 . Exosomes were isolated and characterized in terms of morphology, size and CD-63 surface marker expression. Exosomal, serum and hepatic miRNAs were quantified using q-RT-PCR. An inverse expression pattern of hepatic and total serum miRNAs was observed following acetaminophen or thioacetamide-induced liver injury. Conversely, exosomal miRNAs expression pattern varied according to the type of injury. Overall, ROC analysis revealed superior discriminatory ability of exosomal miRNA-122a-5p following either acetaminophen or thioacetamide injury with earlier diagnostic potential and a wider diagnostic window compared to the corresponding total serum counterpart. Moreover, exosomal miRNAs showed higher correlation with ALT activity in both models. In conclusion, exosomal miRNA-122a-5p shows higher diagnostic performance with a broader diagnostic time window and an earlier diagnostic potential than its serum counterpart in ALI. Furthermore, exosomal miRNAs-122a-5p, 192-5p and 193a-3p exhibit an injury-specific signature in ALI and can be used not only as diagnostic tools in liver injury but also to differentiate between different etiologies of injury., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The primary aim of this study was to establish whether or not embryonic hypoxia selectively affects the growth of specific organs. Chicken embryos were incubated either in normoxia (Nx) or in hypoxia (15% O2 from embryonic day E5, Hx). The length of the beak and third toe (as indexes of skeletal growth) and the weights of internal organs (eyes, brain, heart, lungs, liver, kidneys, stomach, and intestines) were collected at E14, E17, E19, and E20. Hypoxia reduced embryonic body weight (BW). At any given age, the specific weight (organ weight/BW) of some organs in Hx was higher, and that of others was lower, than in Nx. However, almost all differences disappeared when organ weights were compared as function of BW, rather than at fixed chronological ages. The important exception was the chorioallantoic membrane (CAM), the mass of which in Hx developed out of proportion. In a third group of embryos, hypoxic until E14 and normoxic thereafter, there was no post-hypoxic catch-up growth, differently from what known to occur postnatally. A possible interpretation is that catch-up growth does not depend on the age of the embryo but on its BW. In conclusion, at least in the chicken embryo and for the level of hypoxia tested, hypoxia has no selective effects on the growth of specific organs, except for the CAM. Qualitative differences in the weight response to hypoxia among organs observed at any given age can be explained largely by the effects of the blunted growth on the growth trajectory of the individual organs.

We asked to what extent sustained hypoxia during embryonic growth might interfere with the normal development of thermogenesis. White Leghorn chicken eggs were incubated at 38 degrees C either in normoxia (Nx, 21% O2) or in hypoxia [Hx, 15% O2, from embryonic day 5 (E5) until hatching]. The Hx embryos had lower body weight (W) throughout incubation, and hatching was delayed by about 10 h. For both groups, all measurements were conducted in normoxia. At embryonic day E11, the static temperature-oxygen consumption (ambient T-Vo2) curve was typically ectothermic (Q10 = 1.92-1.94) and similar between Nx and Hx. Toward the end of incubation (E20), the Q10 averaged 1.41 +/- 0.06 in Nx and 1.79 +/- 0.08 in Hx (P < 0.005), indicating that the onset of the thermogenic response in Hx lagged behind Nx. In the 1-day-old hatchlings (H1), body weight did not significantly differ between Nx and Hx. At H1, the T-Vo2 curves were endothermic-type, and more so in the older (>8 h old) than in the newly hatched (<8 h old) chicks, whether examined statically or dynamically as a function of time. In either case, the thermogenic responses of Hx were lower than those of Nx. In a 43-31 degrees C thermocline, the preferred T of the Hx hatchlings was around 37.3 degrees C, and similar to Nx, suggesting a similar setpoint for thermoregulation. We conclude that hypoxic incubation blunted the development of thermogenesis. This could be interpreted as an example of epigenetic regulation, in which an environmental perturbation during early development alters the phenotypic expression of a regulatory system.

The relationship between nephritogenic strains of group A beta-hemolytic streptococci (GABS) and acute poststreptococcal glomerulonephritis (APSGN) is well established. Recent studies have cast some doubts on the importance of the M-antigen which is widely used in classifying the nephritogenic strains of GABS. The renal injury occurs as a result of an immune-mediated process which involves the complement system. This leads to deposition of circulating immune complexes and/or their in-situ formation in the kidney resulting in renal damage. Newer antigenic fractions have been identified in GABS, which include; endostreptocin (ESS), nephritis strain associated protein (NSAP), and pre-absorbing antigen (Pa-Ag). These developments have allowed a better insight into the pathogenesis of APSGN.