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Abstract Background The respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality. Aim This study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined. Methods In this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19. Result This study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value:

Ivy Cheng, Adeel Hamad, Ayodele Sasegbon, Shaheen Hamdy Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKCorrespondence: Shaheen Hamdy, Centre for Gastrointestinal Sciences, Salford Royal Foundation Trust, University of Manchester, Clinical Sciences Building, Eccles Old Road, Manchester, Salford, M6 8HD, UK, Email shaheen.hamdy@manchester.ac.ukAbstract: Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.Keywords: dysphagia, neuromodulation, pharmacology, rehabilitation, review, treatment

Porphyrin derivatives are known singlet oxygen sensitizers in photodynamic therapy (PDT). Energy transfer from a class of diolefinic laser dyes (DOLDs) as energy donors to the sodium salt of meso-tetrakis (4-sulfonatophenyl) porphyrin (TPPS) as the accepter of energy would extend the range of photon harvesting down to the UV-region. Energy transfer was substantially enhanced in the presence of metallic silver nanoparticles (AgNPs), as revealed by steady-state emission spectroscopy, lifetimes, and quantum mechanics. DOLDs under investigation are 2,5-distyrylpyrazine (DSP), 1,4-bis (β-pyridyl-2 vinyl) benzene (P2VB), and 1,4 bis (2-methylstyryl) benzene (MSB) as efficient donors of intense absorption in the UV-region. AgNPs enhance the rate of energy transfer from DOLDs to TPPS via bringing donor and acceptor into close- proximity with a concomitant increase in dipole–dipole interaction between excited state donor and ground-state acceptor. The DOLDs molecular structures were optimized using the DFT/CAM-B3LYP/6-311G++ (d, p) level of theory. The calculated electronic absorption spectra for the studied DOLDs in the gaseous phase and methanol solvent were studied using the time-dependent density functional theory (TD-DFT) at M06-2X/6-311G++ (2d,2p) level. The calculated absorption/emission spectra for DSP laser dye in methanol are obtained at the TD/ M06-2X/6-311G++(2d, 2p) method. Notably, all theoretical results of the molecular structures under study highly agreed with the practical optical results. Energy transfer rate constants (kET) amid energy donor/acceptor pairs were determined by Stern-Volmer constants (KSV) and donors' lifetime measurements. The KSV values indicate an enhanced Fluorescence Resonance Energy Transfer (FRET) efficiencies in the presence of negatively charged AgNPs. The critical transfer distances Ro were determined from the spectral overlap between the emission spectrum of donor and absorption spectrum of TTPS. These outcomes propose the application of designed metal-enhanced FRET for energy-transfer-based assays and photodynamic therapy (PDT) applications.

In the present paper, a one-step, simple, efficient and low-cost strategy was demonstrated for preparing of highly stable hybrid platinum-titania (Pt@TiO2) photocatalyst by solvothermal wet chemical process. Platinum (Pt) in the metallic form combined with titania (TiO2) in the crystallographic anatase form has been manufactured using Dimethyl Sulfoxide (DMSO) as a solvent and surfactant using titanium (IV) butoxide and hydrogen hexachloroplatinate(IV) precursors. Full characterization of the hybrid nanomaterials including their morphology, crystalline structure and optical properties was determinate using different experimental techniques such as XRD, TEM and UV–vis spectroscopy. TEM images showed spherically shaped Pt nanoparticles (NPs) of the diameter 5–10 nm with good particle size distribution. The EDXRF data revealed that Pt NPs are in metallic form. Optical investigation show that Pt@TiO2 NPs exhibits a good optical response under UV–vis light excitation compared to bare-TiO2. Furthermore, photocatalytic investigation of Pt@TiO2 colloids photocatalyst towards the photodegradation of diuron, as a model organic pesticide was reported. The hybrid Pt@TiO2 photocatalyst prove high-performance on the photodecomposition of the pesticide under solar light within only 60 min. In the other hand, the plasmonic hybrid Pt@TiO2 was incorporated into the cotton fabric to attain a modified fiber with high self-cleaning activity. Keywords: Solvothermal method, Nanocomposites, Semiconductors, Heterogenous catalysis, Cotton fiber, Self-cleaning

Domenico A Restivo,1 Shaheen Hamdy2 1Neurological Unit, Garibaldi Hospital, Catania, Italy; 2School of Translational Medicine—Inflammation Sciences, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, UK Abstract: Neurogenic dysphagia (ND) can occur in patients with nervous system diseases of varying etiologies. Moreover, recovery from ND is not guaranteed. The therapeutic approaches for oropharyngeal ND have drastically changed over the last decade, mainly due to a better knowledge of the neurophysiology of swallowing along with the progress of neuroimaging and neurophysiological studies. For this reason, it is a priority to develop a treatment that is repeatable, safe, and can be carried out at the bedside as well as for outpatients. Pharyngeal electrical stimulation (PES) is a novel rehabilitation treatment for ND. PES is carried out via location-specific intraluminal catheters that are introduced transnasally and enable clinicians to stimulate the pharynx directly. This technique has demonstrated increasingly promising evidence in improving swallowing performance in patients with ND associated with stroke and multiple sclerosis, probably by increasing the corticobulbar excitability and inducing cortical reorganization of swallowing motor cortex. In this article, we update the reader as to both the physiologic background and past and current studies of PES in an effort to highlight the clinical progress of this important technique. Keywords: pharyngeal electrical stimulation, swallowing, neurogenic dysphagia, swallowing motor cortex, pharynx, catheter

The molecular complexes between barbituric acid (BU) and chloranilic acid (ChA) over graphitic nitride (g-C3N4) are investigated. The molecular complexes and the nanocomposite were investigated both in solid state and in methanol. The solid complexes and the corresponding nanocomposite were investigated using FTIR, TGA, and UV-Vis spectroscopy. The structures were explored using DFT calculations using wB97XD/ and def2-TZVP basis set. The DFT calculations revealed the formation of hydrogen-bonded complexes, which initiate the proton transfer from ChA to BU. Immobilization of the BUChA complex over the g-C3N4 sheet was stabilized by weak non-covalent interactions, such as π–π interactions. g-C3N4 facilitated the charge transfer process, which is beneficial for different applications.

The agricultural use of organophosphorus pesticides is a widespread practice with significant advantages in crop health and product yield. An undesirable consequence is the contamination of soil and groundwater by these neurotoxins resulting from over application and run-off. Here, we design and synthesize the mononuclear zinc(II) complexes, namely, [Zn(AMB)2Cl](ClO4) 1 and [Zn(AMB)2(OH)](ClO4) 2 (AMB = 2-aminomethylbenzimidazole), as artificial catalysts inspired by phosphotriesterase (PTE) for the hydrolysis of organophosphorus compounds (OPs) and simultaneously detect the organophosphate pesticides such as fenitrothion and parathion. Spectral and DFT (B3LYP/Lanl2DZ) calculations revealed that complexes 1 and 2 have a square-pyramidal environment around zinc(II) centers with coordination chromophores of ZnN4Cl and ZnN4O, respectively. Both 1 and 2 were used as a modifier in the construction of a biomimetic sensor for the determination of toxic OPs, fenitrothion and parathion, in phosphate buffer by square wave voltammetry. The hydrolysis of OPs using 1 or 2 generates p-nitrophenol, which is subsequently oxidized at the surface of the modified carbon past electrode. The catalytic activity of 2 was higher than 1, which is attributed to the higher electronegativity of the former. The oxidation peak potentials of p-nitrophenol were obtained at +0.97 V (vs. Ag/AgCl) using cyclic voltammetry (CV) and +0.88 V (vs. Ag/AgCl) using square wave voltammetry. Several parameters were investigated to evaluate the performance of the biomimetic sensor obtained after the incorporation of zinc(II) complex 1 and 2 on a carbon paste electrode (CPE). The calibration curve showed a linear response ranging between 1.0 μM (0.29 ppm) and 5.5 μM (1.6 ppm) for fenitrothion and 1.0 μM (0.28 ppm) and 0.1 μM (0.028 ppm) for parathion with a limit of detection (LOD) of 0.08 μM (0.022 ppm) and 0.51 μM (0.149 ppm) for fenitrothion and parathion, respectively. The obtained results clearly demonstrated that the CPE modified by 1 and 2 has a remarkable electrocatalytic activity towards the hydrolysis of OPs under optimal conditions.

Rainer Wirth,1,2 Rainer Dziewas,3 Anne Marie Beck,4 Pere Clavé,5 Shaheen Hamdy,6 Hans Juergen Heppner,7,8 Susan Langmore,9 Andreas Herbert Leischker,10 Rosemary Martino,11 Petra Pluschinski,12 Alexander Rösler,13 Reza Shaker,14 Tobias Warnecke,3 Cornel Christian Sieber,2,15 Dorothee Volkert2 1Department for Internal Medicine and Geriatrics, St Marien-Hospital Borken, Borken, Germany; 2Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany; 3Department of Neurology, University Hospital Münster, Münster, Germany; 4Department of Nutrition and Health, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark; 5Centro de Investigación Biomédica en Red de enfermadades Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; 6Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Salford Royal Hospital, Salford, UK; 7Department of Geriatrics, Witten- Herdecke University, 8Helios Clinic Schwelm, Schwelm, Germany; 9Department of Speech, Language and Hearing Sciences, Boston University School of Medicine, Boston, MA, USA; 10Department of Geriatrics, Alexianer Hospital Krefeld, Krefeld, Germany; 11Department of Speech-Language Pathology, University of Toronto, Toronto, Canada; 12Department of Phoniatrics and Pediatric Audiology, University of Marburg, Marburg, Germany; 13Department of Geriatrics, Marien Hospital Hamburg, Hamburg, Germany; 14Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA; 15Department of General Internal Medicine and Geriatrics, St John of God Hospital Regensburg, Regensburg, Germany Abstract: Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies. Keywords: aspiration, dehydration, dysphagia, geriatric, malnutrition, older

In an effort to improve and achieve biologically active anticancer agents, a novel series of 1,2,3-triazole-containing hybrids were designed and efficiently synthesized via the Cu-catalyzed azide-alkyne cycloaddition (CuAAC) reaction of substituted-arylazides with alkyne-functionalized pyrazole-[1,2,4]-triazole hybrids. The structure geometry of these new clicked 1,2,3-triazoles was explored by density functional theory (DFT) using the B3LYP/6-311++G(d,p) level; also, the potential activity of the compounds for light absorption was simulated by time-dependent DFT calculations (TD-DFT). The antitumor impacts of the newly synthesized compounds were in vitro estimated to be towards the human liver cancer cell line (HepG-2), the human colon cancer cell line (HCT-116), and human breast adenocarcinoma (MCF-7). Among the tested compounds, conjugate 7 was the most potent cytotoxic candidate towards HepG-2, HCT-116, and MCF-7, with IC50 = 12.22, 14.16, and 14.64 µM, respectively, in comparison to that exhibited by the standard drug doxorubicin (IC50 = 11.21, 12.46, and 13.45 µM). Finally, a molecular docking study was conducted within the epidermal growth factor receptor (EGFR) active site to suggest possible binding modes. Hence, it could conceivably be hypothesized that analogies 7, 6, and 5 could be considered as decent lead candidate compounds for anticancer agents.