Optimal Treatment of Tumor in Upper Human Respiratory Tract Using Microaerosols.

Lung cancer is a frequently diagnosed respiratory disease caused by particulate matter in the environment, especially among older individuals. For its effective treatment, a promising approach involves administering drug particles through the inhalation route. Multiple studies have investigated the flow behavior of inhaled particles in the respiratory airways of healthy patients. However, the existing literature lacks studies on the precise understanding of the transportation and deposition (TD) of inhaled particles through age-specific, unhealthy respiratory tracts containing a tumor, which can potentially optimize lung cancer treatment. This study aims to investigate the TD of inhaled drug particles within a tumorous, age-specific human respiratory tract. The computational model reports that drug particles within the size range of 5-10 µm are inclined to deposit more on the tumor located in the upper airways of a 70-year-old lung. Conversely, for individuals aged 50 and 60 years, an optimal particle size range for achieving the highest degree of particle deposition onto upper airway tumor falls within the 11-20 µm range. Flow disturbances are found to be at a maximum in the airway downstream of the tumor. Additionally, the impact of varying inhalation flow rates on particle TD is examined. The obtained patterns of airflow distribution and deposition efficiency on the tumor wall for different ages and tumor locations in the upper tracheobronchial airways would be beneficial for developing an efficient and targeted drug delivery system.

MonkeyNet: A robust deep convolutional neural network for monkeypox disease detection and classification.

The monkeypox virus poses a new pandemic threat while we are still recovering from COVID-19. Despite the fact that monkeypox is not as lethal and contagious as COVID-19, new patient cases are recorded every day. If preparations are not made, a global pandemic is likely. Deep learning (DL) techniques are now showing promise in medical imaging for figuring out what diseases a person has. The monkeypox virus-infected human skin and the region of the skin can be used to diagnose the monkeypox early because an image has been used to learn more about the disease. But there is still no reliable Monkeypox database that is available to the public that can be used to train and test DL models. As a result, it is essential to collect images of monkeypox patients. The "MSID" dataset, short form of "Monkeypox Skin Images Dataset", which was developed for this research, is free to use and can be downloaded from the Mendeley Data database by anyone who wants to use it. DL models can be built and used with more confidence using the images in this dataset. These images come from a variety of open-source and online sources and can be used for research purposes without any restrictions. Furthermore, we proposed and evaluated a modified DenseNet-201 deep learning-based CNN model named MonkeyNet. Using the original and augmented datasets, this study suggested a deep convolutional neural network that was able to correctly identify monkeypox disease with an accuracy of 93.19% and 98.91% respectively. This implementation also shows the Grad-CAM which indicates the level of the model's effectiveness and identifies the infected regions in each class image, which will help the clinicians. The proposed model will also help doctors make accurate early diagnoses of monkeypox disease and protect against the spread of the disease.

Nanoparticle transport and deposition in a heterogeneous human lung airway tree: An efficient one path model for CFD simulations.

Understanding nano-particle inhalation in human lung airways helps targeted drug delivery for treating lung diseases. A wide range of numerical models have been developed to analyse nano-particle transport and deposition (TD) in different parts of airways. However, a precise understanding of nano-particle TD in large-scale airways is still unavailable in the literature. This study developed an efficient one-path numerical model for simulating nano-particle TD in large-scale lung airway models. This first-ever one-path numerical approach simulates airflow and nano-particle TD in generations 0-11 of the human lung, accounting for 93% of the whole airway length. The one-path model enables the simulation of particle TD in many generations of airways with an affordable time. The particle TD of 5 nm, 10 nm and 20 nm particles is simulated at inhalation flow rates for two different physical activities: resting and moderate activity. It is found that particle deposition efficiency of 5 nm particles is 28.94% higher than 20 nm particles because of the higher dispersion capacity. It is further proved that the diffusion mechanism dominates the particle TD in generations 0-11. The deposition efficiency decreases with the increase of generation number irrespective of the flow rate and particle size. The effects of the particle size and flow rate on the escaping rate of each generation are opposite to the corresponding effects on the deposition rate. The quantified deposition and escaping rates at generations 0-11 provide valuable guidelines for drug delivery in human lungs.

Design optimization of a magnesium-based metal hydride hydrogen energy storage system.

Metal hydrides (MH) are known as one of the most suitable material groups for hydrogen energy storage because of their large hydrogen storage capacity, low operating pressure, and high safety. However, their slow hydrogen absorption kinetics significantly decreases storage performance. Faster heat removal from MH storage can play an essential role to enhance its hydrogen absorption rate, resulting in better storage performance. In this regard, the present study aims to improve heat transfer performance to positively impact the hydrogen absorption rate of MH storage systems. A novel semi-cylindrical coil is first designed and optimized for hydrogen storage and embedded as an internal heat exchanger with air as the heat transfer fluid (HTF). The effect of novel heat exchanger configurations is analyzed and compared with normal helical coil geometry, based on various pitch sizes. Furthermore, the operating parameters of MH storage and HTF are numerically investigated to obtain optimal values. ANSYS Fluent 2020 R2 is utilized for the numerical simulations. Results from this study demonstrate that MH storage performance is significantly improved by using a semi-cylindrical coil heat exchanger (SCHE). The hydrogen absorption duration reduces by 59% compared to a normal helical coil heat exchanger. The lowest coil pitch from SCHE leads to a 61% reduction of the absorption time. In terms of operating parameters for the MH storage with SCHE, all selected parameters provide a major improvement in the hydrogen absorption process, especially the inlet temperature of the HTF.

Heat Wave and Bushfire Meteorology in New South Wales, Australia: Air Quality and Health Impacts.

The depletion of air quality is a major problem that is faced around the globe. In Australia, the pollutants emitted by bushfires play an important role in making the air polluted. These pollutants in the air result in many adverse impacts on the environment. This paper analysed the air pollution from the bushfires from November 2019 to July 2020 and identified how it affects the human respiratory system. The bush fires burnt over 13 million hectares, destroying over 2400 buildings. While these immediate effects were devastating, the long-term effects were just as devastating, with air pollution causing thousands of people to be admitted to hospitals and emergency departments because of respiratory complications. The pollutant that caused most of the health effects throughout Australia was Particulate Matter (PM) PM2.5 and PM10. Data collection and analysis were covered in this paper to illustrate where and when PM2.5 and PM10, and other pollutants were at their most concerning levels. Susceptible areas were identified by analysing environmental factors such as temperature and wind speed. The study identified how these pollutants in the air vary from region to region in the same time interval. This study also focused on how these pollutant distributions vary according to the temperature, which helps to determine the relationship between the heatwave and air quality. A computational model for PM2.5 aerosol transport to the realistic airways was also developed to understand the bushfire exhaust aerosol transport and deposition in airways. This study would improve the knowledge of the heat wave and bushfire meteorology and corresponding respiratory health impacts.

Functional Ultra-High Molecular Weight Polyethylene Composites for Ligament Reconstructions and Their Targeted Applications in the Restoration of the Anterior Cruciate Ligament.

The selection of biomaterials as biomedical implants is a significant challenge. Ultra-high molecular weight polyethylene (UHMWPE) and composites of such kind have been extensively used in medical implants, notably in the bearings of the hip, knee, and other joint prostheses, owing to its biocompatibility and high wear resistance. For the Anterior Cruciate Ligament (ACL) graft, synthetic UHMWPE is an ideal candidate due to its biocompatibility and extremely high tensile strength. However, significant problems are observed in UHMWPE based implants, such as wear debris and oxidative degradation. To resolve the issue of wear and to enhance the life of UHMWPE as an implant, in recent years, this field has witnessed numerous innovative methodologies such as biofunctionalization or high temperature melting of UHMWPE to enhance its toughness and strength. The surface functionalization/modification/treatment of UHMWPE is very challenging as it requires optimizing many variables, such as surface tension and wettability, active functional groups on the surface, irradiation, and protein immobilization to successfully improve the mechanical properties of UHMWPE and reduce or eliminate the wear or osteolysis of the UHMWPE implant. Despite these difficulties, several surface roughening, functionalization, and irradiation processing technologies have been developed and applied in the recent past. The basic research and direct industrial applications of such material improvement technology are very significant, as evidenced by the significant number of published papers and patents. However, the available literature on research methodology and techniques related to material property enhancement and protection from wear of UHMWPE is disseminated, and there is a lack of a comprehensive source for the research community to access information on the subject matter. Here we provide an overview of recent developments and core challenges in the surface modification/functionalization/irradiation of UHMWPE and apply these findings to the case study of UHMWPE for ACL repair.

Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review.

Background: Frontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis. Methods: In this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians' acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed. Results: A total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia. Conclusions: This systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.

Is the SARS CoV-2 Omicron Variant Deadlier and More Transmissible Than Delta Variant?

Genetic variants of severe acute respiratory syndrome coronavirus (SARS-CoV-2) have been globally surging and devastating many countries around the world. There are at least eleven reported variants dedicated with inevitably catastrophic consequences. In 2021, the most dominant Delta and Omicron variants were estimated to lead to more severity and deaths than other variants. Furthermore, these variants have some contagious characteristics involving high transmissibility, more severe illness, and an increased mortality rate. All outbreaks caused by the Delta variant have been rapidly skyrocketing in infection cases in communities despite tough restrictions in 2021. Apart from it, the United States, the United Kingdom and other high-rate vaccination rollout countries are still wrestling with this trend because the Delta variant can result in a significant number of breakthrough infections. However, the pandemic has changed since the latest SARS-CoV-2 variant in late 2021 in South Africa, Omicron. The preliminary data suggest that the Omicron variant possesses 100-fold greater than the Delta variant in transmissibility. Therefore, this paper aims to review these characteristics based on the available meta-data and information from the first emergence to recent days. Australia and the five most affected countries, including the United States, India, Brazil, France, as well as the United Kingdom, are selected in order to review the transmissibility, severity and fatality due to Delta and Omicron variants. Finally, the vaccination programs for each country are also reviewed as the main factor in prevention.

Aus rice root architecture variation contributing to grain yield under drought suggests a key role of nodal root diameter class.

The aus rice variety group originated in stress-prone regions and is a promising source for the development of new stress-tolerant rice cultivars. In this study, an aus panel (~220 genotypes) was evaluated in field trials under well-watered and drought conditions and in the greenhouse (basket, herbicide and lysimeter studies) to investigate relationships between grain yield and root architecture, and to identify component root traits behind the composite trait of deep root growth. In the field trials, high and stable grain yield was positively related to high and stable deep root growth (r = 0.16), which may indicate response to within-season soil moisture fluctuations (i.e., plasticity). When dissecting component traits related to deep root growth (including angle, elongation and branching), the number of nodal roots classified as 'large-diameter' was positively related to deep root growth (r = 0.24), and showed the highest number of colocated genome-wide association study (GWAS) peaks with grain yield under drought. The role of large-diameter nodal roots in deep root growth may be related to their branching potential. Two candidate loci that colocated for yield and root traits were identified that showed distinct haplotype distributions between contrasting yield/stability groups and could be good candidates to contribute to rice improvement.

Elevated serum malondialdehyde (MDA), insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid- stimulating hormone (TSH), and reduced antioxidant vitamins in polycystic ovarian syndrome patients.

Elevated oxidative stress and hormonal imbalance have been suggested to associate with polycystic ovarian syndromes (PCOS), a causal factor for unsuccessful pregnancy outcomes and other associated complications in women. The aim of this study was to compare the oxidative stress markers and different relevant hormones between pregnant women with and without PCOS. The levels of malondialdehyde (MDA), insulin, follicle- stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), vitamin A and vitamin C were measured in 80 pregnant women with PCOS and 80 healthy pregnancies. The mean MDA and insulin levels were significantly elevated in pregnant women with PCOS compared to healthy controls (1.98±0.07 vs. 1.06±0.02 nmol/mL and 11.15±0.25 vs. 6.67±0.25 mIU/L, respectively with p<0.001 for both). Compared to healthy controls, the mean concentrations of FSH (3.65±0.16 vs. 1.75±0.10 IU/L) and LH (15.67±0.63 vs. 3.65±0.16 IU/L) were significantly higher in pregnant women with PCOS, p<0.001 for both comparisons. Similarly, the concentration of serum TSH was also higher in PCOS cases compared to controls (2.79±0.22 vs. 2.34±0.06, p=0.048). In contrast, the levels of vitamin A and C were lower in PCOS cases compared to healthy pregnancy group, 0.45±0.01 vs. 1.05±0.01 and 0.26±0.01 vs. 0.53±0.02, respectively with p-values <0.001 for both comparations. In conclusion, in PCOS cases, serum MDA, insulin, FSH, LH and TSH levels were found to be elevated while the levels of antioxidant vitamins were lower compared to healthy pregnant women. Unusual hormonal imbalance and increase of oxidative stress markers during the pregnancy might be important to establish the PCOS diagnosis.

How severe acute respiratory syndrome coronavirus-2 aerosol propagates through the age-specific upper airways.

The recent outbreak of the COVID-19 causes significant respirational health problems, including high mortality rates worldwide. The deadly corona virus-containing aerosol enters the atmospheric air through sneezing, exhalation, or talking, assembling with the particulate matter, and subsequently transferring to the respiratory system. This recent outbreak illustrates that the severe acute respiratory syndrome (SARS) coronavirus-2 is deadlier for aged people than for other age groups. It is evident that the airway diameter reduces with age, and an accurate understanding of SARS aerosol transport through different elderly people's airways could potentially help the overall respiratory health assessment, which is currently lacking in the literature. This first-ever study investigates SARS COVID-2 aerosol transport in age-specific airway systems. A highly asymmetric age-specific airway model and fluent solver (ANSYS 19.2) are used for the investigation. The computational fluid dynamics measurement predicts higher SARS COVID-2 aerosol concentration in the airway wall for older adults than for younger people. The numerical study reports that the smaller SARS coronavirus-2 aerosol deposition rate in the right lung is higher than that in the left lung, and the opposite scenario occurs for the larger SARS coronavirus-2 aerosol rate. The numerical results show a fluctuating trend of pressure at different generations of the age-specific model. The findings of this study would improve the knowledge of SARS coronavirus-2 aerosol transportation to the upper airways which would thus ameliorate the targeted aerosol drug delivery system.

Carbonaceous Materials Coated Carbon Fibre Reinforced Polymer Matrix Composites.

Carbon fibre reinforced polymer composites have high mechanical properties that make them exemplary engineered materials to carry loads and stresses. Coupling fibre and matrix together require good understanding of not only fibre morphology but also matrix rheology. One way of having a strongly coupled fibre and matrix interface is to size the reinforcing fibres by means of micro- or nanocarbon materials coating on the fibre surface. Common coating materials used are carbon nanotubes and nanofibres and graphene, and more recently carbon black (colloidal particles of virtually pure elemental carbon) and graphite. There are several chemical, thermal, and electrochemical processes that are used for coating the carbonous materials onto a carbon fibre surface. Sizing of fibres provides higher interfacial adhesion between fibre and matrix and allows better fibre wetting by the surrounded matrix material. This review paper goes over numerous techniques that are used for engineering the interface between both fibre and matrix systems, which is eventually the key to better mechanical properties of the composite systems.

Polydisperse Aerosol Transport and Deposition in Upper Airways of Age-Specific Lung.

A comprehensive understanding of airflow characteristics and particle transport in the human lung can be useful in modelling to inform clinical diagnosis, treatment, and management, including prescription medication and risk assessment for rehabilitation. One of the difficulties in clinical treatment of lung disorders lies in the patients' variable physical lung characteristics caused by age, amongst other factors, such as different lung sizes. A precise understanding of the comparison between different age groups with various flow rates is missing in the literature, and this study aims to analyse the airflow and aerosol transport within the age-specific lung. ANSYS Fluent solver and the large-eddy simulation (LES) model were employed for the numerical simulation. The numerical model was validated with the available literature and the computational results showed airway size-reduction significantly affected airflow and particle transport in the upper airways. This study reports higher deposition at the mouth-throat region for larger diameter particles. The overall deposition efficiency (DE) increased with airway size reduction and flow rate. Lung aging effected the pressure distribution and a higher pressure drop was reported for the aged lung as compared to the younger lung. These findings could inform medical management through individualised simulation of drug-aerosol delivery processes for the patient-specific lung.

Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study.

BACKGROUND: Exchange transfusion in newborns is recommended as emergency management of hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. AIM: This study aimed to determine the frequency and document common side effects of exchange transfusion and outcomes of newborns requiring exchange transfusion. MATERIALS AND METHODS: This prospective study was done in the Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, from January 2016 to December 2019. Information was obtained regarding maternal details, newborn demographics, and clinical status. Blood grouping and Rh typing were done for both mothers and newborns. In all newborns, pre-exchange complete blood count, peripheral blood film, Coombs test, reticulocyte count, serum bilirubin and post-exchange serum bilirubin, hemoglobin, random blood sugar, serum electrolyte, and calcium were done. G6PD level was done wherever suspected. Frequency, maternal and neonatal factors, indications, and outcomes were analyzed. RESULTS: Among 839 admitted cases of unconjugated hyperbilirubinemia, 41 patients (4.9%) required exchange transfusion. Most of the babies were inborn (90.2%). Ninety-five percent of mothers received regular antenatal care; among them, 76.3% had bad obstetric history. Only 36.6% of mothers received anti-D in previous pregnancy. None had sonographic findings of hydrops. The commonest indication was Rh incompatibility (80.5%). Coombs test was positive in 58.5% of cases. Mean pre-exchange TSB was 9.44 ± 6.4, and post-exchange TSB was 4.41 ± 2.59. The commonest adverse events noted were hyperglycemia (51.2%), sepsis (19.5%), anemia requiring top-up transfusion (17.1%), and hypocalcemia (14.6%). There were no catheter-related complications. Bilirubin encephalopathy was present in 4.9% of cases. There was one mortality but not due to the procedure. CONCLUSION: Exchange transfusion was required among 4.9% of the admitted newborns with unconjugated hyperbilirubinemia. The common adverse effects were hyperglycemia and sepsis. The commonest indication was Rh incompatibility (80.5%). Overall outcome after exchange transfusion was favorable. HOW TO CITE THIS ARTICLE: Dey SK, Jahan S, Jahan I, et al. Exchange Transfusion for Hyperbilirubinemia among Term and Near Term in NICU of a Tertiary Care Hospital of Bangladesh: Findings from a Prospective Study. Euroasian J Hepato-Gastroenterol 2021;11(1):21-26.

SARS CoV-2 aerosol: How far it can travel to the lower airways?

The recent outbreak of the SARS CoV-2 virus has had a significant effect on human respiratory health around the world. The contagious disease infected a large proportion of the world population, resulting in long-term health issues and an excessive mortality rate. The SARS CoV-2 virus can spread as small aerosols and enters the respiratory systems through the oral (nose or mouth) airway. The SARS CoV-2 particle transport to the mouth-throat and upper airways is analyzed by the available literature. Due to the tiny size, the virus can travel to the terminal airways of the respiratory system and form a severe health hazard. There is a gap in the understanding of the SARS CoV-2 particle transport to the terminal airways. The present study investigated the SARS CoV-2 virus particle transport and deposition to the terminal airways in a complex 17-generation lung model. This first-ever study demonstrates how far SARS CoV-2 particles can travel in the respiratory system. ANSYS Fluent solver was used to simulate the virus particle transport during sleep and light and heavy activity conditions. Numerical results demonstrate that a higher percentage of the virus particles are trapped at the upper airways when sleeping and in a light activity condition. More virus particles have lung contact in the right lung than the left lung. A comprehensive lobe specific deposition and deposition concentration study was performed. The results of this study provide a precise knowledge of the SARs CoV-2 particle transport to the lower branches and could help the lung health risk assessment system.

Optimum Placement of Heating Tubes in a Multi-Tube Latent Heat Thermal Energy Storage.

Utilizing phase change materials in thermal energy storage systems is commonly considered as an alternative solution for the effective use of energy. This study presents numerical simulations of the charging process for a multitube latent heat thermal energy storage system. A thermal energy storage model, consisting of five tubes of heat transfer fluids, was investigated using Rubitherm phase change material (RT35) as the. The locations of the tubes were optimized by applying the Taguchi method. The thermal behavior of the unit was evaluated by considering the liquid fraction graphs, streamlines, and isotherm contours. The numerical model was first verified compared with existed experimental data from the literature. The outcomes revealed that based on the Taguchi method, the first row of the heat transfer fluid tubes should be located at the lowest possible area while the other tubes should be spread consistently in the enclosure. The charging rate changed by 76% when varying the locations of the tubes in the enclosure to the optimum point. The development of streamlines and free-convection flow circulation was found to impact the system design significantly. The Taguchi method could efficiently assign the optimum design of the system with few simulations. Accordingly, this approach gives the impression of the future design of energy storage systems.

The Mechanistic Role of Thymoquinone in Parkinson's Disease: Focus on Neuroprotection in Pre-Clinical Studies.

Thymoquinone (TQ) is one of the leading phytochemicals, which is abundantly found in Nigella sativa L. seeds. TQ exhibited various biological effects such as antioxidant, anti-inflammatory, antimicrobial, and anti-tumoral in several pre-clinical studies. Parkinson's disease (PD) is a long-term neurodegenerative disease with movement difficulties, and the common feature of neurodegeneration in PD patients is caused by dopaminergic neural damage in the substantia nigra pars compacta. The neuroprotective activity of TQ has been studied in various neurological disorders. TQ-mediated neuroprotection against PD is yet to be reported in a single frame; therefore, this review is intended to narrate the potentiality of TQ in the therapy of PD. TQ has been shown to protect against neurotoxins via amelioration of neuroinflammation, oxidative stress, and apoptosis, thereby protecting neurodegeneration in PD models. TQ could be an emerging therapeutic intervention in PD management, but mechanistic studies remain to be investigated to clarify its neuroprotective role.

Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross- sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

A Review on the Fate of Legacy and Alternative Antimicrobials and Their Metabolites during Wastewater and Sludge Treatment.

Antimicrobial compounds are used in a broad range of personal care, consumer and healthcare products and are frequently encountered in modern life. The use of these compounds is being reexamined as their safety, effectiveness and necessity are increasingly being questioned by regulators and consumers alike. Wastewater often contains significant amounts of these chemicals, much of which ends up being released into the environment as existing wastewater and sludge treatment processes are simply not designed to treat many of these contaminants. Furthermore, many biotic and abiotic processes during wastewater treatment can generate significant quantities of potentially toxic and persistent antimicrobial metabolites and byproducts, many of which may be even more concerning than their parent antimicrobials. This review article explores the occurrence and fate of two of the most common legacy antimicrobials, triclosan and triclocarban, their metabolites/byproducts during wastewater and sludge treatment and their potential impacts on the environment. This article also explores the fate and transformation of emerging alternative antimicrobials and addresses some of the growing concerns regarding these compounds. This is becoming increasingly important as consumers and regulators alike shift away from legacy antimicrobials to alternative chemicals which may have similar environmental and human health concerns.

Cellular and developmental basis of orofacial clefts.

During craniofacial development, defective growth and fusion of the upper lip and/or palate can cause orofacial clefts (OFCs), which are among the most common structural birth defects in humans. The developmental basis of OFCs includes morphogenesis of the upper lip, primary palate, secondary palate, and other orofacial structures, each consisting of diverse cell types originating from all three germ layers: the ectoderm, mesoderm, and endoderm. Cranial neural crest cells and orofacial epithelial cells are two major cell types that interact with various cell lineages and play key roles in orofacial development. The cellular basis of OFCs involves defective execution in any one or several of the following processes: neural crest induction, epithelial-mesenchymal transition, migration, proliferation, differentiation, apoptosis, primary cilia formation and its signaling transduction, epithelial seam formation and disappearance, periderm formation and peeling, convergence and extrusion of palatal epithelial seam cells, cell adhesion, cytoskeleton dynamics, and extracellular matrix function. The latest cellular and developmental findings may provide a basis for better understanding of the underlying genetic, epigenetic, environmental, and molecular mechanisms of OFCs.