Facile synthesis of highly basic, nanocrystalline Fe2O3-NiO composites as promising and durable catalysts for selective dehydrogenation of 2-butanol.

Nanocrystalline Fe2O3-NiO composite catalysts were prepared using a sonication-assisted green preparation method. The prepared catalysts were characterized using different techniques, including thermal analyses (TGA/DTA), X-ray diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy, surface area measurements (SBET), and scanning electron microscopy (SEM). The surface basicity of the prepared catalysts was measured using the temperature-programmed desorption of CO2 (CO2-TPD) as a highly acidic probe molecule. The catalytic activity of all the prepared catalysts was tested at a temperature range of 250-325 °C towards the dehydrogenation of 2-butanol to methyl-ethyl ketone (MEK), which is considered a promising fossil fuel alternative and has several industrial applications. The composite catalysts showed better catalytic activity compared to the pure oxides (i.e., Fe2O3 and NiO) due to the strong synergetic effect between the two oxides. Fe2O3 prevented the coke formation over the surface of NiO by the oxygen-scavenging effect of Fe, which promotes the oxidation of the carbonaceous species and increases the catalyst's resistance to deactivation. The effect of weight hourly space velocity (WHSV) on the catalytic activity was tested over a selected catalyst. In addition, the stability and durability of the catalyst were tested across four successive reaction cycles, demonstrating remarkable performance throughout all the reaction cycles.

Optimizing human thermal comfort and mitigating the urban heat island effect on public open spaces in Rome, Italy through sustainable design strategies.

The climate affects how a city's outdoor spaces are utilized. It is more likely that people will use and appreciate public areas designed for pedestrian use, such as parks, squares, streets, and foot-cycle pathways, when they provide a comfortable and healthy environment. A predicted increase in global temperature has made the climate uncomfortable, especially during the summer when heat stress is strengthened and anticipated. This phenomenon is more severe in urban areas, often affected by the Urban Heat Island (UHI) effect. Since the spatial characteristics of a city influence its climate, urban design can be deployed to mitigate the combined effects of climate change and UHI. This research is conducted to study the UHI effect on thermal comfort in an urban open space in Rome (Italy) and aims at identifying and implementing a methodology that urban designers can follow to reduce the impact of urban heat islands and increase thermal comfort in urban outdoor space. This study is based on an urban design concept adopting the Sustainable Development Goals as guidelines; it investigates how UHI's effect affects the use of public space and examines the influence of urban microclimatic conditions on the thermal perception of users through PET, PMV and PPD values, that were assessed through simulations with ENVI-MET software. The study thus proposes a redesign for the site in Rome, with a masterplan based on sustainable design principles, aimed at improving the microclimatic conditions in the site. The design solution was then validated through ex post simulations.

Protective effect of leukotriene receptor antagonist, montelukast, against cyclophosphamide-induced placental toxicity via modulation of NLRP3/IL-1ß signaling pathway in rats.

BACKGROUNDS & AIM: Placental insufficiency is a serious complication that affects pregnancy and fetal growth. Cyclophosphamide (CYC) is considered one of the chemotherapeutic agents. Unfortunately, CYC not only affects tumor cells but also affects healthy cells causing multiple injuries including the placenta. The present study aimed to evaluate the effect of cysteinyl leukotriene receptor antagonist; montelukast (MK), on CYC-induced placental injury in rats. MATERIALS AND METHODS: Forty-eight female Wister rats were randomly divided into 8 experimental groups. Group 1: control pregnant group; Group 2: MK 5 mg-treated pregnant rats; Group 3: MK 10 mg-treated pregnant rats; Group 4: MK 20 mg-treated pregnant rats; Group 5: pregnant rats received CYC (20 mg/kg, i.p); Group 6: pregnant rats received MK 5 mg and CYC; Group 7: pregnant rats received MK 10 mg and CYC; Group 8: pregnant rats received MK 20 mg and CYC. Placental malondialdehyde (MDA), reduced glutathione (GSH), total antioxidant capacity (TAC), placental growth factor (PlGF), and Nod-like receptor p3 (NLRP3) inflammasome were measured. Histological changes, interleukin-1ß (IL-1ß), and cleaved caspase-3 immuno-expressions were also evaluated. RESULTS: CYC showed a significant decrease in placental GSH, TAC, and PlGF with a significant increase in placental MDA, NLRP3, and immuno-expression of IL-1ß and caspase-3. MK showed significant improvement in all oxidative stress (MDA, GSH and TAC), inflammatory (NLRP3 and IL-1ß), and apoptotic (caspase-3) parameters. CONCLUSION: According to the findings, MK was proved to have a possible protective role in CYC-induced placental injury via modulation of NLRP3/IL-1ß signaling pathway with anti-oxidant, anti-inflammatory, and anti-apoptotic effects.

Anticoccidial potentials of Azadirachta indica ethosomal nanovesicle in broiler chicks.

This study evaluated the efficacy of Azadirachta indica ethosomal nanovesicle against Eimeria tenella infection in broiler chicks. Azadirachta indica ethanolic extract was screened phtochemically and analyzed active components of the extracts using high­performance liquid chromatography (HPLC). Azadirachta indica ethosomal nanovesicle was synthesized and characterized by zeta potential and scanning electron microscope. Broiler chicks were allocated into seven groups. Control group. The second group administered nanosized ethosomal vesicles (1 mL/kg b.wt.). The third group administered Azadirachta indica nanovesicles (30 mg/kg b.wt.) from 10th day of age. Fourth group was infected with E. tenella at a dose of 1 mL containing 40000 oocyst/ chick at 14th day of age. The fifth group administered Azadirachta indica nanovesicle (30 mg/kg b.wt.) from 10th day of age and infected with E. tenella as fourth group. The sixth group infected with E. tenella as the fourth group and treated with Azadirachta indica nanovesicle (30 mg/kg b.wt. for 4 days after clinical signs appearance. The seventh group infected with E. tenella as the fourth group and treated with diclazuril group (1 mL/4 L of water) for 2 successive days. Coccidiosis significantly decreased body weight, feed intake, reduced glutathione (GSH) level while increased feed conversion ratio, oocyst count, malonaldehyde (MDA) and nitric oxide (NO) serum levels, protein expression of interleukin-1 beta (IL-1ß), interleukin 6 (IL-6), BAX and Caspase 3, in cecal tissue and induced cecal tissue injury. However, administration of coccidiosis chicks Azadirachta indica nanovesicle enhanced body weight, and serum GSH. While decreased feed intake, feed conversion ratio, oocyst count, MDA, and NO serum levels, and protein expression of IL-1ß, IL-6, BAX, and caspase 3 in cecal tissues and ameliorated cecal tissue damage. This study indicated that, A. indica ethosomal nanovesicle had potent anticoccidial properties.

Brucella infection presenting as infective endocarditis complicated by embolic stroke.

Brucellosis (undulant fever) is a zoonotic infection caused by Brucella species. It typically presents with fever, malaise, night sweats, and arthralgia. One of its rare complications is infective endocarditis, which occurs in approximately 1.3% of patients and can be further complicated by embolic stroke. This report describes a rare occurrence of Brucella endocarditis presenting as an embolic stroke. A 34-year-old male presented with sudden left-sided weakness and fever. He reported headaches, fever, and generalized weakness in the preceding week. The patient worked on a farm and hence had animal contact. A neurological exam showed left-sided facial weakness, and power of 0/5 and 1/5 in the left upper and lower extremities, respectively. CT scan of the head revealed a right middle cerebral artery (MCA) territory infarct with penumbra and a right MCA occlusion. He underwent a cerebral artery thrombectomy with successful recanalization. However, he continued to have fever and high inflammatory markers. Echocardiography showed aortic valve vegetation and blood cultures grew Brucella melitensis. A multidisciplinary meeting was held to determine the optimal management, which included a course of rifampicin and doxycycline.

A systematic review of literature on Insulin-like growth factor-2-mediated hypoglycaemia in non-islet cell tumours.

INTRODUCTION: Insulin-like growth factor-2 (IGF-2)-mediated hypoglycemia is a rare yet clinically significant entity with considerable morbidity and mortality. Existing literature is limited and fails to offer a comprehensive understanding of its clinical trajectory, management and prognostication. METHODS: Systematic review of English-language articles reporting primary patient data on IMH was searched using electronic databases (PubMed, Scopus and Embase) from any date up to 21 December 2022. Data were analysed in STATA-16. RESULTS: The systematic review contains 172 studies, including 1 Randomised controlled trial, 1 prospective observational study, 5 retrospective observational studies, 150 case reports, 11 case series and 4 conference abstracts. A total of 233 patients were analysed, averaging 60.6 ± 17.1 years in age, with comparable proportions of males and females. The commonest tumours associated with Insulin-like Growth Factor-2-mediated hypoglycaemia were fibrous tumours (N = 124, 53.2%), followed by non-fibrous tumours originating from the liver (N = 21, 9%), hemangiopericytomas (N = 20, 8.5%) and mesotheliomas (N = 11, 4.7%). Hypoglycaemia was the presenting feature of NICT in 42% of cases. Predominant clinical features included loss of consciousness (26.7%) and confusion (21%). The mean IGF-2 and IGF-1 levels were 882.3 ± 630.6 ng/dL and 41.8 ± 47.8, respectively, with no significant correlation between these levels and patient outcomes. Surgical removal was the most employed treatment modality (47.2%), followed by medication therapy. The recovery rate was 77%, with chronic liver disease (CLD) significantly associated with a poor outcome (OR: 7.23, P: 0.03). Tumours originating from fibrous tissues were significantly associated with recovery (p < .001). In the logistic regression model, CLD remained a significant predictor of poor outcomes. CONCLUSION: This systematic review highlights that most non-islet-cell tumour-hypoglycaemia (NICTH) is due to fibrous tumours. NICTs demonstrate a variable prognosis, which is fair if originating from fibrous tissue. Management such as octreotide, corticosteroids, diazoxide, embolization, radiotherapy and surgical resection have disparate success rates.

Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial.

Objectives: We aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone. Methods: 32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery. Results: Test group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls. Conclusion: The tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.

Effectiveness of a polycaprolactone scaffold combined with platelet-rich fibrin as guided tissue regeneration materials for preserving an implant-supported overdenture.

Objectives: This study aimed to assess the effectiveness of ridge preservation using a polycaprolactone (PCL) scaffold combined with platelet-rich fibrin (PRF) to promote bone regeneration before implantation. Materials and Methods: This prospective study was conducted at Al-Azhar University in Egypt. It included 30 participants requiring the extraction of their last mandibular premolar before constructing an implant-supported overdenture. The participants were divided into three groups: Group A was treated with a PCL scaffold and PRF as ridge preservative materials, Group B was treated with PRF alone, and Group C (control) was treated with no preservative material. Bone samples were collected for histomorphometric analysis at implant placement. Results: The participants' mean age was 65.3 ± 4.27 years, and 18 (60%) were male. Postoperative alveolar bone lengths differed significantly between Groups A and B (P = 0.001). However, alveolar bone width changes did not differ significantly among groups. In contrast, the postoperative bone density and loss differed significantly among groups (P = 0.001). Conclusion: Combining two ridge preservation techniques (PCL and PRF) enhanced participants' alveolar bone remodelling by decreasing its resorption and maintaining its width.

Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report.

Malignant peritoneal mesothelioma (MPM) is a rare subtype of mesothelioma. There are three main histological subtypes of mesothelioma: epithelioid, sarcomatoid, and biphasic (mixed). Risk factors include asbestos exposure, previous radiation, and some germline mutations. Treatment includes surgical resection of amenable tumors or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We present a 34-year-old male who presented with weight loss, night sweats, and pleuritic chest pain and was found to have ascites with peritoneal nodularity on abdominal imaging. He had a history of tuberculosis contact, but no history of asbestos exposure. After a long challenging and interesting diagnostic process, he was subsequently diagnosed with biphasic MPM. The diagnostic challenge stems from not only the rarity of the tumor but also from the absence of risk factors, the unavailability of some special laboratory investigations, in addition to the potentially misleading effect of tuberculosis exposure history, a top differential diagnosis in the case. This is a case report of a really challenging and totally unexpected diagnosis of biphasic peritoneal mesothelioma in a patient with tuberculosis exposure, constitutional symptoms, but no history of asbestos exposure. It highlights the diagnostic process as well as the importance of early diagnosis to improve the overall survival of such malignancies.

Associate plant parasitic nematodes to weed species in some newly reclaimed lands.

Plant-parasitic nematodes (PPNs) are vital soil organisms well-known to damage and reduce crop yield worldwide. Surveys were attempts to determine the impact of weed species on the communities and composition of nematodes in barley, wheat, quinoa, eggplant, and tomato crops in Alexandria and Ismailia regions of Egypt. During the surveys, eight occurring genera of nematodes were found namely; Meloidogyne spp, Pratylenchus spp, Helicotylenchus spp, Rotylenchulus spp, Xiphinema spp, Criconemoides spp, Ditylenchus spp, and Longidorus spp associated with the soil's rhizosphere of 28 weed species belonging to 12 families. Among these weeds, Hordeum marinum and Sonchus oleraceus were good hosts to nematode species. Both wheat and barley had higher nematode diversity than quinoa in the winter season. Pratylenchus spp, Meloidogyne spp and Rotylenchulus spp can be considered vital potential PPNs with economic importance. Nematode abundances and structural indices varied greatly based on the host weed species, crop types and soil characteristics. A positive correlation was monitored among weeds, nematode frequencies and relative abundances as well as their crops. Finally, weed species are critical components in nematode communities that may increase the incidence and severity of nematode risks based on crop type and soil characteristics. Therefore weeds should be managed properly to diminish reservoir sites when developing nematode management options.

Pulmonary Enteric Adenocarcinoma: A Very Rare Case Report from Qatar.

A 78-year-old male patient presented with dyspnea, loss of appetite, and weight loss. Workup and imaging showed suspected malignant lung lesion. Biopsy was done and showed features of pulmonary enteric adenocarcinoma (PEAC). This is a very rare disease and its diagnosis is challenging.

Pharmacokinetic/Pharmacodynamic anesthesia model incorporating psi-Caputo fractional derivatives.

We present a novel Pharmacokinetic/Pharmacodynamic (PK/PD) model for the induction phase of anesthesia, incorporating the ψ-Caputo fractional derivative. By employing the Picard iterative process, we derive a solution for a nonhomogeneous ψ-Caputo fractional system to characterize the dynamical behavior of the drugs distribution within a patient's body during the anesthesia process. To explore the dynamics of the fractional anesthesia model, we perform numerical analysis on solutions involving various functions of ψ and fractional orders. All numerical simulations are conducted using the MATLAB computing environment. Our results suggest that the ψ functions and the fractional order of differentiation have an important role in the modeling of individual-specific characteristics, taking into account the complex interplay between drug concentration and its effect on the human body. This innovative model serves to advance the understanding of personalized drug responses during anesthesia, paving the way for more precise and tailored approaches to anesthetic drug administration.

Endomyocardial Fibrosis With Bilateral Ventricular Thrombus: A Case Report and Literature Review.

Endomyocardial fibrosis (EMF) is a rare restrictive cardiomyopathy in non-tropical areas. It is seen in most of the patients living in or coming from tropical areas, and is rarely seen in patients who have never visited these areas. It is characterized by fibrotic thickening of the endocardium, predominantly affecting the ventricular apices and inflow tracts. Although thrombus formation is a known complication in various cardiac conditions such as atrial fibrillation, atrial flutter, ventricular heart disease, and patent foramen ovale, the occurrence of bilateral thrombus in EMF is exceptionally rare. We present a case report describing a unique finding of bilateral ventricular thrombus in a patient diagnosed with EMF, highlighting the clinical presentation, diagnostic approach, and management challenges associated with this rare phenomenon.

Cerebral Neuroschistosomiasis Presenting as a Brain Mass.

Neuroschistosomiasis is a rare manifestation of schistosomal infections presenting with cerebral and spinal cord involvement. We reported a case of a 31-year-old woman who presented with a history of headache, dizziness, and nausea. Brain MRI with contrast showed features suggestive of brain lesion with edema, and a serology test for Schistosoma was positive. She was diagnosed with neuroschistosomiasis and treated with intravenous steroids followed by praziquantel resulting in a significant regression of the brain mass. Cerebral neuroschistosomiasis is a rare complication of Schistosoma infection, and clinicians should consider it among the differential diagnosis of unexplained brain lesions.

Bioremediation of industrial wastewater heavy metals using solo and consortium Enterobacter spp.

Heavy metals are considered the most common pollutants in industrial wastewater areas. Out of thirty bacterial isolates, only 3 isolates sighted the highest metal resistance activity for Zn+2, Fe+2, Pb+2, Co+2, Mn+2, Ni+2, and Cd+2. The biochemical and DNA homology identification with similarities 99.58%, 99.79%, and 99.86% of those isolates was identified and deposited in WDCM, respectively, as Enterobacter kobei OM144907 SCUF0000311, Enterobacter cloacae OM180597 SCUF0000312, and Enterobacter hormaechei OM181067 SCUF0000313. The minimum tolerance activity (MIC) of heavy metal concentrations against E. kobei and E. cloacae was 25, 15, and 15 mmol/l for Ni+2, Fe+2, and Mn+2, respectively, and 10 mmol/l for Zn+2, Pb+2, Co+2, and Cd+2, while against E. hormaechei, it is 15 mmol/l for Ni+2, Fe+2, and Mn+2 and 10 mmol/l for Zn+2, Pb+2, Co+2, and Cd+2. The consortium and solitary application of bacterial isolates towards heavy metal removal at 100%, 200%, and 300% industrial wastewater concentrations were conducted and showed that more than 90% removal of Zn+2, Fe+2, Pb+2, Mn+2, Ni+2, and Cd+2 from a non-concentrated polluted sample (100%) was reported by the three strains. With doubling the polluted sample concentration (200%), the highest removal efficiency for Zn+2, Pb+2, Mn+2, Ni+2, and Cd+2 was reported by E. cloacae as 70. 75, 66, 65, and 57%, respectively. Removal efficiency after increasing the polluted sample concentration to 300% showed that E. cloacae removed above 45% of all tested heavy metals except Pb+2. Ultimately, E. cloacae exposed the highest efficiency with recommendations for heavy metals removal under higher concentrations.

Mechanical Ventilation Training Curriculum for Pulmonary Critical Care Fellows during the COVID-19 Pandemic.

Background: Mechanical ventilation (MV) management is an essential skill for pulmonary and critical care medicine (PCCM) fellows to master during training. The unprecedented emergence of the coronavirus disease (COVID-19) pandemic highlighted the need for advanced operator competency in MV to improve patients' outcomes. Objective: We aimed to create a standardized case-based curriculum using a blended approach of high-fidelity simulation, rapid-cycle deliberate practice, video didactics, and hands-on small group sessions for rapid accumulation of knowledge and hands-on skills for PCCM fellows before caring for critically ill patients during the COVID-19 pandemic. Methods: The MV curriculum consisted of the following steps: 1) baseline written knowledge test with 15 multiple-choice questions covering MV, the latest evidence-based practices, and pathophysiology of COVID-19; 2) baseline confidence survey using a 5-point Likert scale; 3) a one-on-one session using a high-fidelity simulation manikin, a lung simulator, and a mechanical ventilator to test baseline competencies; 4) a structured debriefing tailored per fellow's 50-point competency assessment checklist from the simulation using rapid-cycle deliberate practice; 5) video didactics; 6) a hands-on session in small groups for basic knobology, waveforms, and modes of MV; 7) a one-on-one simulation reassessment session; 8) a written knowledge posttest; and 9) a post-training confidence survey using a 5-point Likert scale. Results: Eight PCCM fellows completed the training. The mean multiple-choice question score increased from 7.4 ± 2.9 to 10.4 ± 2.4 (P < 0.05), and the simulation scores increased from 17.1 ± 4.4 to 30.8 ± 3.7 (P < 0.05). Comparing the simulation reassessment to the baseline, fellows showed significant improvement (P < 0.05) in assessing indications for MV; implementing rapid sequence intubation for patients with COVID-19; initiating MV and ventilator bundle per best practices; recognizing and managing mucous plugging, ventilator dyssynchrony, and evidence-based treatments for acute respiratory distress syndrome; and developing a care plan for proning. The post-training survey revealed improved learner confidence in all competencies. Conclusion: This pilot MV curriculum using a blended approach was feasible and allowed PCCM fellows to significantly improve their knowledge and hands-on skills, allowing for the appropriate use of MV during the pandemic. Self-reported improvement scores further reinforced this. The emergent need for novice learners may again be necessary for future pandemic settings where standard training models requiring extensive training time are limited.

A Challenging Case of Adult-Onset Still's Disease Complicated by Macrophage Activation Syndrome With Multiorgan Failure.

Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disease that involves the excessive production of proinflammatory cytokines. Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening immune-mediated disorder that can be primary or secondary to malignancy, infections, and autoimmune diseases. We present an interesting case of a young female with adult-onset Still's disease that commenced during pregnancy. Whole-body fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scan showed diffuse uptake in the spleen and bone marrow with widespread lymphadenopathy. During the delayed diagnostic process to exclude lymphoproliferative malignancy, she developed severe HLH/macrophage activation syndrome (MAS) with multiorgan failure. In this case report, we described the challenges faced during the diagnosis of AOSD. We also highlighted the importance of using clinical criteria to aid in the early diagnosis and management of AOSD patients and the role of FDG-PET/CT scans in patients with AOSD. Additionally, we discussed the management aspects for patients with macrophage activation syndrome.

Thermal performance evaluation of bio-bricks and conventional bricks in residential buildings in Aswan city, Egypt.

From raw material extraction to final product disposal, the construction industry is integrally involved in every stage of the greenhouse gas emissions life cycle. One of the main causes of the climate catastrophe is the increasing use of polluting energy sources to power our homes and businesses. This massive problem of global warming has now forced countries to act. To further address sustainability, they seek to reduce energy consumption and CO2 emissions by adopting more sustainable materials. The current trend in scientific research is to use waste resources to improve the properties of various materials to exacerbate the problems of climate change because of the use of traditional building materials. Therefore, one of the most environmentally friendly alternatives to the standard procedure is the use of agricultural residues to improve the quality of building materials. This improvement will modify the thermal properties of building materials such as bricks, which will lead to an improvement in energy efficiency inside buildings, especially residential buildings. As a result, the research focused solely on simulating several bio-brick alternatives that had been discovered in earlier studies in order to test their viability in terms of increasing the energy efficiency of residential buildings in one of the hot cities. The study demonstrated that using bio-building materials can lower energy usage. In addition to saving energy in residential constructions, rice straw cement bricks and sugarcane bricks have operating efficiency rates of roughly 7% and 12%, respectively. All these advancements over conventional brick reduce greenhouse gas emissions and carbon dioxide.

Refractory cold agglutinin disease successfully treated with daratumumab. A case report and review of literature.

BACKGROUND: Cold agglutinin disease (CAD) is immune-mediated hemolytic anemia. The disease is caused by cold reactive autoantibodies that induce hemolysis through the activation of the complement pathway. Most patients with CAD are elderly, and half may have refractory CAD that may not respond to the first-line treatment option (i.e. rituximab). Some cases are refractory to multiple lines of therapy, including chemotherapeutic agents, which might be toxic, especially for elderly patients. Daratumumab is a human monoclonal antibody targeting CD 38 glycoprotein, a transmembrane protein highly expressed in lymphoid and plasma cells. Daratumumab is currently approved for treating multiple myeloma and is used mainly as a combination therapy with other agents. CASE PRESENTATION: Our patient is a 69-year-old female diagnosed with CAD after presenting with severe anemia and significant circulatory symptoms. Rituximab was not effective in controlling her disease, and she refused other available chemotherapeutic agents due to their side effects profile. We used daratumumab combined with erythropoietin, which led to a dramatic response measured by stabilizing her hemoglobin levels and transfusion independence. CONCLUSION: Our case is the third reported case of refractory CAD successfully treated with daratumumab, which suggests that daratumumab might be a potential agent for the treatment and control of refractory Cold Agglutinin Disease.

A Subacute Presentation of Isolated Tuberculous Septic Hip Arthritis.

Tuberculous septic arthritis is a rare type of septic arthritis that is caused by Mycobacterium tuberculosis. However, it can lead to devastating complications if not diagnosed and treated correctly. We hereby report a 41-year-old female with no medical history who presented with a three-week history of right hip pain and inability to bear weight, found to have moderate to severe tenderness at the right anterior hip and gluteal area and limitation of joint movement. Magnetic resonance imaging (MRI) of the hip showed features of right hip septic arthritis with synovitis and anteromedial and posteromedial small collections. She was diagnosed with tuberculosis (TB) after joint fluid aspiration, and she was started on anti-TB treatment including isoniazid, rifampicin, ethambutol, and pyrazinamide directly after. Considering the case and the subacute presentation that can mimic bacterial septic arthritis, clinicians should always consider TB infection in their differential diagnosis upon assessing a suspected patient with septic arthritis even with a subacute presentation to achieve the correct diagnosis and start appropriate treatment to avoid its harmful complications.