Association of device detected atrial and ventricular tachyarrhythmia with adverse events in patients with an implantable cardioverter-defibrillator.

INTRODUCTION: Heart failure patients with a history of atrial fibrillation (AF) and ventricular tachycardia/ventricular fibrillation (VT/VF) are known to have worse outcomes. However, there are limited data on the temporal relationship between development of these arrhythmias and the risk of subsequent congestive heart failure (CHF) exacerbation and death. METHODS: The study cohort comprised 5511 patients implanted with an implantable cardioverter-defibrillator (ICD) in landmark clinical trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, and RAID) who were in sinus rhythm at enrollment. Multivariate cox analysis was performed to evaluate the time-dependent association between development of in-trial device detected AF and VT/VF with subsequent CHF exacerbation and death. RESULTS: Multivariate analysis showed that AF occurrence and VT/VF occurrence were both associated with a similar magnitude of risk for subsequent CHF exacerbation (HR = 1.73 and 1.87 respectively, p < .001 for both). In contrast, only in-trial VT/VF was associated with a significant > two-fold increase in the risk of subsequent mortality (HR = 2.13, p < .001) whereas AF occurrence was not associated with a significant mortality increase after adjustment for in-trial VT/VF (HR = 1.36, p = .096). CONCLUSION: Our findings from a large cohort of ICD recipients enrolled in landmark clinical trials show that device detected AF and VT/VF can be used to identify patients with increased risk for CHF exacerbation and mortality. These findings suggest a need for early intervention in CHF patients who develop device-detected atrial and ventricular tachyarrhythmias.

Geochemical characteristics, hazards impact assessment and radiogenic heat production of the alkaline rocks.

This study primarily investigates the natural radioactivity level in alkaline rocks collected from the Wadi El-Dib ring complex (WDRC) in North Eastern Desert of Egypt, and assesses potential health risks associated with their use as decorative building materials. The work was accomplished using a high-purity germanium detector as well as ICP-MS and ICP-AES techniques. The WDRC composed essentially of trachyte, quartz syenite, granite and syenite. Geochemically, these rocks contain high SiO2 and alkalis with metaluminous to slightly peraluminous features. All rocks contain high concentrations of rare earth elements (∑REEs = 109-1075 ppm), with clear enrichment in light REEs compared to heavy REEs [(La/Yb)N = 8.3-25.3. Radiometrically, the concentrations of the natural radioisotopes (238U, 232Th, and 40K) in the studied rock types surpassed the worldwide average values assigned for building materials by UNSCEAR. This elevation of the radioisotope concentration values is due to the presence of supplement minerals such as monazite, zircon, allanite, and rutile. Granites exhibit the highest mean concentrations of 238U (av. 164.24 ± 14.76 Bq/kg) and 232Th (av. 214.37 ± 23.33 Bq/kg), while trachytes demonstrate the highest 40K (av. 1352.56 ± 65.56 Bq/kg) concentrations. In contrast, syenites exhibite the lowest mean concentrations for 238U (av. 54.51 ± 6.81 Bq/kg) and 232Th (av. 56.76 ± 6.25 Bq/kg), while quartz syenites display the lowest mean concentration of 40K (av. 1144.78 ± 96.19 Bq/kg). The radiogenic heat production (RHP) associated with U, Th, and K range between 1.41 to 9.33 µW/m3, exceeding the typical crustal mean value of 0.8 to 1.2 µW/m3. The radiological parameters and indices evaluating risks of the outdoor and indoor radiation doses due to the investigated rocks were assessed. The results indicated that these rocks meet globally accepted values and safety standards (approved by UNSCEAR, ICRP, and EC) for surface building materials, as well as they underscore the importance of adhering to safety protocols to safeguard workers from radiation exposure within the WDRC area. Ultimately, the data herein provide a valuable database for assessing the compatibility of geochemical data and natural radioactivity level in WDRC rocks. Additionally, it reveals that from the radiological perspective, the investigated rocks are considered safe for use as decorative construction materials.

Retraction: Colonic Angiolipoma: An Extremely Rare Tumor Clinically Masquerading as Acute Appendicitis.

[This retracts the article DOI: 10.7759/cureus.20659.].

An Adaptive Distributed Denial of Service Attack Prevention Technique in a Distributed Environment.

Cyberattacks in the modern world are sophisticated and can be undetected in a dispersed setting. In a distributed setting, DoS and DDoS attacks cause resource unavailability. This has motivated the scientific community to suggest effective approaches in distributed contexts as a means of mitigating such attacks. Syn Flood is the most common sort of DDoS assault, up from 76% to 81% in Q2, according to Kaspersky's Q3 report. Direct and indirect approaches are also available for launching DDoS attacks. While in a DDoS attack, controlled traffic is transmitted indirectly through zombies to reflectors to compromise the target host, in a direct attack, controlled traffic is sent directly to zombies in order to assault the victim host. Reflectors are uncompromised systems that only send replies in response to a request. To mitigate such assaults, traffic shaping and pushback methods are utilised. The SYN Flood Attack Detection and Mitigation Technique (SFaDMT) is an adaptive heuristic-based method we employ to identify DDoS SYN flood assaults. This study suggested an effective strategy to identify and resist the SYN assault. A decision support mechanism served as the foundation for the suggested (SFaDMT) approach. The suggested model was simulated, analysed, and compared to the most recent method using the OMNET simulator. The outcome demonstrates how the suggested fix improved detection.

Dietary utilization of mealworm frass in rabbit feeding regimes and its effect on growth, carcass characteristics, and meat quality.

This study aimed to shed light on the use of mealworm (Tenebrio molitor) frass (TMF) in rabbit diets and its effects on growth performance, blood profiles, rabbit meat quality, and fatty acid profiles. A total of 48 Gabali rabbits were divided equally and randomly into four groups to be fed one of four dietary treatments: a control (T0) group and three TMF groups, which included TMF meal at 1 (T1), 2 (T2), and 3 (T3) %, respectively. The rabbits were fed on isonitrogenous and isoenergetic diets for 11 weeks, and the growth performance data were recorded. Six rabbits per group were slaughtered at the end of the 11th week, then the pharmacochemical parameters and carcass traits were measured, and meat quality and fatty acid profiles were analyzed. The results indicated that the growth performance of different groups was similar (P > 0.05). The levels of globulin, glucose, and alanine transaminase (ALT) were lower in the mealworm frass groups compared with the control group. Carcass traits were not affected by experimental regimes. Fat was higher in the TMF treatment groups, while moisture was lower compared with the control group. The shear force had a lower value in the treatment groups T3 and T2 compared with the control group. The highest values of redness and chroma (color parameter) of rabbit meat were observed in the treatment groups vs. the control group. Moreover, the proportion of total saturated fatty acids in the meat of rabbits that were fed on the T2 and T3 diets was higher compared to those fed on the control (i.e., T0) and T1 diets. Furthermore, the proportion of monounsaturated fatty acid was higher in the T2, T3, and T1 groups vs. T0 rabbits, whereas the PUFA proportions were lower. It could be concluded that frass has great potential to be used as a partial substitute for rabbit diets.

Structural and Functional Brain Changes in Acute Takotsubo Syndrome.

BACKGROUND: Takotsubo syndrome mimics an acute myocardial infarction, typically in the aftermath of mental or physical stress. OBJECTIVES: The mechanism by which emotional processing in the context of stress leads to significant cardiac injury is poorly understood, so a full exploration of brain structure and function in takotsubo syndrome patients merits investigation. METHODS: Twenty-five acute (<5 days) takotsubo patients and 25 control subjects were recruited into this observational cross-sectional study. Surface-based morphometry was carried out on magnetic resonance imaging (MRI) brain scans to extract cortical morphology based on volume, thickness, and surface area with the use of Freesurfer. Cortical morphology general linear models were corrected for age, sex, photoperiod, and total brain volume. Resting-state functional MRI and diffusion tensor tractography images were preprocessed and analyzed with the use of the Functional Magnetic Resonance Imaging of the Brain Diffusion Toolbox and Functional Connectivity Toolbox. RESULTS: There was significantly smaller total white matter and subcortical gray matter volumes in takotsubo (P < 0.001), with smaller total brain surface area but increased total cortical thickness (both P < 0.001). Individual gray matter regions (hippocampus and others) were significantly smaller in takotsubo (P < 0.001); only thalamus and insula were larger (P < 0.001). There was significant hyperfunctional and hypofunctional connectivity in multiple areas, including thalamus-amygdala-insula and basal ganglia (P < 0.05). All structural tractography connections were increased in takotsubo (P < 0.05). CONCLUSIONS: The authors showed smaller gray and white matter volumes driven by smaller cortical surface area, but increased cortical thickness and structural tractography connections with bidirectional changes in functional connectivity linked to emotion, language, reasoning, perception, and autonomic control. These are interventional targets in takotsubo patients' rehabilitation.

The Therapeutic Potential of the Medicinal Plant Justicia Adhatoda and its Antibacterial and Antifungal Activities: A Comparative Study.

Context: Screening ethnobotanical plants is a pre-requisite to evaluating their therapeutic potential and can lead to the isolation of new bioactive compounds. Objective: To determine the antibacterial and antifungal therapeutic potential of Justicia adhatoda. Design: The research team conducted an antimicrobial activity. Setting: The study was conducted in a bioscience lab at International Islamic University, Islamabad, Pakistan. Intervention: Methanolic, ethanolic, and ethyl acetate crude extracts of Justicia adhatoda were prepared at concentrations of 1000, 500, and 100 µg/ml. Outcome measures: The crude extracts were evaluated for in vitro antibacterial activity against Bacillus subtilis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli and for in vitro antifungal activity against Aspergillus flavus, Aspergillus niger, Candida albicans, and Fusarium oxysporum, indicating different zones of inhibition. Results: The highest antibacterial activity was recorded in Justicia adhatoda-methanolic extract (16.33 ± 0.57 mm) and Justicia adhatoda-ethanolic extract (17 ± 1 mm) against Escherichia coli at 1000 µg/ml. Justicia adhatoda-ethyl acetate extract (13 ± 1 mm) showed a significant result as a zone of inhibition against Staphylococcus aureus at 1000 µg/ml. In the fungal strain culture, the highest antifungal activity was recorded in Justicia adhatoda-methanolic extract (15.66 ± 0.57 mm), Justicia adhatoda-ethanolic extract (14 ± 1 mm), and Justicia adhatoda-ethyl acetate extract (14.33 ± 1.15 mm) against the Aspergillus niger at 1000 µg/ml. Conclusion: The antimicrobial activities may be due to the strong occurrence of active compounds, i.e., saponins, tannins, alkaloids, steroids, phenols, and flavonoids. It has been concluded that Justicia adhatoda extracts are suitable candidates for the development of novel antibacterial compounds.

Association of sleep duration and quality with depression Among University Students and Faculty.

BACKGROUND AND AIM: Highly competitive and demanding environments in educational institutions led to reduced sleep time for both students and faculty globally. The primary objective of this study was to determine the duration and quality of sleep among students and faculty of Imam Abdulrahman Bin Faisal University (IAU). The secondary objective was to explore the relationship between depression and sleep duration and quality among students and faculty. METHODS: The study was conducted during 2021 in Dammam, Saudi Arabia. An online survey was disseminated among the university students. The survey form included: demographic data, Patient Health Questionnaire (PHQ9), Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness scale (ESS). The responses were analyzed using bivariate and multivariate analysis. RESULTS: A total of 509 responses satisfying the inclusion criteria were included (323 student and 186 faculty). The average sleep duration for the entire cohort was 6.21 ± 1.32 hours, with 6.5% sleeping less than 5 hours per night. The mean PSQI score was 7.61 ± 3.09, with 73.1% falling in the poor sleep quality category (PSQI score >5). The mean PHQ9 score was 8.86 ± 6.20, with 63.9% falling in the  mild depression category. The mean ESS score was 6.59 ± 4.02, with 11% having a score >10 (corresponding to excessive daytime sleepiness). CONCLUSIONS: A significant proportion of surveyed students and faculty IAU suffer from sleep insufficiency, poor sleep quality, and mild degree of depression. Initiatives to tackle the issue of poor sleep quality and quantity among university students and faculty are required.

Use of the oral beta blocker bisoprolol to reduce the rate of exacerbation in people with chronic obstructive pulmonary disease (COPD): a randomised controlled trial (BICS).

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, mortality and healthcare costs. Beta blockers are well-established drugs widely used to treat cardiovascular conditions. Observational studies consistently report that beta blocker use in people with COPD is associated with a reduced risk of COPD exacerbations. The bisoprolol in COPD study (BICS) investigates whether adding bisoprolol to routine COPD treatment has clinical and cost-effective benefits. A sub-study will risk stratify participants for heart failure to investigate whether any beneficial effect of bisoprolol is restricted to those with unrecognised heart disease. METHODS: BICS is a pragmatic randomised parallel group double-blind placebo-controlled trial conducted in UK primary and secondary care sites. The major inclusion criteria are an established predominant respiratory diagnosis of COPD (post-bronchodilator FEV1 < 80% predicted, FEV1/FVC < 0.7), a self-reported history of ≥ 2 exacerbations requiring treatment with antibiotics and/or oral corticosteroids in a 12-month period since March 2019, age ≥ 40 years and a smoking history ≥ 10 pack years. A computerised randomisation system will allocate 1574 participants with equal probability to intervention or control groups, stratified by centre and recruitment in primary/secondary care. The intervention is bisoprolol (1.25 mg tablets) or identical placebo. The dose of bisoprolol/placebo is titrated up to a maximum of 4 tablets a day (5 mg bisoprolol) over 4-7 weeks depending on tolerance to up-dosing of bisoprolol/placebo-these titration assessments are completed by telephone or video call. Participants complete the remainder of the 52-week treatment period on the final titrated dose (1, 2, 3, 4 tablets) and during that time are followed up at 26 and 52 weeks by telephone or video call. The primary outcome is the total number of participant reported COPD exacerbations requiring oral corticosteroids and/or antibiotics during the 52-week treatment period. A sub-study will risk stratify participants for heart failure by echocardiography and measurement of blood biomarkers. DISCUSSION: The demonstration that bisoprolol reduces the incidence of exacerbations would be relevant not only to patients and clinicians but also to healthcare providers, in the UK and globally. TRIAL REGISTRATION: Current controlled trials ISRCTN10497306 . Registered on 16 August 2018.

In Vivo Effects of Orally Administered Different Concentrations of Silver Oxide Nanoparticles in Hyperuricemic Mice.

Silver oxide nanoparticles (AgO-NPs) antioxidant, anti-cancer, anti-microbial, and tissue repair properties. Gouty arthritis is the inflammation of tissues and joints caused by the deposition of monosodium urate crystals. In this experiment, we investigated the anti-hyperuricemic effectiveness of different concentrations of AgO-NPs in mice. The present study aimed to investigate the effect of administration of AgO-NPs in monosodium urate (MSU)-induced gouty mice for the very first time. Monosodium urate (MSU) crystals were administered intraperitoneal for gout induction, followed by 5, 10, and 20 µg/mL doses of AgO-NPs for 2 weeks. The positive control was provided with the commercially available drug allopurinol to compare the effects of AgO-NPs and allopurinol. The main purpose of the study was to investigate the effectiveness of the nanoparticles in comparison with commercially available drugs. AgO-NPs have been shown to improve the condition of gouty arthritis by reducing significantly (P ˂ 0.001) increased levels of ALT, AST, and total bilirubin. The total protein estimation results showed significant improvement at concentration of 20 µg/mL of AgO-NPs. The lipid profile results showed that high concentration (20 µg/mL) of AgO-NPs decrease the lipid content significantly as compared to control. It was concluded from this study that the antioxidant, anti-inflammatory, and antilipidemic properties of AgO-NPs may improve the hyperuricemic condition in gouty arthritis mice.

Co-composted biochar derived from rice straw and sugarcane bagasse improved soil properties, carbon balance, and zucchini growth in a sandy soil: A trial for enhancing the health of low fertile arid soils.

Sustainable management of low fertile arid soils using carbon-rich organic amendments such as biochar and compost is of great concern from both agricultural and environmental points of view. The impact of pyrolysis, composting, and co-composting processes of different feedstocks on carbon loss and emissions, soil properties, and plant growth in arid soils with low organic matter content has not been sufficiently explored yet. Consequently, the aim of this work was to 1) investigate the effects of the pyrolysis, composting, and co-composting processes on the properties of the produced biochar, compost, and co-composted biochar from rice straw (RS) and sugarcane bagasse (SB), and 2) examine the impact of addition of RB biochar (RSB), SB biochar (SBB), RS compost (RSC), SB compost (SBC), co-composted RS biochar (RSCB), and co-composted SB biochar (SBCB) at an application dose of 10 ton/hectare on soil properties, carbon emission, and growth of zucchini (Cucurbita pepo) in a sandy arid soil. Carbon loss (kg C kg-1 feedstock) was significantly (P < 0.05) lower during the preparation of the compost (90.36 in RSC, 220.00 in SBC) and co-composted-biochar (146.35 in RSCB, 125.20 in SBCB) than in biochar (176.5 in RSB, 305.6 in SBB). The C/N ratios of the compost and co-composted biochar (11-28.5) were narrower than the corresponding values of biochars (48-90). All amendments increased significantly soil organic carbon content (2.5 in RSC to 5.5 g kg-1 in RSCB), as compared to the non-amended control (1.2 g kg-1). All amendments, particularly RSCB, increased significantly (P < 0.05) the zucchini seed vigor index, dry weight, total chlorophyll content, and root and shoot length, as compared to the control. Moreover, RSCB was the only amendment that showed a positive soil carbon balance. The modified integrated two-way ecological model data also indicated that the co-composted biochar, particularly RSCB, is a promising amendment to improve soil quality and plant growth in sandy arid soils. However, those data should be verified under field conditions.

Pentaglobin (immunoglobulin M-enriched immunoglobulin) as adjuvant therapy for premature and very low-birth-weight neonates with sepsis.

OBJECTIVES: The purpose of this research was to determine the effectiveness of Pentaglobin® as adjuvant therapy in the treatment of sepsis in preterm newborns. MATERIALS AND METHODS: It was a prospective, observational, randomized study for 272 premature neonates and very low birth weight (VLBW) that were diagnosed with sepsis carried at neonatal intensive care units. The patients randomized into control group who received standard sepsis antibiotic treatments, and an intervention group who received Pentaglobin® 5 ml/kg daily for 3 consecutive days as an adjunct therapy to a standard sepsis antibiotic treatment. RESULTS: Multiple organisms that isolated from culture specimens were Gram-negative bacteria, Gram-positive, and candida (56.25%, 42.28%, and 1.47%, respectively). The disease duration was distinctively longer in patients who were treated by the standard antibiotic protocol (mean ± standard deviation [SD]: 30.76 ± 3.97, odds ratio [OR]: 30.76, 95% confidence interval [CI]: 30.051, 31.473) comparing to the patients who received Pentaglobin adjuvant therapy (mean ± SD: 26.48 ± 5.55, OR: 26.48, 95% CI: 25.489, 27.477) (P < 0.000). Patients treated by standard antibiotic protocol were associated to a substantially increased risk of death (11.76%, hazard ratio 4.400, 95% CI: 1.432, 13.529, P = 0.009). CONCLUSION: Neonatal sepsis is more common in premature and VLBW newborns, and Pentaglobin® management of newborn nosocomial sepsis might be used in addition to other therapies.

C-reactive protein levels associated with COVID-19 outcomes in the United States.

CONTEXT: COVID-19 caused a worldwide pandemic, and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. OBJECTIVES: This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay (LoS). METHODS: A retrospective cohort study was conducted utilizing data obtained between March and May 2020. Data were collected by abstracting past medical records through electronic medical records at 10 hospitals within CommonSpirit Health. Patients were included if they had a positive COVID-19 test from a nasopharyngeal swab sample, and if they were admitted and then discharged alive or had in-hospital mortality and were ≥18 years. A total of 541 patients had CRP levels measured and were included in this report. Patient outcome and LoS were the endpoints measured. RESULTS: The 541 patients had their CRP levels measured, as well as the demographic and clinical data required for analysis. While controlling for body mass index (BMI), number of comorbidities, and age, the first CRP was significantly predictive of mortality (p<0.001). The odds ratio for first CRP indicates that for each one-unit increase in CRP, the odds of death increased by 0.007. For LoS, the first CRP was a significant predictor (p<0.001), along with age (p=0.002). The number of comorbidities also predicted LoS (p=0.007), but BMI did not. The coefficient for the first CRP indicates that, for each one-unit increase in CRP, LoS increased 0.003 days. CONCLUSIONS: The results indicate that there is a positive correlation between the CRP levels of COVID-19 patients and their respective outcomes with regard to death and LoS.

Precision and accuracy of FEV1 measurements from the Vitalograph copd-6 mini-spirometer in a healthy Ugandan population.

OBJECTIVE: Evaluate the accuracy and precision of the copd-6 mini-spirometer for FEV1 in a rural Ugandan population. METHODS: In a cross-sectional study, 171 smallholder farmers performed spirometry with copd-6, and a diagnostic-quality spirometer. RESULTS AND DISCUSSION: The copd-6 underestimated FEV1 at low flows and overestimated FEV1 at high flows. Across all participants, the device slightly overestimated FEV1 by 0.04 [0.02; 0.06] L. Calibration data showed similar patterns. CONCLUSION: The copd-6 could be considered as an affordable tool for research on lung function impairment in resource-constrained settings. However, further validation in a study population with obstructive lung disease is needed.

A systematic review of biomarkers in Takotsubo syndrome: A focus on better understanding the pathophysiology.

BACKGROUND: The diagnosis of Takotsubo syndrome is made based on clinical presentation, ECG, biomarker, imaging and coronary angiography. There is a lack of diagnostic biomarkers that can discriminate patients with Takotsubo syndrome from those with acute myocardial infarction (AMI) and provide clinical monitoring and prognostic information in the long-term. METHODS: A literature search of published Takotsubo syndrome biomarkers from PubMed was performed. All studies that included numerical biomarker data on Takotsubo syndrome was included. Exclusion criteria was any study without an AMI cohort for comparison in the acute phase biomarkers or due to the absence of numerical values. The results were tabulated in table form with results expressed as either mean ± SD or median (interquartile range). RESULTS: The literature search produced 14 relevant studies that met search criteria. The results showed; high sensitivity Troponin I (3.21 ± 4.4 vs 34.4 ± 37 ng/ml), BNP [972 (578.5-1671.0) pg/L vs 358 (50.5-688.0) pg/L in NSTEMI and vs 381 (106.0-934.0) pg/L in STEMI] and BNP/Troponin I ratio [642 (331.8-1226.5) vs 184.5 (50.5-372.3) pg/ug in NSTEMI and 7.5 (2.0-29.6) pg/ug in STEMI] patients. DISCUSSION: This study is limited by many studies being retrospective cohort studies. This data shows that acutely troponin is raised in Takotsubo syndrome but not enough to be discriminating from AMI. BNP level is significantly raised in Takotsubo syndrome compared to AMI. CONCLUSION: Current specificity of acute and chronic biomarkers for Takotsubo syndrome is lacking and further work is needed to address the gap in knowledge.

Colonic Angiolipoma: An Extremely Rare Tumor Clinically Masquerading as Acute Appendicitis.

The clinical presentation of right iliac fossa pain, anorexia, and vomiting are the classic clinical features of acute appendicitis. However, a broad spectrum of manifestations may result in a similar clinical picture, including gastrointestinal, genitourinary, and gynecologic pathologies. Imaging studies are crucial to establishing the diagnosis. Here, we report the case of a 58-year-old man who presented to the emergency department with a one-week history of right lower quadrant abdominal pain. The pain was associated with nausea, vomiting, and frequent bowel motions. There was no history of fever or weight loss. The examination of the abdomen showed localized tenderness and guarding in the right iliac fossa. The basic laboratory investigation was within the reference range. The computed tomography scan demonstrated a well-circumscribed intraluminal mass lesion in the ascending colon with no evidence of complete obstruction. The mass was slightly heterogeneous but had fat attenuation. There was no evidence of invasion. There was no stranding of the adjacent fat. The radiological findings were consistent with colonic lipoma. The patient underwent laparoscopic surgery and had a segmental resection of the tumor with primary anastomosis. The appendix was also resected. Histopathological examination showed mature adipose cells along with thin-walled, capillary-sized vessels representing a benign angiolipoma. Further, the resected appendix was completely normal and showed no evidence of acute inflammation. Colonic angiolipoma is an extremely rare tumor. This case demonstrated that a large angiolipoma of the ascending colon may show a presenting clinical picture similar to that of acute appendicitis. Complete resection of the tumor is associated with an excellent outcome.

Hemophagocytic Lymphohistiocytosis After Trauma Due to a Motor Vehicle Accident: A Case Report.

Hemophagocytic lymphohistiocytosis (HLH) is an underdiagnosed, rare clinical syndrome, in particular secondary HLH, which mostly affects adults. HLH can be caused by malignancy, infections, autoimmune disorders, and, rarely, trauma. Here, we present the case of a patient who presented with anemia not responding to blood transfusion but improved after treatment with intravenous immunoglobulin. This case aims to highlight a rare presentation of this disease (HLH secondary to trauma) and to discuss the current HLH diagnostic criteria.

Presenting the characteristics, smoking versus diabetes, and outcome among patients hospitalized with COVID-19.

METHODS: We designed a cross-sectional, observational follow-up for 284 COVID-19 patients involving healthy patients, smokers, diabetics, and diabetic plus smokers recruited from May 1, 2020 to June 25, 2020. The clinical features, severity, duration, and outcome of the disease were analyzed. RESULTS: Of 284 COVID-19 patients, the median age was 48 years (range, 18-80), and 33.80% were female. Common symptoms included fever (85.56%), shortness of breath (49.65%), cough (45.42%), and headache (40.86%). Patients with more than one comorbidity (diabetes and smoking) presented as severe-critical cases compared to healthy patients, diabetics, and smokers. Smokers presented with a lower rate of death in comparison to diabetic patients and diabetic + smoking, furthermore, smoking was less risky than diabetes. Although the mortality rate was high in patients with smokers compared to healthy patients (4.22%, the hazard ratio [HR], 1.358; 95% confidence interval [CI], 1.542-1.100; p = .014), it was less than in diabetics (7.04%, HR 1.531, 95% CI: 1.668-1.337, p = .000), and diabetic plus smoker (10.00%, HR, 1.659; 95% CI, 1.763-1.510; p = .000). CONCLUSION: Multiple comorbidities are closely related to the severity of COVID-19 disease progression and the higher mortality rate. Smokers presented as mild cases compared to diabetic and diabetic + smoking patients, who presented as severe to critical cases. Although a higher death rate in smokers was seen compared with healthy patients, this was smaller when compared to diabetic and diabetic + smoking patients.

Assessment of COVID-19 Treatment containing both Hydroxychloroquine and Azithromycin: A natural clinical trial.

The goal of this study was to assess the clinical effectiveness and safety profile of the COVID-19 treatment protocol (containing both hydroxychloroquine (HCQ) and azithromycin) in an Iraqi specialised hospital. METHODS: This prospective study used a pre- and post-intervention design without a comparison group. The intervention was routine Ministry of Health (MOH) approved the management of COVID-19 for all patients. The study was conducted in a public healthcare setting in Baghdad, Iraq from March 1st to May 25, 2020. The study outcome measures included the changes in clinical and biochemical parameters during the hospitalisation period. Paired t-test and Chi-square test were used to compare the measures of vital signs, lab tests and symptoms before and after treatment. RESULTS: The study included 161 patients who were admitted with positive RT-PCR and clinical symptoms of COVID-19. In terms of severity, 53 (32.9%) patients had amild condition, 47 (29.2%) had moderate condition, 35 (21.7%) had severe condition and 26 (16.1%) had critical condition. Most patients (84.5%) recovered and were discharged without symptoms after testing negative with RT-PCR, while 11 (6.8%) patients died during the study period. The signs and symptoms of COVID-19 were reduced significantly in response to a therapy regimen containing HCQ and azithromycin. The most common reported side effects were stomach pain, hypoglycemia, dizziness, itching, skin rash, QT prolongation, arrhythmia, and conjunctivitis. CONCLUSIONS: This natural trial showed that the COVID-19 regimen containing both HCQ and azithromycin can be helpful to promote the recovery of most patients and reduced their signs and symptoms significantly. It also shows some manageable side effects mostly those related to heart rhythm. In the absence of FDA-approved medications to treat COVID-19, the repurposing of HCQ and azithromycin to control the disease signs and symptoms can be useful.