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1.
Blood ; 139(11): 1659-1669, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35007327

RESUMO

Stem cell transplantation is a cornerstone in the treatment of blood malignancies. The most common method to harvest stem cells for transplantation is by leukapheresis, requiring mobilization of CD34+ hematopoietic stem and progenitor cells (HSPCs) from the bone marrow into the blood. Identifying the genetic factors that control blood CD34+ cell levels could reveal new drug targets for HSPC mobilization. Here we report the first large-scale, genome-wide association study on blood CD34+ cell levels. Across 13 167 individuals, we identify 9 significant and 2 suggestive associations, accounted for by 8 loci (PPM1H, CXCR4, ENO1-RERE, ITGA9, ARHGAP45, CEBPA, TERT, and MYC). Notably, 4 of the identified associations map to CXCR4, showing that bona fide regulators of blood CD34+ cell levels can be identified through genetic variation. Further, the most significant association maps to PPM1H, encoding a serine/threonine phosphatase never previously implicated in HSPC biology. PPM1H is expressed in HSPCs, and the allele that confers higher blood CD34+ cell levels downregulates PPM1H. Through functional fine-mapping, we find that this downregulation is caused by the variant rs772557-A, which abrogates an MYB transcription factor-binding site in PPM1H intron 1 that is active in specific HSPC subpopulations, including hematopoietic stem cells, and interacts with the promoter by chromatin looping. Furthermore, PPM1H knockdown increases the proportion of CD34+ and CD34+90+ cells in cord blood assays. Our results provide the first large-scale analysis of the genetic architecture of blood CD34+ cell levels and warrant further investigation of PPM1H as a potential inhibition target for stem cell mobilization.


Assuntos
Estudo de Associação Genômica Ampla , Células-Tronco Hematopoéticas , Antígenos CD34/metabolismo , Mobilização de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas/metabolismo , Humanos
2.
Electrophoresis ; 45(7-8): 651-662, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38335317

RESUMO

This study aimed to characterize interactions within colloidal silica particles in their concentrated suspensions, using rheo-confocal measurements and imaging, followed by image analysis. We studied the effect of shear rate (0-500 s-1) and solution pH (6, 10) on the dispersion degree of colloidal silica particles via the determination and comparison of interparticle distances and their modeling. Images corresponding to different shear rates were analyzed to identify the coordinates of the particles. These coordinates were further analyzed to calculate the distance among the particles and then their surface-to-surface distance normalized by the particle diameter (H/D). It was found that the population of the particles per unit area of the image and H/D varied with increasing shear rate. The comparison between experimentally measured and theoretically calculated H/D identified that for some particles, the former was shorter than the latter, indicating the unexpected attractions among them against the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory. Then, the modification of previously reported equations for H/D was suggested and confirmed its validity. Assuming pair potential interaction and hydrodynamic interaction were the main non-DLVO interactions, their magnitudes were calculated and confirmed the significance of pH and shear application strength on particle dispersion/coagulation.


Assuntos
Coloides , Tamanho da Partícula , Dióxido de Silício , Suspensões , Dióxido de Silício/química , Coloides/química , Suspensões/química , Hidrodinâmica , Concentração de Íons de Hidrogênio , Reologia/métodos
4.
Environ Res ; 244: 117949, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38109961

RESUMO

Petrochemical-based synthetic plastics poses a threat to humans, wildlife, marine life and the environment. Given the magnitude of eventual depletion of petrochemical sources and global environmental pollution caused by the manufacturing of synthetic plastics such as polyethylene (PET) and polypropylene (PP), it is essential to develop and adopt biopolymers as an environment friendly and cost-effective alternative to synthetic plastics. Research into bioplastics has been gaining traction as a way to create a more sustainable and eco-friendlier environment with a reduced environmental impact. Biodegradable bioplastics can have the same characteristics as traditional plastics while also offering additional benefits due to their low carbon footprint. Therefore, using organic waste from biological origin for bioplastic production not only reduces our reliance on edible feedstock but can also effectively assist with solid waste management. This review aims at providing an in-depth overview on recent developments in bioplastic-producing microorganisms, production procedures from various organic wastes using either pure or mixed microbial cultures (MMCs), microalgae, and chemical extraction methods. Low production yield and production costs are still the major bottlenecks to their deployment at industrial and commercial scale. However, their production and commercialization pose a significant challenge despite such potential. The major constraints are their production in small quantity, poor mechanical strength, lack of facilities and costly feed for industrial-scale production. This review further explores several methods for producing bioplastics with the aim of encouraging researchers and investors to explore ways to utilize these renewable resources in order to commercialize degradable bioplastics. Challenges, future prospects and Life cycle assessment of bioplastics are also highlighted. Utilizing a variety of bioplastics obtained from renewable and cost-effective sources (e.g., organic waste, agro-industrial waste, or microalgae) and determining the pertinent end-of-life option (e.g., composting or anaerobic digestion) may lead towards the right direction that assures the sustainable production of bioplastics.


Assuntos
Compostagem , Plásticos , Humanos , Biopolímeros/química , Tecnologia , Resíduos Industriais
5.
Microb Pathog ; 181: 106202, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37327948

RESUMO

Cutaneous Leishmaniasis (CL) affects millions of people globally and has a significant impact on morbidity and mortality. Innate immune mediators are likely to influence the clinical phenotype of CL through primary responses that restrict or facilitate parasite spread. The aim of this preliminary study was to bring to attention the significance of microbiota in the development of CL and emphasized the necessity of including the role of microbiota in CL while promoting a One Health approach for managing diseases. To achieve this, we used 16S amplicon metagenome sequencing and QIIME2 pipeline to analyze the microbiome composition of CL-infected patients compared to non-infected, healthy subjects. 16S sequencing analysis showed serum microbiome was dominated by Firmicutes, Proteobacteria, Bacteroidota, and Actinobacteria. CL-infected individuals, Proteobacteria were the most prevalent (27.63 ± 9.79), with the relative abundance (10.73 ± 5.33) of Proteobacteria in control. Bacilli class was found to be the most prevalent in healthy controls (30.71 ± 8.44) while (20.57 ± 9.51) in CL-infected individuals. The class Alphaproteobacteria was found to be more in CL-infected individuals (5.47 ± 2.07) as compared to healthy controls (1.85 ± 0.39). The CL-infected individuals had a significantly lower relative abundance of the Clostridia class (p < 0.0001). An altered serum microbiome of CL infection and higher microbial abundance in the serum of healthy individuals was observed.


Assuntos
Leishmaniose Cutânea , Microbiota , Humanos , Microbiota/genética , Bactérias/genética , Metagenoma , Proteobactérias/genética , Inflamação/genética , RNA Ribossômico 16S/genética
6.
Mol Biol Rep ; 49(7): 6495-6507, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35579734

RESUMO

BACKGROUND: Recent discoveries in cancer therapeutics have proven combination therapies more effective than individual drugs. This study describes the efficacy of the combination of Cinnamomum zeylanicum and doxorubicin against benzene-induced leukemia. METHODS AND RESULTS: Brine shrimp assay was used to assess the cytotoxicity of C. zeylanicum, doxorubicin and their combination. After AML induction in Sprague Dawley rats, the same drugs were given to rat groups. Changes in organ weight, haematological profile, and hepatic enzymes were determined. Real-time PCR was used to elucidate the effect on the expression of STMN1, GAPDH, P53 and various TRAIL and NF-kappaB components. C. zeylanicum reduced the cytotoxicity of doxorubicin. The combination treatment showed better anti-leukemic results than any of the individual drugs as evident from STMN1 expression (p < 0.001). It was particularly effective in reducing total white blood cell counts and recovering lymphocytes, monocytes and eosinophils along with hepatic enzymes ALT and AST (p < 0.001). All doses recovered relative organ weights and improved blood parameters. The combination therapy was particularly effective in inducing apoptosis, inhibition of proliferation marker GAPDH (p < 0.001) and NF-kappaB pathway components Rel-A (p < 0.001) and Rel-B (p < 0.01). Expressions of TRAIL components c-FLIP (p < 0.001), TRAIL ligand (p < 0.001) and caspase 8 (p < 0.01) were also altered. CONCLUSION: Cinnamomum zeylanicum in combination with doxorubicin helps to counter benzene-induced cellular and hepatic toxicity and improves haematological profile. The anti-leukemic effects are potentially due to inhibition of GAPDH and NF-kappa B pathway, and through regulation of TRAIL pathway. Our data suggests the use of C. zeylanicum with doxorubicin to improve anti-leukemic therapeutic regimes.


Assuntos
Leucemia , Óleos Voláteis , Animais , Apoptose , Benzeno/farmacologia , Cinnamomum zeylanicum/metabolismo , Doxorrubicina/farmacologia , Leucemia/tratamento farmacológico , NF-kappa B/metabolismo , Óleos Voláteis/farmacologia , Ratos , Ratos Sprague-Dawley , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Ligante Indutor de Apoptose Relacionado a TNF/farmacologia
7.
Genomics ; 113(6): 4015-4021, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34637930

RESUMO

HIV infects the CD4 cells which marks the suppression of our immune system. DNA from serum of healthy, treated and untreated HIV infected individuals was extracted. The DNA was subjected to 16S metagenomic sequencing and analyzed using QIIME2 pipeline. 16S sequencing analysis showed serum microbiome was dominated by Firmicutes, Proteobacteria, Bacteroidota and Actinobacteria. Treated HIV infection showed highest abundance of Firmicutes (66.40%) significantly higher than untreated HIV infection (35.88%) and control (41.89%). Bacilli was most abundant class in treated (63.59%) and second most abundant in untreated (34.53%) while control group showed highest abundance of class Gamma-proteobacteria (45.86%). Untreated HIV infection group showed Enterococcus (10.72%) and Streptococcus (6.599%) as the most abundant species. Untreated HIV infection showed significantly higher (p = 0.0039) species richness than treated and control groups. An altered serum microbiome of treated HIV infection and higher microbial abundance in serum of untreated HIV infection was observed.


Assuntos
Infecções por HIV , Microbiota , Infecções por HIV/genética , Humanos , Metagenoma , Metagenômica , RNA Ribossômico 16S/genética
8.
Sensors (Basel) ; 22(14)2022 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-35891074

RESUMO

Unmanned Aerial Vehicles (UAVs) seem to be the most efficient way of achieving the intended aerial tasks, according to recent improvements. Various researchers from across the world have studied a variety of UAV formations and path planning methodologies. However, when unexpected obstacles arise during a collective flight, path planning might get complicated. The study needs to employ hybrid algorithms of bio-inspired computations to address path planning issues with more stability and speed. In this article, two hybrid models of Ant Colony Optimization were compared with respect to convergence time, i.e., the Max-Min Ant Colony Optimization approach in conjunction with the Differential Evolution and Cauchy mutation operators. Each algorithm was run on a UAV and traveled a predetermined path to evaluate its approach. In terms of the route taken and convergence time, the simulation results suggest that the MMACO-DE technique outperforms the MMACO-CM approach.


Assuntos
Algoritmos , Simulação por Computador
9.
Mol Biol Rep ; 48(4): 3327-3336, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33886057

RESUMO

HIV infection is a global health concern. Current HIV-diagnostics provide information about the disease progression and efficacy of anti-retroviral therapies (ARVs), but this information is very limited and sometimes imprecise. Present study assessed the potential role of mononuclear cell (MNC) death, expression of caspases (1&3) and cell free mitochondrial DNA (CF mt-DNA) in HIV infected individuals. Apoptosis, cell-count, expression of caspases and CF mt-DNA were measured through flow cytometry and qPCR, respectively, in HIV infected individuals (n = 120) divided in two groups i.e. ARVs-receiving (treated, n = 87), ART-naïve (untreated, n = 37) and healthy individuals (n = 47). Data showed significant (p < 0.0001) cell death in untreated individuals than treated and healthy individuals. CD4-positive T-cell percentage declined (p < 0.0001) in untreated as compared to treated individuals. Caspase-1, an indicator of pyroptosis, and CF mt-DNA were also elevated in untreated HIV infected individuals. Untreated individuals when administered with ARVs showed improved CD4-positive T-cell percentage, lower caspase-1, CF mt-DNA and cell death. Data elucidated positive co-relation between cell death and CF mt-DNA in treated and untreated HIV infected individuals. While CD4-positive T-cell percentage was negatively correlated with caspase-1 expression and CF mt-DNA. Elevated levels of CF mt-DNA and caspase-1 in HIV infected individuals, positive correlation between cell death and CF mt-DNA, negative correlation of CD4-positive T-cell percentage with CF mt-DNA and caspase-1 expression clearly indicated the potential of CF mt-DNA and caspase-1 as a novel disease progression and ARTs effectiveness biomarkers in HIV.


Assuntos
Antivirais/uso terapêutico , Caspase 1/genética , DNA Mitocondrial/sangue , Infecções por HIV/sangue , Adulto , Apoptose , Ácidos Nucleicos Livres/sangue , Feminino , Regulação da Expressão Gênica , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , Infecções por HIV/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
10.
Genomics ; 112(2): 1454-1463, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31450007

RESUMO

Artemisia L. is a complex genus of medicinal importance. Publicly available chloroplast genomes of few Artemisia species are insufficient to resolve taxonomic discrepancies at species level. We report chloroplast genome sequences of two further Artemisia species: A. maritima (151,061 bp) and A. absinthium (151,193 bp). Both genomes possess typical quadripartite structure comprising of a large single copy, a small single copy and a pair of long inverted repeats. The two genomes exhibited high similarities in genome sizes, gene synteny, GC content, synonymous and non-synonymous substitutions, codon usage, amino acids frequencies, RNA editing sites, microsatellites, and oligonucleotide repeats. Transition to transversion ratio was <1. Maximum likelihood tree showed Artemisia a monophyletic genus, sister to genus Chrysanthemum. We also identified 20 highly polymorphic regions including rpoC2-rps2, trnR-UCU-trnG-UCC, rps18-rpl20, and trnL-UAG-rpl32 that could be used to develop authentic and cost-effective markers to resolve taxonomic discrepancies and infer phylogenetic relationships among Artemisia species.


Assuntos
Artemisia absinthium/genética , Artemisia/genética , Genoma de Cloroplastos , Mutação , Filogenia , Artemisia/classificação , Artemisia absinthium/classificação , Proteínas de Cloroplastos/genética , Proteínas de Cloroplastos/metabolismo , Polimorfismo Genético
11.
Sensors (Basel) ; 21(11)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34073061

RESUMO

This study proposes a collective motion and self-organization control of a swarm of 10 UAVs, which are divided into two clusters of five agents each. A cluster is a group of UAVs in a dedicated area and multiple clusters make a swarm. This paper designs the 3D model of the whole environment by applying graph theory. To address the aforesaid issues, this paper designs a hybrid meta-heuristic algorithm by merging the particle swarm optimization (PSO) with the multi-agent system (MAS). First, PSO only provides the best agents of a cluster. Afterward, MAS helps to assign the best agent as the leader of the nth cluster. Moreover, the leader can find the optimal path for each cluster. Initially, each cluster contains agents at random positions. Later, the clusters form a formation by implementing PSO with the MAS model. This helps in coordinating the agents inside the nth cluster. However, when two clusters combine and make a swarm in a dynamic environment, MAS alone is not able to fill the communication gap of n clusters. This study does it by applying the Vicsek-based MAS connectivity and synchronization model along with dynamic leader selection ability. Moreover, this research uses a B-spline curve based on simple waypoint defined graph theory to create the flying formations of each cluster and the swarm. Lastly, this article compares the designed algorithm with the NSGA-II model to show that the proposed model has better convergence and durability, both in the individual clusters and inside the greater swarm.

12.
Opt Express ; 28(10): 14618-14626, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32403499

RESUMO

Here, we present a compact, high-resolution, and ultrabroad-bandwidth arrayed waveguide grating (AWG) realized in a silicon nitride (Si3N4) platform. The AWG has a cascaded configuration with a 1×3 flat-passband AWG as the primary filter and three 1×70 AWGs as secondary filters (i.e. 210 output channels in total). The primary AWG has 0.5-dB bandwidth of 45 nm over 190 nm spectral range. The ultrabroad-bandwidth is achieved by using an innovative design that is based on a multiple-input multi-mode interference (MMI) coupler placed at the entrance of the first free propagation region of the primary AWG. The optical bandwidth of the cascaded AWG is 190 nm, and the spectral resolution is 1 nm. The overall device size is only 1.1 × 1.0 cm2. Optical loss at the central channel is 4 dB, which is 3 dB less than a conventional design with the same bandwidth and resolution values but using a primary filter with Gaussian transfer function. To the best of our knowledge, this is the first demonstration of an ultrabroad-bandwidth cascaded AWG on a small footprint. We also propose a novel low-loss (∼ 0.8 dB) design using a small AWG instead of an MMI coupler in the primary filter part, which can be used in applications where the light intensity is very weak, such as Raman spectroscopy.

13.
Pak J Med Sci ; 36(5): 860-866, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32704253

RESUMO

OBJECTIVE: Cell Free mitochondrial DNA (CF mt-DNA) has emerged as a novel biomarker to investigate disease pathophysiology of different infections. The present study was designed to elucidate the association between CF mt-DNA, IL-6 and viral load in HIV, HBV and HCV infections and predict its role as a potential biomarker to assess the disease severity in viral infections. METHODS: Total 120 blood samples were collected from January 2018 to December 2018 of HIV, HBV and HCV patients and healthy controls (30 samples in each group). DNA and RNA were extracted from the serum to determine the levels of CF mt-DNA and viral load, respectively. IL-6 from the serum of infected individuals was quantified with ELISA. RESULTS: HCV patients showed the highest levels of CF mt-DNA, IL-6 and viral load, followed by HBV and HIV. Significant correlation was found between CF mt-DNA and IL-6 among the HBV patients (p=0.017). However, no significant correlation of CF mt-DNA was observed with IL-6 in HIV and HCV or with the viral load in any of the three infections. CONCLUSION: Elevated CF mt-DNA indicates its role in severity of viral infections. Independence of CF mt-DNA expression from viral load and IL-6 in case of HIV and HCV suggests involvement of other inflammatory pathways regulating CF mt-DNA elevation.

15.
Sensors (Basel) ; 16(5)2016 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-27171084

RESUMO

In this paper, a new and novel mathematical fuzzy hybrid scheme is proposed for the stabilization of a tri-rotor unmanned aerial vehicle (UAV). The fuzzy hybrid scheme consists of a fuzzy logic controller, regulation pole-placement tracking (RST) controller with model reference adaptive control (MRAC), in which adaptive gains of the RST controller are being fine-tuned by a fuzzy logic controller. Brushless direct current (BLDC) motors are installed in the triangular frame of the tri-rotor UAV, which helps maintain control on its motion and different altitude and attitude changes, similar to rotorcrafts. MRAC-based MIT rule is proposed for system stability. Moreover, the proposed hybrid controller with nonlinear flight dynamics is shown in the presence of translational and rotational velocity components. The performance of the proposed algorithm is demonstrated via MATLAB simulations, in which the proposed fuzzy hybrid controller is compared with the existing adaptive RST controller. It shows that our proposed algorithm has better transient performance with zero steady-state error, and fast convergence towards stability.

16.
Cureus ; 16(5): e60791, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38910675

RESUMO

Coronary artery disease (CAD) is a major cause of morbidity and mortality in the United States, and as strides have been made in its management, outcomes have continued to improve. Management has evolved from expectant management to coronary artery bypass graft surgery and thrombolysis, to more recently percutaneous intervention with stenting and medical management in select cases. Here, we describe a case of a complex patient with severe triple-vessel disease who was deemed a poor surgical candidate for coronary artery bypass graft surgery and would instead undergo high-risk percutaneous intervention with the placement of nine drug-eluting stents.

17.
Curr Probl Cardiol ; 49(4): 102469, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38369207

RESUMO

First-degree atrioventricular block (1-AVB), characterized by a PR interval exceeding 200 milliseconds, has traditionally been perceived as a benign cardiac condition. Recently, this perception has been challenged by investigations that indicate a potential association between PR prolongation and an elevated risk of atrial fibrillation (AF). To consolidate these findings, we performed a comprehensive review to assess the available evidence indicating a relationship between these two conditions. We searched MEDLINE and EMBASE databases as well as manually searched references of retrieved articles. We selected 18 cohort studies/meta-analyses involving general and special populations. Consistent findings across expansive cohort studies reveal that incremental increases in the PR interval may serve as an independent risk factor for AF. However, our analyses underscore the need for further research into the association between 1-AVB, defined by a specified PR interval cutoff, and the risk of AF.


Assuntos
Fibrilação Atrial , Cardiopatias , Humanos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fatores de Risco
18.
PLoS One ; 18(9): e0291429, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37768962

RESUMO

Novel hardware architectures for dynamic reconfigurable implementation of 64-bit MISTY1 and KASUMI block ciphers are proposed to enhance the performance of cryptographic chips for secure IoT applications. The SRL32 primitive (Reconfigurable Look up Tables-RLUTs) and DPR (Dynamic Partial Reconfiguration) are employed to reconfigure single round MISTY1 / KASUMI algorithms on the run-time. The RLUT based architecture attains dynamic logic functionality without extra hardware resources by internally modifying the LUT contents. The proposed adaptive reconfiguration can be adopted as a productive countermeasure against malicious attacks with the added advantage of less reconfiguration time (RT). On the other hand, the block architecture reconfigures the core hardware by externally uploading the partial bit stream and has significant advantages in terms of low area implementation and power reduction. Implementation was carried out on FPGA, Xilinx Virtex 7. The results showed remarkable results with very low area of 668 / 514 CLB slices consuming 460 / 354 mW for RLUT and DPR architectures respectively. Moreover, the throughput obtained for RLUT architecture was found as 364 Mbps with very less RT of 445 nsec while DPR architecture achieved speed of 176 Mbps with RT of 1.1 msec. The novel architectures outperform the stand-alone existing hardware designs of MISTY1 and KASUMI implementations by adding the dynamic reconfigurability while at the same achieving high performance in terms of area and throughput. Design details of proposed unified architectures and comprehensive analysis is described.

19.
Bioinform Adv ; 3(1): vbad103, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37600847

RESUMO

Motivation: AliGater is an open-source framework to accelerate the development of bioinformatic pipelines for the analysis of large-scale, high-dimensional flow cytometry data. AliGater provides a Python package for automatic feature extraction workflows, as well as building blocks to construct analysis pipelines. Results: We illustrate the use of AliGater in a high-resolution flow cytometry-based genome-wide association study on 46 immune cell populations in 14 288 individuals. Availability and implementation: Source code and documentation at https://github.com/LudvigEk/aligater and https://aligater.readthedocs.io.

20.
Ann Med Surg (Lond) ; 85(4): 1047-1050, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37113891

RESUMO

Granulomatosis with polyangiitis (GPA) is a rare, immunologically mediated systemic vasculitis that presents as an aseptic necrotizing granulomatous inflammation of the small and medium vessels. Case presentation: The authors report the case of a 47-year-old Syrian female smoker who was admitted to the hospital due to painless palpable masses in her left cheek and left upper lip. Her medical and family histories were unremarkable. Physical examination demonstrated facial asymmetry and bulging in the left cheek and left suborbital region, with marked limitation of the mouth opening and notable oozing from the maxillary sinus seen within the area of the extracted second premolar, in addition to swelling in the parotid gland region, which caused facial nerve weakness. Lab findings were significant for an elevated neutrophil count (16 400/mm3) and positivity of Cytoplasmic- Antineutrophil Cytoplasmic Autoantibody (c-ANCA). Microscopic examination revealed noncaseating necrotizing granulomas surrounded by histocytes and multinucleated giant cells. The disease kept its local invasion going despite the treatment with cyclophosphamide. Thus, surgical debridement was considered a notable improvement. Discussion: GPA is a systemic disease that usually affects multiple organs, especially the kidneys and the upper and lower respiratory tracts. The diagnosis of GPA is made based on a biopsy and the presence of c-ANCA. The treatment of GPA is patient-adjusted, and it usually consists of two major phases: induction and maintenance. However, surgery is preferred for patients who do not respond to pharmacotherapy. Conclusion: This article demonstrates a rare case of GPA in the head and neck region; that highlights the significant role of c-ANCA and histological exam in confirming the diagnosis as well as the importance of surgery when the disease is intractable.

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