Survey of drug use and its association with herd-level and farm-level characteristics on German dairy farms

The use of veterinary drugs is of similar importance to that of human drugs in addressing health challenges. In this context, pharmaceuticals and their metabolites inevitably enter soil and water in unknown quantities. Therefore, this study collects and analyzes drug data from 2020 for 50 dairy farms located in Germany. The most frequently used substance group is antibiotics (40.13%), followed by antiphlogistics (18.86%), antiparasitics (13.09%), and hormones (9.29%). Treatment frequencies record the number of days per year on which an average animal on a farm was treated with a substance. The calculated values range from 0.94 to 21.69 d/yr and are distributed heterogeneously across farms. In this study, on average, a cow was treated on 6 d in 2020: 2.34 d with antibiotics, 1.07 d with antiphlogistics, 0.76 d with antiparasitics, and 0.41 d with hormones. In addition to individual farm management practices, other factors are related to treatment frequency. Farms with a veterinary care contract used more hormonal substances than farms without a care contract. In addition, higher milk yield coincides with more frequent treatments with antiphlogistic or hormonal substances. Other related factors include grazing, longevity, farm size, and use of a claw bath. Our study represents an important first step in describing the amounts and determinants of veterinary drugs used in livestock farming. Such insights on magnitudes and farm parameters are essential to estimate potential environmental effects and derive strategies to reduce veterinary drug use.

Acute Non-infectious Cystitis Secondary to Immune-Related Adverse Events in a Patient Receiving Pembrolizumab for Treatment of Non-small Cell Lung Cancer: A Case Report

Immune-related adverse events (IrAEs) involving the bladder are seldom reported and tend to be overlooked by oncologists. Cystitis caused by immune checkpoint inhibitors (ICIs) is rarely reported, with only four documented instances in the literature, of which just one case is attributed to pembrolizumab. We present a rare occurrence of pembrolizumab-induced hemorrhagic cystitis in a 71-year-old male with stage II-b lung adenocarcinoma with an chronic indwelling Foley catheter. He presented with persistent hematuria despite the completion of a course of antibiotics for a urinary infection; a cystoscopic examination was also normal. Drug-induced cystitis was suspected and the patient was treated with prednisone as well as temporary discontinuation of pembrolizumab, which was followed by an improvement of symptoms.

Anaplastic Large Cell Lymphoma (ALCL) With a Sarcomatoid Variant Presenting As Distributive Shock in a 41-Year-Old Female: A Case Report

The sarcomatoid variant is considered a rare subtype of anaplastic large cell lymphoma. We present a 40-year-old diabetic female who was evaluated in the ER for distributive shock, requiring vasopressors and mechanical ventilation. An extensive workup was negative for infection. A serial CT scan of the abdomen and pelvis showed evolving lymphadenopathy, and a biopsy revealed malignant anaplastic lymphoma cells with a sarcomatous variant. The oncology team recommended the initiation of inpatient chemotherapy; however, the family opted to proceed with comfort care measures.

A Rare Presentation of Small Bowel Perforation Secondary to Microscopic Metastasis of Non-small Cell Lung Cancer (NSCLC): A Case Report

Gastrointestinal tract perforation (GITP) due to metastatic lung cancer is an exceptionally rare occurrence. Symptoms can range from mild abdominal discomfort to severe and life-threatening bowel perforation. In this case presentation, we describe an unusual instance involving squamous non-small cell lung cancer (NSCLC), where microscopic metastases in the small bowel led to bowel perforation. Our patient, a 71-year-old male with a history of stage IIIa squamous cell carcinoma in the right lung and smoking history, completed chemoradiation therapy and is currently undergoing treatment with durvalumab. He presented to the ED with complaints of abdominal pain, nausea, and abdominal distention. His review of systems revealed no other significant issues, and his vital signs were stable. However, the abdominal examination revealed noticeable distention with tenderness upon palpation and guarding. Laboratory results were significant for leukocytosis with a left shift of neutrophils and mildly elevated kidney function. A CT scan of the abdomen and pelvis revealed widespread pneumoperitoneum, indicating a bowel perforation. Consequently, the patient underwent an urgent exploratory laparotomy, during which a small bowel perforation measuring 0.6 cm x 0.3 cm in the jejunum was identified, necessitating the resection of the affected bowel segment. Intraoperative esophagogastroduodenoscopy (EGD) showed normal findings. The histopathological examination of the resected bowel revealed clusters of squamous cell carcinoma with a desmoplastic reaction, affecting the submucosal and muscular layers at the site of the defect, with surgical margins free of tumor or inflammation. This finding indicated metastatic disease originating from the known lung squamous cell carcinoma. After the operation, the patient was admitted to the ICU due to septic shock caused by E. coli and Klebsiella peritonitis, requiring intubation and circulatory support with pressors. Ultimately, he was discharged following treatment. This case underscores the rarity of symptomatic bowel perforation from micro-metastasis in squamous NSCLC and emphasizes the need for rigorous assessment and timely surgical intervention. However, it is important to recognize the significant risk of complications and a high mortality rate, leading to a challenging prognosis. As such, individuals with a known history of lung carcinoma who present with abdominal symptoms should undergo comprehensive evaluation to prevent life-threatening complications through early intervention.

A Rare Case Presentation of Vitiligo Associated With Atezolizumab

Immune checkpoint inhibitors (ICIs) are monoclonal antibodies used in the treatment of solid and hematologic malignancies. Immune checkpoint inhibitors target the T-cell deactivation system via the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) receptor, programmed cell death protein 1 (PD-1) receptor, and programmed cell death ligand 1 (PD-L1). As a result, the activated T-cell enhances the host tumor response. However, even with their essential clinical benefits, ICIs are associated with a broad spectrum of adverse effects that can be generalized or tissue-specific inflammatory responses known as immune-related adverse events (irAEs). The most common dermatologic toxicity manifests mainly as maculopapular rash and pruritus. Understanding the complexity of immune-mediated response and the importance of clinical histopathologic correlation in recognizing irAEs allows for appropriate intervention and patient care due. We present the case of a 71-year-old African American male diagnosed with a large-cell poorly differentiated neuroendocrine tumor in the gastroesophageal junction of the stomach with mediastinal lymphadenopathy. He was treated with carboplatin, etoposide, and atezolizumab for 4 cycles. However, he developed vitiligo while on maintenance atezolizumab, which is rarely seen with atezolizumab use. Despite the improving clinical outcomes in oncology with ICIs, their adverse effects should not be ignored. When promptly recognized and treated, patients on ICI monotherapy may not need treatment interruption or discontinuation.

Troubles thyroïdiens et pneumopathie Covid-19 : étude monocentrique à propos de 223 cas

Introduction

Les troubles de la fonction thyroïdienne au cours des viroses sont décrits dans la littérature. Le SARS-Cov2 entraîne des manifestations systémiques notamment une atteinte thyroïdienne.

Patients et méthodes

C’est une étude monocentrique type cohorte rétrospective incluant les patients hospitalisés pour une pneumopathie Covid-19 (septembre 2020–février 2022) et ayant une perturbation du bilan thyroïdien. Les patients ayant des antécédents de pathologies thyroïdiennes ont été exclus. Les caractéristiques clinico-biologiques ont été relevées.

Résultats

Durant cette période, 1237 patients ont été hospitalisé pour une pneumopathie Covid-19. Nous avons inclus 256 patients en excluant 33 patients ayant un antécédent de dysthyroïdie. Il s’agissait de 128 (57 %) femmes et 95 (43 %) hommes. L’âge moyen était de 74 ans. Il s’agissait de 191 (85,7 %) cas d’hyperthyroïdie fruste, 24 (10,7 %) cas d’hypothyroïdie fruste et 8 (3,6 %) cas d’hypothyroïdie dont 6 cas de thyroïdite d’Hashimoto avec des anticorps antithyroperoxydases positifs. Il y avait une normalisation du bilan thyroïdien des cas de dysthyroïdie fruste dont le bilan a été contrôlé à distance de l’infection.

Conclusion

L’infection Covid-19, par le billais du stress hypoxique, la sécrétion de glucocorticoïdes et la libération de cytokines pro inflammatoires, peut perturber la fonction thyroïdienne. L’atteinte semble le plus souvent spontanément réversible dans le cas des dysthyroïdies fruste mais l’attention est toujours requise chez les à haut risque de survenu de fibrillation auriculaire. Ceci augmenterait le risque thromboembolique déjà majoré par la COVID-19. D’authentique cas de thyroïdite auto-immunes ont aussi été découvertes. Ceci confirme la relation déjà soulevé entre SARS-cov2 et auto-immunité.

Comparison of the initial ovarian response, the synchrony of oestrus and ovulation and chronic stress response after administration of 100 or 250 μg of GnRH to randomly cycling Bos indicus cattle

OBJECTIVE

This study investigated the effects of administering saline, 100 or 250 μg of gonadotrophin releasing hormone (GnRH) on ovarian response, synchrony of oestrus and ovulation and chronic stress response in Bos indicus cattle.

DESIGN

Randomised control.

METHODS

Animals were either left untreated (n = 20) or on day 0 treated with an intravaginal progesterone releasing device and either saline (n = 24), 100 μg (n = 35), or 250 (n = 35) μg of GnRH, intramuscular (IM). Blood was sampled 1.4 h after administration of treatment to monitor concentrations of luteinising hormone (LH) and P4 in serum and again 5 days later. On day 5 intravaginal P4 releasing device were removed, cloprostenol was administered IM and again 8 h later. Oestrus and ovulation were then monitored with ultrasonography for 6.5 days. Hair was clipped on day 55 for analysis of hair cortisol concentrations (HCC).

RESULTS

No significant differences were found between Saline and GnRH treatments in the odds of inducing a new corpus luteum (CL) and the synchrony of oestrus or ovulation. HCC did not differ significantly between treatments. Mean concentrations of LH in serum on day 0 were less in the Saline compared to 100 and 250 μg GnRH treatments but did not differ between different doses of GnRH.

CONCLUSION

Mean concentrations of LH and the odds of inducing a new CL were not increased after administering 250 μg compared to 100 μg of GnRH. Animal handling events in the study did not influence HCC. Further research is needed to better optimise responses to GnRH in B. indicus cattle.

Serological cross-sectional survey of equine infectious anemia in Saudi Arabia

The equine infectious anaemia virus (EIAV) is one of the most serious equine diseases worldwide. There is scarce information on the epizootiology of equine infectious anaemia (EIA) in Saudi Arabia. Given the importance of the equine industry in Saudi Arabia, this cross- -sectional study aims to provide information about the prevalence of EIAV based on serological surveillance of the equine population in the country. A total of 4728 sera samples were collected (4523 horses and 205 donkeys) between December 2017 and November 2019. All samples were tested using commercially available EIAV ELISA. All tested samples showed negative results for EIAV antibodies with a 95% confidence interval. The results provided evidence that Saudi Arabia's equine populations (horses and donkeys) are currently free of EIAV. The results also suggest the need for continuous monitoring of EIAV and strict regulation when importing horses from other countries.

Investigating microbial dynamics and potential advantages of anaerobic co-digestion of cheese whey and poultry slaughterhouse wastewaters

Resource recovery and prevention of environmental pollution are key goals for sustainable development. It is widely reported that agro-industrial activities are responsible for the discharge of billions of liters of wastewater to the environment. Anaerobic digestion of these energy rich agro-industrial wastewaters can simultaneously mitigate environmental pollution and recover embedded energy as methane gas. In this study, an assessment of mono- and co-digestion of cheese whey wastewater (CWW) and poultry slaughterhouse wastewater (PSW) was conducted in 2.25-L lab-scale anaerobic digesters. Treatment combinations evaluated included CWW (R1), PSW (R2), 75:25 CWW:PSW (R3), 25:75 CWW:PSW (R4), and 50:50 CWW:PSW (R5). The digestion efficiencies of the mixed wastewaters were compared to the weighted efficiencies of the corresponding combined mono-digested samples. R4, with a mixture of 25% CWW and 75% PSW, achieved the greatest treatment efficiency. This corresponded with an average biodegradability of 84%, which was greater than for R1 and R2 at 68.5 and 71.9%, respectively. Similarly, R4 produced the highest average cumulative methane value compared to R1 and R2 at 1.22× and 1.39× for similar COD loading, respectively. The modified Gompertz model provided the best fit for the obtained methane production data, with lag time decreasing over progressive treatment cycles. PCoA and heatmap analysis of relative microbial abundances indicated a divergence of microbial communities based on feed type over the treatment cycles. Microbial community analysis showed that genus Petrimonas attained the highest relative abundance (RA) at up to 38.9% in the first two cycles, then subsequently decreased to near 0% for all reactors. Syntrophomonas was highly abundant in PSW reactors, reaching up to 36% RA. Acinetobacter was present mostly in CWW reactors with a RA reaching 56.5%. The methanogenic community was dominated by Methanothrix (84.3–99.9% of archaea). The presence of phosphate and Acinetobacter in CWW feed appeared to reduce the treatment efficiency of associated reactors. Despite Acinetobacter being strictly aerobic, previous and current results indicate its survival under anaerobic conditions, with the storage of phosphate likely playing a key role in its ability to scavenge acetate during the digestion process.

Importance of accurate clinical staging in patients with early stage HER2+ and triple negative breast cancer

e12631

Background: Comprehensive radiological evaluation in early-stage breast cancer is essential for accurate staging and subsequent therapeutic decisions. This is especially important in early-stage human epidermal receptor -2 (HER2) positive and triple negative breast cancer (TNBC). For these tumors, current guidelines suggest a neoadjuvant approach for ≥cT2 disease. Standard diagnostic modalities have oftentimes failed to confirm the correct size of these tumors. Misrepresentation of their true size may lead to patients being treated with upfront surgery and potentially missing the added benefits of residual treatment if they were later found to have >T2 disease. Methods: We conducted a retrospective analysis via electronic medical record review of a large institutional database from 2008 to 2020. We reviewed all patients with a diagnosis of early-stage breast cancer (Stage I - III) with triple negative or HER2 positive tumors. Patients who received neoadjuvant chemotherapy were excluded. Data on demographics, comorbidities, receptor status, clinical staging, pathological staging, and mortality were collected. Results: Electronic charts from 448 patients were reviewed. 153 patients had ≤cT1 disease. 33 (21.6%) of the 153 patients were upstaged from cT1 to ≥pT2 tumors. Combined imaging modality with mammogram + ultrasound (US) yielded a statistically significant accuracy in clinical staging compared to US alone (82.6 vs. 44.4%; p = 0.02). Comparisons between other imaging methods were not statistically significant (mammogram + US vs. mammogram only, 74.1 vs. 82.6%, p = 0.41 and mammogram only vs. US only, 74.1 vs. 44.4%, p = 0.13). Magnetic Resonance Imaging (MRI) was only utilized on 2 patients with 50% accuracy. Conclusions: Significant discordance (> 20%) exists between radiological staging and pathological staging of T1 TNBC and HER2 positive breast cancers at our institution. This data has considerable therapeutic implications as landmark studies such as the CREATE-X and KATHERINE trials have provided better survival data with the use of drugs such as capecitabine and trastuzumab emtansine (T-DM1), respectively, in patients with residual disease who have undergone neoadjuvant chemotherapy followed by surgery. Combined imaging with mammography and US yielded the most accurate staging. MRI was utilized on only two patients. MRI has shown to be helpful in evaluation of patients for preoperative systemic therapy, defining the extent of disease, assessing response to treatment and the potential for breast conserving surgery. Several studies have also demonstrated the accuracy of MRI for staging breast cancer. Given the significant discordance seen at our institution, one possible solution may be to employ MRI for staging on patients with inherently aggressive early-stage tumors such as TNBC and HER2+ breast cancers. Further prospective studies are required to validate our findings.

Autonomous Exercise Generator for Upper Extremity Rehabilitation: A Fuzzy-Logic-Based Approach

In this paper, an autonomous exercise generation system based of fuzzy logic approach is presented. This work attempts to close a gap in the design of a completely autonomous robotic rehabilitation system that can recommend exercises to patients based on their data, such as shoulder range of motion (ROM) and muscle strength, from a pre-set library of exercises. The input parameters are fed into a system that uses Mamdani-style fuzzy logic rules to process them. In medical applications, the rationale behind decision making is a sophisticated process that involves a certain amount of uncertainty and ambiguity. In this instance, a fuzzy-logic-based system emerges as a viable option for dealing with the uncertainty. The system’s rules have been reviewed by a therapist to ensure that it adheres to the relevant healthcare standards. Moreover, the system has been tested with a series of test data and the results obtained ensures the proposed idea’s feasibility.

Paraneoplastic Evans Syndrome in a Patient With Prostate Cancer With Small Cell Transformation

Paraneoplastic syndromes are defined as tumor‐associated indirect systemic effects. Prostate cancer-associated paraneoplastic syndromes typically have endocrine, neurologic, and dermatologic manifestations. Reports have suggested up to 70% of metastatic prostate cancers manifest as paraneoplastic entities. Although common in hematological malignancies, it is rare for prostate cancer and other solid tumors to be associated with immune-mediated cytopenias such as Evans syndrome. Based on our PubMed search for the keywords Evans syndrome and prostate cancer, only one other case has been reported in the literature with this association. We report the second such case in a 63-year-old male who initially presented with hemolytic anemia and thrombocytopenia. He was diagnosed with Evans syndrome with initial responses to both steroids and intravenous immunoglobulin. Extensive workup, including an eventual bone marrow biopsy, revealed metastatic prostate cancer with transformation to small cell neuroendocrine carcinoma.

Abstract P3-01-15: Significant discordance between clinical and pathological staging in early stage HER2+ and triple negative breast cancers treated with upfront surgery

Introduction: Treatment of early-stage human epidermal receptor -2 (HER2) positive and triple negative breast cancer (TNBC) remains a challenge as disease recurrences and subsequent morbidity and mortality continues to be high for these tumors. Current guidelines suggest a neoadjuvant approach with chemotherapy alone (in TNBC’s), or in combination with single or dual HER2 directed therapy (in HER2 + tumors), for all ≥cT2 disease. Standard diagnostic modalities have oftentimes failed to confirm the correct size of these aggressive tumors. With recent data showing further survival improvement utilizing regimens for residual disease after neoadjuvant therapy, misrepresentation of the true size of these tumors may lead to patients being treated with upfront surgery and potentially missing the added benefits of residual treatment if they were later found to have ≥T2 disease. We aimed to determine whether there is significant discordance between the clinical and pathological staging of these tumors. Methods: We conducted a retrospective analysis via electronic medical record review of a large institutional database from 2008 to 2020. We reviewed all patients with a diagnosis of early-stage breast cancer (Stage I - III) with triple negative or HER2 positive tumors. Patients who received neoadjuvant chemotherapy were excluded. Data on demographics, comorbidities, receptor status, clinical staging, pathological staging, and mortality were collected. Results: Electronic charts from 448 patients were reviewed. 153 patients had ≤cT1 disease. 33 (21.6%) of the 153 patients were upstaged from cT1 to ≥pT2 tumors. Combined imaging modality with mammogram + ultrasound (US) yielded a statistically significant accuracy in clinical staging compared to US alone (82.6 vs. 44.4%; p=0.02). Comparisons between other imaging methods were not statistically significant (mammogram + US vs. mammogram only, 74.1 vs. 82.6%, p=0.41 and mammogram only vs. US only, 74.1 vs. 44.4%, p= 0.13). Conclusion: Significant discordance (>20%) exists between clinical and pathological staging of T1 TNBC and HER2 positive breast cancers. The possibility that these tumors could indeed be ≥T2 lesions is thus a significant concern. This discordance has considerable therapeutic implications. Landmark studies such as the CREATE-X and KATHERINE trials have provided better survival data with the use of drugs such as capecitabine and trastuzumab emtansine (T-DM1), respectively, in patients with residual disease who have undergone neoadjuvant chemotherapy followed by surgery. Combined imaging with mammography and US may yield the most accurate staging. Based on the data from our retrospective study, a strong consideration may be given to offer neoadjuvant therapy to all clinical T1b and T1c TNBC’s and HER2 positive breast cancers. Meaningful survival analysis was not done due to small sample size. Further studies are needed to validate our findings.

Citation Format: Adarsh Sidda, Layana Biglow, Mahmoud Abdallah, Gurusidda Manu, Todd Gress, Maria Tirona. Significant discordance between clinical and pathological staging in early stage HER2+ and triple negative breast cancers treated with upfront surgery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-15.

Effectiveness and Safety of Secukinumab for Psoriasis in a Real-World Clinical Setting in the Asia-Pacific and Middle East Regions: Results from the REALIA Study

INTRODUCTION

Secukinumab has demonstrated sustained long-term efficacy with a favourable safety profile in various manifestations of psoriatic disease. We investigated effectiveness and safety of secukinumab, other biologics and conventional systemic therapies in patients with chronic plaque psoriasis in a real-world setting.

METHODS

REALIA was a non-interventional, multicentre, prospective, parallel group study. Eligible patients were ≥ 18 years old with chronic plaque psoriasis commencing a new treatment with a biologic agent or conventional systemic therapies.

RESULTS

At baseline, 541 patients were divided into three cohorts based on treatment initiated: conventional systemics (173), secukinumab (184) and other biologics (184). A significantly higher proportion of patients achieved almost clear to clear skin based on physician's judgement in secukinumab versus conventional systemics at month 3 (64.7% versus 22.8%, P < 0.001) and month 6 (61.8% versus 20.8%, P < 0.001). At month 12, clear to almost clear skin was achieved by 52.1% of the patients in secukinumab versus 35.8% in conventional systemics (P = 0.066). The proportion of patients achieving Psoriasis Area Severity Index (PASI) 90 on conventional systemics, secukinumab and other biologics was 18.8%, 59.7% and 40.0% at month 3 and 35.3%, 60.8% and 50.0% at month 12, respectively. Secukinumab patients showed significantly higher change in PASI total score from baseline versus conventional systemics at month 3 {least squares [LS] mean [standard error (SE)]: -14.49 [0.648] versus -8.48 [1.149], P < 0.001} and numerically higher [LS mean (SE): -13.60 (0.475) versus -10.84 (1.733), P = 0.122] at month 12. The proportion of patients with Dermatology Life Quality Index 0/1 score on conventional systemics, secukinumab and other biologics was 22.6%, 65.0% and 41.6% at month 3 and 32.0%, 63.5% and 41.3% at month 12, respectively. Safety profile was comparable across cohorts.

CONCLUSIONS

Secukinumab is effective and well tolerated in patients with chronic plaque psoriasis in a real-world setting in an Asia-Pacific and Middle East population, and these results are in agreement with clinical outcomes of secukinumab reported in randomised clinical trials.

TRIAL REGISTRATION NUMBER

170803-001645.

Appraisal of synthetic cationic Gemini surfactants as highly efficient inhibitors for carbon steel in the acidization of oil and gas wells: an experimental and computational approach

New cationic Gemini surfactant (CGS) molecules were synthesized and investigated as anticorrosive materials for carbon steel (CS) in 1 M HCl solution by chemical, electrochemical and theoretical studies such as DFT and MDS approaches. The anticorrosion efficacy increased with the increase in the CGS concentration. It reached 95.66% at 5 × 10⁻³ M of the CGS molecule using PDP measurements. PDP studies confirm that the CGS molecule acts as a mixed inhibitor. The EIS outcomes were explained by an equivalent circuit in which a constant phase element (CPE) rather than a double-layer capacitance (C_dl) was exploited to donate a more precise fit of the experimental outcomes. The CGS molecule follows the Langmuir isotherm as it is chemically adsorbed onto the surface of CS. To explore the kinetic and adsorption mechanisms, the thermodynamic characteristics of the activation and adsorption processes were assessed under the impact of temperature. Frontier molecular orbitals (FMOs) were achieved by the density functional theory (DFT) method. The study of interatomic interactions at the [CS (Fe(110))]/CGS level was discussed using molecular dynamics (MD) simulation.

New cationic Gemini surfactant (CGS) molecules were synthesized and investigated as anticorrosive materials for carbon steel (CS) in 1 M HCl solution by chemical, electrochemical and theoretical studies such as DFT and MDS approaches.

Investigation of the anticorrosion and adsorption properties of two polymer compounds on the corrosion of SABIC iron in 1 M HCl solution by practical and computational approaches

The anticorrosion efficiency of two polymer compounds, namely polystyrene (PS), polybutylene terephthalate (PBT), against the corrosion of SABIC iron (S-Fe) in 1.0 M HCl solution was investigated. The anticorrosion efficiency was estimated by chemical and electrochemical measurements. The anticorrosion efficiency increased with the increase in the concentration of the polymer compounds and reduction in temperature. All the obtained corrosion data confirmed the anticorrosion strength in the presence of PS and PBT compounds, such as the decreasing values of the corrosion current density, capacity of the double layer, and weight reduction, while the values of the charge-transfer resistance increased. Also, the pitting potential values moved in the noble (+) direction. The anticorrosion efficiency of the PBT compound was higher than that of the PS compound, which was 95.98% at 500 ppm concentration for PBT while for PS it was 93.34% according to polarization measurements. The anticorrosion activity occurred by the adsorption of PS and PBT compounds on the surface of S-Fe according to the Langmuir isotherm. The polarization curves indicated that the PS and PBT compounds were mixed-type inhibitors. Density functional theory (DFT) and Monte Carlo simulation (MC) were performed for the two polymer compounds. The computational quantum functions were found to be in agreement with the experimental results.

Top and side views for adsorption of the two dimers over Fe (110) surface.

Natural parsley oil as a green and safe inhibitor for corrosion of X80 carbon steel in 0.5 M H2SO4 solution: a chemical, electrochemical, DFT and MC simulation approach

This work focuses on the use of natural parsley oil as a safe, eco-friendly and cost-effective inhibitor for dissolution of X80 carbon steel (X80CS) in 0.5 M H₂SO₄ solution. Electrochemical and chemical measurements and theoretical studies were utilized to determine the inhibitory vigor of parsley oil. The inhibition efficacy increases with an increase in the parsley oil concentration and a decrease in temperature. It reached 95.68% at 450 ppm of parsley oil. The inhibition process is explained by spontaneous adsorption of the oil on the X80CS. Adsorption is described by the Langmuir isotherm model. The polarization data demonstrate that parsley oil is categorized as a mixed inhibitor with a dominant control of the cathodic reaction. Parsley oil inhibits the pitting corrosion of X80CS in the presence of NaCl solution by moving the pitting potential to a more positive mode indicating protection against pitting attack. The thermodynamic parameters for activation and adsorption were computed and interpreted. The four chemical components in natural parsley oil were examined using density functional theory (DFT). Monte Carlo (MC) simulation was performed to study the adsorption of parsley oil on the X80CS surface. The outcomes confirmed that the Apiole molecule is the most effective in the inhibition process.

This work focuses on the use of natural parsley oil as a safe, eco-friendly and cost-effective inhibitor for dissolution of X80 carbon steel (X80CS) in 0.5 M H₂SO₄ solution.

Hyperparathyroïdie au cours de la pneumopathie covid-19

Introduction

Patients et méthodes

Résultats

Discussion et conclusion

Acidocétose diabétique euglycémique au décours d’une infection covid-19

Introduction

L’empagliflozine utilisé pour le traitement du diabète de type 2 a démontré son efficacité mais peut être responsable d’effets indésirables comme l’acidocétose diabétique euglycémique (ACDeu). C’est une complication rare favorisée par la déshydratation ou un état anorexigène. Nous rapportons le cas d’ACDeu associé à l’empagliflozine au décours d’une infection Covid 19.

Observation

Il s’agit d’un homme âgé de 49 ans diabétique sous empagleflozine. Il consulte pour un syndrome grippal, dyspnée et anorexie. À l’examen, il avait une glycémie à 1,68 g/l avec une acétonurie et une glycosurie. Il était polypnéique avec une saturation périphérique en O2 à 95 %. Le reste de l’examen était sans anomalie. À la biologie, il avait une acidose métabolique non compensé avec un trou anionique à 28,55 et une insuffisance rénale aiguë fonctionnelle. Devant la dyspnée le test RT-PCR coronavirus SARS cov2 a été pratiqué et il était positif. Le diagnostic d’ACDeu iatrogène à l’empagleflozine a été retenu et il a été arrêté. Le patient a été mis sous insulinothérapie associée à une hydratation et un apport adapté en glucose avec une bonne évolution clinico-biologique.

Conclusion

L’infection Covid 19 peut être responsable d’une déshydratation, une anorexie et une perturbation du métabolisme glucidique. Ces facteurs favorisent la survenue de l’ACDeu chez le patient diabétique sous empagliflozine. La glycémie normale ou faiblement élevée n’exclut pas le diagnostic. Cette observation nous rappelle l’intérêt de l’arrêt des antidiabétiques oraux lors d’une infection Covid 19. Le pronostic est bon si la prise en charge est précoce et adaptée.

Association between estrogen receptor status and Oncotype Dx breast recurrence score

e12519

Background: The 21 gene assay Oncotype Dx Breast Recurrence Score (RS) is currently the standard of care to determine if adjuvant chemotherapy is needed in early stage node negative, hormone receptor positive, HER-2 negative breast cancer. In current American society of clinical oncology (ASCO) guidelines there is little or no benefit of adjuvant chemotherapy in patients older than 50 years whose tumors have Oncotype DX RS <26, and for patients 50 years or less whose tumors have Oncotype DX RS <16. We sought to evaluate the percentage of estrogen receptor (ER) expression as a surrogate measure of determining adjuvant chemotherapy by examining the relationship between ER expression and RS. Methods: We identified 301 patients from years 2015 to 2019 from our cancer registry with early stage hormone receptor positive breast cancer and had oncotype DX testing performed. We divided patients into three groups: Group 1 (ERG1) with ER <10%; Group 2 (ERG2) with ER 10-49%; and Group 3 (ERG3) with ER equal or >50%. We also collected information on tumor size (cm), tumor grade, Nottingham score, and ki-67 percentage. A sub-group analysis was performed for patients < 50 years age (n=30). We compared all continuous variables across ER groups using the Kruskal-Wallis rank test and individual between group comparisons using the Wilcoxon rank sum test. All statistical tests performed utilized a two-tailed p value of <0.05 with the Bonferroni correction for multiple comparisons. Results: Among 301 patients with early stage hormone receptor positive breast cancer, 89.1% were ductal, 7.9% lobular, and 2.9% mixed histology. Median age was 68, 58 and 66 for ERG1, ERG2, and ERG3, respectively (p = 0.41). Median RS was 36 (ERG1), 23 (ERG2), and 16 (ERG3) (p = 0.78 for ERG1 vs. ERG2; p = 0.01 for ERG1 vs. ERG3). As expected, tumor grade, tumor size, and Nottingham score decreased significantly from ERG1 to ERG3. For patients <50 years, median age was 44, 46 and 45 for ERG1, ERG2, and ERG3, respectively (p = 0.75). Median RS was 10 (ERG1), 24 (ERG2) and 18 (ERG3) (p = 0.04 for ERG1 vs. ERG2; p = 0.17 for ERG1 vs. ERG3). Conclusions: We found a significant association between estrogen receptor levels and Oncotype Dx recurrence score (RS) in patients with early stage hormone receptor positive breast cancer patients. Further studies are needed to determine the predictive ability of hormone receptor levels on the outcomes of patients treated for early stage hormone receptor positive breast cancer.

Enhancing the inhibition and adsorption performance of SABIC iron corrosion in sulfuric acid by expired vitamins. Experimental and computational approach

The inhibition potency of expired thiamine or vitamin B1 (VB1) and riboflavin or vitamin B2 (VB2) against SABIC iron corrosion in 0.5 M H₂SO₄ solutions was investigated using chemical and electrochemical techniques. Theoretical studies such as DFT and MC simulations were performed on both VB1 and VB2 inhibitors to obtain information related to the experimental results. It has been found that the inhibition efficacy assigned from all measurements used increases with increasing concentration of the two expired vitamins and reduces at elevated temperatures. It reached 91.14% and 92.40% at 250 ppm of VB1 and VB2, respectively. The inhibition was explicated by the adsorption of the complex formed between expired vitamins and ferrous ions on the SABIC iron surface. The adsorption was found to obey the Langmuir isotherm model. Galvanostatic polarization demonstrated that the two expired vitamins act as an inhibitor of the mixed type. These expired vitamins have proven effective in inhibiting the pitting corrosion induced by the presence of Cl^- ions. The pitting potential is transferred to the positive values showing resistance to pitting damage. The theoretical parameter values are consistent with experimental results.

Design, Simulation, and Development of a BioSensor for Viruses Detection Using FPGA

Objective: Impedance based biosensing provides a unique, highly sensitive electrical approach to biomolecule detection, cell growth, and other biological events. To date, an impedance change due to the cell growth has been considered as a solution to detect some changes in a cell’s behavior. The impedance change detection is normally measured via an impedance analyzer which is expensive and also cumbersome. Rapid and definitive diagnosis of viral infections is imperative in patient treatment process. Early detection followed by appropriate lifestyle and treatment may result to a longer, healthier life. Certain patients require continues monitoring that may require regular visits to hospitals which is not practical. Therefore, a continuous home healthcare device is needed to monitor and detect any change in a patient’s health condition. Methods & Results: In this research, a novel sensor and healthcare monitoring system is modeled, simulated, developed, and tested to detect viruses by detecting the change in the impedance due to antibodies and antigens binding. First, COMSOL simulation tool is used to develop a model to prove the concept. The model predicts increasing impedance during functionalization of electrodes with antibodies and after antigen binding steps. Second, to understand how nanoscale electrode size and spacing would affect biosensing assay (antibody-based affinity binding of a protein antigen), a model using COMSOL is developed. Third, Field Programmable Gate Arrays (FPGA) based signal processing system is developed as well to be connected to analog to digital converter (ADC) to acquire the current and voltage readings of the sensors over time. This healthcare monitoring system is used to continuously monitoring a patient’s condition and reports any changes in the impedance readings which represents virus detection or at least change in the cell’s behavior. Conclusions: The proposed sensor model is simulated, tested and verified via COMSOL and the FPGA prototype is tested and it verified the COMSOL model. This work reports that the proposed sensor can be used to detect viruses via detecting a change in the impedance.

Hormone Receptor Positive/HER2 Negative Breast Cancer With Isolated Bladder Metastasis: A Rare Case

Breast cancer is the most common cancer diagnosed in women in North America. Hormone receptor positive (HR+) and HER2 negative (HER2-) breast cancers account for at least 60% to 70% of all breast cancer cases. They usually metastasize to lymph nodes, bones, liver, lungs, and brain. Urinary bladder is a very unusual site for metastatic HR+/HER2- breast cancer and occurs in only 2% of all metastatic disease. In this article, we present a case of a 63-year-old female with locally advanced breast cancer who underwent mastectomy, adjuvant chemotherapy, radiation, and hormonal therapy. She was in remission for almost 17 years and subsequently presented with hematuria and lower abdominal pain. Cystoscopy was performed, which showed evidence of bladder wall thickening. Histopathology showed metastatic HR+/HER2- breast cancer consistent with her history of breast primary. Imaging studies did not show any other evidence of metastatic disease. She was started on cyclin D kinase 4/6 inhibitor, palbociclib, in combination with an aromatase inhibitor, letrozole. This is an exceedingly rare case of HR+ and HER2- breast cancer with metastasis to the urinary bladder. The late onset of recurrence with bladder metastasis makes this case very unique and to our knowledge only few similar cases have been reported in the literature.

Ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study

OBJECTIVES

To evaluate the efficacy and safety of ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow-rate, power-ramping shock wave lithotripsy.

METHODS

This was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full-power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow-rate, power-ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone-free rate. Perioperative data of the two protocols were compared.

RESULTS

There was no significant difference in preoperative data. The stone-free rate was significantly higher in ultraslow full-power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full-power shock wave lithotripsy protocol as the only significant independent factor for the stone-free rate (odds ratio 12.589, P = 0.025).

CONCLUSION

Ultraslow full-power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone-free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy.

Ablative fractional CO2 laser vs lyophilized growth factor intralesional injection vs combination of both modalities for striae distensae treatment

BACKGROUND

Different studies had evaluated the efficacy of fractional CO₂ laser and platelet-rich plasma (PRP) in treating striae distensae (SD). Lyophilized growth factors (LGF) represent another form of delivering growth factors similar to PRP with a more standardized method. To the best of our knowledge, no previous trials have been reported using LGF in SD.

AIMS

We aimed to compare the efficacy of ablative fractional CO₂ laser vs intralesional injection of LGF vs combination of both modalities for SD treatment.

METHODS

This study included 20 female patients with SD. All patients received three modalities of treatment in separate three areas: area A: received fractional CO₂ laser, area B: received combination of fractional CO₂ laser and intradermal injection of LGF, and area C: received intradermal injection of LGF. Each area received three sessions with 6-week intervals. The outcome was evaluated clinically and histopathologically before treatment and six weeks after the last session.

RESULTS

There was a statistically significant clinical and histopathological improvement of SD both in areas A and B after treatment. Area C exhibited nonsignificant clinical and histopathological improvement. Area B showed the best improvement results as compared to areas A and C.

CONCLUSION

We reported that fractional CO₂ laser combined with LGF injection was more effective than fractional CO₂ laser alone in SD treatment based on clinical and histopathological assessment. We do not advocate LGF as a monotherapy for SD treatment; instead, LGF can be used as a combined therapy with fractional CO₂ laser to improve its outcome.