Medicine

A Single Canal in a Mandibular Second Molar: A Case Report

Root canal anatomy of mandibular second molars differs among individuals. With the aid of the latest dental technologies in endodontics, the present case report highlights the diagnostic tools required to confirm the morphology of the root canal, and the treatment of uncommon root anatomy of a singl...
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Root canal anatomy of mandibular second molars differs among individuals. With the aid of the latest dental technologies in endodontics, the present case report highlights the diagnostic tools required to confirm the morphology of the root canal, and the treatment of uncommon root anatomy of a single-canal single-rooted mandibular second molar. Clinicians should be aware of the various anatomic variations that each tooth may present in order to achieve a satisfactory result. Furthermore, in order to improve the quality of care delivered to their patients, practitioners must have the necessary knowledge and abilities to utilize the diagnostic and therapeutic instruments at their disposal.
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Comprehensive evaluation of root and root canal morphology of mandibular second molars in a Saudi subpopulation evaluated by cone-beam computed tomography

Background The study's goal was to use Cone Beam Computed Tomography (CBCT) to assess the root and root canal anatomy of mandibular second molars with C-shaped root canal configurations in residents of the Hail district. The impact of gender and side on the frequency of root canal morphology was co...
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Background The study's goal was to use Cone Beam Computed Tomography (CBCT) to assess the root and root canal anatomy of mandibular second molars with C-shaped root canal configurations in residents of the Hail district. The impact of gender and side on the frequency of root canal morphology was considered. Methods The sample size for this study was 304 untreated mandibular second molars with completely developed roots on the right and left sides. Using CBCT on the teeth, the root form and canal morphology for each root are based on Vertucci's classification. The occurrence of canals in the shape of a C. The prevalence and resemblance of the left and right sides or men and females were investigated. The Chi-square test was performed to evaluate the findings. Results Of the 304 mandibular second molars studied, 286 teeth had two roots (94.1%), whilst 13 (4.3%) were C-shaped root canal systems. 77 molars (25.3%) had two canal orifices, 219 (72.0%) had three canal orifices, and six (2.0%) and one (0.3%) had four and five root canal orifices, respectively. Type IV was the most common for mesial root, accounting for 57.7% of the sample (n = 176). For distal root, the most common occurrence was type I, which occurred 282 times (96.60%). The most prevalent root canal morphology was the presence of two canals in the mesial root and one canal in the distal root of teeth with two distinct roots (variant 3). (69.4%). The overall prevalence of C-shaped root canal systems is (4.3%) (n = 13). Conclusions The patient's race is an undeniable factor that influences root canal anatomy. The root canal morphology of mandibular second molars revealed significant differences between Saudi subpopulations. The majority of mandibular second molars had two roots and three root canals. When treating these molars, the presence of a C-shaped root canal system must be taken into account.
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From Kiyoshi Shiga to Present-Day Shigella Vaccines: A Historical Narrative Review

author list

author list

Institution: rnfinity

Email: info@rnfinity.com

Crystal M. Herrera,

Crystal M. Herrera

Institution: Reno School of Medicine, University of Nevada,

Email: crystalherrera@med.unr.edu

Jessicia S. Schmitt,

Jessicia S. Schmitt

Institution: Reno School of Medicine, University of Nevada,

Email: jessiciaschmitt@med.unr.edu

Erum I. Chowdhry,

Erum I. Chowdhry

Institution: Reno School of Medicine, University of Nevada,

Email: echowdhry@med.unr.edu

Mark S. Riddle

Mark S. Riddle

Institution: Reno School of Medicine, University of Nevada,

Email: mriddle@unr.edu

We are at an exciting moment in time with the advancement of many vaccines, including a shigella vaccine for the world. It is instructive to look at the long road that some vaccines have traveled to recognize the remarkable accomplishments of those who were pioneers, appreciate the evolution of scie...
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We are at an exciting moment in time with the advancement of many vaccines, including a shigella vaccine for the world. It is instructive to look at the long road that some vaccines have traveled to recognize the remarkable accomplishments of those who were pioneers, appreciate the evolution of scientific and applied technology, and inform the future history of a vaccine that would have great potential for global health. To achieve this valuable retrospective, a narrative historical literature review was undertaken utilizing PubMed and Embase databases with relevant search terms. Retrieved articles were reviewed and information was organized into historical themes, landmark discoveries, and important vaccine development parallels. The literature reviewed was synthesized into major eras of shigella vaccine development from pathogen discovery and first attempts to empirical approaches of killed whole-cell and live-attenuated approaches, and a modern era that applied recombinant DNA engineering and structural vaccinology. The history of shigella vaccine development has largely followed the evolutionary path of vaccine development over the last 120 years, but with important lessons learned that should be considered as we embark on the future chapters of bringing to the world a safe and effective vaccine for global health.
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Urodynamic predictor of EGFR in adult LUTs patients.

CKD is a growing problem, in an increasingly aged population with an increased propensity for metabolic syndrome. Whilst bladder dysfunction is a logical risk factor for declining renal function, this relationship has not been clearly defined in the adult LUTS population; the predominate group of pa...
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CKD is a growing problem, in an increasingly aged population with an increased propensity for metabolic syndrome. Whilst bladder dysfunction is a logical risk factor for declining renal function, this relationship has not been clearly defined in the adult LUTS population; the predominate group of patients who undergo urodynamics evaluation. By contrast in minority cohorts; patients with neuropathic disease and renal transplant, urodynamic parameters have prognostic value in predicting declining function and determining intervention. The aim of this study was to determine if and how urodynamics can be useful as a predictor of CKD in adult LUTs population. Methods Data was gathered from a retrospective urodynamics database of patients who underwent 2 channel filling and voiding cystometry. Patients who had neuropathic disease or renal transplant, or who had inadequate data were excluded from the analysis. Patients most recent EGFR, EGFR prior to urodynamics and earliest EGFR recorded post 2010, upper tract imaging and risk factors for CKD were recorded. Pre urodynamics EGFR was correlated to urodynamic parameters by univariate regression and multivariate regression. Results From a database of 403 patients, (278 Male, 125 Female) with mean age 59.3 ± 17.6 (SD), who had pressure flow studies, 48 patients were excluded because a history of neurological disease and 6 were excluded because of renal transplants, leaving 369 patients who were included in the study. Overall, there was no significant change in the mean EGFR pre urodynamics, at the time of urodynamics, and post urodynamics testing. Only 15 out of the 226 patients who had upper tract imaging had hydronephrosis. So few people had hydronephrosis that overall it was not an important factor for EGFR. On univariate regression of demographic factors, risk factors for CKD and urodynamic parameters, age hypertension and upper tract obstruction was associated with reduced EGFR. The only urodynamic factors associated with reduced EGFR were Qmax, and voided volume. The presence of detrusor overacitvity and loss of compliance were not associated with reduced EGFR, leaving no invasive pressure –flow parameters, therefore a novel factor- the detrusor pressure at which patients expressed the normal desire to void (NDP) was evaluated, and this was most strongly correlated with EGFR at the time pf urodynamics (p=0.000, r2=0.06). On multivariate regression of all the prognostic factors age, hypertension, and obstruction were independent predictors of EGFR. Detrusor pressure at normal desire had the strongest association with EGFR (p=0.001). The only factor that correlated with recovery of EGFR after urodynamics was NDP (p=0.016). Invasive urodynamics provides useful information regarding risk to renal function and this is best evaluated by the detrusor pressure at normal desire.   Introduction Preservation of renal function is a key concern for urologists and renal physicians. Bladder dysfunction has the potential to cause renal impairment and failure. The most dramatic example is urine retention, but here the most catastrophic loss of renal function usually occurs where there has been the most insidious onset of symptoms. Whilst the diagnosis and initial management of retention is obvious without the need for specialised investigations such as urodynamics, it is beneficial to detect patients who have bladder dysfunction, which places the upper tract at risk, before a decline in EGFR occurs. It is easy to conceive that a prolonged bladder pressure, in the storage phase, either due to detrusor overactivity or loss of bladder compliance in particular, would place the upper tract at risk. Maguire initially demonstrated in myelodysplastic bladders, where a detrusor leak point > 40cm H2O was strongly correlated with hydronephrosis [1]. This has been corroborated by other investigators [2], though others have propose a lower threshold of DLPP of > 20cm H2O [3] Likewise in children with myelodysplastic bladders, bladder wall compliance, cystometric capacity and time to maximum flow rate have found to be associated with serum creatinine [4]. In patients with spinal cord injury, maximal detrusor pressure was found to be co associated with reduced effective renal plasma flow on isotope renogram [5]. In renal transplant patients a smaller bladder capacity (though not specifically a urodynamic factor) has been shown to be associated with poorer graft survival [6]. In posterior urethral valves, poor bladder compliance and detrusor overactivity has demonstrated an association with declining renal function [7]. To date however, studies correlating urodynamic parameters to renal function have been unsuccessful in the adults LUTS population, which though individually at lower risk than neuropaths, collectively represent the majority cohort who experience bladder dysfunction and undergo urodynamic testing. In 87 men who had urinary retention, no association between urodynamic parameters in renal function could be determined [8]. In a study of 161 patients with lower urinary tract symptoms, 42 patients had detrusor overactivity and bladder outflow obstruction; amongst this subgroup, men who had reduced compliance had a higher urea (but not creatinine) than those who had normal compliance [9]. In 359 women who underwent urodynamic investigation, there was no significant difference in EGFR between those with and without DO [10]. It is surprising that our most invasive and sophisticated test has never demonstrated a corollary with renal function in adult LUTS patients. Renal function is off course multifactorial as demonstrated by large population based models where diabetes, hypertension and heart failure are prime risk factors [11,12]. In the adult LUTS population, these risk factors are common place and are usually closely monitored and modified by primary care. Given developed world populations have become increasingly aged with increased risked factors for CKD, overall patients may becoming increasingly susceptible to decline in renal function secondary to bladder dysfunction. The aim of this study was to determine if bladder dysfunction as characterised by urodynamic parameters where predictive of renal function in the adult LUTS population.   Methods Patients: A retrospective review of all urodynamic tests undertaken between 5/2014 and 6/2016 was undertaken. Patients were excluded if they had a history of neuropathic disease or renal transplant or had inadequate data. Urodynamics: Two channel pressure flow studies was carried out on an MMS solar silver Machine or a genesis pico 3000 machine, in accordance with ICS good practice guidelines [13]. The filling rate sensations, compliance, detrusor overactivity, maximum cystometric capacity, flow rate, voided volume, Q max, pDetQmax, residual and detrusor pressure at normal desire was recorded. Data Acquisition: Patient demographics, including age gender, risk factors for renal disease, renal imaging and renal function was recorded. Three values of EGFR were recorded for each patient including the most recent, the last prior to urodynamics and the earliest 2010. EGFR was calculated using the MDRD equation. Statistical Analysis The relationship between the EGFRS and urodynamic factors, demographic factors and risk factors for CKD were evaluated using univariate and multivariate linear regression. Statistical significance was taken as p<0.05. Graphing and statistical analysis was undertaken by minitab v17.   Results From a database of 403 patients, 48 patients with neuropathic disease (1 with renal transplant) and a further 6 patients were excluded from the study, leaving 369 patients who were included. There were 257 men and 112 women with a mean age of 59.6 ± 16.0. Risk factors for renal dysfunction were obtained from 348 patients (Table 1). Hypertension and hyperlipidaemia were the most prevalent risk factors for CKD. 226 patients had upper tract imaging, off which only 15 had hydronephrosis on u/s. 6 patients had renal disease process and 14 had upper tract obstruction or loss of a renal unit. There was some missing EGFR data, particularly in earlier EGFR recordings. Because if this absent data it was only subsequently possible to construct a model examining change in EGFR post UDS and pre UDS. Overall there was no significant change in EGFR between the 3 time pools. The most prevalent urodynamic abnormality (n=177), loss of compliance was seen less frequently (n=56). 127 patients demonstrated incontinence during the study, of which 53 had pure stress incontinence, 79 had urge incontinence and 5 patients demonstrated both. Patients with hydronephrosis had a lower EGFR (Figure 1) 71.4 ± 8.9 (SEM, n=14), versus no hydronephrosis 81.2 ± 1.75 (SEM, n=190) and no upper tract imaging 84.3 ± 2.1 (SEM, n=105). However as only 14 patients with an NDP measurement, had hydronephrosis, this was not statistically significant, p= 0.3 by t test. The pre urodynamics EGFR was compared to the urodynamic parameters by univariate and multivariate regression (Table 2). Age, hypertension and obstruction of the bladder where associated with reduced EGFR. Those with hypertension had an EGFR 11.3 (ml/min/1.73m2) less than those without and those with obstruction had a mean EGFR of 14.0 (ml/min/1.73m2) less than those without. In terms of non-invasive parameters, EGFR was associated with the voided volume (Figure 2a) and the Qmax (Figure 2b). However no association could be found between EGFR and any of the standard invasive storage or voiding parameter. The maximum storage detrusor pressure was not associated with the EGFR. The normal desire detrusor pressure was the only urodynamic parameter that was associated with EGFR (Figure 3 and Table 2). The size of the effect was that increase in normal desire detrusor pressure by 10cm H2O was associated with a decrease in EGFR of 2.8 (ml/min/1.73m2) on univariate regression. Multivariate regression was carried out by forward entry of all of the demographics, CKD risk factor and urodynamic factors listed in Table 2 The predictability of the model was associated with an r2=0.29. Age hypertension and upper tract obstruction were associated with reduced EGFR. On multivariate evaluation of urodynamic factors, normal desire detrusor pressure was the only urodynamic factor that was associated with a reduced EGFR, again an increase in normal desire detrusor pressure by 10cm H2O was associated with a decrease in EGFR of 2.8 (ml/min/1.73m2). Detrusor overactivity was associated with an increased EGFR on multivariate regression, but not univariate regression. When multivariate regression was repeated without NDP, the r2 of the model decreased to 0.23 and detrusor overactivity was no longer associated with increased EGFR 9not shown) Figure 3a shows univariate linear regression of pre urodynamics EGFR versus normal desire detrusor pressure (r2 =0.06, p=0.000). Figure 3b highlights patients who had hydronephrosis. From the patients who had a normal desire detrusor pressure ≥ 20cmH2O, 35 out of 52 patients had upper tract imaging, of which 6 (21%) had hydronephrosis and 29 (79%) didn’t. Figure 4 and Table 3; the only predictor of increase in EGFR post urodynamics, on either univariate analysis (p= 0.045) or multivariate analysis (p=0.016), was the detrusor pressure at normal desire. This was a small but statistically significant effect such that an increase in NDP by 10 cmH2O was associated by a rise in EGFR 1.4 of (ml/min/1.73m2). Overall this model was less predictive than for EGFR presented in Table 2 and was associated with an r2=0.06. Table 4 demonstrates how the 52 patients who had NDP ≥ 20 cm H2O were treated which potentially led to an improvement in their EGFR   Discussion This paper demonstrates that pressure flow studies have a role to play in evaluating the risk of renal dysfunction in the adult LUTs population. This required the usage of non-standard urodynamics parameter as the primary variables specific to invasive urodynamics showed no correlation with EGFR. On an initial subset of 100 patients, alternative parameters including maximum detrusor and vesical storage pressure, and pressure at first sensation and first desire were evaluated. The recording of the other sensations were associated with a greater amount of missing data therefore it was decided to focus on detrusor pressure at normal desire as the parameter that showed the greatest correlation to EGFR and it was the only variable found to correlate to EGFR in the final cohort. Maximum storage detrusor pressure was included in the final regression models, however this showed no correlation with EGFR on univariate and multivariate regression, indicating that the timing of pressure measurements during the storage phase, rather than the amplitude is more pertinent to the EGFR. It was not possible to construct a model that examined decline in EGFR prior to urodynamics, as earlier recordings were often unavailable. However a model that looked at recovery of EGFR post urodynamics demonstrated sole correlation to the detrusor pressure at normal desire. Overall there was a trend for a gradual decline in EGFR. It was against this back drop that patients who had an elevated NDP experienced a small but significant increase in their EGFR from interventions, which incorporated pharmacology, surgery and catheterisation as means of improving bladder emptying or reducing the detrusor pressure. 39 out of 52 patients with an NDP ≥ 20 received an intervention. Out of the 13 who didn’t, 12 of these patients, were offered treatment for their bladder subsequent to urodynamics. Off course, as this study was retrospective no clinician was looking at the NDP as a means of evaluating the patient, yet, generally speaking, were able to instinctively determine which patients required intervention. How can we know which patients to treat when there are not clear guidelines from existing urodynamic parameters in the adult LUTS population, and detrusor overactivity and loss of compliance, in this and previous studies, has not shown a correlation with EGFR? This study reaffirms storage pressures as the most pertinent indicator of renal risk but the question is which storage pressure. Loss of compliance would be expected to be a greater risk to renal function than DO but this was not demonstrated in this and previous studies. The problems with compliance as a measure of renal risk is that is primarily a measure of bladder properties as it is not compliance but loss of compliance that causes a rise in pressure as volume is the numerator and pressure the denominator, secondly it depends on the ratio between two values and there is a low threshold for defining loss of compliance i.e. a rise in pressure of 10cm H20 per 400 ml volume. Furthermore most patients who experience loss of compliance do so at end fill. Urodynamics, by its nature may be a provocative test and whilst it is useful to determine maximum cystometric capacity and to illicit the widest ranges of behaviours patients may be pushed towards volumes that they never experience in day to day life as they have adapted coping strategies that prevent them from experiencing discomfort in real life by voiding or leaking urine at lower volumes. Patients on average experienced normal desire at 2/3 of maximum cystometric capacity. Thus an NDP may be closer to the storage pressures that a patient routinely experiences. On multivariate regression but not univariate analysis, detrusor overactvity was associated with an improved EGFR. This was because patients with higher storage pressures not due to DO but due to loss of compliance were associated with reduced EGFR, but for the reasons listed above loss of compliance did not predict EGFR. When a multivariate model was constructed without NDP, then DO was no longer and independent predictor of EGFR, indicated that it is linked with the NDP. NDP is equivalent to the leak point pressure as it is pressure that signal a change from storage to elimination of urine. However it has wider applicability than a leak point pressure (which was rarely undertaken in this cohort), primarily because only 127 out of 359 patients leaked urine, whereas 340 out of 369 patients experienced normal desire during urodynamics. Determining a leak point pressure may be difficult when there is a rapid change in detrusor pressure such as DO, which was a more common finding than loss of compliance in this cohort. It is arguable that DLPP could be defined in those who didn’t leak as being greater than the maximum detrusor pressure encountered during the storage phase, though it has not been traditionally applied in this manner. Urinary leakage is a double edged as far as risk of declining renal function, as it is associated with elevated storage pressures and weakened outflow tract which increase and decrease the risk to the upper tracts respectively and overall it was not a risk factor for declining renal function (univariate regression p=0.79, data not shown). The fact that only 15 patients from 360 hydronephrosis demonstrates that bladder dysfunction is an insidious process and the utility in urodynamic assessment in assessing risk to upper tracts. Conclusion Urodynamics is useful in evaluating the risk to upper tracts from bladder dysfunction in adult LUTS population. The only urodynamic parameter that independently correlates with EGFR is the detrusor pressure a normal desire.
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Report on the 9th National Congress AICPE (Associazione Italiana di Chirurgia Plastica Estetica) Held in Sorrento, Italy, 22–24 April 2022

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author list

Institution: rnfinity

Email: info@rnfinity.com

Egidio Riggio

Egidio Riggio

Institution: Plastic Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133

Email: egidio.riggio@istitutotumori.mi.it

The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery due to the number of participants and as parterre of invited speakers chosen for their renowned scientific value.

Worldwide inverse correlation between Bacille Calmette-Guérin immunization and COVID-19 morbidity and mortality

The COVID-19 pandemic has spread to all countries in the world after more than six months since it was first reported in late 2019, and different countries have been impacted differently. Correlation analysis between COVID-19 death numbers and different demographic and socioeconomic factors for all ...
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The COVID-19 pandemic has spread to all countries in the world after more than six months since it was first reported in late 2019, and different countries have been impacted differently. Correlation analysis between COVID-19 death numbers and different demographic and socioeconomic factors for all world countries (n=210) as of June 1, 2020, reveals that COVID-19 deaths per million population in a country significantly correlates with the country's median age (r=0.48, p=4.8e-4) and per capita gross domestic product (GDP) (r=0.55, p=4.14e-5), and inversely correlates with the country's Bacille Calmette-Guérin (BCG) vaccination rate (r=-0.63, p=9.9e-7). COVID-19 death is found not significantly associated, however, with a country's policy stringency index, population density, extreme poverty rate, hospital beds availability per thousand people, and diphtheria-tetanus-pertussis (DTP3) immunization. Old age is likely a confounding factor for the correlation between COVID-19 and per capita GDP (r=0.66, p=2.3e-7). To control for possible confounding effects of age, countries with similar median age were grouped and analyzed. The inverse correlation between BCG vaccination rates and COVID-19 case (r=-0.338, p=0.0082) and death (r=-0.411, p=0.0011) remained significant among the top 61 countries with highest median age. The current study suggests that BCG might be protective against SARS-CoV-2 infection.
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Metabolic alkalosis and mortality in COVID-19

Abstract Background As a new infectious disease affecting the world, COVID-19 has caused a huge impact on countries around the world. At present, its specific pathophysiological mechanism has not been fully clarified. We found in the analysis of the arterial blood gas data of critically ill patien...
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Abstract Background As a new infectious disease affecting the world, COVID-19 has caused a huge impact on countries around the world. At present, its specific pathophysiological mechanism has not been fully clarified. We found in the analysis of the arterial blood gas data of critically ill patients that the incidence of metabolic alkalosis in such patients is high. Method We retrospectively analyzed the arterial blood gas analysis results of a total of 16 critically ill patients in the intensive ICU area of Xiaogan Central Hospital and 42 severe patients in the intensive isolation ward, and analyzed metabolic acidosis and respiratory acidosis. Metabolic alkalosis and respiratory alkalosis, and the relationship between metabolic alkalosis and death. Result Among the 16 critically ill patients, the incidence of metabolic alkalosis was 100%, while the incidence of metabolic alkalosis in severe patients was 50%; the mortality rate in critically ill patients was 81.3%, and 21.4% in severe patients ; The mortality of all patients with metabolic alkalosis is 95.5%,and 4.5% in without metabolic alkalosis. Conclusion The incidence of metabolic alkalosis in critically ill COVID-19 patients is high, and it is associated with high mortality. Key words :COVID-19, Metabolic alkalosis, mortality
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Does pre-infection stress increase the risk of long COVID? Longitudinal associations between adversity worries and experiences in the month prior to COVID-19 infection and the development of long COVID and specific long COVID symptoms

Long COVID is increasingly recognised as public health burden. Demographic and infection-related characteristics have been identified as risk factors, but less research has focused on psychosocial predictors such as stress immediately preceding the index infection. Research on whether stressors pred...
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Long COVID is increasingly recognised as public health burden. Demographic and infection-related characteristics have been identified as risk factors, but less research has focused on psychosocial predictors such as stress immediately preceding the index infection. Research on whether stressors predict the development of specific long COVID symptoms is also lacking. Methods Data from 1,966 UK adults who had previously been infected with COVID-19 and who took part in the UCL COVID-19 Social Study were analysed. The number of adversity experiences (e.g., job loss) and the number of worries about adversity experiences within the month prior to COVID-19 infection were used to predict the development of self-reported long COVID and the presence of three specific long COVID symptoms (difficulty with mobility, cognition, and self-care). The interaction between a three-level index of socio-economic position (SEP; with higher values indicating lower SEP) and the exposure variables in relation to long COVID status was also examined. Analyses controlled for a range of COVID-19 infection characteristics, socio-demographics, and health-related factors. Findings Odds of self-reported long COVID increased by 1.25 (95% confidence interval [CI]: 1.04 to 1.51) for each additional worry about adversity in the month prior to COVID-19 infection. Although there was no evidence for an interaction between SEP and either exposure variable, individuals in the lowest SEP group were nearly twice as likely to have developed long COVID as those in the highest SEP group (OR: 1.95; 95% CI: 1.19 to 3.19) and worries about adversity experiences remained a predictor of long COVID (OR: 1.43; 95% CI: 1.04 to 1.98). The number of worries about adversity experiences also corresponded with increased odds of certain long COVID symptoms such as difficulty with cognition (e.g., difficulty remembering or concentrating) by 1.46 (95% CI: 1.02 to 2.09) but not with mobility (e.g., walking or climbing steps) or self-care (e.g., washing all over or dressing). Interpretation Results suggest a key role of stress in the time preceding the acute COVID-19 infection for the development of long COVID and for difficulty with cognition specifically. These findings point to the importance of mitigating worries and experiences of adversities during pandemics both to reduce their psychological impact but also help reduce the societal burden of longer-term illness. Funding The Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].
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Delta/ Omicron and BA.1/BA.2 co-infections occurring in Immunocompromised hosts

Concomitant infection of multiple SARS-CoV-2 variants has become an increasing concern, as this scenario increases the likelihood of recombinant variants. Detecting co-infection of SARS-CoV-2 variants is difficult to detect by whole genome sequencing approaches, but genotyping methods facilitate det...
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Concomitant infection of multiple SARS-CoV-2 variants has become an increasing concern, as this scenario increases the likelihood of recombinant variants. Detecting co-infection of SARS-CoV-2 variants is difficult to detect by whole genome sequencing approaches, but genotyping methods facilitate detection. We describe 2 cases of Delta/Omicron and 2 cases of Omicron sublineage BA.1/ BA.2 co-infection as detected by a multiplex genotyping fragment analysis method. Findings were confirmed by whole genome sequencing. Review of the patient characteristics revealed co-morbidities and conditions which weaken the immune system and may make them more susceptible to harboring SARS-CoV-2 variant co-infections.
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Comparison between Bromine, Calcium, Chlorine, Iodine, Potassium, Magnesium, Manganese, and Sodium Contents in Normal Thyroid and Riedel’s Struma

Role of chemical elements (ChE) in etiology and pathogenesis of Riedel’s disease (RD) is unclear. The aim of this exploratory study was to assess whether there were significant changes in thyroid tissue levels of eight ChE (Br, Ca Cl, I, K, Mg, Mn, and Na) are present in the fibrotic transformed...
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Role of chemical elements (ChE) in etiology and pathogenesis of Riedel’s disease (RD) is unclear. The aim of this exploratory study was to assess whether there were significant changes in thyroid tissue levels of eight ChE (Br, Ca Cl, I, K, Mg, Mn, and Na) are present in the fibrotic transformed thyroid. Eight ChE of thyroid tissue were determined in 6 patients with RD. The control group included thyroid tissue samples from 105 healthy individuals. Measurements were conducted using non-destructive instrumental neutron activation analysis with high-resolution spectrometry of short-lived radionuclides. Reduced mean values of Ca and I content in 6.3 and 6.7 times, respectively, while elevated level of Br in 5.1 times were found in thyroid with RD in comparison with normal level. Because considerable changes in some ChE contents in tissue of thyroid with RD were found, it is reasonable to assume that the levels of these ChE in affected thyroid tissue can be used as RD markers. However, this topic needs additional studies.
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