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Immune thrombocytopenia (ITP) is an autoimmune disease characterized by low platelet counts of less then 100 × 109/L with the absence of other blood count abnormalities. Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 which is manifested by a severe multisystemic disease. We present the case of a 76-year-old female who presented with ITP associated with COVID-19 and successfully managed with intravenous immunoglobulin and glucocorticoids.Bladder cancers rarely are non-urothelial in origin. We present here, possibly the youngest case of a 35-year-old White female presenting with shortness of breath. She was found to have a malignant pleural effusion with unknown primary, eventually confirmed with genetic testing as metastatic adenocarcinoma of the urinary bladder with brain and lung metastasis. She was scheduled for palliative chemotherapy, however, passed away before it could be started. We highlight this rare case because of its unique presentation. Owing to similarity in receptors between adenocarcinoma and enteric cancer, similar chemotherapy regimens may be used for both. Unfortunately, treatment of metastatic disease remains highly controversial and needs to be studied further if there is an actual survival benefit to this or not.Introduction Functional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise. Objective The study objective is to investigate whether functional exercise is effective for teaching disaster medicine. Methods Students who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise. Results Ninety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students' willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise. Conclusion Disaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.An estimated 20% of all malignant cutaneous neoplasms are diagnosed as squamous cell carcinoma (SCC). Chemotherapeutic wraps, or chemowraps, consist of application of topical 5-fluorouracil (5-FU) 5% cream along with occlusive zinc oxide and a compressive bandage (e.g., Unna boot). This treatment modality is often used as a less invasive option compared to surgery, especially in the presence of numerous SCCs. Cryotherapy, the use of liquid nitrogen gas, can be utilized to obliterate pre-malignant and malignant skin lesions. In this report, we present four cases in which females between the ages of 65 and 80 with multiple lower extremity SCCs were treated with cryotherapy prior to each chemowrap application, resulting in favorable clinical tumor improvement. Our observations indicate that cryotherapy may enhance the effectiveness of chemowrap treatment when used before each application. To our knowledge, the use of cryotherapy to synergistically enhance the efficacy of chemowraps has not yet been reported. We hypothesize that cryotherapy induces edema and first strips the outer, hyperkeratotic layers of skin, which facilitates deeper penetration of the 5-FU cream from chemowraps. Chemowraps may also relieve the pain associated with cryotherapy. Therefore, dual cryotherapy and chemowrap treatment may be considered to maximize skin penetration, thus minimizing the extent of surgical intervention in patients with a significant number of SCC lesions.Müllerianosis of the urinary bladder is an extremely rare, benign condition defined by the presence of at least two of the three müllerian-derived components (endosalpinx, endometrium, and endocervix) in the lamina propria and muscularis propria of the urinary bladder. It frequently mimics neoplastic condition, either malignant or benign. Here, we present a case of cystic müllerianosis of urinary bladder, which was clinically thought to be a urinary bladder neoplasm.Background In this study, our primary aim was to compare the efficacy of fentanyl and nalbuphine in attenuating the pressor response to laryngoscopy and tracheal intubation in patients undergoing laparoscopic cholecystectomy under general anesthesia. The secondary aim was to observe hemodynamic response to pneumoperitoneum and to study the level of sedation using the Richmond Agitation-Sedation Scale (RASS). Methodology A total of 180 patients belonging to the American Society of Anesthesiologist Physical Status class I/II scheduled to undergo elective laparoscopic cholecystectomy under general anesthesia were divided into two groups of 90 each. group A received intravenous nalbuphine 0.2 mg/kg and group B received intravenous fentanyl 2 μg/kg, five minutes before induction of anesthesia. Technique of anesthesia was standardized for all patients in the study. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded before giving the study desia. There was no significant difference observed between nalbuphine and fentanyl in the hemodynamic response to pneumoperitoneum. The depth of sedation post-extubation was significantly greater with nalbuphine.<br />Coronary artery disease (CAD) is one of the severe diseases that threaten human health worldwide. In addition, the associated rate of comorbidity with depression and anxiety is extremely high. Heat shock proteins (HSPs) are a group of proteins that possesses cardiovascular and psychological protection properties. The objective of this study is to determine the association of the two most widely studied HSPs, namely, HSP70 and HSP90, with CAD comorbid depression and anxiety in a Chinese population.<br />A case-control study involving 271 CAD patients and 113 healthy individuals was conducted. The 271 CAD patients include individuals with (123) and without depression (148) and individuals with (57) and without anxiety (214). Ten single nucleotide polymorphisms (SNPs) for HSP70 and seven SNPs for HSP90 were selected and genotyped.<br />Results revealed that the HSP70 rs10892958 C allele and HSP70 rs2236658 T allele were associated with a decreased risk of CAD (<br />&lt; 0.05), whereas the G allele of the rs11218941 polcreased risk of CAD. The haplotype analysis results indicated that the haplotype TGGGC of the HSPA8 gene (coded the HSP70 family, rs4936770/rs4802/rs10892958/rs11218941/rs2236658) significantly increased the risk of CAD (P = 0.008). Among the patients with CAD, the carriers of the CC genotype for the HSP90 rs1042665 showed higher risks of anxiety than the carriers of another genotypes. However, no significant relationships were found among the CAD with depression and CAD without depression groups for the selected SNPs. These findings suggested that the genetic polymorphisms in the HSP gene, especially the HSPA8 of HSP70, contribute to CAD susceptibility and rs1042665 genetic polymorphisms might have an effect on the anxiety incidence among CAD patients.<br />Although there is evidence linking the relationships between smartphone usage with health, stress, and academic performance, there is still inadequate knowledge about the influence on pro-environmental behaviors. This study seeks to bridge this gap by adapting the theory of attribution framework to examine the effects of personal norms, social norms, perceived behavioral control on pro-environmental behavior of smartphone usage in children.<br />A total of 225 children aged between 11 to 12 from eight selected public primary schools at the Hsinchu Science and Industrial Park in Taiwan were surveyed. Two distinct groups (excessive versus moderate usage) were purposefully selected for comparison, of which 96 participants were excessive smartphone users while the remaining 129 were moderate smartphone users.<br />Findings revealed significant differences between excessive and moderate smartphone usage children groups in personal norms (<br />&lt;0.001), social norms (<br />=0.002), perceived behavioral control (<br />=0.001), aartphone usage children lack positive perceived behavioral control, and their pro-environmental behavior could only be predicted through explicit social norms, whereas pro-environmental behavior of moderate smartphone usage children was implicitly influenced by personal norms through perceived behavioral control.<br />Soil erosion can affect the distribution of soil nutrients, which restricts soil productivity. However, it is still a challenge to understand the response of soil nutrients to erosion under different soil types.<br />The distribution of soil nutrients, including soil organic carbon (SOC), soil organic nitrogen (SON), and soil major elements (expressed as Al<br />O<br />, CaO, Fe<br />O<br />, K<br />O, Na<br />O, MgO, TiO<br />, and SiO<br />), were analyzed in the profiles from yellow soils, red soils, and lateritic red soils in an erosion region of Southeast China. Soil erodibility K factor calculated on the Erosion Productivity Impact Calculator (EPIC) model was used to indicate erosion risk of surface soils (0∼30 cm depth). The relationships between these soil properties were explored by Spearman's rank correlation analysis, further to determine the factors that affected the distribution of SOC, SON, and soil major elements under different soil types.<br />The K factors in the red soils were significantly lower than those in the yellow soilents did not significantly correlate with soil pH or particle distribution in the red soils and lateritic red soils, likely associated with intricate factors.<br />These results suggest that soil nutrients and soil erodibility K factor in the yellow soils were higher than those in the lateritic red soils and red soils. [https://www.selleckchem.com/products/gsk-j1.html click here] The distribution of soil nutrients is controlled by soil erosion and soil evolution in the erosion region of Southeast China.<br />These results suggest that soil nutrients and soil erodibility K factor in the yellow soils were higher than those in the lateritic red soils and red soils. The distribution of soil nutrients is controlled by soil erosion and soil evolution in the erosion region of Southeast China.