INTRODUCTION: In children, idiopathic intracranial hypertension (IIH) is relatively uncommon. It is characterized by an increase in intracranial pressure, in the absence of evidence of underlying brain disease, structural abnormalities, hydrocephalus, or abnormal meningeal improvement. However, very rarely it can occur without papilledema, even though it is the most recognizable clinical sign. Due to this, a delay in diagnosis can lead to severe visual impairments.

CASE PRESENTATION: We describe a patient with a chronic headache but no papilledema. His neurological and systemic examinations were otherwise unremarkable. A lumbar puncture revealed a high opening pressure of 450 mmHO and normal cerebrospinal fluid (CSF) parameters. Magnetic resonance imaging of the brain revealed only tortuous optic nerves, no parenchymal lesions, and no evidence of venous sinus thrombosis. He required acetazolamide treatment. Our patient's symptoms improved significantly in 2 months with medical treatment, weight loss, and exercise, with no development of papilledema.

CONCLUSION: There is a wide range of clinical manifestations of IIH, making it difficult to decide when to begin treatment.

Tomatoes show diverse phytochemical attributes that contribute to their nutritive and health values. This study comprehensively dissects primary and secondary metabolite profiles of seven tomato varieties. UHPLC-qTOF-MS assisted molecular networking was used to monitor 206 metabolites, 30 of which were first-time to be reported. Flavonoids, as valuable antioxidants, were enriched in light-colored tomatoes (golden sweet, sun gold, and yellow plum) versus high tomatoside A, an antihyperglycemic saponin, in cherry bomb and red plum varieties. UV–Vis analysis revealed similar results with a strong absorbance corresponding to rich phenolic content in light varieties. GC–MS unveiled monosaccharides as the main contributors to samples’ segregation, found abundant in San Marzano tomato accounting for its sweet flavor. Fruits also demonstrated potential antioxidant activities in correlation to their flavonoids and phospholipids. This work provides a complete map of tomatoes’ metabolome heterogeneity for future breeding programs and a comparative approach utilizing different metabolomic platforms for tomato analysis. © 2023 Elsevier Ltd

Vertebral artery aneurysm is a rare condition with diverse clinical manifestations in pediatric patients. We present the case of a 12-year-old male who presented with diplopia, vomiting, ataxia, and severe headache. Diagnostic evaluation revealed an extracranial vertebral artery dissection with an associated aneurysm at the C3-C4 level. Despite the absence of recurrent ischemic strokes, the aneurysm posed challenges in differentiating the symptoms from other inflammatory demyelinating disorders, particularly internuclear ophthalmoplegia. Diagnosis relied on a thorough history, physical examination, and imaging studies. Magnetic resonance imaging with magnetic resonance angiography confirmed the diagnosis and played a crucial role in assessing the size, location, and extent of the aneurysm. Additionally, the imaging findings helped guide treatment decisions and determine the need for anticoagulation therapy. Regular follow-up imaging was initiated to monitor for late complications and evaluate the effectiveness of the management approach. This case highlights the atypical presentation of vertebral artery aneurysm in a pediatric patient, underscoring the importance of clinical suspicion and the role of advanced imaging techniques in facilitating accurate diagnosis and guiding appropriate management. Prompt diagnosis and optimal utilization of imaging modalities are essential in preventing severe morbidity and mortality. Further research is warranted to enhance our understanding of this condition and refine imaging and management protocols in pediatric population.

Blockade of the programmed cell death-1/programmed cell death ligand-1 (PD-1/PD-L1) immune checkpoint pathway is an efficient immunotherapeutic modality that provided significant advances in cancer treatment especially in solid tumors highly resistant to traditional therapy. Monoclonal antibodies (mAbs) and small-molecule inhibitors are the two main strategies used to block this axis with mAbs suffering from many limitations. Accordingly, the current alternative is the development of small-molecule PD-1/PD-L1 inhibitors. Here, we present a sequential virtual screening (VS) protocol involving pharmacophore screening followed by molecular docking for the discovery of novel PD-L1 inhibitors. The VS protocol resulted in the discovery of eight novel compounds. A 100 ns MD simulation showed two compounds, and , exhibiting a stable binding mode at the PD-L1 dimer interface. Upon evaluation of their immunological activities, the two compounds induced higher cytokines levels (IL-2, IL-6, and INF-γ) relative to BMS-202, 72 h post treatment of PBMCs of HCC patients. Thus, the discovered hits represent potential leads for the development of novel classes targeting the PD-L1 receptor as anti-hepatocellular carcinoma agents.

The importance of intensifying feedbacks between drought and heat, however, depends on context and can be difficult to quantify (Miralles et al., 2019). Hypothesized drought-heat interactions include (a) surface energy partitioning effects, in which drought leads to enhanced sensible heat flux relative to latent heat flux, convectively warming the planetary boundary layer, (b) surface net radiation effects, in which drought alters incoming solar radiation or surface albedo; thus, changing the amount of energy that needs to be dissipated from the surface, (c) precipitation-mediated feedbacks related to planetary boundary layer processes or convective dynamics, and (d) broader impacts on atmospheric circulations (Seneviratne et al., 2010). Determining whether any of these processes were active in the record-setting events of June 2021 has implications on how we interpret projections of future climate extremes by global climate models (GCMs) that may or may not include such cascading dynamics. Given the growing evidence for cascading dry-hot hazard dynamics in theory and global analysis, the Southwest United States drought and heat extreme of 2021 offers an important opportunity to probe for the presence of hypothesized feedbacks. We do this through controlled numerical experiments with the Weather Research and Forecasting (WRF) model (Skamarock et al., 2021) applied at convection resolving scales, allowing us to consider how dynamics often described in GCMs and global scale analysis played out at local to regional scale during a sentinel event.

Recent years have seen growing appreciation that rapidly intensifying “flash droughts” are significant climate hazards with major economic and ecological impacts. This has motivated efforts to inventory, monitor, and forecast flash drought events. Here we consider the question of whether the term “flash drought” comprises multiple distinct classes of event, which would imply that understanding and forecasting flash droughts might require more than one framework. To do this, we first extend and evaluate a soil moisture volatility-based flash drought definition that we introduced in previous work and use it to inventory the onset dates and severity of flash droughts across the Contiguous United States (CONUS) for the period 1979-2018. Using this inventory, we examine meteorological and land surface conditions associated with flash drought onset and recovery. These same meteorological and land surface conditions are then used to classify the flash droughts based on precursor conditions that may represent predictable drivers of the event. We find that distinct classes of flash drought can be diagnosed in the event inventory. Specifically, we describe three classes of flash drought: “dry and demanding” events for which antecedent evaporative demand is high and soil moisture is low, “evaporative” events with more modest antecedent evaporative demand and soil moisture anomalies, but positive antecedent evaporative anomalies, and “stealth” flash droughts, which are different from the other two classes in that precursor meteorological anomalies are modest relative to the other classes. The three classes exhibit somewhat different geographic and seasonal distributions. We conclude that soil moisture “flash droughts” are indeed a composite of distinct types of rapidly intensifying droughts, and that flash drought analyses and forecasts would benefit from approaches that recognize the existence of multiple phenomenological pathways.

Marrubium vulgare is a valuable source of natural bioactive molecules with high preventive and therapeutic effectiveness. Therefore, this study aimed to study the chemical polymorphism of natural populations of M. vulgare in Tunisia by quantitative chemical markers and the estimation of divergence between populations. Phytochemical analyses of the eight natural populations of Tunisian Marrubium vulgare prospected in different bioclimatic stages, revealed 42 compounds of essential oils representing 96.08% to 100% of the total oil. Hydrocarbon sesquiterpenes were the main fraction of all the populations studied and $\beta$-bisabolene was the major compound (from 30.11% to 71.35% of the total oil). The phytochemical investigation of the M. vulgare plant indicated the presence of essential oil with significant percentages of phenolic compounds. A significant quantitative and qualitative variation in the essential oils is detected for both major and minor compounds. The principal components analysis (PCA) performed in the single and combined traits provides a good distinction among populations, not according to their geographical and/or bioclimatic origins. Moreover, the phytochemical analysis of the leaves showed that the Tunisian populations, i.e., the populations of Kasserine, Kef, and Beja, were very rich in phenolic compounds (from 20.8 to 44.65 mg GAE/g DW). Flavonoids compounds were also the main class of total polyphenols present in all the tested populations (from 8.91 to 37.48 mg RE/g DW). The quantitative genetic diversity estimated by the population's structure, based on PCA analysis, was an adaptation to the changes in the environmental conditions. Overall, our study indicated that natural populations of M. vulgare had different chemotypes of essential oils and they were rich in phenolic compounds, particularly flavonoids, which opens a new prospect for industrial use and differential exploitation of this species.

BACKGROUND:Mortality rates among surgical patients in Africa are double those of surgical patients in high-income countries. Internationally, there is a call to improve access to and safety of surgical and perioperative care. Perioperative research needs to be coordinated across Africa to positively impact perioperative mortality.

METHODS:

The aim of this study was to determine the top 10 perioperative research priorities for perioperative nurses in Africa, using a research priority-setting process. A Delphi technique with 4 rounds was used to establish consensus on the top 10 perioperative research priorities. In the first round, respondents submitted research priorities. Similar research priorities were amalgamated into single priorities when possible. In round 2, respondents ranked the priorities using a scale from 1 to 10 (of which 1 is the first/highest priority, and 10 is the last/lowest priority). The top 20 (of 31) were determined after round 2. In round 3, respondents ranked their top 10 priorities. The final round was an online discussion to reach consensus on the top 10 perioperative research priorities.

RESULTS:

A total of 17 perioperative nurses representing 12 African countries determined the top research priorities, which were: (1) strategies to translate and implement perioperative research into clinical practice in Africa, (2) creating a perioperative research culture and the tools, resources, and funding needed to conduct perioperative nursing research in Africa, (3) optimizing nurse-led postoperative pain management, (4) survey of operating theater and critical care resources, (5) perception of, and adherence to sterile field and aseptic techniques among surgeons in Africa (6) surgical staff burnout, (7) broad principles of infection control in surgical wards, (8) the role of interprofessional communication to promote clinical teamwork when caring for surgical patients, (9) effective implementation of the surgical safety checklist and measures of its impact, and (10) constituents of quality nursing care.

CONCLUSIONS:

These research priorities provide the structure for an intermediate-term research agenda for perioperative research in Africa.

Unlike differentiated cells, cancer stem cells (CSCs) can generate malignancy. Conventional chemotherapy results in CSCsspreading causing metastasis and relapse. Differentiation is an emerging approach providing a safer strategy to eradicate
CSCs. Jasonia montana is a medicinal plant that occurs in Sinai Peninsula in Egypt. Here, we used two human colorectal
cancer cell lines; HCT-116 and Caco-2 to investigate the ability of methanolic and petroleum ether extracts of Jasonia
montana to differentiate colon CSCs. Tandem Mass–Spectrometry (MS/MS) revealed that quercitrin and 5-Hydroxycostic
acid represent the major extracts ingredients. Cytotoxicity assay (SRB) illustrated that petroleum ether extract inhibited Caco-2 cells (IC50=10 μg/ml), whereas, methanolic extract inhibited HCT-116 cells (IC50=20 μg/ml). On treating HCT-116 and
Caco-2 cells with methanolic and petroleum ether extract respectively in diluted doses to alleviate their cytotoxicity, qRT-PCR showed a significant increase in CK20 expression and a significant decrease in CD44 expression, a significant decrease
in Sox-2 and NOTCH-1 expression and a significant increase in PTEN expression. Furthermore, qRT–PCR showed a
significant decrease in miR-21-5P and miR-10b-5P expression and significant increase in miR-34a-5P and miR-145
expression. Our results suggest, for the first time, that Jasonia montana methanolic and petroleum ether extracts can induce
colorectal CSCs differentiation.
Keywords: Jasonia montana extracts; colorectal cancer cells; differentiation; microRNAs