New diterpene lactone derivatives from Aphanamixis polystachya leaves inhibit nitric oxide production in RAW 264.7 cells.

Phytochemical studies on Aphanamixis plants have attracted considerable attention over the past few decades due to the structural diversities and significant biological activities of terpenoids produced by these plants. In the present study, five new acyclic diterpene lactone derivatives, aphanamixionolides A-E (1-5), and three known tirucallane-type triterpenes, namely, piscidinol A (6), hispidone (7), and bourjotinolone A (8), were isolated from the leaves of Aphanamixis polystachya. Their structures were elucidated by comprehensive analyses of HR-ESI-MS and NMR spectroscopic data and by comparison with those reported in the literature. Absolute configurations of the new compounds were determined by experimental and TD-DFT calculated ECD spectra. Compounds 1-8 inhibited NO production with IC50 values of 10.2-37.7 µM, which are comparable to positive control l-NMMA (IC50: 31.5 µM).

Early Impressions and Adoption of the AtriAmp for Managing Arrhythmias Following Congenital Heart Surgery.

AtriAmp is a new medical device that displays a continuous real-time atrial electrogram on telemetry using temporary atrial pacing leads. Our objective was to evaluate early adoption of this device into patient care within our pediatric intensive care unit (PICU). This is a qualitative study using inductive analysis of semi-structured interviews to identify dominant themes. The study was conducted in a single-center, tertiary, academic 21-bed mixed PICU. The subjects were PICU multidisciplinary team members (Pediatric Cardiac Intensivists, PICU Nurse Practitioners, PICU nurses and Pediatric Cardiologists) who were early adopters of the AtriAmp (n = 14). Three prominent themes emerged: (1) Accelerated time from arrhythmia event to diagnosis and treatment; (2) Increased confidence in the accuracy of providers' arrhythmia diagnosis; and (3) Improvement in the ability to educate providers about post-operative arrhythmias. Providers also noted some learning curves, but none compromised medical care or clinical workflow. Insights from early adopters of AtriAmp signal the need for simplicity and fidelity in new PICU technologies. Our research suggests that such technologies can be pivotal to the support and growth of multi-disciplinary teams, even among those who do not participate in early implementation. Further research is needed to understand when and why novel technology adoption becomes widespread in high-stakes settings.

Oleanane-type saponins from Lysimachia laxa Baudo and their anti-bacterial activities.

Seven new oleanane-type triterpene saponins, lysimaponins A-G, were isolated from aerial parts of Lysimachia laxa Baudo. Their chemical structures have been elucidated by analysis of spectroscopic and chemical methods. All compounds were evaluated for their anti-bacterial effects against Microcystis aeruginosa, Vibrio parahaemolyticus, V. harveyi, V. vulinificus, V. cholerae, and V. alginolyticus. All compounds showed potent anti-bacterial activities against the cyanobacteria M. aeruginosa with IC50 values ranging from 14.4 ± 1.2 to 35.3 ± 2.2 µg/mL. Compounds 1, 2, 4-7 inhibited V. parahaemolyticus with MIC values ranging from 64 to 256 µg/mL. The results suggested that saponins from L. laxa could be potential anti-cyanobacteria agents.

CT and MR utilization and morbidity metrics across Body Mass Index.

OBJECTIVE: Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and same-year utilization of CT and MR imaging in a large healthcare population. METHODS: In this retrospective population-based study, all patients aged ≥18 years with a documented BMI in the multi-institutional Cosmos database were included. Cohorts were identified based on ≥1 documented BMI in 2021 within pre-defined ranges. For each cohort, we assessed the percentage of patients undergoing head, neck, chest, spine, or abdomen/pelvis CT and MR during the same year. Disease severity was quantified based on emergency department (ED) visits and mortality. RESULTS: In our population of 49.6 million patients, same-year CT and MR utilization was 14.5 ±0.01% and 6.0±0.01%, respectively. The underweight cohort had the highest CT (25.8±0.1%) and MR (8.01 ± 0.05) imaging utilization. At high extremes of BMI (>50 kg/m2), CT utilization mildly increased (18.4±0.1%), but MR utilization decreased (5.3±0.04%). While morbidity differences may explain some BMI-utilization relationships, lower MR utilization in the BMI>50 cohort contrasts with higher age-adjusted mortality (1.8±0.03%) and ED utilization (32.4±0.1%) in this cohort relative to normal weight (1.5±0.01% and 25.7±0.02%, respectively). CONCLUSION: Underweight patients had disproportionately high CT/MR utilization, and high extremes of BMI are associated with mildly higher CT and lower MR utilization than the normal weight cohort. The elevated mortality and ED utilization in severely obese patients contrasts with their lower MR imaging utilization. Our findings may assist public health efforts to accommodate obesity trends.

Expression of SUMO and NF-κB genes in hepatitis B virus-associated hepatocellular carcinoma patients: An observational study.

Alterations in signaling pathways and modulation of cell metabolism are associated with the pathogenesis of cancers, including hepatocellular carcinoma (HCC). Small ubiquitin-like modifier (SUMO) proteins and NF-κB family play major roles in various cellular processes. The current study aims to determine the expression profile of SUMO and NF-κB genes in HCC tumors and investigate their association with the clinical outcome of HCC. The expression of 5 genes - SUMO1, SUMO2, SUMO3, NF-κB p65, and NF-κB p50 - was quantified in tumor and adjacent non-tumor tissues of 58 HBV-related HCC patients by real-time quantitative PCR and was analyzed for the possible association with clinical parameters of HCC. The expression of SUMO2 was significantly higher in HCC tumor tissues compared to the adjacent non-tumor tissues (P = .01), while no significant difference in SUMO1, SUMO3, NF-κB p65, and NF-κB p50 expression was observed between HCC tumor and non-tumor tissues (P > .05). In HCC tissues, a strong correlation was observed between the expression of SUMO2 and NF-κB p50, between SUMO3 and NF-κB p50, between SUMO3 and NF-κB p65 (Spearman rho = 0.83; 0.82; 0.772 respectively; P < .001). The expression of SUMO1, SUMO2, SUMO3, NF-κB p65, and NF-κB p50 was decreased in grade 3 compared to grades 1 and 2 in HCC tumors according to the World Health Organization grades system. Our results highlighted that the SUMO2 gene is upregulated in tumor tissues of patients with HCC, and is related to the development of HCC, thus it may be associated with the pathogenesis of HCC.

Symplosaponins A-D: New acylated oleanane-type triterpene saponins from Symplocos cochinchinensis and their hepatoprotective effect.

Four new acylated oleanane-type triterpene saponins, symplosaponins A-D (1-4) were successfully isolated from the leaves of Symplocos cochinchinensis (Lour.) S. Moore, alongside with five known compounds (5-9), 2-methoxy-4-prop-1-enylphenyl-1-O-ß-D-apiofuranosyl-(1 â†’ 6)-ß-D-glucopyranoside (5), and 1-[O-ß-d-xylopyranosyl-(1 â†’ 6)-O-ß-d-glucopyranosyl]-2,6-dimethoxy-4-propenyl-phenol (6), 6-O-p-coumaroylsucrose (7), arillatose B (8), and (-)-secoisolariciresinol-O-ß-D-glucopyranoside (9). The structures of these compounds were elucidated through spectroscopic methods, comparison with existing data, and chemical methods. Furthermore, all compounds were assessed for their impact on hepatocellular viability using the Resazurin reduction assay. These investigations aimed to explore the potential hepatoprotective properties of isolated compounds. As a result, 1-[O-ß-d-xylopyranosyl-(1 â†’ 6)-O-ß-d-glucopyranosyl]-2,6-dimethoxy-4-propenyl-phenol (6) and (-)-secoisolariciresinol-O-ß-D-glucopyranoside (9) demonstrated statistically significant hepatoprotective activity in a concentration-dependent manner.

What Do We Know About the Influence of Believers' Religiosity on Happiness and Gratitude? - A Perspective for Clinical Practice.

Introduction: The recognition of religion's significance in mental health has led to several scientific advances in diagnosis or treatment. In contrast, Vietnam is a multi-religious Southeast Asian country with a large number of believers, but there is almost no research addressing the impact of religiosity among Vietnamese believers on mental health concerns such as depression, happiness, and gratitude. Participants and Methods: Our cross-sectional study was focused on Vietnamese believers (N = 374), surveyed directly at different religious facilities in Vietnam. The present study was evaluated utilizing the partial least squares-structural equation modeling (PLS-SEM) methodology. Results: The primary findings of the study indicate that (i) age was found to positively moderate the association between intrinsic religiosity and gratitude (ß = 0.191, 95% CI [0.116, 0.277], p < 0.001); (ii) Intrinsic religiosity has a positive influence on depression-happiness scale (ß = 0.276, 95% CI [0.168, 0.373], p < 0.001) and gratitude (ß = 0.337, 95% CI [0.205, 0.466], p < 0.001); Moreover, (iii) gratitude has a positive influence on depression-happiness scale (ß = 0.381, 95% CI [0.280, 0.491], p < 0.001); Finally, (iv) the study revealed that gratitude mediates the relationship between intrinsic religiosity and depression-happiness scale (ß = 0.128, 95% CI [0.071, 0.197], p < 0.001). Discussion: The findings of this study suggest that gratitude could potentially play a significant role in comprehending the association between religiosity and the levels of depression and happiness experienced by religious individuals in Vietnam.

Thermoluminescence properties and new insights on the UV-vis absorption features of colorless quartz after γ-ray irradiation.

In this paper, we present the results of research on the thermoluminescence (TL) and optical absorption (OA) properties of colorless natural quartz (including natural quartz samples, sodium ion (Na+) rich samples (by diffusion), and alkali metal (M+) ion poor samples (by sweep)). In detail, the relationship between the TL glow peaks and the emission wavelength was determined. The dynamics parameters (E T, s, τ) have been computed for all TL peaks on the glow curve. The recombination mechanism electron-hole with the participation of the region energy has been determined for all electron traps in the temperature range of 50-430 °C through thermally stimulated conductivity measurement (TSC). Nonlinearity and approaching signal saturation are observed at doses above 22 Gy for the electron trap at 110 °C, above 45 Gy for the electron trap at 238 °C, and 80 Gy for the electron traps at 325 °C and 375 °C. The role of irradiation and heat treatment in the formation of absorption centers as well as the relationship of these centers to electronic traps have been also investigated in detail. The role of M+ ions and hydrogen ions (H+) for the absorption bands in the UV-vis region has been discussed. The results of the combination of the TL measurement and monochromatic light absorption according to temperature show that the TL process occurs concurrently with the reduction of the absorbent center produced in the irradiation process.

A theoretical screening of phytochemical constituents from Millettia brandisiana as inhibitors against acetylcholinesterase.

Alzheimer's disease is one of the causes associated with the early stages of dementia. Nowadays, the main treatment available is to inhibit the actions of the acetylcholinesterase (AChE) enzyme, which has been identified as responsible for the disease. In this study, computational methods were used to examine the structure and therapeutic ability of chemical compounds extracted from Millettia brandisiana natural products against AChE. This plant is commonly known as a traditional medicine in Vietnam and Thailand for the treatment of several diseases. Furthermore, machine learning helped us narrow down the choice of 85 substances for further studies by molecular docking and molecular dynamics simulations to gain deeper insights into the interactions between inhibitors and disease proteins. Of the five top-choice substances, γ-dimethylallyloxy-5,7,2,5-tetramethoxyisoflavone emerges as a promising substance due to its large free binding energy to AChE and the high thermodynamic stability of the resulting complex.

Bithiophene and coumestan derivatives from Eclipta prostrata (L.) L. and their hepatoprotective activity.

One new bithiophene derivative, 5-(but-3-en-1-yn-1-yl)-5'-(methoxymethyl)-2,2'-bithiophene (1), along with twelve known compounds, senecioester (2), tiglinsaureester (3), 5-acetoxymethyl-2'-(but-3-en-1-yn-1-yl)-2,5'-bithiophene (4), 5-(4-isovaleroyloxybut-1-ynyl)-2,2'-bithiophene (5), 5-hydroxymethyl-(2,5':2',5'')-terthienyl tiglate (6), 5-hydroxymethyl-(2,5':2',5'')-terthienyl agelate (7), 5- hydroxymethyl-2,5':2',5''-terthiophene dimethylacrylate (8), 5-methoxymethyl-2,2':5',2''-terthiophene (9), α-terthiophene (10), 1,3,8,9-tetrahydroxycoumestan 3-sulfate (11), demethylwedelolactone (12), and wedelolactone (13) were isolated from the methanol extract of aerial parts of Eclipta prostrata (L.) L. All isolated compounds were evaluated for the protective ability on the HepG2 cells. At the concentration of 100 µM, compounds 11-13 showed the highest hepatoprotective effects, with HepG2 cell viability ranging from 38.68% to 48.54%. Bithiophenes showed higher hepatoprotective cell viability than terthiophenes.

Temperature dependence of the dielectric function and critical points of monolayer WSe2.

Monolayer materials typically display intriguing temperature-dependent dielectric and optical properties, which are crucial for improving the structure and functionality of associated devices. Due to its unique photoelectric capabilities, monolayer WSe2 has recently received a lot of attention in the fields of atomically thin electronics and optoelectronics. In this work, we focus on the evolution of the temperature-dependent dielectric function (ε = ε1 + i ε2) of monolayer WSe2 over energies from 0.74 to 6.40 eV and temperatures from 40 to 350 K. We analyze the second derivatives of ε with respect to energy to accurately locate the critical points (CP). The dependence of the observed CP energies on temperature is consistent with the alternative domination of the declining exciton binding energy as the temperature increases.

Algae-constructed wetland integrated system for wastewater treatment: A review.

Integrating algae into constructed wetlands (CWs) enhances wastewater treatment, although the results vary. This review evaluates the role of algae in CWs and the performance of different algae-CW (A-CW) configurations based on literature and meta-analysis. Algae considerably improve N removal, although their impact on other parameters varies. Statistical analysis revealed that 70 % of studies report improved treatment efficiencies with A-CWs, achieving average removal rates of 75 % for chemical oxygen demand (COD), 74 % for total nitrogen and ammonium nitrogen, and 79 % for total phosphorus (TP). This review identifies hydraulic retention times, which average 3.1 days, and their varied impact on treatment efficacy. Mixed-effects models showed a slight increase in COD and TP removal efficiencies of 0.6 % every ten days in the A-CWs. Future research should focus on robust experimental designs, adequate algal storage and separation techniques, and advanced modeling to optimize the treatment potential of algae in CWs.

Modification of Hydrotalcite Loading Tannic Acid with Organic Silane and Application in Anticorrosive Epoxy Coating.

Metal corrosion is a challenge for the world with heavy impacts on the economy. Study on the development of effectiveness anticorrosion additives is a promising strategery for the protection industry. This research focuses on the modification of hydrotalcite Mg-Al (HT) loading tannic acid (TA) with 3-(trimethoxy silyl) propyl methacrylate organo-silane (TMSPM) for applicating as an anti-corrosion additive for epoxy coating on the steel substrate. The suitable ratio of HT and modifiers was investigated and the suitable content of modified HT in epoxy matrix was found based on mechanical properties of the epoxy-based coating. The characteristics of modified HT were assessed through infrared (IR) spectroscopy, X-ray diffraction pattern (XRD), scanning electron microscopy (SEM), thermal gravimetry analysis (TGA), water contact angle (WCA), dynamic light scattering (DLS). Detailly, HT-TA3-S3 shows good stability in distilled water when HT/TA was modified with TMSPM which makes Zeta potential decreases significantly. Besides, SEM analysis presented HT-TA-S has a cylindrical shape about of 500 nm. Moreover, the crystallite size of HT/TA after being modified by TMSPM decreases sharply. All of these prove successfully synthesize HT loading TA with modified TMSPM. Water contact angle (WCA) decreases in case of loading TA and increases in case of modifying with TMSPM (WCA changed from HT (116.3°) to HT-TA (102.4°) and HT-TA-S (120.1°) which indicates the increased hydrophobicity of the sample. The obtained results showed HT/TA was modified successfully with TMSPM. The modification affected the size distribution and surface properties of HT nanoparticles while it did not impact on the crystal structure of HT. After incorporating modified HT/TA into the epoxy coating, the adhesion of coating to steel substrate was improved significantly. Consequently, the adhesion of epoxy/3 wt. % modified HT/TA coating was increased 3 times as compared to epoxy neat (from 0.76 MPa to 2.77 MPa). In addition, the relative hardness and gloss retention of epoxy/3 wt. % modified HT/TA coating reached the maximum values as compared to the others. Owing to salt spraying results, the epoxy/3 wt. % modified HT/TA exhibited an excellent anticorrosion ability for the steel substrate. All the above results show the potential of HT nanoparticles loading TA modified with TMSPM as anticorrosive additives for protective coatings on steel substrates.

Spectrum and antimicrobial resistance in acute exacerbation of chronic obstructive pulmonary disease with pneumonia: a cross-sectional prospective study from Vietnam.

BACKGROUND: Respiratory infections have long been recognized as a primary cause of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Additionally, the emergence of antimicrobial resistance has led to an urgent and critical situation in developing countries, including Vietnam. This study aimed to investigate the distribution and antimicrobial resistance of bacteria in patients with AE-COPD using both conventional culture and multiplex real-time PCR. Additionally, associations between clinical characteristics and indicators of pneumonia in these patients were examined. METHODS: This cross-sectional prospective study included 92 AE-COPD patients with pneumonia and 46 without pneumonia. Sputum specimens were cultured and examined for bacterial identification, and antimicrobial susceptibility was determined for each isolate. Multiplex real-time PCR was also performed to detect ten bacteria and seven viruses. RESULTS: The detection rates of pathogens in AE-COPD patients with pneumonia were 92.39%, compared to 86.96% in those without pneumonia. A total of 26 pathogenic species were identified, showing no significant difference in distribution between the two groups. The predominant bacteria included Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, followed by Acinetobacter baumannii and Streptococcus mitis. There was a slight difference in antibiotic resistance between bacteria isolated from two groups. The frequency of H. influenzae was notably greater in AE-COPD patients who experienced respiratory failure (21.92%) than in those who did not (9.23%). S. pneumoniae was more common in patients with stage I (44.44%) or IV (36.36%) COPD than in patients with stage II (17.39%) or III (9.72%) disease. ROC curve analysis revealed that C-reactive protein (CRP) levels could distinguish patients with AE-COPD with and without pneumonia (AUC = 0.78). CONCLUSION: Gram-negative bacteria still play a key role in the etiology of AE-COPD patients, regardless of the presence of pneumonia. This study provides updated evidence for the epidemiology of AE-COPD pathogens and the appropriate selection of antimicrobial agents in Vietnam.

In Vitro and in Silico Study of New Biscoumarin Glycosides from Paramignya trimera against Angiotensin-Converting Enzyme 2 (ACE-2) for Preventing SARS-CoV-2 Infection.

In Vietnam, the stems and roots of the Rutaceous plant Paramignya trimera (Oliv.) Burkill (known locally as "Xáo tam phân") are widely used to treat liver diseases such as viral hepatitis and acute and chronic cirrhosis. In an effort to search for Vietnamese natural compounds capable of inhibiting coronavirus based on molecular docking screening, two new dimeric coumarin glycosides, namely cis-paratrimerin B (1) and cis-paratrimerin A (2), and two previously identified coumarins, the trans-isomers paratrimerin B (3) and paratrimerin A (4), were isolated from the roots of P. trimera and tested for their anti-angiotensin-converting enzyme 2 (ACE-2) inhibitory properties in vitro. It was discovered that ACE-2 enzyme was inhibited by cis-paratrimerin B (1), cis-paratrimerin A (2), and trans-paratrimerin B (3), with IC50 values of 28.9, 68, and 77 µM, respectively. Docking simulations revealed that four biscoumarin glycosides had good binding energies (∆G values ranging from -10.6 to -14.7 kcal/mol) and mostly bound to the S1' subsite of the ACE-2 protein. The key interactions of these natural ligands include metal chelation with zinc ions and multiple H-bonds with Ser128, Glu145, His345, Lys363, Thr371, Glu406, and Tyr803. Our findings demonstrated that biscoumarin glycosides from P. trimera roots occur naturally in both cis- and trans-diastereomeric forms. The biscoumarin glycosides Lys363, Thr371, Glu406, and Tyr803. Our findings demonstrated that biscoumarin glycosides from P. trimera roots hold potential for further studies as natural ACE-2 inhibitors for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Optimizing Green Synthesis of Hydrotalcite - Silver Nanoparticles using Syzygium Nervosum based Reducing Agent.

Hydrotalcite-silver (HT-Ag) nanoparticles have been involved in various daily crucial applications, such as antibacterial, photocatalytic, adsorption, etc. There are many approaches to synthesizing silver nanoparticles (AgNPs) decorated on hydrotalcite (HT) surface and the most used approach is using a strong reducing agent. Thus, affordable but effective "green" reducing agents - Syzygium nervosum leaf extract, are taken into account in this work to solve several issues related to chemical reducing agents. This work aimed to assess the effect of Syzygium nervosum leaf extract as a reducing agent for green synthesis of AgNPs on HT through an optimizing process using response surface methodology (RSM) and the Box-Benken model. The optimal conditions for the synthesis of AgNPs on HT include a reaction time of 6.15 hours, a reaction temperature of 50 °C, and the ratio of diluted Syzygium nervosum leaf extract to reduce AgNO3 of 50.37 mL/mg. Under the optimal conditions, the yield of the reduction reaction reached 77.54 %, close to the theoretical value of 76.97 %. The optimization model was suitable for the experiment data. Besides, the morphology, density, and characteristics of AgNPs on the surface of HT layers have been determined by using Ultraviolet-visible spectroscopy, Field emission scanning electron microscopy (FESEM), High-resolution transmission electron microscopy (HR-TEM), selected area diffraction, X-ray diffraction, Dynamic light scattering (DLS), Infrared (IR) spectroscopy, Fluorescence emission spectroscopy (FE), Brunauer-Emmett-Teller (BET) methods. The spherical AgNPs were synthesized successfully on the surface of HT with the average particle size of 13.0±1.1 nm. Interestingly, HT-Ag hybrid materials can inhibit strongly the growth of E. coli, S. aureus as well as two antibiotic resistance bacterial strains, P. stutzeri B27, and antibiotic resistance E. coli. Especially, the antibacterial activity quantification and durability of the HT-Ag hybrid materials were also tested. Overall, the HT-Ag hybrid materials are very promising for application in material science and biomedicine fields.

Glycoside constituents from Cayratia geniculata.

Using various chromatographic separations, six glycoside derivatives (1-6), including one new ent-labdane glucoside named cayratioside (1), were isolated from the methanol extract of Cayratia geniculata stems and leaves. Their structures were elucidated by detailed analysis of the 1D, 2D NMR, and HRESIQTOF mass spectra. The inhibitory effect of 1-6 on LPS-induced NO production in RAW264.7 cells was also evaluated. Among isolated compounds, 1 exhibited moderate activity with an IC50 value of 59.65 ± 1.85 µM.

Safety, immunogenicity and efficacy of the self-amplifying mRNA ARCT-154 COVID-19 vaccine: pooled phase 1, 2, 3a and 3b randomized, controlled trials.

Combination of waning immunity and lower effectiveness against new SARS-CoV-2 variants of approved COVID-19 vaccines necessitates new vaccines. We evaluated two doses, 28 days apart, of ARCT-154, a self-amplifying mRNA COVID-19 vaccine, compared with saline placebo in an integrated phase 1/2/3a/3b controlled, observer-blind trial in Vietnamese adults (ClinicalTrial.gov identifier: NCT05012943). Primary safety and reactogenicity outcomes were unsolicited adverse events (AE) 28 days after each dose, solicited local and systemic AE 7 days after each dose, and serious AEs throughout the study. Primary immunogenicity outcome was the immune response as neutralizing antibodies 28 days after the second dose. Efficacy against COVID-19 was assessed as primary and secondary outcomes in phase 3b. ARCT-154 was well tolerated with generally mild-moderate transient AEs. Four weeks after the second dose 94.1% (95% CI: 92.1-95.8) of vaccinees seroconverted for neutralizing antibodies, with a geometric mean-fold rise from baseline of 14.5 (95% CI: 13.6-15.5). Of 640 cases of confirmed COVID-19 eligible for efficacy analysis most were due to the Delta (B.1.617.2) variant. Efficacy of ARCT-154 was 56.6% (95% CI: 48.7- 63.3) against any COVID-19, and 95.3% (80.5-98.9) against severe COVID-19. ARCT-154 vaccination is well tolerated, immunogenic and efficacious, particularly against severe COVID-19 disease.

Epidural injection-related pneumorrhachis: A case report with cauda equina syndrome.

Pneumorrhachis (PR) is an uncommon condition characterized by the accumulation of air within the spinal canal. This finding may occur due to various causes, mostly after trauma and medical procedures. It can manifest with various features depending on the underlying cause, the location, and the extent of the air trapped. Clinically, the symptoms in affected patients can span a spectrum, ranging from being asymptomatic to manifesting as radiculopathies resulting from compression. The pneumorrhachis-related cauda equina syndrome is incredibly rare and typically appears as a large volume of air causing compression or irritation of the nerve roots in the lower spinal cord. In this report, we present a female patient whose cauda equina syndrome developed as a result of accidental extradural pneumorrhachis after epidural injection in the lumbar spine.