bluuebunny/crossref_metadata_2025 huggingface dataset:
NOMA Application to Satellite Communication Networks for 5G: A Comprehensive Survey of Existing Studies
Authors:   Department of Electrical, Electronics & Computer Engineering, Cape Peninsula university of Technology, Cape Town, South Africa, Biyoghe Joel S. , Balyan Vipin
Published: May 2021

The 4th generation of communication networks (4G) seems limited and unable to satisfy the growing networks’ performances demands of new intended communication services such as the internet-of-things (IoTs). The 5th generation of communication networks (5G) has therefore been envisaged to fill the gap. The non-orthogonal multiple access (NOMA) technology and the satellite communication have been identified as key enabling technologies for the achievement of 5G networks. There are many ongoing NOMA related works for 5G; however, the few existing reviews mostly discuss works that apply NOMA to terrestrial networks. This paper therefore, gives a comprehensive and up-to-date review of existing works applying NOMA to satellite communication networks. More precisely, it presents studies that have either designed or do performance analysis of NOMA-based multibeam satellitesystems (MBSSs) or integrated satellite-terrestrial networks (ISTNs). The surveys presented showed that the application of NOMA to satellite communications for 5G is starting to gain considerable interest. Most of the current PD-NOMA design works attempt to maximize the system capacity (sum-rate), and most of the current PD-NOMA performance analysis works demonstrate the superiority of NOMA over OMA through Ergodic Capacity and Outage probability estimations. The surveys also showed that this field is still quite opened for research, with issues such as user-fairness maximization, satellite capacity improvement, ground-surface moving beams (for LEOs and MEOs satellites) and multiple gateways combination … etc. remaining prospective research areas to be explored.
ОПЫТ ЗАРУБЕЖНЫХ СТРАН ПО ВЫХОДУ ИЗ ЭКОНОМИЧЕСКОГО КРИЗИСА В ПЕРИОД ПАНДЕМИИ
Authors: Kuzmenkova Vera G.
Published: May 2021

Пандемия коронавирусной инфекции COVID-19, стремительно распространяясь по странам, становится глобальным явлением, оказывает сильнейшее воздействие на человеческое существование конкретных стран и всего мирового сообщества.
Исследование инструментов и специфики действий различных государств по преодолению коронавируса и снижению его экономических результатов позволяет установить общие и специфические трудности для всех стран, оценить прогнозы по выходу из кризиса.
Актуальность темы исследования. Автором рассмотрен мировой опыт развития бизнеса в условиях выхода из экономического кризиса.
Предмет исследования: антикризисные меры, государственные инструменты, используемые в странах, с различным уровнем развития.
Объект исследования: зарубежный и отечественный опыт отдельных государств по выходу из кризиса, вызванного коронавирусной инфекцией COVID-19.
Цель исследования. Определение особенностей современного мирового кризиса, вызванного пандемией, рассмотрение антикризисных мер, принимаемых правительствами отдельных государств для выхода из кризиса.
Метод или методология проведения работы: общенаучные, описание, метод экспертных оценок и т.д.
Научная новизна данной работы заключается в обзоре направлений мер – поддержки бизнеса, населения и необходимости концентрации усилий правительств государств на поддержку предпринимательства для оперативного выхода стран из кризиса.
Результаты: в статье установлены закономерности выхода мировой экономики из кризиса, вызванных эпидемией на примере групп стран.
Установлено отличие кризиса, вызванного пандемией, от предыдущих, происходящего в основном, в сферах производства и потребления.
Область применения результатов: полученные результаты целесообразно использовать при разработке стратегии и тактики выхода государств из мирового кризиса.
Выводы сформулированы о том, что пандемия COVID-19 перерастает в масштабный экономический кризис и может повлечь за собой значительные преобразования в современной мировой экономике.
ИНСТРУМЕНТЫ МЕНЕДЖМЕНТА КАК ФАКТОРЫ ЭФФЕКТИВНОГО РАЗВИТИЯ МАЛОГО и среднего ПРЕДПРИНИМАТЕЛЬСТВА
Authors: Lovkova Elena S. , Penha Zelada Martin L.
Published: May 2021

Для расширения малого и среднего бизнеса и усиления внутреннего контроля над ним, важно полагаться на инструменты управления, которые помогут принимать более обоснованные решения и стимулировать развитие деятельности организации малого предпринимательства.
Цель работы. В статье составить список основных инструментов менеджмента, используемых руководителями малого и среднего предпринимательства. Выявить основные ошибки препятствующие использованию современных инструментов менеджмента и предложить мероприятия по их устранению.
Метод или методология проведения работы: был использован подход позволяющий комплексно исследовать характеристики инструментов менеджмента и эффективного развития малого и среднего предпринимательства.
Результаты: выделены основные ошибки, препятствующие использованию инструментов менеджмента и таким образом тормозящие развитию предприятий малого и среднего бизнеса. Таким образом, актуальность научного исследования на тематику инструменты менеджмента влияет на эффективность развития малого и среднего предпринимательства.
Область применения результатов: полученные результаты целесообразно использовать предпринимателям малого и среднего бизнеса.
Prospects for the Development of Simferopol International Airport in the Context of Overcoming the Crisis of Macroeconomic Instability
Authors: Rublev V.
Published: May 2021

The article presents the results of a study of the activities of the International Airport "Simferopol". After the Republic of Crimea became a part of the Russian Federation, one of the priorities of the state's domestic policy was the development of the regional infrastructure of the Crimean Peninsula. Simferopol International Airport occupies a special position in the structure of regional airports of the Southern Federal District. Regional airports of the Southern Federal District serve a significant part of the seasonal tourist flow of citizens coming from the regions of the Russian Federation. Based on the analysis of the tourist flow of the Republic of Crimea in the period from 2014 to 2020, as well as on the basis of a comparative analysis of Simferopol International Airport with other regional airports in the Southern Federal District and the analysis of the experience of European airlines in developing the route network on the basis of regional airports, a model of the prospective development of Simferopol International Airport in the period 2021-2025 was developed. It is important to note that the positive economic effect of the airport development will be achieved both at the regional and national level.
Analysis of Office Staff Productivity Factors
Authors: Polyakov V. , Fomicheva Irina
Published: May 2021

The adaptation of well-known approaches to the assessment and identification of reserves for improving the productivity of managerial, administrative and other office work due to the changing format and technologies of its implementation as a result of digitalization is considered. A scientific approach to measuring and evaluating the productivity of intellectual labor is proposed based on the method of calculating productivity reserves as a value that depends on the time of organizational and qualification losses. The article shows the specifics of calculating such criteria for assessing labor productivity as possible and maximum productivity, the size of their reserves and the time loss factor for a particular employee or various organizational structures of managerial, administrative or office activities.
Picturing the Pharaoh Through Language – Remarks on the Linguistic Image of the Egyptian King in the Old Kingdom Religious Texts
Authors: Popielska-Grzybowska Joanna
Published: May 2021

The author of the paper aims at scrutinising the linguistic image of the Egyptian pharaoh in the so-called Pyramid Texts. Was the Egyptian ruler perceived as a human representative of the god on Earth or rather was he a or the god himself? Special emphasis will be put on names and epithets of the King when described or referred to in religious texts of the Old Kingdom. This study is planned as a part of a future research project on picturing the pharaoh through language in religious and royal texts from the beginning of the Old Kingdom till the end of the New Kingdom, and realised in cooperation with Dr. Andrzej Ćwiek and Jadwiga Iwaszczuk.Furthermore, the paper is also a presentation of use of ethnolinguistic methods in Egyptology. Using scholarly methods of the ‘linguistic worldview’ research project in which the present author participates, it is intended to study selected ancient Egyptian concepts. Although language analysis as well as widely understood and studied ‘life context’ of ancient religious notions let us only a textual and linguistic reconstruction of the world presented, concurrently, helps us understand better the Egyptian religious way of description and thinking.
Some Remarks on Cat Mummies in Light of the Examination of Artefacts from the National Museum in Warsaw Collection
Authors: Ejsmond Wojciech , Przewłocki Łukasz
Published: May 2021

Votive mummies of cats were offered at the shrines of particular gods, to whom these animals were sacred. They played an important role in Egyptian religion during the Late and Greco-Roman periods and represent an important source on the popular beliefs and practices of ordinary Egyptians at the twilight of their civilisation. For many years, this subject was neglected and a large number of animal mummies were simply destroyed. However, many specimens of unknown origin are still preserved in collections around the world, which allows further research to be conducted upon them.After the Second World War, the National Museum in Warsaw received five such artefacts. Their exact provenience, archaeological context and the precise time of their execution is unknown. In April 2011, an x-ray examination of the artefacts was conducted by Łukasz Przewłocki, Wojciech Ejsmond (students at the Institute of Archaeology, Warsaw University) and Dr. Monika Dolińska (curator of the Egyptian collection at the National Museum in Warsaw).This paper presents an interpretation of these objects in the wider context of animal mummies and also provides a description of the results of their recent examination. All the specimens can be dated to the Greco- Roman period (332 BC-AD 390) with the exception of one, which probably dates to an earlier time. There are some unusual aspects to the group, such as the presence of a human tooth in one specimen and traces of restoration carried out at an unknown date in other one.
Test Results of Fine Sediment Fractions from the Tell el-Farkha Archaeological Site, Nile Delta, Egypt
Authors: Pawlikowski Maciej , Słowioczek Edyta
Published: May 2021

The Tell el-Farkha site is located immediately to the north of the modern village of Ghazalah and occupies an area of c. 4.5ha. It is marked by three hills: the Eastern Kom, Central Kom and Western Kom. This research will focus on the profile of the layers of sediment. These studies are important because they are innovative and contain information on the history of the site. Research work was conducted on site and produced graphs showing the composition of individual microartefacts within the sediment. Samples were taken from each profile layer then dissolved and sifted to obtain fine fractions. Laboratory work focused on the calculation of the percentage of different microartefacts in each sifted fine fraction. Photographs of selected microartefacts (bones, ceramics, carbon, quartz, and others) were taken using a binocular magnifier at 20x magnification. The examination of this material has provided both new and valuable information concerning the functioning and development of the archaeo-logical site.
Both Sides Matter? Reading Greek Vases Using Pictoral Semiotics
Authors: Miścicki Wawrzyniec
Published: May 2021

This paper explores the possibilities of using methods of analysis from the field of pictorial semiotics in studying Greek vase painting, and thus resolving the problem of interpreting multiple scenes on a single vase. Its aim is to explain and clarify basic notions connected to this discipline, such as imagery, syntagmatic and paradigmatic relations, and how they relate to Greek iconography, using various examples. The main premise is that the separate scenes on the artifact are connected syntagmatically and not only paradigmatically as it is usually indicated, thus the joint interpretation always precedes the analysis of detached scenes, the latter being dependent upon the syntagmatic reducibility of the image.
Improving Drug Prescription in Elderly Diabetic Patients
Authors: Francesc Formiga Pérez
Published: May 2021

Nowadays, there is no doubt that there is a good epidemic of ageing with the inversion of the population pyramid. There is no doubt either about the current epidemic of obesity and bad nutritional habits that have resulted in an increase of diabetic patients in the world. And the union of these epidemics has led to an increase of diabetes (DM) in the elderly.
Nutraceutics, Frailty and Polypharmacy in the Oldest Old
Authors: Graziano Onder
Published: May 2021

Malnutrition and nutritional problems are common in older adults. Multiple chronic disease, inflammation, cognitive and functional impairment, geriatric syndromes (including delirium, falls or chronic pain) and drug use (i.e. polypharmacy, adverse drug reactions) may play a role in the onset of malnutrition and nutritional problems.
Mycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure
Authors: A. Graham Cummiskey  , Michael Reardon
Published: May 2021

Introduction: Mycoplasma pneumonia is one of the most common types of pneumonia, although it is often not diagnosed due to mild clinical course. Aims: In this case study we aim to describe the importance of considering mycoplasma pneumonia in high-risk groups. Methods: We present the case of a 27-year-old woman admitted with pneumonia, progressing to acute respiratory distress syndrome and acute kidney injury. She had a prolonged stay in the ICU, requiring intubation and continuous veno-venous haemofiltration (CVVH). After 1 month in hospital, she was discharged with full recovery. Discussion: Mycoplasma pneumonia is a common type of pneumonia in the community, but only a small percentage of patients require hospitalization. Delayed treatment can result in multi-organ failure, which requires intensive care and long hospital stays.
A Case of Pancytopenia with Many Possible Causes: How Do You Tell Which is the Right One?
Authors: Priscila Diaz  , Mariana Abreu Vieira  , António Carneiro  , Natália Fernandes
Published: May 2021

Systemic lupus erythematosus (SLE) often presents with cytopenia(s); however, pancytopenia is found less commonly, requiring the consideration of possible aetiologies other than the primary disease. The authors describe the case of a female patient with a recent diagnosis of SLE admitted through the Emergency Department with fever of unknown origin and severe pancytopenia. She was medicated with prednisolone, hydroxychloroquine, azathioprine, amlodipine and sildenafil. Extensive investigation suggested azathioprine-induced myelotoxicity. However, the patient was found to have a concomitant cytomegalovirus (CMV) infection, with oral lesions, positive CMV viral load as well as the previously described haematological findings. Pancytopenia is always a diagnostic challenge, with drug-induced myelotoxicity, especially secondary to azathioprine, being a rare aetiology. This report reiterates the importance of the differential diagnosis of pancytopenia, especially in immunosuppressed patients with increased risk for opportunistic infections.
Pernicious Anaemia with Normal Vitamin B12
Authors: Joao Galaz Tavares  , Bernardo Baptista  , Bebiana Gonçalves  , Alexandra Bayão Horta
Published: May 2021

A 49-year-old female patient presented to our hospital with asthenia, odynophagia, low grade fever, worsening symptoms of chronic depression, and symmetric leg paresthesias. Investigations showed macrocytic anaemia, leucopenia, thrombocytopenia, high lactate dehydrogenase levels and a normal Coombs test. Trilineage dysplasia was detected in the bone marrow biopsy specimen. The diagnostic work-up led us to the diagnosis of pernicious anaemia with a spuriously normal value of vitamin B12 and high titres of anti-intrinsic factor autoantibodies. This case highlights the importance of considering vitamin B12 deficiency in the differential diagnosis of myelodysplasia, even when vitamin B12 levels seem to be normal.
Self-Limited Cytomegalovirus Infection During Natalizumab Treatment for Multiple Sclerosis
Authors: Marina Rodrigues Lima  , Luis Arthur Brasil Gadelha Farias  , Maycon Fellipe da Ponte  , Luís Edmundo Teixeira de Arruda Furtado
Published: May 2021

Natalizumab is indicated as monotherapy for the treatment of relapsing-remitting multiple sclerosis; it prevents outbreaks and delays the progression of physical disability. Here, we report the case of a 30-year-old patient with multiple sclerosis receiving natalizumab as monotherapy who subsequently developed self-limited cytomegalovirus disease. Cytomegalovirus infection has been reported during treatment with natalizumab, and in this study, we use new techniques to analyze the possible association of cytomegalovirus infection with natalizumab.
Olmesartan: A Little-Known Cause of Diarrhoea
Authors: Joana Serôdio  , Joana Carneiro  , Manuel Veiga  , António Ferreira
Published: May 2021

Olmesartan's sprue-like enteropathy was first described in 2012 and typically presents with diarrhoea, weight loss, nausea, vomiting, low albumin and histological evidence of intestinal villous atrophy. Coeliac disease is one of the main differential diagnoses and should be excluded. We present the clinical case of a 63-year-old man treated with olmesartan for 10 years who presented with a 2-month history of diarrhoea and was diagnosed with olmesartan´s enteropathy. This case highlights the need for clinical suspicion of this new entity in order to reduce the associated morbidity and unnecessary costly investigations.
Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis
Authors: Ricardo Cleto Marinho  , José Luis Martins  , Susana Costa  , Rui Baptista  , Lino Gonçalves  , Fátima Franco
Published: May 2021

Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases.
An Atypical Case of Vasculitis: When ‘Occult’ 18FDG-PET Scan Findings Create a Classification Dilemma
Authors: Elena Lopez-Francos  , Sammy Place  , Daphnee Delplace  , Frédéric Vandergheynst
Published: May 2021

We describe a 66-year old patient with a recurrent ulcer on her right ankle. Biopsy revealed medium-vessel vasculitis consistent with cutaneous polyarteritis nodosa. There were no signs or symptoms suggestive of systemic vasculitis, but a 18FDG-PET scan showed areas of increased uptake around the large arteries and the pelvic and shoulder girdles. These findings suggested polymyalgia rheumatica in the setting of large-vessel vasculitis. This case thus supports the statement from the Chapel-Hill consensus conference that classification of systemic vasculitis by vessel size is based on the vessels predominantly involved, but vessels of other sizes may also be affected.
Haemoglobin A1C Levels Constantly Below Lower Reference Limit in a Diabetic Patient With Microcytic Anaemia
Authors: Frank Sheng Fan  , Chih-Hao Chen  , Hui-Chun Yang
Published: May 2021

Introduction: Haemoglobin A1C (A1C), as a parameter of long-term glycaemic control, has been adopted to guide diabetic therapy all over the world. However, falsely high or low A1C could be troublesome in daily practice. Case description: A 75-year-old male diabetic patient affected by a reasonably inferred life-long history of microcytic anaemia was found to have abnormally low A1C values in the previous 5 months. Subsequent laboratory assessment with brilliant cresyl blue staining and haemoglobin electrophoresis detected haemoglobin H disease as the underlying cause of both the microcytic anaemia and the disturbed A1C measurement. Discussion: Enhanced erythrocyte destruction such as in haemoglobin H disease could explain a falsely decreased A1C level very well. Upon facing a questionable A1C value, physicians dealing with diabetes should consider the possibility of undiscovered underlying causes rather than too tightly glycaemic control.
Abstract Book of the 18th Conference in Internal Medicine
Authors: Lorella La Leggia  , Authors of ECIM
Published: May 2021

Abstract Book of the 18th Conference in Internal Medicine
Tetraparesis with Major Hypokalaemia and Rhabdomyolysis Induced by Chronic Liquorice Ingestion
Authors: Hassene Attout  , Andry Randriajohany  , Françoise Josse  , Vincent Appavoupoule  , Yoga Thirapathi
Published: May 2021

Chronic ingestion of liquorice induces a syndrome with findings similar to those for primary hyperaldosteronism. This is characterized by hypokalaemia, hypertension, metabolic alkalosis and suppression of the renin-aldosterone system. We describe a 30-year-old woman who, with a plasma potassium level of 1.5 mmol/l, presented with tetraparesis and severe rhabdomyolysis (CK up to 35,460 U/l). She admitted to a daily consumption of nearly 300 g of liquorice sweets during the previous 6 months. This case emphasizes the importance of a detailed anamnesis, which is essential for diagnosis, avoids unnecessary and expensive investigations and reduces the duration of hospitalization.
Severe Acute Liver Injury Related to Heat Stroke
Authors: Fani Ribeiro  , Mário Bibi  , Marta Pereira  , Sofia Ferreira  , Helena Pessegueiro  , Rui Araújo
Published: May 2021

Heat stroke (HS) is a life-threatening condition characterized by hyperthermia and multiple organ failure. Mild to moderate hepatocellular injury is a well-documented complication but severe liver injury and acute liver failure are rare. There are neither established criteria nor optimal timing for liver transplantation and conservative management seems to be the cornerstone treatment. The authors report a case of a patient with severe liver injury related to HS who recovered completely under conservative treatment.
Drug Liver Injury Induced by Olmesartan Mediated by Autoimmune-Like Mechanism: A Case Report
Authors: Manuel de la Torre-Aláez  , Mercedes Iñarrairaegui
Published: May 2021

Autoimmune hepatitis (AIH) was the first liver disease for which an effective therapeutic intervention was carried out, using prednisolone; its usefulness was demonstrated in several clinical trials. Nevertheless, AIH still remains a difficult diagnosis in some cases, because it is necessary to dismiss other possible diagnoses, and perhaps due to it being a heterogeneous disease. The relationship between drug-induced liver injury (DILI) and AIH is complex and not fully understood. There are three possible scenarios: (1) DILI with a strong immunoallergic component mimicking AIH; (2) AIH mimicking a DILI due to drug exposure and (3) AIH triggered by exposure to an offending drug (drug-induced AIH). Drug-induced AIH is well described and documented for some drugs such as nitrofurantoin and minocycline. Histologically distinguishing DILI from AIH remains a challenge. We present an interesting case report which met serologic criteria and histological confirmation to establish AIH, but discontinuation of a suspected drug resolved hypertransaminasaemia.
Cardiac Involvement in Leptospirosis – An Unusual Manifestation
Authors: Vanessa Barcelos  , Ana Carolina Ferreira  , António Xavier Fontes  , Luís Dias  , Humberto Costa  , Dinis Martins
Published: May 2021

Cardiovascular involvement by Leptospira is unusual. We report a case of a 29-year-old male sanitation worker who was diagnosed with leptospirosis (PCR testing for Leptospira spp. was positive in blood and urine). He had no classical clinical findings, and the presence of shock was the main worrisome finding. Within 24 hours of admission, the emergence of chest pain led us to consider cardiac involvement, which was demonstrated by diffuse supra-ST segment elevation, elevated troponin and NT-proBNP and an echocardiogram showing mildly left ventricular ejection fraction (LVEF 48–50%). There are several reports of cardiovascular involvement in severe leptospirosis but most patients are asymptomatic. In this case, the main key to diagnosis of perimyocarditis was the new onset of chest pain.
Isolated Congenital Asplenia in an Asymptomatic Patient: A Very Rare Diagnosis
Authors: Sofia Dinis Ferreira  , Cláudia Lemos  , Mónica Caldeira  , Miguel Homem da Costa  , Maria Luz Brazão  , Fernando Aveiro
Published: May 2021

Isolated congenital asplenia is a rare condition that mostly manifests in the early years, usually due to fatal systemic infections. In this paper, however, we present a case of a 36-year-old asymptomatic patient who was referred for suspected hyposplenism, with no history of splenectomy. There were no significant changes on physical examination. Blood analysis revealed leukocytosis and thrombocytosis as well as moderate anisopoikilocytosis and red blood cells with Howell–Jolly bodies. No spleen or other malformations were identified on imaging. Individuals with isolated congenital asplenia have an increased susceptibility to invasive infections and sepsis, with rapid clinical decline and a high mortality rate despite treatment.
Sweet’s Syndrome Induced by Aromatase Inhibitor in the Treatment of Early Breast Cancer
Authors: Debora Cardoso  , Andreia Coelho  , Leonor Fernandes  , Leonor Vasconcelos Matos  , Isabel Serrano  , Helena Miranda  , Ana Martins
Published: May 2021

Background: Breast cancer is the most commonly diagnosed cancer in women, mainly at an early stage, allowing treatment with curative intent. Aromatase inhibitors are widely used in the adjuvant treatment of oestrogen receptor-positive breast cancer, mainly in postmenopausal women. The most frequent adverse events associated with these therapies are musculoskeletal symptoms and an increased risk of bone fractures. Cutaneous adverse events have been rarely described. Sweet’s syndrome can present as an idiopathic disorder in addition to being malignancy-associated or drug-induced. Case presentation: We report the case of a 69-year old woman, diagnosed with early stage breast cancer, who underwent breast-conserving surgery, followed by adjuvant radio and endocrine treatment with letrozole 2.5 mg daily, for a foreseeable duration of 5 years. Three months after starting letrozole, she presented with sudden fever and exuberant and painful erythematous skin papules and plaques on her upper body. After a full work-up and exclusion of other potential causes, a skin biopsy confirmed the presence of dermal oedema and a diffuse neutrophilic infiltrate, suggesting Sweet’s syndrome. After discontinuation of letrozole and treatment with corticosteroids, the patient fully recovered. She resumed adjuvant treatment with tamoxifen, without symptom recurrence. Conclusions: Sweet’s syndrome is a rare condition and an association with aromatase inhibitors has not been previously reported. Although its occurrence has already been observed in the onset of malignancies such as breast cancer, aromatase inhibitors must be added to the list of potential causes of drug-induced Sweet’s syndrome.
Not All ENT Granulomas Are Wegener’s – Keep Tuberculosis in Mind
Authors: Bárbara Pedro  , Marta Meleiro  , António Marinho
Published: May 2021

Mycobacterium tuberculosis affects the middle ear in rare cases and is a challenging diagnosis. In this case, we present a 57-year-old patient diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-negative granulomatosis with polyangiitis (GPA) following a biopsy result of nasal granulomas, who was immediately started on immunosuppressive treatment. Years later, she developed progressive hypoacusis. Magnetic resonance imaging (MRI) revealed an extensive mass in the tympanic cavity extending to the mastoid. A biopsy of the mass was positive for Mycobacterium tuberculosis. Immunosuppressants were weaned and the patient was started on anti-tuberculous therapy with resolution of the complaints and findings. Tuberculous infections are difficult to diagnose and frequently mimic other illnesses, but in our case, we believe that an indolent tuberculous process was present from the beginning and evolved under immunosuppressive therapy.
Pericardial Effusion as an Initial Presentation of Panhypopituitarism
Authors: Rosa Alves  , Sofia Alegria  , Henrique Vara Luiz  , Tiago Judas
Published: May 2021

Pericardial effusion has a broad spectrum of clinical presentation, ranging from an incidental finding on imaging to a potentially fatal emergency such as pericardial tamponade, the most severe presentation. The authors present a case of a middle-aged male hospitalized due to shortness of breath. Initial work-up was positive for massive pericardial effusion with haemodynamic compromise. Additional study revealed panhypopituitarism. The acromegalic phenotype was suggestive of acromegaly secondary to pituitary adenoma, which had probably evolved to apoplexy. Hormone replacement was started with clinical improvement. At the 3-year follow-up, there was no evidence of recurrence of pericardial effusion. Panhypopituitarism is a relatively rare entity, but can lead to life-threatening complications such as adrenal crisis, coma and myxoedema-associated cardiac failure. Pericardial effusion is an extremely rare manifestation of secondary hypothyroidism.
Pleural Sarcoidosis and Occult Lymphatic Anthracosis: An Unusual Symptomatic Association
Authors: Rosa Alves  , Bruno Sousa  , Francisco d'Orey  , Pedro Sequeira  , Ana Oliveira  , Tiago Judas
Published: May 2021

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology. Virtually any organ or system can be involved, resulting in a wide range of clinical presentation. Pleural sarcoidosis is rare. Pleural effusion can only be attributed to pleural sarcoidosis in the presence of pleural non-caseating epithelioid granulomas and after excluding other granulomatous diseases. Anthracosis is a pneumoconiosis associated with thoracic adenopathies and bronchial disease, and it is usually asymptomatic. The authors present a case of a middle-aged man hospitalized due to cough, right-sided pleuritic chest pain and trepopnoea.
Effectiveness of Tocilizumab in the Treatment of Fasciitis with Eosinophilia: Two Case Reports
Authors: Guiomar Pinheiro  , Ana Rita Costa  , Ana Campar  , Teresa Mendonça
Published: May 2021

Fasciitis with eosinophilia (FE) is a rare connective tissue disease. Due to its rarity, large-scale studies are lacking, which makes its treatment challenging. Systemic corticosteroids (SCSs) are the cornerstone of treatment; however, additional immunosuppressive drugs (ISDs) are frequently necessary (usually methotrexate). We report 2 patients, for whom an SCS and methotrexate were not a viable long-term option. In the first case, we were unable to taper the SCS dose without symptom relapse, the patient showed only a partial response to methotrexate and presented side effects. The second case never fully responded to the SCS and methotrexate and demonstrated serious SCS adverse effects. Both patients were started on tocilizumab with extremely favourable results, making this drug a potential therapeutic weapon for these patients.
Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report
Authors: Mohammad Darvishi  , Sana Rashidi  , Setayesh Abazari
Published: May 2021

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.
Ruptured Sinus of Valsalva Aneurysm Causing Aorto–Atrial Fistula and Acute Heart Failure: A Rare Encounter
Authors: Zafar Ali  , Talal Asif  , Justin Sheehy  , Dany Jacob  , Paramdeep S Baweja
Published: May 2021

A ruptured sinus of Valsalva aneurysm as a cause of aorto–atrial fistula is very rare. We present the case of a 53-year-old female who presented with symptoms of acute heart failure and suspicion of an aorto–atrial fistula found on a transthoracic echocardiogram, which was confirmed on transesophageal echocardiography. A coronary angiogram showed normal coronary arteries but confirmed the right aorto–atrial fistula on aortogram. She underwent successful surgical repair of the fistula. Her postoperative echocardiogram showed a normal right atrium and right ventricle with no shunt. A ruptured sinus of Valsalva aneurysm is a devastating event and presents as acute heart failure. Prompt diagnosis and surgical repair is necessary to prevent mortality.
Necrotizing Fasciitis Causing Acute Compartment Syndrome after Radial Artery Catheterization
Authors: Filipa Cabral Amado  , Carlos Noversa  , Andreia Moura  , Luís Carvalho  , Leila Cardoso
Published: May 2021

Necrotizing fasciitis is a rare but potentially fatal infection involving the subcutaneous tissue and fascia with the development of necrosis of these structures. Acute compartment syndrome occurs when increased pressure within a closed muscle compartment compromises the circulation and function of the tissues within that space. We report the case of a male patient who was admitted to the intensive care unit for the management of urosepsis due to an acute obstructive pyelonephritis complicated by cardiopulmonary arrest. A radial arterial catheter in the left arm was urgently inserted, under suboptimal aseptic technique. His clinical condition progressively deteriorated, and swelling of the left arm with extension to the forearm with incipient signs of compromised perfusion were observed. The diagnosis of necrotizing fasciitis with acute compartment syndrome was made and an emergency fasciectomy performed. Following this, the patient gradually improved, organ dysfunction resolved, and he was discharged without sequelae.
Hepatic Necrosis after Trans-Arterial Embolization of Metastatic Neuroendocrine Tumour
Authors: Sarah Micallef  , Kelvin Cortis  , Claude Magri
Published: May 2021

Liver metastases from neuroendocrine tumours (NETs) are usually seen on cross-sectional imaging at presentation. In such cases, curative surgical resection is usually not possible given that most patients have bilobar disease. Various locoregional approaches are now widely available that enable local control of disease and management of systemic symptoms. These include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), selective internal radiotherapy and thermal ablation. We describe a rare case of hepatic necrosis after TAE in a 61-year-old woman with a metastatic NET. Cross-sectional imaging showed extensive necrosis affecting segments VII and VIII of the liver. This occurred secondary to thrombosis in the portal vein branches to these segments, confirmed on a Doppler ultrasound scan. The mechanism of portal vein thrombosis after TAE could be due to the presence of occult arterioportal anastomoses. These allow transit of the embolizing agents into the portal vein branches supplying the treated segments and subsequent thrombosis.
Syncope Caused by a Head and Neck Cancer Controlled by a Permanent Pacemaker
Authors: Ana Rita Barradas  , Francisco Albuquerque  , Mariana Constante  , Margarida Fonseca  , Filipe Correia  , João Lopes Delgado
Published: May 2021

Syncope caused by carotid sinus syndrome due to head and neck cancer is rare. We report a case of recurrent syncope as a result of extreme bradycardia requiring pacemaker implantation. The patient began chemotherapy and radiation therapy to treat the underlying cause. When diagnosed early, a positive outcome is expected in these situations.
Insulinoma Identified in Puerperium: Association with Pregnancy and Literature Review
Authors: Rossana Orabona  , Cristina Zanardini  , Andrea Lojacono  , Sonia Zatti  , Carlo Cappelli  , Guido AM Tiberio  , Vincenzo Villanacci  , Enrico Sartori
Published: May 2021

Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10x8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork.
Cannabis Hyperemesis Syndrome: A Still Under-Recognized Syndrome
Authors: Attout Hassene  , Amichi Sofia  , Josse Françoise  , Appavoupoule Vincent  , Randriajohany Andrey  , Thirapathi Yogananda
Published: May 2021

Cannabis is one of the most widely used illicit drugs in the world. Its use is associated with several short- and long-term side-effects such as changes in mood, impaired memory, impaired attention, depression and anxiety, and it is correlated with schizophrenia. Cannabinoid hyperemesis syndrome (CHS) is characterized by chronic cannabis use, cyclic intractable nausea and vomiting, and compulsive hot bathing. Patients are typically diagnosed with CHS only after multiple medical evaluations. Recent research has identified type 1 cannabinoid receptors in the intestinal nerve plexus that have an inhibitory effect on gastrointestinal motility. This effect may explain hyperemesis in cannabis users. The thermoregulatory role of endocannabinoids may be responsible for compulsive hot bathing. We describe the cases of two young men seeking repeated emergency room care with recurrent nausea and vomiting. Abstinence from cannabis led to resolution of vomiting symptoms and abdominal pain.
Exuberant Hand-Foot-Mouth Disease: An Immunocompetent Adult with Atypical Findings
Authors: Joana Cordeiro e Cunha  , Ana Lima Silva  , Renato Maia Nogueira  , Diana Silva Fernandes  , Tatiana Salazar  , Maria Vilela  , Jorge Salomão
Published: May 2021

Non-polio enteroviruses are ubiquitous viruses responsible for a wide spectrum of disease in people of all ages, although infection and illness disproportionately affect infants and young children. Hand-foot-mouth disease (HFMD) is an enteroviral clinical syndrome most frequently caused by coxsackievirus-A16 and enterovirus-A71. Since 2008, a novel coxsackievirus-A6 genotype has been associated with more severe HFMD in both children and adults, presenting with a unique constellation of findings, and whose prevalence has been increasing over the last few years. In this case report, an atypical clinical picture of confirmed enterovirus HFMD is described in an immunocompetent adult, with exuberant clinical findings, clinically consistent with coxsackievirus-A6 infection. This case report highlights the importance of awareness of the clinical presentation of this increasingly common infection in adults.
A Case of Meningococcal and HSV-2 Meningitis in a Patient Being Treated with Ustekinumab for Pityriasis Rubra Pilaris
Authors: Charalampos I Kalogeropoulos  , Konstantinos Papathanasiou  , Ismini Tsagkaraki  , Georgios Giannopoulos  , Aristotelis Bamias  , Eleni Boutati
Published: May 2021

Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous dermatosis affecting both adults and children. Six subtypes of PRP have been described. Recently, the management of PRP with biologic immunosuppressive agents regularly used in psoriasis has been supported by several case reports and series. Ustekinumab is an anti-IL12/23 IgG1 kappa human monoclonal antibody. It has been approved for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis and ulcerative colitis. It has also been reported to be effective as an off-label treatment for PRP. Current data are equivocal regarding infectious disease risk with ustekinumab administration. We describe a case of meningococcal and HSV-2 infection of the central nervous system in a patient being treated with ustekinumab for PRP.
Abdominal Pain: A Real Challenge in Novel COVID-19 Infection
Authors: Erika Poggiali  , Pau Mateo Ramos  , Davide Bastoni  , Andrea Vercelli  , Andrea Magnacavallo
Published: May 2021

COVID-19 (coronavirus disease 19) is an infectious disease caused by coronavirus SARS-CoV-2. Since its detection in China at the end of 2019, the novel coronavirus has rapidly spread throughout the world and has caused an international public health emergency. The most common manifestation is flu-like symptoms. Mild infections usually improve within a few days, but COVID-19 can cause severe pneumonia with acute respiratory distress syndrome and death. Gastrointestinal symptoms are less common but possible and more difficult to recognize as part of a COVID-19 syndrome. In line with the current opinion of the WHO, we strongly believe that preventive measures and early diagnosis of COVID-19 are crucial to interrupt virus spread and avoid local outbreaks. We report the cases of COVID-19 patients admitted to our Emergency Department who complained of gastrointestinal symptoms at admission.
Pleurisy Can Cause Chest Wall Tenderness: A Case Report
Authors: Shaul Yaari  , Elchanan Juravel  , Murad Daana  , Samuel Noam Heyman
Published: May 2021

Stab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also.
Disseminated Coccidioidomycosis in Africa
Authors: Samuel Deokjong Yoo  , John K Lusiba  , Robert Lukande  , Kyungmin Shin
Published: May 2021

Background: Coccidioidomycosis is an endemic disease in the Americas. No cases have been reported in Africa. Patient: A 23-year-old HIV seronegative Ugandan man was referred to Mulago National Referral Hospital in Kampala, Uganda with a 10-month history of haemoptysis and difficulty breathing, and a 6-month history of localized swellings on the extremities. He had associated weight loss and drenching sweats, but no fevers. He had taken anti-tuberculosis medicine for 2 months with no improvement. He had never travelled out of Uganda. On physical examination, he had cystic swellings and ulcerated lesions on the extremities. He had tachypnoea, crackles in the chest and mild hepatomegaly. Bronchoscopic examination showed two masses occluding the right main bronchus. Bronchoscopic biopsy showed findings consistent with coccidioidomycosis. The patient improved with antifungal treatment and was discharged. Conclusion: We report the first case of disseminated coccidioidomycosis with pulmonary and cutaneous manifestations in Africa.
Cardiac Lipoma of the Interventricular Septum
Authors: Rodrigo Maia Alves  , Cristina Gamboa
Published: May 2021

Cardiac lipomas are rare benign primary neoplasms of the heart, usually found incidentally, that can become symptomatic depending on their size and location. We report the case of a 61-year-old man presenting with chest pain and elevated troponin and a normal EKG and D-dimers. A transthoracic echocardiogram revealed an intracardiac mass attached to the interventricular septum protruding to the left ventricle, later confirmed to be a lipomatous mass consistent with a cardiac lipoma on cardiac magnetic resonance imaging. Due to the mass characteristics and favourable evolution, it was decided not to excise the tumour, and the patient remains asymptomatic after a 4-year follow-up period.
Thrombocytopenia in the Course of COVID-19 Infection
Authors: Noel Lorenzo-Villalba  , Abrar-Ahmad Zulfiqar  , Marc Auburtin  , Marie Helene Schuhmacher  , Alain Meyer  , Yasmine Maouche  , Olivier Keller  , Emmanuel Andres
Published: May 2021

We report three cases of severe thrombocytopenia during COVID-19 infection associated with either cutaneous purpura or mucosal bleeding. The initial investigations ruled out other causes of thrombocytopenia. Two of the patients were treated with intravenous immunoglobulins and eltrombopag, while the third recovered spontaneously. A good clinical and biological response was achieved in all patients leading to hospital discharge.
Eribulin and Confusion: A Previously Unknown Drug Side-Effect
Authors: Abu Baker Sheikh  , Abhilash Perisetti  , Nismat Javed  , Rahul Shekhar
Published: May 2021

Eribulin is an antineoplastic agent used in advanced breast cancer refractory to anthracycline and taxane treatment regimens. A wide variety of side effects with unclear mechanisms have been noted, but encephalopathy has not been widely reported. Here we describe the case of a middle-aged woman treated with eribulin for advanced breast cancer who subsequently developed central nervous system drug-induced toxicity but improved promptly with steroid administration.