bluuebunny/crossref_metadata_2025 huggingface dataset:
An Internet Platform to Monitor Plant Pathogens Spread: The Italian Case of Xylella
Authors:   Department of Innovation Engineering, University of Salento, Lecce 73100, Italy, Corallo Angelo , Filieri Francesco , Latino Maria Elena , Menegoli Marta , Sarcinella Marco
Published: May 2021

The numerous species of harmful organisms of tropical origin represent real phytosanitary emergencies that are bringing sectors of agri-food production to their knees, determining negative economic consequences for many farms and significant repercussions on the management of the territories on which production activities insist. For some years, a phytosanitary emergency affects tree species of the Mediterranean scrub, especially the olive trees in the south of Italy: Xylella Fastidiosa (Xf) infection. In this scenario, the paper aims to describe a proposed internet platform, developed in order to support farmers in pathogen monitoring, providing information about the crop and the cropping environment. It is able to provide information about Plant Sap Flow Density, Normalized Difference Vegetation Index and Vapor Pressure Deficit. Information was represented using interactive maps able to tell the overtime parameters trend. Stakeholder, can access to the olive oil trees maps, obtaining in a single view the risk derived from the Xf contagion. The platform could benefit farmers and other stakeholders interested in analysis and territorial sustainability (decision makers, researchers, citizens and biologists).
МОДЕЛЬ ОЦЕНКИ ДИНАМИКИ ЗРЕЛОСТИ ПРОМЫШЛЕННЫХ ЭКОСИСТЕМ
Authors: Dudareva Olga V. , Dudarev Dmitry N. , Goncharov Alexander Y.
Published: May 2021

Переход на экономику, устроенную по принципу экосистем, является сверхзадачей Российской Федерации. Стимулирование развития всеохватной и устойчивой промышленности и дальнейшие инвестиции в материальную инфраструктуру, инновации и научные исследования имеют принципиальное значение для долгосрочного экономического развития. Развитие промышленной экологии на основе кросс-отраслевого взаимодействия позволило сформулировать предпосылки и необходимость перехода от традиционных промышленных систем к более интегрированным моделям, подобным биологическим экосистемам. Основным катализатором такой трансформации промышленных систем в экосистемы явилась технологическая динамика. Промышленная экосистема не имеет четких границ и требует специфического набора индикаторов для оценки ее зрелости. Отсутствуют аналоги для сравнения промышленных экосистем, а единственным способом установления целевых значений показателей является опрос участников. Тем не менее, концепция оценки зрелости применима и авторы операционализируют ее путем внедрения ряда индикаторов, позволяющих определить этап развития экосистемы. Подход основан на методологии оценки цифровой зрелости организации Центра перспективных управленческих решений (ЦПУР).

Цель – определение способов и приемов оценки уровня цифровой зрелости промышленной экосистемы.

Метод или методология проведения работы: использовались экономико-математические методы, а также статистические методы анализа.

Результаты: модель позволяет решить важную задачу: оценить текущее состояние экосистемы и выявить проблемы, которые не позволяют ей достичь целевого уровня.

Область применения результатов: полученные результаты целесообразно применять экономическими субъектами, осуществляющими промышленную деятельность.
Sectorial structure of employment and factors of structural changes in the economy of modern Russia
Authors: Basovskaya Elena
Published: May 2021

The aim of the work was to study the dynamics and factors of development of the sectorial structure of employment in the period 2005-2019. To obtain estimates of the dynamics and factors of development of the sectorial structure of employment, we used regression analysis, factor analysis based on the model of principal components, and data on the structure of employment from Rosstat. Steadily growing and steadily shrinking industries are identified. It been established that the first main factor in the change in the sectorial structure of employment in the period under review can be char-acterized as a factor in the development of the export-raw material orientation of the economy and the development of the service sector, including scientific and technical, and the social sphere. The first main factor in the development of the sectorial structure of employment only partially contributed to the strengthening of the export-raw material orientation of the economy, and to greater extent contributed to the development of the modern post-industrial structure of the economy. The second and third main factors of changes in the sectorial structure of employment in the period under review are a reflec-tion of cyclical processes characteristic of modern economic systems. The fourth main factor in changes in the sectorial structure of employment reflects the phenomenon of the modern economy's insensitivity to the use of modern information technologies. There is a lack of susceptibility to scientific and technological progress by the modern economy of Russia at the macroeconomic level.
Digital Ruble As an Element of the Digitalization of the Economy
Authors: Myasnikova E. , Voskresenskaya L.
Published: May 2021

The article is devoted to the discussion of the prospect of issuing in Russia the digital currency of the Central Bank - the digital ruble. The properties and characteristics of the digital ruble, models of the functioning of the digital currency are considered. The place of the Central Bank in the process of functioning of the platform for the production of digital rudders shown. The main stages of development and implementation of the digital ruble are presented. Expert assessments of the possibilities and consequences of the introduction of the digital ruble are discussed. The impact of the digital ruble of the Central Bank on the financial system and the potential risks of introducing a digital currency are assessed. A comparative analysis of technologies for creating a digital ruble platform been carried out. The strategies of the central banks of various countries in creating models and mechanisms for issuing digital currencies into circulation are considered. Conclusions are made about the prospects for the introduction of the digital ruble in Russia. It noted that the problem of choosing the organization of the circulation of digital currency remains unresolved. Model C creates an excessive load of settlements on the Central Bank; Model D distributes the settlement load among commercial banks, which greatly increases the risks of clients – legal entities and individuals.
Problems of the Strategy of Sustainable Development of Manufacturing En-terprises
Authors: Yucis A.
Published: May 2021

The purpose of the work was to assess the sustainability of the development of industrial enterprises in modern Russia and to determine the reasons that give rise to the non-sustainability of their functioning. The work used data from Rosstat on the volume and growth rate of production, profitability of assets, the value and structure of costs of manufacturing enterprises. The tendencies of changes in indicators characterizing the activities of enterprises assessed using linear regression analysis. Estimates of the stabil-ity of the functioning of enterprises assessed by determining the coefficients of variation of indicators characterizing the activities of enterprises. The degree of perception by enterprises of the trends of modern technical and economic development will assessed by the trends in the structure of costs for manufacturing products of the manufacturing industry. In the work it established that the efficiency of the enterprises of the manufac-turing industry is falling, the development of enterprises is unstable. Inefficiency and instability in the development of industrial enterprises is due to the strategy of enterpris-es, which not sufficiently focused on innovative development, based on new technolo-gies and human capital of highly qualified personnel.
Construction and Study of a Game-Theoretic Model of Interaction Between Manufacturers of SLR Cameras, Taking into Account Forecasting Demand
Authors: Vlasov Dmitriy
Published: May 2021

The article discloses the mechanisms for constructing and researching a theoretical and game model of interaction between manufacturers of SLR cameras taking into account demand forecasting. The need for the use of theoretical and game modeling of an advanced level, taking into account the predicted values of demand for mirror photographic equipment, as well as the dynamics of demand for a new photo product, is justified. In order to study the phenomenon of competitive interaction of manufacturers of SLR cameras, a comprehensive application of econometric analysis and theoretical game modeling was implemented. It is noted that this approach can be widely used in the practice of making decisions in the field of the photo industry. Particular attention is paid to the analysis of the advanced game model of the choice by the manufacturer of camera equipment of the time of bringing new photo products to the market. In the process of analyzing the game model, maximax criteria, Laplace criterion, Wald criterion, Sevij criterion, Hurwitz criterion and Hodge Lehman criterion are used. Comprehensive analysis of the game model, supplemented by meaningful interpretations, contributes to improving the quality of decisions made in the photographic technology market, including when choosing marketing strategies for the promotion of photographers in the context of mainstreaming the risks of various nature and the limitations of the pandemic.
Prospects for Cooperation Between Russia and Syria in Various Scenarios of Military Conflict Development
Authors: Haled Alheder
Published: May 2021

The paper is devoted to determining the prospects for cooperation between Russia and the Syrian Arab Republic in various scenarios of military conflicts. In order to identify the relationship between the success of the country's foreign economic policy and the military conflicts waged on its territory, a study was conducted of such indicators of Syria as: the growth rate of the peace index and the GDP growth rate. A strong inverse correlation is revealed, which means that the level of political situation and peace in the state determines the efficiency of the economy. In view of this, various scenarios of the development of the military conflict in Syria have been studied: at the initial stage, at the stage of active hostilities, at the present stage of overcoming the crisis. The last stage involves four different scenarios for the development of a military conflict, including a local nature and a protracted nature with the involvement of other countries of the world. Options for developing cooperation between Russia and Syria have been identified for each scenario. Taking into account the assessment of the international political situation, the two most likely scenarios for further military events in Syria are identified, and the prospects for cooperation between Russia and Syria in these conditions are outlined.
The Flint Industry of Tell el-Farkha in the Predynastic Period – Old and New Perspectives
Authors: Stępień Urszula
Published: May 2021

Excavations of Predynastic deposits on the Eastern Kom of Tell el-Farkha have yielded a small, yet revealing assemblage of flint, as well as evidence of an agate workshop. The flint artefacts are mostly similar to those from other sections of the site and are fairly typical of the flint industry in the Nile Delta. The assemblage not only attests to the impressive skills of local knappers, but also furnishes us with information regarding the nature of the site’s relations with the rest of northeast Africa, especially Upper Egypt.
Red and Black World
Authors: Ćwiek Andrzej
Published: May 2021

The red and black formed in Egypt a système antinomique (B. Mathieu). Desheret (the desert) represented the sphere of the wild and the natural, while kemet (alluvial land) signified cultivated and civilised areas. These were not the only opposites involved. The red desert was seen as the source, base and place of origin of the black land and its inhabitants. This could also be compared to the raw vs worked (natural vs artificial) relationship. At the same time, it reflected the relationships between Seth and Osiris, evil and good and chaos and order. In developed Egyptian cosmology and eschatology, red represented Ra, day, life and activeness against black, which represented Osiris, night, death/rebirth and potential states. From these connections, red/divine and black/royal connotations emerged. Examples of the use of red and black can be found in both architecture and art from Naqada I vessels through to New Kingdom obelisks. This reflects the fundamental ideology of these colours.
The Location of New Kingdom Elite Tombs – Space, Place and Significance
Authors: Auenmüller Johannes Stefan G.
Published: May 2021

This paper deals with the significance of provincial New Kingdom elite tomb location. It aims to describe a key element of the relationship between the elite and the spatial distribution of their archaeological evidence in terms of ‘territoriality’. It focuses especially on the tomb, the pivotal component of the elite’s monumental display. A unique perspective is adopted, derived from both the sociology of space and cultural anthropology. The theoretical background of ‘territoriality’ and its wide range of applications are outlined firstly with a short review of key definitions. The paper’s focus then shifts to the domain of funerary archaeology by examining the location of tombs and its significance. The factors affecting location are discussed from a prosopographical perspective and contrasted with statements from so-called (auto-)biographical self-presentations. Both inscriptional and prosopographical data is the key to understand the underlying considerations for tomb location.
The Ancient Egyptian Second Infinitive? ‘iw + subject + r + infinitive’ Interpreted Through the Biblical Infinitive Absolute and the Polish Second Infinitive
Authors: Prokopowicz Mariusz Izydor
Published: May 2021

Infinitives and infinitival constructions seem to be a kind of conceptualization embedded in a language with a ‘genus’ different to that of other grammatical forms. But why did human cognition invent infinitives and their associated constructions? On an ontological level, infinitives indicate intentionality that is pro-modal and timeless future-situationoriented (Prokopowicz 2012). Timeless future orientation expresses accomplishment or achievement, which are different states of perfectivity. If verbal finished forms direct our attention to the complexity of events, which we can for instance classify and express in ‘eventive’ sentences, infinitival forms draw our attention to situations (for a different context, see Borghouts 2010: ‘situative clauses’; Prokopowicz 2012: ‘quality, state, activity, event vs situation’). Situations are more complex than events as they involve a speaker with varying intentions, as well as the cotext of this speaker’s expression. Infinitival forms are less sentence-projected and more discourse-projected.All of this research has an obvious hermeneutical background. If something is expressed syntactically in one language, it may as well be expressed morphologically or semantically in other languages.
Current Egyptological Research in Croatia
Authors: Tomorad Mladen , Čavka Mislav , Uranić Igor , Šekrst Kristina
Published: May 2021

Over the last years, much Egyptological research has been conducted in Croatia across various different fields. The Croato- Aegyptica Electronica (CAE) project has been in progress and, at several museums across the country, ancient Egyptian artefacts have been analysed and new exhibitions created. At the Archaeological Museum in Zagreb, a radiological study of Egyptian mummies has been conducted and open lectures with a variety of keynote speakers, as well as a workshop on the language of Middle Egypt, have been held. Finally, university curriculums have changed, new publications (articles, catalogues and books) have appeared and international conferences have taken place. In this paper, the authors aim to provide an overview of the Egyptological activity which has occurred in Croatia over the past decade.
Shaming Microloan Delinquents: Evidence from a Field Experiment in China
Authors: Bu Di , Liao Yin
Published: May 2021

We study the effects of village credit information sharing on individual microloan repayment, using a randomized experiment with loan applicants from 40 villages in rural China. In our main treatment, customers received a message on the loan application form that “overdue payment (40 days after each installment due date) will be considered for public disclosure among the village by showing debtors’ names on a blackboard outside the village office of the microlending institution.” On average, this social appeal reduces the share of delinquents and the individual delinquency rate by 18.6% and 5.6% from baseline rates of 79.5% and 15.2%, respectively. The effects appear more pronounced among male and older borrowers. Additional treatments help to benchmark the effect against lender credit information sharing and separate the effects on adverse selection and moral hazard. Mechanism analysis shows that the publicly disclosed “blacklist” of delinquents affects borrowers’ repayment behaviors, partially through borrowers’ fear of losing informal risk insurance from the village society and predominately through public shaming penalties. Overall, these results support that, in traditional societies, social appeals can provide not only pecuniary, but also psychological incentives to improve loan repayment. Psychological incentives, to some extent, have stronger effects.

This paper was accepted by Gustavo Manso, finance.
Embolisation of Vertebral Artery Damaged Following Cervical Disc Removal
Authors: Johannes Borkert  , Annika Hirte  , Jacobus Reimers  , Nicoline Jochmann  , Sigrid Nikol
Published: May 2021

Introduction: The incidence of vertebral artery (VA) injury during cervical spine surgery is rare. Even though tamponade is effective in many cases, early consultation of an endovascular team is recommended if bleeding cannot be controlled. We report a case of emergent endovascular embolisation of left VA due to iatrogenic injury during anterior cervical disc removal and fusion. Case: A 47-year-old woman was admitted to our emergency department with serious arterial bleeding from the neck only hours after undergoing anterior cervical disc removal and fusion surgery.  She was intubated and mechanically ventilated, however hemorrhage could not be successfully controlled by packing with surgical hemostatic agents. Cranial computed tomography, computed tomography of the cervical spine and CT angiography confirmed the suspected diagnosis of injury to the VA. Emergent endovascular embolisation successfully stopped the bleeding. Occlusion of the vessel was achieved by vascular plugging. The patient was discharged from our hospital 14 days after the intervention, receiving a revision surgery of the cervical spine on the day of embolisation. At the date of discharge she presented without any focal neurological deficit. Conclusion: Pre-operative radiographic imaging of the cervical spine should be used routinely to identify anatomic abnormalities of the vertebral arteries. Endovascular embolisation appears to be effective in treating acute iatrogenic dissection of the vertebral arteries.
Strongyloides stercoralis - a Legacy from the Past
Authors: Inês Chora  , Rodrigo Pimentel  , Fernando Friões  , Paula Dias  , Sérgio Silva
Published: May 2021

The authors present the case of a 65-year-old Caucasian man who had previously lived in Guinea-Bissau. The patient was diagnosed in Portugal with an anti-neutrophil cytoplasmic antibody-associated vasculitis and started on corticosteroids plus cyclophosphamide, with clinical improvement. Some months later, his general status deteriorated, iatrogenic bicytopenia developed and immunosuppressive drugs were tapered. Microbiological tests identified numerous larvae and eggs of Strongyloides stercoralis in various biological samples, and a diagnosis of hyperinfection syndrome was established. The patient was started on antihelminthic drugs but developed septic shock and died. This case highlights a rare and severe complication of immunosuppression in developed countries.
Atypical Presentation of Glioblastoma Multiforme
Authors: Wissam Al-Janabi  , Renee Krabs  , Ximena Arcila-Londono  , Iram Zaman  , Bashiruddin K Hamad
Published: May 2021

Background: Glioblastoma multiforme (GBM) is a highly malignant glial tumour classified by the World Health Organization (WHO) as a stage IV astrocytoma. It varies in shape and size and can be cystic, vascular and necrotic. It often appears as a ring-enhancing lesion on magnetic resonance imaging (MRI). The most common symptoms of GBM, such as headache, vomiting and seizures, are due to increased intracranial pressure. The objective of this case report is to describe an atypical presentation of GBM. Case Report: A 53-year-old woman of Italian origin presented with a 2-week history of lack of coordination in her hands and some difficulty in speech. Electromyography for assessment of her arms and cranial bulbar function was normal. However, 2 days later, the patient presented to the emergency department with progressive weakness in her left arm and leg as well as difficulty in speech. Mild left facial asymmetry was noted. A brain MRI revealed a right frontal mass. Stereotactic surgical resection was performed 2 days later, and biopsy confirmed the diagnosis of GBM. Although headache and other features of raised intracranial pressure are the most common initial symptoms of GBM, any atypical neurological or psychiatric presentation in an adult patient should raise suspicion for this tumour. Conclusion: Careful analysis of an adult with atypical signs and symptoms along with thorough review of radiological tests will facilitate early diagnosis of dangerous tumours such as GBM.
Posterior Reversible Encephalopathy Syndrome and Azathioprine
Authors: Sara Pinto Teixeira Vilas-Boas  , Ana Corte-Real
Published: May 2021

Posterior reversible encephalopathy syndrome (PRES) is a rare syndrome that presents with neurological manifestations, often associated with arterial hypertension. Magnetic resonance imaging (MRI) shows bilateral white matter oedema in the posterior vascular territories. Immunosuppression, (pre) eclampsia and autoimmune diseases can be implicated. A 27-year-old woman, with mixed connective tissue disease under azathioprine, was admitted in the emergency room in status epilepticus and with severe hypertension. The MRI showed bilateral oedema in a pattern compatible with PRES. There was clinical improvement after azathioprine suspension. PRES is typically reversible with prompt recognition of the syndrome and its trigger. The association with azathioprine is rare.
Mediastinum Teratoma Rupture: A Rare Manifestation
Authors: João Tavares  , Bernardo Baptista  , Bebiana Gonçalves  , Pedro Raimundo  , Henrique Vaz Velho  , Alexandra Bayão Horta
Published: May 2021

We present the case of a 22-year-old man who presented with cough, haemoptysis and fever of 3 days’ duration. A teratoma had been diagnosed 2 years previously. Physical examination was unremarkable but laboratory tests showed anaemia, neutrophilic leucocytosis and an increase in C-reactive protein. Chest CT revealed a teratoma of the anterior mediastinum with post-obstructive pneumonitis suggestive of tumour rupture. Antibiotic treatment resulted in a good clinical outcome. The patient was submitted to a left upper lobectomy and pathological examination revealed a mature teratoma. Teratomas are germ cell tumours that are usually asymptomatic and their rupture is a rare event.
Haemoperitoneum Due to Spontaneous Rupture of a Liver Metastasis
Authors: Christodoulos Dolapsakis  , Polina Pavli  , Andreas Panagopoulos  , Ekaterini Tavernaraki  , Georgios Varnavas  , Androniki Papapostolou  , Alexandros Machairas
Published: May 2021

Spontaneous rupture of a liver metastasis is a life-threatening complication of metastatic liver disease. Although metastatic liver lesions are much more common than primary tumours, spontaneous rupture of a liver metastasis is rare. Therapeutic decisions must take into account the extent of metastatic liver disease and the patient’s performance status. Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures. We describe a case of haemoperitoneum due to spontaneous rupture of a liver metastasis in a 72-year-old patient with carcinoma of unknown origin who responded well to conservative management.
Severe Immune Thrombocytopenia Complicated by Intracerebral Haemorrhage Associated with Coronavirus Infection: A Case Report and Literature Review
Authors: Mohamed Magdi  , Ali Rahil
Published: May 2021

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder that causes isolated thrombocytopenia. Many viruses have been identified as triggering the autoimmune process, including HIV, MCV, EBV, parvovirus, rubella and measles. However, ITP in association with coronavirus infection has not previously been reported. We describe the case of a healthy man who presented with severe ITP complicated by intracranial haemorrhage following upper respiratory tract infection. An infection screen revealed coronavirus infection.
POEMS Syndrome: an Atypical Presentation with Chronic Diarrhoea and Asthenia
Authors: Joana Alves Vaz  , Lilia Frada  , Maria Manuela Soares  , Alberto Mello e Silva
Published: May 2021

POEMS syndrome is a rare paraneoplastic condition associated with polyneuropathy, organomegaly, monoclonal gammopathy, endocrine and skin changes. We report a case of a man with Castleman disease and monoclonal gammopathy, with a history of chronic diarrhoea and asthenia. Gastrointestinal involvement in POEMS syndrome is not frequently referred to in the literature and its physiopathology is not fully understood. Diagnostic criteria were met during hospitalization but considering the patient’s overall health condition, therapeutic options were limited. Current treatment for POEMS syndrome depends on the management of the underlying plasma cell disorder. This report outlines the importance of a thorough review of systems and a physical examination to allow an attempted diagnosis and appropriate treatment.
Benzylthiouracil-induced ANCA-associated Vasculitis: A Case Report and Literature Review
Authors: Fatima Bensiradj  , Mathilde Hignard  , Rand Nakkash  , Alice Proux  , Nathalie Massy  , Nadir Kadri  , Jean Doucet  , Isabelle Landrin
Published: May 2021

Iatrogenic antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is not exceptional. Many cases of small vessel vasculitis induced by anti-thyroid drugs (ATD), mainly propylthiouracil (PTU), have been reported. We present a case of AAV related to another ATD: benzylthiouracil (BTU) and review the literature. An 84-year-old man with a 4-year history of multinodular goitre with hyperthyroidism was treated with BTU. He presented an acute syndrome with weakness, fever, epigastric pain and abdominal distension. Lactate and lipase tests were normal. An abdominal scan showed a thrombosis of the splenic artery with splenic infarction. We excluded a hypothesis of associated embolic aetiology: atrial fibrillation, atrial myxoma, intraventricular thrombus or artery aneurysm. Exploration of a possible prothrombotic state (complete blood count, haemostasis tests, activated protein C resistance, factor V Leiden, protein C, S, antithrombin III) gave normal results. Tests for antinuclear antibodies (ANA) and antiphospholipid antibodies (APL) were negative. However, testing for p-ANCA, with antimyeloperoxidase (MPO) specificity, was positive: 120.6 CU (N<20.0). We did not find other systemic manifestations, except a non-specific kidney failure. BTU was discontinued without steroids or immune-modulating drugs. Subsequently, symptoms disappeared progressively and titres of ANCA fell until normalization, 4 months later. Many patients treated with BTU present a high prevalence of ANCA, mainly, but not exclusively, directed against MPO. Vasculitis, however, remains an uncommon complication. The mechanism of this anomaly remains to be elucidated. Some studies suggest the possibility of an autoimmune reaction initiated by drug bioactivation mediated by neutrophil-derived MPO. The present observation is particular because the involved drug was BTU and clinical expression was unusual.
Penile Rings: No Innovation without Evaluation
Authors: Sherif Monib  , Bassem Amr
Published: May 2021

Penile strangulation is a rare clinical entity which if left untreated can cause serious urogenital problems. We present the case of 45-year-old male patient who presented with penile strangulation after applying a metallic ring. Strangulation of the external male genitalia is a serious problem that requires urgent intervention in order to avoid serious complications. If left untreated, it can result in gangrene and penile amputation. Management of penile strangulation is a real challenge for the treating surgeon and should be treated as an emergency in order to avoid vascular compromise.
A Case of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging of Eosinophilic Granulomatosis With Polyangiitis Combined With Non-tuberculous Mycobacterium
Authors: Juhyung Kim  , Man-Hoon Han  , Sang Jin Lee
Published: May 2021

Fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography (18FDG-PET/CT) has been used to diagnose vasculitis, tuberculosis and malignancy. Because PET/CT scan show hotspots during an activation of clinically suspected lesions, it is widely used for diagnosis. However, there are rare cases of PET/CT images for vasculitis combined with tuberculosis. Here we report a case of an eosinophilic granulomatosis with polyangiitis in a patient with disseminated non-tuberculosis mycobacterial infection in multiple sites mimicking metastatic malignacy and describe the associated PET/CT scan findings before and after treatment.
Hyperglycaemic Hemichorea and Hyperglycaemic Hyperosmolar Syndrome in a Patient with HbA1c levels of 19.9%: A Rare and Potentially Reversible Case
Authors: Mariana Gravato Guerra  , Gonçalo Silva  , Daniela Marado  , Jorge Fortuna  , Armando Carvalho
Published: May 2021

Hemichorea is a rare clinical manifestation of type 2 diabetes (DMT2). The patient presents with non-ketotic hyperglycemia, hemichorea (characterized by rapid and involuntary movements of a specific part of the body) and the CT imaging reveals the presence of alterations involving the ganglia of the base.
Inferior Vena Cava Agenesis and Deep Vein Thrombosis: A Pharmacological Alternative to Vitamin K Antagonists
Authors: Inês Esteves Cruz  , Pedro Ferreira  , Raquel Silva  , Francisco Silva  , Isabel Madruga
Published: May 2021

Inferior vena cava (IVC) agenesis is a rare congenital abnormality affecting the infrarenal segment, the suprarenal or the whole of the IVC. It has an estimated prevalence of up to 1% in the general population that can rise to 8.7% when abnormalities of the left renal vein are considered. Most IVC malformations are asymptomatic but may be associated with nonspecific symptoms or present as deep vein thrombosis (DVT). Up to 5% of young individuals under 30 years of age with unprovoked DVT are found to have this condition. Regarding the treatment of IVC agenesis-associated DVT, there are no standard guidelines. Treatment is directed towards preventing thrombosis or its recurrence. Low molecular weight heparin and oral anticoagulation medication, in particular vitamin K antagonists (VKAs) are the mainstay of therapy. Given the high risk of DVT recurrence in these patients, oral anticoagulation therapy is suggested to be pursued indefinitely. As far as we know, this is the first case reporting the use of a direct factor Xa inhibitor in IVC agenesis-associated DVT. Given VKA monitoring limitations, the use of a direct Xa inhibitor could be an alternative in young individuals with anatomical defects without thrombophilia, but further studies will be needed to confirm its efficacy and safety.
Drug-Induced Aseptic Meningitis Following Spinal Anesthesia
Authors: Ricardo Paquete Oliveira  , Mafalda Teixeira  , Sofia Cochito  , Ana Furtado  , Bruno Grima  , José Delgado Alves
Published: May 2021

Meningitis is a very uncommon complication of spinal anesthesia, and drug-induced aseptic meningitis (DIAM) is even rarer. We present two cases of DIAM following spinal anesthesia with bupivacaine and ropivacaine, respectively. The patients presented shortly after the procedure with typical meningitis symptoms. Since CSF (cerebrospinal fluid) analysis could not initially exclude bacterial meningitis, they were started on empirical antibiotics. CSF was subsequently found to be negative for viruses and bacteria in both cases, and antibiotics were promptly stopped. Both patients improved rapidly and without neurological sequelae. While it remains a diagnosis of exclusion, it is important to be aware of DIAM as recognition of the condition can lead to shorter admission times and avoid unnecessary use of antibiotics.
Moyamoya Syndrome after Radiation Therapy: a Clinical Report
Authors: Paulo Almeida  , Ana Rocha  , Gonçalo Alves  , Tiago Parreira  , Maria Silva  , António Cerejo  , Pedro Abreu  , Ana Monteiro
Published: May 2021

Moyamoya syndrome (MMS) is a rare, chronic and progressive vasculopathy with a characteristic angiographic pattern and well-recognized predisposing conditions, such as cranial therapeutic radiation. We report the case of a 36-year-old Caucasian female with a history of craniopharyngioma treated with whole-brain radiotherapy 20 years previously. She was admitted to the emergency department with disorientation and imperceptible speech lasting for 1 hour. Upon examination, she had slight motor aphasia, without sensory or motor deficits. However, the neurological deficits worsened on standing position. The computed tomography (CT) angiogram and transcranial Doppler ultrasonography revealed occlusion of the distal portion of the left internal carotid artery (ICA). Mechanical thrombectomy was attempted without success. Head CT was repeated, revealing left periventricular acute ischaemic stroke. The cerebral angiography showed total occlusion of the left ICA with an exuberant network of transdural collateral vessels, confirming MMS. The patient completed a functional rehabilitation program with progressive improvement of deficits and maintained a multidisciplinary follow-up. MMS is a serious late complication from cranial radiation therapy and a well-described risk factor for ischaemic stroke in younger patients. Therefore, early detection and prompt treatment are mandatory, as the consequences can be disastrous, such as cognitive and neurologic decline due to repeated strokes.
Palmoplantar Pustulosis-like Eruption Induced by Baricitinib for Treatment of Rheumatoid Arthritis
Authors: Dimitra Koumaki  , Vasiliki Koumaki  , George Bertsias  , Eleni Lagoudaki  , George Bertsias
Published: May 2021

Objectives: Baricitinib is an orally active Janus kinase (JAK) inhibitor used in the treatment of moderate to severe rheumatoid arthritis (RA). Materials and methods: Here, we report the case of a 56-year-old Caucasian male diagnosed with RA who developed palmoplantar pustulosis (PPP) while being treated with baricitinib. Results: The patient’s PPP resolved after discontinuation of baricitinib and recurred when this was restarted. Based on causality assessment, it was considered a drug-induced PPP. Conclusion: To the authors’ knowledge, this is the first case of baricitinib-induced PPP.
Tuberculoid Leprosy with External Jugular Vein Thrombosis: A Case Report and Literature Review
Authors: Ali Ibrahim Rahil  , Ahmed Osman  , Mohamed Magdi Mohamed Eid  , Sara Kanbour  , Ahmed Mahfouz
Published: May 2021

Thrombotic disease represents a rare manifestation of leprosy. In this study, we report the case of an external jugular vein thrombosis associated with tuberculoid leprosy in a 23-year-old male patient. The patient presented with a 3-month history of painful cord-like swelling on the left side of the neck and a nearly 3-week history of skin lesions on the left cheek and right leg. Physical examination revealed cord-like, tender swelling on the left lateral aspect of the neck overlying the sternocleidomastoid muscle, and a hypopigmented, hypoaesthetic 6×7 cm lesion with an irregular margin on the left cheek. A Doppler ultrasound examination of the jugular vein showed thrombosis of the left external jugular vein. Three-dimensional reconstruction of the computed tomography scan showed the enlarged and enhanced left external jugular vein, as well as 1 of its tributaries, and the thickened skin patch. A skin punch biopsy from the left cheek lesion revealed granulomatous inflammation with occasional peri-adnexal granulomas, consistent with the clinical impression of tuberculoid leprosy. A diagnosis of leprosy with external jugular vein thrombosis was established. Anticoagulation therapy was initiated, and the patient was referred to an infectious disease clinic for treatment with anti-leprosy medications.
Magnetic Resonance Direct Thrombus Imaging (MRDTI) Can Distinguish Between Old and New Thrombosis in the Abdominal Aorta: a Case Report
Authors: Lisette Florence van Dam  , Lucia J.M. Kroft  , Charlotte E.A. Dronkers  , Jan van Schaik  , Guido R. van Haren  , Menno V. Huisman  , Frederikus A. Klok
Published: May 2021

A 43-year-old man complaining of abdominal angina for several months showed a large suprarenal aneurysm of the abdominal aorta with extensive circumferential wall thrombosis, complete occlusion of the right renal artery and a critically stenosed left renal artery on CT angiography. He suffered from severe hypertension and renal failure. A percutaneous transluminal angioplasty (PTA) was planned. After the PTA procedure, which was complicated by the development of left renal artery occlusion, successful rescue revascularization surgery was performed. Since we were hesitant to start anticoagulant treatment because of a high bleeding risk, magnetic resonance direct thrombus imaging was performed to assess the age of the extensive arterial thrombosis. The aortic thrombus showed a low signal intensity, which is indicative of chronic rather than acute thrombosis. Therefore, oral anticoagulant treatment was not started. The patient recovered without major complications.
Recurrent Klebsiella pneumoniae Infection Causing Transcatheter Aortic Valve Implantation (TAVI)-Related Endocarditis
Authors: Valentina Tosatto  , Cristiano Cruz  , Teresa Ferreira  , Torcato Moreira Marques  , Matteo Boattini  , André Almeida  , Rita Barata Moura
Published: May 2021

The authors report the case of an 86-year-old woman presenting with recurrent Klebsiella pneumoniae bacteraemia. She had severe aortic stenosis submitted to a recent transcatheter aortic valve implantation (TAVI). Initially, Klebsiella pneumoniae bacteraemia from a urinary source was diagnosed . Following another 4 episodes of bacteraemia with the same agent, the source was ultimately found to be a periprosthetic abscess. Considering the patient’s unsuitability for surgery, a decision was made for life-long antimicrobial therapy. This approach has been successful in preventing recurrences or complications. Endocarditis is one of the most severe complications seen following TAVI, often carrying a poor prognosis. Even though Klebsiella spp. are common pathogens for healthcare-associated infections among the elderly, they are seldom the causative agent for endocarditis. Being the first reported case of TAVI-related Klebsiella endocarditis, it was successfully managed using a medical approach.
Portal Vein Thrombosis in a Patient with Type 1 Diabetes Presenting as Acute Pyelonephritis
Authors: Zahra Abdulwahed AL Saeed  , Fatimah Mohammed Alabdrabalnabi  , AlAnoud AlAnazi  , Waleed Ibrahim Albaker  , Osma Abdullah Al-Sultan
Published: May 2021

Background: Few cases have been reported with respect to portal vein thrombosis in non-cirrhotic patients. Asymptomatic or non-specific symptoms of portal vein thrombosis may lead to misdiagnosis or may delay the diagnosis until complications develop. We report a case of portal vein thrombosis in a patient with type 1 diabetes presenting as acute pyelonephritis. Case description: An 18-year-old female with type 1 diabetes on an insulin pump presented with epigastric abdominal pain for 3 days associated with nausea and vomiting. She was a conscious, alert, young female who appeared to be in pain. Vital signs were stable with a random blood sugar (RBS) level of 179 mg/dl. Abdominal examination revealed a soft and lax abdomen with tenderness in the epigastric area and right renal angle, as well as no sign of rigidity or rebound tenderness. No signs of ascites, splenomegaly or hepatomegaly were noted. Investigations showed a WBC count of 10.2, neutrophils at 65%, urine microsopy analysis revealed WBCs between 30–50 per high power field, with culture showing >105 CFU/ml. All parameters of a thrombophilic screen were within normal values. Computed tomography (CT) revealed reduced enhancement of the right kidney, likely indicating acute pyelonephritis, and left portal vein oedema with complete occlusion. Local factors and prothrombotic disorders were ruled out. The patient was managed with ciprofloxacin, enoxaparin and warfarin. Follow-up imaging revealed complete resolution of thrombosis. Conclusions:Portal vein thrombosis is an uncommon condition in the absence of liver disease. Few case reports exhibit sepsis and portal vein thrombosis. Sepsis can create a predisposed environment for hypercoagulability. To our knowledge, this is the first case report of pyelonephritis with portal vein thrombosis.
Hypofibrinogenaemia: A Case of Spontaneous Bleeding and Central Venous Thrombosis in the Same Lifetime
Authors: Adriana Watts Soares  , Maria Maia  , João Espirito Santo  , Ana Palricas Costa  , Artur Pereira  , Cristina Catarino
Published: May 2021

The authors present the case of a 27-year-old patient who suffered from spontaneous bleeding during infancy and from a severe and central venous thrombosis in adult years. The patient underwent a thorough laboratory work-up on both occasions and was diagnosed with hypofibrinogenaemia as well as protein S deficiency, 2 diseases that contrast in their intrinsic bleeding/thrombotic risk. The patient´s high-risk pregnancy was carried out up to a successful full-term eutocic delivery which required fibrinogen concentrate to reduce life-threatening bleeding. The patient´s child was also diagnosed with hypofibrinogenaemia, later on confirmed with the pathogenic mutation Fibrinogen Marseilles II. This case was used to conduct a literature review of congenital fibrinogen disorders, rare entities that require more awareness for early diagnosis and accurate management.
Viscous Leptomeningeal Pseudotumoural Masses and Multiple Cranial Neuropathy – Severe Presentation of Neurosarcoidosis
Authors: Rita Ribeiro Dias  , Inês Henriques Ferreira  , Raquel Faria
Published: May 2021

We present a case of a 56-year-old man with a history of episcleritis (left) and cluster headache (left) who had a penetrating trauma of the left eye leading to amaurosis 1 month previously. Since then, he developed multiple cranial neuropathy of the right side (V, VII, VIII, IX, X, XI and XII cranial pairs). Magnetic resonance imaging (MRI) revealed an infiltrative lesion of the base of the skull which extended to the retropharyngeal and jugular space, which progressed to multiple leptomeningeal masses extending to the clivus, despite aggressive immunosuppression. Rebiopsy of 1 meningeal mass supported the diagnosis of neurosarcoidosis. The patient finally responded to high-dose prolonged infliximab therapy, with complete remission.
Complexities of Diagnosing and Treating a Mesenteric Cyst in a Chronic Myeloid Leukaemia Patient
Authors: Carlos Fernando Dias Rodrigues  , Gisela Ferreira  , Eduardo Oliveira  , Marta S. Oliveira  , Sara Pinto  , João Fonseca
Published: May 2021

Mesenteric cysts are a rare nosologic entity, the diagnosis of which is complex due to their nonspecific presentation. They may emerge from any part of the mesentery and grow to any size, thus conditioning a wide range of clinical manifestations that renders them easily mistaken for different gastrointestinal pathologies. Diagnosis encompasses a mixture of clinical suspicion, imaging techniques and sometimes surgery, and curative treatment is based on complete surgical resection of the cyst. We hereby present a case of a mesenteric cyst that developed on the anterior abdominal wall of a 59-year-old man awaiting allogeneic bone marrow transplantation after being diagnosed with chronic myeloid leukaemia. He was admitted to the emergency room with complaints of an increased abdominal perimeter and increased weight, not associated with alterations to his dietary or physical exercise habits. Suspecting ascites in the context of leukaemic progression, the patient was admitted to the medical ward; however, subsequent study identified a mesenteric cyst as the most probable diagnosis and the patient was proposed to undergo surgery. He underwent laparotomic cyst excision without complications and the histological evaluation of the surgical specimen confirmed the diagnosis.
Cough Syncope, a Rare Presenting Symptom of Chiari I Malformation and Atlanto-Occipital Assimilation
Authors: Inês Carrilho Oliveira  , Joana Carvalho  , Luisa Oliveira
Published: May 2021

Chiari I malformation and atlanto-occipital assimilation are both fairly uncommon conditions. Symptoms usually present during adolescence or adulthood, typically consisting of headache or neck pain. Cough-associated syncope is an unusual presenting symptom. The diagnosis of this condition in a pulmonology department is even rarer. We report the case of a 62-year-old male referred to our pulmonology department due to complaints of cough-associated syncope. After several examinations, a pharyngeal CT scan incidentally showed low positioning of the cerebellar tonsils. Cerebral MRI confirmed the diagnosis of Chiari I malformation and atlanto-occipital assimilation and the patient was effectively treated with surgical decompression.
Oesophageal Variceal-Pulmonary Venous Fistula - A Rare Cause of a Right-to-Left Shunt
Authors: Neeraja Swaminathan  , Siddique Chaudhary
Published: May 2021

Oesophageal varices are a dilated submucosal venous plexus in the lower third of the oesophagus which result from increased pressure in the portal venous system. The portal system is connected to the systemic circulation in specific locations referred to as sites of portosystemic anastomosis. An increase in portal venous pressure is therefore reflected at these anastomotic sites, causing manifestations such as oesophageal varices, rectal varices, caput medusae and splenorenal shunts. Varices do not cause symptoms until they leak or rupture and this is the main complication which requires prompt treatment. Here, we present a post-liver transplant patient with metastatic hepatocellular carcinoma who had oesophageal varices that fistularized with a left pulmonary vein, thus creating a right-to-left shunt. Right-to-left shunts are usually intracardiac or intrapulmonary in location. The complications of a right-to-left shunt include predominantly hypoxia, cyanosis and, sometimes, paradoxical emboli in the case of intracardiac shunts. This patient had a very uncommon cause of such a shunt caused by a direct fistulous connection.