bluuebunny/crossref_metadata_2025 huggingface dataset:
Gross and histological findings in the canine placenta and amnion at term: What’s normal, abnormal or pathological?
Authors: Tesi Matteo , Miragliotta Vincenzo , Scala Lorenza , Aronica Elisa , Lazzarini Giulia , Fanelli Diana , Rota Alessandra , Abramo Francesca
Published: February 2021

The canine placenta is an underexamined organ. Placental abnormalities can affect foetus development and may be responsible for a low weight of the infant at birth; however, knowledge on their clinical significance in the canine species is limited. We aimed to describe macroscopic and microscopic findings in the canine placenta and amnion at term in clinically uncomplicated pregnancies and to evaluate their relationship with birth weight of healthy puppies. During natural delivery or C‐section, the birth weight of 82 puppies was recorded, 72 placentas and 66 amnions were recovered. The foetal and maternal surfaces of the placental girdle, marginal haematoma and amnion were evaluated. Each gross finding was recorded, morphometrically assessed and sampled for histological diagnosis. Furthermore, specimens of placenta and amnion were collected from representative areas and microscopic deviations from normal structure were evaluated in haematoxylin and eosin sections. Gross examination revealed ‘abnormalities’ in the 75.4% of the collected placentas. Necrosis was the gross change most commonly observed in the placental girdle (72.5%). Congestion (17.4%) and clotted blood/fibrinoid material (2.9%) were also observed. No gross changes of either the marginal haematoma or the amnion were recorded. Histologically, placental girdle showed necrosis (62.3%), mineralization (52.2%), congestion (36.2%) and neutrophilic infiltration (27.5%). Marginal haematoma exhibited mineralization (11.6%) and neutrophils (29%), while necrotic foci were rarely observed (4.3%). In the amnion, the most frequent alteration observed was hypertrophy of the epithelium (35.9%) followed by oedema (31.2%), mineralized foci (28.1%), fibrosis (23.4%), congestion (15.6%) and more rarely neutrophils (12.5%). Puppies’ birth weight was not statistically affected by either gross or histological abnormalities. Our study revealed that macroscopic and microscopic ‘abnormalities’ of the placenta and amnion may be common in uncomplicated pregnancies at term; however, no implications on puppies’ birth weight were observed. Deviations from ‘normal’ morphology of canine foetal adnexa warrant further investigation to assess their clinical implications if present.
Columnar microbialites of the upper Miocene of Mallorca (Spain): A new morphogenetic model based on concurrent accretion and bioturbation – uncommon or overlooked?
Authors: Suarez‐Gonzalez Pablo , Benito M. Isabel , Arenas Concha , Pomar Luis
Published: February 2021

Bioturbation has long been considered an antagonist of microbialite development and preservation, because metazoan grazing and burrowing destroy benthic microbial communities. However, metazoan bioturbation, in conjunction with microbial accretion, may have had a significant role in the morphogenesis of some columnar microbialites, as suggested by the case study presented and by some Phanerozoic and Upper Proterozoic analogues discussed here. Late Miocene in age, the studied microbial biostrome developed in a western Mediterranean restricted shallow‐water platform dominated by grainy sediments and with a notable influence of bioturbation. This study is focused on the complex accretionary history of the columnar microbialite biostrome and on its striking dark grey colour, which is attributed to Mn‐oxyhydroxides precipitated during meteoric diagenesis linked to subaerial exposure. The characteristic columnar structure of the microbialite biostrome has features consistent with an accretionary origin of the columns, but also has features suggesting metazoan disruption. Therefore, a new morphogenetic model for columnar microbialites is presented, highlighting the concomitant roles of microbial accretion, bioturbation and grainy sediment infill of the intercolumn space. Whether this model is an exception or a rule, should be tested on other examples of Phanerozoic and Upper Proterozoic columnar microbialites. Nevertheless, this model is a step forward in understanding the complex microbe–metazoan interactions as constructive coexistence rather than just as destructive competition.
Sedimentation on high‐energy sand flats in the Bay of Fundy: The record of tidal‐bore activity and deposition from high‐concentration suspensions of sand
Authors: Dalrymple Robert W.
Published: February 2021

The Cobequid Bay – Salmon River estuary, Bay of Fundy, does not possess particularly large tidal bores (maximum ca 30 cm). Nevertheless, detailed logging of 13 peels made from cores spread throughout the entire area influenced by tidal bores indicates that inferred tidal‐bore deposits comprise approximately 15% of the deposits in the upper‐flow‐regime sand flats in the inner part of the estuary, averaging more than 10 tidal‐bore layers per metre of core. A landward increase in tidal‐bore height is accompanied by an increase in the number and thickness of the tidal‐bore layers. The deposit of a single tidal bore begins with structureless sand (from <1 cm to >10 cm thick) that can be gradationally overlain by sand with indistinct parallel lamination, which in turn passes upward into the well‐defined parallel lamination that is the dominant sedimentary structure in these sand‐flat deposits. The bases of the structureless layers range from prominently erosional to passively draping over the ripples formed during the preceding ebb tide. The structureless and indistinctly laminated layers are interpreted to be the deposit of bore‐generated hyperconcentrated suspensions of sand that have similarities with turbidity currents in which near‐bed turbulence is extinguished or damped. The tidal‐bore Froude number (Frtb), which determines the nature of the tidal bore, together with the height of the tidal bore, influences the amount of sand in suspension, and presumably also controls the nature of the deposits. Tidal bores with high Froude numbers (Frtb = 2 to 3) that are breaking create deposits that are analogous to the deposits of high‐concentration turbidity currents; most bore deposits documented to date from other ancient and modern settings are of this high‐energy type. Tidal bores that are closer to the lower limit of bore occurrence (Frtb = 1) generate deposits that will be difficult to distinguish from the background sedimentation.
How frequent a BEER? Assessing the impact of data frequency on real exchange rate misalignment estimation
Authors: Giordano Claire
Published: February 2021

This article explores the robustness of Behavioural Equilibrium Exchange Rate models, employed to estimate real effective exchange rate misalignments, to the frequency of the underlying data. It compares misalignments stemming from an annual model, estimated since 1980, and a comparable quarterly model, estimated since 1999. The two sets of estimates are similar. Moreover, the in‐sample power of quarterly REER misalignments in explaining subsequent REER developments is higher than that of the annual estimates. This article therefore suggests that the “optimal” frequency of a BEER model depends on whether its resulting estimates are employed for research purposes or for policy‐making activities.
MYB30 and ETHYLENE INSENSITIVE3 antagonistically modulate root hair growth in Arabidopsis
Authors: Xiao Fei , Gong Qianyuan , Zhao Shuangshuang , Lin Honghui , Zhou Huapeng
Published: February 2021

Root hair (RH) is essential for plant nutrient acquisition and the plant–environment communication. Here we report that transcription factors MYB30 and ETHYLENE INSENSITIVE3 (EIN3) modulate RH growth/elongation in Arabidopsis in an antagonistic way. The MYB30 loss‐of‐function mutant displays enhanced RH length, whereas the RH elongation in MYB30‐overexpressing plants is highly repressed. MYB30 physically interacts with EIN3, a master transcription factor in ethylene signaling. MYB30 directly binds the promoter region of ROOT HAIR DEFECTIVE SIX‐LIKE4 (RSL4) and represses its transcription. RSL4 loss‐of‐function suppresses the enhanced RH growth in myb30 mutant plants. Ethylene enhances MYB30‐EIN3 complex formation, and reduces the association between MYB30 and RSL4 promotor via the action of EIN3. MYB30 and EIN3 antagonistically regulate the expression of RSL4 and a subset of core RH genes in a genome‐wide way. Taken together, our work revealed a novel transcriptional network that modulates RH growth in plants.
Scalar politics of urban sustainability: Governing the Chinese city in the era of ecological civilisation
Authors: Chung Calvin King Lam , Xu Jiang
Published: February 2021

Studies of urban politics have acknowledged the rescaling of state environmental regulation as a source of pressure for local growth regimes to balance their economic and environmental objectives. However, few inquiries have afforded equal attention to how these local regimes strategise their multi‐scalar context to manage urban economy–environment tensions. Informed by the cultural political economy approach to social transformation, this paper interprets urban sustainability fixes as a strategic combination of structural, discursive, technological, and agential selectivities in the scaling of urban development projects. Given their nodal position in urban governance, some actors are able to advance urban projects with conflicting environmental implications by linking them to different scalar hierarchies, each structurally prioritising different interests. These discourses are subsequently inscribed into material relations through various political technologies. This form of scalar politics is notable in the Chinese city of Guiyang, where local leaders sought to reap the policy benefits offered to cities supporting the national vision of ecological civilisation without slowing down local development. Contemporary urban politics, as Guiyang illustrates, is a scalar politics animated by competing attempts in framing and regulating urban economy–environment relations through and across a mosaic of scales and scalar hierarchies.
La (no) metáfora del cuerpo. Cuerpo abusado, cuerpo torturado, cuerpo transfigurado
Authors: Achondo Moya Pedro Pablo
Published: February 2021

El artículo indaga en la temática del cuerpo a partir de la experiencia del sufrimiento humano: dimensión que supera cualquier escrito y muchas veces fractura las aproximaciones discursivas y teóricas. Sin embargo es menester asumir el riesgo con vistas a la esperanza. Por eso se ha profundizado en el padecimiento ligado al abuso y la tortura, entendiendo al cuerpo como lugar “sin metáforas” donde se alberga la memoria, la resistencia y una esperanza que va más allá de lo meramente racional. El cuerpo, en cuanto exceso de significado, es también un territorio y una membrana en donde se acoge o rechaza al otro. Desde ahí la teología y la ética son desafiadas a repensar la realidad corporal en la perspectiva de una verdadera compasión, confianza y lenguaje que den cuenta de la complejidad del cuerpo maltratado. La actualidad eclesial y social han puesto en tela de juicio prácticas y discursos sobre el cuerpo sufriente. El abuso sexual, de poder y conciencia se han manifestado como realidades que están lejos de ser marginales. A partir de una lectura fenomenológica nos preguntamos por la posibilidad de continuar viviendo –y creyendo– luego de haber padecido lo indecible. Para ello se estudian algunos casos y se lleva a cabo un agudo análisis bibliográfico según el cual se pueden descubrir nuevos rasgos del ser humano y de Cristo, en cuanto Mesías que llora y consuela. La esperanza cristiana de cara al Dios-en-la-carne crucificado puede permitir a los cuerpos que padecen volver a ponerse de pie. Este artículo busca afirmar esto asumiendo la radical dificultad que el sufrimiento impone, para el pensar, el decir y el continuar la vida.
Developing and Implementation of an Optimization Technique for Solar Chimney Power Plant With Machine Learning
Authors: Ulucak Oğuzhan , Kocak Eyup , Bayer Ozgur , Beldek Ulaş , Yapıcı Ekin Özgirgin , Aylı Ece
Published: February 2021

Green energy has seen a huge surge of interest recently due to various environmental and financial reasons. To extract the most out of a renewable system and to go greener, new approaches are evolving. In this paper, the capability of Artificial Neural Network and Adaptive Neuro-Fuzzy Inference System in geometrical optimization of a solar chimney power plant (SCPP) to enhance generated power is investigated to reduce the time cost and errors when optimization is performed with numerical or experimental methods. It is seen that both properly constructed artificial neural networks (ANN) and adaptive-network-based fuzzy inference system (ANFIS) optimized geometries give higher performance than the numerical results. Also, to validate the accuracy of the ANN and ANFIS predictions, the obtained results are compared with the numerical results. Both soft computing methods over predict the power output values with MRE values of 12.36% and 7.25% for ANN and ANFIS, respectively. It is seen that by utilizing ANN and ANFIS algorithms, more power can be extracted from the SCPP system compared to conventional computational fluid dynamics (CFD) optimized geometry with trying a lot more geometries in a notably less time when it is compared with the numerical technique. It is worth mentioning that the optimization method that is developed can be implemented to all engineering problems that need geometric optimization to maximize or minimize the objective function.
Drilling Parameters Optimization Using an Innovative Artificial Intelligence Model
Authors: Ashena Rahman , Rabiei Minou , Rasouli Vamegh , Mohammadi Amir H. , Mishani Siamak
Published: February 2021

Proper selection of the drilling parameters and dynamic behavior is a critical factor in improving drilling performance and efficiency. Therefore, the development of an efficient artificial intelligence (AI) method to predict the appropriate control parameters is critical for drilling optimization. The AI approach presented in this paper uses the power of optimized artificial neural networks (ANNs) to model the behavior of the non-linear, multi-input/output drilling system. The optimization of the model was achieved by optimizing the controllers (combined genetic algorithm (GA) and pattern search (PS)) to reach the global optima, which also provides the drilling planning team with a quantified recommendation on the appropriate optimal drilling parameters. The optimized ANN model used drilling parameters data recorded real-time from drilling practices in different lithological units. Representative portions of the data sets were utilized in training, testing, and validation of the model. The results of the analysis have demonstrated the AI method to be a promising approach for simulation and prediction of the behavior of the complex multi-parameter drilling system. This method is a powerful alternative to traditional analytic or real-time manipulation of the drilling parameters for mitigation of drill string vibrations and invisible lost time (ILT). The utilization can be extended to the field of drilling control and optimization, which can lead to a great contribution of 73% in reduction of the drilling time.
Investigation of the Effect of Block Size, Shape, and Freeze Bond Strength on Flexural Failure of Freshwater Ice Rubble Using the Discrete Element Method
Authors: Afzali Soroosh , Taylor Rocky , Bailey Eleanor , Sarracino Robert , Boroojerdi Marjan T.
Published: February 2021

As part of the Mechanics of Ice Rubble project, recent experiments have been carried out to study the strength and failure behavior of ice rubble beams and the freeze bonds that form between individual ice blocks. In this study, we present results obtained from a newly developed model for the three-dimensional (3D) discrete element modeling (DEM) open-source code LIGGGHTS. The ice model contains normal and shear springs that operate between neighboring particles which are bonded or that overlap due to compressional stresses. Energy dissipation is accounted for by using a viscous damping model. Using this DEM model, medium-scale freshwater ice rubble punch tests have been simulated. Rubble specimens were generated by “raining” individual DEM ice pieces into a rectangular form and compacting the rubble mass to achieve the target porosity. Before the compacting pressure was removed, bonds between contacting blocks were introduced with parameter values based on representative freeze bond experiments. The rubble beam was then deformed by pushing a platen vertically downward through the center of the beam until failure occurred. Two types of block size and shapes have been simulated: cuboid blocks generated based on the size distribution of the actual rubble, and rubble blocks generated by image processing of actual blocks of broken ice used in the comparison experiments. The mechanism of flexural rubble failure for both cuboid block [s4.2] simulations and empirical block [s4.3] simulations is in line with experimental results; however, the empirical block simulations provide a significantly better estimation of the failure force.
Wave Trapping Efficiency of a Flexible Membrane Near a Partially Reflecting Seawall
Authors: Venkateswarlu V. , Vijay K. G. , Raja Pandi R. , Nishad Chandra Shekhar
Published: February 2021

The gravity wave interaction with a flexible membrane placed at a finite distance from the partially reflecting seawall is analyzed under the framework of linear water wave theory using the multi-domain boundary element method (BEM). The flow through a flexible membrane is assumed to follow Darcy’s law in addition to membrane displacements. As a viable alternative to the existing wave dampers, the flexible membrane is examined for the effective dampening of incident waves. The correctness of the numerical results is affirmed with the known results available in the literature. The effect of membrane tension, submergence depth, membrane width, porosity, angle of inclination, and confined chamber spacing on hydrodynamic coefficients is discussed as a function of dimensionless wavenumber. The partially reflecting harbor wall diminishes the wave reflection coefficient in the long-wave regime. The increase in the flexible membrane width does not necessarily ensure the ideal wave capturing performance. A shift in the peak of the maximum deflection is observed with the increase of membrane width while there is a shift in peak outward for the increase in the submergence depth. Moreover, the maximum deflection is found to decrease with the increase in porosity, and it is 62% reduction for membrane porosity b = 1 due to the significant wave damping. The wave run-up and the wall force coefficients are found to be minimum when the relative plate width is B/h = 1. The present study is expected to be useful for the design of cost-effective wave attenuating systems.
T
reg
GF-β: Deletion of TGF-β in T
regs
revisited
Authors: Boothby Ian C. , Rosenblum Michael D.
Published: February 2021

T
reg
-specific ablation of TGF-β clarifies the complicated role of T
reg
-derived TGF-β in immunosuppression in vivo.
Immune Responses and Viral Persistence in Simian/Human Immunodeficiency Virus SHIV.C.CH848-Infected Rhesus Macaques
Authors: Ziani Widade , Bauer Anya , Lu Hong , Wang Xiaolei , Wu Xueling , Bar Katharine J. , Li Hui , Liu Dongfang , Shaw George M. , Veazey Ronald S. , Xu Huanbin
Published: February 2021

SHIVs have been extensively used in a nonhuman primate (NHP) model for HIV research. In this study, we investigated viral reservoirs in tissues and immune responses in an NHP model inoculated with newly generated transmitted/founder HIV-1 clade C-based SHIV.C.CH848.
Effects of varying chest compression depths on carotid blood flow and blood pressure in asphyxiated piglets
Authors: Bruckner Marlies , O’Reilly Megan , Lee Tze-Fun , Neset Mattias , Cheung Po-Yin , Schmölzer Georg M
Published: February 2021

Background

Current neonatal resuscitation guidelines recommend chest compressions (CCs) should be delivered to a depth of approximately 1/3 of the anterior–posterior (AP) chest diameter. The aim of the study was to investigate the haemodynamic effects of different CC depths in a neonatal piglet model.

Methods

CCs were performed with an automated CC machine with 33%, 40% and 25% AP chest diameter in all piglets in the same order for a duration of 3 min each.

Results

Eight newborn piglets (age 1–3 days, weight 1.7–2.3 kg) were included in the study. Carotid blood flow (CBF) and systolic blood pressure were the highest using a CC depth of 40% AP chest diameter (19.3±7.5 mL/min/kg and 58±32 mm Hg).

Conclusion

CC depth influences haemodynamic parameters in asphyxiated newborn piglets during cardiopulmonary resuscitation. The highest CBF and systolic blood pressure were achieved using a CC depth of 40% AP chest diameter.

Trial registration number

PCTE0000148.
Spontaneous tumour lysis syndrome in multiple myeloma with loss of 17p13.1, t(4;14) and monosomy 13
Authors: Tbakhi Bushra , Hanna Sandrine , Samhouri Yazan , Lingutla Deeraj
Published: February 2021

Tumour lysis syndrome (TLS) is a constellation of metabolic derangements caused by lysis of tumour cells. It is an oncological emergency that is considered a rare occurrence in multiple myeloma (MM) and usually occurs after patients have been treated with chemotherapy. We describe a very rare case of TLS occurring before the official diagnosis or treatment of MM. We report infrequent karyotype abnormalities, including loss of 17p13.1 (TP53mutation), t(4;14) (FGFR3/IGH fusion) and monosomy 13, that have not been explicitly described in association with spontaneous tumour lysis syndrome (STLS) in MM. This case adds to the sparse literature available on STLS in MM, which is a life-threatening situation requiring urgent medical intervention.
Case of cholestatic jaundice associated with papillary carcinoma of thyroid: a multidisciplinary challenge
Authors: Sharma Sanchit , Saraya Anoop , Das Prasenjit , Gunjan Deepak
Published: February 2021

The report describes a patient with cholestatic jaundice who had incidentally detected parathyroid hormone-independent hypercalcaemia. The differential diagnosis for this presentation includes systemic granulomatous and infiltrative disorders, drug-induced liver injury and malignancy. As the initial investigations were non-contributory towards the aetiology, she was given steroids and later plasma exchange for symptomatic treatment. The differentials were revised again in view of no clinical and biochemical response. A repeat fine-needle aspiration cytology of the thyroid nodule (seen on positron emission tomography/CT) revealed papillary carcinoma of the thyroid. The patient underwent total thyroidectomy. There was a complete normalisation of liver function tests and serum calcium, and resolution of pruritus 3 months post surgery. She was retrospectively diagnosed as a case of papillary carcinoma of the thyroid with paraneoplastic manifestations—hypercalcaemia and cholestatic jaundice—which got resolved with treatment of the primary tumour.
A Graceful EXIT impeded by obstetrical complications
Authors: Zaretsky Michael , Brockel Megan , Derderian Sarkis Christopher , Francom Christian , Wood Cristina
Published: February 2021

We report an ex utero intrapartum therapy-to-airway procedure in which obstetric factors dramatically influenced the sequence of events necessary to complete the procedure.
Relapsing polychondritis: an unusual cause of sore throat, painful ear swelling and bilateral costal margin pain
Authors: Wang Shuang , Chi Christopher , Xu Dan , Ye Yujin
Published: February 2021

A 54-year-old Chinese woman presented with a 3-month history of sore throat and dry cough, which was treated as chronic pharyngitis with minimal improvement. One month ago, she presented with painful right ear swelling without signs or symptoms of otitis media or otitis externa. She was treated with antibiotics and antiviral drugs without any improvement. Two weeks prior to her presentation to hospital, she developed bilateral costal margin pain with raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), mild chronic pharyngitis and painful right ear swelling. All other investigations including bloods and imaging were non-specific. Her painful right auricle swelling prompted the diagnosis of relapsing polychondritis (RP), which was supported by clinical improvement with high-dose corticosteroids. RP is a clinical diagnosis with non-specific inflammation of affected cartilage. It is a diagnosis of exclusion and early diagnosis can be made by the most common presenting feature of auricular chondritis.
Near miss abdominal pain
Authors: Tint Nyan Phone , Hussain Hamzah
Published: February 2021

An 18-year-old adolescent with intermittent colicky abdominal pain for 4 months was admitted to a Medical Emergency Assessment Unit for further investigation of possible colitis, after being reviewed by a surgeon in Accident and Emergency. Initially he was treated for a urinary tract infection, however a CT of the abdomen revealed appendicular perforation with pelvic abscess formation. The patient required an urgent laparoscopy and was discharged without complications. Typically, appendicitis is an acute surgical problem whereas chronic abdominal pain is routinely considered a medical problem. This case demonstrates the importance of maintaining acute causes as part of the differentials list in young patients with unexplained recurrent abdominal pain as well as justifying the early use of CT when there is ambiguity surrounding a diagnosis.
Thrombolysis of a massive intracardiac thrombus during resuscitation: documentation by transoesophageal echocardiography
Authors: Poppe Michael , Magnet Ingrid , Müller Matthias , Janata-Schwatczek Karin
Published: February 2021

Acute pulmonary embolism is a frequent potentially reversible cause of sudden cardiac arrest. The early diagnosis is challenging but essential for further treatment. New therapeutic options in resuscitation, such as extracorporeal resuscitation, are leading to frequent transports of patients to emergency rooms with ongoing resuscitation. A transoesophageal echo performed during resuscitation can give hints for reversible causes for the cardiac arrest. We present a case of a 40-year-old female patient who was transferred to our department with ongoing resuscitation and received a transoesophageal echo immediately on arrival. The examination showed a massive intracardiac thrombus. The subsequent thrombolysis and following resuscitation were observed and documented via transoesophageal echo.
Treating difficult-to-diagnose tight filum terminale: our experience with four patients
Authors: Sato Takashi , Eguchi Yawara , Enomoto Keigo , Murata Yasuaki
Published: February 2021

Tight filum terminale (TFT) is a general term for pathological conditions that result in abnormal tension on the spinal cord, pulling the conus medullaris caudally. Because symptoms can vary, we aim to review the usefulness of Komagata’s criteria in our experience with four patients who had TFT that was missed in prior workups. We performed a retrospective review of the medical records of four patients who underwent resection of the filum terminale for TFT. A total of four patients underwent surgery. The patients’ chief complaints were lower back pain, lower limb pain and numbness. All patients met the Komagata diagnostic criteria for TFT and also had neurological abnormalities of the upper limbs, such as numbness and pathological reflexes. We resected the filum terminale in all patients, and achieved resolution of their preoperative symptoms. Komagata’s diagnostic criteria are seemingly useful for the diagnosis of TFT.
Cutaneous Rosai–Dorfman disease: a challenging diagnosis
Authors: Sampaio Rita , Silva Leandro , Catorze Goreti , Viana Isabel
Published: February 2021

Rosai–Dorfman disease is a rare benign histiocytic proliferative disease of unknown cause that, in exceptional cases, presents with lesions confined to the skin. Clinically variable types of lesions such as papules, nodules and plaques have been reported. We present a case of a 27-year-old woman with a 1-year history of erythematous papular and nodular lesions on the malar and right axillary regions, previously misdiagnosed as acne. She reported no fever, malaise or weight loss, while physical examination and laboratory workup were normal. Bacteriological and mycobacteriological cultures were negative. Histopathological findings showed dense infiltration of inflammatory cells involving the entire dermis, consisting of large macrophages with emperipolesis, S100 and CD68 positive, neutrophils, eosinophils, lymphocytes and plasma cells. The patient was treated with oral prednisolone without improvement. Dapsone was subsequently initiated with favourable clinical response. The present article aimed to emphasise the clinical and histological differential diagnosis and share the treatment experience.
Endovascular treatment of a sacral dural arteriovenous fistula
Authors: Porwal Mokshal H , Tutton Sean , Sinson Grant P , Sacho Raphael
Published: February 2021

Spinal dural arteriovenous fistula (SDAVF) is a rare pathological communication between arterial and venous vessels within the spinal dural sheath. Clinical presentation includes progressive spinal cord symptoms including gait difficulty, sensory disturbances, changes in bowel or bladder function, and sexual dysfunction. These fistulas are most often present in the thoracolumbar region. Diagnoses of SDVAFs are commonly missed, possibly due to the low index of suspicion, non-specific symptoms and challenging imaging. In this case report, we describe a rare presentation of a sacral SDAVF which was detected by collective efforts between endovascular neurosurgery and interventional radiology. We outline the diagnostic and imaging challenges we faced to discover the fistula. In particular, mechanical pump injection instead of hand injection during angiography was required to reveal the fistula. Following identification, the fistula was successfully treated endovascularly by using onyx (ethylene vinyl alcohol glue), a less invasive alternative to surgical intervention.
A rare cause of adult-onset bilateral vocal cord paralysis
Authors: Soong Chin Mun , Adair Robin
Published: February 2021

A 72-year-old man initially presented to the ENT outpatient department after 20 years with increasing intermittent episodes of dyspnoea and stridor. Flexible nasendoscopy revealed bilateral vocal cord paralysis with the cords in a medial position. He subsequently underwent urgent tracheostomy. He has six similarly affected family members across three generations all requiring tracheostomy to maintain an adequate airway. Follow-up and genetic testing have revealed mutation of the dynactin 1 gene leading to distal hereditary motor neuropathy type 7b. This is a rare occurrence causing this condition to be reported in only three families previously throughout the world.
Delayed diagnosis of bilateral subdural effusions complicating intracranial hypotension in a patient presenting with post lumbar puncture headache
Authors: Huq Saleheen , Iyer Menaka G , Oyibo Samson O
Published: February 2021

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7–14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.
Acute viral hepatitis E complicated with acute pancreatitis in an immunocompetent adult
Authors: Debnath Partha , Datta Amlan Kusum , Chakraborty Uddalak , Chandra Atanu
Published: February 2021

Acute viral hepatitis has been associated with several extrahepatic complications. Fulminant liver failure secondary to acute viral hepatitis may be complicated by acute pancreatitis. However, in the setting of benign viral hepatitis, in the absence of liver failure, association of pancreatitis is uncommon, that too in an otherwise immunocompetent individual. The exact mechanism of hepatitis-related pancreatitis remains elusive. Proposed mechanisms include immune-mediated injury against infected pancreatic acinar cells, oedema of the ampulla of Vater and release of lysosomal enzymes from the liver. A high index of clinical suspicion is needed in any case of viral hepatitis with severe abdominal pain to recognise acute pancreatitis as a possible complication, which may increase both morbidity and mortality if unrecognised. Herein, we report a case of a young man presenting with acute viral hepatitis due to hepatitis E infection, complicated by acute pancreatitis.
Vitamin D deficiency causing eosinophilic esophagogastroenteritis and ascites: a rare association
Authors: Qua Choon-Seng , Peh Kaik-Boo , Saravannan Kannan , Goh Khean-Lee
Published: February 2021

A 54-year-old Chinese man presented with ascites for 2 weeks. He had a preceding 2-year history of intermittent dysphagia, lethargy and general malaise. Blood investigations revealed leucocytosis with eosinophilia of 26.5%, whereas paracentesis showed turbid fluid with high protein content (45 g/L) and a high white blood cell count of 5580/µL, predominantly eosinophils (90%). An incidental assay of vitamin D showed a very low level of 13.5 ng/mL. No other cause of ascites was found. Gastroscopy was normal except for duodenitis. However, biopsies from lower oesophagus confirmed the presence of eosinophilic infiltration. Following vitamin D replacement, the patient experienced marked improvement in symptoms of dysphagia within 2 weeks and no recurrence of ascites after 3 months. The reason for the patient’s vitamin D deficiency remains unclear. The marked improvement in the patient’s health indicates a causative role of vitamin D deficiency in causing eosinophilic esophagogastroenteritis and associated eosinophilic ascites.
Alkaptonuria in an adolescent boy
Authors: Sangeetha Geminiganesan , Chandran Senthil , Ganesan Swathi , Jayaraj Jaippreetha
Published: February 2021

Alkaptonuria is a rare genetic disorder resulting in abnormality of tyrosine metabolism. It is one of the Garrod’s tetrad of ‘inborn errors of metabolism’ proposed to have Mendelian recessive inheritance. The disorder is characterised by deposition of homogentisic acid leading to ochronosis and ochronotic osteoarthropathy; however, blackish discoloration of urine is the only childhood manifestation. Other manifestations present only after third decade. A 13-year-old boy presented to paediatric nephrology clinic with blackish discolouration of urine since infancy. Examination revealed bluish black discolouration of bilateral sclera and ear cartilage; however, he had no symptoms of ochronotic osteoarthropathy. Genetic test pointed towards alkaptonuria. Currently, he is on regular follow-up and is being treated with vitamin C to delay the progression of the disease. Early diagnosis with appropriate intervention delays the onset of complications and preserves the quality of life of the patient.
Hypereosinophilic syndrome with multiorgan involvement: an interdisciplinary work-up
Authors: Looman Kirsten I M , Nuver Maarten E , Korevaar Tim I M , Guillen Samara S
Published: February 2021

A previously healthy 40-year-old man was referred to our emergency department with pruritic skin lesions and dyspnoea. Laboratory investigation revealed hypereosinophilia. Further diagnostic work-up confirmed the diagnosis of idiopathic hypereosinophilic syndrome (iHES), a rare myeloproliferative disease with a heterogeneous clinical presentation. We describe a unique case with cardiac, pulmonary, hepatic and cutaneous involvement at time of presentation. This case accentuates the importance of an extensive multidisciplinary diagnostic work-up, since iHES is a condition with potential rapid progressive multiorgan failure which requires prompt analysis and treatment. In addition, this case emphasises the importance of being aware of tunnel vision, especially during the COVID-19 pandemic, which might give rise to an increased risk of missing rare diagnoses. Our patient was treated with prednisolone, after which both his clinical condition and eosinophil concentrations markedly improved.
Cavernous sinus thrombosis: a late complication of head and neck surgery
Authors: Bhoriwal Sandeep , Dhall Kunal , Yadav Mukesh , Deo Suryanarayana VS
Published: February 2021

Cavernous sinus thrombosis is a rare but fatal condition arising due to various infectious and noninfectious causes. Although its incidence is very low in the setting of head and neck surgery, including radical neck dissection, a high index of suspicion with prompt treatment is the key to a successful outcome. We report a case of a 50-year-old woman with a chondrosarcoma of left lower alveolobuccal complex who underwent en bloc tumour resection with infratemporal fossa clearance and left modified radical neck dissection. Subsequently, she developed cavernous sinus thrombosis, which was successfully managed with a multidisciplinary approach. This case highlights the importance of high clinical suspicion in the postoperative setting to diagnose this potentially lethal complication.
Catamenial pneumothorax due to heterotopic endometriosis in the pericardium
Authors: Takigawa Yuki , Mizuno Daisuke , Iga Norichika , Fujimoto Nobukazu
Published: February 2021

A 46-year-old woman presented with a right pneumothorax at a regular medical examination during menstruation. The pneumothorax resolved without intervention; however, 6 months later, she was referred to our hospital due to chest pain and dyspnoea. A chest X-ray showed grade III pneumothorax and surgery was performed. During surgery, the patient was found to have pleural adhesions around the right upper lung, pores in the diaphragm and a blueberry spot in the pericardium. The margins of the upper lobe and diaphragm were covered with a polyglycolic acid sheet at the operation. Eight days after surgery, she was referred to our hospital again due to massive haemothorax. The reoperation suggested that the aforementioned blueberry spot in the pericardium was the source of bleeding. The spot was resected and shown to be oestrogen and progesterone receptor-positive, providing evidence of heterotopic endometriosis.
Case of recurrent cerebral haemorrhage in an older adult man who uses dimethylsulfoxide (DMSO) for self-management of low mood and pain
Authors: Olds Jonathan , Yousif Mohamed , Abidakun Oladotun , Cannon Abigail
Published: February 2021

We present the case of a man in his 70s who had suffered two separate frontal lobe haemorrhages in the context of using dimethylsulfoxide (DMSO) to manage his low mood. The known pathophysiology of DMSO renders it a likely causative agent of the recurrent intracerebral haemorrhages. This case highlights the need for clinicians to robustly enquire about a patient’s use of over-the-counter medications, of non-prescribed supplements and other substances, as part of the history. In addition, the case highlights the potential for highly debilitating adverse effects from using DMSO.
Lymphogranuloma venereum as a cause of persistent perianal ulcers
Authors: Szumowski John D , Marquez Carina
Published: February 2021

Lymphogranuloma venereum (LGV) has been increasingly reported, and many clinicians are familiar with it as a cause of proctocolitis or inguinal adenopathy. On the other hand, LGV is less commonly considered as a cause of isolated genital ulcerative disease in comparison to other etiologies such as syphilis or herpes simplex. We report a case of persistent perianal ulcerations due to LGV in an HIV-positive patient, confirmed by nucleic acid amplification testing.
Successful management of severe acute respiratory distress syndrome due to COVID-19 with extracorporeal membrane oxygenation during mid-trimester of pregnancy
Authors: Tambawala Zenab Yusuf , Hakim Zeinabsadat Tabatabaei , Hamza Lama Khalid , Al Rayes Maryam
Published: February 2021

A 29-year-old pregnant woman presented at 26 weeks of gestation with fever and cough for 4 days. On admission, her nasopharyngeal swab confirmed COVID-19. As her respiratory distress worsened, she was shifted to the intensive care unit (ICU). Since the patient was unable to maintain saturation even on high settings of mechanical ventilation, she underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) and was monitored in surgical ICU by a multidisciplinary team. The obstetrical team was on standby to perform urgent delivery if needed. Her condition improved, and she was weaned off after 5 days on extracorporeal membrane oxygenation. She was observed in the antenatal ward for another week and discharged home with the mother and fetus in good condition. VV-ECMO can be considered as rescue therapy for pregnant women with refractory hypoxaemia of severe respiratory failure due to COVID-19. It can save two lives, the mother and fetus.
Perioperative challenges in managing a patient with COVID-19 undergoing debridement for massive scalp myiasis
Authors: Lo Shiu Yin , Teah Ming Kai , Ho Yan Zheng , Yeap Tat Boon
Published: February 2021

A young man presented to our centre needing an urgent debridement of his postcraniotomy wound due to massive myiasis during the COVID-19 pandemic in October 2020. Prior to the surgery, his nasopharyngeal swab real-time PCR test result was unknown. One day later, it returned as SARS-CoV-2 positive. All healthcare workers who were involved in the patient management avoided cross infection as they wore appropriate personal protective equipment. This article depicts the importance of adequate preparations when handling potentially infectious patients and the perioperative issues associated with it.
Cetirizine-induced psychosis in a young adult with erythema multiforme
Authors: Croitoru David , Brooks Stephanie G , Piguet Vincent , MacGillivray Lindsey
Published: February 2021

We describe a case of a young man, taking no other routine medications, presenting with erythema multiforme and cetirizine-induced psychosis with re-challenge evidence. On retrospective elicitation of history, it was found that he had been involved in a motor vehicle collision 4 months prior and was a daily cannabis user; there were no objective abnormalities by MRI and neurological evaluations. Although rare, cetirizine-induced psychosis is an important adverse drug reaction that warrants the attention of healthcare practitioners.
Evaluation of eConsult use by Defence Primary Healthcare primary care clinicians using a mixed-method approach
Authors: Willman Antony Sean
Published: February 2021

Introduction

eConsult has recently been introduced into Defence Primary Healthcare to allow Service Personnel of the British Armed Forces and their dependants improved access to healthcare. This review sought the views of primary care clinicians using eConsult.

Method

An 18-item survey was constructed after an initial scoping survey. This was then distributed to primary care clinicians in Defence Primary Healthcare to assess the broader applicability of the themes identified. Data synthesis of this alongside free-text responses from respondents was undertaken to explore advantages and disadvantages of eConsult.

Results

Four themes were identified: accessibility, effects on working practices, impact on the dynamics of the consultation and training/administrative support. eConsult did not save time for clinicians but was generally more convenient for patients. eConsult was often used in conjunction with telephone and face-to-face follow-up, forming a ‘blended consultation’. Accessibility was improved, but cultural factors may affect some patients engaging.

Conclusions

eConsult improves accessibility for patients but does not reduce workload. It should be used alongside conventional access methods, not instead of. It was found to be useful for straightforward clinical and administrative problems but less useful for more complex cases unless part of a ‘blended consultation’. Future use could be modified to provide greater data gathering for occupational health and chronic disease monitoring and should be monitored to ensure it is inclusive of all demographic groups.
Aortic arch stenting: current strategies, new technologies and future directions
Authors: Dhanekula Arjune S , Sweet Matthew P , Desai Nimesh , Burke Christopher R
Published: February 2021

Operating on the aortic arch is a formidable challenge. Open operations remain the gold standard, but despite improvement in technique and outcomes, they are still associated with significant morbidity and mortality. The last 20 years have seen a remarkable reduction in the operative morbidity associated with treatment of the descending thoracic aorta using thoracic endovascular aneurysm repair (TEVAR). To improve outcomes following arch repair, new TEVAR devices, including both single-branched and multibranched designs, have come to clinical trial. This review discusses the modern state of open and hybrid repairs while introducing the reader to technology for endovascular therapy of the aortic arch. We describe important anatomical and operative considerations for the devices. Given these nuances, we believe the future of the aortic arch to be patient-individualised hybrid repairs, involving both open and endovascular options with a multidisciplinary ‘thoracic aorta team’ at the helm.
Impact of COVID-19 on small biopsy diagnostic procedures and cancer resection surgeries in the North-West of Ireland
Authors: O'Connor Eoghan , O'Dowd Gerard , Phelan Sine
Published: February 2021

Aims

To quantify the impact of COVID-19 on small biopsy procedures and cancer resection surgeries in the North-West of Ireland.

Methods

Data was obtained from the Histopathology Departments of University Hospital Galway (UHG) and Letterkenny University Hospital (LUH) Laboratory Information Systems to establish the impact of COVID-19 on both the small biopsy (coded P01) and cancer resection (coded P03) caseloads reported from January to June 2020, with comparison made to January to June 2019.

Results

From January to June 2020 compared with January to June 2019, UHG had an overall decrease of 714 P01 cases (21.5%) and a decrease of 152 P03 cases (14.4%). In this time, LUH had an increase of 9 P01 cases (0.8%) but a decrease of 48 P03 cases (58.5%).

Conclusions

There has been a significant impact on the provision of both diagnostic and therapeutic services in North-West of Ireland due to the COVID-19 pandemic.