bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical Reader System for Digital Measurement Instruments Embedded Industrial Internet of Things
Authors:   Department of Computer Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai, Thailand, Promsuk Natthanan , Taparugssanagorn Attaphongse
Published: May 2021

In industrial factories, many measuring instruments are used to display, for instance, pressure, voltage, temperature or humidity. Human errors are the main problem and often occur in many processes mostly done manually, such as data acquisition. Therefore, the problem of how we obtain such data automatically and correctly in real-time is important. In this paper, a numeral recognition system (NRS) is proposed based on an optical character recognition (OCR) method. The NRS embedded industrial Internet of things (IIoT) is used to serve a real-time service. Moreover, digital image processing (DIP) together with the multi-layer perceptron (MLP) is applied to efficiently recognize the numeral data. Furthermore, it is very common that the instruments' screens can face the rotation problem. This problem can be solved using the histogram of oriented gradients (HOG) and Hough transform (HT) techniques. In addition, realistic conditions under various noise types are considered such as salt and pepper (SP) noise, Gaussian noise, and Speckle noise. The system performances are evaluated in terms of confusion matrices and accuracies. The strong contribution of our proposed NRS system is that it works excellently in any situations and achieve up to 95.13 percent accuracy. From the actual experiments, we achieve an average about 95 percent accuracy. Although the NRS with the HOG and HT technique takes a bit longer computation time and more memory usage to process the images than another NRS, the system provides better results. Our proposed system is suitable for a real-time service due to low computation time.
AODV-MSA: A Security Routing Protocol on Mobile Ad Hoc Network
Authors:   Faculty of Foreign Language and Informatics, Dong Thap University, Viet Nam, Minh Le Quang
Published: May 2021

Network security is an important problem, which attracts more attention because recent network attacks caused huge consequences such as data lose, reduce network performance and increase routing load. In this article, we show network attack forms in MANET and propose Multiple Signature Authenticate (MSA) mechanism using digital signature based on asymmetric encryption RSA. Moreover, we describe a new security routing protocol named AODV-MSA by integrating MSA into AODV. Using NS2 simulator system, we implement and examine the efficiency of the AODV-MSA protocol with the 32-bit keys.
Injection Coding with Spectral Nulls for Even Codeword Lengths
Authors:   Dept. of Elect. and Electron. Eng. Sc., Univ. of Johannesburg, Johannesburg, SA, Ogunyanda O. O. , Shongwe T. , Swart T. G.
Published: May 2021

With a view to adapting information signals to suit the frequency characteristics of digital transmission channels, it is pertinent to design channel coding schemes that can exhibit spectral shaping capabilities after being processed with a suitable modulation technique. This involves concentrating the frequency energy of the coded and modulated information signal towards a predetermined range of the frequency spectrum, or making it have low power content at such frequencies. One modulation scheme that is suitable for achieving this is pulse amplitude modulation (PAM). We thus present a permutation coding (PC) system with injections that can exhibit spectral nulls at rational sub-multiples of the symbol frequency. Such injections are achieved by strategically removing δ columns from the source PC. We also present a mathematical expression that allows for the prediction of zero energy positions in the codebook’s spectrum. Due to the way the injections are introduced, it gives the scheme an advantage of achieving higher symbol rate, when compared with conventional PC systems. The work is however limited to cases where δ =2 and the lengths of the codewords involved are even numbers.
АНАЛИЗ КЛАСТЕРИЗАЦИИ СОЦИАЛЬНО-ЭКОНОМИЧЕСКОГО РАЗВИТИЯ РЕГИОНОВ ЮГА РОССИИ ДО И ПОСЛЕ ВВЕДЕНИЯ МЕЖДУНАРОДНЫХ САНКЦИЙ
Authors: Gichiev Nabiyula S.
Published: May 2021

Усиление региональной дифференциации создает проблемы для проведения эффективной государственной политики, связанной с выравниванием социально-экономического развития регионов страны и приближением их характеристик к уровням более развитых стран. В результате перетока капитала и трудоспособного населения из бедных регионов в богатые повышается риск региональных кризисов и межрегиональных конфликтов, поэтому дифференциация в этом случае дестимулирует развитие и ее приходится снижать. Для решения отмеченной проблемы необходимо на основе кластерного анализа оценить уровень дифференциации социально-экономического развития проблемных регионов Юга России.

Цель исследования: на основе кластерного анализа определить уровень диф-ференциации социально-экономического развития регионов Юга России до и после введения антироссийских санкций.

Метод или методология проведения работы: в статье использовались экономико-статистические методы анализа

Результаты: в статье представлены результаты кластерного анализа регионов Южного и Северо-Кавказского федеральных округов по уровню показателей их социально-экономического развития и демографического положения до и после введения антироссийских санкций.

Область применения результатов: полученные результаты исследования могут применяться при разработке Стратегии социально-экономического развития Северо-Кавказского федерального округа на период до 2035 года.
Methodology for Evaluating the Effectiveness of the Implementation of an Innovative Project in the Field of Information Technology
Authors: Nikolenko T. , Semina L.
Published: May 2021

The research topic is relevant in connection with the growing need to implement innovative projects that increase the level of the national economy. High risks and significant initial investments have determined the need to develop the most accurate methods for evaluating the effectiveness of innovations. The article describes the stages of analysis of an innovative project for the introduction of 5G technology. Calculations are presented that allow us to obtain a single criterion for choosing the most optimal project implementation option. The developed methodology takes into account both standard investment performance indicators and the level of aggregate risk, as a result of which project execution scenarios with unacceptable criteria are excluded under the specified constraints. The advantage of the described method is the simplicity of calculations and the absence of the need for a large amount of initial information about the project. In the conclusion of the study, the author's recommendations on the organization of effective deployment of the fifth-generation network in the Russian Federation are given.
Digital Energy and the Country's Economic Growth
Authors: Burganov Rais , Vyrupaeva Anna , Maymakova Lyudmila
Published: May 2021

This article analyzes the relationship between Russia's economic growth and digital energy. The obtained scientific results include conclusions about the role of digital energy in the economic growth of the country, the results of the analysis of the relationship between digital energy and the economic growth of Russia; provisions on the need to take into account the positive and negative aspects of the impact of digital energy on the economic growth of Russia based on SWOT analysis. The results obtained have a certain scientific novelty, since in the studies studied on a related topic of the present study, such results were not obtained. In addition, the very use of SWOT analysis also refers to the innovations in the analysis of the tandem of the relationship “digital energy - economic growth”.
Practical Experience of Teaching Economic Disciplines Through Game Methods
Authors: Vakhorina Marina
Published: May 2021

The article is devoted to the role of game methods for students of generation " Z " as a tool for increasing the activation of modern learning. The research is based on the analysis of Russian and foreign publications that reveal the importance of game methods of teaching students of economic disciplines in higher education. The main purpose of the research is to substantiate the theoretical provisions of game methods in teaching and to transfer the practical experience of their application in teaching economic disciplines. The role of toys for children's development in the historical aspect is determined.

The author's experience of developing scenarios of classes in the form of a game of teaching economic modules, including accounting disciplines, using innovative methods and emphasizing the need to apply such methods in the educational process is proposed. Observing the basic principles of teaching: through practical experience, consistency and visibility, such pedagogical goals as increasing the involvement of students in the educational process, the formation of new professional skills by practicing them through game methods are achieved.

The main conclusions are that by revealing the projects (developments) of individual game methods, the author shows the possibility of increasing the contingent for economic specialties and, as a result, the interest of students in the chosen profession. The author proposes the definition of "game methods of economic training" as a modeled set of activities in the form of a game, aimed at obtaining professional competencies related to economic activity. The conclusions can be used in teaching and in the development of work programs for special disciplines of students of economic directions in FGOST 3++.
The Implications of Applying the Vienna System to Published Data on Prehistoric Pottery in Lower Egypt
Authors: Sanada Sakura
Published: May 2021

Pottery discovered at Lower Egyptian sites has several features that are distinctly different to those of pottery from Upper Egyptian sites. In this paper, the manner in which data on pottery fabric from Lower Egyptian sites has been classified and presented in published reports will be reviewed and certain problems stemming from this manner of publication will be examined. On the basis of this examination, the type of classification that would be most suited to the integration of all published data on pottery fabric at Lower Egyptian sites (as well as their features) and to the storage of this data as an objective record for future analysis by other researchers will be discussed. It would seem that, although the issue of problematic and biased published pottery data still remains, notating data using a code is one of the most promising methods. This classification method is useful as both a mnemonic device and as an effective means to record and classify the pottery fabric data gathered from Lower Egyptian sites.
Bread Mould Potmarks from a Protodynastic and Early Dynastic Site in the Nile Delta, Egypt
Authors: Sobas Magdalena
Published: May 2021

This article focuses on potmarks from the Western, Eastern and Central Koms of the Tell el-Farkha site. They date back to the Protodynastic and Early Dynastic periods (up until the 1st Dynasty) and are associated with Phases 4 and 5 of the settlement. 91 of the potmarks have been identified and analysed. They were all incised on wet clay and covered either the inside or outside walls of bread moulds. 16 categories of patterns have been distinguished: cross, criss-cross, vertical and horizontal line combination, horizontal line, vertical line, curvilinear line, rectangular-like shape, animal-like shape, plant-like shape, star-like shape, arch-like shape, radial wheel shape, strokes on the rim, V-shaped sign, circle and semi-circle.
Notes on the Origin of Casemate Foundation Platforms in Ancient Egypt
Authors: Małecka-Drozd Natalia
Published: May 2021

Casemate foundation platforms appeared in Egypt in the middle of the 2nd millennium BC during the 2nd Intermediate period. As they are similar in nature to palace-citadel structures from the capital of Egypt under the Hyksos, Avaris, the possibility of their being Asiatic in origin has been considered. Recently, however, similar structures from Deir el-Ballas have been associated with Nubian funerary architecture. Yet making a choice between these two hypotheses means forgetting about the achievements of Egyptian brick architecture. The link between casemate foundation platforms and high Nile floods, as well as their structural features, unquestionably suggest Egyptian origin. Over the course of this paper, I would like to consider if the appearance of casemate platforms in the 2nd Intermediate period and the beginning of the New Kingdom could be related to mastaba burials and the local development of foundation laying methods.
More Perspectives on the Late Prehistoric Site of Qiryat Ata
Authors: Golani Amir
Published: May 2021

In a recent SAAC article, Eliot Braun (2012) has published a critique of my excavations at the late prehistoric site of Qiryat Ata. Reexamination of a site’s stratigraphy and reinterpretation of archaeological data are welcome, if their purpose is to truly enhance our understanding of the history of the site and thus gain a better understanding of the archaeological periods of its occupation. Such a reevaluation should be based on factual evidence, exacting analysis and the realization that even the same data can and is open to different interpretation. Reexamination of the data would strive to offer accurate and useful conclusions that could substantially augment our perception of the archaeological record and be a catalyst for future research and fruitful collegial discussion among scholars.The purpose of the following is to address the claims and allegations raised by Braun in his article. While some points of Braun’s critique may have their merit and provide a future basis for discussion, examination of his major points shows them to be basically unfounded.
A Classification System for Pottery Shape at Prehistoric Sites in Lower Egypt
Authors: Sanada Sakura
Published: May 2021

Pottery data from prehistoric sites in Lower Egypt has been reported using different classification systems dependent on the site where it was discovered. This makes comparative analysis of pottery from different locations highly problematic. The significant majority of pottery excavated at these sites is either incomplete or consists of pot sherds that cannot be reconstructed. This paper will consider the problems that exist in publishing data concerning pottery shape and examine the classification systems adopted in earlier reports. Bearing these earlier systems in mind, the report will consider what the most feasible general classification system would be for the recording and classifying of pot sherd shape data from all Lower Egyptian sites, which would also be able to integrate together even with pottery shape data in the earlier reports as accurately as possible. There might be the feasible system or a prototype of it amongst the systems already in use.
Early Greek Fortifications in the Territory of the Later Bosporan Cities
Authors: Scholl Tomasz
Published: May 2021

Scholars have long debated the question how a small state like the Bosporus managed to remain independent for almost a millennium by the side of two nomadic giants, the Scythians and the Sarmathians. One of the reasons of their success were the fortifications that they had started building around their cities in the early stages of the colonization effort. Summing up the current knowledge of early Greek fortifications in the territory of the future Bosporan state, one cannot but note the weakness of the evidence. Changes of ground topography, natural and anthropic, have destroyed most of the earliest occupation sites. Practically none of the early Greek cities that should have had fortifications judging by their later histories are known.
Mapping Mistakes: The Cartographic Confusion of Ancient Kleitor
Authors: Maher Matthew P.
Published: May 2021

The ancient Greek city of Kleitor lies in a small valley in north central Arkadia. Although only recently the target of systematic excavations, the first plan of its remains was published almost 200 years ago. While this earliest plan is essentially correct in the details, it is also a simple schematic representation with little topographical detail. When a revised plan of the site – comprising a much more skillful representation of the topography – was published in the late 19th century, it soon supplanted the original in the scholarship. Hidden behind its topographic accuracy and artistic flourishes, however, lies the fact that the mapping of the archaeological remains themselves was incorrect. Consequently, as this plan continued to be modified and reproduced throughout the following century, so too were its mistakes duplicated and exaggerated. Showing the cartographical evolution in the representation of ancient Kleitor and its reception by scholars, this paper demonstrates how scholars have constructed their interpretations of the remains around the unintentional predisposition to equate artistic quality with accuracy, and the consequences of this bias on the archaeological interpretations of the site.
Some Initial Observations on a Building Excavated on Fabrika in Nea Paphos in Cyprus by the Australian Archaeological Mission
Authors: Barker Craig
Published: May 2021

The Australian archaeological mission to Nea Paphos in Cyprus has begun exploring the remains of a structure to the rear of the cavea of the ancient theatre on the southeastern edge of the hill known as Fabrika. The preliminary results of this excavation suggest a significantly large post-medieval building constructed using stone taken from the former theatre. The building appears to have been used in some sort of industrial production, the precise nature of which is not yet determined, and is perhaps the source of the etymology of the name of the hill. This paper discusses a need for a reassessment of this area of the city of Nea Paphos in its more recent history, and discusses the needs for a better understanding of the urban relationship between Fabrika and the theatrical precinct during the Hellenistic and Roman periods.
Inappropriate Drug Prescribing in Older Adults: How to Reduce It?
Authors: Mirko Petrovich
Published: May 2021

Because older patients are more vulnerable to adverse drug-related events, there is a need to ensure appropriate pharmacotherapy in these patients. Screening to identify older patients at risk of drug-related problems (DRP) and adverse drug reactions (ADR) is the first critical step within a multistep approach to geriatric pharmacotherapy.
Information and Communication Technologies (ICT) to Improve Prescription Appropriateness and Therapy Adherence in the Multi-morbid Elderly
Authors: Alberto Borghese
Published: May 2021

Multimorbidity patients pose severe challenges to which information and communication technology (ICT) can help patients and doctors to answer with effective and efficient care.
Myalgia, Obtundity and Fever in a Patient with a Prosthesis
Authors: Valeria Di Stefano  , Margherita Migone De Amicis  , Cecilia Bonino  , Natalia Scaramellini  , Yvan Torrente  , Stefania Picone  , Francesca Minozio
Published: May 2021

Objective: We describe a rare case of group G streptococcus (GGS) sepsis complicated by bacterial toxin myopathy. Case: A 65-year-old man, with a history of infection of his shoulder prosthesis, presented with multiorgan failure and notable myalgia likely caused by toxins. The patient was treated successfully with antibiotics and prosthesis removal. Conclusion: This case suggests infection by GGS should be considered in a patient presenting with myalgia associated with sepsis.
Bordetella hinzii Endocarditis, A Clinical Case Not Previously Described
Authors: María Mateos  , Maria Pilar Cubo Romano  , Maria Teresa de Guzmán García Monge  , Beatriz Berzal Martín  , Aída Sánchez García
Published: May 2021

Objective: To review infections by Bordetella hinzii. Materials and methods: A 79-year-old male patient, with a chronic aortic valve biological prosthesis, presented to hospital because of fever. First examinations were normal. However, 72 hours later B. hinzii was isolated in blood cultures, and so meropenem was prescribed. Nevertheless, fever and B. hinzii bacteraemia were still present 7 days later. Results: The transoesophageal echocardiogram revealed an enlarged image suggesting a periprosthetic abscess, confirmed with a PET-CT scan. The patient was sent for cardiac surgery, and biopsy samples confirmed the presence of B. hinzii. Conclusion: There are very few cases of B. hinzii infection in humans. Ours is the first described case of B. hinzii endocarditis.
A Rare Presentation of Ogilvie's Syndrome
Authors: Inês Soler Bargiela  , Maria João Gomes  , Filipa Bordalo Ferreira  , Ana Corte Real  , Ana Sofia Ventura
Published: May 2021

Ogilvie’s syndrome or acute colonic pseudo-obstruction is characterized by massive colon dilation in the absence of mechanical obstruction or toxic megacolon. The phenotype associated with secretory diarrhoea is rare and is related to increased potassium channel activity in the colon, inducing excessive potassium loss, with increased sensitivity to normal serum aldosterone levels. The recommended therapy is potassium-sparing agents. We present the case of an 85-year-old patient who was admitted at the emergency department with prostration, abdominal distension and diarrhoea, corresponding to functional colonic dilation precipitated by severe hypokalaemia. Resolution of the condition only occurred after spironolactone was administered for suspected primary hyperaldosteronism, which was not proved as the patient showed normal aldosterone serum levels. The pathophysiological mechanism of abnormal potassium secretion in this scenario corresponds to ‘relative hyperaldosteronism’ caused by increased sensitivity of colonocytes to aldosterone.
Pseudoxanthoma Elasticum and Cardiorenal Disease: A Case Report
Authors: Luis D'Marco  , Carlos Soto  , Fabiola Dapena
Published: May 2021

Pseudoxanthoma elasticum (PXE) is a rare genetic disorder characterized by calcification of elastic fibres, skin lesions, fundus lesions and systemic vascular complications. PXE affects approximately 1 in 160,000 people, typically appearing as a formation of yellow papules containing abnormally calcified elastic fibres. The renal involvement of PXE has been reported. Several factors are known to promote soft tissue and accelerated arterial calcification in chronic kidney disease, including systemic inflammation, altered calcium and phosphate homeostasis, hypertension and a deficiency of endogenous calcification inhibitors. Given the impact of this disease, nephrologists may seek additional supportive features to improve and avoid the risk of complications. Moreover, PXE per se represents an interesting model to evaluate vascular disease in the early stages of renal disease.
Acute Heart Failure in a Healthy Young Patient after Severe Carbon Monoxide Poisoning
Authors: Christos E Lampropoulos  , Evagelia Sklavou  , Charalampos Anastogiannis  , Vasiliki Papanikolaou  , Dimitris Tsilivarakis  , Vasilis Vasiliou  , Ioanna Papaioannou
Published: May 2021

Introduction: Carbon monoxide (CO) poisoning may cause severe cellular hypoxia. Materials and methods: A 28-year-old male presented reduced levels of consciousness and dyspnoea after CO exposure. Clinical examination revealed tachypnoea, bilateral rales, dilated jugular veins and confusion. Troponin I, lactate and carboxyhaemoglobin levels were increased. Thoracic X-ray depicted pulmonary oedema and an echocardiogram, severe heart failure (HF; EF<25%). He was intubated due to clinical deterioration. Results: He remained intubated for 5 days with excellent improvement of left ventricular function (EF>55%). He was discharged 1 week later with full recovery. Discussion: Acute HF is a rare serious complication of CO poisoning, even in healthy young individuals.
Inclusion Body Myositis Treated with Alemtuzumab
Authors: Juliana Sá  , João Costelha  , Antonio Marinho
Published: May 2021

Inclusion body myositis (IBM) is a chronic inflammatory myopathy with a progressive course. It is more common in the later years of life and usually presents with limb weakness. We present the case of a patient who developed proximal weakness in the lower limbs and, four years later, facial asymmetry. Blood analysis revealed high lactate dehydrogenase and creatinine kinase values. The diagnosis was obtained through muscle biopsy which met the histological criteria for IBM. The patient started treatment with alemtuzumab, leading to stabilisation of the symptoms in two years.
Bilateral Isolated Phrenic Neuropathy: a Rare Cause of Dyspnoea
Authors: Carlos Couto  , Pedro Pereira  , Ana Catarina Moreira  , Vicência Ribeiro  , José Duarte
Published: May 2021

Bilateral diaphragm paralysis due to bilateral isolated phrenic neuropathy (BIPN) is a very rare cause of unexplained respiratory failure. We present a 65-year-old patient with no relevant previous medical history who presented in the Pulmonology Clinic with mMRC1 dyspnoea and orthopnoea. After the medical work-up, diaphragmatic paresis was diagnosed. Inspiratory muscle training resulted in mild symptomatic improvement and treatment with noninvasive mechanical ventilation (NIV) was initiated. This condition is generally chronic and has a poorer prognosis, compared to other cases of phrenic nerve involvement. In this case, NIV restored near-normal daily function.
Fever During Anti-integrin Therapy: New Immunodeficiency
Authors: Eleonora Bonfanti  , Christian Bracco  , Paolo Biancheri  , Andrea Falcetta  , Marco Badinella Martini  , Remo Melchio
Published: May 2021

Background: The causes of inflammatory bowel disease (IBD) have not yet been clearly elucidated, but it is known that genetic susceptibility, altered gut microbiota and environmental factors are all involved, and that a combination of these factors causes an inappropriate immune response, resulting in impaired intestinal barrier function. With regard to the treatment of IBD, the use of conventional immunosuppressive drugs has been complemented by more specific therapeutic agents, including biological drugs. Systemic immune suppression is a risk factor for cytomegalovirus (CMV) infection, which is associated with considerable morbidity and mortality in immunocompromised hosts. Case Report: A 33-year-old male patient was admitted to our medical unit complaining of a 10-day history of fever, fatigue and headache. He had been suffering from ulcerative colitis and primary sclerosing cholangitis for five years and was currently being treated with azathioprine and vedolizumab. In the past he had already taken infliximab, adalimumab and golimumab without any clinical response. After the exclusion of systemic infectious diseases, his serology was consistent with a primary CMV infection. This was successfully treated with intravenous ganciclovir therapy. Conclusion: Vedolizumab is an anti-integrin biological agent approved for IBD treatment. Its gut-selective mechanism of action would appear to increase its safety profile, however data on this are still limited. Moreover, it should always be remembered that IBD patients have an increased risk of CMV infection, both primary and reactivation, because of their concurrent immunosuppression.
Association of Multiple Myeloma and Giant Cell Arteritis – A Case Report
Authors: Rui Marques Osório  , Sérgio Pina  , Teresa Salero  , Margarida Viana Coelho  , Domingos Sousa  , Catarina Mendonça
Published: May 2021

Autoimmune diseases (AID) have been associated with a variety of lymphoproliferative disorders. Multiple myeloma (MM), one of the most common haematologic malignancies characterized by clonal proliferation of bone marrow plasma cells, has been associated with a range of autoimmune disorders. In this report, we described a case study of a patient admitted to our Internal Medicine Department for a bone marrow biopsy and myelogram due to a monoclonal peak observed by his general practitioner. However, at admission he presented typical giant cell arteritis (GCA) complaints, suggesting the coexistence of both diseases. The possible pathogenesis, as found in the literature, explaining the association will be discussed.
Brugada Phenocopy Induced by a Lethal Methanol Intoxication
Authors: Monterrubio-Villar Jesús  , Llinares-Moya David
Published: May 2021

Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission.
A Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia
Authors: Ana Filipa Pires  , Teresa Martins Mendes  , Ana Areia Reis  , Ana Ferreira Pacheco  , Vítor Fagundes  , Mari Mesquita
Published: May 2021

Introduction: Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus. Case description: We report the case of a 35-year-old female admitted to the Emergency Department with severe headache associated with fast head movements. Five days previously she had a eutocic delivery and lumbar epidural anaesthesia was performed. A brain computed tomography (CT) scan showed pneumocephalus and she was admitted to the hospital ward. A brain CT scan on the fourth day of hospitalization showed resolution of ventricular pneumocephalus. Discussion: The most frequently occurring symptom with pneumocephalus is headache associated with fast brain motion resulting from air injection and meningeal irritation. When there is clinical suspicion of pneumocephalus, a brain CT scan should be performed for the diagnosis.
Food for Thought: Dietary Intervention in a Rare Cause of Severe Ventilatory Failure
Authors: Henry Yung  , Keshav Sharma  , William Flowers  , Malcolm Marquette  , Laura Starace  , Clare Sander  , Rowan Burnstein  , Jurgen Herre
Published: May 2021

Plastic bronchitis is a rare condition characterised by endobronchial cast formation. We report the case of a 53-year-old women who deteriorated following an elective bronchoscopy procedure. She developed refractory ventilatory failure and required repeated bronchoscopy, which identified thick tenacious casts as the cause of her airway compromise. She did not respond to conventional therapies including endoscopic clearance, mucolytic therapy and nebulised tissue plasminogen activator (TPA). Total parenteral nutrition and a fat-free enteral diet were instituted while the patient was on extracorporeal membrane oxygenation (ECMO), which led to substantial improvement in her condition and demonstrated the importance of dietary strategies in this case.
Neglected Pulmonary Arterial Hypertension in Sickle Cell Anaemia during Prenatal Care
Authors: Minoodokht Bavarsad Karimi
Published: May 2021

Pulmonary arterial hypertension (PAH) is one of the main complications of sickle cell disease (SCD) and imparts significant risk during pregnancy. Here, we report the outcome of undetected PAH in a pregnant woman with SCD. The patient presented with severe progressive dyspnoea with echocardiographic findings of high pressure in the pulmonary artery in the 37th week of pregnancy. Despite an emergency caesarean section, both mother and neonate died. Regular cardiovascular check-up is essential for SCD patients and careful prenatal care should include cardiovascular evaluation. PAH during pregnancy is associated with high mortality and morbidity. As there is no proof that new advanced therapies decrease the risks, early diagnosis in pregnant patients with underlying disease, like sickle cell anaemia, is essential and termination of pregnancy should be considered.
Cardiac Tamponade after Thrombolysis for Acute Ischemic Stroke - A Case with an Excellent Outcome
Authors: Ana Vera-Cruz  , Marta Cerol  , Maria Margarida Pereira  , Sónia Canadas  , Juliana Mortágua  , Ion Gherbovetchi  , José Pedro Andrade
Published: May 2021

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the established treatment for acute ischemic stroke and has been highly effective in reducing the neurological deficit. Serious adverse events are not uncommon, with hemorrhage being the major complication. We describe the case of a patient with acute ischemic stroke that also presented with vague cardiac symptoms and was treated with rtPA, which was complicated by a hemopericardium causing cardiac tamponade. Pericardiocentesis was promptly performed, which resulted in rapid resolution of the cardiogenic shock. The patient recovered consciousness within a few minutes. A search of the MEDLINE database shows that this is the first report of cardiac tamponade after rtPA thrombolysis occurring in a patient with no history of recent myocardial infarction or aortic dissection.
Spontaneous Uterine Leiomyoma Torsion: A Challenging Differential Diagnosis for Radiologists
Authors: Ekaterini Tavernaraki  , Sofia Athanasiou  , Pavlos Ampatzis
Published: May 2021

Uterine leiomyomas are very common gynaecological benign tumours. Spontaneous torsion of a uterine subserosal leiomyoma is a rare cause of acute lower abdominal pain and should be treated immediately with surgery. We report a case of an enlarged subserosal leiomyoma that was first detected by computed tomography (CT) and further confirmed by laparoscopic surgery to be a subserosal leiomyoma with torsion.
Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine
Authors: Tara Burleigh  , Khandalavala Birgit
Published: May 2021

Objectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted.
Interprofessional Management of Median Arcuate Ligament Syndrome (Dunbar Syndrome) Related to Lumbar Lordosis and Hip Dysplasia: A Patient’s Perspective
Authors: Sclinda Lea Janssen  , Thomas Scholbach  , Susan Jeno  , Holte Laurie  , Mandy Meyer  , Colin Combs, PhD
Published: May 2021

We present a 53-year-old female patient with median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery compression syndrome, related to lumbar lordosis and hip dysplasia. She utilized interprofessional management strategies, which were beneficial in reducing lumbar lordosis and MALS-related symptoms. This finding is important because there are no other reports in the literature describing interprofessional strategies to manage symptoms for patients who are waiting for surgery or are not candidates for surgery.
Fusobacterium Nucleatum Empyema: An Atypical Presentation
Authors: Lucía Barrera López  , Cristina Macía-Rodríguez  , Lucía Ferreiro-Fernández  , José Antonio Díaz-Peromingo
Published: May 2021

A 40-year-old man presented to the emergency room and was evaluated in the internal medicine department for unexplained weight loss, asthenia, anorexia and night sweats over the previous 2 months. After a loculated pleural effusion was identified on thoracic computed tomography, purulent fluid was drained from the lung and Fusobacterium nucleatum was isolated. The patient was successfully treated for 27 days with amoxicillin-clavulanic acid. This was an atypical presentation of a common micro-organism implicated in lung infections.
Clenbuterol-Induced Myocarditis: A Case Report
Authors: Natassja Moriarty  , Nadeem Attar
Published: May 2021

Objective: We present a case of a 22-year-old bodybuilder diagnosed with myocarditis secondary to clenbuterol use. Results: The patient was primarily managed conservatively by the discontinuation of clenbuterol and the temporary use of dual anti-platelets, beta-blockers and nitrates. Conclusion: Clenbuterol is a long-acting beta-2 agonist primarily used in veterinary medicine. In recent years, it has been illegally marketed as a weight loss supplement because of its anabolic properties and is popular among fitness enthusiasts. It is our aim to use this case to underscore the adverse effects of this drug with hopes that tighter regulations will be instituted to stem its illegal distribution.
An Unusual Case of Allergic Reaction to Anakinra in a Patient with Tumor Necrosis Factor Receptor-1 Associated Periodic Syndrome (TRAPS) and Subsequent Canakinumab Treatment
Authors: Marta Mejias Trueba  , Marta Alonso Moreno  , Noemi Garrido Puñal  , Maria Soriano Martinez
Published: May 2021

Tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is a rare hereditary systemic autoinflammatory disease (SAID). Treatment is based on corticosteroids, but often requires the addition of a biologic drug (anti-TNF agent, IL-1 receptor antagonist, etc) to achieve symptom control. The addition of the second drug is not clearly defined and must take into account the characteristics and preferences of the patient. We describe a patient with TRAPS and an allergic reaction to anakinra which was difficult to manage clinically while alternative treatment was being identified.
Transient ST Segment Elevation in Two Patients with COVID-19 and a Normal Transthoracic Echocardiogram
Authors: Talal Asif  , Zafar Ali
Published: May 2021

We continue to learn about cardiac involvement in patients with COVID-19. These patients can develop acute coronary syndrome and severe myocarditis with a reduced ejection fraction. We describe two critically ill COVID-19 patients who developed ST elevation that resolved on repeat ECG without any intervention.
False-Negative Nasopharyngeal Swab RT-PCR Assays in Typical COVID-19: Role of Ultra-low-dose Chest CT and Bronchoscopy in Diagnosis
Authors: Marco Marando  , Adriana Tamburello  , Pietro Gianella
Published: May 2021

On 11 March 2020, the WHO declared COVID-19 a pandemic and global health emergency. We describe the clinical features and role of ultra-low-dose chest computed tomography (CT) and bronchoscopy in the diagnosis of coronavirus disease (COVID-19). In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage (BAL).
Pericardial Fluid in a COVID-19 Patient: Is It Exudate or Transudate?
Authors: Hassan H Allam  , Abdulhalim Jamal Kinsara  , Tareq Tuaima  , Shadwan Alfakeh
Published: May 2021

Background: Very limited information is available on pericardial effusion as a complication of COVID-19 infection. There are no reports regarding pericardial fluid findings in COVID-19 patients. Case description: We describe a 41-year-old woman, with confirmed COVID-19, who presented with a large pericardial effusion. The pericardial fluid was drained. We present the laboratory findings to improve knowledge of this virus. Discussion: We believe this is the first such reported case. Findings suggested the fluid was exudative, with remarkably high lactate dehydrogenase and albumin levels. We hope our data provide additional insight into the diagnosis and therapeutic options for managing this infection.
Multisystemic Infarctions in COVID-19: Focus on the Spleen
Authors: Mariana Santos Leite Pessoa  , Carla Franco Costa Lima  , Ana Carla Farias Pimentel  , José Carlos Godeiro Costa Júnior  , Jorge Luis Bezerra Holanda
Published: May 2021

The literature suggests that COVID-19 provokes arterial and venous thrombotic events, although the mechanism is still unknown. In this study, we describe patients with confirmed coronavirus infection associated with multisystemic infarction, focusing on splenic infarction. More data are required to elucidate how COVID-19 and thrombotic disease interact and so that preventive and early diagnosis strategies can be developed.
Body-Packing: A Rare Diagnosis to Keep in Mind
Authors: Maria Joao Gomes  , Ana João  , Inês Bargiela
Published: May 2021

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages.
Microvascular Coronary Artery Embolism Presenting as an OHCA STEMI Call Detected by CMR
Authors: Napohn Chongprasertpon  , Santhosh David
Published: May 2021

We describe a case of coronary artery embolism leading to an out-of-hospital cardiac arrest (OHCA) in which the diagnosis was achieved with utilisation of cardiac magnetic resonance imaging. The patient was otherwise well prior to this episode. Emergency diagnostic coronary angiography revealed patent arteries with TIMI 3 flow. Subsequent cardiac magnetic resonance imaging demonstrated myocardial infarction and focal microvascular obstruction in the infarcted territory. This report describes an uncommon case presentation, highlights areas for improvement in diagnostic criteria, and briefly discusses the currently available data regarding coronary artery embolism.
A Phantom Opacity on Chest Radiograph
Authors: Diana Pinho dos Santos  , Marlene Delgado  , Adelino Carragoso
Published: May 2021

The authors present a case of phantom tumour of the lung. This is a type of pleural effusion where fluids accumulate in the interlobar fissures, typically in the transverse fissure. Its prompt recognition avoids additional, unnecessary or expensive examination and treatment mistakes.
Liquid Presenting as Solid: A Rare Presentation of Acute Myeloid Leukaemia as a Solid Epidural Mass
Authors: Varsha Gupta  , Firas Ajam  , Gabriella Conte  , Alsadiq Al Hillan  , Kadhim Al-Banaa  , Vinit Singh  , Michael Levitt
Published: May 2021

Myeloid sarcoma (MS) is a very rare malignant tumour composed of myeloblasts. It most commonly involves soft tissue, bone, periosteum and lymph nodes, but unusual presentation sites have also been reported. Typically, MS evolves concurrently with active leukaemia or following remission, when it is known as secondary MS. But rarely MS can occur de novo without evidence of concomitant haematological disease. Herein, we report an unusual case of central nervous system-MS in a patient without evidence of concomitant haematological disease. In this case, progressive thoracic and lumbar pain with paraplegia ultimately led to the diagnosis of acute myeloid leukaemia. We also conducted a PubMed search for case reports, case series and reviews of past literature regarding central nervous system-MS and report our findings.
Reversible Cerebral Vasoconstriction Syndrome Associated with Infundibular Dilation
Authors: Héctor Montenegro-Rosales  , Blanca Karina González-Alonso  , Omar Cárdenas-Sáenz  , Alonso Gutierrez-Romero
Published: May 2021

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is defined as a clinical and radiological syndrome that comprises a group of disorders characterized by sudden-onset severe headache and segmental vasoconstriction of the cerebral arteries with resolution within 3 months. Case presentation: A 51-year-old female patient with a 2-week history of sudden-onset severe headache, visual disturbances and cerebellum; no relevant imaging findings, except for an infundibular dilation at the origin of the posterior communicating artery, and so, angiography was performed. When symptoms persisted, a new imaging study was carried out with findings of RCVS as the cause of the symptoms from the beginning. Conclusions: Findings of RCVS can be obtained in various vasculopathies of the nervous system and vasculitis, being misdiagnosed, and so, clinical suspicion is essential; if vasoconstriction is not demonstrated on the initial image and other diagnoses have been excluded, the patient should be managed as having possible or probable RCVS.
COVID-19 Associated Pneumonia and Pleural Effusion Masquerading as Heart Failure in Rheumatic Heart Disease
Authors: Jahanzeb Malik  , Nismat Javed  , Hesham Naeem  , Abdul Sattar Rana  , Umar Ikram
Published: May 2021

The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus.
Hydroxychloroquine in a G6PD-Deficient Patient with COVID-19 Complicated by Haemolytic Anaemia: Culprit or Innocent Bystander
Authors: François Mastroianni  , Vincent Colombie  , Géraldine Claes  , Axelle Gilles  , Frédéric Vandergheynst  , Sammy Place
Published: May 2021

Hydroxychloroquine has been used worldwide as a first-line treatment for patients hospitalized with COVID-19. Little is known about COVID-19 and its effects on patients with congenital red blood cell disorders. We report a case of haemolytic anaemia in a 32-year-old patient and a fortuitous highlighting of G6PD deficiency. We reviewed the literature to assess the risk of hydroxychloroquine use in this context.
COVID-19 and Cytomegalovirus Co-infection: A Challenging Case of a Critically Ill Patient with Gastrointestinal Symptoms
Authors: Pedro Amaral  , Bernadete Ferreira  , Sergio Roll  , Precil Neves  , luca pivetta  , Sara Mohrbacher  , Eduardo Dias  , Victor Sato  , Érico Oliveira  , Leonardo Pereira  , Alessandra Bales  , Luciana Nardoto  , jessica Ferreira  , Américo Cuvello-Neto  , Pedro Chocair
Published: May 2021

COVID-19 is a severe disease that has reached pandemic status. To the best of our knowledge, we describe the first case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient. We discuss the challenge of establishing the diagnosis as well as the management of tissue-invasive gastrointestinal CMV infection (TI-GI CMV) simulating vascular involvement and intestinal obstruction in a critically ill patient.