bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhaled Tranexamic Acid for Non-Massive Haemoptysis in a Rivaroxaban-Receiving Patient Not Responding to the Oral Form
Authors: Mugahid Eltahir  , Mohamed Nabil Elshafei  , Abdelnasser Elzouki
Published: May 2021

Haemoptysis is the expectoration of blood originating from the respiratory tract and occurs secondary to infection, malignancy, bronchiectasis or vascular disease. Its severity varies from minimal blood-streaked sputum to life-threatening haemorrhage. Therefore, prompt evaluation of the cause of the haemoptysis and its severity, and timely management are crucial. Although there is still no effective therapy for haemoptysis apart from treating the cause, inhaled tranexamic acid (TXA) might have a potential role in controlling non-massive haemoptysis. Here, we present a case of non-massive haemoptysis in a COPD patient with bronchiectasis on rivaroxaban for atrial fibrillation who responded to inhaled TXA following a failed trial of the oral formulation.
Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs
Authors: Gisela Vasconcelos  , Ligia Santos  , Catarina Couto  , Margarida Cruz  , Alice Castro
Published: May 2021

Tuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected.
COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era
Authors: Taku Harada  , Takashi Watari  , Taiju Miyagami  , Satoshi Watanuki  , Taro Shimizu  , Juichi Hiroshige
Published: May 2021

Diagnostic errors are a serious problem in healthcare. The diagnostic process is highly susceptible to cognitive bias and the current COVID-19 pandemic may cause normally accurate healthcare workers to make incorrect decisions. We report a case of aseptic meningitis that required five healthcare visits before it was correctly diagnosed. This case highlights the risk of anchoring bias and the importance of carefully assessing diagnostic processes during the COVID-19 pandemic.
COVID-19 Precipitating Euglycaemic Diabetic Ketoacidosis with SGLT2 Inhibitor Use
Authors: Jiali Fang  , Matthew Genco  , Rachel Caskey
Published: May 2021

Objective: To describe a patient who developed euglycaemic diabetic ketoacidosis (DKA) in the setting of SGLT2 inhibitor use precipitated by COVID-19. Patient and methods: A 52-year-old male with type II diabetes on empagliflozin and no history of DKA presented with symptoms of COVID-19 as well as laboratory findings consistent with euglycaemic DKA. His hospital course was complicated by recurrent episodes of euglycaemic DKA as well as hyperglycaemic DKA.  Conclusion: SGLT2 inhibitors should be held as early as possible in COVID-19 cases due to the risk of euglycaemic DKA. These patients should also have more intense glucose monitoring.
Acute Myocardial Infarction Secondary to Paradoxical Embolism
Authors: Abdullah R Alenezi  , Muath Alanbaei  , Islam Abouelenein
Published: May 2021

Patent foramen ovale is a risk factor for systemic embolic events such as cryptogenic stroke. Far less commonly, patent foramen ovale is associated with non-cerebral systemic embolic events. Paradoxical coronary artery embolism is a rare and underdiagnosed cause of acute myocardial infarction. It should be considered in patients presenting with myocardial infarction and an otherwise low-risk profile for atherosclerotic coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST elevation myocardial infarction. Echocardiography demonstrated patent foramen ovale with a significant shunt. In addition to the treatment of the acute coronary event, patent foramen ovale closure was performed to prevent recurrent paradoxical embolic events.
Angiotensin-Converting Enzyme (ACE) Inhibitors and Pancreatitis: A Potential Dose-dependent Relationship
Authors: Murtaza Hussain  , Smit S Deliwala  , Anoosha Ponnapalli  , Viraj Modi  , Ashok Kanagula  , Mamoon M Elbedawi  , Ghassan Bachuwa
Published: May 2021

Acute pancreatitis (AP) remains one of the most common causes of emergency department visits in the USA. The literature supports an association between angiotensin-converting enzyme inhibitors (ACEi), mainly at steady-state doses, and AP. We present a case of recurrent AP and pseudocyst formation following multiple ACEi dose adjustments after a steady-state period lasting for over a decade. Previous reports have rarely described ACEi-induced pancreatitis and pseudocyst development. ACEi can cause significant ductal obstruction and fluid retention due to its angioedema effects. Consequently, it may trigger AP complicated by pseudocyst formation. Therefore, ACEi administration must be considered in the appropriate clinical context.
Abdominal Cocoon or Encapsulating Peritoneal Sclerosis: A Rare Cause of Small Bowel Obstruction
Authors: Omar Lasheen  , Mohamed ElKorety
Published: May 2021

Encapsulating peritoneal sclerosis (EPS), also known as abdominal cocoon syndrome (AC) or sclerosing encapsulating peritonitis (SEP), is an uncommon condition typically presenting with features of bowel obstruction. We present the case of a 41-year-old male patient who presented to the accident and emergency department with a 7-day history of abdominal pain. Contrast CT of the abdomen and pelvis was ordered and was suggestive of small bowel obstruction involving most of the small bowel with no apparent transition point. Laparotomy showed a tough whitish fibrous membrane encasing the entire length of the small bowel. Advances in CT have made diagnosis possible before a decision on surgical intervention is made.
Mondor’s Disease: A Rare Cause of Chest Pain
Authors: Jorge Miguel Bastos Mendes  , João Filipe Ferreira Gomes  , Lurdes Rovisco Branquinho  , Catarina Oliveira Carvalho  , Patrícia Filipa Afonso Pais Pacheco Mendes  , João Luís Carvalho Madaleno
Published: May 2021

Introduction: Chest pain is a very frequent reason for seeking medical care. When there is no obvious cause, patients are sometimes subjected to tests and treatments that may be unnecessary and potentially harmful. Mondor's disease is a rare but usually benign and self-limited entity characterized by thrombophlebitis in a specific region. Case report: We report the clinical case of a 51-year-old man admitted to the emergency department with a 24-hour history of left chest pain with no other symptoms. Physical examination revealed a palpable subcutaneous cord-like structure that ultrasound confirmed to be thrombophlebitis of a superficial vein in the mammary region. Secondary causes were ruled out, and the condition resolved with ibuprofen and the application of local ice. Discussion: Mondor’s disease can be associated with neoplasms, trauma or hyperviscosity states, but it is mostly idiopathic. Usually, it resolves completely in 4–8 weeks without specific treatment. Because this infrequent diagnosis mainly relies on clinical findings, it is important that clinicians can recognize the syndrome.
Methicillin-Resistant Staphylococcus aureus and Candida albicans Secondary Bloodstream Co-Infection in a Patient with Tubular Oesophageal Duplication
Authors: Marta Carreira  , Joana Pimenta
Published: May 2021

Gastrointestinal duplications are rare congenital anomalies usually found incidentally in asymptomatic adult patients. We report a case of methicillin-resistant Staphylococcus aureus and Candida albicans secondary bloodstream co-infection in a 57-year-old male patient with a communicating tubular oesophageal duplication. The patient completed 21 days of medical treatment with vancomycin and anidulafungin and remained well without any complications, over 2 years of follow-up.
Portal Vein Thrombosis Secondary to Occult Polycythemia Vera
Authors: Antón FR Gameiro  , António Robalo Nunes  , Paula Guerra  , Estela Mateus  , Fátima Fernandes
Published: May 2021

Portal vein thrombosis (PVT) is an uncommon finding in patients without cirrhosis. The underlying aetiology is challenging and the condition has a wide differential diagnosis. We present a case of PVT in an anaemic patient with chronic iron and folic acid deficiency masking underlying polycythemia vera (PV). Only a careful review of the patient’s clinical history allowed the identification of a short period of laboratory erythrocytosis, 6 months before the clinical onset of PVT, while the patient was on iron and folic acid supplementation. The finding raised clinical suspicion of PV previously masked by iron deficiency anaemia. Subsequent investigation confirmed the presence of the JAK2 V617F mutation and, ultimately, showed that the patient met all diagnostic criteria for PV. Myeloproliferative disorders (MPD) are associated with systemic prothrombotic states. PV is distinguished clinically from other MPD by the presence of increased red blood cell mass. Moreover, patients with abnormal haematocrit values in the pre-JAK2 V617F era may have had occult or latent PV. Diagnosis confirmation requires a combination of major and minor criteria to capture occasional cases of occult PV. This case emphasizes the importance of always considering MPD in the aetiological investigation of PVT, even in patients who apparently do not fulfil the diagnostic criteria.
Unusual Location of a Recurrent Epidermoid Cyst
Authors: Oumniya Abouhanine  , Aicha Merzem  , Vianney Ndayishimiye  , Hasnaa Belgadir  , Omar Amriss  , Nadia Moussali  , Naima El Benna
Published: May 2021

Introduction: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions. Patient and Methods: We report the case of a 69-year-old female patient followed up for a symptomatic intradiploic epidermoid cyst of the temporal scale and left mastoid region, which had been operated on but recurred. Results: MRI demonstrated a well-limited lesion seen as a hyposignal on T1-weighted images, hypersignal on T2-weighted images, on FLAIR and on diffusion-weighted images not enhanced by gadolinium. The tumour was compressive, and bone lysis was seen on CT. Conclusion: Epidermoid cysts of the temporal bone are rare, benign lesions whose diagnosis is based on fluid signals seen on MRI but absent on FLAIR sequences.
Acute Myocarditis in a Patient with Exertional Heat Illness: A Rare Association
Authors: Aamir Shahzad  , Adeel Ahmad Khan  , Muhammad Awais Arif  , Zohaib Yousaf
Published: May 2021

Introduction: Exertional heat illness (EHI) is common in hot weather among young athletes, outdoor manual workers and military personnel. EHI can involve multiple organs of the body, including the muscles, kidneys and brain; however, myocardium involvement is infrequent. Materials and methods: We present the case of a 26-year-old male construction worker who worked outdoors in a hot arid environment. He presented with acute kidney injury and rhabdomyolysis and was diagnosed with EHI. During his hospital stay, he developed complete heart block, and cardiac MRI showed features of myocarditis. Work-up to identify other aetiologies of myocarditis was normal. This case highlights the effects of EHI on the myocardium. Conclusion: It is important to keep in mind the various effects of EHI on the myocardium. Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, necessitating specialist intervention.
Cutaneous Manifestations in Four Patients with COVID-19
Authors: Ana Gorgulho  , Maria Margarida Andrade  , Ana Paula Antunes  , Inês Nabais  , Filipa Taborda  , Marta Dias Ramos  , Ana Maria Grilo
Published: May 2021

As the numbers of SARS-CoV-2 infections increased globally, reports of cutaneous manifestations started to emerge. We describe several patients with COVID-19 who presented with skin changes. We noted such manifestations in four out of 110 patients (3.63%) and describe the clinical situation of each of these patients. Each patient had either a maculopapular or a urticariform rash. These manifestations have a broad differential diagnosis and it was difficult to exclude drug reactions. We hope to raise awareness of this possible manifestation of COVID-19 in order to raise suspicion of this diagnosis among clinicians when they encounter patients with fever and rash. Larger series that also include patients with mild disease and skin biopsies may be useful.
Ultrasound Detection of the Aquarium Sign at the Bedside
Authors: Mihiro Kaga  , Emi Yamashita  , Takeshi Ueda
Published: May 2021

Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible.  Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test. Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT).  Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.
The Use of Thalidomide in Severe Refractory Anaemia Due to Gastric Antral Vascular Ectasia (GAVE) in Cirrhosis?
Authors: Marcelo Aveiro  , Tatiana Rodrigues  , Tiago Rabadão  , Filipa Ferreira  , Mariana Teixeira  , Ana Oliveira  , Inês Vasconcelos
Published: May 2021

Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). There is a high recurrence rate, but some evidence suggests that thalidomide could play an important role in controlling refractory anaemia due to GAVE. The authors present the case of a cirrhotic patient with a recent diagnosis of GAVE, who underwent multiple endoscopic treatments and blood transfusions because of haematemesis. The patient started thalidomide and 6 months later, there was no recurrence of haematemesis and haemoglobin levels were stable, with no reported adverse effects.
Boldo-Induced Hepatotoxicity: A Case of Unexplained Jaundice
Authors: Ana Sá  , Teresa Pimentel  , Narciso Oliveira
Published: May 2021

An 87-year-old man was admitted with a 2-week history of asthenia, anorexia and jaundice. Blood tests showed increased serum liver enzymes. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization with supportive care. His wife revealed that the patient had repeatedly consumed infusions of Peumus boldus (commonly known as boldo) leaves during the previous month. After common causes of hepatobiliary pathology were excluded, boldo-induced hepatotoxicity was considered probable. Cessation of its consumption led to complete clinical and laboratory recovery within a week.
Epstein–Barr Virus-induced Meningitis-Retention Syndrome
Authors: Morika Suzuki  , Genya Watanabe  , Takashi Watari
Published: May 2021

Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection. We present the case of a 55-year-old man with fever and dysuria. At the time of hospitalization, the patient had no symptoms of meningitis, but signs of meningeal irritation appeared later during the course of the disease. Investigation revealed that this was a case of MRS due to Epstein–Barr virus. We have to consider MRS when examining patients with fever and urinary retention, as dysuria may precede meningitis symptoms.
Unusual Location of a Giant Cell Tumour
Authors: El Mehdi Kabir  , Fatiha Aghrib  , Hasnaa Belgadir  , Omar Amriss  , Aicha Merzem  , Nadia Moussali  , Naima El Benna
Published: May 2021

Giant cell tumours (GCT) are rare aggressive non-cancerous tumours which usually affect the long bones. We describe a case of GCT of the first rib in a young woman without a relevant history. The patient presented a left cervico-thoracic mass which was biopsied in our department (CT-guided biopsy). She was referred to the thoracic surgery department after histological results.
Severe Headache, Paraesthesias, Facial Diplegia and Pleocytosis: A Misleading Presentation of Guillain-Barré Syndrome
Authors: Mohamed Reda Belkhribchia  , Abderrahim Chekabab  , Yahya Naji  , Latifa Hadrane  , Soufiane Hassar  , Nissrine Louhab  , Najib Kissani
Published: May 2021

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculoneuropathy. Progressive limb weakness, diminished/absent reflexes, sensory disturbance, and variable autonomic dysfunction are its core clinical manifestations. Bifacial weakness with paraesthesias (BFP) is a rare regional variant of GBS and is characterized by simultaneous facial diplegia, distal paraesthesias and minimal or no motor weakness. The association of headache with classic GBS has been rarely reported in the literature, and has not yet been described in the BFP variant. Here we report a misleading case of BFP variant associated with severe headache and mild pleocytosis. The repetition of nerve conduction studies (NCS) was extremely beneficial in this confusing case.
Rare Presentation of a Metastatic Pancreatic Neuroendocrine Neoplasm Presenting with Atrial Flutter
Authors: Paraskevi C Fragkou  , Ioannis A Papadopoulos  , Antonios Papadopoulos  , Evangelos-Achilleas Kontoveros  , Gregory Kaltsas  , Foula Vassilara
Published: May 2021

Pancreatic neuroendocrine neoplasms (PanNENs) rarely secrete serotonin, which is the main cause of carcinoid syndrome. One of its unusual manifestations is carcinoid heart disease or Hedinger’s syndrome which is seldom accompanied by cardiac arrhythmias. We report the case of an 88-year-old woman who presented with recently experienced episodes of palpitations and a newly developed atrial flutter with a ventricular rate of 130 beats per minute. Echocardiography revealed thickened and tethered tricuspid and pulmonary valve leaflets causing severe valvular regurgitation and right ventricular dilatation. Episodes of intermittent diarrhoea over the previous 2 years were mentioned, making carcinoid syndrome our working diagnosis. The 5-hydroxyindoleacetic acid (5-HIAA) levels in a 24-hour urine collection specimen were elevated. Conventional imaging studies and a Ga-68 dodecane tetraacetic acid tyrosine-3-octreotate (DOTATATE) positron emission tomography/computer tomography (PET/CT) scan revealed the presence of a metastatic PanNEN arising from the pancreatic tail. The patient was managed with lanreotide and telotristat with remarkable improvement of her symptoms. To our knowledge, this is the first reported case of carcinoid syndrome presenting with atrial flutter as the initial symptom.
Spontaneous Rupture of a Bicuspid Aortic Valve in a Middle-Aged Weightlifter
Authors: Stylianos Karvounaris  , Evaggelos Sivitanidis  , Petros Mavrommatis  , Georgios Papaetis
Published: May 2021

We describe a 58-year-old Caucasian male weightlifter who presented with acute shortness of breath after finishing his extensive exercise routine. Acute aortic valve regurgitation, due to spontaneous rupture of a bicuspid aortic valve, was diagnosed. Urgent surgical intervention was carried out, during which the bicuspid aortic valve was resected and replaced with an On-X bileaflet mechanical valve. The patient remains asymptomatic and is treated with warfarin, being in excellent physical condition 4 years after aortic valve replacement.
A Seasonal Cause of Encephalitis: Influenza Virus A (H3N1) Infection
Authors: Rúben Reis  , Francisco Adragão  , Catarina Parente  , Inês Nunes  , Armindo Ramos  , Inês Nabais  , Isa Silva
Published: May 2021

Influenza virus infection can have a range of presentations, from asymptomatic to life-threatening disease. We present the case of a 57-year-old woman with a known history of schizophrenia (controlled with medication) who presented to our emergency department in a coma after experiencing a seizure. She had reported flu-like symptoms in the previous week, which evolved to dyspnoea and altered mental status culminating in seizures and coma. Influenza virus A (H3N1) was identified in the cerebrospinal fluid. Although a rare cause of encephalitis, the influenza virus should be considered in the differential diagnosis, especially during epidemics.
Surviving Extreme Anaemia
Authors: Joana Esteves  , Joana Fernandes  , Pedro Oliveira-Monteiro  , Mariana Almeida  , Luís Nogueira-Silva  , Jorge Almeida
Published: May 2021

Before the development of transfusion medicine, severe anaemia was an important cause of morbidity and mortality. The discovery of haematopoietic mechanisms and essential nutrients made it possible to easily treat and prevent this condition. Nevertheless, it is often fatal in patients presenting with extreme anaemia (haemoglobin levels <2 g/dl). We report the rare case of a 54-year-old woman who presented with profound megaloblastic anaemia (haemoglobin of 1.7 g/dl) due to vitamin B12 deficiency, and was successfully treated.
Granulomatosis with Polyangiitis: Recurrence or Treatment Consequences?
Authors: Andreia Diegues  , Joana Tavares  , Diogo Sá  , João Oliveira  , Diana Fernandes  , Josefina Santos  , Guillerme Rocha
Published: May 2021

Granulomatosis with polyangiitis (GPA) is the most common antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). We describe the case of a 38-year-old woman with relapsing GPA who presented with intracranial hypertension, followed by the appearance of cavitated lung nodules despite treatment with azathioprine. Clinical improvement and ANCA titre reduction were observed after rituximab treatment. We report a rare form of GPA relapse and highlight the challenge of following-up patients with GPA, in whom can be hard to distinguish relapse from the consequences of long-term immunosuppression.
Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature
Authors: Giannantoni Nadia Mariagrazia , Rigamonti Elia , Rampolli Francesca Irene , Grazioli-Gauthier Lorenzo , Allali Gilles , Vanini Gianluca
Published: May 2021

The current SARS-CoV-2/COVID-19 pandemic has led to a global health crisis. The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness affecting almost every organ including the central and peripheral nervous systems. Myoclonus, a less expected and relatively unusual neurological complication, together with ataxia, has lately been associated with SARS-CoV-2 infection. We describe the case of a 67-year-old male patient, admitted to our hospital for interstitial bilateral pneumonia due to SARS-CoV-2 infection, who progressively developed general myoclonus and later cerebellar ataxia and gait disturbance. Given the timeline from COVID-19 systemic symptoms to neurological manifestations and the normal results of extensive and non-conclusive diagnostic work-up (blood test, lumbar puncture, EEG, cerebral MRI), a para-infectious encephalopathy related to SARS-CoV-2 was contemplated and a high dose of methylprednisolone was started with prompt symptom improvement.  Further investigation and neuroepidemiological studies are needed to help define the mechanism of neuroinvasion and the entire spectrum of neurological manifestations of SARS-CoV-2 infection, even in mildly affected patients, in terms of prevention, treatment and possible neurological sequelae.
Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review
Authors: Al-banaa Kadhim , Alshaikhli Alfarooq , AL-Hareeri Asal , Abdelhalim Mohammed , Al-Hillan Alsadiq , Joshi Tejas
Published: May 2021

Antiphospholipid syndrome (APS) is a multisystemic autoimmune disease which presents with thromboembolic disease, pregnancy complications and the presence of antiphospholipid antibodies. There are some reports of arterial dissections in different sites of the body associated with APS. We describe two patients with APS who developed ischaemic stroke as a result of vertebral artery dissection in the absence of acquired and genetic risk factors for arterial dissection. We also conducted a systematic review of the literature for cases of arterial dissection associated with APS. We suspect that APS may be a potential cause of vasculopathy and arterial dissection. Further research is needed to explore this possible association.
The Impact of International Tourism on Economic Growth and Carbon Dioxide Emission in Asean Five Country
Authors: Juwita Aulia Hapsari , Suryanto Suryanto , Samudro Bhimo Rizky
Published: May 2021

The purpose of this paper is the international tourism have impact on economic growth and carbon dioxide (CO2) emissionsin ASEAN Five (Indonesia, Malaysia, Philippines, Thailand, Singapore) or not. There are increase in tourism receipts, GDP, and FDI as well as CO2 emissions approximately 9%, 5%, 4% and 26% respectively. They are always increasing, but is there any relation between international tourism, GDP and carbon dioxide (CO2). This research employs data from 1995 to 2018 to examine long-run equilibrium relationships between tourism, CO2, economic growth and foreign direct investment (FDI). Panel analysis with unit root and cointegration test approachis utilized. This paper found that there is a long-term equilibrium relationships between each variable.The tourism receipt, FDI and CO2 emissions affect economic growth positively and statistically significant. In addition, economic growth affect CO2 emissions while tourism does not affect CO2 and FDI indicates a negative relationship on CO2 emissions. Finally, the paper reveals that international tourism receipt affect economic growth but does not affect CO2.
The Influence of Financial Inclusion and Macroeconomic on Foreign Direct Investment (FDI) Flows in The Organization of Islamic Cooperation (OIC) Countries
Authors: Andiansyah Farma
Published: May 2021

Foreign capital flows are important factors in the development of sustainable economies, especially in developing countries such as the OIC countries. Lately, the rapid development of the financial sector and macroeconomic stability became a serious concern by foreign investors, where financial inclusion and macroeconomics played an important role in attracting direct foreign capital flows (FDI). The study aims to investigate the role of financial inclusion and macroeconomic variables on the foreign direct flow of capital (FDI) by using data panels in 8 OKI member States during the 2012-2018 time span. The research uses the Fix Effect Model (FEM) Panel data Analysis tool, which is believed to be able to explain the correlation between independent variables and more accurate dependents. As for the results of the study showed that in partial only variable avaibility (the number of branches of the bank/100,000 adults) is a significant positive draws FDI in the OKI country. While on macroeconomic variables the exchange rates have significant negative effect on FDI, while interest rates and economic growth have significant positive relationships in attracting FDI.
Atualidade da performance das narrativas como vivências continuadas
Authors: Simao Luciano Vinhosa
Published: May 2021

Neste ensaio avançaremos a ideia de que a performance, a partir de seus agregados residuais, tais como a fotografia, os textos críticos, os relatos descritivos e os depoimentos de testemunhas, tem vida continuada nas narrativas que a reconstituem e a recriam no interior de uma comunidade dada. O poder imaginal do sujeito é ferramenta, a mais eficaz, a propiciar essa vida da performance no espaço social.
Os estados da pesquisa artística, da instituição à obra de arte
Authors: Godói Vagner
Published: May 2021

Este artigo propõe uma reflexão renovada sobre a pesquisa do artista, institucionalizada na universidade e considerada uma das qualidades mais proeminentes da arte contemporânea. O texto aproxima o contexto brasileiro do internacional, de modo a conciliar a pesquisa artística universitária com a ideia de pesquisa artística que é intrínseca à obra de arte.
Perinatal and Long Term Outcome of Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome
Authors: Casati D. , Laoreti A. , Faiola S. , Lanna M.
Published: May 2021

Twin-twin transfusion syndrome (TTTS) is the most harmful complication of monochorionic twin pregnancies. Fetoscopic laser coagulation of placental vascular anastomoses represents the causative and first-line treatment for the disease. Substantial improvements in survival rates and long-term outcome have been achieved during the last 20 years of practice. This is due to improvements in antenatal detection of the condition, surgical skills and centralization in the referral fetal therapy unit, as well as postnatal intensive care and follow up programs. Major morbidity issues concern cardiologic, renal and cerebral functions and are mainly caused by intrauterine haemodynamic imbalances and prematurity. This review summarizes the current evidence on the prognosis of monochorionic twins survivors after TTTS treated by laser surgery, focusing on perinatal and long-term outcomes.
Combined Korean Medicine Treatment of a Rare Case of Burst Fracture in an Elderly Patient with Kissing Spine
Authors: Park Eun-Young , Choi Jong-Ho , Jo Hoo-In , Lee Soo-Kyung , Lee June-Haeng , Kang Sun-Woo , Won Yoon-Jae , Choi Sung-Ryul , Cho Yu-Jin
Published: May 2021

A burst fracture refers to the fracture of the anterior and middle vertebral columns which are moving into the spinal canal causing neurological impairments, generally requiring surgical treatment. We herein report a rare case of burst fracture with kissing spine in a 90-year-old man who had severe lower back pain that worsened during back extension. Considering the surgical treatment risk, he was hospitalized at a Korean medicine hospital for 85 days and underwent combined Korean medicine treatments including pharmacopuncture, herbal medicine, chuna, deep-fascia meridian therapy, walking practice, and abdominal breathing. Based on patient-reported scales, his pain was alleviated, and his physical function improved. Furthermore, his range of motion and walking time increased. This case report suggests that combined Korean medicine treatments could be an effective alternative for patients with burst fracture who have surgery risks.
Enhancement of axial resolution and image contrast of a confocal microscope by a microsphere working in noncontact mode
Authors: Yang Xiliang , Hong Minghui
Published: May 2021

A new technique, to the best of our knowledge, for improving the axial resolution and imaging contrast of a reflection mode confocal microscope is proposed. A 50 µm silica microsphere is added in front of the objective lens to enhance both the focusing of illumination and the collection of reflected and scattered light from sample surfaces in noncontact mode. An adjustable pinhole is used to compensate the displacement of the focal point in the axial direction. Various samples, including grouped nanolines and nanosteps, are used to demonstrate imaging performance. By comparison to an NA 0.9 commercial confocal microscope, the new setup achieves the axial resolution up to 100 nm and increases the image contrast by 4.56 times. The entire setup offers a cost-effective solution for high imaging performance, which can be applied in many fields from nanotechnology to biology.
ITO-based microheaters for reversible multi-stage switching of phase-change materials: towards miniaturized beyond-binary reconfigurable integrated photonics
Authors: Taghinejad Hossein , Abdollahramezani Sajjad , Eftekhar Ali A. , Fan Tianren , Hosseinnia Amir H. , Hemmatyar Omid , Eshaghian Dorche Ali , Gallmon Alexander , Adibi Ali
Published: May 2021

Inducing a large refractive-index change is the holy grail of reconfigurable photonic structures, a goal that has long been the driving force behind the discovery of new optical material platforms. Recently, the unprecedentedly large refractive-index contrast between the amorphous and crystalline states of Ge-Sb-Te (GST)-based phase-change materials (PCMs) has attracted tremendous attention for reconfigurable integrated nanophotonics. Here, we introduce a microheater platform that employs optically transparent and electrically conductive indium-tin-oxide (ITO) bridges for the fast and reversible electrical switching of the GST phase between crystalline and amorphous states. By the proper assignment of electrical pulses applied to the ITO microheater, we show that our platform allows for the registration of virtually any intermediate crystalline state into the GST film integrated on the top of the designed microheaters. More importantly, we demonstrate the full reversibility of the GST phase between amorphous and crystalline states. To show the feasibility of using this hybrid GST/ITO platform for miniaturized integrated nanophotonic structures, we integrate our designed microheaters into the arms of a Mach-Zehnder interferometer to realize electrically reconfigurable optical phase shifters with orders of magnitude smaller footprints compared to existing integrated photonic architectures. We show that the phase of optical signals can be gradually shifted in multiple intermediate states using a structure that can potentially be smaller than a single wavelength. We believe that our study showcases the possibility of forming a whole new class of miniaturized reconfigurable integrated nanophotonics using beyond-binary reconfiguration of optical functionalities in hybrid PCM-photonic devices.
True color 3D imaging optimization with missing spectral bands based on hyperspectral LiDAR
Authors: Chen Bowen , Shi Shuo , Chen Biwu , Xu Qian , Gong Wei , Li Fei
Published: May 2021

True color 3D imaging plays an essential role in expressing target characteristics and 3D scene reconstruction. It can express the colors, and spatial position of targets and is beneficial for classification and identification to investigate the target material. As a special case of target imaging, true color 3D imaging is important in understanding and reconstructing real scenes. The fusion of 3D point clouds with RGB images can achieve object reconstructions, yet varying illumination conditions and registration problems still exist. As a new active imaging technique, hyperspectral LiDAR (HSL) system, can avoid these problems through hardware configuration, and provide technical support for reconstructing 3D scenes. The spectral range of the HSL system is 431-751nm. However, spectral information obtained with HSL measurements may be influenced by various factors, that further impinge on the true color 3D imaging. This study aims to propose a new color reconstruction method to improve color reconstruction challenges with missing spectral bands. Two indoor experiments and five color reconstruction schemes were utilized to evaluate the feasibility and repeatability of the method. Compared with the traditional method of color reconstruction, color reconstruction effect and color similarity were considerably improved. The similarity of color components was improved from 0.324 to 0.762. Imaging results demonstrated the reliability of improving color reconstruction effect with missing spectral bands through the new method, thereby expanded the application scopes of HSL measurements.
The Exon Junction Complex and intron removal prevent re-splicing of mRNA
Authors: Joseph Brian , Lai Eric C.
Published: May 2021

Accurate splice site selection is critical for fruitful gene expression. Recently, the mammalian EJC was shown to repress competing, cryptic, splice sites (SS). However, the evolutionary generality of this remains unclear. Here, we demonstrate the Drosophila EJC suppresses hundreds of functional cryptic SS, even though most bear weak splicing motifs and are seemingly incompetent. Mechanistically, the EJC directly conceals cryptic splicing elements by virtue of its position-specific recruitment, preventing aberrant SS definition. Unexpectedly, we discover the EJC inhibits scores of regenerated 5’ and 3’ recursive SS on segments that have already undergone splicing, and that loss of EJC regulation triggers faulty resplicing of mRNA. An important corollary is that certain intronless cDNA constructs yield unanticipated, truncated transcripts generated by resplicing. We conclude the EJC has conserved roles to defend transcriptome fidelity by (1) repressing illegitimate splice sites on pre-mRNAs, and (2) preventing inadvertent activation of such sites on spliced segments.
Whole-genome analysis of Malawian Plasmodium falciparum isolates identifies possible targets of allele-specific immunity to clinical malaria
Authors: Shah Zalak , Naung Myo T. , Moser Kara A. , Adams Matthew , Buchwald Andrea G. , Dwivedi Ankit , Ouattara Amed , Seydel Karl B. , Mathanga Don P. , Barry Alyssa E. , Serre David , Laufer Miriam K. , Silva Joana C. , Takala-Harrison Shannon
Published: May 2021

Individuals acquire immunity to clinical malaria after repeatedPlasmodium falciparuminfections. Immunity to disease is thought to reflect the acquisition of a repertoire of responses to multiple alleles in diverse parasite antigens. In previous studies, we identified polymorphic sites within individual antigens that are associated with parasite immune evasion by examining antigen allele dynamics in individuals followed longitudinally. Here we expand this approach by analyzing genome-wide polymorphisms using whole genome sequence data from 140 parasite isolates representing malaria cases from a longitudinal study in Malawi and identify 25 genes that encode possible targets of naturally acquired immunity that should be validated immunologically and further characterized for their potential as vaccine candidates.
Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients
Authors: de Almeida Danilo Candido , Franco Maria do Carmo Pinho , dos Santos Davi Rettori Pardo , Santos Marina Colella , Maltoni Isabela Soucin , Mascotte Felipe , de Souza Alexandra Aparecida , Pietrobom Paula Massaroni , Medeiros Eduardo Alexandrino , Ferreira Paulo Roberto Abrão , Machado Flavia Ribeiro , Goes Miguel Angelo
Published: May 2021

Background

COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear.

Methods

We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed.

Results

First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge.

Conclusions

In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.
Smooth ROC curve estimation via Bernstein polynomials
Authors: Wang Dongliang , Cai Xueya
Published: May 2021

The receiver operating characteristic (ROC) curve is commonly used to evaluate the accuracy of a diagnostic test for classifying observations into two groups. We propose two novel tuning parameters for estimating the ROC curve via Bernstein polynomial smoothing of the empirical ROC curve. The new estimator is very easy to implement with the naturally selected tuning parameter, as illustrated by analyzing both real and simulated data sets. Empirical performance is investigated through extensive simulation studies with a variety of scenarios where the two groups are both from a single family of distributions (symmetric or right skewed) or one from a symmetric and the other from a right skewed distribution. The new estimator is uniformly more efficient than the empirical ROC estimator, and very competitive to eleven other existing smooth ROC estimators in terms of mean integrated square errors.
Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes
Authors: Åmark Hanna , Pilo Christina , Hulthén Varli Ingela
Published: May 2021

Introduction

The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy.

Material and methods

This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0.

Results

In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group.

Conclusion

In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.
Trend and epidemiological patterns of animal bites in Golestan province (Northern Iran) between 2017 and 2020
Authors: Bay Vahid , Jafari Mehdi , Shirzadi Mohammad Reza , Bagheri Ali , Masoudi Asl Irvan
Published: May 2021

Background

Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century.

Methods

This cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013–2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics.

Results

The incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin.

Conclusion

The increasing rates of animal bites in the study area as well as the higher rate compared to the national average indicates the need for further review of animal bite control programs.