bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Perplexing Case of the Pituitary Apoplexy
Authors: Huang Wenyin , Haddad Taleen , Hasimja Saraqini Delvina 
Published: July 2018

We report an unusual clinical presentation of adrenal insufficiency. A 54-year-old post-menopausal woman with well-controlled hypertension presented with 1 month of progressive anorexia and intermittent low-grade fever. She underwent extensive initial investigations that included computed tomography (CT) of the head, chest, and abdomen; gastroscopy; infectious and autoimmune workups; all of which were unrevealing. The head CT did not demonstrate any hyperintense or space-occupying lesion. When she represented to hospital, we noticed an empty sella on the initial CT. This prompted a magnetic resonance imaging study that revealed pituitary apoplexy, leading to eventual diagnosis of secondary adrenal insufficiency (morning cortisol 81 nmol/L and ACTH 1 pmol/L). Her symptoms resolved within 24 hours of glucocorticoid replacement. Diagnosis was elusive due to patient’s atypical presentation – she did not have visual symptoms or cranial nerve deficits to suggest pituitary apoplexy, and also did not have any objective findings such as hypotension or electrolyte abnormalities to suggest adrenal insufficiency.
RÉSUMÉ
Nous rapportons ici un tableau clinique inhabituel en matière d’insuffisance surrénale. Une femme de 54 ans, ménopausée, dont l’hypertension est bien contrôlée, souffre depuis un mois d’anorexie progressive et d’une fièvre légère intermittente. Elle a subi de nombreux examens, notamment de tomodensitométrie (TDM) de la tête, du thorax et de l’abdomen; une gastroscopie; ainsi que des investigations techniques sur les plans infectieux et auto-immuns. Tous ces examens ont été vains. La TDM de la tête n’a montré aucune lésion hyperintense ou étendue. Lorsque la patiente s’est présentée de nouveau à l’hôpital, une relecture de la TDM initiale indiqua une selle turcique vide. Cela nous a incité à effectuer un examen d’imagerie par résonnance magnétique, qui révéla une apoplexie hypophysaire et nous mena finalement à un diagnostic d’insuffisance surrénale secondaire (taux de cortisol matinal de 81 nmol/L et ACTH de 1 pmol/L). Les symptômes se sont résorbés dans les 24 heures qui suivirent l’administration de glucocorticoïdes. C’est en raison du tableau atypique des symptômes de la patiente que le diagnostic a été difficile à cerner – il y avait absence de symptômes au niveau des yeux et absence de déficits au niveau des nerfs crâniens, ce qui aurait pu indiquer une apoplexie hypophysaire. De plus, il y avait absence de signe objectif comme de l’hypotension ou des anomalies électrolytiques indiquant une insuffisance surrénale.
Hepatic Sarcoidosis
Authors: Nero Joshua , Gilmour Gregory 
Published: July 2018

Sarcoidosis is an idiopathic multisystem disease, characterized by non-caseating granulomas in affected organs. Pulmonary involvement is the most common site of disease activity, although the disease can also affect the liver, bone marrow, and heart. We report a case of symptomatic hepatic sarcoidosis in a 31-year-old African-Canadian woman which responded to treatment with doxycycline.
The patient was referred to internal medicine from a peripheral emergency department after presenting with fever, hepatitis, and thrombocytopenia with a computed tomography scan concerning for hepatic abscesses. The patient remained febrile with worsening liver enzymes despite broad spectrum antibiotics. An extensive infectious workup was negative. Biopsies of bone marrow and liver revealed non-caseating granuloma, and an elevated angiotensin-converting enzyme level. Doxycycline, initially started for presumptive infective etiology, lead to rapid resolution of symptoms and normalization of biochemical markers. To our knowledge, this is the first case report of doxycycline used to treat hepatic sarcoidosis in Canada.
Résume
La sarcoïdose est une maladie multisystémique idiopathique, caractérisée par la présence de granulomes non caséeux dans les organes affectés. Les poumons sont le plus souvent le site de la maladie, quoique celle-ci se manifeste aussi dans le foie, la moelle osseuse et le cœur. Nous décrivons ici un cas de sarcoïdose hépatique symptomatique chez une afro-canadienne de 31 ans qui a répondu à un traitement à la doxycycline.
La patiente a été aiguillée en médecine interne par un service des urgences en périphérie après s’y être présentée avec de la fièvre, une hépatite et une thrombopénie et y avoir subi une tomodensitométrie relative à des abcès au foie. Malgré l’administration d’antibiotiques à large spectre, la patiente est demeurée fébrile et ses enzymes hépatiques ont continué de se dégrader. Les nombreux tests infectieux effectués se sont révélés négatifs. Des biopsies de la moelle osseuse et du foie ont révélé la présence de granulomes non caséeux et un taux élevé de l’enzyme de conversion de l'angiotensine. La doxycycline, initialement administrée pour une étiologie infectieuse présumée, a rapidement entrainé la résorption des symptômes et la normalisation des marqueurs biochimiques. À notre connaissance, il s’agit du premier cas rapporté au Canada de traitement d’une sarcoïdose hépatique par la doxycycline.
Delayed Allergic Cutaneous Hypersensitivity to Icodextrin
Authors: Adunuri NIKESH Reddy , Zafar Saira 
Published: July 2018

Rashes pose a unique challenge to general internists. Here we present a case of a 51-year-old female with end-stage renal disease (ESRD) on peritoneal dialysis who presented to a General Internal Medicine clinic with a vesiculobullous rash on palms and soles 6 months after using icodextrin dialysate, a widely used osmotic agent in peritoneal dialysis. The investigations were positive for an elevated eosinophil count, elevated IgE level and a skin biopsy consistent with an allergic reaction. Her symptoms and labs normalized after stopping icodextrin. There are some reports of allergic reactions to icodextrin which usually occur within a month of initiation of the agent and are self-limiting. Here we hope to report a case of a reaction that occurred 6 months after using icodextrin.
Resume
Les éruptions cutanées posent un défi particulier aux internistes généraux. Nous rapportons ici le cas d’une femme de 51 ans atteinte d’insuffisance rénale terminale (IRT), sous dialyse péritonéale, qui se présente à une clinique de médecine interne générale avec une éruption cutanée vésiculo-bulleuse sur les paumes et la plante des pieds. Depuis six mois, la patiente utilise un dialysat d’icodextrine, un agent osmotique largement utilisé en dialyse péritonéale. Les analyses ont révélé une numération élevée des éosinophiles, un taux élevé d’IgE et une biopsie cutanée a indiqué la présence d’une réaction allergique. Les symptômes et les résultats d’analyses se sont normalisés après l’arrêt de l’icodextrine. Des réactions d’allergie à l’icodextrine ont déjà été rapportées, mais celles-ci surgissent habituellement dans le mois suivant le début de l’usage de l’agent et se résorbent d’elles-mêmes. Nous désirons signaler un cas de réaction survenue six mois après le début de l’utilisation de l’icodextrine.
A Curious Case of Hypercalcemia
Authors: Motomura Douglas Ian Noboru , Cameron Paul Allan 
Published: July 2018

Hypercalcemia is a clinical entity commonly seen on Internal Medicine inpatient units. Through standard diagnostic algorithms, the etiology of most cases can be elucidated. Brivaracetam is a novel anti-epileptic agent that binds synaptic vesicle protein 2A shown to significantly reduce seizure frequency. We describe the first case of hypercalcemia secondary to brivaracetam.
Résumé
L'hypercalcémie est une entité clinique couramment observée sur les unités d'hospitalisation en médecine interne. Grâce à des algorithmes de diagnostic standard, l'étiologie de la plupart des cas peut être élucidée. Brivaracetam est un nouvel agent anti-épileptique qui lie la protéine de vésicule synaptique 2A montrée pour réduire significativement la fréquence de saisie. Nous décrivons le premier cas d'hypercalcémie secondaire à Brivaracetam.
Q Fever Endocarditis: A Diagnostic Dilemma
Authors: Jeffery Rebecca Angela , Walsh Steve , Haroon Babar 
Published: July 2018

Q fever is a zoonotic disease, typically spread by aerosol transmission from infected animals to humans. It can present with a variety of clinical manifestations, but endocarditis is the most common manifestation. We present a case of an 80-year-old man with a prior bioprosthetic aortic valve (AV) replacement who presented with chronic constitutional symptoms that acutely worsened over two days leading up to his presentation. An initial echocardiogram was equivocal for endocarditis, and bloodwork revealed a bicyotpenia, elevated ferritin, and negative blood cultures. He was diagnosed with Q fever endocarditis after positive serology for Coxiella burnetti. Treatment for this patient involved a 24-month course of doxycycline and hydroxychloroquine.
Résumé
Q la fièvre est une maladie zoonotique, généralement propagée par la transmission en aérosol des animaux infectés aux humains. Il peut présenter avec une variété de manifestations cliniques, mais l'endocardite est la manifestation la plus commune. Nous présentons un cas d'un homme de 80 ans avec une valve aortique antérieure de bioprothèse (AV) de remplacement qui a présenté des symptômes chroniques de la Constitution qui s'est aggravée de façon aiguë pendant deux jours menant à sa présentation. Un échocardiogramme initial a été équivoque pour l'endocardite, et analyses a révélé une bicyotpenia, une élévation de la ferritine et des cultures sanguines négatives. On lui a diagnostiqué une endocardite de fièvre Q après une sérologie positive pour Coxiella burnetti. Le traitement pour ce patient a impliqué un cours de 24 mois de doxycycline et de hydroxychloroquine.
The Recurrent Flush: A Case and Review of Systemic Mastocytosis
Authors: Mansoor Wasim , Cavalcanti Rodrigo , Chugh Shaan 
Published: July 2018

Systemic Mastocytosis (SM) is a hematologic neoplasm characterized by an abnormal proliferation of mast cells, which have the potential to infiltrate one or more visceral organs. Patients can present with a wide constellation of symptoms making it a challenging diagnosis for clinicians. Non-specific symptoms such as fatigue, headache, and weight loss may predominate; however, some patients may present with acute onset of urticaria, flushing, and diarrhea. Due to its rarity, clinicians often face a challenge in evaluating, diagnosing and effectively treating systemic mastocytosis. Identification during the indolent phase is important as SM can progress to aggressive leukemias or myeloproliferative disorders. In this article, we present a case of SM, and discuss current practices in diagnosis, evaluation and management. We conclude with future directions for treatments and diagnosis
McMaster University Internal Medicine International Health Elective: A Survey-Based Study to Understand Achievements and Lessons Learned
Authors: Duncan MD Andrew W. , Waiswa MBChB MMed (Int Med) Musa , Prebtani BScPhm MD Ally P.H. , Verhovsek MD Madeleine M. , O’Shea MD MPH Tim M. 
Published: July 2018

The McMaster Internal Medicine International Health Elective (IHE) has been placing senior medical residents (PGY-3) in an elective setting in a teaching hospital in Kampala, Uganda, for the past 7 years. This article discusses a study in which the authors electronically mailed a survey to alumni of this elective to evaluate important aspects of program participation from the residents’ point of view. The factors most commonly cited as being important in the decision to apply to the McMaster IHE were to gain experience practising medicine in a resource-limited setting and to gain exposure to diseases and conditions not commonly encountered in Canada. Most residents (61.5%) planned to have some involvement in global health prior to their elective, and 100% felt the elective experience made them more likely to take part in global health activities in the future. IHEs offer a unique opportunity for residents to explore global health. Residents participating in this survey found the McMaster Internal Medicine IHE to be a successful endeavour.
Pelaksanaan Tindak Pidana Pemerkosaan (Studi Komparasi antara Hukum Islam dan Qanun Jinayat di Aceh)
Authors: Nurhayati Nurhayati 
Published: July 2018

Rape is a sexual crime that indicates highly enough rate in Indonesia. Rape according to the view of Islamic law is different from adultery. Adultery is sexual intercourses between man and woman without legal marriage and carried out consciously on the basis of mutual needs. Rape is not doing of just sexual intercourse but it has additional element that is carried out with force, violence or threats. Sanctions against rapists according to Islamic law is exactly the same as the act of adultery that is stoning and damping. Such sanctions apply only to rapists and not to the victim. Acehâ€™s QaÌ„nuÌ„n on JinaÌ„yat (criminal) law for the people is regulated in Regional Regulation (PERDA) No. 6 of 2014. QaÌ„nuÌ„n JinaÌ„yat for the people of Aceh is a unity of criminal law formed based on Islamic Shari'ah values â€‹â€‹derived from the Qurâ€™an and HÌ£adiÌ„sÌ‡. According to QaÌ„nuÌ„n JinaÌ„yat Aceh, everyone doing sexual rape crime is threatened with â€˜uquÌ„bat taâ€™ziÌ„r which in its application there is a difference of punishment with what is in the view of Islamic law.
Pengaruh Model Problem Based Learning Terhadap Kemampuan Berpikir Kritis Peserta Didik Pada Materi Kalor
Authors: Al-Fikry Izzah , Yusrizal Yusrizal , Syukri Muhammad 
Published: July 2018

Studi ini bertujuan untuk menentukan pengaruh model Problem Based Learning (PBL) terhadap kemampuan berpikir kritis (KBK) peserta didik pada materi kalor. Metode yang digunakan adalah quasi experimental dengan pretest-posttest control group design. Populasi pada penelitian ini yaitu seluruh peserta didik kelas X MIA dan sampelnya peserta didik kelas X MIA-2 dan X MIA-3 yang dipilih secara purposive sampling. Data dikumpulkan dengan menggunakan tes pilihan ganda beralasan sebanyak 15 soal. Data dianalisis dengan menggunakan program microsoft excel. Hasil akhir menunjukkan bahwa nilai rata-rata kelas eksperimen lebih tinggi dari kelas kontrol yaitu 92,32 dan 74,41. Hasil perhitungan N-gain diperoleh rata-rata pada kelas eksperimen dan kelas kontrol adalah 86,59 dan 52,94. Dengan demikian, dapat disimpulkan bahwa model PBL secara signifikan lebih baik dalam meningkatkan KBK peserta didik dibandingkan model konvensional.
EKSISTENSI HUKUM PIDANA ADAT DI INDONESIA : Pengkajian Asas, Norma, Teori, Praktik dan Prosedurnya
Authors: Mulyadi Lilik 
Published: July 2018

Existence of indigenous Indonesian criminal law examined from the perspective of normative (ius constitutum) set forth in Article 18 B of the 1945 Amendment, Article 1, Article 5 paragraph (3) sub B Drt Law No. 1 of 1951, Article 5 paragraph (1), Article 10 paragraph (1) and Article 50 paragraph (1) of Law No. 48 of 2009. Then partial in certain areas such as Nanggroe Aceh Darussalam stipulated in Law No. 44 of 1999, Act No. 11 of 2006, the next is implemented in the form of Qanun both provincial and district levels. Next in Bali set up and implemented in the form of Awig - Awig Village People (Pakraman) as well as from the perspective of ius constituendum set out in Article 2 paragraph (1), (2) of the RUU KUHP of 2012. Then the level of principle set Ciwasasana book or book Purwadhigama, Book of Gajah Mada, Simbur Cahaya, Book Kuntara Raja Niti, Book Lontara 'ade' and Awig awig. In addition, examined from the perspective of theory, practice and procedures found in the form jurisprudence Mahkamah Agung RI as Putusan Mahkamah Agung RI No. 42 K/Kr/1966 Tanggal 8 Januari 1966, Putusan Mahkamah Agung RI No. 275 K/Pid/1983 tanggal 29 Desember 1983 and sanctions adat (traditional medicine) for recovery of the balance essentially magical nature, the cosmos recovery to restore the disturbed balance in order to be religio magic back. Later in the study of criminal law the existence of indigenous Indonesian criminal law is at the level of dogmatic law, legal theory and philosophy of law. Therefore customary criminal law holistically animates all levels of law in the practice of law so that the existence of the law - dimensional nature of criminal law is undoubtedly indigenous capabilities as a characteristic practice of law in Indonesia. Keywords: criminal law customary, traditional sanctions, as well as the principles, norms, theories, practices and procedures
PROBLEMATIKA PELAKSANAAN KEKUASAAN KEHAKIMAN (Dalam Konteks Pelaksanaan Fungsi Check and Balances System)
Authors: Rumadan Ismail 
Published: July 2018

Efforts to support the creation of an independent judiciary as a constitutional mandate in its development has held several changes to the Judicial Authority Law, the last change is the Act Nomber 48 of 2009 on Judicial Authority. But these changes, when studied in depth is still set aside some very fundamental issues. The first is related to the function of law enforcement in the context of the criminal justice system. This concept requires that the law enforcement process should be integrated into a system of justice, but in fact the process of criminal justice, police and prosecutors are in a different scope of judicial power, so that the position can thus be ensured in the intervention process should be independent of law enforcement and free from any influence. The second problem is, of externally monitoring the functioning of the judicial power, which formally made by the Judicial Commission and the desired control by Parliament (as in the draft of the Supreme Court). Supervision models run by Judicial Commission nor desired by the House very serious effect on the performance of the functions of the judicial authorities even add complexity implementation of judicial power function itself, so that the implementation of judicial power considered not able to guarantee legal certainty and justice for litigants. This paper is limited to the study of these two issues in order to reinforce our commitment to build a sound administration of justice and independent in order to provide access to justice for all people and a healthy justice will only be realized in a reciprocal relationship between the environment and the environmental justice community. Keywords: The Judiciary, Law Enforcement
Formation of the Organizational and Functional Structure of Library Education in the Republic of Cameroon
Authors: Zemengue J. 
Published: July 2018

The paper considers the works of Russian specialists and scientists from other countries devoted to the organizational and functional process of training of library personnel. The author proposes to use this experience to form the system of library education in the Republic of Cameroon. The organizational and functional structure of library staff training in the Republic of Cameroon should include the following multifunctional and successively interrelated levels: specialized secondary library education, higher library education, training of scientific personnel and additional training programs for the professional development and retraining of specialists. For realization of such a structure dedicated to the training of specialists, it would seem appropriate to decide at the government level on the establishment of a Library and Information Science College in the country, which would focus on training of mid-level specialists, primarily for small public libraries. At the University of Yaounde ІІ, it is important to create a Library and Information Science Faculty and start the Master’s Degree training of students in librarianship; and in the longer term, Postgraduate programs for scientific staff. Organisation of qualification improvement and professional retraining can be carried out by joint efforts of the University of Yaounde ІІ and the major libraries of Cameroon. Practical introduction of the organizational and functional structure as the basis for implementation of training system for library staff in the Republic of Cameroon shall be carried out on the basis of classical management functions: planning, organization, motivation, coordination and regulation, control, taking into account the external and internal factors influencing the training of library staff.
الملك المنصور الثاني محمد صاحب حماة (642 – 683هـ/1245-1284م)
Authors: Ahmed Ahmed S. 
Published: July 2018

الملخص
ان الغرض من البحث اعطاء صورة عن حياة الملك المنصور الثاني المعروف بصاحب حماة، وهو شخصية ايوبية ظهر في وقت كانت تعاني فيه الدولة الايوبية من التمزق والتفكك، وتم تقسيمها الى اربعة مباحث رئيسية تناول اولها حياته الشخصية للتعرف من قريب على نشأته وكل ما يخص اسرته وتناول المبحث الثاني حياته السياسية من خلال اعطاء صورة واضحة عن والده الملك المظفر (626-642هـ/1229-1284م) الذي توفي عندما كان الملك المنصور في سن الصبا وكيف اصبح تحت وصاية والدته وتوليه الحكم في حماة، أما المبحث الثالث فتناول العلاقات السياسية الداخلية بين الايوبيين التي تبين انها تميزت بالقلق والافتقار الى خط سياسي واضح بسبب تعارض المصالح وتضاربها دون اعتبار للمصلحة العامة او المستقبل السياسي للعائلة الايوبية ودولتهم وموقفه من الصراع بين ملوك الايوبيين في بلاد الشام ومصر، واخيراً تطرق المبحث الرابع إلى علاقاته مع المماليك حكام مصر الجدد وعلاقاته مع المغول والارمن ودوره في معارك عين جالوت ومعركة حمص الأولى والثانية.
لماذا تحتاج الإنسانية إلى الأنبياء؟
Authors: Ibrahim Nuri A. 
Published: July 2018

الملخص
عاش بديع الزمان الإمام سعيد النورسي ( 1876 ــ 1960م) الشطر الأخير من عمر سلطنة الدولة العثمانية، التي أصبحت في تلك الفترة يُطلق عليها بالرجل المريض،ويَصْدُقُ عليها قول الإمام النورسي رحمه الله تعالى:((إنَّ الدولة العثمانية حُبلى حالياً بجنين أوربا وستلد يوماً، وأمَّا أوربا فهي أيضاً حبلى بجنين الإسلام وستلدُ يوماً ما))(1)،وذاق في تلك الحقبة حلاوة الإيمان و الإسلام. وعاش بقية حياته يتقلبُ على جمر من نار على يد الاتحاد والترقي وجلاوزتهم، حيث انقلبت الموازين، واختلت المفاهيم،ونطقت الرويبضة، وخمدت جذوة القيم والمبادئ الإسلامية،ونهضت شوكة الباطل من رقدتها،وأعلنت حربها ضد الإسلام والمسلمين بكل ما أُوتيت من قوة،على شاكلة مَنْ قبلهم أو أَشد مِنَ الكفار والمنافقين والمشركين؛ الذين كانوا يتخبطون في ظلام وضلال الجهالة، فحانت ساعة بعث رسولٍ إليهم،في كل زمان و مكان تحدثُ فيه هذه الفوضى العارمة،التي تؤدي إلى اختلال التوازن في ميزان القيم والأخلاق، ورجحان كفة الشر والشرك بما تحمله من معان؛ فكانت الحاجة ماسةً إلى الأنبياء لتصحيح المسار،وإعادة التوازن إلى الميزان المختل لتصحيح مسار البشرية.وهذا ما يوضحه الإمام سعيد النورسي من خلال رسائل النور،رحمك الله يانورسي.
INVESTIGATION OF DIGGING MACHINES FOR CONSTRUCTION BY THE “DIAPHRAGM WALL” METHOD
Authors: Kadyrov A. S. , Kurmasheva B. K. , Zhunusbekova Zh. Zh. , Karsakova A. Zh. 
Published: July 2018

Introduction.Construction in Kazakhstan is one of the leading sectors that has a significant impact on the development of a large number of related industries of the Republic of Kazakhstan. No construction is complete without road construction equipment. Despite the positive developments in the industry including the park of the main construction machinery, things are still more difficult than that. The acquisition of new machine base, with working bodies’ equipment is very expensive. It is economically expedient to develop hinged working bodies on the basic machines existing in Kazakhstan enterprises.Materials and methods.According to the demonstrated problem, the article considers the method of morphological analysis to identify new types of working bodies of digging machines. Moreover, the main classification features of the working bodies of excavating machines are determined in the research and the number of trajectories of the working element’s movement is established.Results.The constructed morphological tree is presented and as a result of such method, the 484 possible and existing designs of working bodies of excavating machines are revealed. A set of conditions for excluding the unacceptable options for hydro mechanical and mechanical working bodies from the hypothetical working bodies is formulated.Discussion and conclusions. Suspended tunneling equipment could be used for both trenching and well drilling, and such processes are evidenced by the patent for the design.