Search results for: rare

Authors: J. Bouguebrine, L. Bouabsa

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The ground of study is localized in central Hoggar and contains the most important layers and Stanno-Wolframifére indices of the metallogenic province have tin and wolfram of Hoggar. These layers are always associate with post-orogenetic Panafrican magmatism (GMR) which was set up in the form of circumscribed granitic solid masses of relatively reduced size or in dykes of microgranites. The area studied are in Tounine, Aléméda, Hanana-hananére, Tim Amzi, El Karoussa. The geochemical data processing watch peralumineux character rich person out of Li-F and rare metals (MR). Pegmatites of the type stocksheider, formations of greisens and mineralization Sn-W accompany these granites. Mineralisation Sn-W, expressed particularly well in the seams of quartz and greinsen is spacialement and génitiquement dependent on the maguatism specific to white feldspar-topaz (GMR) (grained and microgrenu). the mineral paragenesis is primarily made up of wolframite and cassetérite. The minerals of gangue are represented by quartz, topaz, the micas containing lithia and the fluorite. A microthermometric study of fluid inclusions related to the granites end on white feldspar-topaz of Hanana, topaz of Hananére, the microgranite of Aléméda, and the seams of quartz D In Tounine (Tiftazouine) and of Tim Amzi; allows to characterize the fluids associated with these layers. It comes out from this study the abundance of aqueous inclusions and three types of fluids were given: -Hot and salted fluids rich in volatile elements particularly CO2; -follow-ups by aquo-carbonic fluids less hot and moderately salted with temperatures of homogenisations (HT) average respectively of 300°C and 180°C; -finally of the aqueous fluids very little salted (≤1%pds.éq.NaCl) and definitely colder. An estimate depths éteé made starting from the diagram of (Haas, 1971) in the system H2O-NaCl, the results are the following: • Inclusion aqueous (L and Lw): correspond to depths of about 50 à500m. • Inclusions aquo-carbonic (Lcw and Lwc): correspond to depths of L order of 600 with 1200m • Carbonic inclusion (Vcw): correspond to depths about 1400à1800m

Keywords: fluid inclusions microthermométrie, cassiterite wolframite, granites with rare metals, Central Hoggar

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Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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Authors: Ian Campbell, Gillian Mitchell, Paul James, Na Li, Ella Thompson

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The genetic cause of the majority of multiple-case breast cancer families remains unresolved. Next generation sequencing has emerged as an efficient strategy for identifying predisposing mutations in individuals with inherited cancer. We are conducting whole exome sequence analysis of germ line DNA from multiple affected relatives from breast cancer families, with the aim of identifying rare protein truncating and non-synonymous variants that are likely to include novel cancer predisposing mutations. Data from more than 200 exomes show that on average each individual carries 30-50 protein truncating mutations and 300-400 rare non-synonymous variants. Heterogeneity among our exome data strongly suggest that numerous moderate penetrance genes remain to be discovered, with each gene individually accounting for only a small fraction of families (~0.5%). This scenario marks validation of candidate breast cancer predisposing genes in large case-control studies as the rate-limiting step in resolving the missing heritability of breast cancer. The aim of this study is to screen genes that are recurrently mutated among our exome data in a larger cohort of cases and controls to assess the prevalence of inactivating mutations that may be associated with breast cancer risk. We are using the Agilent HaloPlex Target Enrichment System to screen the coding regions of 168 genes in 1,000 BRCA1/2 mutation-negative familial breast cancer cases and 1,000 cancer-naive controls. To date, our interim analysis has identified 21 genes which carry an excess of truncating mutations in multiple breast cancer families versus controls. Established breast cancer susceptibility gene PALB2 is the most frequently mutated gene (13/998 cases versus 0/1009 controls), but other interesting candidates include NPSR1, GSN, POLD2, and TOX3. These and other genes are being validated in a second cohort of 1,000 cases and controls. Our experience demonstrates that beyond PALB2, the prevalence of mutations in the remaining breast cancer predisposition genes is likely to be very low making definitive validation exceptionally challenging.

Keywords: predisposition, familial, exome sequencing, breast cancer

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Authors: Hai-Hong Gu, Yan-Jun Ai, Zheng Zhou

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Vanadium and titanium are rare metals with superior properties and are important resources in aerospace, aviation, and military. The vanadium/titanium magnetite are mostly ultra-lean ores, and a large number of tailings has been produced in the exploitation process. The tailings are characterized by loose structure, poor nutrient, complex composition and high trace metal contents. Returning green manure has been shown to not only increase plant biomass and soil nutrients but also change the bioavailability of trace metals and the microbial community structure. Fungi play an important role in decomposing organic matter and increasing soil fertility, and the application of organic matter also affects the community structure of fungi. The effects of green manure plants, alfalfa (Medicago sativa L.), returned to the tailings in situ on community structure of fungi, nutrients and bioavailability of trace metals in vanadium/titanium magnetite tailings were investigated in a pot experiment. The results showed that the fungal community diversity and richness were increase after alfalfa green manure returned in situ. The dominant phyla of the fungal community were Ascomycota, Basidiomycota and Ciliophora, especially, the phyla Ciliophora was rare in ordinary soil, but had been found to be the dominant phyla in tailings. Meanwhile, the nutrient properties and various trace metals may shape the microbial communities by affecting the abundance of fungi. It was found that the plant growth was stimulated and the available N and organic C were significantly improved in the vanadium/titanium magnetite tailing with the long-term returning of alfalfa green manure. Moreover, the DTPA-TEA extractable Cd and Zn concentrations in the vanadium/titanium magnetite tailing were reduced by 7.72%~23.8% and 8.02%~24.4%, respectively, compared with those in the non-returning treatment. The above results suggest that the returning of alfalfa green manure could be a potential approach to improve fungal community structure and restore mine tailing ecosystem.

Keywords: fungal community, green manure returning, vanadium/titanium magnet tailings, trace metals

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Authors: Muhammad Yayat Afianto, Darmawan, Agung Putra Utama, Hari Kushardanto

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Fish Forever, Rare’s innovative coastal fisheries program, combined community-based conservation management approach with spatial management to restore and protect Indonesia’s small-scale fisheries by establishing Fishing Managed Access Area. A ‘TURF-Reserve’ is a fishery management approach that positions fishers at the center of fisheries management, empowering them to take care of and make decisions about the future of their fishery. After two years of the program, social marketing campaigns succeeded in changing their behavior by adopting the new conservation behavior. The Pride-TURF-R campaigns developed an overarching hypothesis of impact that captured the knowledge, attitude and behavior changes needed to reduce threats and achieve conservation results. Rare help Batu Belah fishers to develop their group, developed with their roles, sustainable fisheries plan, and the budget plan. On 12th February 2017, the Head of Loka Kawasan Konservasi Perairan Nasional (LKKPN) which is a Technical Implementation Unit for National Marine Conservation Areas directly responsible to the Directorate General for Marine Spatial Management in the Ministry of Marine Affairs and Fisheries had signed a Partnership Agreement with the Head of Batu Belah Village to manage a TURF+Reserve area as wide as 909 hectares. The fishers group have been collecting the catch and submitting the report monthly, initiated the installation of the buoy markers for the No Take Zone, and formed the Pokmaswas (community-based surveillance group). Prior to this behavior adoption, they don’t have any fisheries data, no group of fishers, and they have still fishing inside the No Take Zone. This is really a new behavior adoption for them. This paper will show the process and success story of the social marketing campaign to conserve marine habitat in Anambas through Pride-TURF-R program.

Keywords: behavior adoption, community participation, no take zone, pride-TURF-R

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Authors: Sena Park

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Background: The concurrent presentation with colorectal cancer in the inguinal hernia has been extremely rare. Due to its rarity, its presentation may lead to diagnostic and therapeutic dilemmas. We aim to review all the reported cases on colorectal cancer incarcerated in the inguinal hernia in the last 20 years, and discuss the operative approaches. Methods: We identified all case reports on colorectal cancer within inguinal hernia using PUBMED (2002-2022) and MEDLINE (2002-2022). The search strategy included the following keywords: colorectal cancer (title/abstract) AND inguinal hernia (title/abstract) OR incarceration (title/abstract). The search did not include letters, book chapters, systemic reviews, meta-analysis and editorials. Results: In the last 20 years, a total of 19 cases on colorectal cancer within the inguinal hernia were identified. The age of the patients ranged between 48 and 89. Majority of the patients were male (95%). Most commonly involved part of the large intestine was sigmoid colon (79%). Of all the cases, 79 percent of patients received open procedure and 21 percent had laparoscopic procedure. Discussion: Inguinal hernias are common with an incidence of approximately 1.7 percent. Colorectal cancer is the one of the leading causes of cancer-related mortality worldwide. However, their concurrent presentation has been extremely rare. In the last 20 years, 19 cases on concurrent presentation of colorectal cancer and inguinal hernia have been reported. Most patients who had open procedures had two incisions of groin incision and a midline laparotomy. There were 4 cases where the oncological resection was performed laparoscopically. The advantages of laparoscopic resection include reduced blood lost, reduced post-operative pain, reduced length of hospital stay and similar number of lymph nodes taken. From the review of the cases in the last 20 years, both open and laparoscopic approaches seemed to be safe and achieve adequate oncological resections. Conclusion: This is a brief overview of reported cases of colorectal cancer presenting with inguinal hernia concurrently. Due to its rarity, there are no current guidelines on operative approach in clinical practice. The experience in the last 20 years supports both open and laparoscopic approach.

Keywords: colorectal cancer, inguinal hernia, incarceration, operative approach

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Authors: Atitallah Sofien, Bouyahia Olfa, Krifi farah, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Subcutaneous fat necrosis of the newborn (SCFN) is a rare acute hypodermatitis characterized by skin lesions in the form of infiltrated, hard plaques and subcutaneous nodules, with a purplish-red color, occurring between the first and sixth week of life. SCFN is generally a benign condition that spontaneously regresses without sequelae, but it can be complicated by severe hypercalcemia. Methodology: This is a retrospective case report of neonatal subcutaneous fat necrosis complicated with severe hypercalcemia and nephrocalcinosis. Results: This is a case of a female newborn with a family history of a hypothyroid mother on Levothyrox, born to non-consanguineous parents and from a well-monitored pregnancy. The newborn was delivered by cesarean section at 39 weeks gestation due to severe preeclampsia. She was admitted to the Neonatal Intensive Care Unit at 1 hour of life for the management of grade 1 perinatal asphyxia and immediate neonatal respiratory distress related to transient respiratory distress. Hospitalization was complicated by a healthcare-associated infection, requiring intravenous antibiotics for ten days, with a good clinical and biological response. On the 20th day of life, she developed skin lesions in the form of indurated purplish-red nodules on the back and on both arms. A SCFN was suspected. A calcium level test was conducted, which returned a result of 3 mmol/L. The rest of the phosphocalcic assessment was normal, with early signs of nephrocalcinosis observed on renal ultrasound. The diagnosis of SCFN complicated by nephrocalcinosis associated with severe hypercalcemia was made, and the condition improved with intravenous hydration and corticosteroid therapy. Conclusion: SCFN is a rare and generally benign hypodermatitis in newborns with an etiology that is still poorly understood. Despite its benign nature, SCFN can be complicated by hypercalcemia, which can sometimes be life-threatening. Therefore, it is important to conduct a thorough skin examination of newborns, especially those with risk factors, to detect and correct any potential hypercalcemia.

Keywords: subcutaneous fat necrosis, newborn, hypercalcemia, nephrocalcinosis

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Authors: Ecem Deniz Kırkpantur, Ozge Ecmel Onur, Tuba Cimilli Ozturk, Ebru Unal Akoglu

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Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. The occurrence of Moyamoya disease is related to immune, genetic and other factors. There is no curative treatment for Moyamoya disease. Secondary prevention for patients with symptomatic Moyamoya disease is largely centered on surgical revascularization techniques. We present here a 62-year old male presented with headache and vision loss for 2 days. He was previously diagnosed with hypertension and glaucoma. On physical examination, left eye movements were restricted medially, both eyes were hyperemic and their movements were painful. Other neurological and physical examination were normal. His vital signs and laboratory results were within normal limits. Computed tomography (CT) showed dilated vascular structures around both lateral ventricles and atherosclerotic changes inside the walls of internal carotid artery (ICA). Magnetic resonance imaging (MRI) and angiography (MRA) revealed dilated venous vascular structures around lateral ventricles and hyper-intense gliosis in periventricular white matter. Ischemic gliosis around the lateral ventricles were present in the Digital Subtracted Angiography (DSA). After the neurology, ophthalmology and neurosurgery consultation, the patient was diagnosed with Moyamoya disease, pulse steroid therapy was started for vision loss, and super-selective DSA was planned for further investigation. Moyamoya disease is a rare condition, but it can be an important cause of stroke in both children and adults. It generally affects anterior circulation, but posterior cerebral circulation may also be affected, as well. In the differential diagnosis of acute vision loss, occipital stroke related to Moyamoya disease should be considered. Direct and indirect surgical revascularization surgeries may be used to effectively revascularize affected brain areas, and have been shown to reduce risk of stroke.

Keywords: headache, Moyamoya disease, stroke, visual loss

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Authors: Sabine A. Zauchner-Studnicka

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As the term indicates, reverse-mentoring flips the classical roles of mentoring: In school, students take over the role of mentors for adults, i.e. teachers or parents. Originally reverse-mentoring stems from US enterprises, which implemented this innovative method in order to benefit from the resources of skilled younger employees for the enhancement of IT competences of senior colleagues. However, reverse-mentoring in schools worldwide is rare. Based on empirical studies and theoretical approaches, in this article an implementation model for reverse-mentoring is developed in order to bring the significant potential reverse-mentoring has for education into practice.

Keywords: reverse-mentoring, innovation in education, implementation model, school education

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Authors: Payman Davoodi-Nasab, Ahmad Rahbar-Kelishami, Jaber Safdari, Hossein Abolghasemi

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The high purity rare earth elements (REEs) have been vastly used in the field of chemical engineering, metallurgy, nuclear energy, optical, magnetic, luminescence and laser materials, superconductors, ceramics, alloys, catalysts, and etc. Neodymium is one of the most abundant rare earths. By development of a neodymium–iron–boron (Nd–Fe–B) permanent magnet, the importance of neodymium has dramatically increased. Solvent extraction processes have many operational limitations such as large inventory of extractants, loss of solvent due to the organic solubility in aqueous solutions, volatilization of diluents, etc. One of the promising methods of liquid membrane processes is emulsion liquid membrane (ELM) which offers an alternative method to the solvent extraction processes. In this work, a study on Nd extraction through multi-walled carbon nanotubes (MWCNTs) assisted ELM using response surface methodology (RSM) has been performed. The ELM composed of diisooctylphosphinic acid (CYANEX 272) as carrier, MWCNTs as nanoparticles, Span-85 (sorbitan triooleate) as surfactant, kerosene as organic diluent and nitric acid as internal phase. The effects of important operating variables namely, surfactant concentration, MWCNTs concentration, and treatment ratio were investigated. Results were optimized using a central composite design (CCD) and a regression model for extraction percentage was developed. The 3D response surfaces of Nd(III) extraction efficiency were achieved and significance of three important variables and their interactions on the Nd extraction efficiency were found out. Results indicated that introducing the MWCNTs to the ELM process led to increasing the Nd extraction due to higher stability of membrane and mass transfer enhancement. MWCNTs concentration of 407 ppm, Span-85 concentration of 2.1 (%v/v) and treatment ratio of 10 were achieved as the optimum conditions. At the optimum condition, the extraction of Nd(III) reached the maximum of 99.03%.

Keywords: emulsion liquid membrane, extraction of neodymium, multi-walled carbon nanotubes, response surface method

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Authors: D. Artamonov, A. Tsibulnikova, I. Samusev, V. Bryukhanov, A. Kozhevnikov

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The synthesis and luminescent properties of Yb₂O₃, Nd₂O₃@Bi₂O₃ complex with upconversion generation are discussed in this work. The obtained samples were measured in the visible region of the spectrum under excitation with a wavelength of 980 nm. The studies showed that the obtained complexes have a high degree of stability and intense luminescence in the wavelength range of 400-750 nm. Consideration of the time dependence of the intensity of the upconversion luminescence allowed us to conclude that the enhancement of the intensity occurs in the time interval from 5 to 30 min, followed by the appearance of a stationary mode.

Keywords: lasers, luminescence, upconversion photonics, rare earth metals

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Authors: Gülşah Çelik Gül, Figen Kurtuluş

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Cesium molybdates with general formula CsMIII(MoO4)2, where MIII = Bi, Dy, Pr, Er, exhibit rich polymorphism, and crystallize in a layered structure. These properties cause intensive studies on cesium molybdates. CsBi(MoO4)2 was synthesized by microwave method by using cerium sulphate, bismuth oxide and molybdenum (VI) oxide in an appropriate molar ratio. Characterizations were done by x-ray diffraction (XRD), fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy/energy dispersive analyze (SEM/EDS), thermo gravimetric/differantial thermal analysis (TG/DTA).

Keywords: cesium bismuth dimolybdate, microwave synthesis, powder x-ray diffraction, rare earth dimolybdates

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Authors: Sait Ozsoy, Asude Gokmen, Mehtap Yondem, Hanife A. Alkan, Gulnaz T. Javan

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Deep neck infection often develops due to upper respiratory tract and odontogenic infections. Gastrointestinal System perforation can occur for many reasons and is in need of the early diagnosis and prompt surgical treatment. In both cases late or incorrect diagnosis may lead to increase morbidity and high mortality. A patient with a diagnosis of deep neck abscess died while under treatment due to sepsis and multiple organ failure. Autopsy finding showed duodenal ulcer and this is reported in the literature.

Keywords: peptic ulcer perforation, peritonitis, retropharyngeal abscess, sepsis

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Authors: Rafael Ricieri, Rogerio Barros, Francisco Clovis

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Objective– The Objective of this is study is to report a rare case of dermoid cyst, with a sublingual location and cutaneous fistula in a 4 year-old child.Methods: This study is a case report. The main study instrument was the medical record and the radiological and intraoperative image bank. Results: Infants with congenital cervical lesions eventually need tomography for diagnostic elucidation, and health services should be structured to perform sedation and thin tomographic sections in order to reduce morbidity.

Keywords: congenital, sublingual dermoid cyst, fistula, pediatric surgery, head and kneck surgery

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Authors: Monika Konieczyńska, Joanna Fajfer, Olga Lipińska

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In Poland works related to the exploration and prospection of unconventional hydrocarbons (natural gas accumulated in the Silurian shale formations) started in 2007, based on the experience of the other countries that have created new possibilities for the use of existing hydrocarbons resources. The highly water-consuming process of hydraulic fracturing is required for the exploitation of shale gas which implies a need to ensure large volume of water available. As a result considerable amount of mining waste is generated, particularly liquid waste, i.e. flowback fluid with variable chemical composition. The chemical composition of the flowback fluid depends on the composition of the fracturing fluid and the chemistry of the fractured geological formations. Typically, flowback fluid is highly salinated, can be enriched in heavy metals, including rare earth elements, naturally occurring radioactive materials and organic compounds. The generated fluids considered as the extractive waste should be properly managed in the recovery or disposal facility. Problematic issue is both high hydration of waste as well as their variable chemical composition. Also the limited capacity of currently operating facilities is a growing problem. Based on the estimates, currently operating facilities will not be sufficient for the need of waste disposal when extraction of unconventional hydrocarbons starts. Further more, the content of metals in flowback fluids including rare earth elements is a considerable incentive to develop technology of metals recovery. Also recycling is a key factor in terms of selection of treatment process, which should provide that the thresholds required for reuse are met. The paper will present the study of the flowback fluids chemical composition, based on samples from hydraulic fracturing processes performed in Poland. The scheme of flowback fluid cleaning and recovering technology will be reviewed along with a discussion of the results and an assessment of environmental impact, including all generated by-products. The presented technology is innovative due to the metal recovery, as well as purified water supply for hydraulic fracturing process, which is significant contribution to reducing water consumption.

Keywords: environmental impact, flowback fluid, management of special waste streams, metals recovery, shale gas

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Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Vaibhavi Birle

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Posterior reversible encephalopathy syndrome is a rare clinic-radiological syndrome associated with acute changes in blood pressure during pregnancy. It is characterized symptomatically by headache, seizures, altered mental status, and visual blurring with radiological changes of white matter (vasogenic oedema) affecting the posterior occipital and parietal lobes of the brain. It is being increasingly recognized due to increased institutional deliveries and advances in imaging particularly magnetic resonance imaging (MRI). In spite of the increasing diagnosis the prediction of PRES and patient factors affecting susceptibility is still not clear. Hence, we conducted the retrospective study to analyse the factors associated with PRES at our tertiary centre.

Keywords: pres syndrome, eclampsia, maternal outcome, fetal outcome

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Authors: Magda Gorczyca, Zofia Nocoń

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Past and current studies from different countries showed that river engineering leads to environmental degradation and extinction of many species - often those protected by local and international wildlife conservation laws. Through the years, the main focus of rivers utilization has shifted from industrial applications to recreation and wildlife preservation with a focus on keeping the biodiversity which plays a significant role in preventing climate changes. Thus an opportunity appeared to recreate flooding areas and natural habitats, which are very rare in the scale of Europe. Additionally, river restoration helps to avoid floodings and periodic droughts, which are usually very damaging to the economy. In this research, the biodiversity of dragonflies and ground beetles was analyzed in the context of plant communities and forest stands structure. Results were enriched with data from past and current literature. A comparison was made between two parts of the Odra river. A part where oxbow lake and riparian forest were separated from the river bed by embankment and a part of the river with floodplains left intact. Validity assessment of embankments relocation was made based on the research results. In the period between May and September, insects were collected, phytosociological analysis were taken, and forest stand structure properties were specified. In the part of the river not separated by the embankments, rare and protected species of plants were spotted (e.g., Trapanatans, Salvinianatans) as well as greater species and quantitive diversity of dragonfly. Ground beetles fauna, though, was richer in the area separated by the embankment. Even though the research was done during only one season and in a limited area, the results can be a starting point for further extended research and may contribute to acquiring legal wildlife protection and restoration of the researched area. During the research, the presence of invasive species Impatiens parviflora, Echinocystislobata, and Procyonlotor were observed, which may lead to loss of the natural values of the researched areas.

Keywords: carabidae, floodplains, middle Odra river, Odonata, oxbow lakes, riparian forests

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Authors: Marilou Cadatal-Raduban, Minh Hong Pham, Duong Van Pham, Tu Nguyen Xuan, Mui Viet Luong, Kohei Yamanoi, Toshihiko Shimizu, Nobuhiko Sarukura, Hung Dai Nguyen

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There is a great deal of interest in developing all-solid-state tunable ultrashort pulsed lasers emitting in the ultraviolet (UV) region for applications such as micromachining, investigation of charge carrier relaxation in conductors, and probing of ultrafast chemical processes. However, direct short-pulse generation is not as straight forward in solid-state gain media as it is for near-IR tunable solid-state lasers such as Ti:sapphire due to the difficulty of obtaining continuous wave laser operation, which is required for Kerr lens mode-locking schemes utilizing spatial or temporal Kerr type nonlinearity. In this work, the transient cavity method, which was reported to generate ultrashort laser pulses in dye lasers, is extended to a solid-state gain medium. Ce:LiCAF was chosen among the rare-earth-doped fluoride laser crystals emitting in the UV region because of its broad tunability (from 280 to 325 nm) and enough bandwidth to generate 3-fs pulses, sufficiently large effective gain cross section (6.0 x10⁻¹⁸ cm²) favorable for oscillators, and a high saturation fluence (115 mJ/cm²). Numerical simulations are performed to investigate the spectro-temporal evolution of the broadband UV laser emission from Ce:LiCAF, represented as a system of two homogeneous broadened singlet states, by solving the rate equations extended to multiple wavelengths. The goal is to find the appropriate cavity length and Q-factor to achieve the optimal photon cavity decay time and pumping energy for resonator transients that will lead to ps UV laser emission from a Ce:LiCAF crystal pumped by the fourth harmonics (266nm) of a Nd:YAG laser. Results show that a single ps pulse can be generated from a 1-mm, 1 mol% Ce³⁺-doped LiCAF crystal using an output coupler with 10% reflectivity (low-Q) and an oscillator cavity that is 2-mm long (short cavity). This technique can be extended to other fluoride-based solid-state laser gain media.

Keywords: rare-earth-doped fluoride gain medium, transient cavity, ultrashort laser, ultraviolet laser

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Authors: Madeleine Cox

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Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

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Authors: Mohamed Shafi Mahboob Ali

Abstract:

Male breast cancer (MBC) is a rare entity with overall cases reported less than 1%. However, the incidence of MBC is regularly rising every year. Due to the lack of data on MBC, diagnosis and treatment are tailored to female breast cancer. MBC risk increases with age and is usually diagnosed ten years late as the disease progression is slow compared to female breast cancer (FBC). The most common feature of MBC is an intra-ductal variant, and often, upon diagnosis, the stage of the disease is already advanced. The Prognosis of MBC is often flawed, but new treatment modalities are emerging with the current knowledge and advancement. We presented a series of male breast cancer in our center, highlighting the clinicopathological, radiological and treatment options.

Keywords: male, breast, cancer, clinicopathology, ultrasound, CT scan

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Authors: Anne Nicole Fuentes

Abstract:

A 29 year old Gravida 1 Para 0 who presented at the hospital with a 5-week history of amenorrhea, abdominal pain and vaginal bleeding. Transvaginal ultrasound revealed 3 pathologic findings : Tuboovarian complex on the right adnexa, a complex mass indicative of an unruptured ectopic pregnancy and right ovarian new growth probably endometrioma. Pelvic laparotomy was done and histopathologic finding revealed tubal pregnancy, right and mature cystic teratoma of the right ovary. This case report demonstrates the importance of considering the coexistence of different gynecologic pathologies in the same patient and clinical importance of an accurate diagnostic evaluation.

Keywords: mature cystic teratoma, ectopic pregnancy, Tuboovarian abscess, bHCG

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Authors: Ali Baker, Russel Krawitz

Abstract:

This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: John P. O’Sullivan, Thomas M. P. Ratouis, Michael J. O’Sullivan

Abstract:

As the use of geothermal energy grows internationally more effort is required to monitor and protect areas with rare and important geothermal surface features. A number of approaches are presented for developing and calibrating numerical geothermal reservoir models that are capable of accurately representing geothermal surface features. The approaches are discussed in the context of cases studies of the Rotorua geothermal system and the Orakei-korako geothermal system, both of which contain important surface features. The results show that models are able to match the available field data accurately and hence can be used as valuable tools for predicting the future response of the systems to changes in use.

Keywords: geothermal reservoir models, surface features, monitoring, TOUGH2

Procedia PDF Downloads 379

Authors: Madeleine Cox

Abstract:

Objective: Discussion of diagnosis and management options for myometrial ectopic pregnancy Case: A 30 yo G1P0 presented to the emergency department with vaginal bleeding for the last 4 days. She had a positive home urine pregnancy test, confirmed with a serum HCG. When she presented for an ultrasound, there was no intrauterine pregnancy, no evidence of adnexal pregnancy, however, the anterior myometrium of the uterus was noted to be markedly abnormal. When she presented to the emergency department of a busy tertiary hospital in Queensland, she had a small amount of vaginal bleeding, was anxious but well, observations normal. Repeat blood testes demonstrated a serum HCG of 9246 IU/L, haemoglobin of 143g/L. The patient had an interesting history of a right oophorectomy and open myomectomy in another country. A repeat ultrasound again showed an abnormality within the myometrium of the uterus, which was initially reported as concerning for an AVM, or potentially invasive gestational trophoblastic disease. An MRI was organised 2 days later, which demonstrated a intramural/subserosal irregularity in the right lateral body measuring 35x38x42mm with peripheral enhancement and central cystic components, favouring a myometrial ectopic most likely at the site of previous myomectomy. Alternative diagnosis of AVM, GTD were considered less likely. After discussion with the patient, IV methotrexate was administered as an in patient 4 days after her initial presentation to emergency. After this, her HCG fell to 1236 IU/L on day 6 post treatment. Weekly reviews showed stable ultrasound appearances with a steadily dropping HCG level. A repeat MRI was performed 3 weeks after methotrexate administration which confirmed involution of the myometrial ectopic, however, showed ongoing progression of vascularity surrounding the site. Despite resolution of HCG, the patient persisted to have ongoing bleeding associated with this and went to have uterine artery embolisation. Follow up ultrasound showed resolution of abnormal vascularity and negative HCG levels. Conclusion: Myometrial ectopic pregnancies are a rare occurrence and require a multidisciplinary approach to achieve timely management for these patients. This patient was in a very well resourced setting with excellent access to Interventional Radiology and specialist Radiologists who could work together with the Obstetrics, Gynaecology, and Maternal Fetal Medicine team to provide multiple options of management which preserved her fertility. This case has a very good outcome, with the patient being referred back to our service 12 months later with an early intrauterine pregnancy.

Keywords: ectopic, pregnancy, miscarriage, gynaecology

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Authors: A. Al Yousef, A. Toulon, L. Petit, S. Fraitag, F. Ruemmele, S. Hadj-Rabia, C. Bodemer

Abstract:

Cutaneous Crohn’s disease (CCD) refers to an extremely rare granulomatous inflammation of the skin that is non-contiguous to the bowel tract. These cutaneous lesions can occur prior to, concurrent with, or after the gastrointestinal manifestations. In adults, CCD most frequently occurs in the setting of well-documented intestinal disease. Only 20% of cases occur prior to its development. Review of CCD in children, reveals that 86% of cases (24 of 28) occurring in patients without a known diagnosis of intestinal Crohn’s disease. Overall, the genitalia was the most commonly involved location, representing 21 of the 28 cases with 16 vulvar and 5 penile/scrotal lesions.

Keywords: Crohn’s disease, cutaneous manifestations, children, atypical axillary involvement

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Authors: Angelis P. Barlampas

Abstract:

Objective: The confusion of terms is a common practice in many situations of the everyday life. But, in some circumstances, such as in medicine, the precise meaning of a word curries a critical role for the health of the patient. Fahr disease and Fahr syndrome are often falsely used interchangeably, but they are two different conditions with different physical histories of different etiology and different medical management. A case of the seldom Fahr disease is presented, and a comparison with the more common Fahr syndrome follows. Materials and method: A 72 years old patient came to the emergency department, complaining of some kind of non specific medal disturbances, like anxiety, difficulty of concentrating, and tremor. The problems had a long course, but he had the impression of getting worse lately, so he decided to check them. Past history and laboratory tests were unremarkable. Then, a computed tomography examination was ordered. Results: The CT exam showed bilateral, hyperattenuating areas of heavy, dense calcium type deposits in basal ganglia, striatum, pallidum, thalami, the dentate nucleus, and the cerebral white matter of frontal, parietal and iniac lobes, as well as small areas of the pons. Taking into account the absence of any known preexisting illness and the fact that the emergency laboratory tests were without findings, a hypothesis of the rare Fahr disease was supposed. The suspicion was confirmed with further, more specific tests, which showed the lack of any other conditions which could probably share the same radiological image. Differentiating between Fahr disease and Fahr syndrome. Fahr disease: Primarily autosomal dominant Symmetrical and bilateral intracranial calcifications The patient is healthy until the middle age Absence of biochemical abnormalities. Family history consistent with autosomal dominant Fahr syndrome :Earlier between 30 to 40 years old. Symmetrical and bilateral intracranial calcifications Endocrinopathies: Idiopathic hypoparathyroidism, secondary hypoparathyroidism, hyperparathyroidism, pseudohypoparathyroidism ,pseudopseudohypoparathyroidism, e.t.c The disease appears at any age There are abnormal laboratory or imaging findings. Conclusion: Fahr disease and Fahr syndrome are not the same illness, although this is not well known to the inexperienced doctors. As clinical radiologists, we have to inform our colleagues that a radiological image, along with the patient's history, probably implies a rare condition and not something more usual and prompt the investigation to the right route. In our case, a genetic test could be done earlier and reveal the problem, and thus avoiding unnecessary and specific tests which cost in time and are uncomfortable to the patient.

Keywords: fahr disease, fahr syndrome, CT, brain calcifications

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Authors: Stephanie Cornish

Abstract:

The use of synthetic dermal templates, also known as dermal matrices, such as PolyNovo® Biodegradable Temporising Matrix (BTM), has been well established in the reconstruction of acute wounds with a full thickness defect of the skin. Its use has become common place in the treatment of full thickness burns and is not unfamiliar in the realm of necrotising fasciitis, free flap donor site reconstruction, and the management of acute traumatic wounds. However, the use of dermal templates for more chronic wounds is rare. The authors present the successful use of BTM in the reconstruction of a chronic scalp wound following the excision of a malignancy and multiple previous failed attempts at repair, thus demonstrating the potential for an increased scope of use.

Keywords: dermal template, BTM, chronic, scalp wound, reconstruction

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Authors: M. Olmedilla, M. R. Martinez-Torres, S. L. Toral

Abstract:

Electronic Word-Of-Mouth (eWOM) communities represent today an important source of information in which more and more customers base their purchasing decisions. They include thousands of reviews concerning very different products and services posted by many individuals geographically distributed all over the world. Due to their massive audience, eWOM communities can help users to find the product they are looking for even if they are less popular or rare. This is known as the long tail effect, which leads to a larger number of lower-selling niche products. This paper analyzes the long tail effect in a well-known eWOM community and defines a tool for finding niche products unavailable through conventional channels.

Keywords: eWOM, online user reviews, long tail theory, product categorization, social network analysis

Procedia PDF Downloads 386

Authors: Chao-Ming Su, Pei-Sheng Wu, Yu-Chi Kuo, Yin-Chou Huang, Tan-Yueh Chen, Jefunnie Matahum, Tzong-Rong Ger

Abstract:

Application of magnetic particles (MPs) has been applied in biomedical field for many years. There are lots of advantages through this mediator including high biocompatibility and multi-diversified bio-applications. However, current techniques for evaluating the quantity of the magnetic-labeled sample assays are rare. In this paper, a Wheatstone bridge giant magnetoresistance (GMR) sensor integrated with a homemade detecting system was fabricated and used to quantify the concentration of MPs. The homemade detecting system has shown high detecting sensitivity of 10 μg/μl of MPs with optimized parameter vertical magnetic field 100 G, horizontal magnetic field 2 G and flow rate 0.4 ml/min.

Keywords: magnetic particles, magnetoresistive sensors, microfluidics, biosensor

Procedia PDF Downloads 369