Successful management of severe refractory acquired immune bleeding disorder: Prior to insisting surgery

AbstractINTRODUCTIONAcquired bleeding disorders are rare and may be missed before surgery. Additionally, they may be refractory to conventional treatments.PRESENTATION OF CASEA 50-year-old patient experienced prolonged post-operative bleeding when his bleeding disorder was missed prior to his undergoing inguinal herniorrhaphy. Post-operative investigations revealed severe acquired von Willebrand syndrome associated with a monoclonal gammopathy of undetermined significance. A few months later, he required umbilical herniorrhaphy, but he did not respond to attempts to raise his von Willebrand factor antigen and activity levels using conventional therapies, including desmopressin, cryoprecipitate, intravenous immunoglobulin, and Von Willebrand factor concentrate. A triple therapy combination of dexamethasone, intravenous immunoglobulin, and mycophenolate mofetil was administered, with a successful and sustained response, lasting about 2 months. The surgery was performed safely, without any complications.DISCUSSIONConventional acquired von Willebrand syndrome treatment is usually aimed at replacing von Willebrand factor or stimulating its secretion from storage in endothelial cells. In the present case, the alternative treatment was directed against both the humoral and cell-mediated immune mechanisms.CONCLUSIONThis case of acquired bleeding disorder showed that more attention must be given to a patient's coagulation profile, even if only very minor laboratory coagulation derangements are detected prior to surgery, to avoid missing such rare disorders. The described triple therapy demonstrated good effects and may be considered for inclusion in a controlled randomized study to determine its usefulness for other surgeries delayed due to severe acquired bleeding disorders. To the best of our knowledge, this triple combination treatment has not been previously used for the treatment of severe acquired bleeding disorders that are refractory to conventional therapies

WELL LOGGING AND ELECTROFACIES OF ZUBAIR FORMATION FOR UPPER SANDSTONE MEMBER IN ZUBAIR OIL FIELD, SOUTHERN IRAQ

The Lower Cretaceous Zubair reservoir is a main producing horizon in the Zubair oil Field, southern Iraq. The reservoir consists of a number of isolated vertical major sandstone units. Sedimentary characteristics can be determined using the well log data as one of the most fundamental methods for reservoir characterization in the oil and gas industry. The reading of high gamma-ray response indicates the presence of shale which contains clay minerals, K-feldspar, and organic material that emits natural gamma radiation. The clean sandstones emit less radiation so it has a lower gamma-ray count analysis. Five of electrofacies were identified in the upper sandstone member of Zubair formation in Zubair oil field, in more details H layer divided into three sub-units. Zubair formation delta deposited through sea regression followed by sea progression because shelf facies overlies other delta facies as shown H layer between K and C units both were shale rocks. Porosity and permeability of the upper sandstone member of Zubair Formation were identified in twenty oil-wells. The relationship between the porosity and permeability after correction with data obtained from the core analysis data showed an improvement to the north part of the field precisely in Hammar-Shuaiba domes. On the other hand the grain sizes varied from coarse to medium; medium to fine in Hammar dome while fine to medium fine to very fine with clay influence led to a decrease the porosity and permeability thus reduced oil production

A Comparative Study between Piled-Raft and Two Soil Improvement Techniques

This investigational study was directed to establish the correlation between piled raft foundation and two soil improvement techniques, stone columns and lime columns to evaluate the bearing improvement ratio BCR for the soft clay soil with three values of undrained shear strength, 8 kPa,10 kPa and 12 kPa. The 12 model tests was conducted in the present work, three models of untreated soil, three models of soil with piled raft, three models of soil treated with stone columns and three models of soil treated with lime columns. The container used in experimental works was made of steel with plane area of 500 mm * 500 mm and 500mm in height. The thickness of soil sample inside the container was 400 mm.The study showed that the piled raft was more efficient in the bearing capacity improvement than the two soil improvement techniques. The bearing improvement ratio were 3.39, 3.27 and 2.78 in the three model tests of piled-raft for three samples of soil, respectively, while the lime columns provided the lowest values of the bearing improvement ratio were 1.64, 1.67 and 1.8 respectively

Numerical modeling of the impact of pump wavelength on Yb-doped fiber amplifier performance

Ytterbium-doped optical amplifiers have become common tools for industrial applications due to their high efficiency, relatively low cost and potentially very high output power level. The efficiency of an ytterbium-doped fiber amplifier depends mainly on the absorption of pump radiation, and, therefore, optimum pump wavelengths have been proposed such as 915 nm. However, the semiconductor pump diodes batch supplied by manufacturers may exhibit a spread in the output wavelength. This paper theoretically investigates the performance of Yb-doped amplifiers for different pump wavelengths and defines the pump power penalty when the pump source does not emit at the optimum wavelength. The penalty has been defined as normalized excess pump power required to achieve the desired gain

Isolated sixth cranial nerve palsy as the presenting symptom of a rapidly expanding ACTH positive pituitary adenoma: a case report

<p>Abstract</p> <p>Background</p> <p>Pituitary adenoma may present with neuro-ophthalmic manifestations and, typically, rapid tumor expansion is the result of apoplexy. Herein, we present the first case of an isolated sixth cranial nerve palsy as initial feature of a rapidly expanding ACTH positive silent tumor without apoplexy.</p> <p>Case Presentation</p> <p>A 44 year old female with a history of sarcoidosis presented with an isolated sixth cranial nerve palsy as the initial clinical feature of a rapidly expanding ACTH positive silent pituitary adenoma. The patient underwent emergent transsphenoidal hypophysectomy for this rapidly progressive tumor and subsequently regained complete vision and ocular motility. Despite tumor extension into the cavernous sinus, the other cranial nerves were spared during the initial presentation.</p> <p>Conclusions</p> <p>This case illustrates the need to consider a rapidly growing pituitary tumor as a possibility when presented with a rapidly progressive ophthalmoplegia.</p

Molecular Screening of <i>VAX1</i> Gene Polymorphisms Uncovered the Genetic Heterogeneity of Non-Syndromic Orofacial Cleft in Saudi Arabian Patients

Objective: Nonsyndromic orofacial cleft (NSOFC) including cleft lip with or without cleft palate (CL±P) and cleft palate (CP) are multifactorial developmental disorders with both genetic and environmental etiological factors. In this study we investigated the association between CL±P and CP, and two polymorphisms previously determined using genome-wide association studies, as well as the association between consanguinity and CL±P and CP. Methods: DNA was extracted from saliva specimens from 171 triads consisting of affected individuals and their parents, as well as 189 control triads (matched for age, gender, and location) that were recruited from 11 referral hospitals in Saudi Arabia. Two polymorphisms, rs4752028 and rs7078160, located in the VAX1 gene were genotyped using real-time polymerase chain reaction. A transmission disequilibrium test was carried out using the Family-Based Association Test and PLINK (genetic tool-set) to measure the parent-of-origin effect. Results: Significant differences were found between affected individuals and the control group. In the case of the rs4752028 risk allele in cleft, the phenotypes were: CL±P (fathers: odds ratio [OR] 2.16 [95% CI 1.38–3.4]; mothers: OR 2.39 [95% CI 1.53–3.71]; and infants: OR 2.77 [95% CI 1.77–4.34]) and CP (fathers: OR 2.24 [95% CI 1.15–4.36] and infants: OR 2.43 [95% CI 1.25–4.7]). For CL±P and the rs7078160 risk allele, the phenotypes were: (fathers: OR 1.7 [95% CI 1.05–2.86]; mothers: OR 2.43 [95% CI 1.49–3.97]; and infants: OR 2.34 [95% CI 1.44–3.81]). In terms of consanguinity, we found significant association between consanguinity and the rs4752028 polymorphism minor allele among CL±P compared with controls (p = 0.001). Conclusion: This is the first study to find a relationship between these two loci on 10q25 (rs4752028 and rs7078160) and NSOFC in a population with high levels of consanguinity

The Role of Family Physicians in Mental Health Care: Screening, Diagnosis, and Treatment Options

amily physicians play a pivotal role in the early detection, diagnosis, and management of mental health disorders within the community. This review article delves into the multifaceted responsibilities of family physicians in the realm of mental health care. Emphasizing the importance of primary care settings as the first point of contact for many patients, the article underscores the need for effective screening tools and methodologies tailored for these environments. The diagnostic precision of family physicians, often challenged by the broad spectrum of mental health symptoms, is explored alongside the potential implications of misdiagnoses. Furthermore, the article evaluates various treatment options, from pharmacological interventions to psychotherapy, and their applicability in primary care settings. The integration of technological advancements, such as electronic health records and telemedicine, is also discussed in the context of enhancing patient care. The review concludes by highlighting the importance of educating primary care physicians to not only pay close attention to the mental health of their patients, but also to be able to accurately screen and diagnose mental health issues using various diagnostic tools. Moreover, it is critical to develop more useful tools that can be used in the context of primary care settings