An analysis of social gaming networks in online and face to face bridge communities

Online social games are Internet-based games that use the social networks formed by players to extend in-game functionality. For example, gamers participating in the BBO Fans community combine online bridge play with social networking. Despite an increase in the popularity of online social gaming—currently, there exist over one million online bridge players—, and of decades of research on social networks, the activity characteristics and the community structure of online social gaming remain relatively unknown. In this work we investigate and contrast these aspects for two bridge communities, BBO Fans (online) and Locomotiva (face to face). We propose the use of playing relationships instead of traditional social relationships such as friends and friends-of-friends. Using long-term, large-scale data we have collected from both the online and face to face bridge communities, we analyze user behavior, social network structure, and playing style in bridge communities. We find many similar characteristics in the two studied communities, but we also find more variation in the activity levels and fewer stable partnerships for the face to face bridge community

ALERGIA ALIMENTARĂ ŞI ASTMUL BRONŞIC

Pe plan mondial, alergia alimentară reprezintă o problemă de sănătate publică de mare actualitate, cu o incidenţă în continuă creştere. Asocierea acesteia cu exacerbările astmului bronşic sunt descrise în tot mai multe studii multicentrice internaţionale. În acest context, prezentul articol evidenţiază rolul alimentelor în simptomatologia tractului respirator şi circumstanţele în care alergia alimentară trebuie luată în considerare la pacienţii cu astm bronşic şi/sau rinită alergică

Open Fractures – Time from Trauma to Efficient Surgical Debridement Is the Key Factor for Post-Traumatic Infection

Open fractures represent a challenging aspect of modern traumatology with high individual and social impact especially due to septic complications which require prolonged hospitalization, repeated surgery and considerable costs. That is why medical research is directed to establishing the most effi cient diagnostic and therapeutic algorithms able to decrease the incidence of septic complications and promote optimal fracture healing. The purpose of this paper is to underline the importance of early proper surgical debridement for the outcome of these fractures as reflected by the experience of a Level 1 Trauma Centre in order to include this aspect into future therapeutical guidelines

Diagnostic and classification pitfalls in systemic scleroderma

Generalităţi. Sclerodermia este o boală cronică, multisistemică, de etiologie incertă, caracterizată prin alterarea, indurarea și îngroșarea tegumentului, și prin modificări de tip fibrotic, inflamator și vascular ale unor organe interne (tub digestiv, pulmon, cord, rinichi), însoţită de anomalii imune, celulare și umorale. Prezentare de caz. Prezentăm cazul unei paciente în vârstă de 62 de ani, cunoscută din 2015 cu o importantă patologie cardio-respiratorie (fibroză pulmonară difuză, bronșiectazii bilateral, bronhopneumopatie obstructivă cronică, stadiul III, cord pulmonar cronic compensat, ateroscleroză aortică și mitrală, insuficienţă mitrală forma ușoară), gastroenterologică (reflux gastro-esofagian, steatohepatită cronică, colecistopatie cronică alitiazică), endocrinologică (gușă polimicronodulară, lob tiroidian stâng). Pacienta relatează debutul insidios în urmă cu 1 an a unor fenomene respiratorii – dispnee, tuse iritativă, asociate cu fatigabilitate, astenie fizică, scădere ponderală 17 kg în 6 luni (ianuarie-iunie 2015), pirozis, epigastralgii, disfonie. Se adresează iniţial medicului pneumolog, ulterior fiind direcţionată către diverși specialiști datorită simptomatologiei persistente și rebele la tratament. În ianuarie 2016, ajunge în departamentul de dermatologie, la indicaţia medicului alergolog, acesta găsindu-se în imposibiliatatea realizării testelor cutanate din cauza modificărilor tegumentare. Clinic: se obiectivează tegumente infiltrate și indurate la nivelul mâinilor și feţei, modificări instalate progresiv, însoţite de prurit generalizat. Din anamneza activă reiese că leziunile au fost precedate cu aproximativ 20 de ani de un fenomen Raynaud repetitiv. Pacienta prezintă, de asemenea, macule acromice suborbitar bilateral. Aspectul clinic și patologiile asociate orientează diagnosticul spre sclerodermie sistemică forma acrosclerotică și vitiligo, iar prin corelaţie cu modificările bioumorale se ridică suspiciunea de tiroidită autoimună. S-a instituit corticoterapia sistemică cu Methilprednisolon 16mg/zi, medicaţie vasoactivă, antifibrozantă, bronhodilatator, iar topic se asociază dermatocorticoid și pomadă cu heparină. Evoluţia a fost lent favorabilă, cu diminuarea induraţiei la nivelul membrelor superioare după o lună de tratament. Menţionăm faptul că pacienta s-a adresat serviciului de reumatologie pentru explorări suplimentare în vederea instituirii terapiei cu antagoniști ai receptorilor endotelinei. Astfel, medicul reumatolog decide suprimarea în doze descrescânde a corticoterapiei sistemice, pacienta acuzând, după administrarea ultimei doze, alterarea bruscă a stării generale, cu exacerbarea simptomatologiei pulmonare. S-a indicat reiniţierea corticoterapiei, dar, prin suprapunerea unei viroze respiratorii, evoluţia a fost nefastă, conducând la exitus. Rezultate și concluzii. Particularitatea cazului constă în asocierea, rar raportată în literatura de specialitate, a acestor patologii autoimune, în tipologia/ atipia atingerii pulmonare precoce și amplă, caracteristică pentru sclerodermia sistemica difuză și în nerecunoașterea sclerodermiei sistemice de către serviciile clinice în evidenţa cărora se afl a pacienta. Un alt aspect important ar fi rolul corticoterapiei sistemice în controlul atingerii viscerale și cutanate. Având în vedere heterogenitatea sclerodermiei sistemice, este importantă colaborarea interdisciplinară în vederea diagnosticării corecte și a stabilirii conduitei terapeutice adecvate, pentru îmbunătăţirea calităţii vieţii pacientului.Overview. Scleroderma is a chronic disease, affecting multisystem, of uncertain etiology. It is characterized by alteration, increased hardness and thickness of the skin and by fibrotic, inflammatory and vascular type changes of internal organs (gastrointestinal tract, lungs, heart, kidneys), accompanied by immunological, cellular and humoral abnormalities. Case report. We present a patient aged 62 years, known from 2015 with grave cardio-respiratory (diffuse lung fibrosis, bilateral bronchiectasis, chronic obstructive lung disease stage III, compensated chronic pulmonary heart disease, atherosclerosis, aortic and mitral stenosis, mild form of mitral regurgitation), gastroenterological (gastro-esophageal reflux, chronic steatohepatitis, chronic alithiasic gallbladder), endocrine (multimicronodular left lobe thyroidian goiter) problems. Th e patient relates insidious onset 1 year ago to respiratory phenomenon – dyspnea, irritant cough, associated with fatigue, asthenia, 17 kg weight loss within six months (January-June 2015), gastro-esophageal reflux, epigastric pain, dysphonia. The patient had initially been seen by a pulmonologist doctor, then directed to various medical specialists due to persistent rebelious symptoms refractory to treatment. In January 2016 the patient arrived in the dermatology department, sent by an allergist (allergy skin testing could not be performed because of the hardness of the skin). Clinic: infiltration and induration of the skin of the hands and face, changes progressively installed, accompanied by generalized pruritus. Repetitive Raynaud’s phenomenon has preceded skin lesions for about 20 years. The patient also presents achromic patches suborbital bilaterally. Clinical and biohumoral changes oriented the diagnosis to systemic acrosclerotic form of scleroderma associated with vitiligo and autoimmune thyroiditis. Systemic corticosteroid therapy was instituted (methylprednisolone 16 mg/day), vasoactive, antifibrotic, bronchodilator medication associated with topic dermatocorticoid and heparin ointment was applied as well. Favorable evolution has been slow, with the decrease of upper limb skin induration after one month of treatment. We note that the patient was addressed to the rheumatology service for additional examination and to switch to endothelin receptor antagonist therapy. The rheumatologist decides suppression of systemic corticosteroid therapy, decreasing doses. The patient complained of sudden alteration of general condition, with exacerbation of pulmonary symptoms aft er the last corticosteroid dose. Initiation of corticosteroid therapy was indicated, but by superimposing respiratory viruses, evolution was unfortunate, leading to exitus. Results and conlcusions. The particularity of the case lies: in the rarely reported in the literature combination of these autoimmune diseases, in typology/ atipia of early and wide lung achieving (diffuse systemic scleroderma feature) and in the inability of recognizing this disease (systemic scleroderma) by the other clinical services. Another important aspect is the role of systemic corticosteroid therapy to achieve the control of visceral and cutaneous changes. Considering the heterogeneity of systemic scleroderma, interdisciplinary collaboration is important in establishing the correct diagnosis and appropriate therapeutic management, to improve patient’s quality of life

Non-operative management of the sigmoid volvulus – case presentation

Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%

Cholelitiasis in an adult patient with mild hereditary spherocytosis – a case report

Hereditary spherocytosis (HS) is an inherited abnormality of the red blood cell, caused by defects in structural membrane proteins. The condition is dominantly inherited in 75% of people. The severity of the disorder is related to the type and amount of membrane disruption, which is genetically determined. A patient who suffers from this disorder is commonly found in a surgical ward when the disease becomes unmanageable by a hematologist. Surgeons encounter complications such as: jaundice, splenomegaly, gallstone sand severe anemia. We present the case of a 66-year-old woman with a history of hereditary spherocytosis who presented at the emergency room for pain in the right upper quadrant, jaundice and anemia and was diagnosed with gallbladder stones and common bile duct obstruction

ASPECTE ETICE ŞI PSIHOLOGICE ÎN NEOPLASME CU SINDROM DE COMPRESIUNE MEDIASTINALĂ LA COPIL

Tulburările psihologice precum anxietatea, depresia sau insomnia sunt comune copiilor diagnosticaţi cu neoplasme cu sindrom de compresiune mediastinală şi prezic înrăutăţirea calităţii vieţii lor. Scopul lucrării este de a sublinia principalele aspecte legate de tulburările psihologice întâlnite la pacienţii cu boală Hodgkin, limfom malign non-Hodgkin sau leucemie limfoidă conică cu sindrom de compresiune mediastinală, cât şi evidenţierea rolului deosebit de important al aplicării principiilor fundamentale de etică medicală, cu scopul de a îmbunătăţi calitatea vieţii pacienţilor studiaţi. 60 de copii cu vârsta cuprinsă între 4 şi 17 ani au fost urmăriţi pe o perioadă de 5 ani. Cele mai frecvente tulburări psihologice întâlnite la pacienţii diagnosticaţi cu sindromul de compresiune mediastinală au fost: depresia, anxietatea, panica patologică, insomniile, delirul, anorexia şi foarte rar, ideile de suicid. S-a remarcat că aceste tulburări au infl uenţat în mod negativ capacitatea decizională a copiilor şi adolescenţilor, referitor la consimţământul informat pentru stabilirea atitudinii terapeutice ideale. Succesul măsurilor etice în întâlnirile de zi cu zi ale medicului oncolog cu pacienţii, a depins de capacitatea acestuia de a lua în consideraţie nevoile fi zice, emoţionale şi sociale ale pacienţilor

User behavior, social networking, and playing style in online and face to face bridge communities

Online social games are Internet-based games that use the social networks formed by players to extend in-game functionality. For example, gamers participating in the BBO Fans community combine online bridge play with social networking. Despite an increase in online social gaming’s popularity– currently, there exist over one million online bridge players–, and of decades of research on social networks, the activity characteristics and the community structure of online social gaming remain relatively unknown. In this work we investigate and contrast these aspects for two bridge communities, BBO Fans (online) and Locomotiva (face to face). We propose the use of playing relationships instead of traditional social relationships such as friends and friends-of-friends. Using long-term, large-scale data we have collected from both the online and face to face bridge communities, we analyze user behavior, social network structure, and playing style in bridge communities. We find many similar characteristics in the two studied communities. Surprisingly, we also find more variation in the activity levels and fewer stable partnerships for the face to face bridge community. 1