Quiet a Puzzle: A Case Report of 15 year Old Female with Severe Anemia Due To Scurvy

Scurvy is historically thought of a disease affecting sailors in the seventeenth century. Vitamin C deficiency is rare in the developed world. It is mainly found in patients with poor nutrition and specifically those with developmental delay. The spectrum of scurvy is varied and includes dermatological, dental, bone and systemic manifestations. We present to you a case of a 15 year old female with a history of trisomy 21 presenting with severe anemia as a direct cause of vitamin C deficiency. She presented with a one month history of progressive bilateral lower extremity bruising and inability to walk. Physical exam notable for trisomy 21 features. Bilateral swelling in lower extremities with the right calf more swollen than left. Perifollicular hyperkeratotic papules with surrounding pinpoint hemorrhage in upper extremities with coiled hair. Lower extremity had large areas of ecchymosis associated with significant tenderness. Reminder of the physical exam and review of the systems is unremarkable. Consent for photographs of exam findings were obtained from parents. She underwent extensive work up which showed normocytic anemia hgb 8.7 g/dL. Elevated D dimer. ANA +. Normal Iron studies, Comprehensive metabolic panel, coagulation studies. Autoimmune work was unremarkable. Hemolysis labs were grossly unremarkable. Hematological work up including ADAMTS12, Paroxysmal nocturnal hemoglobinuria , Factor deficiencies, platelet function assay, protein C , S were unremarkable. Duplex ultrasound , CT and CTA of lower extremities were unremarkable. Vitamin C levels were low and barely detectable at \u3c0.1mg/dl. Patient was started on Vitamin C supplementation of 250 mg twice a day and iron supplementation. She was found to have low B12 and vitamin D.. Significant improvement was notable in Three weeks of treatment as the patient was able to walk. In addition to near complete resolution of her ecchymosis and improvement in her anemia

A Case of Transient ST Elevation and Polymorphic Tachycardia without Angina Diagnosed by Holter Monitoring

We report the case of 52-year-old female with recurrent episodes of palpitations and dizziness. Holter monitoring revealed transient ST elevations followed by episodes of polymorphic ventricular tachycardia associated with episodes of palpitations and dizziness. Coronary angiography revealed mildly irregular right coronary artery with 90% stenosis. The patient underwent percutaneous coronary intervention with successful placement of a stent to the mid-right coronary artery. The patient has been followed closely over a period of 12 months. There haven\u27t been any recorded episodes of tachycardia, and the patient has remained symptom-free

Developing a Web-Based Vocabulary Size Test for Indonesian EFL Learners

One important aspect of English language learning is vocabulary. However, the availability of vocabulary proficiency tests, both manual and computer-based, is still limited. Almost all currently existing vocabulary tests are monolingual and have not accommodated the needs of EFL learners. The objective of this study was to develop a web-based vocabulary size test for English learners in Indonesia. It consisted of 6 stages, namely: (1) needs analysis; (2) corpus selection and corpus data analysis; (3) sampling to select words from corpus data; (4) generating test items; (5) developing a web-based version of the test and pilot study; and (6) reflection and evaluation. Pilot study involved having a sample group of English learners in Indonesia try out the designed vocabulary size test. A paired-samples t-test was then used to determine whether there was a significant difference between the learners’ scores on the designed test and those on a free online vocabulary size test not specifically designed for Indonesian test takers. The t-test indicated that there was a significant difference between the designed test scores (M=6433, SD=1169) and free online test scores (M=5700, SD=1616); t(35)=-3.597, p = 0.001. The identifiable factors which seemed to contribute to this difference were different corpus data (COCA vs. BNC), different varieties of English (American vs. British), and different formats (bilingual vs. monolingual). Despite the difference, there was a positive correlation between the two tests (Correlation = 0.657) meaning that higher scores on one of the tests equals higher scores on the other.

Life event ontology based e-government service integration with privacy awareness

University of Technology Sydney. Faculty of Engineering and Information Technology.The advancement of information and communications technology (ICT) and web services offers a promising opportunity for e-government service integration, which can improve the availability and quality of e-government services. One of the key challenges in electronic government (e-government) is the composition of standalone e-government services to achieve complex services. In recent years, the life event model as ontology has been introduced as the core element of integrating complexity of service delivery to improve the efficiency and reusability of e-government services, and web-based information management systems. Despite the conceptual emergence of life event ontology, the question as to how ontology can be used to effectively model life events to support e-government government to citizen service integration remains. Furthermore, privacy concerns represents a major barrier for citizens to accept e-government services, and the question of how to address these privacy issues is becoming increasingly important as the government moves to push service delivery online. Although solutions have been recently suggested in the literature to deal with privacy concerns, there are few practical approaches for helping citizens to create their preferences for privacy protection based on various aspects of privacy policy. These preferences include purpose, retention, consent and the protection of personal information in the context of using e-government services. As a step forward to satisfy the above requirements and to address some of the current challenges, this thesis presents a new framework for supporting e-government service integration based on a life event model. More specifically, the framework enables the system to automatically discover, select, compose and execute correct service across multiple web applications for appropriate life events and to allow a citizen to set up their privacy preferences and to support computerisation of these preferences so that these preferences can be guaranteed. The main contributions are fivefold: (i) the proposal of a conceptual framework of e-government service integration based on life events, (ii) the development of a new life-event model using ontology technique and the methodology to model life events as an ontology model for e-government service integration, (iii) the development of a novel citizen personal information sensitivity model with privacy awareness for supporting citizens in expressing their privacy preferences and for granting the protection of citizens’ personal information, (iv) the development of a suite of techniques to implement the framework including a practical solution to enforce the privacy policies in relation to citizens’ personal information during e-government service integration, and (v) the manifestation of the validity of the proposed framework, models and techniques through the creation of a working prototype of an integrated e-government service system in a specific e-government domain in Saudi Arabia. The significance of this study can be seen from the fact that it: (i) enables the domain expert to model effective life-events based on the use of ontology building methodology, (ii) enables effective modeling of citizens’ personal information, (iii) enables citizens to specify their privacy preferences, (iv) ensures that citizens can be well informed in terms of what information is used, what purpose is it used for, where and how it is stored and who will handle the information, and (v) enforces privacy policies which correspond to the citizens’ privacy preferences so that their privacy concerns can be properly addressed and that citizens’ personal information will be protected and guaranteed against unauthorized access, loss, misuse or alterations based on their privacy preferences. Based on the outcomes of this study, the integrated e-government systems can significantly improve the accessibility of e-government services and enhance the citizens' trust toward the integrated government e-service systems

Investigating health risk perceptions during the Hajj: Pre-Travel advice and adherence to preventative health measures

Background: Every year, over 2 million people gather together to observe the Hajj pilgrimage in Mecca. This presents a public health risk to both Saudi and the pilgrims’ country of origin. The aim of this study was to evaluate the risk perception and the source of health advice by the pilgrims. Methods: We conducted a cross-sectional survey among internal and external pilgrims performing the Hajj. The survey evaluates the general safety and preventative measures applied, factors influencing public health safety at Hajj, source of pre-travel health advice, recommended preventative health measures, and the effective preventative measures. Results: A total of 280 pilgrims from 28 different countries were approached of which 233 completed the survey with response rate of 83%. The majority (219 [94%]) of the respondents considered the Hajj as safe while 205 (88%) sought pretravel health advice. The most popular source of pre-travel health advice among the pilgrims were from medical professionals (83 [25.6%]) and other pilgrims (44 [18.9%]). Diversity and carelessness were believed to be the main factors influencing public health safety in the Hajj by 184 (79%) and 181 (78%) of the respondents respectively. Yellow fever (117 [50%]) and wearing of face masks (56 [24%]) were the most and least adopted recommended public health measures respectively while most pilgrims believed handwashing (137 [59%]) and wearing of face mask (119 [51%]) are the most effective preventative health measures. Conclusion: Our study shows a reduced perception by pilgrims of the health risk of the Hajj and highlights the need to improve how information is channelled to prospective pilgrims about preventative health measures. The discordance between recommended preventative health measures and adherences by pilgrims shows a need for a comprehensive enforcement program underpinned by the Saudi Ministry of Health (MoH)