An Atypical Presentation of Cystic Echinococcosis

Cystic echinococcosis (CE) is an infection caused by the Echinococcus granulosus tapeworm. CE generally manifests in the liver, but it may present in any organ. These patients often first present to the emergency department. Mortality over 10 years is significant for those who go undiagnosed. We report the case of a 34-year-old patient who immigrated from Yemen six years earlier. She presented with acute onset dysuria, suprapubic pain, and fever. Imaging revealed a primary multicystic mass on the right renal pole with a secondary lesion in the right hepatic lobe. On further investigation, the patient’s serum was positive for echinococcus antibodies

Internet Ussage and Agricultural Information Utilization by Agricultural Extension Staff in Bogor District

The vast development of communication technology produces so many communication media that can be used to disseminate information. One of the communication media that can be used is cyberspace communication or internet media. Agricultural extension workers as those who act as diseminator supposedly able to utilize agricultural information communication technology development in carrying out their duties and functions. This study aims to description of internet USAge by agricultural extension, analyze the factors affecting the level of internet USAge, as well as analysis of the utilization of information and its relevance to the level of use by agricultural extension. The level of internet USAge by respondents measured the frequency and duration of use is still low. Respondents use the internet less than three times a week and duration of less than three hours a day. Factors significantly correlated with the use of the Internet by agricultural extension is extension characteristics (age and availability of technology) and information needs of extension (information processing technology, marketing and climate). Utilization by agricultural extension information is stored for consumption in the form of private, shared with a fellow instructor for discussion, and distributed to farmers as extension material. More than half of the respondents utilize the information to be discussed to fellow instructor, the next disseminated to farmers and stored for personal

Renal Cysts in an Immigrant Patient: An Atypical Presentation of Echinococcosis

Introduction: Cystic echinococcosis (CE) is an infection caused by the Echinococcus tapeworm that results in the creation of cysts within a range of visceral organs. Ninety percent of these cysts are in the liver or lungs. In the United States, cases are quite rare and most are found in immigrants from endemic countries. Patients with CE may remain asymptomatic for years. If left undiagnosed and untreated, mortality from CE is estimated to be 90% by ten years. In this case, we discuss a patient who presented to the emergency department with genitourinary complaints and was diagnosed with CE of primary renal involvement, a rare anatomic location. Case Description: A previously healthy 34-year-old female presented to the emergency department with dysuria, suprapubic pain, myalgias and fever of one day duration. The patient had immigrated from Yemen 6 years prior. On presentation, she was febrile to 38.8C and tachycardic to 133. Complete blood count and lactic acid were within normal limits and urinalysis was not consistent with a urinary tract infection. Ultrasound revealed a mass on the right kidney and computerized tomography (CT) showed a subcapsular right renal cystic mass with septations as well as a secondary liver lesion. Further imaging by magnetic resonance confirmed the subscapular multi-cystic mass along the right kidney measuring 7 x 5.2 x 6.1 cm consistent with CE stage III and a 1.7 cm cystic lesion in the right hepatic lobe also consistent with CE. Serum IgG for echinococcus was positive. The patient was diagnosed with echinococcal disease and was initiated on albendazole 200mg BID for 3-4 months with future plans for surgical intervention. Discussion: Echinococcal disease is a parasitic infection with the majority of cases originating in the Middle East, South and Central America and sub-Saharan Africa. The clinical presentation of Echinococcus infection is largely dependent on the location and size of the cysts. Small cysts may be asymptomatic whereas larger cysts may cause mass effect or may present with toxic appearance with rupture. Some cysts present with symptoms up to several decades after initial infection or remain asymptomatic indefinitely. The most common sites of involvement are the liver (approximately 66%) followed by the lungs (25%). Less commonly reported sites include the brain, kidneys, muscle, bone and heart. Our patient’s primary renal cyst was large enough to cause mass effect, leading to dysuria and suprapubic pain. Generally, diagnosis of echinococcal disease is made with both imaging and serology. With regards to imaging, ultrasonography is 90-95% sensitive for CE and CT is only moderately better with 95-100% sensitivity; however, CT is superior to ultrasonography for evaluation of extrahepatic cysts. MRI offers no major advantage over CT. When considering serology, antibody detection has greater sensitivity than antigen detection. Our patient tested positive for echinococcal IgG. IgE and IgM were not pursued as IgG has better sensitivity. Management of these cysts are based on the WHO classification criteria and typically use a combination of observation, albendazole, PAIR (percutaneous puncture, aspiration, injection, re-aspiration) and surgery. Our patient’s renal cyst was classified as WHO stage III, for which the recommended treatment is albendazole followed by either PAIR or surgery. Conclusion: Although CE is uncommon in the United States, careful attention should be paid in individuals who have immigrated from endemic countries. While the liver and lungs are most commonly involved, cysts can be found in any organ and symptoms are often specific to the affected system. The best imaging modality for extrahepatic cysts in particular is by CT. The majority of these patients should be started on albendazole initially with definitive treatment often requiring evaluation by several subspecialists including Infectious Disease, Interventional Radiology and Surgery.https://scholarlycommons.henryford.com/merf2020caserpt/1123/thumbnail.jp

Diltiazem Induced Bullous Leukocytoclastic Vasculitis

Diltiazem is a calcium ion cellular influx inhibitor approved by the U.S. Food and Drug Administration for the management of hypertension and chronic stable angina. Diltiazem is commonly used off label for chronic ventricular rate control in atrial fibrillation. Very few cases of widespread cutaneous vasculitis have been described in association with diltiazem since 1988. We report on a patient developing diffuse petechiae with overlying palpable purpura and tense bullae in both lower extremities, which progressed to the thighs, buttocks, abdomen, and upper extremities 6 days after starting diltiazem for management of atrial fibrillation. Skin biopsy revealed leukocytoclastic vasculitis.https://scholarlycommons.henryford.com/merf2020caserpt/1009/thumbnail.jp

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS). DESIGN: Retrospective cohort study. SETTING: This investigation took place at a single-center, tertiary referral multidisciplinary comprehensive healthcare hospital in metropolitan Detroit, Michigan. PATIENTS: Adult patients 18 years old or older hospitalized in the ICU and diagnosed with ARDS on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Three hundred eight patients were included in the final analysis. Risk factors associated with mortality included advanced age (p \u3c 0.001), increased body mass index (p = 0.008), and a history of chronic kidney disease (p = 0.023). Presence of AKI by day 1 of intubation, with elevated creatinine (p = 0.003) and oliguria (p \u3c 0.001), was significantly associated with mortality. On multivariate analysis, advanced age (relative risk [RR], 1.02), urine output on the day of intubation (RR, 0.388), bicarbonate level (RR, 0.948), and Sequential Organ Failure Assessment severity score (RR, 1.09) were independently associated with mortality. A receiver operating characteristic curve identified a threshold urine output on the day of intubation of 0.7 mL/kg/hr (area under the curve, 0.75; p \u3c 0.001) as most closely associated with inpatient mortality (i.e., urine output \u3c 0.7 mL/kg/hr is associated with mortality). CONCLUSIONS: For patients with ARDS, oliguria on the day of intubation was independently associated with increased mortality. Urine output of less than 0.7 mL/kg/hr predicted 80% of inpatient deaths. These findings herald an augmented understanding of the role of urine output in medical decision-making and prognostication

Location Characteristics of the New Country Capital in East Kalimantan Province

The relocation of the national capital has been carried out by several countries for various reasons. This study aimed to determine the characteristics of the location of the nation’s capital city in East Kalimantan Province. The research was conducted in two regencies, 3 sub-districts, and 4 sub-districts. Penajam Paser Utara District includes Babulu and Sepaku Districts, while Kutai Kartanegara District includes Muara Jawa District. The data used in this study is secondary data from the study literature. The findings from the study are that in West Babulu Village there is a network of arterial roads and local roads. Pemaluan Village, Sepaku Village, and Teluk Dalam Village have a network of local roads and other roads. North Panajam Paser Regency has 3 watersheds and Kutai Kartanegara Regency has 2 watersheds in total there are 5 watersheds. Meeting water needs apart from river water can also be from dams. In 2023, it is estimated that the Nation Capital's water needs will reach 16,500 liters/second, with the needs of surrounding districts in that year reaching 27,232 liters/second. In line with the development of the city and its facilities, the need for water will increase, so the nation’s capital city requires alternative sources of additional water. Topographic conditions seen from elevation, slope, and landform, there are several areas that need to be maintained as protected areas or city green open spaces (RTH), urban forests, which can also function as educational or tourism facilities for Capital cities in order to protect areas that are underneat

Utility of cerebral embolic protection in non-TAVR transcatheter procedures

BACKGROUND: Cerebrovascular events that occur during structural and interventional procedures are a well known risk which is associated with increased mortality. The FDA has approved the use of the Sentinel device in TAVR. Hereby we report on our experience on the safety and efficacy of using Sentinel in a patient population undergoing non-TAVR transcatheter procedures. METHODS: Retrospective analysis of a single center experience with using the Sentinel device for non-TAVR transcatheter procedures. RESULTS: We identified 33 patients (average age was 73.8 years, 36.7% females, and 30% with history of a prior stroke) felt to be at high risk for cerebroembolic events that underwent Sentinel device placement. Sentinel placement was successful in all patients. Examples of high risk features included high atheroma burden in the aortic arch, left sided valve vegetations, intra-cardiac thrombi and severe left sided valve calcifications/thrombi. No patients developed periprocedural stroke or vascular complications. CONCLUSION: Overall, the use of Sentinel for non-TAVR indications appears feasible and safe. The use of cerebral protection devices should be studied further in non-TAVR patients to establish its role and its benefits, especially with expanding the number of non-TAVR transcatheter interventions

Modelado numérico del tiempo aplicado a generación renovable: evaluación de configuraciones en el modelo WRF

En el marco del futuro crecimiento de la participación de la generación renovable en el sistema eléctrico argentino, es necesario estudiar la capacidad de pronóstico del recurso eólico y solar en el territorio nacional, en un horizonte temporal de algunas horas a varios días. En este trabajo se analiza la capacidad del modelo Weather Research and Forecasting (WRF) para ser aplicado a la predicción de variables asociadas a la generación renovable. Para ello, se compararon los pronósticos de WRF utilizando distintas configuraciones contra observaciones de alta calidad de cada uno de los recursos. Se reportan resultados a lo largo de dos semanas testigo y se presentan métricas del error de pronóstico. En base a estos resultados se extraen conclusiones y se proponen líneas de trabajo a futuro.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Modelado numérico del tiempo aplicado a generación renovable: evaluación de configuraciones en el modelo WRF

En el marco del futuro crecimiento de la participación de la generación renovable en el sistema eléctrico argentino, es necesario estudiar la capacidad de pronóstico del recurso eólico y solar en el territorio nacional, en un horizonte temporal de algunas horas a varios días. En este trabajo se analiza la capacidad del modelo Weather Research and Forecasting (WRF) para ser aplicado a la predicción de variables asociadas a la generación renovable. Para ello, se compararon los pronósticos de WRF utilizando distintas configuraciones contra observaciones de alta calidad de cada uno de los recursos. Se reportan resultados a lo largo de dos semanas testigo y se presentan métricas del error de pronóstico. En base a estos resultados se extraen conclusiones y se proponen líneas de trabajo a futuro.Asociación Argentina de Energías Renovables y Medio Ambiente (ASADES

Stratospheric ozone profiles monitoring with DIAL technique in Río Gallegos

El adelgazamiento de la capa de ozono sobre el polo sur de nuestro planeta es un fenómeno estacional que desde la década de los ‘80 se desarrolla cada año durante la primavera. El mismo tiene su máxima expresión sobre la región Antártica, en donde el área de la región con adelgazamiento ha llegado a tener 30 millones de kilómetros cuadrados aproximadamente, alcanzando así en sus bordes la parte sur de nuestro país. Durante la primavera austral de 2005, en la ciudad de Río Gallegos, se desarrolló la primera campaña de mediciones intensivas de parámetros atmosféricos denominada SOLAR (Stratospheric Ozone Lidar of Argentina) realizada por la División Lidar del CEILAP. En la misma se midieron perfiles de ozono utilizando la técnica lidar de absorción diferencial (DIAL), pudiéndose registrar un total de 29 mediciones durante el periodo agosto – noviembre de 2005, cinco de ellas coincidentes con reducción significativa del contenido total de ozono. En el presente trabajo, se presenta un análisis cualitativo de las mismas que permite visualizar las zonas de la estratosfera que más fueron afectadas por el paso del vórtice polar. La utilización de un sistema de coordenadas cuasi-conservativo (latitud equivalente, nivel isentrópico) permitió realizar la selección de los días dentro de esta campaña de medición que estuvieron afectados por el paso del vórtice polar Antártico que contiene al agujero de ozono.The thinning of the ozone layer over the South Pole of our planet is a seasonal phenomenon that from the decade of the 80’s is developed every year during spring time. The same one has its Maxima expression on the Antarctica region, in where the area of the region with ozone depletion has gotten to have 30 million of square kilometers approximately, thus reaching in its edges the South part of our country. During the austral spring of 2005, in the Río Gallegos city, the first campaign of intensive measurements of atmospheric parameters was developed. The same is named SOLAR (Stratospheric Ozone Lidar of Argentina) and is held by the Lidar Division of the CEILAP. We measured ozone profiles using the differential absorption lidar technique (DIAL), being able to register a total of 29 measurements during the period August - November of 2005, five of them coincident with significant reduction of the total ozone content. In the present work, a qualitative analysis of the same ones appears that allows to visualize the zones of the stratosphere which they were more affected by the passage of the polar vortex. The use of a quasi-conservative system of coordinates (equivalent latitude, isentropic level) allowed to make the selection of the days within this campaign of measurement that were affected by the passage of the Antarctic polar vortex that contains to the ozone hole.Fil: Wolfram, Elian Augusto. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Científicas y Técnicas para la Defensa. Centro de Investigación en Láseres y Aplicaciones; ArgentinaFil: Salvador, Jacobo Omar. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Pallotta, Juan Vicente. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Científicas y Técnicas para la Defensa. Centro de Investigación en Láseres y Aplicaciones; ArgentinaFil: D´Elia, R.. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Científicas y Técnicas para la Defensa. Centro de Investigación en Láseres y Aplicaciones; ArgentinaFil: Pazmiño, A.. Service D’Aeronomie; ArgentinaFil: Godin Beeckmann, S.. Service D’Aeronomie; ArgentinaFil: Quel, Eduardo Jaime. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Científicas y Técnicas para la Defensa. Centro de Investigación en Láseres y Aplicaciones; Argentin