STRUCTURILE DE DEFLECTORI, FACTORI DE ÎMBUNĂTĂŢIRE AI HABITATULUI PISCICOL- STUDIU DE CAZ, RÂUL NICOLET (QUEBEC-CANADA)

Deflection structures factors for improve the fish habitat. Case study nicolet river (Quebec-Canada). Există câţiva factori care joacă un rol important în definirea calităţii habitatului fizic al râurilor, speciile de peşti manifestând preferinţe pentru anumite elemente hidraulice (viteză, adâncime, tipul sedimentelor etc). Un habitat sănătos este în mod normal caracterizat printr-o succesiune morfologică de vaduri şi adâncuri cu impact în oxigenarea apei, reproducerea şi hrănirea peştilor etc. Datorită importanţei recreaţionale a pescuitului, în Canada există un număr foarte mare de proiecte de îmbunătăţire a habitatului piscicol. In acest sens, deflectorii amplasaţi în albiile cursurilor de apă s-au dovedit a fi metoda cea mai de succes pentru habitatul păstrăvilor. Pe râul Nicolet (Quebec-Canada) a fost monitorizată influenţa unor astfel de structuri inginereşti asupra menţinerii în timp a structurii de adânc. Din analiza evoluţiei morfologice şi morfometrice a adâncurilor (prin folosirea diferitelor ridicări topografice succesive din perioada 2000-2007), rezultă faptul că structurile inginereşti au un rol benefic în menţinerea unui habitat propice pentru peşti

VISUAL ANTINOMY OF SACRED PERFECTION. GINEVRA DE’ BENCI’S MYSTERY IN TARKOVSKY’S MIRROR

The article examines the significance of Renaissance aesthetics for Andrei Tarkovsky and explores the functioning and semiotic effects of the Renaissance figurative model in the film Mirror. The study focuses on one of the least commented stills with a great symbolic significance – the “Portrait of Ginevra de’ Benci” (or “Portrait of a Young Woman with a Juniper”) by Leonardo da Vinci. The author emphasizes the visual and semantic connection between Leonardo’s canvas and the image of the main character of the film, showing how the director creatively develops the mysterious connection between the two women from different times and cultures. On one hand, the inner world of the main heroine is reflected in Leonardo’s canvas. On the other hand, a certain view of the camera on Ginevra’s portrait and the lighting technique reveal the secret world of the spiritual evolution of the main character. Tarkovsky visually connects the biographical plot with the sacred themes of eternity, immortality, the antinomic perfection of man, and the salvation of the soul, using the symbolically rich Renaissance imagery created by Leonardo da Vinci.The article examines the significance of Renaissance aesthetics for Andrei Tarkovsky and explores the functioning and semiotic effects of the Renaissance figurative model in the film Mirror. The study focuses on one of the least commented stills with a great symbolic significance – the “Portrait of Ginevra de’ Benci” (or “Portrait of a Young Woman with a Juniper”) by Leonardo da Vinci. The author emphasizes the visual and semantic connection between Leonardo’s canvas and the image of the main character of the film, showing how the director creatively develops the mysterious connection between the two women from different times and cultures. On one hand, the inner world of the main heroine is reflected in Leonardo’s canvas. On the other hand, a certain view of the camera on Ginevra’s portrait and the lighting technique reveal the secret world of the spiritual evolution of the main character. Tarkovsky visually connects the biographical plot with the sacred themes of eternity, immortality, the antinomic perfection of man, and the salvation of the soul, using the symbolically rich Renaissance imagery created by Leonardo da Vinci. &nbsp

Chronic ischemic mitral regurgitation

peer reviewe

Mitral regurgitation in patients with systolic heart failure: more than a bystander

Peer reviewe

Another One Bites the Joint: A Case of Reactive Arthritis in an Otherwise Healthy Hispanic Male

Reactive Arthritis is a spondyloarthritis following gastrointestinal or genitourinary infections, traditionally described as a triad of conjunctivitis, urethritis, and arthritis. It is important to identify patients with reactive arthritis as certain disease features portend a poorer prognosis. We present a case of reactive arthritis in a 36-year-old gentleman after a self-limited episode of gastroenteritis. A 36-year-old man presented to the Rheumatology clinic for a 2-week history of multiple arthralgias. The patient reported that one week before the onset of arthritis he experienced a self-limited episode of gastroenteritis. Succeeding, the patient noticed pain and swelling to right wrist, left elbow, and pain and swelling to left wrist. Patient was found to have an elevated ESR and he was prescribed Medrol dose pack and indomethacin which did not resolve symptoms. Patient denied rashes, oral ulcers, conjunctivitis, or constitutional symptoms. Examination was remarkable for swelling of right elbow, bilateral wrists, left knee, and ankles. There was no conjunctivitis, oral ulcers, or keratoderma blenhorragicum. Labs showed negative ANA and rheumatoid factor, sedimentation rate of 107, CRP 8.9, positive HLA-B27. Patient was diagnosed with reactive Arthritis. He was started on Prednisone and Sulfasalazine. Reactive arthritis is a spondyloarthritis that typically affects middle-aged men and is self-limited with remission being achieved by 6-18 months, while recurrence occurs in 25-50% of cases, especially in HLA-B27 positive patients. These patients could potentially develop long term disease resulting in enthesitis and destructive arthritis

Acquired Factor VIII Deficiency Presenting as Gross Hematuria in a Hispanic, Pregnant Patient with Previously Undiagnosed Connective Tissue Disease

Acquired factor VIII deficiency is a bleeding disorder caused by the presence of autoantibodies against clotting factor VIII. We report a case of a 24-year-old pregnant woman who presented with gross hematuria secondary to acquired factor VIII deficiency in the presence of a previously undiagnosed connective tissue disease. *is article includes a literature review of pregnancy-related cases of acquired factor VIII deficiency. We also reviewed various therapeutic approaches for the management of the acquired factor inhibitor which include achieving hemostasis and elimination of the inhibitor via immunosuppressive agents. *is case report describes the rare presentation of acquired factor VIII deficiency related to pregnancy and highlights the importance of considering a factor VIII inhibitor in the differential diagnosis of patients who present with bleeding and prolonged PTT during the peripartum and postpartum periods

Disease Severity and Response to Induction Therapy in Hispanic Patients With Antineutrophilic Cytoplasmic Autoantibody-Associated Vasculitis-Related Diffuse Alveolar Hemorrhage

Objectives We examined the response to induction therapy of Hispanic patients with antibody-associated vasculitis (AAV)-related diffuse alveolar hemorrhage (DAH). This study aimed to determine the severity of disease at presentation and the response to induction therapy in our patient population. Methods We retrospectively reviewed the clinical data of Hispanic patients hospitalized with antineutrophil cytoplasmic antibody (ANCA) vasculitis between October 1, 2010, and December 31, 2021. We identified 98 Hispanic patients hospitalized with AAV and 19 admitted with AAV-related DAH. The Birmingham Vasculitis Activity Score (BVAS) was obtained from all patients on presentation. Results Based on the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides, 12 patients met the diagnostic criteria for microscopic polyangiitis (MPA) and seven met the criteria for diagnosing granulomatosis with polyangiitis (GPA). All patients received methylprednisolone therapy. Induction therapy consisted of cyclophosphamide pulse therapy (n=3), cyclophosphamide plus plasmapheresis (PLEX) (n=1), rituximab induction therapy (n=8), and rituximab induction plus plasmapheresis (n=6), and one patient received one dose of cyclophosphamide followed by rituximab plus plasmapheresis. The average BVAS was 25.53 at presentation. Survival at six months included 67% (n=2) treated with cyclophosphamide alone, 75% (n=6) treated with rituximab alone, and 50% (n=3) treated with rituximab plus PLEX. The patient who received an initial loading dose of cyclophosphamide followed by rituximab plus PLEX did survive for six months; however, the patient treated with cyclophosphamide plus PLEX did not have early survival. Conclusions Hispanic patients with ANCA-associated vasculitis present with a more severe disease burden at presentation based on BVAS. Approximately 37% of our patient population had early death (death at \u3c6 months) despite adhering to the standard of care for induction therapy. Due to the more significant disease burden at presentation, it is vital to include ethnic minorities in large clinical trials to help improve outcomes in these patient populations

A Rare Cause of Lymphadenopathy in a Young Hispanic Female: Unmasking Recurrent Nodal Rosai-Dorfman Disease

Rosai-Dorfman disease (RDD) is a rare histiocytic disorder that can present with painless bilateral symmetrical cervical lymphadenopathy, mimicking lymphomas. RDD is characterized by excessive tissue infiltration by dendritic cells, macrophages, or monocyte-derived cells, with a histopathologic diagnosis based on the presence of CD68+, CD163+, and S100+ histiocytes, which differentiate it from other histiocytic neoplasms. In this case report, we present a young Hispanic female with recurrent subcutaneous growths and lymphadenopathy, initially thought to be lymphoma, who was diagnosed with RDD after a significant diagnostic workup. Treatment initially consisted of surgical excision; however, due to recurrence, the patient was successfully treated with corticosteroids and a steroid-sparing agent, 6-mercaptopurine, with significant improvement in symptoms. RDD should be considered a differential diagnosis for patients with cervical lymphadenopathy, and an interdisciplinary approach is essential to managing this rare disorder effectively. The report highlights the need for an interdisciplinary approach to managing this rare disorder effectively and underscores the importance of multimodal treatment in disease suppression. As a rare disease with slow advancement of defined guidelines for diagnostic and treatment strategies, this case report adds to the existing literature on RDD

Dermatomyositis- Related Intestinal Dysmotility

Dermatomyositis (DM) is an inflammatory myopathy (IIM) characterized by proximal muscle weakness and pathognomonic skin lesions. A 69-year-old woman with a recent diagnosis of DM 1 month prior, treated with corticosteroids and immunomodulators, presented to our inpatient rehabilitation with worsening dysphagia and constipation. At the time of our evaluation, physical examination was notable for erythematous papules over the metacarpophalangeal joints, proximal interphalangeal joints, elbows, and knees as well as a violaceous rash on the face. Muscle strength was diminished bilaterally with proximal distribution being affected greater than distal. Laboratory studies were notable for the creatine kinase (CK) level of 31 IU/l, antinuclear antibodies (ANA) by immunofluorescence of 1:80, and aldolase 4 u/l. The 11-antibody myositis panel was negative showed partially treated acquired IIM with perifascicular atrophy. During hospitalisation, she was found to have pulmonary embolism. She received enoxaparin 1 mg/kg subcutaneous BID. Soon after, she developed rectal bleeding. Colonoscopy showed a stercoral ulcer caused by chronic constipation. While dysphagia is common, being present in 25–50% of patients with DM, lower gastrointestinal problems involving the small and large intestine are rare and typically present as a late manifestation of the disease. Decreased peristalsis in the large colon can lead to constipation, impaction, and subsequent mucosal ulceration, and pressure necrosis induced by faecaloma formation. Although rare, our case highlights the importance of recognising gastrointestinal complications that DM can cause and the effects that those complications have on morbidity and mortality

Rituximab for steroid-resistant organising pneumonia in a woman with rheumatoid arthritis

Organising pneumonia (OP) is a form of interstitial pneumonia characterised by inflammation and scarring leading to obstruction within the small airways and alveoli. Practice guidelines recommend treatment of moderate to severe OP with glucocorticoids; however, there have been cases of steroid-resistant OP successfully treated with rituximab. We describe a case of a woman in her 20s with rheumatoid arthritis who presented with pleuritic chest pain, haemoptysis and dyspnoea on exertion and was diagnosed with OP after multiple radiographic images and biopsies. The patient failed numerous treatment regimens, including corticosteroids, antibiotics and mycophenolate, but was successfully treated with rituximab. This case highlights the importance of identifying new therapeutic agents that will minimise the use of glucocorticoids in the treatment of OP