Abdominal pain with oral pigmentations as a clue for Peutz-Jeghers syndrome

A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and vomiting, constipation, obstipation, and rectorragia. She had a history of similar abdominal pain from a few months ago. She had no history of any specific disease and taking any medication. She had no history of surgery and specific family diseases. Her vital signs on admission were heart rate 90/minute, respiratory rate 18/minute, blood pressure 110/70 mmHg, and temperature of 37.1°C. There were several brown spots on her lips and inside her mouth. On abdominal examination, she had a generalized tenderness, especially in the LLQ. In the digital rectal examination, the rectum was empty. Lab tests showed the following results: leukocyte count 4000/mm3 with 80.9% neutrophils, hemoglobin 12.1 g/dl, platelet 320000/µl, and creatinine 0.6 mg/dl, BUN 14 mg/dl, glucose 152 mg/dl, sodium 137 mEq/L, potassium 4.5 mEq/L. Chest and abdominal radiographs were performed on the patient (Figure 1). No subdiaphragmatic free air was seen in the chest x-ray. The abdominal x-ray showed no air-fluid levels as well as any gas in the rectum. On abdominal and pelvic ultrasound, a moderate amount of free fluid was seen in the abdomen along with jejunoileal intussusception in the LLQ with an intestinal loops thickness increase

The power-creating strategies of the Islamic Republic of Iran in the Persian Gulf

Objective: The Islamic Republic of Iran needs authority to create indigenous and self -regional security in the Persian Gulf, as well as to counter regional and trans -regional threats in the area. Therefore, this article is aimed at identifying environmental factors (strength, weakness, opportunity, threat) and formulating Iranian powerful strategies.Methodology: It is applied research and is used by the case-context-based method to formulate strategies and tapis techniques to prioritize strategies.Results: Data analysis has found 13 part strategies (3 aggressive strategies, 5 competitive strategies, 3 conservative strategies and 2 defensive strategies). According to the improving the improving the number of 7 main power strategies in the Persian Gulf.Conclusion: The strategic position of the Islamic Republic of Iran for attaining authority is in a strong conservative and strong situation that is moving towards a mild and focused offensive

Jejunal Dieulafoy’s Lesion as a Rare Cause of Massive Gastrointestinal Bleeding; a Case Report and Literature Review

Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy’s lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy’s lesion should be included in the differential diagnoses

A Crisis in “Open Access”: Should Communication Scholarly Outputs Take 77 Years to Become Open Access?

This study diachronically investigates the trend of the “open access” in the Web of Science (WoS) category of “communication.” To evaluate the trend, data were collected from 184 categories of WoS from 1980 to 2017. A total of 87,997,893 documents were obtained, of which 95,304 (0.10%) were in the category of “communication.” In average, 4.24% of the documents in all 184 categories were open access. While in communication, it was 3.29%, which ranked communication 116 out of 184. An Open Access Index (OAI) was developed to predict the trend of open access in communication. Based on the OAI, communication needs 77 years to fully reach open access, which undeniably can be considered as “crisis in scientific publishing” in this field. Given this stunning information, it is the time for a global call for “open access” by communication scholars across the world. Future research should investigate whether the current business models of publications in communication scholarships are encouraging open access or pose unnecessary restrictions on knowledge development

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Human-Based Design and Digital Fabrication: Behavioral Mapping Parametric Knitter (BMPK)

Reducing human stress has become a critical issue incontemporary architecture. The design of the physicalenvironment plays an important role in the ease of wayfinding aspeople navigate a path through their surroundings. The goal ofthis project is to create an automated system that can analyzehuman behavior within a building, generate architectural formsbased on the results, and then fabricate an optimal interior spacedesign for facilitating the observed behaviors. The BehavioralMapping Parametric Knitter (BMPK) juxtaposes keycharacteristics of biological design (modularity, robustness,homeostasis, and adaptation) with smart technologies. TheBMPK Robot is an aggregated system that observes humanbehaviors, analyzes this behavioral data, designs parametricpatterns, and then weaves spatial designs. The robot extractsdata about complex human behaviors using intelligent sensorsembedded within the environment. Knowledge extracted fromthis behavioral data is then used to design a parametric pattern.Finally, the robot employs this pattern to determine an optimalspace structure to make the observed human behaviors as easy aspossible. The spatial designs produced by the BMPK Robot arethus intended to help optimize the dynamic human behaviorsthat are already observed within the built environment. Theresults from this research project will lead to reduced stress andimproved wayfinding among end-users. In addition, the researchwill produce a design tool capable of measuring the performanceof different architectural forms in regard to how well theyfacilitate human behavior

Punishment of Third party Duressor in crimes punishable by Hadd

Transparency and comprehensiveness are obvious features of an efficient law. The legislators under Article 151 of the Islamic Penal Code of 2013, explicitly mentioned the punishment for Duressor in the crimes punishable by Ta'zir, while explaining the punishment for direct offenders in crimes. The concluding part of the above mentioned provision stipulates: "In crimes punishable with Hadd and retaliation (Qisas) matters shall be handled in accordance with the relevant provisions of law." Duress in felony under the subject matters in Articles 375-380 of the Act is described in more exhaustive detail than the previous law. However, punishment of Duressor for crimes of Hadd is only referred to in offenses of pederasty, gay, and lesbian, in the assumption of duress by one of the parties to the crime. The legislators just like in the previous legislations on punishment of Duressor in other offenses of Hadd and Bilateral offenses of Hadd, is silent. The vast majority of Islamic jurisprudents believe that punishment of Hadd is inapplicable to Duressor in the above hypothesis. In contrast to the common view, the writers believe that imposing sentences of Hadd on the Duressor is feasible in crimes that can be attributed to the Duressor

Electro-Catalytic Behavior of Silver Nanoparticles Embedded in Potato and Tapioca Starch for Oxygen Reduction Reaction

The present work demonstrates an eco-friendly and facile method for the synthesis of tapioca and potato starches incorporated by silver nanoparticles hereafter named (T-Ag/NPs) and (P-Ag/NPs), respectively. The analysis of UV–vis showed the appearance of surface plasmon resonance. The TEM analysis shows the formation of highly distributed Ag/NPs with an average diameter and standard deviation of 19.65 ± 2.45 and 12.27 ±7.39 nm for (P-Ag/NPs) and (T-Ag/NPs), respectively. The prepared (T-Ag/NPs) show remarkable potential applicability in energy as low-cost electrode material compared with (P-Ag/NPs). They are used as a non-precious catalyst for oxygen reduction reaction (ORR) in the alkaline medium. The presence of starch promotes long-term stability up to 1000 cycles and avoid the dissolution and agglomeration of silver nanoparticles. The (T-Ag/NPs) show significant stability and reproducibility

Analyzing the Driving Affecting Factors on Investment Efficiency on IT Projects

ABSTRACT The purpose of writing this paper is to identify, analyze and categorize the driving affecting factors on IT investment efficiency. For the purpose, 2 separated questionnaires by the same main questions were designed. The driving affecting factors include "overall questionnaire", "intangible variables", "financial requirements", "nonfinancial requirements", "strategic requirements", "tactical requirements" and "operational requirements". The results of applying Chi-Square test show that there are positive and meaningful correlations between the variables above and investment efficiency on IT. Also Binomial test was used to survey the variables levels in which all of them were placed in favorable levels. Finally the results of utilizing fuzzy TOPSIS technique show that "work time", "job enrichment" and "competitive advantages" were selected as the most important sub criteria