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

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

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

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