An unusual case of multiple myeloma

The case concerns the unusual presentation of a non-secretory multiple myeloma with diarrhoea secondary to large bowel infiltration. In December 2009, a 74-year-old lady presented to hospital and complained of a two year history of intermittent diarrhoea which had been worsening over a three month period. She also had sustained a deep vein thrombosis and was investigated for pulmonary embolism. Routine blood investigations showed a raised ESR & CRP and a normochromic normocytic anaemia. Urea and electrolytes, liver function tests, calcium, phosphate and albumin where all normal, creatinine was elevated. Serum protein electrophoresis was normal at presentation. Chest X-ray revealed lytic rib and vertebral lesions which were followed by CT scan and MRI. Colonic biopsy revealed a plasma cell infiltration and rib trucut biopsy revealed plasmacytoma. Bone marrow biopsy confirmed Multiple Myeloma. This is a plasma cell disorder that characterised by abnormal proliferation and accumulation in the bone marrow. Typically it is accompanied by monoclonal protein in the serum and/ or urine and consequent tissue damage such as kidney failure and pathological fractures due to bone damage.peer-reviewe

Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Day care units are playing an increasingly important role in healthcare provision, however they require the development of specialised resources to fulfil their role. The rate of unplanned admissions following day-case procedures is considered as one of several indicators of the quality of day-case services available.1 The aim of this study is to identify how often there are delayed discharged or unplanned admissions following day-cases at the Day Care Unit at Mater Dei Hospital (MDH), Malta. A list of patients whose discharge did not go as planned was forwarded daily to the authors by the Bed Management Unit at MDH. The medical files of these patients were then reviewed and data collected. This included demographics, type of procedure carried out and reasons for delayed discharge or unplanned admission. The study was carried out over 45 days.peer-reviewe

Evaluation of signalised intersections in NSW with right turn filters

The use of right turn filters provides improved intersection efficiency, although results in higher rates of ‘right through’ and ‘cross traffic’ crashes. This research paper aims to quantify the effects on road safety of the use of right turn filter movements at signalised intersections. This research examines 77 traffic signal site with 147 approaches with right turn filtering enabled throughout the greater Sydney metropolitan, Newcastle and Wollongong areas. This research looks into factors influencing crash rates at these intersections including speed, number of opposing lanes, traffic volumes and characteristics of the right turning driver including gender and age. It was found that the opposing traffic volume has a large impact on both the ability for drivers to undertake right turn movements and the rate of ‘right through’ crashes. It was found that at opposing traffic volumes between 100 to 300 vehicles per hour per lane results in the highest rate of ‘right through’ crashes. Above 300 vehicles per hour the ability to undertake opposed right turns is very limited and the right turn filter benefits of improved traffic efficiency are non-existent. The crash data indicates that young drives (17-29) are much more likely to be involved in ‘right through’ crashes than any other age group. The occurrence of ‘right through’ crashes decreased as the age of the driver increases. It was found that as the age of the drive increased their risk of crashing at a signalised intersection with right turn filters enabled decreased. There is no indication that older drivers (>60) have an increased crash risk at these intersections. In fact, the data shows that driver in this age bracket have the lowest crash risk of all ages

Glycosylated haemoglobin (HbA1c) and cortisol levels on admission to intensive care as predictors of outcome

Objective: To evaluate the predictive value of glycosylated haemoglobin and cortisol on admission, in critical care patients. Design: Prospective, observational, single centre study. Setting: 14 bedded Intensive care unit of a tertiary-level university hospital. Patients: 124 consecutive emergency medical and surgical patients. Methods: Data collected on admission included patient demographics, medical history, medication, diagnosis, type of nutrition, TISS28 score, serum blood glucose, Glycosylated haemoglobin (HbA1c), cortisol, mean arterial blood pressure, and the use of inotropes in the first 24hrs. Daily baseline tests included complete blood count, urea and electrolytes, creatinine, twice weekly liver function tests. The primary outcome measure was intensive care unit mortality. Secondary outcome measures were ITU stay, days of ventilation, peak urea, peak creatinine, lowest platelet count, peak bilirubin, lowest Pa/FiO2, and the number of transfusions. Measurements and results: 124 patients (mean age 56.2 years SD 23.2) were included. Regression analysis was used to identify any potential predictors of outcome: HbA1c levels on admission were not found to be significantly associated with mortality (p=0.51), or any other secondary endpoints listed above. However, subgroup analysis revealed a predictive role of HbA1c with regards to length of ITU stay (p= 0.01) and number of days of ventilation (p=0.007) in those patients with a history of diabetes. Glucose level on admission emerged as an independent marker of mortality (p=0.009). Conclusions: This study suggests that HbA1c may not be a predictor of outcome in the general ITU population but may be of predictive value in diabetic ITU patients. On the other hand, blood glucose levels on admission emerged as a predictor of mortality, whilst no association was found between HbA1c and cortisol levels on admission.peer-reviewe

tert-Butyl 4-(1-methyl-1H-pyrazol-5-yl)piperidine-1-carboxyl­ate

The reaction of (E)-tert-butyl 4-[3-(dimethyl­amino)acrylo­yl]piperidine-1-carboxyl­ate with methyl­hydrazine leads to the formation of the title compound, C14H23N3O2, with a 1-methyl-1H-pyrazol-5-yl substituent. The plane of the pyrazole ring forms a dihedral angle of 33.4 (1)° with the approximate mirror plane of the piperidine ring

Bis(2-naphthyl­meth­yl)diphenyl­silane

The title compound, C34H28Si, was prepared as an inter­nal standard for diffusion-ordered NMR spectroscopy. The four ligands are arranged tetra­hedrally around the Si atom. The two naphthalene systems are nearly perpendicular, making an angle of 86.42 (4)° with one another. A naphthalene system and a phenyl ring are also nearly perpendicular, making an angle of 86.18 (6)° with one another. In the crystal, the mol­ecules pack in columns parallel to the a axis, and exhibit arene C—H⋯π(arene) inter­actions both within and between columns

2-Benzoyl­pyridine semicarbazone

The title compound, C13H12N4O, crystallizes with two independent mol­ecules in the asymmetric unit. The compound crystallizes as the ZE isomer, where Z and E refer to the configuration around the C=N and N—C bonds, respectively, with an N—H⋯Npy (py is pyridine) intra­molecular hydrogen bond. The dihedral angles between the least-squares planes through the semicarbazone group and the pyridyl ring are 22.70 (9) and 27.26 (9)° for the two mol­ecules. There are intermolecular N—H⋯O hydrogen bonds

Increasing the value of offshore wind by integrating on-board energy storage

Energy storage technologies are considered a promising solution for overcoming one of the most pertinent hurdles to high renewable energy penetration: the mismatch between energy supply and consumer demand. The intermittent nature of variable renewable energy technologies at high penetration rates leads to a loss of value for each unit of energy produced. Generationside energy storage can allow wind turbines to alter their generation strategies and derive additional value through improved market participation. On-board storage leads to more efficient use of space and a potential for cost reductions. In the present work, a brief review of existing work on these aspects was undertaken, followed by a time-series analysis of an offshore 6 MW wind turbine coupled to an energy storage system. The performance of the wind+storage system was simulated using one year of data from the Egmond aan Zee offshore wind farm site. A statistical analysis was undertaken to estimate the required charge/discharge cycles and establish the required storage capacity under different operating conditions. A lithium-ion battery was then considered as the competing energy storage technology, and a cumulative damage model was applied based on the depth-of-discharge characteristics. Findings indicate that despite their competitive capital costs, battery technologies would have a limited lifetime resulting from high charging/discharging cycles. A more viable approach in the long-term could be to opt for technologies that are less dependent on charge/discharge cycles and which have a lifetime that can match that of the wind turbine itself.peer-reviewe

5-Chloro-N-[2-(1H-imidazol-4-yl)eth­yl]-N-methyl-7H-pyrrolo[2,3-d]pyrimidin-4-amine

The title compound, C12H13ClN6, was prepared by reaction of 4,5-dichloro-7H-pyrrolo[2,3-d]pyrimidine with 2-(1H-imid­azol-4-yl)-N-methyl­ethanamine, and the X-ray study confirmed that chloro-substituent in six-membered ring was replaced in the reaction. The exocyclic N atom environment is approximately coplanar with the pyrrolo[2,3-d]pyrimidine [corresponding dihedral angle is 5.5 (1)°], whereas the mean plane of the N—C—C—C link connecting with the imidazolyl ring is almost exactly orthogonal to the plane of the bicyclic system [dihedral angle = 91.6 (2)°]. The imidazolyl plane itself, however, forms a relatively small dihedral angle of 20.8 (1)° with the pyrrolo[2,3-d]pyrimidine plane. There are two independent N—H⋯N hydrogen bonds in the structure, which link mol­ecules into layers parallel to (03)

Bis(1,10-phenanthroline-κ2 N,N′)bis­(thio­cyanato-κN)cadmium

The title compound, [Cd(NCS)2(C12H8N2)2], has been obtained from the decomposition reaction of dithio­oxamide in a dimethyl­formamide solution containing 1,10-phenanthroline (phen) and Cd(NO3)2·4H2O. Its crystal structure is formed by monuclear CdII entities in which the metal atom is sited on a twofold rotation axis. The CdII atom is six-coordinated in the form of a distorted octa­hedron by two chelating phenanthroline mol­ecules and two thio­cyanate anions coordinated through their N atoms. In the crystal, C—H⋯N hydrogen bonds are established between the phenanthroline and thio­cyanate ligands of neighbouring complexes