Spontaneous intra-peritoneal bleeding secondary to warfarin, presenting as an acute appendicitis: a case report and review of literature

BACKGROUND: Warfarin is a coumarin anti-coagulant, used widely for the therapeutic and prophylactic anticoagulation. Although, it is considered as a life saving medicine, it is associated with the significant adverse effects including intra-abdominal bleeding, which have been very well documented in literature. However, the presentation of warfarin induced intra-peritoneal bleeding as an acute appendicitis has not been reported in English literature. We report this rare, spontaneous intra-peritoneal bleeding secondary to warfarin therapy, mimicking the signs and symptoms of an acute appendicitis for the first time in English literature. CASE PRESENTATION: A 41 year-old female patient who was on warfarin for prophylaxis following the previous episode of pulmonary embolism, presented to the Casualty with the typical symptoms of an acute appendicitis. During operative intervention, we found it to be the spontaneous intra-peritoneal bleeding secondary to warfarin. The patient recovered well following the operation. CONCLUSION: We recommend the use of the radiological investigations in all the cases of acute abdomen who are on warfarin even if the INR is within the therapeutic range

A solitary Peutz-Jeghers type polyp in the jejunum of a 19 year-old male

A 19-year old male presented with melena and anemia. A duodenoscopy revealed no abnormalities, but a small bowel X-ray series demonstrated a large jejunal polyp. This 4 cm large polyp was visualised during peroperative small bowel endoscopy and was subsequently surgically removed. The polyp had the characteristic histologic appearance of a Peutz-Jeghers type polyp, but the patient had no other signs of Peutz-Jeghers syndrome, such as the characteristic mucocutaneous pigmentation, the presence of multiple polyps or a positive family history. After removal of the polyp, melena did not recur and his hemoglobin concentration normalized. Altogether, the patient does not fulfill the diagnostic criteria for Peutz-Jeghers syndrome and appears to have a solitary jejunal Peutz-Jeghers type polyp. All previously reported patients with such polyps were older than this patient

Environmental risk assessments for transgenic crops producing output trait enzymes

The environmental risks from cultivating crops producing output trait enzymes can be rigorously assessed by testing conservative risk hypotheses of no harm to endpoints such as the abundance of wildlife, crop yield and the rate of degradation of crop residues in soil. These hypotheses can be tested with data from many sources, including evaluations of the agronomic performance and nutritional quality of the crop made during product development, and information from the scientific literature on the mode-of-action, taxonomic distribution and environmental fate of the enzyme. Few, if any, specific ecotoxicology or environmental fate studies are needed. The effective use of existing data means that regulatory decision-making, to which an environmental risk assessment provides essential information, is not unnecessarily complicated by evaluation of large amounts of new data that provide negligible improvement in the characterization of risk, and that may delay environmental benefits offered by transgenic crops containing output trait enzymes

Welfare Effects of Distortionary Tax Incentives Under Preference Heterogeneity: An Application to Employer-Provided Electric Cars

This paper presents an approach for the estimation of welfare effects of tax policy changes under heterogeneity in consumer preferences. The approach is applied to evaluate the welfare effects of current tax advantages for electric vehicles supplied as fringe benefits by employers. Drawing on stated preferences of Dutch company car drivers, we assess the short-run welfare effects of changes in the taxation of the private use of these vehicles. We find that the welfare gain of a marginal increase in the taxation of electric company cars is substantial and even outweighs the marginal tax revenue raised

Understanding (and tackling) need satisfier escalation

Contemporary consumption patterns, embedded in profit-maximizing economic systems, are driving a worsening socio-ecological crisis, in particular through the escalating production and consumption of goods with high material and/or energy intensity. Establishing minimum and maximum standards of consumption (or “consumption corridors”) has been suggested as a way to address this crisis. Consumption corridors provide the normative basis for sustainable consumption, that is, enough consumption for individuals to satisfy needs, but not too much to collectively surpass environmental limits. Current consumption patterns (especially in the global North) do not yet fall within consumption corridors, and standards are not fixed over time. Consumption is socially constructed and can escalate due to socio-economic, technological, or infrastructural influences. In this article, we propose a framework to understand such escalating trends. This approach can be used as a tool for comprehending how consumption evolves over time, as well as for identifying the most effective leverage points to intervene and prevent escalation from happening in the first place. We build on theories of human-need satisfaction and combine these conceptual understandings with insights from research on socio-technical provisioning systems, sociological approaches to consumption, and perspectives on infrastructure lock-in. We illustrate our framework by systemically considering escalation for a specific technological product – the private car

Changes in physiological groups of microorganisms in soil following wildfire

Physiological groups of soil microorganisms were investigated in a forest (Pinus pinaster Sol.) to asses their response to wildfire-induced soil changes. Microbial fluctuations were recorded 1 month and 1 year after the fire, both in the field and during controlled soil incubations. In both the burned and the unburned soil, starch-mineralizing microbes predominated over cellulose-mineralizing microbes; there were a relatively high number of ammonium-producers, whereas nitrite and nitrate producers were scarce. In the short term, burning produced a decreasing to nearly undetectable number in cellulase-producers whilst amylase-producers, and especially, ammonifying microbes increased, and the nitrifying groups did not change. One year after the wildfire, the burning effect was slightly overcome by cellulolytic microorganisms and the amylolytic population was slightly decreased; the improvement of ammonifiers was reduced, ammonium oxidizers were positively affected and nitrite oxidizers continued to be unaffected by the fire. The trends of populations during soil incubation indicated that, in the long term, the effect of burning will probably be nil on ammonifiers, somewhat negative on cellulolytic and amylolytic microbes and slightly positive on nitrite- and nitrate-formers.This research was supported in part by funds provided by the Conselleria de Educacidn de la Xunta de Galicia in Santiago de Compostela and by the Comision Intermisterial de Ciencia y Tecnologia (CICYT) in Madrid.Peer reviewe

Microbial fluctuations after soil heating and organic amendment

Microorganisms in heated (200°C, 1 h) soil not inoculated (H) or inoculated with 0.5% of fresh soil (Hi) and amended with wheat straw (Hi+WS) or poultry manure (Hi+PM) were determined during a 3-month soil incubation. Heating completely sterilised the soil, although the normal soil manipulation in the laboratory contaminated H with a few microbes. In the inoculated soil samples, whether amended or not, microbes were able to actively proliferate, but soil inoculation was essential to develop field microbial conditions. Organic amendment (WS or PM) neither inhibited microbial proliferation nor changed the order of the sizes of the various subgroups. Saprophytic bacteria predominated over the other microbial groups, followed by fungal propagules and actinomycetes; fungal mycelium was relatively well developed, whereas the numbers of photoautotrophs, cyanobacteria and algae were low. With regard to the N-mineralizers, there was a relatively high number of ammonifiers, while chemoautotrophic nitrifiers, both NH4+- and NO2−-oxidizers, were scarce. Microbial groups, however, differed in their response to treatment. In regard to the heterotrophic microbes, amendment with WS increased counts of fungal propagules and hyphae length, while bacteria, particularly actinomycetes and ammonifiers, were lowered; conversely, PM treatment favoured bacterial, actinomycetal, ammonifier and fungal mycelium development and propagule generation. All the autotrophic microbes, whether photo- or chemo-autotrophs, were decreased by the addition of organic residues and, in general, the effect was more negative with PM than with WS. The results indicated that WS could restore the numbers of fungi in the heated soil, but it could cause a reduction in other microbial groups, whereas PM increased the numbers of all the taxonomic groups and the ammonifiers. However, neither residue favoured the recovery of autotrophic C- and N-fixers and nitrifiers in the heated soil.for their capable and kindly technical assistance. This research was supported by funds provided by the Conselleria de Educación de la Xunta de Galicia in Santiago de Compostela and by the Comisión Interministerial de Ciencia y Tecnologfa (CICYT) in Madrid.Peer reviewe