The context of pandemic of the human coronavirus COVID-19, preventive strategies based on mandatory social isolation (quarantine) were imposed by governments to reduce transmission in the community. However, they have had a strong impact on the economies of the countries and on the people as massive layoffs, decreased wages, uncertainty, inability to work formally, increasing precariousness and inequality and food insecurity. Without a doubt, the pandemic surprised Argentina without the necessary tools to amortize the attacks of the disease, and all the collateral consequences that emerge from it. The concept of food insecurity represents a situation or a process experienced by households in which there is a limited and uncertain availability of the quantity and quality of food that allow covering the nutritional requirements of people, thus as an also limited and uncertain availability of the ability to acquire them in an acceptable way from a social and cultural perspective. This work addresses household food insecurity at the micro-social level based on their own surveys and describes the strategies carried out by households in the metropolitan area of Buenos Aires city, Argentina to withstand the effect. FI status was assessed among 200 adult university students a mean age of 28±6 years (57% female, 43% male) during isolation period in April -May 2020 using the food insecurity experience scale (FIES). The students responded affirmatively and with a higher percentage value to the items related to the lack of money to consume healthy and nutritious food. Food security status of the 200 students survey, 23.5 per cent (n = 47) were food secure. Food insecurity was reported by 76.5% (n = 153). Of these, 50% (n = 100) were mild food insecurity, 25.5% (n = 51) were moderate, while 1% (n = 2) were severe food insecurity. Food insecurity derived from access,…
Background: A 70 year old male presented with acute left flank pain and was found to have extensive free air in both the mediastinal and peritoneal cavities. He was managed successfully without surgery. Case: A 70 year old male presented with left flank pain that began an hour prior to arrival. He had a history of obstructive sleep apnea that had been treated with continuous positive airway pressure therapy (CPAP) at home for many years. His vital signs, physical exam, and laboratory testing were all unremarkable. However, imaging findings were impressive for massive pneumoperitoneum and pneumomediastinum. Given his clinical stability, operative exploration was deferred, and he was admitted for observation and bowel rest. He was discharged less than 48 hours after admission without incident. His history of home CPAP therapy was the only attributable cause for the ominous findings seen on his imaging. Recognizing that this was a case of benign free air saved this patient from the morbidity and potential for death that comes with an unnecessary operative exploration. Conclusion: Continuous positive airway pressure therapy can result in benign free air within the mediastinal and peritoneal cavities. Evaluating the complete clinical scenario will allow for recognition of similar cases in which these grim findings are not indicative of surgical disease, thus avoiding the iatrogenesis of unnecessary surgery.
A 63 year old Caucasian female with ampullary pancreatic cancer s/p pancreaticoduodenectomy in 2016 was admitted to our cancer center with complaints of fever (temperature 103° F) and abdominal pain. She was found to have multiple liver abscesses. Her blood culture grew out Shewanella algae. We herein report on this rare human bacterial infection.
A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review
Introduction: Nesidioblastosis is a hyperplasia of the beta cells that causes persistent hyperinsulinemic hypoglycemia, unfortunately, it is difficult to diagnose through imaging studies. Case presentation: A 68-year-old woman with palpitations, diaphoresis, dizziness and alterations in the level of consciousness that improve with food intake. Laboratories: glucose 35.0 mg/dl, insulin 12.5 mUI/ml, proinsulin 14.1 pmol/L and peptide C 2.55 ng/ml. Octreoscan reveals an abnormal epigastric uptake area and the tomography shows a focal hypervascular lesion in pancreatic body of 12×11 mm. A distal pancreatectomy was performed without palpating the tumor in transoperative period, and a diffuse nesiodioblastosis was reported in the histopathological study. The patient persists with hypoglycemia and an additional pancreatic resection was performed, resecting 90% of the organ. Although an insulinoma was not located in the piece, an area surrounded by connective tissue was observed where islet hyperplasia was more accentuated. Discussion: The pathophysiology of nesidioblastosis is unknown, its main differential diagnosis is insulinoma and this should be suspected when the tumor can not be identified. Most agree that a pancreatectomy that involves 60-80% of the total organ can control glucose levels with low risk of diabetes and pancreatic insufficiency. Conclusion: The nesidioblastosis should be suspected when a hyperinsulinemic hypoglycemia is difficult to control and when a tumor can not be identified. The extension of the pancreatectomy should be individualized and if an insulinoma is not localized and a nesidioblastosis is suspected, an intraoperative histopathological examination with frozen section evaluation for the margins could determine the extent of pancreatectomy.
Pleomorphic adenoma is a benign tumor of the salivary gland with the highest incidence rate among all salivary gland tumors in the general population. Even though it’s common, ectopic presentation of the same is rare. When it happens, it presents in the head and neck region. We discuss in this paper a rare case of ectopic pleomorphic adenoma on the plane of the cheek.
We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.
Methemoglobinemia – A review and recommendation for management – Acute methemoglobinemia with hemolytic anemia following suicidal use of aniline based substance
Methemoglobinemia is a rare disease classification related with congenital or acquired (usually iatrogenic) hemoglobin oxygenation disorder. Despite the fact that number of potentially methemoglobin forming agents is very long, methemoglobinemia is still a case-report of patients admitting to the Emergency Departments. The patient was brought after consuming resin hardener for suicidal purposes from the Center of lower reference to the hospital Emergency Department with suspected burns of the gastrointestinal tract. The patient presented cyanosis, dyspnoea and brown-colored urine on admission.
In order to improve the feasibility and accuracy of the roadbed settlement prediction model, the factor analysis method is combined with the BP neural network method, and an improved BP neural network roadbed settlement prediction model is proposed. Select example data to test the improved BP neural network roadbed settlement prediction model. The test results: The relative average error of the 10 sets of training samples’ predicted and actual roadbed settlements was 4.287%, and the roads of five predicted samples The relative error of subgrade settlement is 1.79%, 1.93%, 6.62%, 7.19%, 4.05%, all less than 10%, which proves that the improved BP neural network prediction model has good prediction accuracy.
This paper focuses on a solution to the finance restrictions that obstacle the development of railways section in Sudan. Sudan is a big country with an area estimated at more than 1,800,000 km2. It owns variety of natural and other resources. The transportation system in Sudan specially railways suffers a lot of restrictions that affect its contribution to the national economy. Sudan railways is one of the longest railways in Africa with about 5,000 km. Railways were the earliest mechanical means of transport to be introduced in Sudan. The construction of the first railway line started in the last decade of the Nineteen century. Railways have been playing a significant role in transportation for long time. However, railways in Sudan lack passengers’ trains recently. Moreover, the capacity of freight trains is enough to meet just 10% of needed capacity. Also, most of the rails are very old and exceeded their expire date; and as the result a lot of derailments had been occurred. Also, most of the rail on the western lines are not suited to all of the diesels. Moreover, most sleepers are creosoted wood which differ from that used in the neighboring countries that use steel or concrete. And to overcome all these issues, there is a huge need of finance. However, lacking of finance is one of the main restrictions that face the development of railways section in Sudan. And, in spite of that, the Build Operate-Transport (BOT) approach could be the best option to deal with the current situation that faces railways section in Sudan. Build-Operate-Transport Approach (BOT) is a well-known method of initiating, financing and managing public capital projects by private section for specific period of time and then transfer them to the public owners. The idea of the approach is to give the private…
Image Restoration for University Leaders’ Public Health COVID-19 Response: A Case Study of Notre Dame
Do as I say, not as I do is a common phrase that applies to the case of Notre Dame’s president as he began the Fall 2020 semester chastising students for gathering in large groups off campus leading to the spread of COVID-19 while he, just a month later, gathered unmasked in the U.S. White House Rose Garden to celebrate the nomination of a Notre Dame alum to the Supreme Court. This study draws upon image restoration strategies in crisis response literature to examine Notre Dame and its president’s public response to both the two-week move to remote education in Fall 2020 following COVID-19 outbreak among its students and the unmasked attendance to an event that resulted in Notre Dame’s president testing positive for COVID-19. Overall, evasion of responsibility and corrective action typified the university’s response to students’ behaviors that led to public health risk, but mortification along with contradictory messages evading responsibility typified the individual response of the university’s president that led to public health risk. Of interest to the case is the lack of religious appeal intertwined in the image restoration strategies used in the president’s apology yet the use of religious appeal in the university’s accusations against student public health behavior. Given that Notre Dame is a religiously affiliated university and the president is clergy, the inconsistent use of religious appeal may undermine the image restoration rhetoric of the president.