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Acquired Haemophilia Associated with Urticarial Vasculitis
Get PDFAcquired haemophilia (AHA) is a rare autoimmune disorder caused by circulating autoantibodies that inhibit the activity of factor VIII (FVIII). Acquired inhibitors against FVIII are rarely seen, with a reported incidence of approximately 1 case per million/year . Clinical conditions and contexts associated with AHA include autoimmune diseases, lymphoproliferative malignancies, drug treatment, pregnancy and infections. An association with urticarial vasculitis is even more rare. Here, we report a case of a 59-year-old woman presenting with cutaneous and muscle haematomas secondary to AHA in association with urticarial vasculitis, who was successfully treated with factor eight inhibitor bypassing activity (FEIBA) and prednisolone
A Peculiar Case of Priapism: The Hypercoagulable State in Patients with Severe COVID-19 Infection
Get PDFIt is increasingly recognised that patients with severe COVID-19 infection have a significant risk of thromboembolic events. We describe a patient who rapidly deteriorated due to severe infection with COVID-19, and developed priapism in the last days of his life. We believe development of priapism may be associated with a prothrombotic state secondary to COVID-19 infection. This case report supports the widely reported increased incidence of thrombosis in patients with severe COVID-19 infection
Point-of-Care Ultrasound Can Suggest COVID-19
Get PDFCoronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the World Health Organization (WHO) declared it a pandemic on 11 March 2020. Point-of-care ultrasound (POCUS) is a real-time bedside tool used by physicians to guide rapid, focused and accurate evaluation in order to identify or rule out various pathologies. We describe the case of an elderly man who had fallen at home 3 days previously and was hypoxic at presentation to the emergency department (ED). POCUS in the ED helped to identify a combination of lung and vascular involvement that indicated COVID-19 infection, which was confirmed by a laboratory test
Emphysematous Gastritis in the Setting of Chronic Abdominal Pain
Get PDFEmphysematous gastritis is a rare but fatal variant of gastritis. It is caused by gastric wall invasion by gas-forming organisms. It follows disruption of gastric mucosal integrity by a variety of factors, most commonly caustic ingestion and alcohol abuse. Patients typically present with abdominal symptoms with features of septic shock. Emphysematous gastritis carries a high mortality rate warranting early intervention with supportive measures and broad-spectrum antibiotics. It is essential to consider this rare entity in the differential diagnosis of a patient presenting with abdominal pain as timely intervention is crucial for survival
Pleurisy Can Cause Chest Wall Tenderness: A Case Report
Get PDFStab-like localized chest pain, aggravated by breathing, is compatible with pleuritic pain or with aching related to chest wall abnormalities. Local tenderness inflicted by palpation helps to differentiate pleuritic from musculoskeletal chest pain and serves as a principal accessory manoeuvre in the algorithm of chest pain evaluation. Herein, we report the case of a 27-year-old patient with pulmonary thromboembolism and right lower lobe consolidation/atelectasis. The patient presented with right-sided chest pain, radiating to the shoulder, related to pleural irritation, yet associated with confounding intense chest wall tenderness and guarding, also involving the costovertebral angle. We propose that spinal reflex-related chest wall tenderness was involved, similar to peritoneal signs evoked by irritation of the parietal peritoneum. This case report illustrates that localized chest wall tenderness and guarding, triggered by palpation, may not serve as unequivocal indicators of musculoskeletal pain, and could be unrecognized features of pleuritic chest pain also
Long-Term GeneXpert Positivity after Treatmentfor Pulmonary Tuberculosis
Get PDFTuberculosis (TB) is a cause of ill health and death worldwide. Since 2010, the diagnostic process has strongly relied on GeneXpert assays on biological specimens. Xpert MTB/RIF is an automated nucleic acid amplification test (NAAT) for Mycobacterium tuberculosis and rifampicin resistance, endorsed by the World Health Organization and the US Food and Drug Administration. Xpert is used in many countries as the initial diagnostic test for tuberculosis. Nevertheless, the reliability of GeneXpert positive tests in patients with a history of TB is largely unknown, due to possible false-positive results (i.e., GeneXpert-positive but culture-negative patients). We present a case report of a patient with a history of pulmonary TB, who was GeneXpert positive but culture negative on bronchoalveolar lavage 22 months after completion of appropriate antitubercular therapy
Recurring Asystole and Paradoxical Air Embolization in a Patient with a Patent Foramen Ovale Treated with Home Parenteral Nutrition
Get PDFHome parenteral nutrition is a therapeutic option for chronic intestinal failure. A tunnelled central venous catheter is commonly used for self-application of nutrition and hydration over a long period of time; that is, months or years. Air embolization within the venous circulation can be caused by inconsistent self-handling of the catheter in combination with air bubbles in the infusion set. Paradoxical air embolization within the brain and coronary arteries together with catheter perforation is a rare medical and technical complication. The authors report the case of a 63-year-old woman with type 3 chronic intestinal failure treated with home parenteral nutrition. During the first year of treatment and use of the catheter a fatal complication occurred. The patient experienced recurring asystolic episodes and strokes with monoplegia during flushing of the catheter. Although 2 resuscitations were successful, the third was not, and the patient died. The cause of these life-threatening complications was an unknown patent foramen ovale, with paradoxical air embolization within the coronary and brain arteries. The authors discuss the clinical consequences of arterial and venous air embolization, the differences between these and the therapeutic algorithm with a link to practice
"Guida pratica agli incentivi per l'efficienza energetica e le fonti rinnovabili nella Pubblica Amministrazione" con tavola riassuntiva degli incentivi di interesse per il CNR
Get PDFQuesta Guida pratica riassume gli incentivi pubblici per interventi di miglioramento dell'efficienza energetica e per l'installazione di impianti rinnovabili in edifici della Pubblica Amministrazione, con particolare riguardo alle agevolazioni di interesse applicativo nelle strutture del CNR
Dipendenza da gaming online: psicobiologia del fenomeno
Get PDFL’odierna tecnologia, tascabile ed accessibile nei costi e nell’utilizzo, rende possibile un accesso costante ad Internet: sebbene sia giudizio comune che l’uso sregolato di videogiochi, computer e smartphone sia nocivo per l'individuo, recenti studi dimostrano l’evidenza diretta tra uso mirato dei videogiochi e miglioramento delle funzioni cognitive generali (Bavelier & Green, 2016). Scopo di questo articolo è di poter fornire al lettore una maggior conoscenza dei comportamenti (sia nocivi che adattivi) che si celano dietro il fenomeno del gaming online, ponendosi come obiettivo finale quello di poter fornire degli strumenti utili alla comprensione di un argomento così vasto e in rapida diffusione
Greener Nanocomposite Polyurethane Foam Based on Sustainable Polyol and Natural Fillers: Investigation of Chemico-Physical and Mechanical Properties
Get PDFNowadays, the chemical industry is looking for sustainable chemicals to synthesize
nanocomposite bio-based polyurethane foams, PUs, with the aim to replace the conventional
petrochemical precursors. Some possibilities to increase the environmental sustainability in the
synthesis of nanocomposite PUs include the use of chemicals and additives derived from renewable
sources (such as vegetable oils or biomass wastes), which comprise increasingly wider base raw
materials. Generally, sustainable PUs exhibit chemico-physical, mechanical and functional properties,
which are not comparable with those of PUs produced from petrochemical precursors. In order
to enhance the performances, as well as the bio-based aspect, the addition in the polyurethane
formulation of renewable or natural fillers can be considered. Among these, walnut shells and
cellulose are very popular wood-based waste, and due to their chemical composition, carbohydrate,
protein and/or fatty acid, can be used as reactive fillers in the synthesis of Pus. Diatomite, as a natural
inorganic nanoporous filler, can also be evaluated to improve mechanical and thermal insulation
properties of rigid PUs. In this respect, sustainable nanocomposite rigid PU foams are synthesized
by using a cardanol-based Mannich polyol, MDI (Methylene diphenyl isocyanate) as an isocyanate
source, catalysts and surfactant to regulate the polymerization and blowing reactions, H2O as a
sustainable blowing agent and a suitable amount (5 wt%) of ultramilled walnut shell, cellulose and
diatomite as filler. The effect of these fillers on the chemico-physical, morphological, mechanical and
functional performances on PU foams has been analyze