A case report of ChAdOx1 nCoV-19 vaccine–associated encephalitis

Background Vaccination against COVID-19 continues apace, but side-effects, both common and severe, continue to be reported. We report here the first published case of COVID-19 vaccine-related encephalitis. Case presentation A young woman presented with acute neuropsychiatric symptoms following recent ChAdOx1 nCoV-19 vaccination. Extensive investigation did not identify alternative causes. Conclusions This difficult case is here described, including presentation, investigation, and management. Further study on neuropsychiatric side-effects of COVID-19 vaccination, including investigation as to whether there may be a causal link, is required.

Pluricentricity and minority languages: the difficult case of North Frisian

Common definitions of pluricentricity rely on the notions of centre, nation, and norm, frequently without, however, offering sufficient detail on what precisely these mean. These terms are often applied to classify languages as pluricentric or not, without adequately recognising intra-linguistic variation and dynamics of power within a speaker community (language ownership). Using the example of a national minority language from North-West Germany, North Frisian, this article discusses how a narrow reading of the definition of pluricentricity would deny such a status to this language, when in fact the sociolinguistic situation of North Frisian matches that of many acknowledged pluricentric languages. Instead, the article suggests that the term nation should no longer be equated with state, that the term centre be further specified to determine what institution or which individuals have authority over language, and that the term norm be more clearly articulated to account for the variability in “correct” language use.

Two-stage spline-approximation in linear structure routing

In the article, computer design of routes of linear structures is considered as a spline approximation problem. A fundamental feature of the corresponding design tasks is that the plan and longitudinal profile of the route consist of elements of a given type. Depending on the type of linear structure, line segments, arcs of circles, parabolas of the second degree, clothoids, etc. are used. In any case, the design result is a curve consisting of the required sequence of elements of a given type. At the points of conjugation, the elements have a common tangent, and in the most difficult case, a common curvature. Such curves are usually called splines. In contrast to other applications of splines in the design of routes of linear structures, it is necessary to take into account numerous restrictions on the parameters of spline elements arising from the need to comply with technical standards in order to ensure the normal operation of the future structure. Technical constraints are formalized as a system of inequalities. The main distinguishing feature of the considered design problems is that the number of elements of the required spline is usually unknown and must be determined in the process of solving the problem. This circumstance fundamentally complicates the problem and does not allow using mathematical models and nonlinear programming algorithms to solve it, since the dimension of the problem is unknown. The article proposes a two-stage scheme for spline approximation of a plane curve. The curve is given by a sequence of points, and the number of spline elements is unknown. At the first stage, the number of spline elements and an approximate solution to the approximation problem are determined. The method of dynamic programming with minimization of the sum of squares of deviations at the initial points is used. At the second stage, the parameters of the spline element are optimized. The algorithms of nonlinear programming are used. They were developed taking into account the peculiarities of the system of constraints. Moreover, at each iteration of the optimization process for the corresponding set of active constraints, a basis is constructed in the null space of the constraint matrix and in the subspace – its complement. This makes it possible to find the direction of descent and solve the problem of excluding constraints from the active set without solving systems of linear equations. As an objective function, along with the traditionally used sum of squares of the deviations of the initial points from the spline, the article proposes other functions taking into account the specificity of a particular project task.

Intraluminal pyloric duplication cyst- a rare cause of non-bilious vomiting in a neonate: A case report

Background: Duplications of the alimentary tract are rare congenital malformations, out of which, true pyloric duplications constitute only 2.2%. They present with non-bilious vomiting and mimic hypertrophic pyloric stenosis (HPS). Pyloric duplications that are intraluminal are not separately visible at laparotomy, making their diagnosis difficult. Case presentation: Our case is a neonate with an intraluminal pyloric duplication cyst who presented with recurrent vomiting. The radiological evaluation suggested a duplication cyst medial to the second part of the duodenum towards the stomach’s lesser curvature with features of gastric outlet obstruction. Intraoperatively, a cystic mass of 1 x 2 cm intraluminally was found on opening the pylorus which was excised and pyloroplasty was done. Postoperatively the baby was discharged in a stable condition. Conclusion: Intraluminal pyloric duplication cysts are rare and the clinical presentation mimics HPS. They should be considered as a differential diagnosis in a neonate presenting with features of gastric outlet obstruction.

Placenta Accreta Spectrum Disorder in a Patient with Six Previous Caesarean Deliveries: Step by Step Management

The definition placenta accreta spectrum disorders (PAS) introduced by FIGO (International Federation of Gynaecology and Obstetrics) indicates an abnormal, pathological adherence or invasion of the placenta. The growing worldwide incidence of this pathological entity, and the possible serious correlated surgical risks, has caused a significant increase in attention among the scientific community. Previous caesarean delivery and presence of placenta previa are the main risk factors for the onset of PAS. Here, we present the intriguing case of a 39-year-old woman, at the 33rd week of gestation, with six previous caesarean sections and with a diagnosis of placenta previa accreta. At our referral center for PAS disorders, we successfully managed this difficult case with the help of a multidisciplinary skilled team.