O30 Case report of Cogan syndrome in a child with audiovestibular dysfunction and ocular inflammation

Case report - Introduction Cogan syndrome is a very rare disorder of probable autoimmune vasculitic origin, first described in 1934. The age of onset seems to range from 3 to 50 years with an average age of disease onset at 29 years. It is characterised by audiovestibular dysfunction and ocular inflammation. The cause remains unknown and the epidemiology of the disease is purely based on case reporting. As of 2015, there were fewer than 250 case reports. Interestingly, it seems extremely rare in Arabic and Middle Eastern countries in which a new case has been recently diagnosed and is being reported in this abstract. Case report - Case description A 14-year-old girl of Arabic origin first presented to the ENT specialist with a 3-week history of balance problems, left tinnitus and sensorineural hearing loss in both ears worse on the left. She first received treatment for vestibular neuritis with no improvement. Two months later, she complained of bilateral red eyes and excessive lacrimation when diffuse interstitial keratitis was diagnosed by the ophthalmologist. An array of blood tests including a full autoimmune disease was arranged and a rheumatology opinion was sought. The patient had a normal inflammatory response and her screen for antinuclear antibodies, extractable nuclear antigen, rheumatoid factor and antineutrophil cytoplasmic antibodies were all negative. A full virology screen was also negative. Having failed to respond to all supportive treatment modalities, a trial of a tapering 2-week course of prednisolone starting at 25mg daily was instigated. The patient’s symptoms improved by more than 50% on glucocorticoids subsequent to which the diagnosis of Cogan syndrome was anticipated. As the patient’s symptoms relapsed when glucocorticoids were stopped, she was recommenced on prednisolone 25mg in line with azathioprine 100mg daily. The patient’s hearing, which was almost lost in the left ear, improved significantly by more than 70% initially, and then to normal hearing as stated by the patient supported by special ENT testing. Her balance problems and vertigo also improved remarkably. Her tinnitus, which was the last symptom to resolve, almost went away over the subsequent 2 months. The patient had already come off glucocorticoids 6 months down the line, and stayed on azathioprine 75-100mg daily for almost a year after which gradual weaning was trialled and then eventually succeeded. She has now been off azathioprine for 6 months without experiencing any disease relapse. Case report - Discussion Cogan syndrome can be difficult to diagnose particularly in children. The diagnosis is essentially clinical depending on the presence of audio-vestibular symptoms and interstitial keratitis along with a prompt response to immunosuppressive medication. In this patient, the consistent clinical picture supported by the positive response to glucocorticoids especially in the absence of an alternative diagnosis would have made the diagnosis of Cogan syndrome likely. Given the rarity of this disorder, there are no classification criteria as yet hence the ongoing need for case reporting. Moreover, there is no clear guidance on the duration of immunosuppressive treatment of this condition. Case report - Key learning points It is pivotal in managing conditions with a suspected autoimmune origin to have a multidisciplinary approach involving other relevant specialties in a holistic approach. The prompt response to glucocorticoid therapy still remains the key in securing the diagnosis of a number of conditions in clinical practice especially in the absence of diagnostic criteria and/ or supportive investigations such as serological and tissue-based testing. Case reporting has a crucial role in enhancing awareness of rare medical conditions.

OPERATIONAL RESPONSE AS A FUNCTION OF ORGANIZATIONAL AND ANALYTICAL SUPPORT AND OPERATIONAL RESPONSE UNITS NATIONAL POLICE OF UKRAINE

The content of the activity of bodies and subdivisions of the National Police of Ukraine, which carry out operative response, is revealed. It is argued that the organizational-analytical support and operational response units of the National Police of Ukraine play a central role in organizing the immediate arrival of police officers to the applicant or at the specified scene in order to stop the offense, identify and detain the alleged offender, preserve traces of the offense and provide assistance victims within the powers of the police. The algorithm of response of police officers to statements and notifications about criminal, administrative offenses or other events coming from citizens, according to the requirements of the order of the Ministry of Internal Affairs of Ukraine is clarified. The main problems that arise during the prompt response of police units to statements and reports of criminal, administrative offenses or events are identified. The average total time of assignment of tasks to police squads in the territory of the region and the average total time of arrival of squads to the scene in August 2020 were analyzed. The topical issue of organizing the response to reports of offenses and other events through the use of logistics devices involved in police teams is analyzed. Coordination of patrols is singled out as one of the means to reduce deadlines and improve control over the passage of information from the call center «102» to the main executor, which leads to a real reduction in the time of arrival of police squads to the scene. Also, the main means of activity of dispatchers have been identified, which allow to manage police squads and reduce the time to respond to applications and notifications of citizens. The own definition of operative response as one of functions of divisions of organizational and analytical maintenance and operative response of National police of Ukraine is formulated.

“So many of our destinies are tied beyond our understanding:” Rethinking religious hybridity in Latinx/o/a contexts

In December 2018, then congresswoman-elect Alexandria Ocasio-Cortez made headlines for a brief speech she was invited to give at a Hanukkah-lighting event sponsored by Jews for Racial and Economic Justice in Queens, New York. Some people found Ocasio-Cortez’s statements problematic. In partial and prompt response, she further clarified her perspective in a Twitter thread that amply demonstrated some of the tensions that arise in the study of Latinx/a/o religious pluralism. This article examines how Latinx/a/o stories can complicate dominant definitions of religion in part because of the memory of colonialism that frames religion as a category in Latina/o/x contexts. However, Latinx/o/a contexts themselves have been overly dominated by romanticized narratives of mixture that present their own challenges, particularly when encoded with a linear, straight temporality focused on both origins and destinations. Nevertheless, drawing on the work of Yomaira C. Figueroa-Vásquez (2020) and her use of apocalypso, I turn to understandings of hybridity that could disrupt a neat, linear temporality.

Part 1 Refugees, 2 Refugees Defined and Described

This chapter defines and describes refugees. The term ‘refugee’ is a term of art, that is, a term with a content verifiable according to principles of general international law. In ordinary usage, it has a broader, looser meaning, signifying someone in flight, who seeks to escape conditions or personal circumstances found to be intolerable. For the purposes of international law, States have further limited the concept of the refugee. Defining refugees may appear an unworthy exercise in legalism and semantics, obstructing a prompt response to the needs of people in distress. On the one hand, States have nevertheless insisted on fairly restrictive criteria for identifying those who benefit from refugee status and asylum or local protection. On the other hand, the definition or description may facilitate and justify aid and protection, while satisfying the relevant criteria ought in practice to indicate entitlement to the pertinent rights or benefits. In determining the content in international law of the class of refugees, therefore, the traditional sources—treaties and the practice of States—must be examined, also taking into account the normative impact of the practice and procedures of the various bodies established by the international community to deal with the problems of refugees.

Neutrality is Impossible: Nationalism, Unequal Treaties and the National Christian Council of China 1925-1926

"This article takes the National Christian Council of China (NCC) as a ease study. By examining the responses from various stakeholder both mainline Chinese Protestants and western mission within the NCC to the campaigns for the abrogation of the unequal treaties during the period of 1925——1926, it aims to reveal the tension and interaction between Christian missions? Chinese churches and the nationalist discourse. This article argues that although both Protestant missions and Chinese churches were in general the beneficiaries of the utoleration clauses“ of the unequal treaties and were aware of the necessity of drawing a clear borderline with the treaties > the two parties viewed the matter from different standpoints. To the majority of the missionary societies associated with the NCC > it was a diplomatic matter to be solved through formal negotiation between the governments. Whereas to most of the mainline Chinese Protestants> it had developed into a fundamental factor causing not only Christianity's unfavourable position in Chinese society, but also China's backwardness and uhumiliation. Considerably influenced by the nationalist discourse? they ardently engaged themselves in the campaigns to abrogate the unequal treaties > individually or as a group. Specific Chinese socio-political context and the nationalist discourse contributed significantly to the divergence of views. The NCC, incorporating both sides?was obliged to make a prompt response to the treaty issue and struggled to find common ground among the cooperating bodies.

Localised childhood vulvar pemphigoid: a rare case study

In this case report we present a young patient with localised childhood vulvar pemphigoid. It is a rare variant of bullous pemphigoid with mostly a favourable prognosis and prompt response to potent topical corticosteroids. She presented with relapsing vulvar pain and lesions. Our case enlightens the recognition of this unusual subtype and the importance of performing a cutaneous biopsy.

Benchmark and Legal Framework Study on Oil Spill Prompt Response and Contingency Resources for Oil & Gas Offshore Structures: A Global Cooperation

ABSTRACT A well-developed legal and regulatory framework on contingency planning and response arrangements with establishment of clear responsibilities and coordination between government and industry is one of the success keys for an effective oil spill preparedness and response strategy. Furthermore, international co-operation and mutual assistance in preparing for and responding to major oil pollution incidents have become critical in order to reduce potential impacts to the environment and populations. National policies on oil spill coordination and response vary from nation to nation. Governments are encouraged to ratify the International Convention on Oil Pollution Preparedness, Response and Co-operation of 1990 (OPRC 90) and develop laws and procedures for preparing for and responding to oil spills. This is often accomplished through the preparation of a national contingency plan under the auspices of an agreed national regulatory authority (IPIECA, 2000). Following recent oil spills, such as the 2010 Deepwater Horizon within the Gulf of Mexico, interest on oil spill legislation has risen among stakeholders, as regional and national policies in some regions of the globe became stricter, notably on the need of available contingency resources, as well as transboundary and coordinated response (as required, for example, by the recent Europewide Safety of Offshore Oil and Gas Operations). In this context, a benchmark and legal framework study on oil spill prompt response and contingency resources for Oil & Gas offshore infrastructures was performed, focusing on six relevant Oil & Gas production areas: United States, Canada, North Sea, India, Southeast Asia, Australia and New Zealand. The continuous process of information gathering, review and consolidation throughout the analysis comprehended an establishment of a cooperation network of Oil & Gas consultant experts from these different areas of interest, including communication with local regulatory agencies in cases of uncertainties. The intent of this paper is to present the benchmarking and comparison of the legal requirements and regulatory framework on the availability of oil spill prompt response and contingency resources of these six areas of interest, as well as discuss potential legal weaknesses and opportunities for improvements on their regional and national contingency system.