Saber sheath trachea: A radiological sign of severe airway obstruction

A middle-aged man, chronic smoker, presented with complaints of productive cough & exertional breathlessness (mMRC grade III) for 3 years with frequent episodes of exacerbation in the past. There was no other comorbidity or significant past history. His chest radiograph showed narrowing of trachea. Evaluation with computerized tomography of thorax showed normal extra-thoracic trachea with narrowing of the coronal diameter with increase in the sagittal diameter of the trachea along with thickening and calcification of the tracheal wall seen in saber sheath trachea. Keywords: forced expiratory volume; tracheal narrowing; saber sheath trachea.

Regret, Self-regulatory Abilities, and Well-Being: Their Intricate Relationships

Emotions, like regret, have been heralded as instruments of self-regulation, by instigating reflection, learning and feedback for betterment and thus increasing well-being. Yet, this view neglects taking the frequency of regret into consideration. Frequently experiencing regret may instead be a sign of repeatedly failing to achieve betterment. Previous work has shown that people who experience regret often have lower life satisfaction. We suggest that, by itself, the reflective function of regret is not enough to lead to betterment. Rather, in addition to regret, self-regulatory abilities are needed. In the absence of these abilities, the reflective function of regret does not turn off but is likely to lead to frequent episodes of regret and turn into counter-productive rumination, reducing rather than increasing well-being. We tested these possibilities in two studies. In Study 1, reports were administered about regret frequency, self-regulatory abilities, and life satisfaction in 388 US adults (54.6% males; Mage = 35, SD = 10). In the preregistered Study 2, the same instruments were administered in a replication sample of 470 British adults (22.1% males; Mage = 36, SD = 12). In both studies, low self-regulatory abilities were associated with higher regret frequency, which in turn, was associated with poorer life satisfaction. Moreover, in both studies, the negative association between regret frequency and life satisfaction was explained by ruminative brooding styles. In sum, the positive reflective function of regret for well-being cannot stand alone, but needs self-regulatory abilities. Without these abilities, regret experience is frequent and its reflective function turns into brooding rumination that negatively affects well-being.

Mind the Gap: Acetazolamide Prolonged Periods without Paralysis in a Girl with Andersen-Tawil Syndrome

We present a case report of a 13-year-old girl with Andersen-Tawil Syndrome (ATS), a rare genetic disorder which is characterized by dysmorphic features, ventricular arrhythmias, and frequent episodes of muscle paralysis that interfere with daily activities and social engagement. After the introduction of off-label treatment with acetazolamide periods without paralysis lengthened, our patient became more independent of the help of her parents and required a wheelchair less frequently, thus improving her social life. Based on our experience, we recommend a trial of acetazolamide in patients with ATS.

Malignant insulinoma hypoglycaemia: complex palliative management

This case presentation describes a 65-year-old woman with metastatic malignant insulinoma who experienced frequent episodes of hypoglycaemia causing significant distress and burden to her quality of life. The report describes how medical management was altered and how the patient was supported in order to alleviate these burdens. In particular, the report highlights the first documented use of flash glucose monitoring in insulinoma, which was beneficial in reducing the discomfort of lancet use and anxiety associated with hypoglycaemic episodes. This case demonstrates the benefits of an individualised approach, collaboration with other specialisms and recommends further evaluation of the use of flash glucose monitoring in palliative care.

PEDIATRIC MANIFESTATION OF IRRITABLE BOWEL SYNDROME AND AYURVEDIC MANAGEMENT: A CASE REPORT

Irritable bowel syndrome (IBS) is a common and bothersome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their parents and poses a significant burden on healthcare systems. As the patho-physiology of IBS is multifactorial It is difficult to overcome the therapeutic demand of childhood IBS using the same conventional therapeutic agents. The treatment trials are still going on to understand the paediatric IBS and currently focusing on multiple combined interventions in modern science. Background: A 14 years old male patient came to OPD (29/02/2020) having complaint of frequent abdominal pain with increased frequency of motion along with visible mucus discharge whole day since 15 days with frequent episodes since last 2 years. Methodology: In Ayurveda this problem comes under Jatharagni dusti and the present case has been successfully treated as per treatment regimen of Grahani chikitsa. Result: The complete relief has been seen in 6 weeks.

An Accidental Intestinal Myiasis Caused by Cochliomyia macellaria

Intestinal myiasis is recognized as pseudomyiasis or accidental myiasis caused by dipteran fly larvae transmitted to humans via contaminated food or water. A case of intestinal myiasis acquired via contaminated food is reported in this case study. The patient is a 4-year-old boy who had frequent episodes of crampy abdominal pain and diarrhoea and the passage of many live worms at each time. As the child had the habit of eating ripe guava from his garden, the infection source was suggested as ripe guava, and the possibility was explored. All larvae collected from faeces and fruit were morphologically similar, and it has been identified as Cochliomyia macellaria. The treatment with several antihelmintics failed, and the recovery was achieved with a simple measure of abstinence from eating guava that came from his garden.

Painful, reappearing eruption in a medically complex 4-year-old

A 4-year-old boy with atypical, complete DiGeorge and CHARGE (coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities and ear abnormalities) syndromes presented with frequent episodes of a painful, markedly erythematous eruption associated with swelling. Evaluation revealed non-specific findings on skin biopsy at the time of eruption and no pathogenic mutation in the SCN9A gene. The patient was diagnosed with secondary erythromelalgia based on clinical presentation. Erythromelalgia is a rare disorder characterised by recurrent episodes of pain and erythema typically affecting the distal extremities. This case represents the first case of erythromelalgia in the setting of DiGeorge and CHARGE syndromes.

Mining serial positioning episode rules by natural exponent inertia weight based swallow swarm optimization algorithm with constraint based event sequences

The Frequent Episode Mining (FEM) is a challenging framework to identify frequent episodes from a sequence database. In a sequence, an ordered collection of events defines an episode, and frequent episodes are only considered by the earlier studies. Also, it doesn’t support for the serial based episode rule mining. In this work, the episode rules are mined with precise and serial based rule mining considering the temporal factor, so that, the occurrence time of the consequent is specified in contrast to the traditional episode rule mining. The proposed work has a larger number of candidates and specific time constraints to generate the fixed-gap episodes, and mining such episodes from whole sequence where the time span between any two events is a constant which is utilized to improve the proposed framework’s performance. In order to improve the efficiency, an Optimal Fixed-gap Episode Occurrence (OFEO) is performed using the Natural Exponent Inertia Weight based Swallow Swarm Optimization (NEIWSSO) algorithm. The temporal constraints significantly evaluate the effectiveness of episode mining, and a noticeable advantage of the present work is to generate optimal fixed-gap episodes for better prediction. The effective use of memory consumption and performance enhancement is achieved by developing new trie-based data structure for Mining Serial Positioning Episode Rules (MSPER) using a pruning method. The position of frequent events is updated in the precise-positioning episode rule trie instead of frequent events to reduce the memory space. The benchmark datasets Retail, Kosarak, and MSNBC is used to evaluate the proposed algorithm’s efficiency. Eventually, it is found that it outperforms the existing techniques with respect to memory consumption and execution time. On an average, the proposed algorithm achieves 28 times lesser execution time and consumes 45.5% less memory space for the highest minimum support value on the Retail dataset compared to existing methods.

Abstract 12885: Sleepless Nights and Squeamish Days: A Conundrum of Recurrent Myocardial Ischemia

A 63-year old Caucasian female with history of aortic valve replacement and CAD with prior drug-eluting stent placement (DES) to proximal LAD and LCX, presented as a hospital transfer with recurrent episodes of chest pain. Chest discomfort was described as severe chest pressure, radiating to bilateral upper extremities. Episodes were not associated with significant exertion and frequently occurred at night/early morning. Of note, the patient had undergone coronary angiography at the outside hospital, revealing no in-stent restenosis or new coronary lesions. Soon after the patient’s arrival in the CCU, she developed profound chest pressure, accompanied by hypotension, diaphoresis and nausea. Her 12-lead ECG revealed 2-mm ST-elevation in aVR, accompanied by ST-depression in inferior, anterior, and apical leads. Initial high-sensitivity (hs)-troponin T was 26 ng/L. She was given sublingual nitroglycerin and was started on a nitroglycerin and nicardipine infusion, with resolution of symptoms after ~30 minutes, followed by normalization of hs-troponin T. A transthoracic echocardiogram did not reveal focal left ventricular (LV) wall motion abnormalities, mild LV hypertrophy was present. Given the patients’ presentation with no in-stent restenosis or new lesions, frequent episodes of chest pain-not related to exertion with occurrence at nighttime and early morning, her presentation was deemed to be consistent with epicardial coronary vasospasm. Subsequently, the patients’ anti-anginal regimen was uptitrated to include extended-release nitrates, calcium-channel blockade, and I Na blockade. Unfortunately, she continued to have frequent episodes of profound angina, accompanied by hypotension, and significant ischemic ECG changes. This prompted us to pursue bilateral sympathectomy. Subsequently, the patient had resolution of prior symptoms. She was continued on an anti-vasospastic regimen, consisting of extended release nitrates and calcium-channel blockade. This case represents the challenging management of medication-resistant epicardial coronary artery vasospasm. As previously described, sympathectomy remains an effective therapeutic option for management in these difficult and life-threatening situations.

PERIPHERAL GENRES OF CHUVASH LITERATURE: TESTAMENT

Работа посвящена осмыслению завещания как жанра чувашской художественной литературы в историческом аспекте. Анализируемые в статье тексты входят в состав классической чувашской словесности. Им посвящено значительное число научных работ, однако пока еще данные произведения не становились объектом специального рассмотрения с точки зрения жанровой специфики, которая выделяет их в одно целое. Основу завещания в первую очередь составляют инолитературные аналоги и затем - фольклорные тексты (благословения и собственно предсмертные завещания). В литературе чаще встречаются эпизоды, описывающие акт духовного завещания, в частности, в произведениях П. Хузангая, В. Митты, Е. Лисиной, но сам жанр за всю историю современной письменной культуры чувашского народа в чистом виде был реализован лишь считанное количество раз - в виде завещания чувашскому народу просветителя И. Я. Яковлева и стихотворения «Как умру…» М. Сеспеля. Отличительными чертами завещания как жанра являются императивность и высокий пафос, формируемые особыми условиями создания завещательных текстов в ожидании скорой кончины. Остальные параметры носят идиостилевой характер и варьируются в широких пределах - достаточно сказать, что имеющиеся в чувашской литературе завещания написаны в разных формах: эпической и лирической. The work is devoted to understanding the testament as a genre of the Chuvash fiction in historical perspective. The authors analyzed the texts of the Chuvash classical literature. A significant number of scientific works has been devoted to the texts of the Chuvash classical literature. However, those texts have never been investigated from the point of view of genre specificity, which distinguishes them as a whole. The testamentis primarily based on analogue ethnic literature and also on folklore texts (blessings and testaments as such). The most frequent episodes describing the testament are in the works of P. Khuzangay, V. Mitta, E. Lisina. Nevertheless, the genre itself in its pure form was implemented only a few times in the entire history of the modern written culture of the Chuvash people:in the testament to the Chuvash people by I. Yakovlev and the poem «When I die ...» by M. Sespel. The distinguishing features of the testament as a genre are the imperative and high pathos, due to the peculiar conditions for creating the texts of the testament in anticipation of impending death. Otherfeatures are individual and vary widely. The testaments in the Chuvash literature are written in different forms: epic and lyrical.