Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

Heterotopic pregnancy (HP) is the simultaneous occurrence of intrauterine and ectopic pregnancies (EP). The incidence of HPs occurring spontaneously ranges from 1 in 10,000 to 1 in 30,000. However, this incidence is reported to be 1 in 100 pregnancies following artificial reproductive techniques. HP is a potentially life-threatening condition that is frequently misdiagnosed, as most diagnoses for HPs are delayed, and are only made after rupture of the EP. A high index of suspicion is, therefore, required for an accurate and timely diagnosis in order to reduce maternal morbidity and mortality, which currently stands at 1 in 200,000 live births. The most common risk factors include pelvic inflammatory disease, previous EP, assisted reproduction techniques, and ovarian hyperstimulation syndrome. Transvaginal ultrasound is the gold standard for diagnosis. As detection of an intrauterine pregnancy often leads to the mistaken exclusion of a concomitant EP, a careful transvaginal scanning of the uterus and appendages should be performed in all females of reproductive age with a positive pregnancy test and red flags in anamnesis, and/or with clinical symptoms. Routine transvaginal ultrasound at Day 27 after embryo transfer could facilitate the diagnosis of HP; however, symptoms onset before or after Day 27 are clues to early diagnosis. MRI can be very helpful in diagnosing atypical cases.

Simultaneous occurrence of accelerated nodulosis in lungs, liver, and kidneys, and acute exacerbation of interstitial pneumonia in a patient with rheumatoid arthritis: an autopsy case report

Background Accelerated nodulosis (ARN) is a rare variant of rheumatoid nodules (RNs) that is characterized by a rapid onset or the worsening of RNs. It generally develops at the fingers in patients with rheumatoid arthritis (RA) receiving methotrexate (MTX). Few case reports have described ARN at an extracutaneous location. Case presentation An elderly patient with long-standing RA was admitted to our hospital with acute respiratory failure. Computed tomography upon admission showed diffuse ground-glass opacities superimposed with subpleural reticular shadowing and honeycombing and multiple nodules in the lungs and liver. Despite the discontinuation of MTX and introduction of an immunosuppressive regimen with pulse methylprednisolone followed by a tapering dose of prednisolone and intravenous cyclophosphamide, the patient died due to the acute exacerbation (AE) of RA-related interstitial lung disease (ILD) following the parallel waxing and waning of a diffuse interstitial shadow and pulmonary and liver nodules. At autopsy, RNs were scattered throughout both lung fields in addition to extensive interstitial changes. RNs were also detected in the liver and kidneys. The foci of cryptococcosis were mainly identified in alveolar spaces. Based on the clinical and pathological findings, these nodules were most consistent with ARN because of acute increases in the size and number of previously detected pulmonary nodules. Conclusion The present case is noteworthy because ARN was concurrently detected in multiple internal organs and may be associated with the AE of RA-related ILD.

Low level wind shear over Bomba airport

Significant climatological features based on 329 Low Level Wind Shear (LLWS) reports from 1985 to 1989 at Bombay airport are presented, The monsoon season has the highest frequency of occurrence of LLWS mainly due to thunderstorms and strong gusty winds, Other than monsoon season, occurrence of LLWS is related to sea and land breeze and nocturnal increase of surface temperature during night. The preferred time of occurrence of LLWS is between 0000 to 0600 IST and 1800 to 240J IST. The simultaneous occurrence of strong and severe LL WS, low cloud ceiling and very poor visibility has an adverse effect on aircraft operations at Bombay airport during landing and take-off.

Assessing the role of compound drought and heatwave events on unprecedented 2020 wildfires in the Pantanal

The year 2020 had the most catastrophic fire season over the last two decades in the Pantanal, which led to outstanding environmental impacts. Indeed, much of the Pantanal has been affected by severe dry conditions since 2019, with evidence of the 2020’s drought being the most extreme and widespread ever recorded in the last 70 years. Although it is unquestionable that this mega-drought contributed significantly to the increase of fire risk, so far, the 2020’s fire season has been analyzed at the univariate level of a single climate event, not considering the co-occurrence of extreme and persistent temperatures with soil dryness conditions. Here, we show that similarly to other areas of the globe, the influence of land-atmosphere feedbacks contributed decisively to the simultaneous occurrence of dry and hot spells (HPs), exacerbating fire risk. The ideal synoptic conditions for strong atmospheric heating and large evaporation rates were present, in particular during the HPs, when the maximum temperature was, on average, 6 ºC above the normal. The short span of the period during those compound drought-heatwave (CDHW) events accounted for 55% of the burned area of 2020. The vulnerability in the northern forested areas was higher than in the other areas, revealing a synergistic effect between fuel availability and weather-hydrological conditions. Accordingly, where fuel is not a limiting factor, fire activity tends to be more modelled by CDHW events. Our work advances beyond an isolated event-level basis towards a compound and cascading natural hazards approach, simultaneously estimating the contribution of drought and heatwaves to fuelling extreme fire outbreaks in the Pantanal such as those in 2020. Thus, these findings are relevant within a broader context, as the driving mechanisms apply across other ecosystems, implying higher flammability conditions and further efforts for monitoring and predicting such extreme events.

A Novel, Low Computational Complexity, Parallel Swarm Algorithm for Application in Low-Energy Devices

In this work, we propose a novel metaheuristic algorithm that evolved from a conventional particle swarm optimization (PSO) algorithm for application in miniaturized devices and systems that require low energy consumption. The modifications allowed us to substantially reduce the computational complexity of the PSO algorithm, translating to reduced energy consumption in hardware implementation. This is a paramount feature in the devices used, for example, in wireless sensor networks (WSNs) or wireless body area sensors (WBANs), in which particular devices have limited access to a power source. Various swarm algorithms are widely used in solving problems that require searching for an optimal solution, with simultaneous occurrence of a different number of sub-optimal solutions. This makes the hardware implementation worthy of consideration. However, hardware implementation of the conventional PSO algorithm is challenging task. One of the issues is an efficient implementation of the randomization function. In this work, we propose novel methods to work around this problem. In the proposed approach, we replaced the block responsible for generating random values using deterministic methods, which differentiate the trajectories of particular particles in the swarm. Comprehensive investigations in the software model of the modified algorithm have shown that its performance is comparable with or even surpasses the conventional PSO algorithm in a multitude of scenarios. The proposed algorithm was tested with numerous fitness functions to verify its flexibility and adaptiveness to different problems. The paper also presents the hardware implementation of the selected blocks that modify the algorithm. In particular, we focused on reducing the hardware complexity, achieving high-speed operation, while reducing energy consumption.

Performing Crisis Management: National Repertoires of Symbolic Action and Their Usage during the Covid-19 Pandemic in Europe

The role of the symbolic is often overlooked in the public policy literature. Yet, it is a key component of public action, particularly in crisis management. During the Covid-19 pandemic, all democratic states needed to carry out cognitive and emotional work to persuade their citizens to show solidarity and comply with heavy restrictions. The near-simultaneous occurrence of the pandemic’s first wave (March–May 2020) allows us to compare the patterns of symbolic crisis management across four European countries (France, Germany, Italy and the United Kingdom). Our analysis finds significant variation in governments’ usage of the symbolic. We analyse leaders’ performances (wordcraft and stagecraft) as they try to reassure citizens, unite the nation, and legitimise themselves and their decisions. Our article shows not only that national leaders pay great attention to the symbolic in the management of crises, but also that their performances differ systematically in line with their personas and distinct national political cultures.

Simultaneous Dirac-like Cones at Two Energy States in Tunable Phononic Crystals: An Analytical and Numerical Study

Simultaneous occurrence of Dirac-like cones at the center of the Brillouin zone (Г) at two different energy states is termed Dual-Dirac-like cones (DDC) in this article. The occurrence of DDC is a rare phenomenon. Thus, the generation of multiple Dirac-like cones at the center of the Brillouin zone is usually non-manipulative and poses a challenge to achieve through traditional accidental degeneracy. However, if predictively created, DDC will have multiple engineering applications with acoustics and vibration. Thus, the possibilities of creating DDC have been identified herein using a simple square periodic array of tunable square phononic crystals (PnCs) in air media. It was found that antisymmetric deaf bands may play critical roles in tracking the DDC. Hence, pivoting on the deaf bands at two different energy states, an optimized tuning parameter was found to achieve Dirac-like cones at two distinct frequency states, simultaneously. Orthogonal wave transport identified as key Dirac phenomena was achieved at two frequencies, herein. It was identified that beyond the Dirac-like cone, the Dirac phenomena remain dominant when a doubly degenerated state created by a top band with positive curvature and a near-flat deaf band are lifted from a bottom band with negative curvature. Utilizing a mechanism of rotating the PnCs near a fixed deaf band, frequencies are tracked to form the DDC, and orthogonal wave transport is demonstrated. Exploiting the dispersion behavior, unique acoustic phenomena, such as ballistic wave transmission, pseudo diffusion and acoustic cloaking are also demonstrated at the Dirac frequencies using numerical simulation. The proposed tunable acoustic PnCs will have important applications in acoustic and ultrasonic imaging, waveguiding and even acoustic computing.

Clinical Manifestation of Subacute Thyroiditis Triggered by SARS-CoV-2 Infection Can Be HLA-Dependent

In the last two years, we have been struggling with the pandemic of SARS-CoV-2, the virus causing COVID-19. Several cases of subacute thyroiditis (SAT) have already been described as directly related to SARS-CoV-2 infection. The clinical course of SAT induced by SARS-CoV-2 can be entirely different from the classic SAT course, and one of the most important differences is a very rapid SAT onset observed in some patients, especially a phenomenon of the simultaneous presence of both diseases. The aim of this report is to compare HLA profile and clinical course of SAT in four patients, in whom SAT was considered as triggered by COVID-19, with special attention paid to the differences between a patient with rare simultaneous presence of SAT and COVID-19, and patients with longer time lag between the diseases. The unusual phenomenon of simultaneous occurrence of COVID-19 and SAT induced by SARS-CoV-2 infection can be HLA-dependent and related to the presence of homozygosity at HLA-B*35. Additionally, the clinical course of SAT triggered by COVID-19 can be HLA-related in regard to the risk of recurrence, and to a variety of other aspects, including severity of thyrotoxicosis.