Double Trouble Research Articles

Sjogren's Syndrome Presenting with Refractory Hypokalemia and inflam-matory peripheral vascular disease: Double Trouble

Sjogren's syndrome is a slowly progressing autoimmune disease that is characterized by lymphocytic infiltra-tion of the exocrine glands resulting in impaired secretory function. There are varied causes of quadriparesis ranging from cervical cord myelopathy to neuromuscular junction disorders. Even though hypokalemia is a fre-quent cause of quadriparesis but is usually due to periodic paralysis. Here we present a case in which hypokale-mia secondary to Sjogren’s syndrome presented with quadriparesis, which progressed, to respiratory paralysis. Keywords: Sjogren's syndrome, distal renal tubular acidosis, hypokalemia, peripheral vascular disease

Double Trouble: Trump, Transatlantic Relations and European Strategic Autonomy

Double Trouble: Trump, Transatlantic Relations and European Strategic Autonomy

Double trouble: A unique case of TRUS biopsy induced left upper moiety infection of a duplicated ectopic ureter

Duplex collecting systems are seen in 0.7% of the population and its association with an ectopic ureter (specifically in the ejaculatory duct) is even less common. We presented a 57 year-old male with an elevated PSA and suspicious findings on a multiparametric MRI (mpMRI) who underwent transrectal ultrasound (TRUS) guided biopsies. The procedure led to an infection of the upper moiety of the duplicated left collecting system with ectopic ureter draining into the ejaculatory duct. CT-scan was used for the diagnosis and an urgent surgical treatment was performed. To our knowledge, no such case has ever been reported.

Double trouble: A case of trisomy 21 and achondroplasia

Double trouble: A case of trisomy 21 and achondroplasia

“Double Trouble”: Preoperative Embolization in a Case of Double Rupture of Hepatic Hemangioma during Pregnancy

AbstractHepatic hemangiomas are the most common benign space-occupying lesion of the liver. These lesions are associated with the gestational age of the patient. They can easily be missed and can rarely present with complications. Spontaneous rupture of hemangioma is a rare occurrence. Preoperative arterial embolization of hemangiomas plays a vital role to reduce intraoperative bleed during surgical resection. Here is a case of a young pregnancy presenting with a complicated outcome.

386 Double Trouble? A Curious Case of Acute Kidney Injury and Respiratory Failure in an Elder Patient

386 Double Trouble? A Curious Case of Acute Kidney Injury and Respiratory Failure in an Elder Patient

Double trouble: co-infections of chytrid fungi will severely impact widely distributed newts

Invasive fungal pathogens Batrachochytrium dendrobatidis (Bd) and B. salamandrivorans (Bsal) are causing mortality events and population declines in amphibians around the world. B. salamandrivorans has not been found in the Americas but is predicted to emerge there given the presence of competent hosts, high volume import pathways, and lack of effective biosecurity measures. Eastern newts (Notophthalmus viridescens) are the most abundant and widespread salamanders in United States with known susceptibility to both fungi. However, little is known about how their current Bd infections will interact with novel Bsal infections. Here, we ran a series of experiments in which we exposed newts to each fungal pathogen, combinations of both fungi, and three Bd isolates to: (1) determine if natural exposure to Bd provides protection against Bsal, (2) quantify the effect of co-infections on newt survival, and (3) examine if resistance responses are general to multiple lineages. We found that hosts exposed under simultaneous co-infections experienced 78% mortality over a period of 18 weeks, which was driven by the persistence of Bsal because newts cleared Bd infection within a month. In a subsequent experiment, resistant newts also resolved infections of three Bd genotypes, suggesting that the defense mechanism is effective across all lineages. However, re-exposing these individuals with a tenfold higher dose (106Bd zoospores) increased their susceptibility to Bsal, and 93% of them sustained Bsal infections. Our findings will improve the estimates of decline risk for a species that could serve as a potential superspreader of Bsal in North America.

Double trouble: two cases of dual adrenal pathologies in one adrenal mass.

SummaryContextAdrenal incidentalomas (AI) represent an increasingly common problem in modern endocrine practice. The diagnostic approach to AIs can be challenging and occasionally reveals surprising features. Here we describe two rare cases of complex adrenal lesions consisting of phaeochromocytomas with synchronous metastases from extra-adrenal primaries.Case descriptionsPatient 1 – a 65-year-old gentleman with a newly diagnosed malignant melanoma was found to harbour an adrenal lesion with suspicious radiographic characteristics. Percutaneous adrenal biopsy was consistent with adrenocortical adenoma. After excision of the skin melanoma and regional lymphatic metastases, he was followed up without imaging. Three years later, he presented with abdominal discomfort and enlargement of his adrenal lesion, associated with high plasma metanephrines. Adrenalectomy revealed a mixed tumour consisting of a large phaeochromocytoma with an embedded melanoma metastasis in its core. Patient 2 – a 63-year-old lady with a history of NF-1-related phaeochromocytoma 20 years ago and previous breast cancer presented with a new adrenal lesion on the contralateral side. Plasma normetanephrine was markedly elevated. Elective adrenalectomy revealed an adrenal tumour consisting of chromaffin cells intermixed with breast carcinoma cells.ConclusionsAdrenal incidentalomas require careful evaluation to exclude metastatic disease, especially in the context of a history of previous malignancy. Adrenal biopsy provides limited and potentially misleading information. Phaeochromocytomas are highly vascularised tumours that may function as a sieve, extracting and retaining irregularly shaped cancer cells, thereby yielding adrenal masses with intriguing dual pathology.Learning points:Adrenal incidentalomas require careful evaluation focused on exclusion of underlying hormone excess and malignant pathology.Adrenal biopsy can be misleading and should only be considered in select cases.Phaeochromocytomas harbouring intratumoural metastases from other, extra-adrenal primary malignancies represent rare pathological entities that highlight the complexities that can be presented by adrenal tumours.

Double trouble: Description of an attack on a nesting Delta sp. (Vespidae) by two Stilbum cyanurum (Chrysididae) cuckoo wasps

Cuckoo wasps (Chrysididae) are well known for their habit of laying eggs in other insects’ nests, but the strategies by which they sneak their eggs into hosts’ nests have seldom been described. I report observations of an attack by two Stilbum cyanurum (Chrysididae) individuals on a nesting Delta sp. (Vespidae: Eumeninae). The attack lasted over 1h 30 min and involved both S. cyanurum wasps simultaneously mobbing the Delta sp. in attempts to gain access to her nest. The mode of attack and oviposition are described, and details are compared with observations of attacks by S. cyanurum in other parts of its range.

Double Trouble: How Being Outnumbered and Negatively Stereotyped Threatens Career Outcomes of Women in STEM.

Masculine work contexts form an important source of social identity threat for working women. But what aspect of masculine work contexts is most threatening to women’s gender identity at work: A numerical majority of male colleagues (i.e., numerical male dominance), working in a profession in which women are negatively stereotyped (i.e., normative male dominance), or the combination? The current study aimed to disentangle these two aspects of masculine work contexts by testing its combined impact on the experience of gender identity threat among women and men who work in the STEM sector (i.e., Science, Technology, Engineering and Mathematics). A field study was conducted among women (N = 177) and men (N = 630) graduates holding an academic degree in a STEM educational program. Respondents either worked in- or outside the STEM sector (i.e., stronger vs. weaker gender stereotype) and estimated the ratio of men to women in their direct work environment. Results from a Structural Equation Model demonstrated that women in STEM face double trouble: The combination of working almost solely with male colleagues (being outnumbered) and working in the technical sector (where women are negatively stereotyped) predicted the highest levels of experienced gender identity threat, particularly among women who highly identified with their gender group. Gender identity threat, in turn, negatively predicted women’s work engagement and career confidence. Men did not face double trouble: Their experience of gender identity threat was not related to working in a masculine STEM sector. Importantly, considering that the women in this sample already hold a degree in STEM, and have proven their competence in STEM and resilience to gender stereotypes, this research reveals how in naturalistic work settings, prevailing social identity threats continue to affect women’s professional careers.

Tropical Pacific SST and ITCZ Biases in Climate Models: Double Trouble for Future Rainfall Projections?

AbstractThe double Intertropical Convergence Zone bias remains a persistent problem in coupled general circulation model simulations. Due to the strong sea surface temperature (SST)‐convection relationship in the tropics, precipitation biases are sensitive to background SST. Using historical simulations of 24 coupled general circulation models and an atmospheric general circulation model, we show that cold equatorial SST biases at least exacerbate double Intertropical Convergence Zone biases in the Pacific. A linear regression model is used to demonstrate that improved predictability of precipitation trends is possible with such model‐dependent information as mean‐state SST biases accompanying projected SST trends. These results provide a better understanding of the root of the double Intertropical Convergence Zone bias and a possible path to reduced uncertainty in future tropical precipitation trends.

Double trouble? Gag in conjunction with double insert in HIV protease contributes to reduced DRV susceptibility.

HIV protease is essential for processing the Gag polyprotein to produce infectious virions and is a major target in antiretroviral therapy. We have identified an unusual HIV-1 subtype C variant that contains insertions of leucine and asparagine (L38↑N↑L) in the hinge region of protease at position 38. This was isolated from a protease inhibitor naïve infant. Isothermal titration calorimetry showed that 10% less of L38↑N↑L protease was in the active conformation as compared with a reference strain. L38↑N↑L protease displayed a ±50% reduction in KM and kcat The catalytic efficiency (kcat/KM) of L38↑N↑L protease was not significantly different from that of wild type although there was a 42% reduction in specific activity for the variant. An in vitro phenotypic assay showed the L38↑N↑L protease to be susceptible to lopinavir (LPV), atazanavir (ATV) and darunavir in the context of an unrelated Gag. However, in the presence of the related Gag, L38↑N↑L showed reduced susceptibility to darunavir while remaining susceptible to LPV and ATV. Furthermore, a reduction in viral replication capacity (RC) was observed in combination with the related Gag. The reduced susceptibility to darunavir and decrease in RC may be due to PTAPP duplication in the related Gag. The present study shows the importance of considering the Gag region when looking at drug susceptibility of HIV-1 protease variants.

Double Trouble: An Analysis of IRS Attention and Financial Reporting

We examine whether the IRS uses public information to obtain qualitative signals regarding the quality of firms’ financial information or management integrity. Using the procurement of public information as a proxy for IRS attention, we test whether public signals of poor information quality (restatements) lead to an increase in IRS attention. To begin, we document that the IRS is both more likely and quicker to acquire public filings announcing a restatement than any other filing of the firm. Furthermore, we examine instances in which the IRS is more likely to learn of a restatement and find an increase in attention around both press releases and media coverage of the restatement. Next, we examine the implications of increased IRS attention. Employing path analysis, we find that IRS attention is associated with both higher levels of future tax settlements, and a greater likelihood of the mention of a tax audit. Overall, our results are consistent with the IRS responding to signals of poor information quality or management integrity as if financial misreporting and tax reporting are related.

Double Trouble: Contralateral Breast Cancer Risk Management in the Modern Era.

Double Trouble: Contralateral Breast Cancer Risk Management in the Modern Era.

Nurses in double trouble: Antecedents of job burnout in nursing profession.

Objective:To understand the most prominent factors contributing to job burnout in the nursing profession.Methods:Mixed method design was used in this study. In the qualitative part of the study, a focus group discussion approach was used to determine the major factors contributing in nurses’ job burnout. The quantitative part was conducted by using a questionnaire based on the theme generated in the qualitative part along with other demographic information. The data was collected from 93 nurses with 90.3% response rate.Results:The proposed logistic regression model was able to correctly classify the 96% job burnout cases using factors mutually agreed in the focus group discussion. All the factors are significantly contributing to job burnout. However, the unfavourable work environment contributes more to job burnout as compared to the unfavourable support from family.Conclusion:unfavourable support of work environment and unfavourable support from family are the main contributors in the job burnout of nurses. Therefore, an equal improvements in both areas should be made on the priority basis to retain the happy nurses to deliver excellent healthcare services.

Double Trouble: The Burden of Child Rearing and Working on Maternal Mortality

English Abstract: We document increased old-age mortality rates among Swedish twin mothers compared to non-twin mothers. Results are based on administrative data on mortality for the years 1990 to 2010. We argue that twins are an unplanned shock to fertility in the cohorts of older women considered. Deaths due to lung cancer, chronic obstructive pulmonary disease and heart attacks, which are associated with stress during life, are significantly increased. Stratifying the sample by education and pension income shows the highest increase in mortality rates among highly educated mothers and those with above-median pension income. These results are consistent with the existence of a double burden from child rearing and working on mothers’ health. German Abstract: Wir beobachten eine angestiegene Sterblichkeitsrate fur Mutter von Zwillingen im Vergleich zu Muttern ohne Zwillinge. Hierfur haben wir administrative Daten in Schweden von 1990 bis 2010 ausgewertet. Zwillingsgeburten fuhren zu einem unerwarteten Anstieg der Kinderzahl. Unsere Ergebnisse zeigen, dass stressbedingte Krankheiten signifikant haufiger als Todesursachen bei den Muttern von Zwillingen angegeben wurden. Stratifziert nach Bildung und Renteneinkommen sind die grosten Unterschiede bei Muttern mit hohem Bildungsstand und hohem Renteneinkommen zu beobachten. Diese Ergebnisse deuten auf eine Doppelbelastung durch Kindererziehung und Arbeit fur die mutterliche Gesundheit hin.

Double Trouble: High Prevalence of Rhinitis in Asthma

Double Trouble: High Prevalence of Rhinitis in Asthma

Low Socioeconomic Status but Resilient: Panacea or Double Trouble? John Henryism in the International IMIAS Study of Older Adults.

John Henry (JH) theory provides a framework for understanding the physiological toll exerted on low socioeconomic status (SES) individuals as they overcome psychosocial stressors imposed by their environments. This theory suggests that resilience, a seemingly positive social adaptation, may in fact be physically deleterious. JH theory has been well-described in low-SES rural male African Americans, however it is currently unclear whether validity of this theory extends to women, other races and outside the rural US. We assessed whether, in individuals with low income, there is an association between self-mastery/resilience and either blood pressure or depressive symptoms that is different from the association seen in individuals with higher income. Data were obtained from 1353 older men and women participants of the International Mobility in Aging Study (IMIAS). Across 3 countries and 4 sites, higher self-mastery/resilience was associated with lower depressive symptoms in both low and high income groups. In low income individuals from Saint-Hyacinthe, Québec, higher self-mastery/resilience was associated with both higher mean systolic blood pressure (n = 240, β = 0.135, p ≤ 0.05) and higher mean diastolic blood pressure (n = 240, β = 0.241, p ≤ 0.0001). In the high income group of Saint-Hyacinthe, no such associations were observed. The findings in the Saint-Hyacinthe cohort (but not the other settings), are consistent with the John Henry hypothesis, and demonstrates this effect extends beyond a rural African American population. This finding indicates that in certain populations, the positive psychological effects of resilience come with a cost to physical health.

Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease Overlap Syndrome - Double Trouble

COPD- OSA overlap syndrome has been defined in the recent past as a syndrome of these two co-existing illnesses. Whether the overlap is synergistic is unknown, however it has been proven to have increased risk of complications like pulmonary artery hypertension. Mechanisms for each worsening the other have been postulated, putting a potential scare for the prognosis. An attempt to understand and recognize this syndrome will be the basis of defining treatment options for the same. The difficulties in defining and treating this syndrome have also been highlighted in this review.

Double Trouble: Intracranial Hemorrhage Risk with Antithrombotic Use and Underlying Thrombocytopenia

Double Trouble: Intracranial Hemorrhage Risk with Antithrombotic Use and Underlying Thrombocytopenia