Case report of a man with HIV presenting with malignant syphilis.

BACKGROUND: Malignant syphilis is a rare manifestation of secondary syphilis and is commonly associated with human immunodeficiency virus coinfection. It can present with multiorgan involvement, which poses a diagnostic dilemma to clinicians. METHODS: We report a case of a middle aged male who presented with near complete vision loss in his right eye with initial concern for fungal endophthalmitis due to his injecting drug use history. He concurrently had right cheek and forearm ulcerative plaques. RESULTS: He was diagnosed with disseminated syphilis following the punch biopsy of his right cheek, with positive Treponema pallidum result on polymerase chain reaction and identification of spirochaetes on immunostaining from histopathology. CONCLUSIONS: We present the epidemiology of syphilis in Australia and highlight the importance of testing for common sexually transmitted diseases within the emergence of the monkeypox outbreak.

An application of interactive fuzzy optimization model for redesigning supply chain for resilience.

Supply chain disruptions compel professionals all over the world to consider alternate strategies for addressing these issues and remaining profitable in the future. In this study, we considered a four-stage global supply chain and designed the network with the objectives of maximizing profit and minimizing disruption risk. We quantified and modeled disruption risk as a function of the geographic diversification of facilities called supply density (evaluated based on the interstage distance between nodes) to mitigate the risk caused by disruptions. Furthermore, we developed a bi-criteria mixed-integer linear programming model for designing the supply chain in order to maximize profit and supply density. We propose an interactive fuzzy optimization algorithm that generates efficient frontiers by systematically taking decision-maker inputs and solves the bi-criteria model problem in the context of a realistic example. We also conducted disruption analysis using a discrete set of disruption scenarios to determine the advantages of the network design from the bi-criteria model over the traditional profit maximization model. Our study demonstrates that the network design from the bi-criteria model has a 2% higher expected profit and a 2.2% lower profit variance under disruption than the traditional profit maximization solution. We envisage that this model will help firms evaluate the trade-offs between mitigation benefits and mitigation costs.

Concordant PET/CT and ICG positive lymph nodes in endometrial cancer: a case of mistaken identity.

Endometrial carcinoma is the most common gynecological malignancy in developed countries. In early stage endometrial cancer, routine systemic pelvic lymphadenectomy showed no survival benefits and results in increased morbidity. The role of PET/CT imaging for the pre-operative detection of lymph node metastases in endometrial cancer is unclear. Sentinel lymph node (SLN) mapping may reduce the surgical staging morbidity while maintaining prognostic information of the lymph node status. Recently, indocyanine green (ICG) SLN mapping has been utilized to detect nodal metastasis in endometrial cancer. Endosalpingiosis is defined as the presence of tubal-like epithelium outside of the fallopian tube and can sometimes be misinterpreted as cancer metastasis. Here, we discuss a patient with newly diagnosed endometrial cancer who had pelvic and para-aortic lymph nodes with high glucose avidity on PET/CT, and ICG positivity on SLN mapping, suspected clinically to be metastatic adenocarcinoma, but with the pathological finding of endosalpingiosis only.

An integrated dataset on current adoption practices, readiness and willingness to use m-commerce amongst women fish vendors in Karnataka state, India.

The dataset describes the survey data on current adoption practices, readiness and willingness amongst woman fish vendors (WFVs) towards the adoption of m-commerce in Coastal Karnataka region, India. The coastal Karnataka belt houses three districts viz. Udupi, Uttara Kannada and Dakshina Kannada. Primary data is retrieved from 383 WFVs who serve 26 markets in the districts mentioned above. The dataset comprises of demographic details of the respondents like age, education, per-day sales etc. and specific responses to the items measuring their current adoption practices, as well as readiness and willingness to use m-commerce in their day to day business activities. Availability of this data will help researchers, policy makers and social entrepreneurs to determine optimal strategies towards efficient adoption of m-commerce models amongst small vendors in similar emerging markets thereby increasing their income levels.

A Mutation Outside the Dimerization Domain Causing Atypical STING-Associated Vasculopathy With Onset in Infancy.

BACKGROUND: Mutations in the gene encoding stimulator of interferon genes (STING) underlie a type I interferon (IFN) associated disease, STING-associated vasculopathy with onset in infancy (SAVI). Patients suffer cutaneous vasculopathy and interstitial lung disease, but are not known to suffer life-threatening infection. CASE: We describe a child who presented with Pneumocystis jirovecii pneumonia in early life, from which he recovered. He went on to suffer failure to thrive, developmental delay, livedo reticularis, and vesicular rash, but without cutaneous vasculitis, and with normal C-reactive protein and erythrocyte sedimentation rates. At 3 years of age, he developed life-threatening pulmonary hypertension. METHODS: Whole genome sequencing (WGS) was performed using the Illumina HiSeqX10 platform and the Seave platform was used for bioinformatic analysis. mRNA expression of IFN-stimulated genes and inflammatory cytokines from peripheral blood mononuclear cells was determined by quantitative polymerase chain reaction. Luciferase assay was used to model IFNß and NF-κB activity in vitro. RESULTS: WGS revealed a de novo mutation p.Arg284Ser in STING at an amino acid previously associated with SAVI. Although this mutation did not fall in the dimerization domain (DD), mRNA analysis revealed constitutive IFN-gene activation consistent with an interferonopathy, which correlated to STING activation in vitro. The patient was treated with corticosteroids and the JAK inhibitor Ruxolitinib, resulting in a rapid improvement of pulmonary hypertension, general well-being, and resolution of the IFN gene signature. However, he did go on to evolve a nasal septal erosion suggesting incomplete control of disease. CONCLUSION: This case provides molecular evidence to support the p.Arg284Ser variant in STING exerting pathogenicity through a gain-of-function mechanism. The lack of cutaneous vasculitis or elevated systemic inflammatory markers, and the occurrence of an opportunistic infection are notable, and raise the possibility that variants outside the STING DD may potentially manifest with an atypical SAVI phenotype. Nevertheless, there was an objective clinical improvement in response to JAK inhibition.