Key Clinical MessageWe describe a rare case of Graves’ disease presenting with atrial fibrillation and severe cholestasis. An extensive evaluation for hepatobiliary causes of cholestasis, including hepatic biopsy, was entirely negative. He was successfully treated with methimazole and eventual thyroidectomy. With caution, thionamides can be utilized successfully for such patients.
A 39-year-old male presented with a painful paraspinal mass, which had been present for several weeks. The mass had previously been treated with oral sulfamethoxazole and trimethoprim DS, as the patient reported a history of “boils,” with no improvement in his pain or size of the mass. No further diagnostic workup was pursued until he was admitted with intractable pain. Eventual biopsy revealed adenocarcinoma, likely of pulmonary origin. This report, as well as other incoming cases, highlights this rare phenomenon of muscular metastases as the sole presentation of a distant primary malignancy.
Market Distortions and Political Rent:The Case of Fertilizer Price Divergence in Africa * We examine the fertilizer retail-import price gap in 14 African countries between 2002 and 2013. This price differential is large and remains persistent even after accounting for changes in the cost of domestic transportation. We hypothesize that these persistent deviations may be indicative of market power by importers/suppliers granted to them by governments that are prepared to bar competition in exchange for political rent. Our results show that the retailimport price differential is negatively correlated with government effectiveness. Quality of institutions both in terms of executing public policy and delivering services is, on average, likely to affect retail-import price gaps. Overall, our understanding of market imperfections is enhanced by a closer examination of the role of governance and regulation. The study illustrates this by establishing a link between retail-import price differentials and market efficiency and the quality of regulatory environment in Africa.
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