This paper describes one patient with Antineutrophil Cytoplasmic Antibody- (ANCA-) associated vasculitis who initially presented with multiple ischemic fingers and toes. On further evaluation, the patient was also found to have pulmonary-renal involvement and episcleritis. The diagnosis was supported with a positive cANCA (anti-proteinase 3) and a bronchoscopy consistent with diffuse alveolar hemorrhage. Although the patient refused a tissue biopsy, clinical presentation including nasal ulceration, sinus congestion, and epistaxis and anti-proteinase 3 antibody were more consistent with Granulomatosis with Polyangiitis (GPA) rather than Microscopic Polyangiitis (MPA) or Eosinophilic Granulomatosis with Polyangiitis (EGPA) based on the recently presented ACR/EULAR Provisional 2017 Classification Criteria for GPA (Luqmani et al., 2016). The patient responded well to therapy including high dose steroids and cyclophosphamide, with improvement of all organs involved and had no further digital ischemia or gangrene on follow-up. We include a review of the English literature summarizing presentation, management, and outcome of 16 similar cases.
West Nile virus (WNV) is a mosquito-borne RNA Flavivirus which emerged in North America in 1999. Most patients present with a febrile illness but a few develop WNV neuroinvasive disease. Myopathy is an uncommon manifestation. We describe a case of a 42-year-old male from Los Angeles who presented with 8 days of fever and muscle pain. Initial physical exam was normal except for 4/5 muscle strength testing in his extremity proximal muscles. Laboratory revealed a creatine kinase of 45,000 and a urinalysis with large blood but no red blood cells, suggesting rhabdomyolysis. The patient's condition declined despite aggressive supportive care and hydration, and on hospital day #6 he developed severe altered mental status and progressed to complete right arm paralysis and 2/5 muscle strength in bilateral legs. EMG/NCS showed sensorimotor axonal polyneuropathy and the cerebrospinal fluid was positive for IgM and IgG WNV antibodies. The patient was diagnosed with WNV neuroinvasive disease, poliomyelitis (and encephalitis) type with myopathy/muscle involvement. He was treated supportively and his muscle and neurologic disease gradually improved. At 12-month follow-up his muscle enzymes had normalized and his weakness had improved to 5/5 strength in bilateral legs and 3/5 strength in the right arm.
One of the most important legacies of the late President, Sheikh Zayed Al Nahyan left to the people of the UAE was his insistence that women participate fully and equally in the growth and prosperity of the UAE. This paper examines the readiness of students, professors and professionals to accept women in professional roles in the oil and gas industries in the UAE.Working at the Petroleum Institute in Abu Dhabi, the researchers train both men and women to become future engineers for the Abu Dhabi National Oil Company (ADNOC). In this study, future and present professionals were asked to rate their opinions about working with women in integrated work places. To solicit these opinions, a survey of seven questions, with a place for comments, was distributed to various age groups in various job categories. Distributed in educational institutions and local petroleum societies, the survey asked participants to rate their willingness to hire, mentor, work with, promote, and work for a woman engineer. This paper• analyzed a seven-statement survey. Finding that although most respondents agreed that greater numbers of women would be welcomed into the workplace, the researchers noted a stubborn minority of both men and women who did so with reservations. Looking for a plausible explanation, they concluded that stereotyping might be a motivator.• described ways that included mentoring, presenting women role models, demanding academic parity, engaging in professional activities, etc. to combat stereotyping to ensure a smooth transition of more women into the work place.• examined roadblocks, like [1) low number of women, 2) retaining and promoting women employees and 3)understanding differences] that companies needed to be alert to for a successful diversified culture and then listed five strategies [1) women-to-women mentoring 2) empathy vs. advice 3) anger management 4) working through 2 SPE 119204 problems 5) healthy environment] that must be addressed if companies want to hire and, more importantly, retain women.• concluded that while programs to address the needs and attitudes of future women engineers are in place or being established, programs for future men engineers are not. This might be the first place that women and men should look for parity.
From the day in 1859 that Edwin Drake drilled the first oil well in Titusville, Pennsylvania, English has been the lingua franca of the petroleum industry. As the quest for oil escalates into all areas of the world and as solutions to the world's energy needs become more complex, national and international oil companies compete to employ the best and brightest to ensure that the flow of precious hydrocarbons remains unabated. The Abu Dhabi National Oil Company (ADNOC) in the United Arab Emirates (UAE), a state-owned petroleum producer that boasts some of the largest known oil reserves on the planet, perpetually finds it difficult to employ enough qualified English-speaking staff to manage its petroleum exploration, production, and distribution subsidiaries. Concerned about its inability to fill positions locally, ADNOC has attempted many local initiatives and has even been compelled to provide scholarships for Emirati citizens to be educated in institutions of higher learning in North America, Europe and Australia. Nevertheless, this national oil company has been forced to import expensive, qualified engineers from abroad. (Geologists, 2008). Grateful for employment as well as a safe environment to raise their families, many of these foreign engineers have remained and prospered in the UAE while accepting second-class status in a land they can never really call their home. Many of these professionals are now clamoring, however, for opportunities for their own children to be able to remain and become educated into the petroleum professions on a fairer footing.
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