PurposeThe purpose of this study, with its central thesis placed on excelling at business measures, is to underscore the need for business entities to understand the significant implication of hidden failure costs and its impact on their business processes. The study also stresses the need for organizations to systematically break the many norms.Design/methodology/approachThis study looked at capturing the often‐overlooked component of poor quality cost via a simple function of measurement which requires an effortless yet painstaking way of collecting data pertaining to intangible wastages in the form of time, service charges and material.FindingsA simple formula is introduced, using three types of indicators that could be used to monitor the level of poor quality costs (PQC), to quantify the total failure costs by accumulating the values of both hidden and visual failure costs.Originality/valueThe study breaks the boundaries of existing methods of understanding and calculating the all‐embracing cost of doing business, hence paving the way to make inroads in business processes improvement, enhanced job‐scope comprehension, agility and performance, further intensification of internal and external customer satisfaction.
Paroxysmal nocturnal hemoglobinuria is a rare acquired stem cell disorder characterized by intravascular hemolysis, aplasia and an increased risk of thrombosis. We describe a patient under treatment with the anti-complement antibody eculizumab who developed pancytopenia, requiring blood transfusions, due to massive splenomegaly. The patient underwent two separate splenic embolizations, which reduced the size of the spleen and improved his blood count to the point that blood transfusions were no longer necessary. Splenic embolization was chosen over splenectomy due to the potential postoperative complications of splenectomy, especially that of thrombosis.
A 40-year-old man who was a smoker with no history of intravenous drug use presented to a tertiary hospital with a week-long high-grade fever, dry cough, and streaky hemoptysis. He had hypoxia at room air. Chest x-ray showed bilateral ground-glass opacities with relative sparing of apexes and left base (Figure 1).Sputum and blood cultures (including fungal) and HIV tests were negative. He had received intravenous piperacillin and tazobactam empirically for a week, with fair clinical improvement and resolution of radiological shadows. He was referred to our tertiary center for further management. Ocular fundi had multiple preretinal hemorrhages, a few with central clearing (Figure 2).Transthoracic echocardiogram revealed a bilobed, oscillating, 2ϫ1.5-cm right ventricular mass with peduncle arising from the anterior end of the moderator band ( Figure 3A and Movie I of the online Data Supplement).Transesophageal echocardiogram ( Figure 3B and Movie II) showed a 2-mm patent foramen ovule, and all valves were normal. The mass was visualized in a modified 4-chamber midesophageal view. Sixty-four-slice computed tomography pulmonary angiography showed no filling defects in the pulmonary artery. Cardiac magnetic resonance imaging (Figure 4 and Movie III) showed the contrast-nonenhancing mass and confirmed a structurally normal heart. His blood cultures were negative even after prolonged culture. He was started on empirical endocarditic therapy with vancomycin and gentamicin on suspicion of the mass being infective vegetation. Because the fever continued beyond a week of antibiotics, the decision to remove the mass was made.He underwent right atriotomy under cardiopulmonary bypass. The right ventricle and tricuspid valve were normal. A linear 2ϫ0.5-cm pale white growth and a smaller 0.5ϫ0.5-cm pale gray growth that were loosely attached to the moderator band were noted and removed. Right ventricular endothelium was normal throughout, and excision of the moderator band was not done.Histopathological examination showed fibrinous material with predominantly neutrophilic infiltrates ( Figure 5) and Gram-positive cocci (Figure 6). Culture of specimen yielded Staphylococcus aureus sensitive to methicillin and gentamicin. Hence, oxacillin and gentamicin were continued for another 2 weeks. The patient became afebrile, and C-reactive protein values were normalized. He was doing well at the 1-year follow-up visit.
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