BACKGROUNDSjögren's syndrome (SS) is a systemic autoimmune disease characterized by chronic inflammation of the exocrine glands, mainly the salivary and lacrimal ones, causing keratoconjunctivitis sicca, xerostomia, xerotrachea and vaginal dryness. The population prevalence is 0.5-1% and it predominantly affects middle aged women in their fourth decade of life. Renal involvement can be found in up to 5% of patients with the primary form of the disease, occurring as interstitial nephritis or glomerulonephritis. CASE REPORTA 39-year-old female patient, with no previously known comorbidities. She reported two episodes of parotitis in 2006 and 2009 that were resolved with antibiotic treatment. In 2012, she was hospitalized with hypokalemic periodic paralysis. As of 2014, she started to follow up with the ophthalmology team due to xerophthalmia, at the time with a 2 mm Schirmer's test in the right eye and 3 mm in the left eye, with no defined etiology until then. In 2019, she underwent routine tests, which showed an increase in serum creatinine levels, hypokalemia and metabolic acidosis. Investigation of SS with distal tubular involvement was initiated. Salivary gland scintigraphy was performed, showing an important impairment in the accumulation and elimination of parotid and submandibular glands. Laboratory tests: potassium level of 3.3; creatinine level of 2.2; urine test showing hyposthenuria (urinary density of 1005) and urinary pH of 7; protein electrophoresis showing hypergammaglobulinemia; normal anion gap; chloride level of 107; positive rheumatoid factor; positive anti-Ro and anti-La; ANA: fine speckled nuclear pattern 1/640.
Results: Approximately 11% of the population is left-handed, with a similar prevalence among surgeons. The otolaryngologist's reliance on specialized equipment requires adaptations to facilitate use by left-handed physicians. We propose modifications for the lefthanded otolaryngologist in the outpatient setting and in endoscopic sinus, otologic, head and neck, facial plastic, and upper aerodigestive procedures. Furthermore, survey results regarding handedness are presented. A minority of left-handed otolaryngologists had specific mentoring or instruction during their training. Most surgeons, regardless of handedness, believe that proficiency with their nondominant hand is crucial and that left-handedness does not impede successful surgical performance or residency training. Conclusion: Adaptations made by the left-handed otolaryngologist who practices in a right-handed-dominated field are often intuitive. However many surgeons, particularly trainees, may benefit from recommendations specifically tailored for lefthanded otolaryngologists. We offer suggestions for these individuals and present results of a survey regarding handedness among otolaryngology residents and attendings.
This paper has the main purpose to describe the overview development of a Risk Based Inspection (RBI) methodology applicable to a semisubmersible production platform. Considering news and inventive methodologies for: inspection, acquisition and management of corrosion rates, critical points monitoring, crack propagation studies based on fracture mechanics, structural reliability and a structural database in order to facilitate the structural management in the asset. The data for this paper are based on inspection historical data and hydrodynamic and structural analysis software ABS OSAP System; see reference 8, to provide the structural results of buckling and fatigue analysis. RBI methodology can be applied to semisubmersible platforms in order to rationalize the structure integrity management, as well as optimize the class process maintenance. The RBI methodology when compared with the traditional method has a lot of advantages as: focusing inspection during the unit life, lower accidents risk, resulting in the reduction of the maintenance cost. The main focus of RBI methodology for semi's concentrate in the reduction of underwater scope of inspection, while increase the importance of focusing critical areas based on the risk assessment and reliablility results. The proposed paper has a significant contribution to the knowledge on reliability of semisubmersible, as well as the optimization and rationalization of integrity management. Introduction The pioneer development of RBI for FPSO has been done during the year of 2001. It has been a result of significant joined efforts from different companies and the first implemented RBI in the world. Since this time, the methodology has been improved and for different purposes ABS also establishes different levels for the methodology and respective requirements. Considering the needs to optimize the conventional survey inspection programs of a semi-submersible Platform, the RBI methodology has been considered a next step of new technology to be invstigated. In order to reach the objective some tasks have been carried out and will be described on this paper.
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