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While malignant mesothelioma may initially present in a variety of ways, it is uncommon to present with systemic lupus erythematosus (SLE) seropositivity and thus obscuring its diagnosis. Our case involves a 75-year-old Caucasian male with a past medical history of essential hypertension, remote prostate cancer status post prostatectomy, and lifetime nontobacco use presenting with progressive shortness of breath over one month. After a negative cardiac assessment, a postcardiac catheterization chest X-ray (CXR) revealed a right-sided moderate-to-large pleural effusion that, on further workup, was found to be exudative. Effusion studies were negative for malignancy and bacterial growth. Recurrent accumulation of fluid after a thoracentesis one week prior prompted an autoimmune work up. Positive markers included antinuclear antibodies, anti-double stranded DNA antibodies, and anti-histone antibodies, while anti-Smith antibodies were negative. Although SLE was initially suspected based on serologies, no clinical signs or symptoms were present to fulfill the diagnosis criteria. A trial of oral prednisone resulted in decreased pleural effusion size with no further recurrence. Additional studies included a CT scan of the chest that showed pleural masses confirmed with biopsy to be epithelioid mesothelioma. Given the patient's age and new diagnosis of malignant mesothelioma, we hypothesized that the presence of autoantibodies was likely false positives due to acquired autoantibodies with age, hyperactivity of the immune system from malignancy, and possible prior asbestos exposure.

Hemosuccus pancreaticus is a rare but life-threatening cause of upper gastrointestinal bleeding through the main pancreatic duct. This clinical entity is a difficult diagnosis due to its rarity, intermittent nature of the hemorrhage, and peculiar clinical presentation. It is still considered a surgical problem but advances in medical therapy may enable clinically stable patients to undergo less-invasive angiographic embolization. We chronicle here a unique case of hemosuccus pancreaticus in a patient presenting with melena who could not be diagnosed on multiple standard forward-viewing esophagogastroduodenoscopies and computed tomography angiography. Eventually, side-viewing duodenoscope identified the intermittent bleeding through the ampulla of Vater. This paper illustrates that clinicians should be vigilant for this etiology, especially in patients with intermittent crescendo-decrescendo abdominal pain, acute gastrointestinal hemorrhage, and elevated serum lipase levels. A multidisciplinary team approach with the centralization of gastrointestinal bleed services and a well-established management protocol is of paramount importance to reduce the morbidity and mortality of this disorder. Additionally, this article serves to outline our current understanding of the epidemiology of and risk factors for hemosuccus pancreaticus, the pathophysiology of this disease, and currently available approaches to diagnosis and treatment.

Esophageal stent placement is used to treat benign strictures, esophageal perforations, fistulas and for palliative therapy of esophageal cancer. Although it is a safe and effective method, complications are increasing the morbidity and mortality rate. Small bowel perforation as a result of esophageal stent migration is a remarkably rare occurrence. We report one case from our clinical experience and undertake a review of the previously reported cases retrieved from the PubMed. A total of six cases were found accessible. Abdominal pain was the common clinical presentation. The mean time from stent placement to perforation was 3.4 months (range, two weeks to 12 months). The jejunum was the frequently perforated portion of the small bowel. Surgical intervention was the mainstay of treatment. This comparative review illustrates that clinicians should remain vigilant for small bowel perforation in patients with esophageal stent placement. Further studies are required to delineate the magnitude and scope of this association.

Over the past decade, political framework in the energy sector all over the world has provoked a strong focus on the production of renewable energies. The study focuses on agent-based modelling approach to identify the suitable and economical distribution of biogas power plants over time in the area of interest. For sufficient supply of biomass (silage maize) on a regional basis to run biogas power plants economically and smoothly, different thematic layers with defined rules for Agent Analyst used to simulate the future installations of power plants. In conjunction with ArcGIS, the Agent Analyst software generates simulations that prove the robustness of the model in finding the suitable location of power plants. The resultant location from the model is analysed in different aspects. The designed methodology could be implemented in other areas with minor edits as per requirement of the area.

There is a global realization in all governmental setups of the need to provoke the efficient appraisal of crop water budgeting in order to manage water resources efficiently. This study aims to use the satellite remote sensing techniques to determine the water deficit in the crop rich Lower Bari Doab Canal (LBDC) command area. Crop classification was performed using multi-temporal NDVI profiles of Landsat-8 imagery by distinguishing the crop cycles based on reflectance curves. The reflectance-based crop coefficients (Kc) were derived by linear regression between normalized difference vegetation index (NDVI) cycles of the Moderate Resolution Imaging Spectroradiometer (MODIS) MOD13Q1 and MYD13Q1 products and Food and Agriculture Organization (FAO) defined crop coefficients. A MODIS 250 m NDVI product of the last 10 years (2004-2013) was used to identify the best performing crop cycle using Fourier filter method. The meteorological parameters including rainfall and temperature substantiated the reference evapotranspiration (ET0) calculated using the Hargreaves method. The difference of potential ET and actual ET, derived from the reflectance-based Kc calculated using reference NDVI and current NDVI, generates the water deficit. Results depict the strong correlation between ET, temperature and rainfall, as the regions having maximum temperature resulted in high ET and low rainfall and vice versa. The derived Kc values were observed to be accurate when compared with the crop calendar. Results revealed maximum water deficit at middle stage of the crops, which were observed to be particularly higher at the tail of the canal command. Moreover, results also depicted that kharif (summer) crops suffer higher deficit in comparison to rabi (winter) crops due to higher ET demand caused by higher temperature. Results of the research can be utilized for rational allocation of canal supplies and guiding farmers towards usage of alternate sources to avoid crop water stress.

Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.

Primary gastrointestinal lymphoma is a rare neoplasm that accounts for less than 5% of all gastrointestinal malignancies. We present a case of a 37-year-old woman positive for human immunodeficiency virus who presented with abdominal pain and vomiting for three months. She underwent endoscopic biopsy and was found to have high-grade diffuse large B-cell lymphoma in the jejunum. This report discusses her treatments and includes a brief literature review highlighting the rarity of this entity, the etiological agents implicated in its pathogenesis, and the lack of specific guidelines for treatment.

This study seeks to examine, both theoretically and empirically, the impact of climate change on farm Profit efficiency in Rural Punjab Pakistan. Current study explores the climate change impact by using Stochastic Profit Frontier Model at farm level with panel data. The outcomes of this study are indicative of a strong impact of climate change on the agriculture of Punjab, Pakistan. Increase in long run normal precipitation and temperature have significant effect on farm profit that fluctuates in direction as well as magnitude across quarters. The incidence of weather shocks and socioeconomic characteristics of the farming households are important factors of profit efficiency at farm level. The quasi fixed inputs are positively and significantly related to farm profits while input prices contribute negatively to farm profitability. The average profit efficiency score turned out to be 0.72, suggesting that the average farm, by improving their efficiency can increase the profit up to 28 percent. The findings of present study are evocative of huge impact of climate change on the rain-fed areas of Punjab since these are water scarce areas depending on rain fall for cropping. Arguably, it is vital for the better performance of the agriculture sector to combat the impact of climate change more effectively through implementation of adaptation strategies.Keywords. Agriculture, Farm production, Climate change, Profit efficiency, Stochastic profit frontier model and farm level panel data.JEL. C23, D01, Q12.

The objective of our study was to recognize hepatitis B reactivation as a complication of rituximab chemotherapy and to realize the importance of screening for prior Hepatitis B virus (HBV) exposure in all patients with hematologic malignancies who will receive rituximab as part of their therapy. Rituximab is a monoclonal antibody targeting CD 20 receptors on the membrane of B cells. In this case report, we described a 79-year-old man who presented to our department with nausea, fatigue, and jaundice. Two months ago, he had received the last dose of the chemotherapy regimen containing rituximab for follicular B cell lymphoma. Ultrasound and computed tomography (CT) scan of abdomen did not show any focal lesions. Liver function tests showed worsening hepatic failure and viral serology demonstrated active HBV infection. Antiviral therapy with entecavir and tenofovir disoproxil fumarate failed to improve his symptoms, and he died of fulminant hepatic failure. Rituximab targets CD 20 receptors positive B cells. It can destroy both cancerous and normal B cells. A decline in immune function can activate occult HBV infection. Prior to initiation of rituximab therapy, screening should be conducted in all cases for HBV associated serological markers. Patients with active or occult HBV infection must be started on appropriate antiviral therapy to prevent any severe outcomes with rituximab-containing regimens.

Response modification factors (R-Factor) are used to modify the elastic seismic response obtained from the linear elastic analysis to account for the effect of allowed damage. Recent studies show that UBC-97 code-based response modification factors are not valid for high-rise buildings. Where wind governs the design, their validity comes in question further. In this study, an actual 40- storied tall RC building located in Bangkok, Thailand is investigated in detail to determine the actual R-factor in each and every significant mode located in low to moderate seismic risk area with mean hourly wind gust of 90 MPH and exposure type-B. The code based designed building is analyzed using elastic displacement-based pushover analysis procedure in each and every mode to determine the modified R- factor. It is found that actual R-factor is in the order of only 1 to 1.25 in all significant modes.

Seismic response of the multi-storey buildings is created by the interaction of both the structure and underlying soil medium. The seismic design philosophy is incorporated using response modification factor “R”. Current Code based values of “R” factor does not reflect the SSI problem as it is based on fixed base condition. In this study, the modified values of “R” factor for moment resisting frame (MRF) considering SSI are evaluated. The response of structure with and without SSI has been compared using equivalent linear static and nonlinear static pushover analyses for 10- storied moment resisting frame building. The building is located in seismic zone 2B situated on different soils with shear wave velocity (Vs) of 300m/sec (SD) and 1200m/s (SB). Code based “R” factor value for building frame system has been taken as 5.5. Soil medium is modelled using identical but mutually independent horizontal and vertical springs. It was found that the modified “R” factor values have been decreased by 47% and 43% for soil SD & SB respectively as compared to that of code based “R” factor.