ABSTRACT
Introduction: Disseminated histoplasmosis (DH) presents as primarily lung manifestations with extrapulmonary involvement in immunocompromised hosts. Granulomatous hepatitis as first presentation of DH in an immunocompetent host is uncommon. Case Description/Methods: 25-year-old female presented with one month of fever, fatigue, myalgias, 30-pound weight loss, cough, nausea, vomiting, and epigastric pain. She has lived in the Midwest and southwestern US. Presenting labs: TB 1.9 mg/dL, AP 161 U/L, AST 172 U/L, ALT 463 U/L. Workup was negative for COVID, viral/autoimmune hepatitis, sarcoidosis, tuberculosis, and HIV. CT scan showed suspected gallstones and 9 mm left lower lobe noncalcified nodule. EUS showed a normal common bile duct, gallbladder sludge and enlarged porta hepatis lymph nodes which underwent fine needle aspiration (FNA). She was diagnosed with biliary colic and underwent cholecystectomy, with white plaques noted on the liver surface (A). Liver biopsy/FNA showed necrotizing granulomas (B) and fungal yeast on GMS stain (C). Although histoplasmosis urine and blood antigens were negative, histoplasmosis complement fixation was >1:256. She could not tolerate itraconazole for DH, requiring amphotericin B. She then transitioned to voriconazole, discontinued after 5 weeks due to increasing AP. However, her symptoms resolved with normal transaminases. At one year follow up, she is asymptomatic with normal liver function tests. Discussion(s): DH is a systemic granulomatous disease caused by Histoplasma capsulatum endemic to Ohio, Mississippi River Valley, and southeastern US. DH more commonly affects immunocompromised hosts with AIDS, immunosuppressants, and organ transplant. Gastrointestinal involvement is common in DH (70-90%) with liver involvement in 90%. However, granulomatous hepatitis as primary manifestation of DH is rare (4% of liver biopsies). Hepatic granulomas are seen in < 20%. Patients may present with nonspecific systemic symptoms. Serum/urine antigens may be negative. Gold standard for diagnosis is identifying yeast on tissue stains. Recommended treatment is amphotericin B followed by 1 year of itraconazole. However, shorter treatment duration may be effective in immunocompetent hosts. This case is unique in that granulomatous hepatitis was the first presentation of DH in our immunocompetent patient diagnosed on EUS FNA and liver biopsy. Clinicians must have a high degree of suspicion for DH in patients with fever of unknown origin especially in endemic areas regardless of immunologic status. (Table Presented).
ABSTRACT
Although house prices and airports are influenced by distinct factors that shape their evolutions, they are also intrinsically connected through the natural and built environment. Standard theory suggests that air-traffic noise and proximity to key economic hubs such as airports are of prime importance to house prices and the housing market. This study contributes to understanding the link between the housing market, airport location proximity and air traffic. The research investigates this association across four key urban areas within New Zealand proximal to an international airport: Auckland, Wellington, Christchurch and Queenstown. Applying a generalized least squares (GLS) regression approach, the analysis reveals that house prices, air-traffic activity and proximity to airports within New Zealand demonstrate a statistically significant effect, and that air traffic volume has a positive effect on house prices. Moreover, the findings reveal a ‘U'-shape relationship between distance to the airport and house prices, suggesting that airport noise and pollution adversely affect house prices, with this effect diminishing with distance, indicating that economic influences and employment may also serve as a positive externality. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Software developers use a variety of social media channels and tools in order to keep themselves up to date, collaborate with other developers, and find projects to contribute to. Meetup is one of such social media used by software developers to organize community gatherings. We in this work, investigate the dynamics of Meetup groups and events related to software development. Our work is different from previous work as we focus on the actual event and group data that was collected using Meetup API. In this work, we performed an empirical study of events and groups present on Meetup which are related to software development. First, we identified 6,327 Meetup groups related to software development and extracted 250,36 9 events organized by them. Then we took a sample of 452 events on which we performed open coding, based on which we were able to develop 9 categories of events (8 main categories +'Others'). Next, we did a popularity analysis of the categories of events and found that Talks by Domain Experts, Hands-on Sessions, and Open Discussions are the most popular categories of events organized by Meetup groups related to software development. Our findings show that more popular categories are those where developers can learn and gain knowledge. On doing a diversity analysis of Meetup groups we found 20.46% of the members on average are female, and 20.34% of the actual event participants are female, which is a larger proportion as compared to numbers reported in previous studies on gender representation in software engineering communities. We also found evidence that the gender of Meetup group organizer affects gender distribution of group members and event participants. Finally, we also looked at some data on how COVID-19 has affected the Meetup activity and found that the event activity has dropped, but not stalled. A substantial number of events are now being organized virtually. The results and insights uncovered in our work can guide future studies related to software communities, groups, and diversity-related studies. © 2022 IEEE.