Effect of Post Weld Heat Treatment on the Microstructure and Electrochemical Characteristics of Dissimilar Material Welded by Butter Method.

In the present study, the effect of post weld heat treatment (PWHT) on the microstructure and corrosion kinetics of butter welded Nickel Alloy 617 and 12Cr steel was investigated. Buttering was carried out on the 12Cr side with the Thyssen 617 filler metal. Furthermore, post weld heat treatment (PWHT) was conducted at 730 °C with a holding time of 4 h followed by furnace cooling. Optical Microscopy (OM) was conducted to study the microstructural evolution in dissimilar material welding as a result of PWHT. Moreover, Scanning Electron Microscopy with energy dispersive spectroscopy (SEM-EDS) was employed to determine the elemental concentrations in all important regions of the butter weld before and after the PWHT. In addition, the effect of PWHT on the corrosion kinetics of the butter weld was also investigated by potentiodynamic polarization measurements in 5 wt.% NaCl + 0.5 wt.% CH3COOH electrolyte at room temperature, 30 °C, 50 °C and 70 °C. The corrosion activation parameters were also determined for both the samples by using Arrhenius plots. The results revealed the higher susceptibility of corrosion of the butter weld after PWHT, which was attributed to the reduced Cr content in the heat affected zone of the 12Cr region due to the sensitization effect of the heat treatment, resulting in higher corrosion rates.

Intracranial hemorrhage in a young COVID-19 patient.

COVID-19 patients are increasingly understood to develop multisystem manifestations, including neurologic involvement. We report the case of a 42-year old COVID-19 positive patient with a fatal intracerebral hemorrhage (ICH). The patient presented with fever and dyspnea, requiring intubation due to medical complications. After prolonged sedation and anticoagulation, the patient suddenly developed bilaterally fixed and dilated pupils, caused by a right-sided intracranial hemorrhage with uncal herniation. The course of this case illustrates the delicate balance between hypercoagulability and coagulation factor depletion; especially in the intubated and sedated patient, in whom regular neurological assessments are impeded. As we expand our understanding of the neurological ramifications of COVID-19, clinicians need to be increasingly aware of the precarious coagulation balance.

Hydroxychloroquine-induced inverse psoriasis.

A 65-year-old woman presented to our rheumatology clinic with pain and swelling of multiple joints of her hands. After a thorough evaluation, she was diagnosed with rheumatoid arthritis and was started on hydroxychloroquine therapy. A week later, she presented to our clinic with an acute condition and reported that after taking hydroxychloroquine for a few days she developed multiple rashes, most prominent at skin folds around her breasts, neck, axillae and buttocks. The rashes were characteristic of inverse psoriasis. Hydroxychloroquine was discontinued and the patient was started on methotrexate therapy that resulted in resolution of her rashes in a week.

Sinking Skin Flap Syndrome: Phenomenon of Neurological Deterioration after Decompressive Craniectomy.

Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. Management is largely conservative. We here present a case of a patient with large craniectomy who was admitted to our hospital with pneumonia. Later on, he developed worsening mental status and CT head revealed sinking skin flap with significant midline shift. This is a very rare case of neurological deterioration after craniectomies, commonly known as sinking skin flap syndrome. To our knowledge, only few cases have been reported so far.

Shewanella putrefaciens: An Emerging Cause of Nosocomial Pneumonia.

Gram-negative infections are a rising concern faced by the medical community. Approximately 30% of nosocomial bloodstream infections in intensive care units in the United States are caused by these gram-negative species. Emergence of multidrug-resistant organisms further complicate this issue. In this article, we report a case of an 84-year-old Caucasian male who was diagnosed with Shewanella pneumonia treated with cefepime with minimal to no improvement in his symptoms. To the best of our knowledge, this is the third reported case of Shewanella putrefaciens nosocomial pneumonia and first case of bacteremia secondary to pneumonia by Shewanella putrefaciens.

Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries.

Congenital absence of left circumflex artery is a rare occurrence and very few cases have been reported in literature. It is a benign incidental finding; however some patients present with sudden onset chest pain mimicking acute coronary syndrome often resulting in detection of this rare anatomy on coronary angiography. Coronary computed tomography angiography is a relatively new noninvasive imaging modality which can be used to confirm this suspicion and diagnose this unique morphology reliably.

Metabolic ketoacidosis with normal blood glucose: A rare complication of sodium-glucose cotransporter 2 inhibitors.

Ketoacidosis is a significant and often a life-threatening complication of diabetes mellitus seen mostly in type 1 diabetes mellitus as well as occasionally in type 2 diabetes mellitus. Diabetic ketoacidosis usually manifests with high blood glucose more than 250 mg/dL, but euglycemic diabetic ketoacidosis is defined as ketoacidosis associated with blood glucose level less than 250 mg/dL. Normal blood glucose in such patients results in significant delay in diagnosis and management of diabetic ketoacidosis, thus increasing mortality and morbidity. We present a case of euglycemic diabetic ketoacidosis secondary to canagliflozin in a type 2 diabetic patient.