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Abstract Aleukemic leukemia cutis (LC) is an extremely rare clinical presentation. All patients eventually develop acute leukemia, mostly monocytic and myelomonocytic types. It is a diagnostic challenge, resolved by careful immunophenotyping and cytochemistry. The diagnosis indicates a poor prognosis. Here, we report a case of an 85-year-old white male with LC, who had normal peripheral blood and bone marrow histology. The fragility of our patient precluded any definite anti-leukemic therapy.

Spur cell haemolytic anaemia (SCA) is a form of anaemia that can be seen in patients with severely impaired liver function or advanced cirrhosis. It is associated with high mortality. The treatment options for SCA secondary to cirrhosis are limited. Our patient is a middle-aged man who developed SCA and was not a candidate for liver transplantation or splenectomy. High-dose steroids helped ameliorate haemolysis and improve anaemia and general condition of our patient.

Cholangiocarcinomas (CCA) are uncommon malignancies that present late and have a poor prognosis. The patients may remain undiagnosed for many years because of non-specific presentation. CCA metastasises commonly to liver and adjacent lymph nodes. It can rarely metastasise to bone, lung, colon, pancreas, adrenal glands and spleen. Multiple treatment options are available including surgery, chemotherapy, radiotherapy and photodynamic therapy. The tumours have high rate of recurrence and most patients require palliative care. Our patient is a middle-aged man who presented with pain in right ring finger, workup of which revealed digital metastasis from underlying cholangiocarcinoma.

Non-cirrhotic, non-malignant portal vein thrombosis (PVT) is commonly secondary to inherited or acquired prothrombotic states. However, even after extensive workup, 25% of patients with PVT have no apparent prothrombotic aetiology identified (idiopathic PVT). Inherited conditions include factor V Leiden, PT mutation and protein C/S/AT deficiency. Acquired conditions include APS, PNH and BCR-ABL 1-negative myeloproliferative neoplasms (MPN). BCR-ABL-1 negative MPNs are the most frequent underlying prothrombotic risk factor for PVT (15%–30%). However, peripheral blood counts often remain within normal ranges in these patients with MPN because of portal hypertension sequel. Despite suggestive features of MPN in bone marrow, these patients lack adequate diagnostic criteria and are classified as occult MPN. The discovery of recurrent molecular abnormalities such as CALR gene exon 9 mutation presented a crucial advance in the diagnosis of occult MPNs. In our patient, the diagnosis of MPN was made on this basis, despite lack of peripheral evidence of MPN.

Aggressive systemic mastocytosis (ASM) is characterized by mast cell accumulation in systemic organs. Though ASM may be associated with other hematological disorders, the association with pure red cell aplasia (PRCA) is rare and has not been reported. Pure red cell aplasia (PRCA) is a syndrome, characterized by normochromic normocytic anemia, reticulocytopenia, and severe erythroid hypoplasia. The myeloid and megakaryocytic cell lines usually remain normal. Here, we report an unusual case of ASM, presenting in association with PRCA and the management challenges.

Downstream turbines in a wind farm often operate under the influence of wakes from upstream turbines. Aerodynamic losses and aeromechanical issues (stochastic loads) associated with such wake-turbine interactions have been investigated before. However, the role such interactions play in the generation of aerodynamic noise has not been evaluated. This paper presents a two-step approach for predicting noise due to wake-turbine interaction. The first step involves an aerodynamic analysis of a wind farm using large eddy simulations. Time accurate data and turbulence statistics in the turbine wakes are obtained from this simulation just ahead of the downstream wind turbines. The second step uses the turbulence information with aeroacoustic models to predict radiated noise in the far field. Simulation results of two simplified model problems corresponding to these two steps are presented in this paper.

This work has two primary parts: (1) an exhaustive literature review highlighting the need and the direction to study broadband noise generation from the fan stage of a modern high bypass ratio turbofan engine, and (2) a benchmark study of noise generation by the flow over a rod and an airfoil in tandem arrangement. The literature review highlights that not all the experimental data has been consistently explained with the theory and thus these gaps are required to be filled in to improve the fan noise prediction during the design phases. The benchmark case provides flow conditions where the upstream located circular rod sheds periodic vortices and creates turbulence which interacts with downstream located symmetric airfoil at zero angle of attack. This interaction produces noise which radiates to farfield. The periodic shedding and the resulting turbulence provides energy to the tonal and broadband components of the total noise. This test case is used to validate a new approach to predict noise in farfield which uses incompressible flow solver, pimpleFoam (part of OpenFOAM), along with Amiet's theory.

Purpose - The purpose of this paper is to present a framework for estimating the costs of adaptation to climate change impacts on ecosystems. Design/methodology/approach - While existing studies on costing adaptation base themselves on either the financial flows on conservation or the costs of specific adaptation measures at the global level, the methodology presented here takes into account the impacts on ecosystems, the identification of vulnerable areas, and adaptation options at a more regional level. Findings - The framework is then applied to forest ecosystems in India. The authors find that the total adaptation costs for forest ecosystems in India until 2085 are in the range of $1.34-2.32 billion. Originality/value - The key contribution of this paper is the proposal that for any robust estimation of adaptation costs, people should take into account the regional level impacts and the multiple adaptation options linked to those impacts.

Untreated tooth decay and missing teeth can affect your ability to chew nutritious foods, leading to vitamin and mineral deficiencies that impact your general health. Poor oral hygiene habits can also lead to the risk of untreated gum and bone disease, which destroys the bones, gums and tissue holding your teeth in place and also heightens your risk of chronic conditions. For diabetics, gum and bone disease can make it difficult to control their blood...

This paper presents a detailed methodology for estimating the cost of adaptation to climate change impacts on ecosystems. Up to date estimates are built-up following national investments in measures such as protected areas, with inaccurate estimates of the adaptation level needed. Here we propose a new methodology which identifies vulnerable areas due to climate impacts and the specific adaptation options feasible for these regions. An illustration of the methodology for shifts in forest ecosystems in India is presented. Advantages and future requirements for this methodology are finally discussed.