The effects of violating detailed balance on critical dynamics

We present an overview of the effects of detailed-balance violating perturbations on the universal static and dynamic scaling behavior near a critical point. It is demonstrated that the standard critical dynamics universality classes are generally quite robust: In systems with non-conserved order parameter, detailed balance is effectively restored at criticality. This also holds for models with conserved order parameter, and isotropic non-equilibrium perturbations. Genuinely novel features are found only for models with conserved order parameter and spatially anisotropic noise correlations.Comment: 4 pages, revtex, no figure

Vitamin B12 Deficiency and Subacute Combined Degeneration

A 23 year old male with no pertinent past medical history presented to ED with acute worsening ataxia and paresthesia of upper and lower extremities with an onset of 5 days. Patient denied recent vaccinations, respiratory or GI illness, prior episodes of ataxia or paresthesia, bowel or urinary incontinence, and camping or tick bites. On physical exam, patient exhibited hyporeflexia in upper and lower extremities, along with impaired proprioception and detection of light touch and vibration, but patient’s motor strength was preserved. MRI of brain revealed no abnormalities. MRI of C-spine demonstrated an abnormal T2 signal within the cervical spinal cord extending from level of C2 to C6, in addition to spinal canal narrowing at C4 to C5 and evidence of degenerative intervertebral disc disease, most prominent at C4-C5. Upon evaluation of basic laboratory tests, B12 was staggeringly low, but there was no evidence of megaloblastic anemia. The following day, patient was started on vitamin B12 1000mcg daily, in addition to Solu-Medrol 1g daily due to suspicions of Guillain-Barre syndrome and MS. Within three days of initiating the therapy, patient regained reflexes (+2) in upper and lower extremities. He also reported subjectively feeling better as his stay in the hospital progressed. However, the workup for vitamin B12 deficiency turned out negative, and the patient was then asked about nitrous oxide use. He initially denied it, but later admitted to inhaling nitrous oxide on a daily basis and that he last used inhaled it 6 months ago. Nitrous oxide, commonly known as “laughing gas”, is becoming notorious for substance abuse. It inactivates vitamin B12, which then cannot participate in the metabolic pathways involving methionine synthase and methymalonyl-CoA mutase. As a result, patients can present with symptoms mimicking a vitamin B12 deficiency. Although in our case, the patient presented with a vitamin B12 deficit, serum B12 levels may be normal or even elevated, since nitrous oxide is reported to inhibit the activation of vitamin B12, but not reduce the levels of this essential vitamin. Hence, it is imperative physicians are aware of the neurological effects of nitrous oxide use and specifically ask about its use in patients suspected of such symptoms, since past literature suggests nitrous oxide related neuropathy can persist, to some extent, even after treatment

A Case of Chorea-Hemiballism in the Presence of Labile Glucose Levels

Introduction: Uncontrolled blood glucose is notorious for inflicting multi-organ pathologies. One such pathology, chorea-hemiballism, has been reported in individuals who exhibited either hyperglycemia or hypoglycemia, and although rare, it is debilitating and calls for active management. Case Description: A 50-year-old female, with a past medical history of anemia, chronic kidney disease, type 2 diabetes mellitus, and hypertension, presented to the emergency room with acute onset chorea-hemiballism. Patient reported experiencing abnormal movements for two weeks prior to her ER visit, but otherwise denied prior episodes of movement disorders. On physical examination, patient displayed generalized jerky choreiform movements of upper and lower extremities, face, and neck. Upon admission, patient’s blood glucose level was at 311mg/dL; CT of the head was unremarkable and an EEG revealed no abnormalities. The following day, it was found that her blood glucose levels ranged from 150mg/dL to 309mg/dL during the day, and at night, her glucose levels would consistently drop as low as 40mg/dL. Patient underwent an MRI of the head, which revealed no evidence of an acute infarct. The next day, patient’s chorea had improved substantially, although this improvement is most likely attributed to the haloperidol she received prior to the MRI scan. Given her wildly fluctuating blood glucose levels, there was suspicion the chorea-hemiballism was a result of either hypoglycemia or hyperglycemia; however, in the past, patient was admitted to the ER for severe hypoglycemia on numerous occasions and she did not present with chorea during these episodes. Patient was started on olanzapine 2.5mg at bedtime as an empiric management for chorea. Discussion: Very few cases have illustrated chorea-hemiballism in diabetic patients, but even fewer have depicted such a condition in individuals with negative imaging and with labile glucose levels. This case suggests a rare but far-reaching effect of uncontrolled blood glucose levels

A Case of Infective Endocarditis in Aortic Stenosis Status Post TVAR

A 80 year old woman, with a past medical history of aortic stenosis status post TVAR, sick sinus syndrome with permanent pacemaker placement, and hypertension, presented to ED with generalized body weakness and persistent fevers with an onset of three days. On physical exam, patient was tachypneic, tachycardic, febrile, and she exhibited a motor strength of 1/5 in her left upper extremity with intact motor strength in all other extremities. CT of head revealed chronic small vessel ischemic changes, and an MRI of the head, obtained consequently, depicted multifocal bilateral supratentorial acute infarcts. Patient’s physical findings also prompted for blood cultures; they were positive for gram positive cocci and patient was started on an empiric therapy of Vancomycin and Zosyn. Patient was suspected to be at high risk for developing infective endocarditis, so she underwent a TTE the following day, which revealed no abnormalities, but two days later, she underwent a TEE, which did reveal a small nodular density on the prosthetic valve. The blood cultures were positive for MSSA, and patient’s IV antibiotics were adjusted to Oxacillin and Rifampin. Within 24 hours, blood cultures were negative, and patient was scheduled to continue her IV antibiotic regimen for upwards of 6 weeks. In the following days, patient’s left upper extremity weakness resolved, but she developed characteristic Janeway lesions on the soles of her feet. A repeat TEE revealed a small nodular density attached to the prosthetic valve; however, it was larger in size than the nodular density seen in the previously done TEE. Patient was planned for emergent surgical intervention; however, she developed pulseless electrical activity and resuscitation efforts were not successful

Acute Exacerbation of Heart Failure in a 35-Year-Old Hispanic Female With Premature Coronary Artery Disease Status Post CABG X 4 and Multiple Comorbidities: A Case Report

Background: Coronary artery disease (CAD) is the leading cause of death in adults worldwide.1 Although CHD prevalence is highest in adults of middle age and above, it is important to be aware of risk factors in young adults that predispose them to premature CAD and its complications. We present a case of a young Hispanic female with acute exacerbation of heart failure (HF), CAD, and multiple comorbidities. Case: A 35-year-old Hispanic female with past medical history of CAD status post coronary artery bypass graft (CABG) X 4, HF with reduced ejection fraction (EF) of 40-45%, chronic kidney disease stage 4, type 2 diabetes mellitus, and hypertension presented with shortness of breath for one day. No other associated symptoms. Vitals revealed she was tachycardic (110s) and hypertensive (160s/90s). Physical exam revealed decreased breath sounds. Echocardiogram revealed an EF of 20-25%. The patient was successfully managed with furosemide, isosorbide dinitrate, hydralazine, and fluid restriction. Conclusions: This is a rare case of premature CAD with multiple complications (CABG X4) in a young female. Approximately 3% of all CAD cases occur in patients less than 40 years old.2 This prevalence is likely underreported due to young patients exhibiting less symptoms. Risk factors for CAD in young adults, such as smoking, diabetes, hypercholesterolemia, and obesity,2 should be considered when assessing for CAD in populations with a high prevalence of comorbidities such as the Rio Grande Valley, Tx. Careful observation for these factors can lead to prevention of CAD and its complications

Nonequilibrium critical dynamics of the relaxational models C and D

We investigate the critical dynamics of the $n$-component relaxational models C and D which incorporate the coupling of a nonconserved and conserved order parameter S, respectively, to the conserved energy density rho, under nonequilibrium conditions by means of the dynamical renormalization group. Detailed balance violations can be implemented isotropically by allowing for different effective temperatures for the heat baths coupling to the slow modes. In the case of model D with conserved order parameter, the energy density fluctuations can be integrated out. For model C with scalar order parameter, in equilibrium governed by strong dynamic scaling (z_S = z_rho), we find no genuine nonequilibrium fixed point. The nonequilibrium critical dynamics of model C with n = 1 thus follows the behavior of other systems with nonconserved order parameter wherein detailed balance becomes effectively restored at the phase transition. For n >= 4, the energy density decouples from the order parameter. However, for n = 2 and n = 3, in the weak dynamic scaling regime (z_S <= z_rho) entire lines of genuine nonequilibrium model C fixed points emerge to one-loop order, which are characterized by continuously varying critical exponents. Similarly, the nonequilibrium model C with spatially anisotropic noise and n < 4 allows for continuously varying exponents, yet with strong dynamic scaling. Subjecting model D to anisotropic nonequilibrium perturbations leads to genuinely different critical behavior with softening only in subsectors of momentum space and correspondingly anisotropic scaling exponents. Similar to the two-temperature model B the effective theory at criticality can be cast into an equilibrium model D dynamics, albeit incorporating long-range interactions of the uniaxial dipolar type.Comment: Revtex, 23 pages, 5 eps figures included (minor additions), to appear in Phys. Rev.

DD-dimensions Dirac fermions BEC-BCS cross-over thermodynamics

An effective Proca Lagrangian action is used to address the vector condensation Lorentz violation effects on the equation of state of the strongly interacting fermions system. The interior quantum fluctuation effects are incorporated as an external field approximation indirectly through a fictive generalized Thomson Problem counterterm background. The general analytical formulas for the $d$-dimensions thermodynamics are given near the unitary limit region. In the non-relativistic limit for $d=3$, the universal dimensionless coefficient $\xi ={4}/{9}$ and energy gap $\Delta/\epsilon_f ={5}/{18}$ are reasonably consistent with the existed theoretical and experimental results. In the unitary limit for $d=2$ and T=0, the universal coefficient can even approach the extreme occasion $\xi=0$ corresponding to the infinite effective fermion mass $m^*=\infty$ which can be mapped to the strongly coupled two-dimensions electrons and is quite similar to the three-dimensions Bose-Einstein Condensation of ideal boson gas. Instead, for $d=1$, the universal coefficient $\xi$ is negative, implying the non-existence of phase transition from superfluidity to normal state. The solutions manifest the quantum Ising universal class characteristic of the strongly coupled unitary fermions gas.Comment: Improved versio