Metformin is used for treating type 2 diabetes.
Active Ingredient: metformin
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1 Pediatric Congenital Hematologic Disorders Research Center, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pediatric Infectious Diseases, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Pediatric Pathology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
Received 15 December 2012; Accepted 13 January 2013
Academic Editors: P. Czauderna and A. Gedalia
Copyright © 2013 Samin Alavi et al. This is an open access article distributed under the Creative Commons Attribution License. which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abstract
Kawasaki disease (KD) is a systemic vasculitis of unknown etiology and a leading cause of acquired heart disease. It is assumed that there is an activation of the immune system by an infectious trigger in a genetically susceptible host. Neuroblastoma is the most common extracranial solid tumor in young children. It mainly originates from primordial neural crest cells that generate the adrenal medulla and sympathetic ganglia. A diagnosis of concurrent KD and neuroblastoma in a living child has been made in only one previous report. We report the second case and review the literature.1. Introduction
Kawasaki disease (KD) is an acute vasculitis of childhood that predominantly affects the coronary arteries. The etiology of KD remains unknown; however, an infectious agent is strongly suspected based on clinical and epidemiologic features [1 ]. It typically affects children younger than 5 years of age. The peak age of incidence of KD is from 6 months to 2 years of age and it is rare in infants ≤3 months old [2 ]. The highest annual incidence rates of KD are reported from Japan with 206.2 and 239.6 per 100,000 children aged 0 to 4 years in 2009 and 2010, respectively [3 ].
Neuroblastoma is the most common extracranial solid tumor in children, accounting for 8% to 10% of all childhood cancers. The prevalence is about 1 case per 7,000 live births, and there are about 800 new cases of neuroblastoma per year in the United States [4. 5 ]. It is the most common cancer diagnosed during infancy and occurs most frequently in children less than 5 years of age, with a median age of 17 months at presentation [6 ]. We here report an extremely rare case of an infant diagnosed with concurrent Kawasaki disease and neuroblastoma.2. Case Report
An 18-month-old girl was admitted to our infectious diseases department with a fever for 6 days and puffy red eyes. On physical examination, she was acutely ill, febrile, and irritable. Bulbar conjunctivitis, facial erythema at midline, red fissured lips, and a strawberry tongue were other significant findings (Figure 1 (a)). There were also several small bilateral cervical lymphadenopathies, the greatest of which was 1.5 × 1.0 cm. On hospital day 2, mild swelling and desquamation developed on her hands and feet (Figure 1. inset). Transthoracic echocardiography demonstrated a 3 mm dilatation in her right coronary artery, and a diagnosis of Kawasaki disease was made.
Figure 1: Clinical, radiographic, and pathologic features of a patient with concurrent Kawasaki disease and neuroblastoma. Red fissured lips (a) and desquamation of finger tips (inset). Computed tomography scan showing a mass originating from the right adrenal gland (b). Histopathology showing a tumor composed of predominantly atypical small round cells arranged in sheets, with pleomorphic nuclei, pink cytoplasm, and high mitotic indices (c).
She received 2 gr/kg intravenous immunoglobulin (IVIG) for two days as well as aspirin 80 mg/kg/day. Due to the persistence of fever, a computed tomography scan of the brain, chest, abdomen, and pelvis was performed, which was remarkable for a 3 cm × 3 cm abdominal mass originating from the right adrenal gland and with foci of calcification (Figure 1 (b)). A 24-hour urine collection showed elevated vanillylmandelic acid levels at 8.5 mg/24 h (normal range: 2–5 mg/24 h). Exploratory laparatomy and total adrenalectomy without any gross residual tumor were performed. The pathology was reported as a stroma-poor undifferentiated neuroblastoma with unfavorable prognosis (Figure 1 (c)). MYCN amplification by fluorescence in situ hybridization revealed 8 copy numbers of this oncogene. A bone scan as well as a bone marrow aspiration and biopsy were unremarkable. Three days after laparotomy, she developed periungual desquamation over the distal parts of her extremities. Chemotherapy with the N6 protocol (Cyclophosphamide/Adriamycin/Vincristine alternating with Cisplatin and VP-16) was initiated. The patient had an unremarkable course and repeat imaging three months later showing no evidence of residual tumor. The patient is free of tumor after 18 months at the time of the report of this case.3. Discussion
Yanagisawa et al. reported a 6-month-old male infant who died of KD and had a small encapsulated mass in the left paravertebral region found on necropsy. The histopathological diagnosis was neuroblastoma [7 ]. In another study on autopsy results of 61 cases of KD who died between 2 months and 8 years after complete recovery of KD, one patient had a neuroblastoma on autopsy [8 ]. The case reported here is the second living child reported in the literature with concurrent KD and neuroblastoma. The only other available report is a 4-month-old boy with KD who developed acute urinary retention on the third day of admission and was later found to have a stroma-poor undifferentiated neuroblastoma [9 ]. Neuroblastoma is one of the malignancies in infants that may be diagnosed as an incidental finding by imaging studies [10. 11 ], like in our case. Adrenal incidentalomas are slightly more frequent in the right adrenal gland and in females [11 ]. Our patient was also a girl with a tumor originating from the right adrenal gland.
There are a few reports of cases with malignancy diagnosed following a diagnosis of KD. The malignancies reported are acute lymphoblastic leukemia in 3 cases, Hodgkin’s disease in one case, osteosarcoma in one case, Schwannoma in one case, giant cell tumor of the tendon sheath in one case, and malignant reticuloma in one case [12. 13 ]. Alterations in the immune system have been postulated to underlie KD [14 –16 ]. Whether such alterations predispose to certain types of malignancy as well is unclear. Larger epidemiological studies are required to determine whether the observed associations are mere coincidence or reflect true associations.Disclosure
While this paper was under review, another report (Lim et al. Indian J Pediatr 2012 Dec) was published with two cases of concurrent KD and neuroblastoma, one in a 2-year-old girl and the other in a 3-year-old boy. Both cases presented with KD, and, after their fever did not respond to immunoglobulin, were discovered to have a paravertebral neuroblastoma and right adrenal neuroblastoma, respectively.References
I am from Seattle and graduated from Bellevue High School. My first teaching experience was in my junior year when I volunteered at my school's tutoring program to teach biology and calculus. Since then I realized how much I enjoy teaching.
My favorite topics to teach are biology, chemistry and math. My hobbies are swimming in the lake Washington, reading books about the brain, dancing and reading comic books
So far at MIT I have taught DELVE AP Bio, SPLASH, HSSP and this summer I am going to teach JUNCTION.Past Classes
AP Biology in Delve 2011-2012
The AP Biology course is designed to be taken by students after the successful completion of a first course in high school biology and one in high school chemistry. It aims to provide students with the conceptual framework, factual knowledge, and analytical skills necessary to deal critically with the rapidly changing science of biology. The two main goals of AP Biology are to help students develop a conceptual framework for modern biology and to help students gain an appreciation of science as a process. The ongoing information explosion in biology makes these goals even more challenging. Primary emphasis in an AP Biology course should be on developing an understanding of concepts rather than on memorizing terms and technical details. Essential to this conceptual understanding are the following: a grasp of science as a process rather than as an accumulation of facts; personal experience in scientific inquiry; recognition of unifying themes that integrate the major topics of biology; and application of biological knowledge and critical thinking to environmental and social concerns. (from collegeboard.com)
Cancer: Is it really curable? in Splash! 2009
In this class we will cover the basics behind what cancer is and how we can try to cure it. We will talk about possible reasons for cancer emergence, its progression and mostly about current and future therapies.
HIV/AIDS in Splash! 2009
In this class we look at the discovery of the human immunodeficiency virus, its biology and finally the disease it is responsible for. We will then look at current drugs and treatments, and discuss the possibility of a vaccine or a cure.
Biochemistry in HSSP Spring 2009
This class is designed for students who have a keen interest in biology and especially interested in how things work at a molecular level. In this class we will go into great detail talking about the building blocks of life. I will focus mostly on proteins, structure and function, enzymes for about 4 weeks. For the rest of the sessions we will look at DNA/RNA, replication, transcription, translation.
Virus Genetics & HIV in Splash! 2008
This is a short introduction to viruses: their life cycles (lytic & lysogenic), mechanism of infection (acute & chronic), and their genetics (DNA & RNA). In the last half of the class I will talk about HIV, T-cells, B-cells and the AIDS epidemic.
Introduction to the Immune System in Splash! 2008
This is a short introduction to the human immune system. I'll talk about all the different immune cells (T cells, B cells, etc) in the body and how they fight bacterial and viral infections. We'll also talk about different infections that bypass our immune system.
101 Diseases You Don't Want to Get! in JUNCTION (2009)
Warning: this is a scary class :-O From Rabies to Ebola, in this class I will go over 101 diseases.
Biology in DELVE (2009)
This class is roughly equivalent to a first-year college biology class. General topics will include molecules and cells, heredity and.
Caffeine and Your Brain in JUNCTION (2009)
As a Seattlite I never miss my venti 2 pump hazel nut extra hot extra foam latte. When I stopped.
AP Biology in DELVE (2008)
This course is preparation for the Advanced Placement Biology Exam in May of 2009. The class will cover Molecules and.
Sameen Shaw. also known as Indigo Five Alpha. Dr. Sameen Shaw or simply Shaw. is a physician and a former operative for the U.S. Army Intelligence Support Activity. Prior to joining the team Shaw was part of an operation known as Catalyst Indigo, responsible for acting on relevant list intelligence delivered by the Machine. which she knew only as "Research".Contents Character Background Edit
Shaw was born with the first name Sameen. Her father was killed in an automobile accident, but the name and location of her mother are unknown. (“ Razgovor ”) Shaw says her mother was an immigrant from Iran, and it is later revealed that someone risked their life to smuggle her mother out of the country when terrorists attacked. (“ Allegiance ”) Little is known about her childhood, but she was a resident in a teaching hospital before leaving medicine to join the U.S. Marine Corps.
On October 2, 1988, she traveled with her father on a road trip to Philadelphia, Pennsylvania. (“ Mors Praematura ”)
Shaw has what she describes as an Axis II Personality Disorder, which she diagnosed herself. She has little concern for her victims, along with a flat affect and few demonstrable emotions. As she removes a bullet from her abdomen after a failed operation, she explains why she left medical school, remarking ironically that she was "better at killing people than fixing them." (“ Relevance ”)
In actuality, Shaw completed medical school and had begun her residency, where she was praised for her technical skills, but came under criticism for her lack of concern for whether her patients lived or died. She was deemed unfit to become a doctor. (“ The Devil's Share ”)Activity with the ISA Edit
During her earliest activities with ISA and the beginnings of Catalyst Indigo, she was tasked with intercepting and killing those responsible for a laptop belonging to a runaway programmer named Daniel Casey. Among those killed were Chinese buyers of the laptop as well as Rick Dillinger. the man who sold it to them. During the firefight, one buyer escaped, but was deemed irrelevant to Control. Upon her report to Special Counsel. it was noted that "if she was sent sooner, she would have killed everyone." (“ RAM ”)
While with the ISA, Shaw was partnered with Michael Cole. her tactical and surveillance support, who monitors her actions and communicates with her via a remote comm. During a mission in Berlin, Shaw and Cole locate a group of terrorists making a dirty bomb. Shaw enters their apartment, where she single-handedly kills the group before blowing up the apartment in order to cover her tracks. Mission completed, she and Cole are sent to New York by Control, the mysterious head of the organization she knows only as the Program.
In New York, Shaw meets with her handler, Wilson. who passes her the new Social Security number. A keen observer with paranoia gained from experience, she becomes aware of a man in a suit observing her. She is suspicious, but he soon walks away.
That night, while waiting for her target James Mercer to leave his apartment, she talks with Cole talks about how Research gets the numbers. Shaw believes Research is infallible, but Cole wonders if sometimes they're wrong, having discovered that on one of their previous missions, a money transfer thought to have been made to a man named Daniel Aquino from Hezbollah was actually made by the U.S. government.
When Mercer leaves his house, Shaw and Cole break in and access his computer, discovering e-mails with their names on them, a clear set-up. Seconds after Cole and Shaw see a warning message on the computer indicating that the house is a trap, the room is flooded with automatic weapon fire. Cole tries to protect Shaw and dies. Shaw fights back as Reese appears, saying that he's there to help. She shoots him in the chest before escaping, injured, in a hail of gunfire.
Shaw finds herself on her own, and injured, but is able to treat her wound with the assistance of a drug dealer she knows. Eventually, she calls Veronica Sinclair, a CIA analyst Cole had worked with, and Wilson, her handler, threatening to make Cole’s research public and demanding to meet Control.
Having recovered sufficiently, Shaw meets the woman she believes to be Veronica Sinclair, who tells her the government group responsible for the Aquino money transfer cover-up was the ISA as part of a shadowy project called Northern Lights. As they talk, Shaw suddenly hears a noise from the bathroom and discovers the real Veronica tied up and gagged.
Before she can react, Root. who has been masquerading as Veronica, tases Shaw and ties her to a chair, threatening her with torture to get information about the name of the man who hired Aquino. Before Root can learn anything, Wilson's men arrive forcing Root to run. Shaw fights back, but is outnumbered. Reese arrives and rescues her before taking her to meet Finch.Meeting Reese and Finch Edit
Reese takes Shaw to an empty office building, where Harold Finch introduces himself. Shaw is guarded as he explains that they help people in trouble the same way she and Cole did. She is skeptical until he gives her Cole's number and her own. Shaw claims that her employers are good at finding people and she only wants to live long enough to find Control. Finch insists that she'll never succeed, and urges her to stop running. Despite Finch’s offers of help, Shaw tells him that Cole was one of the few friends she had and that she believes he deserved better. Finch gives her his number in case she changes her mind, but she returns it to him and walks away.
Soon after, Shaw meets Special Counsel at a party. He explains he is not Control, but he is as close as she's going to get. Shaw points out that they killed the one person she liked. Away from the party, Special Counsel explains the Program and the need for secrecy to her. Shaw admits she would do the same and hands over Cole's research on the case, as Special Counsel realizes Shaw’s goals are the same as his. Shaw walks away, seemingly free. Suddenly, Hersh comes up behind her and injects her with poison. But Shaw does not die.
With the help of Carter. Fusco and Leon Tao. who poses as an EMT, Finch and Reese save her life. Finch points out that her employers wanted her dead, and now she is. This time, Shaw takes Finch's card when he offers it. (“ Relevance ”)Joining the Team Edit
Some time later, Reese stands near the home of Cole's parents, where he finds Shaw; it appears he’s been looking for her for some time. She reveals that the government lied about Cole when telling his parents about his death, identifying him as a traitor. John warns her not to talk with Cole’s parents as she might put them in danger.
Soon after, Shaw abruptly appears in the Library. surprising Finch and thanking him for making Cole's death "publicly" noble. As they talk, she recognizes a photograph of Root and leaves with a list of Root's known aliases. (“ Trojan Horse ”).
She returns some time later, now actively hunting for Root, to help Reese stop Decima from gaining control of The Machine. (“ Zero Day ”) Shaw’s mission to find Root soon crosses over Reese’s to protect Finch, leading him to tell Shaw about the Machine. Together they follow Root and Finch across country to the base where the Machine is stored, only to find it has moved itself. Special Counsel’s arrival confirms her suspicions that the Program has betrayed her, and she leaves with Reese, Finch and an injured Root. (“ God Mode ”)Working with Finch and Reese Edit
Now fully aware that the Program cannot be trusted, Shaw reluctantly allies herself with Finch and Reese. She works on her own terms, keeps her own schedule and refuses to carry a phone. (“ Liberty ”) Shaw’s early role is largely tactical support providing backup to Reese, Fusco and Carter as they work in close.
As she becomes more accustomed to working with the team, Shaw begins to take a more active role in missions, including serving as an undercover office worker (“ Nothing to Hide ”). as one of a group of women setting themselves up as targets for a predatory man (“ Lady Killer ”). as a member of a women’s book group in order to protect them (“ Reasonable Doubt ”). and simply as backup to help Reese protect another POI. (“ The Perfect Mark ”) As she works with the team, she grows increasingly fond of Bear. eventually purchasing a metal studded collar for him.
Shaw finds herself unexpectedly central to a mission when she must protect a ten-year old Russian immigrant girl whose monitoring of her neighbors leads to her having recorded conversations between HR and Peter Yogorov while Reese and Finch stop the gunmen trying to kill her. The girl brings back memories of the death of Shaw’s father, and reminds Shaw of herself. Shaw finds herself growing attached, despite herself, and is moved when the grateful girl gives Shaw her grandfather’s Order of Lenin medal. (“ Razgovor ”)
That same night, as she sleeps, Shaw is captured by Root, who needs Shaw’s skills to complete a mission Root believes the Machine has given to her. Root has learned about the car accident in which Shaw’s father was killed, and uses it to persuade Shaw to work with her. As she does, Shaw learns that the Machine has a new category besides "relevant" and "irrelevant" numbers”, but does not learn what it is.
Root and Shaw infiltrate a CIA pickup site, where Root disguises herself as prisoner while Shaw poses as a CIA agent, allowing Root to help Jason Greenfield. a necessary number being held in custody, escape the place. After a confrontation with members of a privacy protection group Vigilance. Root sends Jason out of the country, as Shaw protects them. Their mission complete, Shaw knocks out Root, allowing Finch to recapture her. (“ Mors Praematura ”)
Shaw secretly helps Carter in her quest to end HR, providing her with weapons that Carter uses to intercept one of the Russians' drug deliveries. She and Reese later hide and prepare to stop HR from executing the Russians, but the FBI arrive and arrest both groups after they receive a tip from Carter. (“ Endgame ”)
Shaw later saves Fusco 's son Lee from HR. for which Fusco is deeply grateful. (“ The Crossing ”) Shaw then begins to brutally interrogate criminals to find Patrick Simmons. the last HR member standing and the man responsible for Carter's death. (“ The Devil's Share ”)
When Reese temporarily leaves the team, Shaw begins working with Finch full-time in his old arrangement, posing as a doctor in order to keep an eye on POI Arthur Claypool. Shaw and Finch escape the hospital with Arthur and his wife Diane after Vigilance attacks looking for Arthur. Shaw engages in a brief gunfight with Vigilance member Peter Collier before escaping. Later, at a safe house, Diane reveals herself to be Control as Arthur's memories of his real (now dead) wife return; Control calls in a team led by Hersh that holds Shaw, Finch, and Arthur at gunpoint, and declares she will only release them after gaining access to either the Machine or Arthur's own AI project named Samaritan. (“ Lethe ”) With no need for Shaw, Control orders her death, but with a distraction from Root Shaw escapes with Finch and Arthur.
When they go to a bank to retrieve the back up of Samaritan. they encounter Peter Collier and his team. To make matter worse, Hersh also arrives, disguised as a SWAT team. Trapped in a vault, Finch maintains contact with her via cell phone, and she tells him how to treat a bank manager wounded by Collier. Unable to take out Collier and his men, as they're the only thing keeping Hersh's team from storming the bank, she creates a pipe bomb to blow open an exit to the sewers. Two Vigilance men are able to enter the vault, but Shaw shoots them down, and with last-minute help from Reese and Fusco, they manage to escape the bank through the sewer. (“ Aletheia ”)
She encounters Finch a few days later, who uneasily asks her to revisit the ISA, her former employers, and find out what they know about Owen Matthews. a potential relevant number that the Machine is forcing Reese into helping on a plane. She goes to a travel agency the ISA uses to make arrangements for its agents and greets the clerk, Foster. Shaw figures that Foster set up Owen's plane ride, grabs him, and chokes him until he talks. Foster admits that he arranged for Shaw's successor, codenamed Indigo 6A, to be on the plane.
Upon hearing this, Shaw dresses up as a waitress at a restaurant where Hersh is eating. Once she's served him his food, Shaw sits down next to Hersh and tells him that she poisoned his meal with scopolamine, rendering him docile and causing amnesia. She demands to know who Owen is, and Hersh explains that they set Owen up as the Sphinx in return of 30% of his profits, which they use to help finance the ISA. Since Owen is going public, Hersh's superiors figure he'll expose the ISA to the world, ruining their organization and thus making him a threat to national security. As Shaw begins to leave, the dazed Hersh asks if her current employers are treating her okay. Shaw says that they haven't tried to kill her yet and notes that she could have easily killed Hersh if she wanted him dead. and that it's a shame he won't remember anything she said. Using this information, Reese and Finch stop the plane from crashing and save Owen's life. (“ 4C ”)
During a mission involving Cyrus Wells. Shaw ends up in a solo standoff with Vigilance after taking down one of its snipers to save the team. Collier locks her in a building to smoke her out, and he appeals to Shaw to consider the misdeeds of the government who betrayed her. He offers Shaw a place in the organization for both revenge and a role in writing "new chapter in American history." Shaw decides that Vigilance's brutal methods overshadow any redeeming goals they may have, declaring they are terrorists and fighting back. Shaw eventually escapes alive and returns to the library, then meets Root to care for a gunshot wound she received. (“ Root Path (/) ”)
Next, Shaw works a number with Finch and Reese which brings back memories of her family. She reflects on her parents' bravery with the POI and later Fusco. (“ Allegiance ”)Going into Hiding Edit
When Samaritan comes online, Shaw assumes the identity Sameen Grey, a sales woman in the cosmetics department at Bloomingdale's. After a brief period of silence between the group, Shaw resumes working numbers with Finch and Reese. She also becomes part of a group of thieves led by a man named Romeo (“ Panopticon ”). which she later quits after they prove they aren't good enough. (“ Honor Among Thieves ”)
While on a mission to protect a POI, she is intercepted by ISA agent Devon Grice. They recognize each other, but Grice allows her to leave, trusting and respecting her against orders. He later attempts to delete surveillance footage of the incident to protect her, but Samaritan is able to recover this footage. (“ Honor Among Thieves ”) Using this information and Shaw's ties to Romeo's group of thieves, Martine begins to hunt her down, managing to trace her phone to Bloomingdale's. Though Samaritan still cannot recognize her due to the servers Root planted in Samaritan's hardware, Martine uses the footage to spot her and attacks. (“ Point of Origin ”) Shaw reveals gigantic weaponry she's kept in her stand the entire time she's worked at Bloomingdale's for such a moment, fighting back against Martine until she can escape the building, where Root is waiting to extract her on a motorcycle.
Her cover identity blown, Shaw must now stay entirely off the radar to avoid capture. When Reese gets into serious danger caught between Elias and the Brotherhood, however, she insists she must come to his aid, ignoring any threat to herself. Root decides she must sedate her and bring her back to the subway hideout forcefully to protect her. Though Root is able to keep Shaw safe in this manner, Scarface and other Brotherhood members are killed as a result. (“ The Devil You Know ”) Shaw only forgives the team for betraying her once Finch buys her her favorite sandwich.
When Samaritan and the Machine's standoff begins to escalate, she wonders if the AIs beginning to cooperate wouldn't be the best option, clashing with Finch's stern belief that AIs teaming up could lead to the end of humanity. After the situation continues to spiral, Shaw decides she cannot stay cooped up in hiding anymore and leaves the subway without telling the others (“ The Cold War ”). helping with numbers or in what other little ways she can.
When the rest of the team becomes trapped by Samaritan, Shaw must retrieve information from a Stock Exchange employee to assist them; however, she is forced to first talk down a suicide bomber affected by the Flash Crash of the stock market. With advice from Fusco, she succeeds and gets the intel in time. She then rushes to the Stock Exchange and crawls through 50 yards of air duct to reach the others, arriving moments before they likely would have been wiped out by Samaritan agents. She and Root defend the team as they all board the elevator to freedom, not realizing an override button must be pressed before the elevator will move. Shaw kisses Root before running to the button and sacrificing herself to give the others a chance to escape; she is shot down by Martine and taken captive, while the rest of the team is left not knowing if she even survived. (“ If-Then-Else ”) Days later, she awakens in a hospital bed overlooked by Greer, who comments that she will need her rest for what awaits her. (“ M.I.A. ”)
She is later used as bait for a trap to capture Root; she calls Root with a phone that traces back to the asylum where Shaw is being held and which houses Samaritan's base of operations. When Root and Finch come to rescue her, Samaritan's agents move Shaw before they can find her; Root finds the coat she wore when she was shot and glimpses her being taken through the window. Martine tells Root that Shaw was subjected to months of torture before she eventually broke, implying that Shaw had been brainwashed into supporting Greer and willingly supported the plan to bait Root. Shaw is last seen looking pensively out the window of a car, and her current mental state and allegiances are unknown. (“ Asylum ”)Skills and Talents Edit