Pancreatic tubercular abscess in a patient of disseminated tuberculosis

Pancreatic tuberculosis is a rare clinical entity, despite the high prevalence of tuberculosis worldwide. When present pancreatic TB is seen usually associated with military/ disseminated TB in  immuno-compromised patients with HIV topping the list in recent times. Here we present an unusual case of an immuno-competent individual with disseminated tuberculosis including pancreatic tubercular abscess a 30-year- old female was admitted with 3 months history of productive cough, constitutional symptoms and persistent epigastric discomfort. Patient had pallor and was febrile with no mass palpable per abdomen. Ultrasonography (USG)/ Contrast enhanced computed tomography (CECT) of abdomen showed cystic pancreatic lesion. Acid fast bacilli (AFB) were demonstrated in sputum as well as  material obtained from USG guided  fine needle aspiration (FNA) of pancreatic lesion which after 6 weeks of incubation showed growth of mycobacterium tuberculosis (MTB) confirming diagnosis of disseminated tuberculosis with pancreatic involvement. Patient was put on antitubercular therapy (ATT) and response was excellent. This case highlights that TB can affect nearly every organ of the body. It should be kept among differentials while evaluating pancreatic lesions. With adequate treatment it is curable

Solitary brain metastasis: A rare initial presentation of prostate carcinoma

Cerebral metastasis as an initial clinical presentation of prostate carcinoma is extremely rare. Usually, patients have widespread metastasis in the body before presenting with brain metastasis. In the absence of extensive metastasis, especially without bony metastasis, only brain metastasis is an unusual presentation of the disease. We report a case of a 59-years-old patient who presented with a lack of concentration and decreased vision. Magnetic resonance imaging (MRI) of the brain revealed a large right parietal-occipital space-occupying lesion. He underwent surgery and the pathological diagnosis of the tumor turned out to be metastatic prostate carcinoma. Further evaluation by a whole-body computed tomography (CT) scan revealed an enlarged prostate with no other metastatic deposit and a mildly raised level of prostate-specific antigen (PSA). It was possible for us to provide this patient with multi-modality treatment with the help of multidisciplinary tumor board meetings. Further studies addressing the biological as well as clinical characteristics of prostate carcinoma with this rare metastatic presentation will help us to define prognostic factors and therapeutic intervention and will help us to understand the basis of this unique presentation without bone metastasi

Calcium levels and metabolic disturbance in renal disease patients receiving hemodialysis: a cross sectional study highlighting its association in dialysis patients

Background: The aim of this study was to determine the disturbances in Calcium and other mineral levels in patients on hemodialysis at Tabba Kidney Institute, Karachi, Sindh, Pakistan.Methods: A cross sectional observational study through convenient sampling technique was conducted from January 2017 to August 2017 at Tabba Kidney Institute, Karachi after obtaining ethical approval. 255 patients, all above 18 years of age and on hemodialysis were included in the study. Multi-organ failure patients on dialysis, other systemic diseased patients on hemodialysis were excluded. Demographic variables, mineral levels, symptoms and supplementations were recorded. SPSS version 20.0 was used for data analysis.Results: A total of 255 patients on hemodialysis were selected and divided into groups depending upon median years of hemodialysis below and above 5 years of hemodialysis. Median and IQR of calcium were 8.8 and 8.2-9.1 mg/dl for below 5 years, 8.6 and 8.1-9.1 mg/dl for above 5 years (P value=0.44). Median and IQR of phosphate were 4.9 and 3.9-5.7 mg/dl for below 5 years and 4.6 and 3.7-5.5 mg/dl for above 5 years (P value=0.21). Median and IQR of parathyroid hormone were 393 and 212-699 pg/ml for below 5 years and 329 and 128-657 pg/ml for above 5 years. (P value=0.13) Median and IQR of albumin were 4.0 and 3.6-4.2 mg/dl for below 5 years and 4.0 and 3.8-4.3 for above 5 years (P value=0.30). Total of 18 (10.9%) had para thyroidectomy.Conclusions: Present study showed that significant difference in mineral levels did not exist in patients on hemodialysis as regards to the duration of dialysis. However clinical features had a tendency to decrease as duration of dialysis increased to above 5 years. Para thyroidectomy and itching were two main significant findings in this study

Renal bone disease in patients on hemodialysis: an observational study focusing on the variation of calcium metabolism

Background: The aim of this study was to determine the disturbances in the levels of mineral in the body due to hemodialysis at different levels of parathormone levels and to assess its association with the calcium levels.Methods: Study was a cross sectional for the period of 6 months taking ethical approval. Total 255 cases were registered in this study after taking their informed consent. The cases were divided into three groups according to PTH level. Group 1 has 87 subjects with PTH level <250, group 2 has 102 subjects with PTH level 250-650 and group 3 has 66 cases with PTH level >650. The cases were taking hemodialysis for greater than 6 months and have the ages more than 18 years were included in this study. The demographic data includes age, sex dialysis related data like duration of hemodialysis, levels of calcium, phosphorus, albumin, PTH, ALP were observed.Results: Hemodialysis duration were recorded in respective three groups as 7.28±5.71, 6.26±5.56 and 6.15±4.30 days respectively  (P=0.319). Calcium was found in group 1, 8.70±0.81, in group 2, 8.39±0.89 and in group 3, 8.76±0.82 (P=0.01). PTH level in three respective group were recorded to be 123.46±74.15, 418.47±115.49 and 1314.67±1188.63 (P <0.001).Conclusions: Present study showed that significant difference was found in mineral levels in patients on hemodialysis with PTH level as well as with alkaline phosphatase level. Nevertheless, no significant difference was found with duration of dialysis and with parameter of albumin

The Effectiveness of Selective Serotonin Reuptake Inhibitors for Treatment of Obsessive-Compulsive Disorder in Adolescents and Children: A Systematic Review and Meta-Analysis

Background: Obsessive-compulsive disorder (OCD) is a common behavioral disorder among adolescents and children. The selective serotonin reuptake inhibitors (SSRIs) are the first pharmacological choice for this condition due to mild adverse effect profile. Objective: This systematic review was performed to evaluate the efficacy of SSRI for OCD in adolescents and children. Methods: Search terms were entered into PubMed, PsycINFO, Scopus, CINAHL, and Google Scholar. The included studies were randomized, placebo-controlled trials of SSRIs conducted in populations of children and adolescents younger than 18 years. Change from baseline Children\u27s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), end-treatment CY-BOCS with respective SD, and response and remission rates were collected for continuous and dichotomous outcome assessment, respectively. Cochrane Rev Man software was used for meta-analyses, providing Forest plots where applicable. Results: SSRIs were superior to placebo with a small effect size. There was no additional benefit of combination treatment over cognitive behavioral therapy (CBT) alone, but CBT added substantial benefit to SSRI monotherapy. Fluoxetine and sertraline appear to be superior to fluvoxamine. Conclusion: The results of current systematic review and meta-analysis support the existing National Institute for Health and Care Excellence (NICE) guidelines for choosing CBT as first line of treatment and substituting it with SSRI, depending on patient preference. Adding CBT to current SSRI treatment is effective for non-responders and partial responders, but adding SSRI to ongoing CBT does not prove beneficial. The SSRIs have different effectiveness, and their relative efficacy remains to be investigated

Voronoi Cell Geometry Based Dynamic Fractional Frequency Reuse for OFDMA Cellular Networks

Interference Management (1M) is one of the major challenges of next generation wireless communication. Fractional Frequency Reuse (FFR) has been acknowledged as an efficient 1M technique, which offers significant capacity enhancement and improve cell edge coverage with low complexity. In literature, FFR has been analyzed mostly with cellular networks described by Hexagon Grid Model, which is neither tractable nor scalable to the dense deployment of next generation wireless networks. Moreover, the perfect geometry based grid model tends to overestimate the system performance and not able to reflect the reality. In this paper, we use the stochastic geometry approach, FFR is analyzed with cellular network modeled by homogeneous Poisson Point Process (PPP). A dynamic frequency allocation scheme is proposed which take into account the randomness of the cell coverage area describe by Voronoi tessellation. It is shown that the proposed scheme outperforms the traditional fixed frequency allocation schemes in terms of per user capacity and capacity density

A cuckoo search optimization-based forward consecutive mean excision model for threshold adaptation in cognitive radio

The forward consecutive mean excision (FCME) algorithm is one of the most effective adaptive threshold estimation algorithms presently deployed for threshold adaptation in cognitive radio (CR) systems. However, its effectiveness is often limited by the manual parameter tuning process and by the lack of prior knowledge pertaining to the actual noise distribution considered during the parameter modeling process of the algorithm. In this paper, we propose a new model that can automatically and accurately tune the parameters of the FCME algorithm based on a novel integration with the cuckoo search optimization (CSO) algorithm. Our model uses the between-class variance function of the Otsu’s algorithm as the objective function in the CSO algorithm in order to auto-tune the parameters of the FCME algorithm. We compared and selected the CSO algorithm based on its relatively better timing and accuracy performance compared to some other notable metaheuristics such as the particle swarm optimization, artificial bee colony (ABC), genetic algorithm, and the differential evolution (DE) algorithms. Following close performance values, our findings suggest that both the DE and ABC algorithms can be adopted as favorable substitutes for the CSO algorithm in our model. Further simulation results show that our model achieves reasonably lower probability of false alarm and higher probability of detection as compared to the baseline FCME algorithm under different noise-only and signal-plus-noise conditions. In addition, we compared our model with some other known autonomous methods with results demonstrating improved performance. Thus, based on our new model, users are relieved from the cumbersome process involved in manually tuning the parameters of the FCME algorithm; instead, this can be done accurately and automatically for the user by our model. Essentially, our model presents a fully blind signal detection system for use in CR and a generic platform deployable to convert other parameterized adaptive threshold algorithms into fully autonomous algorithms.http://link.springer.com/journal/5002020-11-03hj2020Electrical, Electronic and Computer Engineerin

Use of Gabapentin in the Treatment of Substance Use and Psychiatric Disorders: A Systematic Review

Objective: Gabapentin (GBP) is an anticonvulsant medication that is also used to treat restless legs syndrome (RLS) and posttherapeutic neuralgia. GBP is commonly prescribed off-label for psychiatric disorders despite the lack of strong evidence. However, there is growing evidence that GBP may be effective and clinically beneficial in both psychiatric disorders and substance use disorders. This review aimed to perform a systematic analysis of peer-reviewed published literature on the efficacy of GBP in the treatment of psychiatric disorders and substance use disorders. Methods: This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed and Ovid MEDLINE literature databases were screened and filtered by using specific search terms and inclusion/exclusion criteria. The full texts of selected studies were subsequently retrieved and reviewed. The search terms generated 2,604 results from the databases. After excluding all duplicates, 1,088 citations were left. Thereafter, we applied inclusion and exclusion criteria; a total of 54 papers were retained for detailed review. Results: This literature review concludes that GBP appears to be effective in the treatment of various forms of anxiety disorders. It shows some effectiveness in bipolar disorder as an adjunctive therapeutic agent, while the evidence for monotherapy is inconclusive. In substance use disorders, GBP is effective for acute alcohol withdrawal syndrome (AWS) with mild to moderate severity; it reduces cravings, improves the rate of abstinence, and delays return to heavy drinking. GBP may have some therapeutic potential in the treatment of opioid addiction and cannabis dependence, but there is limited evidence to support its use. No significant benefit of GBP has been conclusively observed in the treatment of OCD, PTSD, depression, or cocaine and amphetamine abuse. Conclusion: GBP appears to be effective in some forms of anxiety disorders such as preoperative anxiety, anxiety in breast cancer survivors, and social phobia. GBP has shown to be safe and effective in the treatment of alcohol dependence. However, the literature suggests that GBP is effective as an adjunctive medication rather than a monotherapy. More clinical trials with larger patient populations are needed to support gabapentin\u27s off-label use in psychiatric disorders and substance use disorders. It is worth noting that numerous clinical studies that are discussed in this review are open-label trials, which are inherently less rigorously analyzed. Therefore, more extensive investigations are required to examine not only the efficacy of GBP, but also its safety and tolerance