May-Thurner syndrome causing venous thromboembolism in a young female with Sturge weber syndrome and connective tissue disease

May-Thurner syndrome (MTS) is a rare condition characterized by the compression of the left common iliac vein by the overlying right common iliac artery. It is a unique causal reason for development of deep venous thrombosis (DVT) and pulmonary embolism (PE). Young females developing DVT should be examined and investigated with details as triggers can include trauma, pregnancy, autoimmunity. In this case report we report a case of a young female who had Sturge Weber Syndrome, and how a left hip pain was diagnosed as DVT which led to diagnosis of an underlying MTS and autoimmune trigger for her hypercoagulable state

Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India

Background: Meningitis is one of the fatal infections occurring in infants and older children. In acute bacterial meningitis (ABM), inflammation of the leptomeninges is triggered by bacteria present in the subarachnoid space. ABM is associated with a high rate of acute complications and long-term morbidity. Aim of our study was to determine the incidence, etiological profile and complications of acute bacterial meningitis amongst children belonging to one month to five years of age.Methods: The present study was conducted over a period of one year and diagnosis of meningitis was made on basis of history, examination and laboratory investigations. Clinical features were recorded on case sheet. Lumbar puncture was done, and CSF was sent for biochemical analysis, cell counts, staining, culture and latex agglutination test (LAT).Results: Out of total 1560 admitted cases (1 month to 5years age group), 160 cases were suspected with meningitis while 57 cases were confirmed to have ABM. Most (59.6%) cases belonged to 3 months to 1-year age group and males outnumbered the females by a ratio of 2:1. Group B Streptococcus (45.6%) was most common pathogen in 45.6% cases followed by Streptococcus pneumoniae (21%) and Hemophilus influenzae (10.52%). Seizures (45%) and increased ICP (28%) were main acute complications observed during hospitalization while hemiparesis 9.6%, monoparesis 4.8%, seizures 38%, vision and hearing deficits were the sequelae observed on follow up examination. These complications were predominantly contributed by S. pneumoniae and H. Influenzae.Conclusions: The incidence of ABM is still high and Group B streptococcus is main pathogen even in post neonatal period. The complications of ABM are markedly higher in cases of S. pneumoniae, H. Influenzae meningitis in comparison to Group B streptococcus meningitis. Formulating standard protocols for management of ABM and rational antibiotic use to prevent resistance is the need of hour

Co-existence of nocardiosis with pulmonary aspergillosis in a single patient

AbstrAct Introduction: Nocardia and Aspergillus are important causes of opportunistic infections in immunocompromised individuals. An aggressive workup is essential since these infections are remediable but potentially mortal. case report: We describe a case of a 50-year-old diabetic female with pulmonary aspergillosis who presented with cough and breathlessness for one and ahalf months. she was given steroids and itraconazole for the same but there was no relief. Later on, bronchoalveolar lavage on Kinyoun stain showed Nocardia. conclusion: this case highlights the importance to look for other causes as well in patients with pulmonary aspergillosis not responding to treatment since delay in diagnosis can be fatal for the patient

Causal ambiguity: deciphering the etiology of secondary thrombotic microangiopathy with systemic lupus erythematosus and vivax malaria

Hemolytic uremic syndrome (HUS) falls under the spectrum of thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and thrombi in small vessels leading to end-organ damage. It's classified into typical HUS (caused by Shiga toxin-producing E. coli), atypical HUS (due to uncontrolled complement activation), and secondary HUS (sHUS) linked with coexisting conditions. We present a compelling case of a 21-year-old female with fever, jaundice, anemia, thrombocytopenia, and oliguric acute kidney injury (AKI), ultimately diagnosed with Plasmodium vivax malaria. Despite adequate antimalarial therapy, the patient's clinical trajectory remained intricate, characterized by sustained hematological abnormalities and renal dysfunction. A comprehensive assessment revealed Coombs-negative hemolytic anemia. Subsequently, a renal biopsy confirmed TMA. Considering the rarity of vivax malaria causing TMA, an autoimmune workup was conducted, suggesting systemic lupus erythematosus (SLE). Systemic autoimmune disease-associated HUS (SAID-HUS) is a rare entity that exhibits diverse clinical presentations, with SLE being best-described etiology in literature. SLE-associated HUS was considered and was managed with steroids and hydroxychloroquine resulting in significant renal and hematological improvement. This report underscores significance of assessing autoimmune factors in case of secondary TMA, while also shedding light on evolving understanding of vivax malaria's potential relationship with TMA

7th International Conference on Recent Advances in Mathematical Sciences and its Applications-2024: Abstract Book

This book presents the abstracts of the selected contributions to the 7th International Conference on Recent Advances in Mathematical Sciences and its Applications (RAMSA 2024), held on 29 February- 02 March 2024, by the Department of Mathematics, Jaypee Institute of Information Technology, Noida, India. RAMSA 2024 aims to assemble esteemed mathematicians, scientists, engineers, researchers from industry, and scholars, facilitating a platform for the exchange of ideas and discussions on recent advancements across various areas of mathematics. RAMSA-2024 provides an opportunity to delve into research findings and breakthroughs in mathematics, sciences, and engineering. This conference serves as a forum to address practical challenges encountered in different application domains and explore potential solutions. Conference Title: 7th International Conference on Recent Advances in Mathematical Sciences and its ApplicationsConference Acronym: RAMSA-2024Conference Date: 29 Feb-02 March 2024Conference Venue: Hybrid Mode (JIIT Noida & Online)Conference Organizer: Department of Mathematics, Jaypee Institute of Information Technology, Noida, Indi

7th International Conference on Recent Advances in Mathematical Sciences and its Applications-2024: Abstract Book

This book presents the abstracts of the selected contributions to the 7th International Conference on Recent Advances in Mathematical Sciences and its Applications (RAMSA 2024), held on 29 February- 02 March 2024, by the Department of Mathematics, Jaypee Institute of Information Technology, Noida, India. RAMSA 2024 aims to assemble esteemed mathematicians, scientists, engineers, researchers from industry, and scholars, facilitating a platform for the exchange of ideas and discussions on recent advancements across various areas of mathematics. RAMSA-2024 provides an opportunity to delve into research findings and breakthroughs in mathematics, sciences, and engineering. This conference serves as a forum to address practical challenges encountered in different application domains and explore potential solutions. Conference Title: 7th International Conference on Recent Advances in Mathematical Sciences and its ApplicationsConference Acronym: RAMSA-2024Conference Date: 29 Feb-02 March 2024Conference Venue: Hybrid Mode (JIIT Noida & Online)Conference Organizer: Department of Mathematics, Jaypee Institute of Information Technology, Noida, Indi

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline