Malignant peripheral nerve sheath tumor of the cervical vagus nerve in a neurofibromatosis type 1 patient - An unusual presentation

Malignant peripheral nerve sheath tumors (MPNST’S) of the head and neck comprise 2% to 6% of head and neck sarcomas. These tumors may arise as sporadic variants or in patients with neurofibromatosis (NF). Development of these MPNST’s is one of the serious complications of neurofibromatosis type 1(NF1). To our knowledge there are only two reported cases of MPNST’s arising in the cervical vagal nerve, occurring in NF1 patients. We present here an NF1 patient who developed an MPNST of the cervical vagus nerve and presented only with a cervical swelling and hoarseness

Undifferentiated Carcinoma of Larynx of Nasopharyngeal Type

Undifferentiated carcinoma of nasopharyngeal type arising in the larynx is unusual. This type of carcinoma-which occurs almost exclusively in nasopharynx-is very infrequent in the larynx (0.2%). Till date only 17 cases are reported in the medical literature. We present the clinical and histopathological findings along with the management of one additional case of undifferentiated carcinoma of nasopharyngeal type in the larynx which was managed successfully with radiotherapy

Insular Carcinoma of Thyroid Presenting as a Giant Skull Lesion: A Dilemma in Treatment.

Thyroid surgeons are becoming increasingly more aware of a histologically distinct subset of thyroid carcinoma whose classification falls between well-differentiated and anaplastic carcinomas with respect to both cell differentiation and clinical behavior. This subtype of tumors has been categorized as poorly differentiated or insular carcinoma, based on its characteristic cell groupings. Although the differentiation of insular carcinoma from other thyroid carcinomas has important prognostic and therapeutic significance, relatively little about insular carcinoma has been published in the otolaryngology literature. In this article, we discuss a case of insular carcinoma of thyroid presenting with concurrent distant metastasis to skull, lung, ribs, and inguinal region with review of the literature. We conclude that insular thyroid carcinoma warrants aggressive management with total thyroidectomy and excision of accessible giant lesion followed by radioactive iodine ablation of any remaining thyroid tissue

A New Simulation Metric to Determine Safe Environments and Controllers for Systems with Unknown Dynamics

We consider the problem of extracting safe environments and controllers for reach-avoid objectives for systems with known state and control spaces, but unknown dynamics. In a given environment, a common approach is to synthesize a controller from an abstraction or a model of the system (potentially learned from data). However, in many situations, the relationship between the dynamics of the model and the \textit{actual system} is not known; and hence it is difficult to provide safety guarantees for the system. In such cases, the Standard Simulation Metric (SSM), defined as the worst-case norm distance between the model and the system output trajectories, can be used to modify a reach-avoid specification for the system into a more stringent specification for the abstraction. Nevertheless, the obtained distance, and hence the modified specification, can be quite conservative. This limits the set of environments for which a safe controller can be obtained. We propose SPEC, a specification-centric simulation metric, which overcomes these limitations by computing the distance using only the trajectories that violate the specification for the system. We show that modifying a reach-avoid specification with SPEC allows us to synthesize a safe controller for a larger set of environments compared to SSM. We also propose a probabilistic method to compute SPEC for a general class of systems. Case studies using simulators for quadrotors and autonomous cars illustrate the advantages of the proposed metric for determining safe environment sets and controllers.Comment: 22nd ACM International Conference on Hybrid Systems: Computation and Control (2019

Fever of Unknown Origin: An Unusual Case

Recurrent episodic fever of unknown origin (FUO) arising from tumour of the gastrointestinal tract is rare. We report an otherwise healthy 62-year-old man with recurrent circumscribed bouts of fever and raised CRP for 3 years who has remained well and fever-free 2 years after the removal of a well-differentiated adenocarcinoma of the colon. Occult colonic neoplasm should be considered and sought when routine investigations for FUO are negative

Pion-less effective field theory for atomic nuclei and lattice nuclei

We compute the medium-mass nuclei $^{16}$O and $^{40}$Ca using pionless effective field theory (EFT) at next-to-leading order (NLO). The low-energy coefficients of the EFT Hamiltonian are adjusted to experimantal data for nuclei with mass numbers $A=2$ and $3$, or alternatively to results from lattice quantum chromodynamics (QCD) at an unphysical pion mass of 806 MeV. The EFT is implemented through a discrete variable representation in the harmonic oscillator basis. This approach ensures rapid convergence with respect to the size of the model space and facilitates the computation of medium-mass nuclei. At NLO the nuclei $^{16}$O and $^{40}$Ca are bound with respect to decay into alpha particles. Binding energies per nucleon are 9-10 MeV and 30-40 MeV at pion masses of 140 MeV and 806 MeV, respectively.Comment: 26 page

An Assessment of Knowledge and Practices Regarding Tuberculosis in the Context of RNTCP Among Non Allopathic Practitioners in Gwalior District

Introduction: India has the highest TB burden accounting for one-fifth of the global incidence with an estimated 1.98 million cases. Non- allopathic practitioners are the major service providers especially in rural and peri-urban areas, treating not just patients of diarrhea, respiratory infections and abdominal Pain but also of tuberculosis. Objectives: To assess the knowledge of sign and symptoms of TB and its management as per the RNTCP guidelines and to assess the practicing pattern regarding tuberculosis. Material & Methods: The present was carried out among the registered non allopathic practitioners providing their services in Gwalior District during the study period. A total of 150 non allopathic practitioners of various methods from both government and private sectors were interviewed using a pre-designed, pre-tested semi-structured questionnaire. The information was collected on the General profile of the participant, knowledge about signs and symptoms of TB and its management, practices commonly adopted in the management and their views on involvement of non allopathic practitioners in RNTCP programme. Result: The average score of government practitioners was 7.3 compared to 4.6 by private practitioners. There was a statistically significant difference between the two group on issue related to the management of TB patients as per the RNTCP guidelines. Government practitioners relied mostly on sputum examination for diagnosis and follow up compared to private practitioners who chose other modalities like X-ray, blood examination for this work. Conclusion: There is a gap in knowledge and practices of practitioners of both the sectors. Some serious efforts were required to upgrade the knowledge of non allopathic practitioners if the government is serious about controlling tuberculosis in India

Association of Intraocular Pressure With Human Immunodeficiency Virus

PURPOSE: Prior studies have shown an association between human immunodeficiency virus (HIV) and reduced intraocular pressures (IOP). The purpose of this study was to determine if patients with HIV on highly active antiretroviral therapy (HAART) had any difference in their IOP compared with patients without HIV or with HIV who are not on HAART. DESIGN: Retrospective cross-sectional study. METHODS: We included 400 patients from our academic eye center between 2000 and 2016. Group 1 (G1) consisted of patients with HIV on HAART (n = 176), Group 2 (G2) consisted of patients with HIV who were not on HAART (n = 48), and Group 3 (G3) consisted of controls without HIV (n = 176). An analysis of variance (ANOVA) was performed to compare mean IOP values. Multivariate linear and logistic regression models were performed to assess factors impacting IOP. Difference in IOP was the primary outcome being measured. RESULTS: The mean IOPs in mm Hg were 13.7 +/- 5.1 (G1), 13.1 +/- 3.6 (G2), and 17.3 +/- 3.8 (G3), P \u3c .01. In regression modeling, having a CD4 count CONCLUSIONS: Absolute CD4 counts may play a role in IOP fluctuations. This association was found in patients with HIV regardless of whether patients were on HAART

Mortality implications and factors associated with nonengagement in a public epilepsy care initiative in a transient population

BACKGROUND: Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs. AIMS: The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative. METHODS: In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died. RESULTS: Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity. CONCLUSIONS: Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied