Pituitary Tuberculoma

Tuberculosis rarely involves the hypothalamo-pituitary region and constitutes only 1% of the lesions involving the sellar and/or suprasellar region. Coleman and Meredith first reported pituitary tuberculosis in 1940, and only a handful of cases have been reported ever since. It may manifest as a chiasmal syndrome due to compression of the optic chiasm or as hypopituitarism due to pituitary destruction. It has a characteristic radiological appearance and can mimic a pituitary adenoma. Diagnostic procedures, such as trans-sphenoidal biopsy, are crucial for accurate diagnosis. We report a case of a 32-year male, who presented with complaints of headache and decreased visual acuity for the past 6 months. Eye examination revealed bitemporal hemianopsia. Brain MRI scan showed a mass in the sella with features suggestive of pituitary adenoma. Transcranial resection of the mass was performed; histopathology of the excised mass proved it to be a pituitary tuberculoma

Comparsion of Topical Corticosteroid Nasal Spray / Second Generation Antihistamine with Topical Corticosteroid Nasal Spray

Objective: To compare the effectiveness of topical nasal corticosteroids alone and in combination with second generation oral antihistamine in the treatment of moderate to severe allergic rhinitis.Study design: Randomized control trialDuration of study: One year from 15th June 2011 to 15th June 2012, E.N.T outpatient department Fauji foundation hospital Rawalpindi.Methodology: 200 cases meeting the inclusion and exclusion criteria were taken from the outpatient E.N.T Department Fauji Foundation Hospital Rawalpindi and informed consent was taken from each of them for using their data in this study. My study variables are age, gender, the effectiveness of treatment given to each of the two groups, rhinorrhoea, sneezing, nasal blocking, nasal itching, post nasal drip and condition of nasal mucosa. Nasal speculum is used to examine the nose with the head light and post nasal drip is seen with the help of tongue depressor. There were 200 patients divided into two groups of 100 patients each. Group I treated with topical nasal corticosteroid spray (flunisolide) and group II receiving second generation oral antihistamine tablet (loratadine) in addition to the topical nasal corticosteroid (flunisolide). Results: 200 patients were included in the study from E.N.T outpatient department in Fauji foundation hospital Rawalpindi. On the basis of treatments, intranasal corticosteroid spray (INCS) alone and in combination with second generation oral antihistamine patients were divided into two groups of 100 patients in each group and evaluated for effectiveness of each treatment. Effectiveness was assessed by improvement score in symptoms for both the types of treatments to see which treatment of the two was more effective. Conclusion: The comparative study of Intranasal corticosteroids spray alone and in combination with second-generation antihistamines proved that combination treatment of INCS with antihistamine is better therapy than intranasal corticosteroid spray alone in allergic rhinitis

Simulation of the research process

This paper presents first steps towards the development of a formal model of the research process. We evaluate the use of simulation as a tool for the evaluation of research strategies in nascent research organizations faced with the absence of significant data. We start by modeling the research process by using the ”Publish or Perish” paradigm, a well-known criteria of evaluation of research. We demonstrate the use of this model for researchers to evaluate the effects of selection of a particular publishing venue over time. We then perform various experiments using this basic idea. By means of various visualization techniques, we see how researchers with similar publishing policies might self-organize in the form of groups. We also evaluate the effects of giving higher weights to articles in journals and see where the effects of publishing in these venues breaks even for both top as well as average acceptance rates

Multidetector CT improving surgical outcomes in breast cancer (MISO-BC) : a randomised controlled trial

Background: Early diagnosis of malignant axillary nodes in breast cancer guides the extent of axillary surgery: patients with known axillary malignancy receive a more extensive single operation at the same time as surgery to their breast. A multicentre randomised controlled trial assessed whether a Computed Tomography (CT) scan of the axilla could more accurately diagnose malignant axillary lymph node involvement in patients with newly diagnosed breast cancer when compared to usual care. Methods: Patients with newly diagnosed breast cancer (identified via screening and symptomatic pathways) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care. In addition, one group received a CT scan of their axilla on the same side as the breast cancer. The primary endpoint was the need to undergo a second axillary surgical procedure. Findings: The trial recruited 297 patients of whom 291 contributed to findings. The proportion of patients undergoing a second operation was similar (CT vs UC: 19.4% vs. 19.7%; CT-UC: −0.3%, 95%CI: = −9.5% to 8.9%, χ2 [1]: p = 1.00). Patients in the two groups were similar before treatment, had similar types and grade of cancer, experienced similar patterns of post-operative complications and reported similar experiences of care. Interpretation: CT scan-guided care did not result in a change in the number of patients requiring a second operation; similar numbers of patients needed further axillary surgery in both groups. New diagnostic imaging technologies regularly enter NHS centres. It is important these are evaluated rigorously before becoming routine care

Management of the Triple Negative Locally Advanced Breast Cancer

One out of eight women is suffering from the breast cancer. 2.3 million New cases is predicted by 2023 worldwide. Triple negative breast cancer (TNBC) is having 10–15% incidence. As categorized with the lack of estrogen, progesterone and human epidermal growth factor receptor 2 neu receptor expression. Though it presents with narrow management opportunities that makes it to be the poor prognostic as well as survival rate. The management of the TNBC includes: neoadjuvant treatment then surgery and the adjuvant treatment or the surgery as the first step and then the adjuvant treatment options accordingly. The discussion are still going on to set a management protocol for the triple negative breast cancers with positive outcome and the good disease free survival. Neoadjuvant or adjuvant chemotherapy decreases the estradiol levels and thus improves the survival. The immune check points and immune modulators are under the research and the trials are still going on to treat the TNBC with the improved outcomes. It has been concluded that the management of the TNBC, still wanting the guidelines as tumor-specific targeted therapies is in trials

Autonomous landing of an UAV using H∞ based model predictive control

ossibly the most critical phase of an Unmanned Air Vehicle (UAV) flight is landing. To reduce the risk due to pilot error, autonomous landing systems can be used. Environmental disturbances such as wind shear can jeopardize safe landing, therefore a well-adjusted and robust control system is required to maintain the performance requirements during landing. The paper proposes a loop-shaping-based Model Predictive Control (MPC) approach for autonomous UAV landings. Instead of conventional MPC plant model augmentation, the input and output weights are designed in the frequency domain to meet the transient and steady-state performance requirements. Then, the H∞ loop shaping design procedure is used to synthesize the state-feedback controller for the shaped plant. This linear state-feedback control law is then used to solve an inverse optimization problem to design the cost function matrices for MPC. The designed MPC inherits the small-signal characteristics of the H∞ controller when constraints are inactive (i.e., perturbation around equilibrium points that keep the system within saturation limits). The H∞ loop shaping synthesis results in an observer plus state feedback structure. This state estimator initializes the MPC problem at each time step. The control law is successfully evaluated in a non-linear simulation environment under moderate and severe wind downburst. It rejects unmeasured disturbances, has good transient performance, provides an excellent stability margin, and enforces input constraints

Improving the early identification of COVID-19 pneumonia:a narrative review

Delayed presentation of COVID-19 pneumonia increases the risk of mortality and need for high-intensity healthcare. Conversely, early identification of COVID-19 pneumonia grants an opportunity to intervene early and thus prevent more complicated, protracted and less successful hospital admissions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with early disease progression. Through an evolving literature review, we examined: the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations, clinical examination and chest X-ray; the value of postexertion oxygen saturations; and the use of CRP to monitor disease progression. We go on to discuss the challenges in monitoring the COVID-19 patient in the community and discuss thresholds for further assessment. Confusion, persistent fever and shortness of breath were identified as worrying symptoms suggestive of COVID-19 disease progression necessitating urgent clinical contact. Importantly, a significant proportion of COVID-19 pneumonia patients appear not to suffer dyspnoea despite severe disease. Patients with this asymptomatic hypoxia seem to have a poorer prognosis. Such patients may present with other signs of hypoxia: severe fatigue, exertional fatigue and/or altered mental status. We found duration of symptoms to be largely unhelpful in determining risk, with evidence of deterioration at any point in the disease. Basic clinical parameters (pulse, respiratory rate, blood pressure, temperature and oxygen saturations (SpO(2))) are likely of high value in detecting the deteriorating community COVID-19 patient and/or COVID-19 mimickers/complications (eg, sepsis, bacterial pneumonia and pulmonary embolism). Of these, SpO(2) carried the greatest utility in detecting COVID-19 progression. CRP is an early biochemical parameter predictive of disease progression and used appropriately is likely to contribute to the early identification of COVID-19 pneumonia. Identifying progressive COVID-19 in the community is feasible using basic clinical questions and measurements. As such, if we are to limit the mortality, morbidity and the need for complicated, protracted admissions, monitoring community COVID-19 cases for signs of deterioration to facilitate early intervention is a viable strategy

Structural insights and characterization of human Npas4 protein

Npas4 is an activity dependent transcription factor which is responsible for gearing the expression of target genes involved in neuro-transmission. Despite the importance of Npas4 in many neuronal diseases, the tertiary structure of Npas4 protein along with its physico-chemical properties is limited. In the current study, first we perfomed the phylogenetic analysis of Npas4 and determined the content of hydrophobic, flexible and order-disorder promoting amino acids. The protein binding regions, post-translational modifications and crystallization propensity of Npas4 were predicted through different in-silico methods. The three dimensional model of Npas4 was predicted through LOMET, SPARSKS-X, I-Tasser, RaptorX, MUSTER and Pyhre and the best model was selected on the basis of Ramachandran plot, PROSA, and Qmean scores. The best model was then subjected to further refinement though MODREFINER. Finally the interacting partners of Npas4 were identified through STRING database. The phylogenetic analysis showed the human Npas4 gene to be closely related to other primates such as chimpanzees, monkey, gibbon. The physiochemical properties of Npas4 showed that it is an intrinsically disordered protein with N-terminal ordered region. The post-translational modification analyses indicated absence of acetylation and mannosylation sites. Three potential phosphorylation sites (S108, T130 and T136) were found in PAS A domain whilst a single phosphorylation site (S273) was present in PAS B domain. The predicted tertiary structure of Npas4 showed that bHLH domain and PAS domain possess tertiary structures while the rest of the protein exhibited disorder property. Protein-protein interaction analysis revealed NPas4 interaction with various proteins which are mainly involved in nuclear trafficking of proteins to cytoplasm, activity regulated gene transcription and neurodevelopmental disorders. Moreover the analysis also highlighted the direct relation to proteins involved in promoting neuronal survival, plasticity and cAMP responsive element binding protein proteins. The current study helps in understanding the physicochemical properties and reveals the neuro-modulatory role of Npas4 in crucial pathways involved in neuronal survival and neural signalling hemostasis

Identification of drought tolerant maize genotypes and seedling based morpho-physiological selection indices for crop improvement

Maize is an imperative grain crop used as a staple food in several countries around the world. Water deficiency is a serious problem limiting its growing area and production. Identification of drought tolerant maize germplasm is comparatively easy and sustainable approach to combat this issue. Present research was conducted to evaluate 50 maize genotypes for drought tolerance at early growth stage. Drought tolerance was assessed on the basis of several morphological and physiological parameters. Analysis of variance showed significant variation among the tested maize genotypes for recorded parameters. Principal component analysis revealed important morpho-physiological traits that were playing key role in drought tolerance. Correlation studies depicted significant positive correlation among the attributes such as fresh shoot length (FSL), fresh root length (FRL), dry shoot weight (DSW), dry root weight (DRW), relative water contents (RWC) and total dry matter (TDM) while a strongly negative correlation was observed among RWC and excised leaf water loss. Results concluded that the parameters fresh shoot weight, fresh root weight, FRL, DRW, TDM, cell membrane thermo stability (CMT) and RWC can be useful for rapid screening of maize germplasm for drought tolerance at early growth stages. Furthermore, the genotypes 6, 16, 18, 40, 45 and 50 can be used as a drought tolerant check in breeding programs. Moreover, biplot analysis along with other indices was proved to be a useful approach for rapid and cost efficient screening of large number of genotypes against drought stress condition