Internal jugular vein thrombosis presenting as paraneoplastic syndrome in benign cystic teratoma of ovary: a case report

Internal jugular vein thrombosis is a rare vascular disease that can be overlooked or misdiagnosed and is generally seen in persons with intravenous drug abuse or in patients with prolonged central venous catheterization due to iatrogenic trauma. The most common germ cell tumour of the ovary is benign (mature) cystic teratoma, occurring in adolescents and young women. We are presenting a case of a 50-year-old premenopausal woman, diagnosed to have right internal jugular vein thrombosis extending into the right subclavian and axillary vein. Her laboratory investigations revealed no predisposing cause of thrombosis. Four months later she was evaluated for menorrhagia and imaging studies showed multiple uterine fibroids with left ovarian mass (ovarian teratoma) with moderate ascites and her tumour markers levels of CA125 was elevated. She underwent staging laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection with infracolic omentectomy. Pathologically, ovarian cyst showed mature thyroid tissue with islands of bone, muscle tissue and fatty tissue consistent with benign cystic teratoma. Postoperatively her tumour marker CA125 level returned to normal levels and there was no reaccumulation of fluid. As there were no predisposing factors for internal jugular vein thrombosis, it was concluded to be a paraneoplastic syndrome preceding the diagnosis of benign cystic teratoma. To the best of our knowledge this is the first case report in the literature with an association between internal jugular vein thrombosis and benign cystic teratoma with raised serum tumour marker CA 125

Chronic nail biting, orthodontic treatment and Enterobacteriaceae in the oral cavity

Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug resistance gram negative bacteria are on the rise globally. Several of the foodborne bacteria fall within the Enterobacteriaceae family but very few studies have explored these microbes in the oral cavity of children with chronic nail-biting habit or orthodontic treatment. The study aims to investigate oral load of Enterobacteriaceae in children with chronic nail-biting habit and or those undergoing orthodontic treatment. 150 children (no nail-biting n=30, nail biting n=60, fixed orthodontic treatment n =30 and a combination of fixed orthodontic appliance use and nail-biting habit n =30) were assessed for culture based microbiological investigation. The concentrated oral rinse technique was used. The rinse was inoculated in MacConkey?s and Blood Agar. The gram stained culture was subjected to biochemical tests for sub-species identification using Biomerieux Vitek 2 Compact Automated Microbiological Analyzer. Fisher?s exact and Kruskal Wallis with post hoc analysis using Dunn method was performed to test association and difference between groups. Enterobacteriaceae was positive for 72% of the children. Of them, nail biting or orthodontic treatment group comprised 89%. Those with a combination of nail biting and undergoing orthodontic treatment exhibited highest CFU/ml and those without nail biting or orthodontic treatment exhibited the lowest. Three of the four organisms isolated tested positive in the orthodontic treatment group. E. coli was positive in 38% of the children while Klebsiella and E. cloacae were isolated exclusively in the orthodontic treatment group. Chronic nail biting or the use of fixed orthodontic appliances is associated with higher incidence of Enterobacteriaceae in the oral cavity. Oral health professionals play an important role in preventing multi drug resistance infectious diseases

Internal jugular vein thrombosis presenting as paraneoplastic syndrome in benign cystic teratoma of ovary: a case report

Internal jugular vein thrombosis is a rare vascular disease that can be overlooked or misdiagnosed and is generally seen in persons with intravenous drug abuse or in patients with prolonged central venous catheterization due to iatrogenic trauma. The most common germ cell tumour of the ovary is benign (mature) cystic teratoma, occurring in adolescents and young women. We are presenting a case of a 50-year-old premenopausal woman, diagnosed to have right internal jugular vein thrombosis extending into the right subclavian and axillary vein. Her laboratory investigations revealed no predisposing cause of thrombosis. Four months later she was evaluated for menorrhagia and imaging studies showed multiple uterine fibroids with left ovarian mass (ovarian teratoma) with moderate ascites and her tumour markers levels of CA125 was elevated. She underwent staging laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection with infracolic omentectomy. Pathologically, ovarian cyst showed mature thyroid tissue with islands of bone, muscle tissue and fatty tissue consistent with benign cystic teratoma. Postoperatively her tumour marker CA125 level returned to normal levels and there was no reaccumulation of fluid. As there were no predisposing factors for internal jugular vein thrombosis, it was concluded to be a paraneoplastic syndrome preceding the diagnosis of benign cystic teratoma. To the best of our knowledge this is the first case report in the literature with an association between internal jugular vein thrombosis and benign cystic teratoma with raised serum tumour marker CA 125

Thermal Performance Assessment of Envelope Retrofits for Existing School Buildings in a Hot–Humid Climate: A Case Study in Chennai, India

This study aims to propose building envelope retrofit packages for existing naturally ventilated school buildings in the hot–humid climatic region of Chennai, India. Indoor thermal parameters were collected through field studies from nine sample classrooms of a selected school building in May 2019, between 9.00 am and 4.00 pm. The thermal performance assessment of the existing building was performed by examining the discomfort hours using the CBE thermal comfort tool. Envelope retrofit strategies gathered from the literature and building standards were applied and studied through simulation. The findings reveal the enormous potential to increase the thermal comfort of existing school buildings through envelope retrofit measures. The results demonstrate that the whole-building temperature can be reduced up to 3.2 °C in summer and up to 3.4 °C in winter. Implementing retrofit measures to the building envelopes of existing buildings will help school owners to increase the comfortable hours of whole buildings by up to 17%. In comparison, annual energy savings of up to 13% for the whole building can be made by enhancing the thermal performance of the building envelope. The findings will also help architects to optimise thermal performance and energy usage with minimal interventions

Occupational Heat Stress Impacts on Health and Productivity in a Steel Industry in Southern India

Background: Workers laboring in steel industries in tropical settings with high ambient temperatures are subjected to thermally stressful environments that can create well-known risks of heat-related illnesses and limit workers’ productivity. Methods: A cross-sectional study undertaken in a steel industry in a city nicknamed “Steel City” in Southern India assessed thermal stress by wet bulb globe temperature (WBGT) and level of dehydration from urine color and urine specific gravity. A structured questionnaire captured self-reported heat-related health symptoms of workers. Results: Some 90% WBGT measurements were higher than recommended threshold limit values (27.2–41.7°C) for heavy and moderate workloads and radiational heat from processes were very high in blooming-mill/coke-oven (67.6°C globe temperature). Widespread heat-related health concerns were prevalent among workers, including excessive sweating, fatigue, and tiredness reported by 50% workers. Productivity loss was significantly reported high in workers with direct heat exposures compared to those with indirect heat exposures (χ2 = 26.1258, degrees of freedom = 1, p<0.001). Change in urine color was 7.4 times higher among workers exposed to WBGTs above threshold limit values (TLVs). Conclusion: Preliminary evidence shows that high heat exposures and heavy workload adversely affect the workers’ health and reduce their work capacities. Health and productivity risks in developing tropical country work settings can be further aggravated by the predicted temperature rise due to climate change, without appropriate interventions. Apart from industries enhancing welfare facilities and designing control interventions, further physiological studies with a seasonal approach and interventional studies are needed to strengthen evidence for developing comprehensive policies to protect workers employed in high heat industries