1,359 research outputs found
Sarcomatoid Carcinoma of Lung Presenting as Localized Bronchiectasis: A Case Report and Review of Literature
© 2018 The Authors Sarcomatoid carcinoma (SC) of the lung is a rare and aggressive biphasic lung tumor with a 5-year survival of 20%. Early detection and treatment is the only way to improve outcomes in patients with SC of the lung. We present a case of primary SC identified early based on high suspicion. A 56-year-old female with a history of chronic obstructive pulmonary disease (COPD) presented with hemoptysis and exertional dyspnea. Chest X-ray revealed right upper lobe (RUL) opacity and patient was started on antibiotics for pneumonia. Due to the persistence of hemoptysis, a computed tomography scan was performed which showed RUL bronchiectasis with scattered nodular opacities suggestive of an infectious process. The patient underwent bronchoscopy which revealed a pedunculated mass in the RUL biopsy of which was consistent with poorly differentiated SC. Positron-emission tomography scan revealed Flourdeoxyglucose-avid right peri-hilar mass and another nodule in the RUL. The patient was not a surgical candidate because of severe COPD and was started on chemoradiation therapy. SC of the lung can have various presentations and is usually detected at a later stage and hence, difficult to treat. Our case highlights the importance of critical thinking and prompt diagnostic evaluation in high-risk patients with localized bronchiectasis even without an obvious lung mass on imaging
Long-term occupational exposure to DDT
Blood serum of twenty workers occupationally exposed to DDT for an average duration of 14 years was analysed for organochlorine pesticides by gas-liquid chromatography with an electron capture detector. Significant levels of BHC, p,p'-DDT, p,p'-DDD and p,p-DDE were detected. A higher incidence of total DDT equivalent, about 10 times, was observed in DDT exposed workers when compared with a comparable sample of unexposed persons from the general population. Levels of DDT in serum of occupationally exposed workers were more than the permitted level of 200 ppb. The daily intake was computed to be about 10 mg/man/day as against 0.25 mg-the acceptable daily intale. Abnormal nerve conduction was encountered in a few cases of DDT sprayers. No significant correlation was observed between the total DDT equivalent in serum and duration of occupational exposure in workers. Levels of BHC in controls was 2.3 times the level in exposed workers, possibly due to induction of hepatic drug metabolising enzymes by high levels of DDT in the latter group. Findings are discussed in the light of existing knowledge of the bio-chemical effects evoked due to residual intoxication of DDT during occupational exposure
Emerging bacterial resistance patterns in febrile neutropenic patients: experience at a tertiary care hospital in Pakistan
Objective: To look at the clinical presentations, spectrum and site of isolation of the organisms, sensitivity patterns of the organisms and the antibiotic prescribing practices for the treatment of febrile neutropenic patients at our hospital.Methods: The data were collected retrospectively from the records of all neutropenic patients with an absolute neutrophil count (ANC) of less than 500/ml admitted during the period of 3 years from August 1999 to July 2002 at AKUH.Results: Out of the total of 404 patients, 65% had hematological malignancies and around half of them had leukaemia, 86% of the patients presented with fever. A total of 124 bacterial organisms were isolated from 96 patients among which 47% were gram positive and 53% were gram negative organisms; 16.1% of the patients had septicaemia. Coagulase Negative Staphylococci (CoNS) were the most common gram positive and E. coli was the most commonly isolated gram negative organism. Most of the gram positive organisms were isolated from blood (67%). There was emerging resistance to all commonly used antibiotics including imipenem, cloxacillin, vancomycin and amikacin. The average duration of neutropenia was 6.4 days. The mortality rate was 6%.CONCLUSION: There is increasing trend of gram negative organisms developing resistance to commonly used antibiotics. Gram positive bacteria including Enterococcus spp. and CoNS are also showing emerging resistance to vancomycin
Hormone replacement therapy menopause with a better future--a survey of views on hormone replacement therapy (HRT)
Objective: To assess the views and prescribing practices of doctors regarding hormone replacement therapy (HRT).Methods: In April 1999, 103 doctors from a teaching hospital participated in a survey. Using a self-administered questionnaire, subjects were contacted at the departments of Internal Medicine, Family Medicine, Obstetrics and Gynaecology, and Orthopaedics.Results: Seventy-two percent were below 40 years of age and 67% of the respondents were male. Most doctors believed that HRT decreases the risk of subsequent osteoporosis (97%), ischaemic heart disease (77%) and depression associated with menopause (64%). Doctors generally considered menopausal symptoms (90%), premature menopause (87%), surgical menopause (85%) and osteoporotic fracture (77%) as clear indications for hormone replacement therapy. Absolute contraindications to the therapy were stated as recent breast cancer (82%) and recent endometrial cancer (84%). Among the specialities covered, there were differing views on proposed duration of HRT. It was generally believed that a pelvic examination, cervical smear and mammography were pre-requisites when initiating and monitoring HRT. Majority (69%) felt that HRT should be offered to all menopausal women, assuming no contraindications and most (73%) did discuss HRT with their patients. However, less than 10% of the menopausal patients under their care were using HRT. Those doctors not in favor of universal offering of HRT (31%) considered unreliable patient follow up to be the main reason. Females were two times more likely to discuss HRT with their patients (p = .08). Doctors who discussed HRT with their patients were four times more likely to consider HRT for themselves or their spouses (p = .13). Gynecologists were eight times more likely to prescribe HRT than non-gynecologists (p = .001).CONCLUSION: Doctors are positively disposed to the universal offering, and use of HRT. Further studies are needed to understand a possible gap between perceived and actual prescribing practice
Occupancy based household energy disaggregation using ultra wideband radar and electrical signature profiles
Human behaviour and occupancy accounts for a substantial proportion of variation in the energy efficiency pro le of domestic buildings. Yet while people often claim that they would like to reduce their energy bills, rhetoric frequently fails to match action due to the effort involved in understand- ing and changing deeply engrained energy consumption habits. Here, we present and, through dedicated experiments, test in-house developed soft-ware to remotely identify appliance energy usage within buildings, using energy equipment which could be placed at the electricity meter location. Furthermore, we monitor and compare the occupancy of the location under study through Ultra-Wideband (UWB) radar technology and compare the resulting data with those received from the power monitoring software, via time synchronization. These signals when mapped together can potentially provide both occupancy and speci c appliances power consumption, which could enable energy usage segregation on a yet impossible scale as well as usage attributable to occupancy behaviour. Such knowledge forms the basis for the implementation of automated energy saving actions based on a households unique energy profi le
PGE1 nebulisation during caesarean section for Eisenmenger's syndrome: a case report
<p>Abstract</p> <p>Introduction</p> <p>Eisenmenger's syndrome in pregnancy can lead to death in 50% to 65% of parturients. Expensive invasive monitoring and medication have improved management and outcomes. Cheaper alternatives for the management of high-risk patients who present with no prenatal care are still not available.</p> <p>Case presentation</p> <p>We describe the obstetric anaesthesia management of a 34-year-old, 34-weeks pregnant woman who presented with a recent diagnosis of severe Eisenmenger's syndrome. A combined spinal epidural anaesthesia was used together with invasive cardiac monitoring as well as PGE1 nebulisation after delivery of the baby. This helped achieve a reduction of shunt, improvement of hypoxia and reduction of pulmonary pressures.</p> <p>Conclusion</p> <p>We found this to be a cheaper and safe alternative in the management of such patients who present with no adequate prior management.</p
On the Internal Absorption of Galaxy Clusters
A study of the cores of galaxy clusters with the Einstein SSS indicated the
presence of absorbing material corresponding to 1E+12 Msun of cold cluster gas,
possibly resulting from cooling flows. Since this amount of cold gas is not
confirmed by observations at other wavelengths, we examined whether this excess
absorption is present in the ROSAT PSPC observations of 20 bright galaxy
clusters. For 3/4 of the clusters, successful spectral fits were obtained with
absorption due only to the Galaxy, and therefore no extra absorption is needed
within the clusters, in disagreement with the results from the Einstein SSS
data for some of the same clusters. For 1/4 of the clusters, none of our
spectral fits was acceptable, suggesting a more complicated cluster medium than
the two-temperature and cooling flow models considered here. However, even for
these clusters, substantial excess absorption is not indicated.Comment: accepted by the Astrophysical Journa
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