Anticoagulation in pulmonary TB induced deep vein thrombosis is it always warranted: a case report

India is a densely populated developing country and accounts for one quarter of the total tuberculosis cases reported worldwide. Deep vein thrombosis (DVT) has been associated with 1.5-3.4% cases of tuberculosis. A 14 year female presented with complaints of cough with progressive breathlessness (NYHA Grade III) since 15 days along with easy fatiguability and fever for 3 days. The patient was started on Anti-Tubercular Treatment (ATT) as per RNTCP guidelines after thorough investigations. One week after the patient was started on ATT, the patient developed edema of the right lower limb accompanied by pain. Color doppler was suggestive of thrombosis in the superficial and deep veins. Early immobilization and physiotherapy was started immediately. Over a period of 10 days, the swelling gradually decreased, and pain subsided. Tuberculosis is an independent risk factor for the development of venous thromboembolism irrespective of the presence of other risk factors. Emphasis is thus laid on high index of suspicion and early diagnosis to control and prevent further complications like pulmonary embolism. We can propose that in patients diagnosed with pulmonary tuberculosis, early immobilization and physiotherapy can prevent the development of DVT

Fetomaternal outcome in pregnancy with hepatitis E infection

Background: HEV infection, a major public health concern, is known to cause large-scale epidemic and sporadic cases of acute viral hepatitis in developing countries. The infection occurs primarily in young adults and is generally mild and self-limiting; however, the case fatality rate is reportedly higher among pregnant women.Methods: Our study, a retrospective observational study, was conducted in a tertiary care center for over a period of 3 years (January 2017 to January 2020) to find out the fetal and maternal outcome in pregnant women with HEV infection.Results: A total of 38 antenatal cases with anti-HEV IgM-positive were included, and the maternal-fetal outcome was analyzed. The maternal mortality was 52.63 % especially during 3rd trimester and post-partum period, including 5 antenatal death. The most common maternal complication was acute fulminant hepatitis (39.5 %), DIC (36.8 %) and hepatic encephalopathy (31.6%). Prematurity (33.3% of total live births) and Still births (32.3 %) including 4 freshes still births were the commonest fetal complications noted.Conclusions: Our study shows that pregnant woman with acute viral hepatitis due to hepatitis E virus infection had a high mortality rate especially during 3rd trimester and post-partum period with poor obstetric and fetal outcome

Adenosquamous Carcinoma Presenting with Necrotising Mediastinal Lymphadenopathy in a Non-smoker Young Adult: A Rare Case Report

Introduction: Adenosquamous carcinoma (ASC) of lung is a rare and poorly described subtype of bronchogenic carcinoma. Most patients of adenosquamous carcinoma of lung come from older age group and present with cough, chest pain, weight loss, dyspnoea, haemoptysis, and fatigue. The radiologic findings of adenosquamous lung carcinoma may consist typically a peripheral solitary nodule or less commonly a central hilar mass. Here we present a unique case of adenosquamous lung carcinoma in a young adult who presented with nonspecific complaints and unusual chest X ray along with atypical findings on contrast enhanced computerised tomography in the form of necrotising mediastinal lymphadenopathy.Presentation of Case: A 30 years old male non-smoker and non-alcoholic office worker presented at with nonspecific symptoms of dry cough and exertional dyspnoea. Physical examination revealed a single, hard, non-tender lymph node in right supraclavicular region which on excisional biopsy and histopathology revealed poorly differentiated metastatic adenosquamouscarcinoma confirmed by immunohistochemistry. Chest skiagram PA view showed bilateral nodular shadows in mid and lower zones and right paratracheal opacity. CECT thorax revealed multiple mediastinal lymph nodes with hypo areas suggestive of internal necrosis. In spite of adequate anticancer chemotherapy regimen, clinico-radiological deterioration was observed.Conclusion: Adenosquamous carcinomas usually presents in advanced stage, show an aggressive histologic behaviour with poor survival rates than the single histology group. Early identification of such cases with varied presentation may save lives. Keeping these things in mind, early identification of such cases with varied presentation may improve survival to some extent

Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse

APPLICATION-AWARE DELIVERY OF MULTICAST TRAFFIC

Techniques are presented herein that support application layer replication to optimally deliver multicast traffic over either the public Internet or a service provider network. The presented techniques encompass extensions to Border Gateway Protocol (BGP)-based signaling mechanisms that may be employed to notify network devices (such as endpoints) of the presence of an application-aware multicast capability. The presented techniques further encompass a replicator component that a controller may dynamically launch and program. Multicast traffic, that would normally travel along a conventional delivery path, may then take a unicast path to such a replicator at which point replication may be performed more efficiently within the network