Bilateral Adrenal Hemorrhage Heralds Bronchogenic Carcinoma.

This case study delves into the unusual presentation of non-small cell lung carcinoma (NSCLC), where bilateral hemorrhagic adrenal metastasis served as the primary indication of an underlying malignancy. Our patient, a 58-year-old male, sought medical attention due to acute abdominal pain and lower back discomfort, leading to an in-depth diagnostic exploration. Radiological examinations revealed bilateral adrenal masses exhibiting hemorrhagic characteristics, a distinctive feature not commonly associated with NSCLC. The subsequent biopsy and histopathological analysis definitively identified metastatic NSCLC as the culprit. The uniqueness of this case lies in the bilateral nature of the metastasis and the presence of hemorrhagic elements, challenging traditional diagnostic expectations. This report emphasizes the necessity for a nuanced approach to diagnostic investigations when confronted with atypical presentations, especially considering the rarity of bilateral involvement and hemorrhagic features in adrenal metastases from NSCLC. It highlights the importance of interdisciplinary collaboration between radiologists, pathologists, and oncologists to ensure accurate and timely diagnosis. The overarching significance of this case extends beyond its rarity; it underscores the imperative for healthcare practitioners to broaden their diagnostic considerations in the absence of conventional symptoms. By presenting this distinctive case, we contribute to the evolving understanding of the diverse clinical manifestations of NSCLC, advocating for heightened vigilance and comprehensive diagnostic approaches in the pursuit of early intervention and optimal patient care.

A High-Resolution Digital Bathymetric Elevation Model Derived from ICESat-2 for Adam's Bridge.

This data descriptor elaborates the details of a high-resolution digital bathymetric elevation model generated for the region, namely, Adam's Bridge, which encompasses a chain of shoals between Rameswaram Island, off the southeastern coast of Tamil Nadu, India, and Mannar Island, off the northwestern coast of Sri Lanka. The proposed dataset has taken advantage of the photon penetrability in the shallow waters by the green laser of ICESat-2 LiDAR to derive the seabed topography. Seafloor depths from ~0.2 million geolocated photons of ICESat-2 for the study area were accrued and interpolated to generate a 10 m digital bathymetric elevation model. Adam's Bridge, an isthmus and submerged reefal assemblage in shallow and super-shallow waters, is a feature of scientific curiosity. Our dataset has the potential to enhance the understanding of Adam's Bridge structure by providing substantial information to reconstruct its evolution.

Physical features of Adam's Bridge interpreted from ICESat-2 based high-resolution digital bathymetric elevation model.

Adam's Bridge is a submerged ridge connecting India and Sri Lanka, generally regarded as a chain of shoals extending for ~ 29 km from Dhanushkodi on the Indian side to Talaimannar Island of Sri Lanka. A high-resolution digital bathymetric elevation model generated using the seafloor returned photons of ICESat-2 was used to understand the intricate details of Adam's Bridge structure. Photons emanating from ICESat-2's green laser have the potential to detect the seafloor up to a depth of ~ 40 m; taking a cue from this potentiality, in our research, we have accrued ~ 0.2 million photons representing the depth information and generated a 10 m resolution bathymetric data for the extent of Adam's Bridge. Visual interpretations made from this bathymetric data through 3D perspectives with multi-directional lighting effects, and also with the derived parameters like contours, slope, and volumetric analysis, enabled us to recognize the current form of Adam's Bridge's physical features. The results from our research confirm that, in its entirety, Adam's Bridge is a submarine continuation of Dhanushkodi and Talaimannar Island. Throughout the crest line of Adam's Bridge, approximately 1.5 km on either side is highly undulating within the super-shallow water with occurrences of sudden depths. There is an asymmetry of transverse slopes to the base on both sides of Adam's Bridge, indicating dominant transgression of material energy from the waters of the Gulf of Mannar compared to the Palk Strait. The volume of Adam's Bridge computed in our research yielded a value of ~ 1 km3; interestingly, only 0.02 percent of this volume is above the mean sea level, and in general, the same is visible in optical satellite imagery-in total ~ 99.98 percent of the Adam's Bridge is submerged in shallow and super-shallow waters.

Characterization of Polycyclic Aromatic Hydrocarbons (PAHs) associated with fine aerosols in ambient atmosphere of high-altitude urban environment in Sikkim Himalaya.

Polycyclic Aromatic Hydrocarbons (PAHs) compounds are ubiquitous in ambient air due to their persistence, carcinogenicity, and mutagenicity. Gangtok being one of the cleanest cities in India located in Eastern Himalayan region, witnesses high developmental activities with enhanced urbanization affecting the ambient air quality. The present study aims to measure PM2.5 and PAHs in the ambient atmosphere of the Sikkim Himalaya to understand the influence of natural and anthropogenic activities on aerosol loading and their chemical characteristics. The PM2.5 samples were collected and analysed for the duration from Jan 2020 to Feb 2021.The seasonal mean concentrations of PM2.5 and PAHs were observed to be high during autumn and low during summer season. Overall, the annual mean concentration of PM2.5 was found higher than the prescribed limit of World Health Organization and National Ambient Air Quality Standards. The concentration of the 16 individual PAHs were found to be highest during autumn season (55.26 ± 37.15 ng/m3). Among the different PAHs, the annual mean concentration of fluorene (3.29 ± 4.07 ng/m3) and naphthalene (1.15 ± 3.76 ng/m3) were found to be the highest and lowest, respectively. The Molecular Diagnostic Ratio (MDR) test reveals higher contribution from heavy traffic activities throughout the winter and autumn seasons. The other possible sources identified over the region are fossil fuel combustion, and biomass burning. The multivariate statistical analysis (Multifactor Principal Component Analysis) also indicates a strong association between PM2.5 /PAHs and meteorological variables across the region in different seasons. The precipitation and wind pattern during the study period suggests that major contribution of the PM2.5 and PAHs were from local sources, with minimal contribution from long-range transport. The findings are important for comprehending the trends of PAH accumulation over a high-altitude urban area, and for developing sustainable air quality control methods in the Himalayan region.

Cutaneous metastases as initial presentation of malignancy.

We describe a case of 73-year-old female who presented with dry cough, chest pain and light-headedness. On examination, multiple subcutaneous masses were noticed on the chest wall, bilateral breast, anterior abdomen and both arms. Subsequent CT-TAP and CT-brain showed multiple subcutaneous nodules in scalp, neck, anterior chest wall, breast and abdomen. A biopsy taken from breast revealed metastatic malignant melanoma; however there was no evidence of primary cutaneous malignant melanoma. We also describe a case of 72-year-old male who presented with tender mass on his lower back and posterior neck. He was known to have COPD and was a heavy smoker. A CT-TAP showed right lower lung mass with soft tissue masses near lumbar spine and lower cervical spine. While awaiting bronchoscopy, biopsy taken from the mass on lower back showed features of metastatic lung adenocarcinoma. In fact, presence of cutaneous metastasis is heraldsign and indicates advanced malignancy with poor prognosis regardless of type of primary malignancy.

Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, having high recurrence despite antibiotic prophylaxis. Small bowel dysmotility and bacterial overgrowth have been documented to be related to SBP. The purpose of the present paper was (i) to study whether addition of a prokinetic agent to norfloxacin ameliorates the development of SBP in high-risk patients; and (ii) to identify risk factors for SBP development. METHODS: A prospective, single blinded, randomized controlled trial was conducted in high-risk cirrhotic patients with ascites who had either recovered from an episode of SBP or who had low ascitic fluid protein. Norfloxacin 400 mg once daily (group I) or norfloxacin 400 mg once daily with cisapride 20 mg twice a day (group II) was given and occurrence of side-effects of therapy and mortality were recorded. RESULTS: Of the 94 patients, 48 (51%) were in group I, and 46 (49%) in group II. The actuarial probability of developing SBP at 12 month in group I was 56.8% and in group II, 21.7% (P = 0.026). Treatment failure was observed in five patients (10%) in group I and none in group II (P = 0.003). The actuarial probability of death at 18 months was 20.6% in group I and 6.2% in group II (P = 0.1). Low serum albumin, low ascitic fluid protein and alcoholic cirrhosis were related to development of SBP (P < 0.05). Additionally, low serum albumin (2.8 g/dL), gastrointestinal bleeding, alcoholic cirrhosis and low ascitic fluid protein were significantly associated with multiple occurrences of SBP. CONCLUSIONS: Prophylaxis with norfloxacin and cisapride significantly reduces the incidence of SBP in high-risk cirrhosis patients; low serum albumin, low ascitic fluid protein and alcoholic cirrhosis predispose to the development of SBP in high-risk cirrhosis patients; and low ascitic fluid protein should also be considered as a risk factor for the development of SBP requiring prophylaxis.