Brucellosis Masquerading as Disseminated Tuberculosis: A Clinical Case Report.

Human brucellosis is a common zoonotic disease in certain regions of the world, especially in rural populations, yet it is often neglected. The index patient presented with prolonged fever and headache. Examination revealed hepatosplenomegaly, and investigations revealed transaminitis with bicytopenia with serological evidence positive for Brucella. The radiological picture suggested granulomatous disease with miliary nodules, and a bone marrow examination revealed a noncaseating granuloma. The case was unique and challenging, as the clinical picture was consistent with epidemiologically prevailing tuberculosis, which is also seen in brucellosis-endemic countries. Brucellosis mimicked disseminated tuberculosis, making the case intriguing to diagnose and treat. The case demonstrated that physicians need to have a high index of suspicion for brucellosis, which should be actively investigated in cases with prolonged fever. It also illustrated the fundamental importance of teamwork and the centrality of the multidisciplinary team in the planning and prioritization of treatment.

Ultrasonography for Assessment of Sarcopenia: A Primer.

The human skeletal muscle has a pivotal role in preserving health by maintaining mobility, balance, and metabolic homeostasis. Significant muscle loss as a part of aging and accelerated by disease leads to sarcopenia which becomes an important predictor of quality of life in older persons. Therefore, clinical screening for sarcopenia and validation by precise qualitative and quantitative measurement of skeletal muscle mass (MM) and function is at the center-stage of translational research. Many imaging modalities are available, each having their strengths and limitations, either in interpretation, technical processes, time constraints, or expense. B-mode ultrasonography (US) is a relatively novel approach to evaluating muscle. It can measure several parameters such as MM and architecture simultaneously including muscle thickness, cross-sectional area, echogenicity, pennate angle, and fascicle length. It can also evaluate dynamic parameters like muscle contraction force and muscle microcirculation. US has not gained global attention due to a lack of consensus on standardization and diagnostic threshold values to diagnose sarcopenia. However, it is an inexpensive and widely available technique with clinical applicability. The ultrasound-derived parameters correlate well with strength and functional capacity and provide potential prognostic information. Our aim is to present an update on the evidence-based role of this promising technique in sarcopenia, its advantages over the existing modalities, and its limitations in actual practice with the hope that it may emerge as the "stethoscope" for community diagnosis of sarcopenia.

Bilateral Complete Oculomotor Palsy in Tubercular Meningitis.

A 20-year-old female presented to the emergency department with fever, anorexia, headache, and neck stiffness for two weeks with recent onset of diplopia and ptosis. She was found to have bilateral symmetrical and complete oculomotor palsy. The diagnosis of tubercular meningitis (TBM) was established on magnetic resonance imaging of the brain and cerebrospinal fluid examination. The oculomotor palsy was attributed to tubercular exudates along the ventral surface of midbrain. Although cranial nerves palsies are common in TBM, such a pattern is rarely seen and has been reported only in the context of tuberculoma in midbrain. She was treated with anti-tubercular therapy for nine months, but there was only partial recovery of the oculomotor function.

Hepato-Duodenal Fistula Complicating a Pyogenic Liver Abscess: An Unusual Presentation.

An elderly male with type 2 diabetes mellitus was admitted to the emergency ward with fever and pain over the right hypochondrium since one month. An abdominal ultrasound revealed an ill-defined hypoechoic lesion with multiple air foci measuring 8 x 6 x 4 cm within the left lobe of the liver implicating segments III b and IV. A contrast-enhanced computed tomography (CECT) scan of the abdomen showed a similar lesion with leakage of oral contrast into the dependent areas of the collection from a rent in the antero-inferior aspect of the first part of the duodenum. Hepato-duodenal fistula or entero-hepatic fistula secondary to pyogenic liver abscess is an atypical and unusual complication requiring a high degree of suspicion for its diagnosis. Though optimal therapy for its management is still not known, early diagnosis with prompt initiation of therapy is imperative to reduce mortality.

Visual implications of digital device usage in school children: a cross-sectional study.

PURPOSE: To evaluate the use of digital devices, reading habits and the prevalence of eyestrain among urban Indian school children, aged 11-17 years. METHODS: The study included 576 adolescents attending urban schools who were surveyed regarding their electronic device usage. Additional information on the factors that may have an effect on ocular symptoms was collected. RESULTS: Twenty percent of students aged 11 in the study population use digital devices on a daily basis, in comparison with 50% of students aged 17. In addition to using these devices as homework aids, one third of study participants reported using digital devices for reading instead of conventional textbooks. The majority of students preferred sitting on a chair while reading (77%; 445 students), with only 21% (123 students) preferring to lie on the bed and 8 students alternating between chair and bed. There was a significant association between the students who preferred to lie down and those who experienced eyestrain, as reported by a little over one fourth of the student population (27%). Out of 576 students, 18% (103) experienced eyestrain at the end of the day after working on digital devices. CONCLUSIONS: The increased use of digital devices by adolescents brings a new challenge of digital eyestrain at an early age. Our study reports the patterns of electronic device usage by school children, evaluates factors associated with eyestrain and highlights the need for further investigation of these issues.