Hemophagocytic lymphohistiocytosis complicating septicemic melioidosis: A case report.

Melioidosis is an infectious disease caused by Burkholderia pseudomallei. People infected with B. pseudomallei experience fever and skin changes, pneumonia, abscesses, and septic shock that could cause death. Hemophagocytic lymphohistiocytosis is a severe inflammatory syndrome due to the excess activation of macrophages and T cells. We report a 50-year-old hypertensive and diabetic male patient presented with high-grade intermittent fever with loss of appetite and weight loss for two months and a history of jaundice, backache and swelling of both feet for 15 days. Blood and bone marrow culture grew Burkholderia pseudomallei. A liver biopsy revealed Kupffer cell hyperplasia and hemophagocytosis. The patient was treated with an injection of dexamethasone 4mg intravenous three times a day for five days and tapered over 15 days with ceftazidime 2 gm intravenous three times a day for six weeks. Early suspicion in the diagnosis of hemophagocytic lymphohistiocytosis in septicemia can prevent severe complications, even death.

Ovarian mass Presenting as Paraneoplastic cerebellar degeneration with peripheral neuropathy and anti-Yo antibody.

Paraneoplastic neurological syndromes (PNS) are a group of disorders with diverse neurological manifestations that are observed in patients with various types of cancer. Any portion of the nervous system can be affected by these syndromes, which are brought on by processes other than metastasis, direct tumour spread or chemotherapy side effects. An immune-mediated attack on the cerebellar Purkinje cells and consequent cerebellar symptoms define paraneoplastic cerebellar degeneration(PCD), a subtype of the PNS. Axonal or demyelinating paraneoplastic peripheral neuropathies are both possible. Here, we describe the case of a middle-aged woman who presented with subacute-onset cerebellar symptoms and peripheral neuropathy, was discovered to have a positive anti-Yo antibody, and was later detected to have an ovarian mass. This case illustrates the significance of considering a paraneoplastic aetiology in patients with otherwise unexplained neurological manifestations and initiating an appropriate workup and early treatment for the primary malignancy.

Attention-based fusion of multiple graphheat networks for structural to functional brain mapping.

Over the last decade, there has been growing interest in learning the mapping from structural connectivity (SC) to functional connectivity (FC) of the brain. The spontaneous fluctuations of the brain activity during the resting-state as captured by functional MRI (rsfMRI) contain rich non-stationary dynamics over a relatively fixed structural connectome. Among the modeling approaches, graph diffusion-based methods with single and multiple diffusion kernels approximating static or dynamic functional connectivity have shown promise in predicting the FC given the SC. However, these methods are computationally expensive, not scalable, and fail to capture the complex dynamics underlying the whole process. Recently, deep learning methods such as GraphHeat networks and graph diffusion have been shown to handle complex relational structures while preserving global information. In this paper, we propose a novel attention-based fusion of multiple GraphHeat networks (A-GHN) for mapping SC-FC. A-GHN enables us to model multiple heat kernel diffusion over the brain graph for approximating the complex Reaction Diffusion phenomenon. We argue that the proposed deep learning method overcomes the scalability and computational inefficiency issues but can still learn the SC-FC mapping successfully. Training and testing were done using the rsfMRI data of 1058 participants from the human connectome project (HCP), and the results establish the viability of the proposed model. On HCP data, we achieve a high Pearson correlation of 0.788 (Desikan-Killiany atlas with 87 regions) and 0.773 (AAL atlas with 86 regions). Furthermore, experiments demonstrate that A-GHN outperforms the existing methods in learning the complex nature of the structure-function relation of the human brain.

Clinical presentation and outcome of children with hydatid disease: a retrospective cross-sectional study from a tertiary care hospital in eastern India.

Clinical presentation of echinococcosis in paediatric population is varied and depends on the site of involvement. The present study was planned to analyse the clinical presentations and therapeutic options for management of echinococcosis in children admitted to a tertiary care hospital. Medical records of children with echinococcosis was reviewed retrospectively over a period of 3 year and 6 months. Demographic data, clinical presentation, management and outcome data were collected and analysed. During the study period, 14 children with hydatid disease were admitted to the hospital. The frequency was higher in male (71.4%) compared to females (28.6%). Liver was found to be the commonest site for hydatid cyst with 78% of all cases had hydatid cyst localised to liver. In half of all cases liver was the only site of involvement. Both liver and lung were involved in 21.4% cases and one patient (7.1%) had pelvic hydatid cyst in addition to liver involvement. Two patients (14.3%) had only pulmonary involvement and one (7.1%) patient had a hydatid cyst in common bile duct. Right upper abdominal pain was the most common presentation (78.5%) with cyst in liver. Cough, breathing difficulty, jaundice was observed in 28.5%, 21.4% and 7.1% of all patients respectively. All children were managed with a combination of surgical and medical therapy. Right upper abdominal pain and chronic cough were the common clinical presentation of hydatid cyst with hepatic and pulmonary involvement respectively. Presence of such chronic symptoms would raise the clinical suspicion of hydatid disease in endemic regions.