Granulicatella adiacens as an Unusual Cause of Empyema: A Case Report and Review of Literature.

Granulicatella adiacens , a nutritionally variant Streptococcus (NVS), is part of the normal commensal flora of human mouth, genital, and intestinal tracts and rarely causes disease. It has been mostly reported from bacteremia and endocarditis cases, but rarely can cause vertebral osteomyelitis, pancreatic abscess, otitis media, and endovascular, central nervous system, ocular, oral, bone and joint, and genitourinary infections. Due to requirement of fastidious culture conditions and non-specific colony morphology, serious diagnostic difficulties may arise in cases of NVS infections. Here, we are reporting a rare fatal infection of G. adiacens presented with empyema complicated to sepsis and necrotizing fasciitis. Clinicians should be aware of the pathogenic potential of Granulicatella adiacens (a normal commensal flora of human mouth, genital and intestinal tracts). Appropriate supplemented media and a reliable detection system should be used to identify these fastidious organisms. We present this rare case to bring awareness among clinicians regarding such a rare but potentially fatal infection.

Concomitant echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase rearrangement and epidermal growth factor receptor mutation in non-small cell lung cancer patients from eastern India.

BACKGROUND: In non-small cell lung cancer common driver mutations such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) are usually mutually exclusive. This study aimed to elucidate the concurrence of EGFR mutation and ALK rearrangement in eastern India patients with primary lung adenocarcinoma and assess the response of EGFR tyrosine kinase inhibitor (TKI) therapy after 6 months in primary lung adenocarcinoma. METHODS: We retrospectively analyzed 198 adenocarcinomas for EGFR and ALK mutations. EGFR and ALK tests were done by real-time polymerase chain reaction and immunohistochemistry (IHC) techniques, respectively. Radiological response was assessed by Response Evaluation Criteria in Solid Tumors (version 1.1). RESULTS: EGFR/ALK co-alteration was found in 4 adenocarcinoma patients. All were males with advanced disease. Younger patients had exon 19 deletion whereas older ones showed exon 21 mutation. The initial option of ALK-TKI in all four patients was excluded straightaway due to the high-cost burden of ALK-TKI. Two of them showed a partial response while other two had stable disease after 6 months of EGFR TKI therapy. CONCLUSION: EGFR/ALK co-alterations in adenocarcinomas albeit rare do exist. The challenge of monetary hurdle in developing countries with ALK TKI therapy can be handled by giving only EGFR TKI in these cases of concomitant mutations. Future perspective in research could be finding an agent with the potential of dual inhibition of ALK and EGFR.

Rasmussen's aneurysm masquerading as mass lesion.

Haemoptysis is an often encountered respiratory symptom. The amount of haemoptysis varies from mild to life-threatening severity and may indicate the underlying pulmonary disorder. Herein, we report a 50-year-old male smoker who presented with occasional streaky to mild haemoptysis for last 1 year. He had pulmonary tuberculosis 10 years ago and had received adequate treatment. Chest radiograph was suspicious of a mass lesion in left upper lung. Contrast-enhanced CT scan of thorax revealed pulmonary artery pseudoaneurysm suggestive of Rasmussen's aneurysm. Unlike this case, Rasmussen's aneurysm usually manifests as life-threatening haemoptysis and portends a high mortality.

Tuberculous splenic abscess in the immunocompetent host: a report and review of literature.

Tubercular splenic abscess is rare, particularly in immunocompetent patients. Diagnostic difficulties usually arise in patients with tubercular splenic abscess because of its non-specific presentation. We report an elderly male who presented with cough and fever and had pulmonary infiltrates suspicious of tuberculosis. Bronchoalveolar lavage microbiology including XpertMTB/Rif assay was non-contributory. Contrast enhanced computed tomography scan of abdomen revealed multiple non-enhancing lesions in the spleen. Ultrasound guided splenic aspirate revealed pus that was positive for Mycobacterium tuberculosis in XpertMTB/Rif assay confirming the diagnosis of tuberculosis.

Nano-Ionic Solid State Resistive Memories (Re-RAM): A Review.

Nano-ionic devices based on modest to fast ion conductors as active materials intrigued a revolution in the field of nano solid state resistive memories (the so-called Re-RAM) ever since HP labs unveiled the first solid state memristor device based on titanium dioxide (TiO2). This has brought impetus to the practical implementation of fourth missing element called "Memristor" correlating charge (q) and flux (φ) based on the conceptual thought by Chua in 1971 completing a missing gap between the passive electronic components (R, C and L). It depicts various functional features as memory element in terms of ionic charge transport in solid state by virtue of external electric flux variations. Consequently, a new avenue has been found by manipulating the ionic charge carriers creating a fast switching resistive random access memory (Re-RAM) or the so-called Memristors. The recent research has led to low power, faster switching speed, high endurance and high retention time devices that can be scaled down the order of few nanometers dimension and the 3D stacking is employed that significantly reduces the die area. This review is organized to provide the progress hitherto accomplished in the materials arena to make memristor devices with respect to current research attempts, different stack structures of ReRAM cells using various materials as well as the application of memristive system. Different synthesis approaches to make nano-ionic conducting metal oxides, the fabrication methods for ReRAM cells and its memory performance are reviewed comprehensively.