Recent studies have shown that there is an increase in the incidence of mycobacterium tuberculosis (MBT). This is more prevalent among immune compromised patients (those on dialysis) and recipients of organ transplants. Furthermore, extra-pulmonary presentation appears to be more common and difficult to diagnose. We aimed in this study to assess and evaluate the presentation of MBT in a retrospective study conducted among 256 hemodialysis (HD) patients where 18 of them were diagnosed and managed for tuberculosis over a 10-year period between 1990 and 2000. The mean age of the patients was 38 years (21-75 years). The mean interval between the onset of HD and the time of diagnosis was about 24 months (1-120 months). The diagnosis of tuberculosis was made either by isolation of acid-fast bacilli (AFB), the typical caseating granuloma on biopsy, or by recovery of tubercle bacilli from the culture of the biopsy material. Extra-pulmonary tuberculosis was more common (77.8%) than pulmonary tuberculosis (22.2%). The various extra-pulmonary tuberculosis sites noted were cervical lymphadenitis (16.7%), gastrointestinal (16.7%), genitourinary (11.1%), peritonitis (11.1%), pleural effusion (5.6%), pericardial effusion (5.6%), miliary tuberculosis (5.6%), and pyrexia of unknown origin (5.6%). None of the patients with extra-pulmonary tuberculosis had evidence of pulmonary tuberculosis. The atypical presentation with insidious onset was quite common. Anergy to tuberculin skin test was noticed in 56% of cases. All of our patients received modified antituberculosis treatment for 1 year with adequate response, and without undue side effects. We conclude that a high index of suspicion is required especially in the diagnosis of extra-pulmonary tuberculosis, and when there is a high percentage of anergy to tuberculin skin test. Tissue biopsy both for characteristic histology and demonstration of MTB, either by staining or culture, remains the main criteria for the diagnosis of extra-pulmonary tuberculosis.
Aims: To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). Methods: Case records were reviewed of all patients with TGN and MS who underwent posterior fossa exploration with a view to MVD between 1993 and 2001. In all patients, magnetic resonance tomoangiography (MRTA) demonstrated vascular compression. Results: Nine patients were included in the study. Seven patients underwent MVD alone; in 2 patients a partial sensory rhizotomy of the trigeminal nerve was added to the decompression. All patients had excellent initial pain relief. Recurrence of neuralgia was noted in 5 patients after MVD and in 1 of the 2 patients after partial sensory rhizotomy. Long-term pain relief was obtained in 1 patient who underwent a redo MVD after postoperative MRTA scans demonstrated recurrent vascular compression of the root entry zone (REZ). Thus only 4 out of 9 patients maintained pain relief. In addition, 3 patients experienced transient worsening of their MS. Conclusions: Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in ‘idiopathic’ TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.
• In the post-sunset hours, the plasma restructuring results into independent EPBs • The migrating structure assumed a wave-like pattern possibly related to LSTIDs moving with a velocity of about 650 m/s • The method used to derive PPEFs from the overall ionospheric disturbance is able to discriminate between prompt and delayed disturbance
Low-latitude Pi2 pulsations in the topside ionosphere are investigated using vector magnetic field measurements from LEO satellite, CHAMP, and underneath ground station. Substorm-associated Pi2s are initially identified using high-resolution data from Indian station Shillong, during 2007Shillong, during -2009, and are further classified into three subgroups of Pi2 band (6-25 mHz), based on its frequency. During nighttime, coherent in-phase oscillations are observed in the compressional component at satellite and horizontal component at underneath ground station for all the Pi2 events, irrespective of the Pi2 frequency. We observe that the identification of daytime Pi2s at CHAMP (compressional component) depends on the frequency of Pi2 oscillation; i.e., 40%, 45%, and 100% of Pi2 events observed in dayside ground station with frequency between 6-10 mHz, 10-15 mHz, and 15-25 mHz were identified at satellite, respectively. At CHAMP during daytime, the presence of a dominant power in the lower frequencies of Pi2 band, which is unique to satellite, is consistently observed and can modify the Pi2 oscillations. Pi2s having frequency >15 mHz are less affected by these background frequencies, and a clear signature of daytime Pi2s at CHAMP is possible to observe, provided that contribution from non-Pi2 frequencies at satellite from the lower end of Pi2 band is eliminated. Daytime Pi2s identified in the topside ionosphere showed coherent but mostly opposite phase oscillations with underneath ground station, and satellite-to-ground amplitude ratio is, in general, found to be less than 1. Present results indicate that a combination of fast cavity-mode oscillations and an instantaneous transmission of Pi2 electric field from high-to low-latitude ionosphere is responsible for the observation of daytime Pi2s.
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