We present a case of prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor, a site suitable to perform an endoscopic third ventriculostomy (ETV) stoma, managed endoscopically, and discuss our findings. A 5-year-old male child was admitted in an unconscious state with a history of gradually progressive symptoms of raised intracranial pressure and low-grade fever for the last 3 months. Head computed tomography showed thick enhancing basal exudates, a prepontine-suprasellar ring-enhancing lesion with consequent obstructive hydrocephalus. The child was subjected to urgent endoscopy which revealed multiple ependymal tubercles along with prepontine-suprasellar tuberculoma involving the premamillary region of the third ventricular floor. The tuberculoma was decompressed using a 5-french catheter, and ETV was performed. Postoperatively, the child improved clinicoradiologically on antitubercular chemotherapy and needed no further cerebrospinal fluid diversion surgery; he is under regular follow-up. We conclude that ETV may be attempted even in the presence of thick basal exudates and/or prepontine-suprasellar tuberculoma.
BACKGROUND This study emphasizes the importance of computed tomography (CT) imaging in acute pancreatitis to grade clinical severity and predict outcome. The clinical and radiological findings in acute pancreatitis were correlated to predict the severity of the disease and its prognosis. MATERIALS AND METHODS Selected patients with clinical diagnosis of acute pancreatitis were evaluated clinically using Ranson's criteria and then by CT scan for Balthazar grading and CT severity index (CTSI). RESULTS In our prospective study of 91 patients of acute pancreatitis, the male:female ratio was approximately 2:1 and the aetiological agents were mainly alcoholism (41) seen predominantly in males and cholelithiasis (32) which was more in females. The Ranson's score of acute pancreatitis was calculated based on appropriate laboratory data and divided into two groups-mild in 51 and severe in 40 patients. The findings on CT scan were taken as standard for classifying acute pancreatitis into mild (57) and severe (34) forms based on Balthazar CTSI. 5 patients with severe form had prolonged hospital stay (>20 days). Also 5 patients had expired during the study duration (5.5 %) and they had severe form. The sensitivity and specificity of Ranson's criteria to correctly prognosticate the severity of acute pancreatitis were 86% and 68% respectively on correlation with Balthazar's CTSI. The discrepancy between Ranson's and Balthazar's CTSI in assessing the severity of acute pancreatitis existed in approximately 22% of the cases. CONCLUSION The Balthazar's CTSI based classification is superior to Ranson's scoring system in prediction and prognostication of severity of acute pancreatitis as computed tomography study provides direct visualization of anatomical distortion and pathological extension of disease process in acute pancreatitis, with particular emphasis on pancreatic necrosis.
Atrial fibrillation (AF) is considered as one of the most common cardiac arrhythmias worldwide and is always associated with a significantly increased risk of stroke and thromboembolism. VKAs (Warfarin & Acenocoumarol) are highly effective in reducing the risk of stroke in patients with AF, but bleeding issues & disutility sparked the development of direct oral anticoagulants (DOACs) or NOACs (Novel oral anticoagulants). These drugs, offer the convenience of once or twice daily dosing without the need for laboratory monitoring of coagulation activity (PT/ INR) or routine dose adjustment. Various clinical trials proved their non-inferiority to warfarin (VKA) in reducing the risk of stroke or systemic embolism, and each was associated with markedly lower rates of ICH than well-adjusted warfarin. Yet there are no direct head-to-head comparative trials for the efficacy & safety of NOACs. In this review we try to provide patient centric approach to assist Indian physicians in selecting right OAC therapy for SPAF with respect to best possible evidence and recommendations available worldwide.
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