Rete middle cerebral artery presenting with a ruptured aneurysm

ABSTRACT

The developmental anomaly of the middle cerebral artery (MCA) is a rare occurrence. Rete MCA, also known as "unfused," "twig-like," and aplastic MCA, is an even rarer anomaly. These immature rete vessels are prone to flow-related aneurysms which rupture themselves presenting with intraparenchymal hematoma. We here with present a case of rete MCA with a ruptured aneurysm and discuss its pathophysiology and management.

Incremental yield of Xpert® MTB/RIF Ultra over Xpert® MTB/RIF in the diagnosis of extrapulmonary TB

BACKGROUND: Extrapulmonary TB (EPTB) comprises approximately 15-20% of TB cases worldwide, and its diagnosis is difficult. The sensitivity of Xpert^® MTB/RIF (Xpert) in the diagnosis of EPTB is low on account of its paucibacillary nature. Xpert^® MTB/RIF Ultra (Ultra) was developed to improve sensitivity.OBJECTIVE: To compare the sensitivity of Ultra test with that of Xpert against MGIT™ (Mycobacteria Growth Indicator Tube) culture and a composite reference standard (CRS).METHODS: We recruited consecutive treatment-naïve patients with suspected EPTB. Demographic information, clinical and relevant laboratory data were collected.RESULTS: From January 2019 to November 2019, 210 patients provided 250 samples. Against MGIT culture, the sensitivity of Ultra was significantly higher than Xpert (72% vs. 51.1%; P = 0.04), the specificity was lower (87.8% vs. 95.1%). Against the CRS also, the sensitivity of Ultra was significantly higher than Xpert (45.4% vs. 25.2%; P = 0.002); however, the specificities were similar (98.2% vs. 99.1%). The trend towards higher sensitivity of Ultra compared to Xpert was seen in most of the individual samples. The sensitivities against MGIT and CRS were as follows: lymph node (68.1% vs. 31.8%; P = 0.01) and (59.5% vs. 23.8%; P = 0.001), pleural biopsy (80.0% on both; P = NS) and (53.8% vs. 46.2%; P = NS) and pleural fluid (66.7% vs. 50%; P = NS) and (22.5% vs. 9.6%; P = NS), respectively.CONCLUSIONS: Xpert Ultra showed a significantly higher sensitivity in diagnosing EPTB than Xpert.

Shallow convective mixing promotes massive Noctiluca scintillans bloom in the northeastern Arabian Sea

The northeastern Arabian Sea (NEAS) experiences convective mixing during winter, but this mixing does not reach up to the silicicline, resulting in the limited supply of silicate (Si) compared to nitrate (N) and phosphate (P) to the mixed layer (ML) and formation of non-diatom blooms. The poleward advection of waters of low surface salinity by the West India Coastal Current (WICC) to the NEAS weakens the vertical mixing and reduces the Si input to the mixed layer, resulting in occurrence of Noctiluca scintillans blooms. The saturation of dissolved oxygen in the NEAS varied between 88 and 98%, suggesting N. scintillans blooms occur in oxic conditions. Enhanced cell abundance of N. scintillans was observed in the bloom region in the upper 10 m. Phytoplankton pigments data revealed higher contribution of Chlorophytes, Prasinophytes, Prymnesiophytes and Prochlorophytes in the bloom than non-bloom region. The isotopic composition of nitrogen and carbon of particulate organic matter indicated that natural and in situ processes contributed to both nutrients and organic carbon pool in the NEAS in supporting the massive occurrence of N. scintillans blooms than hitherto hypothesized to anthropogenic sources. This study further suggests that the effect of anthropogenic pollutants released into the NEAS from the mega-cities is limited to the neighbourhood of these cities and does not affect the open ocean.

Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?

SETTING

Antiretroviral treatment (ART) Centre in Tumkur district of Karnataka State, India. There is no published information about pre-ART loss to follow-up from India.

OBJECTIVE

To assess the proportion lost to follow-up (defined as not visiting the ART Centre within 1 year of registration) and associated socio-demographic and immunological variables.

DESIGN

Retrospective cohort study involving a review of medical records of adult HIV-infected persons (aged ⩾15 years) registered in pre-ART care during January 2010-June 2012.

RESULTS

Of 3238 patients registered, 2519 (78%) were eligible for ART, while 719 (22%) were not. Four of the latter were transferred out; the remaining 715 individuals were enrolled in pre-ART care, of whom 290 (41%) were lost to follow-up. Factors associated with loss to follow-up on multivariate analysis included age group ⩾45 years, low educational level, not being married, World Health Organization Stage III or IV and rural residence.

CONCLUSION

About four in 10 individuals in pre-ART care were lost to follow-up within 1 year of registration. This needs urgent attention. Routine cohort analysis in the national programme should include those in pre-ART care to enable improved review, monitoring and supervision. Further qualitative research to ascertain reasons for loss to follow-up is required to design future interventions.

Intramolecular cyclization assisted oxidative addition: synthesis of octahedral cycloplatinated methyl complexes

Cycloplatination of XMeC₆H₄CCC-(R_f) (N-4-OCH₃C₆H₄) [X = S, Se and R_f = perfluoroalkyl groups] with PtCl₂ gave a monomeric octahedral Pt(iv) complex. Emission and reactivity studies of the Pt(iv) complexes are discussed.

Comment on "The great Sumatra-Andaman earthquake of 26 December 2004"

Lay et al. (Research Articles, 20 May 2005, p. 1127) estimated a 600-km length for the tsunami source region. Adding tide-gauge data from Paradip, the northernmost of the Indian east-coast stations and therefore the most critical constraint on the northern extent of the source, we estimate that its length was greater by approximately 30%.