ABSTRACT
Introduction: Adenocarcinoma is the most common form oflung cancer. It is a type of non small cell carcinoma of lung,most commonly seen in women. Adenocarcinoma occurs inmore peripheral lung location and may be associated with thehistory of smoking.Case report: A 54 year old female caretaker presented withcough with expectoration since 1 month, gradual in onset,non progressive, scanty in amount associated with decreasedappetite since 1 month and breathlessness on exertion since 1week. She had a history of exposure to tuberculosis patient andwas diagnosed with meningioma. There was history of passivesmoking. General examination showed right supraclavicularlymph node enlargement. Respiratory examination showeddecreased chest movements bilaterally along with coarsecrepitation all over lung fields along with decreased intensityof breath sounds bilaterally. Chest x-ray was suggestive ofmetastasis. HRCT chest also suggested metastasis. FNAClymph node and sputum of cytology suggestive of metastaticadenocarcinoma. USG abdomen and pelvis as well as CECTabdomen was done to rule out primary lesionConclusion: As survival rates vary significantly depending onthe type of adenocarcinoma, the survival rate after five yearsdepends on the stage of cancer. So early detection is criticalfor better outcome. The prognosis for different metastaticpattern of intrathoracic metastasis of Lung distinct in EGFRmutant lung adenocarcinoma patient. Early diagnosis andprompt initiation of treatment is key for the prognosis.
ABSTRACT
Introduction: Bleeding is a significant complication whenpatients are on anticoagulant therapy. The risk of bleedingoverall when anticoagulant therapy is used is 3.8%. A numberof risk factors are associated with increased bleeding whenpatients are on anticoagulants. A practical risk score HASBLED score was developed to estimate 1year risk for majorbleeding in patients with atrial fibrillation. This study aimedto understand to assess the relevance of HAS-BLED scorein predicting bleeding in patients coming to AJ institute ofmedical sciences.Material and methods: We conducted a case control studyin patients on Warfarin therapy for Atrial fibrillation whopresented with major bleeding manifestations betweenSeptember2017-2018 in a tertiary care centre in AJ InstituteOf Medical Sciences in South India. Patients or their medicalpower of attorneys provided written informed consent. Atotal no of 100 patients were enrolled based on the inclusioncriteria patients aged more than 18 years. They were groupedinto cases who had bleeding and controls who did not havebleeding. HAS BLED score was calculated. The data wasentered in Microsoft Excel and was analysed with SPSSResults: Total of 100patients (50cases and 50controls) werestudied. On analysing the HAS-BLED score the P valueshowed significant difference between the case and controlgroups. The sensitivity was 80% and specificity was 68%. Thepositive and negative predictive value of HAS-BLED valueswere 71.4% and 77.27% respectively.Conclusion: Our study emphasises the need for making betteruse of HAS-BLED score in predicting bleeding and the needfor monitoring the INR regularly and educating patients onWarfarin therapy about frequent monitoring, the risks ofbleeding and to seek early medical attention on developingbleeding.
ABSTRACT
The incidence of extrapulmonary tuberculosis is rising globally due to the increased prevalence of HIV infection. Hence a high clinical suspicion and supportive diagnostics is necessary for the diagnosis . The incidence of Acid fast bacilli being positive by ZN stain is very low, but in our patient who prented with easy fatigability, fever and abdominal distension of 5 months duration found to have both pleural and ascitic fluid positive for the organism.the patient was started with anti-tuberculosis treatment and is improving.