Chronic Extrahepatic Portal Vein Occlusion in a Young Patient.

Extrahepatic portal vein obstruction (EHPVO) is a rare condition characterized by the occlusion or narrowing of the portal vein outside the liver. We present a case report of a patient with EHPVO secondary to combined protein C and S deficiency and pancytopenia secondary to hypersplenism, highlighting the clinical presentation, diagnostic challenges, and management strategies. Early recognition of this condition and prompt initiation of appropriate treatment can prevent life-threatening complications such as variceal bleeding and portal hypertension. This case underscores the need for a high index of suspicion for inherited thrombophilias in patients presenting with portal vein thrombosis, particularly in the absence of traditional risk factors.

Hematological Parameters for Predicting Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

(1) Introduction: COPD is a common and serious condition affecting a significant proportion of the population globally. Patients often suffer from exacerbations which lead to the worsening of their health status and respiratory function, and can often lead to death. Quick and cheap investigations are required that are capable of predicting mortality in patients with acute exacerbations that can be applied in low resource settings. (2) Materials and methods: This was a retrospective study carried out using hospital records of patients admitted for AECOPD from 1 January 2017 to 30 November 2022. Chi-square test (for sex) and Student's t-test were used to look for significant associations. Receiver Operating Characteristics (ROC) curves were plotted and Area Under Curve (AUC) values were calculated for various hematological parameters. Youden's J was used to identify the ideal cut-off with optimal sensitivity and specificity. Multivariate Cox regression was used to identify independent hematological predictors of mortality. Kaplan-Meir survival plots for neutrophil lymphocyte ratio (NLR) with the optimal cut-off were plotted. (3) Results: Amongst the 500 patients, 42 died while 458 survived, giving a mortality rate of 8.4%. NLR had the strongest association with mortality. The cut-off for various parameters were: NLR 14.83 (AUC 0.73), total leukocyte count (TLC) 13,640 cells/mm3 (AUC 0.60), absolute neutrophil count (ANC) 12,556 cells/mm3 (AUC 0.62), derived NLR (dNLR) 9.989 (AUC 0.73), hemoglobin 11.8 mg/dL (AUC 0.59), packed cell volume (PCV) 36.6% (AUC 0.60), and platelet lymphocyte ratio (PLR) 451.32 (AUC 0.55). (4) Conclusions: In patients with acute exacerbation of COPD, NLR was strongly associated with mortality, followed by dNLR. Cox regression identified NLR as an independent predictor of mortality.

Recurrent Strokes in a Patient With Metastatic Lung Cancer.

A stroke, also known as cerebrovascular accident (CVA), is a medical condition that occurs when the blood supply to the brain is interrupted, resulting in brain cell death. Cancer-associated stroke (CAS) is a rare but serious complication of cancer, where a malignant tumor or its metastases invade or compress the blood vessels in the brain, resulting in a stroke. We describe a case of a 60-year-old male patient recently diagnosed with lung cancer with metastasis to the liver, esophagus, small intestine, and pancreas who has had at least three CVAs within a span of three months. He developed sequelae such as hemiplegia and aphasia. He was managed with dual antiplatelet therapy, neuroprotective drugs, and physiotherapy. Patients with advanced cancers should be routinely screened for neurovascular complications and risks. Prophylactic therapy should be started wherever warranted.

Geospatial Mapping of Indoor Air Quality and Respiratory Illnesses in an Urban Slum.

Introduction Air pollution is a well-recognized determinant of health. The general perception has focused primarily on outdoor pollution, and indoor pollution which may be due to smoking, biomass use, an extension of outdoor pollution, etc. has been neglected. It is therefore imperative to understand the levels of indoor pollution and find out if these are associated with high rates of illnesses, particularly, respiratory diseases. Material and methods This was a cross-sectional study involving 300 houses and 727 participants in an urban slum, selected through simple random sampling. Indoor air quality was assessed using the Prana C -Air Plus air quality monitor (Prana Air, New Delhi, India). The instrument detected formaldehyde, air quality index (AQI), temperature, humidity, PM2.5, PM10 particles, and total volatile organic (TVO) compounds. Socio-demographic details were noted, and geospatial mapping was done using Q-GIS software (www.qgis.org). A questionnaire was used to survey the residents of those houses. Ethical committee clearance was obtained before starting the project. Results The mean distribution of pollution parameters over the entire study area was AQI - 67.4±65.48, PM 2.5 - 37.6±35.82 µg/m3, formaldehyde - 0.09±0.37 mg/m3, PM 10 - 43.9±38.59 µg/m3, TVO compounds - 0.43±2.13 mg/m3, CO2 - 1128.9±323.86 ppm, temperature - 23.7±21.2 degree Celsius, and PM 1 - 24.3±20.5 µg/m3; 2.6% of the participants had respiratory diseases, and a significant association was found between the AQI, TVO compounds and ventilation, and respiratory diseases (p<0.05). Conclusion Indoor air pollution not unlike outdoor pollution can have dramatic health effects and needs to be addressed to lower the overall respiratory disease burden. The AQI, TVOC, and poor ventilation/cross-ventilation are associated with respiratory illnesses. Geospatial mapping shows a concentration of cases in areas of high pollution.