ABSTRACT
Cowden syndrome is a rare genetic anomaly mostly attributed to mutations in the Phosphatase and Tensin (PTEN) Homolog gene. This illness manifests with a diverse array of symptoms that impact several physiological systems and an increased susceptibility to various forms of malignancy. The patient typically exhibits mucocutaneous lesions and a heightened vulnerability to the formation of neoplasms, specifically thyroid carcinomas. The inclusion of thyroid disorders, such as Graves' disease, introduces complications to the management procedure, necessitating a complete approach that includes many healthcare practitioners to guarantee optimal care. Despite some advancements in the field, there remains a dearth of evidence-based recommendations for pediatric patients, encompassing individuals with Cowden syndrome and other thyroid disorders. The current investigation focuses on a 13-year-old female patient who presents with comorbid Cowden syndrome and Graves' disease. We emphasize the challenges associated with the diagnosis and treatment of these illnesses. A collaborative and multidisciplinary team approach was used to administer therapeutic approaches, such as total thyroidectomy, emphasizing the essential requirement for interdisciplinary cooperation among healthcare providers. Continual research endeavors play a pivotal role in elucidating the optimal management protocols and augmenting outcomes for this particular cohort of individuals.
ABSTRACT
Background. In India, dengue epidemics are becoming more frequent (WHO, 2008). The majority of dengue viral infections are self-limiting, but complications may cause high morbidity and mortality. Objectives. To assess the clinical profile of the dengue infection in children less than 14 years of age and to evaluate the outcomes of dengue fever from September 2013 to August 2015 at the Pediatric Department of Maharaja Krishna Chandra Gajapati Medical College, the largest tertiary care hospital of southern Odisha. Results. A total of 97 cases were classified into 84 (86.59%) nonsevere and 13 (13.40%) severe dengue cases. The most common age of presentation was above 11 yrs. The mean age of admission was 8.7 yrs. The most common presenting symptom was fever seen in 100% and hepatomegaly (43.8%), the most common physical finding. Gastrointestinal bleeding was markedly seen in severe dengue (76.9%). Elevation in aspartate transaminase (SGOT) was found in 47.42% and thrombocytopenia in 27.5%. The correlation between hepatomegaly and elevated SGOT was significant (P value 0.0346). Case fatality rate (CFR) was 1.03%. The mean duration of hospitalisation was 3.8 days. Conclusion. In children, if symptoms like fever, pain, rashes, and vomiting are associated with hepatomegaly and elevated SGOT in context of low TPC, a strong possibility of dengue fever is present, especially in an epidemic setting. Early suspicion and effective management can reduce the severity.
ABSTRACT
The geologic architecture in aquifer systems affects the behavior of fluid flow and the dispersion of mass. The spatial distribution and connectivity of higher-permeability facies play an important role. Models that represent this geologic structure have reduced entropy in the spatial distribution of permeability relative to models without structure. The literature shows that the stochastic model with the greatest variance in the distribution of predictions (i.e., the most conservative model) will not simply be the model representing maximum disorder in the permeability field. This principle is further explored using the Shannon entropy as a single metric to quantify and compare model parametric spatial disorder to the temporal distribution of mass residence times in model predictions. The principle is most pronounced when geologic structure manifests as preferential-flow pathways through the system via connected high-permeability sediments. As per percolation theory, at certain volume fractions the full connectivity of the high-permeability sediments will not be represented unless the model is three-dimensional. At these volume fractions, two-dimensional models can profoundly underrepresent the entropy in the real, three-dimensional, aquifer system. Thus to be conservative, stochastic models must be three-dimensional and include geologic structure.
