Tuberculous mediastinal lymphadenopathy presenting with left vocal cord palsy: A rare entity.

A 23-year-old-male student, never-smoker presented to our hospital outpatient department with complaints of loss of appetite, unintentional weight loss, fatigue and low-grade fever for two months, hoarseness of voice (HOV) for two weeks. He was evaluated for HOV with video laryngoscopy which demonstrated left vocal cord palsy. Contrast enhanced CT Chest (CECT) was performed for evaluation of mediastinal lesions which revealed multiple peripheral enhancing conglomerate mediastinal lymph nodes. EBUS-trans bronchial needle aspiration (TBNA) and endobronchial biopsy were performed and specimens sent for smear and culture for AFB, Xpert MTB/RIF assay and histopathology. Results were consistent with Mycobacterium tuberculosis (MTB) infection and culture was positive for M. tuberculosis complex. Patient had been started on anti tubercular therapy (ATT) and during his 4th month follow up he showed clinicoradiological improvement without recovery of recurrent laryngeal nerve palsy.

Umbilical Vein and Maternal Serum Inhibin A, Activin A, and Follistatin Concentrations in IUGR due to Placental Dysfunction Pregnancies.

OBJECTIVE: The objective of this study were to (1) quantify the concentrations of inhibin A, activin A, and follistatin in maternal serum and umbilical vein (inhibin A, activin A) in IUGR due to placental dysfunction pregnancies and control group, (2) determine the concentration differences of these factors in maternal and umbilical vein serum in control and subject group, and (3) examine the relationship between fetal growth and placental function. METHOD: Sandwich ELISA was used to measure the concentrations in control (n = 40) and subject groups (n = 30). RESULTS: Umbilical vein serum inhibin A, activin A concentrations were increased in subject group compared with controls (inhibin A regression coefficient, 0.7647, P < 0.001, activin A P < 0.0005). Maternal serum inhibin A, activin A were significantly increased in subject group compared with controls (inhibin A regression coefficient, 0.7614, P < 0.001, activin A P < 0.0005). Maternal serum activin: follistatin ratio was significantly increased in subject group compared with controls (P < 0.0005). Maternal serum inhibin A, activin A concentrations were more when compared to the umbilical vein inhibin A, activin A concentrations in subject group. CONCLUSION: The present study strengthens the evidence of using inhibin A, activin A, and follistatin as serum markers in routine screening for early detection of IUGR. But large prospective studies are needed to further define their role in clinical practice.