Cerebral venous sinus thrombosis remains a diagnostic challenge courtesy to its variable degree of presentation and low level of clinical suspicion. We report a rare case of cerebral venous sinus thrombosis presenting as a complication of alcohol intoxication. Symptoms of cerebral venous sinus thrombosis are likely to remain camouflaged in alcoholics making the task for the clinician more so difficult. Strong suspicion should remain in any alcoholics with persistent neurologic features. A 52-year-old gentleman presenting with delirium, seizure, and a persistent headache was found to have multiple cerebral venous sinus thrombosis. After ruling out all the possible risk factors eventually we came into the conclusion of the role of alcohol inducing this catastrophic condition. He was treated with anticoagulant resulting in prompt resolution of his symptoms. Anti-coagulation was discontinued after 3 months and the patient continues to remain asymptomatic after 6months of regular follow-up.

A systemically well 66-year-old white Caucasian man presented to the urgent care department with a short history of progressive pain and blurring of vision in his left eye. He denied a history of trauma, intraocular surgery or use of illicit drugs. He was diagnosed with endogenous endophthalmitis. Vitreous biopsy grew Serratia marcescens, a Gram negative bacteria. In spite of extensive investigation, there was no obvious source of infection. He had an indwelling urine catheter for prostate hypertrophy, but urine culture was negative. There was no evidence of immunocompromise. He was treated with systemic as well as intravitreal antibiotics. In spite of appropriate treatment, the patient lost vision. S. marcescens endophthalmitis, seen even in immunocompetent people, carries a poor visual prognosis.

This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.

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Introduction: There is a need for rapid and sensitive detection of Mycobacterium tuberculosis in clinical samples. A study was conducted in which the target for the amplification being a segment of IS6110 in the M. tuberculosis chromosome was evaluated using real time PCR and its results were compared with routine tests, using pulmonary and extra-pulmonary specimen. Methods: In this descriptive cross-sectional retrospective study, specificity and sensitivity of PCR were analyzed. A total of 293 clinical samples were processed at a tertiary care hospital of Peshawar, during the time period of 2016-2018, from patients suspected of having pulmonary and extra-pulmonary tuberculosis and Follow up patients with DOTS treatment and MDR treatment that are referred by tertiary hospital were also included in this study after taking their informed consent. Patients not willing to participate in the study were excluded. For identification specimens were stained by Ziehl Neelsen staining (ZN), cultured on Lowenstein–Jensen (LJ) medium and then confirmed by PCR for the detection of Mycobacterium tuberculosis (MTB). Results: Of the 293 samples, 165(56.3%) were from males and 128(43.7%) females. Mean age was 44 years (2-85 years). Specimen types included: CSF (30.4%), pleural fluid (4.1%), sputum (15%), urine (2.4%), synovial fluid (2.4%), other fluids (33.1%) and biopsies (12.6%). Only 3.1% of specimens were ZN-smear positive for (MTB). LJ culture identified 7.2% whereas PCR method detected (MTB) in 15% of the total specimens. Using PCR as gold standard, ZN microscopy correctly identified 20.5% of total (MTB) positive specimens and LJ culture detected 47.7%.Specimen types showed significant association with PCR test: 42.9% of synovial fluid samples and 41.7% of pleural fluid samples; 28.6% of urine samples were positive for (MTB) by PCR method. This indicates that PCR analysis of these specimens’ exhibit greater positivity rates for (MTB) as opposed to CSF and other fluids and biopsies Conclusions: TB PCR is a rapid and reliable test in the diagnosis and management of tuberculosis.