Disseminated tuberculosis is more prevalent in immunocompromised hosts; however, it can affect people with intact immune systems. Here, we present a case of an immunocompetent young woman who presented with headache, vomiting, and dizziness for the past two months. There was a history of significant weight loss during this period. Examination revealed postural hypotension and positive cerebellar signs. Imaging of the brain revealed a conglomerate mass in the cerebellar vermis suggestive of tuberculoma. Tubercle bacilli were detected in gastric lavage specimens. Laboratory investigations revealed hyponatremia with low serum osmolality. Further investigations showed low serum cortisol and high adrenocorticotrophic hormone levels. CT of the abdomen revealed atrophy of both adrenal glands. Our patient was diagnosed with cerebellar dysfunction and adrenal insufficiency secondary to disseminated tuberculosis. We started the patient on antituberculous drugs, along with mineralocorticoid and glucocorticoid replacement. Subsequent follow-up showed significant improvement in symptoms. Hence, timely diagnosis of the disease is essential to prevent lethal outcomes.

Actinomyces are Gram-positive, filamentous rods found endogenously as a part of the normal flora and can be acquired exogenously as they are present in the soil. The most common species known to infect humans is Actinomyces israelii. Five forms of the disease have been identified so far, of which the primary infection of the skin is the most uncommon. It is also commonly considered one of the most misdiagnosed diseases. We present a case of a young male diagnosed with primary cutaneous actinomycosis based on a histopathology specimen after multiple failed diagnoses of Madura foot/mycetoma, cutaneous tuberculosis, and malignancy. The patient was successfully treated with antibiotics with the restoration of his functional disability caused by the lesion.

Building Information Modeling (BIM) is gaining attention worldwide due to its assistances during the entire building’s construction life cycle covering all phases of project from commencement to accomplishment. BIM integrates different disciplines by effective communication, analyzes the project systems for constructability, estimates the cost and time of projects at any time using quantity takeoffs. Notwithstanding that fact Pakistan like other developing countries is lagging in Building Information Modeling (BIM) adoption. To facilitate the adoption of Building Information Modeling (BIM) in the AEC industry, the purpose of this research study is to identify the important factors for BIM adoption among construction engineers of Pakistan to carry out the awareness. It is found statistically that Building Information Modeling (BIM) capability is most important factors for the adoption of BIM among the construction engineers in Pakistan having the factors of motivation and management support which positively effect on BIM adoption in Pakistan. The trainings are very important to increase the BIM adoption in the industry.

Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta and its major branches. The disease has a female preponderance, and it presents with a wide variety of symptoms including skin manifestations, mainly ulcerative nodules, pyoderma gangrenosum, and erythema nodosum-like lesions. We report a case of a 50-year-old female who presented to the outpatient department with multiple ulcerative lesions over both upper extremities and chest. On physical examination, the patient had pulseless upper limbs. Laboratory investigations revealed positive antinuclear antibodies (ANA) and raised inflammatory markers. CT angiography of the aorta showed thickened aortic arch with the obliterated lumen of the left common carotid and left subclavian arteries. A biopsy of the skin lesion revealed surface ulceration and densely inflamed granulation tissue with a fibroblastic proliferation of deeper tissues. The patient had three out of six features of the American College of Rheumatology 1990 (ACR-1990) criteria for the classification of TA and was diagnosed with TA associated with pyoderma gangrenosum. The patient was managed with steroids and immunosuppressants along with gentle wound debridement with grafting of skin wounds. Since TA has varying presentations, its diagnosis is often challenging and requires a combined approach including clinical signs and symptoms, as well as laboratory and radiological workup. The disease also requires longterm follow-up due to its remitting and relapsing course.

Central pontine myelinolysis (CPM) is a part of the spectrum of osmotic demyelination syndrome (ODS), which is a rare demyelinating disorder due to the rapid correction of low serum sodium. It affects the neurons of the pons but may also involve other extra-pontine sites. The disease is characterized by a wide variety of clinical features ranging from dysarthria, dysphagia, bulbar palsy, quadriplegia, and behavioral and psychiatric disturbances. We present a case of a young female who developed CPM due to rapid sodium correction after vomiting. She presented with quadriplegia and locked-in syndrome. The diagnosis is on the basis of clinical and radiographic features. Magnetic resonance imaging (MRI) of the brain is superior to computed tomography (CT) in detecting changes. It shows hyperintensities on T2-weighted images that are classically known as the trident sign in the region of the pons. The patient was managed supportively, and the family was counseled regarding the poor prognosis of the disease. Unfortunately, she met a fatal fate due to a complication of CPM that is aspiration pneumonia. It is, therefore, imperative to create more awareness regarding the disease, and measures should be taken for its prevention that includes correction of low sodium levels not greater than 10 mmol/L/day.