Good morning, myself, Dr. Dhruv Indoshi, second-year resident at GCS Medical College and guided by Dr. Nikunj Desai, professor at the GCS Medical College. So my topic is MR imaging spectrum of intracranial infections in HIV positive patients. So my aims and objective is to study the imaging spectrum of intracranial infections in HIV positive patients on MRI introduction. HIV is a neurotropic virus that enters the cranial nerve system early in the course of infections. There are three stages in the HIV infection. First is HIV infection primary. Second is latent disease and third it's a disease of the central nervous system in the patient infected with HIV results directly from the virus itself or from the variety of upper genetic agents. Up to 60% of the all patients with AIDS develop the neurological complications. And first manifestation of symptoms, symptomatic HIV infection is in 10 to 20% of the patient when the CD4 counts is false below the 200 cells. So a typical manifestation may be seen due to layering on unmasking phenomenon. So we can see HIV encephalitis. So what we can see is AIDS dementia complex is an HIV associated chronic neurodegenerative syndrome. The imaging findings of the AIDS dementia complex are referred as HIV encephalitis. So in the typical MRI, we can see that it is a cortical atrophy with central predominance and x-vecuode ventricular dilatations, symmetrical patchy or confluent T2 and flare hyperintense disease with periventricular or deep fight matter, frontal or predominant lesion, lesions and no enhancement of the mass effect. On MRI, we can see that is a T2 and a flare images shows the bilateral symmetrical periventricular hyperintense disease with some dilatation of the bilateral frontal hauls of the lateral ventricles. On contrast in T1 and post contrast T1, we can see there is no enhancements noted on T1. So basically with given history and the MR findings, we can see there is a diagnosis of HIV encephalitis. So we are going to the second case. The second case is progressive multifocal depot encephalopathy, PML. PML is a progressive demilandering disorder that results from the JC virus infection of oligodendrocytes. Though so the MR findings that includes multifocal asymmetrical areas of T1 and T2 prolongation in the periventricular and subcortical white matter. Involvement of subcortical u-fibers, posterior fossa environment in the one-third of the cases and a faint peripheral enhancement may be seen in the 10% of cases and there may be seen a mass effect, but it is rare, only 10% in cases. So on the T2 and flare, we can see there is a bilateral diffuse asymmetrical, some hyperintense it is and with subcortical involving the subcortical white matter. On the post-contrast studies, we can see there is a faint peripheral enhancement, faint peripheral enhancement. So with the clinical features, we can see there is a the diagnosis as a progressive multifocal depot encephalopathy. These are T1 image and it is post-contrast T1 image. There is mild peripheral enhancement, but it's not clearly, but we can say with the clinical features that it must be this. So the next disease is toxoplasma. Toxoplasma is caused by an obligate intracellular protozoa toxoplasma gondip. In MRI, we can see that a pre-delication of the basal ganglia, thalamus, cortico medialis junction in frontal and parietal lobes, regions appears typically hypo-indent to iso-intensive T2 weighted images with surrounding vasoviric edema. So ring enhancement is noted in post-contrast studies and enhancing eccentric nodule may be seen, may be noted. It is called a target sign. Preference of a hemorrhage helps to differentiate from the lymphoma. So in T2 and flare hypo, T2 and flare hepatitis intensities is seen in the basal ganglia, thalamus and gray white matter differentiation. We can see it is by the arrow. So in the DWI, we can see high signal intensity rims and low signal intensity enters into the lesion. High signal intensity rim with low signal intensity in the lesion. Post-contrast, we can see there is a mild peripheral eccentric nodule enhancement. So the diagnosis is tuxoblasmosis. The next is cryptococcal infections. It is caused by the cryptococcal neoformants and encapsulated yeast-like fungus. The imaging findings may be consist with the manningoncephalitis, cryptococomas, gelatinous pseudosys or hydrocephalosis. Gelatinous pseudosys are iso-intensive to CSF on MR images and primarily located in the mid-brain basal ganglia. No enhancement is noted in the post-gadolinium images. Cryptococcal is present as a masses of the low single signal intensity. It is on T1W images and a high signal on T2 embedded images. An enhancement of the contrast admission is also seen in the cryptococcal infections. So in the MRI, we can see there is a on T2 and flare. We can see that multiple small lesions are seen in the bilateral basal ganglia, which appears hyperindex on T2 weighted and hypoindex on flare images. Now on the T1 post-contrast, we can see there is a peripheral nodule enhancement. So with given history, we can see there is a maybe extrude the other diagnosis and we can say it is a cryptococcal infections. The next is tuberculosis. Tuberculosis is the most common. CNS tuberculosis aids patient results from the reactivation of the previous infection of the or rarely from the newly acquired infections. The common intracranial infestation of the TB include meningitis, tuberculoma, gandulomas, abscess, cerebral ischemia and infuctions. Fewer basal exudates or greater number of acid-fast basili occur in the brain parenchyma and meningitis in the patient with HIV infections. So on a T2 weighted and post-contrast study, we can see there is a meningeal enhancement on the post-contral images. This is a pure case of, clear case, classic case of ring enhancement lesions, which is seen tuberculoma ring enhancement lesions, which is seen in the post-contrast study. This is axial and this is sagittal sections. So we can clearly say it is tuberculomas. So another differential with the ring enhancement lesions like this is a NCC. But on the basis of the clinical correlation, we can differentiate it on with the spectro. We can differentiate it from the spectro MR spectro. So the summary and conclusion with my topic is HIV related immunological disease is classified into direct complication, indirect complication. The development of the neurological complication depends on the variety of the factors, including therapy with the inter-eteroval drugs and the patients of overall degree of immunosuppressions. The common intracranial infections of HIV positive patient include the HIV encephalitis, progressive, multifocal, leucoencephalopathy, tuberculosis, toxoplasmosis and cryptocallin infections. Knowledge of the imaging finding is assured with the various infection agents that involves the CNS in HIV infected patients is important for guiding the treatment and differentiate from the infection pathology. So my topic is over. Thank you for the listening.


I'm going to read another poem called Pomegranates. And I'm a little bit crazy about pomegranates as my husband and son can attest to. I grew up eating pomegranates before they were commercially known. My parents planted a lot of trees from the Mediterranean region.  And most people just let them fall and drop to the ground. But we would raid other people's trees. So when the pomegranate craze, the palm wonderful, started appearing in the stores, I thought, huh, that's so funny.  And I never really appreciated their antioxidant qualities. But I always loved eating them. So when the first collection I edited came out called A World Between, my cousin made a beautiful picture of a pomegranate on the cover. And suddenly, all these Iranians were sending me pomegranate photographs, jewelry, sculptures. It was as if this hidden pomegranate lust was suddenly unleashed. So I decided I'd better write a poem about pomegranates. And this is in memory of my father, Baba, who taught me how to eat pomegranates. To root themselves in their new home, mother and Baba planted native trees, madrone, oak, and the manzanita at the end of the drive. To remind them of their foreignness, they planted olive, almond, quince, pomegranate. The first time my mother packed one in my lunch, I shrank in embarrassment, quickly returning the leathery bulb to the brown bag. How to eat a pomegranate without being conspicuous? It is a slow and exacting endeavor, an act of worship. You never slice them with a knife, Baba would say, when the September heat made the trees sag with the ornaments of autumn. In his world, men sold them on the streets for a few tumans, shouting, anare hosmeze, delicious pomegranates, rolling sun flushed hides between their palms. Customers at the corner of a cart needed coax the last of the blood red juice from a hole, allowing it to touch only their lips. Our American sensibility refused this technique. We never took their exotic form for granted. Throw them in the air, let them crack open, my brothers yelled, waiting for the quiet thud. And then the invisible seam that would split them open like an unhealed wound. I liked the splatter of color on face and hands, evidence of pomegranate carnage. In my 20s, I understood the feaken symbol. A health magazine in the waiting room advised women wanting to conceive, eat estrogen-rich foods, shrimp, scallops, pomegranates. Like the larvae of a magical butterfly, the red ovules offered a cure for barren women. There are two kinds of people in the world, those who plucked the seeds from the waxy yellow membrane, tossing them into their mouths, and those who hoard the ruby jewels, jealously guarding the pile until the last kernel is extracted.  Burry it, I said, looking at the inedible remains. Baba would not tolerate such sacrilege. When I learned a Sephardic version of the fall that it was pomegranate and not an apple, I felt a kind of secret pride. This fall, my son, undaunted, eats his first pomegranate. His tiny probing fingers harvest the seeds one by one. With hands stained by this baptism, he offers them to me like the remnants of an untold story inherited in the womb. That boy was two, and now he's 12.


Jack Saunders your host for this issue of the big picture. 1966 was a critical year for the United States Army. A year that saw a major combat force deployed to the Far East to implement our government support of a free South Vietnam. On your Army reports today we bring you some of the personalities and events of 1966 that made Army history that gave new inspiration to the American fighting man and new meaning to the high principle of justice which he defends. This is Edelbrook Luxembourg a quaint European city made famous in World War two by an American soldier. Each year a ceremony is held honoring the memory of General George S. Patton Jr. who launched an historic attack from this region in the critical Battle of the Bulge in 1944. This is Edelbrook's 21st annual remembrance day honoring General Patton's contribution to World War two victory. As part of the observance United States Army skydivers demonstrate parachuting skills which play an important part in airborne techniques. Helicopters are employed in staging a mock aerosol. In today's Army the emphasis on steadily deployed combat troops recalls General Patton's military faith in the swiftly moving armored forces of World War two. Presented is from Luxembourg and the United States around hand to pay tribute to the memory of the dynamic American general. The mayor of Edelbrook greets the assemblage of distinguished visitors. United States Ambassador to Luxembourg Mrs. Patricia Roberts Harris is among the major speakers. Highlights of Patton's career are described for the large audience attending the ceremony. General Patton was chosen to command the Army Force in Operation Torch. The landing of American troops in North Africa which marked our entry into combat against the Nazis. High ranking US Army officers praised General Patton's unique ability to organize and lead his men. American forces and troops of seven allied nations take part in a colorful parade one of the high points in the observance. Individual ways often made him a controversial figure but in the battle for a free world he knew only one direction forward. His dedicated Army career remains an inspiration to today's fighting man who also moves forward on the path to freedom. On the Pentagon Mall in Washington DC Sergeant Major William O. Woodridge is sworn into the newly created position of Sergeant Major of the Army. The appointment of a non-commissioned officer to serve as consultant to the Army Chief of Staff on matters concerning enlisted men is designed to stimulate pride and promote confidence among enlisted personnel. Army Chief of Staff General Harold K. Johnson who selected Sergeant Major Woodridge from among thousands of senior non-commissioned officers administers the oath of office to the 43 year old much-decorated veteran of World War II when Vietnam. In addition to the Chief of Staff and the Secretary of the Army other distinguished guests participate along with ceremonial old guard troops from the Third Infantry. Woodridge assists in pinning the new insignia on her husband who after 25 years of service becomes the first NCO to hold the official position of Sergeant Major of the United States Army. Having assumed his new office, Woodridge makes a trip to Brownwood, Texas to be guest of honor of the town he left as a young man 25 years before. Family and friends are on hand to greet him. Local and state officials proclaim September 28th 1966 as William O. Woodridge Day. Congratulations are extended to the Sergeant Major as a dedicated soldier who has honored his hometown and his nation. At the Brownwood Coliseum members of the Chamber of Commerce and various civic organizations join in a warm reception for their guests. The American Legion and other military service organizations present him with honorary membership symbolizing the spirit of the American Fighting Man which Woodridge so ably represents. The luncheon is literally topped off with presentation of a typical Texas hat adding an informal note to the day's ceremony. The afternoon at the Army Brooke Medical Center, the Sergeant Major signs in for a visit with some of the men who have been wounded in Vietnam. Woodridge's understanding of the enlisted man and his sympathy for their problems makes him an ideal choice as their representative to the Chief of Staff. His busy schedule includes a parade through Brownwood Main Street led by the distinguished visitors. Elements of the Texas National Guard take part in the festivities. The local band utilizes a unique form of transport and a play as you go latest weapons are featured in an impressive display of Army firepower through Academy of Freedom, named in honor of a famous American military leader, a retreat ceremony is observed by the Sergeant Major. The United States Army, Kentucky for a visit with elements of the 101st Airborne Division. He is greeted by division commander Major General Benjamin Sternberg. Despite bad weather on his arrival, the President inspects the Honor Guard assembled to receive him. For the Chief is a firsthand explanation on the workings of one of the 101st Airborne Helicopters. The Presidential Party has two other distinguished visitors, Army Chief of Staff General Johnson and Sergeant Major of the Army, Woodridge. A tour of the camp includes a view of communist weapons captured in Vietnam, grim evidence of the jungle war. Hidden stores of yet Kong weapons and ammunition are often discovered in caves and tunnels by US troops on search and destroy missions. One of the features of the exhibit of captured enemy equipment is a dummy dressed in the uniform of a Viet Cong. In a Fort Campbell testing area, the President observes a demonstration of aerosol techniques, which are being used by our forces in Vietnam. The lack of roads and rail facilities in the dense interior of South Vietnam has emphasized heavy use of Army aircraft in moving troops and equipment. Army training programs stress deployment by air of combat groups. The impressive demonstration we assure the President that these airborne soldiers are superbly trained professionals, experts in the most modern combat techniques. Following the demonstrations, an address to the troops and their families and friends, affirmation of United States policy in Vietnam, and the President's own deep conviction that small nations must be allowed to determine their own way of life unhappened by aggression. Afterwards, the presidential party, including Mrs Johnson and daughter Lucy, greet some of the men of the 101st who have fought in Vietnam. Behind them is a tradition of courage forged in the snows of Bastogne, where the 101st Airborne Division earned its place in history in a heroic battle against the Nazis. A day of meaning for the Commander-in-Chief and for the men who carry on this tradition of our nation's great freedom fighters. But the Army year 1966 is a year not only of remembrance and dedication, but of action of men training for battle of combat in the eternal twilight of the Vietnamese jungle of that indomitable spirit in the American Fighting Man, which persists no matter what the obstacle. Not a ballet school. And these men are definitely not dancers. They are learning the grim art of hand-to-hand combat at the United States Army Jungle Training School in the Canal Zone. With the increasing commitment of American troops in Vietnam, orientation in jungle fighting has become a vital part of the Army's training program. Students are familiarized with the hazards of the jungle environment and learn what to do about animals and snakes. Here's one jungle enemy that requires very special handling. A course in weapons, mines and traps includes demonstrations of various kinds of devices employed by the enemy to impede the advance of our troops. Survival in the jungle war often depends on the ability of a soldier to recognize enemy camouflage which may conceal dangerous hazards. One of the perils of jungle fighting is walking into an enemy trap. Classes are held in ambush and countering techniques. These are followed by field tests during which the soldiers are exposed to a simulated ambush. The attic guerrilla fighter, he will conceal himself in a brush in a test of a swiftness of a student soldier's response to enemy surprise attacks. It's all part of a special course designed to sharpen the jungle soldier's reaction to the ambush situation. The training at the jungle school is a day navigation course which will help point the way through dense interior jungle. This calls for considerable skill in map and compass reading. Moving forward in the jungle may often mean moving up and a little mountain climbing training is very much in order. The jungle soldier must be expert in maneuvering on the most difficult terrain and he learns to scale the high places using whatever means are at hand. Many of the instructors at the school have had combat experience in Vietnam and pass along their firsthand knowledge to the students. Much important combat intelligence is obtained from the capture and search of prisoners. Techniques of handling captured enemy soldiers or agents are learned in realistic field problems. Combat teams learn how to make river crossings and assault boats in a problem stressing attack via waterway. There isn't always a boat available. In that case the soldier takes a ride down the rope traverse. Sometimes our combat troops in Vietnam encounter a seemingly deserted village which may conceal enemy fighters. A mock-up of a Vietnamese village provides an effective facility for training in search and destroy missions. These missions often turn up collaborators who have been giving aid to the Viet Cong. All instruction is aimed at giving the U.S. soldier as complete an experience as possible to prepare him for jungle combat. Graduation time for men who have made it. All volunteers selected for many different Army units received congratulations from Major General J. D. Alger who heads up the United States Army Forces Southern Command. Each man has earned his diploma of a hard way but because of his rigorous training at the Army Jungle School he will be a better soldier. Better able to carry out the difficult assignment of jungle warfare at the 101st Airborne Brigade Forward Base Camp in Vietnam. A guest from the entertainment world brings a touch of home to U.S. soldiers. Actor John Wayne on the U.S.O. Tour of our military camp stops off for a brief visit with the airborne men who are enjoying a well earned rest after having completed Operation Hawthorne. An important 101st combat assignment. It's a wet day for signing autographs but actor Wayne is lucky enough to have one of those pens that writes underwater. No John that cone isn't a studio prop so better watch that famous trigger finger. The actor serves as a reminder of stateside to our fighting men in far off Vietnam. During weather later in the day a victory festival is held to celebrate the success of Operation Hawthorne. Local entertainment is provided by girls from the village who perform a native dance for the soldiers of the brigade. The name of the free people of South Vietnam. Supported by the Vietnamese welcoming committee is warm but the drinks are cool. A combination that hits the spot with these weary combat troops. While one American force celebrates victory another is deeply engaged in combat in Vietnam's central highland. Elements of the 25th Infantry Division launch Operation Hawthorne Revere. A strategic move aimed at preventing the Viet Cong from infiltrating into South Vietnam. Artillery is moved by air to position from which a fire mission will be carried out to clear an area where troops and supply-carrying helicopters may land. Because the terrain here is impassable for ground vehicles everything has to be brought in by air including ammunition and support equipment. A battery of 105 millimeter howitzers prepares to go into action against the Viet Cong ridden jungle ahead. Expert artillery men make sure the shells will land on target. The fire mission is launched. Supplies and equipment for the jungle task force are loaded aboard helicopters of an army aviation battalion for deliveries in the landing area. Bring their men in and they move swiftly into action. Proof effective and attaining specific jungle objectives which would be impossible to accomplish by conventional military means. Is not all guns and shells. As in all US Army operations. Military civic action teams assist the people of the surrounding villages in every way possible. The battle for a free South Vietnam is fought with many types of ammunition. Clothing is ammunition too in the fight against poverty and economic hardship which characterizes so much of Southeast Asia for occupants of this village in central Vietnam. Army civic action teams move into 1,000 villages along with our combat troops ready to provide aid wherever they can. Sinphal Revere and awards ceremony is held at Second Corps headquarters Participants are colorful Montagnard tribesmen who form part of the South Vietnamese Irregular Defense Group. Montagnard women too are enlisted in the fight against the Viet Cong. Combined American and Vietnamese forces are addressed by now Lieutenant General Stanley Larson, commander of the United States First Field Forces. Officers observe the proceedings as soldiers of both countries await their awards. The Vietnamese medal for gallantry in battle and who have won honor in combat goes to respect and admiration of freedom loving people everywhere. These were some of the people and events that contributed toward achievement of this goal. The Sergeant Major Jack Saunders bringing to a close this issue of your army report.


that if we want to be successful in this green revolution, we have to be efficient at all levels. This European who supports us with the funds is national with a good, sometimes legal solution, for example. But we have to take our citizens on board and it is crucial for me. The ambitious goals in the green deal are not only extremely important for the WSB region, but it is completely in line with our vision of development of our region. We are a relatively big region in Poland, 23,000 square hectares, 35% covered by beautiful forests, 80 km of beautiful seashore, a lot of lakes, a lot of rivers, and we have to protect it for our kids. So, of course, in our strategy adopted in 2019, we put the green growth in the central place. I have to admit that a lot of work was done in my region. In my region, we are producing more than 20% of Polish green energy. It covers more than 70% of our consumption. We implemented more than 1,500 environmental programs in my region recently, starting from big programs in the public transport, for example, in the capital city, but ending with very small wastewater treatment plants in the small villages. I think that if we want to be successful, we have to go farther. Right now, we have huge challenges in our cities. In Poland, for example, connected with the air quality, we have to replace a lot of very old type heat resources based on coil to clean up our air. We have to green our cities if we want to have green lungs in our cities. We have to make our cities even more blue just to have good water management. We should collect rainwater and use it to green our cities. So, we have a lot of infrastructural challenges. But on the other hand, I think that it is crucial to remember about the social dimension of the problem. So, if we want to be successful, finally, we have to do all our actions, not for the people, but with the people. So, we have to have youngsters on board as well as seniors on board. We have to have citizens of a city on board and the citizens in the countryside as well. And I think that it is our common challenge, common responsibility and common task for the next generations.