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This study focuses on the first-ever high-sensitivity, low-cost, and quick response electrochemical estimation of metadoxine (MTD) in pharmaceuticals and human blood serum using a non-enzymatic nanocomposite modified glassy carbon electrode (CuO/CH/GCE) loaded with chitosan. The electroactive surface of GCE was produced by drop-casting a suspension of CuO/CH nanocomposite in N,N-dimethylformamide (DMF) onto the non-enzymatic electrode surface. Synthesized nanocomposite was characterised by using XRD, XPS, EDX, TEM, Raman and FESEM techniques. EIS technique was utilized to study the enhanced charge-transfer phenomenon occurring at the surface of modified sensor. The electrooxidation of MTD at CuO/CH/GCE surface is depending at pH of supporting electrolyte, scan rate and concentration of analyte. CV and SWV technique were used to carry out electrochemical study, optimised voltammetric response is observed in the BR buffer at pH 2.5, with irreversible diffusion-controlled process. Within the linear concentration range of MTD from 1.99 μg/L to 29.56 μg/L, this sensor exhibited lowest LOD (0.64 μg/L) and LOQ (2.14 μg/L). The MTD in pharmaceutical formulation and human blood serum can be determined with this highly selective peak potential (Ep ∼ 1.2 V), repeatable (%RSD 0.91), and reproducible (%RSD 2.31) method. The average percentage recovery in human blood serum and pharmaceutical formulation is 99.89% and 99.90%. This paper reports a lowest LOD value for MTD detection in the comparison with other reported methods (Table S1). None of the selected excipients were found to interfere more than 5% with redox potential of MTD without affecting the performance of sensor.

Energy is vital for techno-socio-economic development of global transportation sector. A country’s energy policy will aim to provide an appropriate mix of resources to meet its energy demand. Biofuels have emerged as an alternative to meet the energy requirements. The contribution of this study is the evaluation of sustainable biofuel energy policies to increase the usage of biofuels in the transport sector without affecting the country's food security and to achieve social, economic and environmental benefits. The successful implementation of complex relationship between the factors influencing the production and use of biofuels is also addressed. In the present work, a system dynamics model has been developed to evaluate biofuel production focusing food security and to assess its impact on the economy and the environment. Simulation results have shown that the maximum biodiesel blending between 3.03% to 11.01% is possible without impacting the food security. It has been noted that 20% or less of biodiesel blends can be used as direct replacements for diesel fuel in all heavy-duty diesel vehicles without any alteration or modification of their engines. It has been demonstrated that biofuel blending strategies have a positive impact on the reduction of CO2 emission in the Indian transport sector.

Favipiravir, a pyrazine analog, is proposed as providential antiviral agent against the COVID-19 infection during 2020 pandemic emergency. For the first time, a fabric phase sorptive extraction (FPSE) combined with gas chromatography-mass spectrometry (GC-MS) has been developed and applied for the determination of favipiravir (FAV) in biological samples (human plasma, blood and urine), pharmaceutical and forensic samples. The method comprises of extraction of FAV by FPSE followed by its derivatization with N, O-bis (trimethylsilyl) trifluoroacetamide (BSTFA) and GC-MS analysis. Design of experiment-based optimization was performed using Placket-Burman Design (PBD) and Central Composite Design (CCD) for the screening of significant factors of FPSE and their optimization, respectively. Among all tested membranes, sol-gel polyethylene glycol (PEG) has offered the best extraction efficiency for FAV. Under optimum conditions, the proposed method was found to be linear in the range of 0.01–10 µg mL−1 by GC-MS. The LODs and LOQs were as low as 0.001-0.0026 µg mL−1 and 0.003-0.0086 µg mL−1, respectively by GC-MS. Intra-day and inter-day precisions were less than 5 and 10%, respectively, showing good method precision. The proposed method has been successfully applied to detect and quantify FAV in human urine, whole blood and plasma samples along with seized forensic samples. In addition, the proposed method has been evaluated for its green character by ComplexGAPI index.

Aspirin (ASA) is a globally used anti-inflammatory drug and salicylic acid (SA) is the biological metabolite of ASA. As an analytical chemist, it's always a challenge to accurately and precisely determine a drug along with its metabolites with a single method. Hence, we aim to develop a simple and low-cost assay based on combination of vortex assisted-dispersive liquid-liquid microextraction (VADLLME) with smartphone based digital image colorimetry (DIC) as a promising platform for simple low-cost analysis of ASA and SA. The method comprises of three simple steps viz. (i) extraction and pre-concentration of ASA/SA by VADLLME, (ii) reaction of ASA/SA with Trinder reagent on a filter paper strip to produce blue colour, and (iii) DIC of developed colour with imageJ software. Design of experiment approach comprising of Plackett-Burman design (PBD) and central composite design (CCD) were used for optimization of parameters affecting the efficiency of the proposed method. Under the optimized conditions, the limits of detection (LOD) and the limit of quantitation (LOQ) were found to be 8.88 and 29.0 µg mL−1, respectively. Calibration plot demonstrated good linearity in the range of 50–400 µg mL−1, with coefficients of determination (R2) higher than 0.993 and standard deviation less than 10%. The proposed method has been successfully applied for the estimation of ASA/SA in pharmaceutical formulations (tablets), cosmetic product and human urine samples, with percent recoveries (%R) ranging from 92.14–99.6%. In addition, the green character of the proposed method from sample collection to final determination has been evaluated by using ComplexGAPI index.

Flash-X is a highly composable multiphysics software system that can be used to simulate physical phenomena in several scientific domains. It derives some of its solvers from FLASH, which was first released in 2000. Flash-X has a new framework that relies on abstractions and asynchronous communications for performance portability across a range of increasingly heterogeneous hardware platforms. Flash-X is meant primarily for solving Eulerian formulations of applications with compressible and/or incompressible reactive flows. It also has a built-in, versatile Lagrangian framework that can be used in many different ways, including implementing tracers, particle-in-cell simulations, and immersed boundary methods.

Reports related to incidences of drug facilitated crimes (DFCs) have notably increased in recently. In such cases, victims report being assaulted or robbed while under the influence of drugs. Lorazepam (LZ) is frequently used in DFCs as it can easily make victims docile owing to its potent numbing effect. Therefore, a straightforward and green analytical method to analyze LZ in spiked food matrices in connection with criminal acts becomes important. The current study reports a simple, green, and high sample throughput analytical method for determining LZ in food and drink matrices commonly encountered in DFCs, based on recently introduced cellulose paper sorptive extraction (CPSE). For the extraction of LZ from food matrices, pristine cellulose paper (CP, commonly used laboratory filter paper) was used as a sorptive medium. Five pieces of CP (1.5″ × 1.5″ each) were dipped into diluted food matrices (cream biscuits and tea) and stirred on a rotary shaker for 30 min at 200 rpm. The CPs were then dried, and the adsorbed LZ was back-extracted into 2 mL of methanol. The extract was then subjected to GC–MS analysis in selected ion monitoring (SIM) mode. Several parameters, including CP size and number, back-extraction solvent type and volume, sample volume, extraction time and stirring speed, pH, ionic strength, elution time and speed, were thoroughly screened and optimized. Under the optimized conditions, the method was found to be linear in the range of 0.2–10 µg·mL−1 (or µg·g−1) with a coefficient of determination (R2) ranging from 0.996–0.998. The limit of detection and limit of quantification for cream biscuits were 0.054 and 0.18 µg·g−1 whereas they were 0.05 and 0.16 µg·mL−1 for tea samples. For all measurements, the relative standard deviations (%RSD) were always below 10%. Two mL of methanol per sample was used during the entire sample preparation process. The greenness of the proposed procedure was evaluated using Analytical Eco-Scale and GAPI greenness assessment tools. Finally, the CPSE–GC–MS method has been applied for the determination of LZ in forensic food samples which were used in DFCs.

In the present work, a chemically modified electrode has been fabricated utilizing Bi2O3/ZnO nanocomposite. The nanocomposite was synthesized by simple sonochemical method and characterized for its structural and morphological properties by using XRD, FESEM, EDAX, HRTEM and XPS techniques. The results clearly indicated co-existence of Bi2O3 and ZnO in the nanocomposite with chemical interaction between them. Bi2O3/ZnO nanocomposite based glassy carbon electrode (GCE) was utilized for sensitive voltammetric detection of an anti-biotic drug (balofloxacin). The modification amplified the electroactive surface area of the sensor, thus providing more sites for oxidation of analyte. Cyclic and square wave voltammograms revealed that Bi2O3/ZnO modified electrode provides excellent electrocatalytic action towards balofloxacin oxidation. The current exhibited a wide linear response in concentration range of 150–1000 nM and detection limit of 40.5 nM was attained. The modified electrode offered advantages in terms of simplicity of preparation, fair stability (RSD 1.45%), appreciable reproducibility (RSD 2.03%) and selectivity. The proposed sensor was applied for determining balofloxacin in commercial pharmaceutical formulations and blood serum samples with the mean recoveries of 99.09% and 99.5%, respectively.

Favipiravir (FAV) has become a promising antiviral agent for the treatment of COVID-19. Herein, a green, fast, high-sample-throughput, non-instrumental, and affordable analytical method is proposed based on surfactant-assisted dispersive liquid–liquid microextraction (SA-DLLME) combined with thin-layer chromatography–digital image colourimetry (TLC-DIC) for determining favipiravir in biological and pharmaceutical samples. Triton X-100 and dichloromethane (DCM) were used as the disperser and extraction solvents, respectively. The extract obtained after DLLME procedure was spotted on a TLC plate and allowed to develop with a mobile phase of chloroform:methanol (8:2, v/v). The developed plate was photographed using a smartphone under UV irradiation at 254 nm. The quantification of FAV was performed by analysing the digital images’ spots with open-source ImageJ software. Multivariate optimisation using Plackett–Burman design (PBD) and central composite design (CCD) was performed for the screening and optimisation of significant factors. Under the optimised conditions, the method was found to be linear, ranging from 5 to 100 µg/spot, with a correlation coefficient (R2) ranging from 0.991 to 0.994. The limit of detection (LOD) and limit of quantification (LOQ) were in the ranges of 1.2–1.5 µg/spot and 3.96–4.29 µg/spot, respectively. The developed approach was successfully applied for the determination of FAV in biological (i.e., human urine and plasma) and pharmaceutical samples. The results obtained using the proposed methodology were compared to those obtained using HPLC-UV analysis and found to be in close agreement with one another. Additionally, the green character of the developed method with previously reported protocols was evaluated using the ComplexGAPI, AGREE, and Eco-Scale greenness assessment tools. The proposed method is green in nature and does not require any sophisticated high-end analytical instruments, and it can therefore be routinely applied for the analysis of FAV in various resource-limited laboratories during the COVID-19 pandemic.

Fabric phase sorptive extraction (FPSE) has become a popular sorptive-based microextraction technique for the rapid analysis of a wide variety of analytes in complex matrices. The present study describes a simple and green analytical protocol based on in-matrix methyl chloroformate (MCF) derivatization of non-steroidal anti-inflammatory (NSAID) drugs in urine samples followed by FPSE and gas chromatography-mass spectrometry (GC-MS) analysis. Use of MCF as derivatizing reagent saves substantial amounts of time, reagent and energy, and can be directly performed in aqueous samples without any sample pre-treatment. The derivatized analytes were extracted using sol–gel Carbowax 20M coated FPSE membrane and eluted in 0.5 mL of MeOH for GC-MS analysis. A chemometric design of experiment-based approach was utilized comprising a Placket–Burman design (PBD) and central composite design (CCD) for screening and optimization of significant variables of derivatization and FPSE protocol, respectively. Under optimized conditions, the proposed FPSE-GC-MS method exhibited good linearity in the range of 0.1–10 µg mL−1 with coefficients of determination (R2) in the range of 0.998–0.999. The intra-day and inter-day precisions for the proposed method were lower than

Abstract Background Current multi-petaflop supercomputers are powerful systems, but present challenges when faced with problems requiring large machine learning workflows. Complex algorithms running at system scale, often with different patterns that require disparate software packages and complex data flows cause difficulties in assembling and managing large experiments on these machines. Results This paper presents a workflow system that makes progress on scaling machine learning ensembles, specifically in this first release, ensembles of deep neural networks that address problems in cancer research across the atomistic, molecular and population scales. The initial release of the application framework that we call CANDLE/Supervisor addresses the problem of hyper-parameter exploration of deep neural networks. Conclusions Initial results demonstrating CANDLE on DOE systems at ORNL, ANL and NERSC (Titan, Theta and Cori, respectively) demonstrate both scaling and multi-platform execution.

RNA editing modifies transcripts and may alter their regulation or function. In humans, the most common modification is adenosine to inosine (A-to-I). We examined the global characteristics of RNA editing in 4,301 human tissue samples. More than 1.6 million A-to-I edits were identified in 62% of all protein-coding transcripts. mRNA recoding was extremely rare; only 11 novel recoding sites were uncovered. Thirty single nucleotide polymorphisms from genome-wide association studies were associated with RNA editing; one that influences type 2 diabetes (rs2028299) was associated with editing in ARPIN. Twenty-five genes, including LRP11 and PLIN5, had editing sites that were associated with plasma lipid levels. Our findings provide new insights into the genetic regulation of RNA editing and establish a rich catalogue for further exploration of this process.

Background. Endoscopy nurse (RN) has a pivotal role in administration and monitoring of moderate sedation during endoscopic procedures. When sedation for the procedure is administered and monitored by an anesthesia specialist, the role of an RN is less clear. The guidelines on this issue by nursing and gastroenterology societies are contradictory. Methods. Survey study of endoscopy lab managers and directors at outpatient endoscopy units in Texas. The questions related to staffing patterns for outpatient endoscopies and responsibilities of different personnel assisting with endoscopies. Results. Responses were received from 65 endoscopy units (response rate 38%). 63/65 (97%) performed at least a few cases with an anesthesia specialist. Of these, 49/63 (78%) involved only an endoscopy technician, without an additional RN in the room. At 12/49 (25%) units, the RN performed tasks of an endoscopy technician. At 14/63 (22%), an additional RN was present during endoscopic procedures and performed tasks not directly related to patient care. Conclusions. Many ambulatory endoscopy units do not have an RN present at all times when sedation is administered by an anesthesia specialist. An RN, when present, did not perform tasks commensurate with the education and training. This has implications about optimal utilization of nurses and cost of performing endoscopies.

Trichloroethylene (TCE) is widely used as a metal degreaser in industrial processes. The present study reports on the effects of TCE exposure on workers employed in the lock industries. To ensure exposure of the workers to TCE, its toxic metabolites, trichloroacetic acid (TCA), dichloroacetic acid (DCA) and trichloroethanol (TCEOH) were detected in the plasma of the subjects through solid phase microextraction-gas chromatography-electron capture detection. TCA, DCA and TCEOH were detected in the range of 0.004–2.494 μg/mL, 0.01–3.612 μg/mL and 0.002–0.617 μg/mL, respectively. Quantitative reverse transcription polymerase chain reaction analysis revealed up-regulated expression of p53 (2.4-fold; p

The present study reports voltammetric reduction of nitazoxanide in BrittonâRobinson (BâR) buffer by cyclic and square-wave voltammetry at glassy carbon electrode. A versatile fully validated voltammetric method for quantitative determination of nitazoxanide in pharmaceutical formulation has been proposed. A squrewave peak current was linear over the nitazoxanide concentration in the range of 20â140 µg/mL. The limit of detection (LOD) and limit of quantification (LOQ) was calculated to be 5.23 μg/mL and 17.45 μg/mL, respectively. Keywords: Nitazoxanide, Squarewave voltammetry, Glassy carbon electrode, Pharmaceutical formulation

Granisetron showed one well-defined reduction peak at Hanging Mercury Drop Electrode (HMDE) in the potential range from â1.3 to â1.5Â V due to reduction of C=N bond. Solid-phase extraction technique was employed for extraction of Granisetron from spiked human plasma. Granisetron showed peak current enhancement of 4.45% at square-wave voltammetry and 5.33% at cyclic voltammetry as compared with the non stripping techniques. The proposed voltammetric method allowed quantification of Granisetron in pharmaceutical formulation over the target concentration range of 50â200Â ng/mL with detection limit 13.63Â ng/mL, whereas in human plasma 50â225Â ng/mL with detection limit 11.75Â ng/mL. Keywords: Granisetron, Human plasma, Solid-phase extraction, Pharmaceutical formulation, Voltammetry, Hanging mercury drop electrode

Electrochemical reduction behavior of Adefovir was studied using Hanging Mercury Drop Electrode (HMDE) in BrittonâRobinson (BR) buffer solution. Voltammetric study showed one well-defined reduction peak in the potential range â1.2 to â1.4 V (vs. Ag/AgCl) due to reduction of C=N bond of the imidazole ring. Solid-phase extraction and protein-precipitation techniques were employed for extraction of Adefovir from human plasma. The proposed method allows quantification of Adefovir in human plasma over the concentration range 0.50â5.00 μg/mL with the detection limit 0.17 μg/mL, whereas in pharmaceutical formulation 0.25â2.25 μg/mL with the detection limit 0.08 μg/mL. Keywords: Voltammetry, Adefovir, Solid-phase extraction, Protein-precipitation, Human plasma, Pharmaceutical formulation

Redox behavior of midazolam was studied at a glassy carbon electrode in various buffer systems, supporting electrolytes and pH using differential pulse, square-wave and cyclic voltammetry. Based on its reduction behavior, a direct differential pulse voltammetric method has been developed and validated for the determination of midazolam in parenteral dosage. Three well-defined peaks were observed in 0.1% SLS, BrittonâRobinson (BR) buffer of pH 2.5. The effect of surfactants like sodium lauryl sulfate (SLS), cetyl trimethyl ammonium bromide (CTAB) and Tween 20 was studied. Among these surfactants SLS showed significant enhancement in reduction peak. The cathodic peak currents were directly proportional to the concentration of midazolam with correlation coefficient of 0.99. Keywords: Midazolam, Voltammetry, Surfactant, Glassy carbon electrode, Parenteral dosage form

A sensitive electroanalytical method for quantification of pheniramine in pharmaceutical formulation has been investigated on the basis of the enhanced electrochemical response at glassy carbon electrode modified with multi-walled carbon nanotubes in the presence of sodium lauryl sulfate. The experimental results suggest that the pheniramine in anionic surfactant solution exhibits electrocatalytic effect resulting in a marked enhancement of the peak current response. Peak current response is linearly dependent on the concentration of pheniramine in the range 200â1500 μg/mL with correlation coefficient 0.9987. The limit of detection is 58.31 μg/mL. The modified electrode shows good sensitivity and repeatability. Keywords: Pheniramine, Sodium lauryl sulfate (SLS), Glassy carbon electrode modified with multi-walled carbon nanotubes (GCE-MWCNTs), Solubilized systems, Voltammetric quantification

We report the case of a 57-year-old male physician who presented with a life threatening secretory and refractory diarrhoea of around 20 L/day. This was complicated by severe hypotension, hypokalaemia, hypercalcaemia, renal failure requiring dialysis, metabolic acidosis, cardiorespiratory arrest and ventilation for 12 days. His diarrhoea responded immediately to the first dose of a therapeutic trial of subcutaneous octreotide 100 mcg 8 hourly which was started on clinical grounds alone before any investigations were carried out. After one day he was extubated and his blood pressure returned to normal. When a functioning neuroendocrine tumour is suspected clinically, the use of octreotide can, as in this case, be life saving.

schemic infarction is a rare cause of acute myelopathy. We report the case of a young woman admitted to Sultan Qaboos University Hospital, Oman, who developed extensive spinal cord infarction in the setting of surgical evacuation and packing of liver haematoma and post-operative epidural analgesia. She had no vascular risk factors for stroke. The vascular mechanism underlying ischemic myelopathy and the relationship to abdominal surgery and epidural analgesia are discussed.

Objectives: To stratify the magnetic resonance (MR) pelvimetric diameters according to mode of delivery and establish possible reference values for pelvic diameters and outlet index for trial of labor after a previous caesarean section. Methods: This is a retrospective study of 125 patients at Sultan Qaboos University Hospital who underwent MR pelvimetry prior to a trial of vaginal delivery after a previous caesarean section between May 2001 and October 2003. Sagittal inlet, Transverse inlet, interspinous diameter, sagittal outlet and transverse outlet diameters were measured in all patients. The mean diameters were stratified according to delivery modality (vaginal delivery or caesarean section). The outlet index (sum of interspinous, sagittal outlet and intertuberous diameters), biparietal diameter of the foetus and head circumference were compared in women who delivered by caesarean section or vaginally. Results: All the diameters except sagittal inlet, were significantly larger (P < 0.05) in women who delivered normally as compared with those who had a caesarean section for any indication. The mean outlet index in the spontaneous delivery group with vertex presentation 31.89 ± 2.05, was significantly larger than that of the elective and emergency caesarean section, which were 29.69 ± 1.85 & 30.62 ± 1.80 respectively. The mean head circumference was also found to be significantly larger in the caesarean section deliveries. Conclusion: An outlet index of 31.89 ± 2.05 and the pelvic diameters, transverse inlet 12.56 ± 0.80cm, sagittal outlet 10.54 ± 1.00 cm, interspinous diameter10.46 ± 0.89cm, and intertuberous diameter (transverse outlet) 10.89 ± 1.02cm are useful cut-off points for vaginal delivery in our population.

We report the case of a 7 year-old Omani girl with tuberous sclerosis (TS), attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD), at Sultan Qaboos University Hospital (SQUH), Oman. For a year she had been suffering from hyperactivity, aggression, over talkativeness, insomnia, risk-taking behaviour, distractibility, poor attention and seizures. This clinical picture evolved slowly, but was progressive in nature. Before the consultation at her local health centre, she was given four drugs without being properly investigated; she continued to deteriorate. In SQUH, she showed hyperactive-impulsive behaviour, elation, flight of ideas, preoccupation with self and high self-confidence. The physical examination revealed multiple hypomelanotic patches all over the body and a shagreen patch at the sacral area. The electroencephalogram showed generalised epileptic discharges, while brain imaging showed multiple parenchymal calcified foci in both cerebral hemispheres. Other investigations were normal. She was given valproate, and then a psychostimulant, methylphenidate, that controlled her state. Our aim in reporting this case is not only because it is unique, given its rare comorbidity (ADHD, TS and BD), but also to remind our junior colleagues to be alert to the possibility of an underlying neuropathology when performing clinical examinations and investigations of children presenting with neuropsychiatric symptoms.

We present the case of a 37 year-old female who had disseminated tuberculosis (TB) with bilateral adrenal involvement resulting in primary adrenal failure (Addison’s disease) with refractory hyponatraemia and possible extrapontine ‘myelinolysis’. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB.

Marjolin’s ulcers are malignancies that arise in chronic venous ulcers, scars, burns, long standing wounds or sinuses. Radiography provides important information regarding bone destruction and periosteal reaction, and magnetic resonance (MR) imaging provides excellent soft tissue detail, like tumour extent, depth, margins, any underlying bone cortical or marrow involvement, or involvement of adjacent neuro-vascular structures. We report two cases of Marjolin’s ulcer and describe their radiographic and MR appearances.

Two months after a stab injury to the abdomen, a 35-year-old male presented at the All India Institute of Medical Sciences with haematemesis, shock and portal hypertension. Computed tomography of the abdomen and abdominal angiography revealed a large fistulous communication between an abdominal aortic pseudoaneurysm and a branch of the superior mesenteric vein. The fistula was occluded percutaneously, which allowed the patient to stabilise haemodynamically and, finally, to undergo a definitive surgical excision of the pseudoaneurysm and repair of the aortic defect.

A 29-year-old lady receiving repeated blood transfusions for β thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine.

The medical records of three children who were entrapped inside vehicles are reviewed and their outcome following the incidents were assessed in this report. The children developed heat stroke following the incidents and survived after several days in coma but with severe cognitive functions impairment. Two of the children were left with hyperactivity and attention deficit, while the third had active epilepsy.Vehicular entrapment heat stroke is one of the preventable brain injuries in children. Several children get entrapped in cars or other vehicles yearly and survivors are left with significant brain damage. The usual cause for brain damage is heat stroke the lesson learned was to never leave children unattended in cars. Therefore, it is essential to double check that doors are locked when leaving children unattended near vehicles.

A case report of unsuspected adrenal carcinoma with pulmonary artery obstruction in a young girl who was admitted with recurrent episodes of hypotension is presented. Computed tomography (CT) scans demonstrated a large right adrenal mass extending into the inferior vena cava (IVC), right atrium, right ventricle and right pulmonary artery. There are many case reports in literature documenting IVC and right atrial thrombus in patients with adrenal carcinoma. To our knowledge, this is the first case report specifically documenting pulmonary infarction secondary to tumour extension into the pulmonary artery.

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