A case report of ruptured amoebic liver abscess causing cardiac tamponade and requiring pericardial window

Background Amoebiasis is a prevalent infection in the tropics. Amoebic liver abscess is the most common extraintestinal manifestation. Cardiac tamponade is an uncommon complication of amoebic liver abscess that may need urgent pericardiocentesis. Case summary A 25-year-old man presented with abdominal pain and fever for 1 month. Abdominal ultrasound revealed a 4.7 × 4.7 cm abscess in the left lobe of the liver. Percutaneous pigtail drainage was performed to evacuate the abscess. After 2 days, the patient developed signs of cardiac tamponade and bilateral pleural effusion, requiring urgent pericardiocentesis and chest drain insertion. Persistent posterior collection of thick abscess in pericardium needed pericardial window for complete drainage. The patient recovered completely after pericardial window. There was no evidence of chronic constrictive pericarditis after 1 year of follow-up. Discussion A rare complication of the amoebic liver abscess was observed in this young adult who developed cardiac tamponade, requiring an urgent pericardiocentesis, and later requiring pericardial window. Management includes amoebicidal and luminicidal drugs for complete eradication of Entamoeba histolytica.

Early Window Tailoring: A New Approach to Increase the Number of TCP Connections Served

In the absence of losses, TCP constantly increases the amount of data sent per instant of time. This behavior leads to problems that affect its performance, especially when multiple devices share the same gateway. Several studies have been done to mitigate such problems, but many of them require TCP side changes or a meticulous configuration. Some studies have shown promise, such as the use of gateway techniques to change the receiver’s advertised window of ACK segments based on the amount of memory in the gateway; in this work, we use the term “network-return” to refer to these techniques. In this paper, we present a new network-return technique called early window tailoring (EWT). For its use, it does not require any modification in the TCP implementations at the sides and does not require that all routers in the path use the same congestion control mechanism, and the use in the gateway is sufficient. With the use of the simulator ns-3 and following the recommendations of RFC 7928, the new approach was tested in multiple scenarios. The EWT was compared to drop-tail, RED, ARED, and the two network-return techniques—explicit window adaptation (EWA) and active window management (AWM). In the results, it was observed that EWT was shown to be efficient in congestion control. Its use avoided losses of segments, bringing expressive gains in the transfer latency and goodput and maintaining fairness between the flows. However, unlike other approaches, the most prominent feature of EWT is its ability to maintain a very high number of active flows at a given level of segment loss rate. The EWT allowed the existence of a number of flows, which is on average 49.3% better than its best competitor and 75.8% better when no AQM scheme was used.