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SARS-COV2 pandemic has spread like wildfire and has affected all the countries worldwide. The virus mainly affects the lungs and has numerous manifestations. The development of spontaneous pneumatocele and pneumothorax has rarely been reported in the literature, especially in spontaneously breathing patients. We report two cases of COVID-19 patients who developed these complications after discharge from our hospital. These complications are uncommon but can be potentially fatal and the treating physician should keep these complications as differential while managing such cases. [ABSTRACT FROM AUTHOR]

Pulmonary alveolar proteinosis (PAP) is a rare disease which involves the accumulation of insoluble lipoproteinaceous material in the alveoli leading to impaired gas exchange and even respiratory failure. Autoimmune PAP is the most common type and is characterized by the presence of anti-granulocyte-monocyte colony stimulating factor (anti GM-CSF) antibody. Whole lung lavage has been traditionally used as first-line management of PAP but there is a lack of clarity especially in the treatment of relapsing cases of PAP. Rituximab is an anti Cluster of Differentiate 20 (CD 20) monoclonal antibody that has been tried as salvage therapy for relapsing cases of PAP. We present a case of 35 years old female patient who was diagnosed as a case of relapsing PAP who was managed initially with neoadjuvant rituximab. This is a retrospective observational report showing novel use of neoadjuvant rituximab in a difficult case of relapsing PAP. [ABSTRACT FROM AUTHOR]

Tuberculosis is a leading cause of death in our country. Multidrug-resistant tuberculosis increases the morbidity and mortality due to severe manifestations and difficult and prolonged medications. Newer antitubercular drugs like delamanid have been approved by WHO in management of these cases, but the real-world experience of this drug is lacking in our country. We present our early experience of use of delamanid in extensively drug-resistant pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

The peripheral high-flow vascular malformation (HFVM) comprises arteriovenous malformation (AVM) and fistula (AVF), shows varied clinical presentation (ranging from subtle skin lesion to life-threatening congestive heart failure), and frequently poses diagnostic and therapeutic challenges. Importance of assigning a specific diagnosis to the vascular malformation cannot be overstated, as the treatment strategy is based on the type of vascular anomaly. Although the International Society for the Study of Vascular Anomalies (ISSVA) classification system is the most commonly accepted system for classifying congenital vascular anomalies in clinical practice, the Cho–Do et al classification is of utmost help in guiding optimal mode of treatment in peripheral AVM. Although transarterial approach remains the most commonly employed route for peripheral AVM embolization, the role of transvenous and direct percutaneous approach is ever increasing and the final decision on the approach depends on angioarchitecture of the AVM. In this article, we review various commonly employed classification systems for congenital vascular anomalies, and describe clinical features, imaging and treatment strategies for peripheral arteriovenous malformation (PAVM). [ABSTRACT FROM AUTHOR]

Introduction: Organizing pneumonia (OP) is an idiopathic interstitial pneumonia characterized radiologically by the patchy peripheral areas of ground-glass opacities and consolidation. It is commonly associated with a variety of conditions such as connective tissue diseases (CTD), drugs, infections, malignancy, radiation exposure, post-transplant, and other interstitial pneumonia. There are no specific clinical manifestations unless there is an underlying etiology. We present a series of such cases. Aims and Objectives: The aim of the study was to identify the clinical characteristics and etiological spectrum of patients manifesting radiologically with OP pattern. Materials and Methods: This was a retrospective analysis of clinico-radiological profile and etiological diagnosis of 23 patients, who had a radiological diagnosis of OP during the period of January 2017-September 2019. Results: Our patients presented with nonspecific symptoms of cough, fever, breathlessness, and occasionally with hemoptysis. The various etiologies identified were CTD (n = 4), infection (n = 2), drugs (n = 4), radiation (n = 1), chronic aspiration syndrome (n = 1), malignancy (n = 2), hypersensitivity pneumonitis (n = 1), and chronic heart failure (n = 2), and in majority (n = 7), no underlying etiology was evident and were labeled as cryptogenic organizing pneumonia. Conclusion: OP is an underdiagnosed entity and is associated with numerous diseases varying from pulmonary tuberculosis to malignancy. Identification of the underlying disease process is of paramount importance as it enables the treating physician to implement necessary therapeutic interventions. [ABSTRACT FROM AUTHOR]

Introduction: Hematuria following iatrogenic trauma or renal vascular malformations is less common but important causes warranting definite emergency procedure in cases not responding to conservative management. Endovascular embolization is accepted as an effective technique for the treatment of acute intractable hematuria. Considering the need of microcatheter for selective embolization, its use during the procedure increases the procedural cost significantly. The purpose of the present study is to assess the effectiveness and safety of selective renal artery embolization in patients with intractable hematuria using a 4-F glide catheter (GC). The microcatheter usage during our study was intended to be restricted to cases where the GC was not navigable to the optimal site for embolization. Materials and Methods: A retrospective analysis was done for 21 cases with acute intractable hematuria referred to our center between January 2015 and February 2019. Fifteen male and 6 female patients were included. Seventeen cases followed iatrogenic injury during a renal biopsy, 2 cases were due to renal neoplasm, and 1 each due to PCN and abdominal trauma. Embolization was carried out after selective catheterization of the feeding artery, with a 4-F GC using polyvinyl alcohol (PVA) particles in combination with pushable coils in all cases. Results: The source of bleeding was identified as arteriovenous fistula (AVF) in 14, AVF with pseudoaneurysm (PA) in 3, PA alone in 2, and abnormal tumor vascularity in 2 patients. In all but 2 cases, the hematuria stopped within 24 h after embolization. In the remaining 2 cases, hematuria stopped completely within 72 h. One patient developed minor puncture site bleed with no major procedural complications or recurrence on follow-up. Conclusion: Endovascular embolization is a highly effective minimally invasive technique for the treatment of acute intractable hematuria. Good results were achieved without using any microcatheter (hence cost-effective) with no clinically significant nontarget embolization. [ABSTRACT FROM AUTHOR]

Heat tolerance was studied in spring wheat using membrane stability indices (electrical conductivity and malate dehydrogenase, MDH isozymes). Flag leaf of parents and F1's of six crosses, viz., PBN 51 × Lok 45, PBN 51 × PBW 343, MP 3091 × Raj 3765, MP 3091 × PBW 343, Raj 4012 × Raj 3765 and Raj 4012 × PBW 343, at the time of anthesis were used to study the membrane thermostability through electrical conductivity of cellular leachates. Membrane injury as indicated by electrical conductivity varied among six parents from 31.50 to 53.03% and F1's from 26.50 to 52.01%. It was observed from the electrical conductivity experiment that Raj 4012, MP 3091, Raj 3765 and Raj 4012 × Raj 3765 were heat-tolerant genotypes as there was minimum increase in electrical conductivity under heat stress. MDH isozymes under non heat stress control and heat stress treatments revealed polymorphism. A new band present at higher heat treatment in Raj 3765 could be putative heat shock protein furnishing tolerance against heat to the genotype. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Aim of present study is to compare audiological and surgical outcomes in prelingual deaf children with Mondini's dysplasia (MD) and those with normal inner ear anatomy. MATERIALS and METHODS: Retrospective data was collected from Jan 2008 to Dec 2016. Children with bony IEM other than MD, syndromic association, multiple disabilities, those lost to follow up, and perilingual or postlingual deafness were excluded from study. Audiological outcomes for auditory perception (CAP score) and speech intelligibility (SIR score) was noted for a follow up period of 1 year. RESULTS: Mean age at implantation was 2.8 years (Range of 2 to 6 years). 2 patients had intraoperative CSF ooze which was controlled intraoperatively by conservative measures. Post operative facial nerve function was normal in all patients. None of the patient in either group had any complications at one year of follow up period. There was statistically significant improvement in CAP & SIR score in Group A at 6 & 12 months compared to pretreatment. There was no statistically significant difference between the 2 groups in terms of CAP & SIR score at 6 & 12 months. CONCLUSION: The study stresses the fact that cochlear implantation can be safely performed in children with MD although there is a risk of intraoperative CSF leak which can be controlled intraoperatively. Cochlear implantation in children with MD has good surgical, auditory and speech outcomes at par with children with normal bony inner ear anatomy. [ABSTRACT FROM AUTHOR]

Background: Intrapleural fibrinolytic therapy (IPFT) has been used as an effective agent since 1949 for managing complicated pleural effusion and empyema. Several agents, such as streptokinase, urokinase (UK), and recombinant tissue plasminogen activator (rt-PA), have been found to be effective with variable effectiveness. However, a head-tohead controlled trial comparing the efficacy of the most frequently used agents, i.e., UK and rt-PA (alteplase) for managing complicated pleural effusion has rarely been reported., Methods: A total of 50 patients were randomized in two intervention groups, i.e., UK and rt-PA. The dose of rt-PA was 10 mg, and that of UK was 1.0 lac units. UK was given thrice daily for 2 days, followed by clamping to allow the retainment of drugs in the pleural space for 2 hours. rt-PA was instilled into the pleural space twice daily for 2 days, and intercostal drainage was clamped for 1 hour., Results: A total of 50 patients were enrolled into the study, of which 84% (n=42) were males and 16% (n=8) were females. Among them, 30 (60%) patients received UK, and 20 (40%) patients received alteplase as IPFT agents. The percentage of mean± standard deviation changes in pleural opacity was -33.0%±9.9% in the UK group and -41.0%±14.9% in the alteplase group, respectively (p=0.014). Pain was the most common adverse side effect, occurring in 60% (n=18) of the patients in the UK group and in 40% (n=8) of the patients in the alteplase group (p=0.24), while fever was the second most common side effect. Patients who reported early (within 6 weeks of onset of symptoms) showed a greater response than those who reported late for the intervention., Conclusion: IPFT is a safe and effective option for managing complicated pleural effusion or empyema, and newer agents, such as alteplase, have greater efficacy and a similar adverse effect profile when compared with conventional agents, such as UK.