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Since the declaration of COVID-19 infection as Pandemic in March, 2020, There has been rise in Multisystem Complications apart from regular Acute Respiratory Syndrome which is hallmark of COVID-19 infection. As the second wave surge of COVID-19 has occurred, most of the patients already suffered from dyspnoea but also rare complications like CVA (Infarct and Haemorrhage) , Seizure and altered sensorium related to Hypoxic Brain Injury. COVID-19 frequently presents with a state of altered coagulability which increases the risk of pulmonary embolism and other Thrombotic events such as Cerebrovascular events. This case report is limited to Neurological complications seen in COVID-19 Infected patients
Résumé
Coronavirus Disease 2019 (COVID-19) is a Respiratory Tract Infection (RTI) caused by a newly emergent Coronavirus, that was first recognized in Wuhan, China, in December 2019. Genetic sequencing of the virus suggests that it is a Beta Coronavirus closely linked to the SARS virus1. By the end of 2019, several cases of Pneumonia with unknown aetiology were reported in Wuhan, China2-5. Most cases progressed to Acute Respiratory Distress Syndrome (ARDS)2. As the second wave surge of COVID-19 has occurred, most of the patients already suffered from dyspnoea but rare complications also seen more frequently in respiratory presentation. Cases of Pneumothorax and Subcutaneous emphysema is not seen frequently in COVID-19 patients so far. Here we are presenting two unusual complications in COVID-19 patients of our COVID facility. The possibility of spontaneous Pneumothorax/Tension Pneumothorax should be kept in differential diagnosis in COVID-19 patient presented with severe breathlessness and on higher settings of Non-invasive ventilation and on higher respiratory assistance can cause Subcutaneous emphysema
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Purpose: The study purpose included dosimetric comparison of cobalt 60 (60Co) and iridium 192 (192Ir) high dose rate (HDR) source used in brachytherapy treatment of cervical cancer. Materials and Methods: Computed tomography (CT) scans for 15 patients of carcinoma of uterine cervix using 3-mm slice thickness were considered for the study The contouring of high-risk clinical target volume (HRCTV), bladder, and rectum on CT images was done as per the GEC ESTRO guidelines with the help of magnetic resonance imaging images in the treatment planning system. All parameters were kept the same for 60Co (3.5 mm active length, 0.5 mm active dia, Bebig) and 192Ir (3.5 mm active length, 0.6 mm active dia, Bebig) HDR source with 2.5-mm step size and dose prescription to Point A. As per the International Commission on Radiation Unit (ICRU)-89 guidelines, the dose–volume parameters such as D50(Gy), D90(Gy), and D98(Gy) for HRCTV and D0.1cc (Gy), D1cc (Gy), D2cc (Gy), and D5cc (Gy) to the bladder and rectum were calculated for both the HDR sources. Results: The difference in dose–volume histogram parameters such as D50,D90,and D98 of HRCTV was 3.19%, 1.13%, and 0.50%, respectively, for the two radioisotopes. The difference in dose values of D0.1cc, D1cc, D2cc, D5cc, and ICRU reference points of bladder was –0.58%, –0.67%, –0.99%, –0.94%, and –1.75%, respectively. On the other hand, dose difference for D0.1cc, D1cc, D2cc, D5cc, and ICRU reference points of rectum was 0.67%, 0.26%, 0.56%, 0.63%, and –0.33%, respectively. Conclusions: The present study results show that all the dose parameters of HRCTV, bladder, and rectum with 60Co were comparable with those of 192Ir HDR source. The isodose distribution is more bulge out for 60Co in cranial-caudal direction compared to that of 192Ir. However, these differences can be reduced by treatment planning optimization techniques. The clinical plan evaluation in each slice and plane is necessary to explore the logistic and financial benefits of miniaturized 60Co source over 192Ir HDR source
Résumé
BACKGROUND: Coronary artery calcification is a part of the development of atherosclerosis. It occurs exclusively in atherosclerotic arteries and can be used as a noninvasive marker of coronary atherosclerosis. As there is no large-scale study on coronary calcium score reported in the Indian population till date, this study was undertaken for calculating the score in Indians at intermediate-to-high risk of coronary artery disease, and to correlate it with angiographically proven coronary artery disease. METHODS AND RESULTS: A total of 388 consecutive patients who underwent coronary calcium scoring and coronary angiography were included in the study. Calcium scoring was performed based on a modification of the Agatston Score using a high-speed computed tomography scanner (GE CT/i scanner). Coronary calcium scores were correlated with the presence or absence of significant coronary artery disease (defined as > or = 70% stenosis of at least one major epicardial coronary artery) on angiography. Out of 388 patients who underwent coronary angiography, 298 were found to have significant coronary artery disease. Mean coronary calcium score was significantly higher in patients with angiographically proven coronary artery disease (226.7+/-65.2) as compared to those who had normal angiograms (20.29+/-56.7; p value<0.0001). All the 72 patients who had a score > 400 had an abnormal angiogram (sensitivity 23.1%, specificity 100%, positive predictive value 100%, and negative predictive value 24.1%). On the other hand, among the patients who had a score > 0, 298 were found to have abnormal angiograms, while 16 had normal angiograms (sensitivity 95.5%, specificity 78.9%, positive predictive value 94.9%, and negative predictive value 81.1%). CONCLUSIONS: Detection of coronary calcium score by a helical computed tomography scanner is a useful tool for predicting the presence of significant coronary artery disease in intermediate-to-high risk patients. An absolute score of 0 has a high negative predictive value for the presence of coronary artery disease, and may obviate the need to perform coronary angiogram in intermediate-risk patients. On the other extreme, score > 400 is highly predictive of the presence of coronary artery disease, and virtually confirms the presence of significant coronary artery disease in intermediate-to-high risk patients.