Nephrotic syndrome leading to recurrent pulmonary embolism: A report of two cases.

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Role of blood urea nitrogen and serum albumin ratio in predicting severity of community acquired pneumonia (CAP).

Blood urea nitrogen and serum albumin levels are independent risk factors for poor clinical outcome in CAP. However, there is a paucity in the literature on the role of Blood urea nitrogen and albumin ratio(B/A) in CAP. This was a prospective observational study in which 112 admitted patients with the diagnosis of CAP underwent routine blood examinations, ABG, procalcitonin and Chest X-ray. Univariate analysis among various risk factors, CURB-65 scores, blood parameters including B/A ratios and clinical outcomes were carried out followed by multiple logistic regression. Cox regression was done to look at B/A values and time to mortality. In the logistic regression, age, CURB -65 score, B/A ratio and procalcitonin came out to be independent risk factors for ICU admission and mortality. Odds ratio of B/A in predicting mortality and ICU admission came out to be 67.8 (49.2-95.4) and 11.2 (8.4-14), respectively. Cox regression showed B/A values were also found to have a statistically significant relationship with time to mortality (p=0.001). B/A ratio has the potential to become a veritable predictor of poor clinical outcomes in patients with CAP.

Progressive Disseminated Histoplasmosis in an Immunocompetent Host: A Rare Presentation of an Uncommon Disease.

Disseminated Histoplasmosis, a systemic fungal infection caused by Histoplasma capsulatum is predominantly seen in immunocompromised cases. It is usually endemic, although sporadic cases have been reported. Following initial infection to the lungs, it disseminates to various organs by lymphatic and hematogenous routes. Clinical features are non-specific and depend on the extent and severity of organ involvement. A Biopsy is required for diagnosis and timely intervention decreases morbidity and mortality. Our case report describes an atypical association of progressive disseminated Histoplasmosis with bone marrow involvement in an immunocompetent adult from a non-endemic region and alerts the clinicians to a rare yet life-threatening mycosis.

Paraquat lung - a rare cause of diffuse parenchymal lung disease.

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Post partum dyspnoea: look beyond the lungs.

The aetiology of acute-onset dyspnoea in the post partum period is diverse. However, subtle clinical and radiological findings assist in early diagnosis and definitive management, thereby conferring better prognosis and survival. https://bit.ly/361b4qm.

Clinico-radiological profile of connective tissue disease related-interstitial lung diseases from a tertiary care centre of India: a cross sectional study.

Interstitial lung diseases (ILDs) are a frequently occurring pulmonary manifestation in patients of connective tissue diseases (CTD). Detailed understanding of this subset of lung diseases is vital, hence the study was conducted to analyze the clinico-radiological characteristics of CTD-ILD. The present study was conducted between March 2017 to February 2018 at a tertiary care teaching hospital from western India. A total of 100 patients having respiratory symptoms suggestive of ILD, who were either diagnosed cases of CTD or had clinical manifestations of underlying CTD, were included in the study.  27% of patients belonged to age group 41-50 years and 78% were females. Chief respiratory complaints were dyspnea and cough. Clubbing was present in 29% patients. The most common CTDs were rheumatoid arthritis [RA] (26%), systemic sclerosis [SSC] (21%), mixed connective tissue disorder [MCTD] (19%) and Sjogren's syndrome [SS] (16%). Restrictive defect on spirometry was seen in 58% cases and was most significant among patients with RA (65%) and SS (62%). Pulmonary arterial hypertension was seen in 40% cases and was most evident in MCTD (78%) and SSC patients (58%). Chest radiograph was normal in 47% of subjects. Most common radiological pattern on high resolution computed tomography (HRCT) thorax was non-specific interstitial pneumonia (42%) followed by usual interstitial pneumonia (21%). ILD is a common manifestation of CTD. Work-up for an underlying CTD should be offered to all ILD patients and vice versa.

A review of Ciclesonide in COVID-19. Still a long way to go.

As no definitive therapy or vaccine is yet available for COVID-19, in a desperate attempt repurposed drugs are being explored as an option. A drug repurposing study identified Ciclesonide as a potential candidate. We reviewed the available evidence and clinical trials on the use of Ciclesonide in COVID-19. At present the evidence is limited to a report of three cases. However, five clinical trials are underway, and their results will help in elucidating the role of Ciclesonide in COVID-19.

Using a simple open-source automated machine learning algorithm to forecast COVID-19 spread: A modelling study.

INTRODUCTION: Machine learning algorithms have been used to develop prediction models in various infectious and non-infectious settings including interpretation of images in predicting the outcome of diseases. We demonstrate the application of one such simple automated machine learning algorithm to a dataset obtained about COVID-19 spread in South Korea to better understand the disease dynamics. MATERIAL AND METHODS: Data from 20th January 2020 (when the first case of COVID-19 was detected in South Korea) to 4th March 2020 was accessed from Korea's centre for disease control (KCDC). A future time-series of specified length (taken as 7 days in our study) starting from 5th March 2020 to 11th March 2020 was generated and fed to the model to generate predictions with upper and lower trend bounds of 95% confidence intervals. The model was assessed for its ability to reliably forecast using mean absolute percentage error (MAPE) as the metric. RESULTS: As on 4th March 2020, 145,541 patients were tested for COVID-19 (in 45 days) in South Korea of which 5166 patients tested positive. The predicted values approximated well with the actual numbers. The difference between predicted and observed values ranged from 4.08% to 12.77% . On average, our predictions differed from actual values by 7.42% (MAPE) over the same period. CONCLUSION: Open source and automated machine learning tools like Prophet can be applied and are effective in the context of COVID-19 for forecasting spread in naïve communities. It may help countries to efficiently allocate healthcare resources to contain this pandemic.

Extrapolation of mortality in COVID-19: Exploring the role of age, sex, co-morbidities and health-care related occupation.

We used a publicly available data of 44,672 patients reported by China's centre for disease control to study the role of age, sex, co-morbidities and health-care related occupation on COVID-19 mortality. The data is in the form of absolute numbers and proportions. Using the percentages, retrospective synthetic data of 100 survivors and 100 deaths were generated using random number libraries so that proportions of ages, genders, co-morbidities, and occupations were constant as in the original data. Logistic regression of the four predictor factors of age, sex, co-morbidities and occupation revealed that only age and comorbidities significantly affected mortality. Sex and occupation when adjusted for other factors in the equation were not significant predictors of mortality. Age and presence of co-morbidities correlated negatively with survival with co-efficient of -1.23 and -2.33 respectively. Odds ratio (OR) for dying from COVID-19 for every 10-year increase in age was 3.4 compared to the previous band of 10 years. OR for dying of COVID-19 was 10.3 for the presence of any of the co-morbidities. Our findings could help in triaging the patients in the emergency room and emphasize the need to protect the elderly and those with comorbidities from getting exposed.

Quarantine of Health Care Workers in the COVID-19 Crisis: Why and How Long?

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Low dose radiotherapy for COVID pneumonia: Irradiate to Eradicate - Will it be possible?

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Asymptomatic patient with "lumpy and bumpy" airways. A case of pulmonary MALToma.

Primary pulmonary lymphoma is a rare disease. The most frequent primary pulmonary lymphoma (PPL) is extranodal marginal zone B-cell lymphoma of MALT. About half of the patients are asymptomatic at diagnosis. We report a case of a 62-year-old male referred to us for preoperative assessment of surgery for Benign Prostatic Hyperplasia (BPH). He had no respiratory complaints but on evaluation was detected to have Pulmonary MALToma. Our case highlights the importance of tissue diagnosis.

Asymptomatic gossypiboma with complete intramural migration and ileoileal fistula.

Retained gossypiboma is a rare and under-reported complication of surgery, which can present in a variety of ways. Thus, a very high index of suspicion is required by the clinician to clinch the diagnosis in a postoperative patient. A 45-year-old woman, who was otherwise asymptomatic, presented to the General Surgery outpatient department (OPD) with a contrast-enhanced CT suggestive of a retained intra-abdominal foreign body from previous surgery. An exploratory laparotomy was planned on elective basis. Intraoperatively, dense inter-bowel adhesions were found in the upper abdomen. After a meticulous adhesiolysis, an ileoileal fistula and an intraluminal surgical sponge were discovered. Resection and anastomosis of the involved ileal segment was done. An asymptomatic patient with a migrated intramural gossypiboma with an ileoileal fistula is an extremely rare occurrence. In these circumstances, it becomes almost impossible for the surgeon to clinch the diagnosis of a gossypiboma in an otherwise asymptomatic patient, without the aid of radiological investigations.