Esophageal Melanosis: An Unknown Entity.

Esophageal melanosis is the proliferation of melanocytes in the squamous epithelium of the esophagus and the accumulation of melanin in the walls of the esophagus. Normal esophageal mucosa does not contain melanocytes. It is a rare disease of the digestive system, and its significance has yet to be fully understood. Various studies have attributed it to gastroesophageal reflux disease, but hard evidence supporting such a claim is lacking. Some studies also point towards it being a pre-malignant condition, and further evaluation is warranted for earlier detection and treatment. We hereby present a case of chronic iron deficiency anemia incidentally found to have esophageal melanosis, confirmed with histopathological examination.

A Case of Type 2 Protein S Deficiency Presenting as Cerebral Venous Thrombosis (CVT) in an 18-Year-Old Female.

Here, we report a case of cerebral venous thrombosis in an 18-year-old female. On evaluation, she was found to have type 2 protein S deficiency, which is the rarest form of protein S deficiency and is also known as a qualitative defect. Protein S is primarily synthesized by hepatocytes and undergoes vitamin K-dependent gamma-carboxylation. Mature protein S circulates in two states: free and bound to the complement component C4b-binding protein (C4b-BP). The free form of protein S acts as a cofactor for activated protein C. This case is unique as here, there is a qualitative effect that is responsible for the manifestations.

Pattern of Lung Involvement in Predicting Severity and Sequelae in Patients With COVID-19.

Background During the COVID pandemic, high-resolution CT scan has played a pivotal role in detecting lung involvement and severity based on the segments of the lung involved. The pattern of involvement was not considered, and our aim is to observe the pattern of lung involvement in predicting severity and guiding management protocol in patients with COVID-19. Methodology It was a prospective observational study conducted with 151 patients admitted with COVID-19 with a positive reverse transcriptase polymerase chain reaction test (RT-PCR) in a single tertiary care hospital in south India. Patients with pre-existing lung pathologies were excluded from the study. Eligible patients were then divided into mild, moderate, and severe categories based on Indian Council of Medical Research (ICMR) guidelines, and high-resolution computed tomography (HRCT) chest was done, findings of which were then categorized based on lung involvement; into ground glass opacities (GGO), interstitial involvement and mixture of both. These were then analyzed to determine their importance with respect to the duration of stay and severity of the disease. Results The data collected was analyzed by IBM SPSS software version 23.0 (IBM Corp., Armonk, NY, USA). The study population included 114 males (75.5%) and 37 females (24.5%). HRCT chest was done which showed 62.3% of patients had GGO, 14.6% had interstitial lung involvement, 18.5% had a mixture of both and 4.6% had normal lung findings. These findings, when compared to clinical categories of severity, showed a significant co-relation between pattern of involvement of the lung and the severity of the disease. It also showed significant co-relation with the duration of stay. Conclusion HRCT chest has proven to be useful in the determination of patient's severity and can guide with management. We suggest earlier initiation of steroids and anticoagulants in patients with interstitial involvement even for the patients not on oxygen therapy yet. It can be used as a triage modality for screening due to the advantage of presenting with immediate results as opposed to RT-PCR which might take hours and can delay treatment which can prevent worsening.