A Rare Case of Idiopathic Pleuro-Parenchymal Fibroelastosis Presenting With Bilateral Spontaneous Pneumothoraces.

Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease (ILD), characterized by predominantly upper lobe pleural and subjacent sub-pleural parenchymal fibrosis. Its name refers to a combination of fibrosis involving the visceral pleura with fibroelastotic changes, predominantly in the subpleural lung parenchyma. We describe the case of a 67-year-old lady who presented to the accident and emergency department of Weston General Hospital with worsening shortness of breath (SOB) and cachexia of six to eight months' duration. The initial imaging studies showed bilateral spontaneous pneumothoraces on a background of pleural-based consolidation and fibrotic changes. A subsequent high-resolution CT (HRCT) chest showed evidence of pleuroparenchymal fibroelastosis in the background. She was not considered for anti-fibrotic medications due to the advanced stage of the disease and was managed with supportive measures, including oxygen support, oral steroids and antibiotics to cover for any infections. After initial management of symptoms and long discussions with the patient, family and the palliative team, she was discharged home with community follow-up.

Estimating the salivary levels of IL-35 in smokers with periodontitis: A cross sectional study.

Background: A refined network and integrated host immune response to bacteria are formed by anti-inflammatory cytokines and the cells that they are associated to IL-35 has been recognized as having strong suppressive activity in chronic inflammatory diseases, together with IL-10 and TGF-ß. It is believed that inflammatory diseases like periodontitis trigger the inducible Treg population to express IL-35, expanding regulatory responses by increasing infection. Aim: The objective is to estimate and compare the salivary IL-35 levels in Periodontally healthy subjects, smokers and non-smokers with Periodontitis in order to educate on the consequences of periodontal health among the diseased patients. Materials and Methods: Totally 42 subjects were included and they were categorized into Group 1 (n = 14) as Periodontally healthy subjects, Group 2 (n = 14) as systemically healthy non-Smokers with periodontitis and Group 3 (n = 14) as systemically healthy smokers with periodontitis. Each subject was assessed for clinical parameters such as Plaque index, Gingival index, Probing depth, clinical attachment. A polypropylene tube was used to collect unstimulated saliva and centrifuged it at 800 × g for 10 min. Supernatants were collected and stored at -80◦C. A commercially available enzyme-linked immunosorbent assay kit was used to analyse levels of human salivary IL-35. Results: The average age of the subjects in Group 1, Group 2 and Group 3 were 50.53, 52.93 and 52.07 years respectively. All three groups showed a statistically significant difference in clinical parameters including Plaque index, Gingival index, Probing depth and clinical attachment. The salivary IL-35 level was found to be elevated in non-smokers who have periodontitis compared to smokers with periodontitis and healthy individuals. Despite this, the salivary IL-35 levels were found to be statistically significant among three groups at P < 0.001. Conclusion: The salivary levels of IL-35 were found to increase in Periodontitis patients with/without smoking, along with increased clinical parameters. IL-35 is considered a influential biomarker for periodontal disease.

Pneumocystis jirovecii Pneumonia (PCP) in a Non-HIV Lung Cancer Patient in the Absence of Common Risk Factors.

Pneumocystis jirovecii pneumonia (PCP) has been described mainly in AIDs and in immunocompromised patients with hematological malignancies, organ transplant recipients, collagen vascular disease, and primary immune deficiencies or those under treatment with steroids or chemotherapy. The incidence of PCP pneumonia is increasing in solid organ tumors and hematological malignancies receiving chemotherapy. Pneumocystis pneumonia has been rarely reported in patients with non-small cell lung cancer (NSCLC). We describe a 68-year-old woman with a recent diagnosis of squamous cell lung cancer, who received radiotherapy two weeks prior to the current hospital admission with shortness of breath and dry cough. The initial investigations, including chest X-ray and CT images, were suggestive of atypical pneumonia, with PCP pneumonia as the top differential. Treatment was started with high-dose trimethoprim-sulfamethoxazole (cotrimoxazole) and oxygen support. Serum beta-glucan was found to be more than 500 pg/ml in favor of PCP infection. Oral steroids were added to the treatment in view of hypoxia (arterial oxygen pressure (PaO2) < 70 mmHg) requiring high-flow nasal cannula support. Subsequently, bronchoscopy was done and the bronchoalveolar lavage (BAL) sample came positive for PCP polymerase chain reaction (PCR). The patient made a significant recovery after four weeks of treatment with cotrimoxazole and was discharged home in stable condition with cotrimoxazole prophylaxis. The reported cases of PCP pneumonia in lung cancers were following chemotherapy, chemoradiation, or steroid treatment. The incidence of PCP pneumonia in lung cancer patients receiving radiotherapy is relatively rare. Our patient could not tolerate chemotherapy for the cancer due to an anaphylactic reaction and hence was treated with radiotherapy alone for the lung cancer prior to getting PCP pneumonia. Therefore, it is important to carry a high index of suspicion for PCP infection in a lung cancer patient presenting with features of atypical pneumonia following cancer treatments, including radiotherapy alone.

Clinico-demographic profile of COVID-19 positive patients - first wave versus second wave - an experience in north-east India.

INTRODUCTION: India witnessed two distinct COVID-19 waves. We evaluated the clinico-demographic profile of patients infected during first wave (FW) and second wave (SW) in a hospital in north-east India. METHODOLOGY: Patients who tested positive for severe acute respiratory syndrome-coronavirus-2 specific gene by reverse transcriptase polymerase chain reaction across FW and SW were diagnosed as COVID-19 positive. The clinico-demographic data of these positive patients were retrieved from the specimen-referral-form. Vital parameters including respiratory rate, SpO2, data on COVID-19-associated mucormycosis (CAM), COVID-19-associated acute respiratory distress syndrome (CARDS) were obtained from hospital records for in-patients. Patients were categorized based on disease severity. The data obtained in both waves were analyzed comparatively. RESULTS: Out of a total of 119,016 samples tested, 10,164 (8.5%) were SARS-CoV-2 positive (2907 during FW, 7257 during SW). Male predominance was seen across both waves (FW: 68.4%; SW:58.4%), with more children infected during SW. Patients with travel history (24%) and contact with laboratory confirmed cases (61%) were significantly higher during SW relative to FW (10.9% and 42.1% respectively). Healthcare worker infection was higher in SW (5.3%). Symptoms like vomiting [14.8%], diarrhea [10.5%], anosmia [10.4%] and aguesia [9.4%] were more in SW. More patients developed CARDS in SW (6.7%) compared to FW (3.4%) with 85% and 70% patients expiring across FW and SW respectively. No case of CAM is documented in our study. CONCLUSIONS: This was probably the most comprehensive study from north-east India. Industrial oxygen cylinder usage may have been the source of CAM in the rest of the country.

Influence of strain on an ultrafast phase transition.

The flexibility of 2D materials combined with properties highly sensitive to strain makes strain engineering a promising avenue for manipulation of both structure and function. Here we investigate the influence of strain, associated with microstructural defects, on a photo-induced structural phase transition in Td-WTe2. Above threshold photoexcitation of uniform, non-strained, samples result in an orthorhombic Td to a metastable orthorhombic 1T* phase transition facilitated by shear displacements of the WTe2 layers along the b axis of the material. In samples prepared with wrinkle defects WTe2 continue its trajectory through a secondary transition that shears the unit cell along the c axis towards a metastable monoclinic 1T' phase. The time scales and microstructural evolution associated with the transition and its subsequent recovery to the 1T* phase is followed in detail by a combination of ultrafast electron diffraction and microscopy. Our findings show how local strain fields can be employed for tailoring phase change dynamics in ultrafast optically driven processes with potential applications in phase change devices.

Clofibrate as an Adjunct to Phototherapy for Unconjugated Hyperbilirubinemia in Term Neonates.

OBJECTIVE: To evaluate the efficacy of oral clofibrate as an adjunct to phototherapy for unconjugated hyperbilirubinemia in term neonates. METHODS: This randomized controlled trial was done in the level III neonatal intensive care unit (NICU) of a tertiary care hospital. Ninety term neonates with unconjugated hyperbilirubinemia with serum bilirubin 15-25 mg/dl were randomized to either intervention group (single dose of clofibrate in a dose of 50 mg/kg prior to starting phototherapy) or standard care group (only phototherapy). Primary outcome was absolute fall in bilirubin by 48 h. Secondary outcomes were duration of phototherapy, absolute fall in bilirubin levels at 12, 24, 36, 48 h, need for exchange transfusion and incidence of side-effects. RESULTS: After 48 h of intervention, significantly lower bilirubin levels were noted in the intervention group compared to standard care group with a mean difference of 7 mg/dl (95% CI 6.7 mg/dl to 7.2 mg/dl). Duration of phototherapy required was less in the intervention group compared to standard care group with mean difference of 23.82 h (95% CI 30.46 h to 17.18 h). Exchange transfusion was needed for 4 neonates in the standard care group and none in the intervention group. No side-effects were noted with clofibrate. CONCLUSIONS: Single dose clofibrate prior to starting phototherapy in term neonates with uncomplicated unconjugated hyperbilirubinemia reduces the duration of phototherapy significantly.

Design and implementation of an automated secondary cooling system for the continuous casting of billets.

This paper describes a heat transfer model based automatic secondary cooling system for a billet caster. The model aims to minimize the variation in surface temperature and excessive reheating of the billet strands. It is also used to avoid the low ductility trough of the solidifying steel, which aggravates the tendency of steel to crack. The system has been designed and implemented in an integrated steel plant. A Programmable Logic Controller (PLC) based automation system has been developed to control the water flow in the secondary cooling zones of the strand. The results obtained through field trials have shown complete elimination of internal and off-corner cracks for the fifty billet samples that were monitored.