Subhajit Sen

Abstract

Recent reports have described a secondary Multi system In?ammatory Syndrome in adult (MIS-A)and its temporal association with COVID-19 infection. Here, we report the case of a 25-year-old male who presented with shock and multi organ failure. Three-week prior to present admission he developed an Influenza like illness, secondary to SARS-CoV2 infection as detected by a reverse-transcription polymerase chain reaction (RT-PCR). Three weeks later, patient had recurrence of fever associated with throat pain, neck swelling, and a rash followed by shock and multiorgan failure. Laboratory work revealed elevated inflammatory markers. His throat swab for SARS-CoV-2 by RT-PCR was negative and SARS-CoV-2 IgG antibody was reactive.In view of presentation like multi-inflammatory syndrome in children (MIS-C) a probable diagnosis of MIS-A was made. He was successfully treated with intravenous Immunoglobulin and pulse dose Methylprednisolone. This case highlights the need to remain vigilant for multisystem in?ammatory syndromes in the COVID-19 affected patients.[   Keywords: SARS COV2, MIS­A, IVIG

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Abstract

A 73 years old male, known hypertensive on medication, with the history of SARS-CoV-2 infection nine months ago, presented to us with mucormycosis, he was treated with Liposomal amphotericin B initially. He developed acute kidney injury with recurrent pulmonary oedema requiring ICU admission and Haemodialysis. He later developed catheter related blood stream infection that grew Carbapenem resistant Klebsiella pneumonia and was started on Polymyxin B. However from day 3 of antibiotics he started to develop recurrent respiratory arrest with no apparent cause. He required a brief period of mechanical ventilation and was successfully weaned. He had recurrent such episodes with no apparent cause. After extensive work up and literature search it was diagnosed as Polymyxin B induced respiratory failure. Polymyxins were stopped, patient was discharged in a stable condition after five days of further observation and is currently on follow up with no such episode of dyspnoea.   Keywords: Respiratory failure, Polymyxin B, Neuromuscular blockade

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Abstract

The article presents a 22 year old female being treated as a case of asthma without any benefit, whom was ultimately found to have an endobronchial growth which on biopsy revealed Granular Cell Tumor. Pulmonary Granular Cell Tumors are very rare benign tumors as less than 80 cases has been described since 1938, when it was first described.   Keywords: Endobronchial granular cell tumor, Asthma, Obstructive airway disease

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Abstract

Background and Objectives: Pneumothorax is a common respiratoryemergency that requires active interventions in many cases specially Tube thoracostomy. Objective of the present study is to find out changes in clinical and arterial blood gas parameters in primary and secondary pneumothorax following tube thoracostomy at different time intervals. Materials and Methods: Total 30 cases, Primary spontaneous pneumothorax (PSP) 11 and secondary spontaneous pneumothorax (SSP) 19. Clinical parameters: pulse rate, blood pressure, respiratory rates, oxygen saturation (SpO2). ABG analysis: pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), AaDO2. Time interval: pre tube thoracostomy, 1hour and 24hours after thoracostomy and after tube removal. Results: PSP was found more in young patients (mean 34.18), SSP in older patient (mean 52.68), (P=0.001). Among clinical parameters statistically significant changes were seen in pulse rate, (P In PSP group hypoxaemia was present in 54.54% patients before giving chest tube, after 1 hour of tube thoracostomy only 18.18% cases had mild hypoxaemia. In SSP group 68.42% cases presented with hypoxaemia initially, after tube removal 26.31% cases had mild hypoxaemia.No significant changes in other blood gas parameters were seen in either groups. Conclusions: The impact of tube thoracostomy on primary and secondary pneumothorax are mainly reflected on clinical parameters rather than blood gas parameters.   Keywords: Pneumothorax, ICTD, ABG, Respiratory physiology

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