Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS).

The new coronavirus COVID-19 disease caused by SARS-CoV-2 was declared a global public health emergency by WHO on Jan 30, 2020. Despite massive efforts from various governmental, health and medical organizations, the disease continues to spread globally with increasing fatality rates. Several experimental drugs have been approved by FDA with unknown efficacy and potential adverse effects. The exponentially spreading pandemic of COVID-19 deserves prime public health attention to evaluate yet unexplored arenas of management. We opine that one of these treatment options is low dose radiation therapy for severe and most critical cases. There is evidence in literature that low dose radiation induces an anti-inflammatory phenotype that can potentially afford therapeutic benefit against COVID-19-related complications that are associated with significant morbidity and mortality. Herein, we review the effects and putative mechanisms of low dose radiation that may be viable, useful and of value in counter-acting the acute inflammatory state induced by critical stage COVID-19.

Mechanism of the Palladium-Catalyzed Synthesis of Münchnones: The Role of Ligands in N-Acyl Iminium Salt Carbonylation.

The palladium-catalyzed carbonylative coupling of imines, acid chlorides, and dipolarophiles can provide efficient routes to prepare nitrogen-containing heterocycles. One challenge in developing this reaction, and in the creation of more active catalyst systems, is the lack of data on how this complex transformation proceeds. To address this, we report here the results of our mechanistic studies on this system, and in particular the formation of mesoionic münchnones. This includes the synthesis of key catalytic intermediates, model reactions, and kinetic studies that support the role of these compounds in catalysis. Together, these studies provide a clear picture of the impact of catalyst structure, ligands, and palladium nanoparticles on facilitating the carbonylation of in situ generated iminium salts, and suggest an avenue for the creation of more active catalyst systems.

Outcome of endoscopic sinus surgery in patients with symptomatic chronic rhinosinusitis with minimal changes on computerised tomography.

This study was designed to assess the efficacy of functional endoscopic sinus surgery (FESS) in chronic rhinosinusitis (CRS) patients with minimal radiological findings, and based on one centre, prospective randomized controlled study, conducted in the Department of Otorhinolaryngology, Lady Hardinge Medical College, New Delhi. All the CRS out-patients (>18 years) refractory to 3 weeks of medical therapy were radiologically evaluated with computerised tomographic scan (CT) of nose and paranasal sinuses. These patients were grouped based on CT scoring (Lund Mackay staging system): group A (CT score 0-6) and group B (CT score 7-24); with 35 patients in each group. All the patients underwent FESS using Messerklinger technique. Symptom scoring of all the patients was done using visual analog scale preoperatively and postoperatively at 1-, 3-, 6- and 12-month follow-up. CRS patients with minimal evidence of disease on CT showed statistically significant improvement in symptom scores after FESS. There was no significant difference noted in the overall symptom score improvement as well as for improvement in specific symptoms in both the groups. Further, there was no correlation between the pre-operative symptoms and CT scores. A good subjective outcome in terms of symptom improvement can be obtained with FESS in patients with CRS with minimal evidence of disease on CT.

Lipoma of the deep lobe of parotid gland - a case report and review of literature.

Lipoma of deep lobe of parotid gland is a rare clinical entity. Less than 10 cases have been reported in the literature in our knowledge. Because of their rarity, they are not often considered in the differential diagnosis of parotid tumors. A case of 45-year-old man with an unusually large deep lobe lipoma of parotid gland is presented in this article which was surgically managed by total conservative parotidectmy. The clinical picture, radiological and histopathological features of this entity is being discussed here. Review of literature of this clinical situation has been presented in the present article.

Comparative evaluation of Transient Evoked Oto-acoustic Emissions and Brainstem Evoked Response Audiometry as screening modality for hearing impairment in neonates.

OBJECTIVE: This study was designed to evaluate Transient Evoked Oto-acoustic Emission (TEOAE) as screening modality for hearing impairment in neonates. Brainstem Evoked Response Auditometry (BERA) was used as gold standard diagnostic tool in this study. The factors affecting the specificity of TEOAE were also studied. METHODS: The study group of 200 randomly selected neonates was subjected to TEOAE and BERA (400 ears). Oto-endoscopy was done in all TEOAE failures and a repeat test was done after suction cleaning of blocked external auditory canal (EAC). RESULTS: Otoscopic evaluation of all 52 TEOAE failures was done. EAC obstruction was noticed in 31 ears and 4 ears showed collapsible EAC. TEOAE was repeated after suction cleaning of the obstructed EAC and using long probe tips for collapsible EAC. This improved the Pass rate of TEOAE from 87% to 92%. EAC obstruction and collapsible EAC were the two factors identified in this study that significantly affected the specificity of TEOAE as a screening test. Pass rate of TEOAE in <48 hrs age group was found to be 55.5%, which was nearly half of over-all pass rate. This was because of high prevalence of obstructed EAC in this age group. TEOAE was found to be a rapid screening tool as average time taken for BERA was 35 min/neonate and for TEOAE was 17.4 min/neonate. Acceptability of TEOAE was found to be higher as compared to BERA. CONCLUSIONS: TEOAE is a simple and rapid test with relatively higher acceptability. But, the low sensitivity and specificity are the main shortcomings that take away from TEOAE, the status of independent screening modality for hearing impairment in neonates. TEOAE cannot completely replace BERA as screening modality for hearing impairment in neonates, however can complement it.

Direct, palladium-catalyzed, multicomponent synthesis of beta-lactams from imines, acid chloride, and carbon monoxide.

A new palladium-catalyzed synthesis of 3-amido-substituted beta-lactams is reported. This process involves the one-pot coupling of four components, imines, carbon monoxide, and acid chloride, providing a flexible route to construct this class of heterocycle. The generation of beta-lactams with two different imines can also be accomplished, providing a method to assemble these products with independent control over five separate substituents.

Bleomycin sclerotherapy in congenital lymphatic and vascular malformations of head and neck.

Bleomycin is an established antineoplastic drug, but recently some attempts were made to inject it locally as a sclerosing agent in cases of congenital lymphatic malformations. We present the outcome of this treatment modality tried on 10 paediatric cases of whom 9 had such malformation in the cervical region and one in the parotid region. Seven of these cases had congenital lymphatic malformation while three had haemodynamically less active congenital vascular malformation. All these children were subjected to percutaneous intralesional administration of bleomycin. The size of swelling reduced by 50% or more in seven patients out of which three showed complete or near complete response. There were no major deleterious side effects.

Non-inherited manifestation of bilateral branchial fistulae, bilateral pre-auricular sinuses and bilateral hearing loss: A variant of branchio-oto-renal syndrome.

A rare manifestation of branchio-oto-renal like syndrome as an isolated finding with normal chromosomal analysis in a 6 year old child with bilateral branchial simises, bilateral pre-auricular simuses, bilateral auricular malformation, and bilateral hearing loss is presented here.

Multi-lobulated cervical pneumatocoele communicating with pyopneumothorax and bronchopleural fistula.

Cervical herniation of lung in infants is a very rare condition which may present as a diagnostic dilemma. Reported here is an infant who presented with a swelling apparently looking like an external laryngocoele but was finally diagnosed as an apical pneumatocoele communicating with pyopneumothorax.

Palladium-catalyzed multicomponent coupling of alkynes, imines, and acid chlorides: a direct and modular approach to pyrrole synthesis.

A new palladium-catalyzed method to prepare pyrroles directly from three basic building blocks-imines, alkynes, and acid chlorides-is described. This approach provides a straightforward method both to prepare pyrroles in one step and to diversify their structure by simple variation of any of the three starting materials. Mechanistic studies suggest that this process occurs via a complex series of eight individual steps, and this is discussed.

The development of a catalytic synthesis of münchnones: a simple four-component coupling approach to alpha-amino acid derivatives.

A new palladium-catalyzed route to prepare 1,3-oxazolium-5-oxides (i.e., Münchnones) directly from imine, carbon monoxide, and acid chloride building blocks has been developed. This provides a straightforward catalytic synthesis of Münchnones and is amenable to generating a diverse range of products by simple modification of the imine or acid chloride starting materials. Münchnones are vital synthetic intermediates to a variety of heterocyclic and peptide-based molecules. As such, this methodology has been utilized to design a new catalytic synthesis of alpha-amino acid derivatives via a one-pot coupling of imines, carbon monoxide, and acid chloride followed by alcohol. The latter represents the first reported catalytic synthesis of alpha-amino acids directly from imine and carbon monoxide building blocks.

Fibrous variant of rhinophyma.

Rhinophyma is a rare disease which causes disfiguring soft tissue hypertrophy of the nose. The fibrous variant of rhinophyma is still rare which mimics fibrous papule of nose and lupus pernio. We report an unusual fibrous variant which was surgically managed with the good results. The use of scalpel for sculpting and the use of split thickness skin graft is being highlighted.

Rare case of spontaneous closure of tracheo-esophageal fistula secondary to disc battery ingestion.

Accidental ingestion of foreign bodies by children is not an uncommon event. Now a day, with increasing accessibility of electronic toys and devices to the children, ingestion of miniature size batteries is on the rise [J. Am. Med. Assoc., 249, (1983), 2495]. Unlike the usual foreign bodies, ingestion of button alkaline batteries may be associated with serious complications if not removed early [Am. J. Otolaryngol., 21 (2000) 333]. We report a rare and interesting case, in which a child developed tracheo-esopbageal fistula secondary to disc battery ingestion, and importantly, its conservative management resulting in its spontaneous closure.

Spontaneous coronary artery dissection: the clinical spectrum.

Spontaneous coronary artery dissection is a rare but increasingly reported cause of myocardial ischemia and sudden death. It is more commonly seen in younger age groups and has a predilection for postpartum women. The clinical spectrum of its presentation includes angina, myocardial infarction, cardiogenic shock, and death. No specific cardiac risk factors have been associated with its occurrence. In postpartum patients, it is presumed that dissection results from pregnancy-induced degeneration of collagen and the additional stresses of parturition. The sporadic nature of spontaneous coronary artery dissection has precluded the development of any consensus for a medical approach, and treatment is usually tailored to individual patient needs. A case of postpartum spiral dissection of the left anterior descending coronary artery with successful medical management is reported.

The Use of Carbon Monoxide and Imines as Peptide Derivative Synthons: A Facile Palladium-Catalyzed Synthesis of α-Amino Acid Derived Imidazolines.

One of the most facile routes to prepare carboxylate-substituted imidazolines is by the palladium-catalyzed coupling of an imine, carbon monoxide, and an acid chloride. In this reaction, a peptide unit is constructed and directly incorporated into the heterocyclic core.