Development of pneumatocele and spontaneous pneumothorax as a late complication of COVID-19 pneumonia.

SARS-COV2 pandemic has spread like wildfire and has affected all the countries worldwide. The virus mainly affects the lungs and has numerous manifestations. The development of spontaneous pneumatocele and pneumothorax has rarely been reported in the literature, especially in spontaneously breathing patients. We report two cases of COVID-19 patients who developed these complications after discharge from our hospital. These complications are uncommon but can be potentially fatal and the treating physician should keep these complications as differential while managing such cases.

INTRAPLEURAL FIBRINOLYSIS WITH UROKINASE VERSUS ALTEPLASE IN COMPLICATED PLEURAL EFFUSIONS AND EMPYEMA: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL.

Introduction: Intrapleural fibrinolytic therapy is being used as an effective agent since 1949 in managing complicated pleural effusion and empyema. Several agents like streptokinase (STK), urokinase (UK), and recombinant tissue plasminogen activator (rt-PA) are found to effective with variable effectiveness. However, head-to-head controlled trial to compare the efficacy of the most frequently used i.e., UK and rt-PA (alteplase) in managing complicated pleural effusion has rarely been reported. Methodology: 50 patients were randomized in two intervention groups i.e., UK and rt-PA. The dose of rt-PA was 10 mg, and that of UK was 1.0 lac unit. UK was given thrice daily for two days, followed by clamping to allow the drugs to retain in the pleural space for 2 hrs. rt-PA was instilled in the pleural space twice daily for two days, and the intercostal drainage was clamped for 1 hour. Results: A total of 50 patients were enrolled for the study out of which84% (n=42) were males and 16 % (n=8) were females. Among them, 30 (60%) patients received UK, and 20 (40%) patients received alteplase as IPFT agents. The of mean changes in the pleural opacity in the UK group was -33.0 % (SD +/- 9.9) and -41.0 % (SD +/- 14.9) in the alteplase group (P-value-0.014). Pain was the most common adverse side effect, occurring in 60% (n=18) of the patients in the UK group and 40% (n=8) in the alteplase group (P-value 0.24) while fever was the second most common side effect. Patient who reported early (within 6 weeks of onset of symptoms) have shown greater response than who reported late for intervention. Conclusion: IPFT is a safe and effective option in managing complicated pleural effusion or empyema, and newer agents like alteplase have greater efficacy and similar adverse effects effect profile when compared with conventional agents like UK.

Real-world experience of monoclonal antibodies in mild-to-moderate COVID-19 patients at a tertiary care center.

Background: Neutralizing antibodies cocktail (casirivimab and imdevimab) has received emergency use authorization recommendation by Food and Drug Administration (FDA) and WHO for mild-to-moderate COVID-19 infection in specific high-risk groups. Antibodies cocktail has shown promising results in preventing progression to severe disease, but the real-world experience is still evolving. Herein, we present a retrospective analysis of 22 patients who were administered the antibodies cocktail between August 2021 and March 2022 at our tertiary care center. Methods: We conducted an observational retrospective analysis of clinicoradiological, inflammatory parameters, progression of the disease, and outcome among 22 mild and moderate COVID-19 patients treated with antibodies cocktail. Results: The mean age was 67.7 years (SD ± 18.3) and comprised of 13 males (59%), while 9 were females (40.9%). Nine (40.9%) patients were fully vaccinated with two doses, nine (40.9%) were partially vaccinated with one dose while four patients (18.2%) were unvaccinated, and the rest were unvaccinated. Diabetes and hypertension were the commonest comorbidities; hematological and solid organ malignancies were other comorbidities. Eight patients had radiological opacities consistent with COVID-19 pneumonia and had shown significant regression in four patients after the therapy. None of our patients required supplemental oxygen or progressed to severe acute respiratory distress syndrome. All patients were discharged in a stable condition within 6 days of the therapy. Conclusions: The neutralizing antibodies cocktail has shown encouraging results in our analysis in preventing progression to severe disease in patients with high-risk conditions.

A Conundrum of Severe Hypokalaemic Quadriparesis, Acute Kidney Injury, and Lung Involvement as the Initial Presentation of Catastrophic Primary Sjögren's Syndrome: Is it a New Entity? A Case Report.

Sjögren's syndrome (SS) is a systemic chronic autoimmune disorder that classically affects the exocrine glands. Only 15% of the patients with primary SS (pSS) develop extraglandular symptoms involving the lungs, kidneys, joints, nervous system, and skin. Hypokalaemic paralysis is a rare presentation. The most common cause of hypokalaemia is distal renal tubular acidosis. The prevalence of clinically significant lung involvement in pSS is 9-20 %. Primary SS is an indolent disease leading to increased morbidity and poor quality of life. We present a case of a 40-year-old female with severe hypokalaemic paralysis, tubulointerstitial nephritis, and lung involvement as the initial presentation of catastrophic pSS without sicca symptoms. The course of hospitalisation was complicated by ventilator-associated pneumonia. She was managed with broad spectrum antibiotics, five sessions of plasma exchange and alternate-day haemodialysis followed by oral glucocorticoids and intravenous cyclophosphamide. To the best of our knowledge, this is the first case of catastrophic presentation of pSS with a favourable outcome.