Chest Computed Tomography (CT) Severity Score Assessment to Explore Association between Tuberculosis and COVID-19 Pneumonia for Assessing the TB Bulwark against Moderate to Severe COVID-19 Infection.

Importance Objective: First case of Covid-19 pneumonia was reported in Wuhan and soon it became pandemic.1 Pulmonary tuberculosis (TB) is mainly a disease of tropical and poor countries like India.9 Initially, it wasn't clear how these two diseases will interact with each other. We tried to determine if TB has any impact on course and prognosis of Covid-19 pneumonia. DESIGN SETTING: In this retrospective analytical study, data of 7774 patients were collected from various state government owned hospitals of India. Chest CT scans were reviewed for present or past stigmata of pulmonary TB, CORADS and CT severity score. Statistical analysis was done for class wise frequency distribution and association of attributes were calculated. RESULTS: 95.01% Patients with Covid-19 pneumonia didn't have CT signs of history of active or old healed pulmonary TB, while 4.99% had it. In first group 44.85 % mild, 36.17 % moderate and 13.98 % had severe disease, while in second group figure is 3.39 % 1.21 % and 0.40 % respectively. Probability of TB providing immunity against developing moderate or severe form of Covid-19 pneumonia is 0.6778. CONCLUSIONS: Patients with active or past history of TB are less prone to develop moderate or severe form of Covid-19 pneumonia. It may be the reason for less mortality in health resource poor India as compared to Europe or America.

Pulmonary mycotic pseudo-aneurysm with a prior history of ventricular septal defect. Case report with review of literature.

In general aneurysms of the pulmonary arteries are less frequent than intracranial, aortic or other vascular locations. Infectious causes include bacteria such as Staphylococcus sp and Streptococcus sp, mycobacteria, Treponema pallidium (syphilis) and rarely fungi. We report a 7 year old female with two right-sided parahilar pseudo-aneurysm of fungal origin with a prior history of ventricular septal defect. Pulmonary mycotic pseudo-aneurysms are very rare and require a high suspicion to diagnose. If a patient is still symptomatic for fever and cough for a long time, and consolidation on x-ray is not improving on antibiotics, contrast-enhanced computed tomography is indicated. It can be suspected that the "friable mass attached to ventricular septal defect patch" was a source of fungeal emboli to pulmonary arteries thus giving weight to the infective endocarditis etiology. A prior history of ventricular septal defect repair could favour fungal endocarditis.

An Association of Chronic Hyperaldosteronism with Medullary Nephrocalcinosis.

BACKGROUND: An association between chronic hyperaldosteronism and medullary nephrocalcinosis has rarely been made, with only a handful of cases described in literature. CASE REPORT: We describe five cases of hyperaldosteronism with a long- standing history in whom associated medullary nephrocalcinosis was established. CONCLUSIONS: We infer that a chronic hyperaldosteronic status, whether primary or secondary, is a causal factor in the etiopathogenesis of medullary nephrocalcinosis. This article illustrates and summarizes various postulated theories that support our proposed association between hyperaldosteronism and nephrocalcinosis. We conclude that chronic hyperaldosteronism should be included as one of the causes of nephrocalcinosis and that our case series emphasizes the need of a well-organized retrospective study to prove it further.

Giant mandibular osteoma, CT findings for the primary care provider.

We report a very rare case of 35-year-old female with a giant mandibular osteoma in the angle of the mandible. We highlight the importance of CT in diagnosing as well as defining the extent of this rare case so that proper management can be undertaken. We also showcase the importance of angiography to show relationship of this mass with the surrounding vessels.

Joubert syndrome: A classic case.

Joubert syndrome is a rare autosomal recessive disorder characterized by hyperpnoea and eye movements, hypotonia, ataxia, developmental retardation with neuropathologic abnormalities of cerebellum and brainstem including inherited hypoplasia or aplasia of vermis. Cerebellar vermin anomalies are described in other disorders such as Dandy-Walker and rhombencephalon synapsis. These disorders should be distinguished from Joubert syndrome on the basis of imaging. Comparison with typical imaging and clinical findings may be helpful for appropriate diagnosis.

Radiological differentiation of phaeochromocytoma from other malignant adrenal masses: importance of wash-in characteristics on multiphase CECT.

Rationale and introduction: To evaluate the computerised tomography (CT) characteristics of phaeochromocytoma (PCC) that differentiate them from other non-benign adrenal masses such as adrenocortical carcinoma (ACC), primary adrenal lymphoma (PAL) and adrenal metastases (AM). Methods: This retrospective study was conducted at a tertiary health care institute from Western India. Patients presented between January 2013 and August 2016 with histological diagnosis of PCC or other non-benign adrenal mass having adequate reviewable imaging data comprising all four CECT phases were included. Results: The study cohort consisted of 72 adrenal masses from 66 patients (33 PCC, 22 ACC, 4 PAL, 13 AM). Unlike other masses, majority of PCC (25/33) showed peak enhancement in early arterial phase (EAP). PCC had significantly higher attenuation in EAP and early venous phase (EVP), and higher calculated percentage arterial enhancement (PAE) and percentage venous enhancement (PVE) than other adrenal masses (P < 0.001). For diagnosis of PCC with 100% specificity, PAE value ≥100% and EAP attenuation ≥100 HU had 78.8 and 63.6% sensitivity respectively. ACC were significantly larger in size as compared to PCC and metastasis. The adreniform shape was exclusively found in PAL (two out of four) and AM (4 out of 13). None of the enhancement, wash-in or washout characteristics were discriminatory among ACC, PAL and AM. Conclusion: Peak enhancement in EAP, PAE value ≥100% and EAP attenuation ≥100 HU differentiate PCC from other malignant adrenal masses with high specificity.

Hepatic Capillariasis- Drug Targets.

Zoonotic infections are increasingly becoming public health menaces and are usually transmitted to humans due to unsuitable environmental conditions. One of them is hepatic capillariasis, caused by the parasite Capillaria hepatica, primarily a disease of rodents, with hepatic manifestations in humans. Although its prevalence is very low, it can cause significant morbidity and mortality, with cases reported from all over the world. The main infective form for humans is the embryonated egg of the parasite, which hatches in the intestine and ultimately colonize the liver. The larvae mature and reproduce, and eventually form embryonated eggs, which cause chronic focal inflammation and septal hepatic fibrosis. Clinical presentation mainly consists of fever, abdominal pain, hepatomegaly and eosinophilia. Spurious infection with unembryonated eggs cause gastrointestinal symptoms. Diagnostic modalities include liver biopsy, ultrasonography, CT scan, immunological tests like ELISA and IIFT. The infection can be treated mainly with a combination of benzimidazoles like thiabendazole, mebendazole and albendazole; with corticosteroids. The study emphasizes the need for hepatic capillariasis to be considered as a differential diagnosis in cases of suspected hepatitis, leptospirosis, abdominal lymphadenopathy or other hepatic or parasitic infections prevalent in the region concerned; and meticulously assess the cases to facilitate early diagnosis and prompt treatment, thus reducing the distress faced by patients.

Sinonasal paraganglioma and Cushing's syndrome: A rare association.

In general, paragangliomas are symptomatic tumors, which may be clinically taken for other tumors, benign or malignant lesions. Paragangliomas of the nasal cavity and paranasal sinuses are an extremely rare entity and what is even rarer is its association with ectopic adrenocorticotropic hormone production. We report this very rare case to highlight the rare association of Cushing's syndrome with nasal paraganglioma and the importance of total surgical resection in its treatment.