Tuberculosis (TB) is a highly prevalent disease in developing countries of the world such as India. Central nervous system (CNS) involvement by TB can produce devastating effects and can be parenchymal, meningeal, intraventricular, subdural, or extradural. Common modes of CNS involvement include leptomeningitis and intracranial tuberculomas. Similar involvement of the spinal cord can produce tubercular arachnoiditis and intramedullary spinal tuberculomas. Atypical locations of tuberculomas include basal ganglia, brainstem, corpus callosum, and extra-axial and suprasellar locations. Uncommon modes of CNS involvement include tubercular pachymeningitis, focal tubercular cerebritis, cerebral abscess formation, and miliary TB. Tubercular pachymeningitis can also involve the dural lining of the spinal cord. We have presented cases of CNS TB, both atypical forms of common presentations as well as uncommon presentations with findings on magnetic resonance imaging (MRI) presenting a diagnostic dilemma. The radiologist plays a central role in the diagnosis of CNS TB in such cases, and careful tailoring of the MRI examination based on the clinical picture of the patient can play a vital role in making the diagnosis, even in atypical presentations.

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Lung abscesses are necrotizing consolidation of lung parenchyma which usually require a prolonged course of antibiotics. However, underlying secondary etiologies of lung abscess such as malignancy should be sought for, especially in unresponsive cases. Clinicoradiological correlation often assists, however, bronchoscopy and histopathology eventually confirm the diagnosis. We present a case of lung abscess who after initial response to antibiotics was subsequently diagnosed as squamous cell carcinoma of the lung.

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Introduction: Dual ectopic thyroid has been regarded as a rare developmental anomaly with the most common site being lingual/sublingual and the mode of presentation being hypothyroidism. Patients and Methods: Three patients suffering from dual ectopic thyroid are discussed here along with a review of Indian literature. Conclusion: Increasing reports of dual ectopic thyroid in the literature indicate that the entity might not be so uncommon. Since this is liable to influence the clinical management, especially from the surgical standpoint, thyroid scintigraphy must be included in the preoperative protocol in all cases of thyroid gland ectopia.

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Objectives: To study the course and prediction of significant hyperbilirubinemia in healthy late preterm and term newborns. Material and Methods: Study comprises of 150 neonates: 92 term newborns and 58 late preterm neonates, each with birth weight >2000g, without Rh or ABO incompatibility or G6PD deficiency. A thorough clinical examination with biochemical measurement of serum bilirubin was done in both groups serially at 6th hour of birth, 2nd day of life, 3rd day, 4th day and on 7th day respectively and the pattern of rise of serum bilirubin and development of significant hyperbilirubinemia were compared in both groups. Results: Out of total 150 neonates, significant hyperbilirubinemia requiring phototherapy or exchange transfusion was noted in 28 patients (18.6%); 12 were term (13%) and 16 were late preterm babies (27.5%) i.e. late preterm babies were 2 times more likely to develop significant hyperbilirubinemia. Conclusion: Since late preterm babies are more vulnerable than their term counterparts, to the complications associated in early life especially hyperbilirubinemia, special attention is required in treating these babies.

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Aim: To assess the impact of atopic dermatitis (AD) on quality of life (QoL) and the factor affecting QoL in Thai children and their families. Materials and Methods: This cross-sectional study was conducted on 86 AD patients at Siriraj Hospital. AD patients aged <16 years and their families were asked to complete the Thai versions of the Infants' Dermatitis Quality of Life Index (IDQoL), Children's Dermatology Quality of Life Index (CDLQI), and Dermatitis Family Impact Questionnaire (DFI). Results: Mean age of the patients was 6.5 ± 0.5 years old and 67.4% were females. The mean ± SD of QoL scores affected by AD was 8.88 ± 5.65. QoL score was high in the group of questions related to symptoms and feelings, followed by sleep problems. The mean ± SD score for DFI was 9.94 ± 7.49. Impact on QoL in Thai children and their families was significantly correlated with disease severity (P = 0.03, r = 0.24; and P= 0.01, r = 0.30, respectively). Factors that caused negative impact on QoL of patients were taking oral medications and disease severity (P = 0.01). Factors causing negative impact on QoL of families were disease severity (P = 0.01), positive for family member with allergic diseases (P= 0.01), start attending school (P = 0.02), and taking oral medications (P = 0.04). Limitation: The limitation of the study was the disadvantage of questionnaire-based study in collecting data. Conclusions: AD caused significant impact on QoL of Thai children and their families. QoL measurement should be included in the patient care assessment to improve effective management of AD.

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Background: Standard aggressive treatment of AML is expensive, requires significant supportive care (blood and platelet support) and toxic with significant morbidity and mortality. The metronomic approach refers to repetitive low doses of chemotherapy drugs and serves as one of the options of treatment for the patients who are unable to arrange the supportive care and those who are ineligible for intensive chemotherapy. Material and Methods: This is a hospital based observational single arm pilot study in which newly diagnosed 36 patients of AML who were unable to take standard aggressive chemotherapy were started on low dose metronomic chemotherapy and its effects evaluated over a period of 12 months. Results: Observed overall response rate (OR) was 21.87% (6.25% CR and 15.62% PR), mean survival was 3.58 months. 43.75% patients had non-hematological drug toxicities, 40.62% patients developed hematological toxicity, 3.12% developed hepatotoxicity and 9.32% patients developed febrile illness. Out of expired patients at the end of 1 year duration 70% died at their home with cause of death unidentified however rest 30% died in hospital (23% from bleeding and 7% from infection). On FACT-L questionnaire overall improvements were elicited in well being along with 43% improvement in additional concerns (including night sweats, pains, weight loss, tiredness). Conclusion: Data from our small study suggests that oral PEM metronomic chemotherapy for patients of AML with treatment possible on OPD basis itself appears to be an effective regimen with acceptable toxicities.

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Background: Cutaneous leishmaniasis endemic in 70 countries worldwide and in certain regions of India is otherwise an uncommon presentation in non-endemic zones, leading to their missed diagnosis. Movement of people between these regions further exposes them to the risk of this infection. The aim of this study was to analyze the presentation of these missed cases, basis of their final diagnosis, management and follow up with the objective of highlighting cutaneous leishmaniasis as an important differential diagnosis in these cases. Methods: A prospective 4-year cohort of patients who were diagnosed as cutaneous leishmaniasis (CL) and post kala azar dermal leishmaniasis (PKDL) between 2012 and 2016 were studied. Their presentation, basis of diagnosis, treatment response to different agents and follow up was studied. Results: Of a total of 380547 patients seen in the four-year period, 15 CL and 2 PKDL symptomatic from 6 months to 7 years were diagnosed at our centre. Leishmania amastigotes were seen in smears in 10 and 4 in skin biopsy. Four were diagnosed based on polymerase chain reaction for Leishmania. Ten were managed with iv Sodium Stibogluconate (SSG), five with intralesional SSG and one with liposomal amphotericin B. All responded to treatment and were followed up for one year thereafter. Conclusion: Although CL and PKDL are rare outside their endemic zones, travelers and population exposed to newer endemic zones may result in atypical presentations which clinicians are not experienced with. This study highlights this possibility and our experience in diagnosing and treating such cases.

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Aim: Airway management in maxillofacial injuries is challenging. Conventionally, the method of securing the airway is using Macintosh laryngoscope to intubate the patients. Knowing the clinical variables associated with the need for nonconventional (nonMacintosh) laryngoscopy will aid in better airway management. The present analysis was aimed to identifying the clinical variables associated with nonconventional tracheal intubation in patients with maxillofacial injury. Materials and Methods: Medical records of maxillofacial injury patients with at least one facial bone fracture who needed tracheal intubation from January 2009 to June 2016 in a teaching institute were screened for data collection. The clinicodemographic parameters, techniques, and instruments used for tracheal intubation were noted. The INSTAT software was used for statistical analysis, and P < 0.05 was considered significant. Results: Seventy-three patients (mean age 27.47 ± 9.92 years; 94.52% male) were analyzed. A total of 61.64% of tracheal intubations required nonconventional techniques [i.e. video laryngoscope (27.4%), fiberoptic bronchoscope (26.03%), tracheostomy (6.85%), and 1.37% retrograde intubation]. Video laryngoscopy was preferred over Macintosh in patients with confirmed/suspected C-spine injury. Mouth opening <2 cm [odds ratio (OR): 7.33], multiple facial bone fracture (OR: 4.80), and concomitant mandible and maxilla fractures (OR: 6.50) were associated with tracheal intubation by nonconventional laryngoscopy (P = 0.01). Conclusion: Multiple facial bone fractures, concomitant mandible and maxilla fracture, and mouth opening <2 cm need tracheal intubation using a technique other than Macintosh laryngoscopy.

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Chemoport, a central venous infusion system, is commonly used in cancer patients for administration of chemotherapy. Dislodgement with subsequent migration of chemoport catheter in to the heart is a rare but potentially catastrophic complication. The treatment of choice is immediate retrieval of the dislodged part of catheter by surgery or percutaneous approach. Percutaneous removal is safer and less invasive making it the standard treatment modality. We report the case of a 9-year-old child who was referred to us for the management of a dislodged chemoport catheter.

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Introduction: Larynx is a seat of a host of benign and malignant conditions. Conventionally, otolaryngologists have relied upon laryngoscopy in making a diagnosis. However, this simple doctor's office tool suffers from several limitations and flaws. In such a clinical landscape, a completely nonintrusive high-resolution ultrasonography examination can play a significant complementary role by defining the precise extent of the pathologic process. This prospective cross-sectional study, possibly the first of its kind in India, endeavours to define this synergetic relationship. Patients and Methods: A total of 60 patients with diverse undiagnosed laryngeal pathologies were taken up for the study. Those with proven laryngeal carcinoma and (or) past laryngeal surgery were excluded. Results: HRUS was found to be valuable in detecting laryngeal growth (78.57%), vocal cord polyp (66.67%), vocal cord nodule (10%), vocal cord palsy/paresis (66.67%), chronic laryngitis (17.64%), and Reinke's edema (50%). Conclusion: Compared to laryngoscopy, the role of HRUS is limited except in laryngeal lesions such as laryngeal growth and vocal cord polyp. HRUS can augment rather than replace conventional laryngoscopy in the diagnosis of laryngeal lesions.

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A 13-year girl presented with fever, chest pain, cough, and decreased appetite of 15 days. General and respiratory examination was normal. Routine investigations were normal. Sputum for AFB was negative. Chest X-ray revealed bilateral miliary nodules. Eye examination showed choroid tubercles with chorioretinitis. She was diagnosed as disseminated TB and started on ATT daily regime with oral prednisolone. After 5 days, she developed pneumothorax and ICD was inserted. CECT chest showed bilateral multiple miliary nodules with bilateral pneumothorax. She had recurrence (6 times) of Pneumothoraces during 3 months and managed with ICD. She underwent thoracoscopic surgical biopsy for confirmation of diagnosis. Immunohistocytology was negative for CD1a and HMB45. Biopsy was consistent with TB. The final diagnosis was miliary tuberculosis with bilateral recurrent Pneumothoraces. ATT continue for 9 months with tapering of steroid. Chemical pleurodesis was performed. She was followed up for 2 years with no recurrent of pneumothorax. Bilateral recurrent pneumothorax is rare complication of miliary TB.

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Renal sinus lipomatosis is a rare entity where there is abnormal proliferation of sinus fat. Fat proliferation can also occur in perinephric and periureteric regions. It is a benign condition which does not give rise to symptoms or any renal impairment. However, severe form of this condition, i.e. renal replacement lipomatosis, leads to atrophy of renal parenchyma, thereby leading to impairment of renal functions. Here, we report a case of renal sinus lipomatosis in a transplanted kidney, which is even rarer and has been reported in less than 10 previously reported cases in the English literature.

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Anatomic obstruction of the tracheobronchial tree in a patient with large posttricuspid shunt is rare and causes significant respiratory symptoms. The treatment of such patients is challenging. Here, we discuss and highlight the importance of detailed evaluation, planning, and teamwork for minimally invasive treatment of two major causes of respiratory distress. Hospital record analysis of a young infant who underwent simultaneous minimally invasive therapy for both cardiac and tracheal lesions. A 7-month-old infant weighing 4.4 kg had very large patent ductus arteriosus (PDA), along with heart failure and severe subglottic stenosis. She underwent successful minimally invasive balloon dilatation of subglottic stenosis followed by transcatheter device closure of PDA. Minimally invasive therapy for subglottic stenosis and device closure of PDA in a small infant is a safe and effective treatment in a well-planned and coordinated team approach.

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