Search

Introduction: Dengue is an important viral infectious disease, mostly seen in tropical countries during the rainy season, and is emerging as a public health hazard for healthcare facilities. The most common parameters used to assess the severity of dengue are platelet count and haematocrit. However, new haematological parameters have emerged to predict the severity of dengue fever and assist clinicians, especially in resource-limited settings. Aim: To highlight the significance of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil-Platelet Ratio (NPR), and Neutrophil-to-Lymphocyte and Platelet Ratio (NLPR) in predicting outcomes in patients with dengue infection. Materials and Methods: A retrospective observational study was conducted in rural central India in the Department of Medicine at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India. A total of 540 patients infected with the dengue virus between June 2021 and December 2021. Data analysis was conducted from January to April 2022. Neutrophil, platelet, and lymphocyte counts were used to calculate NLR, NPR, and NLPR, and their roles in predicting the final outcome were studied. The final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 21.0. The p-value<0.05 than 0.05 was considered statistically significant. Results: The mean age of the patients was 29.85±13.40 years, ranging from 18 to 85 years, with a median age of 25 years. A total of 331 (61.7%) patients below 30 years of age were significantly higher than patients aged 30 years or older (38.3%) (Z=3.39; p=0.0007). The Area Under Curve (AUC) for NLR (0.852) was higher than that for NLPR (0.828) and NPR (0.708). Therefore, NLR was more effective in predicting adverse outcomes compared to NLPR and NPR. However, the efficacies of NLR and NLPR seemed to be more or less equal. Conclusion: The NLR was a better predictor of outcome or severity in dengue fever when compared to NPR and NLPR. Hence, it can be a cost-effective tool used by physicians working in rural hospitals with limited resources. [ABSTRACT FROM AUTHOR]

Introduction: Prediabetes is a state of impaired glucose tolerance that often precedes overt diabetes mellitus and is frequently underdiagnosed. Glycation of platelet proteins leads to increased platelet reactivity which can be an essential predisposing event in the pathogenesis of coronary artery disease (CAD). Although research has been conducted to diagnose CAD in prediabetes and to assess platelet indices in prediabetes, there has been no attempt to assess platelet indices in prediabetic patients who have CAD. Methods: This cross-sectional study was carried out in a rural tertiary care center in Central India from September 2019 to August 2021. A total of 180 patients were enrolled in this study, having documented CAD in coronary angiography (CAG) and blood glucose levels in the diagnostic range of prediabetes by the criteria set by the World Health Organization. Platelet indices, glycosylated hemoglobin, blood sugar levels, and CAG findings were documented for all participants. Results: The mean platelet volume (MPV) in our study population was 9.58 ± 1.14 fL, platelet distribution width (PDW) was 15.69% ± 1.36%, plateletcrit was 0.3% ± 0.07%, and platelet count was 319 ± 44 x 103 cells/mm3. PDW was the best tool to predict double-vessel disease (P < 0.0001), while MPV (P = 0.6146) and PDW (P = 0.0266) were best predictors of triple-vessel disease. Conclusion: Platelet indices that are readily available investigations prescribed by clinicians routinely are significantly associated with blood sugar levels and can predict the severity of CAD in prediabetics in terms of the number of vessels involved. Early assessment of platelet indices in prediabetics can aid in the diagnosis and prognosis of CAD, thereby helping in planning early intervention. [ABSTRACT FROM AUTHOR]

Background: Till date, there is no consensus reached on the foremost tool for identifying the propensity of risk in critically sick patients. In this study, we plan to assess the nutritional risk in critically ill patients admitted to the medical ICU using the modified nutrition risk in critically ill (mNUTRIC) score and to anticipate the outcome in terms of overall mortality, 72-hour mortality, and the use of mechanical ventilation. Method: A total of 1,990 patients were analyzed by calculating their mNUTRIC scores using various variables, which were a part of the scoring system, such as age, a thorough history and clinical examination, and pre-existing comorbidities. Group differences were compared using the t-test or the Wilcoxon test for continuously distributed data and the chi-squared test for categorical data. Results: In this study, the mean age of the patients were 50.48 ± 17.58 years. Of them, 395 died while 1,595 survived; and 799 had a high ($6) mNUTRIC score, and 1191 had a low (#5) mNUTRIC score. The area under the curve for mNUTRIC score in predicting overall mortality and 72-hour mortality was 0.938 and 0.89, respectively, thus demonstrating better diagnostic performance. Conclusion: The discriminative performance of mNUTRIC scores for assessing overall mortality and the need for mechanical ventilation was found to be effective in this study. [ABSTRACT FROM AUTHOR]

Background and Objective: Severe asthma phenotyping based on invasive and non-invasive bio-markers assists in a better understanding of heterogeneity of clinical presentations and thereby using targeted therapies. Therefore, the current study was conducted to evaluate phenotypes based on non-invasive bio-markers of severe asthma patients attending a tertiary care hospital in North India. Methods: This was a retrospective, observational study conducted on the patients who visited the respiratory department of a tertiary care hospital in North India. Patients aged 18 years and above diagnosed with severe asthma were classified into distinct phenotypes, namely, atopic asthma, eosinophilic asthma, and Type 2 low asthma. Patients with their clinical and functional parameters were classified based on the levels of bio-chemical and hematological results [such as total/specific IgE, blood absolute eosinophil count (AEC)], skin prick tests, history of allergy, and the presence of allergic symptoms. Results: Out of total 100 severe asthmatics, the majority of the patients had an eosinophilic asthma (49%) phenotype, followed by atopic (allergic) asthma (36%) and Type 2 low asthma (15%) phenotypes. However, it was found that 29% of these patients had overlap of both atopy and eosinophilia. The atopic phenotype showed allergic symptoms, positive skin prick tests, and elevated IgE levels. The eosinophilic phenotype had high AEC (=300 cells/uL) and low IgE (< 30 IU/ml) levels. The Type 2 low phenotype showed low AEC and IgE levels along with the absence of allergic symptoms. However, among these 100 patients, overlapping traits of both atopy and eosinophilia were labelled as overlap phenotypes. 50% of type 2 low severe asthma cases had eosinophils >150 cells/cmm and were eligible for mepolizumab. Conclusions: Identification of severe asthma pheno-endotypes based on simple non-invasive bio-markers is feasible in Indian settings, and it is of utmost importance for future treatment planning in these patients with available biologicals. Overlap of eosinophilic and atopic endotypes in one-third cases would challenge physicians to choose upfront appropriate biologicals in our country. Type 2 low asthma was least common with only <10% cases of severe asthma being ineligible for any biological. [ABSTRACT FROM AUTHOR]

Dyspnea experienced in the upright position which is relieved in the supine position, is known as Platypnea. Accompanying desaturation in the arterial blood associated with Platypnea is known as orthodeoxia. Various causes of Platypnea orthodeoxia syndrome, such as hepatopulmonary syndrome, patent foramen ovale and atrial septal defects, are well described in the literature. However, a rather uncommon and underreported cause of Platypnea orthodeoxia syndrome is organophosphorus poisoning. We report a case series of three cases that were reported after ingestion of organophosphorus compounds and developed breathlessness later in the course of the hospital stay, which was diagnosed as Platypnea orthodeoxia syndrome resulting from organophosphorus poisoning. All three cases were treated with supportive management, incentive spirometry and respiratory physiotherapy and responded well to the treatment. [ABSTRACT FROM AUTHOR]

Fulminant hepatitis is a potentially life-threatening disease that is evident through the findings of organ dysfunction, jaundice, and hepatomegaly, which is painful. Dysfunction of the endothelial cells and thus the damage of the endothelium is the probable mechanism, which is responsible for causing complications of hepatobiliary system in patients with sickle cell disease. Various acute as well as chronic manifestations of the hepatobiliary system, having varied severity and pathophysiology are associated with sickle cell disease. Dengue fever may also affect the liver starting from asymptomatic liver enzyme derangement to fulminant hepatic failure. This case series describes the first ever association of fulminant hepatic failure resulting from the synergistic effect of dengue fever with sickle cell disease and thus highlights the importance of prevention of dengue fever in sickle cell patients, thereby preventing potentially lethal fulminant hepatic failure. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 disease caused by the SARS-CoV-2 virus, has toppled the world since first case noted in 2019, and the cases have been increasing there after. This grave effect is caused by the cytokine storm induced inflammation produced by the noxious virus. As it is an inflammatory state, various acute phase reactants are expected to raise; thus serum ferritin is contemplated to increase. Here we aim to anchor serum ferritin as a way marker for diagnosis and management of COVID-19 patients and study its role as a prognostic marker. Another aspect is the association of COVID-19 with the N: L ratio; observation has stated that higher N: L ratio results in more severe outcome. The study aimed to establish a correlation of COVID-19 severity with serum ferritin in the form of HRCT Score, N: L Ratio and Clinical Outcome in the patients admitted in Intensive Care Unit. Result: Out of 200 patients who were admitted in the intensive care unit with COVID-19, the association of serum ferritin with N: L Ratio and HRCT Score was significant, and the association of serum ferritin with clinical outcome in terms of discharged and expired was found to be statistically significant. Conclusion: Serum ferritin was found to be a potent marker for clinical outcome in intensive care unit patients in terms of death versus treated. HRCT Score and N:L ratio were found to be correlated with serum ferritin. Therefore, we conclude that serum ferritin may determine the severity of COVID-19 infection and it can be used as a marker for Clinical Outcome thereby making it an often neglected biomarker for predicting prognosis in COVID-19 with most of the physicians focusing mostly on interleukin 6, C Reactive protein and d dimer as a marker of severe COVID infection. [ABSTRACT FROM AUTHOR]

Partial Hemolysis, elevation of liver enzymes and low platelet count (HELLP) syndrome is a leading cause of maternal mortality. With the exceeding spread of COVID-19, leading to increasing number of COVID-19 infected cases there has been a emergence of an overlap of COVID-19 with HELLP Syndrome. Multiple factors are associated with the thrombocytopenia witnessed in COVID-19 somewhat similar to what is witnessed in preeclampsia and HELLP Syndrome. We Describe a case series of two ante natal cases who presented with a picture of HELLP syndrome and upon investigations turned out to be COVID-19 thus trying to establish an association between the two. [ABSTRACT FROM AUTHOR]

Background: Interleukin 6 (IL-6) encoded by the gene coded as IL 6 acts as a proinflammatory cytokine as well as an anti-inflammatory myokine. It is postulated that IL 6 is associated directly with the severity of coronavirus disease-2019 (COVID-19). Another domain that is thought to predict the severity of COVID-19 is the neutrophil:lymphocyte (N:L) ratio; a higher N:L ratio is postulated to be related to more severe outcomes. Thus, the present study was aimed to establish a correlation of COVID-19 with IL-6 in terms of clinical outcomes. We had also tried to find the relationship between IL-6 and N:L ratio and high-resolution computed tomography (HRCT) score. Methods: We have conducted a cross-sectional study of 200 patients who were admitted to the intensive care unit (ICU) with reverse transcriptase- polymerase chain reaction (RT-PCR) positive for COVID-19 from January to May 2021. Serum IL-6, N:L ratio, and HRCT chest were conducted on admission. Result: Out of 200 patients who were admitted to the ICU with COVID-19, while the IL-6 was higher in patients with increased N:L ratio and HRCT score, the association of IL-6 with clinical outcomes in terms of discharged and expired was found to be statistically not significant. Conclusion: Serum IL-6 was found not to be a potent marker for clinical outcomes in ICU patients in terms of death vs survived. However, the IL-6 levels on admission can be correlated with the computed tomography (CT) severity scores as well as N:L ratio of patients admitted to an ICU. [ABSTRACT FROM AUTHOR]

Background: Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis (IPF) has been established by multiple clinical trials. This study aims to assess the efficacy and safety of nintedanib in real-world IPF patients in India. Methods: Clinical records of IPF patients (prescribed with nintedanib) visiting tertiary pulmonary care center, between June 2016 and December 2019, were analyzed retrospectively. Data were analyzed for forced vital capacity (FVC), Diffusing capacity of lung for carbon monoxide(DLCO), 6-min walk distance (6-MWD). Acute exacerbations and adverse events were also analyzed. Results: A total of 76 IPF patients were prescribed with nintedanib. Drug was prescribed at 100 and 150 mg BD dose to 37 and 39 patients. Ten patients (13.1%), of which eight were over the age of 60 years, died during the study period. Only 42 patients visited for follow-up. Mean baseline FVC was 1.67 L and mean annualized absolute change in FVC and FVC % predicted was -0.07 L and -1.80%, respectively. Mean baseline DLCO was 37.21% and mean annualized absolute change in DLCO % predicted was-2.20%. At follow-up, 1 (2.38%), 17 (40.47%), and 24 (57.14%) patients were at Deparatment of Internal Medicine stage I, II, and III, respectively. Acute exacerbations and adverse events were reported by 48 and 6 patients, respectively. Conclusion: Our results support the findings from previous studies, that nintedanib leads to annual decline in parameters such as FVC and DLCO and increased 6-MWD. It was found to be well tolerated in the Indian patients with IPF. [ABSTRACT FROM AUTHOR]

Pulmonary sarcoidosis is an enigma due to its similarities with many other diseases in terms of presentation and hence the disease may require repeated reconsideration and revision of diagnosis. It is largely a diagnosis of exclusion. In India, exclusion of tuberculosis (TB) in every new suspected case of pulmonary sarcoidosis is a colossal task due to overlapping features and the high burden of TB. However, pulmonary sarcoidosis may be associated with extrapulmonary organ involvement, and in such cases, diagnosis can be made with greater certainty. Once diagnosed, whether to treat or not, and with what agent, and for how long are questions unsettled despite 150 years of the disease being known to mankind. This is due to a lack of randomized controlled trials as well as a dissimilar natural course of the disease among patients with a similar clinicoradiological presentations. This makes a generalization about treatment impossible and hence, individualized decisions need to be made utilizing predictors of future worsening by multidisciplinary experts. Oral steroids form the core of treatment but longterm side effects of oral steroids ultimately dictate the use of steroidsparing agents and discontinuation of steroids once the disease stabilizes and the goals of treatment are achieved. Some patients with a benign course of sarcoidosis may not require any treatment. There remains a gap in our knowledge of sarcoidosis, especially in the context of India, as it features as a common cause of interstitial lung disease and a close differential of TB. We need to intervene before the condition worsens, as this may reduce the survival significantly. However, this is not always possible and more research including longitudinal studies are needed to define and understand the course of the disease. [ABSTRACT FROM AUTHOR]

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS-CoV-2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVIDI9 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole. [ABSTRACT FROM AUTHOR]

We report the case of a young female suffering from fever and generalized weakness on presentation and was diagnosed to be a case of cryptogenic organizing pneumonia (COP). She developed breathlessness on rest and required oxygen support and on further evaluation diagnosed with Scrub typhus IgM positive status. This case report highlights the importance of a rare presentation of Scrub typhus in a young female presenting with clinically silent chest changes initially and preventable worse outcomes if detected and managed for scrub typhus infection early in the course of disease. [ABSTRACT FROM AUTHOR]

Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature, it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male. [ABSTRACT FROM AUTHOR]

A rare clinical syndrome, giant bullous emphysema, also known by the name of vanishing lung syndrome (VLS), is characterized by an X-ray of the chest showing disappearance of the lung. VLS is a chronic disease that progresses gradually and is usually seen in young male smokers, with other risk factors being alpha-1 antitrypsin deficiency and marijuana abuse. Giant emphysematous bullae are a pathognomonic presentation with a preference towards the upper lobe of the lungs. These emphysematous bullae may remain dormant for a long duration before presenting as worsening dyspnoea. Computed tomography is an essential tool to diagnose VLS. The treatment modalities include surgical and thoracoscopic resection of the bullae. We have reported a rare case of VLS in a 58-year-old chronic smoker managed conservatively. [ABSTRACT FROM AUTHOR]

Recurrent angioedema is a particularly puzzling problem for clinicians worldwide. The cause is often idiopathic with chronic angioedema recurring over weeks to months. Intake of certain drugs and contact with other offending agents can also induce chronic angioedema. In systemic lupus erythematosus patients, recurrent angioedema may be due to an acquired deficiency of C1 inhibitor (C1-INH) caused most probably due to formation of antibody against C1-INH molecule. A 26-year-old female, who had systemic lupus erythematosus, presented to the Emergency Department with the chief complaint of puffiness of face, swelling of lips and bilateral lower limbs since one day, which occurred following application of aloe vera cream thrice within a duration of 24 hours. Upon investigations, absolute eosinophil count was raised while C4 and C1q levels were reduced. A diagnosis of acquired angioedema was made. Patient was managed with corticosteroids, cyclophosphamide, antibiotics, antihistaminics, oxygen support and other supportive measures. However, the patient's condition declined further and she succumbed on day 5 of admission. Therefore, this report highlights the importance of chronic angioedema in a patient with systemic lupus erythematosus and the potential lethal outcome that it can result into. [ABSTRACT FROM AUTHOR]

The Percutaneous technique for tracheostomy has become the standard procedure, due to its ease in placement, minimal complications, and has almost replaced the traditional open (surgical) tracheostomy in intensive care units. We describe a case of broken tracheal cartilage which slipped into the tracheobronchial tree following percutaneous tracheostomy (PCT), impinging and causing collapse of medial basal segment of right lower lobe. [ABSTRACT FROM AUTHOR]

Dengue fever is a prominent challenge in the developing countries throughout the world, with dengue shock syndrome as a leading cause of morbidity and mortality during the seasonal dengue epidemics. Most common presenting features of dengue fever are high grade fever with chills, headache, rash, nausea and vomiting. With the increasing challenges of treating dengue shock syndrome to prevent mortality in the young, it is important to determine factors which can be used to predict dengue shock syndrome. This report showcases a case of 20-year-old young female who presented with the chief complaint of pedal oedema, pain in abdomen along with breathlessness. Upon investigations it was found to be a of dengue fever with pleural effusion and ascites. The patient later developed dengue shock syndrome, which was managed successfully with the help of intravenous fluids, inotropic support and platelet transfusion. Hence, this case report highlights the importance of detection of serositis in the form of ascites, pleural effusion and pedal oedema in dengue fever as a tell-tale sign of upcoming dengue shock syndrome and the pathophysiology behind it. [ABSTRACT FROM AUTHOR]

We report a young female having severe pallor and breathlessness on presentation, being diagnosed as a case of megaloblastic anemia, which was confirmed on bone marrow biopsy. On detailed history taking, she was revealed to have anorexia nervosa precipitated due to extreme fear of COVID-19 along with obsessive-compulsive disorder. Thus, a psychiatric disorder presenting due to simple phobia of COVID-19 can also have a fatal outcome in the young. Therefore, psychiatric health needs urgent attention by physicians, governments, and policymakers across the globe to prevent the surge of mental illness during the ongoing pandemic. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a multiorgan disease that can affect any part of the body. Though it is thought to be affecting mainly the pulmonary system, genitourinary TB is a rare but important manifestation of TB. It has been reported in <0.5% of Extrapulmonary Tuberculosis (EPTB). Amongst instances of genitourinary TB, glandular TB is even scarcer. Maximum patients seek medical intervention later in the progression of ailment due to the attached stigma linked with tuberculosis and in view of affected site and part of the body and the reluctance on the patient's side. In the present case report, a 58-year-old male presented to Department of Medicine, with the complaint of a non healing wound on the scrotal region with excoriation since one month and irritability with altered sensorium since a week. Ultimately, it turned out to be a case of tubercular meningitis resulting from a neglected scrofula with neck rigidity, Kernig's and Brudzinski's sign positive. Though many case reports involving tubercular meningitis have been reported, a neglected scrofula remains a rare manifestation of tubercular meningitis. [ABSTRACT FROM AUTHOR]

Chylothorax is an uncommon pleural effusion characterized by the presence of chyle in the pleural space. Malignancy, trauma, and infections such as tuberculosis and filariasis can result in chylothorax. The chyle is an odourless and white liquid; however, around 50% of chylothorax is not milky (serosanguineous) and 10% of chylothorax is idiopathic which can pose a diagnostic dilemma. We propose a systematic approach which includes pleural fluid triglycerides and cholesterol for all undiagnosed pleural effusion. The case highlights the diagnostic dilemma as well as therapeutic challenges.This study highlights the recurrent non‐traumatic idiopathic chylothorax with proposed algorithmic approach to undiagnosed milky or turbid blood‐tinged pleural effusion. [ABSTRACT FROM AUTHOR]

Introduction: COVID 19 is novel coronavirus which first struck the world 5 months ago and became pandemic in such a short time. China suffered first and then this virus spread to more than 180 countries. Primary organ involved is lungs and the commonest cause of fatality is respiratory failure1. Although, its new virus, related to two earlier deadly viruses e.g. SARS and MERS but has already caused tremendous morbidity and mortality in nations heavily affected by it. This short review highlights about lung involvement due to this virus and to make our healthcare professionals aware about what to expect by learning from the experience of the countries where it has already affected thousands of civilians. Methodology: This review article was written with systematic literature review with the help of data search machine like Pubmed, Scopus, Web of Sciences and google scholar. In this article observational study wand case reports were included. Most of the data were taken from China, Italy and Spain. Review Findings: COAVID 19 affects lung parenchyma in moderate to severe disease causing pneumonia which starts as unilateral lower lobe, commonly on right side, peripheral ground glass infiltrates and rapidly spreads to involve both lungs with bilateral, multifocal consolidations2. Pleural effusion and pericardial involvement may occur. In severe cases the disease progresses to Acute Respiratory Distress Syndrome accounting for >90% of mortality. Pathology of lungs showed diffuse alveolar damage with organization and fibrosis as disease progresses. Conclusions: COVID 19 a novel coronavirus which is presently a pandemic has affected the world in manner reminiscence of 1918 Spanish flu. Lung involvement as community acquired pneumonia is determinant of mortality, which spreads exponentially to develop sever respiratory failure. [ABSTRACT FROM AUTHOR]

© 2021 Indian Chest Society | Published by Wolters Kluwer- Medknow Radiological quandary: Unilateral interstitial lung disease - Truth or dare Sir, Unilateral interstitial lung disease (ILD) has always intrigued clinicians. Letters to Editor 202 Lung India • Volume 38 • Issue 2 • March-April 2021 was no hemodynamic instability. In view of pulmonary artery aneurysm and persistent hemoptysis, the patient underwent endovascular management. [Extracted from the article]

Schistosomiasis is an uncommon waterborne helminthic infection that infects humans. Although it is not prevalent in India, many cases are reported due to contact with infested water bodies. Schistosomiasis primarily involves the lower urinary tract and colorectal region. Pulmonary schistosomiasis, although very unusual, has been described with the systemic manifestation of the disease; however, pleural involvement with schistosomiasis has never been described before in the literature. We report this first case of pleural schistosomiasis masquerading as tuberculosis, which posed a diagnostic challenge and later a new learning point in the presentation of the disease. [ABSTRACT FROM AUTHOR]

Although in COVID this requires further evaluation a similar conduct may be considered.[[3]] We observed polyneuropathy in 2 patients with SARS-CoV2. Sir, Post-COVID-19 complications are predominantly those of the respiratory system and may rarely be neurological.[[1]] Neurological manifestations such as stroke, Guillain Barre Syndrome, encephalopathy, and neuropathy are some that have been observed and are likely to manifest in patients with comorbidities with a rare preponderance for those with mere risk factors but no established diagnosis.[[2]] In other viruses, neurological manifestations are as a result of direct effect of the virus, post infection immune mediated diseases or Para-infections. Only a small percentage of people develop neurological manifestations due to COVID with a relatively smaller percentage developing critical illness neuropathy. [Extracted from the article]