Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease. Diagnosis is established by bronchoalveolar lavage (BAL), which has macroscopic ‘milky appearance’, and in the presence of typical computed tomography, findings are diagnostic of PAP but, however, the feature of periodic acid–Schiff-positive eosinophilic proteinaceous fluid raises the confidence of the diagnosis. We report late-onset PAP in a 10-year-old girl who had acid fast bacilli on an initial BAL examination, but was subsequently diagnosed as PAP.

Context: Peripubertal and adolescent children are vulnerable to vitamin D deficiency as this is the period of rapid skeletal growth. Aims: This study was done to assess the vitamin D status in school children between the age of 8–14 years attending the government schools in rural and urban areas of Assam in Northeast India. Settings and Design: This was a cross-sectional observational study. Materials and Methods: About 500 students (350 from rural and 150 from urban areas) were recruited in the study. Serum 25-hydroxy vitamin-D [25(OH)D], parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase were measured in fasting state. Daily nutrition intake and sunlight exposure were assessed. Statistical Analysis: Student's t -test and Pearson correlation test were done to assess the association between different variables. P value <0.05 was considered significant. Results: The prevalence of vitamin D deficiency was 8.4% and vitamin D insufficiency was 14.2%. There was no significant difference of mean 25(OH)D levels and sun exposure between rural and urban children. Out of 42 children with vitamin D deficiency, 36 (85.7%) had sun exposure <20% and 41 (97.6%) had calcium intake < 1000 mg/day. The rural children had a higher calcium intake as compared to urban children ( P = 0.005). There was a significant positive correlation of mean 25(OH)D levels with serum calcium, sun exposure and calcium intake. Conclusion: The prevalence of vitamin D deficiency in peripubertal and adolescent age group children in and around Guwahati city of Assam is comparatively lower than that in other parts of the country.

Aim: To investigate the prevalence and the risk factors for cardiac autonomic neuropathy (CAN) in type 2 diabetes mellitus (DM) patients. Study Design: Cross-sectional cohort study. Place and Duration of Study: This study was conducted in the Department of Endocrinology, Gauhati Medical College and Hospital, Assam, India between December 2016 to March 2018. Methodology: We included 100 patients (60 males and 40 females; age range: 36–72 years) with type 2 DM. Their clinical, biochemical, and metabolic parameters were analyzed and assessment of CAN were done based on the Ewing's criteria. Results: Out of 100 patients, 60 were males and 40 were females. The mean age of the patients was 53.3 ± 10.37 years (36–72 years) and the mean duration of diabetes was 9.03 ± 6.4 years (6 months–25 years). Patients were divided into two groups: “without CAN” (CAN−) and “with CAN” (CAN+). The prevalence of CAN was 70%, with early CAN in 25%, definite CAN in 24%, and severe CAN in 21% cases The patients with CAN were older ( P = 0.0005), had longer diabetes duration (11.56 vs. 3.13; P = 0.0001), higher creatinine ( P < 0.0001), and lower estimated glomerular filtration rate (eGFR) ( P = 0.0001) compared to patients without CAN. Retinopathy, peripheral neuropathy, and nephropathy were common in CAN + patients. On multiple logistic regression analysis, duration of diabetes [odds ratio (OR); 6.7, P < 0.0001), older age (OR; 1.07, P < 0.016), and lower eGFR (OR; 0.97, P < 0.03) were risk factors for CAN. Conclusion: CAN is a common microvascular complication in type 2 DM with duration of diabetes, age, and severity of nephropathy being its significant determinants.

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Background: Chiari malformations are herniation of part of cerebellum into the foramen magnum. Professor Hans Chiari classified chiari malformations into four types: type I to type IV. Type I chiari malformation is the most extensively studied entity. Type III and IV are very rare variety. Aim: Magnetic Resonance Imaging (MRI) study of the different types of chiari malformations in a tertiary care hospital in NorthEast India. Materials and Methods: After performing MRI of brain and spinal cord, 63 cases of chiari malformations were included in the study. The cases were classified according to the classification of Hans Chiari. Results: 73.02% cases were type I followed by 22.22% cases of type II chiari malformations. Male predominated female and more than half of the patients were under twenty years of age. Hydrocephalus and syringomyelia were mostly associated with type I chiari malformations. Conclusion: various aspects of such a rare type of congenital anomaly were studied in this part of the country.