Apart from routine symptoms such as fever, cough, sore throat, myalgia, and dyspnea in severe form of Coronavirus Disease-2019 (COVID-19) infection, very rarely patients can develop worsening of dyspnea due to bilateral pneumothorax. The present case series is about five adult patients, of age ranging from 39 to 57 years, who developed bilateral pneumothorax during their stay in the hospital. All the cases were reported between May 2021 and October 2021 and were tested positive for COVID-19 by reverse transcriptase polymerase chain reaction. Out of five adults, three patients were males and were two females. All the patients were assessed with quick sequential organ failure assessment (q SOFA) score on admission and then monitored by SOFA Score. On admission, baseline contrast enhanced computer tomography chest was done for three patients, and chest radiography for one patient all showing features of moderate to severe COVID-19 pneumoniae. One patient with q SOFA Score of 3 on admission required immediate invasive mechanical ventilatory support with ultrasonogram chest immediately performed showing bilateral pneumothorax. Patients were started on remdesivir, dexamethasone, low molecular weight heparin or unfractionated heparin, tocilizumab, and antibiotics. Subsequently, during the course of stay in the hospital, rest of the four patients developed symptoms of pneumothorax and emergency bedside chest ultrasonography showed the typical barcode or stratosphere sign confirming bilateral pneumothorax. All the patients were managed with bilateral chest intercostal water seal drainage intercostal drain tube and invasive mechanical ventilation. Fraction of Inspired Oxygen (FIO2), and other ventilatory settings were adjusted depending on daily arterial blood gas findings. Attempts to wean off from ventilatory support and extubation were successful for two patients, whereas three patients did not survive. In this case series, we will be presenting about those five cases of bilateral pneumothorax in COVID-19 patients reported at a tertiary care hospital in Mizoram, India.

How to cite this article: Zosangpuii, Wendy L Ralte. Prospective Clinical study of pregnancy outcome in amniotic fluid index less than five in term low risk pregnancy.

Background: Cancer is not a notifiable disease in India. The data pertaining to liver cancer and hepatic lesions are very limited in India. Aims and Objectives:  The current study was intended to observe the proportion of different types of liver lesions reported from private hospitals in Mizoram and also to study the association of liver malignancies in relation to gender and age. Materials and Methods: This is a cross-sectional study design. The data were collected from the cytopathology data base of a private laboratory (Genesis Laboratory) in Aizawl, Mizoram. Data regarding 204 patients with hepatic lesions, who have been referred from three private hospitals to a private laboratory in Mizoram from January 15, 2018, to November 31, 2021, were included in the study. Details regarding cytopathology reports of image-guided fine needle aspiration cytology of liver mass, age, and gender were collected. Air-dried smears received at a private laboratory were routinely stained with Leishman-Giemsa and Papanicolaou stains, Ziehl-Neelsen staining was done wherever needed. From the cytopathological diagnosis made, the frequency and patterns of various hepatic lesions were then analyzed using SPSS Version 22. Results: Out of 204 cases, 15 (7.35%) cases were reported as inadequate samples and 4 cases (1.96%) were inconclusive in diagnosis. Hence, remaining 185 study participants were included in the final analysis. The mean age was 58. Majority 122 (65.40%) were males and in the age group 41–60 years (49.19%). Majority of the lesions were malignant 145 (78.37%) and remaining 40 (21.62%) were benign lesions. The most common malignant lesion found was hepatocellular carcinoma (HCC) 87 (47.02%), followed by metastatic carcinoma 31 (16.75%). Liver malignancies were found to be higher among males (74.5%) as compared to females (14.3%), but were not statistically significant (P=0.08). The proportion of males (52.5%) versus females (36.5%) diagnosed with HCC was statistically significant (P=0.03). Conclusion: The most commonly reported liver malignancy was HCC. The proportion of males diagnosed with HCC was higher than females in the present study.

Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022- February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient’s Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital.