Pulmonary tuberculosis is the most common cause for cavitary lung disease in India due to its endemic nature and high case burden. In spite of awareness by government organizations regarding symptoms, diagnostic modalities and treatment options for disease, Pulmonary tuberculosis management is delayed in all aspects due to the large proportion of cases receiving access to the private sector where adequate training and awareness regarding tuberculosis is missing. Constitutional symptoms of tuberculosis are not severe and fatal as well and this is the most common reason for lack of timely suspicion as commonly occurred with cardiac ailments. Constitutional symptoms in tuberculosis cases are usually managed by general practitioners in line with enteric fever, jaundice, bronchitis and pneumonia and these cases were treated accordingly. In present case report, 45-year-old female, with constitutional symptoms for six months were treated in outdoor and indoor settings by general practitioners, family physicians and other healthcare professionals with antibiotics and bronchodilators in line with enteric fever, jaundice and bronchitis with asthma on many occasions with partial response to treatment and symptoms worsening. She was referred to our center after an episode of moderate hemoptysis and we have retrospectively studied the reports and noted chronic lung cavitation in chest x-rays done a few months before which is clearly demarcated and visible in posteroanterior and lateral views. Her radiological abnormalities were never evaluated as she was never examined by a pulmonologist before our center and only x-ray was done without a confirmed diagnosis. We have documented typical cavitary lesions favoring chronic infective disease with radiological features of tuberculous cavity in HRCT chest. Her induced sputum examination for CBNAAT (Cartridge based nucleic acid amplification) MTB (mycobacterium tuberculosis) positive, Rifampicin mutation (Rpo-b) Negative. Treatment initiated with anti-tuberculosis (ATT). We have recorded near complete radiological resolution, bacteriological cure after eight months of ATT with good compliance. Pulmonary tuberculosis should be suspected early in cases with cavitating lung disease with constitutional symptoms to have a successful treatment outcome.

The prevalence of cutaneous malignancies is frequently observed in the facial region, with a notable predilection for the nasal area. The distribution of nonmelanoma skin tumors is predominantly observed in the head and neck region, accounting for approximately 75% of cases. Specifically, the nasal area is affected in approximately 30% of these instances. Basal cell carcinoma and squamous cell carcinoma represent significant clinical-surgical indications within the medical field. Moreover, the utilization of skin flaps for nasal reconstruction exhibits remarkable versatility in its various applications. The potential outcome of the reconstruction procedure is based upon various factors, including the precise location, dimensions, and depth of the defect, as well as the feasibility of accessing a suitable donor area. Just as important are the surgeon's choices regarding the materials, techniques, and approaches employed during the intervention. The innovative research conducted by Burget and Menick has brought about a paradigm shift in the field of nasal reconstruction surgery. Their pioneering contribution lies in the introduction of the concept of aesthetic subunits of the nose, in which variations in elasticity, color, contour, and skin texture are taken into account. This innovative method has significantly enhanced the precision and finesse of nasal surgical procedures, leading to remarkable advancements in the field. The unique attributes of the dermal layer that envelops the region, along with the numerous waves and projections present on its outermost layer, necessitate careful consideration in order to restore the usual natural shape and functioning. Even a small, unnoticed alteration in structure may have a significant influence on both aesthetic appeal and structural integrity. The therapeutic approach includes both functional and cosmetic considerations, with the primary objective being the mitigation of the most minimal degree of anatomical abnormality.

The Objective of this study is to check the connection of exchange rate volatility in response to COVID- 19, with the help of two different models. We used twelve variables in these two model Exchange rate volatilities, Govt Effectiveness, Unemployment, Inflation, Lending Interest rate, GDP per capita, Population, Immunization, Govt Expenditure on education, Life- Expectancy, and Hand washing. The data collected from World Development Indicator, World Health Organization, International Financial Statistics, Worldwide Governs indicators, and COVID-19 data collected from-our-world-in-data. ARCH and GARCH models are used to find out the Volatility of the Exchange rate. This study employed the Generalized Method of Moments (GMM) model because it is a versatile and effective statistical technique that permits parameter estimation in models with potential endogeneity and measurement error concerns. Panel GMM Technique is used to find the significant result. According to model one Exchange rate volatility has a positive and significant connection with the Covid-19 cases or death rate, Govt effectiveness, and Govt Expenditure on education, and negative relation with Unemployment, Inflation, Lending interest rate, Number of COVID-19 cases, Population, and GDP Per capita. According to our second model results, all the variables have a positive relation with COVID-19 except Government Effectiveness and Immunization.

Spontaneous intracranial hypotension (SIH) is an uncommon disorder caused by cerebrospinal fluid (CSF) leaks in the spine. Treatment is directed at sealing the site of leak, which is often difficult to localize. We present a case of near fatal SIH that was treated with cervical epidural blood patch (EBP) and burr hole drainage of the hematoma. A 41-year old male presented with severe headache after drinking alcohol over several weeks. Brain magnetic resonance imaging (MRI) showed features typical of SIH. But, further imaging with MR myelography and radionuclide cisternography failed to identify a precise site of leak. Despite lumbar EBP, the patient’s orthostatic headache recurred and developed acute subdural hematoma(SDH) to require burr hole drainage for hematoma evacuation. After surgery, the patient’s mental state improved, and the amount of SDH decreased, but he still complained of severe orthostatic headache. We performed EBP at cervico-thoracic junction level. The headache was rapidly relieved and the SDH was completely absorbed. In this case, we aim to remind clinicians that cervical EBP should be considered management for SIH as an alternative to the repeated lumbar blood patch.

Proteus syndrome is a rare, complex, and progressive disorder characterized by tissue overgrowth, deformities, and vascular anomalies. We present a case of a 56-year-old patient with Proteus syndrome who underwent successful incision and drainage an ulcerative lesion on a Cerebriform connective tissue nevus on the left plantar surface under spinal anesthesia. The patient had a history of mild lumbar scoliosis and a previous hospitalization for pulmonary embolism. Due to the patient's difficult airway and increased risk of thromboembolism, spinal anesthesia was chosen as the anesthetic technique. The procedure was carried out without complications, and the patient had a satisfactory postoperative recovery.

Introduction: Cyclic Cushing's syndrome is a not widely known pathology with low incidence; however, an increase in the number of cases has been observed in recent years. The intermittent clinical symptoms and discordant laboratory results make it a complicated diagnosis; therefore, close follow-up is crucial. We describe a case of ectopic cyclic Cushing's syndrome in a woman in her seventies who presented weight gain, proximal myopathy, moderate hypokalemia and uncontrolled hypertension; in the first evaluation hypercortisolism was found, however, 2 months later cortisol presented normal levels. Subsequently, a close follow-up was carried out and the study protocol was continued once the presence of 3 peaks and 2 valleys was demonstrated, obtaining compatible values for ectopic ACTH-dependent cyclic Cushing's syndrome. In thoracoabdominal MRI a spiculated lesion was found in the left basal lung field surrounding 25% of the aorta. Due to the location of the lesion, the patient refused surgical treatment, being currently under adequate control with the use of ketoconazole and octreotide injections. Conclusions: The possibility of cyclic Cushing's syndrome diagnosis should be kept in mind in those patients with symptoms suggestive of Cushing's syndrome that remit sporadically and whose laboratory studies show intermittent results of hypercortisolism and normocortisolism, since early identification allows opportune treatment and therefore better prognosis.

Wolfram syndrome it’s a rare autosomal genetic disease. Also, kwon as DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness). Its classified as one of infancy onset diabetes mellitus non autoimmune causes, its presentation generally happens at an early age; other characteristics of the disease are insipidus diabetes, optic atrophy, neurosensorial deafness, psychiatric alterations and other neurodegenerative disorders.