Medicine

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.

A 5-y-old female with COVID-19 infection, presented in shock with nonanion gap metabolic acidosis, polyuria, very low bicarbonate, potassium and phosphate, non-nephrotic range proteinuria, glucosuria, elevated beta-2 microglobulin in urine, and urinary phosphate loss, confirming the diagnosis of proximal renal tubular acidosis. She required aggressive fluid, bicarbonate, potassium, and phosphorus correction. There was a gradual decrease in urine output and improvement in the acidosis and electrolyte abnormalities. She had normal parameters on follow-up. COVID-19 infection with renal involvement has been documented in several adult case series. A study from Wuhan documented proteinuria, hematuria, and azotemia in 44%, 27%, and 14% respectively [1]. Transient renal tubulopathy presenting as nephrogenic DI or transient Fanconi syndrome have also been reported [2]. Renal histopathological findings of 26 patients with COVID-19 by light microscopy revealed tubular damage with loss of brus...

The hereditary form of pulmonary alveolar proteinosis (PAP) is an uncommon entity. We report a case of PAP due to colony-stimulating factor 2 receptor alpha (CSF2RA) gene mutation. The standard of care includes whole lung lavage (WLL). We faced two challenges: Firstly, a severely hypoxemic patient, and secondly, the nonavailability of appropriate size of double-lumen endotracheal tube for pediatric patients for a WLL while permitting single-lung ventilation. Hence, we performed WLL using venovenous extracorporeal membrane oxygenation (VV ECMO) with a successful outcome. The patient has been discharged and is off oxygen support since more than a year. There are only a few case reports of children having hereditary PAP treated with WLL using ECMO in Indian and Western literature.

During the last two decades, the number of percutaneous coronary interventions (PCI) has steadily increased in Switzerland, as has the use of coronary stents. However, reports of coronary stent infections are very rare. In the present article we review all published cases of coronary stent infections. All patients presented with symptoms of infection within the first four weeks after PCI. Clinical hallmarks of stent infection were fever and chest pain. Blood cultures were positive in all patients. Despite the use of intravenous antibiotics in all except one patient and surgical drainage of the infectious focus in the majority of affected individuals mortality was high (40%). Thus, coronary stent infection, although exceedingly rare, represents a life-threatening complication and should be considered in the differential diagnosis of patients presenting with fever during the first few weeks after PCI.

This paper takes a hard look at the experience with official intervention in sovereign debt crises, focusing on debt crises of the 1980s, Russia in 1998, Argentina in 2001, and Greece in 2010. Based on the track record, the authors argue that in situations where countries face a solvency problem, official intervention is more likely to succeed if official money