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CT guided percutaneous renal cryoablation appears to be a feasible treatment option for small, noncentrally located renal tumors. While early results appear promising, longer followup is needed to more clearly define the role of this treatment method.

From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality.

scintigraphic method for the estimation of the thyroid mass in patients with Graves' disease is described. The method was first standardized using thyroid phantoms with eight different volumes ranging from 5 to 110 cm(3). The planar and single photon emission computed tomography (SPECT) images of each phantom were acquired with four different activities [3.7 MBq (100 microCi), 11.1 MBq (300 microCi), 22.2 MBq (600 microCi) and 37 MBq (1.0 mCi) of 99mTc-pertechnetate] with a 20% window symmetrically placed over the photopeak of 99mTc. The thyroid lobes were enclosed with the help of regions of interest (ROI) tools and a threshold was selected to identify the thyroid boundaries. The same threshold was used in all slices of an image. In the phantom study, a 20% threshold for planar images and a 30% threshold for SPECT were found to be optimum for measuring the thyroid volume. The volume from planar images was calculated by the formula described by Allen and Goodwin (The scintillation counter as an instrument for in-vivo determination of thyroid weight. Radiology 1952; 58: 68-79), whereas, in SPECT images, the sum of the slice areas was multiplied by the slice thickness. The estimated volume of each phantom was compared and correlated with its actual volume. After standardization of the technique with phantom studies, planar scintigraphy (with 20% threshold) in 51 patients and SPECT (with 30% and 35% threshold) in 40 patients with Graves' disease were performed to estimate the thyroid size. The thyroid size was also estimated by ultrasonography, which showed good agreement with the scintigraphic method, particularly with SPECT.

ObjectivesTo ascertain the feasibility of endoscopic (4 mm) stapedotomy, and compare intra- and post-operative variations with microscopic stapedotomies.MethodsForty otosclerosis patients were scheduled for microscopic or endoscopic stapedotomy. Intra-operative variables compared were: incision, canalplasty, canal wall curettage for ossicular assessment, chorda tympani manipulation, ability to perform stapes footplate perforation before its supra-structure removal, and operative time. Post-operative variables compared were ear pain and hearing improvement.ResultsOf the 20 microscopy patients, 4 required endaural incision and canalplasty because of canal overhangs, and 7 required canal wall curettage for ossicular assessment. None of the 20 endoscopy patients required these procedures. Chorda tympani was manipulated in 13 and 6 patients in the microscopy and endoscopy groups respectively, while the stapes footplate could be perforated in 5 and 11 patients respectively. Mean operative time was 50.25 and 76.05 minutes in the microscopy and endoscopy groups respectively. In the endoscopy group, mean air–bone gap was 37.12 and 10.73 dB pre- and post-operation respectively; in the microscopy group, these values were 35.95 and 13.81 dB.ConclusionEndoscopic stapedotomy has comparable hearing outcomes. Sinonasal endoscope serves as a better tool for: minimal incision, canalplasty avoidance, less chorda tympani mobilisation, and stapes footplate perforation ability.