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Angiosarcoma arising in a schwannoma is extremely rare with only fourteen cases having been reported in the literature to the best of our knowledge. Amongst these fourteen, only five cases developed from vagal schwannoma. We describe a case of epithelioid angiosarcoma arising in a long standing vagal schwannoma in a 41 years male patient. Grossly the tumor was well encapsulated with variegated cut surface. On microscopy the tumor had two distinct components composed of benign schwannoma and malignant angiosarcoma which were further confirmed by immunohistochemistry. On further work up, he was found to have multiple distant metastases. This is the sixth reported case of angiosarcoma arising in a vagal schwannoma. The proposed histogenesis of this rare transformation, its prognostic factors and a review of literature regarding this entity is discussed.

<p class="abstract"><strong>Background:</strong> Hoarseness is one of the earliest signal of local and systemic disease. It should be emphasized that hoarseness is not a disease in itself but a symptom of disease or disturbance of larynx or laryngeal innervation. The aim of the study was to analyse various causes and conditions associated with hoarseness of voice.</p><p class="abstract"><strong>Methods:</strong> We studied 150 patients in a prospective randomised study with inclusion criteria of hoarseness of voice, attending otolaryngology outpatient department of Dayanand medical college and hospital, Ludhiana, irrespective of their age, sex and duration of disease. No exclusion criteria were applied. All the routine investigations like Hb, BT, CT, TLC, DLC, urine-for albumin and sugar were carried out in all patients. X-ray chest- PA view and X-Ray soft tissue neck- AP and lateral view were done when required. Larynx was examined by flexible fibreoptic laryngoscopy followed by biopsy if suspicious looking area was seen. 4% lignocaine spray was used orally and nasally to provide local anaesthesia.</p><p class="abstract"><strong>Results:</strong> In the present study of 150 cases 87 were males and 63 were females with M:F ratio of 1.4:1 and age ranged from 10–90 years with majority of cases in 4th and 6th decade of their life. All patients had history of hoarseness of voice with most of patients having duration of disease between one month to one year. On flexible fibreoptic laryngoscopy 27% of cases showed normal study, vocal nodule was  most common, seen in 20% of cases, 10% showed vocal cord palsy and 10% had laryngopharyngeal reflux disease. Bilateral lesion (72.6%) predominated overall, with left sided (15.2%) of larynx affected more as compared to right side (12%).</p><p><strong>Conclusions:</strong> Flexible fibreoptic laryngoscopy is an effective alternative for diagnosis of laryngeal lesions and various causes of hoarseness of voice. Vocal nodule has been found as the commonest cause of hoarseness of voice followed by vocal cord palsy and laryngopharyngeal reflux disease. </p>

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We describe presenting clinical and imaging manifestations of SARS-CoV-19-associated rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-19 pandemic in India. Data on the presenting manifestations was collected from March 01 to May 31, 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by six of 36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%) and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in seven out of 11 subjects with facial palsy and available MR imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, nine (39%) demonstrated long-segment bright signal in posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-19-associated ROCM. Facial nerve palsy is more common than previously appreciated and ishaemic lesions of the posterior portion of the optic nerve underlie complete vision loss.

A bstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and has been declared as a pandemic. COVID-19 patients may require transport for diagnostic or therapeutic purposes intra- or interhospital or transport from an outside hospital to a healthcare facility. Transport of critically ill or infectious patients is always challenging and involves the integration of various tasks and manpower. The adverse events have been attributed to various factors such as a multidisciplinary team and lack of appropriate communication among team members, absence of equipment, or failure during transport, apart from physiological alteration inherent to the disease of the patient. The transport of COVID-19 patients carries an additional risk of not only the disease itself but also due to the risk of its transmission to the transport team. The human-to-human transmission of the virus can occur via respiratory droplets. So, the person involved in the transport of such patients shall be at risk and warrants appropriate steps for their safety. Appropriate planning by a well-trained transport team is an essence for the safe transport of the suspected or confirmed COVID-19 patients. The Transport Medicine Society guidelines present consensus guidelines for the safe transport of COVID-19 patients. Disclaimer These consensus guidelines are applicable for the safe transport of suspected or confirmed COVID-19 adult patients. These recommendations should be used in conjunction with medical management guidelines and advisories related to COVID-19. These recommendations should be adapted to the local policies prevalent at the workplace and also per agreement among the hospitals for transport (agreement between referring and receiving facilities). With the emergence of new scientific evidence, these guidelines may require modification. How to cite this article Munjal M, Ahmed SM, Garg R, Das S, Chatterjee N, Mittal K, et al. The Transport Medicine Society Consensus Guidelines for the Transport of Suspected or Confirmed COVID-19 Patients. Indian J Crit Care Med 2020;24(9):763–770.