Pulmonary Alveolar Microlithiasis (PAM) is an uncommon inherited lung disorder characterized by the accumulation of calcium phosphate microliths within the intra-alveolar spaces, despite the absence of any known abnormalities in calcium metabolism. This condition is associated with mutations in the SLC34A2 gene, which encodes the type IIb sodium-dependent phosphate transporter. These mutations impair the ability of alveolar type 2 epithelial cells to remove phosphate ions from the alveolar space, leading to the development of microliths in the extracellular fluid. A hallmark feature of PAM is a disconnect between clinical symptoms and radiological findings—imaging typically reveals distinct patterns that closely align with pathological changes. Diagnosis is often made based on characteristic radiologic features and the detection of microliths in samples from bronchoalveolar lavage (BAL) or even sputum. In many cases, a lung biopsy or transbronchial biopsy confirms the diagnosis. At present, there are no approved medical or gene-based treatments, though lung transplantation remains a potential option. Here we describe five interesting cases of PAM, suspected on incidental Chest X-Ray findings and proved from BAL samples and corelated with familial screening with Chest X-Rays.

Introduction: Fanconi syndrome is characterized by generalized proximal tubular dysfunction leading to urinary wasting of phosphate, glucose, bicarbonate, amino acids, and other solutes. Adult-onset disease is uncommon and typically secondary to drugs, toxins, or systemic disorders. Genetic forms presenting in early adulthood are rare and may remain unrecognized until skeletal complications occur.[1] Case Report: A 20-year-old previously healthy woman presented with chronic low back and bilateral hip pain and was found to have bilateral iliac stress fractures. Biochemical evaluation revealed persistent hypophosphatemia, Vitamin D deficiency, normoglycemic glucosuria, aminoaciduria, phosphaturia, tubular proteinuria, and proximal renal tubular acidosis, consistent with Fanconi syndrome. Secondary causes were excluded. Genetic testing identified a pathogenic SLC34A1 mutation, confirming inherited proximal tubular dysfunction. She was treated with alkali therapy (sodium bicarbonate and potassium citrate) and phosphate supplementation, resulting in biochemical improvement and no further fractures on follow-up. Conclusion: This case underscores the importance of considering proximal tubular disorders in young adults with unexplained hypophosphatemia and stress fractures. Early recognition and targeted metabolic correction are crucial to prevent progressive skeletal morbidity and preserve renal function.

Background: Postmenopause is an estrogen deficient state associated with increased incidence of insulin resistance(IR). Yoga has been described as having beneficial effect on IR in many studies and populations. The aim of our research was to study the effect of 3 month long Yoga practice on IR in early postmenopausal women. Methods: A prospective longitudinal study of 67 women within five years of menopause between 45 and 60 years of age attending the menopause clinic of a tertiary care hospital fulfilling inclusion and exclusion criteria and consenting were enrolled for study. Yoga group participants received intervention of Integrated Yoga module comprising asanas, pranayama, savasana, and OM chanting in addition to routine gynaecological management for 12 weeks. IR of 37 cases (Yoga group) and 30 controls (non Yoga group) was measured using HOMA-IR method pre and postintervention. Statistical Analysis was done by GraphPad Prism Version 5 software. Values are a mean and standard error of mean. Statistical significance was set up at P < 0.05. Result: A definite increase was observed in S. Fasting Insulin and HOMA-IR in Yoga group but it failed to achieve statistical significance. In the Non-Yoga group, S. Fasting Insulin levels (p=0.0066) and HOMA-IR measurements (p=0.0212) showed significant rise after 3 months. Conclusion: Three month long Yoga practice attenuated increase in insulin resistance in early postmenopausal women and has the potential to prevent early onset of IR and prevent further development of type 2 diabetes mellitus in our population if instated early in menopause.

Background: Tympanic membrane perforation (TMP) is a common otologic condition and an important cause of conductive hearing loss. The degree of hearing impairment depends on several anatomical factors, including perforation size, site, malleolar involvement, and mastoid pneumatization. Understanding these relationships is essential for improving clinical assessment and treatment planning. Objective: To evaluate the correlation between TMP characteristics and the degree and frequency pattern of conductive hearing loss in patients with unilateral dry perforations. Methods: This prospective observational study included 100 patients aged 18–50 years with unilateral dry TMP attending the ENT department of a tertiary care hospital between March 2021 and September 2023. Patients with active infection, bilateral perforations, prior ear surgery, tympanosclerosis, ossicular pathology, or sensorineural hearing loss were excluded. Perforation size and location were assessed microscopically, and mastoid pneumatization was evaluated radiologically. Hearing status was measured using pure tone audiometry (PTA) and tuning fork tests. Data were analyzed using SPSS version 25 with a significance threshold of p < 0.05. Results: Most patients were aged 31–50 years (65%), with equal gender distribution. The anteroinferior quadrant was the most common perforation site (78%). Chronic otitis media accounted for 86% of cases. Moderate-to-severe hearing loss was more prevalent in ears with larger perforations, posterior quadrants, malleolar involvement, and sclerosed mastoids. PTA demonstrated greater loss at lower frequencies, consistent with the classical inverted “V” pattern. Conclusion: Perforation size, location, malleolar involvement, and mastoid pneumatization significantly influence conductive hearing loss in TMP. Larger and posterior perforations are associated with greater hearing impairment. These findings may help clinicians predict hearing outcomes and tailor surgical decision-making.