Borrelia Ocular Infection: A Case Report and a Systematic Review of Published Cases

<b><i>Introduction:</i></b> Lyme borreliosis can cause many diverse manifestations, also ocular disease where the diagnosis of ocular borreliosis is challenging. The primary aim was to report on the evidence of <i>Borrelia spirochetes</i> in the ocular tissue in presumed ocular borreliosis. <b><i>Methods:</i></b> A systematic review of pathological eye conditions was performed where <i>Borrelia</i> has been suspected in relevant ocular tissue, together with a case report of diagnosed uveitis with polymerase chain reaction (PCR)-confirmed <i>Borrelia afzelii</i> in the vitreous. The evidence for clinical and laboratory diagnosis was evaluated systematically. As a secondary aim, the treatment of ocular <i>Borrelia</i> infection was also evaluated for confirmed cases. <b><i>Results:</i></b> Thirteen includable studies were found, and after the removal of case duplicates, eleven unique cases were extracted. Apart from the present case report, 4 other cases reported strong evidence for the detection of <i>B. spirochetes</i> in ocular tissue. Four cases presented reasonable evidence for assumed detected <i>Borrelia</i>, while three additional cases showed only weak diagnostic credibility that <i>Borrelia</i> was detected. <b><i>Conclusion:</i></b> This systematic review, including all reported cases and our case report, supports evidence of ocular infection of <i>Borrelia</i> species. Furthermore, in case of suspicion of infection and seronegativity, it is justified to look for <i>Borrelia</i> in eye tissue samples. In addition, microscopy without using PCR is not sufficient to confirm the diagnosis of borreliosis on ocular tissue. In the articles studied, there was no unambiguous recommendation of treatment.

Case Report: Medicolegal evaluation in a case of fatal scald where a child fell into a cauldron in rural Nepal

Thermal injuries in young children involving the buttocks, perineum, and lower limbs raise suspicion of child abuse. Determining the manner of death and ruling out homicide in a fatal case of scalding remains a challenge for forensic practitioners. One such issue is reported in the present case report, where a medicolegal evaluation of a fatal scald in a two-year-old girl child is discussed. Young children sustaining serious injuries from scalds is a grave social concern. Such young lives need to be protected from scald injuries whether accidental or purposeful. Differences in injury patterns on the basis of their distribution and their characteristics are important to determine manner of death in such cases.

Identification of equine herpesvirus 8 in donkey abortion: a case report

Background Equine herpesvirus-8 (EHV-8) is one of the most economically significant viruses that infect mammals of the genus Equus worldwide, which cause severe respiratory diseases and abortion in horses. However, there is no report of abortion caused by EHV-8 in donkeys. Case presentation The present case report is about a 4-year-old donkey having an abortion and showing a serious respiratory issue on the 296th day of pregnancy. Bacteriological and molecular tests were used to screen possible bacterial/viral pathogens to detect the etiological agent. Salmonella abortus equi, EHV-1, EHV-4, and EAV were all negative in the current study. EHV-8, on the other hand, was the only agent that was isolated and identified. Conclusions This was for the first time that EHV-8 had been isolated from a donkey in China. EHV-8 infection can cause abortion in donkeys; therefore, veterinarians and breeders should be aware of it.

Pantoprazole-induced Thrombocytopenia: Unresponsive to Corticosteroid and Thrombocyte Concentrate Transfusion

Introduction Pantoprazole is a proton pump inhibitor (PPI) class drug that is widely used in the treatment of SRMD (stress-related mucosal disease in critical ill patients. PPI are one class of drugs used commonly both for treatment and prophylactic therapy for stress ulcers in intensive care unit (ICU). Case We report a case of a 51-year old male who was referred to PKU Hospital. He was admitted to ICU with diagnosis of Hyperosmolar Hyperglymic State and bronchopneumonia. Thrombocytopenia was noted in admission. There was more than 70% decrease in platelet count after initiation of pantoprazole. Patient received Thrombocyte Concentrate (TC) transfusion and corticosteroid iv for several days, but only had minor increase in platelet count. The platelets recovered after stopping pantoprazole. Discussion In the present case report, another exposures to parenteral pantoprazole in a dose of 40 mg once daily reproduced the same adverse drug reaction. In comparison to lansoprazole, thrombocytopenia from pantoprazole is more severe that necessitate TC transfusion and corticosteroid trial. However, in the present case, TC transfusion and corticosteroid fail to escalate platelet count. This finding suggests probability of non-immune mechanism of pantoprazole-induced thrombocytopenia. Conclusion Pantoprazole may induce thrombocytopenia with new features that were immediately developed, resulting a decrease in platelet count >70%. The mechanism found in this case may be non-immune. Drug-induced thrombocytopenia is one of the rare complications that has to be kept in mind with the use of pantoprazole.

Subcutaneous Facial Emphysema Following Open-Flap Air-Powder Abrasive Debridement for Peri-Implantitis: A Case Report and an Overview

Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement.

Xanthogranuloma of nose in an adult: an uncommon presentation

<p class="abstract">Xanthogranuloma is a relatively rare histiocytic cutaneous disorder that typically affects the pediatric age group. Its occurrence in adulthood is still rarer with only a handful of cases on the record. The present case report describes a case of adult-onset xanthogranuloma in a 49 years old lady who presented to the otorhinolaryngology clinic with a 6 months history of a nodule on the left side of the columella. There was no history of associated pain or bleeding from the site. Local examination revealed a 0.6×0.6 cm, non-tender, soft-to-firm, pinkish dome-shaped lesion with rounded edges. No similar lesions were found elsewhere. Excisional biopsy of the lesion was performed and microscopy showed a dermal lesion comprising of sheets of histiocytes admixed with lymphoplasmacytic infiltrate, touton giant cells and few spindle cells. A diagnosis of xanthogranuloma was rendered. A number of lympho-histiocytic lesions comes in the differential diagnosis of xanthogranuloma and hence it is important to be aware of such unusual presentations in order to make correct histological diagnosis.</p>

Leech Infestation in the Vulvar Region: Causes of Vaginal Bleeding in a Six years old Child

Background: Leeches are hermaphroditic rare blood-sucking human endoparasitesof phylum Annelida and class Hirudinea. Leech infestation is a zoonotic disease acquired by drinking contaminated water, swimming in ponds and streams .1Epidemiology of leech bites in literature is limited and the majority of existing data are case reports from the tropics or subtropics.2–4 Leech bites can occur on various orifices of the body including internal body cavities and orifices, such as the uterus, rectum, urinary bladder, vulva, nasal cavity, peritoneal cavity, nasopharynx, oropharynx, oesophagus, trachea, bronchi and the vagina.5 Different chemicals for leech removal have been utilized and include anesthetics drugs like lidocaine and topical anesthetic spray. Salt, saline, vinegar, alcohol, and heat are also viable options. Of these, saltwater has been shown to be effective in causing the leech to relax and release.Vaginal bleeding resulting from leech bite is rare, but when it occurs, it may be of severe morbidity.2–4 In the present case report that happened at Kabaya district hospital, a six year old child with vaginal bleeding that turned out to be caused by vaginal leech infestation is presented. Kabaya district hospital is a rural hospital with 144-bed capacity and serves 188,902 inhabitants and is geographically difficult to access due to the lack of reliable roads and bridges, especially in the rainy season.

A RARE CASE OF MUCINOUS CYSTADENOCARCINOMA OF LIVER PRESENTING AS HYDATID CYST

Hepatobiliary cystadenocarcinoma is a very rare cystic tumor that arises in the liver or, less frequently, in the extrahepatic biliary system mostly seen in elderly patients. It has been shown to arise in congenital liver cysts, bile ducts, biliary cystadenoma, in the context of bro- polycystic disease and in the hepatoduodenal ligament. In the present case report, we describe a case of rare entity of hepatobiliary cystadenocarcinoma presented in a 36 year old male patient presented to opd with complaints of pain abdomen in right side of upper abdomen since 2 months. Main concern of this case report is preoperative imaging is imprecise and frequently misdiagnosed as benign cystic lesions and delays in treatment.

Spontaneous pneumothorax in a pregnant woman with COVID-19: a case report

Numerous symptoms and complications of COVID-19 include pneumothorax as a rare but potentially-lethal condition. The present case report involved a pregnant woman with COVID-19 presenting with pneumothorax. A 30-year-old pregnant woman with COVID-19 and a gestational age of 32 weeks presented to our hospital with dyspnea, coughs and fever. The rales initially heard in both lungs continued to be heard only in the left lung after 24 hours. Pneumothorax was confirmed through radiology. The emergency cesarean section performed to avoid the potential detrimental effects of the infection on the fetus caused no breathing episodes in the biophysical profile. The patient recovered postpartum without complications and both the mother and the newborn were discharged 12 days later. Spontaneous pneumothorax is a rare complication in COVID-19 pregnant patients that can emerge at any stage of the disease.

An unusual case of maxillary permanent 1st molar with two pulp canals with pulp necrosis; diagnosis and endodontic management.

The present case report highlights the need to identify variations in root canal anatomy as a prerequisite for effective nonsurgical root canal therapy planning. As clinicians, we need to develop our observational and clinical abilities as well as amend our understanding of the complexities of the canal anatomy. Reports describing the structure of teeth and pulp canals rarely report the presence of two pulp canals in two permanent upper 1st molars. In this case, it describes the nonsurgical root canal therapy of the upper right 1st permanent molar with two pulp canals, which was confirmed by a cone beam.