Small Bowel Internal Herniation through Acquired Defect of Vesicouterine Pouch- A Late Complication following Oophorectomy

Hollow viscus herniation through a defect between vesicouterine pouch following previous pelvis surgery is exceedingly rare. There was only 1 similar case reported in the English literature. In this current report, we describe a 84-year-old woman presented with lower abdominal pain. She had a history of previous gynecology surgery. Computed tomography of abdomen showed small bowel obstruction with transition zone at the pelvis. Laparotomy revealed small bowel loops trapped in the vesico-uterine space via a narrow defect about 1.5cm. The detailed clinical summary and operative management are described in the report.

A rare cause of recurrent gastrointestinal bleed: Blue rubber bleb nevus syndrome

Congenital venous malformations (VMs) are rare cause of gastrointestinal (GI) bleed in children. Blue rubber bleb nevus syndrome characterized by VMs in GI tract and skin affect at early age in life. Diagnosis is based on typical skin lesion and history of recurrent GI bleed. In this article, we presented a similar case of young girl with typical skin lesion and recurrent GI bleed requiring multiple blood transfusions presenting our department. She was subjected to surgical treatment and endoscopy therapy due to failure of conservative therapy. This case report depicts importance of typical clinical features of rare diseases.

Dimensions of ‘self-affine sponges’ invariant under the action of multiplicative integers

Let $m_1 \geq m_2 \geq 2$ be integers. We consider subsets of the product symbolic sequence space $(\{0,\ldots ,m_1-1\} \times \{0,\ldots ,m_2-1\})^{\mathbb {N}^*}$ that are invariant under the action of the semigroup of multiplicative integers. These sets are defined following Kenyon, Peres, and Solomyak and using a fixed integer $q \geq 2$ . We compute the Hausdorff and Minkowski dimensions of the projection of these sets onto an affine grid of the unit square. The proof of our Hausdorff dimension formula proceeds via a variational principle over some class of Borel probability measures on the studied sets. This extends well-known results on self-affine Sierpiński carpets. However, the combinatoric arguments we use in our proofs are more elaborate than in the self-similar case and involve a new parameter, namely $j = \lfloor \log _q ( {\log (m_1)}/{\log (m_2)} ) \rfloor $ . We then generalize our results to the same subsets defined in dimension $d \geq 2$ . There, the situation is even more delicate and our formulas involve a collection of $2d-3$ parameters.

POSACONAZOLE INDUCED PSEUDOHYPERALDOSTERONISM WITH CONCURRENT ACUTE PRIMARY ADRENAL INSUFFICIENCY-A CASE REPORT

In this covid 19 pandemic,there were increased incidence of Mucormycosis and thereby increase in usage of antifungals especially oral posaconazole which is more recently available in tablet form.There are already enough case reports of the incidence of new onset hypertension and hypokalemia with supressed renin and aldosterone which is termed as “Posaconazole induced pseudohyperaldosteronism”.We describe here about a similar case that presented with hypertensive urgency as Acute pulmonary edema with an associated primary adrenal insufciency.The potential mechanism include inhibition of 11 β HSD which degrades cortisol to cortisone,thereby increasing the levels of cortisol that stimulates Mineralocorticoid receptor.Also there is inhibition of steroidogenesis at the level of adrenal which in our patient presented with features of Acute adrenal insufciency.

Respiratory Muscle Weakness in Thyrotoxic Periodic Palsy: A Lesson to Remember

Thyrotoxic periodic palsy (TPP) is a sporadic form of hypokalemic periodic palsy that may occur in association with hyperthyroidism mostly with Graves’ disease. Acute thyrotoxic periodic palsy is a disorder most commonly seen in Asian men and characterized by abrupt onset of hypokalemia and paralysis. The disorder primarily affects the lower extremities and can involve all four limbs and presents as acute flaccid paralysis. The diagnosis of thyrotoxic periodic palsy is not difficult, but the disease's low incidence and many differentials for acute flaccid paralysis delay and complicate the diagnosis. TPP is not related to the etiology, severity, and duration of thyrotoxicosis. The treatment is similar to hypokalemic periodic palsy with potassium supplementation and initiation of antithyroid drugs and beta-blocker therapy. Here a similar case of quadriparesis is reported, which got precipitated after abrupt cessation of carbimazole in a young male. This initially was thought to be a case of hypokalemic periodic palsy and was later diagnosed to be TPP and recovered after initiating antithyroid drugs and potassium supplementation.

Self-limiting severe neutropenia in a patient with COVID-19

Neutropenia is a rare haematological complication of COVID-19 infection in immunocompetent patients. There is sparse literature on neutropenia in patients with COVID-19, except a few case reports. We encountered a similar case in an intensive care unit that developed severe neutropenia on day 24 of illness. Neutropenia resolved spontaneously on 4th day of its appearance. The patient was isolated and kept under close observation, antibiotics were upgraded and strict asepsis was maintained. Thus, we observed in a patient with no comorbidities and uncomplicated neutropenia that strict measures to prevent infection may suffice and the undue risk of hematopoietic therapy can be avoided. An expert opinion should always be sought in such cases as the presence of complications may require an aggressive approach.

Diaphyseal Radius Fracture Associated with Irreducible Head Dislocation. Case Report

Irreducible dislocation of the radial head is an extremely rare lesion, especially in an adult patient. We present a case of diaphyseal radius fracture associated with a posterior elbow dislocation and an irreducible radial head dislocation. After closed reduction of the elbow, we performed open reduction and ostheosynthesis of the radius, and the radial head remained irreducible. We finally found, surrounding the radius, the interposition of the insertion of the biceps, and, after extracting it, we performed the correct reduction of the radial head. Six months after the surgery, the patient presented a full articular balance, with no pain. We have not found any similar case in the literature.

Autochthonous North American Leprosy: A Second Case in Canada

Autochthonous leprosy was reported in the Southern USA in 2011 and has comprised an average of 34% of new cases from 2015 to 2020 in that country. We report a similar case in a patient from Western Canada. A 50-year old male patient presented with a four-year history of a chronic rash. Pathology stains revealed acid-fast bacilli prompting specialist referral. Examination was suspicious for leprosy, which was confirmed on slit skin smears and molecular testing. The patient responded well to treatment. Genotypic testing mapped the organism to the 3I-2 SNP type, which is of European origin and is the type found in implicated armadillo species in North America.

Adult presentation of multisystem inflammatory syndrome (MIS) associated with recent COVID-19 infection: lessons learnt in timely diagnosis and management

Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon and under-recognised postinfectious manifestation that presents 4–6 weeks after COVID-19 infection. Patients affected tend to be young or middle-aged, from ethnic minority backgrounds and previously healthy. In addition to high fever and myalgia, there are a myriad of extrapulmonary symptoms and signs, including cardiac, gastrointestinal, neurological and dermatological involvement. Cardiovascular shock and markedly raised inflammatory markers are prominent features, while significant hypoxia is uncommon. Patients respond well to corticosteroid therapy, but failure of clinicians to recognise this recently identified phenomenon, which can mimic common conditions including sepsis, could delay diagnosis and treatment. Here we present a case of MIS-A in an adult woman, compare her presentation and management with other similar case reports, and reflect on how clinicians can learn from our experiences.