Extrapulmonary Tuberculosis Manifests as Middle Ear Tuberculosis: A Rare Case Report from Secondary Health Care Center at Sub-Himalayan Region

Tuberculosis of ear is a rare entity. Early diagnosis and prompt treatment can prevent many serious complications. Here we report a case of 45 year old female with middle ear tuberculosis which was cured with mastoid exploration followed by anti tubercular treatment. Keywords: Tuberculosis, TB, Extrapulmonary Tuberculosis, Middle Ear Tuberculosis, Sub-Himalayan Region

Case Report: A Case of COVID Vaccine-Induced Thrombotic Thrombocytopenia Manifested as Pulmonary Embolism and Hemorrhagia. A First Reported Case From Slovakia

COVID-19 vaccine-induced thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector (ChAdOx1 nCoV-19) vaccine administration. It is presented as thrombocytopenia and thrombotic manifestations in various sites, especially in cerebral veins. Pulmonary emboli have been reported rarely. We present a case of a young male patient who developed severe thrombocytopenia and pulmonary embolism 12 days after the first dose of the vaccine. Severe thrombocytopenia, skin hematomas, and segmental pulmonary emboli were detected. Anti-platelet factor 4 (aPF-4) antibody was highly positive supporting the diagnosis of VITT. Prompt treatment with fondaparinux, intravenous immunoglobulin, and prednisone led to a marked improvement of clinical condition and thrombocytes count. We report the first known case of VITT in Slovakia.

Smart Healthcare IoT Applications Using AI

Globally, healthcare professionals strive to diagnose, monitor, and save human lives. An application that advances the medical field to the next level is the need of the hour. Smart healthcare systems using IoT help in the process of monitoring human health by minimizing human intervention. Taking care and monitoring of human health has a significant contribution in declining the mortality rate as well. IoT in healthcare has aided smarter communications and prompt treatment to save lives. Patient data are sensed by sensors/microcontrollers, sent over the internet, stored in the cloud, and received by healthcare professionals during emergencies. Applications of such smart healthcare using IoT are blood glucose meters, medical vehicles, sphygmomanometer, pulse oximeter, Holter monitor, etc. This chapter elucidates several smart healthcare IoT applications using artificial intelligence and cloud computing technology. The chapter also elaborates the importance and functions of various cloud and AI components in designing a smart healthcare application.

Congenital granular cell epulis: a rare paediatric tumour of newborn

Congenital granular cell epulis is a congenital growth rarely found on the gingiva of neonates. These remarkably large tumours present in an infant’s mouth may impede with feeding, respiration or adequate mouth closure. Recognition of this entity and prompt treatment are essential for preventing any difficulties for the neonate. This is a case report of a 35-day-old female neonate who presented with a single exophytic lesion in the maxillary alveolar ridge. The differential diagnosis, management regimens and complications of this condition are reviewed. The lesion was excised under intravenous sedation and subjected to histopathological analysis. Based on the microscopic findings, the diagnosis of congenital granular cell epulis was confirmed. Clinicians including paediatricians, sonographers, dentists and surgical pathologists should be able to timely recognise and intervene such tumours as they may be potentially harmful to the infant.

A rare case of ovarian torsion in a pregnant patient

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. It is an uncommon cause of acute abdominal pain in females, and it is a gynecologic emergency. The majority of the cases present in the pregnant (22.7%) than in non-pregnant (6.1%) women. Diagnostic delay can result in loss of the ovary. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to ischemia and infarction. The increased use of ovarian stimulation and assisted reproductive technology has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). The differential diagnosis of adnexal torsion is particularly difficult in combination with OHSS or pregnancy, as abdominal pain, nausea and vomiting can be presenting symptoms of hyperstimulation or pregnancy as well. Here, we report a case of ovarian torsion occurring in pregnancy in which diagnostic delay occurred due to confusion with OHSS leading to oophorectomy. Fertility conservation may have been possible in case of earlier diagnosis and prompt treatment.

Advance Malignant Phyllodes Tumor with Active Bleeding in Children: A Rare Case

Introduction: Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, there are only a few large pediatric phyllodes tumor series. Current guidelines do not differentiate treatment recommendations between children and adults.Case Presentation: A 12-year-old girl presented with a lump in her right breast which grew rapidly within a month. On physical examination, we found a mass on the right breast sized ± 10 x 10 cm; the lump was fragile and bled easily. The patient’s condition was getting worse and worse. Due to this deterioration, we performed a mastectomy immediately.Conclusions: The incidence of malignant phyllodes tumor in children is very rare and required prompt treatment in emergency cases.

Multigravid Women with Uterine Rupture: A Case Report

Introduction: Uterine rupture is the discontinuation of the uterine scar that creates connection between uterine and peritoneal cavity. The most common etiology for uterine rupture is dehiscence of uterine scar tissue from previous cesarean section. In patient with uterine rupture and fetal expulsion to the peritoneal cavity, fetal survival becomes extremely poor. Therefore, it is important for clinician to understand the uterine rupture and be able to give prompt treatment in order to prevent maternal and fetal morbidity and mortality. Case Presentation: A 34-year-old woman, G3P2A0 38 weeks of gestation complained that she had abdominal pain, couldn’t feel her baby movement, watery discharge since 10 hours before admission. Bloody discharge and trauma were all denied. Patient underwent twice cesarean section before. Patient only had four times antenatal care with obstetrician at 24, 28, 32, and 36 weeks of gestation. She was scheduled for caesarean section at 38 weeks of gestation. Patient looked alert with low blood pressure and tachycardia. On physical examination, we found that she was pale, fundal height could not be determined, and there was no fetal heart rate detected. Speculum examination showed livide portio, closed external orifice of uterus, and inactive blood. There was positive slinger sign and Douglas cavity was bulging. Ultrasound examination showed intrauterine fetal demise, complete uterine rupture on lower segment, and positive sign of free fluid on abdominal cavity. Patient underwent operation and we found the died male neonate was in the peritoneal cavity and the placenta was still attached in the uterine cavity. We delivered the baby and placenta completely. There was uterine rupture on the previous CS scar, the edge of the uterine wound was regular with no necrosis and extended to the right side of uterus. Then, we performed hysterorrhaphy in order to stop the bleeding and repair the uterus, and we also performed tubal ligation. The died neonate had maceration grade I. Conclusion: Uterine rupture causes poor fetal and maternal prognosis. Early diagnosis and prompt treatment is really important in uterine rupture. Prevention of uterine rupture could be done by meticulous antenatal care, especially visiting to obstetrician in order to review maternal and fetal condition and determine mode of delivery.

Undiagnosed Wilson’s disease masquerading as hemolytic anemia in pregnancy: a case report

Successful pregnancy is a rare phenomenon in women with Wilson’s disease. We report a case of a primigravid 19 -years old woman who presented with hemolytic anemia and was later diagnosed with Wilson’s disease for the first time during pregnancy. With prompt treatment, she delivered a healthy albeit pre-term child.

Neonatal Atrial Flutter: Case Report

Neonatal atrial flutter is a rare entity seen in the newborn period. With prompt treatment, they mostly revert to normal rhythm, with good long-term prognosis. But prolonged untreated atrial flutter can result in heart failure. This necessitates prompt diagnosis and treatment of the condition. However, all available treatment modalities are not effective in all patients. Here, we report 2 newborns with atrial flutter who did not respond initially to medical management, but eventually responded to cardioversion, with good outcome.

Endoscopic optic nerve decompression in traumatic optic neuropathy: our experience in a tertiary care centre

<p><strong>Background: </strong>Traumatic optic neuropathy (TON) a vision threatening disorder requires early diagnosis and prompt treatment. High dose steroid injections, optic nerve decompression or combined therapy are the available current treatment options. This study aims to determine the visual outcome with transnasal endoscopic optic nerve decompression in patients with TON having no improvement in vision despite high dose steroids.</p><p><strong>Methods:</strong> A prospective study was conducted at the department of ENT, government medical college Kozhikode; on patients who presented with loss of vision following history of trauma. All patients suspected of compressive optic neuropathy received injection methyl prednisolone (30 mg/kg/day) with assessment of vision and HRCT scan. Patients with deterioration or no improvement in vision despite high steroid therapy were taken up for trans-nasal endoscopic optic nerve decompression.</p><p><strong>Results:</strong> In our study 19 patients with TON underwent trans-nasal endoscopic optic nerve decompression. 11(57.9%) patients had improvement of vision, 7 (36.8%) patients had no improvement of vision and 1 (5.3%) patient had worsening of vision. The visual improvement was seen in 8 (80%) patients when treatment was initiated within 7 days and in only 3(33.3%) patients when treatment was initiated after 7 days. The visual acuity at presentation and time interval between trauma and intervention are factors that determine better visual outcomes.</p><p><strong>Conclusions:</strong> The decreased visual acuity in TON requires prompt treatment. High dose steroid must be started at once when it is suspected or diagnosed. The timely surgical intervention with trans-nasal endoscopic optic nerve decompression is a relatively safe and effective technique enabling better visual prognosis.</p>