Part IV Vitiation, 11 Misrepresentation

The chapters in this Part (chapters 11 to 15) concern pre-formation events which entitle a party to rescind the contract (or agreed variation). The categories of vitiation are: misrepresentation, duress, undue influence, and unconscionability—that is reprehensible exploitation of severe weakness (non-disclosure can be a vitiating factor, but only in special and exceptional circumstances [11.178]). Where a vitiating factor is made out, the agreement will be held to be vitiated and hence voidable.

Rare presentation of multisystem inflammatory syndrome in an adult associated with SARS-CoV-2 infection: unilateral neck swelling

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but often severe complication of SARS-CoV-2 infection. While several case reports about MIS-A in the setting of COVID-19 have been published since the term was first coined in June 2020, a clear description of the underlying pathophysiology and guideline-based recommendations on the diagnostic and therapeutic approach are lacking. What has been reported is that in the absence of severe respiratory illness, MIS-A can present with hypotension or shock, high-grade fever, abdominal pain, diarrhoea and severe weakness days to weeks after SARS-CoV-2 infection. Here, we present a case of a 28-year-old man who presented with a rarely described initial symptom: unilateral neck swelling. His presentation, disease progression and treatment course provide further information about MIS-A as a complication and in formulating diagnostic guidelines.

A Rare Entity in Cushing’s Disease: Severe Hypokalemia and Metabolic Alkalosis

Introduction: This case report aimed to highlight the prominence of considering Cushing's disease in the differential diagnosis of severe hypokalemia and metabolic alkalosis. Case Report: A 63-year-old woman who admitted to the emergency room of Bezmialem Vakif University Hospital, Istanbul with fatigue and severe weakness of extremities. Biochemistry results indicated severe hypokalemia (potassium=1.2 mmol/L) and metabolic alkalosis (pH= 7.83) and based on further endocrinological investigations, the final diagnosis of Cushing’s disease was confirmed, and magnetic resonance imaging revealed a macroadenoma in the right lobe of the pituitary. Transsphenoidal surgery was performed and Cushing’s disease was cured without any treatment. Conclusions: Although hypokalemia can be present in Cushing’s disease, none of the previous studies have reported hypokalemia as severe as in this case.

Myasthenia Gravis Revealing Hodgkin’s Lymphoma

Introduction: Myasthenia gravis is a rare autoimmune disease caused by autoantibodies directed against the synapses of the neuromuscular junction. Patient and methods: We report the case of a young patient with myasthenia gravis associated with Hodgkin's lymphoma. Results: A 22-year-old patient presented with a 2-month history of severe weakness associated with muscle fatigability and intermittent ptosis without dysphonia or respiratory signs. Clinical examination revealed generalized myasthenia. The EMG did not show post-synaptic block, and anti-acetylcholine receptor antibodies were elevated at 3 nmol/l (normal ?0.3 nmol/l). CT of the thorax showed an anterior medial mass. Immunohistochemistry of the mass revealed mixed cellularity Hodgkin’s lymphoma. Conclusion: The association of lymphomas with myasthenia gravis has been rarely reported.

A bedridden young lady with hypophosphatemic rickets treated with denosumab: a case report

Background Hypophosphatemic rickets is associated with delayed walking, bone deformities, growth failure and physical dysfunction that can limit daily activities. Treatment consists of phosphate salts and calcitriol. We report a case that received denosumab with marked improvement in her condition. Case presentation A 24-year-old Yemeni female with hypophosphatemic rickets presented to an endocrinologist with severe weakness and severe pain in the extremities, she had been bedridden for the last 4 years. Bone density showed severe osteoporosis (T score of hip was − 5.0 and Z score of hip was − 5.0, T score of the spine was − 6.0 and Z score of the spine was − 6.1) so the patient was started on denosumab in addition to calcitriol and after 7months she was feeling stronger and felt she could stand assisted and was walking with assistance within 9 months and after 1.5 years of treatment she was walking unassisted. Conclusion Denosumab is an effective treatment for osteoporosis, we used it in our patient in addition to calcitriol because she had severe osteoporosis due to long standing hypophosphatemic rickets that had not been treated properly, the patient improved markedly and regained the ability to walk again after being bedridden for 4 years. It may be a drug to consider in such cases although further studies need to be done to confirm this.

Acute Erythroleukemia in a Trauma Patient. A Case Report.

Introduction: Acute erythroid leukemia (AEL) is a rare type of acute myeloblastic leukemia. Acute erythroid leukemia is characterized by a predominant erythroid proliferation, there are 2 subtypes: erythroleukemia (erythroid/myeloid leukemia) and pure erythroid leukemia… Myelodysplastic syndromes (MDS) are a group of biologically and clinically heterogeneous clonal disorders characterized by ineffective hematopoiesis and peripheral cytopenia due to high apoptosis The purpose to presenting this case is how to differentiate an acute erythroleukemia (AEL) from myelodysplastic syndrome (MDS). Case report. A 74-year-old man came to emergency room after he falling down from the stairs and then was hospitalized with a two weeks history of severe weakness, anorexia, weight loss. He suffered of diabetes mellitus type II insulin dependent, and HTA. The physical examination showed cutaneous and conjunctival pallor, large ecchymosis in the low extremities and hepatosplenomegaly. CBC showed: pancytopenia and macrocytosis, neutrophils 60%, normoblasts 4:100 and reticulocyte count 3%. Conclusions: The diagnosis was Acute Erythroid Leukemia. The % of myeloblasts in bone marrow was > 20% of non-erythroid cells. Erythroleukemia characterizes from hepatomegaly this is found and in our case. Differential diagnosis is based mainly in bone marrow aspiration, immunophenotyping (flow cytometry).

Multi-cavity cyst of the left ovary and uterine prolapse. Removal of tumor, abdominal attachment of the uterus. Convalescence

Patient V., turned to Dr. Moreau for advice, complaining of various painful symptoms: lack of appetite, severe weakness, profuse menstruation, difficulty in urination and defecation.

KIDNEY TUBULAR ACIDOSIS: CAUSES, SYMPTOMS, DIAGNOSTICS, TREATMENT (LITERATURE DATA AND THE AUTHORS’ OWN OBSERVATIONS)

The article presents a literature review on the etiology, pathogenesis, clinical presentation, diagnosis and therapy of renal tubular acidosis in children, as well as our own 9-years-long observation of a child with this disease. Clinical manifestations from the initial symptoms starting at 3.5 years of age in the form of recurrent acetonemic states, episodes of dehydration with fever, and polyuria were analyzed. Further dynamics of symptoms was traced in the form of severe weakness in the legs, rapid fatigue, gait disturbance, inability to running, jumping, X-shaped deformity of the lower extremities. The literature data on the erroneous prescription of massage to a child with rickets-like diseases without normalization of phosphorus-calcium metabolism and disappearance of acidosis signs are presented. A thorough analysis of these mistakes was carried out and the positive dynamics was demonstrated in the clinical condition and development of the child in response to adequate treatment after a correctly made diagnosis. The differential diagnosis was carried out with Fanconi's syndrome, proximal RTA, hyperparathyroidism, primary hyperoxaluria. Molecular genetic study permitted to exclude cystinosis. Such children require constant monitoring and treatment by specialists, primarily from the point of view of preventing the renal failure progression. Knowledge of the features of renal tubular acidosis course will significantly help the clinicians in making the diagnosis, prescribing consultations of narrow specialists, as well as choosing an adequate treatment tactics.

Features of mahagment of a patient with a new coronaviral infection in the observator on the basis of student’s dormitory

The article is devoted to the peculiarities of clinical manifestations and the severity of a new coronary virus infection in a university student transferred to an observatory organized in a hotel-type hostel to prevent the spread of COVID-19 among students living in hostels. The data on the epidemiological history of the patient, the results of clinical observation and examination are provided. The tactics of managing a patient with a suspected of COVID-19 on an outpatient basis, symptoms that determine the indications for hospitalization, the results of examination and treatment in a hospital, and further observation at the observatory are considered. A new coronavirus infection can lead to a rapid deterioration in the condition of young patients, which does not correlate with indicators indicating lung damage on the 5th day of the disease. Persistent hyperthermia and severe weakness with anorexia can be indicators of the complicated course of the disease, including the development of hyperactive inflammatory syndrome. Hypochromic anemia can be another disease, which is an unfavorable background for the development of COVID-19. The course of the new coronavirus infection in young patients requires careful attention and further study.

الأسباب الاقتصادية والصحية للعود للمخدر في دولة الامارات العربية المتحدة

The study was launched from the statistical indicators on the drug addiction phenomenon and returning to it, as this phenomenon is considered universal, so the researcher sought to verify this phenomenon by studying the economic and health motives leading to the drug return, where the researcher examined the theoretical studies and benefited from them and made a special questionnaire on the phenomenon Where the questionnaire included 190 cases after excluding 10 cases because they were not complete. The study reached a number of conclusions, including: There is a severe weakness in the economic and health treatments for preventing the recurrence of the drug, as the study showed that there is a strong relationship between economic and health motives and the recurrence of the drug. The study came out with a set of recommendations, including: the need to activate and support economic and health institutions and increase awareness of community members about the phenomenon and the need for economic and health institutions to come together in the fight against drug addiction addiction.