Dermoid cyst is a benign cutaneous developmental anomaly that arises from the entrapment of ectodermal elements commonly arising from midline where the embryonic structures fuse. It is lined by stratified squamous epithelium with mature skin appendages found on their wall and their lumens filled with keratin and hair. Dermoid cysts usually form in the ovary, testes, the skin of the head, neck, face, or lower back, or in the central nervous system. Rarely dermoid cyst can occur on the lateral part of the neck or floor of the mouth. Neck swellings are difficult to diagnose clinically and are close to vital structures. Radiological investigations will help in diagnosis, but it is not confirmatory. We report a case of a 9-year-old girl who attended our institution with a right-sided neck swelling that had been present for five years and had an occasional history of pain. Examination of neck showed submental swelling above the hyoid, toward the right side, 3 × 4 cm, soft cystic, nontender, moving with deglutition and protrusion of tongue. Intraorally, the swelling was not visible, but it was bimanually palpable. Treated surgically and excision biopsy reported as a dermoid cyst. In the present article we report this rare mode of presentation of a dermoid cyst with a diagnostic confusion and a surgical challenge.
Objective To understand the impact of Ramadan fasting on people with diabetes and cardiovascular diseases (CVDs). Many people with diabetes have a range of CVD conditions, such as coronary artery disease, heart failure, and/or diabetic cardiomyopathy. This is of particular importance as there is no benchmark to compare the incidence for cardiac events during fasting in Ramadan in people with diabetes due to lack of adequate studies. Methods We observed the frequency of admission with cardiac events such as congestive cardiac failure, unstable angina, acute coronary syndrome, non-ST elevation myocardial infarction, and ST elevation myocardial infarction in people with and without diabetes across the 3 months of Sha'ban (the month pre-Ramadan), Ramadan, and Shawwal (the month post-Ramadan) in the year 2018. The detailed history and biophysical and biochemical data are presented as frequency and percentages. Result The majority of admissions were from people with Muslim background (87.1%). People with diabetes constituted 45.5% of total admissions. Nondiabetic patients were younger (53.50 ± 11.91 vs. 63.56 ± 13.17 years, p = 0.05) and have significantly higher low-density lipoprotein-cholesterol value compared to those with diabetes (129.70 ± 45.47 vs. 97.00 ± 29.56 mg/dL, p = 0.05). In Muslim patients, hospitalization in the month of Ramadan was much lower compared to the months of Sha'ban and Shawwal (24.1, 40.4, and 35.5%, respectively). Admissions in those with no previous history of diabetes was lower during Ramadan (57.1%) compared to Shaaban (64.6%) and Shawwal (72.2%). In people with diabetes, the hospitalization rate during Ramadan with ischemic heart disease (IHD) was higher (88.91%) compared to the months of Shaaban (63.6%) and Shawwal (62.9.%). However, during the same period, admissions with congestive heart failure (CHF) were much lower (11.1, 36.4, and 36.1%, respectively). Conclusion The overall admission with CVD during Ramadan is lower than the month before or after. The rate of reduction in admissions during Ramadan was marginal in those with previous history of CVD and diabetes mellitus; however, this was much more obvious in those with no history of CVD. During the month of Ramadan, there were lower rates of admission with CHF while admissions with IHD were higher compared to the previous or following month in diabetic patients.
Although respiratory symptoms are the predominant manifestations of coronavirus disease 2019 (COVID-19) infection, thyroid dysfunction is a commonly recognized sequela. We report a case of delayed silent thyroiditis that manifested 3 months following COVID-19 infection in a 14-year-old female. A 14-year-old female presented with palpitations, tremors, and sweating that started around 3 months after the resolution of COVID-19 infection. Her presentation, thyroid function tests, along with ultrasonographic pictures and radioiodine uptake scan of the thyroid were consistent with a diagnosis of silent thyroiditis. She was managed symptomatically with propranolol, after which her symptoms improved, and thyroid function tests returned to normal. COVID-19 is a possible trigger for delayed silent thyroiditis that health care providers should recognize for accurate diagnosis and management.
