Approximately one-third of patients with COVID-19 develop thrombocytopenia, and it is more commonly seen in those with severe infection We present a 66-year-old gentleman with confirmed COVID-19 who developed severe thrombocytopenia during his admission He was asymptomatic at diagnosis He developed petechial rash over both arms, root of the mouth and under the tongue and was confirmed to have thrombocytopaenia This was managed by Platelet transfusion Thrombocytopenia is usually mild in patients with COVID-19 unlike our case Nonetheless, a comprehensive evaluation of thrombocytopenia remains important as treatment of the underlying cause may reduce the risk of potentially catastrophic consequences Clinicians should remain vigilant of the association between COVID-19 and thrombocytopenia, and instigate prompt supportive treatment accordingly © 2021
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset Chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.
Knowledge of anatomical variation involving the superficial branch of the radial nerve will help in several clinical interventions such as nerve transfer procedures, guiding surgical incisions, diagnostic trauma reconstructive surgery, flap harvest and in performing nerve blocks etc. We report here a variant distribution pattern of the superficial branch of radial nerve and discuss the clinical implications. In the present case, in addition to sensory distribution, the superficial branch of radial nerve also provided motor innervation to extensor carpi radialis brevis and brachioradialis muscles. Further, the branch supplying the brachioradialis, pierced its tendon distally and communicated with the parent trunk to supply skin of dorsum of the hand. Because of the unusual motor distribution to these muscles, which act on wrist joint, an iatrogenic damage or traumatic injury of the nerve might jeopardize the sensori-motor qualities of the upper limb.
Guillermo GARCIA-GARCIA 1 and Vivekanand Jha ; on behalf of the World Kidney Day Steering Committee * 1 Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jal. Mexico 2 Postgraduate Institute of Medical Education and Research, Chandigarh, India, George Institute for Global Health, New Delhi, India and University of Oxford, United Kingdom
Introduction: Acetabular fractures are severe injuries, and the operative management is a challenge among orthopaedics trauma surgeons. There is no data available on long term follow up results as well as differences between the major acetabular fracture patterns in Brunei. Materials and methods: This is a retrospective study of 42 acetabular fractures treated surgically at RIPAS Hospital, Brunei Darussalam. Clinical and radiological measures were undertaken for measuring outcomes with a mean follow up of four years. Results The 42 cases consisted of 33 men, and 9 women with ages ranging from 13 to 60 years. All fractures were fixed with AO 3.5 mm lag screws, AO spring hook and AO 3.5 mm reconstruction plates through either posterior or ilioinguinal approaches. Congruent reduction was achieved in 41 hips (97.6%). Good or excellent functional results were achieved in 40 patients (95.2%). There was no case of infection. There were two cases of heterotopic ossification and three cases of grade II degenerative changes but none required arthrodesis or total hip replacement. Positive relationship was established between number of days before ambulation and total days spent in the hospital. Though the median duration of hospital stay was 26 days, transverse fractures spent 53.17 days in hospital. Conclusion: Early mobilisation is important to obtain favourable results. Functional results were comparable to other international studies and regional countries. Follow-up of four years is too short to predict the chances of development of degenerative changes in this study and therefore, these cases are still being monitored.
Osteoradionecrosis of the temporal bone is a rare complication of radiotherapy treatment for nasopharyngeal carcinoma (NPC). We report the case of a 72-year-old man with osteoradionecrosis of bilateral temporal bones three years after completion of radiation therapy for NPC. He presented to us with chronic ear discharge secondary to persistent right chronic otitis media for the past 15 years. Pure tone audiometry showed bilateral moderate mixed hearing loss. A right cortical mastoidectomy showed extensive granulation tissue in the mastoid cavity. Recovery was uneventful but required the use of hearing aids.
Introduction: Sore throat following tracheal intubation is a common postoperative complaint with a reported incidence of up to 90%. We performed a prospective randomised doubleblind clinical trial to compare the effectiveness of lignocaine 2% gel with waterbased lubricant (KY Jelly) in reducing post� intubation sore throat. Materials and Methods: One hundred and fifty one patients with American Society of Anaesthesiologists (ASA) physical status I or II undergoing elective surgery under general anaesthesia with tracheal intubation were enrolled into this study. Cuffed endotracheal tubes were lu� bricated with either lignocaine 2% (Group A) or a waterbased lubricant (Group B). Patients were as� sessed at three intervals (1, 12, and 24 h after surgery) by a blinded investigator for presence of sore throat, severity of sore throat and throat related complaints. Results: Significantly larger number of patients in Group A complained of throat dryness at 1 h ( p=0.035) and sore throat at 12 h ( p=0.001). Incidences of sore throat and throat related complaints were comparable at other time intervals. No differences in severity of sore throat were observed, and none of the patients required further treat� ment. Conclusion: Lignocaine 2% gel was not effective in reducing postintubation sore throat in com� parison with waterbased lubricant.
Introduction : Patients with stroke often perceive difficulty in walking, balance, and function which may hinder their recovery. This study was done to compare perception of patients with their true actual abilities. Materials and Methods: A total of 105 patients with new onset of stroke, attending outpa! tient clinics, participated in this study. Patients were given a self!administered questionnaire measu ring perception of their abilities in walking, balance and functional health status. The actual walking capaci! ty, balance, and functional health status of patients were measured by 10 metres walking test, Tandem Balance Test, and the Barthel index respectively. Result: Most of the patients had good perception towards their walking abilities. Good perception of balance and functional status were found in 68% and 56% of patients respectively. We also observed moderate agreement in walking (k: 0.497, p< 0.001) and balance (k: 0.537, p<0.001), but poor agreement in functional status (k: 0.144, p:0.004). Conclusion: Poor perception of functional status among stroke patients might be related to the aging and deterioration of other co!morbidities leading tnegative outlook in persons post stroke. Fur! ther research need to be undertaken to justify this finding.
Musculoskeletal manifestations may be the only apparent abnormality at the onset of disease in child- hood acute lymphoblastic leukaemia (ALL). These clinical presentations are often misdiagnosed as di- verse forms of orthopaedic and rheumatologic disease, therefore contributes to delay in diagnosis and treatment. We report the case of a 3-year-old child who was diagnosed with ALL after recurrent visits with persistent painful left ankle swelling. Initial haematological and radiological findings revealed sub- tle abnormalities. A bone marrow aspiration confirmed the diagnosis of precursor-B ALL. This case highlights that acute leukemia needs to be considered in the differential diagnosis in any child present- ing with musculoskeletal pain and unexplained lymphocytosis and neutropenia. Radiological abnormali- ties include diffuse osteopaenia, radiolucent metaphyseal bands, osteolytic lesion and sclerotic lesions which may raise the suspicion of acute leukemia, but are not always pathognomonic. Delay in diagnosis and treatment may have a deleterious impact on prognosis.
Rhythm disturbances are rare but potentially fatal cardiac manifestations of dengue fever. However many are not recognised and not reported. The diversity of the clinical presentations throws a great challenge in the diagnosis of dengue myocarditis. Manifestations vary from the common uncomplicated febrile illness to the less common complete heart block with cardiogenic shock. We report the case of a 28-year-old lady who developed uncomplicated 2 nd degree Mobitz type 1 heart block during the deferversence phase of a dengue illness. Although rare, 2 nd degree Mobitz type 1 heart block has been reported in dengue fever. Therefore, this case emphasizes that ECG is a useful tool in the management of dengue. Any changes in vital signs especially the heart rate, should prompt the clinicians to look for possible underlying cause because this may be the early indication of cardiac arrhythmia which occurs in dengue.
Accessory muscles in the forearm region have been reported widely. In the present case, an accessory flexor muscle was observed in the front of the left forearm. The fibres extended from the tendon of flexor carpi radialis to flexor digitorum superficialis. A few lower fibres formed a tendon which inserted into the radial side of the flexor digitorum superficialis. It was innervated by the median nerve. The accessory muscle described here could increase the range and power of movement of the forearm and the palm. This type of variation is noteworthy in conditions like pressure neuritis.
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome affecting the posterior cerebral regions and is associated with an accelerated rise in blood pressure, renal disease or autoimmune disorders. Our objective was to review the association of PRES with renal outcome. Materials and Methods: Retrospective review of all nephrology patients diagnosed with PRES from 2010 to 2013 at our institution. The diagnosis of PRES was based on the presence of clinical features such as headache, altered mental status, visual disturbances and seizures with positive radiological findings on either Magnetic Resonance Imaging or Computed Tomography of the brain. Their demographic and laboratory result were analysed in particular, progression to end stage renal disease (ESRD). Results: Seven patients (3 males: 4 females), median age of 21 (IQR 17-24) years were recruited. Majority had lupus nephritis except one patient who had crescenteric IgA nephropathy. Median duration of their disease was 52.83 (IQR 3.3 – 58.17) months. Mean systolic and diastolic blood pressure were 186.43 ± 18.87 and 110.43 ± 14.02 mm Hg. Mean serum albumin and creatinine were 27.3 ± 8.7 g/L and 403.4 ± 183.6 umol/L respectively, at presentation. Two patients developed ESRD at the development of PRES whereas three patients progressed to ESRD at 2.73, 5.77 and 17.13 months. The other two patients had complete recovery of renal function to normal levels. All patients had full neurological recovery within one week. Conclusion: Development of PRES in patients with underlying chronic kidney disease may be a predictor of poor renal survival.
Epistaxis in children is a common presentation, mainly due to local causes. The most common causes are due to inflammatory disease, infections and trauma. A small percentage of epistaxis in children can be caused by tumour whereby the differential diagnosis includes juvenile nasoangiofibroma and rhabdomyosarcoma. We report the case of a 2-year-old child who had presented with intermittent epistaxis that was later diagnosed to be secondary to a yolk sac tumour of the maxillary sinus.
Hypoglossal nerve palsy (cranial nerve XII) commonly occurs in conjunction with other cranial nerve palsies. Isolated hypoglossal nerve paralysis is a rare complication of any procedures that do not in�
Introduction: Cervical cancer is the third most common cancer among women and is more common in developing countries such as India, due to lack of good screening tests. The efficacy of the Pap smear is hampered by high inter-observer variability and high false positive and false negative rates. Liquid based cytology has not been shown to improve sensitivity or specificity when compared to Pap smear. Histological assessment which is considered the gold standard is also hampered by intra- and inter-observer variability. This study was undertaken to assess the p16ink4a expression in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the cervix and its role in a developing country. Materials and Methods: This was a retrospective study of a total of 80 cases with 16 cases each of chronic nonspecific cervicitis, cervical intraepithelial lesion CIN1, CIN2, CIN3, and invasive squamous cell carcinoma, on which immunohistochemistry was performed with primary mouse monoclonal antibody (Immunogen clone G175, SOTYPE IgG). Results: The p16ink4a expression score associated well with the degree of cervical neoplasia from chronic non-specific cervicitis to the invasive cervical cancer group. The percentage of tumour cells showing progressive increase in the positive staining; Chronic non-specific cervicitis 25% (n=4/16) positivity, CIN1 62.6% (n=10/16), CIN2 75% (n=12/16), CIN3 81.2% (n=13/16) and there was 100% positivity of p16ink4a staining in squamous cell carcinoma. Conclusion: Our study confirmed the usefulness of p16ink4a and findings from this study reiterate its importance for a low resource setting also.
Tuberculosis otitis media is relatively rare and often masquerade as other common otological conditions resulting in delay of diagnosis and complications of disease. It is usually characterised by painless chronic ear discharge with multiple tympanic membrane perforation and presence of abundant granula- tion tissues in the middle ear on examination. We report the case of a 66-year-old man who presented with symptoms of acute otitis media secondary to tuberculosis.
Diagnosis and treatment of the nasal type of Natural Killer (NK)/T-Cell Lymphoma can be challenging. NK/T-Cell lymphoma of the nasal type is very aggressive and invasive and may present with nonspecific symptoms. This usually leads to delay in diagnosis and initiation of treatment. Lymphomatous lesions show areas of necrosis and hence multiple biopsies are usually needed for histopathological diagnosis with the aid of immunochemistry. We report the case of nasal type NK/T-Cell lymphoma in a middle aged lady who presented with unilateral nasal blockage, constitutional symptoms and soft palate perforating ulcer with delay in diagnosis.
Encapsulating Peritoneal Sclerosis (EPS) is a rare but serious complication of long-term peritoneal dialysis (PD) that is associated with a high morbidity and mortality. EPS has been previously referred to as sclerosing peritonitis, sclerosing encapsulating peritonitis or the ‘abdominal cocoon’. EPS is characterised by diffuse thickening and sclerosis of the peritoneal membrane which leads to a decrease in ultrafiltration, ascites and ultimately partial or complete small bowel obstruction. The aetiology of EPS is unknown but it has been reported to be closely associated with the duration on PD, recurrent peritonitis, high transporter status and use of high concentration of glucose dialysis solutions. Stopping or switching from PD seems to be another trigger factor. Several treatment options including oestrogen and immunosuppressive therapy have been tried, but the mortality remains high at approximately 50%. In some cases, surgery has been attempted but this is associated with high morbidity and mortality. Supportive therapy includes nutritional support with total parenteral nutrition. EPS needs to be diagnosed early and one has to have a high index of suspicion. We report three cases of EPS in patients on PD with different presentation of EPS, their treatment and a brief literature review.
Epithelial-myoepithelial carcinoma (EMC) is one of the tumours of the salivary glands. It rarely occurs and accounts less than 1% of all salivary gland tumours. It commonly arises in the major salivary gland especially in the parotid gland, and less frequently in the minor salivary gland. We are reporting a case of a young man diagnosed with EMC in the right hard palate that extended into the maxillary sinus and pterygopalatine fossa. The incidence, clinical features, treatment of choice and the disease progression are discussed in this report.
Introduction: Human papillomavirus (HPV) is a major factor for cervical cancer. However, routine HPV vaccination to combat the disease is not widely available in most developing countries, and the uptake is poor. Lack of knowledge or awareness may be a factor. This study assessed the perception, knowledge and attitude of university students toward HPV vaccination and cervical cancer prevention. Methods and Materials: A cross#sectional survey among 826 students using a validated question# naire was conducted at Universiti Kebangsaan Malaysia. The convenience sampling technique was used to recruits study subjects. The knowledge score was categorised into poor (score ≤5), moderate (score 6#10) and good (score 11#15). Results: Sixty#eight percent were aware that persistent HPV infection can lead cervical cancer and 76% had heard about HPV vaccination to prevent cervical cancer. Female students were aware of the role of HPV vaccine against cervical cancer compared to their coun# terparts (41% vs. 28%, p<0.001). The pool mean total knowledge score was 8.03 (95% Confidence Interval [CI]; 7.83#8.24). Although only 12% of the students perceived themselves as at risk of HPV infection, only 55% had an intention to receive HPV vaccination. Of those who declined HPV vaccina# tion, 36% worried about the side effects, and 28% doubted on its effectiveness. Female students had significantly higher acceptability towards HPV vaccine compared to male (39% vs. 16%, p=0.001). Intention to receive HPV vaccine was significantly correlated with the scores for awareness and knowledge of HPV vaccination, student’s perception on their susceptibility and seriousness of HPV infec# tion. Conclusion: The perception and knowledge of HPV infection and vaccination for cervical cancer prevention was unimpressive. This greatly will contribute to diminish acceptability for the vaccination.
