En coup de sabre (ECDS) is a rare form of linear scleroderma that typically presents in childhood and may lead to progressive craniofacial tissue atrophy. Adult-onset disease is uncommon and may delay recognition. Early identification is important to prevent permanent deformity and potential neurologic complications. A 60-year-old woman with no significant past medical history presented with a nine-month history of progressive hyperpigmentation, skin tightening, and indentation involving the nasal bridge and left frontoparietal region. Over time, the discoloration extended toward the right forehead and was associated with contour changes of the nasal bridge and left forehead. Laboratory evaluation revealed a positive anti-histone antibody, with no evidence of systemic autoimmune or infectious disease. Imaging and endoscopic evaluation excluded sinonasal, bony, and intracranial pathology. Skin biopsy findings were consistent with a localized sclerosing process. A diagnosis of linear scleroderma ECDS was established. The patient was initiated on systemic corticosteroid therapy along with topical treatment and referred for multidisciplinary management. This case highlights an atypical late-onset presentation of ECDS. Although most cases occur in pediatric populations, adult-onset disease can present diagnostic challenges and may be associated with delayed recognition. The potential for neurologic involvement, even in the absence of initial symptoms, underscores the importance of careful evaluation and monitoring. Linear scleroderma ECDS should be considered in adults presenting with progressive craniofacial atrophy. Early diagnosis, prompt initiation of therapy, and ongoing neurologic surveillance are essential to reduce the risk of long-term functional and cosmetic sequelae.

Background and Aims: As part of the COVID-19 control strategy, a growing number of vaccine portfolios evolved and got fast-tracked through regulatory agencies, with a limited examination of their efficacy and safety in vulnerable populations, such as patients with chronic conditions and immunocompromised states. Patients with chronic liver disease (CLD), and cohorts post liver transplant (LT) in particular, were underrepresented in the determinant trials of vaccine development, hence the paucity of data on their efficacy and safety in published literature. This systematic review aims to examine the available evidence and ascertain the effectiveness and safety of Covid-19 vaccination in patients with CLD and those with LT. Methods: A systematic review of PubMed (Medline), Google Scholar, Cochrane Library, and ScienceDirect from inception until 1st March 2022 was conducted. We included observational studies and assessed vaccine efficacy regarding seroconversion or immunological rate, whereas serious or significant adverse effects have been considered safety outcomes when reported. Results: Studies comprised 45275 patients, performed in 11 different countries. Seroconversion or immunological rate after Covid-19 vaccination was mostly the primary endpoint, whereas other endpoints like covid-19 related adverse effects were also reported. Twenty-four of the final analyzed studies are prospective cohort studies, while four are retrospective cohort studies. Twenty-one studies included patients who underwent LT and received the Covid vaccine; nine included patients who had CLD due to various etiologies. The median age range of all included patients varied from 43–69 years. All patients with LT who received at least two doses of Covid vaccine had a seroconversion rate of around 60%. Patients with CLD had a seroconversion rate of about 92% post two doses of Covid vaccination. The average seroconversion rate in post-transplant recipients was around 45% after two doses of the significant Covid vaccines: Pfizer, AstraZeneca, Moderna, and Jansen. Only two studies have reported a higher seroconversion rate of 75% and 73% after the third dose of Covid vaccine. No significant adverse effects were reported in all studies; the most commonly reported negative effect was local injection site pain. Conclusion: The present systematic review, comprising real-world observational data studies, concludes that Covid-19 vaccination was associated with 92% and 60% seroconversion rates in patients with CLD and LT, respectively. No significant side effects were reported in all studies. This finding helps to resolve the uncertainty associated with Covid-19 vaccination in this cohort of patients.

Vitamin D is a vital nutrient that plays a significant part in several physiological processes within the human body, including calcium metabolism, bone health, immune function, and cell growth and differentiation. It is obtained mainly through exposure to sunlight but can be acquired from certain foods and supplements as well. Vitamin D deficiency (VDD) could be the risk factor for cardiovascular diseases (CVDs), such as heart disease and stroke. In blood vitamin D low levels have been linked with an enhanced risk of developing CVDs. However, it is unclear whether vitamin D levels are the leading cause or consequence of these conditions. While some studies highlight that taking vitamin D supplements could decrease the risk of CVD; however, more research is required to better understand the association between vitamin D and cardiovascular health. In this review, we aimed to summarize the currently available evidence supporting the association between vitamin D and CVDs and anesthesia considerations.

AbstractDiabetes has increased in prevalence and is the most common chronic metabolic disease worldwide. Its incidence and prevalence have particularly increased among older adults over the last few decades. The older adult population older than 60 years is diagnosed chiefly with type 2 diabetes, prediabetes, and type 1 diabetes in a small percentage; there is also an incidence of a transient form of diabetes secondary to chronic underlying diseases or as a part of their treatment-related complications. The primary goal in managing older adults with diabetes is to maintain glycemic status against the risk of hypoglycemia and its complications. In the older adult population, the problem of polypharmacy and nutrition must be kept in mind while achieving glycemic targets and preventing diabetes complications. Few studies have highlighted the importance of nutrition in older adults with diabetes and hypoglycemia as a complication leading to increased morbidity and mortality. Many factors in the older aged groups interplay in diabetes patients. Increasing the risk of hypoglycemia and managing nutritional aspects is paramount in older adults with diabetes mellitus. This review highlights various aspects of nutritional management in older adults with diabetes based on the current evidence available in the literature. However, most dietary recommendations for older adults with diabetes are based on studies in the adult population, and further studies targeting the older adult population are needed.

Pneumonia is one of the illnesses for which pulmonary embolism (PE) is most often mistaken because of the considerable overlap in their clinical picture. Moreover, pneumonia may occasionally mask PE, particularly in patients with predominant systemic symptoms such as fever, and with no evidence of deep vein thrombosis (DVT) or trauma. In this report, we presented a 35-year-old male patient with pneumonia and PE in whom pneumonia initially masked the diagnosis of PE. The patient presented with fever, productive cough associated with streaks of blood and pleuritic chest pain for 3 days duration, and was admitted as a case of lobar pneumonia based on his clinical presentation as well as on chest X-ray and non-enhanced computed tomography chest. He had an initial improvement in response to antibiotics; however, during his follow-up at the clinic, he appeared sick, complaining of right-sided persistent pleuritic chest pain and persistent cough, occasionally associated with streaks of blood and breathlessness on exertion. The patient was readmitted and PE was confirmed by computed tomography pulmonary angiography. Anticoagulation initiated with noticeable clinical improvement. This case highlights the importance of considering PE in patients with pneumonia when there was an initial therapeutic response followed by worsening of the condition during the treatment of pneumonia.

Thyrotoxicosis factitia is not very uncommon but most often underestimated in the developing world. There are considerable chance of it being underdiagnosed or missed in our routine clinical practice which can have deleterious effects on patients and leads to significant patient morbidity apart from putting burden on health-care resources. It’s a condition which arises from the long term ingestion of thyroid hormones most often in those individuals who have psychological issues, for cosmetic reasons or accidental ingestion of high quantity of thyroid hormones, which has been especially seen in medical personnel who have easy access to thyroid hormones. Most of the times the patients deny the fact that they are taking thyroid hormones despite being aware of it. Hereby our team report a case of thyrotoxicosis factitia masquerading as refractory thyrotoxicosis in a young female patient diagnosed to have uncontrolled hyperthyroidism for more than five years on high dose methimazole despite the fact that her thyroid radioactive iodine uptake repeated twice showed very low uptake and was in favor of thyroiditis. A high index of clinical suspicion led to a detailed history and review of her file which eventually led us to the diagnosis of factitial hyperthyroidism.

Malaria infection, which results due to the parasitic protozoan Plasmodium, has several known etiologies of hemolytic anemia as a possible complication in cases such as concurrent G6PD deficiency, severe parasitemia, or use of parenteral antimalarials. Although artemisinin-based antimalarial therapies are generally well-tolerated, several cases of severe post-artemisinin delayed hemolysis (PADH) have been recently reported, which present a diagnostic challenge, and affect morbidity and mortality in patients with malarial infection. We highlight the case of a young lady with Plasmodium falciparum severe parasitemia who developed hemolytic anemia after parenteral artesunate therapy.

COVID-19 Virus has affected the world in many ways, resulting in several challenges. COVID 19 vaccines were introduced recently, with a variable degree of immunogenicity and safety. We report a 61-year-old man who had GBS a few days after Receiving The vaccine, his condition improved after 5 days of IVIG

Patients with neurological symptoms should be enquired about recent vaccination history. It is important after the COVID-19 mRNA vaccine, which is newly introduced as it might link to the development of a wider variety of neurological diseases.

The outbreak of Corona Virus disease 2019 (COVID-19) in December 2019 has spread around the world and become a global pandemic. It belongs to Beta coronavirus which also contains SARS-CoV and Middle East respiratory syndrome CoV (MERS-CoV). There are lots of new studies coming up with update in pathophysiology, clinical manifestation, diagnostic tools, and newer medications and its action along with ongoing clinical trials. We are presenting a fast review about the COVID-19 from origin of the virus to the latest updates in management, so that physicians and health care providers across the globe can review latest news and views about the COVID-19 till date which can help in understanding the diagnosis and management of disease in this challenging time.

Neuroschistosomiasis is a rare manifestation of Schistosoma infection and can either manifest as cerebritis or with spinal cord involvement. We present a case of low back pain and lower limb weakness, which was initially managed as idiopathic transverse myelitis and later on found to have neuroschistosomiasis. A 23-year-old Sudanese gentleman presented with a one-week history of low back pain, lower limb weakness, and urinary retention. An urgent MRI of the spine with contrast showed features suggestive of transverse myelitis. The patient was treated with intravenous methylprednisolone for five days, which showed significant improvement in his symptoms. One week later, the patient developed the same symptoms again. An urgent MRI spine showed an interval progression of MRI findings. Repeat history taking revealed a history of swimming many times in the river Nile. Serology was sent for Schistosoma and came positive with titer 1:1280. He was treated as neuroschistosomiasis with intravenous steroids for three days, followed by praziquantel for five days along with the steroids, after which he showed significant improvement in his lower limb weakness. Spinal neuroschistosomiasis is one of the very rare complications of Schistosoma infection that should be kept in mind when dealing with unexplained myelopathy with a history of travel or origin from an endemic area. If not treated promptly, it can result in severe irreversible complications.

COVID 19 pandemic in 6-8 months has left many countries in a devastating state, it has caused mortality and disabilities with different mechanism in the body which have been continuously evolving since the origin of the SARS COV2 virus causing great social, psychological and financial burden on the countries around the world. As we all know it's a viral infection with been different theories suggesting different action of SARS COV2, which have been evolved in last few months and still its ongoing to understand the exact nature of its virulence with its involvement of different mechanism of actions in different population which not only makes difficult in clinical prediction, prognosis but also its utmost challenging in the management and treatment of COVID 19 infection. In our review article we mainly emphasize over the recent updates involved in different action of SARS COV2 infection on different organs of human body, its virulence variation in selected populations, clinical predictors. We also briefly discuss about the latest modality of management for SARS COV2 infection along with treatment regimens and updates on vaccination.

Typhoid fever is not uncommon in developing countries or travellers returning from tropical destinations. Once patient is diagnosed with typhoid fever, the treatment should be prompt with effective and appropriate antibiotics regime; otherwise there is an increase risk of various complications. We report a case of a young patient diagnosed with typhoid fever and Multi Drug Resistance (XDR) Salmonella typhi infection.

Pulmonary adenocarcinoma is one of the major types of lung cancers in which metastasis is very common and it accounts approximately to one-third of all primary pulmonary cancers. Although a minority of patients with lung cancer are asymptomatic, which gets usually detected in routine chest radiography, most of the patients present with some symptoms. Lung cancer metastasis may occur virtually in every organ system. Patients with non-small-cell lung cancer commonly have extrathoracic metastases to the adrenal glands, liver, brain, bones, and lymph nodes at presentation. Approximately one-third of patients with lung cancer will present with symptoms related to extrathoracic spread. Metastasis to the bone is not uncommon in lung cancer; however, osteoblastic bone metastasis is very rare. Here we present a 30-year-old female diagnosed to have pulmonary adenocarcinoma with multiple sclerotic bony lesions in the vertebra.

Extra skeletal Myxoid Chondrosarcoma (EMC) is a rare soft tissue sarcoma, which primarily occurs deep in extremities, especially in the skeletal muscle or tendon. Unusual locations include tongue, retroperitoneum, spine, intracranium, testis, inguinal region, synovium, mammary gland, labium and pleura, however no case of has been described the aggressive involvement of lung with multiple canon ball metastatic atypical chondromyxoid neoplasm with unknown primary. We hereby present a 38 year old Asian male patient initially presented for cough and occasional blood stained sputum with chest pain since few days, found to have multiple canon ball lung lesions which histopathological suggestive of atypical chondromyxoidnbsp sarcoma and primary source remained to be unknown. nbsp