Vaginal prolapse of a large uterine cervical leiomyoma complicated with cervical inversion: A case report of an extremely rare entity with review of the literature.

Cervical leiomyoma is a relatively uncommon type of uterine leiomyoma. Prolapse of a cervical leiomyoma with inversion of the cervix is an extremely rare phenomenon, especially in a non-puerperal woman. Only a handful of cases are reported in the English literature. The case discussed here is of a vaginal prolapse of a submucous cervical fibroid complicated by cervical inversion in a South Asian perimenopausal woman with multiple comorbidities who had defaulted medical follow-up during the second wave of the COVID-19 pandemic. Being one of the largest reported cervical fibroids to date is another particularity of this case. Emphasis is given to the clinical diagnostic, anaesthetic, and surgical challenges encountered with a brief note on the impact of COVID-19 on outpatient clinic follow-up.

Reactivation of varicella-zoster virus following mRNA COVID-19 vaccination in a patient with moderately differentiated adenocarcinoma of rectum: A case report.

Herpes zoster which is the reactivation of varicella-zoster virus, a pathogenic human alpha-herpes virus, following primary infection or chicken pox, is known to occur especially in advanced age and in the immunocompromised among other predisposing factors. COVID-19 vaccination-induced immunomodulation is a novel scenario, hypothesized to be a result of shifting of T-lymphocyte population towards vaccine-induced naïve CD8+ subset, offsetting the balance of varicella-zoster virus responsive T-helper cells, thereby defecting the cell-mediated immunity which suppresses the latent varicella-zoster virus. The exact mechanism, however, is still elusive. Herein, we discuss a case of reactivation of varicella-zoster virus following BNT162b2 mRNA COVID-19 vaccine in an elderly female on oral medication for long-term diabetes and hypertension with good control who has undergone local radiotherapy for an underlying adenocarcinoma of rectum awaiting surgical resection, highlighting the key features of pathogenesis of the disease in relation to COVID-19 vaccination with a pertinent survey of the literature. This case report highlights the importance of differentiating vaccine-related cutaneous reactions with clinically more significant adverse events, early specific therapy thus preventing poorer acute and chronic outcomes.

Vaginal prolapse of a large uterine cervical leiomyoma complicated with cervical inversion: A case report of an extremely rare entity with review of the literature

Cervical leiomyoma is a relatively uncommon type of uterine leiomyoma. Prolapse of a cervical leiomyoma with inversion of the cervix is an extremely rare phenomenon, especially in a non-puerperal woman. Only a handful of cases are reported in the English literature. The case discussed here is of a vaginal prolapse of a submucous cervical fibroid complicated by cervical inversion in a South Asian perimenopausal woman with multiple comorbidities who had defaulted medical follow-up during the second wave of the COVID-19 pandemic. Being one of the largest reported cervical fibroids to date is another particularity of this case. Emphasis is given to the clinical diagnostic, anaesthetic, and surgical challenges encountered with a brief note on the impact of COVID-19 on outpatient clinic follow-up.

To blunt or not to blunt: Still an outlawed practice in peripheral nerve blocks?

Probably the first published account of regional nerve blocks was by Gaston Labat in 1922. Since the earlier experimentation, regional anesthesia has seen many ups and downs. The concept of field anesthesia popularized by the military anesthesiologists to be used in the battlefields, was quickly picked up by their colleagues working in the civil hospitals. The real breakthrough was brought about the invention of block needles to be used specifically for the peripheral nerve blocks, and proved to be safer than ordinary hypodermic syringe needles. The block needles, however, come at a higher price and the availability remains a constant problem, especially in the remote places of the low-income countries. The next revolution came with the advent of nerve stimulator and the ultrasound in the block techniques. Both of these developments really revolutionized the art of regional anesthesia. The authors describe a technique of use of blunted stylets of the ordinary intravenous cannulas. The technique can be used if resources are scarce, and with proper sterilization.

Haemophagocytic Lymphohistiocytosis with Leptospirosis: A Rare but Devastating Complication.

INTRODUCTION: Secondary haemophagocytic lymphohistiocytosis (sHLH), often associated with an array of infections, malignancies, and autoimmune diseases, is rarely seen with leptospirosis, which carries a relatively poor prognosis even with modern state-of-the-art medical care. We describe a patient with leptospirosis complicated by sHLH who succumbed to illness following multiorgan dysfunction. Case Description. A 74-year-old farmer presented with high-grade, unsettling fever for a week. Muddy water exposure and suggestive symptoms prompted investigation and management in the line of leptospirosis (IV ceftriaxone was instituted, and later, MAT (microscopic agglutination test) became positive). Subsequently, he developed severe acute hypoxemia requiring mechanical ventilation and acute renal failure requiring renal replacement therapy. Bone marrow biopsy and markedly elevated serum ferritin and triglyceride levels done on day 10 (with unresolving fever, hepatosplenomegaly, and pancytopaenia) confirmed the diagnosis of HLH. The routine cultures, retroviral studies, CMV, dengue, hanta and mycoplasma antibodies, tuberculosis and COVID-19 PCR, and malaria screening were all normal. There was no improvement of hypoxemia following intravenous methylprednisolone. He died on day 15 despite escalating organ support. CONCLUSION: Leptospirosis is a common zoonotic disease in the tropics with significant morbidity and mortality. In the case of severe leptospirosis, overlapping clinical features with sHLH make the diagnosis of the latter challenging. No assessment tools are available to date to predict the risk of developing sHLH in a patient having leptospirosis. Outcome following sHLH due to leptospirosis still remains majorly ominous. A high index of suspicion and low threshold for specific investigations could possibly alter the outcome following such an occurrence.